Table Of Contents of the INDEX

 

Abdominal aortic aneurysm
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1) - paragraph (I)
DIVISION B TITLE III SEC 1305. (a) Quoted: (iii) (1) (I)
Automated Concept:

ABDOMINAL aortic aneurysm for certain individuals ;   Ultrasound screening for

Index of Sec 1305. ...

Acceptable coverage
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (1)
Automated Concept:

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. ...
(2) EXTENDED TREATMENT AS TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (b) (2)
Automated Concept:

ACCEPTABLE coverage ;   End of period referred in subparagraph being not otherwise covered under

Index of Sec 1702. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(3) CHIP MOE TERMINATION DATE. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (3) (B)
Automated Concept:

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
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (a) (1)
Automated Concept:

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. ...
Sec 1121. -- Sustainable Growth Rate Reform.
(e) APPLICATION TO ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (e) (2)
Automated Concept:

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. ...
Sec 1158. -- Revision Of Medicare Payment Systems To Address Geographic Inequities.
(a) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1158. (a)
Automated Concept:

ACCOUNT recommendations making in report under section 1157(d) ;   Taking into

Index of Sec 1158. ...
Sec 1161. -- Phase-In Of Payment Based On Fee-For-Service Costs.
(2) SPECIFIED AMOUNT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1161. (2) Quoted: (n) (2)
Automated Concept:

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. ...
Sec 1167. -- Improving Risk Adjustment For Payments.
(b) IMPROVEMENTS TO RISK ADJUSTMENT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (b)
Automated Concept:

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. ...
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(4) MEDICAL LOSS RATIO TO BE DEFINED.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (a) Quoted: (p) (4)
Automated Concept:

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. ...
Sec 1191. -- Telehealth Expansion And Enhancements.
(iii) RECOMMENDATIONS OF THE TELEHEALTH ADVISORY COMMITTEE.
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (2) Quoted: (iii)
Automated Concept:

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. ...
Sec 1205. -- Intelligent Assignment In Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1205. (a)
Automated Concept:

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. ...
Sec 1303. -- Payment Incentive For Selected Primary Care Services.
(3) PRIMARY CARE PRACTITIONER DEFINED. - paragraph (A) - paragraph (ii)
DIVISION B TITLE III SEC 1303. (a) Quoted: (p) (3) (A) (ii)
Automated Concept:

ACCOUNT for 50 percent of physician or practitioner's total allowed charges under section 1848  ;  

Index of Sec 1303. ...
(A) WITH OTHER PRIMARY CARE INCENTIVES.
DIVISION B TITLE III SEC 1303. (a) Quoted: (p) (5) (A)
Automated Concept:

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. ...
(B) WITH QUALITY INCENTIVES.
DIVISION B TITLE III SEC 1303. (a) Quoted: (p) (5) (B)
Automated Concept:

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. ...
(b) CONFORMING AMENDMENTS. - paragraph (1) - paragraph (4)
DIVISION B TITLE III SEC 1303. (b) (1) Quoted: (4)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(4) TAKING INTO ACCOUNT POTENTIAL DIFFERENCES. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (c) (4) (A)
Automated Concept:

ACCOUNT potential for differences in effectiveness of health care items and services used with various subpopulations ;   Designing to take into

Index of Sec 1401. ...
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (dd)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (dd)
Automated Concept:

ACCOUNT pending resolution of subsequent appeals ;   Providing that amounts collected kept in

Index of Sec 1421. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (IV)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iv) (IV)
Automated Concept:

ACCOUNT pending resolution of subsequent appeals ;   Providing that amounts collected kept in

Index of Sec 1421. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (dd)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (IV) (dd)
Automated Concept:

ACCOUNT pending resolution of subsequent appeals ;   Providing that amounts collected kept in

Index of Sec 1421. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(I) MAINTENANCE OF PRIMARY CARE RESIDENT LEVEL.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (I)
Automated Concept:

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. ...
(iii) CONSIDERATIONS IN REDISTRIBUTION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iii)
Automated Concept:

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: escrow
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (cc)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (cc)
Automated Concept:

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. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iv) (III)
Automated Concept:

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. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (cc)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (IV) (cc)
Automated Concept:

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
Sec 1149. -- Medpac Study And Report On Bone Mass Measurement.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1149. (a) (1)
Automated Concept:

ACCOUNT costs of acquiring necessary equipment ;   Assessment of adequacy of Medicare payment rates for services taking into

Index of Sec 1149. ...

Account recommendations
Sec 1744. -- Payments For Graduate Medical Education.
(4) SPECIFICATION OF GOALS AND REQUIREMENTS. - paragraph (A)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (4) (A)
Automated Concept:

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
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (1) (A)
Automated Concept:

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
Sec 1157. -- Institute Of Medicine Study Of Geographic Adjustment Factors Under Medicare.
(c) EVALUATION. - paragraph (1) - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1157. (c) (1) (A)
Automated Concept:

ACCOUNT workforce mobility between urban and rural areas ;   Recruitment and retention taking into

Index of Sec 1157. ...

Accounting: services or
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (iv)
Automated Concept:

ACCOUNTING or financial services to facility ;   Providing management or administrative services, clinical consulting services or

Index of Sec 1411. ...

Accounting period: recent
Sec 1501. -- Distribution Of Unused Residency Positions.
(II) USE OF MOST RECENT ACCOUNTING PERIOD TO RECOGNIZE EXPANSION OF EXISTING PROGRAMS.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (A) (ii) (II)
Automated Concept:

ACCOUNTING period to recognize expansion of existing Programs ;   Use of recent

Index of Sec 1501. ...

Accreditation
Sec 1148. -- Durable Medical Equipment Program Improvements.
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(III) ACCREDITATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (III)
Automated Concept:

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: independent
Sec 1148. -- Durable Medical Equipment Program Improvements.
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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:
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(2) REPORT. - paragraph (B)
DIVISION B TITLE V SEC 1505. (b) (2) (B)
Automated Concept:

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 requirement: applicable standards and
Sec 1148. -- Durable Medical Equipment Program Improvements.
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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. ...

Administrative or other item
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (B) - paragraph (3)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (B) Quoted: (3)
Automated Concept:

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
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) CONSIDERATIONS. - paragraph (2)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1193. (b) (2)
Automated Concept:

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
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (1)
Automated Concept:

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
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(c) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1713. (c)
Automated Concept:

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
Sec 1641. -- Required Repayments Of Medicare And Medicaid Overpayments.
(3) CLARIFICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (3)
Automated Concept:

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
Sec 1741. -- Payments To Pharmacists.
(2) DEFINITION OF AMP. - paragraph (C) - paragraph (v)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (2) (C) Quoted: (v)
Automated Concept:

ADMINISTRATIVE procedures ;   Infusion or injectable drug or Secretary determining as allowed in Agency

Index of Sec 1741. ...

Administrative requirements
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(b) ADMINISTRATIVE REQUIREMENTS RELATING TO REIMBURSEMENTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b)
Automated Concept:

ADMINISTRATIVE requirements relating to reimbursements  ;  

Index of Sec 1204. ...

Administrative services
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (iv)
Automated Concept:

ACCOUNTING or financial services to facility ;   Providing management or administrative services, clinical consulting services or

Index of Sec 1411. ...

Affiliation
Affiliation and affiliation or affiliations
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(3) AUTHORITY TO DENY PARTICIPATION.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (3)
Automated Concept:

AFFILIATION and affiliation or affiliations of provider or supplier posing serious risk of fraud, waste or abuse  ;  

Index of Sec 1632. ...

Affiliation: previous
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(2) ENHANCED SAFEGUARDS.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (2)
Automated Concept:

AFFILIATION of provider or supplier posing risk of fraud, waste or abuse ;   Secretary determining that previous

Index of Sec 1632. ...

Affiliation: Control and management
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
SEC 1757. -- MEDICAID AND CHIP EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS.
DIVISION B TITLE VII SUBTITLE F SEC 1757.
Automated Concept:

AFFILIATIONS ;   Sec 1757, medicaid and Chip exclusion from participation relating to certain ownership, Control and management

Index of Sec 1757. ...

Affiliation: previous
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
SEC 1632. -- ENHANCED MEDICARE, MEDICAID, AND CHIP PROGRAM DISCLOSURE REQUIREMENTS RELATING TO PREVIOUS AFFILIATIONS.
DIVISION B TITLE VI SUBTITLE C SEC 1632.
Automated Concept:

AFFILIATIONS ;   Enhancing medicare, medicaid and Chip Program disclosure requirements relating to previous

Index of Sec 1632. ...

Affiliation agreement
Sec 1501. -- Distribution Of Unused Residency Positions.
(iii) AFFILIATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (A) (iii)
Automated Concept:

AFFILIATION agreement ;   Filling additional resident slots allocated to other hospitals through

Index of Sec 1501. ...

Affordability credits
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(A) NON-TRADITIONAL INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (A)
Automated Concept:

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. ...
(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (3)
Automated Concept:

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. ...
(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (3) (B)
Automated Concept:

AFFORDABILITY credits ;   State Medicaid agency determining that Exchange-eligible individual being not eligible for

Index of Sec 1702. ...

All-condition measure of readmissions
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(B) EXPANSION OF APPLICABLE CONDITIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (B)
Automated Concept:

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
Sec 1724. -- Optional Coverage For Freestanding Birth Center Services.
(a) IN GENERAL. - paragraph (1) - paragraph (C) - paragraph (29)
DIVISION B TITLE VII SUBTITLE C SEC 1724. (a) (1) (C) Quoted: (29)
Automated Concept:

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
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(F) LIMITATION ON APPLICATION TO CERTAIN CONVERTED FACILITIES.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (F)
Automated Concept:

AMBULATORY surgical center to hospital after date of enactment of subsection ;   Hospital not converted from

Index of Sec 1156. ...

Ambulatory surgical centers
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (1)
Automated Concept:

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. ...
(d) NON-PREEMPTION OF STATE LAWS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (d)
Automated Concept:

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. ...
SEC 1461. -- REQUIREMENT FOR PUBLIC REPORTING BY HOSPITALS AND AMBULATORY SURGICAL CENTERS ON HEALTH CARE-ASSOCIATED INFECTIONS.
DIVISION B TITLE IV SUBTITLE E SEC 1461.
Automated Concept:

AMBULATORY surgical Centers on health Care-associated infections ;   Sec 1461, requirement for public reporting by hospitals and

Index of Sec 1461. ...
SEC 1138A. -- REQUIREMENT FOR PUBLIC REPORTING BY HOSPITALS AND AMBULATORY SURGICAL CENTERS ON HEALTH CARE-ASSOCIATED INFECTIONS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A.
Automated Concept:

AMBULATORY surgical Centers on health Care-associated infections ;   Sec 1138a, requirement for public reporting by hospitals and

Index of Sec 1461. ...
(c) ANNUAL REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (c) (1)
Automated Concept:

AMBULATORY surgical centers during year ;   Number and types of health care-associated infections reported under subsection in hospitals and

Index of Sec 1461. ...
(c) ANNUAL REPORT TO CONGRESS. - paragraph (5)
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (c) (5)
Automated Concept:

AMBULATORY surgical centers ;   Best practices to eliminate rates of occurrence type of infection in hospitals and

Index of Sec 1461. ...
(b) EFFECTIVE DATE.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (b)
Automated Concept:

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
Sec 1144. -- Require Ambulatory Surgical Centers (Ascs) To Submit Cost Data And Other Data.
(1) IN GENERAL. - paragraph (B) - paragraph (C)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1144. (b) (1) (B) Quoted: (C)
Automated Concept:

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
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(iii) REVIEW AND ADJUSTMENTS. - paragraph (III)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (iii) (III)
Automated Concept:

ANALYTIC contractors to identify and analyzing services identified under clause ;   Secretary using

Index of Sec 1122. ...

Angiographies
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(F) PROCEDURE ROOMS.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (F)
Automated Concept:

ANGIOGRAPHIES, angiograms and endoscopies furnished ;   Term procedure rooms including rooms in which catheterizations,

Index of Sec 1156. ...

Appointment
Sec 1401. -- Comparative Effectiveness Research.
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

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. ...
Sec 1422. -- National Independent Monitor Pilot Program.
(e) COST OF APPOINTMENT.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (e)
Automated Concept:

APPOINTMENT of independent monitors under pilot program ;   Chain to be responsible for portion of costs associated with

Index of Sec 1422. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (iii)
Automated Concept:

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: further
Sec 1601. -- Increased Funding And Flexibility To Fight Fraud And Abuse.
(7) ADDITIONAL FUNDING.
DIVISION B TITLE VI SUBTITLE A SEC 1601. (a) (1) Quoted: (7)
Automated Concept:

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
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (6)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (6)
Automated Concept:

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. ...
Sec 1616. -- Enhanced Penalties For Provision Of False Information By Medicare Advantage And Part D Plans.
(a) IN GENERAL.
DIVISION B TITLE VI SUBTITLE B SEC 1616. (a)
Automated Concept:

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. ...
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (F)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (F)
Automated Concept:

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: quality
Sec 1412. -- Accountability Requirements.
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (1) (C) Quoted: (ii) (I)
Automated Concept:

ASSESSMENT and assurance activities conducted under clause ;   Coordinating implementation of plan with quality

Index of Sec 1412. ...
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (2) (C) Quoted: (ii) (I)
Automated Concept:

ASSESSMENT and assurance activities conducted under clause ;   Coordinating implementation of plan with quality

Index of Sec 1412. ...
(4) FACILITY PLAN.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (4)
Automated Concept:

ASSESSMENT and assurance activities conducted under clause of sections ;   Coordinating implementation of plan with quality

Index of Sec 1412. ...

Assessment of adequacy of Medicare payment rates
Sec 1149. -- Medpac Study And Report On Bone Mass Measurement.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1149. (a) (1)
Automated Concept:

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
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(c) RESPONSIBILITIES. - paragraph (4)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (c) (4)
Automated Concept:

ASSESSMENT of communication strategies for dual eligibles to determine whether additional informational materials or outreach  ;  

Index of Sec 1905. ...

Assessment of factors
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(c) RESPONSIBILITIES. - paragraph (5)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (c) (5)
Automated Concept:

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
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (3)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (3)
Automated Concept:

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: evaluation and
Sec 1157. -- Institute Of Medicine Study Of Geographic Adjustment Factors Under Medicare.
(b) MATTERS INCLUDED.
DIVISION B TITLE I SUBTITLE C SEC 1157. (b)
Automated Concept:

ASSESSMENT of following with respect to adjustment factors ;   Study including evaluation and

Index of Sec 1157. ...

Asset
Asset or resource test
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(A) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (2) (A)
Automated Concept:

ASSET or resource test in determining eligibility of individual after first day under following ;   State applying

Index of Sec 1703. ...

Asset: waiver of
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(B) OVERRIDING CONTRARY PROVISIONS; REFERENCES.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (2) (B)
Automated Concept:

ASSET or resource test described in subparagraph waived ;   Provisions of title preventing waiver of

Index of Sec 1703. ...

Attestation
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(3) REPORTING REQUIREMENT. - paragraph (D)
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (3) (D)
Automated Concept:

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: verifiable and
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C)
Automated Concept:

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. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C)
Automated Concept:

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: prior
Sec 1205. -- Intelligent Assignment In Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1205. (a)
Automated Concept:

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. ...

Beneficiary
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(2) TIMING OF REIMBURSEMENTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (2)
Automated Concept:

DRUG plan or Ma-pd plan making reimbursement under subsection to retroactive lis enrollment beneficiary with respect to claim ;   Prescription

Index of Sec 1204. ...
(2) TIMING OF REIMBURSEMENTS. - paragraph (B)
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (2) (B)
Automated Concept:

BENEFICIARY filing claim with plan ;   Date on which

Index of Sec 1204. ...
(1) COVERED DRUG COSTS. - paragraph (A)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (1) (A)
Automated Concept:

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. ...
(2) ELIGIBLE THIRD PARTY.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (2)
Automated Concept:

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. ...
Sec 1224. -- Definitions.
(11) MEDICARE BENEFICIARY.
DIVISION B TITLE II SUBTITLE B SEC 1224. (11)
Automated Concept:

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. ...
Sec 1234. -- Part B Special Enrollment Period And Waiver Of Limited Enrollment Penalty For Tricare Beneficiaries.
(l) - paragraph (1)
DIVISION B TITLE II SUBTITLE C SEC 1234. (a) (1) Quoted: (l) (1)
Automated Concept:

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. ...
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1234. (b) (2) (B) (i)
Automated Concept:

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. ...
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1236. (c) (1)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(C) TARGETED HIGH NEED BENEFICIARY DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (1) (C)
Automated Concept:

BENEFICIARY meaning high need beneficiary being generally within upper 50th percentile of Medicare beneficiaries ;   Term targeted high need

Index of Sec 1302. ...
(D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (iii)
Automated Concept:

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. ...
(C) HIGH NEED BENEFICIARY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (C)
Automated Concept:

BENEFICIARY meaning individual requiring regular medical monitoring, advising or treatment ;   Term high need

Index of Sec 1302. ...
(D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (D) (ii)
Automated Concept:

RISK-adjustment in determining amount of per beneficiary per month payment under paragraph ;   Use appropriate

Index of Sec 1302. ...

Beneficiary access
Sec 1149. -- Medpac Study And Report On Bone Mass Measurement.
(a) IN GENERAL. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1149. (a) (2)
Automated Concept:

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. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(g) EVALUATION AND REPORT. - paragraph (2)
DIVISION B TITLE II SUBTITLE B SEC 1222. (g) (2)
Automated Concept:

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
Sec 1202. -- Elimination Of Part D Cost-Sharing For Certain Non-Institutionalized Full-Benefit Dual Eligible Individuals.
(II) CERTAIN OTHER INDIVIDUALS.
DIVISION B TITLE II SUBTITLE A SEC 1202. (a) (2) Quoted: (II)
Automated Concept:

BENEFICIARY coinsurance described in section 1860d-2(b)(2) ;   Elimination of

Index of Sec 1202. ...

Beneficiary data
Sec 1167. -- Improving Risk Adjustment For Payments.
(a) REPORT TO CONGRESS.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (a)
Automated Concept:

BENEFICIARY data ;   Need and feasibility of including further gradations of diseases or conditions and multiple years of

Index of Sec 1167. ...

Beneficiary payment
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(4) ADDITIONAL TERMS. - paragraph (B)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (4) (B)
Automated Concept:

BENEFICIARY payment ;   Discount not to be applied against negotiated price for purpose of calculating

Index of Sec 1182. ...

Beneficiary programs
Sec 1401. -- Comparative Effectiveness Research.
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (3) (A) (iii)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (A)
Automated Concept:

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
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(ii) EXEMPTIONS. - paragraph (I)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (4) (B) (ii) (I)
Automated Concept:

BENEFICIARY'S record ;   Friends or other persons untrained in interpretation or translation and grantee documenting request in

Index of Sec 1222. ...

Bilingual
Sec 1224. -- Definitions.
(1) BILINGUAL.
DIVISION B TITLE II SUBTITLE B SEC 1224. (1)
Automated Concept:

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: competent
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (4) (B) (i)
Automated Concept:

BILINGUAL staff or competent interpreter or translation services ;   Payments to be provided under section only to grantees utilizing competent

Index of Sec 1222. ...

Biologic
Sec 1181. -- Elimination Of Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (1)
Automated Concept:

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. ...
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (1)
Automated Concept:

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. ...

Biological or medical supply
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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. ...
(e) ANNUAL REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (e) (1)
Automated Concept:

INFORMATION during year ;   Biological or medical supply submitting

Index of Sec 1451. ...
(8) MANUFACTURER OF A COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (8)
Automated Concept:

DISTRIBUTION of covered drug, device, biological or medical supply ;   Conversion, processing, marketing or

Index of Sec 1451. ...
(C) EXCLUSIONS. - paragraph (vii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (vii)
Automated Concept:

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. ...

Biological or medical supply and term
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) APPLICABLE MANUFACTURER; APPLICABLE DISTRIBUTOR.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (1)
Automated Concept:

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. ...

By-claim or lump sum basis and payment: claim-
Sec 1121. -- Sustainable Growth Rate Reform.
(e) APPLICATION TO ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (e) (2)
Automated Concept:

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
Cancer: cervical
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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: colorectal
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1) - paragraph (B)
Sec 1306. -- Waiver Of Deductible For Colorectal Cancer Screening Tests Regardless Of Coding, Subsequent Diagnosis, Or Ancillary Tissue Removal.
SEC 1306. -- WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER SCREENING TESTS REGARDLESS OF CODING, SUBSEQUENT DIAGNOSIS, OR ANCILLARY TISSUE REMOVAL.
DIVISION B TITLE III SEC 1306.
Automated Concept:

CANCER screening Tests regardless of coding, subsequent diagnosis or ancillary Tissue removal ;   Sec 1306, waiver of deductible for colorectal

Index of Sec 1306. ...
(a) IN GENERAL.
DIVISION B TITLE III SEC 1306. (a)
Automated Concept:

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: prostate
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1) - paragraph (A)

Capital contributions: owner or investor's
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (v)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (v)
Automated Concept:

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: minimum
Sec 1412. -- Accountability Requirements.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (c) (1) (C)
Automated Concept:

CAPITALIATIONS ;   Requirements relating to surety bonds, liability insurance or minimum

Index of Sec 1412. ...

Capitation model: partial
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (2) (A)
Automated Concept:

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. ...
(B) NO ADDITIONAL PROGRAM EXPENDITURES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (2) (B)
Automated Concept:

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
Sec 1161. -- Phase-In Of Payment Based On Fee-For-Service Costs.
(2) SPECIFIED AMOUNT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1161. (2) Quoted: (n) (2)
Automated Concept:

CAPITATION rates described in subsection ;   Indirect costs of medical education from

Index of Sec 1161. ...

Catheterizations
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(F) PROCEDURE ROOMS.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (F)
Automated Concept:

ANGIOGRAPHIES, angiograms and endoscopies furnished ;   Term procedure rooms including rooms in which catheterizations,

Index of Sec 1156. ...

Certification
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(1) PART A. - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1639. (a) (1) (B)
Automated Concept:

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. ...
(2) PART B. - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1639. (a) (2) (B)
Automated Concept:

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
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a) (1)
Automated Concept:

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. ...
(a) IN GENERAL. - paragraph (2) - paragraph (A)

Certification: review and
Sec 1302. -- Medical Home Pilot Program.
(2) STANDARD SETTING AND QUALIFICATION PROCESS FOR PATIENT-CENTERED MEDICAL HOMES. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (2) (B)
Automated Concept:

CERTIFICATION of medical practices as meeting standards ;   Initially providing for review and

Index of Sec 1302. ...

Certification: survey or
Sec 1413. -- Nursing Home Compare Medicare Website.
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (2) (A) Quoted: (E)
Automated Concept:

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. ...
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (2) (A) Quoted: (E)
Automated Concept:

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: written
Sec 1401. -- Comparative Effectiveness Research.
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

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
Sec 1638. -- Requirement For Physicians To Provide Documentation On Referrals To Programs At High Risk Of Waste And Abuse.
(a) PHYSICIANS AND OTHER SUPPLIERS. - paragraph (10)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (a) Quoted: (10)
Automated Concept:

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. ...
(b) PROVIDERS OF SERVICES. - paragraph (3) - paragraph (X)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (b) (3) Quoted: (X)
Automated Concept:

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. ...
(d) EFFECTIVE DATE.
DIVISION B TITLE VI SUBTITLE C SEC 1638. (d)
Automated Concept:

CERTIFICATIONS and referrals making after January 1 ;   Amendments making by section applying to orders,

Index of Sec 1638. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(d) APPLICATION TO MEDICAID AND CHIP.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (d)
Automated Concept:

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
Sec 1413. -- Nursing Home Compare Medicare Website.
(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (c) (1) Quoted: (D) (i)
Automated Concept:

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. ...
(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (c) (2) Quoted: (D) (i)
Automated Concept:

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. ...

Certification: written orders and
Sec 1637. -- Physicians Who Order Durable Medical Equipment Or Home Health Services Required To Be Medicare Enrolled Physicians Or Eligible Professionals.
(d) EFFECTIVE DATE.
DIVISION B TITLE VI SUBTITLE C SEC 1637. (d)
Automated Concept:

CERTIFICATIONS making after July 1 ;   Amendments making by section applying to written orders and

Index of Sec 1637. ...

Certification agency: State survey and
Sec 1415. -- Standardized Complaint Form.
(9) STANDARDIZED COMPLAINT FORM.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (1) Quoted: (9)
Automated Concept:

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. ...
(11) STANDARDIZED COMPLAINT FORM.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (1) Quoted: (11)
Automated Concept:

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: State survey and
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (iv)
Automated Concept:

CERTIFICATION programs ;   Links to State Internet websites with information regarding State survey and

Index of Sec 1413. ...
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (A) (ii)
Automated Concept:

CERTIFICATION programs ;   Links to State Internet websites with information regarding State survey and

Index of Sec 1413. ...

Charity care: provision of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(C) EXCLUSIONS. - paragraph (v)

Child
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (C)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (C)
Automated Concept:

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 and parent outcomes
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (j) (1) (A)
Automated Concept:

CHILD maltreatment ;   Effect of home visitation programs on child and parent outcomes including

Index of Sec 1904. ...

Child health
Child health and development
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (i)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (i)
Automated Concept:

CHILD health and development ;   Reducing abuse and neglect and improving

Index of Sec 1904. ...

Child health: maternal or
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (1)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (1)
Automated Concept:

CHILD health and pregnancy outcomes or increasing birth intervals between pregnancies ;   Improving maternal or

Index of Sec 1713. ...

Child health assistance
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(c) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1713. (c)
Automated Concept:

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. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(3) CHIP MOE TERMINATION DATE. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (3) (B)
Automated Concept:

CHILD health assistance or pregnancy-related assistance under State child health plan referred in paragraph ;   Eligible for

Index of Sec 1703. ...

Child health plan
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1) (C)
Automated Concept:

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. ...
(d) PROGRAM INTEGRITY.
DIVISION B TITLE VI SUBTITLE C SEC 1631. (b) (2) Quoted: (d)
Automated Concept:

CHILD health plan including description of procedures to be used by State ;   State

Index of Sec 1631. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (1)
Automated Concept:

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. ...
(2) LIMITATION.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (2)
Automated Concept:

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. ...
(3) CHIP MOE TERMINATION DATE. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (3) (B)
Automated Concept:

CHILD health plan referred in paragraph ;   Eligible for child health assistance or pregnancy-related assistance under State

Index of Sec 1703. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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. ...
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
SEC 1756. -- TERMINATION OF PROVIDER PARTICIPATION UNDER MEDICAID AND CHIP IF TERMINATED UNDER MEDICARE OR OTHER STATE PLAN OR CHILD HEALTH PLAN.
DIVISION B TITLE VII SUBTITLE F SEC 1756.
Automated Concept:

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. ...
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1756. (c) (2)
Automated Concept:

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. ...
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (c) (2)
Automated Concept:

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. ...
Sec 1759. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicaid.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1759. (c) (2)
Automated Concept:

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: maternal and
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (2)
Automated Concept:

CHILD involvement in criminal justice system ;   Improving family stability or reducing maternal and

Index of Sec 1713. ...

Child maltreatment
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (A)
Automated Concept:

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. ...
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (j) (1) (A)
Automated Concept:

CHILD maltreatment ;   Effect of home visitation programs on child and parent outcomes including

Index of Sec 1904. ...

Child's enrollment: necessary transitional care
Sec 1722. -- Medical Home Pilot Program.
(d) MEDICALLY FRAGILE CHILDREN.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (d)
Automated Concept:

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. ...

Chronic
Sec 1233. -- Advance Care Planning Consultation.
(3) - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (3) (B)
Automated Concept:

HEALTH condition of individual including diagnosis of chronic ;   Significant change in

Index of Sec 1233. ...

Chronic or co-morbid conditions
Sec 1167. -- Improving Risk Adjustment For Payments.
(a) REPORT TO CONGRESS.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (a)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (3)
Automated Concept:

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
Sec 1162. -- Quality Bonus Payments.
(ii) ESTABLISHMENT OF OUTCOME-BASED MEASURES. - paragraph (IV)
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (B) (ii) (IV)
Automated Concept:

CHRONIC diseases ;   Measures of health functioning and survival for patients with

Index of Sec 1162. ...

Chronic diseases: multiple
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (iii)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (iii)
Automated Concept:

CHRONIC illnesses, transitional care services, care plan ;   Teaching self-care skills for managing

Index of Sec 1302. ...

Citizenship of parties and jurisdiction: controversy o
Sec 1415. -- Standardized Complaint Form.
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iii)
Automated Concept:

CITIZENSHIP of parties and jurisdiction to grant complete relief ;   Jurisdiction over action without regard to amount in controversy or

Index of Sec 1415. ...
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iii)
Automated Concept:

CITIZENSHIP of parties and jurisdiction to grant complete relief ;   Jurisdiction over action without regard to amount in controversy or

Index of Sec 1415. ...

Civil
Civil and administrative violations
Sec 1412. -- Accountability Requirements.
(i) REQUIREMENT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (i)
Automated Concept:

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. ...
(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iii) (I)
Automated Concept:

ADMINISTRATIVE violations under Act and promoting quality of care ;   Effective in preventing and detecting criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (III)
Automated Concept:

ADMINISTRATIVE violations under Act ;   Propensity to engage in criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (V)
Automated Concept:

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. ...
(i) REQUIREMENT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (i)
Automated Concept:

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. ...
(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iii) (I)
Automated Concept:

ADMINISTRATIVE violations under Act and promoting quality of care ;   Effective in preventing and detecting criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (III)
Automated Concept:

ADMINISTRATIVE violations under Act ;   Propensity to engage in criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (V)
Automated Concept:

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 or administrative
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (C)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (C)
Automated Concept:

ADMINISTRATIVE proceeding ;   Discovery or admissibility of information described in section in criminal, civil or

Index of Sec 1451. ...

Civil or criminal sanctions
Sec 1641. -- Required Repayments Of Medicare And Medicaid Overpayments.
(3) CLARIFICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (3)
Automated Concept:

CRIMINAL sanctions involving same claim if determined later ;   Applicable interests, fines and specialties or civil or

Index of Sec 1641. ...

Civil money penalty
Civil money penaltyes
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (A)
Automated Concept:

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. ...
(B) LIMITATION.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (B)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (2) (A)
Automated Concept:

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. ...
(B) LIMITATION.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (2) (B)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (i)
Automated Concept:

CIVIL money penalties in amount not to exceed $10,000 for day of noncompliance or not to exceed $25,000  ;  

Index of Sec 1614. ...

Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(C) APPLICATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (4) Quoted: (5) (C)
Automated Concept:

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. ...
Sec 1181. -- Elimination Of Coverage Gap.
(F) PENALTIES FOR FAILURE TO PROVIDE TIMELY INFORMATION AND PROVISION OF FALSE INFORMATION. - paragraph (ii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (F) (ii)
Automated Concept:

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. ...
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES.
(VIII) PROCEDURE.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VIII)
Automated Concept:

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. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES.
(I) AMOUNT.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (I)
Automated Concept:

CIVIL money penalty in amount not to exceed $10,000 for daying or instance of noncompliance ;   Secretary imposing

Index of Sec 1421. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES.
(V) PROCEDURE.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (V)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (A)
Automated Concept:

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. ...
(3) USE OF FUNDS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (3)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(A) IN GENERAL. - paragraph (v)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (v)
Automated Concept:

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. ...

Civil money penalty and placement of amounts
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (cc)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (cc)
Automated Concept:

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. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iv) (III)
Automated Concept:

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. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (cc)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (IV) (cc)
Automated Concept:

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: ambulatory payment
Sec 1145. -- Treatment Of Certain Cancer Hospitals.
(A) STUDY.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1145. Quoted: (18) (A)
Automated Concept:

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
Sec 1111. -- Payments To Skilled Nursing Facilities.
(D) IMPLEMENTATION.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (D)
Automated Concept:

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. ...
(E) BUDGET NEUTRALITY.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (E)
Automated Concept:

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: alternative case mix
Sec 1111. -- Payments To Skilled Nursing Facilities.
(B) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (1) (B)
Automated Concept:

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: future skilled nursing facility
Sec 1111. -- Payments To Skilled Nursing Facilities.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (A) (i)
Automated Concept:

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. ...
(ii) APPLICATION.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (A) (ii)
Automated Concept:

CLASSIFIATIONS system implemented to apply to services furnished during fiscal year beginning with fiscal year 2011 ;   Future skilled nursing facility

Index of Sec 1111. ...

Clinical
Sec 1124. -- Modifications To The Physician Quality Reporting Initiative (Pqri).
(7) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR REPORTING.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1124. (c) Quoted: (7)
Automated Concept:

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. ...
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (iv)
Automated Concept:

ACCOUNTING or financial services to facility ;   Providing management or administrative services, clinical consulting services or

Index of Sec 1411. ...

Clinical: appropriate
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(d) ASSURANCES. - paragraph (1)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (1)
Automated Concept:

EDUCATION and training in linguistically appropriate service delivery ;   Ensuring that appropriate clinical and support staff receiving ongoing

Index of Sec 1222. ...

Clinical care
Sec 1401. -- Comparative Effectiveness Research.
(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY. - paragraph (IV)

Clinical decision support
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1)
Automated Concept:

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. ...
(1) DISSEMINATION. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (E)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (E)
Automated Concept:

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
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (5)
Automated Concept:

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. ...
(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS. - paragraph (A)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (5) (A)
Automated Concept:

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. ...
(2) CLINICAL INVESTIGATION.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (2)
Automated Concept:

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
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (5)
Automated Concept:

CLINICAL investigations ;   Delaying reporting for payments making PURSUANT to

Index of Sec 1451. ...

Clinical outcomes
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (H)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (H)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (H)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (H)
Automated Concept:

CLINICAL perspective advisory panel for research priority determined under subparagraph ;   Appointing

Index of Sec 1401. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (A)
Automated Concept:

CLINICAL perspective advisory panel described in paragraph ;   Appointing members of Commission or

Index of Sec 1401. ...
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

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. ...
(i) DISCLOSURE OF FINANCIAL INTEREST.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (i)
Automated Concept:

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. ...
(ii) PROHIBITIONS ON PARTICIPATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (ii)
Automated Concept:

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. ...
(iii) WAIVER.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iii)
Automated Concept:

CLINICAL perspective advisory panel described in paragraph 2(h) essential expertise ;   Secretary determining necessary to afford Commission or

Index of Sec 1401. ...
(iii) WAIVER. - paragraph (I)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iii) (I)
Automated Concept:

CLINICAL perspective advisory panel meeting ;   Participating as non-voting member with respect to particular matter considered in Commission or

Index of Sec 1401. ...
(iii) WAIVER. - paragraph (II)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iii) (II)
Automated Concept:

CLINICAL perspective advisory panel meeting ;   Participating as voting member with respect to particular matter considered in Commission or

Index of Sec 1401. ...
(II) PROHIBITION ON VOTING STATUS ON CLINICAL PERSPECTIVE ADVISORY PANELS.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iv) (II)
Automated Concept:

CLINICAL perspective advisory panel receiving waiver ;   No more than two nonvoting members of

Index of Sec 1401. ...
(2) USE OF CLINICAL PERSPECTIVE ADVISORY PANELS.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (c) (2)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (E)
Automated Concept:

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
Sec 1162. -- Quality Bonus Payments.
(iii) RULES FOR SELECTION OF MEASURES. - paragraph (I)
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (B) (iii) (I)
Automated Concept:

CLINICAL quality measures endorsed by entity with contract with Secretary under section 1890(a) ;   Secretary providing preference to

Index of Sec 1162. ...

Clinical registries and development
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (E)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (B)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (B)
Automated Concept:

CLINICAL research including original research conducted subsequent to date of enactment of section ;   Conduct and support systematic reviews of

Index of Sec 1401. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) IN GENERAL. - paragraph (F)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (F)
Automated Concept:

CLINICAL research ;   Separately listed information as funding for

Index of Sec 1451. ...

Clinical supervised experience
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (2) - paragraph (B)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (2) (B)
Automated Concept:

MARRIAGE and family therapy ;   Obtaining degree performed 2 years of clinical supervised experience in

Index of Sec 1308. ...

Clinical work and practice expenses
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (i)
Automated Concept:

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. ...
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (D) (i)
Automated Concept:

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. ...

Coding: regardless of
Sec 1306. -- Waiver Of Deductible For Colorectal Cancer Screening Tests Regardless Of Coding, Subsequent Diagnosis, Or Ancillary Tissue Removal.
SEC 1306. -- WAIVER OF DEDUCTIBLE FOR COLORECTAL CANCER SCREENING TESTS REGARDLESS OF CODING, SUBSEQUENT DIAGNOSIS, OR ANCILLARY TISSUE REMOVAL.
DIVISION B TITLE III SEC 1306.
Automated Concept:

CANCER screening Tests regardless of coding, subsequent diagnosis or ancillary Tissue removal ;   Sec 1306, waiver of deductible for colorectal

Index of Sec 1306. ...

Commission
Sec 1617. -- Enhanced Penalties For Medicare Advantage And Part D Marketing Violations.
(a) IN GENERAL. - paragraph (2) - paragraph (J)
DIVISION B TITLE VI SUBTITLE B SEC 1617. (a) (2) Quoted: (J)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (A)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (B)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (B)
Automated Concept:

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: previo
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (I)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (I)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (C)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (C)
Automated Concept:

COMPARATIVE effectiveness studies and using methodologies appropriately ;   Continuously developing rigorous scientific methodologies for conducting

Index of Sec 1401. ...
(C) OMBUDSMAN. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (c) (3) (C) (ii)
Automated Concept:

COMPARATIVE effectiveness studies reviewed by Commission ;   Ensuring that comments from patients regarding proposed

Index of Sec 1401. ...

Compensation
Sec 1401. -- Comparative Effectiveness Research.
(11) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (11) (E)
Automated Concept:

COMPENSATION ;   Providing transportation and subsistence for persons serving without

Index of Sec 1401. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) INCLUSIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (B)
Automated Concept:

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. ...
(C) EXCLUSIONS. - paragraph (vii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (vii)
Automated Concept:

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: investment and
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1)
Automated Concept:

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
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(5) CLARIFICATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (5)
Automated Concept:

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. ...
(b) VERIFYING COMPLIANCE.
DIVISION B TITLE I SUBTITLE C SEC 1156. (b)
Automated Concept:

COMPLIANCE with requirements ;   Secretary using unannounced site reviews of hospitals and audits to verify

Index of Sec 1156. ...
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(B) DISCOUNT AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (2) (B)
Automated Concept:

COMPLIANCE ;   Secretary establishing terming and conditioning of agreement including terming and conditions relating to

Index of Sec 1182. ...
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (V)
Automated Concept:

COMPLIANCE with standards ;   Organization taking reasonable steps to achieve

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (V)
Automated Concept:

COMPLIANCE with standards ;   Organization taking reasonable steps to achieve

Index of Sec 1412. ...
Sec 1422. -- National Independent Monitor Pilot Program.
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR. - paragraph (1)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (c) (1)
Automated Concept:

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. ...
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR. - paragraph (2)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (c) (2)
Automated Concept:

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. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(c) GAO REPORT.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (c)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) IN GENERAL. - paragraph (2) - paragraph (B)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a) (2) (B)
Automated Concept:

COMPLIANCE with requirements ;   Secretary determining that hospice program certified for participation under title in

Index of Sec 1614. ...
(A) IN GENERAL. - paragraph (v)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (v)
Automated Concept:

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: discussion of Center's
Sec 1401. -- Comparative Effectiveness Research.
(1) ANNUAL REPORTS.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (f) (1)
Automated Concept:

COMPLIANCE with subsection ;   Report including discussion of Center's

Index of Sec 1401. ...

Compliance: plan's
Sec 1162. -- Quality Bonus Payments.
(iv) AUTHORITY TO DISQUALIFY CERTAIN PLANS.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (E) (iv)
Automated Concept:

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
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(1) IN GENERAL.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (1)
Automated Concept:

COMPLIANCE program containing core elements established under paragraph ;   Establish

Index of Sec 1635. ...
Sec 1753. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
SEC 1753. -- REQUIRE PROVIDERS AND SUPPLIERS TO ADOPT PROGRAMS TO REDUCE WASTE, FRAUD, AND ABUSE. - paragraph (3) - paragraph (76)
DIVISION B TITLE VII SUBTITLE F SEC 1753. (3) Quoted: (76)
Automated Concept:

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: model
Sec 1412. -- Accountability Requirements.
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (ii) (I)
Automated Concept:

COMPLIANCE program ;   Promulgating regulations for effective compliance and ethics program for operating organizations including model

Index of Sec 1412. ...
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (ii) (I)
Automated Concept:

COMPLIANCE program ;   Developing regulations for effective compliance and ethics program for operating organizations including model

Index of Sec 1412. ...

Compliance standards and procedures
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (I)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION. - paragraph (D)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (D)
Automated Concept:

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. ...

Consent: prior
Sec 1617. -- Enhanced Penalties For Medicare Advantage And Part D Marketing Violations.
(a) IN GENERAL. - paragraph (2) - paragraph (J)
DIVISION B TITLE VI SUBTITLE B SEC 1617. (a) (2) Quoted: (J)
Automated Concept:

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: furtherance of
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (E)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (E)
Automated Concept:

CONSPIRACY involved ;   $50,000 for violation described in section committed in furtherance of

Index of Sec 1645. ...
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (F)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (F)
Automated Concept:

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. ...

Consumer
Sec 1413. -- Nursing Home Compare Medicare Website.
(2) REQUIREMENT. - paragraph (C) - paragraph (D)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (d) (2) (C) Quoted: (D)
Automated Concept:

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. ...

Consumers
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (K)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (K)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (3) (A) (iii)
Automated Concept:

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. ...
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (iii)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (A) (i)
Automated Concept:

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. ...

Consumers and families
Sec 1233. -- Advance Care Planning Consultation.
(hhh) ADVANCE CARE PLANNING CONSULTATION. - paragraph (1) - paragraph (D)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (D)
Automated Concept:

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. ...

Consumer advocacy groups
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C)
Automated Concept:

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. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C)
Automated Concept:

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
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (ff)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (ff)
Automated Concept:

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. ...
(B) CONFORMING AMENDMENT.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (B)
Automated Concept:

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. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (ff)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (IV) (ff)
Automated Concept:

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
Sec 1201. -- Improving Assets Tests For Medicare Savings Program And Low-Income Subsidy Program.
(2) ANNUAL INCREASE IN LIS RESOURCE TEST. - paragraph (D) - paragraph (IV)
DIVISION B TITLE II SUBTITLE A SEC 1201. (a) (2) (D) Quoted: (IV)
Automated Concept:

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 12-month period
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(ii) DEFAULT AMOUNT. - paragraph (II)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (c) (1) (B) (ii) (II)
Automated Concept:

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
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (2) (A)
Automated Concept:

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. ...
Sec 1157. -- Institute Of Medicine Study Of Geographic Adjustment Factors Under Medicare.
(a) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1157. (a)
Automated Concept:

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. ...
Sec 1162. -- Quality Bonus Payments.
(iii) RULES FOR SELECTION OF MEASURES. - paragraph (I)
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (B) (iii) (I)
Automated Concept:

CONTRACT with Secretary under section 1890(a) ;   Secretary providing preference to clinical quality measures endorsed by entity with

Index of Sec 1162. ...
Sec 1174. -- Strengthening Audit Authority.
(A) INFORMATION IN CONTRACT.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1174. (b) (1) Quoted: (5) (A)
Automated Concept:

CONTRACT with Ma organization under section including terms informing organization of provisions in subsection ;   Secretary requiring that

Index of Sec 1174. ...
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (A)
Automated Concept:

CONTRACT entered with PDP sponsor under part with respect to prescription drug plan requiring that sponsor complying with subparagraphs  ;  

Index of Sec 1181. ...
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (i)
Automated Concept:

CONTRACT ;   Prescription drug plan offered by sponsor of plan awarding

Index of Sec 1204. ...
(ii) RFP CONTRACT DESCRIBED.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (ii)
Automated Concept:

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. ...
Sec 1224. -- Definitions.
(13) SERVICE PROVIDER.
DIVISION B TITLE II SUBTITLE B SEC 1224. (13)
Automated Concept:

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. ...
Sec 1415. -- Standardized Complaint Form.
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iii)
Automated Concept:

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. ...
(iv) RIGHTS NOT WAIVABLE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iv)
Automated Concept:

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. ...
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iii)
Automated Concept:

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. ...
(iv) RIGHTS NOT WAIVABLE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iv)
Automated Concept:

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. ...
Sec 1422. -- National Independent Monitor Pilot Program.
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (c)
Automated Concept:

CONTRACT with Secretary to participate in conduct of program ;   Independent monitor entering into

Index of Sec 1422. ...
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(1) CONSENSUS-BASED ENTITY.
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (d) (1)
Automated Concept:

CONTRACT with Secretary under section 1890 ;   Term consensus-based entity meaning entity with

Index of Sec 1441. ...
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (2)
Automated Concept:

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. ...
(3) MULTI-STAKEHOLDER INPUT.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (3)
Automated Concept:

CONTRACT provided under section 1890 ;   Recommendations to be included in transmissions consensus-based entity makes to Secretary under

Index of Sec 1443. ...
Sec 1444. -- Application Of Quality Measures.
(x) - paragraph (I)
DIVISION B TITLE IV SUBTITLE C SEC 1444. (a) Quoted: (x) (I)
Automated Concept:

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. ...
(x) - paragraph (II)
DIVISION B TITLE IV SUBTITLE C SEC 1444. (a) Quoted: (x) (II)
Automated Concept:

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. ...
Sec 1636. -- Maximum Period For Submission Of Medicare Claims Reduced To Not More Than 12 Months.
(7) PERIOD FOR SUBMISSION OF CLAIMS.
DIVISION B TITLE VI SUBTITLE C SEC 1636. (b) (3) Quoted: (7)
Automated Concept:

CONTRACT ;   Contract requiring Ma organization or PDP sponsor to require provider of services under

Index of Sec 1636. ...
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(a) IN GENERAL. - paragraph (3) - paragraph (xiii)
DIVISION B TITLE VII SUBTITLE E SEC 1743. (a) (3) Quoted: (xiii)
Automated Concept:

CONTRACT providing that entity reporting to State  ;  

Index of Sec 1743. ...

Contract: bid or
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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: Federal or State law or
Sec 1415. -- Standardized Complaint Form.
(iv) RIGHTS NOT WAIVABLE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iv)
Automated Concept:

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. ...
(iv) RIGHTS NOT WAIVABLE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iv)
Automated Concept:

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: plan
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO. - paragraph (C)
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (b) Quoted: (4) (C)
Automated Concept:

CONTRACT if plan failing to have medical loss ratio for 5 consecutive contract years ;   Secretary terminating plan

Index of Sec 1173. ...

Contract: privileges of employment or
Sec 1415. -- Standardized Complaint Form.
(i) PROHIBITION AGAINST RETALIATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (i)
Automated Concept:

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. ...
(i) PROHIBITION AGAINST RETALIATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (i)
Automated Concept:

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: reasonable cost reimbursement
Sec 1165. -- Extension Of Reasonable Cost Contracts.
SEC 1165. -- EXTENSION OF REASONABLE COST CONTRACTS. - paragraph (2)
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1165. (2)
Automated Concept:

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: rfp
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (i)
Automated Concept:

CONTRACT described in clause ;   Pursuant to rfp

Index of Sec 1204. ...
(ii) RFP CONTRACT DESCRIBED.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (ii)
Automated Concept:

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
Sec 1141. -- Rental And Purchase Of Power-Driven Wheelchairs.
(b) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1141. (b)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(11) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS. - paragraph (C)
Sec 1755. -- Managed Care Organizations.
(3) EFFECTIVE DATE.
DIVISION B TITLE VII SUBTITLE F SEC 1755. (a) (3)
Automated Concept:

CONTRACTS entered or renewed after July 1 ;   Amendments making by subsection applying to

Index of Sec 1755. ...

Contract: similar
Sec 1301. -- Accountable Care Organization Pilot Program.
(3) INVOLVEMENT IN PRIVATE PAYER ARRANGEMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (3)
Automated Concept:

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 State State program
Sec 1177. -- Extension Of Authority Of Special Needs Plans To Restrict Enrollment.
(1) PLANS DESCRIBED.
DIVISION B TITLE I SUBTITLE D PART 3 SEC 1177. (b) (1)
Automated Concept:

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
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO. - paragraph (B)
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (b) Quoted: (4) (B)
Automated Concept:

CONTRACT year ;   Secretary not permitting enrollment of new enrollees under plan for coverage during second succeeding

Index of Sec 1173. ...
Sec 1634. -- Evaluations And Reports Required Under Medicare Integrity Program.
(a) IN GENERAL. - paragraph (3) - paragraph (4)
DIVISION B TITLE VI SUBTITLE C SEC 1634. (a) (3) Quoted: (4)
Automated Concept:

CONTRACT year beginning in 2011 and subsequent contract year  ;  

Index of Sec 1634. ...
Sec 1752. -- Evaluations And Reports Required Under Medicaid Integrity Program.
SEC 1752. -- EVALUATIONS AND REPORTS REQUIRED UNDER MEDICAID INTEGRITY PROGRAM. - paragraph (2) - paragraph (D)
DIVISION B TITLE VII SUBTITLE F SEC 1752. (2) Quoted: (D)
Automated Concept:

CONTRACT year beginning in 2011 and subsequent contract year  ;  

Index of Sec 1752. ...

Contract year: subsequent
Sec 1634. -- Evaluations And Reports Required Under Medicare Integrity Program.
(a) IN GENERAL. - paragraph (3) - paragraph (4)
DIVISION B TITLE VI SUBTITLE C SEC 1634. (a) (3) Quoted: (4)
Automated Concept:

CONTRACT year ;   Contract year beginning in 2011 and subsequent

Index of Sec 1634. ...
Sec 1752. -- Evaluations And Reports Required Under Medicaid Integrity Program.
SEC 1752. -- EVALUATIONS AND REPORTS REQUIRED UNDER MEDICAID INTEGRITY PROGRAM. - paragraph (2) - paragraph (D)
DIVISION B TITLE VII SUBTITLE F SEC 1752. (2) Quoted: (D)
Automated Concept:

CONTRACT year ;   Contract year beginning in 2011 and subsequent

Index of Sec 1752. ...

Contract years
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (a) Quoted: (p) (3) (A)
Automated Concept:

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. ...
Sec 1174. -- Strengthening Audit Authority.
(c) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1174. (c)
Automated Concept:

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. ...
Sec 1175. -- Authority To Deny Plan Bids.
(c) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1175. (c)
Automated Concept:

CONTRACT years beginning after January 1 ;   Amendments making by section applying to bids for

Index of Sec 1175. ...
Sec 1183. -- Repeal Of Provision Relating To Submission Of Claims By Pharmacies Located In Or Contracting With Long-Term Care Facilities.
(c) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE E SEC 1183. (c)
Automated Concept:

CONTRACT years beginning with 2010 ;   Amendments making by section applying for

Index of Sec 1183. ...
Sec 1205. -- Intelligent Assignment In Enrollment.
(b) EFFECTIVE DATE.
DIVISION B TITLE II SUBTITLE A SEC 1205. (b)
Automated Concept:

CONTRACT years beginning with 2012 ;   Amendment making by subsection taking effect for

Index of Sec 1205. ...

Contract year: consecutive
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO. - paragraph (C)
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (b) Quoted: (4) (C)
Automated Concept:

CONTRACT years ;   Secretary terminating plan contract if plan failing to have medical loss ratio for 5 consecutive

Index of Sec 1173. ...

Cooperative entity
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(1) ELIGIBLE PROVIDER. - paragraph (H)
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (1) (H)
Automated Concept:

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. ...

Corporation
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(D) ORGANIZATIONAL STRUCTURE. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (D) (i)
Automated Concept:

INTEREST in corporation being equal or exceeding 5 percent ;   Shareholders of corporation having ownership

Index of Sec 1411. ...

Corporation: shareholders of
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(D) ORGANIZATIONAL STRUCTURE. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (D) (i)
Automated Concept:

INTEREST in corporation being equal or exceeding 5 percent ;   Shareholders of corporation having ownership

Index of Sec 1411. ...

Criminal
Sec 1412. -- Accountability Requirements.
(i) REQUIREMENT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (i)
Automated Concept:

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. ...
(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iii) (I)
Automated Concept:

ADMINISTRATIVE violations under Act and promoting quality of care ;   Effective in preventing and detecting criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (III)
Automated Concept:

ADMINISTRATIVE violations under Act ;   Propensity to engage in criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (V)
Automated Concept:

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. ...
(i) REQUIREMENT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (i)
Automated Concept:

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. ...
(iii) REQUIREMENTS FOR COMPLIANCE AND ETHICS PROGRAMS. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iii) (I)
Automated Concept:

ADMINISTRATIVE violations under Act and promoting quality of care ;   Effective in preventing and detecting criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (III)
Automated Concept:

ADMINISTRATIVE violations under Act ;   Propensity to engage in criminal, civil and

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (V)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (C)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (C)
Automated Concept:

ADMINISTRATIVE proceeding ;   Discovery or admissibility of information described in section in criminal, civil or

Index of Sec 1451. ...

Criminal justice system
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (2)
Automated Concept:

CRIMINAL justice system ;   Improving family stability or reducing maternal and child involvement in

Index of Sec 1713. ...

Criminal sexual abuse
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (vii) - paragraph (II)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (vii) (II)
Automated Concept:

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: bad
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (1) (B)
Automated Concept:

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. ...

Deficiency
Sec 1421. -- Civil Money Penalties.
(bb) CERTAIN OTHER DEFICIENCIES.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (V) (bb)
Automated Concept:

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. ...
(II) CERTAIN OTHER DEFICIENCIES.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (v) (II)
Automated Concept:

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. ...
(II) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (II)
Automated Concept:

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. ...

Deficiency: case of
Sec 1421. -- Civil Money Penalties.
(II) APPLICABLE PER INSTANCE AMOUNT. - paragraph (bb)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (II) (bb)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...
(III) APPLICABLE PER DAY AMOUNT. - paragraph (aa)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (III) (aa)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...
(ii) APPLICABLE PER INSTANCE AMOUNT. - paragraph (II)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (ii) (II)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...
(iii) APPLICABLE PER DAY AMOUNT. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iii) (I)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...

Deficiency analyses of chain: root-cause quality and
Sec 1422. -- National Independent Monitor Pilot Program.
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR. - paragraph (1)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (c) (1)
Automated Concept:

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
Sec 1412. -- Accountability Requirements.
(III) EVALUATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (ii) (III)
Automated Concept:

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. ...
(III) EVALUATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (ii) (III)
Automated Concept:

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
Sec 1431. -- Dementia And Abuse Prevention Training.
(a) SKILLED NURSING FACILITIES.
DIVISION B TITLE IV SUBTITLE B PART 3 SEC 1431. (a)
Automated Concept:

DEMENTIA management training and resident abuse prevention training after curriculum  ;  

Index of Sec 1431. ...
(b) NURSING FACILITIES.
DIVISION B TITLE IV SUBTITLE B PART 3 SEC 1431. (b)
Automated Concept:

DEMENTIA management training and resident abuse prevention training after curriculum  ;  

Index of Sec 1431. ...

Developmental delays
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (v) - paragraph (VI)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (v) (VI)
Automated Concept:

SOCIAL ;   Skills to recognize and seek help for issues related to health, developmental delays and

Index of Sec 1904. ...

Diabetes
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1) - paragraph (H)

Diabetic testing supplies
Sec 1148. -- Durable Medical Equipment Program Improvements.
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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. ...

Diagnostic: advanced
Sec 1147. -- Payment For Imaging Services.
(C) ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1147. (a) (1) (B) Quoted: (C)
Automated Concept:

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: secondary
Sec 1751. -- Health-Care Acquired Conditions.
(a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH CARE-ACQUIRED CONDITIONS. - paragraph (3) - paragraph (25)
DIVISION B TITLE VII SUBTITLE F SEC 1751. (a) (3) Quoted: (25)
Automated Concept:

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
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(A) EXCLUSION FROM OPD FEE SCHEDULE.
DIVISION B TITLE III SEC 1305. (b) (2) (A)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (ii)
Automated Concept:

DIFFERENTIAL payments based on capabilities of independent patient-centered medical home ;   Allowing for

Index of Sec 1302. ...

Discharge
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (1) (A)
Automated Concept:

DISCHARGE ;   Base operating DRG payment amount for

Index of Sec 1151. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (2) (A)
Automated Concept:

DISCHARGE if subsection not ;   Payment amount otherwise to be made under subsection for

Index of Sec 1151. ...
(E) READMISSION.
(2) CONSIDERATIONS. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1151. (d) (2) (A)
Automated Concept:

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. ...
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(3) POST ACUTE SERVICES.
DIVISION B TITLE I SUBTITLE C SEC 1152. (a) (3)
Automated Concept:

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. ...
Sec 1415. -- Standardized Complaint Form.
(i) PROHIBITION AGAINST RETALIATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (i)
Automated Concept:

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. ...
(i) PROHIBITION AGAINST RETALIATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (i)
Automated Concept:

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: date of
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(E) READMISSION.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (E)
Automated Concept:

DISCHARGE ;   Admission of individual to same or another applicable hospital within time period specified by Secretary from date of

Index of Sec 1151. ...

Discharge: initial
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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: subsection
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (1)
Automated Concept:

DISCHARGE by amount equal to product ;   Secretary reducing payments otherwise to be made to hospital under subsection

Index of Sec 1151. ...

Discharges
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(3) PRODUCTIVITY ADJUSTMENT.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (c) Quoted: (3)
Automated Concept:

DISCHARGES for hospital ;   Annual percentage increase factor applying to base rate for

Index of Sec 1103. ...
(2) PRODUCTIVITY ADJUSTMENT.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (2)
Automated Concept:

DISCHARGES for hospital or unit ;   Annual percentage increase factor applying to base rate for

Index of Sec 1103. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (1)
Automated Concept:

DISCHARGES from applicable hospital occurring during fiscal year beginning after October 1 ;   Respect to payment for

Index of Sec 1151. ...
(B) AGGREGATE PAYMENTS FOR ALL DISCHARGES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (B)
Automated Concept:

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. ...
Sec 1751. -- Health-Care Acquired Conditions.
(d) EFFECTIVE DATE.
DIVISION B TITLE VII SUBTITLE F SEC 1751. (d)
Automated Concept:

DISCHARGES occurring after January 1 ;   Amendments making by section applying to

Index of Sec 1751. ...

Discharges or services
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(C) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (C)
Automated Concept:

DISCHARGES or services furnished after first day of fiscal year or rate year beginning after October 1 ;   Subparagraph applying to

Index of Sec 1151. ...

Discharge: minimum number of
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(ii) EXCLUSION OF CERTAIN READMISSIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (ii)
Automated Concept:

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. ...

Discharge: services or
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) DETAILS. - paragraph (3)
DIVISION B TITLE I SUBTITLE C SEC 1152. (b) (3)
Automated Concept:

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: appropriate
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (VI)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (VI)
Automated Concept:

DISCIPLINARY mechanisms as appropriate ;   Standards to be consistently enforced through appropriate

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (VI)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (VI)
Automated Concept:

DISCIPLINARY mechanisms as appropriate ;   Standards to be consistently enforced through appropriate

Index of Sec 1412. ...

Disciplinary team
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS. - paragraph (iv)
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B) (iv)
Automated Concept:

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
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.

Disclosure
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(6) CONFIDENTIALITY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (6)
Automated Concept:

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. ...
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (A)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (A)
Automated Concept:

DISCLOSURE or reporting of information not of type required to be disclosed or reported under section  ;  

Index of Sec 1451. ...
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (B)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (B)
Automated Concept:

DISCLOSURE or reporting of type of information required to be disclosed or reported under section to Federal  ;  

Index of Sec 1451. ...

Disclosure of ownership
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
SEC 1411. -- REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411.
Automated Concept:

DISCLOSURE of ownership and additional DISCLOSABLE partying information ;   Requiring

Index of Sec 1411. ...
(c) REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c)
Automated Concept:

DISCLOSURE of ownership and additional DISCLOSABLE partying information ;   Requiring

Index of Sec 1411. ...

Disclosures
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...
Sec 1801. -- 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.
SEC 1801. -- 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.
DIVISION B TITLE VIII SEC 1801.
Automated Concept:

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. ...
(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.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19)
Automated Concept:

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. ...
(d) EFFECTIVE DATE.
DIVISION B TITLE VIII SEC 1801. (d)
Automated Concept:

DISCLOSURES making after date being 12 months after date of enactment of Act ;   Amendments making by section applying to

Index of Sec 1801. ...

Disclosure report: financial
Sec 1401. -- Comparative Effectiveness Research.
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

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: substantial
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (III)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (III)
Automated Concept:

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
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(c) MEDICARE DSH.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (c)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(4) MEDICAID DSH.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (a) (4)
Automated Concept:

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
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(B) TARGETED HOSPITALS. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (B) (i)
Automated Concept:

DISPROPORTIONATE share payments using latest available data as estimated by Secretary ;   Eligible to receive $10,000,000 or more in

Index of Sec 1151. ...

Dissemination
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1)
Automated Concept:

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. ...
(1) DISSEMINATION. - paragraph (D)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (D)
Automated Concept:

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. ...
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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. ...
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(l) RESERVATIONS OF FUNDS. - paragraph (1)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (l) (1)
Automated Concept:

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: broad
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (K)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (K)
Automated Concept:

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: appropriate
Sec 1401. -- Comparative Effectiveness Research.
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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. ...

Dissemination: types of
Sec 1401. -- Comparative Effectiveness Research.
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(5) DISTRIBUTOR OF A COVERED DRUG, DEVICE, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (5)
Automated Concept:

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. ...
(8) MANUFACTURER OF A COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (8)
Automated Concept:

DISTRIBUTION of covered drug, device, biological or medical supply ;   Conversion, processing, marketing or

Index of Sec 1451. ...

Distribution of grants
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (a)
Automated Concept:

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: appropriate amount and
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (a) (1) (A)
Automated Concept:

DISTRIBUTION of Medicare dss to compensate for higher Medicare costs associated with serving low-income beneficiaries ;   Appropriate amount and

Index of Sec 1112. ...
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (a) (1) (B)
Automated Concept:

DISTRIBUTION of Medicare dss to hospitals given continued uncompensated care costs ;   Appropriate amount and

Index of Sec 1112. ...

Distribution: profit
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) INCLUSIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (B)
Automated Concept:

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. ...

Dividend
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) INCLUSIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (B)
Automated Concept:

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. ...

Doctoral degree
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (2) - paragraph (A)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (2) (A)
Automated Concept:

CERTIFICATION as marriage and family therapist pursuant to State law ;   Possessing master or doctoral degree qualifying for licensure or

Index of Sec 1308. ...

Documentation
Sec 1638. -- Requirement For Physicians To Provide Documentation On Referrals To Programs At High Risk Of Waste And Abuse.
SEC 1638. -- REQUIREMENT FOR PHYSICIANS TO PROVIDE DOCUMENTATION ON REFERRALS TO PROGRAMS AT HIGH RISK OF WASTE AND ABUSE.
DIVISION B TITLE VI SUBTITLE C SEC 1638.
Automated Concept:

DOCUMENTATION on Referrals to Programs at high Risk of wasting and abusing ;   Sec 1638, requirement for Physicians to provide

Index of Sec 1638. ...
(a) PHYSICIANS AND OTHER SUPPLIERS. - paragraph (10)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (a) Quoted: (10)
Automated Concept:

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. ...
(b) PROVIDERS OF SERVICES. - paragraph (3) - paragraph (X)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (b) (3) Quoted: (X)
Automated Concept:

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: additional
Sec 1203. -- Eliminating Barriers To Enrollment.
(iii) CERTIFICATION OF INCOME AND RESOURCES. - paragraph (II)
DIVISION B TITLE II SUBTITLE A SEC 1203. (a) (1) Quoted: (iii) (II)
Automated Concept:

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
Sec 1181. -- Elimination Of Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (1)
Automated Concept:

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. ...
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (1)
Automated Concept:

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. ...
(4) ADDITIONAL TERMS. - paragraph (A)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (4) (A)
Automated Concept:

DRUG ;   Sponsor or plan providing discount to enrollee at time enrollee paying for

Index of Sec 1182. ...
(i) - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A) (i) (I)
Automated Concept:

DRUG application approved by Food and drugging Administration ;   Drug produced or distributed under original new

Index of Sec 1182. ...
(i) - paragraph (II)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A) (i) (II)
Automated Concept:

DRUG application approved by Food and drugging Administration ;   Drug originally marketed under original new

Index of Sec 1182. ...
Sec 1185. -- Permitting Mid-Year Changes In Enrollment For Formulary Changes That Adversely Impact An Enrollee.
(ii) EXCEPTION.
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (ii)
Automated Concept:

DRUG being therapeutic equivalent or utilization management applied ;   Drug replaced with generic

Index of Sec 1185. ...
(ii) EXCEPTION. - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (ii) (I)
Automated Concept:

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. ...
(ii) EXCEPTION. - paragraph (II)
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (ii) (II)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (E)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(3) COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.
Sec 1741. -- Payments To Pharmacists.
(2) DEFINITION OF AMP. - paragraph (C) - paragraph (v)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (2) (C) Quoted: (v)
Automated Concept:

DRUG ;   Price concessions in order to obtain accurate amp for

Index of Sec 1741. ...
Sec 1742. -- Prescription Drug Rebates.
(C) TREATMENT OF NEW FORMULATIONS.
DIVISION B TITLE VII SUBTITLE E SEC 1742. (a) (1) Quoted: (C)
Automated Concept:

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
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) CLINICAL INVESTIGATION.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (2)
Automated Concept:

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: new
Sec 1742. -- Prescription Drug Rebates.
(C) TREATMENT OF NEW FORMULATIONS.
DIVISION B TITLE VII SUBTITLE E SEC 1742. (a) (1) Quoted: (C)
Automated Concept:

DRUG or product ;   Rebate obligation with respect to drug under section to be amount computed under section for new

Index of Sec 1742. ...

Drug: coverage of
Sec 1185. -- Permitting Mid-Year Changes In Enrollment For Formulary Changes That Adversely Impact An Enrollee.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (i)
Automated Concept:

DRUG under plan ;   Formulary of plan materially changed so to reduce coverage of

Index of Sec 1185. ...

Drug: covered
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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. ...
(e) ANNUAL REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (e) (1)
Automated Concept:

DRUG ;   Information submitted under section during preceding year aggregated for applicable manufacturer or distributor of covered

Index of Sec 1451. ...
(1) APPLICABLE MANUFACTURER; APPLICABLE DISTRIBUTOR.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (1)
Automated Concept:

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. ...
(5) DISTRIBUTOR OF A COVERED DRUG, DEVICE, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (5)
Automated Concept:

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. ...
(8) MANUFACTURER OF A COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (8)
Automated Concept:

DRUG, device, biological or medical supply ;   Conversion, processing, marketing or distribution of covered

Index of Sec 1451. ...
(C) EXCLUSIONS. - paragraph (vii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (vii)
Automated Concept:

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: covered outpatient
Sec 1741. -- Payments To Pharmacists.
(3) MANUFACTURER REPORTING REQUIREMENTS. - paragraph (A) - paragraph (iv)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (3) (A) Quoted: (iv)
Automated Concept:

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: covered part D
Sec 1181. -- Elimination Of Coverage Gap.
(2) REBATE AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (2)
Automated Concept:

DRUG of manufacturer dispensed after December 31, 2010 ;   Amount specified in paragraph for covered part D

Index of Sec 1181. ...
(B) MEDICAID REBATE AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (B)
Automated Concept:

DRUG provided by manufacturer for rebate period ;   Respect to dosage form and strength of covered part D

Index of Sec 1181. ...
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C)
Automated Concept:

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: generic
Sec 1185. -- Permitting Mid-Year Changes In Enrollment For Formulary Changes That Adversely Impact An Enrollee.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (i)
Automated Concept:

DRUG when so enrolled ;   Case of individual enrolled in prescription drug plan prescribed and using covered part D

Index of Sec 1185. ...
(ii) EXCEPTION.
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (ii)
Automated Concept:

DRUG being therapeutic equivalent or utilization management applied ;   Drug replaced with generic

Index of Sec 1185. ...

Drug: injectable
Sec 1741. -- Payments To Pharmacists.
(2) DEFINITION OF AMP. - paragraph (C) - paragraph (v)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (2) (C) Quoted: (v)
Automated Concept:

ADMINISTRATIVE procedures ;   Infusion or injectable drug or Secretary determining as allowed in Agency

Index of Sec 1741. ...

Drug: new
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(4) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO PRODUCT DEVELOPMENT AGREEMENTS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (4)
Automated Concept:

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. ...
(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (5)
Automated Concept:

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: number of units of dosage and strength of
Sec 1181. -- Elimination Of Coverage Gap.
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (i) - paragraph (II)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (i) (II)
Automated Concept:

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: outpatient
Sec 1181. -- Elimination Of Coverage Gap.
(B) MEDICAID REBATE AMOUNT. - paragraph (ii)

Drug: part D
Sec 1181. -- Elimination Of Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (1)
Automated Concept:

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: qualifying
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (1)
Automated Concept:

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. ...
(C) DRUG-COMPONENT NEGOTIATED PRICE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (C)
Automated Concept:

DRUG ;   Term drug-component negotiated price means with respect to qualifying

Index of Sec 1182. ...

Drug: recall or withdrawal of
Sec 1185. -- Permitting Mid-Year Changes In Enrollment For Formulary Changes That Adversely Impact An Enrollee.
(ii) EXCEPTION.
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (ii)
Automated Concept:

DRUG issued by Food and drugging Administration ;   Drug removed from formulary of plan because of recall or withdrawal of

Index of Sec 1185. ...

Drug: strength of
Sec 1181. -- Elimination Of Coverage Gap.
(B) REPORT FORM AND CONTENTS. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (i)
Automated Concept:

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: total number of units of dosage and strength of
Sec 1181. -- Elimination Of Coverage Gap.
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (ii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (ii)
Automated Concept:

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: total number of units of dosage form and strengt
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (A) (i)
Automated Concept:

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
Drug application: new
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(i) - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A) (i) (I)
Automated Concept:

DRUG application ;   Including drug product marketed by cross-licensed producers or distributors operating under new

Index of Sec 1182. ...

Drug application: original new
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(i) - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A) (i) (I)
Automated Concept:

DRUG application approved by Food and drugging Administration ;   Drug produced or distributed under original new

Index of Sec 1182. ...
(i) - paragraph (II)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A) (i) (II)
Automated Concept:

DRUG application approved by Food and drugging Administration ;   Drug originally marketed under original new

Index of Sec 1182. ...

Drug costs
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(1) COVERED DRUG COSTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (1)
Automated Concept:

DRUG costs meaning amount ;   Term covered

Index of Sec 1204. ...

Drug costs: covered
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(2) ELIGIBLE THIRD PARTY.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (2)
Automated Concept:

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: prescription
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(D) ACTUAL GAP IN COVERAGE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (D)
Automated Concept:

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. ...
(E) ORIGINAL GAP IN COVERAGE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (E)
Automated Concept:

DRUG coverage occurring between initial coverage limit ;   Term original in gap coverage meaning gap in prescription

Index of Sec 1182. ...

Drug means
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(A) QUALIFYING DRUG.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A)
Automated Concept:

DRUG means with respect to prescription drug plan or Ma-pd plan ;   Term qualifying

Index of Sec 1182. ...

Drug plan
Drug plan: prescription
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(A) QUALIFYING DRUG.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A)
Automated Concept:

DRUG plan or Ma-pd plan ;   Term qualifying drug means with respect to prescription

Index of Sec 1182. ...
(B) QUALIFYING ENROLLEE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (B)
Automated Concept:

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. ...
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(1) LINE-ITEM DESCRIPTION.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (1)
Automated Concept:

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. ...
(2) TIMING OF REIMBURSEMENTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (2)
Automated Concept:

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: case of PDP sponsor of prescription
Sec 1205. -- Intelligent Assignment In Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1205. (a)
Automated Concept:

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: dual eligible Medicare
Sec 1181. -- Elimination Of Coverage Gap.
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (i) - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (i) (I)
Automated Concept:

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. ...
(B) REPORT FORM AND CONTENTS. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (i)
Automated Concept:

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. ...
(B) REPORT FORM AND CONTENTS. - paragraph (iii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (iii)
Automated Concept:

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: overall quality of prescription
Sec 1205. -- Intelligent Assignment In Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1205. (a)
Automated Concept:

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: prescription
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (A)
Automated Concept:

DRUG plan requiring that sponsor complying with subparagraphs ;   Contract entered with PDP sponsor under part with respect to prescription

Index of Sec 1181. ...
(B) REPORT FORM AND CONTENTS. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (i)
Automated Concept:

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. ...
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(4) ADDITIONAL TERMS.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (4)
Automated Concept:

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. ...
Sec 1185. -- Permitting Mid-Year Changes In Enrollment For Formulary Changes That Adversely Impact An Enrollee.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (i)
Automated Concept:

DRUG plan prescribed and using covered part D drug when so enrolled ;   Case of individual enrolled in prescription

Index of Sec 1185. ...

Drug plan: Secretary and sponsor of prescription
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (A) (i)
Automated Concept:

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. ...
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (i)
Automated Concept:

CONTRACT ;   Prescription drug plan offered by sponsor of plan awarding

Index of Sec 1204. ...
(ii) RFP CONTRACT DESCRIBED.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (ii)
Automated Concept:

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 plan: prescription
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(B) DISCOUNT AGREEMENT. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (2) (B) (i)
Automated Concept:

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 plan: prescription
Sec 1174. -- Strengthening Audit Authority.
(2) APPLICATION UNDER PART D.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1174. (b) (2)
Automated Concept:

DRUG plans under part D ;   Provision applying amendment making by paragraph to prescription

Index of Sec 1174. ...
Sec 1181. -- Elimination Of Coverage Gap.
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (i) - paragraph (II)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (i) (II)
Automated Concept:

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. ...
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (ii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (ii)
Automated Concept:

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: prescription
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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 product
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(i) - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (A) (i) (I)
Automated Concept:

DRUG application ;   Including drug product marketed by cross-licensed producers or distributors operating under new

Index of Sec 1182. ...

Drug program
Drug program: average Medicare
Sec 1181. -- Elimination Of Coverage Gap.
(B) REPORT FORM AND CONTENTS. - paragraph (iv)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (iv)
Automated Concept:

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: Medicare prescription
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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: term average Medicare
Sec 1181. -- Elimination Of Coverage Gap.
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C)
Automated Concept:

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: low-income prescription
Sec 1801. -- 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.
(C) RESTRICTION ON INDIVIDUALS FOR WHOM DISCLOSURE MAY BE REQUESTED. - paragraph (i)
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (C) (i)
Automated Concept:

DRUG subsidy under section 1860d-14 of Social Security Act and not applying for subsidy ;   Eligible for low-income prescription

Index of Sec 1801. ...
(D) RESTRICTION ON USE OF DISCLOSED INFORMATION.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (D)
Automated Concept:

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
Drug-component: 50 percent of amount of
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(3) DISCOUNT AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (3)
Automated Concept:

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: term
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(C) DRUG-COMPONENT NEGOTIATED PRICE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (C)
Automated Concept:

DRUG-component negotiated price means with respect to qualifying drug ;   Term

Index of Sec 1182. ...

Durable medical equipment
Sec 1148. -- Durable Medical Equipment Program Improvements.
(a) WAIVER OF SURETY BOND REQUIREMENT.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (a)
Automated Concept:

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. ...
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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. ...
Sec 1633. -- Required Inclusion Of Payment Modifier For Certain Evaluation And Management Services.
(p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.
DIVISION B TITLE VI SUBTITLE C SEC 1633. Quoted: (p)
Automated Concept:

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. ...
Sec 1638. -- Requirement For Physicians To Provide Documentation On Referrals To Programs At High Risk Of Waste And Abuse.
(a) PHYSICIANS AND OTHER SUPPLIERS. - paragraph (10)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (a) Quoted: (10)
Automated Concept:

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. ...
(b) PROVIDERS OF SERVICES. - paragraph (3) - paragraph (X)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (b) (3) Quoted: (X)
Automated Concept:

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. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
SEC 1639. -- FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639.
Automated Concept:

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: established
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (E) - paragraph (8)

Economic self-sufficiency
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (3)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (3)
Automated Concept:

ECONOMIC self-sufficiency, employment advancement, school-readiness and educational achievement or reducing dependence on public assistance ;   Increasing

Index of Sec 1713. ...

Economy: annual
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(a) INPATIENT ACUTE HOSPITALS. - paragraph (1) - paragraph (B) - paragraph (II)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (a) (1) (B) Quoted: (II)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (v) - paragraph (VII)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (v) (VII)
Automated Concept:

EDUCATION of children ;   Activities designed to help parents becoming full partners in

Index of Sec 1904. ...
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(2) ESTABLISHMENT OF CORE ELEMENTS.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (2)
Automated Concept:

EDUCATION pertaining to fraud, waste and abuse for organization's employees and contractors ;   Effective training and

Index of Sec 1635. ...

Education: medical
Sec 1744. -- Payments For Graduate Medical Education.
(2) SUBMISSION OF INFORMATION. - paragraph (A)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (2) (A)
Automated Concept:

EDUCATION and payments used for graduate medical education ;   Information on total payments for graduate medical

Index of Sec 1744. ...

Education: continuous involvement and
Sec 1722. -- Medical Home Pilot Program.
(d) MEDICALLY FRAGILE CHILDREN.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (d)
Automated Concept:

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. ...

Education: medical
Sec 1161. -- Phase-In Of Payment Based On Fee-For-Service Costs.
(2) SPECIFIED AMOUNT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1161. (2) Quoted: (n) (2)
Automated Concept:

CAPITATION rates described in subsection ;   Indirect costs of medical education from

Index of Sec 1161. ...
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(4) APPLICATION.
DIVISION B TITLE V SEC 1503. (c) (4)
Automated Concept:

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. ...
Sec 1744. -- Payments For Graduate Medical Education.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (1)
Automated Concept:

EDUCATION consistent with subsection whether provided or outside of hospital ;   Term medical assistance including payment for costs of graduate medical

Index of Sec 1744. ...
(2) SUBMISSION OF INFORMATION. - paragraph (A)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (2) (A)
Automated Concept:

EDUCATION ;   Information on total payments for graduate medical education and payments used for graduate medical

Index of Sec 1744. ...
(b) CONFORMING AMENDMENT. - paragraph (3) - paragraph (v)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (b) (3) Quoted: (v)
Automated Concept:

EDUCATION ;   Rates including payment for graduate medical

Index of Sec 1744. ...
(c) EFFECTIVE DATE.
DIVISION B TITLE VII SUBTITLE E SEC 1744. (c)
Automated Concept:

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: ongoing
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(d) ASSURANCES. - paragraph (1)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (1)
Automated Concept:

EDUCATION and training in linguistically appropriate service delivery ;   Ensuring that appropriate clinical and support staff receiving ongoing

Index of Sec 1222. ...

Education costs: medical
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(4) APPLICATION.
DIVISION B TITLE V SEC 1503. (c) (4)
Automated Concept:

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
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (3)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (3)
Automated Concept:

EDUCATIONAL achievement or reducing dependence on public assistance ;   Increasing economic self-sufficiency, employment advancement, school-readiness and

Index of Sec 1713. ...

Educational tool
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(2) PATIENT DECISION AID.
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (2)
Automated Concept:

EDUCATIONAL tool helping patients if appropriate ;   Term patient decision aid meaning

Index of Sec 1236. ...

Electronic versions of Medicare
Sec 1233. -- Advance Care Planning Consultation.
(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS.
DIVISION B TITLE II SUBTITLE C SEC 1233. (c) (1) (B)
Automated Concept:

ELECTRONIC versions of Medicare ;   Secretary including information described in subparagraph in paper and

Index of Sec 1233. ...

Eligibility
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(c) RESPONSIBILITIES. - paragraph (6)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (c) (6)
Automated Concept:

ELIGIBILITY, benefit and cost-sharing assistance available to dual eligibles by State ;   Collection of data and database describing

Index of Sec 1905. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
SEC 1639. -- FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639.
Automated Concept:

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. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(A) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (2) (A)
Automated Concept:

ELIGIBILITY of individual after first day under following ;   State applying asset or resource test in determining

Index of Sec 1703. ...
Sec 1714. -- State Eligibility Option For Family Planning Services.
(hh) - paragraph (3)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (2) Quoted: (hh) (3)
Automated Concept:

ELIGIBILITY for services under subsection ;   Option of State, purposes of subsection, determining

Index of Sec 1714. ...

Eligibility: Commissioner of
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(A) NON-TRADITIONAL INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (A)
Automated Concept:

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: determination of
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(ii) PRESUMPTIVE ELIGIBILITY OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (ii)
Automated Concept:

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: determinations of
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (3)
Automated Concept:

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. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(b) EFFECTIVE DATE.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (b)
Automated Concept:

ELIGIBILITY making after January 1 ;   Amendment making by subsection applying to determinations of

Index of Sec 1733. ...

Eligibility: notice of
Sec 1234. -- Part B Special Enrollment Period And Waiver Of Limited Enrollment Penalty For Tricare Beneficiaries.
(l) - paragraph (4)
DIVISION B TITLE II SUBTITLE C SEC 1234. (a) (1) Quoted: (l) (4)
Automated Concept:

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. ...

Eligibility: redeterminations of
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(A) NON-TRADITIONAL INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (A)
Automated Concept:

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. ...
(i) REGULAR ENROLLMENT OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (i)
Automated Concept:

ELIGIBILITY of individual consistent with sectioning and memorandum ;   Redeterminations of

Index of Sec 1702. ...

Eligibility determination
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(b) CONFORMING AMENDMENTS TO ERROR RATE. - paragraph (1) - paragraph (vi)
DIVISION B TITLE VII SUBTITLE A SEC 1702. (b) (1) Quoted: (vi)
Automated Concept:

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: presumptive
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(ii) PRESUMPTIVE ELIGIBILITY OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (ii)
Automated Concept:

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: continuous
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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 period: presumptive
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(ii) PRESUMPTIVE ELIGIBILITY OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (ii)
Automated Concept:

ELIGIBILITY in same manner ;   State providing for making medical assistance available during presumptive eligibility period and promptly making determination of

Index of Sec 1702. ...
Sec 1714. -- State Eligibility Option For Family Planning Services.
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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. ...
(2) CONFORMING AMENDMENTS. - paragraph (A)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (2) (A)
Automated Concept:

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. ...
(2) CONFORMING AMENDMENTS. - paragraph (B) - paragraph (ii)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (2) (B) (ii)
Automated Concept:

ELIGIBILITY period under section ;   Medical assistance provided to individual described in subsection of section 1920c during presumptive

Index of Sec 1714. ...

Eligibility standards
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (1)
Automated Concept:

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. ...
(1) MAINTENANCE OF EFFORT.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (1)
Automated Concept:

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. ...

Eligibility standards: effect
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (1)
Automated Concept:

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. ...

Employee
Sec 1401. -- Comparative Effectiveness Research.
(i) DISCLOSURE OF FINANCIAL INTEREST.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (i)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(10) PHYSICIAN.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (10)
Automated Concept:

INFORMATION under subsection ;   Term not including physician being employee of applicable manufacturer required to submit

Index of Sec 1451. ...

Employees
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (V)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (I)
Automated Concept:

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. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (V)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (V)
Automated Concept:

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. ...
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (vii) - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (vii) (III)
Automated Concept:

CIVIL monetary penalties levied against facility, employees, contractors and other agents ;   Number of

Index of Sec 1413. ...
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C)
Automated Concept:

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. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C)
Automated Concept:

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. ...
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(2) ESTABLISHMENT OF CORE ELEMENTS.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (2)
Automated Concept:

EDUCATION pertaining to fraud, waste and abuse for organization's employees and contractors ;   Effective training and

Index of Sec 1635. ...
Sec 1641. -- Required Repayments Of Medicare And Medicaid Overpayments.
(3) CLARIFICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (3)
Automated Concept:

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. ...
Sec 1801. -- 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.
(D) RESTRICTION ON USE OF DISCLOSED INFORMATION.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (D)
Automated Concept:

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. ...

Employee turnover and tenure and hours of care
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C) (iv)
Automated Concept:

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. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C) (iv)
Automated Concept:

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. ...

Employers
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(3) CHIP MOE TERMINATION DATE. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (3) (B)
Automated Concept:

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. ...

Employment: aspect of
Sec 1415. -- Standardized Complaint Form.
(i) PROHIBITION AGAINST RETALIATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (i)
Automated Concept:

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. ...
(i) PROHIBITION AGAINST RETALIATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (i)
Automated Concept:

DISCHARGE ;   No person working at nursing facility to be penalized, discriminated or retaliated with respect to aspect of employment including

Index of Sec 1415. ...

Employment advancement, school-readiness
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (3)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (3)
Automated Concept:

EDUCATIONAL achievement or reducing dependence on public assistance ;   Increasing economic self-sufficiency, employment advancement, school-readiness and

Index of Sec 1713. ...

Endorsement
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(B) EXPANSION OF APPLICABLE CONDITIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (B)
Automated Concept:

ENDORSEMENT described in subparagraph but applying measures without ;   Secretary seeking

Index of Sec 1151. ...

Endorsement of measures
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (2) (A)
Automated Concept:

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: angiograms and
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(F) PROCEDURE ROOMS.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (F)
Automated Concept:

ENDOSCOPIES furnished ;   Term procedure rooms including rooms in which catheterizations, angiographies, angiograms and

Index of Sec 1156. ...

English proficiency: limited
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
SEC 1222. -- DEMONSTRATION TO PROMOTE ACCESS FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH PROFICIENCY BY PROVIDING REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1222.
Automated Concept:

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: month of notification of
Sec 1234. -- Part B Special Enrollment Period And Waiver Of Limited Enrollment Penalty For Tricare Beneficiaries.
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1234. (b) (2) (B) (i)
Automated Concept:

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: law or
Sec 1415. -- Standardized Complaint Form.
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iii)
Automated Concept:

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. ...
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iii)
Automated Concept:

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: full-time
Sec 1502. -- Increasing Training In Nonprovider Settings.
(a) DIRECT GME. - paragraph (3) - paragraph (A) - paragraph (II)
DIVISION B TITLE V SEC 1502. (a) (3) (A) Quoted: (II)
Automated Concept:

EQUIVALENCY ;   Time so spent by resident to be counted towards determination of full-time

Index of Sec 1502. ...
(b) IME. - paragraph (2) - paragraph (II)
DIVISION B TITLE V SEC 1502. (b) (2) Quoted: (II)
Automated Concept:

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. ...
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(a) DIRECT GME. - paragraph (2) - paragraph (I)
DIVISION B TITLE V SEC 1503. (a) (2) Quoted: (I)
Automated Concept:

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. ...
(xi) - paragraph (II)
DIVISION B TITLE V SEC 1503. (b) Quoted: (xi) (II)
Automated Concept:

EQUIVALENCY if hospital ;   Occuring in hospital to be counted toward determination of full-time

Index of Sec 1503. ...

Ethics program
Ethics program: compliance and
Sec 1412. -- Accountability Requirements.
(i) REQUIREMENT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (i)
Automated Concept:

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. ...
(i) REQUIREMENT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (i)
Automated Concept:

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. ...

Ethics program: effective compliance and
Sec 1412. -- Accountability Requirements.
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (ii) (I)
Automated Concept:

COMPLIANCE and ethics program for operating organizations including model compliance program ;   Promulgating regulations for effective

Index of Sec 1412. ...
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (ii) (I)
Automated Concept:

COMPLIANCE and ethics program for operating organizations including model compliance program ;   Developing regulations for effective

Index of Sec 1412. ...

Ethics program: evaluation of compliance and
Sec 1412. -- Accountability Requirements.
(III) EVALUATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (ii) (III)
Automated Concept:

COMPLIANCE and ethics programs required to be established under subparagraph ;   Secretary completeing evaluation of

Index of Sec 1412. ...
(III) EVALUATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (ii) (III)
Automated Concept:

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
Sec 1731. -- Optional Medicaid Coverage Of Low-Income Hiv-Infected Individuals.
(d) EXEMPTION FROM FUNDING LIMITATION FOR TERRITORIES.
DIVISION B TITLE VII SUBTITLE D SEC 1731. (d)
Automated Concept:

EXEMPTION from funding limitation for territories  ;  

Index of Sec 1731. ...

Expenditure
Sec 1158. -- Revision Of Medicare Payment Systems To Address Geographic Inequities.
(c) FUNDING.
DIVISION B TITLE I SUBTITLE C SEC 1158. (c)
Automated Concept:

EXPENDITURE for services furnished in one payment year ;   No more than one-half of amounts to be available for

Index of Sec 1158. ...

Expenditure: eligible
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (C)
Automated Concept:

EXPENDITURE with respect to which State submitting claim for payment under other provision of Federal law ;   Not including

Index of Sec 1904. ...
(g) NO USE OF OTHER FEDERAL FUNDS FOR STATE MATCH.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (g)
Automated Concept:

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: own
Sec 1121. -- Sustainable Growth Rate Reform.
(e) APPLICATION TO ACCOUNTABLE CARE ORGANIZATION PILOT PROGRAM. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (e) (1)
Automated Concept:

EXPENDITURE targeting and updating for practitioners that consistent with methodologies described in subsection ;   Allowing organization to have own

Index of Sec 1121. ...

Expenditures
Sec 1121. -- Sustainable Growth Rate Reform.
(II) INCREASE BY GROWTH RATE TO OBTAIN 2010 ALLOWED EXPENDITURES FOR SERVICE CATEGORY.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (d) (3) (B) Quoted: (11) (B) (i) (II)
Automated Concept:

EXPENDITURES for Service category ;   Increase by growth Rate to obtain 2010 allowed

Index of Sec 1121. ...
Sec 1147. -- Payment For Imaging Services.
(D) ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1147. (b) Quoted: (D)
Automated Concept:

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. ...
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (a) (3) Quoted: (7) (A)
Automated Concept:

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. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (A)
Automated Concept:

EXPENDITURES for items and services covered under parts A and B ;   Resulting from normal variation in

Index of Sec 1301. ...
(iii) ADJUSTMENT FACTOR.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (B) (iii)
Automated Concept:

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. ...
(1) REPORTS TO CONGRESS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (g) (1)
Automated Concept:

EXPENDITURES, access and quality under title ;   Report addressing impact of use of authorities on

Index of Sec 1301. ...
Sec 1414. -- Reporting Of Expenditures.
SEC 1414. -- REPORTING OF EXPENDITURES.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414.
Automated Concept:

EXPENDITURES ;   Sec 1414 reporting of

Index of Sec 1414. ...
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (1)
Automated Concept:

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. ...
(3) CATEGORIZATION BY FUNCTIONAL ACCOUNTS.
(4) AVAILABILITY OF INFORMATION SUBMITTED.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (4)
Automated Concept:

EXPENDITURES submitted under subsection readily available to interested parties upon request ;   Secretary establishing procedures to make information on

Index of Sec 1414. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(2) LIMITATION.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (2)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(2) EFFECTIVE DATE.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (d) (2)
Automated Concept:

EXPENDITURES making after July 1 ;   Amendment making by subsection to be applying to

Index of Sec 1704. ...
Sec 1731. -- Optional Medicaid Coverage Of Low-Income Hiv-Infected Individuals.
(e) EFFECTIVE DATE; SUNSET.
DIVISION B TITLE VII SUBTITLE D SEC 1731. (e)
Automated Concept:

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. ...
Sec 1744. -- Payments For Graduate Medical Education.
(2) SUBMISSION OF INFORMATION. - paragraph (B)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (2) (B)
Automated Concept:

EXPENDITURES being made consistent with goals and requirements as established under paragraph  ;  

Index of Sec 1744. ...

Expenditure: actual
Sec 1121. -- Sustainable Growth Rate Reform.
(I) TOTAL 2009 ACTUAL EXPENDITURES FOR ALL SERVICES INCLUDED IN SGR COMPUTATION FOR EACH SERVICE CATEGORY.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (d) (3) (B) Quoted: (11) (B) (i) (I)
Automated Concept:

EXPENDITURES for Services included in SGR compuations for Service category ;   Total 2009 actual

Index of Sec 1121. ...

Expenditure: additional Federal
Sec 1771. -- Puerto Rico And Territories.
(c) SPECIFICATION OF PERCENTAGES.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (c)
Automated Concept:

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. ...

Expenditure: aggregate
Sec 1301. -- Accountable Care Organization Pilot Program.
(ii) LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (C) (ii)
Automated Concept:

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. ...
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(d) MAINTENANCE OF EFFORT.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (d)
Automated Concept:

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. ...

Expenditure: allowed
Sec 1121. -- Sustainable Growth Rate Reform.
(II) INCREASE BY GROWTH RATE TO OBTAIN 2010 ALLOWED EXPENDITURES FOR SERVICE CATEGORY.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (d) (3) (B) Quoted: (11) (B) (i) (II)
Automated Concept:

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. ...

Expenditure: allowed and actual
Sec 1121. -- Sustainable Growth Rate Reform.
(ii) COMPUTATION OF ALLOWED AND ACTUAL EXPENDITURES BASED ON SERVICE CATEGORIES.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (d) (3) (B) Quoted: (11) (A) (ii)
Automated Concept:

EXPENDITURES based on Service categories ;   Compuations of allowed and actual

Index of Sec 1121. ...

Expenditure: annual attributable
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) AUTHORITY FOR SEPARATE INCENTIVE ARRANGEMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (1)
Automated Concept:

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. ...

Expenditure: eligible
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(A) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (2) (A)
Automated Concept:

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. ...

Expenditure: estimated
Sec 1111. -- Payments To Skilled Nursing Facilities.
(E) BUDGET NEUTRALITY.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (E)
Automated Concept:

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. ...

Expenditure: growth of
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (a)
Automated Concept:

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. ...

Expenditure: high
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) APPLICABLE CONDITION. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (A) (i)
Automated Concept:

EXPENDITURES under title ;   Readmissions representing conditions or procedures being high volume or high

Index of Sec 1151. ...

Expenditure: means
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A)
Automated Concept:

EXPENDITURES to provide voluntary home visitation as families with young children and families expecting children as practicable ;   Means

Index of Sec 1904. ...

Expenditure: total
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(b) TRANSFERS TO FUND. - paragraph (4) - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (b) (4) (B)
Automated Concept:

ACCOUNT ;   Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or

Index of Sec 1802. ...

Expenditure: total amount of
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (a) (3) Quoted: (7) (A)
Automated Concept:

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. ...

Expenditure: total of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(A) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (2) (A)
Automated Concept:

EXPENDITURES exceeding applicable percentage for fiscal year of allotment of State under subsection for fiscal year ;   Total of

Index of Sec 1904. ...

Expenditure amount: base
Sec 1301. -- Accountable Care Organization Pilot Program.
(iv) REBASING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (B) (iv)
Automated Concept:

EXPENDITURE amount described in clause ;   Model Secretary periodically rebasing base

Index of Sec 1301. ...

Expenditures and expansion of pilot program: program
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(c) LIMITATION. - paragraph (2)
DIVISION B TITLE I SUBTITLE C SEC 1152. (f) (1) Quoted: SEC 1866D. (c) (2)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) FOLLOWING APPLICABLE BENEFICIARIES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (d) (2)
Automated Concept:

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 State: aggregate
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(d) MAINTENANCE OF EFFORT.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (d)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (1) (B)
Automated Concept:

FEASABILITY and advisability of reimbursing medical homes for medical home services under title on permanent basis  ;  

Index of Sec 1302. ...

Feasibility
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (B)
Automated Concept:

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. ...
(2) ANALYSES. - paragraph (D)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (D)
Automated Concept:

RELATIVE value scale by using adjustments when patient being LEP ;   Feasibility of modifying existing Medicare resource-based

Index of Sec 1221. ...

Feasibility and advisability
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (1)
Automated Concept:

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. ...

Feasibility of Medicare
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (C)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (C)
Automated Concept:

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. ...

Feasibility: need and
Sec 1167. -- Improving Risk Adjustment For Payments.
(a) REPORT TO CONGRESS.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (a)
Automated Concept:

BENEFICIARY data ;   Need and feasibility of including further gradations of diseases or conditions and multiple years of

Index of Sec 1167. ...

Financial
Financial or cash management services
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (i)
Automated Concept:

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 or managerial control
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (i)
Automated Concept:

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: Federal
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(h) GENERAL PROVISIONS.
DIVISION B TITLE II SUBTITLE B SEC 1222. (h)
Automated Concept:

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
Sec 1191. -- Telehealth Expansion And Enhancements.
(C) CONFLICTS OF INTEREST.
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (1) (B) Quoted: (c) (2) (C)
Automated Concept:

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 interests
Sec 1401. -- Comparative Effectiveness Research.
(ii) PROHIBITIONS ON PARTICIPATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (ii)
Automated Concept:

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. ...
(D) FINANCIAL INTEREST DEFINED.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (D)
Automated Concept:

FINANCIAL interest under section 208(a) of title 18, United States coding ;   Term financial interest meaning

Index of Sec 1401. ...
(i) DISCLOSURE OF FINANCIAL INTEREST.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (i)
Automated Concept:

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
Financial participation: additional Federal
Sec 1722. -- Medical Home Pilot Program.
(f) FUNDING.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (f)
Automated Concept:

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: Federal
Sec 1721. -- Payments To Primary Care Practitioners.
(3) - paragraph (B)
DIVISION B TITLE VII SUBTITLE C SEC 1721. (b) Quoted: (3) (B)
Automated Concept:

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. ...
Sec 1741. -- Payments To Pharmacists.
(5) PHARMACY REIMBURSEMENTS THROUGH DECEMBER 31, 2010.
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (5)
Automated Concept:

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
Sec 1174. -- Strengthening Audit Authority.
(B) ENFORCEMENT AUTHORITY.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1174. (b) (1) Quoted: (5) (B)
Automated Concept:

FINANCIAL recoveries ;   Secretary authorized to take actions including pursuit of

Index of Sec 1174. ...

Financial relationships
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
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 WITH ENTITIES THAT BILL FOR SERVICES UNDER MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H.
Automated Concept:

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 Reports Physicians
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
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 WITH ENTITIES THAT BILL FOR SERVICES UNDER MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H.
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (2) (A)
Automated Concept:

FINANCIAL risk ;   Partial capitation model described in paragraph being model in which qualifying ACO at

Index of Sec 1301. ...

Financial services
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (iv)
Automated Concept:

FINANCIAL services to facility ;   Providing management or administrative services, clinical consulting services or accounting or

Index of Sec 1411. ...

Financing: loans or
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (ii)
Automated Concept:

FINANCING for physician owner or investor in hospital ;   Hospital not directly or indirectly providing loans or

Index of Sec 1156. ...

Fiscal year
Sec 1101. -- Skilled Nursing Facility Payment Update.
(a) IN GENERAL. - paragraph (3) - paragraph (IV)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1101. (a) (3) Quoted: (IV)
Automated Concept:

FISCAL year involved ;   Rate computed for previous fiscal year increased by skilled nursing facility market basket percentage change for

Index of Sec 1101. ...
Sec 1111. -- Payments To Skilled Nursing Facilities.
(ii) APPLICATION.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (A) (ii)
Automated Concept:

FISCAL year 2011 ;   Future skilled nursing facility classifiations system implemented to apply to services furnished during fiscal year beginning with

Index of Sec 1111. ...
(C) RULEMAKING.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (C)
Automated Concept:

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. ...
(E) BUDGET NEUTRALITY.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (E)
Automated Concept:

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. ...
(C) BUDGET NEUTRALITY.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (c) Quoted: (13) (C)
Automated Concept:

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. ...
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(B) STRUCTURE OF PAYMENT INCREASE. - paragraph (i)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (3) (B) (i)
Automated Concept:

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. ...
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(1) FUNDING.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (b) (1)
Automated Concept:

FISCAL year to be available until expended ;   Amounts appropriated under paragraph for

Index of Sec 1122. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (1)
Automated Concept:

FISCAL year beginning after October 1 ;   Respect to payment for discharges from applicable hospital occurring during

Index of Sec 1151. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (3) (A) (i)
Automated Concept:

FISCAL year ;   Ratio described in subparagraph for hospital for applicable period for

Index of Sec 1151. ...
(A) AGGREGATE PAYMENTS FOR EXCESS READMISSIONS. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (A) (i)
Automated Concept:

FISCAL year for condition ;   Base operating DRG payment amount for hospital for

Index of Sec 1151. ...
(B) AGGREGATE PAYMENTS FOR ALL DISCHARGES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (B)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (A)
Automated Concept:

FISCAL year ;   2011 Secretary making payment adjustment for hospital described in subparagraph, respect

Index of Sec 1151. ...
(i) AGGREGATE CAP.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (C) (i)
Automated Concept:

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. ...
(ii) HOSPITAL-SPECIFIC LIMIT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (C) (ii)
Automated Concept:

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. ...
(b) APPLICATION TO CRITICAL ACCESS HOSPITALS. - paragraph (2) - paragraph (5)
DIVISION B TITLE I SUBTITLE C SEC 1151. (b) (2) Quoted: (5)
Automated Concept:

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. ...
(e) FUNDING.
DIVISION B TITLE I SUBTITLE C SEC 1151. (e)
Automated Concept:

FISCAL year to be available until expended ;   Amounts appropriated under subsection for

Index of Sec 1151. ...
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(1) FUNDING.
DIVISION B TITLE I SUBTITLE C SEC 1152. (d) (1)
Automated Concept:

FISCAL year to be available until expended ;   Amounts appropriated under paragraph for

Index of Sec 1152. ...
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) FUNDING.
DIVISION B TITLE I SUBTITLE C SEC 1156. (c) (1)
Automated Concept:

FISCAL year to be available until expended ;   Amounts appropriated under paragraph for

Index of Sec 1156. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(6) FUNDING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (6)
Automated Concept:

FISCAL year to be available until expended ;   Amounts appropriated under paragraph for

Index of Sec 1301. ...
Sec 1302. -- Medical Home Pilot Program.
(1) OPERATIONAL COSTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (g) (1)
Automated Concept:

FISCAL year to be available until expended ;   Amounts appropriated under paragraph for

Index of Sec 1302. ...
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) INDIAN TRIBES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (1)
Automated Concept:

FISCAL year ;   Amount reserved under subsection for

Index of Sec 1904. ...
(2) STATES AND TERRITORIES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (2)
Automated Concept:

FISCAL year remaining after making reservations required by subsection ;   Amount appropriated under subsection for

Index of Sec 1904. ...
(d) MAINTENANCE OF EFFORT.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (d)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (e) (1)
Automated Concept:

FISCAL year For which funds appropriated under subsection  ;  

Index of Sec 1904. ...
(A) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (2) (A)
Automated Concept:

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. ...
(l) RESERVATIONS OF FUNDS.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (l)
Automated Concept:

FISCAL year under subsection ;   Amounts appropriated for

Index of Sec 1904. ...
Sec 1652. -- Elimination Of Duplication Between The Healthcare Integrity And Protection Data Bank And The National Practitioner Data Bank.
(e) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VI SUBTITLE D SEC 1652. (e) (2)
Automated Concept:

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. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(2) LIMITATION.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (2)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(A) FISCAL YEAR 2017. - paragraph (i)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (c) (1) (B) Quoted: (7) (A) (i)
Automated Concept:

FISCAL year decreased by $1,500,000,000 ;   Total dss allotments otherwise to be determined under subsection for

Index of Sec 1704. ...
(A) FISCAL YEAR 2017. - paragraph (ii)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (c) (1) (B) Quoted: (7) (A) (ii)
Automated Concept:

FISCAL year decreased by $2,500,000,000 ;   Total dss allotments otherwise to be determined under subsection for

Index of Sec 1704. ...
(A) FISCAL YEAR 2017. - paragraph (iii)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (c) (1) (B) Quoted: (7) (A) (iii)
Automated Concept:

FISCAL year decreased by $6,000,000,000 ;   Total dss allotments otherwise to be determined under subsection for

Index of Sec 1704. ...
Sec 1771. -- Puerto Rico And Territories.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (b) (1)
Automated Concept:

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. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(b) TRANSFERS TO FUND. - paragraph (4)
(b) TRANSFERS TO FUND. - paragraph (4) - paragraph (A)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (b) (4) (A)
Automated Concept:

FISCAL year ;   Amount equivalent to net revenues received in Treasury from fees imposed under subchapter B of chapter 34 for

Index of Sec 1802. ...
(b) TRANSFERS TO FUND. - paragraph (4) - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (b) (4) (B)
Automated Concept:

ACCOUNT ;   Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or

Index of Sec 1802. ...
(A) IN GENERAL.
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (c) (1) (A)
Automated Concept:

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. ...
(i) IN GENERAL.
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (c) (1) (B) (i)
Automated Concept:

FISCAL year to be default amount determined under clause for fiscal year ;   Fair share per capita amount under paragraph for

Index of Sec 1802. ...
(2) LIMITATION ON MEDICARE FUNDING.
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (c) (2)
Automated Concept:

FISCAL year exceeding $90,000,000 ;   No case amount transferred under subsection for

Index of Sec 1802. ...
(2) ALLOCATION FOR COMMISSION.
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (d) (2)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(A) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (2) (A)
Automated Concept:

FISCAL year of allotment of State under subsection for fiscal year ;   Total of expenditures exceeding applicable percentage for

Index of Sec 1904. ...

Fiscal year: subsequent
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(b) APPLICATION TO CRITICAL ACCESS HOSPITALS. - paragraph (2) - paragraph (5)
DIVISION B TITLE I SUBTITLE C SEC 1151. (b) (2) Quoted: (5)
Automated Concept:

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
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(C) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (C)
Automated Concept:

FISCAL year or rate year beginning after October 1 ;   Subparagraph applying to discharges or services furnished after first day of

Index of Sec 1151. ...

Fiscal year: preceding
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(d) MAINTENANCE OF EFFORT.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (d)
Automated Concept:

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. ...
Sec 1771. -- Puerto Rico And Territories.
(7) FISCAL YEAR 2020 AND SUBSEQUENT FISCAL YEARS.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (a) (1) (B) Quoted: (7)
Automated Concept:

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. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(ii) DEFAULT AMOUNT. - paragraph (II)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (c) (1) (B) (ii) (II)
Automated Concept:

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: previous
Sec 1101. -- Skilled Nursing Facility Payment Update.
(a) IN GENERAL. - paragraph (3) - paragraph (IV)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1101. (a) (3) Quoted: (IV)
Automated Concept:

FISCAL year increased by skilled nursing facility market basket percentage change for fiscal year involved ;   Rate computed for previous

Index of Sec 1101. ...
(a) IN GENERAL. - paragraph (3) - paragraph (V)

Fiscal year: respective
Sec 1704. -- Reduction In Medicaid Dsh.
(A) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (3) (A)
Automated Concept:

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: subsequent
Sec 1412. -- Accountability Requirements.
(3) PROPOSAL TO REVISE QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAMS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (3)
Automated Concept:

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. ...
Sec 1444. -- Application Of Quality Measures.
(x) - paragraph (I)
DIVISION B TITLE IV SUBTITLE C SEC 1444. (a) Quoted: (x) (I)
Automated Concept:

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: succeeding
Sec 1771. -- Puerto Rico And Territories.
(6) FISCAL YEARS 2011 THROUGH 2019.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (a) (1) (B) Quoted: (6)
Automated Concept:

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. ...
(7) FISCAL YEAR 2020 AND SUBSEQUENT FISCAL YEARS.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (a) (1) (B) Quoted: (7)
Automated Concept:

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 years
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(g) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (g)
Automated Concept:

FISCAL year 2010 ;   Applying to annual increases effected for fiscal years beginning with

Index of Sec 1103. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (A)
Automated Concept:

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: subsequent
Sec 1771. -- Puerto Rico And Territories.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (b) (1)
Automated Concept:

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
Sec 1445. -- Consensus-Based Entity Funding.
SEC 1445. -- CONSENSUS-BASED ENTITY FUNDING.
DIVISION B TITLE IV SUBTITLE C SEC 1445.
Automated Concept:

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
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(g) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (g)
Automated Concept:

FISCAL year 2010 ;   Applying to annual increases effected for fiscal years beginning with

Index of Sec 1103. ...
Sec 1111. -- Payments To Skilled Nursing Facilities.
(2) ADJUSTMENT IN RECALIBRATION FACTOR.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (a) (2)
Automated Concept:

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. ...
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) FUNDING.
DIVISION B TITLE I SUBTITLE C SEC 1156. (c) (1)
Automated Concept:

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. ...
Sec 1903. -- Extension Of Gainsharing Demonstration.
(1) IN GENERAL.
DIVISION B TITLE IX SEC 1903. (b) (1)
Automated Concept:

FISCAL year 2010, $1,600,000 ;   Subsection of section amended by inserting and

Index of Sec 1903. ...
Sec 1601. -- Increased Funding And Flexibility To Fight Fraud And Abuse.
(7) ADDITIONAL FUNDING.
DIVISION B TITLE VI SUBTITLE A SEC 1601. (a) (1) Quoted: (7)
Automated Concept:

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
Sec 1111. -- Payments To Skilled Nursing Facilities.
(ii) APPLICATION.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (A) (ii)
Automated Concept:

FISCAL year 2011 ;   Future skilled nursing facility classifiations system implemented to apply to services furnished during fiscal year beginning with

Index of Sec 1111. ...
(E) BUDGET NEUTRALITY.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (E)
Automated Concept:

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. ...
Sec 1146. -- Medicare Improvement Fund.
SEC 1146. -- MEDICARE IMPROVEMENT FUND. - paragraph (A)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1146. Quoted: (A)
Automated Concept:

FISCAL year 2011 and ending with fiscal year 2019 ;   Period beginning with

Index of Sec 1146. ...
Sec 1771. -- Puerto Rico And Territories.
(6) FISCAL YEARS 2011 THROUGH 2019.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (a) (1) (B) Quoted: (6)
Automated Concept:

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
Sec 1111. -- Payments To Skilled Nursing Facilities.
(C) RULEMAKING.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (C)
Automated Concept:

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
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(b) APPLICATION TO CRITICAL ACCESS HOSPITALS. - paragraph (2) - paragraph (5)
DIVISION B TITLE I SUBTITLE C SEC 1151. (b) (2) Quoted: (5)
Automated Concept:

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. ...
Sec 1444. -- Application Of Quality Measures.
(x) - paragraph (I)
DIVISION B TITLE IV SUBTITLE C SEC 1444. (a) Quoted: (x) (I)
Automated Concept:

FISCAL year 2012 and subsequent fiscal year ;   Purposes of reporting data on quality measures for inpatient hospital services furnished during

Index of Sec 1444. ...
(f) EFFECTIVE DATE.
DIVISION B TITLE IV SUBTITLE C SEC 1444. (f)
Automated Concept:

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
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(b) TRANSFERS TO FUND. - paragraph (4)

Fiscal year 2017
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (1)
Automated Concept:

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. ...
(B) PUBLICATAION DEADLINE. - paragraph (i)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (3) (B) (i)
Automated Concept:

FISCAL year 2017 ;   Respect to dss allotments described in subparagraph for

Index of Sec 1704. ...

Fiscal year 2018
Sec 1704. -- Reduction In Medicaid Dsh.
(B) PUBLICATAION DEADLINE. - paragraph (ii)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (3) (B) (ii)
Automated Concept:

FISCAL year 2018 ;   Respect to dss allotments described in subparagraph for

Index of Sec 1704. ...

Fiscal year 2018 and $6,000,000,000
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (1)
Automated Concept:

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
Sec 1146. -- Medicare Improvement Fund.
SEC 1146. -- MEDICARE IMPROVEMENT FUND. - paragraph (A)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1146. Quoted: (A)
Automated Concept:

FISCAL year 2019 ;   Period beginning with fiscal year 2011 and ending with

Index of Sec 1146. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (1)
Automated Concept:

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. ...
(B) PUBLICATAION DEADLINE. - paragraph (iii)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (b) (3) (B) (iii)
Automated Concept:

FISCAL year 2019 ;   Respect to dss allotments described in subparagraph for

Index of Sec 1704. ...

Fiscal year 2020
Sec 1771. -- Puerto Rico And Territories.
(6) FISCAL YEARS 2011 THROUGH 2019.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (a) (1) (B) Quoted: (6)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (b) (1)
Automated Concept:

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. ...
(7) FISCAL YEAR 2020 AND SUBSEQUENT FISCAL YEARS.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (a) (1) (B) Quoted: (7)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(g) FUNDING OF COMPARATIVE EFFECTIVENESS RESEARCH.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (g)
Automated Concept:

FISCAL year limitation to Secretary to carry out that section ;   Need for further appropriations and without

Index of Sec 1401. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(1) IN GENERAL.
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (d) (1)
Automated Concept:

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 years 2009
Sec 1445. -- Consensus-Based Entity Funding.
SEC 1445. -- CONSENSUS-BASED ENTITY FUNDING.
DIVISION B TITLE IV SUBTITLE C SEC 1445.
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(1) OPERATIONAL COSTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (g) (1)
Automated Concept:

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. ...
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (f) (1)
Automated Concept:

FISCAL years 2010 through 2014 ;   $25,000,000 to Secretary for purposes of carrying out that section for

Index of Sec 1442. ...
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (7) (A)
Automated Concept:

FISCAL years 2010 through 2014 ;   $1,000,000 to Secretary for purposes of carrying out that subsection for

Index of Sec 1443. ...
Sec 1445. -- Consensus-Based Entity Funding.
SEC 1445. -- CONSENSUS-BASED ENTITY FUNDING.
DIVISION B TITLE IV SUBTITLE C SEC 1445.
Automated Concept:

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
Sec 1771. -- Puerto Rico And Territories.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE G SEC 1771. (b) (1)
Automated Concept:

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
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(2) ESTABLISHMENT OF CORE ELEMENTS.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (2)
Automated Concept:

FRAUD, waste and abuse for organization's employees and contractors ;   Effective training and education pertaining to

Index of Sec 1635. ...
Sec 1641. -- Required Repayments Of Medicare And Medicaid Overpayments.
(3) CLARIFICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (3)
Automated Concept:

FRAUD by provider or supplier or employees or agents of provider or supplier ;   Reason for overpayment related to

Index of Sec 1641. ...
0
SUBTITLE D -- ACCESS TO INFORMATION NEEDED TO PREVENT FRAUD, WASTE, AND ABUSE.
DIVISION B TITLE VI SUBTITLE D
Automated Concept:

FRAUD, Waste and Abuse ;   Subtitle D across Access to information needed to prevent

Index of 0

Fraud and Abuse
Sec 1633. -- Required Inclusion Of Payment Modifier For Certain Evaluation And Management Services.
(p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.
DIVISION B TITLE VI SUBTITLE C SEC 1633. Quoted: (p)
Automated Concept:

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. ...
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(5) PILOT PROGRAM.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (5)
Automated Concept:

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. ...
Sec 1636. -- Maximum Period For Submission Of Medicare Claims Reduced To Not More Than 12 Months.
(a) PURPOSE.
DIVISION B TITLE VI SUBTITLE C SEC 1636. (a)
Automated Concept:

FRAUD and abuse ;   Narrowing window for claims processing not overburdening providers and reducing

Index of Sec 1636. ...
Sec 1714. -- State Eligibility Option For Family Planning Services.
(B) RULE OF CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (b) (2) (B)
Automated Concept:

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. ...
Sec 1758. -- Requirement To Report Expanded Set Of Data Elements Under Mmis To Detect Fraud And Abuse.
SEC 1758. -- REQUIREMENT TO REPORT EXPANDED SET OF DATA ELEMENTS UNDER MMIS TO DETECT FRAUD AND ABUSE.
DIVISION B TITLE VII SUBTITLE F SEC 1758.
Automated Concept:

FRAUD and Abuse ;   Sec 1758, requirement to Report expanded Set of data elements under MMIS to detect

Index of Sec 1758. ...

Fraud or abuse
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(c) APPLICATION TO OTHER AREAS UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (c)
Automated Concept:

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: risk of
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(2) ENHANCED SAFEGUARDS.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (2)
Automated Concept:

FRAUD, waste or abuse ;   Secretary determining that previous affiliation of provider or supplier posing risk of

Index of Sec 1632. ...

Fraud: serious risk of
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(3) AUTHORITY TO DENY PARTICIPATION.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (3)
Automated Concept:

FRAUD, waste or abuse ;   Affiliation and affiliation or affiliations of provider or supplier posing serious risk of

Index of Sec 1632. ...

Fraud schemes
Sec 1636. -- Maximum Period For Submission Of Medicare Claims Reduced To Not More Than 12 Months.
(a) PURPOSE.
DIVISION B TITLE VI SUBTITLE C SEC 1636. (a)
Automated Concept:

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
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL.
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1)
Automated Concept:

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: false or
Sec 1612. -- Enhanced Penalties For Submission Of False Statements Material To A False Claim.
(a) IN GENERAL. - paragraph (3) - paragraph (9)
DIVISION B TITLE VI SUBTITLE B SEC 1612. (a) (3) Quoted: (9)
Automated Concept:

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: following
Sec 1414. -- Reporting Of Expenditures.
(3) CATEGORIZATION BY FUNCTIONAL ACCOUNTS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (3)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (A) - paragraph (vi)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (1) (A) (vi)
Automated Concept:

FUNCTIONAL status where applicable ;   Improvement in health outcomes including patient

Index of Sec 1302. ...

General
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(D) ORGANIZATIONAL STRUCTURE. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (D) (iv)
Automated Concept:

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
Sec 1157. -- Institute Of Medicine Study Of Geographic Adjustment Factors Under Medicare.
(a) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1157. (a)
Automated Concept:

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. ...
Sec 1158. -- Revision Of Medicare Payment Systems To Address Geographic Inequities.
(a) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1158. (a)
Automated Concept:

GEOGRAPHIC adjustment factors for payment systems for services furnished under Medicare program ;   Proposals to revise

Index of Sec 1158. ...

Geographic adjustments
Sec 1123. -- Payments For Efficient Areas.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1123. Quoted: (x) (2) (A)
Automated Concept:

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. ...
Sec 1158. -- Revision Of Medicare Payment Systems To Address Geographic Inequities.
(c) FUNDING.
DIVISION B TITLE I SUBTITLE C SEC 1158. (c)
Automated Concept:

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: local
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (iii)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (A)
Automated Concept:

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: additional
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) SCOPE.
DIVISION B TITLE I SUBTITLE C SEC 1152. (f) (1) Quoted: SEC 1866D. (b)
Automated Concept:

GEOGRAPHIC areas and additional conditions ;   Pilot program under subsection including additional

Index of Sec 1152. ...

Geographic areas: different
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) DETAILS. - paragraph (4)
DIVISION B TITLE I SUBTITLE C SEC 1152. (b) (4)
Automated Concept:

GEOGRAPHIC areas ;   Rates to be established on national basis or different

Index of Sec 1152. ...

Geographic indices
Sec 1125. -- Adjustment To Medicare Payment Localities.
(ii) TRANSITION.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1125. (a) Quoted: (6) (A) (ii)
Automated Concept:

MALPRACTICE geographic indices described in clauses ;   Calculating work, practice expense and

Index of Sec 1125. ...

Geographic practice cost index
Sec 1125. -- Adjustment To Medicare Payment Localities.
(ii) LINK WITH GEOGRAPHIC INDEX DATA REVISION.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1125. (a) Quoted: (6) (B) (ii)
Automated Concept:

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
Sec 1191. -- Telehealth Expansion And Enhancements.
(ii) REQUIREMENTS FOR APPOINTING MEMBERS. - paragraph (III)
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (1) (B) Quoted: (c) (2) (A) (ii) (III)
Automated Concept:

GEOGRAPHIC regions ;   Ensuring that membership of Advisory Committee representing balance of specialties and

Index of Sec 1191. ...

Gift
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) INCLUSIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (B)
Automated Concept:

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: payment and
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a) (1)
Automated Concept:

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
Guidance: issue
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL. - paragraph (3)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a) (3)
Automated Concept:

GUIDANCE to States regarding improving coordination and protection ;   Issue

Index of Sec 1905. ...

Guidance: regulations or
Sec 1617. -- Enhanced Penalties For Medicare Advantage And Part D Marketing Violations.
(a) IN GENERAL. - paragraph (2) - paragraph (K)
DIVISION B TITLE VI SUBTITLE B SEC 1617. (a) (2) Quoted: (K)
Automated Concept:

GUIDANCE ;   Failing to comply with marketing restrictions described in subsections and section 1851 or applicable implementing regulations or

Index of Sec 1617. ...

Health
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(ii) EXEMPTIONS. - paragraph (II)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (4) (B) (ii) (II)
Automated Concept:

HEALTH of patient ;   Case of medical emergency where delay directly associated with obtaining competent interpreter or translation services jeopardizing

Index of Sec 1222. ...
Sec 1303. -- Payment Incentive For Selected Primary Care Services.
(b) CONFORMING AMENDMENTS. - paragraph (3)
DIVISION B TITLE III SEC 1303. (b) (3)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(4) COVERED RECIPIENT. - paragraph (E)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (4) (E)
Automated Concept:

HEALTH benefiting plan ;   Health insurance issuer, group health plan or other entity offering

Index of Sec 1451. ...
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (v) - paragraph (VI)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (v) (VI)
Automated Concept:

HEALTH, developmental delays and social ;   Skills to recognize and seek help for issues related to

Index of Sec 1904. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(iv) PRIORITY FOR CERTAIN HOSPITALS. - paragraph (V)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iv) (V)
Automated Concept:

HEALTH professional needs area ;   Place greater emphasis upon training in health professional shortage area or

Index of Sec 1501. ...
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(D) ENROLLMENT OF NON-TRADITIONAL MEDICAID ELIGIBLES.
DIVISION B TITLE VII SUBTITLE A SEC 1701. (d) Quoted: (D)
Automated Concept:

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
Sec 1224. -- Definitions.
(2) COMPETENT INTERPRETER SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (2)
Automated Concept:

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. ...
(3) COMPETENT TRANSLATION SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (3)
Automated Concept:

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
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a) (1)
Automated Concept:

HEALTH and safety of individuals program furnishing items and servicing ;   Deficiencies involved immediately jeopardizing

Index of Sec 1614. ...
(a) IN GENERAL. - paragraph (2)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a) (2)
Automated Concept:

HEALTH and safety of individuals program furnishing items and servicing ;   Deficiencies involved not immediately jeopardizing

Index of Sec 1614. ...
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (iii)
Automated Concept:

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: interest of
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) IN GENERAL.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a)
Automated Concept:

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. ...
(C) COMMENCEMENT OF PAYMENT.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (C)
Automated Concept:

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
Sec 1421. -- Civil Money Penalties.
(bb) CERTAIN OTHER DEFICIENCIES.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (V) (bb)
Automated Concept:

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. ...
(II) CERTAIN OTHER DEFICIENCIES.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (v) (II)
Automated Concept:

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: community
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (iii)
Automated Concept:

HEALTH workers including nurses or other non-physician practitioners ;   Organization employing community

Index of Sec 1302. ...

Health: measures of
Sec 1162. -- Quality Bonus Payments.
(ii) ESTABLISHMENT OF OUTCOME-BASED MEASURES. - paragraph (IV)
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (B) (ii) (IV)
Automated Concept:

CHRONIC diseases ;   Measures of health functioning and survival for patients with

Index of Sec 1162. ...

Health: other
Sec 1233. -- Advance Care Planning Consultation.
(F) - paragraph (iii) - paragraph (II)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (F) (iii) (II)
Automated Concept:

HEALTH professionals signing orders for life sustaining treatment ;   Orders to physicians and other

Index of Sec 1233. ...

Health: performance and improvement of population
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(2) QUALITY MEASURE.
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (d) (2)
Automated Concept:

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: primary care
Sec 1303. -- Payment Incentive For Selected Primary Care Services.
(1) IN GENERAL.
DIVISION B TITLE III SEC 1303. (a) Quoted: (p) (1)
Automated Concept:

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 shortage area or
Sec 1501. -- Distribution Of Unused Residency Positions.
(iv) PRIORITY FOR CERTAIN HOSPITALS. - paragraph (V)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iv) (V)
Automated Concept:

HEALTH professional needs area ;   Place greater emphasis upon training in health professional shortage area or

Index of Sec 1501. ...

Health: senior
Sec 1504. -- Preservation Of Resident Cap Positions From Closed Hospitals.
(II) PROCESS FOR HOSPITALS IN CERTAIN AREAS.
DIVISION B TITLE V SEC 1504. (a) Quoted: (vi) (II)
Automated Concept:

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
Sec 1224. -- Definitions.
(7) HEALTH CARE-RELATED SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (7)
Automated Concept:

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. ...
Sec 1233. -- Advance Care Planning Consultation.
(F) - paragraph (iii) - paragraph (III)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (F) (iii) (III)
Automated Concept:

HEALTH care professionals across continuum of care about goals and use of orders for life sustaining treatment ;   Providing training for

Index of Sec 1233. ...
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(2) PATIENT DECISION AID.
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (2)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (2)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1)
Automated Concept:

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. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
SEC 1461. -- REQUIREMENT FOR PUBLIC REPORTING BY HOSPITALS AND AMBULATORY SURGICAL CENTERS ON HEALTH CARE-ASSOCIATED INFECTIONS.
DIVISION B TITLE IV SUBTITLE E SEC 1461.
Automated Concept:

HEALTH Care-associated infections ;   Sec 1461, requirement for public reporting by hospitals and ambulatory surgical Centers on

Index of Sec 1461. ...
SEC 1138A. -- REQUIREMENT FOR PUBLIC REPORTING BY HOSPITALS AND AMBULATORY SURGICAL CENTERS ON HEALTH CARE-ASSOCIATED INFECTIONS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A.
Automated Concept:

HEALTH Care-associated infections ;   Sec 1138a, requirement for public reporting by hospitals and ambulatory surgical Centers on

Index of Sec 1461. ...
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (1)
Automated Concept:

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. ...
(b) PUBLIC POSTING OF INFORMATION.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (b)
Automated Concept:

HEALTH care-associated infections ;   Information to be set forth in manner allowing for comparison of information on

Index of Sec 1461. ...
(c) ANNUAL REPORT TO CONGRESS. - paragraph (2)
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (c) (2)
Automated Concept:

HEALTH care worker immunization rates ;   Factors contributing to occurrence of infections including

Index of Sec 1461. ...
(d) NON-PREEMPTION OF STATE LAWS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (d)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (e) (1)
Automated Concept:

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. ...
(2) RELATED TO RECEIVING HEALTH CARE.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (e) (2)
Automated Concept:

HEALTH care meaning that infection not incubating or present at time health care provided ;   Term related to receiving

Index of Sec 1461. ...
Sec 1724. -- Optional Coverage For Freestanding Birth Center Services.
(3) - paragraph (C)
DIVISION B TITLE VII SUBTITLE C SEC 1724. (a) (2) Quoted: (3) (C)
Automated Concept:

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: quality of
Sec 1223. -- Iom Report On Impact Of Language Access Services.
(b) CONTENTS. - paragraph (2)
DIVISION B TITLE II SUBTITLE B SEC 1223. (b) (2)
Automated Concept:

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. ...

Health care and community
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (iii)
Automated Concept:

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
Sec 1224. -- Definitions.
(4) EFFECTIVE COMMUNICATION.
DIVISION B TITLE II SUBTITLE B SEC 1224. (4)
Automated Concept:

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: direct provision of
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (1)
Automated Concept:

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: provider of
Sec 1224. -- Definitions.
(4) EFFECTIVE COMMUNICATION.
DIVISION B TITLE II SUBTITLE B SEC 1224. (4)
Automated Concept:

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. ...

Health care: accessible
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (3)
Automated Concept:

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: additional
Sec 1751. -- Health-Care Acquired Conditions.
(c) PERMISSION TO INCLUDE ADDITIONAL HEALTH CARE-ACQUIRED CONDITIONS.
DIVISION B TITLE VII SUBTITLE F SEC 1751. (c)
Automated Concept:

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. ...

Health care: affordability and patient-centeredness of
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES. - paragraph (3)
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (c) (3)
Automated Concept:

CENTEREDNESS of health care including due to variations in care ;   Greatest potential for improving performance, affordability and patient-

Index of Sec 1441. ...

Health care: another
Sec 1303. -- Payment Incentive For Selected Primary Care Services.
(2) PRIMARY CARE SERVICES DEFINED. - paragraph (B)
DIVISION B TITLE III SEC 1303. (a) Quoted: (p) (2) (B)
Automated Concept:

HEALTH care professional to be described in subparagraph if furnished by physician ;   Including services furnished by another

Index of Sec 1303. ...

Health care: behalf of
Sec 1644. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicare.
(D) BILLING AGENTS AND CLEARINGHOUSES REQUIRED TO BE REGISTER UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1644. (a) Quoted: (D)
Automated Concept:

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. ...
Sec 1759. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicaid.
(a) IN GENERAL. - paragraph (3) - paragraph (78)
DIVISION B TITLE VII SUBTITLE F SEC 1759. (a) (3) Quoted: (78)
Automated Concept:

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: bilingual
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (1)
Automated Concept:

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. ...

Health care: number and types of
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(c) ANNUAL REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (c) (1)
Automated Concept:

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: one other
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(1) ELIGIBLE PROVIDER. - paragraph (H)
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (1) (H)
Automated Concept:

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. ...

Health care: other
Sec 1401. -- Comparative Effectiveness Research.
(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY. - paragraph (IV)
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(2) QUALITY MEASURE.
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (d) (2)
Automated Concept:

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: patients and
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (A)
Automated Concept:

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: professional time of
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(2) PAYMENT FOR FOLLOW-UP COUNSELING VISIT. - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1236. (c) (2) (B)
Automated Concept:

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: section 1886(d)(4)(d)( iv and
Sec 1751. -- Health-Care Acquired Conditions.
(a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH CARE-ACQUIRED CONDITIONS. - paragraph (3) - paragraph (25)
DIVISION B TITLE VII SUBTITLE F SEC 1751. (a) (3) Quoted: (25)
Automated Concept:

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: term
Sec 1224. -- Definitions.
(7) HEALTH CARE-RELATED SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (7)
Automated Concept:

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: time
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (e) (1)
Automated Concept:

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. ...
(2) RELATED TO RECEIVING HEALTH CARE.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (e) (2)
Automated Concept:

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
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(c) ANNUAL REPORT TO CONGRESS. - paragraph (4)
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (c) (4)
Automated Concept:

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: more informed
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (K)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (K)
Automated Concept:

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
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS. - paragraph (v)
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B) (v)
Automated Concept:

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: efficiency and cost-effectivenes
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(g) EVALUATION AND REPORT. - paragraph (2)
DIVISION B TITLE II SUBTITLE B SEC 1222. (g) (2)
Automated Concept:

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: other
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(b) REPORTING OF OWNERSHIP INTEREST BY PHYSICIANS IN HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (b)
Automated Concept:

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. ...
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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
Health care items: effectiveness of
Sec 1401. -- Comparative Effectiveness Research.
(4) TAKING INTO ACCOUNT POTENTIAL DIFFERENCES. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (c) (4) (A)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(4) ANTIDISCRIMINATION LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (4)
Automated Concept:

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: full spectrum of
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (A)
Automated Concept:

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
Health care needs: patient's
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (1) (C)
Automated Concept:

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. ...

Health care needs: personal
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (3)
Automated Concept:

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
Health care program: Federal
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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. ...
Sec 1612. -- Enhanced Penalties For Submission Of False Statements Material To A False Claim.
(a) IN GENERAL. - paragraph (3) - paragraph (9)
DIVISION B TITLE VI SUBTITLE B SEC 1612. (a) (3) Quoted: (9)
Automated Concept:

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. ...
Sec 1615. -- Enhanced Penalties For Individuals Excluded From Program Participation.
(a) IN GENERAL. - paragraph (3) - paragraph (11)
DIVISION B TITLE VI SUBTITLE B SEC 1615. (a) (3) Quoted: (11)
Automated Concept:

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. ...
Sec 1619. -- Exclusion Of Certain Individuals And Entities From Participation In Medicare And State Health Care Programs.
(4) - paragraph (A)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (A)
Automated Concept:

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. ...
(4) - paragraph (B)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (B)
Automated Concept:

HEALTH care program ;   Item or service paid by Federal

Index of Sec 1619. ...
(C) - paragraph (i)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (i)
Automated Concept:

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. ...
(C) - paragraph (iii)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (iii)
Automated Concept:

HEALTH care program contractor provided inaccurate or misleading information resulted in waiver of overpayment under clause ;   Federal

Index of Sec 1619. ...
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (B) - paragraph (i)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (B) (i)
Automated Concept:

HEALTH care program ;   Striking participating in program under title XVIII or State health care program and inserting participating in Federal

Index of Sec 1645. ...
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (B) - paragraph (ii)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (B) (ii)
Automated Concept:

HEALTH care program ;   Subparagraph, striking title XVIII or State health care program and inserting Federal

Index of Sec 1645. ...
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (D) - paragraph (13)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (D) Quoted: (13)
Automated Concept:

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. ...
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (B) - paragraph (3)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (B) Quoted: (3)
Automated Concept:

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: relevant Federal
Sec 1619. -- Exclusion Of Certain Individuals And Entities From Participation In Medicare And State Health Care Programs.
(C) - paragraph (iii)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (iii)
Automated Concept:

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 program: Federal
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (iii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (iii)
Automated Concept:

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 program: public
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (2)
Automated Concept:

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: Federal
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (A) - paragraph (2) - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (A) Quoted: (2) (B)
Automated Concept:

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's behalf: Federal
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (A) - paragraph (2) - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (A) Quoted: (2) (B)
Automated Concept:

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
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(d) REPORT ON ADDITIONAL DATA.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (d)
Automated Concept:

HEALTH care quality and patient safety ;   Order to improve

Index of Sec 1461. ...

Health care reforms: impact of
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (a) (1)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (a) (1)
Automated Concept:

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
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(ii) EXEMPTIONS. - paragraph (II)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (4) (B) (ii) (II)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (A)
Automated Concept:

HEALTH care services for chronically ill beneficiaries across variety of health care settings ;   Applications from geographic areas proposing to coordinate

Index of Sec 1302. ...
(4) PREFERENCE. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (C)
Automated Concept:

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. ...
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) DETERMINATION OF AREAS WHERE QUALITY MEASURES ARE REQUIRED.
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (b)
Automated Concept:

HEALTH care services in United States needed ;   Secretary determining areas in which quality measures for assessing

Index of Sec 1442. ...

Health care services: efficient
Sec 1301. -- Accountable Care Organization Pilot Program.
(D) OTHER PHYSICIAN ORGANIZATIONAL MODEL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (1) (D)
Automated Concept:

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: better delivery of
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES. - paragraph (G)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (c) (1) (G)
Automated Concept:

HEALTH care services ;   Collecting as part of health information technologies supporting better delivery of

Index of Sec 1442. ...

Health care services: delivery of
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES.
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (c)
Automated Concept:

HEALTH care services in United States ;   Secretary ensuring that priority given to areas in delivery of

Index of Sec 1441. ...
(2) QUALITY MEASURE.
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (d) (2)
Automated Concept:

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. ...
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (a) (1)
Automated Concept:

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: provision of
Sec 1224. -- Definitions.
(9) LANGUAGE SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (9)
Automated Concept:

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: term
Sec 1224. -- Definitions.
(6) HEALTH CARE SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (6)
Automated Concept:

HEALTH care services meaning services ;   Term

Index of Sec 1224. ...

Health care services: utilization of
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(g) REPORT.
DIVISION B TITLE II SUBTITLE C SEC 1236. (g)
Automated Concept:

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: variety of
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (A)
Automated Concept:

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
Health center: approved teaching
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (A)
DIVISION B TITLE V SEC 1502. (d) (2) (A)
Automated Concept:

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: teaching
Sec 1502. -- Increasing Training In Nonprovider Settings.
(3) APPROVED TEACHING HEALTH CENTER DEFINED.
DIVISION B TITLE V SEC 1502. (d) (3)
Automated Concept:

HEALTH center meaning nonprovider setting ;   Term approved teaching

Index of Sec 1502. ...

Health centers
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (A)
Automated Concept:

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. ...
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(6) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
DIVISION B TITLE III SEC 1308. (a) (6)
Automated Concept:

HEALTH Centers ;   Coverage of marriage and Family Therapist Services provided in rural health clinics and federally qualified

Index of Sec 1308. ...
(6) COVERAGE OF MENTAL HEALTH COUNSELOR SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
DIVISION B TITLE III SEC 1308. (b) (6)
Automated Concept:

HEALTH Centers ;   Coverage of mental health counselor Services provided in rural health clinics and federally qualified

Index of Sec 1308. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(iv) PRIORITY FOR CERTAIN HOSPITALS. - paragraph (III)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iv) (III)
Automated Concept:

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: rural
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (A)
Automated Concept:

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. ...
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(6) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
DIVISION B TITLE III SEC 1308. (a) (6)
Automated Concept:

HEALTH Centers ;   Coverage of marriage and Family Therapist Services provided in rural health clinics and federally qualified

Index of Sec 1308. ...
(6) COVERAGE OF MENTAL HEALTH COUNSELOR SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
DIVISION B TITLE III SEC 1308. (b) (6)
Automated Concept:

HEALTH Centers ;   Coverage of mental health counselor Services provided in rural health clinics and federally qualified

Index of Sec 1308. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(iv) PRIORITY FOR CERTAIN HOSPITALS. - paragraph (III)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iv) (III)
Automated Concept:

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
Sec 1233. -- Advance Care Planning Consultation.
(3) - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (3) (B)
Automated Concept:

HEALTH condition of individual including diagnosis of chronic ;   Significant change in

Index of Sec 1233. ...

Health coverage
Health coverage: accident or
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(c) APPLICABLE SELF-INSURED HEALTH PLAN.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4376. (c)
Automated Concept:

ACCIDENT or health coverage ;   Term applicable self-insured health plan meaning plan for providing

Index of Sec 1802. ...

Health coverage: provision of accident or
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(B) DESCRIPTION OF ARRANGEMENTS.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (c) (3) (B)
Automated Concept:

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. ...

Health coverage: term accident and
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(1) ACCIDENT AND HEALTH COVERAGE.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (a) (1)
Automated Concept:

ACCIDENT and health coverage meaning coverage causing policy to be specified health insurance policy ;   Term

Index of Sec 1802. ...

Health data: electronic
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (E)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (A) - paragraph (ii)
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (c) (1) (E)
Automated Concept:

HEALTH disparities including associated with individual race ;   Assessing

Index of Sec 1442. ...

Health facility
Sec 1724. -- Optional Coverage For Freestanding Birth Center Services.
(3) - paragraph (B)
DIVISION B TITLE VII SUBTITLE C SEC 1724. (a) (2) Quoted: (3) (B)
Automated Concept:

HEALTH facility ;   Term freestanding birth center meaning

Index of Sec 1724. ...

Health market basket percentage increases
Sec 1155. -- Incorporating Productivity Improvements Into Market Basket Update For Home Health Services.
(b) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE C SEC 1155. (b)
Automated Concept:

HEALTH market basket percentage increases for years beginning with 2010 ;   Amendment making by subsection applying to home

Index of Sec 1155. ...

Health outcomes
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(g) EVALUATION AND REPORT. - paragraph (2)
DIVISION B TITLE II SUBTITLE B SEC 1222. (g) (2)
Automated Concept:

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. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (a)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(1) EVALUATION OF COST AND QUALITY. - paragraph (A) - paragraph (vi)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (1) (A) (vi)
Automated Concept:

FUNCTIONAL status where applicable ;   Improvement in health outcomes including patient

Index of Sec 1302. ...

Health outcomes of population
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS. - paragraph (v)
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B) (v)
Automated Concept:

HEALTH outcomes of population physicians serving ;   Including experience and participation in continuous quality improvement projects to improve

Index of Sec 1505. ...

Health plan
Health plan: applicable self-insured
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(c) APPLICABLE SELF-INSURED HEALTH PLAN.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4376. (c)
Automated Concept:

ACCIDENT or health coverage ;   Term applicable self-insured health plan meaning plan for providing

Index of Sec 1802. ...

Health plan: group
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(4) COVERED RECIPIENT. - paragraph (E)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (4) (E)
Automated Concept:

HEALTH benefiting plan ;   Health insurance issuer, group health plan or other entity offering

Index of Sec 1451. ...

Health plan: Federal and private
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1)
Automated Concept:

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 plan: private
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (4)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (4)
Automated Concept:

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 plan: self-insured
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(1) GENERAL RULE.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B
Automated Concept:

HEALTH Plans ;   B insured and self-insured

Index of Sec 1802. ...

Health quality
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(g) REPORT.
DIVISION B TITLE II SUBTITLE C SEC 1236. (g)
Automated Concept:

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: electronic
Sec 1124. -- Modifications To The Physician Quality Reporting Initiative (Pqri).
(7) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR REPORTING.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1124. (c) Quoted: (7)
Automated Concept:

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. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(D) REPORTING AND OTHER REQUIREMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (D)
Automated Concept:

HEALTH records and other similar initiatives under section 1848 and using alternative criteria ;   Electronic

Index of Sec 1301. ...
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (E)
Automated Concept:

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: indian
Sec 1184. -- Including Costs Incurred By Aids Drug Assistance Programs And Indian Health Service In Providing Prescription Drugs Toward The Annual Out-Of-Pocket Threshold Under Part D.
SEC 1184. -- INCLUDING COSTS INCURRED BY AIDS DRUG ASSISTANCE PROGRAMS AND INDIAN HEALTH SERVICE IN PROVIDING PRESCRIPTION DRUGS TOWARD THE ANNUAL OUT-OF-POCKET THRESHOLD UNDER PART D.
DIVISION B TITLE I SUBTITLE E SEC 1184.
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (C)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (C)
Automated Concept:

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: designated
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1) (B)
Automated Concept:

HEALTH services provided outside United States or entities ;   Requirement of subsection not applying to designated

Index of Sec 1156. ...
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT. - paragraph (C) - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2) (C) (ii)
Automated Concept:

HEALTH services furnished outside United States or entities ;   Requirements of paragraph not applying to designated

Index of Sec 1156. ...

Health services: durable medical equipment or Home
Sec 1637. -- Physicians Who Order Durable Medical Equipment Or Home Health Services Required To Be Medicare Enrolled Physicians Or Eligible Professionals.
SEC 1637. -- PHYSICIANS WHO ORDER DURABLE MEDICAL EQUIPMENT OR HOME HEALTH SERVICES REQUIRED TO BE MEDICARE ENROLLED PHYSICIANS OR ELIGIBLE PROFESSIONALS.
DIVISION B TITLE VI SUBTITLE C SEC 1637.
Automated Concept:

HEALTH Services required to be medicare enrolled Physicians or eligible Professionals ;   Order durable medical equipment or Home

Index of Sec 1637. ...

Health services: Home
Sec 1155. -- Incorporating Productivity Improvements Into Market Basket Update For Home Health Services.
SEC 1155. -- INCORPORATING PRODUCTIVITY IMPROVEMENTS INTO MARKET BASKET UPDATE FOR HOME HEALTH SERVICES.
DIVISION B TITLE I SUBTITLE C SEC 1155.
Automated Concept:

HEALTH Services ;   Incorporating productivity improvements into Market basket updating for Home

Index of Sec 1155. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
SEC 1639. -- FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639.
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(4) ANTIDISCRIMINATION LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (4)
Automated Concept:

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. ...

Hearing prior
Sec 1421. -- Civil Money Penalties.
(VIII) PROCEDURE.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VIII)
Automated Concept:

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. ...
(V) PROCEDURE.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (V)
Automated Concept:

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
Hh: section 1861(
Sec 1307. -- Excluding Clinical Social Worker Services From Coverage Under The Medicare Skilled Nursing Facility Prospective Payment System And Consolidated Payment.
(b) CONFORMING AMENDMENT.
DIVISION B TITLE III SEC 1307. (b)
Automated Concept:

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. ...

Hh: section 1902(
Sec 1714. -- State Eligibility Option For Family Planning Services.
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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. ...
(1) PRESUMPTIVE ELIGIBILITY PERIOD. - paragraph (A)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (b) (1) (A)
Automated Concept:

HH ;   Begining with date on which qualified entity determining that individual described in section 1902(

Index of Sec 1714. ...

Hh: Social Security Act 42 USC 1395x(
Sec 1307. -- Excluding Clinical Social Worker Services From Coverage Under The Medicare Skilled Nursing Facility Prospective Payment System And Consolidated Payment.
(b) CONFORMING AMENDMENT.
DIVISION B TITLE III SEC 1307. (b)
Automated Concept:

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
Home: alternative
Sec 1423. -- Notification Of Facility Closure.
(i) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (a) (1) Quoted: (7) (B) (i)
Automated Concept:

HOME and community-based setting ;   State ensuring that residents of facility successfully relocated to another facility or alternative

Index of Sec 1423. ...
(i) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (b) (1) Quoted: (9) (B) (i)
Automated Concept:

HOME and community-based setting ;   State ensuring that residents of facility successfully relocated to another facility or alternative

Index of Sec 1423. ...

Home: based medical
Sec 1302. -- Medical Home Pilot Program.
(A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (A)
Automated Concept:

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. ...
(B) COMMUNITY-BASED MEDICAL HOME DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B)
Automated Concept:

HOME meaning nonprofit community-based or State-based organization certified under paragraph as meeting following requirements ;   Term community-based medical

Index of Sec 1302. ...
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (D) (i)
Automated Concept:

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: centered medical
Sec 1302. -- Medical Home Pilot Program.
(A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (1) (A)
Automated Concept:

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. ...
(B) INDEPENDENT PATIENT-CENTERED MEDICAL HOME DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (1) (B)
Automated Concept:

HOME meaning physician-directed or nurse-practitioner-directed practice qualified under paragraph ;   Term independent patient-centered medical

Index of Sec 1302. ...
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (i)
Automated Concept:

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. ...
(D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (ii)
Automated Concept:

HOME ;   Allowing for differential payments based on capabilities of independent patient-centered medical

Index of Sec 1302. ...

Home: medical
Sec 1302. -- Medical Home Pilot Program.
(4) PARTICIPATION OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (4) (A)
Automated Concept:

HOME so long ;   Nothing in section to be construed as preventing nurse practitioner from leading patient centered medical

Index of Sec 1302. ...
(4) PARTICIPATION OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (4) (B)
Automated Concept:

HOME so long ;   Nothing in section to be construed as preventing physician assistant from participating in patient centered medical

Index of Sec 1302. ...
(B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (B)
Automated Concept:

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. ...
(B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (B)
Automated Concept:

HOME ;   Secretary making two separate monthly payments for high need beneficiary consenting to receive medical home services through medical

Index of Sec 1302. ...

Home: one medical
Sec 1302. -- Medical Home Pilot Program.
(1) NO DUPLICATION IN PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (f) (1)
Automated Concept:

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 and care of home health agency
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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: medical
Sec 1722. -- Medical Home Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (a)
Automated Concept:

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: medical
Sec 1302. -- Medical Home Pilot Program.
(h) TREATMENT OF TRHCA MEDICARE MEDICAL HOME DEMONSTRATION FUNDING. - paragraph (2)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (h) (2)
Automated Concept:

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 health
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) DETAILS. - paragraph (8)
DIVISION B TITLE I SUBTITLE C SEC 1152. (b) (8)
Automated Concept:

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. ...

Home health care: limitation
Sec 1615. -- Enhanced Penalties For Individuals Excluded From Program Participation.
(a) IN GENERAL. - paragraph (3) - paragraph (11)
DIVISION B TITLE VI SUBTITLE B SEC 1615. (a) (3) Quoted: (11)
Automated Concept:

HEALTH care ;   Ordering or prescribing item or service including without limitation home

Index of Sec 1615. ...

Home health services
Sec 1638. -- Requirement For Physicians To Provide Documentation On Referrals To Programs At High Risk Of Waste And Abuse.
(a) PHYSICIANS AND OTHER SUPPLIERS. - paragraph (10)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (a) Quoted: (10)
Automated Concept:

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. ...
(b) PROVIDERS OF SERVICES. - paragraph (3) - paragraph (X)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (b) (3) Quoted: (X)
Automated Concept:

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. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(d) APPLICATION TO MEDICAID AND CHIP.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (d)
Automated Concept:

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. ...

Home health services: durable medical equipment and
Sec 1637. -- Physicians Who Order Durable Medical Equipment Or Home Health Services Required To Be Medicare Enrolled Physicians Or Eligible Professionals.
(c) DISCRETION TO EXPAND APPLICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1637. (c)
Automated Concept:

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
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (1)
Automated Concept:

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. ...
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (4)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (4)
Automated Concept:

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: provision of
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (4)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (4)
Automated Concept:

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: costs of
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (3)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (3)
Automated Concept:

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: result of Medicare coverage of
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (2)
Automated Concept:

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 infusion therapy fee-for-service Medicare program
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (1)
Automated Concept:

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
Home model: centered medical
Sec 1302. -- Medical Home Pilot Program.
(h) TREATMENT OF TRHCA MEDICARE MEDICAL HOME DEMONSTRATION FUNDING. - paragraph (2)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (h) (2)
Automated Concept:

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. ...

Home model: medical
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (C)
Automated Concept:

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 model: following medical
Sec 1302. -- Medical Home Pilot Program.
(3) MODELS OF MEDICAL HOMES IN THE PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (3)
Automated Concept:

HOME models ;   Pilot program evaluating following medical

Index of Sec 1302. ...

Home model: one or more of medical
Sec 1722. -- Medical Home Pilot Program.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (b) (1)
Automated Concept:

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: medical
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (1)
Automated Concept:

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 pilot project: medical
Sec 1722. -- Medical Home Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (a)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (b) (1)
Automated Concept:

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. ...
(a) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (a)
Automated Concept:

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
Home services: centered medical
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (1)
Automated Concept:

HOME services meaning services ;   Term patient-centered medical

Index of Sec 1302. ...
Sec 1722. -- Medical Home Pilot Program.
(d) MEDICALLY FRAGILE CHILDREN.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (d)
Automated Concept:

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: medical
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (1)
Automated Concept:

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. ...
(A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (1) (A)
Automated Concept:

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. ...
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (A)
Automated Concept:

HOME services furnished by independent patient-centered medical homes ;   Secretary establishing methodolology for payment for medical

Index of Sec 1302. ...
(B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (B)
Automated Concept:

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. ...
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (i)
Automated Concept:

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. ...
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (i)
Automated Concept:

HOME services ;   Organization providing beneficiaries with medical

Index of Sec 1302. ...
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (ii)
Automated Concept:

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. ...
(4) PREFERENCE. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (B)
Automated Concept:

HOME services for chronically ill patients covered by payors ;   Applications including other payors furnishing medical

Index of Sec 1302. ...
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (A)
Automated Concept:

HOME services furnished under CBMH model ;   Secretary establishing methodolology for payment for medical

Index of Sec 1302. ...
(B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (B)
Automated Concept:

HOME services through medical home ;   Secretary making two separate monthly payments for high need beneficiary consenting to receive medical

Index of Sec 1302. ...
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (D) (i)
Automated Concept:

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. ...
(1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (1) (B)
Automated Concept:

HOME services under title on permanent basis ;   Feasability and advisability of reimbursing medical homes for medical

Index of Sec 1302. ...
(1) NO DUPLICATION IN PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (f) (1)
Automated Concept:

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. ...
(h) TREATMENT OF TRHCA MEDICARE MEDICAL HOME DEMONSTRATION FUNDING. - paragraph (2)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (h) (2)
Automated Concept:

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 services community: medical
Sec 1302. -- Medical Home Pilot Program.
(A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (A)
Automated Concept:

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 stays
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (2)
Automated Concept:

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
Home visitation: based models of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (i)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (i)
Automated Concept:

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: childhood
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(l) RESERVATIONS OF FUNDS. - paragraph (1)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (l) (1)
Automated Concept:

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: high quality programs of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) DESCRIPTION OF HOME VISITATION PROGRAMS.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (1)
Automated Concept:

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. ...

Home visitation: model of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(A) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (2) (A)
Automated Concept:

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. ...

Home visitation: programs of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(d) MAINTENANCE OF EFFORT.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (d)
Automated Concept:

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: voluntary
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(a) PURPOSE.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (a)
Automated Concept:

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. ...
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (A)
Automated Concept:

HOME visitation programs using funds provided under section ;   Supporting

Index of Sec 1904. ...
(3) ASSURANCES. - paragraph (B)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (B)
Automated Concept:

HOME visitation programs using funds ;   State reserving 5 percent of grant funds for training and technical assistance to

Index of Sec 1904. ...
(3) ASSURANCES. - paragraph (C)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (C)
Automated Concept:

HOME visitation programs using funds provided under section ;   Supporting

Index of Sec 1904. ...
(3) ASSURANCES. - paragraph (D)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (D)
Automated Concept:

HOME visitation programs supported using funds providing referrals to other programs serving children and families  ;  

Index of Sec 1904. ...

Home visitation programs: effect of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (j) (1) (A)
Automated Concept:

CHILD maltreatment ;   Effect of home visitation programs on child and parent outcomes including

Index of Sec 1904. ...

Home visitation programs: independent evaluation of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (j) (1)
Automated Concept:

HOME visitation programs receiving funds provided under section ;   Secretary providing for conduct of independent evaluation of effectiveness of

Index of Sec 1904. ...

Home visitation programs: other
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (C)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (C)
Automated Concept:

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. ...

Home visitation services
Home visitation services: nurse
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(c) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1713. (c)
Automated Concept:

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: term nurse
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa)
Automated Concept:

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
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa)
Automated Concept:

HOME visits by trained nurses to families with first-time pregnant woman or child ;   Term nurse home visitation services meaning

Index of Sec 1713. ...

Honorarium
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) INCLUSIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (B)
Automated Concept:

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
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(3) PRODUCTIVITY ADJUSTMENT.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (c) Quoted: (3)
Automated Concept:

HOSPITAL ;   Annual percentage increase factor applying to base rate for discharges for

Index of Sec 1103. ...
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (1) (A)
Automated Concept:

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. ...
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (1) (B)
Automated Concept:

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. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (1)
Automated Concept:

DISCHARGE by amount equal to product ;   Secretary reducing payments otherwise to be made to hospital under subsection

Index of Sec 1151. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (3) (A) (i)
Automated Concept:

FISCAL year ;   Ratio described in subparagraph for hospital for applicable period for

Index of Sec 1151. ...
(B) RATIO.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (3) (B)
Automated Concept:

HOSPITAL for applicable period being equal to 1 minus ratio ;   Ratio described in subparagraph for

Index of Sec 1151. ...
(A) AGGREGATE PAYMENTS FOR EXCESS READMISSIONS. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (A) (i)
Automated Concept:

FISCAL year for condition ;   Base operating DRG payment amount for hospital for

Index of Sec 1151. ...
(B) AGGREGATE PAYMENTS FOR ALL DISCHARGES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (B)
Automated Concept:

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. ...
(i) IN GENERAL. - paragraph (II)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (II)
Automated Concept:

HOSPITAL for condition with respect to applicable period ;   Risk adjusted expected readmissions for

Index of Sec 1151. ...
(6) LIMITATIONS ON REVIEW. - paragraph (D)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (6) (D)
Automated Concept:

HOSPITAL-specific limit under paragraph and form of payment making by Secretary under paragraph  ;  

Index of Sec 1151. ...
(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (7)
Automated Concept:

HOSPITAL to undertake action to alleviate steps ;   Secretary determining that hospital taking step, notice to hospital and opportunity for

Index of Sec 1151. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (A)
Automated Concept:

FISCAL year ;   2011 Secretary making payment adjustment for hospital described in subparagraph, respect

Index of Sec 1151. ...
(ii) HOSPITAL-SPECIFIC LIMIT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (C) (ii)
Automated Concept:

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. ...
(2) CONSIDERATIONS. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1151. (d) (2) (A)
Automated Concept:

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. ...
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(3) POST ACUTE SERVICES.
DIVISION B TITLE I SUBTITLE C SEC 1152. (a) (3)
Automated Concept:

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. ...
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(a) IN GENERAL. - paragraph (1) - paragraph (C) - paragraph (C)
(a) IN GENERAL. - paragraph (2) - paragraph (C) - paragraph (D)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (2) (C) Quoted: (D)
Automated Concept:

HOSPITAL meeting requirements described in subsection  ;  

Index of Sec 1156. ...
(B) PROHIBITION ON PHYSICIAN OWNERSHIP OR INVESTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (B)
Automated Concept:

HOSPITAL ;   Percentage of total value of ownership or investment interests holding in hospital or entity whose asseal including

Index of Sec 1156. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (i)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (ii)
Automated Concept:

FINANCING for physician owner or investor in hospital ;   Hospital not directly or indirectly providing loans or

Index of Sec 1156. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iii)
Automated Concept:

HOSPITAL not directly or indirectly guaranteeing loan  ;  

Index of Sec 1156. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iv)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iv)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (vi)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (vi)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (vii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (vii)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (viii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (viii)
Automated Concept:

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. ...
(E) PATIENT SAFETY. - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (E) (ii)
Automated Concept:

HOSPITAL lacking additional capabilities required to treat emergency  ;  

Index of Sec 1156. ...
(F) LIMITATION ON APPLICATION TO CERTAIN CONVERTED FACILITIES.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (F)
Automated Concept:

HOSPITAL after date of enactment of subsection ;   Hospital not converted from ambulatory surgical center to

Index of Sec 1156. ...
(i) ESTABLISHMENT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (A) (i)
Automated Concept:

HOSPITAL applying for exception from requirement under paragraph ;   Secretary establishing and implementing process under which

Index of Sec 1156. ...
(ii) OPPORTUNITY FOR COMMUNITY INPUT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (A) (ii)
Automated Concept:

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. ...
(B) FREQUENCY.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (B)
Automated Concept:

HOSPITAL to apply for exception up to once every 2 years ;   Process described in subparagraph permitting

Index of Sec 1156. ...
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (C) (i)
Automated Concept:

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. ...
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E)
Automated Concept:

HOSPITAL ;   Secretary granting exception under process described in subparagraph only to

Index of Sec 1156. ...
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (i)
Automated Concept:

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. ...
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (ii)
Automated Concept:

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. ...
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (iii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (iii)
Automated Concept:

HOSPITAL to discriminate against beneficiaries ;   Not discriminating against beneficiaries of Federal health care programs and not permitting physicians practicing at

Index of Sec 1156. ...
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (v)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (v)
Automated Concept:

HOSPITAL located ;   Average bed occupancy rate estimated to be greater than average bed occupancy rate in State in which

Index of Sec 1156. ...
(4) PATIENT SAFETY REQUIREMENT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (4)
Automated Concept:

HOSPITAL admiting patient and not physician available on premises 24 hours per day  ;  

Index of Sec 1156. ...
(4) PATIENT SAFETY REQUIREMENT. - paragraph (A)
(5) CLARIFICATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (5)
Automated Concept:

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. ...
Sec 1233. -- Advance Care Planning Consultation.
(5) - paragraph (B) - paragraph (ii)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (5) (B) (ii)
Automated Concept:

HOSPITAL or remaining at current care setting ;   Individual's desire regarding transfer to

Index of Sec 1233. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(B) INCLUSION OF OTHER PROVIDERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (1) (B)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(b) REPORTING OF OWNERSHIP INTEREST BY PHYSICIANS IN HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (b)
Automated Concept:

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. ...
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (1)
Automated Concept:

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. ...
(d) NON-PREEMPTION OF STATE LAWS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (d)
Automated Concept:

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. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(I) IN GENERAL.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (A) (ii) (I)
Automated Concept:

HOSPITAL For which cost report settled if not determined by Secretary ;   Recent cost reporting periods of

Index of Sec 1501. ...
(II) USE OF MOST RECENT ACCOUNTING PERIOD TO RECOGNIZE EXPANSION OF EXISTING PROGRAMS.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (A) (ii) (II)
Automated Concept:

ACCOUNTING period to recognize expansion of existing Programs ;   Use of recent

Index of Sec 1501. ...
(II) DEDICATED ASSIGNMENT OF ADDITIONAL RESIDENT POSITIONS TO PRIMARY CARE.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (II)
Automated Concept:

HOSPITAL assigning additional resident positions for primary care residents  ;  

Index of Sec 1501. ...
(III) ACCREDITATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (III)
Automated Concept:

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. ...
(v) LIMITATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (v)
Automated Concept:

HOSPITAL ;   More than 20 full-time equivalent additional residency positions to be made available under subparagraph with respect to

Index of Sec 1501. ...
(vi) DISTRIBUTION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (vi)
Automated Concept:

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. ...
(2) CONFORMING PROVISION. - paragraph (x)
DIVISION B TITLE V SEC 1501. (b) (2) Quoted: (x)
Automated Concept:

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. ...
Sec 1502. -- Increasing Training In Nonprovider Settings.
(a) DIRECT GME. - paragraph (3) - paragraph (A) - paragraph (II)
DIVISION B TITLE V SEC 1502. (a) (3) (A) Quoted: (II)
Automated Concept:

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. ...
(b) IME. - paragraph (2) - paragraph (II)
DIVISION B TITLE V SEC 1502. (b) (2) Quoted: (II)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE V SEC 1502. (d) (1)
Automated Concept:

HOSPITAL to operate program ;   Manner similar to manner in which payments to be made to hospital if

Index of Sec 1502. ...
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(xi) - paragraph (II)
DIVISION B TITLE V SEC 1503. (b) Quoted: (xi) (II)
Automated Concept:

HOSPITAL ;   Occuring in hospital to be counted toward determination of full-time equivalency if

Index of Sec 1503. ...

Hospital and opportunity
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (7)
Automated Concept:

HOSPITAL and opportunity for hospital to undertake action to alleviate steps ;   Secretary determining that hospital taking step, notice to

Index of Sec 1151. ...

Hospital: physician groups or number of
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) SCOPE.
DIVISION B TITLE I SUBTITLE C SEC 1152. (f) (1) Quoted: SEC 1866D. (b)
Automated Concept:

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: applicable
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(B) OTHER TERMS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (3) (B)
Automated Concept:

HOSPITAL and readmission having meanings given terms in section 1886(p)(5) of Social Security Act ;   Terms applicable condition, applicable

Index of Sec 1151. ...

Hospital or center
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (1)
Automated Concept:

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
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(B) PROHIBITION ON PHYSICIAN OWNERSHIP OR INVESTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (B)
Automated Concept:

HOSPITAL or entity whose asseal including hospital ;   Percentage of total value of ownership or investment interests holding in

Index of Sec 1156. ...

Hospital: subsection
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(C) APPLICABLE HOSPITAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (C)
Automated Concept:

HOSPITAL or hospital paid under section 1814(b)(3) ;   Term applicable hospital meaning subsection

Index of Sec 1151. ...

Hospital or unit
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(2) PRODUCTIVITY ADJUSTMENT.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (2)
Automated Concept:

HOSPITAL or unit ;   Annual percentage increase factor applying to base rate for discharges for

Index of Sec 1103. ...

Hospital: accredited teaching
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (A)
DIVISION B TITLE V SEC 1502. (d) (2) (A)
Automated Concept:

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: applicable
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (1)
Automated Concept:

FISCAL year beginning after October 1 ;   Respect to payment for discharges from applicable hospital occurring during

Index of Sec 1151. ...
(C) APPLICABLE HOSPITAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (C)
Automated Concept:

HOSPITAL meaning subsection hospital or hospital paid under section 1814(b)(3) ;   Term applicable

Index of Sec 1151. ...
(E) READMISSION.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (E)
Automated Concept:

DISCHARGE ;   Admission of individual to same or another applicable hospital within time period specified by Secretary from date of

Index of Sec 1151. ...
(B) TARGETED HOSPITALS.
(b) APPLICATION TO CRITICAL ACCESS HOSPITALS. - paragraph (2) - paragraph (5)
DIVISION B TITLE I SUBTITLE C SEC 1151. (b) (2) Quoted: (5)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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: applicable period and
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(ii) EXCLUSION OF CERTAIN READMISSIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (ii)
Automated Concept:

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. ...

Hospital: avoided or shortened
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (2)
Automated Concept:

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: case of
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(B) ADJUSTMENTS.
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2)
Automated Concept:

HOSPITAL meeting requirements described in subsection ;   Case of

Index of Sec 1156. ...
(E) PATIENT SAFETY.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (E)
Automated Concept:

HOSPITAL not offering emergency services ;   Case of

Index of Sec 1156. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(III) SPECIAL PROVIDER AGREEMENT.
Sec 1504. -- Preservation Of Resident Cap Positions From Closed Hospitals.
(II) PROCESS FOR HOSPITALS IN CERTAIN AREAS.
DIVISION B TITLE V SEC 1504. (a) Quoted: (vi) (II)
Automated Concept:

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: contracting
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (B)
DIVISION B TITLE V SEC 1502. (d) (2) (B)
Automated Concept:

CONTRACTING hospital's resident limit ;   Number of primary care residents of center not counting against

Index of Sec 1502. ...
(2) CONDITIONS. - paragraph (C)
DIVISION B TITLE V SEC 1502. (d) (2) (C)
Automated Concept:

CONTRACTING hospital agreeing not to diminish number of residents in primary care residency training program  ;  

Index of Sec 1502. ...

Hospital: control of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (vii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (vii)
Automated Concept:

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: critical access
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(b) APPLICATION TO CRITICAL ACCESS HOSPITALS. - paragraph (2) - paragraph (5)
DIVISION B TITLE I SUBTITLE C SEC 1151. (b) (2) Quoted: (5)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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. ...
(2) CONSIDERATIONS. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1151. (d) (2) (A)
Automated Concept:

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. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(f) APPLICATION TO CRITICAL ACCESS HOSPITALS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (f)
Automated Concept:

HOSPITAL ;   Term hospital including critical access

Index of Sec 1461. ...

Hospital: disproportionate share
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL. - paragraph (4)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (d) (1) Quoted: (4)
Automated Concept:

HOSPITAL or essential access hospital ;   No hospital to be defined or deemed as disproportionate share

Index of Sec 1704. ...

Hospital: essential access
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL. - paragraph (4)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (d) (1) Quoted: (4)
Automated Concept:

HOSPITAL ;   No hospital to be defined or deemed as disproportionate share hospital or essential access

Index of Sec 1704. ...

Hospital: inpatient
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) DETAILS. - paragraph (8)
DIVISION B TITLE I SUBTITLE C SEC 1152. (b) (8)
Automated Concept:

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: investors of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2) (A)
Automated Concept:

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: main campus of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) INCREASE LIMITED TO FACILITIES ON THE MAIN CAMPUS OF THE HOSPITAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (D)
Automated Concept:

HOSPITAL ;   Procedure rooms or beds of hospital pursuant to paragraph only occurring in facilities on main campus of

Index of Sec 1156. ...

Hospital: no
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL. - paragraph (4)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (d) (1) Quoted: (4)
Automated Concept:

DISPROPORTIONATE share hospital or essential access hospital ;   No hospital to be defined or deemed as

Index of Sec 1704. ...

Hospital: number of
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) SCOPE.
DIVISION B TITLE I SUBTITLE C SEC 1152. (f) (1) Quoted: SEC 1866D. (b)
Automated Concept:

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: outpatient department of
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(B) CONFORMING AMENDMENTS. - paragraph (iii) - paragraph (H)
DIVISION B TITLE III SEC 1305. (b) (2) (B) (iii) Quoted: (H)
Automated Concept:

HOSPITAL ;   Respect to additional preventive services furnished by outpatient department of

Index of Sec 1305. ...

Hospital: outside of
Sec 1744. -- Payments For Graduate Medical Education.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (1)
Automated Concept:

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: paragraph or beds of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (C) (i)
Automated Concept:

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: periods of
Sec 1501. -- Distribution Of Unused Residency Positions.
(I) IN GENERAL.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (A) (ii) (I)
Automated Concept:

HOSPITAL For which cost report settled if not determined by Secretary ;   Recent cost reporting periods of

Index of Sec 1501. ...

Hospital: premises of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (vi)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (vi)
Automated Concept:

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: primary care residency program of
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (A)
DIVISION B TITLE V SEC 1502. (d) (2) (A)
Automated Concept:

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: procedure rooms or beds of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (C) (i)
Automated Concept:

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. ...
(ii) 100 PERCENT INCREASE LIMITATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (C) (ii)
Automated Concept:

HOSPITAL exceeding 200 percent of baseline number of operating ;   Procedure rooms or beds of

Index of Sec 1156. ...
(D) INCREASE LIMITED TO FACILITIES ON THE MAIN CAMPUS OF THE HOSPITAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (D)
Automated Concept:

HOSPITAL pursuant to paragraph only occurring in facilities on main campus of hospital ;   Procedure rooms or beds of

Index of Sec 1156. ...

Hospital: qualifying
Sec 1501. -- Distribution Of Unused Residency Positions.
(i) IN GENERAL.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (i)
Automated Concept:

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. ...

Hospital: subsection and
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (A)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (2) (A)
Automated Concept:

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. ...

Hospital: subsection or
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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: targeted
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(E) USE OF ADDITIONAL PAYMENT. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (E) (i)
Automated Concept:

HOSPITAL to other settings ;   Providing care coordination services to assist in transitions from targeted

Index of Sec 1151. ...

Hospital: term
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(f) APPLICATION TO CRITICAL ACCESS HOSPITALS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (f)
Automated Concept:

HOSPITAL including critical access hospital ;   Term

Index of Sec 1461. ...

Hospital closure: date of
Sec 1504. -- Preservation Of Resident Cap Positions From Closed Hospitals.
(II) PROCESS FOR HOSPITALS IN CERTAIN AREAS.
DIVISION B TITLE V SEC 1504. (a) Quoted: (vi) (II)
Automated Concept:

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: settled
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(4) APPLICATION.
DIVISION B TITLE V SEC 1503. (c) (4)
Automated Concept:

HOSPITAL cost reports ;   Amendments making by section not to be applied in manner requiring reopening of settled

Index of Sec 1503. ...

Hospital filling: demonstrated likelihood of
Sec 1501. -- Distribution Of Unused Residency Positions.
(iii) CONSIDERATIONS IN REDISTRIBUTION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iii)
Automated Concept:

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 hospital's costs of salary and fringe benefits
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (A)
DIVISION B TITLE V SEC 1502. (d) (2) (A)
Automated Concept:

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
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (i)
Automated Concept:

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: disproportionate share
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(G) DISPROPORTIONATE SHARE HOSPITAL PAYMENT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (G)
Automated Concept:

HOSPITAL payment meaning additional payment amount under subsection ;   Term disproportionate share

Index of Sec 1151. ...

Hospital post
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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: preventable
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
SEC 1151. -- REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151.
Automated Concept:

HOSPITAL READMISSIONS ;   Sec 1151 reducing potentially preventable

Index of Sec 1151. ...

Hospital services: inpatient
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(1) REFERENCE TO ESTABLISHMENT AND IMPLEMENTATION OF SYSTEM.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (1)
Automated Concept:

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. ...
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(c) MEDICARE DSH.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (c)
Automated Concept:

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. ...
Sec 1444. -- Application Of Quality Measures.
(x) - paragraph (I)
DIVISION B TITLE IV SUBTITLE C SEC 1444. (a) Quoted: (x) (I)
Automated Concept:

FISCAL year 2012 and subsequent fiscal year ;   Purposes of reporting data on quality measures for inpatient hospital services furnished during

Index of Sec 1444. ...
(F) USE OF ENDORSED QUALITY MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1444. (b) Quoted: (F)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(4) MEDICAID DSH.
DIVISION B TITLE VII SUBTITLE A SEC 1704. (a) (4)
Automated Concept:

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: three-day
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) DETAILS. - paragraph (9)
DIVISION B TITLE I SUBTITLE C SEC 1152. (b) (9)
Automated Concept:

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: temporary adjustment
Sec 1504. -- Preservation Of Resident Cap Positions From Closed Hospitals.
(b) NO EFFECT ON TEMPORARY FTE CAP ADJUSTMENTS.
DIVISION B TITLE V SEC 1504. (b)
Automated Concept:

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. ...

Hospital's residency programs
Sec 1501. -- Distribution Of Unused Residency Positions.
(III) ACCREDITATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (III)
Automated Concept:

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
Sec 1125. -- Adjustment To Medicare Payment Localities.
(i) REVISION. - paragraph (II)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1125. (a) Quoted: (6) (A) (i) (II)
Automated Concept:

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
Sec 1162. -- Quality Bonus Payments.
(ii) IDENTIFICATION OF HIGH QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (E) (ii)
Automated Concept:

IDENTIFICATION of high quality Plans in Top quintile based on projected enrollment  ;  

Index of Sec 1162. ...
(iii) IDENTIFICATION OF IMPROVED QUALITY PLANS IN TOP QUINTILE BASED ON PROJECTED ENROLLMENT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (E) (iii)
Automated Concept:

IDENTIFICATION of improved quality Plans in Top quintile based on projected enrollment  ;  

Index of Sec 1162. ...
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...
Sec 1801. -- 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.
SEC 1801. -- 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.
DIVISION B TITLE VIII SEC 1801.
Automated Concept:

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. ...
(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.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19)
Automated Concept:

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
Sec 1614. -- Enhanced Hospice Program Safeguards.
(3) SECRETARIAL AUTHORITY.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (3)
Automated Concept:

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: improved quality plan of
Sec 1162. -- Quality Bonus Payments.
(F) NOTIFICATION.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (F)
Automated Concept:

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. ...

Identity: detailed description of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2) (A)
Automated Concept:

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
Sec 1232. -- Extended Months Of Coverage Of Immunosuppressive Drugs For Kidney Transplant Patients And Other Renal Dialysis Provisions.
(2) EXTENSION OF SECONDARY PAYER REQUIREMENTS FOR ESRD BENEFICIARIES.
DIVISION B TITLE II SUBTITLE C SEC 1232. (a) (2)
Automated Concept:

IMMUNOSUPPRESSIVE drugs furnished after date of enactment of America's Affordable Health Choices acting of 2009 ;   Regard to

Index of Sec 1232. ...

Implementation
Sec 1302. -- Medical Home Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (3) (A)
Automated Concept:

IMPLEMENTATION improving quality of care as determined by Secretary ;   Including that

Index of Sec 1302. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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
Sec 1722. -- Medical Home Pilot Program.
(f) FUNDING.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (f)
Automated Concept:

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. ...

Implementation of plan
Sec 1412. -- Accountability Requirements.
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (1) (C) Quoted: (ii) (I)
Automated Concept:

ASSESSMENT and assurance activities conducted under clause ;   Coordinating implementation of plan with quality

Index of Sec 1412. ...
(I) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (2) (C) Quoted: (ii) (I)
Automated Concept:

ASSESSMENT and assurance activities conducted under clause ;   Coordinating implementation of plan with quality

Index of Sec 1412. ...
(4) FACILITY PLAN.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (4)
Automated Concept:

ASSESSMENT and assurance activities conducted under clause of sections ;   Coordinating implementation of plan with quality

Index of Sec 1412. ...

Implementation of program
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(i) STATE REPORTS. - paragraph (7)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (i) (7)
Automated Concept:

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. ...

Implementation of provisions of division A of Act State
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (1)
Automated Concept:

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
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(ii) IDENTIFICATION OF POTENTIALLY MISVALUED CODES.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (ii)
Automated Concept:

IMPLEMENTATION of rbrvs ;   Codes not being subject to review since

Index of Sec 1122. ...

Implementation: purposes of
Sec 1310. -- Expanding Access To Vaccines.
(G) IMPLEMENTATION.
DIVISION B TITLE III SEC 1310. (c) (3) Quoted: (G)
Automated Concept:

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: available initial
Sec 1302. -- Medical Home Pilot Program.
(6) INITIAL IMPLEMENTATION FUNDING.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (6)
Automated Concept:

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. ...

Implementation: establishment and
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(1) REFERENCE TO ESTABLISHMENT AND IMPLEMENTATION OF SYSTEM.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (1)
Automated Concept:

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: initial
Sec 1302. -- Medical Home Pilot Program.
(3) DURATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (3)
Automated Concept:

IMPLEMENTATION funding under subsection ;   Without regard to receipt of initial

Index of Sec 1302. ...

Implementation: monitor fidelity of program
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (iv)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (iv)
Automated Concept:

IMPLEMENTATION to ensure that services delivered according to specified model ;   Monitor fidelity of program

Index of Sec 1904. ...

Implementation: purposes of
Sec 1111. -- Payments To Skilled Nursing Facilities.
(C) RULEMAKING.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (C)
Automated Concept:

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: initial
Sec 1302. -- Medical Home Pilot Program.
(3) DURATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (3)
Automated Concept:

IMPLEMENTATION phase ;   Demonstration site under pilot program operating for period of up to 5 years after initial

Index of Sec 1302. ...

Implementation plan: detailed
Sec 1302. -- Medical Home Pilot Program.
(6) INITIAL IMPLEMENTATION FUNDING.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (6)
Automated Concept:

IMPLEMENTATION plan including funds to be used ;   Organization providing Secretary with detailed

Index of Sec 1302. ...

Imposition
Sec 1421. -- Civil Money Penalties.
(VIII) PROCEDURE.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VIII)
Automated Concept:

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. ...
(V) PROCEDURE.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (V)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(3) SECRETARIAL AUTHORITY.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (3)
Automated Concept:

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: date of
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (cc)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (cc)
Automated Concept:

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. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iv) (III)
Automated Concept:

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. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (cc)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (IV) (cc)
Automated Concept:

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: initial day of
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (bb)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (bb)
Automated Concept:

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. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (II)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iv) (II)
Automated Concept:

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. ...
(IV) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (bb)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (IV) (bb)
Automated Concept:

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
Sec 1614. -- Enhanced Hospice Program Safeguards.
(1) DEVELOPMENT AND IMPLEMENTATION. - paragraph (B)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (1) (B)
Automated Concept:

IMPOSITION of sanctions ;   Appropriate procedures for appealing determinations relating to

Index of Sec 1614. ...

Imposition: date of
Sec 1421. -- Civil Money Penalties.
(II) REDUCTION OF CIVIL MONEY PENALTIES IN CERTAIN CIRCUMSTANCES.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (2) (A) Quoted: (ii) (II)
Automated Concept:

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. ...

Imposition: result of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(3) USE OF FUNDS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (3)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(1) ENSURING TRANSPARENCY, CREDIBILITY, AND ACCESS. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (c) (1) (A)
Automated Concept:

INAPPROATIONS political or stakeholder influence ;   Establishment of agenda and conduct of research to be insulated from

Index of Sec 1401. ...

Incentive arrangements: separate
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) AUTHORITY FOR SEPARATE INCENTIVE ARRANGEMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (1)
Automated Concept:

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: payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (f) (1)
Automated Concept:

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
Incentive models: different payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (a)
Automated Concept:

INCENTIVE models ;   Secretary conducting pilot program to test different payment

Index of Sec 1301. ...

Incentive models: payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) TESTING AND REFINEMENT OF PAYMENT INCENTIVE MODELS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (h) (1)
Automated Concept:

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: specific payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (a)
Automated Concept:

INCENTIVE models described in subsection ;   Including specific payment

Index of Sec 1301. ...
(c) SPECIFIC PAYMENT INCENTIVE MODELS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c)
Automated Concept:

INCENTIVE models described in subsection following ;   Specific payment

Index of Sec 1301. ...

Incentive payment
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (A)
Automated Concept:

EXPENDITURES for items and services covered under parts A and B ;   Resulting from normal variation in

Index of Sec 1301. ...
(i) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (C) (i)
Automated Concept:

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. ...
(2) TRANSITION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (i) (2)
Automated Concept:

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: receipt of
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) TRANSITION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (i) (2)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(B) INCLUSION OF OTHER PROVIDERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (1) (B)
Automated Concept:

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. ...
(D) OTHER PHYSICIAN ORGANIZATIONAL MODEL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (1) (D)
Automated Concept:

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. ...
(2) QUALIFYING CRITERIA. - paragraph (A)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (2) (A)
Automated Concept:

INCENTIVE payments under section ;   Group having legal structure allowing group to receive and distribute

Index of Sec 1301. ...
(ii) LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (C) (ii)
Automated Concept:

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. ...
(D) REPORTING AND OTHER REQUIREMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (D)
Automated Concept:

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. ...
(2) EXTENSION. - paragraph (A)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (g) (2) (A)
Automated Concept:

INCENTIVE payments with respect to first 4 years of pilot agreement and consistently meeting quality standards ;   ACO receiving

Index of Sec 1301. ...
(3) TERMINATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (g) (3)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(D) REPORTING AND OTHER REQUIREMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (D)
Automated Concept:

INCENTIVE payments and penalties related to physician quality reporting initiative ;   Secretary incorporating reporting requirements,

Index of Sec 1301. ...

Income
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (a) (1) (A)
Automated Concept:

INCOME beneficiaries ;   Appropriate amount and distribution of Medicare dss to compensate for higher Medicare costs associated with serving low-

Index of Sec 1112. ...
Sec 1167. -- Improving Risk Adjustment For Payments.
(a) REPORT TO CONGRESS.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (a)
Automated Concept:

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. ...
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) INDIAN TRIBES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (1)
Automated Concept:

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. ...
(2) STATES AND TERRITORIES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (2)
Automated Concept:

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. ...
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(ii) PRESUMPTIVE ELIGIBILITY OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (ii)
Automated Concept:

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. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(3) CHIP MOE TERMINATION DATE. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (3) (B)
Automated Concept:

INCOME child or otherwise ;   Term Chip enrollee meaning targeted low-

Index of Sec 1703. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(1) IN GENERAL. - paragraph (C) - paragraph (IX)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (b) (1) (C) Quoted: (IX)
Automated Concept:

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: 133 1/3 percent of
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(1) IN GENERAL. - paragraph (C) - paragraph (VIII)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (a) (1) (C) Quoted: (VIII)
Automated Concept:

INCOME official poverty line applicable to family of size involved ;   Families whose income not exceeding 133 1/3 percent of

Index of Sec 1701. ...
(1) IN GENERAL. - paragraph (C) - paragraph (IX)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (b) (1) (C) Quoted: (IX)
Automated Concept:

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: certain low
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(ii) RFP CONTRACT DESCRIBED.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (ii)
Automated Concept:

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: eligibility determinations
Sec 1201. -- Improving Assets Tests For Medicare Savings Program And Low-Income Subsidy Program.
(b) EFFECTIVE DATE.
DIVISION B TITLE II SUBTITLE A SEC 1201. (b)
Automated Concept:

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: family
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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: maximum amount of
Sec 1731. -- Optional Medicaid Coverage Of Low-Income Hiv-Infected Individuals.
(a) IN GENERAL. - paragraph (2) - paragraph (ii) - paragraph (2)
DIVISION B TITLE VII SUBTITLE D SEC 1731. (a) (2) Quoted: (ii) (2)
Automated Concept:

INCOME disabled individual described in subsection and obtaining medical assistance under plan ;   Whose income not exceeding maximum amount of

Index of Sec 1731. ...

Income: Part B
Sec 1235. -- Exception For Use Of More Recent Tax Year In Case Of Gains From Sale Of Primary Residence In Computing Part B Income-Related Premium.
SEC 1235. -- EXCEPTION FOR USE OF MORE RECENT TAX YEAR IN CASE OF GAINS FROM SALE OF PRIMARY RESIDENCE IN COMPUTING PART B INCOME-RELATED PREMIUM.
DIVISION B TITLE II SUBTITLE C SEC 1235.
Automated Concept:

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: whose
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(1) IN GENERAL. - paragraph (C) - paragraph (VIII)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (a) (1) (C) Quoted: (VIII)
Automated Concept:

INCOME not exceeding 133 1/3 percent of income official poverty line applicable to family of size involved ;   Families whose

Index of Sec 1701. ...
(1) IN GENERAL. - paragraph (C) - paragraph (IX)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (b) (1) (C) Quoted: (IX)
Automated Concept:

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. ...
Sec 1731. -- Optional Medicaid Coverage Of Low-Income Hiv-Infected Individuals.
(a) IN GENERAL. - paragraph (2) - paragraph (ii) - paragraph (2)
DIVISION B TITLE VII SUBTITLE D SEC 1731. (a) (2) Quoted: (ii) (2)
Automated Concept:

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
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...
Sec 1801. -- 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.
SEC 1801. -- 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.
DIVISION B TITLE VIII SEC 1801.
Automated Concept:

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. ...

Income families
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (A)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (A)
Automated Concept:

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
Sec 1801. -- 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.
(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.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19)
Automated Concept:

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: low
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(1) COVERED DRUG COSTS. - paragraph (B)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (1) (B)
Automated Concept:

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: retroactive low
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
SEC 1204. -- ENHANCED OVERSIGHT RELATING TO REIMBURSEMENTS FOR RETROACTIVE LOW INCOME SUBSIDY ENROLLMENT.
DIVISION B TITLE II SUBTITLE A SEC 1204.
Automated Concept:

INCOME Subsidy enrollment ;   Enhancing oversight relating to reimbursements for retroactive low

Index of Sec 1204. ...

Income subsidy program
Income subsidy program
Sec 1201. -- Improving Assets Tests For Medicare Savings Program And Low-Income Subsidy Program.
SEC 1201. -- IMPROVING ASSETS TESTS FOR MEDICARE SAVINGS PROGRAM AND LOW-INCOME SUBSIDY PROGRAM.
DIVISION B TITLE II SUBTITLE A SEC 1201.
Automated Concept:

INCOME Subsidy Program ;   Sec 1201 improving asseal testing for medicare savings Program and low-

Index of Sec 1201. ...

Income subsidy program: low
Sec 1781. -- Technical Corrections.
(C) DETERMINING AVAILABILITY OF MEDICAL ASSISTANCE.
DIVISION B TITLE VII SUBTITLE H SEC 1781. (b) (3) Quoted: (C)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (C)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (C)
Automated Concept:

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: ease of use of
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (E)
Automated Concept:

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
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(3) SHARED DECISION MAKING.
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (3)
Automated Concept:

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. ...

Incorporation of findings
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (E)
Automated Concept:

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: effective communication of
Sec 1401. -- Comparative Effectiveness Research.
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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. ...

Influenza and hepatitis B and administration
Sec 1310. -- Expanding Access To Vaccines.
(c) CONFORMING AMENDMENTS. - paragraph (5)
DIVISION B TITLE III SEC 1310. (c) (5)
Automated Concept:

HEPATITIS B and administration and inserting federally recommended vaccines and respective administration ;   Influenza and

Index of Sec 1310. ...

Information
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1)
Automated Concept:

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. ...
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1) (B)
Automated Concept:

INFORMATION to be provided in form, manner and times as Secretary specifying  ;  

Index of Sec 1156. ...
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT. - paragraph (C) - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2) (C) (ii)
Automated Concept:

INFORMATION to be reported or disclosed under paragraph to be provided in form, manner and times as Secretary specifying  ;  

Index of Sec 1156. ...
(3) PUBLICATION OF INFORMATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (3)
Automated Concept:

INFORMATION submitted by hospitals under paragraph on public Internet website of Centers for Medicare and Medicaid Services  ;  

Index of Sec 1156. ...
(5) FAILURE TO REPORT OR DISCLOSE INFORMATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (4) Quoted: (5)
Automated Concept:

INFORMATION ;   Failure to report or disclose

Index of Sec 1156. ...
Sec 1181. -- Elimination Of Coverage Gap.
(B) REPORT FORM AND CONTENTS. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (i)
Automated Concept:

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. ...
(B) REPORT FORM AND CONTENTS. - paragraph (iii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (iii)
Automated Concept:

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. ...
(D) CONFIDENTIALITY OF INFORMATION.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (D)
Automated Concept:

INFORMATION disclosed by manufacturers or wholesalers under section ;   Provisions applying to

Index of Sec 1181. ...
(E) OVERSIGHT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (E)
Automated Concept:

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. ...
(F) PENALTIES FOR FAILURE TO PROVIDE TIMELY INFORMATION AND PROVISION OF FALSE INFORMATION. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (F) (i)
Automated Concept:

INFORMATION required under subparagraph on timely basis ;   Failing to provide

Index of Sec 1181. ...
Sec 1233. -- Advance Care Planning Consultation.
(F) - paragraph (i) - paragraph (II)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (F) (i) (II)
Automated Concept:

INFORMATION needed for individual or legal surrogate to make informed decisions regarding completion order  ;  

Index of Sec 1233. ...
(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS.
DIVISION B TITLE II SUBTITLE C SEC 1233. (c) (1) (B)
Automated Concept:

ELECTRONIC versions of Medicare ;   Secretary including information described in subparagraph in paper and

Index of Sec 1233. ...
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(2) APPLICATION.
DIVISION B TITLE II SUBTITLE C SEC 1236. (b) (2)
Automated Concept:

INFORMATION as Secretary requiring ;   Eligible provider seeking to participate in program submitting to Secretary application at time and containing

Index of Sec 1236. ...
(3) PREFERENCE. - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1236. (b) (3) (B)
Automated Concept:

INFORMATION required by Secretary for reporting purposes ;   Necessary information technology infrastructure to collect

Index of Sec 1236. ...
(3) SHARED DECISION MAKING.
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (3)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(A) OBTAINING OFFICIAL DATA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (3) (A)
Automated Concept:

INFORMATION to Center on agreed upon schedule ;   Head of department or agency furnishing that

Index of Sec 1401. ...
(B) DATA COLLECTION. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (3) (B) (iii)
Automated Concept:

INFORMATION for use by Center and Commission under subsection in making reports and recommendations ;   Interesting party to submit

Index of Sec 1401. ...
(2) DUTIES. - paragraph (G)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (G)
Automated Concept:

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. ...
(2) DUTIES. - paragraph (H)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (H)
Automated Concept:

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. ...
(2) DUTIES. - paragraph (J)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (J)
Automated Concept:

INFORMATION produced by research being objective ;   Routinely review processes of Center with respect to research to confirm that

Index of Sec 1401. ...
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
SEC 1411. -- REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411.
Automated Concept:

INFORMATION ;   Requiring disclosure of ownership and additional DISCLOSABLE partying

Index of Sec 1411. ...
(c) REQUIRED DISCLOSURE OF OWNERSHIP AND ADDITIONAL DISCLOSABLE PARTIES INFORMATION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c)
Automated Concept:

INFORMATION ;   Requiring disclosure of ownership and additional DISCLOSABLE partying

Index of Sec 1411. ...
(1) DISCLOSURE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (1)
Automated Concept:

INFORMATION described in paragraph available ;   Facility to have

Index of Sec 1411. ...
(1) DISCLOSURE. - paragraph (A)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (1) (A)
Automated Concept:

INFORMATION ;   State or State long-term care ombudsman requesting

Index of Sec 1411. ...
(1) DISCLOSURE. - paragraph (B)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (1) (B)
Automated Concept:

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. ...
(2) PUBLIC AVAILABILITY OF INFORMATION. - paragraph (A)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (2) (A)
Automated Concept:

INFORMATION ;   Making information described in paragraph available to public upon request and updating

Index of Sec 1411. ...
(A) IN GENERAL. - paragraph (i)
(B) SPECIAL RULE WHERE INFORMATION IS ALREADY REPORTED OR SUBMITTED.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (B)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (4) (A)
Automated Concept:

INFORMATION reported by facility in accordance with final regulations being accurate and current ;   Final regulations ensuring that facility certifying that

Index of Sec 1411. ...
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (b) (1)
Automated Concept:

INFORMATION reported in accordance with final regulations to be made available to public in accordance with procedures established by Secretary  ;  

Index of Sec 1411. ...
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (i)
Automated Concept:

INFORMATION reported to Secretary under section 1124(c)(4)  ;  

Index of Sec 1413. ...
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (ii)
Automated Concept:

INFORMATION on Special Focus Facility program established by Centers for Medicare and Medicaid Services according to procedures established by Secretary  ;  

Index of Sec 1413. ...
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (iii)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (iv)
Automated Concept:

CERTIFICATION programs ;   Links to State Internet websites with information regarding State survey and

Index of Sec 1413. ...
(i) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (B) (i)
Automated Concept:

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. ...
(ii) EXCEPTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (B) (ii)
Automated Concept:

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. ...
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (2) (A) Quoted: (E)
Automated Concept:

INFORMATION provided on Nursing Home comparing Medicare website ;   Secretary using information submitted under preceding sentence to update

Index of Sec 1413. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (A) (i)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (A) (ii)
Automated Concept:

CERTIFICATION programs ;   Links to State Internet websites with information regarding State survey and

Index of Sec 1413. ...
(i) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (B) (i)
Automated Concept:

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. ...
(ii) EXCEPTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (B) (ii)
Automated Concept:

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. ...
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (2) (A) Quoted: (E)
Automated Concept:

INFORMATION provided on Nursing Home comparing Medicare website ;   Secretary using information submitted under preceding sentence to update

Index of Sec 1413. ...
(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (c) (1) Quoted: (D) (ii)
Automated Concept:

INFORMATION about complainants or residents ;   Facility not making available under clause identifying

Index of Sec 1413. ...
(D) AVAILABILITY OF SURVEY, CERTIFICATION, AND COMPLAINT INVESTIGATION REPORTS. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (c) (2) Quoted: (D) (ii)
Automated Concept:

INFORMATION about complainants or residents ;   Facility not making available under clause identifying

Index of Sec 1413. ...
(1) GUIDANCE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (d) (1)
Automated Concept:

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. ...
Sec 1414. -- Reporting Of Expenditures.
(4) AVAILABILITY OF INFORMATION SUBMITTED.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (4)
Automated Concept:

EXPENDITURES submitted under subsection readily available to interested parties upon request ;   Secretary establishing procedures to make information on

Index of Sec 1414. ...
Sec 1415. -- Standardized Complaint Form.
(E) GOOD FAITH DEFINED. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (E) (i)
Automated Concept:

INFORMATION reported or disclosed in complaint being true  ;  

Index of Sec 1415. ...
(E) GOOD FAITH DEFINED. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (E) (ii)
Automated Concept:

INFORMATION ;   Violation of title occurring or occurring in relation to

Index of Sec 1415. ...
(E) GOOD FAITH DEFINED. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (E) (i)
Automated Concept:

INFORMATION reported or disclosed in complaint being true  ;  

Index of Sec 1415. ...
(E) GOOD FAITH DEFINED. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (E) (ii)
Automated Concept:

INFORMATION ;   Violation of title occurring or occurring in relation to

Index of Sec 1415. ...
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C)
Automated Concept:

INFORMATION submitted under preceding sentence ;   Specifications requiring that

Index of Sec 1416. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C) (iv)
Automated Concept:

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. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C)
Automated Concept:

INFORMATION submitted under preceding sentence ;   Specifications requiring that

Index of Sec 1416. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C) (iv)
Automated Concept:

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. ...
Sec 1422. -- National Independent Monitor Pilot Program.
(2) SELECTION.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (a) (2)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) AGGREGATE REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (2)
Automated Concept:

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. ...
(6) CONFIDENTIALITY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (6)
Automated Concept:

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. ...
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (B)
Automated Concept:

INFORMATION presented by name of applicable manufacturer or distributor ;   Containing

Index of Sec 1451. ...
(1) IN GENERAL. - paragraph (F)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (F)
Automated Concept:

CLINICAL research ;   Separately listed information as funding for

Index of Sec 1451. ...
(1) IN GENERAL. - paragraph (H)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (H)
Automated Concept:

INFORMATION making available to public with respect to covered recipient ;   Providing covered recipient opportunity to submit corrections to

Index of Sec 1451. ...
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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. ...
(3) SPECIAL RULE FOR DRUG SAMPLES.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (3)
Automated Concept:

INFORMATION relating to drug samples provided under subsection not to be made available to public by Secretary  ;  

Index of Sec 1451. ...
(4) SPECIAL RULE FOR NATIONAL PROVIDER IDENTIFIERS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (4)
Automated Concept:

INFORMATION relating to national provider identifiers provided under subsection not to be made available to public by Secretary  ;  

Index of Sec 1451. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (A)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (2) (A)
Automated Concept:

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. ...
(e) ANNUAL REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (e) (1)
Automated Concept:

INFORMATION during year ;   Biological or medical supply submitting

Index of Sec 1451. ...
(10) PHYSICIAN.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (10)
Automated Concept:

INFORMATION under subsection ;   Term not including physician being employee of applicable manufacturer required to submit

Index of Sec 1451. ...
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (A)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (A)
Automated Concept:

INFORMATION not of type required to be disclosed or reported under section ;   Disclosure or reporting of

Index of Sec 1451. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (1)
Automated Concept:

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. ...
(2) REPORTING PROTOCOLS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (2)
Automated Concept:

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. ...
(4) PROCEDURES TO ENSURE THE VALIDITY OF INFORMATION.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (4)
Automated Concept:

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. ...
(b) PUBLIC POSTING OF INFORMATION.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (b)
Automated Concept:

INFORMATION reported under subsection ;   Secretary promptly posting

Index of Sec 1461. ...
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(i) STATE REPORTS. - paragraph (2)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (i) (2)
Automated Concept:

INFORMATION on service model used by program and performance of program ;   Characteristics program including

Index of Sec 1904. ...
Sec 1616. -- Enhanced Penalties For Provision Of False Information By Medicare Advantage And Part D Plans.
(a) IN GENERAL.
DIVISION B TITLE VI SUBTITLE B SEC 1616. (a)
Automated Concept:

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. ...
Sec 1643. -- Access To Certain Information On Renal Dialysis Facilities.
SEC 1643. -- ACCESS TO CERTAIN INFORMATION ON RENAL DIALYSIS FACILITIES. - paragraph (15)
DIVISION B TITLE VI SUBTITLE C SEC 1643. Quoted: (15)
Automated Concept:

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. ...
0
SUBTITLE D -- ACCESS TO INFORMATION NEEDED TO PREVENT FRAUD, WASTE, AND ABUSE.
DIVISION B TITLE VI SUBTITLE D
Automated Concept:

FRAUD, Waste and Abuse ;   Subtitle D across Access to information needed to prevent

Index of 0
Sec 1652. -- Elimination Of Duplication Between The Healthcare Integrity And Protection Data Bank And The National Practitioner Data Bank.
(h) SUNSET OF THE HEALTHCARE INTEGRITY AND PROTECTION DATA BANK; TRANSITION PROCESS.
DIVISION B TITLE VI SUBTITLE D SEC 1652. (a) (3) Quoted: (h)
Automated Concept:

INFORMATION required to be reported under preceding provisions of section in npdb ;   Secretary ceasing operation of HIPDB and collecting

Index of Sec 1652. ...
(1) IN GENERAL.
DIVISION B TITLE VI SUBTITLE D SEC 1652. (c) (1)
Automated Concept:

INFORMATION described in paragraph to be available from National Practitioner Data Bank to Secretary of Veterans Affairs without charging  ;  

Index of Sec 1652. ...
(2) INFORMATION DESCRIBED.
DIVISION B TITLE VI SUBTITLE D SEC 1652. (c) (2)
Automated Concept:

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. ...
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (3) (B)
Automated Concept:

INFORMATION on basis of which determination being made to Commissioner ;   Agency forwarding

Index of Sec 1702. ...
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(a) IN GENERAL. - paragraph (3) - paragraph (xiii)
DIVISION B TITLE VII SUBTITLE E SEC 1743. (a) (3) Quoted: (xiii)
Automated Concept:

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. ...
Sec 1744. -- Payments For Graduate Medical Education.
(2) SUBMISSION OF INFORMATION. - paragraph (A)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (2) (A)
Automated Concept:

EDUCATION and payments used for graduate medical education ;   Information on total payments for graduate medical

Index of Sec 1744. ...
(3) REVIEW OF INFORMATION.
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (3)
Automated Concept:

INFORMATION submitted under paragraph ;   Secretary and Advisory Committee independently reviewing

Index of Sec 1744. ...
Sec 1801. -- 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.
(B) APPLICABLE YEAR.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (B)
Automated Concept:

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
Sec 1181. -- Elimination Of Coverage Gap.
(F) PENALTIES FOR FAILURE TO PROVIDE TIMELY INFORMATION AND PROVISION OF FALSE INFORMATION.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (F)
Automated Concept:

INFORMATION and Provision of false information ;   Penalties for failure to provide timely

Index of Sec 1181. ...

Information: accuracy of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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: additional
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) ELIGIBILITY. - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1222. (b) (1) (B)
Automated Concept:

INFORMATION as Secretary requiring ;   Manner and accompanied by additional

Index of Sec 1222. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(d) REPORT ON ADDITIONAL DATA.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (d)
Automated Concept:

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. ...
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(2) ENHANCED SAFEGUARDS.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (2)
Automated Concept:

BOND ;   Requiring or unannounced site visits or inspections, additional information reporting requirements and conditioning enrollment on provision of surety

Index of Sec 1632. ...

Information: analysis of appropriateness of types of
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(c) GAO REPORT.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (c)
Automated Concept:

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: annual submission of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) LIMITATION.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (B)
Automated Concept:

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. ...
(B) LIMITATION.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (2) (B)
Automated Concept:

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: appropriate
Sec 1401. -- Comparative Effectiveness Research.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (d) (1)
Automated Concept:

INFORMATION contained in report to be posted on official public Internet site of Center and Commission as applicable ;   Appropriate

Index of Sec 1401. ...

Information: assurances and
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(e) APPLICATION FOR GRANT.
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (e)
Automated Concept:

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: case of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) IN GENERAL. - paragraph (F)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (F)
Automated Concept:

INFORMATION submitted with respect to payment or other transfer of value described in subsection, lists ;   Case of

Index of Sec 1451. ...

Information: Commission or
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(B) SPECIAL RULE WHERE INFORMATION IS ALREADY REPORTED OR SUBMITTED.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (B)
Automated Concept:

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: comparison of
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(b) PUBLIC POSTING OF INFORMATION.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (b)
Automated Concept:

HEALTH care-associated infections ;   Information to be set forth in manner allowing for comparison of information on

Index of Sec 1461. ...

Information: confidentiality of
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(2) ADMINISTRATION. - paragraph (D)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (b) (2) (D)
Automated Concept:

CONFIDENTIALITY of information ;   Excepting for provisions related to

Index of Sec 1122. ...

Information: copy of
Sec 1181. -- Elimination Of Coverage Gap.
(C) SUBMISSION TO SECRETARY.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (C)
Automated Concept:

INFORMATION reported under subparagraph to Secretary for purpose of audit oversight and evaluation ;   PDP sponsor promptly transmitting copy of

Index of Sec 1181. ...

Information: credible research and
Sec 1401. -- Comparative Effectiveness Research.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (1)
Automated Concept:

INFORMATION resulting from research ;   Ensuring activities resulting in highly credible research and

Index of Sec 1401. ...

Information: date of receipt of
Sec 1181. -- Elimination Of Coverage Gap.
(2) REBATE AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (2)
Automated Concept:

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. ...

Information: disclosure of
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(d) NON-PREEMPTION OF STATE LAWS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (d)
Automated Concept:

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. ...

Information: disclosure of return
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...

Information: discovery or admissibility of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (C)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (C)
Automated Concept:

ADMINISTRATIVE proceeding ;   Discovery or admissibility of information described in section in criminal, civil or

Index of Sec 1451. ...

Information: exchange of
Sec 1224. -- Definitions.
(4) EFFECTIVE COMMUNICATION.
DIVISION B TITLE II SUBTITLE B SEC 1224. (4)
Automated Concept:

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: false
Sec 1181. -- Elimination Of Coverage Gap.
(F) PENALTIES FOR FAILURE TO PROVIDE TIMELY INFORMATION AND PROVISION OF FALSE INFORMATION.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (F)
Automated Concept:

INFORMATION ;   Penalties for failure to provide timely information and Provision of false

Index of Sec 1181. ...
(F) PENALTIES FOR FAILURE TO PROVIDE TIMELY INFORMATION AND PROVISION OF FALSE INFORMATION. - paragraph (ii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (F) (ii)
Automated Concept:

INFORMATION ;   Sponsor being subject to civil money penalty in amount not to exceed $100,000 for item of false

Index of Sec 1181. ...

Information: following
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(e) REPORTING REQUIREMENTS.
DIVISION B TITLE II SUBTITLE B SEC 1222. (e)
Automated Concept:

INFORMATION ;   Report including following

Index of Sec 1222. ...

Information: Form or
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) IN GENERAL.
(B) SPECIAL RULE WHERE INFORMATION IS ALREADY REPORTED OR SUBMITTED.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (B)
Automated Concept:

INFORMATION to meet requirements of paragraph submitted in manner specified by Secretary ;   Secretary allowing Form or

Index of Sec 1411. ...

Information: further
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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: inaccurate or misleading
Sec 1619. -- Exclusion Of Certain Individuals And Entities From Participation In Medicare And State Health Care Programs.
(C) - paragraph (iii)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (iii)
Automated Concept:

INFORMATION resulted in waiver of overpayment under clause ;   Federal health care program contractor provided inaccurate or misleading

Index of Sec 1619. ...

Information: inclusion of
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (ii)
Automated Concept:

INFORMATION with respect ;   Procedures providing for inclusion of

Index of Sec 1413. ...

Information: manufacturer provision of
Sec 1310. -- Expanding Access To Vaccines.
(G) IMPLEMENTATION.
DIVISION B TITLE III SEC 1310. (c) (3) Quoted: (G)
Automated Concept:

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: Medicare program of
Sec 1162. -- Quality Bonus Payments.
(F) NOTIFICATION.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (F)
Automated Concept:

INFORMATION described in previous sentence ;   Secretary providing for publication on website for Medicare program of

Index of Sec 1162. ...

Information: other
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) IN GENERAL. - paragraph (F)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (F)
Automated Concept:

INFORMATION submitted under subsection and designating ;   Information separately from other

Index of Sec 1451. ...
(1) IN GENERAL. - paragraph (G)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (G)
Automated Concept:

INFORMATION Secretary determining to be helpful to average consumer ;   Containing other

Index of Sec 1451. ...
Sec 1744. -- Payments For Graduate Medical Education.
(2) SUBMISSION OF INFORMATION. - paragraph (A) - paragraph (vi)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (2) (A) (vi)
Automated Concept:

INFORMATION as Secretary determining assisting in carrying out paragraphs ;   Other

Index of Sec 1744. ...

Information: other return
Sec 1801. -- 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.
(A) IN GENERAL. - paragraph (vi)
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (A) (vi)
Automated Concept:

INFORMATION relating to individual as prescribed by Secretary by regulation ;   Other return

Index of Sec 1801. ...

Information: other treatment of
Sec 1652. -- Elimination Of Duplication Between The Healthcare Integrity And Protection Data Bank And The National Practitioner Data Bank.
(h) SUNSET OF THE HEALTHCARE INTEGRITY AND PROTECTION DATA BANK; TRANSITION PROCESS.
DIVISION B TITLE VI SUBTITLE D SEC 1652. (a) (3) Quoted: (h)
Automated Concept:

INFORMATION specified in section ;   Other treatment of

Index of Sec 1652. ...

Information: performance
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (2)
Automated Concept:

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: personal health
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) CONSIDERATIONS. - paragraph (2)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1193. (b) (2)
Automated Concept:

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: provisions of paragraph and
Sec 1415. -- Standardized Complaint Form.
(v) REQUIREMENT TO POST NOTICE OF EMPLOYEE RIGHTS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (v)
Automated Concept:

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. ...
(v) REQUIREMENT TO POST NOTICE OF EMPLOYEE RIGHTS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (v)
Automated Concept:

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. ...

Information: related
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(ii) PRESUMPTIVE ELIGIBILITY OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (ii)
Automated Concept:

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. ...

Information: return
Sec 1801. -- 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.
(D) RESTRICTION ON USE OF DISCLOSED INFORMATION.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (D)
Automated Concept:

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: submission of
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C) (iv)
Automated Concept:

INFORMATION with respect to specific categories ;   Nothing in subparagraph to be construed as preventing Secretary from requiring submission of

Index of Sec 1416. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C) (iv)
Automated Concept:

INFORMATION with respect to specific categories ;   Nothing in subparagraph to be construed as preventing Secretary from requiring submission of

Index of Sec 1416. ...

Information: summary of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(g) ANNUAL REPORTS TO STATES.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (g)
Automated Concept:

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: timeliness and comprehensiveness of
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (2) (A) (i)
Automated Concept:

INFORMATION reported on websiteing as of day before date of enactment of subsection ;   Clarity of presentation, timeliness and comprehensiveness of

Index of Sec 1413. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (2) (A) (i)
Automated Concept:

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: timeliness of
Sec 1413. -- Nursing Home Compare Medicare Website.
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (2) (A) Quoted: (E)
Automated Concept:

INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ;   Improving timeliness of

Index of Sec 1413. ...
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (2) (A) Quoted: (E)
Automated Concept:

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: transmission of
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(3) COORDINATION WITH HIT.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (a) (3)
Automated Concept:

INFORMATION under subsection coordinated with systems established under HITECH Act where appropriate ;   Ensuring that transmission of

Index of Sec 1461. ...

Information: truth or falsity of
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (D) - paragraph (7) - paragraph (C)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (D) Quoted: (7) (C)
Automated Concept:

INFORMATION ;   Acts in reckless disregarding of truth or falsity of

Index of Sec 1645. ...

Information: type of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (1)
Automated Concept:

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. ...
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS. - paragraph (B)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2) (B)
Automated Concept:

INFORMATION required to be disclosed or reported under section to Federal ;   Disclosure or reporting of type of

Index of Sec 1451. ...

Information: United States
Sec 1401. -- Comparative Effectiveness Research.
(A) OBTAINING OFFICIAL DATA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (3) (A)
Automated Concept:

INFORMATION necessary to enable to carry out that section ;   Center securing directly from department or agency of United States

Index of Sec 1401. ...

Information: useful
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (F)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (1) (F)
Automated Concept:

INFORMATION on participating patients enabling practice to treat patients comprehensively ;   Clinically useful

Index of Sec 1302. ...
Sec 1413. -- Nursing Home Compare Medicare Website.
(2) REQUIREMENT. - paragraph (C) - paragraph (D)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (d) (2) (C) Quoted: (D)
Automated Concept:

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. ...

Information: users of
Sec 1401. -- Comparative Effectiveness Research.
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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: validity of
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(4) PROCEDURES TO ENSURE THE VALIDITY OF INFORMATION.

Information drug-component
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(B) DISCOUNT AGREEMENT. - paragraph (iii)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (2) (B) (iii)
Automated Concept:

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: taxpayer
Sec 1801. -- 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.
(B) APPLICABLE YEAR.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (B)
Automated Concept:

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
Sec 1651. -- Access To Information Necessary To Identify Fraud, Waste, And Abuse.
(d) ACCESS TO INFORMATION NECESSARY TO IDENTIFY FRAUD, WASTE, AND ABUSE.
DIVISION B TITLE VI SUBTITLE D SEC 1651. Quoted: (d)
Automated Concept:

INFORMATION systems security requirements enacted by law or otherwise required by Secretary ;   Subject to

Index of Sec 1651. ...

Information technologies: part of health
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(1) PATIENT-CENTERED AND POPULATION-BASED MEASURES. - paragraph (G)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (c) (1) (G)
Automated Concept:

HEALTH care services ;   Collecting as part of health information technologies supporting better delivery of

Index of Sec 1442. ...

Information technology
Information technology: users of health
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (E)
Automated Concept:

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. ...

Information technology: vendors of health
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1)
Automated Concept:

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 technology infrastructure: necessary
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(3) PREFERENCE. - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1236. (b) (3) (B)
Automated Concept:

INFORMATION required by Secretary for reporting purposes ;   Necessary information technology infrastructure to collect

Index of Sec 1236. ...

Instead of State plans
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(B) DISCOUNT AGREEMENT. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (2) (B) (i)
Automated Concept:

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. ...

Institutional
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(2) QUALITY MEASURE.
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (d) (2)
Automated Concept:

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. ...
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) CONSIDERATIONS. - paragraph (3)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1193. (b) (3)
Automated Concept:

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. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (e) (1)
Automated Concept:

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
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(2) EXEMPTION FOR CERTAIN POLICIES.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (c) (2)
Automated Concept:

INSURANCE if substantially of coverage of excepted benefits described in section 9832(c) ;   Term specified health insurance policy not including

Index of Sec 1802. ...

Insurance: contract of
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(2) INSURANCE POLICY.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (a) (2)
Automated Concept:

CONTRACT of insurance issued, renewed or extended ;   Term insurance policy meaning policy or other instrument whereby

Index of Sec 1802. ...

Insurance: health
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(4) COVERED RECIPIENT. - paragraph (E)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (4) (E)
Automated Concept:

HEALTH benefiting plan ;   Health insurance issuer, group health plan or other entity offering

Index of Sec 1451. ...

Insurance: liability
Sec 1412. -- Accountability Requirements.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (c) (1) (C)
Automated Concept:

CAPITALIATIONS ;   Requirements relating to surety bonds, liability insurance or minimum

Index of Sec 1412. ...

Insurance benefits: hospital
Sec 1234. -- Part B Special Enrollment Period And Waiver Of Limited Enrollment Penalty For Tricare Beneficiaries.
(l) - paragraph (1)
DIVISION B TITLE II SUBTITLE C SEC 1234. (a) (1) Quoted: (l) (1)
Automated Concept:

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. ...
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1234. (b) (2) (B) (i)
Automated Concept:

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. ...

Insurance policy
Insurance policy: accident or health
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(1) IN GENERAL.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (c) (1)
Automated Concept:

HEALTH insurance policy issued with respect to individuals residing in United States ;   Term specified health insurance policy meaning accident or

Index of Sec 1802. ...

Insurance policy: health
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(1) IN GENERAL.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (c) (1)
Automated Concept:

ACCIDENT or health insurance policy issued with respect to individuals residing in United States ;   Term specified health insurance policy meaning

Index of Sec 1802. ...
(2) EXEMPTION FOR CERTAIN POLICIES.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (c) (2)
Automated Concept:

HEALTH insurance policy not including insurance if substantially of coverage of excepted benefits described in section 9832(c) ;   Term specified

Index of Sec 1802. ...

Insurance policy: specified health
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(a) IMPOSITION OF FEE.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (a)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4375. (c) (3) (A) (i)
Automated Concept:

HEALTH insurance policy ;   Arrangement to be treated as specified

Index of Sec 1802. ...
(1) ACCIDENT AND HEALTH COVERAGE.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (a) (1)
Automated Concept:

HEALTH insurance policy ;   Term accident and health coverage meaning coverage causing policy to be specified

Index of Sec 1802. ...

Insurance policy: term
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(2) INSURANCE POLICY.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (a) (2)
Automated Concept:

CONTRACT of insurance issued, renewed or extended ;   Term insurance policy meaning policy or other instrument whereby

Index of Sec 1802. ...

Insurance program
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED. - paragraph (A)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (b) (3) (A)
Automated Concept:

INSURANCE program established under title XVIII of Social Security Act  ;  

Index of Sec 1802. ...

Interest
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(C) SPECIAL RULE. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (C) (ii)
Automated Concept:

INTEREST being equal or exceeding 5 percent of total property or asseal of entirety  ;  

Index of Sec 1411. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(b) REPORTING OF OWNERSHIP INTEREST BY PHYSICIANS IN HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (b)
Automated Concept:

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. ...

Interest: investment
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (v)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (v)
Automated Concept:

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: whole or part
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(C) SPECIAL RULE. - paragraph (ii)
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (ii)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(11) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS. - paragraph (F)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (11) (F)
Automated Concept:

INTERNAL organization and operation of Commission ;   Prescribing rules and regulations as deeming necessary with respect to

Index of Sec 1401. ...

Jeopardy
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a) (1)
Automated Concept:

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: immediate
Sec 1421. -- Civil Money Penalties.
(II) APPLICABLE PER INSTANCE AMOUNT. - paragraph (bb)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (II) (bb)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...
(III) APPLICABLE PER DAY AMOUNT. - paragraph (aa)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (III) (aa)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...
(ii) APPLICABLE PER INSTANCE AMOUNT. - paragraph (II)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (ii) (II)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...
(iii) APPLICABLE PER DAY AMOUNT. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iii) (I)
Automated Concept:

JEOPARDY ;   Case of deficiency where facility cited for actual harm or immediate

Index of Sec 1421. ...

Jurisdiction
Sec 1415. -- Standardized Complaint Form.
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iii)
Automated Concept:

CITIZENSHIP of parties and jurisdiction to grant complete relief ;   Jurisdiction over action without regard to amount in controversy or

Index of Sec 1415. ...
(iii) COMMENCEMENT OF ACTION.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iii)
Automated Concept:

CITIZENSHIP of parties and jurisdiction to grant complete relief ;   Jurisdiction over action without regard to amount in controversy or

Index of Sec 1415. ...

Justification: empirical
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (1) (A)
Automated Concept:

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
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(c) RESPONSIBILITIES. - paragraph (2)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (c) (2)
Automated Concept:

LEAD to betting coordination of community-based care  ;  

Index of Sec 1905. ...

Lease agreement: purchase or
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(C) EXCLUSIONS. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (iii)
Automated Concept:

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
Sec 1705. -- Expanded Outstationing.
(b) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE A SEC 1705. (b) (2)
Automated Concept:

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. ...
Sec 1711. -- Required Coverage Of Preventive Services.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1711. (c) (2)
Automated Concept:

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. ...
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1756. (c) (2)
Automated Concept:

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. ...
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (c) (2)
Automated Concept:

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. ...
Sec 1759. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicaid.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1759. (c) (2)
Automated Concept:

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
Legislature: close of first regular session of State
Sec 1705. -- Expanded Outstationing.
(b) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE A SEC 1705. (b) (2)
Automated Concept:

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. ...
Sec 1711. -- Required Coverage Of Preventive Services.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1711. (c) (2)
Automated Concept:

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. ...
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1756. (c) (2)
Automated Concept:

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. ...
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (c) (2)
Automated Concept:

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. ...
Sec 1759. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicaid.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1759. (c) (2)
Automated Concept:

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: separate regular session of State
Sec 1705. -- Expanded Outstationing.
(b) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE A SEC 1705. (b) (2)
Automated Concept:

LEGISLATURE ;   Year of session to be deemed to be separate regular session of State

Index of Sec 1705. ...
Sec 1711. -- Required Coverage Of Preventive Services.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1711. (c) (2)
Automated Concept:

LEGISLATURE ;   Year of session to be deemed to be separate regular session of State

Index of Sec 1711. ...
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1756. (c) (2)
Automated Concept:

LEGISLATURE ;   Year of session to be deemed to be separate regular session of State

Index of Sec 1756. ...
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (c) (2)
Automated Concept:

LEGISLATURE ;   Year of session to be deemed to be separate regular session of State

Index of Sec 1757. ...
Sec 1759. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicaid.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1759. (c) (2)
Automated Concept:

LEGISLATURE ;   Year of session to be deemed to be separate regular session of State

Index of Sec 1759. ...

Liability: potential
Sec 1641. -- Required Repayments Of Medicare And Medicaid Overpayments.
(3) CLARIFICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (3)
Automated Concept:

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. ...

Licensure or certification
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (2) - paragraph (A)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (2) (A)
Automated Concept:

CERTIFICATION as marriage and family therapist pursuant to State law ;   Possessing master or doctoral degree qualifying for licensure or

Index of Sec 1308. ...
(kkk) MENTAL HEALTH COUNSELOR SERVICES. - paragraph (2) - paragraph (A)
DIVISION B TITLE III SEC 1308. (b) (2) Quoted: (kkk) (2) (A)
Automated Concept:

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: time of declaration and
Sec 1148. -- Durable Medical Equipment Program Improvements.
(iii) EXCEPTION FOR BANKRUPTCY.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (d) Quoted: (iii)
Automated Concept:

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
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iii)
Automated Concept:

LOAN ;   Hospital not directly or indirectly guaranteeing

Index of Sec 1156. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(C) EXCLUSIONS. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (ii)
Automated Concept:

LOAN of covered device for short-term trial period to permit evaluation of covered device by covered recipient  ;  

Index of Sec 1451. ...

Logistics and drug destruction
Sec 1741. -- Payments To Pharmacists.
(2) DEFINITION OF AMP. - paragraph (C) - paragraph (iii)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (2) (C) Quoted: (iii)
Automated Concept:

DRUG destruction ;   Damaging, expired or otherwise unsalable returned goods reversing logistics and

Index of Sec 1741. ...

Malpractice: practice expense and
Sec 1125. -- Adjustment To Medicare Payment Localities.
(ii) TRANSITION.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1125. (a) Quoted: (6) (A) (ii)
Automated Concept:

MALPRACTICE geographic indices described in clauses ;   Calculating work, practice expense and

Index of Sec 1125. ...

Mammography
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(A) EXCLUSION FROM OPD FEE SCHEDULE.
DIVISION B TITLE III SEC 1305. (b) (2) (A)
Automated Concept:

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. ...

Mammography: diagnostic
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(A) EXCLUSION FROM OPD FEE SCHEDULE.
DIVISION B TITLE III SEC 1305. (b) (2) (A)
Automated Concept:

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
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (1)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (1)
Automated Concept:

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. ...
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (2) - paragraph (A)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (2) (A)
Automated Concept:

MARRIAGE and family therapist pursuant to State law ;   Possessing master or doctoral degree qualifying for licensure or certification as

Index of Sec 1308. ...
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (2) - paragraph (B)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (2) (B)
Automated Concept:

MARRIAGE and family therapy ;   Obtaining degree performed 2 years of clinical supervised experience in

Index of Sec 1308. ...
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A HEALTH CARE PROFESSIONAL.
DIVISION B TITLE III SEC 1308. (a) (4) (B)
Automated Concept:

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. ...

Marriage: coverage of
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(6) COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
DIVISION B TITLE III SEC 1308. (a) (6)
Automated Concept:

HEALTH Centers ;   Coverage of marriage and Family Therapist Services provided in rural health clinics and federally qualified

Index of Sec 1308. ...

Marriage: term
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (1)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (1)
Automated Concept:

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
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(b) CONFORMING AMENDMENTS. - paragraph (1)
DIVISION B TITLE VII SUBTITLE E SEC 1743. (b) (1)
Automated Concept:

MEDICAID managed care organization if organization being responsible for coverage of drugs ;   Including drugs dispensed to individuals enrolled with

Index of Sec 1743. ...

Medicaid and Chip
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
SEC 1756. -- TERMINATION OF PROVIDER PARTICIPATION UNDER MEDICAID AND CHIP IF TERMINATED UNDER MEDICARE OR OTHER STATE PLAN OR CHILD HEALTH PLAN.
DIVISION B TITLE VII SUBTITLE F SEC 1756.
Automated Concept:

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. ...

Medicaid and Chip exclusion
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
SEC 1757. -- MEDICAID AND CHIP EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS.
DIVISION B TITLE VII SUBTITLE F SEC 1757.
Automated Concept:

AFFILIATIONS ;   Sec 1757, medicaid and Chip exclusion from participation relating to certain ownership, Control and management

Index of Sec 1757. ...

Medicaid and Chip Program disclosure requirements
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
SEC 1632. -- ENHANCED MEDICARE, MEDICAID, AND CHIP PROGRAM DISCLOSURE REQUIREMENTS RELATING TO PREVIOUS AFFILIATIONS.
DIVISION B TITLE VI SUBTITLE C SEC 1632.
Automated Concept:

AFFILIATIONS ;   Enhancing medicare, medicaid and Chip Program disclosure requirements relating to previous

Index of Sec 1632. ...

Medicaid: Enrollees of
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
SEC 1743. -- EXTENSION OF PRESCRIPTION DRUG DISCOUNTS TO ENROLLEES OF MEDICAID MANAGED CARE ORGANIZATIONS.
DIVISION B TITLE VII SUBTITLE E SEC 1743.
Automated Concept:

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 Medicaid Integrity Program.
SEC 1752. -- EVALUATIONS AND REPORTS REQUIRED UNDER MEDICAID INTEGRITY PROGRAM.
DIVISION B TITLE VII SUBTITLE F SEC 1752.
Automated Concept:

MEDICAID integrity Program ;   Sec 1752, evaluations and Reports required under

Index of Sec 1752. ...

Medicaid or Chip and entities
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
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 WITH ENTITIES THAT BILL FOR SERVICES UNDER MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H.
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(3) PRINCIPAL CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (3)
Automated Concept:

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. ...
Sec 1502. -- Increasing Training In Nonprovider Settings.
(c) OIG STUDY ON IMPACT ON TRAINING.
DIVISION B TITLE V SEC 1502. (c)
Automated Concept:

MEDICAL residents in training in nonprovider settings as result of amendments making by section ;   Increase in time spent by

Index of Sec 1502. ...
Sec 1643. -- Access To Certain Information On Renal Dialysis Facilities.
SEC 1643. -- ACCESS TO CERTAIN INFORMATION ON RENAL DIALYSIS FACILITIES. - paragraph (15)
DIVISION B TITLE VI SUBTITLE C SEC 1643. Quoted: (15)
Automated Concept:

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. ...

Medical and therapy staff
Sec 1414. -- Reporting Of Expenditures.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (1)
Automated Concept:

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. ...

Medical: centered
Sec 1302. -- Medical Home Pilot Program.
(B) PER BENEFICIARY PER MONTH PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (B)
Automated Concept:

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. ...

Medical: regular
Sec 1302. -- Medical Home Pilot Program.
(C) HIGH NEED BENEFICIARY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (C)
Automated Concept:

BENEFICIARY meaning individual requiring regular medical monitoring, advising or treatment ;   Term high need

Index of Sec 1302. ...

Medical assistance
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(1) DUAL ELIGIBLE.
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (e) (1)
Automated Concept:

MEDICAL assistance under title XIX ;   Term dual eligible meaning individual being dually eligible for benefits under title XVIII and

Index of Sec 1905. ...
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(y) ADDITIONAL EXPENDITURES SUBJECT TO 100% FMAP. - paragraph (1)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (a) (2) (B) Quoted: (y) (1)
Automated Concept:

MEDICAL assistance for individuals described in subclause of section 1902(a) ;   Amounts expended for

Index of Sec 1701. ...
(3) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE A SEC 1701. (a) (3)
Automated Concept:

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. ...
(3) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE A SEC 1701. (b) (3)
Automated Concept:

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. ...
(c) 100% MATCHING RATE FOR TEMPORARY COVERAGE OF CERTAIN NEWBORNS. - paragraph (2) - paragraph (2)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (c) (2) Quoted: (2)
Automated Concept:

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. ...
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(ii) PRESUMPTIVE ELIGIBILITY OPTION.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (B) (ii)
Automated Concept:

ELIGIBILITY in same manner ;   State providing for making medical assistance available during presumptive eligibility period and promptly making determination of

Index of Sec 1702. ...
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(c) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1713. (c)
Automated Concept:

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. ...
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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. ...
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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. ...
(2) NOTIFICATION REQUIREMENTS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (c) (2) (B)
Automated Concept:

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. ...
(3) APPLICATION FOR MEDICAL ASSISTANCE.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (c) (3)
Automated Concept:

MEDICAL assistance by not later than last day of month following month during that determination being made ;   Individual applying for

Index of Sec 1714. ...
(d) PAYMENT. - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (d) (2)
Automated Concept:

MEDICAL assistance provided by plan for purposes of clause of first sentence of section 1905(b) ;   Treating as

Index of Sec 1714. ...
(2) CONFORMING AMENDMENTS. - paragraph (A)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (2) (A)
Automated Concept:

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. ...
(2) CONFORMING AMENDMENTS. - paragraph (B) - paragraph (ii)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (2) (B) (ii)
Automated Concept:

ELIGIBILITY period under section ;   Medical assistance provided to individual described in subsection of section 1920c during presumptive

Index of Sec 1714. ...
(5) COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (c) Quoted: (5)
Automated Concept:

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. ...
Sec 1721. -- Payments To Primary Care Practitioners.
(3) - paragraph (A)
DIVISION B TITLE VII SUBTITLE C SEC 1721. (b) Quoted: (3) (A)
Automated Concept:

MEDICAL assistance for services described in section 1902(a) furnished after January 1, 2010 ;   Portion of amounts expended for

Index of Sec 1721. ...
Sec 1722. -- Medical Home Pilot Program.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (b) (1)
Automated Concept:

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. ...
Sec 1731. -- Optional Medicaid Coverage Of Low-Income Hiv-Infected Individuals.
(a) IN GENERAL. - paragraph (2) - paragraph (ii) - paragraph (2)
DIVISION B TITLE VII SUBTITLE D SEC 1731. (a) (2) Quoted: (ii) (2)
Automated Concept:

MEDICAL assistance under plan ;   Whose income not exceeding maximum amount of income disabled individual described in subsection and obtaining

Index of Sec 1731. ...
(a) IN GENERAL. - paragraph (2) - paragraph (ii) - paragraph (3)
DIVISION B TITLE VII SUBTITLE D SEC 1731. (a) (2) Quoted: (ii) (3)
Automated Concept:

MEDICAL assistance under plan ;   Whose resources not exceeding maximum amount of resources disabled individual described in subsection and obtaining

Index of Sec 1731. ...
(5) DISREGARDING MEDICAL ASSISTANCE FOR OPTIONAL LOW-INCOME HIV-INFECTED INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE D SEC 1731. (d) Quoted: (5)
Automated Concept:

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. ...
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(a) IN GENERAL. - paragraph (3) - paragraph (xiii)
DIVISION B TITLE VII SUBTITLE E SEC 1743. (a) (3) Quoted: (xiii)
Automated Concept:

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. ...
Sec 1744. -- Payments For Graduate Medical Education.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (1)
Automated Concept:

EDUCATION consistent with subsection whether provided or outside of hospital ;   Term medical assistance including payment for costs of graduate medical

Index of Sec 1744. ...
Sec 1781. -- Technical Corrections.
(B) FURNISHING MEDICAL ASSISTANCE WITH REASONABLE PROMPTNESS.
DIVISION B TITLE VII SUBTITLE H SEC 1781. (b) (3) Quoted: (B)
Automated Concept:

MEDICAL assistance with reasonable promptness ;   Purpose of State's obligation under section 1902(a)(8) to furnish

Index of Sec 1781. ...
(C) DETERMINING AVAILABILITY OF MEDICAL ASSISTANCE.
DIVISION B TITLE VII SUBTITLE H SEC 1781. (b) (3) Quoted: (C)
Automated Concept:

MEDICAL assistance to be made available ;   Purpose of determining when

Index of Sec 1781. ...
(f) CLARIFYING AMENDMENT TO SECTION 1115 OF THE SOCIAL SECURITY ACT.
DIVISION B TITLE VII SUBTITLE H SEC 1781. (f)
Automated Concept:

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: Federal
Sec 1721. -- Payments To Primary Care Practitioners.
(3) - paragraph (B)
DIVISION B TITLE VII SUBTITLE C SEC 1721. (b) Quoted: (3) (B)
Automated Concept:

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. ...
Sec 1782. -- Extension Of Qi Program.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE VII SUBTITLE H SEC 1782. (b) (1) (C)
Automated Concept:

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
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED. - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (b) (3) (B)
Automated Concept:

MEDICAL assistance program established by title XIX or XXI of Social Security Act  ;  

Index of Sec 1802. ...

Medical assistance State plan
Sec 1714. -- State Eligibility Option For Family Planning Services.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (c) (1) (A)
Automated Concept:

MEDICAL assistance under State plan ;   Forms as necessary for application to be made by individual described in subsection for

Index of Sec 1714. ...
(3) APPLICATION FOR MEDICAL ASSISTANCE.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (c) (3)
Automated Concept:

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
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1236. (c) (1)
Automated Concept:

MEDICAL care ;   Preferences and concerns relating to

Index of Sec 1236. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED. - paragraph (C)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (b) (3) (C)
Automated Concept:

MEDICAL care to individuals by reason of individuals ;   Program established by Federal law for providing

Index of Sec 1802. ...
(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED. - paragraph (D)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (b) (3) (D)
Automated Concept:

MEDICAL care to members of Indian tribes ;   Program established by Federal law for providing

Index of Sec 1802. ...

Medical care of condition
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1236. (c) (1)
Automated Concept:

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. ...

Medical care component
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(ii) DEFAULT AMOUNT. - paragraph (II)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (c) (1) (B) (ii) (II)
Automated Concept:

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. ...

Medical diagnosis and treatment services
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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. ...
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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
Sec 1619. -- Exclusion Of Certain Individuals And Entities From Participation In Medicare And State Health Care Programs.
(4) - paragraph (A) - paragraph (ii)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (A) (ii)
Automated Concept:

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. ...
(C) - paragraph (i)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (i)
Automated Concept:

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 emergency
Medical emergencyes
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(ii) EXEMPTIONS. - paragraph (II)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (4) (B) (ii) (II)
Automated Concept:

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. ...

Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(ii) EXEMPTIONS. - paragraph (II)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (4) (B) (ii) (II)
Automated Concept:

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
Sec 1223. -- Iom Report On Impact Of Language Access Services.
(b) CONTENTS. - paragraph (2)
DIVISION B TITLE II SUBTITLE B SEC 1223. (b) (2)
Automated Concept:

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. ...

Medical homes
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (A)
Automated Concept:

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. ...
(1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (1) (B)
Automated Concept:

HOME services under title on permanent basis ;   Feasability and advisability of reimbursing medical homes for medical

Index of Sec 1302. ...

Medical homes: based
Sec 1302. -- Medical Home Pilot Program.
(3) DURATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (3)
Automated Concept:

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. ...

Medical homes: centered
Sec 1302. -- Medical Home Pilot Program.
(1) ESTABLISHMENT OF PILOT PROGRAM.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (a) (1)
Automated Concept:

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. ...
(2) STANDARD SETTING AND QUALIFICATION PROCESS FOR PATIENT-CENTERED MEDICAL HOMES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (2)
Automated Concept:

MEDICAL Homes ;   Standard setting and qualification Process for patient-centered

Index of Sec 1302. ...
(2) STANDARD SETTING AND QUALIFICATION PROCESS FOR PATIENT-CENTERED MEDICAL HOMES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (2) (A)
Automated Concept:

MEDICAL homes ;   Establishing standards to enable medical practices to qualify as patient-centered

Index of Sec 1302. ...
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (A)
Automated Concept:

MEDICAL homes ;   Secretary establishing methodolology for payment for medical home services furnished by independent patient-centered

Index of Sec 1302. ...

Medical items and services
Sec 1401. -- Comparative Effectiveness Research.
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (a) Quoted: (p) (2) (A)
Automated Concept:

MEDICAL loss ratio on timely basis ;   Data necessary for Secretary to publish

Index of Sec 1173. ...
(C) USE OF STANDARDIZED ELEMENTS AND DEFINITIONS.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (a) Quoted: (p) (2) (C)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (a) Quoted: (p) (3) (A)
Automated Concept:

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. ...
(4) MEDICAL LOSS RATIO TO BE DEFINED.
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (a) Quoted: (p) (4)
Automated Concept:

MEDICAL loss ratio having meaning given term by Secretary ;   Term

Index of Sec 1173. ...
(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO.
(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO. - paragraph (C)
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (b) Quoted: (4) (C)
Automated Concept:

CONTRACT years ;   Secretary terminating plan contract if plan failing to have medical loss ratio for 5 consecutive

Index of Sec 1173. ...

Medical need
Sec 1148. -- Durable Medical Equipment Program Improvements.
(iii) CONTINUATION OF SUPPLY.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (b) (1) (B) Quoted: (iii)
Automated Concept:

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
Sec 1233. -- Advance Care Planning Consultation.
(F) - paragraph (ii) - paragraph (I)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (F) (ii) (I)
Automated Concept:

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
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(3) SHARED DECISION MAKING.
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (3)
Automated Concept:

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 practices
Sec 1302. -- Medical Home Pilot Program.
(2) STANDARD SETTING AND QUALIFICATION PROCESS FOR PATIENT-CENTERED MEDICAL HOMES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (2) (A)
Automated Concept:

MEDICAL homes ;   Establishing standards to enable medical practices to qualify as patient-centered

Index of Sec 1302. ...
(2) STANDARD SETTING AND QUALIFICATION PROCESS FOR PATIENT-CENTERED MEDICAL HOMES. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (2) (B)
Automated Concept:

CERTIFICATION of medical practices as meeting standards ;   Initially providing for review and

Index of Sec 1302. ...

Medical Supplies
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
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 WITH ENTITIES THAT BILL FOR SERVICES UNDER MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H.
Automated Concept:

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
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) APPLICABLE MANUFACTURER; APPLICABLE DISTRIBUTOR.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (1)
Automated Concept:

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. ...
(5) DISTRIBUTOR OF A COVERED DRUG, DEVICE, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (5)
Automated Concept:

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
Sec 1157. -- Institute Of Medicine Study Of Geographic Adjustment Factors Under Medicare.
(c) EVALUATION. - paragraph (1) - paragraph (C)
DIVISION B TITLE I SUBTITLE C SEC 1157. (c) (1) (C)
Automated Concept:

MEDICAL technologies ;   Patient access to providers and needed

Index of Sec 1157. ...

Medical topic
Sec 1444. -- Application Of Quality Measures.
(x) - paragraph (II)
DIVISION B TITLE IV SUBTITLE C SEC 1444. (a) Quoted: (x) (II)
Automated Concept:

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
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1236. (a)
Automated Concept:

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 Medicare.
SEC 1221. -- ENSURING EFFECTIVE COMMUNICATION IN MEDICARE.
DIVISION B TITLE II SUBTITLE B SEC 1221.
Automated Concept:

MEDICARE ;   Sec 1221 ensuring effective communication in

Index of Sec 1221. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
SEC 1222. -- DEMONSTRATION TO PROMOTE ACCESS FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH PROFICIENCY BY PROVIDING REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1222.
Automated Concept:

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. ...
Sec 1307. -- Excluding Clinical Social Worker Services From Coverage Under The Medicare Skilled Nursing Facility Prospective Payment System And Consolidated Payment.
SEC 1307. -- EXCLUDING CLINICAL SOCIAL WORKER SERVICES FROM COVERAGE UNDER THE MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM AND CONSOLIDATED PAYMENT.
DIVISION B TITLE III SEC 1307.
Automated Concept:

MEDICARE skilled nursing facility prospective payment system and consolidated payment ;   Sec 1307 excluding clinical social worker Services from coverage under

Index of Sec 1307. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
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 WITH ENTITIES THAT BILL FOR SERVICES UNDER MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H.
Automated Concept:

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. ...
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
SEC 1632. -- ENHANCED MEDICARE, MEDICAID, AND CHIP PROGRAM DISCLOSURE REQUIREMENTS RELATING TO PREVIOUS AFFILIATIONS.
DIVISION B TITLE VI SUBTITLE C SEC 1632.
Automated Concept:

AFFILIATIONS ;   Enhancing medicare, medicaid and Chip Program disclosure requirements relating to previous

Index of Sec 1632. ...
Sec 1637. -- Physicians Who Order Durable Medical Equipment Or Home Health Services Required To Be Medicare Enrolled Physicians Or Eligible Professionals.
SEC 1637. -- PHYSICIANS WHO ORDER DURABLE MEDICAL EQUIPMENT OR HOME HEALTH SERVICES REQUIRED TO BE MEDICARE ENROLLED PHYSICIANS OR ELIGIBLE PROFESSIONALS.
DIVISION B TITLE VI SUBTITLE C SEC 1637.
Automated Concept:

MEDICARE enrolled Physicians or eligible Professionals ;   Order durable medical equipment or Home health Services required to be

Index of Sec 1637. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
SEC 1639. -- FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639.
Automated Concept:

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. ...
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
SEC 1756. -- TERMINATION OF PROVIDER PARTICIPATION UNDER MEDICAID AND CHIP IF TERMINATED UNDER MEDICARE OR OTHER STATE PLAN OR CHILD HEALTH PLAN.
DIVISION B TITLE VII SUBTITLE F SEC 1756.
Automated Concept:

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
Sec 1617. -- Enhanced Penalties For Medicare Advantage And Part D Marketing Violations.
SEC 1617. -- ENHANCED PENALTIES FOR MEDICARE ADVANTAGE AND PART D MARKETING VIOLATIONS.
DIVISION B TITLE VI SUBTITLE B SEC 1617.
Automated Concept:

MEDICARE Advantage and Part D marketing violations ;   Enhancing penalties for

Index of Sec 1617. ...

Medicare Claims: submission of
Sec 1636. -- Maximum Period For Submission Of Medicare Claims Reduced To Not More Than 12 Months.
SEC 1636. -- MAXIMUM PERIOD FOR SUBMISSION OF MEDICARE CLAIMS REDUCED TO NOT MORE THAN 12 MONTHS.
DIVISION B TITLE VI SUBTITLE C SEC 1636.
Automated Concept:

MEDICARE Claims reduced to not more than 12 months ;   Maximum period for submission of

Index of Sec 1636. ...

Medicare cost: related subsidies and
Sec 1201. -- Improving Assets Tests For Medicare Savings Program And Low-Income Subsidy Program.
(b) EFFECTIVE DATE.
DIVISION B TITLE II SUBTITLE A SEC 1201. (b)
Automated Concept:

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: dual eligible
Sec 1181. -- Elimination Of Coverage Gap.
(2) REPORTING REQUIREMENT FOR THE DETERMINATION AND PAYMENT OF REBATES BY MANUFACTURES RELATED TO REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2)
Automated Concept:

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. ...
(7) REPORTING REQUIREMENT FOR THE DETERMINATION AND PAYMENT OF REBATES BY MANUFACTURERS RELATED TO REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7)
Automated Concept:

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. ...
(D) REPORTING REQUIREMENT RELATED TO REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (B) Quoted: (D)
Automated Concept:

MEDICARE Drug Plan Enrollees ;   Reporting requirement related to Rebate for full-Benefit dual eligible

Index of Sec 1181. ...

Medicare exceptions
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
SEC 1156. -- LIMITATION ON MEDICARE EXCEPTIONS TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS MADE TO HOSPITALS.
DIVISION B TITLE I SUBTITLE C SEC 1156.
Automated Concept:

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 Medicare Integrity Program.
SEC 1634. -- EVALUATIONS AND REPORTS REQUIRED UNDER MEDICARE INTEGRITY PROGRAM.
DIVISION B TITLE VI SUBTITLE C SEC 1634.
Automated Concept:

MEDICARE integrity Program ;   Sec 1634, evaluations and Reports required under

Index of Sec 1634. ...

Medicare prescription Drug Program
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...
Sec 1801. -- 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.
SEC 1801. -- 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.
DIVISION B TITLE VIII SEC 1801.
Automated Concept:

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. ...
(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.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19)
Automated Concept:

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. ...

Medicare savings Program
Sec 1201. -- Improving Assets Tests For Medicare Savings Program And Low-Income Subsidy Program.
SEC 1201. -- IMPROVING ASSETS TESTS FOR MEDICARE SAVINGS PROGRAM AND LOW-INCOME SUBSIDY PROGRAM.
DIVISION B TITLE II SUBTITLE A SEC 1201.
Automated Concept:

INCOME Subsidy Program ;   Sec 1201 improving asseal testing for medicare savings Program and low-

Index of Sec 1201. ...

Medicine
Medicine: family
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (2)
Automated Concept:

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: general internal
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (2)
Automated Concept:

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: geriatric
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (2)
Automated Concept:

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: pediatric
Sec 1302. -- Medical Home Pilot Program.
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (2)
Automated Concept:

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
Sec 1121. -- Sustainable Growth Rate Reform.
(10) UPDATE FOR 2010.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1121. (a) Quoted: (10)
Automated Concept:

MEI ;   Updating to single conversion factor established in paragraph for 2010 to be percentage increase in

Index of Sec 1121. ...

Mental health
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(kkk) MENTAL HEALTH COUNSELOR SERVICES. - paragraph (1)
DIVISION B TITLE III SEC 1308. (b) (2) Quoted: (kkk) (1)
Automated Concept:

HEALTH counselor for diagnosis and treatment of mental illnesses ;   Term mental health counselor services meaning services performed by mental

Index of Sec 1308. ...
(kkk) MENTAL HEALTH COUNSELOR SERVICES. - paragraph (2) - paragraph (A)
DIVISION B TITLE III SEC 1308. (b) (2) Quoted: (kkk) (2) (A)
Automated Concept:

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. ...
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A PHYSICIAN.
DIVISION B TITLE III SEC 1308. (b) (4) (B)
Automated Concept:

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. ...
(6) COVERAGE OF MENTAL HEALTH COUNSELOR SERVICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.
DIVISION B TITLE III SEC 1308. (b) (6)
Automated Concept:

HEALTH Centers ;   Coverage of mental health counselor Services provided in rural health clinics and federally qualified

Index of Sec 1308. ...

Mental health and substance abuse needs
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(D) ENROLLMENT OF NON-TRADITIONAL MEDICAID ELIGIBLES.
DIVISION B TITLE VII SUBTITLE A SEC 1701. (d) Quoted: (D)
Automated Concept:

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. ...

Mental health: supervised
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(kkk) MENTAL HEALTH COUNSELOR SERVICES. - paragraph (2) - paragraph (B)
DIVISION B TITLE III SEC 1308. (b) (2) Quoted: (kkk) (2) (B)
Automated Concept:

HEALTH counselor practice ;   Obtaining degree performed 2 years of supervised mental

Index of Sec 1308. ...

Mental illnesses
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (1)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (1)
Automated Concept:

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. ...
(kkk) MENTAL HEALTH COUNSELOR SERVICES. - paragraph (1)
DIVISION B TITLE III SEC 1308. (b) (2) Quoted: (kkk) (1)
Automated Concept:

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: physical and
Sec 1111. -- Payments To Skilled Nursing Facilities.
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (A) (i)
Automated Concept:

MENTAL status, ability to perform activities of daily ;   Analysis considering use of appropriate indicators including age, physical and

Index of Sec 1111. ...

Misconduct: related
Sec 1760. -- Denial Of Payments For Litigation-Related Misconduct.
(a) IN GENERAL. - paragraph (3) - paragraph (27) - paragraph (B)
DIVISION B TITLE VII SUBTITLE F SEC 1760. (a) (3) Quoted: (27) (B)
Automated Concept:

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. ...

Misrepresenations
Sec 1616. -- Enhanced Penalties For Provision Of False Information By Medicare Advantage And Part D Plans.
(a) IN GENERAL.
DIVISION B TITLE VI SUBTITLE B SEC 1616. (a)
Automated Concept:

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: false statement or
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (F)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (F)
Automated Concept:

MISREPRESENATIONS, cases under paragraph ;   Second sentence, striking false statement or misrepresenations and inserting false statement or

Index of Sec 1645. ...

Misrepresenations: omission or
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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. ...
(a) IN GENERAL. - paragraph (6)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (6)
Automated Concept:

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. ...

Monetary penalties: civil
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (vii) - paragraph (III)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (vii) (III)
Automated Concept:

CIVIL monetary penalties levied against facility, employees, contractors and other agents ;   Number of

Index of Sec 1413. ...
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS.
DIVISION B TITLE VI SUBTITLE C SEC 1645.
Automated Concept:

CIVIL monetary penalties to false Claims Act amendments ;   Sec 1645 conforming

Index of Sec 1645. ...

Monetary penalty: civil
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(4) CMS ENFORCEMENT AUTHORITY.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (4)
Automated Concept:

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. ...

Money or property
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (D) - paragraph (13)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (D) Quoted: (13)
Automated Concept:

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. ...
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (A) - paragraph (2) - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (A) Quoted: (2) (B)
Automated Concept:

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
Sec 1631. -- Enhanced Cms Program Protection Authority.
(4) MORATORIUM ON ENROLLMENT OF PROVIDERS AND SUPPLIERS.
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (4)
Automated Concept:

MORATORIUM not adversely impacting access of individuals to care under program  ;  

Index of Sec 1631. ...
(1) MEDICAID. - paragraph (A)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (b) (1) (A)
Automated Concept:

MORATORIUM under section 1128g(a)(4) applied during period of moratorium ;   Person or entity to which

Index of Sec 1631. ...

Moratorium: period of
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) MEDICAID. - paragraph (A)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (b) (1) (A)
Automated Concept:

MORATORIUM ;   Person or entity to which moratorium under section 1128g(a)(4) applied during period of

Index of Sec 1631. ...

Natural variations
Sec 1301. -- Accountable Care Organization Pilot Program.
(1) AUTHORITY FOR SEPARATE INCENTIVE ARRANGEMENTS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (1)
Automated Concept:

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
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(ii) TREATMENT OF CERTAIN NONPROVIDER AND DIDACTIC ACTIVITIES.
DIVISION B TITLE V SEC 1503. (a) (1) (B) Quoted: (ii)
Automated Concept:

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. ...
(xi) - paragraph (II)
DIVISION B TITLE V SEC 1503. (b) Quoted: (xi) (II)
Automated Concept:

NONPATIENT care activities ;   Time spent by intern or resident in approved medical residency training program in

Index of Sec 1503. ...

Nonprofit community
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B)
Automated Concept:

NONPROFIT community-based or State-based organization certified under paragraph as meeting following requirements ;   Term community-based medical home meaning

Index of Sec 1302. ...

Nonvoting: two
Sec 1401. -- Comparative Effectiveness Research.
(II) PROHIBITION ON VOTING STATUS ON CLINICAL PERSPECTIVE ADVISORY PANELS.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iv) (II)
Automated Concept:

CLINICAL perspective advisory panel receiving waiver ;   No more than two nonvoting members of

Index of Sec 1401. ...

Notification
Sec 1423. -- Notification Of Facility Closure.
(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (a) (1) Quoted: (7) (B) (ii)
Automated Concept:

NOTIFICATION submiting and ending on date on which resident successfully relocated  ;  

Index of Sec 1423. ...
(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (b) (1) Quoted: (9) (B) (ii)
Automated Concept:

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: written
Sec 1423. -- Notification Of Facility Closure.
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (a) (1) Quoted: (7) (A) (ii)
Automated Concept:

NOTIFICATION submitted ;   Ensuring that facility not admitting new residents after date on which written

Index of Sec 1423. ...
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (b) (1) Quoted: (9) (A) (ii)
Automated Concept:

NOTIFICATION submitted ;   Ensuring that facility not admitting new residents after date on which written

Index of Sec 1423. ...

Of-pocket threshold
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (a) (3) Quoted: (7) (A)
Automated Concept:

OF-pocket threshold from amounts otherwise computed ;   Consistent with paragraph progressively increase initial coverage limit and decreaseing annual out-

Index of Sec 1181. ...
(C) DECREASE IN ANNUAL OUT-OF-POCKET THRESHOLD.
DIVISION B TITLE I SUBTITLE E SEC 1181. (a) (3) Quoted: (7) (C)
Automated Concept:

OF-pocket threshold otherwise computed without regard to paragraph to be decreased and #189 ;   Annual out-

Index of Sec 1181. ...
(E) OUT-OF-POCKET GAP AMOUNT. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (a) (3) Quoted: (7) (E) (i)
Automated Concept:

OF-pocket threshold specified in paragraph for year ;   Annual out-

Index of Sec 1181. ...

Of-pocket threshold of subsection
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(D) ACTUAL GAP IN COVERAGE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (D)
Automated Concept:

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: California Rest-
Sec 1125. -- Adjustment To Medicare Payment Localities.
(i) PERIODIC REVIEW AND ADJUSTMENTS IN FEE SCHEDULE AREAS.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1125. (a) Quoted: (6) (B) (i)
Automated Concept:

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: payment methodolology
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (B)
Automated Concept:

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
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (B)
Automated Concept:

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. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (1)
Automated Concept:

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. ...

Orthotics and supplies
Sec 1148. -- Durable Medical Equipment Program Improvements.
(a) WAIVER OF SURETY BOND REQUIREMENT.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (a)
Automated Concept:

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. ...
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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
Sec 1501. -- Distribution Of Unused Residency Positions.
(iv) PRIORITY FOR CERTAIN HOSPITALS. - paragraph (III)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iv) (III)
Automated Concept:

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. ...

Outpatient drugs: covered
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(a) IN GENERAL. - paragraph (3) - paragraph (xiii)
DIVISION B TITLE VII SUBTITLE E SEC 1743. (a) (3) Quoted: (xiii)
Automated Concept:

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. ...

Ownership
Ownership or compensation arrangement
Sec 1643. -- Access To Certain Information On Renal Dialysis Facilities.
SEC 1643. -- ACCESS TO CERTAIN INFORMATION ON RENAL DIALYSIS FACILITIES. - paragraph (15)
DIVISION B TITLE VI SUBTITLE C SEC 1643. Quoted: (15)
Automated Concept:

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. ...

Ownership or control interest
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(C) SPECIAL RULE. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (C) (i)
Automated Concept:

INTEREST including direct or indirect interests including interests in intermediate entities ;   Ownership or control

Index of Sec 1411. ...

Ownership or investment interest
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iii)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iv)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iv)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (v)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (v)
Automated Concept:

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. ...

Ownership: other transfer of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (1) (A)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (2) (A)
Automated Concept:

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. ...

Ownership: stock or stock optio
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(B) INCLUSIONS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (B)
Automated Concept:

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. ...

Ownership: percentage of total
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(B) PROHIBITION ON PHYSICIAN OWNERSHIP OR INVESTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (B)
Automated Concept:

HOSPITAL or entity whose asseal including hospital ;   Percentage of total value of ownership or investment interests holding in

Index of Sec 1156. ...

Ownership: physician
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (viii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (viii)
Automated Concept:

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. ...

Ownership or investment returns
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iv)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iv)
Automated Concept:

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. ...

Ownership: certain
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
SEC 1757. -- MEDICAID AND CHIP EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS.
DIVISION B TITLE VII SUBTITLE F SEC 1757.
Automated Concept:

AFFILIATIONS ;   Sec 1757, medicaid and Chip exclusion from participation relating to certain ownership, Control and management

Index of Sec 1757. ...

Ownership: entity's
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1)
Automated Concept:

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: physician
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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. ...

Ownership exceptions: Provider and hospital
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(i) REQUIREMENTS TO QUALIFY FOR RURAL PROVIDER AND HOSPITAL OWNERSHIP EXCEPTIONS TO SELF-REFERRAL PROHIBITION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i)
Automated Concept:

HOSPITAL ownership exceptions to self-referral prohibition ;   Requirements to qualify for rural Provider and

Index of Sec 1156. ...

Ownership interest
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(D) ORGANIZATIONAL STRUCTURE. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (D) (i)
Automated Concept:

INTEREST in corporation being equal or exceeding 5 percent ;   Shareholders of corporation having ownership

Index of Sec 1411. ...
(D) ORGANIZATIONAL STRUCTURE. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (D) (iv)
Automated Concept:

INTEREST in limited partnership being equal or exceeding 10 percent ;   General partners and limited partners of limited partnership having ownership

Index of Sec 1411. ...

Ownership shares
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(b) REPORTING OF OWNERSHIP INTEREST BY PHYSICIANS IN HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (b)
Automated Concept:

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. ...

Oxygen: supplier of
Sec 1148. -- Durable Medical Equipment Program Improvements.
(iii) EXCEPTION FOR BANKRUPTCY.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (d) Quoted: (iii)
Automated Concept:

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: continuous period of use of
Sec 1148. -- Durable Medical Equipment Program Improvements.
(2) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (b) (2)
Automated Concept:

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: child and
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (i)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (i)
Automated Concept:

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: limited
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(D) ORGANIZATIONAL STRUCTURE. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (D) (iv)
Automated Concept:

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
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1) - paragraph (L)
DIVISION B TITLE III SEC 1305. (a) Quoted: (iii) (1) (L)
Automated Concept:

PELVIC exam ;   Screening pap smear and screening

Index of Sec 1305. ...

Periodic
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT. - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2) (A)
Automated Concept:

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
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(1) INTERIM REPORTS.
DIVISION B TITLE I SUBTITLE C SEC 1152. (e) (1)
Automated Concept:

PERIODIC basis on plan described in subsection ;   Secretary issuing interim public reports on

Index of Sec 1152. ...

Periodic evaluations of effectiveness of activities
Sec 1634. -- Evaluations And Reports Required Under Medicare Integrity Program.
(a) IN GENERAL. - paragraph (3) - paragraph (4)
DIVISION B TITLE VI SUBTITLE C SEC 1634. (a) (3) Quoted: (4)
Automated Concept:

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. ...
Sec 1752. -- Evaluations And Reports Required Under Medicaid Integrity Program.
SEC 1752. -- EVALUATIONS AND REPORTS REQUIRED UNDER MEDICAID INTEGRITY PROGRAM. - paragraph (2) - paragraph (D)
DIVISION B TITLE VII SUBTITLE F SEC 1752. (2) Quoted: (D)
Automated Concept:

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
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(iii) REVIEW AND ADJUSTMENTS. - paragraph (IV)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (iii) (IV)
Automated Concept:

PERIODIC review described in subparagraph ;   Secretary coordinating review and appropriate adjustment described in clause with

Index of Sec 1122. ...

Periodic review of adjustment
Sec 1125. -- Adjustment To Medicare Payment Localities.
(ii) LINK WITH GEOGRAPHIC INDEX DATA REVISION.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1125. (a) Quoted: (6) (B) (ii)
Automated Concept:

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. ...

Periodic reviews
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (I)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (I)
Automated Concept:

COMPARATIVE effectiveness research and studies conducted by Center under subsection ;   Make recommendations for priority for periodic reviews of previous

Index of Sec 1401. ...
Sec 1422. -- National Independent Monitor Pilot Program.
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR. - paragraph (1)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (c) (1)
Automated Concept:

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. ...

Periodicity
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(A) NON-TRADITIONAL INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (A)
Automated Concept:

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. ...

Periodicity of redeterminations
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(A) NON-TRADITIONAL INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (A)
Automated Concept:

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
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(C) REPORTING ON MMCO DRUGS.
DIVISION B TITLE VII SUBTITLE E SEC 1743. (b) (2) Quoted: (C)
Automated Concept:

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. ...

Pharmacy: case of
Sec 1148. -- Durable Medical Equipment Program Improvements.
(a) WAIVER OF SURETY BOND REQUIREMENT.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (a)
Automated Concept:

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. ...
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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
Planning: advance care
Sec 1233. -- Advance Care Planning Consultation.
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE II SUBTITLE C SEC 1233. (c) (1) (A) (ii)
Automated Concept:

PLANNING and advance directives ;   Description of Federal and State resources available to assist individuals and families with advance care

Index of Sec 1233. ...

Planning: advance care
Sec 1233. -- Advance Care Planning Consultation.
(hhh) ADVANCE CARE PLANNING CONSULTATION. - paragraph (1) - paragraph (D)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (D)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (ii) - paragraph (I)
DIVISION B TITLE II SUBTITLE C SEC 1233. (c) (1) (A) (ii) (I)
Automated Concept:

PLANNING ;   Available State legal service organizations to assist individuals with advance care

Index of Sec 1233. ...

Planning: care
Sec 1233. -- Advance Care Planning Consultation.
(A) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1233. (b) (1) Quoted: (3) (A)
Automated Concept:

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. ...
(B) PROPOSED SET OF MEASURES.
DIVISION B TITLE II SUBTITLE C SEC 1233. (b) (1) Quoted: (3) (B)
Automated Concept:

PLANNING ;   Secretary publishing in Federal Register proposed quality measures on end of life care and advanced care

Index of Sec 1233. ...

Planning: family
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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. ...
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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: practitioner of advance care
Sec 1233. -- Advance Care Planning Consultation.
(hhh) ADVANCE CARE PLANNING CONSULTATION. - paragraph (1) - paragraph (A)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (A)
Automated Concept:

PLANNING including key questions and considerations ;   Explanation by practitioner of advance care

Index of Sec 1233. ...

Planning consulations: advance care
Sec 1233. -- Advance Care Planning Consultation.
(3) - paragraph (A)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (3) (A)
Automated Concept:

PLANNING consulations for purposes of applying 5-year limitation under paragraph ;   Considering advance care

Index of Sec 1233. ...
(3) - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (3) (B)
Automated Concept:

PLANNING consulations with respect to individual to be conducted more frequently than provided under paragraph ;   Advance care

Index of Sec 1233. ...

Planning consultations: case of advance care
Sec 1233. -- Advance Care Planning Consultation.
(3) FREQUENCY LIMITATION. - paragraph (A) - paragraph (iii) - paragraph (P)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (3) (A) (iii) Quoted: (P)
Automated Concept:

PLANNING consultations performed more frequently than covered under section ;   Case of advance care

Index of Sec 1233. ...

Planning service
Planning service: family
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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. ...
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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. ...

Planning service: family
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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. ...
(a) STATE OPTION.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (a)
Automated Concept:

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. ...
(5) COVERAGE OF FAMILY PLANNING SERVICES AND SUPPLIES.
DIVISION B TITLE VII SUBTITLE B SEC 1714. (c) Quoted: (5)
Automated Concept:

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. ...

Political subdivision
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (1)
Automated Concept:

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. ...
(2) NO PREEMPTION OF ADDITIONAL REQUIREMENTS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (h) (2)
Automated Concept:

POLITICAL subdivision of State requiring following ;   Paragraph not preempting law or regulation of State or

Index of Sec 1451. ...

Population
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (i)
Automated Concept:

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. ...

Population growth of State
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (i)
Automated Concept:

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
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(3) UNITED STATES.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (a) (3)
Automated Concept:

POSSESSION of United States ;   Term united States including

Index of Sec 1802. ...
(d) NO COVER OVER TO POSSESSIONS.
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (d)
Automated Concept:

POSSESSION of United States ;   No amount collected under subchapter to be covered to

Index of Sec 1802. ...

Poverty line
Poverty line: 200 percent of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) INDIAN TRIBES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (1)
Automated Concept:

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. ...
(2) STATES AND TERRITORIES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (2)
Automated Concept:

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. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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: official
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(1) IN GENERAL. - paragraph (C) - paragraph (VIII)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (a) (1) (C) Quoted: (VIII)
Automated Concept:

POVERTY line applicable to family of size involved ;   Families whose income not exceeding 133 1/3 percent of income official

Index of Sec 1701. ...
(1) IN GENERAL. - paragraph (C) - paragraph (IX)
DIVISION B TITLE VII SUBTITLE A SEC 1701. (b) (1) (C) Quoted: (IX)
Automated Concept:

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. ...

Poverty line bears: 200 percent of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) INDIAN TRIBES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (1)
Automated Concept:

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. ...
(2) STATES AND TERRITORIES.
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (c) (2)
Automated Concept:

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
Sec 1141. -- Rental And Purchase Of Power-Driven Wheelchairs.
(a) IN GENERAL. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1141. (a) (2)
Automated Concept:

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: rehabilitative
Sec 1141. -- Rental And Purchase Of Power-Driven Wheelchairs.
(a) IN GENERAL. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1141. (a) (2)
Automated Concept:

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
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1)
DIVISION B TITLE III SEC 1305. (a) Quoted: (iii) (1)
Automated Concept:

PREVENTIVE services meaning following ;   Term Medicare covered

Index of Sec 1305. ...
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (2)
DIVISION B TITLE III SEC 1305. (a) Quoted: (iii) (2)
Automated Concept:

PREVENTIVE services ;   Respect to specific Medicare covered

Index of Sec 1305. ...
(A) IN GENERAL.
DIVISION B TITLE III SEC 1305. (b) (1) (A)
Automated Concept:

PREVENTIVE services ;   Respect to Medicare covered

Index of Sec 1305. ...
(A) EXCLUSION FROM OPD FEE SCHEDULE.
DIVISION B TITLE III SEC 1305. (b) (2) (A)
Automated Concept:

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. ...
(3) WAIVER OF APPLICATION OF DEDUCTIBLE FOR ALL PREVENTIVE SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1305. (b) (3) (A)
Automated Concept:

PREVENTIVE services ;   Clause, striking items and services described in section 1861(s) and inserting Medicare covered

Index of Sec 1305. ...
(4) APPLICATION TO PROVIDERS OF SERVICES.
DIVISION B TITLE III SEC 1305. (b) (4)
Automated Concept:

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. ...
Sec 1711. -- Required Coverage Of Preventive Services.
(a) COVERAGE. - paragraph (1) - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1711. (a) (1) (B)
Automated Concept:

PREVENTIVE services described in subsection  ;  

Index of Sec 1711. ...
(z) PREVENTIVE SERVICES.
DIVISION B TITLE VII SUBTITLE B SEC 1711. (a) (2) Quoted: (z)
Automated Concept:

PREVENTIVE services described in subsection being services not otherwise described in subsection or Secretary determining  ;  

Index of Sec 1711. ...

Preventive services: additional
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(B) CONFORMING AMENDMENTS. - paragraph (iii) - paragraph (H)
DIVISION B TITLE III SEC 1305. (b) (2) (B) (iii) Quoted: (H)
Automated Concept:

HOSPITAL ;   Respect to additional preventive services furnished by outpatient department of

Index of Sec 1305. ...

Primary activity
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(K) NONPROVIDER SETTING THAT IS PRIMARILY ENGAGED IN FURNISHING PATIENT CARE.
DIVISION B TITLE V SEC 1503. (a) (3) Quoted: (K)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) QUALIFYING CRITERIA. - paragraph (B)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (2) (B)
Automated Concept:

PRIMARY care physicians for applicable beneficiaries for whose care group being accountable ;   Group including sufficient number of

Index of Sec 1301. ...
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (1) (A)
Automated Concept:

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. ...
(2) PRIMARY CARE.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (2)
Automated Concept:

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. ...
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (ii)
Automated Concept:

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. ...
(4) PREFERENCE. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (A)
Automated Concept:

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. ...
Sec 1303. -- Payment Incentive For Selected Primary Care Services.
(b) CONFORMING AMENDMENTS. - paragraph (3)
DIVISION B TITLE III SEC 1303. (b) (3)
Automated Concept:

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. ...
Sec 1501. -- Distribution Of Unused Residency Positions.
(II) DEDICATED ASSIGNMENT OF ADDITIONAL RESIDENT POSITIONS TO PRIMARY CARE.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (II)
Automated Concept:

PRIMARY care residents ;   Hospital assigning additional resident positions for

Index of Sec 1501. ...
(III) ACCREDITATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (ii) (III)
Automated Concept:

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. ...
(vi) DISTRIBUTION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (vi)
Automated Concept:

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. ...
(D) MAINTENANCE OF PRIMARY CARE RESIDENT LEVEL. - paragraph (i)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (D) (i)
Automated Concept:

PRIMARY care residents in residency training programs ;   Number of

Index of Sec 1501. ...
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (B)
DIVISION B TITLE V SEC 1502. (d) (2) (B)
Automated Concept:

CONTRACTING hospital's resident limit ;   Number of primary care residents of center not counting against

Index of Sec 1502. ...
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE V SEC 1505. (b) (1) (A)
Automated Concept:

PRIMARY care and other specialties ;   Range of residency programs including

Index of Sec 1505. ...

Primary care services
Sec 1721. -- Payments To Primary Care Practitioners.
(1) FEE-FOR-SERVICE PAYMENTS. - paragraph (C) - paragraph (C)
DIVISION B TITLE VII SUBTITLE C SEC 1721. (a) (1) (C) Quoted: (C)
Automated Concept:

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. ...
(2) UNDER MEDICAID MANAGED CARE PLANS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE C SEC 1721. (a) (2) (B)
Automated Concept:

PRIMARY care services described in section 1902(a) ;   Case of

Index of Sec 1721. ...

Primary language
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(3) DETERMINATION OF PAYMENTS FOR LANGUAGE SERVICES. - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (3) (B)
Automated Concept:

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. ...
(d) ASSURANCES. - paragraph (4)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (4)
Automated Concept:

PRIMARY language ;   Notifying Medicare beneficiaries of right to receive language services in

Index of Sec 1222. ...

Primary language data
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(d) ASSURANCES. - paragraph (6) - paragraph (A)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (6) (A)
Automated Concept:

PRIMARY language data collected for recipients of language services  ;  

Index of Sec 1222. ...

Primary residence
Sec 1235. -- Exception For Use Of More Recent Tax Year In Case Of Gains From Sale Of Primary Residence In Computing Part B Income-Related Premium.
SEC 1235. -- EXCEPTION FOR USE OF MORE RECENT TAX YEAR IN CASE OF GAINS FROM SALE OF PRIMARY RESIDENCE IN COMPUTING PART B INCOME-RELATED PREMIUM.
DIVISION B TITLE II SUBTITLE C SEC 1235.
Automated Concept:

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. ...
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1235. (a)
Automated Concept:

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. ...

Principal business
Sec 1422. -- National Independent Monitor Pilot Program.
(c) RESPONSIBILITIES OF THE INDEPENDENT MONITOR. - paragraph (2)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (c) (2)
Automated Concept:

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
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (1) (A)
Automated Concept:

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. ...
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (ii)
Automated Concept:

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. ...

Privacy
Privacy of patients
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) CONSIDERATIONS. - paragraph (2)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1193. (b) (2)
Automated Concept:

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. ...

Privacy of research
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION. - paragraph (D)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1) (D)
Automated Concept:

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
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(d) ASSURANCES. - paragraph (6) - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (6) (B)
Automated Concept:

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. ...

Production
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (B)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (B)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(8) MANUFACTURER OF A COVERED DRUG, DEVICE, BIOLOGICAL, OR MEDICAL SUPPLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (8)
Automated Concept:

PRODUCTION, preparation, propagation ;   Term manufacturer of covered drug, device, biological or medical supply meaning entity engaged in

Index of Sec 1451. ...

Productivity
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(a) INPATIENT ACUTE HOSPITALS. - paragraph (1) - paragraph (B) - paragraph (II)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (a) (1) (B) Quoted: (II)
Automated Concept:

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: multi-factor
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(a) INPATIENT ACUTE HOSPITALS. - paragraph (1) - paragraph (B) - paragraph (II)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (a) (1) (B) Quoted: (II)
Automated Concept:

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
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(a) INPATIENT ACUTE HOSPITALS. - paragraph (1) - paragraph (A)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (a) (1) (A)
Automated Concept:

PRODUCTIVITY adjustment described in subclause ;   Subject to

Index of Sec 1103. ...
(a) INPATIENT ACUTE HOSPITALS. - paragraph (1) - paragraph (B) - paragraph (II)
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (a) (1) (B) Quoted: (II)
Automated Concept:

PRODUCTIVITY adjustment described in subclause or other annual period  ;  

Index of Sec 1103. ...
(b) SKILLED NURSING FACILITIES.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (b)
Automated Concept:

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. ...
(3) PRODUCTIVITY ADJUSTMENT.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (c) Quoted: (3)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Factor to be subject to

Index of Sec 1103. ...
(f) HOSPICE CARE.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (f)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii  ;  

Index of Sec 1103. ...
Sec 1131. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(b) AMBULANCE SERVICES.
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (b)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Subject to

Index of Sec 1131. ...
(c) AMBULATORY SURGICAL CENTER SERVICES. - paragraph (2) - paragraph (v)
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (c) (2) Quoted: (v)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Factor to be subject to

Index of Sec 1131. ...
(d) LABORATORY SERVICES. - paragraph (2) - paragraph (C) - paragraph (V)
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (d) (2) (C) Quoted: (V)
Automated Concept:

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. ...
(e) CERTAIN DURABLE MEDICAL EQUIPMENT. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (e) (1)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Subject to

Index of Sec 1131. ...
(e) CERTAIN DURABLE MEDICAL EQUIPMENT. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (e) (2)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Subject to

Index of Sec 1131. ...
(e) CERTAIN DURABLE MEDICAL EQUIPMENT. - paragraph (3)
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (e) (3)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Subject to

Index of Sec 1131. ...
(e) CERTAIN DURABLE MEDICAL EQUIPMENT. - paragraph (4)
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131. (e) (4)
Automated Concept:

PRODUCTIVITY adjustment described in section 1886(b)(3)(b)( iii ;   Subject to

Index of Sec 1131. ...

Productivity improvements
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
SEC 1103. -- INCORPORATING PRODUCTIVITY IMPROVEMENTS INTO MARKET BASKET UPDATES THAT DO NOT ALREADY INCORPORATE SUCH IMPROVEMENTS.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103.
Automated Concept:

PRODUCTIVITY improvements into Market basket updating not already incorporating improvements ;   Incorporating

Index of Sec 1103. ...
Sec 1131. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
SEC 1131. -- INCORPORATING PRODUCTIVITY IMPROVEMENTS INTO MARKET BASKET UPDATES THAT DO NOT ALREADY INCORPORATE SUCH IMPROVEMENTS.
DIVISION B TITLE I SUBTITLE B PART 2 SEC 1131.
Automated Concept:

PRODUCTIVITY improvements into Market basket updating not already incorporating improvements ;   Incorporating

Index of Sec 1131. ...
Sec 1155. -- Incorporating Productivity Improvements Into Market Basket Update For Home Health Services.
SEC 1155. -- INCORPORATING PRODUCTIVITY IMPROVEMENTS INTO MARKET BASKET UPDATE FOR HOME HEALTH SERVICES.
DIVISION B TITLE I SUBTITLE C SEC 1155.
Automated Concept:

HEALTH Services ;   Incorporating productivity improvements into Market basket updating for Home

Index of Sec 1155. ...

Professional associations
Sec 1401. -- Comparative Effectiveness Research.
(1) DISSEMINATION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (1)
Automated Concept:

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
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(C) EXCLUSIONS. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (iv)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (ii)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (ii)
Automated Concept:

PROFESSIONAL development and show strong organizational capacity to implement program ;   Providing for ongoing training and

Index of Sec 1904. ...

Professional needs area
Sec 1501. -- Distribution Of Unused Residency Positions.
(iv) PRIORITY FOR CERTAIN HOSPITALS. - paragraph (V)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (iv) (V)
Automated Concept:

PROFESSIONAL needs area ;   Place greater emphasis upon training in health professional shortage area or health

Index of Sec 1501. ...

Professional nurses: licensed
Sec 1414. -- Reporting Of Expenditures.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (1)
Automated Concept:

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: covered
Sec 1233. -- Advance Care Planning Consultation.
(A) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1233. (b) (1) Quoted: (3) (A)
Automated Concept:

PROFESSIONAL services furnished during 2011 and subsequent year ;   Purposes of reporting data on quality measures for covered

Index of Sec 1233. ...

Professional shortage area
Sec 1303. -- Payment Incentive For Selected Primary Care Services.
(1) IN GENERAL.
DIVISION B TITLE III SEC 1303. (a) Quoted: (p) (1)
Automated Concept:

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. ...
(b) CONFORMING AMENDMENTS. - paragraph (3)
DIVISION B TITLE III SEC 1303. (b) (3)
Automated Concept:

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. ...

Professional teams
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS. - paragraph (iv)
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B) (iv)
Automated Concept:

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
Proficiency: limited English
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (F)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (F)
Automated Concept:

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. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(d) ASSURANCES. - paragraph (3)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (3)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(2) DISSEMINATION PROTOCOLS AND STRATEGIES.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (e) (2)
Automated Concept:

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: sufficient degree of
Sec 1224. -- Definitions.
(1) BILINGUAL.
DIVISION B TITLE II SUBTITLE B SEC 1224. (1)
Automated Concept:

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. ...

Property
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (vii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (vii)
Automated Concept:

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: entity or
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(C) SPECIAL RULE. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (C) (ii)
Automated Concept:

PROPERTY or asseal ;   Deed of trust, note or other obligation secured by entity or

Index of Sec 1411. ...

Property: purchase or lease of
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (vi)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (vi)
Automated Concept:

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: real
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(A) ADDITIONAL DISCLOSABLE PARTY. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (6) (A) (ii)
Automated Concept:

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: 5 percent of total
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(C) SPECIAL RULE. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (C) (ii)
Automated Concept:

PROPERTY or asseal of entirety ;   Interest being equal or exceeding 5 percent of total

Index of Sec 1411. ...

Proportional
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (iv)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (iv)
Automated Concept:

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. ...
(D) ENSURING BONA FIDE OWNERSHIP AND INVESTMENT. - paragraph (v)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (1) (D) (v)
Automated Concept:

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
Sec 1148. -- Durable Medical Equipment Program Improvements.
(a) WAIVER OF SURETY BOND REQUIREMENT.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (a)
Automated Concept:

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. ...
(c) TREATMENT OF CURRENT ACCREDITATION APPLICATIONS. - paragraph (3) - paragraph (iii)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (c) (3) Quoted: (iii)
Automated Concept:

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. ...

Protection
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(c) RESPONSIBILITIES. - paragraph (5)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (c) (5)
Automated Concept:

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: better coordination and
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL. - paragraph (2)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a) (2)
Automated Concept:

PROTECTION improving care and costs ;   Identify areas of policies where better coordination and

Index of Sec 1905. ...

Protection: coordination and
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL. - paragraph (3)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a) (3)
Automated Concept:

PROTECTION ;   Issue guidance to States regarding improving coordination and

Index of Sec 1905. ...

Protection: greater or additional
Sec 1415. -- Standardized Complaint Form.
(iv) RIGHTS NOT WAIVABLE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (C) (iv)
Automated Concept:

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. ...
(iv) RIGHTS NOT WAIVABLE.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (C) (iv)
Automated Concept:

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: improved coordination and
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(b) ELEMENTS.
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (b)
Automated Concept:

PROTECTION under section including efforts ;   Improved coordination and

Index of Sec 1905. ...

Protection: Medicare and Medicaid and
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL.
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a)
Automated Concept:

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. ...

Psychiatric hospital or unit
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(2) PRODUCTIVITY ADJUSTMENT.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (2)
Automated Concept:

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
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(1) REFERENCE TO ESTABLISHMENT AND IMPLEMENTATION OF SYSTEM.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (1)
Automated Concept:

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
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(1) REFERENCE TO ESTABLISHMENT AND IMPLEMENTATION OF SYSTEM.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (1)
Automated Concept:

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. ...

Public
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (A)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (A)
Automated Concept:

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. ...
(h) CONSTRUCTION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (h)
Automated Concept:

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. ...
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(1) DISCLOSURE. - paragraph (A)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (1) (A)
Automated Concept:

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. ...
(2) PUBLIC AVAILABILITY OF INFORMATION. - paragraph (A)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (2) (A)
Automated Concept:

INFORMATION ;   Making information described in paragraph available to public upon request and updating

Index of Sec 1411. ...
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (b) (1)
Automated Concept:

INFORMATION reported in accordance with final regulations to be made available to public in accordance with procedures established by Secretary  ;  

Index of Sec 1411. ...
Sec 1413. -- Nursing Home Compare Medicare Website.
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (2) (A) Quoted: (E)
Automated Concept:

INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ;   Improving timeliness of

Index of Sec 1413. ...
(E) SUBMISSION OF SURVEY AND CERTIFICATION INFORMATION TO THE SECRETARY.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (2) (A) Quoted: (E)
Automated Concept:

INFORMATION making available to public under subparagraph and provided on Nursing Home comparing Medicare website under subsection ;   Improving timeliness of

Index of Sec 1413. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(1) IN GENERAL. - paragraph (H)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (1) (H)
Automated Concept:

INFORMATION making available to public with respect to covered recipient ;   Providing covered recipient opportunity to submit corrections to

Index of Sec 1451. ...
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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. ...
(3) SPECIAL RULE FOR DRUG SAMPLES.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (3)
Automated Concept:

INFORMATION relating to drug samples provided under subsection not to be made available to public by Secretary  ;  

Index of Sec 1451. ...
(4) SPECIAL RULE FOR NATIONAL PROVIDER IDENTIFIERS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (4)
Automated Concept:

INFORMATION relating to national provider identifiers provided under subsection not to be made available to public by Secretary  ;  

Index of Sec 1451. ...

Public or use
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (2)
Automated Concept:

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. ...

Public access of data
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (G)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (G)
Automated Concept:

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
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(a) IN GENERAL. - paragraph (2) - paragraph (aa) - paragraph (3)
DIVISION B TITLE VII SUBTITLE B SEC 1713. (a) (2) Quoted: (aa) (3)
Automated Concept:

PUBLIC assistance ;   Increasing economic self-sufficiency, employment advancement, school-readiness and educational achievement or reducing dependence on

Index of Sec 1713. ...

Public comment
Sec 1162. -- Quality Bonus Payments.
(iii) RULES FOR SELECTION OF MEASURES. - paragraph (II)
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1162. (a) (2) Quoted: (o) (3) (B) (iii) (II)
Automated Concept:

PUBLIC comment on measure ;   Secretary publishing in Federal registering measure and providing for period of

Index of Sec 1162. ...
Sec 1401. -- Comparative Effectiveness Research.
(1) ENSURING TRANSPARENCY, CREDIBILITY, AND ACCESS. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (c) (1) (E)
Automated Concept:

PUBLIC comment on methods and findings of research ;   Center providing opportunities for stakeholders involved to review and provide

Index of Sec 1401. ...
Sec 1741. -- Payments To Pharmacists.
(4) AUTHORITY TO PROMULGATE REGULATION.
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (4)
Automated Concept:

PUBLIC comment ;   Regulations becoming effective on interim final basis pending opportunity for

Index of Sec 1741. ...
Sec 1744. -- Payments For Graduate Medical Education.
(4) SPECIFICATION OF GOALS AND REQUIREMENTS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (4) (B)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (d) (1)
Automated Concept:

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
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(3) PUBLICATION OF INFORMATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (3)
Automated Concept:

PUBLIC Internet website of Centers for Medicare and Medicaid Services ;   Information submitted by hospitals under paragraph on

Index of Sec 1156. ...
(G) PUBLICATION OF FINAL DECISIONS.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (G)
Automated Concept:

PUBLIC Internet website of Centers for Medicare and Medicaid servicing final decision with respect to application ;   Secretary publishing on

Index of Sec 1156. ...

Public nominations
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (4) (B)
Automated Concept:

NOMINATIONS ;   Process under paragraph ensuring that selection of representatives of multi-stakeholder groups including provision for public

Index of Sec 1443. ...

Public reports: interim
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(1) INTERIM REPORTS.
DIVISION B TITLE I SUBTITLE C SEC 1152. (e) (1)
Automated Concept:

PERIODIC basis on plan described in subsection ;   Secretary issuing interim public reports on

Index of Sec 1152. ...

Pursuant
Sec 1111. -- Payments To Skilled Nursing Facilities.
(D) IMPLEMENTATION.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (D)
Automated Concept:

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. ...
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(ii) IDENTIFICATION OF POTENTIALLY MISVALUED CODES.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (ii)
Automated Concept:

IDENTIFYING potentially misvalued services pursuant to clause ;   Purposes of

Index of Sec 1122. ...
(iii) REVIEW AND ADJUSTMENTS. - paragraph (VI)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (iii) (VI)
Automated Concept:

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. ...
(v) ADJUSTMENTS.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (v)
Automated Concept:

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. ...
Sec 1141. -- Rental And Purchase Of Power-Driven Wheelchairs.
(b) EFFECTIVE DATE.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1141. (b)
Automated Concept:

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. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(i) AGGREGATE CAP.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (C) (i)
Automated Concept:

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. ...
(ii) HOSPITAL-SPECIFIC LIMIT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (C) (ii)
Automated Concept:

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. ...
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(D) INCREASE LIMITED TO FACILITIES ON THE MAIN CAMPUS OF THE HOSPITAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (D)
Automated Concept:

HOSPITAL ;   Procedure rooms or beds of hospital pursuant to paragraph only occurring in facilities on main campus of

Index of Sec 1156. ...
(5) CLARIFICATION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (5)
Automated Concept:

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. ...
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (i)
Automated Concept:

CONTRACT described in clause ;   Pursuant to rfp

Index of Sec 1204. ...
(ii) RFP CONTRACT DESCRIBED.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (ii)
Automated Concept:

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. ...
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (C)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (C)
Automated Concept:

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. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(d) ASSURANCES. - paragraph (6) - paragraph (B)
DIVISION B TITLE II SUBTITLE B SEC 1222. (d) (6) (B)
Automated Concept:

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. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) TRANSITION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (i) (2)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(A) PAYMENT AUTHORITY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (1) (A)
Automated Concept:

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. ...
(A) AUTHORITY FOR PAYMENTS.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (A)
Automated Concept:

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. ...
Sec 1310. -- Expanding Access To Vaccines.
(G) IMPLEMENTATION.
DIVISION B TITLE III SEC 1310. (c) (3) Quoted: (G)
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

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. ...
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (4) (A)
Automated Concept:

TRANSPARENT process for activities conducted pursuant to convening ;   Consensus-based entity described in paragraph providing for open and

Index of Sec 1443. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(4) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO PRODUCT DEVELOPMENT AGREEMENTS.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (4)
Automated Concept:

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. ...
(5) DELAYED REPORTING FOR PAYMENTS MADE PURSUANT TO CLINICAL INVESTIGATIONS. - paragraph (A)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (5) (A)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (ii)
Automated Concept:

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. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(b) CONDITION OF PAYMENT FOR DURABLE MEDICAL EQUIPMENT.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (b)
Automated Concept:

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. ...
(d) APPLICATION TO MEDICAID AND CHIP.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (d)
Automated Concept:

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. ...
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (b) (1)
Automated Concept:

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. ...
Sec 1714. -- State Eligibility Option For Family Planning Services.
(3) LIMITATION ON BENEFITS. - paragraph (B)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (a) (3) (B)
Automated Concept:

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. ...

Pursuant State la
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(jjj) MARRIAGE AND FAMILY THERAPIST SERVICES. - paragraph (2) - paragraph (A)
DIVISION B TITLE III SEC 1308. (a) (2) Quoted: (jjj) (2) (A)
Automated Concept:

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
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
(c) CONSIDERATIONS IN SETTING NATIONAL PRIORITIES. - paragraph (5)
DIVISION B TITLE IV SUBTITLE C SEC 1441. Quoted: PART E SEC 1191. (c) (5)
Automated Concept:

RAPID improvement due to existing evidence, standards of care or other reasons ;   Potential for

Index of Sec 1441. ...

Readmission
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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. ...
(2) CONSIDERATIONS. - paragraph (C)
DIVISION B TITLE I SUBTITLE C SEC 1151. (d) (2) (C)
Automated Concept:

READMISSION ;   Applying payment reduction for physicians treating patient during initial admission resulting in

Index of Sec 1151. ...

Readmission: provider and
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(i) IN GENERAL. - paragraph (I)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (I)
Automated Concept:

READMISSIONS based on actual readmissions ;   Risk adjusted

Index of Sec 1151. ...
(i) IN GENERAL. - paragraph (II)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (II)
Automated Concept:

HOSPITAL for condition with respect to applicable period ;   Risk adjusted expected readmissions for

Index of Sec 1151. ...
(ii) EXCLUSION OF CERTAIN READMISSIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (ii)
Automated Concept:

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. ...
(A) APPLICABLE CONDITION. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (A) (i)
Automated Concept:

EXPENDITURES under title ;   Readmissions representing conditions or procedures being high volume or high

Index of Sec 1151. ...
(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (7)
Automated Concept:

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. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (A)
Automated Concept:

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. ...

Readmission: actual
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(i) IN GENERAL. - paragraph (I)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (I)
Automated Concept:

READMISSIONS ;   Risk adjusted readmissions based on actual

Index of Sec 1151. ...

Readmission: excess
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) AGGREGATE PAYMENTS FOR EXCESS READMISSIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (A)
Automated Concept:

READMISSIONS meaning sum ;   Term aggregate payments for excess

Index of Sec 1151. ...
(ii) EXCLUSION OF CERTAIN READMISSIONS.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (ii)
Automated Concept:

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. ...
(D) APPLICABLE PERIOD.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (D)
Automated Concept:

READMISSIONS ;   Period as Secretary specifying for purposes of determining excess

Index of Sec 1151. ...

Readmission: measures of
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(6) LIMITATIONS ON REVIEW. - paragraph (C)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (6) (C)
Automated Concept:

READMISSIONS as described in paragraph ;   Measures of

Index of Sec 1151. ...

Readmission: overall rate of
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(iii) ADJUSTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (iii)
Automated Concept:

READMISSIONS for applicable conditions ;   Order to promote reduction over time in overall rate of

Index of Sec 1151. ...

Readmission measure methodolology
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(i) IN GENERAL. - paragraph (I)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (I)
Automated Concept:

READMISSION measure methodolology endorsed under paragraph ;   Determining consistent with

Index of Sec 1151. ...

Readmission rates
Readmission rates: normal
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(E) USE OF ADDITIONAL PAYMENT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (E)
Automated Concept:

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: preventable
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(E) USE OF ADDITIONAL PAYMENT. - paragraph (v)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (8) (E) (v)
Automated Concept:

READMISSION rates ;   Developing quality improvement plan to assess and remedy preventable

Index of Sec 1151. ...

Readmission ratios
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(iii) ADJUSTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (iii)
Automated Concept:

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
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(1) STUDY.
DIVISION B TITLE I SUBTITLE C SEC 1151. (d) (1)
Automated Concept:

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. ...

Readmissions ratio: excess
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(iii) ADJUSTMENT.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (iii)
Automated Concept:

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. ...

Reassessment of compliance program
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (VIII)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (VIII)
Automated Concept:

COMPLIANCE program to identify changing necessary to reflect changes within organization and facilities ;   Organization periodically undertaking reassessment of

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (VIII)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (VIII)
Automated Concept:

COMPLIANCE program to identify changing necessary to reflect changes within organization and facilities ;   Organization periodically undertaking reassessment of

Index of Sec 1412. ...

Rebate
Sec 1181. -- Elimination Of Coverage Gap.
(2) REBATE AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (2)
Automated Concept:

REBATE for rebate period ending after December 31, 2010 ;   Rebate agreement under subsection requiring manufacturer to provide to Secretary

Index of Sec 1181. ...
Sec 1207. -- Application Of Ma Premiums Prior To Rebate In Calculation Of Low Income Subsidy Benchmark.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1207. (a)
Automated Concept:

REBATE computed under section 1854(b)(1)(c)(i) for plan and year involved ;   Application of monthly

Index of Sec 1207. ...

Rebate of premiums
Sec 1173. -- Information For Beneficiaries On Ma Plan Administrative Costs.
(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO. - paragraph (A)
DIVISION B TITLE I SUBTITLE D PART 2 SEC 1173. (b) Quoted: (4) (A)
Automated Concept:

REBATE of premiums under part by amounting ;   Secretary requiring Medicare Advantage organization offering plan to give enrollees

Index of Sec 1173. ...

Rebate: amount of
Sec 1181. -- Elimination Of Coverage Gap.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (A)
Automated Concept:

REBATE period to be equal to product ;   Amount of rebate specified under paragraph for manufacturer for

Index of Sec 1181. ...
(B) REPORT FORM AND CONTENTS. - paragraph (iv)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (iv)
Automated Concept:

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
Sec 1741. -- Payments To Pharmacists.
(2) DEFINITION OF AMP. - paragraph (C) - paragraph (iv)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (2) (C) Quoted: (iv)
Automated Concept:

REBATES, discounts or price concessions not passed to retail pharmacies ;   Providing that

Index of Sec 1741. ...
(2) DEFINITION OF AMP. - paragraph (C) - paragraph (vi)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (2) (C) Quoted: (vi)
Automated Concept:

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
Sec 1234. -- Part B Special Enrollment Period And Waiver Of Limited Enrollment Penalty For Tricare Beneficiaries.
(iii) REBATES.
DIVISION B TITLE II SUBTITLE C SEC 1234. (b) (2) (B) (iii)
Automated Concept:

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. ...

Rebate: price concessions and
Sec 1181. -- Elimination Of Coverage Gap.
(B) REPORT FORM AND CONTENTS. - paragraph (iii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (iii)
Automated Concept:

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. ...

Rebate: total amount of
Sec 1743. -- Extension Of Prescription Drug Discounts To Enrollees Of Medicaid Managed Care Organizations.
(C) REPORTING ON MMCO DRUGS.
DIVISION B TITLE VII SUBTITLE E SEC 1743. (b) (2) Quoted: (C)
Automated Concept:

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
Sec 1181. -- Elimination Of Coverage Gap.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (1)
Automated Concept:

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. ...
(2) REBATE AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (2)
Automated Concept:

REBATE agreement under subsection requiring manufacturer to provide to Secretary rebate for rebate period ending after December 31, 2010  ;  

Index of Sec 1181. ...
(4) LENGTH OF AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (4)
Automated Concept:

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. ...
(6) REBATE FOR FULL-BENEFIT DUAL ELIGIBLE MEDICARE DRUG PLAN ENROLLEES.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (3) Quoted: (6)
Automated Concept:

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: dual eligible
Sec 1181. -- Elimination Of Coverage Gap.
(B) REPORT FORM AND CONTENTS. - paragraph (iv)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (iv)
Automated Concept:

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. ...

Rebate amount means: dual eligible
Sec 1181. -- Elimination Of Coverage Gap.
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C)
Automated Concept:

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. ...

Rebate obligation
Sec 1742. -- Prescription Drug Rebates.
(C) TREATMENT OF NEW FORMULATIONS.
DIVISION B TITLE VII SUBTITLE E SEC 1742. (a) (1) Quoted: (C)
Automated Concept:

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
Sec 1181. -- Elimination Of Coverage Gap.
(2) REBATE AGREEMENT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (2)
Automated Concept:

REBATE period ending after December 31, 2010 ;   Rebate agreement under subsection requiring manufacturer to provide to Secretary rebate for

Index of Sec 1181. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (A)
Automated Concept:

REBATE period to be equal to product ;   Amount of rebate specified under paragraph for manufacturer for

Index of Sec 1181. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (A) (i)
Automated Concept:

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. ...
(B) MEDICAID REBATE AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (B)
Automated Concept:

REBATE period ;   Respect to dosage form and strength of covered part D drug provided by manufacturer for

Index of Sec 1181. ...
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C)
Automated Concept:

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. ...
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (i) - paragraph (II)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (i) (II)
Automated Concept:

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. ...
(C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT. - paragraph (ii)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (3) (C) (ii)
Automated Concept:

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. ...
(B) REPORT FORM AND CONTENTS. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (2) (A) Quoted: (7) (B) (i)
Automated Concept:

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. ...
Sec 1742. -- Prescription Drug Rebates.
(C) TREATMENT OF NEW FORMULATIONS. - paragraph (iii)
DIVISION B TITLE VII SUBTITLE E SEC 1742. (a) (1) Quoted: (C) (iii)
Automated Concept:

REBATE period ;   Total number of units of dosage form and strength of line extension product paid under State plan in

Index of Sec 1742. ...

Rebate period: last day of month of
Sec 1741. -- Payments To Pharmacists.
(3) MANUFACTURER REPORTING REQUIREMENTS. - paragraph (A) - paragraph (iv)
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (3) (A) Quoted: (iv)
Automated Concept:

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: term
Sec 1181. -- Elimination Of Coverage Gap.
(B) REBATE PERIOD.
DIVISION B TITLE I SUBTITLE E SEC 1181. (b) (1) (B) Quoted: (f) (6) (B)
Automated Concept:

REBATE period having meaning given term in section 1927(k)(8) ;   Term

Index of Sec 1181. ...

Recalibration factor: appropriate
Sec 1111. -- Payments To Skilled Nursing Facilities.
(2) ADJUSTMENT IN RECALIBRATION FACTOR.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (a) (2)
Automated Concept:

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. ...

Recertification: certification or
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(2) PART B. - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1639. (a) (2) (B)
Automated Concept:

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. ...

Reckless
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (3) - paragraph (D) - paragraph (7) - paragraph (C)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (3) (D) Quoted: (7) (C)
Automated Concept:

INFORMATION ;   Acts in reckless disregarding of truth or falsity of

Index of Sec 1645. ...

Regulatory authority
Sec 1412. -- Accountability Requirements.
(3) PROPOSAL TO REVISE QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAMS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (3)
Automated Concept:

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: statutory or
Sec 1412. -- Accountability Requirements.
(3) PROPOSAL TO REVISE QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT PROGRAMS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (b) (3)
Automated Concept:

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. ...

Rehabilitation facilities
Rehabilitation facilities:
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(3) POST ACUTE SERVICES.
DIVISION B TITLE I SUBTITLE C SEC 1152. (a) (3)
Automated Concept:

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. ...

Rehabilitation facilities: inpatient
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(3) POST ACUTE SERVICES.
DIVISION B TITLE I SUBTITLE C SEC 1152. (a) (3)
Automated Concept:

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. ...

Reimbursement
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(1) LINE-ITEM DESCRIPTION.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (1)
Automated Concept:

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. ...
(2) TIMING OF REIMBURSEMENTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (2)
Automated Concept:

REIMBURSEMENT under subsection to retroactive lis enrollment beneficiary with respect to claim ;   Prescription drug plan or Ma-pd plan making

Index of Sec 1204. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
SEC 1222. -- DEMONSTRATION TO PROMOTE ACCESS FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH PROFICIENCY BY PROVIDING REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1222.
Automated Concept:

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. ...
Sec 1401. -- Comparative Effectiveness Research.
(h) CONSTRUCTION.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (h)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL. - paragraph (4) - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (d) (1) Quoted: (4) (B)
Automated Concept:

REIMBURSEMENT under title for services provided to eligible beneficiaries under title  ;  

Index of Sec 1704. ...

Reimbursement: Medicare and Medicaid Services of total
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(3) REPORTING REQUIREMENT. - paragraph (D)
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (3) (D)
Automated Concept:

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. ...

Reimbursements
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
SEC 1204. -- ENHANCED OVERSIGHT RELATING TO REIMBURSEMENTS FOR RETROACTIVE LOW INCOME SUBSIDY ENROLLMENT.
DIVISION B TITLE II SUBTITLE A SEC 1204.
Automated Concept:

INCOME Subsidy enrollment ;   Enhancing oversight relating to reimbursements for retroactive low

Index of Sec 1204. ...
(b) ADMINISTRATIVE REQUIREMENTS RELATING TO REIMBURSEMENTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b)
Automated Concept:

REIMBURSEMENTS ;   Administrative requirements relating to

Index of Sec 1204. ...

Reimbursement limit: Federal upper
Sec 1741. -- Payments To Pharmacists.
(5) USE OF AMP IN UPPER PAYMENT LIMITS.
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (1) (A) Quoted: (5)
Automated Concept:

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
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(xi) - paragraph (II) - paragraph (cc)
DIVISION B TITLE V SEC 1503. (b) Quoted: (xi) (II) (cc)
Automated Concept:

REIMBURSEMENT system authorized under section 1814(b)(3) ;   Reimbursing under

Index of Sec 1503. ...

Relative
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(b) DETAILS. - paragraph (8)
DIVISION B TITLE I SUBTITLE C SEC 1152. (b) (8)
Automated Concept:

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: based
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (D)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (D)
Automated Concept:

RELATIVE value scale by using adjustments when patient being LEP ;   Feasibility of modifying existing Medicare resource-based

Index of Sec 1221. ...

Relative value units
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(iii) REVIEW AND ADJUSTMENTS. - paragraph (VI)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (iii) (VI)
Automated Concept:

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. ...
(i) IN GENERAL.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (i)
Automated Concept:

RELATIVE value units under fee schedule under subsection ;   Secretary establishing process to validate

Index of Sec 1122. ...
(iii) SCOPE OF CODES.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (iii)
Automated Concept:

RELATIVE value units including sampling of codes for services being same as codes listed under subparagraph ;   Validation of work

Index of Sec 1122. ...
(v) ADJUSTMENTS.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (v)
Automated Concept:

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. ...
Sec 1147. -- Payment For Imaging Services.
(C) ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1147. (a) (1) (B) Quoted: (C)
Automated Concept:

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
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(i) IN GENERAL. - paragraph (II)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (i) (II)
Automated Concept:

RELATIVE values established under paragraph for services identified as potentially misvalued under subclause ;   Review and making appropriate adjustments to

Index of Sec 1122. ...
(ii) IDENTIFICATION OF POTENTIALLY MISVALUED CODES.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (ii)
Automated Concept:

RELATIVE values initially established for codes ;   Codes for new technologies or services within appropriate period after

Index of Sec 1122. ...

Relative values: low
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(iii) REVIEW AND ADJUSTMENTS. - paragraph (V)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (K) (iii) (V)
Automated Concept:

RELATIVE values described in clause ;   Including with respect to codes with low

Index of Sec 1122. ...

Renal dialysis facility
Renal dialysis facilityes
Sec 1643. -- Access To Certain Information On Renal Dialysis Facilities.
SEC 1643. -- ACCESS TO CERTAIN INFORMATION ON RENAL DIALYSIS FACILITIES. - paragraph (15)
DIVISION B TITLE VI SUBTITLE C SEC 1643. Quoted: (15)
Automated Concept:

DIALYSIS facilities for items and services under section under paragraph ;   Purposes of evaluating or auditing payments making to renal

Index of Sec 1643. ...

Sec 1643. -- Access To Certain Information On Renal Dialysis Facilities.
SEC 1643. -- ACCESS TO CERTAIN INFORMATION ON RENAL DIALYSIS FACILITIES. - paragraph (15)
DIVISION B TITLE VI SUBTITLE C SEC 1643. Quoted: (15)
Automated Concept:

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
Sec 1148. -- Durable Medical Equipment Program Improvements.
(iii) EXCEPTION FOR BANKRUPTCY.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (d) Quoted: (iii)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(l) RESERVATIONS OF FUNDS. - paragraph (2)

Residency
Sec 1501. -- Distribution Of Unused Residency Positions.
(D) MAINTENANCE OF PRIMARY CARE RESIDENT LEVEL. - paragraph (i)
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (D) (i)
Automated Concept:

RESIDENCY training programs ;   Number of primary care residents in

Index of Sec 1501. ...

Residency: approved medical
Sec 1503. -- Rules For Counting Resident Time For Didactic And Scholarly Activities And Other Activities.
(ii) TREATMENT OF CERTAIN NONPROVIDER AND DIDACTIC ACTIVITIES.
DIVISION B TITLE V SEC 1503. (a) (1) (B) Quoted: (ii)
Automated Concept:

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. ...
(a) DIRECT GME. - paragraph (2) - paragraph (I)
DIVISION B TITLE V SEC 1503. (a) (2) Quoted: (I)
Automated Concept:

RESIDENCY training program on vacation, sick leave or other approved leave ;   Time spent by intern or resident in approved medical

Index of Sec 1503. ...
(xi) - paragraph (II)
DIVISION B TITLE V SEC 1503. (b) Quoted: (xi) (II)
Automated Concept:

NONPATIENT care activities ;   Time spent by intern or resident in approved medical residency training program in

Index of Sec 1503. ...
(xi) - paragraph (III)
DIVISION B TITLE V SEC 1503. (b) Quoted: (xi) (III)
Automated Concept:

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. ...
Sec 1744. -- Payments For Graduate Medical Education.
(4) SPECIFICATION OF GOALS AND REQUIREMENTS. - paragraph (A)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (4) (A)
Automated Concept:

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: existing
Sec 1501. -- Distribution Of Unused Residency Positions.
(II) USE OF MOST RECENT ACCOUNTING PERIOD TO RECOGNIZE EXPANSION OF EXISTING PROGRAMS.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (A) (ii) (II)
Automated Concept:

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: medical
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS.
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B)
Automated Concept:

RESIDENCY training programs to foster physician workforce so ;   Goals of medical

Index of Sec 1505. ...
(1) IN GENERAL.
DIVISION B TITLE V SEC 1505. (b) (1)
Automated Concept:

RESIDENCY training programs ;   Comptroller General of United States conducting study to evaluate extent to which medical

Index of Sec 1505. ...
(2) REPORT.
DIVISION B TITLE V SEC 1505. (b) (2)
Automated Concept:

RESIDENCY training programs to be further encouraged to meet goals through means ;   Medical

Index of Sec 1505. ...

Residency: primary care
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (C)
DIVISION B TITLE V SEC 1502. (d) (2) (C)
Automated Concept:

RESIDENCY training program ;   Contracting hospital agreeing not to diminish number of residents in primary care

Index of Sec 1502. ...

Residency positions
Residency positions: additional
Sec 1501. -- Distribution Of Unused Residency Positions.
(vi) DISTRIBUTION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (vi)
Automated Concept:

HOSPITAL attributable to increase provided under subparagraph ;   Respect to additional residency positions in

Index of Sec 1501. ...

Residency positions: equivalent additional
Sec 1501. -- Distribution Of Unused Residency Positions.
(v) LIMITATION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (v)
Automated Concept:

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
Residency programs: approved medical
Sec 1504. -- Preservation Of Resident Cap Positions From Closed Hospitals.
(III) LIMITATION.
DIVISION B TITLE V SEC 1504. (a) Quoted: (vi) (III)
Automated Concept:

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: medical
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(2) REPORT. - paragraph (B)
DIVISION B TITLE V SEC 1505. (b) (2) (B)
Automated Concept:

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. ...

Residency programs: range of
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE V SEC 1505. (b) (1) (A)
Automated Concept:

PRIMARY care and other specialties ;   Range of residency programs including

Index of Sec 1505. ...

Responsibility
Responsibility: inpatient
Sec 1502. -- Increasing Training In Nonprovider Settings.
(2) CONDITIONS. - paragraph (A)
DIVISION B TITLE V SEC 1502. (d) (2) (A)
Automated Concept:

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. ...

Sec 1148. -- Durable Medical Equipment Program Improvements.
(iii) CONTINUATION OF SUPPLY.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (b) (1) (B) Quoted: (iii)
Automated Concept:

RESPONSIBILITY for continuing to furnish equipment during remainder of period ;   Another supplier accepted

Index of Sec 1148. ...
Sec 1302. -- Medical Home Pilot Program.
(1) PATIENT-CENTERED MEDICAL HOME SERVICES. - paragraph (A)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (b) (1) (A)
Automated Concept:

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. ...
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(2) ACCURACY OF REPORTING.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (c) (2)
Automated Concept:

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
Sec 1421. -- Civil Money Penalties.
(VII) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (aa)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (a) (1) Quoted: (ii) (VII) (aa)
Automated Concept:

RESPONSIBILITY of State survey agency for making final recommendations for penalties ;   Opportunity not affecting

Index of Sec 1421. ...
(iv) COLLECTION OF CIVIL MONEY PENALTIES. - paragraph (I)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1421. (b) (1) (A) (ii) Quoted: (G) (iv) (I)
Automated Concept:

RESPONSIBILITY of State survey agency for making final recommendations for penalties ;   Opportunity not affecting

Index of Sec 1421. ...

Restrictive: more
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (1)
Automated Concept:

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. ...
(1) MAINTENANCE OF EFFORT.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (1)
Automated Concept:

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. ...

Retroactive coverage
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(ii) RFP CONTRACT DESCRIBED.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (B) (ii)
Automated Concept:

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
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(1) COVERED DRUG COSTS. - paragraph (A)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (1) (A)
Automated Concept:

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. ...
(2) ELIGIBLE THIRD PARTY.
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (2)
Automated Concept:

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. ...

Retroactive lis enrollment
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(2) TIMING OF REIMBURSEMENTS.
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (2)
Automated Concept:

RETROACTIVE lis enrollment beneficiary with respect to claim ;   Prescription drug plan or Ma-pd plan making reimbursement under subsection to

Index of Sec 1204. ...
(3) RETROACTIVE COVERAGE PERIOD. - paragraph (A)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (3) (A)
Automated Concept:

RETROACTIVE lis enrollment beneficiary described in paragraph ;   Respect to

Index of Sec 1204. ...
(3) RETROACTIVE COVERAGE PERIOD. - paragraph (B)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (3) (B)
Automated Concept:

RETROACTIVE lis enrollment beneficiary described in paragraph ;   Respect to

Index of Sec 1204. ...

Risk
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(i) IN GENERAL. - paragraph (I)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (I)
Automated Concept:

READMISSIONS based on actual readmissions ;   Risk adjusted

Index of Sec 1151. ...
(i) IN GENERAL. - paragraph (II)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (4) (C) (i) (II)
Automated Concept:

HOSPITAL for condition with respect to applicable period ;   Risk adjusted expected readmissions for

Index of Sec 1151. ...
(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES.
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (7)
Automated Concept:

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. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(iii) ADJUSTMENT FACTOR.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (B) (iii)
Automated Concept:

RISK as determined appropriate by Secretary ;   Adjustment factor to be adjusted for

Index of Sec 1301. ...
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (2) (A)
Automated Concept:

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. ...
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(2) ENHANCED SAFEGUARDS.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (2)
Automated Concept:

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
Sec 1637. -- Physicians Who Order Durable Medical Equipment Or Home Health Services Required To Be Medicare Enrolled Physicians Or Eligible Professionals.
(c) DISCRETION TO EXPAND APPLICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1637. (c)
Automated Concept:

RISK of waste ;   Secretary determining that application helping to reduce

Index of Sec 1637. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(c) APPLICATION TO OTHER AREAS UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (c)
Automated Concept:

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. ...

Risk: high
Sec 1633. -- Required Inclusion Of Payment Modifier For Certain Evaluation And Management Services.
(p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.
DIVISION B TITLE VI SUBTITLE C SEC 1633. Quoted: (p)
Automated Concept:

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. ...

Risk: high
Sec 1635. -- Require Providers And Suppliers To Adopt Programs To Reduce Waste, Fraud, And Abuse.
(5) PILOT PROGRAM.
DIVISION B TITLE VI SUBTITLE C SEC 1635. (a) Quoted: (d) (5)
Automated Concept:

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: higher
Sec 1302. -- Medical Home Pilot Program.
(A) ESTABLISHMENT OF METHODOLOGY.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (A)
Automated Concept:

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. ...
(D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (iii)
Automated Concept:

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: significant
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL.
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1)
Automated Concept:

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. ...

Risk adjustment system
Sec 1167. -- Improving Risk Adjustment For Payments.
(b) IMPROVEMENTS TO RISK ADJUSTMENT.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (b)
Automated Concept:

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. ...

Risk adjustment system: adequacy of
Sec 1167. -- Improving Risk Adjustment For Payments.
(a) REPORT TO CONGRESS.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1167. (a)
Automated Concept:

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. ...

Risk physicians' services or items and services
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (2) (A)
Automated Concept:

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-adjustment: appropriate
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (iii)
Automated Concept:

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. ...
(D) AMOUNT OF PAYMENT. - paragraph (ii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (D) (ii)
Automated Concept:

RISK-adjustment in determining amount of per beneficiary per month payment under paragraph ;   Use appropriate

Index of Sec 1302. ...

Rural
Sec 1149. -- Medpac Study And Report On Bone Mass Measurement.
(a) IN GENERAL. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1149. (a) (2)
Automated Concept:

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. ...
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(i) REQUIREMENTS TO QUALIFY FOR RURAL PROVIDER AND HOSPITAL OWNERSHIP EXCEPTIONS TO SELF-REFERRAL PROHIBITION.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i)
Automated Concept:

HOSPITAL ownership exceptions to self-referral prohibition ;   Requirements to qualify for rural Provider and

Index of Sec 1156. ...

Rural areas: urban and
Sec 1157. -- Institute Of Medicine Study Of Geographic Adjustment Factors Under Medicare.
(c) EVALUATION. - paragraph (1) - paragraph (A)
DIVISION B TITLE I SUBTITLE C SEC 1157. (c) (1) (A)
Automated Concept:

RURAL areas ;   Recruitment and retention taking into account workforce mobility between urban and

Index of Sec 1157. ...

Safety
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS. - paragraph (iv)
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B) (iv)
Automated Concept:

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: patient
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(d) REPORT ON ADDITIONAL DATA.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (d)
Automated Concept:

SAFETY ;   Order to improve health care quality and patient

Index of Sec 1461. ...

Safety and quality
Safety and quality: repeated
Sec 1422. -- National Independent Monitor Pilot Program.
(b) REQUIREMENTS.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (b)
Automated Concept:

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: serious
Sec 1422. -- National Independent Monitor Pilot Program.
(b) REQUIREMENTS.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1422. (b)
Automated Concept:

SAFETY and quality of care problems ;   Including where evidence suggesting that one or more facilities of chain experiencing serious

Index of Sec 1422. ...

Safety procedures: patient
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(d) NON-PREEMPTION OF STATE LAWS.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (d)
Automated Concept:

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
Sec 1223. -- Iom Report On Impact Of Language Access Services.
(b) CONTENTS. - paragraph (3)
DIVISION B TITLE II SUBTITLE B SEC 1223. (b) (3)
Automated Concept:

SAVINGS related to provision of language access services ;   Description of costs associated or

Index of Sec 1223. ...

Savings: amount of
Sec 1301. -- Accountable Care Organization Pilot Program.
(A) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (A)
Automated Concept:

SAVINGS being greater ;   Incentive payment to be made only if

Index of Sec 1301. ...
(4) LIMITATIONS ON REVIEW. - paragraph (C)
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (e) (4) (C)
Automated Concept:

SAVINGS achieved and amount of savings ;   Determinations with respect whether

Index of Sec 1301. ...

Savings: potential
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (2)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (2)
Automated Concept:

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: Medicare
Sec 1232. -- Extended Months Of Coverage Of Immunosuppressive Drugs For Kidney Transplant Patients And Other Renal Dialysis Provisions.
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE II SUBTITLE C SEC 1232. (a) (1) (B) (ii) Quoted: (b) (1) (B)
Automated Concept:

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. ...

Secretarial
Sec 1163. -- Extension Of Secretarial Coding Intensity Adjustment Authority.
SEC 1163. -- EXTENSION OF SECRETARIAL CODING INTENSITY ADJUSTMENT AUTHORITY.
DIVISION B TITLE I SUBTITLE D PART 1 SEC 1163.
Automated Concept:

CODING intensity adjustment authority ;   Extension of secretarial

Index of Sec 1163. ...

Security: data
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) CONSIDERATIONS. - paragraph (2)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1193. (b) (2)
Automated Concept:

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
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(1) IN GENERAL. - paragraph (A) - paragraph (v) - paragraph (VI)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (f) (1) (A) (v) (VI)
Automated Concept:

SOCIAL ;   Skills to recognize and seek help for issues related to health, developmental delays and

Index of Sec 1904. ...

Social security administration's outreach
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...
Sec 1801. -- 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.
SEC 1801. -- 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.
DIVISION B TITLE VIII SEC 1801.
Automated Concept:

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. ...
(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.
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19)
Automated Concept:

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. ...

Social services
Sec 1224. -- Definitions.
(7) HEALTH CARE-RELATED SERVICES.
DIVISION B TITLE II SUBTITLE B SEC 1224. (7)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(iii) ADJUSTMENT FACTOR.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (B) (iii)
Automated Concept:

SPECIFIC basis and determined on per capita basis ;   Local or organization-

Index of Sec 1301. ...

Specific case
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(4) ENFORCEMENT THROUGH STATE ATTORNEYS GENERAL.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (d) (4)
Automated Concept:

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
Sec 1416. -- Ensuring Staffing Accountability.
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (a) Quoted: (C) (iv)
Automated Concept:

SPECIFIC categories ;   Nothing in subparagraph to be construed as preventing Secretary from requiring submission of information with respect to

Index of Sec 1416. ...
(C) SUBMISSION OF STAFFING INFORMATION BASED ON PAYROLL DATA IN A UNIFORM FORMAT. - paragraph (iv)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1416. (b) Quoted: (C) (iv)
Automated Concept:

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
Sec 1412. -- Accountability Requirements.
(II) DESIGN OF REGULATIONS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (ii) (II)
Automated Concept:

SPECIFIC elements or formality of program varying with size of organization ;   Regulations with respect to

Index of Sec 1412. ...
(II) DESIGN OF REGULATIONS.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (ii) (II)
Automated Concept:

SPECIFIC elements or formality of program varying with size of organization ;   Regulations with respect to

Index of Sec 1412. ...

Specific limit
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(6) LIMITATIONS ON REVIEW. - paragraph (D)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (6) (D)
Automated Concept:

HOSPITAL-specific limit under paragraph and form of payment making by Secretary under paragraph  ;  

Index of Sec 1151. ...

Specific Medicare
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (2)
DIVISION B TITLE III SEC 1305. (a) Quoted: (iii) (2)
Automated Concept:

PREVENTIVE services ;   Respect to specific Medicare covered

Index of Sec 1305. ...

Specific research inquiry
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (H)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (H)
Automated Concept:

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. ...

Specific resources
Sec 1233. -- Advance Care Planning Consultation.
(hhh) ADVANCE CARE PLANNING CONSULTATION. - paragraph (1) - paragraph (D)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (D)
Automated Concept:

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
Sec 1301. -- Accountable Care Organization Pilot Program.
(5) CONSTRUCTION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (5)
Automated Concept:

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. ...

Specific upper limit
Sec 1741. -- Payments To Pharmacists.
(5) PHARMACY REIMBURSEMENTS THROUGH DECEMBER 31, 2010.
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (5)
Automated Concept:

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. ...

Statment
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (F)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (F)
Automated Concept:

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. ...

Subject
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(6) CONFIDENTIALITY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (6)
Automated Concept:

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. ...

Subsidy
Subsidyes
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(3) REPORTING REQUIREMENT. - paragraph (A)
DIVISION B TITLE II SUBTITLE A SEC 1204. (b) (3) (A)
Automated Concept:

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. ...

Subsidy: low-income
Sec 1203. -- Eliminating Barriers To Enrollment.
(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.
DIVISION B TITLE II SUBTITLE A SEC 1203. (b)
Automated Concept:

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. ...

Sec 1206. -- Special Enrollment Period And Automatic Enrollment Process For Certain Subsidy Eligible Individuals.
(D) SUBSIDY ELIGIBLE INDIVIDUALS.
DIVISION B TITLE II SUBTITLE A SEC 1206. (a) Quoted: (D)
Automated Concept:

SUBSIDY eligible individual ;   Case of individual determined under subparagraph of section 1860d-14(a)(3) to be

Index of Sec 1206. ...
Sec 1801. -- 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.
(C) RESTRICTION ON INDIVIDUALS FOR WHOM DISCLOSURE MAY BE REQUESTED. - paragraph (i)
DIVISION B TITLE VIII SEC 1801. (a) Quoted: (19) (C) (i)
Automated Concept:

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: individual
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(B) QUALIFYING ENROLLEE.
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (5) (B)
Automated Concept:

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
Sec 1432. -- Study And Report On Training Required For Certified Nurse Aides And Supervisory Staff.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 3 SEC 1432. (a) (1)
Automated Concept:

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. ...

Surety bond
Sec 1148. -- Durable Medical Equipment Program Improvements.
(a) WAIVER OF SURETY BOND REQUIREMENT.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (a)
Automated Concept:

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. ...

Surety bond: provision of
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(2) ENHANCED SAFEGUARDS.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (2)
Automated Concept:

BOND ;   Requiring or unannounced site visits or inspections, additional information reporting requirements and conditioning enrollment on provision of surety

Index of Sec 1632. ...

Surety bonds
Sec 1412. -- Accountability Requirements.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (c) (1) (C)
Automated Concept:

CAPITALIATIONS ;   Requirements relating to surety bonds, liability insurance or minimum

Index of Sec 1412. ...

Surveillance efforts: medical device
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (a) (2) (E)
Automated Concept:

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
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(e) NET REVENUES. - paragraph (2)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (e) (2)
Automated Concept:

TAX imposed by chapter 1 resulting from fees imposed by subchapter ;   Decrease in

Index of Sec 1802. ...

Teaching adjustment factor: indirect
Sec 1501. -- Distribution Of Unused Residency Positions.
(2) CONFORMING PROVISION. - paragraph (x)
DIVISION B TITLE V SEC 1501. (b) (2) Quoted: (x)
Automated Concept:

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. ...

Teaching self-care skills
Sec 1302. -- Medical Home Pilot Program.
(B) COMMUNITY-BASED MEDICAL HOME DEFINED. - paragraph (iii)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (1) (B) (iii)
Automated Concept:

CHRONIC illnesses, transitional care services, care plan ;   Teaching self-care skills for managing

Index of Sec 1302. ...

Telehealth services
Sec 1191. -- Telehealth Expansion And Enhancements.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (1) (B) Quoted: (c) (1)
Automated Concept:

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: delivery of
Sec 1191. -- Telehealth Expansion And Enhancements.
(iii) RECOMMENDATIONS OF THE TELEHEALTH ADVISORY COMMITTEE.
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (2) Quoted: (iii)
Automated Concept:

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. ...

Telemedicine
Telemedicine or telehealth programs
Sec 1191. -- Telehealth Expansion And Enhancements.
(ii) REQUIREMENTS FOR APPOINTING MEMBERS. - paragraph (II)
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (1) (B) Quoted: (c) (2) (A) (ii) (II)
Automated Concept:

TELEHEALTH programs ;   Giving preference to individuals providing telemedicine or telehealth services or involved in telemedicine or

Index of Sec 1191. ...

Telemedicine or telehealth services
Sec 1191. -- Telehealth Expansion And Enhancements.
(ii) REQUIREMENTS FOR APPOINTING MEMBERS. - paragraph (II)
DIVISION B TITLE I SUBTITLE F SEC 1191. (b) (1) (B) Quoted: (c) (2) (A) (ii) (II)
Automated Concept:

TELEHEALTH programs ;   Giving preference to individuals providing telemedicine or telehealth services or involved in telemedicine or

Index of Sec 1191. ...

Tenure: turnover and
Sec 1413. -- Nursing Home Compare Medicare Website.
(A) IN GENERAL. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (a) (1) (B) Quoted: (i) (1) (A) (iii)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1413. (b) (1) (B) Quoted: (i) (1) (A) (i)
Automated Concept:

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
Sec 1781. -- Technical Corrections.
(e) TECHNICAL CORRECTION TO SECTION 1905 OF THE SOCIAL SECURITY ACT.
DIVISION B TITLE VII SUBTITLE H SEC 1781. (e)
Automated Concept:

THEMSELVES ;   Section 1905(a) of Social Security Act 42 USC 1396d(a) amended by inserting or care and servicing

Index of Sec 1781. ...

Title
Sec 1103. -- Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements.
(1) REFERENCE TO ESTABLISHMENT AND IMPLEMENTATION OF SYSTEM.
DIVISION B TITLE I SUBTITLE A PART 1 SEC 1103. (e) Quoted: (o) (1)
Automated Concept:

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. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) APPLICABLE CONDITION. - paragraph (i)
DIVISION B TITLE I SUBTITLE C SEC 1151. (a) (1) Quoted: (p) (5) (A) (i)
Automated Concept:

TITLE ;   Readmissions representing conditions or procedures being high volume or high expenditures under

Index of Sec 1151. ...
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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. ...
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(c) LIMITATION. - paragraph (1)
DIVISION B TITLE I SUBTITLE C SEC 1152. (f) (1) Quoted: SEC 1866D. (c) (1)
Automated Concept:

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. ...
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1)
Automated Concept:

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. ...
(1) IN GENERAL. - paragraph (B)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (1) (B)
Automated Concept:

TITLE very infrequently ;   Secretary determining providing services For which payment to be made under

Index of Sec 1156. ...
(2) REQUIREMENTS FOR HOSPITALS WITH PHYSICIAN OWNERSHIP OR INVESTMENT. - paragraph (C) - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (3) Quoted: (f) (2) (C) (ii)
Automated Concept:

TITLE very infrequently ;   Secretary determining providing services For which payment to be made under

Index of Sec 1156. ...
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(1) COVERED DRUG COSTS. - paragraph (A)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (1) (A)
Automated Concept:

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. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (a)
Automated Concept:

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. ...
(B) INCLUSION OF OTHER PROVIDERS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (b) (1) (B)
Automated Concept:

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. ...
(i) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (C) (i)
Automated Concept:

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. ...
(ii) LIMITATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (c) (1) (C) (ii)
Automated Concept:

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. ...
(2) FOLLOWING APPLICABLE BENEFICIARIES.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (d) (2)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (f) (1)
Automated Concept:

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. ...
(1) REPORTS TO CONGRESS.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (g) (1)
Automated Concept:

TITLE ;   Report addressing impact of use of authorities on expenditures, access and quality under

Index of Sec 1301. ...
Sec 1302. -- Medical Home Pilot Program.
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (c) (3) (D) (i)
Automated Concept:

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. ...
(4) PREFERENCE. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (C)
Automated Concept:

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. ...
(D) AMOUNT OF PAYMENT. - paragraph (i)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (5) (D) (i)
Automated Concept:

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. ...
(1) EVALUATION OF COST AND QUALITY. - paragraph (B)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (e) (1) (B)
Automated Concept:

TITLE on permanent basis ;   Feasability and advisability of reimbursing medical homes for medical home services under

Index of Sec 1302. ...
(2) NO EFFECT ON PAYMENT FOR EVALUATION AND MANAGEMENT SERVICES.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (f) (2)
Automated Concept:

TITLE ;   Payment for evaluation and management services making under

Index of Sec 1302. ...
Sec 1414. -- Reporting Of Expenditures.
(1) IN GENERAL.
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1414. Quoted: (f) (1)
Automated Concept:

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. ...
Sec 1423. -- Notification Of Facility Closure.
(A) IN GENERAL. - paragraph (i) - paragraph (II)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (a) (1) Quoted: (7) (A) (i) (II)
Automated Concept:

TITLE ;   Case of facility where Secretary terminating facility's participation under

Index of Sec 1423. ...
(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (a) (1) Quoted: (7) (B) (ii)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (i) - paragraph (II)
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (b) (1) Quoted: (9) (A) (i) (II)
Automated Concept:

TITLE ;   Case of facility where Secretary terminating facility's participation under

Index of Sec 1423. ...
(ii) CONTINUATION OF PAYMENTS UNTIL RESIDENTS RELOCATED.
DIVISION B TITLE IV SUBTITLE B PART 2 SEC 1423. (b) (1) Quoted: (9) (B) (ii)
Automated Concept:

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. ...
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(1) LIST OF MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (1)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) IN GENERAL.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a)
Automated Concept:

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. ...
(a) IN GENERAL. - paragraph (2) - paragraph (B)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (a) (2) (B)
Automated Concept:

COMPLIANCE with requirements ;   Secretary determining that hospice program certified for participation under title in

Index of Sec 1614. ...
(A) IN GENERAL. - paragraph (ii)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a) Quoted: SEC 1819A. (b) (2) (A) (ii)
Automated Concept:

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. ...
(b) APPLICATION TO MEDICAID. - paragraph (4)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (b) Quoted: (4)
Automated Concept:

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. ...
SEC 2114. -- ASSURING QUALITY OF CARE IN HOSPICE CARE.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (c) Quoted: SEC 2114.
Automated Concept:

TITLE in same manner ;   Provisions of section 1819a applying to hospice program providing hospice care under

Index of Sec 1614. ...
Sec 1631. -- Enhanced Cms Program Protection Authority.
(3) PROGRAM INTEGRITY.
DIVISION B TITLE VI SUBTITLE C SEC 1631. (b) (3) Quoted: (3)
Automated Concept:

TITLE ;   Provisions of section 1128g(a) applying to enrollments and renewals of enrollments of providers of services and suppliers under

Index of Sec 1631. ...
Sec 1633. -- Required Inclusion Of Payment Modifier For Certain Evaluation And Management Services.
(p) PAYMENT MODIFIER FOR CERTAIN EVALUATION AND MANAGEMENT SERVICES.
DIVISION B TITLE VI SUBTITLE C SEC 1633. Quoted: (p)
Automated Concept:

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. ...
Sec 1637. -- Physicians Who Order Durable Medical Equipment Or Home Health Services Required To Be Medicare Enrolled Physicians Or Eligible Professionals.
(c) DISCRETION TO EXPAND APPLICATION.
DIVISION B TITLE VI SUBTITLE C SEC 1637. (c)
Automated Concept:

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. ...
Sec 1638. -- Requirement For Physicians To Provide Documentation On Referrals To Programs At High Risk Of Waste And Abuse.
(a) PHYSICIANS AND OTHER SUPPLIERS. - paragraph (10)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (a) Quoted: (10)
Automated Concept:

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. ...
(b) PROVIDERS OF SERVICES. - paragraph (3) - paragraph (X)
DIVISION B TITLE VI SUBTITLE C SEC 1638. (b) (3) Quoted: (X)
Automated Concept:

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. ...
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (1)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (b) (1)
Automated Concept:

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. ...
(b) CONFORMING AMENDMENTS TO ERROR RATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE A SEC 1702. (b) (2)
Automated Concept:

TITLE and titling XIX ;   Clause of section 1903(u)(1)(d) applying with respect to application of requirements under

Index of Sec 1702. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(1) MAINTENANCE OF EFFORT.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (1)
Automated Concept:

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. ...
Sec 1704. -- Reduction In Medicaid Dsh.
(1) IN GENERAL. - paragraph (4) - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1704. (d) (1) Quoted: (4) (B)
Automated Concept:

TITLE for services provided to eligible beneficiaries under title ;   Reimbursement under

Index of Sec 1704. ...
Sec 1714. -- State Eligibility Option For Family Planning Services.
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE VII SUBTITLE B SEC 1714. (b) (1) Quoted: SEC 1920C. (b) (2) (A) (i)
Automated Concept:

TITLE ;   Eligible for payments under State plan approved under

Index of Sec 1714. ...
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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. ...
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
(a) STATE PLAN REQUIREMENT. - paragraph (3) - paragraph (77) - paragraph (A)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (a) (3) Quoted: (77) (A)
Automated Concept:

TITLE during period determining by Secretary or State agency to be delinquent ;   Unpaid overpayments under

Index of Sec 1757. ...
(a) STATE PLAN REQUIREMENT. - paragraph (3) - paragraph (77) - paragraph (B)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (a) (3) Quoted: (77) (B)
Automated Concept:

TITLE during period ;   Suspending or excluded from participation or whose participation terminated under

Index of Sec 1757. ...
(a) STATE PLAN REQUIREMENT. - paragraph (3) - paragraph (77) - paragraph (C)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (a) (3) Quoted: (77) (C)
Automated Concept:

TITLE during period ;   Affiliating with individual or entity suspended or excluded from participation under title or whose participation terminated under

Index of Sec 1757. ...

Title and incentive payments
Sec 1301. -- Accountable Care Organization Pilot Program.
(6) FUNDING.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (j) (6)
Automated Concept:

INCENTIVE payments under subsection ;   Other than payments for items and services furnished under title and

Index of Sec 1301. ...

Title: provisions of
Sec 1301. -- Accountable Care Organization Pilot Program.
(2) WAIVER.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (e) (2)
Automated Concept:

TITLE and title XI in manner Secretary determining necessary in order implement pilot program ;   Secretary waiving provisions of

Index of Sec 1301. ...

Title: part C of
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a) (1)
Automated Concept:

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 of 12-month
Sec 1733. -- Requirement Of 12-Month Continuous Coverage Under Certain Chip Programs.
(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.
DIVISION B TITLE VII SUBTITLE D SEC 1733. (a) Quoted: (6)
Automated Concept:

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: part B of
Sec 1224. -- Definitions.
(11) MEDICARE BENEFICIARY.
DIVISION B TITLE II SUBTITLE B SEC 1224. (11)
Automated Concept:

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. ...
Sec 1642. -- Expanded Application Of Hardship Waivers For Oig Exclusions To Beneficiaries Of Any Federal Health Care Program.
SEC 1642. -- EXPANDED APPLICATION OF HARDSHIP WAIVERS FOR OIG EXCLUSIONS TO BENEFICIARIES OF ANY FEDERAL HEALTH CARE PROGRAM.
DIVISION B TITLE VI SUBTITLE C SEC 1642.
Automated Concept:

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. ...

Title: part C of
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (1)
Automated Concept:

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. ...
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) ELIGIBILITY. - paragraph (A) - paragraph (iii)
DIVISION B TITLE II SUBTITLE B SEC 1222. (b) (1) (A) (iii)
Automated Concept:

TITLE ;   Part C organization offering Medicare part C plan under part C of

Index of Sec 1222. ...

Title: part D of
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (F)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (F)
Automated Concept:

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. ...

Title: provisions of
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(B) OVERRIDING CONTRARY PROVISIONS; REFERENCES.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (b) (1) Quoted: (aa) (2) (B)
Automated Concept:

ASSET or resource test described in subparagraph waived ;   Provisions of title preventing waiver of

Index of Sec 1703. ...

Title: requirements of
Sec 1705. -- Expanded Outstationing.
(b) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE A SEC 1705. (b) (2)
Automated Concept:

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. ...
Sec 1711. -- Required Coverage Of Preventive Services.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE B SEC 1711. (c) (2)
Automated Concept:

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. ...
Sec 1756. -- Termination Of Provider Participation Under Medicaid And Chip If Terminated Under Medicare Or Other State Plan Or Child Health Plan.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1756. (c) (2)
Automated Concept:

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. ...
Sec 1757. -- Medicaid And Chip Exclusion From Participation Relating To Certain Ownership, Control, And Management Affiliations.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1757. (c) (2)
Automated Concept:

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. ...
Sec 1759. -- Billing Agents, Clearinghouses, Or Other Alternate Payees Required To Register Under Medicaid.
(c) EFFECTIVE DATE. - paragraph (2)
DIVISION B TITLE VII SUBTITLE F SEC 1759. (c) (2)
Automated Concept:

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. ...

Title: respective
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(c) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1713. (c)
Automated Concept:

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: violation of
Sec 1415. -- Standardized Complaint Form.
(E) GOOD FAITH DEFINED. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (a) (2) Quoted: (6) (E) (ii)
Automated Concept:

INFORMATION ;   Violation of title occurring or occurring in relation to

Index of Sec 1415. ...
(E) GOOD FAITH DEFINED. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1415. (b) (2) Quoted: (8) (E) (ii)
Automated Concept:

INFORMATION ;   Violation of title occurring or occurring in relation to

Index of Sec 1415. ...

Title 18
Title 18: section 208(a) of
Sec 1401. -- Comparative Effectiveness Research.
(D) FINANCIAL INTEREST DEFINED.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (D)
Automated Concept:

TITLE 18, United States coding ;   Term financial interest meaning financial interest under section 208(a) of

Index of Sec 1401. ...

Title 18: section 208(b)(1) of
Sec 1401. -- Comparative Effectiveness Research.
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

TITLE 18 ;   Later requiring written determination as referred in section 208(b)(1) of

Index of Sec 1401. ...

Title 18: section 208(b)(3) of
Sec 1401. -- Comparative Effectiveness Research.
(B) EVALUATION AND CRITERIA.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (B)
Automated Concept:

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: section 210.57 of
Sec 1185. -- Permitting Mid-Year Changes In Enrollment For Formulary Changes That Adversely Impact An Enrollee.
(ii) EXCEPTION. - paragraph (I)
DIVISION B TITLE I SUBTITLE E SEC 1185. (a) Quoted: (F) (ii) (I)
Automated Concept:

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
Title 31: section 3729(b) of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(7) KNOWINGLY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (7)
Automated Concept:

TITLE 31, United States coding ;   Term knowingly having meaning given term in section 3729(b) of

Index of Sec 1451. ...

Title 31: section 3729(b)(3) of
Sec 1641. -- Required Repayments Of Medicare And Medicaid Overpayments.
(A) KNOWS.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (4) (A)
Automated Concept:

TITLE 31 of United States coding ;   Term knowing having meaning given terms knowing and knowingly in section 3729(b) of

Index of Sec 1641. ...
(2) TIMING.
DIVISION B TITLE VI SUBTITLE C SEC 1641. Quoted: (c) (2)
Automated Concept:

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
Title 42: final adverse action of
Sec 1148. -- Durable Medical Equipment Program Improvements.
(a) WAIVER OF SURETY BOND REQUIREMENT.
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1148. (a)
Automated Concept:

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: section 412.531 of
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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: section 413.79 of
Sec 1504. -- Preservation Of Resident Cap Positions From Closed Hospitals.
(b) NO EFFECT ON TEMPORARY FTE CAP ADJUSTMENTS.
DIVISION B TITLE V SEC 1504. (b)
Automated Concept:

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. ...

Title 42: section 447.332 of
Sec 1741. -- Payments To Pharmacists.
(5) PHARMACY REIMBURSEMENTS THROUGH DECEMBER 31, 2010.
DIVISION B TITLE VII SUBTITLE E SEC 1741. (a) (5)
Automated Concept:

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: section 484.220 of
Sec 1154. -- Payment Adjustments For Home Health Care.
(I) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1154. (a) (2) Quoted: (vi) (I)
Automated Concept:

TITLE 42 ;   Respect to case mix adjustments established in section 484.220 of

Index of Sec 1154. ...

Title 44: chapter 35 of
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(2) ADMINISTRATION. - paragraph (A)
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (b) (2) (A)
Automated Concept:

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. ...
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(2) EXPEDITED DATA COLLECTION.
DIVISION B TITLE I SUBTITLE C SEC 1152. (d) (2)
Automated Concept:

TITLE 44, United States Code not applying to section ;   Chapter 35 of

Index of Sec 1152. ...
Sec 1301. -- Accountable Care Organization Pilot Program.
(5) ADMINISTRATION.
DIVISION B TITLE III SEC 1301. Quoted: SEC 1866D. (e) (5)
Automated Concept:

TITLE 44, United States Code not applying to section ;   Chapter 35 of

Index of Sec 1301. ...
Sec 1302. -- Medical Home Pilot Program.
(3) ADMINISTRATION.
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (f) (3)
Automated Concept:

TITLE 44, United States Code not applying to section ;   Chapter 35 of

Index of Sec 1302. ...
Sec 1310. -- Expanding Access To Vaccines.
(G) IMPLEMENTATION.
DIVISION B TITLE III SEC 1310. (c) (3) Quoted: (G)
Automated Concept:

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: section 552 of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(6) CONFIDENTIALITY.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (a) (6)
Automated Concept:

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. ...

Title and PDP sponsors of prescription drug plan: part
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (F)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (F)
Automated Concept:

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: subtitle C of
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(A) NON-TRADITIONAL INDIVIDUALS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (2) (A)
Automated Concept:

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. ...
(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a) Quoted: SEC 1943. (a) (3)
Automated Concept:

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. ...
(b) CONFORMING AMENDMENTS TO ERROR RATE. - paragraph (1) - paragraph (vi)
DIVISION B TITLE VII SUBTITLE A SEC 1702. (b) (1) Quoted: (vi)
Automated Concept:

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: part B of
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
SEC 1904. -- GRANTS TO STATES FOR QUALITY HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN.
DIVISION B TITLE IX SEC 1904.
Automated Concept:

TITLE IV of Social Security Act 42 USC 621-629i amended by adding at end following ;   Part B of

Index of Sec 1904. ...

Title post
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(h) GENERAL PROVISIONS.
DIVISION B TITLE II SUBTITLE B SEC 1222. (h)
Automated Concept:

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: subtitle A o
Sec 1901. -- Repeal Of Trigger Provision.
SEC 1901. -- REPEAL OF TRIGGER PROVISION.
DIVISION B TITLE IX SEC 1901.
Automated Concept:

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
Title xi
Sec 1401. -- Comparative Effectiveness Research.
(a) IN GENERAL.
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a)
Automated Concept:

TITLE XI of Social Security Act amended by adding at end following new part  ;  

Index of Sec 1401. ...
Sec 1441. -- Establishment Of National Priorities For Quality Improvement.
SEC 1441. -- ESTABLISHMENT OF NATIONAL PRIORITIES FOR QUALITY IMPROVEMENT.
DIVISION B TITLE IV SUBTITLE C SEC 1441.
Automated Concept:

TITLE XI of Social Security Act being further amended by adding at end following new part  ;  

Index of Sec 1441. ...
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(a) IN GENERAL.
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a)
Automated Concept:

TITLE XI of Social Security Act amended by inserting after section 1138 following section  ;  

Index of Sec 1461. ...
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
SEC 1905. -- IMPROVED COORDINATION AND PROTECTION FOR DUAL ELIGIBLES.
DIVISION B TITLE IX SEC 1905.
Automated Concept:

TITLE XI of Social Security Act amended by inserting after section 1150 following new section  ;  

Index of Sec 1905. ...

Title xi: part E of
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
SEC 1442. -- DEVELOPMENT OF NEW QUALITY MEASURES; GAO EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT.
DIVISION B TITLE IV SUBTITLE C SEC 1442.
Automated Concept:

TITLE XI of Social Security Act amended by adding at end following new sections ;   Part E of

Index of Sec 1442. ...

Title xix
Title xix
Sec 1156. -- Limitation On Medicare Exceptions To The Prohibition On Certain Physician Referrals Made To Hospitals.
(E) CONDITIONS FOR APPROVAL OF AN INCREASE IN FACILITY CAPACITY. - paragraph (ii)
DIVISION B TITLE I SUBTITLE C SEC 1156. (a) (5) Quoted: (i) (2) (E) (ii)
Automated Concept:

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. ...
Sec 1182. -- Discounts For Certain Part D Drugs In Original Coverage Gap.
(B) DISCOUNT AGREEMENT. - paragraph (i)
DIVISION B TITLE I SUBTITLE E SEC 1182. (3) Quoted: (g) (2) (B) (i)
Automated Concept:

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. ...
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (G)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (G)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(4) PREFERENCE. - paragraph (C)
DIVISION B TITLE III SEC 1302. (a) Quoted: SEC 1866E. (d) (4) (C)
Automated Concept:

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. ...
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(1) DUAL ELIGIBLE.
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (e) (1)
Automated Concept:

TITLE XIX ;   Term dual eligible meaning individual being dually eligible for benefits under title XVIII and medical assistance under

Index of Sec 1905. ...
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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. ...
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1) (C)
Automated Concept:

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. ...
Sec 1702. -- Requirements And Special Rules For Certain Medicaid Eligible Individuals.
(a) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1702. (a)
Automated Concept:

TITLE XIX of Social Security Act amended by adding at end following new section  ;  

Index of Sec 1702. ...
Sec 1722. -- Medical Home Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (a)
Automated Concept:

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. ...
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE C SEC 1722. (b) (1)
Automated Concept:

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. ...
Sec 1744. -- Payments For Graduate Medical Education.
(c) EFFECTIVE DATE.
DIVISION B TITLE VII SUBTITLE E SEC 1744. (c)
Automated Concept:

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. ...
Sec 1751. -- Health-Care Acquired Conditions.
(c) PERMISSION TO INCLUDE ADDITIONAL HEALTH CARE-ACQUIRED CONDITIONS.
DIVISION B TITLE VII SUBTITLE F SEC 1751. (c)
Automated Concept:

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. ...

Title xix: purposes of
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1) (C)
Automated Concept:

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
Sec 1701. -- Eligibility For Individuals With Income Below 133.
(3) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE A SEC 1701. (a) (3)
Automated Concept:

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. ...
(3) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE A SEC 1701. (b) (3)
Automated Concept:

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
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(d) APPLICATION TO MEDICAID AND CHIP.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (d)
Automated Concept:

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. ...
Sec 1713. -- Optional Coverage Of Nurse Home Visitation Services.
(c) CONSTRUCTION.
DIVISION B TITLE VII SUBTITLE B SEC 1713. (c)
Automated Concept:

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. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED. - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (b) (3) (B)
Automated Concept:

TITLE XIX or XXI of Social Security Act ;   Medical assistance program established by

Index of Sec 1802. ...

Title xviii
Title xviii
Sec 1111. -- Payments To Skilled Nursing Facilities.
(E) BUDGET NEUTRALITY.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1111. (b) (2) (E)
Automated Concept:

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. ...
Sec 1143. -- Home Infusion Therapy Report To Congress.
SEC 1143. -- HOME INFUSION THERAPY REPORT TO CONGRESS. - paragraph (1)
DIVISION B TITLE I SUBTITLE B PART 3 SEC 1143. (1)
Automated Concept:

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. ...
Sec 1151. -- Reducing Potentially Preventable Hospital Readmissions.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1151. (c) (1) (A)
Automated Concept:

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. ...
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1152. (a) (1)
Automated Concept:

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. ...
Sec 1302. -- Medical Home Pilot Program.
(a) IN GENERAL.
DIVISION B TITLE III SEC 1302. (a)
Automated Concept:

TITLE XVIII of Social Security Act amended by inserting after section 1866d as inserted by section 1301  ;  

Index of Sec 1302. ...
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(1) DUAL ELIGIBLE.
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (e) (1)
Automated Concept:

MEDICAL assistance under title XIX ;   Term dual eligible meaning individual being dually eligible for benefits under title XVIII and

Index of Sec 1905. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(b) APPLICATION TO MEDICAID. - paragraph (4)
DIVISION B TITLE VI SUBTITLE B SEC 1614. (b) Quoted: (4)
Automated Concept:

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. ...
SEC 2114. -- ASSURING QUALITY OF CARE IN HOSPICE CARE.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (c) Quoted: SEC 2114.
Automated Concept:

TITLE XVIII ;   Provisions applying to hospice program providing hospice care under

Index of Sec 1614. ...
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL.
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1)
Automated Concept:

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. ...
(2) SCREENING. - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (2) (B)
Automated Concept:

TITLE XVIII, XIX or XXI ;   Screening against list of individuals and entities excluded from program under

Index of Sec 1631. ...
Sec 1632. -- Enhanced Medicare, Medicaid, And Chip Program Disclosure Requirements Relating To Previous Affiliations.
(1) DISCLOSURE.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (1)
Automated Concept:

TITLE XVIII ;   Application for enrollment and renewing enrollment in program under

Index of Sec 1632. ...
(2) ENHANCED SAFEGUARDS.
DIVISION B TITLE VI SUBTITLE C SEC 1632. (a) Quoted: (b) (2)
Automated Concept:

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. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(c) APPLICATION TO OTHER AREAS UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (c)
Automated Concept:

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. ...
Sec 1751. -- Health-Care Acquired Conditions.
(a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH CARE-ACQUIRED CONDITIONS. - paragraph (3) - paragraph (25)
DIVISION B TITLE VII SUBTITLE F SEC 1751. (a) (3) Quoted: (25)
Automated Concept:

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. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(b) TRANSFERS TO FUND. - paragraph (4) - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (b) (4) (B)
Automated Concept:

FISCAL year ;   Title XVIII of Social Security Act during

Index of Sec 1802. ...
(3) EXEMPT GOVERNMENTAL PROGRAM DEFINED. - paragraph (A)
DIVISION B TITLE VIII SEC 1802. (b) (1) Quoted: B SEC 4377. (b) (3) (A)
Automated Concept:

TITLE XVIII of Social Security Act ;   Insurance program established under

Index of Sec 1802. ...

Title xviii: part D of
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (G)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (G)
Automated Concept:

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. ...
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(d) APPLICATION TO MEDICAID AND CHIP.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (d)
Automated Concept:

TITLE XVIII of Act ;   Same manner and same extent as requirements applying in case of physicians making certifications under

Index of Sec 1639. ...
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(b) TRANSFERS TO FUND. - paragraph (4) - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (b) (4) (B)
Automated Concept:

ACCOUNT ;   Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or

Index of Sec 1802. ...

Title xviii or State health care program
Sec 1645. -- Conforming Civil Monetary Penalties To False Claims Act Amendments.
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (B) - paragraph (i)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (B) (i)
Automated Concept:

HEALTH care program and inserting participating in Federal health care program ;   Striking participating in program under title XVIII or State

Index of Sec 1645. ...
SEC 1645. -- CONFORMING CIVIL MONETARY PENALTIES TO FALSE CLAIMS ACT AMENDMENTS. - paragraph (1) - paragraph (B) - paragraph (ii)
DIVISION B TITLE VI SUBTITLE C SEC 1645. (1) (B) (ii)
Automated Concept:

HEALTH care program and inserting Federal health care program ;   Subparagraph, striking title XVIII or State

Index of Sec 1645. ...

Title xviii or XIX
Sec 1619. -- Exclusion Of Certain Individuals And Entities From Participation In Medicare And State Health Care Programs.
(C) - paragraph (ii)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (ii)
Automated Concept:

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. ...
(C) - paragraph (iii)
DIVISION B TITLE VI SUBTITLE B SEC 1619. (a) (2) Quoted: (4) (C) (iii)
Automated Concept:

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: D of
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(C) VARIATION IN GRANTEES. - paragraph (i)
DIVISION B TITLE II SUBTITLE B SEC 1222. (b) (2) (C) (i)
Automated Concept:

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. ...
Sec 1224. -- Definitions.
(12) MEDICARE PROGRAM.
DIVISION B TITLE II SUBTITLE B SEC 1224. (12)
Automated Concept:

TITLE XVIII of Social Security Act ;   Term Medicare program meaning programs under parts A through D of

Index of Sec 1224. ...
Sec 1636. -- Maximum Period For Submission Of Medicare Claims Reduced To Not More Than 12 Months.
(a) PURPOSE.
DIVISION B TITLE VI SUBTITLE C SEC 1636. (a)
Automated Concept:

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: part A of
Sec 1224. -- Definitions.
(11) MEDICARE BENEFICIARY.
DIVISION B TITLE II SUBTITLE B SEC 1224. (11)
Automated Concept:

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. ...
Sec 1234. -- Part B Special Enrollment Period And Waiver Of Limited Enrollment Penalty For Tricare Beneficiaries.
(i) IN GENERAL.
DIVISION B TITLE II SUBTITLE C SEC 1234. (b) (2) (B) (i)
Automated Concept:

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. ...
Sec 1614. -- Enhanced Hospice Program Safeguards.
(a) MEDICARE.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (a)
Automated Concept:

TITLE XVIII of Social Security Act amended by inserting after section 1819 following new section ;   Part A of

Index of Sec 1614. ...
Sec 1642. -- Expanded Application Of Hardship Waivers For Oig Exclusions To Beneficiaries Of Any Federal Health Care Program.
SEC 1642. -- EXPANDED APPLICATION OF HARDSHIP WAIVERS FOR OIG EXCLUSIONS TO BENEFICIARIES OF ANY FEDERAL HEALTH CARE PROGRAM.
DIVISION B TITLE VI SUBTITLE C SEC 1642.
Automated Concept:

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. ...

Title xviii: part A or part B of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(b) REPORTING OF OWNERSHIP INTEREST BY PHYSICIANS IN HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (b)
Automated Concept:

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: part B of
Sec 1308. -- Coverage Of Marriage And Family Therapist Services And Mental Health Counselor Services.
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A HEALTH CARE PROFESSIONAL.
DIVISION B TITLE III SEC 1308. (a) (4) (B)
Automated Concept:

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. ...
(B) DEVELOPMENT OF CRITERIA WITH RESPECT TO CONSULTATION WITH A PHYSICIAN.
DIVISION B TITLE III SEC 1308. (b) (4) (B)
Automated Concept:

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. ...
Sec 1721. -- Payments To Primary Care Practitioners.
(1) FEE-FOR-SERVICE PAYMENTS. - paragraph (C) - paragraph (C)
DIVISION B TITLE VII SUBTITLE C SEC 1721. (a) (1) (C) Quoted: (C)
Automated Concept:

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. ...

Title xviii: part C of
Sec 1611. -- Enhanced Penalties For False Statements On Provider Or Supplier Enrollment Applications.
(a) IN GENERAL. - paragraph (4) - paragraph (8)
DIVISION B TITLE VI SUBTITLE B SEC 1611. (a) (4) Quoted: (8)
Automated Concept:

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: part D of
Sec 1204. -- Enhanced Oversight Relating To Reimbursements For Retroactive Low Income Subsidy Enrollment.
(a) IN GENERAL.
DIVISION B TITLE II SUBTITLE A SEC 1204. (a)
Automated Concept:

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. ...
(A) IN GENERAL. - paragraph (i)
DIVISION B TITLE II SUBTITLE A SEC 1204. (c) (4) (A) (i)
Automated Concept:

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: part E of
Sec 1152. -- Post Acute Care Services Payment Reform Plan And Bundling Pilot Program.
(1) IN GENERAL.
DIVISION B TITLE I SUBTITLE C SEC 1152. (f) (1)
Automated Concept:

TITLE XVIII of Social Security Act amended by inserting after section 1866c following new section ;   Part E of

Index of Sec 1152. ...

Title xviii: part of
Sec 1224. -- Definitions.
(13) SERVICE PROVIDER.
DIVISION B TITLE II SUBTITLE B SEC 1224. (13)
Automated Concept:

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. ...

Title xviii: parts A and B of
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (F)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (F)
Automated Concept:

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. ...
Sec 1905. -- Improved Coordination And Protection For Dual Eligibles.
(a) IN GENERAL. - paragraph (1)
DIVISION B TITLE IX SEC 1905. Quoted: SEC 1150A. (a) (1)
Automated Concept:

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
Sec 1614. -- Enhanced Hospice Program Safeguards.
(c) APPLICATION TO CHIP.
DIVISION B TITLE VI SUBTITLE B SEC 1614. (c)
Automated Concept:

TITLE XXI of Social Security Act amended by adding at end following new section  ;  

Index of Sec 1614. ...
Sec 1631. -- Enhanced Cms Program Protection Authority.
(1) IN GENERAL. - paragraph (C)
DIVISION B TITLE VI SUBTITLE C SEC 1631. (a) Quoted: SEC 1128G. (a) (1) (C)
Automated Concept:

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. ...
Sec 1703. -- Chip And Medicaid Maintenance Of Effort.
(1) IN GENERAL.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (1)
Automated Concept:

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. ...
(2) LIMITATION.
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (2)
Automated Concept:

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. ...
(3) CHIP MOE TERMINATION DATE. - paragraph (B)
DIVISION B TITLE VII SUBTITLE A SEC 1703. (a) (2) Quoted: (gg) (3) (B)
Automated Concept:

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. ...

To-face encounter: physician face-
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(1) PART A. - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1639. (a) (1) (B)
Automated Concept:

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. ...
(2) PART B. - paragraph (B)
DIVISION B TITLE VI SUBTITLE C SEC 1639. (a) (2) (B)
Automated Concept:

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. ...
(b) CONDITION OF PAYMENT FOR DURABLE MEDICAL EQUIPMENT.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (b)
Automated Concept:

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. ...

To-face encounter requirement: face-
Sec 1639. -- Face To Face Encounter With Patient Required Before Physicians May Certify Eligibility For Home Health Services Or Durable Medical Equipment Under Medicare.
(c) APPLICATION TO OTHER AREAS UNDER MEDICARE.
DIVISION B TITLE VI SUBTITLE C SEC 1639. (c)
Automated Concept:

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: national
Sec 1233. -- Advance Care Planning Consultation.
(hhh) ADVANCE CARE PLANNING CONSULTATION. - paragraph (1) - paragraph (D)
DIVISION B TITLE II SUBTITLE C SEC 1233. (a) (1) (B) Quoted: (hhh) (1) (D)
Automated Concept:

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. ...

Trade
Sec 1236. -- Demonstration Program On Use Of Patient Decisions Aids.
(3) SHARED DECISION MAKING.
DIVISION B TITLE II SUBTITLE C SEC 1236. (h) (3)
Automated Concept:

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. ...

Training
Training and resident abuse prevention
Sec 1431. -- Dementia And Abuse Prevention Training.
(a) SKILLED NURSING FACILITIES.
DIVISION B TITLE IV SUBTITLE B PART 3 SEC 1431. (a)
Automated Concept:

DEMENTIA management training and resident abuse prevention training after curriculum  ;  

Index of Sec 1431. ...
(b) NURSING FACILITIES.
DIVISION B TITLE IV SUBTITLE B PART 3 SEC 1431. (b)
Automated Concept:

DEMENTIA management training and resident abuse prevention training after curriculum  ;  

Index of Sec 1431. ...

Training and technical assistance
Sec 1904. -- Grants To States For Quality Home Visitation Programs For Families With Young Children And Families Expecting Children.
(3) ASSURANCES. - paragraph (B)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (b) (3) (B)
Automated Concept:

HOME visitation programs using funds ;   State reserving 5 percent of grant funds for training and technical assistance to

Index of Sec 1904. ...
(i) STATE REPORTS. - paragraph (7)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (i) (7)
Automated Concept:

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. ...
(l) RESERVATIONS OF FUNDS. - paragraph (1)
DIVISION B TITLE IX SEC 1904. Quoted: SUBPART 3 SEC 440. (l) (1)
Automated Concept:

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: initial
Sec 1432. -- Study And Report On Training Required For Certified Nurse Aides And Supervisory Staff.
(1) IN GENERAL. - paragraph (A)
DIVISION B TITLE IV SUBTITLE B PART 3 SEC 1432. (a) (1) (A)
Automated Concept:

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
Sec 1501. -- Distribution Of Unused Residency Positions.
(vi) DISTRIBUTION.
DIVISION B TITLE V SEC 1501. (a) (4) Quoted: (8) (B) (vi)
Automated Concept:

TRAINING positions to qualifying hospitals under subparagraph not later than July 1 ;   Secretary distributing increase in resident

Index of Sec 1501. ...

Training programs
Sec 1412. -- Accountability Requirements.
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (IV)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (1) Quoted: (C) (iv) (IV)
Automated Concept:

TRAINING programs or disseminating publications explaining in practical manner what required ;   Requiring participation in

Index of Sec 1412. ...
(iv) REQUIRED COMPONENTS OF PROGRAM. - paragraph (IV)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1412. (a) (2) Quoted: (C) (iv) (IV)
Automated Concept:

TRAINING programs or disseminating publications explaining in practical manner what required ;   Requiring participation in

Index of Sec 1412. ...
Sec 1505. -- Improving Accountability For Approved Medical Residency Training.
(B) GOALS AND ACCOUNTABILITY FOR APPROVED MEDICAL RESIDENCY TRAINING PROGRAMS.
DIVISION B TITLE V SEC 1505. (a) (2) Quoted: (B)
Automated Concept:

RESIDENCY training programs to foster physician workforce so ;   Goals of medical

Index of Sec 1505. ...
(1) IN GENERAL.
DIVISION B TITLE V SEC 1505. (b) (1)
Automated Concept:

RESIDENCY training programs ;   Comptroller General of United States conducting study to evaluate extent to which medical

Index of Sec 1505. ...
(2) REPORT.
DIVISION B TITLE V SEC 1505. (b) (2)
Automated Concept:

RESIDENCY training programs to be further encouraged to meet goals through means ;   Medical

Index of Sec 1505. ...
Sec 1744. -- Payments For Graduate Medical Education.
(4) SPECIFICATION OF GOALS AND REQUIREMENTS. - paragraph (A)
DIVISION B TITLE VII SUBTITLE E SEC 1744. (a) Quoted: (bb) (4) (A)
Automated Concept:

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
Sec 1401. -- Comparative Effectiveness Research.
(2) DUTIES. - paragraph (J)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (2) (J)
Automated Concept:

TRANSPARENT process including consultations with appropriate stakeholders ;   Consistent with standards of evidence established under section and developed through

Index of Sec 1401. ...

Transparent process: open and
Sec 1443. -- Multi-Stakeholder Pre-Rulemaking Input Into Selection Of Quality Measures.
(A) IN GENERAL.
DIVISION B TITLE IV SUBTITLE C SEC 1443. Quoted: (d) (4) (A)
Automated Concept:

TRANSPARENT process for activities conducted pursuant to convening ;   Consensus-based entity described in paragraph providing for open and

Index of Sec 1443. ...

Transportation and subsistence
Sec 1401. -- Comparative Effectiveness Research.
(11) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS. - paragraph (E)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (11) (E)
Automated Concept:

COMPENSATION ;   Providing transportation and subsistence for persons serving without

Index of Sec 1401. ...

Trust: deed of
Sec 1411. -- Required Disclosure Of Ownership And Additional Disclosable Parties Information.
(C) SPECIAL RULE. - paragraph (ii)
DIVISION B TITLE IV SUBTITLE B PART 1 SEC 1411. (a) Quoted: (c) (3) (C) (ii)
Automated Concept:

PROPERTY or asseal ;   Deed of trust, note or other obligation secured by entity or

Index of Sec 1411. ...

Trust fund or account: respective
Sec 1802. -- Comparative Effectiveness Research Trust Fund; Financing For Trust Fund.
(b) TRANSFERS TO FUND. - paragraph (4) - paragraph (B)
DIVISION B TITLE VIII SEC 1802. (a) (1) Quoted: SEC 9511. (b) (4) (B)
Automated Concept:

ACCOUNT ;   Proportion to total expenditures during fiscal year being made under title XVIII of Act from respective trust fund or

Index of Sec 1802. ...

Ultrasound
Sec 1305. -- Coverage And Waiver Of Cost-Sharing For Preventive Services.
(iii) MEDICARE COVERED PREVENTIVE SERVICES. - paragraph (1) - paragraph (I)
DIVISION B TITLE III SEC 1305. (a) Quoted: (iii) (1) (I)
Automated Concept:

ABDOMINAL aortic aneurysm for certain individuals ;   Ultrasound screening for

Index of Sec 1305. ...

Undercapitalization
Sec 1412. -- Accountability Requirements.
(1) IN GENERAL. - paragraph (C)

Uninsurance: national rate of
Sec 1112. -- Medicare Dsh Report And Payment Adjustments In Response To Coverage Expansion.
(A) IN GENERAL.
DIVISION B TITLE I SUBTITLE A PART 2 SEC 1112. (b) (2) (A)
Automated Concept:

UNINSURANCE from 2012 to 2014 exceeding 8 percentage points ;   Decrease in national rate of

Index of Sec 1112. ...

Usability: testing of feasibility and
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(3) TESTING OF PROPOSED MEASURES.
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1192. (c) (3)
Automated Concept:

USABILITY of proposed measures ;   Testing funded under paragraph including testing of feasibility and

Index of Sec 1442. ...

Vaccine
Sec 1310. -- Expanding Access To Vaccines.
(lll) FEDERALLY RECOMMENDED VACCINES.
DIVISION B TITLE III SEC 1310. (b) Quoted: (lll)
Automated Concept:

VACCINE meaning approved vaccine recommended by Advisory Committee on Immunization Practices ;   Term federally recommended

Index of Sec 1310. ...
(c) CONFORMING AMENDMENTS. - paragraph (4)
DIVISION B TITLE III SEC 1310. (c) (4)
Automated Concept:

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: approved
Sec 1310. -- Expanding Access To Vaccines.
(lll) FEDERALLY RECOMMENDED VACCINES.
DIVISION B TITLE III SEC 1310. (b) Quoted: (lll)
Automated Concept:

VACCINE recommended by Advisory Committee on Immunization Practices ;   Term federally recommended vaccine meaning approved

Index of Sec 1310. ...

Validation
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(ii) COMPONENTS AND ELEMENTS OF WORK.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (ii)
Automated Concept:

VALIDATION of pre ;   Process described in clause including validation of work elements involved with furnishing service and including

Index of Sec 1122. ...
(iv) METHODS.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (iv)
Automated Concept:

VALIDATION under subparagraph using methods described in subclauses ;   Secretary conducting

Index of Sec 1122. ...

Validation of data
Sec 1442. -- Development Of New Quality Measures; Gao Evaluation Of Data Collection Process For Quality Measurement.
(b) CONSIDERATIONS. - paragraph (1)
DIVISION B TITLE IV SUBTITLE C SEC 1442. Quoted: SEC 1193. (b) (1)
Automated Concept:

VALIDATION of data as relevant and scientifically credible ;   System for collection of data for quality measures providing for

Index of Sec 1442. ...

Validation of work
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(iii) SCOPE OF CODES.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (iii)
Automated Concept:

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 work elements
Sec 1122. -- Misvalued Codes Under The Physician Fee Schedule.
(ii) COMPONENTS AND ELEMENTS OF WORK.
DIVISION B TITLE I SUBTITLE B PART 1 SEC 1122. (a) Quoted: (L) (ii)
Automated Concept:

VALIDATION of pre ;   Process described in clause including validation of work elements involved with furnishing service and including

Index of Sec 1122. ...

Verification: methods of
Sec 1203. -- Eliminating Barriers To Enrollment.
(iii) CERTIFICATION OF INCOME AND RESOURCES. - paragraph (II)
DIVISION B TITLE II SUBTITLE A SEC 1203. (a) (1) Quoted: (iii) (II)
Automated Concept:

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
Video interpretation: telephonic and
Sec 1221. -- Ensuring Effective Communication In Medicare.
(2) ANALYSES. - paragraph (C)
DIVISION B TITLE II SUBTITLE B SEC 1221. (a) (2) (C)
Automated Concept:

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. ...

Video interpretation: telephonic interpretation or
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(1) IN GENERAL.
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (1)
Automated Concept:

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. ...

Voting
Sec 1401. -- Comparative Effectiveness Research.
(iii) WAIVER. - paragraph (I)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iii) (I)
Automated Concept:

CLINICAL perspective advisory panel meeting ;   Participating as non-voting member with respect to particular matter considered in Commission or

Index of Sec 1401. ...
(iii) WAIVER. - paragraph (II)
DIVISION B TITLE IV SUBTITLE A SEC 1401. (a) Quoted: PART D SEC 1181. (b) (8) (C) (iii) (II)
Automated Concept:

CLINICAL perspective advisory panel meeting ;   Participating as voting member with respect to particular matter considered in Commission or

Index of Sec 1401. ...

Warranty
Warranty: contractual
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(C) EXCLUSIONS. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (iii)
Automated Concept:

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. ...

Warranty: terms of
Sec 1451. -- Reports On Financial Relationships Between Manufacturers And Distributors Of Covered Drugs, Devices, Biologicals, Or Medical Supplies Under Medicare, Medicaid, Or Chip And Physicians And Other Health Care Entities And Between Physicians And Other Health Care Entities.
(C) EXCLUSIONS. - paragraph (iii)
DIVISION B TITLE IV SUBTITLE D SEC 1451. (a) Quoted: SEC 1128H. (f) (9) (C) (iii)
Automated Concept:

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: very
Sec 1222. -- Demonstration To Promote Access For Medicare Beneficiaries With Limited English Proficiency By Providing Reimbursement For Culturally And Linguistically Appropriate Services.
(3) DETERMINATION OF PAYMENTS FOR LANGUAGE SERVICES. - paragraph (A)
DIVISION B TITLE II SUBTITLE B SEC 1222. (c) (3) (A)
Automated Concept:

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. ...

Worker immunization rates
Sec 1461. -- Requirement For Public Reporting By Hospitals And Ambulatory Surgical Centers On Health Care-Associated Infections.
(c) ANNUAL REPORT TO CONGRESS. - paragraph (2)
DIVISION B TITLE IV SUBTITLE E SEC 1461. (a) Quoted: SEC 1138A. (c) (2)
Automated Concept:

IMMUNIZATION rates ;   Factors contributing to occurrence of infections including health care worker

Index of Sec 1461. ...

Worker services
Worker services: clinical social
Sec 1307. -- Excluding Clinical Social Worker Services From Coverage Under The Medicare Skilled Nursing Facility Prospective Payment System And Consolidated Payment.
SEC 1307. -- EXCLUDING CLINICAL SOCIAL WORKER SERVICES FROM COVERAGE UNDER THE MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM AND CONSOLIDATED PAYMENT.
DIVISION B TITLE III SEC 1307.
Automated Concept:

MEDICARE skilled nursing facility prospective payment system and consolidated payment ;   Sec 1307 excluding clinical social worker Services from coverage under

Index of Sec 1307. ...
(a) IN GENERAL.
DIVISION B TITLE III SEC 1307. (a)
Automated Concept:

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. ...


http://healthcarebillindex.com
The Index is © 2009 healthcarebillindex.com


111th CONGRESS
1st Session


    To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.


IN THE HOUSE OF REPRESENTATIVES

July 14, 2009

    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


A BILL

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

DIVISION BMedicare and Medicaid Improvements

SEC. 1001. Table of contents of division.

The table of contents for this division is as follows:


DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS


TITLE I—IMPROVING HEALTH CARE VALUE

Subtitle A—Provisions related to Medicare part A

PART 1—MARKET BASKET UPDATES


PART 2—OTHER MEDICARE PART A PROVISIONS


Subtitle B—Provisions Related to Part B

PART 1—PHYSICIANS’ SERVICES


PART 2—MARKET BASKET UPDATES


PART 3—OTHER PROVISIONS


Subtitle C—Provisions Related to Medicare Parts A and B


Subtitle D—Medicare Advantage Reforms

PART 1—PAYMENT AND ADMINISTRATION


PART 2—BENEFICIARY PROTECTIONS AND ANTI-FRAUD


PART 3—TREATMENT OF SPECIAL NEEDS PLANS


Subtitle E—Improvements to Medicare Part D


Subtitle F—Medicare Rural Access Protections


TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS

Subtitle A—Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries


Subtitle B—Reducing Health Disparities


Subtitle C—Miscellaneous Improvements


TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE


TITLE IV—QUALITY

Subtitle A—Comparative Effectiveness Research


Subtitle B—Nursing Home Transparency

PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES


PART 2—TARGETING ENFORCEMENT


PART 3—IMPROVING STAFF TRAINING


Subtitle C—Quality Measurements


Subtitle D—Physician Payments Sunshine Provision


Subtitle E—Public Reporting on Health Care-Associated Infections


TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION


TITLE VI—PROGRAM INTEGRITY

Subtitle A—Increased funding To fight waste, fraud, and abuse


Subtitle B—Enhanced penalties for fraud and abuse


Subtitle C—Enhanced Program and Provider Protections


Subtitle D—Access to Information Needed To Prevent Fraud, Waste, and Abuse


TITLE VII—MEDICAID AND CHIP

Subtitle A—Medicaid and Health Reform


Subtitle B—Prevention


Subtitle C—Access


Subtitle D—Coverage


Subtitle E—Financing


Subtitle F—Waste, Fraud, and Abuse


Subtitle G—Puerto Rico and the Territories


Subtitle H—Miscellaneous


TITLE VIII—REVENUE-RELATED PROVISIONS


TITLE IX—MISCELLANEOUS PROVISIONS

TITLE IImproving Health Care Value

subtitle AProvisions related to Medicare part A

PART 1Market basket updates

SEC. 1101. Skilled nursing facility payment update.

(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.

SEC. 1102. Inpatient rehabilitation facility payment update.

(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.

SEC. 1103. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements.

(a) Inpatient acute hospitals.—Section 1886(b)(3)(B) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)) is amended—

(1) in clause (iii)—

(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.

PART 2Other Medicare part A provisions

SEC. 1111. Payments to skilled nursing facilities.

(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.—

(A) ANALYSIS.—

(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).”.

SEC. 1112. Medicare DSH report and payment adjustments in response to coverage expansion.

(a) DSH report.—

(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.

subtitle BProvisions Related to Part B

PART 1Physicians’ Services

SEC. 1121. Sustainable growth rate reform.

(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—

(A) in subparagraph (A)—

(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) FOR 2010.—For 2010:

“(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 subsection (d)—

(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”;

(iii) in subsection (f)(1)—

(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.

SEC. 1122. Misvalued codes under the physician fee schedule.

(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).”.

(b) Implementation.—

(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.

(2) ADMINISTRATION.—

(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.

SEC. 1123. Payments for efficient areas.

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.”.

SEC. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI).

(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”.

SEC. 1125. Adjustment to Medicare payment localities.

(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.—

“(A) IN GENERAL.—

“(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.

“(B) SUBSEQUENT REVISIONS.—

“(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”.

PART 2Market basket updates

SEC. 1131. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements.

(a) Outpatient hospitals.—

(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

(2) clause (ii)—

(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)”.

PART 3Other Provisions

SEC. 1141. Rental and purchase of power-driven wheelchairs.

(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.

SEC. 1142. Extension of payment rule for brachytherapy.

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”.

SEC. 1143. Home infusion therapy report to congress.

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.

SEC. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and other data.

(a) Cost reporting.—

(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.

SEC. 1145. Treatment of certain cancer hospitals.

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.”.

SEC. 1146. Medicare Improvement Fund.

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”.

SEC. 1147. Payment for imaging services.

(a) Adjustment in practice expense to reflect higher presumed utilization.—Section 1848 of the Social Security Act (42 U.S.C. 1395w) is amended—

(1) in subsection (b)(4)—

(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.

SEC. 1148. Durable medical equipment program improvements.

(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—

(1) in clause (i)—

(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.”.

SEC. 1149. MedPAC study and report on bone mass measurement.

(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.

subtitle CProvisions Related to Medicare Parts A and B

SEC. 1151. Reducing potentially preventable hospital readmissions.

(a) Hospitals.—

(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.

“(3) ADJUSTMENT FACTOR.—

“(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).

“(C) CAPS.—

“(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—

(1) in paragraph (5)—

(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.—

(1) INTERIM POLICY.—

(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).

(d) Physicians.—

(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.

SEC. 1152. Post acute care services payment reform plan and bundling pilot program.

(a) Plan.—

(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.

(d) Administration.—

(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.

(e) Public reports.—

(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:

“SEC. 1866D. Conversion of Acute Care Episode Demonstration to Pilot Program and Expansion to Include Post Acute Services.

“(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”.

SEC. 1153. Home health payment update for 2010.

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:

        “(V) 2007, 2008, and 2009, subject to clause (v), the home health market basket percentage increase;

        “(VI) 2010, subject to clause (v), 0 percent; and”.

SEC. 1154. Payment adjustments for home health care.

(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—

(1) in clause (i)—

(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).”.

SEC. 1155. Incorporating productivity improvements into market basket update for home health services.

(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.

SEC. 1156. Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals.

(a) In general.—Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is amended—

(1) in subsection (d)(2)—

(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).”;

(2) in subsection (d)(3)—

(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.—

“(A) PROCESS.—

“(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.

“(C) PERMITTED INCREASE.—

“(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.

(c) Implementation.—

(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).

SEC. 1157. Institute of Medicine study of geographic adjustment factors under Medicare.

(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.

SEC. 1158. Revision of Medicare payment systems to address geographic inequities.

(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).

(b) Payment adjustments.—

(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.

subtitle DMedicare Advantage Reforms

PART 1Payment and Administration

SEC. 1161. Phase-in of payment based on fee-for-service costs.

Section 1853 of the Social Security Act (42 U.S.C. 1395w–23) is amended—

(1) in subsection (j)(1)(A)—

(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, 112 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—

“(A) for 2011 the sum of—

“(i) 23 of the applicable amount (as defined in subsection (k)) for the area and year; and

“(ii) 13 of the amount specified in paragraph (2) for the area and year;

“(B) for 2012 the sum of—

“(i) 13 of the applicable amount for the area and year; and

“(ii) 23 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.”.

SEC. 1162. Quality bonus payments.

(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.

“(B) COMPUTATION OF SCORE.—

“(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.

“(E) RANKING OF PLANS.—

“(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.”.

SEC. 1163. Extension of Secretarial coding intensity adjustment authority.

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

(2) in subclause (II)—

(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”.

SEC. 1164. Simplification of annual beneficiary election periods.

(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);

(2) in clause (iv)—

(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).

SEC. 1165. Extension of reasonable cost contracts.

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”.

SEC. 1166. Limitation of waiver authority for employer group plans.

(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.

SEC. 1167. Improving risk adjustment for payments.

(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).

SEC. 1168. Elimination of MA Regional Plan Stabilization Fund.

(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.

PART 2Beneficiary Protections and Anti-Fraud

SEC. 1171. Limitation on cost-sharing for individual health services.

(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.”.

(c) Effective dates.—

(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.

SEC. 1172. Continuous open enrollment for enrollees in plans with enrollment suspension.

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”;

(2) in subparagraph (D)—

(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”.

SEC. 1173. Information for beneficiaries on MA plan administrative costs.

(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.

“(2) SUBMISSION OF DATA.—

“(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.”.

SEC. 1174. Strengthening audit authority.

(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.

SEC. 1175. Authority to deny plan bids.

(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.

PART 3Treatment of special needs plans

SEC. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs individuals.

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).”.

SEC. 1177. Extension of authority of special needs plans to restrict enrollment.

(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.

subtitle EImprovements to Medicare Part D

SEC. 1181. Elimination of coverage gap.

(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

“(ii) the sum of—

“(I) the annual deductible under paragraph (1) for the year; and

“(II) 14 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).”.

SEC. 1182. Discounts for certain part D drugs in original coverage gap.

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).

“(2) DISCOUNT AGREEMENT.—

“(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.”.

SEC. 1183. Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities.

(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.

SEC. 1184. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D.

(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;

(2) in clause (ii)—

(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.

SEC. 1185. Permitting mid-year changes in enrollment for formulary changes that adversely impact an enrollee.

(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.

subtitle FMedicare Rural Access Protections

SEC. 1191. Telehealth expansion and enhancements.

(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.

“(2) MEMBERSHIP; TERMS.—

“(A) MEMBERSHIP.—

“(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).

SEC. 1192. Extension of outpatient hold harmless provision.

Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is amended—

(1) in subclause (II)—

(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”.

SEC. 1193. Extension of section 508 hospital reclassifications.

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”.

SEC. 1194. Extension of geographic floor for work.

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”.

SEC. 1195. Extension of payment for technical component of certain physician pathology services.

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”.

SEC. 1196. Extension of ambulance add-ons.

(a) In general.—Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended—

(1) in subparagraph (A)—

(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”.

TITLE IIMedicare Beneficiary Improvements

subtitle AImproving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries

SEC. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program.

(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.

SEC. 1202. Elimination of part D cost-sharing for certain non-institutionalized full-benefit dual eligible individuals.

(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.

SEC. 1203. Eliminating barriers to enrollment.

(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.

SEC. 1204. Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment.

(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.

SEC. 1205. Intelligent assignment in enrollment.

(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.

SEC. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals.

(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.

SEC. 1207. Application of MA premiums prior to rebate in calculation of low income subsidy benchmark.

(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.

subtitle BReducing Health Disparities

SEC. 1221. Ensuring effective communication in Medicare.

(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;”.

SEC. 1222. Demonstration to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services.

(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.

(b) Eligibility; priority.—

(1) ELIGIBILITY.—To be eligible to receive a grant under subsection (a) an entity shall—

(A) be—

(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.

(2) PRIORITY.—

(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.

(c) Use of funds.—

(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).

(4) LIMITATIONS.—

(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.

(B) TYPE OF SERVICES.—

(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

(6) ensure that—

(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.

SEC. 1223. IOM report on impact of language access services.

(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.

SEC. 1224. Definitions.

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.

subtitle CMiscellaneous Improvements

SEC. 1231. Extension of therapy caps exceptions process.

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”.

SEC. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions.

(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)—

(A) in the first sentence—

(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

(B) in the second sentence—

(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”.

SEC. 1233. Advance care planning consultation.

(a) Medicare.—

(1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(A) in subsection (s)(2)—

(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:

“Advance Care Planning Consultation

“(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—

(A) in paragraph (1)—

(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.—

(1) 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.

SEC. 1234. Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries.

(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”.

(2) EFFECTIVE DATE.—

(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.

SEC. 1235. Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium.

(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.

SEC. 1236. Demonstration program on use of patient decisions aids.

(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.

(b) Sites.—

(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 IIIPromoting Primary Care, Mental Health Services, and Coordinated Care

SEC. 1301. Accountable Care Organization pilot program.

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.

SEC. 1302. Medical home pilot program.

(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.

“(e) Expansion of program.—

“(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).

“(3) EXPANSION OF PROGRAM.—

“(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.

SEC. 1303. Payment incentive for selected primary care services.

(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).”.

(b) Conforming amendments.—

(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”.

SEC. 1304. Increased reimbursement rate for certified nurse-midwives.

(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.

SEC. 1305. Coverage and waiver of cost-sharing for preventive services.

(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:

“Medicare Covered Preventive Services

“(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.—

(1) IN GENERAL.—

(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.

SEC. 1306. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal.

(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.

SEC. 1307. Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment.

(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.

SEC. 1308. Coverage of marriage and family therapist services and mental health counselor services.

(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:

“Marriage And Family Therapist Services

“(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;”.

(4) AMOUNT OF PAYMENT.—

(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:

“Mental Health Counselor Services

“(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;”.

(4) AMOUNT OF PAYMENT.—

(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.

SEC. 1309. Extension of physician fee schedule mental health add-on.

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”.

SEC. 1310. Expanding access to vaccines.

(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:

“Federally Recommended Vaccines

“(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).”.

(c) Conforming amendments.—

(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.

TITLE IVQuality

subtitle AComparative Effectiveness Research

SEC. 1401. Comparative effectiveness research.

(a) In general.—title XI of the Social Security Act is amended by adding at the end the following new part:

“Part DComparative Effectiveness Research

    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.

“(3) POWERS.—

“(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.

subtitle BNursing Home Transparency

PART 1Improving transparency of information on skilled nursing facilities and nursing facilities

SEC. 1411. Required disclosure of ownership and additional disclosable parties information.

(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.

“(3) INFORMATION DESCRIBED.—

“(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.

“(4) REPORTING.—

“(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)).

(c) Conforming Amendments.—

(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).

SEC. 1412. Accountability requirements.

(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.

SEC. 1413. Nursing home compare Medicare website.

(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.”.

(b) Nursing Facilities.—

(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)).

SEC. 1414. Reporting of expenditures.

Section 1888 of the Social Security Act (42 U.S.C. 1395yy) is amended by adding at the end the following new subsection:

SEC. 1415. Standardized complaint form.

(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.”.

(b) Nursing Facilities.—

(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.

SEC. 1416. Ensuring staffing accountability.

(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.”.

PART 2Targeting Enforcement

SEC. 1421. Civil money penalties.

(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),”.

(b) Nursing Facilities.—

(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:

“(G) CIVIL MONEY PENALTIES.—

“(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.

SEC. 1422. National independent monitor pilot program.

(a) Establishment.—

(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)).

(i) Evaluation and report.—

(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.

SEC. 1423. Notification of facility closure.

(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.

“(B) RELOCATION.—

“(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)”.

(b) Nursing Facilities.—

(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.

“(B) RELOCATION.—

“(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.

PART 3Improving staff training

SEC. 1431. Dementia and abuse prevention training.

(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.

SEC. 1432. Study and report on training required for certified nurse aides and supervisory staff.

(a) Study.—

(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.

subtitle CQuality Measurements

SEC. 1441. Establishment of national priorities for quality improvement.

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:

“Part EQuality Improvement

    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.

SEC. 1442. Development of new quality measures; GAO evaluation of data collection process for quality measurement.

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:

“SEC. 1192. Development of new quality measures.

“(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.

“(f) Funding.—

“(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.

“SEC. 1193. GAO evaluation of data collection process for quality measurement.

“(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.”.

SEC. 1443. Multi-stakeholder pre-rulemaking input into selection of quality measures.

Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection:

SEC. 1444. Application of quality measures.

(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.

SEC. 1445. Consensus-based entity funding.

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.”

subtitle DPhysician Payments Sunshine Provision

SEC. 1451. Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and other health care entities and between physicians and other health care entities.

(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:

“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 with entities that bill for services under Medicare.

“(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)).

“(c) Public availability.—

“(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.—

“(1) FAILURE TO REPORT.—

“(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.

“(h) Relation to State laws.—

“(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.

subtitle EPublic Reporting on Health Care-Associated Infections

SEC. 1461. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections.

(a) In general.—Title XI of the Social Security Act is amended by inserting after section 1138 the following section:

“SEC. 1138A. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections.

“(a) Reporting requirement.—

“(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.

TITLE VMedicare Graduate Medical Education

SEC. 1501. Distribution of unused residency positions.

(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.

“(B) REDISTRIBUTION.—

“(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.”.

(b) IME.—

(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”.

SEC. 1502. Increasing training in nonprovider settings.

(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.

SEC. 1503. Rules for counting resident time for didactic and scholarly activities and other activities.

(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.

SEC. 1504. Preservation of resident cap positions from closed hospitals.

(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.

(c) Conforming amendments.—

(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”.

SEC. 1505. Improving accountability for approved medical residency training.

(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).

TITLE VIProgram Integrity

subtitle AIncreased funding To fight waste, fraud, and abuse

SEC. 1601. Increased funding and flexibility to fight fraud and abuse.

(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.”.

(2) in paragraph (4)(A)—

(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”.

subtitle BEnhanced penalties for fraud and abuse

SEC. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications.

(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.

SEC. 1612. Enhanced penalties for submission of false statements material to a false claim.

(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.

SEC. 1613. Enhanced penalties for delaying inspections.

(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.

SEC. 1614. Enhanced hospice program safeguards.

(a) Medicare.—Part A of title XVIII of the Social Security Act is amended by inserting after section 1819 the following new section:

“SEC. 1819A. Assuring quality of care in hospice care.

“(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.

“(b) Intermediate sanctions.—

“(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.

“(2) SPECIFIED 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:

“SEC. 2114. Assuring quality of care in hospice care.

“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.”.

SEC. 1615. Enhanced penalties for individuals excluded from program participation.

(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.

SEC. 1616. Enhanced penalties for provision of false information by Medicare Advantage and part D plans.

(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.

SEC. 1617. Enhanced penalties for Medicare Advantage and part D marketing violations.

(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.

SEC. 1618. Enhanced penalties for obstruction of program audits.

(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.

SEC. 1619. Exclusion of certain individuals and entities from participation in Medicare and State health care programs.

(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.”.

subtitle CEnhanced Program and Provider Protections

SEC. 1631. Enhanced CMS program protection authority.

(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:

“SEC. 1128G. Enhanced program and provider protections in the Medicare, Medicaid, and CHIP programs.

“(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.”.

(b) Conforming amendments.—

(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.”.

SEC. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations.

(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.”.

(b) Conforming amendments.—

(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.”.

SEC. 1633. Required inclusion of payment modifier for certain evaluation and management services.

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.”.

SEC. 1634. Evaluations and reports required under Medicare Integrity Program.

(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.

SEC. 1635. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse.

(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.

SEC. 1636. Maximum period for submission of Medicare claims reduced to not more than 12 months.

(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.

SEC. 1637. Physicians who order durable medical equipment or home health services required to be Medicare enrolled physicians or eligible professionals.

(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)”.

(b) Home health services.—

(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.

SEC. 1638. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse.

(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.

SEC. 1639. Face to face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare.

(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.

SEC. 1640. Extension of testimonial subpoena authority to program exclusion investigations.

(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.

SEC. 1641. Required repayments of Medicare and Medicaid overpayments.

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.”.

SEC. 1642. Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program.

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”.

SEC. 1643. Access to certain information on renal dialysis facilities.

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.”.

SEC. 1644. Billing agents, clearinghouses, or other alternate payees required to register under Medicare.

(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.

SEC. 1645. Conforming civil monetary penalties to False Claims Act amendments.

Section 1128A of the Social Security Act, as amended by sections 1611, 1612, 1613, and 1615, is further amended—

(1) in subsection (a)—

(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))”;

(B) in paragraph (4)—

(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

(3) in subsection (i)—

(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.”;

(C) in paragraph (6)—

(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.”.

subtitle DAccess to Information Needed To Prevent Fraud, Waste, and Abuse

SEC. 1651. Access to Information Necessary to Identify Fraud, Waste, and Abuse.

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.”.

SEC. 1652. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank.

(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.

SEC. 1653. Compliance with HIPAA privacy and security standards.

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.

TITLE VIIMedicaid and CHIP

subtitle AMedicaid and Health Reform

SEC. 1701. Eligibility for individuals with income below 13313 percent of the Federal poverty level.

(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 13313 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 13313 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 13313 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.

SEC. 1702. Requirements and special rules for certain Medicaid eligible individuals.

(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.”.

SEC. 1703. CHIP and Medicaid maintenance of effort.

(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.”.

SEC. 1704. Reduction in Medicaid DSH.

(a) Report.—

(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.

(b) Medicaid DSH reductions.—

(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.

(c) Conforming amendments.—

(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.

SEC. 1705. Expanded outstationing.

(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)) ” .

(b) Effective date.—

(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.

subtitle BPrevention

SEC. 1711. Required coverage of preventive services.

(a) Coverage.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 1701(a)(2)(B), is amended—

(1) in subsection (a)(4)—

(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).

(c) Effective date.—

(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.

SEC. 1712. Tobacco cessation.

(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.

SEC. 1713. Optional coverage of nurse home visitation services.

(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—

(1) in subsection (a)—

(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.

SEC. 1714. State eligibility option for family planning services.

(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),”.

(b) Presumptive eligibility.—

(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.

(2) CONFORMING AMENDMENTS.—

(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.

subtitle CAccess

SEC. 1721. Payments to primary care practitioners.

(a) In general.—

(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.

SEC. 1722. Medical home pilot program.

(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.

(b) Pilot project described.—

(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.

(e) Evaluation; report.—

(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.

SEC. 1723. Translation or interpretation services.

(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.

SEC. 1724. Optional coverage for freestanding birth center services.

(a) In general.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 1713(a), is amended—

(1) in subsection (a)—

(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.

SEC. 1725. Inclusion of public health clinics under the vaccines for children program.

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)),”.

subtitle DCoverage

SEC. 1731. Optional medicaid coverage of low-income HIV-infected individuals.

(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.

SEC. 1732. Extending transitional Medicaid Assistance (TMA).

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”.

SEC. 1733. Requirement of 12-month continuous coverage under certain CHIP programs.

(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.

subtitle EFinancing

SEC. 1741. Payments to pharmacists.

(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—

(1) in subparagraph (A)—

(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”.

SEC. 1742. Prescription drug rebates.

(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;

(2) in subclause (V)—

(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.”.

SEC. 1743. Extension of prescription drug discounts to enrollees of medicaid managed care organizations.

(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

(3) in subsection (j)—

(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.

SEC. 1744. Payments for graduate medical education.

(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.

subtitle FWaste, Fraud, and Abuse

SEC. 1751. Health-care acquired conditions.

(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.

SEC. 1752. Evaluations and reports required under Medicaid Integrity Program.

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.”.

SEC. 1753. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse.

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.”.

SEC. 1754. Overpayments.

(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.

SEC. 1755. Managed Care Organizations.

(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.

(b) Patient encounter data.—

(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.

SEC. 1756. Termination of provider participation under Medicaid and CHIP if terminated under Medicare or other State plan or child health plan.

(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)”.

(c) Effective date.—

(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.

SEC. 1757. Medicaid and CHIP exclusion from participation relating to certain ownership, control, and management affiliations.

(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)”.

(c) Effective date.—

(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.

SEC. 1758. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse.

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”.

SEC. 1759. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid.

(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).”.

(c) Effective date.—

(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.

SEC. 1760. Denial of payments for litigation-related misconduct.

(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.

subtitle GPuerto Rico and the Territories

SEC. 1771. Puerto Rico and territories.

(a) Increase in cap.—

(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.

(b) Increase in FMAP.—

(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.

subtitle HMiscellaneous

SEC. 1781. Technical corrections.

(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.”.

SEC. 1782. Extension of QI program.

(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.

TITLE VIIIRevenue-related provisions

SEC. 1801. 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.

(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.

SEC. 1802. Comparative Effectiveness Research Trust Fund; financing for Trust Fund.

(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:

“SEC. 9511. Health Care Comparative Effectiveness Research Trust Fund.

“(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.—

“(1) COMPUTATION.—

“(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.

“(d) Expenditures From Fund.—

“(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:

“Sec. 9511. Health Care Comparative Effectiveness Research Trust Fund.”.

(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:

“subchapter BInsured and Self-Insured Health Plans
“Sec. 4375. Health insurance.
“Sec. 4376. Self-insured health plans.
“Sec. 4377. Definitions and special rules.

“SEC. 4375. Health insurance.

“(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.

“SEC. 4376. Self-Insured health plans.

“(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.

“(b) Liability for Fee.—

“(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,

“(C) in the case of—

“(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).

“SEC. 4377. Definitions and special rules.

“(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.”.

(2) CLERICAL AMENDMENTS.—

(A) Chapter 34 of such Code is amended by striking the chapter heading and inserting the following:

“CHAPTER 34TAXES ON CERTAIN INSURANCE POLICIES

“SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS


“SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS

“subchapter APolicies Issued By Foreign Insurers”.

(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:


“CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES”.

(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.

TITLE IXMiscellaneous Provisions

SEC. 1901. Repeal of trigger provision.

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.

SEC. 1902. Repeal of comparative cost adjustment (CCA) program.

Section 1860C–1 of the Social Security Act (42 U.S.C. 1395w–29), as added by section 241(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173), is repealed.

SEC. 1903. Extension of gainsharing demonstration.

(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”.

(b) Funding.—

(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”.

(c) Reports.—

(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”.

SEC. 1904. Grants to States for quality home visitation programs for families with young children and families expecting children.

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:

“subpart 3Support for quality home visitation programs

“SEC. 440. Home visitation programs for families with young children and families expecting children.

“(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.

“(c) Allotments.—

“(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.

“(e) Payment of grant.—

“(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.

“(f) Eligible expenditures.—

“(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

“(v) provide parents with—

“(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.

“(h) Waiver authority.—

“(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.

“(j) Evaluation.—

“(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.”.

SEC. 1905. Improved coordination and protection for dual eligibles.

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.


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