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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 IV--QUALITY
Subtitle A--Comparative 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 D--Comparative 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) Oversight by Comparative Effectiveness Research Commission-
`(1) IN GENERAL- The Secretary shall establish an independent Comparative Effectiveness Research Commission (in this section referred to as the `Commission') to oversee and evaluate the activities carried out by the Center under subsection (a), subject to the authority of the Secretary, to ensure such activities result in highly credible research and information resulting from such research.
`(2) DUTIES- The Commission shall--
`(A) determine national priorities for research described in subsection (a) and in making such determinations consult with a broad array of public and private stakeholders, including patients and health care providers and payers;
`(B) monitor the appropriateness of use of the CERTF described in subsection (g) with respect to the timely production of comparative effectiveness research determined to be a national priority under subparagraph (A);
`(C) identify highly credible research methods and standards of evidence for such research to be considered by the Center;
`(D) review the methodologies developed by the center under subsection (a)(2)(C);
`(E) not later than one year after the date of the enactment of this section, enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation and report on standards of evidence for such research;
`(F) support forums to increase stakeholder awareness and permit stakeholder feedback on the efforts of the Center to advance methods and standards that promote highly credible research;
`(G) make recommendations for policies that would allow for public access of data produced under this section, in accordance with appropriate privacy and proprietary practices, while ensuring that the information produced through such data is timely and credible;
`(H) appoint a clinical perspective advisory panel for each research priority determined under subparagraph (A), which shall consult with patients and advise the Center on research questions, methods, and evidence gaps in terms of clinical outcomes for the specific research inquiry to be examined with respect to such priority to ensure that the information produced from such research is clinically relevant to decisions made by clinicians and patients at the point of care;
`(I) make recommendations for the priority for periodic reviews of previous comparative effectiveness research and studies conducted by the Center under subsection (a);
`(J) routinely review processes of the Center with respect to such research to confirm that the information produced by such research is objective, credible, consistent with standards of evidence established under this section, and developed through a transparent process that includes consultations with appropriate stakeholders; and
`(K) make recommendations to the center for the broad dissemination of the findings of research conducted and supported under this section that enables clinicians, patients, consumers, and payers to make more informed health care decisions that improve quality and value.
`(3) COMPOSITION OF COMMISSION-
`(A) IN GENERAL- The members of the Commission shall consist of--
`(i) the Director of the Agency for Healthcare Research and Quality;
`(ii) the Chief Medical Officer of the Centers for Medicare & Medicaid Services; and
`(iii) 15 additional members who shall represent broad constituencies of stakeholders including clinicians, patients, researchers, third-party payers, consumers of Federal and State beneficiary programs.
Of such members, at least 9 shall be practicing physicians, health care practitioners, consumers, or patients.
`(B) QUALIFICATIONS-
`(i) DIVERSE REPRESENTATION OF PERSPECTIVES- The members of the Commission shall represent a broad range of perspectives and shall collectively have experience in the following areas:
`(I) Epidemiology.
`(II) Health services research.
`(III) Bioethics.
`(IV) Decision sciences.
`(V) Health disparities.
`(VI) Economics.
`(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY- At least one member shall represent each of the following health care communities:
`(I) Patients.
`(II) Health care consumers.
`(III) Practicing Physicians, including surgeons.
`(IV) Other health care practitioners engaged in clinical care.
`(V) Employers.
`(VI) Public payers.
`(VII) Insurance plans.
`(VIII) Clinical researchers who conduct research on behalf of pharmaceutical or device manufacturers.
`(C) LIMITATION- No more than 3 of the Members of the Commission may be representatives of pharmaceutical or device manufacturers and such representatives shall be clinical researchers described under subparagraph (B)(ii)(VIII).
`(4) APPOINTMENT-
`(A) IN GENERAL- The Secretary shall appoint the members of the Commission.
`(B) CONSULTATION- In considering candidates for appointment to the Commission, the Secretary may consult with the Government Accountability Office and the Institute of Medicine of the National Academy of Sciences.
`(5) CHAIRMAN; VICE CHAIRMAN- The Secretary shall designate a member of the Commission, at the time of appointment of the member, as Chairman and a member as Vice Chairman for that term of appointment, except that in the case of vacancy of the Chairmanship or Vice Chairmanship, the Secretary may designate another member for the remainder of that member's term. The Chairman shall serve as an ex officio member of the National Advisory Council of the Agency for Health Care Research and Quality under section 931(c)(3)(B) of the Public Health Service Act.
`(6) TERMS-
`(A) IN GENERAL- Except as provided in subparagraph (B), each member of the Commission shall be appointed for a term of 4 years.
`(B) TERMS OF INITIAL APPOINTEES- Of the members first appointed--
`(i) 8 shall be appointed for a term of 4 years; and
`(ii) 7 shall be appointed for a term of 3 years.
`(7) COORDINATION- To enhance effectiveness and coordination, the Secretary is encouraged, to the greatest extent possible, to seek coordination between the Commission and the National Advisory Council of the Agency for Healthcare Research and Quality.
`(8) CONFLICTS OF INTEREST-
`(A) IN GENERAL- In appointing the members of the Commission or a clinical perspective advisory panel described in paragraph (2)(H), the Secretary or the Commission, respectively, shall take into consideration any financial interest (as defined in subparagraph (D)), consistent with this paragraph, and develop a plan for managing any identified conflicts.
`(B) EVALUATION AND CRITERIA- When considering an appointment to the Commission or a clinical perspective advisory panel described paragraph (2)(H) the Secretary or the Commission shall review the expertise of the individual and the financial disclosure report filed by the individual pursuant to the Ethics in Government Act of 1978 for each individual under consideration for the appointment, so as to reduce the likelihood that an appointed individual will later require a written determination as referred to in section 208(b)(1) of title 18, United States Code, a written certification as referred to in section 208(b)(3) of title 18, United States Code, or a waiver as referred to in subparagraph (D)(iii) for service on the Commission at a meeting of the Commission.
`(C) DISCLOSURES; PROHIBITIONS ON PARTICIPATION; WAIVERS-
`(i) DISCLOSURE OF FINANCIAL INTEREST- Prior to a meeting of the Commission or a clinical perspective advisory panel described in paragraph (2)(H) regarding a `particular matter' (as that term is used in section 208 of title 18, United States Code), each member of the Commission or the clinical perspective advisory panel who is a full-time Government employee or special Government employee shall disclose to the Secretary financial interests in accordance with subsection (b) of such section 208.
`(ii) PROHIBITIONS ON PARTICIPATION- Except as provided under clause (iii), a member of the Commission or a clinical perspective advisory panel described in paragraph (2)(H) may not participate with respect to a particular matter considered in meeting of the Commission or the clinical perspective advisory panel 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, excluding interests exempted in regulations issued by the Director of the Office of Government Ethics as too remote or inconsequential to affect the integrity of the services of the Government officers or employees to which such regulations apply.
`(iii) WAIVER- If the Secretary determines it necessary to afford the Commission or a clinical perspective advisory panel described in paragraph 2(H) essential expertise, the Secretary may grant a waiver of the prohibition in clause (ii) to permit a member described in such subparagraph to--
`(I) participate as a non-voting member with respect to a particular matter considered in a Commission or a clinical perspective advisory panel meeting; or
`(II) participate as a voting member with respect to a particular matter considered in a Commission or a clinical perspective advisory panel meeting.
`(iv) LIMITATION ON WAIVERS AND OTHER EXCEPTIONS-
`(I) DETERMINATION OF ALLOWABLE EXCEPTIONS FOR THE COMMISSION- The number of waivers granted to members of the Commission cannot exceed one-half of the total number of members for the Commission.
`(II) PROHIBITION ON VOTING STATUS ON CLINICAL PERSPECTIVE ADVISORY PANELS- No voting member of any clinical perspective advisory panel shall be in receipt of a waiver. No more than two nonvoting members of any clinical perspective advisory panel shall receive a waiver.
`(D) FINANCIAL INTEREST DEFINED- For purposes of this paragraph, the term `financial interest' means a financial interest under section 208(a) of title 18, United States Code.
`(9) COMPENSATION- While serving on the business of the Commission (including travel time), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code; and while so serving away from home and the member's regular place of business, a member may be allowed travel expenses, as authorized by the Director of the Commission.
`(10) AVAILABILITY OF REPORTS- The Commission shall transmit to the Secretary a copy of each report submitted under this subsection and shall make such reports available to the public.
`(11) DIRECTOR AND STAFF; EXPERTS AND CONSULTANTS- Subject to such review as the Secretary deems necessary to assure the efficient administration of the Commission, the Commission may--
`(A) appoint an Executive Director (subject to the approval of the Secretary) and such other personnel as Federal employees under section 2105 of title 5, United States Code, as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service);
`(B) seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies;
`(C) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 3709 of the Revised Statutes (41 U.S.C. 5));
`(D) make advance, progress, and other payments which relate to the work of the Commission;
`(E) provide transportation and subsistence for persons serving without compensation; and
`(F) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Commission.
`(c) Research Requirements- Any research conducted, supported, or synthesized under this section shall meet the following requirements:
`(1) ENSURING TRANSPARENCY, CREDIBILITY, AND ACCESS-
`(A) The establishment of the agenda and conduct of the research shall be insulated from inappropriate political or stakeholder influence.
`(B) Methods of conducting such research shall be scientifically based.
`(C) All aspects of the prioritization of research, conduct of the research, and development of conclusions based on the research shall be transparent to all stakeholders.
`(D) The process and methods for conducting such research shall be publicly documented and available to all stakeholders.
`(E) Throughout the process of such research, the Center shall provide opportunities for all stakeholders involved to review and provide public comment on the methods and findings of such research.
`(2) USE OF CLINICAL PERSPECTIVE ADVISORY PANELS- The research shall meet a national research priority determined under subsection (b)(2)(A) and shall consider advice given to the Center by the clinical perspective advisory panel for the national research priority.
`(3) STAKEHOLDER INPUT-
`(A) IN GENERAL- The Commission shall consult with patients, health care providers, health care consumer representatives, and other appropriate stakeholders with an interest in the research through a transparent process recommended by the Commission.
`(B) SPECIFIC AREAS OF CONSULTATION- Consultation shall include where deemed appropriate by the Commission--
`(i) recommending research priorities and questions;
`(ii) recommending research methodologies; and
`(iii) advising on and assisting with efforts to disseminate research findings.
`(C) OMBUDSMAN- The Secretary shall designate a patient ombudsman. The ombudsman shall--
`(i) serve as an available point of contact for any patients with an interest in proposed comparative effectiveness studies by the Center; and
`(ii) ensure that any comments from patients regarding proposed comparative effectiveness studies are reviewed by the Commission.
`(4) TAKING INTO ACCOUNT POTENTIAL DIFFERENCES- Research shall--
`(A) be designed, as appropriate, to take into account the potential for differences in the effectiveness of health care items and services used with various subpopulations such as racial and ethnic minorities, women, different age groups (including children, adolescents, adults, and seniors), and individuals with different comorbidities; and
`(B) seek, as feasible and appropriate, to include members of such subpopulations as subjects in the research.
`(d) Public Access to Comparative Effectiveness Information-
`(1) IN GENERAL- Not later than 90 days after receipt by the Center or Commission, as applicable, of a relevant report described in paragraph (2) made by the Center, Commission, or clinical perspective advisory panel under this section, appropriate information contained in such report shall be posted on the official public Internet site of the Center and of the Commission, as applicable.
`(2) RELEVANT REPORTS DESCRIBED- For purposes of this section, a relevant report is each of the following submitted by the Center or a grantee or contractor of the Center:
`(A) Any interim or progress reports as deemed appropriate by the Secretary.
`(B) Stakeholder comments.
`(C) A final report.
`(e) Dissemination and Incorporation of Comparative Effectiveness Information-
`(1) DISSEMINATION- The Center shall provide for the dissemination of appropriate findings produced by research supported, conducted, or synthesized under this section to health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans, and other relevant stakeholders. In disseminating such findings the Center shall--
`(A) convey findings of research so that they are comprehensible and useful to patients and providers in making health care decisions;
`(B) discuss findings and other considerations specific to certain sub-populations, risk factors, and comorbidities as appropriate;
`(C) include considerations such as limitations of research and what further research may be needed, as appropriate;
`(D) not include any data that the dissemination of which would violate the privacy of research participants or violate any confidentiality agreements made with respect to the use of data under this section; and
`(E) assist the users of health information technology focused on clinical decision support to promote the timely incorporation of such findings into clinical practices and promote the ease of use of such incorporation.
`(2) DISSEMINATION PROTOCOLS AND STRATEGIES- The Center shall develop protocols and strategies for the appropriate dissemination of research findings in order to ensure effective communication of findings and the use and incorporation of such findings into relevant activities for the purpose of informing higher quality and more effective and efficient decisions regarding medical items and services. In developing and adopting such protocols and strategies, the Center shall consult with stakeholders concerning the types of dissemination that will be most useful to the end users of information and may provide for the utilization of multiple formats for conveying findings to different audiences, including dissemination to individuals with limited English proficiency.
`(f) Reports to Congress-
`(1) ANNUAL REPORTS- Beginning not later than one year after the date of the enactment of this section, the Director of the Agency of Healthcare Research and Quality and the Commission shall submit to Congress an annual report on the activities of the Center and the Commission, as well as the research, conducted under this section. Each such report shall include a discussion of the Center's compliance with subsection (c)(B)(4), including any reasons for lack of complicance with such subsection.
`(2) RECOMMENDATION FOR FAIR SHARE PER CAPITA AMOUNT FOR ALL-PAYER FINANCING- Beginning not later than December 31, 2011, the Secretary shall submit to Congress an annual recommendation for a fair share per capita amount described in subsection (c)(1) of section 9511 of the Internal Revenue Code of 1986 for purposes of funding the CERTF under such section.
`(3) ANALYSIS AND REVIEW- Not later than December 31, 2013, the Secretary, in consultation with the Commission, shall submit to Congress a report on all activities conducted or supported under this section as of such date. Such report shall include an evaluation of the overall costs of such activities and an analysis of the backlog of any research proposals approved by the Commission but not funded.
`(g) Funding of Comparative Effectiveness Research- For fiscal year 2010 and each subsequent fiscal year, amounts in the Comparative Effectiveness Research Trust Fund (referred to in this section as the `CERTF') under section 9511 of the Internal Revenue Code of 1986 shall be available, without the need for further appropriations and without fiscal year limitation, to the Secretary to carry out this section.
`(h) Construction- Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.'.
(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 B--Nursing Home Transparency
PART 1--IMPROVING 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:
`(f) Reporting of Direct Care Expenditures-
`(1) IN GENERAL- For cost reports submitted under this title for cost reporting periods beginning on or after the date that is 3 years after the date of the enactment of this subsection, skilled nursing facilities shall separately report expenditures for wages and benefits for direct care staff (breaking out (at a minimum) registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff).
`(2) MODIFICATION OF FORM- The Secretary, in consultation with private sector accountants experienced with skilled nursing facility cost reports, shall redesign such reports to meet the requirement of paragraph (1) not later than 1 year after the date of the enactment of this subsection.
`(3) CATEGORIZATION BY FUNCTIONAL ACCOUNTS- Not later than 30 months after the date of the enactment of this subsection, the Secretary, working in consultation with the Medicare Payment Advisory Commission, the Inspector General of the Department of Health and Human Services, and other expert parties the Secretary determines appropriate, shall take the expenditures listed on cost reports, as modified under paragraph (1), submitted by skilled nursing facilities and categorize such expenditures, regardless of any source of payment for such expenditures, for each skilled nursing facility into the following functional accounts on an annual basis:
`(A) Spending on direct care services (including nursing, therapy, and medical services).
`(B) Spending on indirect care (including housekeeping and dietary services).
`(C) Capital assets (including building and land costs).
`(D) Administrative services costs.
`(4) AVAILABILITY OF INFORMATION SUBMITTED- The Secretary shall establish procedures to make information on expenditures submitted under this subsection readily available to interested parties upon request, subject to such requirements as the Secretary may specify under the procedures established under this paragraph.'.
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 2--TARGETING 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 3--IMPROVING 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 C--Quality 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 E--Quality 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.
`(b) Recommendations for National Priorities- In establishing and updating national priorities under subsection (a), the Secretary shall solicit and consider recommendations from multiple outside stakeholders.
`(c) Considerations in Setting National Priorities- With respect to such priorities, the Secretary shall ensure that priority is given to areas in the delivery of health care services in the United States that--
`(1) contribute to a large burden of disease, including those that address the health care provided to patients with prevalent, high-cost chronic diseases;
`(2) have the greatest potential to decrease morbidity and mortality in this country, including those that are designed to eliminate harm to patients;
`(3) have the greatest potential for improving the performance, affordability, and patient-centeredness of health care, including those due to variations in care;
`(4) address health disparities across groups and areas; and
`(5) have the potential for rapid improvement due to existing evidence, standards of care or other reasons.
`(d) Definitions- In this part:
`(1) CONSENSUS-BASED ENTITY- The term `consensus-based entity' means an entity with a contract with the Secretary under section 1890.
`(2) QUALITY MEASURE- The term `quality measure' means a national consensus standard for measuring the performance and improvement of population health, or of institutional providers of services, physicians, and other health care practitioners in the delivery of health care services.
`(e) 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 $2,000,000, for the activities under 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 $2,000,000 for each of the fiscal years 2010 through 2014.'.
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:
`(d) Multi-stakeholder Pre-rulemaking Input Into Selection of Quality Measures-
`(1) LIST OF MEASURES- Not later than December 1 before each year (beginning with 2011), the Secretary shall make public a list of measures being considered for selection for quality measurement by the Secretary in rulemaking with respect to payment systems under this title beginning in the payment year beginning in such year and for payment systems beginning in the calendar year following such year, as the case may be.
`(2) CONSULTATION ON SELECTION OF ENDORSED QUALITY MEASURES- A consensus-based entity that has entered into a contract under section 1890 shall, as part of such contract, convene multi-stakeholder groups to provide recommendations on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in public health care programs.
`(3) MULTI-STAKEHOLDER INPUT- Not later than February 1 of each year (beginning with 2011), the consensus-based entity described in paragraph (2) shall transmit to the Secretary the recommendations of multi-stakeholder groups provided under paragraph (2). Such recommendations shall be included in the transmissions the consensus-based entity makes to the Secretary under the contract provided for under section 1890.
`(4) REQUIREMENT FOR TRANSPARENCY IN PROCESS-
`(A) IN GENERAL- In convening multi-stakeholder groups under paragraph (2) with respect to the selection of quality measures, the consensus-based entity described in such paragraph shall provide for an open and transparent process for the activities conducted pursuant to such convening.
`(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS- The process under paragraph (2) shall ensure that the selection of representatives of multi-stakeholder groups includes provision for public nominations for, and the opportunity for public comment on, such selection.
`(5) USE OF INPUT- The respective proposed rule shall contain a summary of the recommendations made by the multi-stakeholder groups under paragraph (2), as well as other comments received regarding the proposed measures, and the extent to which such proposed rule follows such recommendations and the rationale for not following such recommendations.
`(6) MULTI-STAKEHOLDER GROUPS- For purposes of this subsection, the term `multi-stakeholder groups' means, with respect to a quality measure, a voluntary collaborative of organizations representing persons interested in or affected by the use of such quality measure, such as the following:
`(A) Hospitals and other institutional providers.
`(B) Physicians.
`(C) Health care quality alliances.
`(D) Nurses and other health care practitioners.
`(E) Health plans.
`(F) Patient advocates and consumer groups.
`(G) Employers.
`(H) Public and private purchasers of health care items and services.
`(I) Labor organizations.
`(J) Relevant departments or agencies of the United States.
`(K) Biopharmaceutical companies and manufacturers of medical devices.
`(L) Licensing, credentialing, and accrediting bodies.
`(7) FUNDING-
`(A) 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 $1,000,000, to the Secretary for purposes of carrying out this subsection for each of the fiscal years 2010 through 2014.
`(B) AUTHORIZATION OF APPROPRIATIONS- For purposes of carrying out the provisions of this subsection, 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 $1,000,000 for each of the fiscal years 2010 through 2014.'.
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 D--Physician 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 E--Public 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 V--MEDICARE 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 VI--PROGRAM INTEGRITY
Subtitle A--Increased 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 B--Enhanced 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 C--Enhanced 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 D--Access 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 VII--MEDICAID AND CHIP
Subtitle A--Medicaid and Health Reform
SEC. 1701. ELIGIBILITY FOR INDIVIDUALS WITH INCOME BELOW 133 1/3 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 133 1/3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;'.
(2) 100% FMAP FOR NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS- Section 1905 of such Act (42 U.S.C. 1396d) is amended--
(A) in the third sentence of subsection (b) by inserting before the period at the end the following: `and with respect to amounts described in subsection (y)'; and
(B) by adding at the end the following new subsection:
`(y) Additional Expenditures Subject to 100% FMAP- For purposes of section 1905(b), the amounts described in this subsection are the following:
`(1) Amounts expended for medical assistance for individuals described in subclause (VIII) of section 1902(a)(10)(A)(i).'.
(3) CONSTRUCTION- Nothing in this subsection shall be construed as not providing for coverage under subclause (VIII) of section 1902(a)(10)(A)(i) of the Social Security Act, as added by paragraph (1) of, and an increased FMAP under the amendment made by paragraph (2) for, an individual who has been provided medical assistance under title XIX of the Act under a demonstration waiver approved under section 1115 of such Act or with State funds.
(4) CONFORMING AMENDMENT- Section 1903(f)(4) of the Social Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting `1902(a)(10)(A)(i)(VIII),' after `1902(a)(10)(A)(i)(VII),'.
(b) Eligibility for Traditional Medicaid Eligible Individuals With Income Not Exceeding 133 1/3 Percent of the Federal Poverty Level-
(1) IN GENERAL- Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396b(a)(10)(A)(i)), as amended by subsection (a), is amended--
(A) by striking `or' at the end of subclause (VII);
(B) by adding `or' at the end of subclause (VIII); and
(C) by adding at the end the following new subclause:
`(IX) who are under 65 years of age, who would be eligible for medical assistance under the State plan under one of subclauses (I) through (VII) (based on the income standards, methodologies, and procedures in effect as of June 16, 2009) but for income and who are in families whose income does not exceed 133 1/3 percent of the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved;'.
(2) 100% FMAP FOR CERTAIN TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS- Section 1905(y) of such Act (42 U.S.C. 1396d(b)), as added by subsection (a)(2)(B), is amended by inserting `or (IX)' after `(VIII)'.
(3) CONSTRUCTION- Nothing in this subsection shall be construed as not providing for coverage under subclause (IX) of section 1902(a)(10)(A)(i) of the Social Security Act, as added by paragraph (1) of, and an increased FMAP under the amendment made by paragraph (2) for, an individual who has been provided medical assistance under title XIX of the Act under a demonstration waiver approved under section 1115 of such Act or with State funds.
(4) CONFORMING AMENDMENT- Section 1903(f)(4) of the Social Security Act (42 U.S.C. 1396b(f)(4)), as amended by subsection (a)(4), is amended by inserting `1902(a)(10)(A)(i)(IX),' after `1902(a)(10)(A)(i)(VIII),'.
(c) 100% Matching Rate for Temporary Coverage of Certain Newborns- Section 1905(y) of such Act, as added by subsection (a)(2)(B), is amended--
(1) in paragraph (1), by inserting before the period at the end the following: `, and who is not provided medical assistance under section 1943(b)(2) of this title or section 205(d)(1)(B) of the America's Affordable Health Choices Act of 2009'; and
(2) by adding at the end the following:
`(2) Amounts expended for medical assistance for children described in section 203(d)(1)(A) of the America's Affordable Health Choices Act of 2009 during the time period specified in such section.'.
(d) Network Adequacy- Section 1932(a)(2) of the Social Security Act (42 U.S.C. 1396u-2(a)(2)) is amended by adding at the end the following new subparagraph:
`(D) ENROLLMENT OF NON-TRADITIONAL MEDICAID ELIGIBLES- A State may not require under paragraph (1) the enrollment in a managed care entity of an individual described in section 1902(a)(10)(A)(i)(VIII) unless the State demonstrates, to the satisfaction of the Secretary, that the entity, through its provider network and other arrangements, has the capacity to meet the health, mental health, and substance abuse needs of such individuals.'.
(e) Effective Date- The amendments made by this section shall take effect on the first day of Y1, and shall apply with respect to items and services furnished on or after such date.
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) Treatment of Certain Newborns-
`(1) IN GENERAL- In the case of a child who is deemed under section 205(d)(1) of the America's Affordable Health Choices Act of 2009 to be a non-traditional Medicaid eligible individual and enrolled under this title pursuant to such section, the State shall provide for a determination, by not later than the end of the period referred to in subparagraph (A) of such section, of the child's eligibility for medical assistance under this title.
`(2) EXTENDED TREATMENT AS TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL- In accordance with subparagraph (B) of section 205(d)(1) of the America's Affordable Health Choices Act of 2009, in the case of a child described in subparagraph (A) of such section who at the end of the period referred to in such subparagraph is not otherwise covered under acceptable coverage, the child shall be deemed (until such time as the child obtains such coverage or the State otherwise makes a determination of the child's eligibility for medical assistance under its plan under this title pursuant to paragraph (1)) to be a traditional Medicaid eligible individual described in section 1902(l)(1)(B).
`(c) Definitions - In this section:
`(1) MEDICAID ELIGIBLE INDIVIDUALS- In this section, the terms `Medicaid eligible individual', `traditional Medicaid eligible individual', and `non-traditional Medicaid eligible individual' have the meanings given such terms in section 205(e)(5) of the America's Affordable Health Choices Act of 2009.
`(2) MEMORANDUM- The term `memorandum' means a Medicaid memorandum of understanding under section 205(e)(4) of the America's Affordable Health Choices Act of 2009.
`(3) Y1- The term `Y1' has the meaning given such term in section 100(c) of the America's Affordable Health Choices Act of 2009.'.
(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:
`(aa) Maintenance of Medicaid Effort; Simplifying and Coordinating Eligibility Rules Between Health Insurance Exchange and Medicaid-
`(1) MAINTENANCE OF EFFORT- A State is not eligible for payment under subsection (a) for a calendar quarter beginning after the date of the enactment of this subsection if eligibility standards, methodologies, or procedures under its plan under this title (including any waiver under this 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. The Secretary shall extend such a waiver (including the availability of Federal financial participation under such waiver) for such period as may be required for a State to meet the requirement of the previous sentence.
`(2) REMOVAL OF ASSET TEST FOR CERTAIN ELIGIBILITY CATEGORIES-
`(A) IN GENERAL- A State is not eligible for payment under subsection (a) for a calendar quarter beginning on or after the first day of Y1 (as defined in section 100(c) of the America's Affordable Health Choices Act of 2009), if the State applies any asset or resource test in determining (or redetermining) eligibility of any individual on or after such first day under any of the following:
`(i) Subclause (I), (III), (IV), or (VI) of section 1902(a)(10)(A)(i).
`(ii) Subclause (II), (IX), (XIV) or (XVII) of section 1902(a)(10)(A)(ii).
`(iii) Section 1931(b).
`(B) OVERRIDING CONTRARY PROVISIONS; REFERENCES- The provisions of this title that prevent the waiver of an asset or resource test described in subparagraph (A) are hereby waived.
`(C) REFERENCES- Any reference to a provision described in a provision in subparagraph (A) shall be deemed to be a reference to such provision as modified through the application of subparagraphs (A) and (B).'.
(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 B--Prevention
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.
`(b) Definitions- For purposes of this section:
`(1) PRESUMPTIVE ELIGIBILITY PERIOD- The term `presumptive eligibility period' means, with respect to an individual described in subsection (a), the period that--
`(A) begins with the date on which a qualified entity determines, on the basis of preliminary information, that the individual is described in section 1902(hh); and
`(B) ends with (and includes) the earlier of--
`(i) the day on which a determination is made with respect to the eligibility of such individual for services under the State plan; or
`(ii) in the case of such an individual who does not file an application by the last day of the month following the month during which the entity makes the determination referred to in subparagraph (A), such last day.
`(2) QUALIFIED ENTITY-
`(A) IN GENERAL- Subject to subparagraph (B), the term `qualified entity' means any entity that--
`(i) is eligible for payments under a State plan approved under this title; and
`(ii) is determined by the State agency to be capable of making determinations of the type described in paragraph (1)(A).
`(B) RULE OF CONSTRUCTION- Nothing in this paragraph shall be construed as preventing a State from limiting the classes of entities that may become qualified entities in order to prevent fraud and abuse.
`(c) Administration-
`(1) IN GENERAL- The State agency shall provide qualified entities with--
`(A) such forms as are necessary for an application to be made by an individual described in subsection (a) for medical assistance under the State plan; and
`(B) information on how to assist such individuals in completing and filing such forms.
`(2) NOTIFICATION REQUIREMENTS- A qualified entity that determines under subsection (b)(1)(A) that an individual described in subsection (a) is presumptively eligible for medical assistance under a State plan shall--
`(A) notify the State agency of the determination within 5 working days after the date on which determination is made; and
`(B) inform such individual at the time the determination is made that an application for medical assistance is required to be made by not later than the last day of the month following the month during which the determination is made.
`(3) APPLICATION FOR MEDICAL ASSISTANCE- In the case of an individual described in subsection (a) who is determined by a qualified entity to be presumptively eligible for medical assistance under a State plan, the individual shall apply for medical assistance by not later than the last day of the month following the month during which the determination is made.
`(d) Payment- Notwithstanding any other provision of law, medical assistance that--
`(1) is furnished to an individual described in subsection (a)--
`(A) during a presumptive eligibility period;
`(B) by a entity that is eligible for payments under the State plan; and
`(2) is included in the care and services covered by the State plan,
shall be treated as medical assistance provided by such plan for purposes of clause (4) of the first sentence of section 1905(b).'.
(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 C--Access
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
131`1905(l)(1)),'.
Subtitle D--Coverage
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 E--Financing
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 F--Waste, 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 G--Puerto 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 H--Miscellaneous
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 VIII--REVENUE-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 B--Insured 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 34--TAXES ON CERTAIN INSURANCE POLICIES
`subchapter a. policies issued by foreign insurers
`subchapter b. insured and self-insured health plans
`Subchapter A--Policies 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 IX--MISCELLANEOUS 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 3--Support 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.
`(b) Elements- The improved coordination and protection under this section shall include efforts--
`(1) to simplify access of dual eligibles to benefits and services under Medicare and Medicaid;
`(2) to improve care continuity for dual eligibles and ensure safe and effective care transitions;
`(3) to harmonize regulatory conflicts between Medicare and Medicaid rules with regard to dual eligibles; and
`(4) to improve total cost and quality performance under Medicare and Medicaid for dual eligibles.
`(c) Responsibilities- In carrying out this section, the Secretary shall provide for the following:
`(1) An examination of Medicare and Medicaid payment systems to develop strategies to foster more integrated and higher quality care.
`(2) Development of methods to facilitate access to post-acute and community-based services and to identify actions that could lead to better coordination of community-based care.
`(3) A study of enrollment of dual eligibles in the Medicare Savings Program (as defined in section 1144(c)(7)), under Medicaid, and in the low-income subsidy program under section 1860D-14 to identify methods to more efficiently and effectively reach and enroll dual eligibles.
`(4) An assessment of communication strategies for dual eligibles to determine whether additional informational materials or outreach is needed, including an assessment of the Medicare website, 1-800-MEDICARE, and the Medicare handbook.
`(5) Research and evaluation of areas where service utilization, quality, and access to cost sharing protection could be improved and an assessment of factors related to enrollee satisfaction with services and care delivery.
`(6) Collection (and making available to the public) of data and a database that describe the eligibility, benefit and cost-sharing assistance available to dual eligibles by State.
`(7) Monitoring total combined Medicare and Medicaid program costs in serving dual eligibles and making recommendations for optimizing total quality and cost performance across both programs.
`(8) Coordination of activities relating to Medicare Advantage plans under 1859(b)(6)(B)(ii) and Medicaid.
`(d) Periodic Reports- Not later than 1 year after the date of the enactment of this section and every 3 years thereafter the Secretary shall submit to Congress a report on progress in activities conducted under this section.
`(e) Definitions- In this section:
`(1) DUAL ELIGIBLE- The term `dual eligible' means an individual who is dually eligible for benefits under title XVIII, and medical assistance under title XIX, including such individuals who are eligible for benefits under the Medicare Savings Program (as defined in section 1144(c)(7)).
`(2) MEDICARE; MEDICAID- The terms `Medicare' and `Medicaid' mean the programs under titles XVIII and XIX, respectively.'.
DIVISION C--PUBLIC HEALTH AND WORKFORCE DEVELOPMENT
SEC. 2001. TABLE OF CONTENTS; REFERENCES.
(a) Table of Contents- The table of contents of this division is as follows:
Sec. 2001. Table of contents; references.
Sec. 2002. Public Health Investment Fund.
TITLE I--COMMUNITY HEALTH CENTERS
Sec. 2101. Increased funding.
TITLE II--WORKFORCE
Subtitle A--Primary Care Workforce
Part 1--National Health Service Corps
Sec. 2201. National Health Service Corps.
Sec. 2202. Authorizations of appropriations.
Part 2--Promotion of Primary Care and Dentistry
Sec. 2211. Frontline health providers.
`subpart xi--health professional needs areas
`Sec. 340H. In general.
`Sec. 340I. Loan repayments.
`Sec. 340J. Report.
`Sec. 340K. Allocation.
Sec. 2212. Primary care student loan funds.
Sec. 2213. Training in family medicine, general internal medicine, general pediatrics, geriatrics, and physician assistantship.
Sec. 2214. Training of medical residents in community-based settings.
Sec. 2215. Training for general, pediatric, and public health dentists and dental hygienists.
Sec. 2216. Authorization of appropriations.
Subtitle B--Nursing Workforce
Sec. 2221. Amendments to Public Health Service Act.
Subtitle C--Public Health Workforce
Sec. 2231. Public Health Workforce Corps.
`subpart xii--public health workforce
`Sec. 340L. Public Health Workforce Corps.
`Sec. 340M. Public Health Workforce Scholarship Program.
`Sec. 340N. Public Health Workforce Loan Repayment Program.
Sec. 2232. Enhancing the public health workforce.
Sec. 2233. Public health training centers.
Sec. 2234. Preventive medicine and public health training grant program.
Sec. 2235. Authorization of appropriations.
Subtitle D--Adapting Workforce to Evolving Health System Needs
Part 1--Health Professions Training for Diversity
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistance in the health professions regarding individuals from disadvantaged backgrounds.
Sec. 2242. Nursing workforce diversity grants.
Sec. 2243. Coordination of diversity and cultural competency programs.
Part 2--Interdisciplinary Training Programs
Sec. 2251. Cultural and linguistic competency training for health care professionals.
Sec. 2252. Innovations in interdisciplinary care training.
Part 3--Advisory Committee on Health Workforce Evaluation and Assessment
Sec. 2261. Health workforce evaluation and assessment.
Part 4--Health Workforce Assessment
Sec. 2271. Health workforce assessment.
Part 5--Authorization of Appropriations
Sec. 2281. Authorization of appropriations.
TITLE III--PREVENTION AND WELLNESS
Sec. 2301. Prevention and wellness.
`TITLE XXXI--PREVENTION AND WELLNESS
`Subtitle A--Prevention and Wellness Trust
`Sec. 3111. Prevention and Wellness Trust.
`Subtitle B--National Prevention and Wellness Strategy
`Sec. 3121. National Prevention and Wellness Strategy.
`Subtitle C--Prevention Task Forces
`Sec. 3131. Task Force on Clinical Preventive Services.
`Sec. 3132. Task Force on Community Preventive Services.
`Subtitle D--Prevention and Wellness Research
`Sec. 3141. Prevention and wellness research activity coordination.
`Sec. 3142. Community prevention and wellness research grants.
`Subtitle E--Delivery of Community Prevention and Wellness Services
`Sec. 3151. Community prevention and wellness services grants.
`Subtitle F--Core Public Health Infrastructure
`Sec. 3161. Core public health infrastructure for State, local, and tribal health departments.
`Sec. 3162. Core public health infrastructure and activities for CDC.
`Subtitle G--General Provisions
`Sec. 3171. Definitions.
TITLE IV--QUALITY AND SURVEILLANCE
Sec. 2401. Implementation of best practices in the delivery of health care.
Sec. 2402. Assistant Secretary for Health Information.
Sec. 2403. Authorization of appropriations.
TITLE V--OTHER PROVISIONS
Subtitle A--Drug Discount for Rural and Other Hospitals
Sec. 2501. Expanded participation in 340B program.
Sec. 2502. Extension of discounts to inpatient drugs.
Sec. 2503. Effective date.
Subtitle B--School-Based Health Clinics
Sec. 2511. School-based health clinics.
Subtitle C--National Medical Device Registry
Sec. 2521. National medical device registry.
Subtitle D--Grants for Comprehensive Programs To Provide Education to Nurses and Create a Pipeline to Nursing
Sec. 2531. Establishment of grant program.
Subtitle E--States Failing To Adhere to Certain Employment Obligations
Sec. 2541. Limitation on Federal funds.
(b) References- Except as otherwise specified, whenever in this division an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.).
SEC. 2002. PUBLIC HEALTH INVESTMENT FUND.
(a) Establishment of Funds-
(1) IN GENERAL- There is established a fund to be known as the `Public Health Investment Fund' (referred to in this section as the `Fund').
(2) FUNDING-
(A) There shall be deposited into the Fund--
(i) for fiscal year 2010, $4,600,000,000;
(ii) for fiscal year 2011, $5,600,000,000;
(iii) for fiscal year 2012, $6,900,000,000;
(iv) for fiscal year 2013, $7,800,000,000;
(v) for fiscal year 2014, $9,000,000,000;
(vi) for fiscal year 2015, $9,400,000,000;
(vii) for fiscal year 2016, $10,100,000,000;
(viii) for fiscal year 2017, $10,800,000,000;
(ix) for fiscal year 2018, $11,800,000,000; and
(x) for fiscal year 2019, $12,700,000,000.
(B) Amounts deposited into the Fund shall be derived from general revenues of the Treasury.
(b) Authorization of Appropriations From the Fund-
(1) NEW FUNDING-
(A) IN GENERAL- Amounts in the Fund are authorized to be appropriated by the Committees on Appropriations of the House of Representatives and the Senate for carrying out activities under designated public health provisions.
(B) DESIGNATED PROVISIONS- For purposes of this paragraph, the term `designated public health provisions' means the provisions for which amounts are authorized to be appropriated under section 330(s), 338(c), 338H-1, 799C, 872, or 3111 of the Public Health Service Act, as added by this division.
(2) BASELINE FUNDING-
(A) IN GENERAL- Amounts in the Fund are authorized to be appropriated (as described in paragraph (1)) for a fiscal year only if (excluding any amounts in or appropriated from the Fund)--
(i) the amounts specified in subparagraph (B) for the fiscal year involved are equal to or greater than the amounts specified in subparagraph (B) for fiscal year 2008; and
(ii) the amounts appropriated, out of the general fund of the Treasury, to the Prevention and Wellness Trust under section 3111 of the Public Health Service Act, as added by this division, for the fiscal year involved are equal to or greater than the funds--
(I) appropriated under the heading `Prevention and Wellness Fund' in title VIII of division A of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5); and
(II) allocated by the second proviso under such heading for evidence-based clinical and community-based prevention and wellness strategies.
(B) AMOUNTS SPECIFIED- The amounts specified in this subparagraph, with respect to a fiscal year, are the amounts appropriated for the following:
(i) Community health centers (including funds appropriated under the authority of section 330 of the Public Health Service Act (42 U.S.C. 254b)).
(ii) The National Health Service Corps Program (including funds appropriated under the authority of section 338 of such Act (42 U.S.C. 254k)).
(iii) The National Health Service Corps Scholarship and Loan Repayment Programs (including funds appropriated under the authority of section 338H of such Act (42 U.S.C. 254q)).
(iv) Primary care loan funds (including funds appropriated for schools of medicine or osteopathic medicine under the authority of section 735(f) of such Act (42 U.S.C. 292y(f))).
(v) Primary care education programs (including funds appropriated under the authority of sections 736, 740, 741, and 747 of such Act (42 U.S.C. 293, 293d, and 293k)).
(vi) Sections 761 and 770 of such Act (42 U.S.C. 294n and 295e).
(vii) Nursing workforce development (including funds appropriated under the authority of title VIII of such Act (42 U.S.C. 296 et seq.)).
(viii) The National Center for Health Statistics (including funds appropriated under the authority of sections 304, 306, 307, and 308 of such Act (42 U.S.C. 242b, 242k, 242l, and 242m)).
(ix) The Agency for Healthcare Research and Quality (including funds appropriated under the authority of title IX of such Act (42 U.S.C. 299 et seq.)).
(3) BUDGETARY IMPLICATIONS- Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Fund.
TITLE I--COMMUNITY HEALTH CENTERS
SEC. 2101. INCREASED FUNDING.
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended--
(1) in subsection (r)(1)--
(A) in subparagraph (D), by striking `and' at the end;
(B) in subparagraph (E), by striking the period at the end and inserting `; and'; and
(C) by inserting at the end the following:
`(F) Such sums as may be necessary for each of fiscal years 2013 and 2019.'; and
(2) by inserting after subsection (r) the following:
`(s) Additional Funding- For the purpose of carrying out this section, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) For fiscal year 2010, $1,000,000,000.
`(2) For fiscal year 2011, $1,500,000,000.
`(3) For fiscal year 2012, $2,500,000,000.
`(4) For fiscal year 2013, $3,000,000,000.
`(5) For fiscal year 2014, $4,000,000,000.
`(6) For fiscal year 2015, $4,400,000,000.
`(7) For fiscal year 2016, $4,800,000,000.
`(8) For fiscal year 2017, $5,300,000,000.
`(9) For fiscal year 2018, $5,900,000,000.
`(10) For fiscal year 2019, $6,400,000,000.'.
TITLE II--WORKFORCE
Subtitle A--Primary Care Workforce
PART 1--NATIONAL HEALTH SERVICE CORPS
SEC. 2201. NATIONAL HEALTH SERVICE CORPS.
(a) Fulfillment of Obligated Service Requirement Through Half-Time Service-
(1) WAIVERS- Subsection (i) of section 331 (42 U.S.C. 254d) is amended--
(A) in paragraph (1), by striking `In carrying out subpart III' and all that follows through the period and inserting `In carrying out subpart III, the Secretary may, in accordance with this subsection, issue waivers to individuals who have entered into a contract for obligated service under the Scholarship Program or the Loan Repayment Program under which the individuals are authorized to satisfy the requirement of obligated service through providing clinical practice that is half-time.';
(B) in paragraph (2)--
(i) in subparagraphs (A)(ii) and (B), by striking `less than full time' each place it appears and inserting `half time';
(ii) in subparagraphs (C) and (F), by striking `less than full-time service' each place it appears and inserting `half-time service'; and
(iii) by amending subparagraphs (D) and (E) to read as follows:
`(D) the entity and the Corps member agree in writing that the Corps member will perform half-time clinical practice;
`(E) the Corps member agrees in writing to fulfill all of the service obligations under section 338C through half-time clinical practice and either--
`(i) double the period of obligated service; or
`(ii) in the case of contracts entered into under section 338B, accept a minimum service obligation of 2 years with an award amount equal to 50 percent of the amount that would otherwise be payable for full-time service; and'; and
(C) in paragraph (3), by striking `In evaluating a demonstration project described in paragraph (1)' and inserting `In evaluating waivers issued under paragraph (1)'.
(2) DEFINITIONS- Subsection (j) of section 331 (42 U.S.C. 254d) is amended by adding at the end the following:
`(5) The terms `full time' and `full-time' mean a minimum of 40 hours per week in a clinical practice, for a minimum of 45 weeks per year.
`(6) The terms `half time' and `half-time' mean a minimum of 20 hours per week (not to exceed 39 hours per week) in a clinical practice, for a minimum of 45 weeks per year.'.
(b) Reappointment to National Advisory Council- Section 337(b)(1) (42 U.S.C. 254j(b)(1)) is amended by striking `Members may not be reappointed to the Council.'.
(c) Loan Repayment Amount- Section 338B(g)(2)(A) is amended (42 U.S.C. 254l-1(g)(2)(A)) by striking `$35,000' and inserting `$50,000, plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation,'.
(d) Treatment of Teaching as Obligated Service- Subsection (a) of section 338C (42 U.S.C. 254m) is amended by adding at the end the following: `The Secretary may treat teaching as clinical practice for up to 20 percent of such period of obligated service.'.
SEC. 2202. AUTHORIZATIONS OF APPROPRIATIONS.
(a) National Health Service Corps Program- Section 338 (42 U.S.C. 254k) is amended--
(1) in subsection (a), by striking `2012' and inserting `2019'; and
(2) by adding at the end the following:
`(c) For the purpose of carrying out this subpart, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $63,000,000 for fiscal year 2010.
`(2) $66,000,000 for fiscal year 2011.
`(3) $70,000,000 for fiscal year 2012.
`(4) $73,000,000 for fiscal year 2013.
`(5) $77,000,000 for fiscal year 2014.
`(6) $81,000,000 for fiscal year 2015.
`(7) $85,000,000 for fiscal year 2016.
`(8) $89,000,000 for fiscal year 2017.
`(9) $94,000,000 for fiscal year 2018.
`(10) $98,000,000 for fiscal year 2019.'.
(b) Scholarship and Loan Repayment Programs- Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) is amended--
(1) in section 338H(a)--
(A) in paragraph (4), by striking `and' at the end;
(B) in paragraph (5), by striking the period at the end and inserting `; and'; and
(C) by adding at the end the following:
`(6) for fiscal years 2013 and 2019, such sums as may be necessary.'; and
(2) by inserting after section 338H the following:
`SEC. 338H-1. ADDITIONAL FUNDING.
`For the purpose of carrying out this subpart, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $254,000,000 for fiscal year 2010.
`(2) $266,000,000 for fiscal year 2011.
`(3) $278,000,000 for fiscal year 2012.
`(4) $292,000,000 for fiscal year 2013.
`(5) $306,000,000 for fiscal year 2014.
`(6) $321,000,000 for fiscal year 2015.
`(7) $337,000,000 for fiscal year 2016.
`(8) $354,000,000 for fiscal year 2017.
`(9) $372,000,000 for fiscal year 2018.
`(10) $391,000,000 for fiscal year 2019.'.
PART 2--PROMOTION OF PRIMARY CARE AND DENTISTRY
SEC. 2211. FRONTLINE HEALTH PROVIDERS.
Part D of title III (42 U.S.C. 254b et seq.) is amended by adding at the end the following:
`Subpart XI--Health Professional Needs Areas
`SEC. 340H. IN GENERAL.
`(a) Program- The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a program, to be known as the Frontline Health Providers Loan Repayment Program, to address unmet health care needs in health professional needs areas through loan repayments under section 340I.
`(b) Designation of Health Professional Needs Areas-
`(1) IN GENERAL- In this subpart, the term `health professional needs area' means an area, population, or facility that is designated by the Secretary in accordance with paragraph (2).
`(2) DESIGNATION- To be designated by the Secretary as a health professional needs area under this subpart:
`(A) In the case of an area, the area must be a rational area for the delivery of health services.
`(B) The area, population, or facility must have, in one or more health disciplines, specialties, or subspecialties for the population served, as determined by the Secretary--
`(i) insufficient capacity of health professionals; or
`(ii) high needs for health services.
`(C) With respect to the delivery of primary health services, the area, population, or facility must not include a health professional shortage area (as designated under section 332), except that the area, population, or facility may include such a health professional shortage area to which no member of the National Health Service Corps is currently assigned.
`(c) Eligibility- To be eligible to participate in the Program, an individual shall--
`(1) hold a degree in a course of study or program (approved by the Secretary) from a school defined in section 799B(1)(A) (other than a school of public health);
`(2) hold a degree in a course of study or program (approved by the Secretary) from a school or program defined in subparagraph (C), (D), or (E)(4) of section 799B(1), as designated by the Secretary;
`(3) be enrolled as a full-time student--
`(A) in a school or program defined in subparagraph (C), (D), or (E)(4) of section 799B(1), as designated by the Secretary, or a school described in paragraph (1); and
`(B) in the final year of a course of study or program, offered by such school or program and approved by the Secretary, leading to a degree in a discipline referred to in subparagraph (A) (other than a graduate degree in public health), (C), (D), or (E)(4) of section 799B(1);
`(4) be a practitioner described in section 1842(b)(18)(C) or 1848(k)(3)(B)(iii) or (iv) of the Social Security Act; or
`(5) be a practitioner in the field of respiratory therapy, medical technology, or radiologic technology.
`(d) Definition- In this subpart, the term `primary health services' has the meaning given to such term in section 331(a)(3)(D).
`SEC. 340I. LOAN REPAYMENTS.
`(a) Loan Repayments- The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall enter into contracts with individuals under which--
`(1) the individual agrees--
`(A) to serve as a full-time primary health services provider or as a full-time or part-time provider of other health services for a period of time equal to 2 years or such longer period as the individual may agree to;
`(B) to serve in a health professional needs area in a health discipline, specialty, or a subspecialty for which the area, population, or facility is designated as a health professional needs area under section 340H; and
`(C) in the case of an individual described in subsection 340H(c)(3) who is in the final year of study and who has accepted employment as primary health services provider or provider of other health services in accordance with subparagraphs (A) and (B), to complete the education or training and maintain an acceptable level of academic standing (as determined by the educational institution offering the course of study or training); and
`(2) the Secretary agrees to pay, for each year of such service, an amount on the principal and interest of the undergraduate or graduate educational loans (or both) of the individual that is not more than 50 percent of the average award made under the National Health Service Corps Loan Repayment Program under subpart III in that year.
`(b) Practice Setting- A contract entered into under this section shall allow the individual receiving the loan repayment to satisfy the service requirement described in subsection (a)(1) through employment in a solo or group practice, a clinic, an accredited public or private nonprofit hospital, or any other health care entity, as deemed appropriate by the Secretary.
`(c) Application of Certain Provisions- The provisions of subpart III of part D shall, except as inconsistent with this section, apply to the loan repayment program under this subpart in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program established under section 338B.
`(d) Insufficient Number of Applicants- If there are an insufficient number of applicants for loan repayments under this section to obligate all appropriated funds, the Secretary shall transfer the unobligated funds to the National Health Service Corps for the purpose of--
`(1) recruitment of sufficient applicants for the National Health Service Corps for the following year; or
`(2) making additional loan repayments under section 338B if there is an excess number of qualified applicants for loan repayments under such section.
`SEC. 340J. REPORT.
`The Secretary shall submit to the Congress an annual report on the program carried out under this subpart.
`SEC. 340K. ALLOCATION.
`Of the amount of funds obligated under this subpart each fiscal year for loan repayments--
`(1) 90 percent shall be for physicians and other health professionals providing primary health services; and
`(2) 10 percent shall be for health professionals not described in paragraph (1).'.
SEC. 2212. PRIMARY CARE STUDENT LOAN FUNDS.
(a) Loan Provisions- Section 722 (42 U.S.C. 292r) is amended by striking subsection (e) and inserting the following:
`(e) Rate of Interest- Such loans shall bear interest, on the unpaid balance of the loan, computed only for periods for which the loan is repayable, at the rate of 2 percentage points less than the applicable rate of interest described in section 427A(l)(1) of the Higher Education Act of 1965 per year.'.
(b) Medical Schools and Primary Health Care- Subsection (a) of section 723 (42 U.S.C. 292s) is amended--
(1) in paragraph (1), by striking subparagraph (B) and inserting the following:
`(B) to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.'; and
(2) by striking paragraph (3) and inserting the following:
`(3) NONCOMPLIANCE BY STUDENT- If an individual fails to comply with an agreement entered into pursuant to paragraph (1), such agreement shall provide that the total interest to be paid on the loan, over the course of the loan period, shall equal the total amount of interest that would have been incurred by the individual if, from the outset of the loan, the loan was repayable at the rate of interest described in section 427A(l)(1) of the Higher Education Act of 1965 per year instead of the rate of interest described in section 722(e).'.
(c) Student Loan Guidelines-
(1) IN GENERAL- Section 735 (42 U.S.C. 292y) is amended--
(A) by redesignating subsection (f) as subsection (g); and
(B) by inserting after subsection (e) the following:
`(f) Determination of Financial Need- The Secretary--
`(1) may require, or authorize a school or other entity to require, the submission of financial information to determine the financial resources available to any individual seeking assistance under this subpart; and
`(2) shall take into account the extent to which such individual is financially independent in determining whether to require or authorize the submission of such information regarding such individual's family members.'.
(2) REVISED GUIDELINES- The Secretary of Health and Human Services shall--
(A) strike the second sentence of section 57.206(b) of title 42, Code of Federal Regulations; and
(B) make such other revisions to guidelines and regulations in effect as of the date of the enactment of this Act as may be necessary for consistency with the amendments made by paragraph (1).
SEC. 2213. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, GERIATRICS, AND PHYSICIAN ASSISTANTSHIP.
Section 747 (42 U.S.C. 293k) is amended--
(1) by amending the section heading to read as follows: `primary care training and enhancement';
(2) by redesignating subsection (e) as subsection (f); and
(3) by striking subsections (a) through (d) and inserting the following:
`(a) Program- The Secretary shall establish a primary care training and capacity building program consisting of awarding grants and contracts under subsections (b) and (c).
`(b) Support and Development of Primary Care Training Programs-
`(1) IN GENERAL- The Secretary shall make grants to, or enter into contracts with, eligible entities--
`(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program, in the field of family medicine, general internal medicine, general pediatrics, or geriatrics for medical students, interns, residents, or practicing physicians;
`(B) to provide financial assistance in the form of traineeships and fellowships to medical students, interns, residents, or practicing physicians, who are participants in any such program, and who plan to specialize or work in family medicine, general internal medicine, general pediatrics, or geriatrics;
`(C) to plan, develop, operate, or participate in an accredited program for the training of physicians who plan to teach in family medicine, general internal medicine, general pediatrics, or geriatrics training programs including in community-based settings;
`(D) to provide financial assistance in the form of traineeships and fellowships to practicing physicians who are participants in any such programs and who plan to teach in a family medicine, general internal medicine, general pediatrics, or geriatrics training program; and
`(E) to plan, develop, operate, or participate in an accredited program for physician assistant education, and for the training of individuals who plan to teach in programs to provide such training.
`(2) ELIGIBILITY- To be eligible for a grant or contract under paragraph (1), an entity shall be--
`(A) an accredited school of medicine or osteopathic medicine, public or nonprofit private hospital, or physician assistant training program;
`(B) a public or private nonprofit entity; or
`(C) a consortium of 2 or more entities described in subparagraphs (A) and (B).
`(c) Capacity Building in Primary Care-
`(1) IN GENERAL- The Secretary shall make grants to or enter into contracts with eligible entities to establish, maintain, or improve--
`(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of family medicine, general internal medicine, general pediatrics, or geriatrics; or
`(B) programs that improve clinical teaching in such specialties.
`(2) ELIGIBILITY- To be eligible for a grant or contract under paragraph (1), an entity shall be an accredited school of medicine or osteopathic medicine.
`(d) Preference- In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
`(1) Training the greatest percentage, or significantly improving the percentage, of health care professionals who provide primary care.
`(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.
`(3) A high rate of placing graduates in practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).
`(4) Supporting teaching programs that address the health care needs of vulnerable populations.
`(e) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.
`(f) Definition- In this section, the term `health disparities' has the meaning given the term in section 3171.'.
SEC. 2214. TRAINING OF MEDICAL RESIDENTS IN COMMUNITY-BASED SETTINGS.
Title VII (42 U.S.C. 292 et seq.) is amended--
(1) by redesignating section 748 as 749A; and
(2) by inserting after section 747 the following:
`SEC. 748. TRAINING OF MEDICAL RESIDENTS IN COMMUNITY-BASED SETTINGS.
`(a) Program- The Secretary shall establish a program for the training of medical residents in community-based settings consisting of awarding grants or contracts under this section.
`(b) Development and Operation of Community-Based Programs- The Secretary shall make grants to, or enter into contracts with, eligible entities--
`(1) to plan and develop a new primary care residency training program, which may include--
`(A) planning and developing curricula;
`(B) recruiting and training residents and faculty; and
`(C) other activities designated to result in accreditation of such a program; or
`(2) to operate or participate in an established primary care residency training program, which may include--
`(A) planning and developing curricula;
`(B) recruitment and training of residents; and
`(C) retention of faculty.
`(c) Eligible Entity- To be eligible to receive a grant or contract under subsection (b), an entity shall--
`(1) be designated as a recipient of payment for the direct costs of medical education under section 1886(k) of the Social Security Act;
`(2) be designated as an approved teaching health center under section 1502(d) of the America's Affordable Health Choices Act of 2009 and continuing to participate in the demonstration project under such section; or
`(3) be an applicant for designation described in paragraph (1) or (2) and have demonstrated to the Secretary appropriate involvement of an accredited teaching hospital to carry out the inpatient responsibilities associated with a primary care residency training program.
`(d) Preferences- In awarding grants and contracts under paragraph (1) or (2) of subsection (b), the Secretary shall give preference to entities that--
`(1) support teaching programs that address the health care needs of vulnerable populations; or
`(2) are a Federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act) or a rural health clinic (as defined in section 1861(aa)(2) of such Act).
`(e) Additional Preferences for Established Programs- In awarding grants and contracts under subsection (b)(2), the Secretary shall give preference to entities that have a demonstrated record of training--
`(1) a high or significantly improved percentage of health care professionals who provide primary care;
`(2) individuals who are from underrepresented minority groups or disadvantaged backgrounds; or
`(3) individuals who practice in settings having the principal focus of serving underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).
`(f) Period of Awards-
`(1) IN GENERAL- The period of a grant or contract under this section--
`(A) shall not exceed 2 years for awards under subsection (b)(1); and
`(B) shall not exceed 5 years for awards under subsection (b)(2).
`(2) SPECIAL RULES-
`(A) An award of a grant or contract under subsection (b)(1) shall not be renewed.
`(B) The period of a grant or contract awarded to an entity under subsection (b)(2) shall not overlap with the period of any grant or contact awarded to the same entity under subsection (b)(1).
`(g) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.
`(h) Definitions- In this section:
`(1) PRIMARY CARE RESIDENCY TRAINING PROGRAM- The term `primary care residency training program' means an approved medical residency training program described in section 1886(h)(5)(A) of the Social Security Act that is--
`(A) in the case of entities seeking awards under subsection (b)(1), actively applying to be accredited by the Accreditation Council for Graduate Medical Education; or
`(B) in the case of entities seeking awards under subsection (b)(2), so accredited.
`(2) HEALTH DISPARITIES- The term `health disparities' has the meaning given the term in section 3171.'.
SEC. 2215. TRAINING FOR GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTS AND DENTAL HYGIENISTS.
Title VII (42 U.S.C. 292 et seq.) is amended--
(1) in section 791(a)(1), by striking `747 and 750' and inserting `747, 749, and 750'; and
(2) by inserting after section 748, as added, the following:
`SEC. 749. TRAINING FOR GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTS AND DENTAL HYGIENISTS.
`(a) Program- The Secretary shall establish a dental medicine training program consisting of awarding grants and contracts under this section.
`(b) Support and Development of Dental Training Programs- The Secretary shall make grants to, or enter into contracts with, eligible entities--
`(1) to plan, develop, operate, or participate in an accredited professional training program for oral health professionals;
`(2) to provide financial assistance to oral health professionals who are in need thereof, who are participants in any such program, and who plan to work in general, pediatric, or public heath dentistry, or dental hygiene;
`(3) to plan, develop, operate, or participate in a program for the training of oral health professionals who plan to teach in general, pediatric, or public health dentistry, or dental hygiene;
`(4) to provide financial assistance in the form of traineeships and fellowships to oral health professionals who plan to teach in general, pediatric, or public health dentistry or dental hygiene;
`(5) to establish, maintain, or improve--
`(A) academic administrative units (including departments, divisions, or other appropriate units) in the specialties of general, pediatric, or public health dentistry; or
`(B) programs that improve clinical teaching in such specialties;
`(6) to plan, develop, operate, or participate in predoctoral and postdoctoral training in general, pediatric, or public health dentistry programs, or training for dental hygienists;
`(7) to plan, develop, operate, or participate in a loan repayment program for full-time faculty in a program of general, pediatric, or public health dentistry; and
`(8) to provide technical assistance to pediatric dental training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.
`(c) Eligibility- To be eligible for a grant or contract under subsection (a), an entity shall be--
`(1) an accredited school of dentistry, training program in dental hygiene, or public or nonprofit private hospital;
`(2) a training program in dental hygiene at an accredited institution of higher education;
`(3) a public or private nonprofit entity; or
`(4) a consortium of--
`(A) 2 or more of the entities described in paragraphs (1) through (3); and
`(B) an accredited school of public health.
`(d) Preference- In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
`(1) Training the greatest percentage, or significantly improving the percentage, of oral health professionals who practice general, pediatric, or public health dentistry.
`(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.
`(3) A high rate of placing graduates in practice settings having the principal focus of serving in underserved areas or populations experiencing health disparities (including serving patients eligible for medical assistance under title XIX of the Social Security Act or for child health assistance under title XXI of such Act or those with special health care needs).
`(4) Supporting teaching programs that address the dental needs of vulnerable populations.
`(5) Providing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.
`(e) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.
`(f) Definition- In this section:
`(1) The term `health disparities' has the meaning given the term in section 3171.
`(2) The term `oral health professional' means an individual training or practicing--
`(A) in general dentistry, pediatric dentistry, public health dentistry, or dental hygiene; or
`(B) another dental medicine specialty, as deemed appropriate by the Secretary.'.
SEC. 2216. AUTHORIZATION OF APPROPRIATIONS.
(a) In General- Part F of title VII (42 U.S.C. 295j et seq.) is amended by adding at the end the following:
`SEC. 799C. FUNDING THROUGH PUBLIC HEALTH INVESTMENT FUND.
`(a) Promotion of Primary Care and Dentistry- For the purpose of carrying out subpart XI of part D of title III and sections 723, 747, 748, and 749, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $240,000,000 for fiscal year 2010.
`(2) $253,000,000 for fiscal year 2011.
`(3) $265,000,000 for fiscal year 2012.
`(4) $278,000,000 for fiscal year 2013.
`(5) $292,000,000 for fiscal year 2014.
`(6) $307,000,000 for fiscal year 2015.
`(7) $322,000,000 for fiscal year 2016.
`(8) $338,000,000 for fiscal year 2017.
`(9) $355,000,000 for fiscal year 2018.
`(10) $373,000,000 for fiscal year 2019.'.
(b) Existing Authorizations of Appropriations-
(1) SECTION 735- Paragraph (1) of section 735(g), as so redesignated, is amended by inserting `and such sums as may be necessary for subsequent years through fiscal year 2019' before the period at the end.
(2) SECTION 747- Subsection (f), as so redesignated, of section 747 (42 U.S.C. 293k) is amended by striking `2002' and inserting `2019'.
Subtitle B--Nursing Workforce
SEC. 2221. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.
(a) Definitions- Section 801 (42 U.S.C. 296 et seq.) is amended--
(1) in paragraph (1), by inserting `nurse-managed health centers' after `nursing centers,'; and
(2) by adding at the end the following:
`(16) NURSE-MANAGED HEALTH CENTER- The term `nurse-managed health center' means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and is associated with an accredited school of nursing, Federally qualified health center, or independent nonprofit health or social services agency.'.
(a) Grants for Health Professions Education- Title VIII (42 U.S.C. 296 et seq.) is amended by striking section 807.
(b) Advanced Education Nursing Grants- Section 811(f) (42 U.S.C. 296j(f)) is amended--
(1) by striking paragraph (2);
(2) by redesignating paragraph (3) as paragraph (2); and
(3) in paragraph (2), as so redesignated, by striking `that agrees' and all that follows through the end and inserting: `that agrees to expend the award--
`(A) to train advanced education nurses who will practice in health professional shortage areas designated under section 332; or
`(B) to increase diversity among advanced education nurses.'.
(c) Nurse Education, Practice, and Retention Grants- Section 831 (42 U.S.C. 296p) is amended--
(1) in subsection (b), by amending paragraph (3) to read as follows:
`(3) providing coordinated care, quality care, and other skills needed to practice nursing;'; and
(2) by striking subsection (e) and redesignating subsections (f) through (h) as subsections (e) through (g), respectively.
(d) Student Loans- Subsection (a) of section 836 (42 U.S.C. 297b) is amended--
(1) by striking `$2,500' and inserting `$3,300';
(2) by striking `$4,000' and inserting `$5,200';
(3) by striking `$13,000' and inserting `$17,000'; and
(4) by adding at the end the following: `Beginning with fiscal year 2012, the dollar amounts specified in this subsection shall be adjusted by an amount determined by the Secretary on an annual basis to reflect inflation.'.
(e) Loan Repayment- Section 846 (42 U.S.C. 297n) is amended--
(1) in subsection (a), by amending paragraph (3) to read as follows:
`(3) who enters into an agreement with the Secretary to serve for a period of not less than 2 years--
`(A) as a nurse at a health care facility with a critical shortage of nurses; or
`(B) as a faculty member at an accredited school of nursing;'; and
(2) in subsection (g)(1), by striking `to provide health services' each place it appears and inserting `to provide health services or serve as a faculty member'.
(f) Nurse Faculty Loan Program- Paragraph (2) of section 846A(c) (42 U.S.C. 297n-1(c)) is amended by striking `$30,000' and all that follows through the semicolon and inserting `$35,000, plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation;'.
(g) Public Service Announcements- Title VIII (42 U.S.C. 296 et seq.) is amended by striking part H.
(h) Technical and Conforming Amendments- Title VIII (42 U.S.C. 296 et seq.) is amended--
(1) by redesignating section 810 (relating to prohibition against discrimination by schools on the basis of sex) as section 809 and moving such section so that it follows section 808;
(2) in sections 835, 836, 838, 840, and 842, by striking the term `this subpart' each place it appears and inserting `this part';
(3) in section 836(h), by striking the last sentence;
(4) in section 836, by redesignating subsection (l) as subsection (k);
(5) in section 839, by striking `839' and all that follows through `(a)' and inserting `839. (a)';
(6) in section 835(b), by striking `841' each place it appears and inserting `871';
(7) by redesignating section 841 as section 871, moving part F to the end of the title, and redesignating such part as part H;
(8) in part G--
(A) by redesignating section 845 as section 851; and
(B) by redesignating part G as part F; and
(9) in part I--
(A) by redesignating section 855 as section 861; and
(B) by redesignating part I as part G.
(i) Funding-
(1) IN GENERAL- Part H, as redesignated, of title VIII is amended by adding at the end the following:
`SEC. 872. FUNDING THROUGH PUBLIC HEALTH INVESTMENT FUND.
`For the purpose of carrying out this title, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $115,000,000 for fiscal year 2010.
`(2) $122,000,000 for fiscal year 2011.
`(3) $127,000,000 for fiscal year 2012.
`(4) $134,000,000 for fiscal year 2013.
`(5) $140,000,000 for fiscal year 2014.
`(6) $147,000,000 for fiscal year 2015.
`(7) $154,000,000 for fiscal year 2016.
`(8) $162,000,000 for fiscal year 2017.
`(9) $170,000,000 for fiscal year 2018.
`(10) $179,000,000 for fiscal year 2019.'.
(2) EXISTING AUTHORIZATIONS OF APPROPRIATIONS-
(A) SECTIONS 831, 846, 846A, AND 861- Sections 831(g) (as so redesignated), 846(i)(1) (42 U.S.C. 297n(i)(1)), 846A(f) (42 U.S.C. 297n-1(f)), and 861(e) (as so redesignated) are amended by striking `2007' each place it appears and inserting `2019'.
(B) SECTION 871- Section 871, as so redesignated, is amended to read as follows:
`SEC. 871. FUNDING.
`For the purpose of carrying out parts B, C, and D (subject to section 845(g)), there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2019.'.
Subtitle C--Public Health Workforce
SEC. 2231. PUBLIC HEALTH WORKFORCE CORPS.
Part D of title III (42 U.S.C. 254b et seq.), as amended by section 2211, is amended by adding at the end the following:
`Subpart XII--Public Health Workforce
`SEC. 340L. PUBLIC HEALTH WORKFORCE CORPS.
`(a) Establishment- There is established, within the Service, the Public Health Workforce Corps (in this subpart referred to as the `Corps'), for the purpose of ensuring an adequate supply of public health professionals throughout the Nation. The Corps shall consist of--
`(1) such officers of the Regular and Reserve Corps of the Service as the Secretary may designate; and
`(2) such civilian employees of the United States as the Secretary may appoint.
`(b) Administration- Except as provided in subsection (c), the Secretary shall carry out this subpart acting through the Administrator of the Health Resources and Services Administration.
`(c) Placement and Assignment- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop a methodology for placing and assigning Corps participants as public health professionals. Such methodology may allow for placing and assigning such participants in State, local, and tribal health departments and Federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act).
`(d) Application of Certain Provisions- The provisions of subpart II shall, except as inconsistent with this subpart, apply to the Public Health Workforce Corps in the same manner and to the same extent as such provisions apply to the National Health Service Corps established under section 331.
`(e) Report- The Secretary shall submit to the Congress an annual report on the programs carried out under this subpart.
`SEC. 340M. PUBLIC HEALTH WORKFORCE SCHOLARSHIP PROGRAM.
`(a) Establishment- The Secretary shall establish the Public Health Workforce Scholarship Program (referred to in this section as the `Program') for the purpose described in section 340L(a).
`(b) Eligibility- To be eligible to participate in the Program, an individual shall--
`(1)(A) be accepted for enrollment, or be enrolled, as a full-time or part-time student in a course of study or program (approved by the Secretary) at an accredited graduate school or program of public health; or
`(B) have demonstrated expertise in public health and be accepted for enrollment, or be enrolled, as a full-time or part-time student in a course of study or program (approved by the Secretary) at--
`(i) an accredited graduate school or program of nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine; or
`(ii) another accredited graduate school or program, as deemed appropriate by Secretary;
`(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Service or be eligible for selection for civilian service in the Corps; and
`(3) sign and submit to the Secretary a written contract (described in subsection (c)) to serve full-time as a public health professional, upon the completion of the course of study or program involved, for the period of obligated service described in subsection (c)(2)(E).
`(c) Contract- The written contract between the Secretary and an individual under subsection (b)(3) shall contain--
`(1) an agreement on the part of the Secretary that the Secretary will--
`(A) provide the individual with a scholarship for a period of years (not to exceed 4 academic years) during which the individual shall pursue an approved course of study or program to prepare the individual to serve in the public health workforce; and
`(B) accept (subject to the availability of appropriated funds) the individual into the Corps;
`(2) an agreement on the part of the individual that the individual will--
`(A) accept provision of such scholarship to the individual;
`(B) maintain full-time or part-time enrollment in the approved course of study or program described in subsection (b)(1) until the individual completes that course of study or program;
`(C) while enrolled in the approved course of study or program, maintain an acceptable level of academic standing (as determined by the educational institution offering such course of study or program);
`(D) if applicable, complete a residency or internship; and
`(E) serve full-time as a public health professional for a period of time equal to the greater of--
`(i) 1 year for each academic year for which the individual was provided a scholarship under the Program; or
`(ii) 2 years; and
`(3) an agreement by both parties as to the nature and extent of the scholarship assistance, which may include--
`(A) payment of reasonable educational expenses of the individual, including tuition, fees, books, equipment, and laboratory expenses; and
`(B) payment of a stipend of not more than $1,269 (plus, beginning with fiscal year 2011, an amount determined by the Secretary on an annual basis to reflect inflation) per month for each month of the academic year involved, with the dollar amount of such a stipend determined by the Secretary taking into consideration whether the individual is enrolled full-time or part-time.
`(d) Application of Certain Provisions- The provisions of subpart III shall, except as inconsistent with this subpart, apply to the scholarship program under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Scholarship Program established under section 338A.
`SEC. 340N. PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM.
`(a) Establishment- The Secretary shall establish the Public Health Workforce Loan Repayment Program (referred to in this section as the `Program') for the purpose described in section 340L(a).
`(b) Eligibility- To be eligible to participate in the Program, an individual shall--
`(1)(A) have a graduate degree from an accredited school or program of public health;
`(B) have demonstrated expertise in public health and have a graduate degree in a course of study or program (approved by the Secretary) from--
`(i) an accredited school or program of nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine; or
`(ii) another accredited school or program approved by the Secretary; or
`(C) be enrolled as a full-time or part-time student in the final year of a course of study or program (approved by the Secretary) offered by a school or program described in subparagraph (A) or (B), leading to a graduate degree;
`(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Service or be eligible for selection for civilian service in the Corps;
`(3) if applicable, complete a residency or internship; and
`(4) sign and submit to the Secretary a written contract (described in subsection (c)) to serve full-time as a public health professional for the period of obligated service described in subsection (c)(2).
`(c) Contract- The written contract between the Secretary and an individual under subsection (b)(4) shall contain--
`(1) an agreement by the Secretary to repay on behalf of the individual loans incurred by the individual in the pursuit of the relevant public health workforce educational degree in accordance with the terms of the contract;
`(2) an agreement by the individual to serve full-time as a public health professional for a period of time equal to 2 years or such longer period as the individual may agree to; and
`(3) in the case of an individual described in subsection (b)(1)(C) who is in the final year of study and who has accepted employment as a public health professional, in accordance with subsection 340L(c), an agreement on the part of the individual to complete the education or training, maintain an acceptable level of academic standing (as determined by the educational institution offering the course of study or training), and serve the period of obligated service described in paragraph (2).
`(d) Payments-
`(1) IN GENERAL- A loan repayment provided for an individual under a written contract under the Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for reasonable educational expenses, including tuition, fees, books, equipment, and laboratory expenses, incurred by the individual.
`(2) PAYMENTS FOR YEARS SERVED-
`(A) IN GENERAL- For each year of obligated service that an individual contracts to serve under subsection (c), the Secretary may pay up to $35,000 (plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation) on behalf of the individual for loans described in paragraph (1).
`(B) REPAYMENT SCHEDULE- Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service.
`(e) Application of Certain Provisions- The provisions of subpart III shall, except as inconsistent with this subpart, apply to the loan repayment program under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program established under section 338B.'.
SEC. 2232. ENHANCING THE PUBLIC HEALTH WORKFORCE.
Section 765 (42 U.S.C. 295) is amended to read as follows:
`SEC. 765. ENHANCING THE PUBLIC HEALTH WORKFORCE.
`(a) Program- The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall establish a public health workforce training and enhancement program consisting of awarding grants and contracts under subsection (b).
`(b) Grants and Contracts- The Secretary shall award grants and contracts to eligible entities--
`(1) to plan, develop, operate, or participate in, an accredited professional training program in the field of public health (including such a program in nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine) for members of the public health workforce including mid-career professionals;
`(2) to provide financial assistance in the form of traineeships and fellowships to students who are participants in any such program and who plan to specialize or work in the field of public health;
`(3) to plan, develop, operate, or participate in a program for the training of public health professionals who plan to teach in any program described in paragraph (1); and
`(4) to provide financial assistance in the form of traineeships and fellowships to public health professionals who are participants in any program described in paragraph (1) and who plan to teach in the field of public health, including nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine.
`(c) Eligibility- To be eligible for a grant or contract under subsection (a), an entity shall be--
`(1) an accredited health professions school, including an accredited graduate school or program of public health; nursing; health administration, management, or policy; preventive medicine; laboratory science; veterinary medicine; or dental medicine;
`(2) a State, local, or tribal health department;
`(3) a public or private nonprofit entity; or
`(4) a consortium of 2 or more entities described in paragraphs (1) through (3).
`(d) Preference- In awarding grants or contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
`(1) Training the greatest percentage, or significantly improving the percentage, of public health professionals who serve in underserved communities.
`(2) Training individuals who are from underrepresented minority groups or disadvantaged backgrounds.
`(3) Training individuals in public health specialties experiencing a significant shortage of public health professionals (as determined by the Secretary).
`(4) Training the greatest percentage, or significantly improving the percentage, of public health professionals serving in the Federal Government or a State, local, or tribal government.
`(e) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.'.
SEC. 2233. PUBLIC HEALTH TRAINING CENTERS.
Section 766 (42 U.S.C. 295a) is amended--
(1) in subsection (b)(1), by striking `in furtherance of the goals established by the Secretary for the year 2000' and inserting `in furtherance of the goals established by the Secretary in the national prevention and wellness strategy under section 3121'; and
(2) by adding at the end the following:
`(d) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.'.
SEC. 2234. PREVENTIVE MEDICINE AND PUBLIC HEALTH TRAINING GRANT PROGRAM.
Section 768 (42 U.S.C. 295c) is amended to read as follows:
`SEC. 768. PREVENTIVE MEDICINE AND PUBLIC HEALTH TRAINING GRANT PROGRAM.
`(a) Grants- The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Director of the Centers for Disease Control and Prevention, shall award grants to, or enter into contracts with, eligible entities to provide training to graduate medical residents in preventive medicine specialties.
`(b) Eligibility- To be eligible for a grant or contract under subsection (a), an entity shall be--
`(1) an accredited school of public health or school of medicine or osteopathic medicine;
`(2) an accredited public or private hospital;
`(3) a State, local, or tribal health department; or
`(4) a consortium of 2 or more entities described in paragraphs (1) through (3).
`(c) Use of Funds- Amounts received under a grant or contract under this section shall be used to--
`(1) plan, develop (including the development of curricula), operate, or participate in an accredited residency or internship program in preventive medicine or public health;
`(2) defray the costs of practicum experiences, as required in such a program; and
`(3) establish, maintain, or improve--
`(A) academic administrative units (including departments, divisions, or other appropriate units) in preventive medicine and public health; or
`(B) programs that improve clinical teaching in preventive medicine and public health.
`(d) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.'.
SEC. 2235. AUTHORIZATION OF APPROPRIATIONS.
(a) In General- Section 799C, as added by section 2216 of this Act, is amended by adding at the end the following:
`(b) Public Health Workforce- For the purpose of carrying out subpart XII of part D of title III and sections 765, 766, and 768, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $51,000,000 for fiscal year 2010.
`(2) $54,000,000 for fiscal year 2011.
`(3) $57,000,000 for fiscal year 2012.
`(4) $59,000,000 for fiscal year 2013.
`(5) $62,000,000 for fiscal year 2014.
`(6) $65,000,000 for fiscal year 2015.
`(7) $68,000,000 for fiscal year 2016.
`(8) $72,000,000 for fiscal year 2017.
`(9) $75,000,000 for fiscal year 2018.
`(10) $79,000,000 for fiscal year 2019.'.
(b) Existing Authorization of Appropriations- Subpart (a) of section 770 (42 U.S.C. 295e) is amended by striking `2002' and inserting `2019'.
Subtitle D--Adapting Workforce to Evolving Health System Needs
PART 1--HEALTH PROFESSIONS TRAINING FOR DIVERSITY
SEC. 2241. SCHOLARSHIPS FOR DISADVANTAGED STUDENTS, LOAN REPAYMENTS AND FELLOWSHIPS REGARDING FACULTY POSITIONS, AND EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS REGARDING INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
Paragraph (1) of section 738(a) (42 U.S.C. 293b(a)) is amended by striking `not more than $20,000' and all that follows through the end of the paragraph and inserting: `not more than $35,000 (plus, beginning with fiscal year 2012, an amount determined by the Secretary on an annual basis to reflect inflation) of the principal and interest of the educational loans of such individuals.'
SEC. 2242. NURSING WORKFORCE DIVERSITY GRANTS.
Subsection (b) of section 821 (42 U.S.C. 296m) is amended--
(1) in the heading, by striking `Guidance' and inserting `Consultation'; and
(2) by striking `shall take into consideration' and all that follows through `consult with nursing associations' and inserting `shall, as appropriate, consult with nursing associations'.
SEC. 2243. COORDINATION OF DIVERSITY AND CULTURAL COMPETENCY PROGRAMS.
Title VII (42 U.S.C. 292 et seq.) is amended by inserting after section 739 the following:
`SEC. 739A. COORDINATION OF DIVERSITY AND CULTURAL COMPETENCY PROGRAMS.
`The Secretary shall, to the extent practicable, coordinate the activities carried out under this part and section 821 in order to enhance the effectiveness of such activities and avoid duplication of effort.'.
PART 2--INTERDISCIPLINARY TRAINING PROGRAMS
SEC. 2251. CULTURAL AND LINGUISTIC COMPETENCY TRAINING FOR HEALTH CARE PROFESSIONALS.
Section 741 (42 U.S.C. 293e) is amended--
(1) in the section heading, by striking `Grants for Health Professions Education' and inserting `Cultural and Linguistic Competency Training for Health Care Professionals';
(2) by redesignating subsection (b) as subsection (h); and
(3) by striking subsection (a) and inserting the following:
`(a) Program- The Secretary shall establish a cultural and linguistic competency training program for health care professionals, including nurse professionals, consisting of awarding grants and contracts under subsection (b).
`(b) Cultural and Linguistic Competency Training- The Secretary shall award grants and contracts to eligible entities--
`(1) to test, develop, and evaluate models of cultural and linguistic competency training (including continuing education) for health professionals; and
`(2) to implement cultural and linguistic competency training programs for health professionals developed under paragraph (1) or otherwise.
`(c) Eligibility- To be eligible for a grant or contract under subsection (b), an entity shall be--
`(1) an accredited health professions school or program;
`(2) an academic health center;
`(3) a public or private nonprofit entity; or
`(4) a consortium of 2 or more entities described in paragraphs (1) through (3).
`(d) Preference- In awarding grants and contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
`(1) Addressing, or partnering with an entity with experience addressing, the cultural and linguistic competency needs of the population to be served through the grant or contract.
`(2) Addressing health disparities.
`(3) Placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border.
`(4) Carrying out activities described in subsection (b) with respect to more than one health profession discipline, specialty, or subspecialty.
`(e) Consultation- The Secretary shall carry out this section in consultation with the heads of appropriate health agencies and offices in the Department of Health and Human Services, including the Office of Minority Health.
`(f) Definition- In this section, the term `health disparities' has the meaning given to the term in section 3171.
`(g) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.'.
SEC. 2252. INNOVATIONS IN INTERDISCIPLINARY CARE TRAINING.
Part D of title VII (42 U.S.C. 294 et seq.) is amended by adding at the end the following:
`SEC. 759. INNOVATIONS IN INTERDISCIPLINARY CARE TRAINING.
`(a) Program- The Secretary shall establish an innovations in interdisciplinary care training program consisting of awarding grants and contracts under subsection (b).
`(b) Training Programs- The Secretary shall award grants to, or enter into contracts with, eligible entities--
`(1) to test, develop, and evaluate health professional training programs (including continuing education) designed to promote--
`(A) the delivery of health services through interdisciplinary and team-based models, which may include patient-centered medical home models, medication therapy management models, and models integrating physical, mental, or oral health services; and
`(B) coordination of the delivery of health care within and across settings, including health care institutions, community-based settings, and the patient's home; and
`(2) to implement such training programs developed under paragraph (1) or otherwise.
`(c) Eligibility- To be eligible for a grant or contract under subsection (b), an entity shall be--
`(1) an accredited health professions school or program;
`(2) an academic health center;
`(3) a public or private nonprofit entity (including an area health education center or a geriatric education center); or
`(4) a consortium of 2 or more entities described in paragraphs (1) through (3).
`(d) Preferences- In awarding grants and contracts under this section, the Secretary shall give preference to entities that have a demonstrated record of the following:
`(1) Training the greatest percentage, or significantly increasing the percentage, of health professionals who serve in underserved communities.
`(2) Broad interdisciplinary team-based collaborations.
`(3) Addressing health disparities.
`(e) Report- The Secretary shall submit to the Congress an annual report on the program carried out under this section.
`(f) Definitions- In this section:
`(1) The term `health disparities' has the meaning given the term in section 3171.
`(2) The term `interdisciplinary' means collaboration across health professions and specialties, which may include public health, nursing, allied health, and appropriate medical specialties.'.
PART 3--ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND ASSESSMENT
SEC. 2261. HEALTH WORKFORCE EVALUATION AND ASSESSMENT.
Subpart 1 of part E of title VII (42 U.S.C. 294n et seq.) is amended by adding at the end the following:
`SEC. 764. HEALTH WORKFORCE EVALUATION AND ASSESSMENT.
`(a) Advisory Committee- The Secretary, acting through the Assistant Secretary for Health, shall establish a permanent advisory committee to be known as the Advisory Committee on Health Workforce Evaluation and Assessment (referred to in this section as the `Advisory Committee').
`(b) Responsibilities- The Advisory Committee shall--
`(1) not later than 1 year after the date of the establishment of the Advisory Committee, submit recommendations to the Secretary on--
`(A) classifications of the health workforce to ensure consistency of data collection on the health workforce; and
`(B) based on such classifications, standardized methodologies and procedures to enumerate the health workforce;
`(2) not later than 2 years after the date of the establishment of the Advisory Committee, submit recommendations to the Secretary on--
`(A) the supply, diversity, and geographic distribution of the health workforce;
`(B) the retention of the health workforce to ensure quality and adequacy of such workforce; and
`(C) policies to carry out the recommendations made pursuant to subparagraphs (A) and (B); and
`(3) not later than 4 years after the date of the establishment of the Advisory Committee, and every 2 years thereafter, submit updated recommendations to the Secretary under paragraphs (1) and (2).
`(c) Role of Agency- The Secretary shall provide ongoing administrative, research, and technical support for the operations of the Advisory Committee, including coordinating and supporting the dissemination of the recommendations of the Advisory Committee.
`(d) Membership-
`(1) NUMBER; APPOINTMENT- The Secretary shall appoint 15 members to serve on the Advisory Committee.
`(2) TERMS-
`(A) IN GENERAL- The Secretary shall appoint members of the Advisory Committee for a term of 3 years and may reappoint such members, but the Secretary may not appoint any member to serve more than a total of 6 years.
`(B) STAGGERED TERMS- Notwithstanding subparagraph (A), of the members first appointed to the Advisory Committee under paragraph (1)--
`(i) 5 shall be appointed for a term of 1 year;
`(ii) 5 shall be appointed for a term of 2 years; and
`(iii) 5 shall be appointed for a term of 3 years.
`(3) QUALIFICATIONS- Members of the Advisory Committee shall be appointed from among individuals who possess expertise in at least one of the following areas:
`(A) Conducting and interpreting health workforce market analysis, including health care labor workforce analysis.
`(B) Conducting and interpreting health finance and economics research.
`(C) Delivering and administering health care services.
`(D) Delivering and administering health workforce education and training.
`(4) REPRESENTATION- In appointing members of the Advisory Committee, the Secretary shall--
`(A) include no less than one representative of each of--
`(i) health professionals within the health workforce;
`(ii) health care patients and consumers;
`(iii) employers;
`(iv) labor unions; and
`(v) third-party health payors; and
`(B) ensure that--
`(i) all areas of expertise described in paragraph (3) are represented;
`(ii) the members of the Advisory Committee include members who, collectively, have significant experience working with--
`(I) populations in urban and federally designated rural and nonmetropolitan areas; and
`(II) populations who are underrepresented in the health professions, including underrepresented minority groups; and
`(iii) individuals who are directly involved in health professions education or practice do not constitute a majority of the members of the Advisory Committee.
`(5) DISCLOSURE AND CONFLICTS OF INTEREST- Members of the Advisory Committee shall not be considered employees of the Federal Government by reason of service on the Advisory Committee, except members of the Advisory Committee shall be considered to be special Government employees within the meaning of section 107 of the Ethics in Government Act of 1978 (5 U.S.C. App.) and section 208 of title 18, United States Code, for the purposes of disclosure and management of conflicts of interest under those sections.
`(6) NO PAY; RECEIPT OF TRAVEL EXPENSES- Members of the Advisory Committee shall not receive any pay for service on the Committee, but may receive travel expenses, including a per diem, in accordance with applicable provisions of subchapter I of chapter 57 of title 5, United States Code.
`(e) Consultation- In carrying out this section, the Secretary shall consult with the Secretary of Education and the Secretary of Labor.
`(f) Collaboration- The Advisory Committee shall collaborate with the advisory bodies at the Health Resources and Services Administration, the National Advisory Council (as authorized in section 337), the Advisory Committee on Training in Primary Care Medicine and Dentistry (as authorized in section 749A), the Advisory Committee on Interdisciplinary, Community-Based Linkages (as authorized in section 756), the Advisory Council on Graduate Medical Education (as authorized in section 762), and the National Advisory Council on Nurse Education and Practice (as authorized in section 851).
`(g) FACA- The Federal Advisory Committee Act (5 U.S.C. App.) except for section 14 of such Act shall apply to the Advisory Committee under this section only to the extent that the provisions of such Act do not conflict with the requirements of this section.
`(h) Report- The Secretary shall submit to the Congress an annual report on the activities of the Advisory Committee.
`(i) Definition- In this section, the term `health workforce' includes all health care providers with direct patient care and support responsibilities, including physicians, nurses, physician assistants, pharmacists, oral health professionals (as defined in section 749(f)), allied health professionals, mental and behavioral professionals, and public health professionals (including veterinarians engaged in public health practice).'.
PART 4--HEALTH WORKFORCE ASSESSMENT
SEC. 2271. HEALTH WORKFORCE ASSESSMENT.
(a) In General- Section 761 (42 U.S.C. 294n) is amended--
(1) by redesignating subsection (c) as subsection (e); and
(2) by striking subsections (a) and (b) and inserting the following:
`(a) In General- The Secretary shall, based upon the classifications and standardized methodologies and procedures developed by the Advisory Committee on Health Workforce Evaluation and Assessment under section 764(b)--
`(1) collect data on the health workforce (as defined in section 764(i)), disaggregated by field, discipline, and specialty, with respect to--
`(A) the supply (including retention) of health professionals relative to the demand for such professionals;
`(B) the diversity of health professionals (including with respect to race, ethnic background, and gender); and
`(C) the geographic distribution of health professionals; and
`(2) collect such data on individuals participating in the programs authorized by subtitles A, B, and C and part 1 of subtitle D of title II of division C of the America's Affordable Health Choices Act of 2009.
`(b) Grants and Contracts for Health Workforce Analysis-
`(1) IN GENERAL- The Secretary may award grants or contracts to eligible entities to carry out subsection (a).
`(2) ELIGIBILITY- To be eligible for a grant or contract under this subsection, an entity shall be--
`(A) an accredited health professions school or program;
`(B) an academic health center;
`(C) a State, local, or tribal government;
`(D) a public or private entity; or
`(E) a consortium of 2 or more entities described in subparagraphs (A) through (D).
`(c) Collaboration and Data Sharing- The Secretary shall collaborate with Federal departments and agencies, health professions organizations (including health professions education organizations), and professional medical societies for the purpose of carrying out subsection (a).
`(d) Report- The Secretary shall submit to the Congress an annual report on the data collected under subsection (a).'.
(b) Period Before Completion of National Strategy- Pending completion of the classifications and standardized methodologies and procedures developed by the Advisory Committee on Health Workforce Evaluation and Assessment under section 764(b) of the Public Health Service Act, as added by section 2261, the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration and in consultation with such Advisory Committee, may make a judgment about the classifications, methodologies, and procedures to be used for collection of data under section 761(a) of the Public Health Service Act, as amended by this section.
PART 5--AUTHORIZATION OF APPROPRIATIONS
SEC. 2281. AUTHORIZATION OF APPROPRIATIONS.
(a) In General- Section 799C, as added by section 2216 of this Act, is amended by adding at the end the following:
`(c) Health Professions Training for Diversity- For the purpose of carrying out sections 736, 737, 738, 739, and 739A, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $90,000,000 for fiscal year 2010.
`(2) $97,000,000 for fiscal year 2011.
`(3) $100,000,000 for fiscal year 2012.
`(4) $104,000,000 for fiscal year 2013.
`(5) $110,000,000 for fiscal year 2014.
`(6) $116,000,000 for fiscal year 2015.
`(7) $121,000,000 for fiscal year 2016.
`(8) $127,000,000 for fiscal year 2017.
`(9) $133,000,000 for fiscal year 2018.
`(10) $140,000,000 for fiscal year 2019.
`(d) Interdisciplinary Training Programs, Advisory Committee on Health Workforce Evaluation and Assessment, and Health Workforce Assessment- For the purpose of carrying out sections 741, 759, 761, and 764, in addition to any other amounts authorized to be appropriated for such purpose, there are authorized to be appropriated, out of any monies in the Public Health Investment Fund, the following:
`(1) $91,000,000 for fiscal year 2010.
`(2) $97,000,000 for fiscal year 2011.
`(3) $101,000,000 for fiscal year 2012.
`(4) $105,000,000 for fiscal year 2013.
`(5) $111,000,000 for fiscal year 2014.
`(6) $117,000,000 for fiscal year 2015.
`(7) $122,000,000 for fiscal year 2016.
`(8) $129,000,000 for fiscal year 2017.
`(9) $135,000,000 for fiscal year 2018.
`(10) $141,000,000 for fiscal year 2019.'.
(b) Existing Authorizations of Appropriations-
(1) SECTION 736- Paragraph (1) of section 736(h) (42 U.S.C. 293(h)) is amended by striking `2002' and inserting `2019'.
(2) SECTIONS 737, 738, AND 739- Subsections (a), (b), and (c) of section 740 are amended by striking `2002' each place it appears and inserting `2019'.
(3) SECTION 741- Subsection (h), as so redesignated, of section 741 is amended--
(A) by striking `and' after `fiscal year 2003,'; and
(B) by inserting `, and such sums as may be necessary for subsequent fiscal years through the end of fiscal year 2019' before the period at the end.
(4) SECTION 761- Subsection (e)(1), as so redesignated, of section 761 is amended by striking `2002' and inserting `2019'.
TITLE III--PREVENTION AND WELLNESS
SEC. 2301. PREVENTION AND WELLNESS.
(a) In General- The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:
`TITLE XXXI--PREVENTION AND WELLNESS
`Subtitle A--Prevention and Wellness Trust
`SEC. 3111. PREVENTION AND WELLNESS TRUST.
`(a) Deposits Into Trust- There is established a Prevention and Wellness Trust. There are authorized to be appropriated to the Trust--
`(1) amounts described in section 2002(b)(2)(ii) of the America's Affordable Health Choices Act of 2009 for each fiscal year; and
`(2) in addition, out of any monies in the Public Health Investment Fund--
`(A) for fiscal year 2010, $2,400,000,000;
`(B) for fiscal year 2011, $2,800,000,000;
`(C) for fiscal year 2012, $3,100,000,000;
`(D) for fiscal year 2013, $3,400,000,000;
`(E) for fiscal year 2014, $3,500,000,000;
`(F) for fiscal year 2015, $3,600,000,000;
`(G) for fiscal year 2016, $3,700,000,000;
`(H) for fiscal year 2017, $3,900,000,000;
`(I) for fiscal year 2018, $4,300,000,000; and
`(J) for fiscal year 2019, $4,600,000,000.
`(b) Availability of Funds- Amounts in the Prevention and Wellness Trust shall be available, as provided in advance in appropriation Acts, for carrying out this title.
`(c) Allocation- Of the amounts authorized to be appropriated in subsection (a)(2), there are authorized to be appropriated--
`(1) for carrying out subtitle C (Prevention Task Forces), $35,000,000 for each of fiscal years 2010 through 2019;
`(2) for carrying out subtitle D (Prevention and Wellness Research)--
`(A) for fiscal year 2010, $100,000,000;
`(B) for fiscal year 2011, $150,000,000;
`(C) for fiscal year 2012, $200,000,000;
`(D) for fiscal year 2013, $250,000,000;
`(E) for fiscal year 2014, $300,000,000;
`(F) for fiscal year 2015, $315,000,000;
`(G) for fiscal year 2016, $331,000,000;
`(H) for fiscal year 2017, $347,000,000;
`(I) for fiscal year 2018, $364,000,000; and
`(J) for fiscal year 2019, $383,000,000.
`(3) for carrying out subtitle E (Delivery of Community Preventive and Wellness Services)--
`(A) for fiscal year 2010, $1,100,000,000;
`(B) for fiscal year 2011, $1,300,000,000;
`(C) for fiscal year 2012, $1,400,000,000;
`(D) for fiscal year 2013, $1,600,000,000;
`(E) for fiscal year 2014, $1,700,000,000;
`(F) for fiscal year 2015, $1,800,000,000;
`(G) for fiscal year 2016, $1,900,000,000;
`(H) for fiscal year 2017, $2,000,000,000;
`(I) for fiscal year 2018, $2,100,000,000; and
`(J) for fiscal year 2019, $2,300,000,000.
`(4) for carrying out section 3161 (Core Public Health Infrastructure and Activities for State and Local Health Departments)--
`(A) for fiscal year 2010, $800,000,000;
`(B) for fiscal year 2011, $1,000,000,000;
`(C) for fiscal year 2012, $1,100,000,000;
`(D) for fiscal year 2013, $1,200,000,000;
`(E) for fiscal year 2014, $1,300,000,000;
`(F) for fiscal year 2015, $1,400,000,000;
`(G) for fiscal year 2016, $1,500,000,000;
`(H) for fiscal year 2017, $1,600,000,000;
`(I) for fiscal year 2018, $1,800,000,000; and
`(J) for fiscal year 2019, $1,900,000,000; and
`(5) for carrying out section 3162 (Core Public Health Infrastructure and Activities for CDC), $400,000,000 for each of fiscal years 2010 through 2019.
`Subtitle B--National Prevention and Wellness Strategy
`SEC. 3121. NATIONAL PREVENTION AND WELLNESS STRATEGY.
`(a) In General- The Secretary shall submit to the Congress within one year after the date of the enactment of this section, and at least every 2 years thereafter, a national strategy that is designed to improve the Nation's health through evidence-based clinical and community prevention and wellness activities (in this section referred to as `prevention and wellness activities'), including core public health infrastructure improvement activities.
`(b) Contents- The strategy under subsection (a) shall include each of the following:
`(1) Identification of specific national goals and objectives in prevention and wellness activities that take into account appropriate public health measures and standards, including departmental measures and standards (including Healthy People and National Public Health Performance Standards).
`(2) Establishment of national priorities for prevention and wellness, taking into account unmet prevention and wellness needs.
`(3) Establishment of national priorities for research on prevention and wellness, taking into account unanswered research questions on prevention and wellness.
`(4) Identification of health disparities in prevention and wellness.
`(5) A plan for addressing and implementing paragraphs (1) through (4).
`(c) Consultation- In developing or revising the strategy under subsection (a), the Secretary shall consult with the following:
`(1) The heads of appropriate health agencies and offices in the Department, including the Office of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women's Health.
`(2) As appropriate, the heads of other Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary).
`(3) As appropriate, nonprofit and for-profit entities.
`(4) The Association of State and Territorial Health Officials and the National Association of County and City Health Officials.
`Subtitle C--Prevention Task Forces
`SEC. 3131. TASK FORCE ON CLINICAL PREVENTIVE SERVICES.
`(a) In General- The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish a permanent task force to be known as the Task Force on Clinical Preventive Services (in this section referred to as the `Task Force').
`(b) Responsibilities- The Task Force shall--
`(1) identify clinical preventive services for review;
`(2) review the scientific evidence related to the benefits, effectiveness, appropriateness, and costs of clinical preventive services identified under paragraph (1) for the purpose of developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;
`(3) as appropriate, take into account health disparities in developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;
`(4) identify gaps in clinical preventive services research and evaluation and recommend priority areas for such research and evaluation;
`(5) as appropriate, consult with the clinical prevention stakeholders board in accordance with subsection (f);
`(6) as appropriate, consult with the Task Force on Community Preventive Services established under section 3132; and
`(7) as appropriate, in carrying out this section, consider the national strategy under section 3121.
`(c) Role of Agency- The Secretary shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force.
`(d) Membership-
`(1) NUMBER; APPOINTMENT- The Task Force shall be composed of 30 members, appointed by the Secretary.
`(2) TERMS-
`(A) IN GENERAL- The Secretary shall appoint members of the Task Force for a term of 6 years and may reappoint such members, but the Secretary may not appoint any member to serve more than a total of 12 years.
`(B) STAGGERED TERMS- Notwithstanding subparagraph (A), of the members first appointed to serve on the Task Force after the enactment of this title--
`(i) 10 shall be appointed for a term of 2 years;
`(ii) 10 shall be appointed for a term of 4 years; and
`(iii) 10 shall be appointed for a term of 6 years.
`(3) QUALIFICATIONS- Members of the Task Force shall be appointed from among individuals who possess expertise in at least one of the following areas:
`(A) Health promotion and disease prevention.
`(B) Evaluation of research and systematic evidence reviews.
`(C) Application of systematic evidence reviews to clinical decisionmaking or health policy.
`(D) Clinical primary care in child and adolescent health.
`(E) Clinical primary care in adult health, including women's health.
`(F) Clinical primary care in geriatrics.
`(G) Clinical counseling and behavioral services for primary care patients.
`(4) REPRESENTATION- In appointing members of the Task Force, the Secretary shall ensure that--
`(A) all areas of expertise described in paragraph (3) are represented; and
`(B) the members of the Task Force include practitioners who, collectively, have significant experience treating racially and ethnically diverse populations.
`(e) Subgroups- As appropriate to maximize efficiency, the Task Force may delegate authority for conducting reviews and making recommendations to subgroups consisting of Task Force members, subject to final approval by the Task Force.
`(f) Clinical Prevention Stakeholders Board-
`(1) IN GENERAL- The Task Force shall convene a clinical prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in clinical preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.
`(2) MEMBERSHIP- The members of the clinical prevention stakeholders board shall include representatives of the following:
`(A) Health care consumers and patient groups.
`(B) Providers of clinical preventive services, including community-based providers.
`(C) Federal departments and agencies, including--
`(i) appropriate health agencies and offices in the Department, including the Office of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women's Health; and
`(ii) as appropriate, other Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary).
`(D) Private health care payors.
`(3) RESPONSIBILITIES- In accordance with subsection (b)(5), the clinical prevention stakeholders board shall--
`(A) recommend clinical preventive services for review by the Task Force;
`(B) suggest scientific evidence for consideration by the Task Force related to reviews undertaken by the Task Force;
`(C) provide feedback regarding draft recommendations by the Task Force; and
`(D) assist with efforts regarding dissemination of recommendations by the Director of the Agency for Healthcare Research and Quality.
`(g) Disclosure and Conflicts of Interest- Members of the Task Force or the clinical prevention stakeholders board shall not be considered employees of the Federal Government by reason of service on the Task Force, except members of the Task Force shall be considered to be special Government employees within the meaning of section 107 of the Ethics in Government Act of 1978 (5 U.S.C. App.) and section 208 of title 18, United States Code, for the purposes of disclosure and management of conflicts of interest under those sections.
`(h) No Pay; Receipt of Travel Expenses- Members of the Task Force or the clinical prevention stakeholders board shall not receive any pay for service on the Task Force, but may receive travel expenses, including a per diem, in accordance with applicable provisions of subchapter I of chapter 57 of title 5, United States Code.
`(i) Application of FACA- The Federal Advisory Committee Act (5 U.S.C. App.) except for section 14 of such Act shall apply to the Task Force to the extent that the provisions of such Act do not conflict with the provisions of this title.
`(j) Report- The Secretary shall submit to the Congress an annual report on the Task Force, including with respect to gaps identified and recommendations made under subsection (b)(4).
`SEC. 3132. TASK FORCE ON COMMUNITY PREVENTIVE SERVICES.
`(a) In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a permanent task force to be known as the Task Force on Community Preventive Services (in this section referred to as the `Task Force').
`(b) Responsibilities- The Task Force shall--
`(1) identify community preventive services for review;
`(2) review the scientific evidence related to the benefits, effectiveness, appropriateness, and costs of community preventive services identified under paragraph (1) for the purpose of developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;
`(3) as appropriate, take into account health disparities in developing, updating, publishing, and disseminating evidence-based recommendations on the use of such services;
`(4) identify gaps in community preventive services research and evaluation and recommend priority areas for such research and evaluation;
`(5) as appropriate, consult with the community prevention stakeholders board in accordance with subsection (f);
`(6) as appropriate, consult with the Task Force on Clinical Preventive Services established under section 3131; and
`(7) as appropriate, in carrying out this section, consider the national strategy under section 3121.
`(c) Role of Agency- The Secretary shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force.
`(d) Membership-
`(1) NUMBER; APPOINTMENT- The Task Force shall be composed of 30 members, appointed by the Secretary.
`(2) TERMS-
`(A) IN GENERAL- The Secretary shall appoint members of the Task Force for a term of 6 years and may reappoint such members, but the Secretary may not appoint any member to serve more than a total of 12 years.
`(B) STAGGERED TERMS- Notwithstanding subparagraph (A), of the members first appointed to serve on the Task Force after the enactment of this section--
`(i) 10 shall be appointed for a term of 2 years;
`(ii) 10 shall be appointed for a term of 4 years; and
`(iii) 10 shall be appointed for a term of 6 years.
`(3) QUALIFICATIONS- Members of the Task Force shall be appointed from among individuals who possess expertise in at least one of the following areas:
`(A) Public health.
`(B) Evaluation of research and systematic evidence reviews.
`(C) Disciplines relevant to community preventive services, including health promotion; disease prevention; chronic disease; worksite health; qualitative and quantitative analysis; and health economics, policy, law, and statistics.
`(4) REPRESENTATION- In appointing members of the Task Force, the Secretary--
`(A) shall ensure that all areas of expertise described in paragraph (3) are represented;
`(B) shall ensure that such members include sufficient representatives of each of--
`(i) State health officers;
`(ii) local health officers;
`(iii) health care practitioners; and
`(iv) public health practitioners; and
`(C) shall appoint individuals who, collectively, have significant experience working with racially and ethnically diverse populations.
`(e) Subgroups- As appropriate to maximize efficiency, the Task Force may delegate authority for conducting reviews and making recommendations to subgroups consisting of Task Force members, subject to final approval by the Task Force.
`(f) Community Prevention Stakeholders Board-
`(1) IN GENERAL- The Task Force shall convene a community prevention stakeholders board composed of representatives of appropriate public and private entities with an interest in community preventive services to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services.
`(2) MEMBERSHIP- The members of the community prevention stakeholders board shall include representatives of the following:
`(A) Health care consumers and patient groups.
`(B) Providers of community preventive services, including community-based providers.
`(C) Federal departments and agencies, including--
`(i) appropriate health agencies and offices in the Department, including the Office of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women's Health; and
`(ii) as appropriate, other Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary).
`(D) Private health care payors.
`(3) RESPONSIBILITIES- In accordance with subsection (b)(5), the community prevention stakeholders board shall--
`(A) recommend community preventive services for review by the Task Force;
`(B) suggest scientific evidence for consideration by the Task Force related to reviews undertaken by the Task Force;
`(C) provide feedback regarding draft recommendations by the Task Force; and
`(D) assist with efforts regarding dissemination of recommendations by the Director of the Centers for Disease Control and Prevention.
`(g) Disclosure and Conflicts of Interest- Members of the Task Force or the community prevention stakeholders board shall not be considered employees of the Federal Government by reason of service on the Task Force, except members of the Task Force shall be considered to be special Government employees within the meaning of section 107 of the Ethics in Government Act of 1978 (5 U.S.C. App.) and section 208 of title 18, United States Code, for the purposes of disclosure and management of conflicts of interest under those sections.
`(h) No Pay; Receipt of Travel Expenses- Members of the Task Force or the community prevention stakeholders board shall not receive any pay for service on the Task Force, but may receive travel expenses, including a per diem, in accordance with applicable provisions of subchapter I of chapter 57 of title 5, United States Code.
`(i) Application of FACA- The Federal Advisory Committee Act (5 U.S.C. App.) except for section 14 of such Act shall apply to the Task Force to the extent that the provisions of such Act do not conflict with the provisions of this title.
`(j) Report- The Secretary shall submit to the Congress an annual report on the Task Force, including with respect to gaps identified and recommendations made under subsection (b)(4).
`Subtitle D--Prevention and Wellness Research
`SEC. 3141. PREVENTION AND WELLNESS RESEARCH ACTIVITY COORDINATION.
`In conducting or supporting research on prevention and wellness, the Director of the Centers for Disease Control and Prevention, the Director of the National Institutes of Health, and the heads of other agencies within the Department of Health and Human Services conducting or supporting such research, shall take into consideration the national strategy under section 3121 and the recommendations of the Task Force on Clinical Preventive Services under section 3131 and the Task Force on Community Preventive Services under section 3132.
`SEC. 3142. COMMUNITY PREVENTION AND WELLNESS RESEARCH GRANTS.
`(a) In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall conduct, or award grants to eligible entities to conduct, research in priority areas identified by the Secretary in the national strategy under section 3121 or by the Task Force on Community Preventive Services as required by section 3132.
`(b) Eligibility- To be eligible for a grant under this section, an entity shall be--
`(1) a State, local, or tribal department of health;
`(2) a public or private nonprofit entity; or
`(3) a consortium of 2 or more entities described in paragraphs (1) and (2).
`(c) Report- The Secretary shall submit to the Congress an annual report on the program of research under this section.
`Subtitle E--Delivery of Community Prevention and Wellness Services
`SEC. 3151. COMMUNITY PREVENTION AND WELLNESS SERVICES GRANTS.
`(a) In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a program for the delivery of community preventive and wellness services consisting of awarding grants to eligible entities--
`(1) to provide evidence-based, community preventive and wellness services in priority areas identified by the Secretary in the national strategy under section 3121; or
`(2) to plan such services.
`(b) Eligibility-
`(1) DEFINITION- To be eligible for a grant under this section, an entity shall be--
`(A) a State, local, or tribal department of health;
`(B) a public or private entity; or
`(C) a consortium of--
`(i) 2 or more entities described in subparagraph (A) or (B); and
`(ii) a community partnership representing a Health Empowerment Zone.
`(2) HEALTH EMPOWERMENT ZONE- In this subsection, the term `Health Empowerment Zone' means an area--
`(A) in which multiple community preventive and wellness services are implemented in order to address one or more health disparities, including those identified by the Secretary in the national strategy under section 3121; and
`(B) which is represented by a community partnership that demonstrates community support and coordination with State, local, or tribal health departments and includes--
`(i) a broad cross section of stakeholders;
`(ii) residents of the community; and
`(iii) representatives of entities that have a history of working within and serving the community.
`(c) Preferences- In awarding grants under this section, the Secretary shall give preference to entities that--
`(1) will address one or more goals or objectives identified by the Secretary in the national strategy under section 3121;
`(2) will address significant health disparities, including those identified by the Secretary in the national strategy under section 3121;
`(3) will address unmet community prevention needs and avoids duplication of effort;
`(4) have been demonstrated to be effective in communities comparable to the proposed target community;
`(5) will contribute to the evidence base for community preventive and wellness services;
`(6) demonstrate that the community preventive services to be funded will be sustainable; and
`(7) demonstrate coordination or collaboration across governmental and nongovernmental partners.
`(d) Health Disparities- Of the funds awarded under this section for a fiscal year, the Secretary shall award not less than 50 percent for planning or implementing community preventive and wellness services whose primary purpose is to achieve a measurable reduction in one or more health disparities, including those identified by the Secretary in the national strategy under section 3121.
`(e) Emphasis on Recommended Services- For fiscal year 2013 and subsequent fiscal years, the Secretary shall award grants under this section only for planning or implementing services recommended by the Task Force on Community Preventive Services under section 3122 or deemed effective based on a review of comparable rigor (as determined by the Director of the Centers for Disease Control and Prevention).
`(f) Prohibited Uses of Funds- An entity that receives a grant under this section may not use funds provided through the grant--
`(1) to build or acquire real property or for construction; or
`(2) for services or planning to the extent that payment has been made, or can reasonably be expected to be made--
`(A) under any insurance policy;
`(B) under any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act); or
`(C) by an entity which provides health services on a prepaid basis.
`(g) Report- The Secretary shall submit to the Congress an annual report on the program of grants awarded under this section.
`(h) Definitions- In this section, the term `evidence-based' means that methodologically sound research has demonstrated a beneficial health effect, in the judgment of the Director of the Centers for Disease Control and Prevention.
`Subtitle F--Core Public Health Infrastructure
`SEC. 3161. CORE PUBLIC HEALTH INFRASTRUCTURE FOR STATE, LOCAL, AND TRIBAL HEALTH DEPARTMENTS.
`(a) Program- The Secretary, acting through the Director of the Centers for Disease Control and Prevention shall establish a core public health infrastructure program consisting of awarding grants under subsection (b).
`(b) Grants-
`(1) AWARD- For the purpose of addressing core public health infrastructure needs, the Secretary--
`(A) shall award a grant to each State health department; and
`(B) may award grants on a competitive basis to State, local, or tribal health departments.
`(2) ALLOCATION- Of the total amount of funds awarded as grants under this subsection for a fiscal year--
`(A) not less than 50 percent shall be for grants to State health departments under paragraph (1)(A); and
`(B) not less than 30 percent shall be for grants to State, local, or tribal health departments under paragraph (1)(B).
`(c) Use of Funds- The Secretary may award a grant to an entity under subsection (b)(1) only if the entity agrees to use the grant to address core public health infrastructure needs, including those identified in the accreditation process under subsection (g).
`(d) Formula Grants to State Health Departments- In making grants under subsection (b)(1)(A), the Secretary shall award funds to each State health department in accordance with--
`(1) a formula based on population size; burden of preventable disease and disability; and core public health infrastructure gaps, including those identified in the accreditation process under subsection (g); and
`(2) application requirements established by the Secretary, including a requirement that the State submit a plan that demonstrates to the satisfaction of the Secretary that the State's health department will--
`(A) address its highest priority core public health infrastructure needs; and
`(B) as appropriate, allocate funds to local health departments within the State.
`(e) Competitive Grants to State, Local, and Tribal Health Departments- In making grants under subsection (b)(1)(B), the Secretary shall give priority to applicants demonstrating core public health infrastructure needs identified in the accreditation process under subsection (g).
`(f) Maintenance of Effort- The Secretary may award a grant to an entity under subsection (b) only if the entity demonstrates to the satisfaction of the Secretary that--
`(1) funds received through the grant will be expended only to supplement, and not supplant, non-Federal and Federal funds otherwise available to the entity for the purpose of addressing core public health infrastructure needs; and
`(2) with respect to activities for which the grant is awarded, the entity will maintain expenditures of non-Federal amounts for such activities at a level not less than the level of such expenditures maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the grant.
`(g) Establishment of a Public Health Accreditation Program-
`(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall--
`(A) develop, and periodically review and update, standards for voluntary accreditation of State, local, or tribal health departments and public health laboratories for the purpose of advancing the quality and performance of such departments and laboratories; and
`(B) implement a program to accredit such health departments and laboratories in accordance with such standards.
`(2) COOPERATIVE AGREEMENT- The Secretary may enter into a cooperative agreement with a private nonprofit entity to carry out paragraph (1).
`(h) Report- The Secretary shall submit to the Congress an annual report on progress being made to accredit entities under subsection (g), including--
`(1) a strategy, including goals and objectives, for accrediting entities under subsection (g) and achieving the purpose described in subsection (g)(1); and
`(2) identification of gaps in research related to core public health infrastructure and recommendations of priority areas for such research.
`SEC. 3162. CORE PUBLIC HEALTH INFRASTRUCTURE AND ACTIVITIES FOR CDC.
`(a) In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall expand and improve the core public health infrastructure and activities of the Centers for Disease Control and Prevention to address unmet and emerging public health needs.
`(b) Report- The Secretary shall submit to the Congress an annual report on the activities funded through this section.
`Subtitle G--General Provisions
`SEC. 3171. DEFINITIONS.
`In this title:
`(1) The term `core public health infrastructure' includes workforce capacity and competency; laboratory systems; health information, health information systems, and health information analysis; communications; financing; other relevant components of organizational capacity; and other related activities.
`(2) The terms `Department' and `departmental' refer to the Department of Health and Human Services.
`(3) The term `health disparities' includes health and health care disparities and means population-specific differences in the presence of disease, health outcomes, or access to health care. For purposes of the preceding sentence, a population may be delineated by race, ethnicity, geographic setting, or other population or subpopulation determined appropriate by the Secretary.
`(4) The term `tribal' refers to an Indian tribe, a Tribal organization, or an Urban Indian organization, as such terms are defined in section 4 of the Indian Health Care Improvement Act.'.
(b) Transition Provisions Applicable to Task Forces-
(1) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, AND ADMINISTRATIVE ACTIONS- All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Preventive Services Task Force convened under section 915(a) of the Public Health Service Act and the Task Force on Community Preventive Services (as such section and Task Forces were in existence on the day before the date of the enactment of this Act) shall be transferred to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a).
(2) RECOMMENDATIONS- All recommendations of the Preventive Services Task Force and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this Act, shall be considered to be recommendations of the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, established under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a).
(3) MEMBERS ALREADY SERVING-
(A) INITIAL MEMBERS- The Secretary of Health and Human Services may select those individuals already serving on the Preventive Services Task Force and the Task Force on Community Preventive Services, as in existence on the day before the date of the enactment of this Act, to be among the first members appointed to the Task Force on Clinical Preventive Services and the Task Force on Community Preventive Services, respectively, under sections 3121 and 3122 of the Public Health Service Act, as added by subsection (a).
(B) CALCULATION OF TOTAL SERVICE- In calculating the total years of service of a member of a task force for purposes of section 3131(d)(2)(A) or 3132(d)(2)(A) of the Public Health Service Act, as added by subsection (a), the Secretary of Health and Human Services shall not include any period of service by the member on the Preventive Services Task Force or the Task Force on Community Preventive Services, respectively, as in existence on the day before the date of the enactment of this Act.
(c) Period Before Completion of National Strategy- Pending completion of the national strategy under section 3121 of the Public Health Service Act, as added by subsection (a), the Secretary of Health and Human Services, acting through the relevant agency head, may make a judgment about how the strategy will address an issue and rely on such judgment in carrying out any provision of subtitle C, D, E, or F of title XXXI of such Act, as added by subsection (a), that requires the Secretary--
(1) to take into consideration such strategy;
(2) to conduct or support research or provide services in priority areas identified in such strategy; or
(3) to take any other action in reliance on such strategy.
(d) Conforming Amendments-
(1) Paragraph (61) of section 3(b) of the Indian Health Care Improvement Act (25 U.S.C. 1602) is amended by striking `United States Preventive Services Task Force' and inserting `Task Force on Clinical Preventive Services'.
(2) Section 126 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Appendix F of Public Law 106-554) is amended by striking `United States Preventive Services Task Force' each place it appears and inserting `Task Force on Clinical Preventive Services'.
(3) Paragraph (7) of section 317D of the Public Health Service Act (42 U.S.C. 247b-5) is amended by striking `United States Preventive Services Task Force' each place it appears and inserting `Task Force on Clinical Preventive Services'.
(4) Section 915 of the Public Health Service Act (42 U.S.C. 299b-4) is amended by striking subsection (a).
(5) Subsections (s)(2)(AA)(iii)(II), (xx)(1), and (ddd)(1)(B) of section 1861 of the Social Security Act (42 U.S.C. 1395x) are amended by striking `United States Preventive Services Task Force' each place it appears and inserting `Task Force on Clinical Preventive Services'.
TITLE IV--QUALITY AND SURVEILLANCE
SEC. 2401. IMPLEMENTATION OF BEST PRACTICES IN THE DELIVERY OF HEALTH CARE.
(a) In General- Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is amended--
(1) by redesignating part D as part E;
(2) by redesignating sections 931 through 938 as sections 941 through 948, respectively;
(3) in section 938(1), by striking `931' and inserting `941'; and
(4) by inserting after part C the following:
`PART D--IMPLEMENTATION OF BEST PRACTICES IN THE DELIVERY OF HEALTH CARE
`SEC. 931. CENTER FOR QUALITY IMPROVEMENT.
`(a) In General- There is established the Center for Quality Improvement (referred to in this part as the `Center'), to be headed by the Director.
`(b) Prioritization-
`(1) IN GENERAL- The Director shall prioritize areas for the identification, development, evaluation, and implementation of best practices (including innovative methodologies and strategies) for quality improvement activities in the delivery of health care services (in this section referred to as `best practices').
`(2) CONSIDERATIONS- In prioritizing areas under paragraph (1), the Director shall consider--
`(A) the priorities established under section 1191 of the Social Security Act; and
`(B) the key health indicators identified by the Assistant Secretary for Health Information under section 1709.
`(c) Other Responsibilities- The Director, acting directly or by awarding a grant or contract to an eligible entity, shall--
`(1) identify existing best practices under subsection (e);
`(2) develop new best practices under subsection (f);
`(3) evaluate best practices under subsection (g);
`(4) implement best practices under subsection (h);
`(5) ensure that best practices are identified, developed, evaluated, and implemented under this section consistent with standards adopted by the Secretary under section 3004 for health information technology used in the collection and reporting of quality information (including for purposes of the demonstration of meaningful use of certified electronic health record (EHR) technology by physicians and hospitals under the Medicare program (under sections 1848(o)(2) and 1886(n)(3), respectively, of the Social Security Act)); and
`(6) provide for dissemination of information and reporting under subsections (i) and (j).
`(d) Eligibility- To be eligible for a grant or contract under subsection (c), an entity shall--
`(1) be a nonprofit entity;
`(2) agree to work with a variety of institutional health care providers, physicians, nurses, and other health care practitioners; and
`(3) if the entity is not the organization holding a contract under section 1153 of the Social Security Act for the area to be served, agree to cooperate with and avoid duplication of the activities of such organization.
`(e) Identifying Existing Best Practices- The Secretary shall identify best practices that are--
`(1) currently utilized by health care providers (including hospitals, physician and other clinician practices, community cooperatives, and other health care entities) that deliver consistently high-quality, efficient health care services; and
`(2) easily adapted for use by other health care providers and for use across a variety of health care settings.
`(f) Developing New Best Practices- The Secretary shall develop best practices that are--
`(1) based on a review of existing scientific evidence;
`(2) sufficiently detailed for implementation and incorporation into the workflow of health care providers; and
`(3) designed to be easily adapted for use by health care providers across a variety of health care settings.
`(g) Evaluation of Best Practices- The Director shall evaluate best practices identified or developed under this section. Such evaluation--
`(1) shall include determinations of which best practices--
`(A) most reliably and effectively achieve significant progress in improving the quality of patient care; and
`(B) are easily adapted for use by health care providers across a variety of health care settings;
`(2) shall include regular review, updating, and improvement of such best practices; and
`(3) may include in-depth case studies or empirical assessments of health care providers (including hospitals, physician and other clinician practices, community cooperatives, and other health care entities) and simulations of such best practices for determinations under paragraph (1).
`(h) Implementation of Best Practices-
`(1) IN GENERAL- The Director shall enter into voluntary arrangements with health care providers (including hospitals and other health facilities and health practitioners) in a State or region to implement best practices identified or developed under this section. Such implementation--
`(A) may include forming collaborative multi-institutional teams; and
`(B) shall include an evaluation of the best practices being implemented, including the measurement of patient outcomes before, during, and after implementation of such best practices.
`(2) PREFERENCES- In carrying out this subsection, the Director shall give priority to health care providers implementing best practices that--
`(A) have the greatest impact on patient outcomes and satisfaction;
`(B) are the most easily adapted for use by health care providers across a variety of health care settings;
`(C) promote coordination of health care practitioners across the continuum of care; and
`(D) engage patients and their families in improving patient care and outcomes.
`(i) Public Dissemination of Information- The Director shall provide for the public dissemination of information with respect to best practices and activities under this section. Such information shall be made available in appropriate formats and languages to reflect the varying needs of consumers and diverse levels of health literacy.
`(j) Report-
`(1) IN GENERAL- The Director shall submit an annual report to the Congress and the Secretary on activities under this section.
`(2) CONTENT- Each report under paragraph (1) shall include--
`(A) information on activities conducted pursuant to grants and contracts awarded;
`(B) summary data on patient outcomes before, during, and after implementation of best practices; and
`(C) recommendations on the adaptability of best practices for use by health providers.'.
(b) Initial Quality Improvement Activities and Initiatives To Be Implemented- Until the Director of the Agency for Healthcare Research and Quality has established initial priorities under section 931(b) of the Public Health Service Act, as added by subsection (a), the Director shall, for purposes of such section, prioritize the following:
(1) HEALTH CARE-ASSOCIATED INFECTIONS- Reducing health care-associated infections, including infections in nursing homes and outpatient settings.
(2) SURGERY- Increasing hospital and outpatient perioperative patient safety, including reducing surgical-site infections and surgical errors (such as wrong-site surgery and retained foreign bodies).
(3) EMERGENCY ROOM- Improving care in hospital emergency rooms, including through the use of principles of efficiency of design and delivery to improve patient flow.
(4) OBSTETRICS- Improving the provision of obstetrical and neonatal care, including the identification of interventions that are effective in reducing the risk of preterm and premature labor and the implementation of best practices for labor and delivery care.
SEC. 2402. ASSISTANT SECRETARY FOR HEALTH INFORMATION.
(a) Establishment- Title XVII (42 U.S.C. 300u et seq.) is amended--
(1) by redesignating sections 1709 and 1710 as sections 1710 and 1711, respectively; and
(2) by inserting after section 1708 the following:
`SEC. 1709. ASSISTANT SECRETARY FOR HEALTH INFORMATION.
`(a) In General- There is established within the Department an Assistant Secretary for Health Information (in this section referred to as the `Assistant Secretary'), to be appointed by the Secretary.
`(b) Responsibilities- The Assistant Secretary shall--
`(1) ensure the collection, collation, reporting, and publishing of information (including full and complete statistics) on key health indicators regarding the Nation's health and the performance of the Nation's health care;
`(2) facilitate and coordinate the collection, collation, reporting, and publishing of information regarding the Nation's health and the performance of the Nation's health care (other than information described in paragraph (1));
`(3)(A) develop standards for the collection of data regarding the Nation's health and the performance of the Nation's health care; and
`(B) in carrying out subparagraph (A)--
`(i) ensure appropriate specificity and standardization for data collection at the national, regional, State, and local levels;
`(ii) include standards, as appropriate, for the collection of accurate data on health and health care by race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socioeconomic status, rural, urban, or other geographic setting, and any other population or subpopulation determined appropriate by the Secretary;
`(iii) ensure, with respect to data on race and ethnicity, consistency with the 1997 Office of Management and Budget Standards for Maintaining, Collecting and Presenting Federal Data on Race and Ethnicity (or any successor standards); and
`(iv) in consultation with the Director of the Office of Minority Health, and the Director of the Office of Civil Rights, of the Department, develop standards for the collection of data on health and health care with respect to data on primary language;
`(4) provide support to Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary) for the collection and collation of information described in paragraphs (1) and (2);
`(5) ensure the sharing of information described in paragraphs (1) and (2) among the agencies of the Department;
`(6) facilitate the sharing of information described in paragraphs (1) and (2) by Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary);
`(7) identify gaps in information described in paragraphs (1) and (2) and the appropriate agency or entity to address such gaps;
`(8) facilitate and coordinate identification and monitoring by the agencies of the Department of health disparities to inform program and policy efforts to reduce such disparities, including facilitating and funding analyses conducted in cooperation with the Social Security Administration, the Bureau of the Census, and other appropriate agencies and entities;
`(9) consistent with privacy, proprietary, and other appropriate safeguards, facilitate public accessibility of datasets (such as de-identified Medicare datasets or publicly available data on key health indicators) by means of the Internet; and
`(10) award grants or contracts for the collection and collation of information described in paragraphs (1) and (2) (including through statewide surveys that provide standardized information).
`(c) Key Health Indicators-
`(1) IN GENERAL- In carrying out subsection (b)(1), the Assistant Secretary shall--
`(A) identify, and reassess at least once every 3 years, key health indicators described in such subsection;
`(B) publish statistics on such key health indicators for the public--
`(i) not less than annually; and
`(ii) on a supplemental basis whenever warranted by--
`(I) the rate of change for a key health indicator; or
`(II) the need to inform policy regarding the Nation's health and the performance of the Nation's health care; and
`(C) ensure consistency with the national strategy developed by the Secretary under section 3121 and consideration of the indicators specified in the reports under sections 308, 903(a)(6), and 913(b)(2).
`(2) RELEASE OF KEY HEALTH INDICATORS- The regulations, rules, processes, and procedures of the Office of Management and Budget governing the review, release, and dissemination of key health indicators shall be the same as the regulations, rules, processes, and procedures of the Office of Management and Budget governing the review, release, and dissemination of Principal Federal Economic Indicators (or equivalent statistical data) by the Bureau of Labor Statistics.
`(d) Coordination- In carrying out this section, the Assistant Secretary shall coordinate with--
`(1) public and private entities that collect and disseminate information on health and health care, including foundations; and
`(2) the head of the Office of the National Coordinator for Health Information Technology to ensure optimal use of health information technology.
`(e) Request for Information From Other Departments and Agencies- Consistent with applicable law, the Assistant Secretary may secure directly from any Federal department or agency information necessary to enable the Assistant Secretary to carry out this section.
`(f) Report-
`(1) SUBMISSION- The Assistant Secretary shall submit to the Secretary and the Congress an annual report containing--
`(A) a description of national, regional, or State changes in health or health care, as reflected by the key health indicators identified under subsection (c)(1);
`(B) a description of gaps in the collection, collation, reporting, and publishing of information regarding the Nation's health and the performance of the Nation's health care;
`(C) recommendations for addressing such gaps and identification of the appropriate agency within the Department or other entity to address such gaps;
`(D) a description of analyses of health disparities, including the results of completed analyses, the status of ongoing longitudinal studies, and proposed or planned research; and
`(E) a plan for actions to be taken by the Assistant Secretary to address gaps described in subparagraph (B).
`(2) CONSIDERATION- In preparing a report under paragraph (1), the Assistant Secretary shall take into consideration the findings and conclusions in the reports under sections 308, 903(a)(6), and 913(b)(2).
`(g) Proprietary and Privacy Protections- Nothing in this section shall be construed to affect applicable proprietary or privacy protections.
`(h) Consultation- In carrying out this section, the Assistant Secretary shall consult with--
`(1) the heads of appropriate health agencies and offices in the Department, including the Office of the Surgeon General of the Public Health Service, the Office of Minority Health, and the Office on Women's Health; and
`(2) as appropriate, the heads of other Federal departments and agencies whose programs have a significant impact upon health (as determined by the Secretary).
`(i) Definition- In this section:
`(1) The terms `agency' and `agencies' include an epidemiology center established under section 214 of the Indian Health Care Improvement Act.
`(2) The term `Department' means the Department of Health and Human Services.
`(3) The term `health disparities' has the meaning given to such term in section 3171.'.
(b) Other Coordination Responsibilities- Title III (42 U.S.C. 241 et seq.) is amended--
(1) in paragraphs (1) and (2) of section 304(c) (42 U.S.C. 242b(c)), by inserting `, acting through the Assistant Secretary for Health Information,' after `The Secretary' each place it appears; and
(2) in section 306(j) (42 U.S.C. 242k(j)), by inserting `, acting through the Assistant Secretary for Health Information,' after `of this section, the Secretary'.
SEC. 2403. AUTHORIZATION OF APPROPRIATIONS.
Section 799C, as added and amended, is further amended by adding at the end the following:
`(e) Quality and Surveillance- For the purpose of carrying out part D of title IX and section 1709, in addition to any other amounts authorized to be appropriated for such purpose, there is authorized to be appropriated, out of any monies in the Public Health Investment Fund, $300,000,000 for each of fiscal years 2010 through 2014 and $330,000,000 for each of fiscal years 2015 through 2019.'.
TITLE V--OTHER PROVISIONS
Subtitle A--Drug Discount for Rural and Other Hospitals
SEC. 2501. EXPANDED PARTICIPATION IN 340B PROGRAM.
(a) Expansion of Covered Entities Receiving Discounted Prices- Section 340B(a)(4) (42 U.S.C. 256b(a)(4)) is amended by adding at the end the following:
`(M) A children's hospital excluded from the Medicare prospective payment system pursuant to section 1886(d)(1)(B)(iii) of the Social Security Act which would meet the requirements of subparagraph (L), including the disproportionate share adjustment percentage requirement under subparagraph (L)(ii), if the hospital were a subsection (d) hospital as defined in section 1886(d)(1)(B) of the Social Security Act.
`(N) An entity that is a critical access hospital (as determined under section 1820(c)(2) of the Social Security Act).
`(O) An entity receiving funds under title V of the Social Security Act (relating to maternal and child health) for the provision of health services.
`(P) An entity receiving funds under subpart I of part B of title XIX of the Public Health Service Act (relating to comprehensive mental health services) for the provision of community mental health services.
`(Q) An entity receiving funds under subpart II of such part B (relating to the prevention and treatment of substance abuse) for the provision of treatment services for substance abuse.
`(R) An entity that is a Medicare-dependent, small rural hospital (as defined in section 1886(d)(5)(G)(iv) of the Social Security Act).
`(S) An entity that is a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of the Social Security Act).
`(T) An entity that is classified as a rural referral center under section 1886(d)(5)(C) of the Social Security Act.'.
(b) Prohibition on Group Purchasing Arrangements- Section 340B(a) (42 U.S.C. 256b(a)) is amended--
(1) in paragraph (4)(L)--
(A) by adding `and' at the end of clause (i);
(B) by striking `; and' at the end of clause (ii) and inserting a period; and
(C) by striking clause (iii);
(2) in paragraph (5), by redesignating subparagraphs (C) and (D) as subparagraphs (D) and (E), respectively, and by inserting after subparagraph (B) the following:
`(C) PROHIBITING USE OF GROUP PURCHASING ARRANGEMENTS-
`(i) A hospital described in subparagraph (L), (M), (N), (R), (S), or (T) of paragraph (4) shall not obtain covered outpatient drugs through a group purchasing organization or other group purchasing arrangement, except as permitted or provided pursuant to clause (ii).
`(ii) The Secretary shall establish reasonable exceptions to the requirement of clause (i)--
`(I) with respect to a covered outpatient drug that is unavailable to be purchased through the program under this section due to a drug shortage problem, manufacturer noncompliance, or any other reason beyond the hospital's control;
`(II) to facilitate generic substitution when a generic covered outpatient drug is available at a lower price; and
`(III) to reduce in other ways the administrative burdens of managing both inventories of drugs obtained under this section and not under this section, if such exception does not create a duplicate discount problem in violation of subparagraph (A) or a diversion problem in violation of subparagraph (B).'.
SEC. 2502. EXTENSION OF DISCOUNTS TO INPATIENT DRUGS.
(a) In General- Section 340B (42 U.S.C. 256b) is amended--
(1) in subsection (b)--
(A) by striking `In this section, the terms' and inserting the following: `In this section:
`(1) IN GENERAL- The terms'; and
(B) by adding at the end the following new paragraph:
`(2) COVERED DRUG- The term `covered drug'--
`(A) means a covered outpatient drug (as defined in section 1927(k)(2) of the Social Security Act); and
`(B) includes, notwithstanding the section 1927(k)(3)(A) of such Act, a drug used in connection with an inpatient or outpatient service provided by a hospital described in subparagraph (L), (M), (N), (R), (S), or (T) of subsection (a)(4) that is enrolled to participate in the drug discount program under this section.'; and
(2) in paragraphs (5), (7), and (9) of subsection (a), by striking `outpatient' each place it appears.
(b) Medicaid Credits on Inpatient Drugs- Subsection (c) of section 340B (42 U.S.C. 256b(c)) is amended to read as follows:
`(c) Medicaid Credits on Inpatient Drugs-
`(1) IN GENERAL- For the cost reporting period covered by the most recently filed Medicare cost report under title XVIII of the Social Security Act, a hospital described in subparagraph (L), (M), (N), (R), (S), or (T) of subsection (a)(4) and enrolled to participate in the drug discount program under this section shall provide to each State under its plan under title XIX of such Act--
`(A) a credit on the estimated annual costs to such hospital of single source and innovator multiple source drugs provided to Medicaid beneficiaries for inpatient use; and
`(B) a credit on the estimated annual costs to such hospital of noninnovator multiple source drugs provided to Medicaid beneficiaries for inpatient use.
`(2) AMOUNT OF CREDITS-
`(A) SINGLE SOURCE AND INNOVATOR MULTIPLE SOURCE DRUGS- For purposes of paragraph (1)(A)--
`(i) the credit under such paragraph shall be equal to the product of--
`(I) the annual value of single source and innovator multiple source drugs purchased under this section by the hospital based on the drugs' average manufacturer price;
`(II) the estimated percentage of the hospital's drug purchases attributable to Medicaid beneficiaries for inpatient use; and
`(III) the minimum rebate percentage described in section 1927(c)(1)(B) of the Social Security Act;
`(ii) the reference in clause (i)(I) to the annual value of single source and innovator multiple source drugs purchased under this section by the hospital based on the drugs' average manufacturer price shall be equal to the sum of--
`(I) the annual quantity of each single source and innovator multiple source drug purchased during the cost reporting period, multiplied by
`(II) the average manufacturer price for that drug;
`(iii) the reference in clause (i)(II) to the estimated percentage of the hospital's drug purchases attributable to Medicaid beneficiaries for inpatient use; shall be equal to--
`(I) the Medicaid inpatient drug charges as reported on the hospital's most recently filed Medicare cost report, divided by
`(II) total drug charges reported on the cost report; and
`(iv) the terms `single source drug' and `innovator multiple source drug' have the meanings given such terms in section 1927(k)(7) of the Social Security Act.
`(B) NONINNOVATOR MULTIPLE SOURCE DRUGS- For purposes of paragraph (1)(B)--
`(i) the credit under such paragraph shall be equal to the product of--
`(I) the annual value of noninnovator multiple source drugs purchased under this section by the hospital based on the drugs' average manufacturer price;
`(II) the estimated percentage of the hospital's drug purchases attributable to Medicaid beneficiaries for inpatient use; and
`(III) the applicable percentage as defined in section 1927(c)(3)(B) of the Social Security Act;
`(ii) the reference in clause (i)(I) to the annual value of noninnovator multiple source drugs purchased under this section by the hospital based on the drugs' average manufacturer price shall be equal to the sum of--
`(I) the annual quantity of each noninnovator multiple source drug purchased during the cost reporting period, multiplied by
`(II) the average manufacturer price for that drug;
`(iii) the reference in clause (i)(II) to the estimated percentage of the hospital's drug purchases attributable to Medicaid beneficiaries for inpatient use shall be equal to--
`(I) the Medicaid inpatient drug charges as reported on the hospital's most recently filed Medicare cost report, divided by
`(II) total drug charges reported on the cost report; and
`(iv) the term `noninnovator multiple source drug' has the meaning given such term in section 1927(k)(7) of the Social Security Act.
`(3) CALCULATION OF CREDITS-
`(A) IN GENERAL- Each State calculates credits under paragraph (1) and informs hospitals of amount under section 1927(a)(5)(D) of the Social Security Act.
`(B) HOSPITAL PROVISION OF INFORMATION- Not later than 30 days after the date of the filing of the hospital's most recently filed Medicare cost report, the hospital shall provide the State with the information described in paragraphs (2)(A)(ii) and (2)(B)(ii). With respect to each drug purchased during the cost reporting period, the hospital shall provide the dosage form, strength, package size, date of purchase and the number of units purchased.
`(4) PAYMENT DEADLINE- The credits provided by a hospital under paragraph (1) shall be paid within 60 days after receiving the information specified in paragraph (3)(A).
`(5) OPT OUT- A hospital shall not be required to provide the Medicaid credit required under paragraph (1) if it can demonstrate to the State that it will lose reimbursement under the State plan resulting from the extension of discounts to inpatient drugs under subsection (b)(2) and that the loss of reimbursement will exceed the amount of the credit otherwise owed by the hospital.
`(6) OFFSET AGAINST MEDICAL ASSISTANCE- Amounts received by a State under this subsection in any quarter shall be considered to be a reduction in the amount expended under the State plan in the quarter for medical assistance for purposes of section 1903(a)(1) of the Social Security Act.'.
(c) Conforming Amendments- Section 1927 of the Social Security Act (42 U.S.C. 1396r-8) is amended--
(1) in subsection (a)(5)(A), by striking `covered outpatient drugs' and inserting `covered drugs (as defined in section 340B(b)(2) of the Public Health Service Act)';
(2) in subsection (a)(5), by striking subparagraph (D) and inserting the following:
`(D) STATE RESPONSIBILITY FOR CALCULATING HOSPITAL CREDITS- The State shall calculate the credits owed by the hospital under paragraph (1) of section 340B(c) of the Public Health Service Act and provide the hospital with both the amounts and an explanation of how it calculated the credits. In performing the calculations specified in paragraphs (2)(A)(ii) and (2)(B)(ii) of such section, the State shall use the average manufacturer price applicable to the calendar quarter in which the drug was purchased by the hospital.'; and
(3) in subsection (k)(1)--
(A) in subparagraph (A), by striking `subparagraph (B)' and inserting `subparagraphs (B) and (D)'; and
(B) by adding at the end the following:
`(D) CALCULATION FOR COVERED DRUGS- With respect to a covered drug (as defined in section 340B(b)(2) of the Public Health Service Act), the average manufacturer price shall be determined in accordance with subparagraph (A) except that, in the event a covered drug is not distributed to the retail pharmacy class of trade, it shall mean the average price paid to the manufacturer for the drug in the United States by wholesalers for drugs distributed to the acute care class of trade, after deducting customary prompt pay discounts.'.
SEC. 2503. EFFECTIVE DATE.
(a) In General- The amendments made by this subtitle shall take effect on July 1, 2010, and shall apply to drugs dispensed on or after such date.
(b) Effectiveness- The amendments made by this subtitle shall be effective, and shall be taken into account in determining whether a manufacturer is deemed to meet the requirements of section 340B(a) of the Public Health Service Act (42 U.S.C. 256b(a)) and of section 1927(a)(5) of the Social Security Act (42 U.S.C. 1396r-8(a)(5)), notwithstanding any other provision of law.
Subtitle B--School-Based Health Clinics
SEC. 2511. SCHOOL-BASED HEALTH CLINICS.
(a) In General- Part Q of title III (42 U.S.C. 280h et seq.) is amended by adding at the end the following:
`SEC. 399Z-1. SCHOOL-BASED HEALTH CLINICS.
`(a) Program- The Secretary shall establish a school-based health clinic program consisting of awarding grants to eligible entities to support the operation of school-based health clinics (referred to in this section as `SBHCs').
`(b) Eligibility- To be eligible for a grant under this section, an entity shall--
`(1) be an SBHC (as defined in subsection (l)(4)); and
`(2) submit an application at such time, in such manner, and containing such information as the Secretary may require, including at a minimum--
`(A) evidence that the applicant meets all criteria necessary to be designated as an SBHC;
`(B) evidence of local need for the services to be provided by the SBHC;
`(C) an assurance that--
`(i) SBHC services will be provided in accordance with Federal, State, and local laws governing--
`(I) obtaining parental or guardian consent; and
`(II) patient privacy and student records, including section 264 of the Health Insurance Portability and Accountability Act of 1996 and section 444 of the General Education Provisions Act;
`(ii) the SBHC has established and maintains collaborative relationships with other health care providers in the catchment area of the SBHC;
`(iii) the SBHC will provide on-site access during the academic day when school is in session and has an established network of support and access to services with backup health providers when the school or SBHC is closed;
`(iv) the SBHC will be integrated into the school environment and will coordinate health services with appropriate school personnel and other community providers co-located at the school; and
`(v) the SBHC sponsoring facility assumes all responsibility for the SBHC administration, operations, and oversight; and
`(D) such other information as the Secretary may require.
`(c) Use of Funds- Funds awarded under a grant under this section may be used for--
`(1) providing training related to the provision of comprehensive primary health services and additional health services;
`(2) the management and operation of SBHC programs; and
`(3) the payment of salaries for health professionals and other appropriate SBHC personnel.
`(d) Consideration of Need- In determining the amount of a grant under this section, the Secretary shall take into consideration--
`(1) the financial need of the SBHC;
`(2) State, local, or other sources of funding provided to the SBHC; and
`(3) other factors as determined appropriate by the Secretary.
`(e) Preferences- In awarding grants under this section, the Secretary shall give preference to SBHCs that have a demonstrated record of service to the following:
`(1) A high percentage of medically underserved children and adolescents.
`(2) Communities or populations in which children and adolescents have difficulty accessing health and mental health services.
`(3) Communities with high percentages of children and adolescents who are uninsured, underinsured, or eligible for medical assistance under Federal or State health benefits programs (including titles XIX and XXI of the Social Security Act).
`(f) Matching Requirement- The Secretary may award a grant to an SBHC only if the SBHC agrees to provide, from non-Federal sources, an amount equal to 20 percent of the amount of the grant (which may be provided in cash or in kind) to carry out the activities supported by the grant.
`(g) Supplement, Not Supplant- The Secretary may award a grant to an SBHC under this section only if the SBHC demonstrates to the satisfaction of the Secretary that funds received through the grant will be expended only to supplement, and not supplant, non-Federal and Federal funds otherwise available to the SBHC for operation of the SBHC (including each activity described in paragraph (1) or (2) of subsection (c)).
`(h) Payor of Last Resort- The Secretary may award a grant to an SBHC under this section only if the SBHC demonstrates to the satisfaction of the Secretary that funds received through the grant will not be expended for any activity to the extent that payment has been made, or can reasonably be expected to be made--
`(1) under any insurance policy;
`(2) under any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act); or
`(3) by an entity which provides health services on a prepaid basis.
`(i) Regulations Regarding Reimbursement for Health Services- The Secretary shall issue regulations regarding the reimbursement for health services provided by SBHCs to individuals eligible to receive such services through the program under this section, including reimbursement under any insurance policy or any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act).
`(j) Technical Assistance- The Secretary shall provide (either directly or by grant or contract) technical and other assistance to SBHCs to assist such SBHCs to meet the requirements of this section. Such assistance may include fiscal and program management assistance, training in fiscal and program management, operational and administrative support, and the provision of information to the SBHCs of the variety of resources available under this title and how those resources can be best used to meet the health needs of the communities served by the SBHCs.
`(k) Evaluation; Report- The Secretary shall--
`(1) develop and implement a plan for evaluating SBHCs and monitoring quality performances under the awards made under this section; and
`(2) submit to the Congress on an annual basis a report on the program under this section.
`(l) Definitions- In this section:
`(1) COMPREHENSIVE PRIMARY HEALTH SERVICES- The term `comprehensive primary health services' means the core services offered by SBHCs, which shall include the following:
`(A) PHYSICAL- Comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions and referrals to, and follow-up for, specialty care.
`(B) MENTAL HEALTH- Mental health assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs.
`(C) OPTIONAL SERVICES- Additional services, which may include oral health, social, and age-appropriate health education services, including nutritional counseling.
`(2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS- The term `medically underserved children and adolescents' means a population of children and adolescents who are residents of an area designated by the Secretary as an area with a shortage of personal health services and health infrastructure for such children and adolescents.
`(3) SCHOOL-BASED HEALTH CLINIC- The term `school-based health clinic' means a health clinic that--
`(A) is located in, or is adjacent to, a school facility of a local educational agency;
`(B) is organized through school, community, and health provider relationships;
`(C) is administered by a sponsoring facility; and
`(D) provides, at a minimum, comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with State and local laws and regulations, established standards, and community practice.
`(4) SPONSORING FACILITY- The term `sponsoring facility' is--
`(A) a hospital;
`(B) a public health department;
`(C) a community health center;
`(D) a nonprofit health care agency;
`(E) a local educational agency; or
`(F) a program administered by the Indian Health Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization under the Indian Self-Determination and Education Assistance Act, a Native Hawaiian entity, or an urban Indian program under title V of the Indian Health Care Improvement Act.
`(m) Authorization of Appropriations- For purposes of carrying out this section, there are authorized to be appropriated $50,000,000 for fiscal year 2010 and such sums as may be necessary for each of the fiscal years 2011 through 2014.'.
(b) Effective Date- The Secretary of Health and Human Services shall begin awarding grants under section 399Z-1 of the Public Health Service Act, as added by subsection (b), not later than July 1, 2010, without regard to whether or not final regulations have been issued under section 399Z-1(h) of such Act.
Subtitle C--National Medical Device Registry
SEC. 2521. NATIONAL MEDICAL DEVICE REGISTRY.
(a) Registry-
(1) IN GENERAL- Section 519 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360i) is amended--
(A) by redesignating subsection (g) as subsection (h); and
(B) by inserting after subsection (f) the following:
`National Medical Device Registry
`(g)(1) The Secretary shall establish a national medical device registry (in this subsection referred to as the `registry') to facilitate analysis of postmarket safety and outcomes data on each device that--
`(A) is or has been used in or on a patient; and
`(B) is--
`(i) a class III device; or
`(ii) a class II device that is implantable, life-supporting, or life-sustaining.
`(2) In developing the registry, the Secretary shall, in consultation with the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare & Medicaid Services, the head of the Office of the National Coordinator for Health Information Technology, and the Secretary of Veterans Affairs, determine the best methods for--
`(A) including in the registry, in a manner consistent with subsection (f), appropriate information to identify each device described in paragraph (1) by type, model, and serial number or other unique identifier;
`(B) validating methods for analyzing patient safety and outcomes data from multiple sources and for linking such data with the information included in the registry as described in subparagraph (A), including, to the extent feasible, use of--
`(i) data provided to the Secretary under other provisions of this chapter; and
`(ii) information from public and private sources identified under paragraph (3);
`(C) integrating the activities described in this subsection with--
`(i) activities under paragraph (3) of section 505(k) (relating to active postmarket risk identification);
`(ii) activities under paragraph (4) of section 505(k) (relating to advanced analysis of drug safety data); and
`(iii) other postmarket device surveillance activities of the Secretary authorized by this chapter; and
`(D) providing public access to the data and analysis collected or developed through the registry in a manner and form that protects patient privacy and proprietary information and is comprehensive, useful, and not misleading to patients, physicians, and scientists.
`(3)(A) To facilitate analyses of postmarket safety and patient outcomes for devices described in paragraph (1), the Secretary shall, in collaboration with public, academic, and private entities, develop methods to--
`(i) obtain access to disparate sources of patient safety and outcomes data, including--
`(I) Federal health-related electronic data (such as data from the Medicare program under title XVIII of the Social Security Act or from the health systems of the Department of Veterans Affairs);
`(II) private sector health-related electronic data (such as pharmaceutical purchase data and health insurance claims data); and
`(III) other data as the Secretary deems necessary to permit postmarket assessment of device safety and effectiveness; and
`(ii) link data obtained under clause (i) with information in the registry.
`(B) In this paragraph, the term `data' refers to information respecting a device described in paragraph (1), including claims data, patient survey data, standardized analytic files that allow for the pooling and analysis of data from disparate data environments, electronic health records, and any other data deemed appropriate by the Secretary.
`(4) Not later than 36 months after the date of the enactment of this subsection, the Secretary shall promulgate regulations for establishment and operation of the registry under paragraph (1). Such regulations--
`(A)(i) in the case of devices that are described in paragraph (1) and sold on or after the date of the enactment of this subsection, shall require manufacturers of such devices to submit information to the registry, including, for each such device, the type, model, and serial number or, if required under subsection (f), other unique device identifier; and
`(ii) in the case of devices that are described in paragraph (1) and sold before such date, may require manufacturers of such devices to submit such information to the registry, if deemed necessary by the Secretary to protect the public health;
`(B) shall establish procedures--
`(i) to permit linkage of information submitted pursuant to subparagraph (A) with patient safety and outcomes data obtained under paragraph (3); and
`(ii) to permit analyses of linked data;
`(C) may require device manufacturers to submit such other information as is necessary to facilitate postmarket assessments of device safety and effectiveness and notification of device risks;
`(D) shall establish requirements for regular and timely reports to the Secretary, which shall be included in the registry, concerning adverse event trends, adverse event patterns, incidence and prevalence of adverse events, and other information the Secretary determines appropriate, which may include data on comparative safety and outcomes trends; and
`(E) shall establish procedures to permit public access to the information in the registry in a manner and form that protects patient privacy and proprietary information and is comprehensive, useful, and not misleading to patients, physicians, and scientists.
`(5) To carry out this subsection, there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 and 2011.'.
(2) EFFECTIVE DATE- The Secretary of Health and Human Services shall establish and begin implementation of the registry under section 519(g) of the Federal Food, Drug, and Cosmetic Act, as added by paragraph (1), by not later than the date that is 36 months after the date of the enactment of this Act, without regard to whether or not final regulations to establish and operate the registry have been promulgated by such date.
(3) CONFORMING AMENDMENT- Section 303(f)(1)(B)(ii) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 333(f)(1)(B)(ii)) is amended by striking `519(g)' and inserting `519(h)'.
(b) Electronic Exchange and Use in Certified Electronic Health Records of Unique Device Identifiers-
(1) RECOMMENDATIONS- The HIT Policy Committee established under section 3002 of the Public Health Service Act (42 U.S.C. 300jj-12) shall recommend to the head of the Office of the National Coordinator for Health Information Technology standards, implementation specifications, and certification criteria for the electronic exchange and use in certified electronic health records of a unique device identifier for each device described in section 519(g)(1) of the Federal Food, Drug, and Cosmetic Act, as added by subsection (a).
(2) STANDARDS, IMPLEMENTATION CRITERIA, AND CERTIFICATION CRITERIA- The Secretary of the Health Human Services, acting through the head of the Office of the National Coordinator for Health Information Technology, shall adopt standards, implementation specifications, and certification criteria for the electronic exchange and use in certified electronic health records of a unique device identifier for each device described in paragraph (1), if such an identifier is required by section 519(f) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360i(f)) for the device.
Subtitle D--Grants for Comprehensive Programs To Provide Education to Nurses and Create a Pipeline to Nursing
SEC. 2531. ESTABLISHMENT OF GRANT PROGRAM.
(a) Purposes- It is the purpose of this section to authorize grants to--
(1) address the projected shortage of nurses by funding comprehensive programs to create a career ladder to nursing (including Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational Nurses, and Registered Nurses) for incumbent ancillary health care workers;
(2) increase the capacity for educating nurses by increasing both nurse faculty and clinical opportunities through collaborative programs between staff nurse organizations, health care providers, and accredited schools of nursing; and
(3) provide training programs through education and training organizations jointly administered by health care providers and health care labor organizations or other organizations representing staff nurses and frontline health care workers, working in collaboration with accredited schools of nursing and academic institutions.
(b) Grants- Not later than 6 months after the date of the enactment of this Act, the Secretary of Labor (referred to in this section as the `Secretary') shall establish a partnership grant program to award grants to eligible entities to carry out comprehensive programs to provide education to nurses and create a pipeline to nursing for incumbent ancillary health care workers who wish to advance their careers, and to otherwise carry out the purposes of this section.
(c) Eligibility- To be eligible for a grant under this section, an entity shall be--
(1) a health care entity that is jointly administered by a health care employer and a labor union representing the health care employees of the employer and that carries out activities using labor management training funds as provided for under section 302(c)(6) of the Labor Management Relations Act, 1947 (29 U.S.C. 186(c)(6));
(2) an entity that operates a training program that is jointly administered by--
(A) one or more health care providers or facilities, or a trade association of health care providers; and
(B) one or more organizations which represent the interests of direct care health care workers or staff nurses and in which the direct care health care workers or staff nurses have direct input as to the leadership of the organization;
(3) a State training partnership program that consists of nonprofit organizations that include equal participation from industry, including public or private employers, and labor organizations including joint labor-management training programs, and which may include representatives from local governments, worker investment agency one-stop career centers, community-based organizations, community colleges, and accredited schools of nursing; or
(4) a school of nursing (as defined in section 801 of the Public Health Service Act (42 U.S.C. 296)).
(d) Additional Requirements for Health Care Employer Described in Subsection (c)- To be eligible for a grant under this section, a health care employer described in subsection (c) shall demonstrate that it--
(1) has an established program within their facility to encourage the retention of existing nurses;
(2) provides wages and benefits to its nurses that are competitive for its market or that have been collectively bargained with a labor organization; and
(3) supports programs funded under this section through 1 or more of the following:
(A) The provision of paid leave time and continued health coverage to incumbent health care workers to allow their participation in nursing career ladder programs, including certified nurse assistants, licensed practical nurses, licensed vocational nurses, and registered nurses.
(B) Contributions to a joint labor-management training fund which administers the program involved.
(C) The provision of paid release time, incentive compensation, or continued health coverage to staff nurses who desire to work full- or part-time in a faculty position.
(D) The provision of paid release time for staff nurses to enable them to obtain a bachelor of science in nursing degree, other advanced nursing degrees, specialty training, or certification program.
(E) The payment of tuition assistance which is managed by a joint labor-management training fund or other jointly administered program.
(e) Other Requirements-
(1) MATCHING REQUIREMENT-
(A) IN GENERAL- The Secretary may not make a grant under this section unless the applicant involved agrees, with respect to the costs to be incurred by the applicant in carrying out the program under the grant, to make available non-Federal contributions (in cash or in kind under subparagraph (B)) toward such costs in an amount equal to not less than $1 for each $1 of Federal funds provided in the grant. Such contributions may be made directly or through donations from public or private entities, or may be provided through the cash equivalent of paid release time provided to incumbent worker students.
(B) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION- Non-Federal contributions required in subparagraph (A) may be in cash or in kind (including paid release time), fairly evaluated, including equipment or services (and excluding indirect or overhead costs). Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.
(2) REQUIRED COLLABORATION- Entities carrying out or overseeing programs carried out with assistance provided under this section shall demonstrate collaboration with accredited schools of nursing which may include community colleges and other academic institutions providing associate, bachelor's, or advanced nursing degree programs or specialty training or certification programs.
(f) Use of Funds- Amounts awarded to an entity under a grant under this section shall be used for the following:
(1) To carry out programs that provide education and training to establish nursing career ladders to educate incumbent health care workers to become nurses (including certified nurse assistants, licensed practical nurses, licensed vocational nurses, and registered nurses). Such programs shall include one or more of the following:
(A) Preparing incumbent workers to return to the classroom through English -as-a-second language education, GED education, pre-college counseling, college preparation classes, and support with entry level college classes that are a prerequisite to nursing.
(B) Providing tuition assistance with preference for dedicated cohort classes in community colleges, universities, accredited schools of nursing with supportive services including tutoring and counseling.
(C) Providing assistance in preparing for and meeting all nursing licensure tests and requirements.
(D) Carrying out orientation and mentorship programs that assist newly graduated nurses in adjusting to working at the bedside to ensure their retention postgraduation, and ongoing programs to support nurse retention.
(E) Providing stipends for release time and continued health care coverage to enable incumbent health care workers to participate in these programs.
(2) To carry out programs that assist nurses in obtaining advanced degrees and completing specialty training or certification programs and to establish incentives for nurses to assume nurse faculty positions on a part-time or full-time basis. Such programs shall include one or more of the following:
(A) Increasing the pool of nurses with advanced degrees who are interested in teaching by funding programs that enable incumbent nurses to return to school.
(B) Establishing incentives for advanced degree bedside nurses who wish to teach in nursing programs so they can obtain a leave from their bedside position to assume a full- or part-time position as adjunct or full-time faculty without the loss of salary or benefits.
(C) Collaboration with accredited schools of nursing which may include community colleges and other academic institutions providing associate, bachelor's, or advanced nursing degree programs, or specialty training or certification programs, for nurses to carry out innovative nursing programs which meet the needs of bedside nursing and health care providers.
(g) Preference- In awarding grants under this section the Secretary shall give preference to programs that--
(1) provide for improving nurse retention;
(2) provide for improving the diversity of the new nurse graduates to reflect changes in the demographics of the patient population;
(3) provide for improving the quality of nursing education to improve patient care and safety;
(4) have demonstrated success in upgrading incumbent health care workers to become nurses or which have established effective programs or pilots to increase nurse faculty; or
(5) are modeled after or affiliated with such programs described in paragraph (4).
(h) Evaluation-
(1) PROGRAM EVALUATIONS- An entity that receives a grant under this section shall annually evaluate, and submit to the Secretary a report on, the activities carried out under the grant and the outcomes of such activities. Such outcomes may include--
(A) an increased number of incumbent workers entering an accredited school of nursing and in the pipeline for nursing programs;
(B) an increasing number of graduating nurses and improved nurse graduation and licensure rates;
(C) improved nurse retention;
(D) an increase in the number of staff nurses at the health care facility involved;
(E) an increase in the number of nurses with advanced degrees in nursing;
(F) an increase in the number of nurse faculty;
(G) improved measures of patient quality (which may include staffing ratios of nurses, patient satisfaction rates, patient safety measures); and
(H) an increase in the diversity of new nurse graduates relative to the patient population.
(2) GENERAL REPORT- Not later than 2 years after the date of the enactment of this Act, and annually thereafter, the Secretary of Labor shall, using data and information from the reports received under paragraph (1), submit to the Congress a report concerning the overall effectiveness of the grant program carried out under this section.
(i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section such sums as may be necessary.
Subtitle E--States Failing To Adhere to Certain Employment Obligations
SEC. 2541. LIMITATION ON FEDERAL FUNDS.
A State is eligible for Federal funds under the provisions of the Public Health Service Act (42 U.S.C. 201 et seq.) only if the State--
(1) agrees to be subject in its capacity as an employer to each obligation under division A of this Act and the amendments made by such division applicable to persons in their capacity as an employer; and
(2) assures that all political subdivisions in the State will do the same.
END
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Welcome
Hopefully links to video's, documents, past news stories, occasionally music, can be found here.
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Sovereign
Hopefully links to video's, documents, past news stories, occasionally music, can be found here.
Enjoy your stay, may you find something useful
Sovereign
Cutting Through The Matrix
The Corbett Report
The International Forecaster
Alex Jones: Prison Planet News Feed
Films: Predictive Programming
- A I (2001) [Trailer]
- Gattaca (1997) [Trailer]
- I am legend (2007) [Trailer]
- Logan's Run [trailer] (1976)
- Omega Man (1971) [Movie In Parts]
- Soylent Green (1973) [Full Film]
- The Last Man on Earth (Full Film/Public Domain) - 87 (1964)
- Things To Come (1936) [Full Film/Public domain]
- THX-1138 (1971) [Trailer]
Essential Tools: Tools
Essential Tools: News
Books You Need To Read
- [Podcast] The Republic By Plato
- [Audiobook] Herodotus Histories Vol. 1 By Herodotus
- [Audiobook] The Twelve Caesars By Gaius Suetonius Tranquillus
- [Audiobook] William The Conqueror
- [Audiobook] Richard The First
- [Audiobook] Queen Elizabeth By Jacob Abbott
- [Audiobook] Cleopatra By Jacob Abbott
- [Audiobook] Alexander The Great By Jacob Abbott
- [Audiobook] Peter The Great By Jacob Abbott
- [Link] Adventures In English Literature (1973) Harcourt Brace Jovanovich
Grooveshark Widget
Songs i own but dunno where the cd is :P
Tyrione
Truth produces mind numbing phases to a mind which wants to continue living by the notion that none of our leadership would ever mislead our citizens. Once that house of cards falls the withdrawals of the mind will fight until they are exhausted before Truth can ever become Fact to a sheltered mind.
Tyrione -Commentor
Tyrione -Commentor
Books: Eugenics & Population Control
- Anatomy of Reality (1983) Jonas E. Salk [Online text not avaible]
- Carroll Quigley - The Anglo American Establishment [Full Text]
- Man Unfolding (1972) Jonas E. Salk [Online text not avaible]
- Survival of the Wisest (1973) Jonas E. Salk [Online text not avaible]
- The First Global Revolution- The Club Of Rome [Full Text PDF]
- The Pivot of Civilization (1922) Margret Sanger [ Read Full Text ]
- World Population and Human Values: A New Reality (1981) Jonas E. Salk [Online text not avaible]
Radio Project Front Page Podcast
Cutting Through the Matrix with Alan Watt Podcast (.xml Format)
Blacklisted News Widget
Prison Planet Widget
Main Stream Media: C-SPAN
Main Stream Media/Overseas: The Japan Times
Main Stream Media: AL JAZEERA ENGLISH (AJE)
Main Stream Media: Bloomberg
Other: Haaretz
![A I (2001) [Trailer]](http://www.youtube.com/watch?v=LrAoXaGrXrI&eurl=http://video.google.com/videosearch?hl=en&client=firefox-a&rls=org.mozilla:en-US:official&hs=hoE&resnumiurl=http://i1.ytimg.com/vi/LrAoXaGrXrI/default.jpg){kind=link}
![Gattaca (1997) [Trailer]](http://www.youtube.com/watch?v=o7OYCmynrRU&eurl=http://video.google.com/videosearch?hl=en&client=firefox-a&rls=org.mozilla:en-US:official&hs=7Au&resnumiurl=http://i4.ytimg.com/vi/o7OYCmynrRU/default.jpg){kind=link}
Endgame: Blueprint For Global Enslavement
Most Essential Film Overall
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- Video: My apologies
- Video: Natural Sweetner
- Article: 'Ghost bus' takes migrants on trip to Russia
- Video: Think Tank Shuffle
- How to detox from Vaccines:
- Article: Polio surge in Nigeria after vaccine viru...
- Article: [Not In U.S. Media] Doctors told to watch...
- Program: Frontline - The House Of Saud
- Article: Police given powers to enter homes and te...
- Movie: The Andromeda Strain
- Video: Roosevelt on the Bank Holiday in 19 33
- Video: Internment / Resettlement Specialists
- Documentary: Stalin and the betrayal of Leningrad
- Profile: Pol Pot
- Profile: Joseph Stalin
- Cartoon: Don't Give Up The Sheep
- Alert: Navy to poison American coastline with Depl...
- Video: Conyers [no point in reading bills]
- Text: H. R. 3200 [The health care bill] Part 1
- Text: H. R. 3200 [The health care bill] Part 2
- Video: Global Governance
- Video: Aldous Huxley on Brave New World
- Movie: Brave New World [1980]
- Film: 1984 [1954 version]
- Video: Beaker
- Music: Metal Cookie
- Film-Essential: Network
- Music: The internet is tubes
- Video: Blood & Gore, Cap & Trade
- Video: GeoEngineering
- Audio/Video: Predictive programming explained
- Movie: Z.P.G. [zero population growth] Predictive ...
- Video: Uninsured Americans go to camps, for health...
- ► April 2009 (23)
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Films: Essential Films
- Alfred Hitchcock Documentary On The Holocaust
- Behold a Pale Horse
- Bowling For Columbine
- Bush Family Fortunes
- Cathy O'Brien & Mark Philips On Mind-Control & MK-Ultra
- Cathy O'Brien Presenting Trance Form America Part 1
- Cathy O'Brien Presenting Trance Form America Part 2
- Chemtrails - What Is Wrong With Our Skies?
- CIA's Drug Ops
- Clifford Carnicom' Aerosol Crimes
- Codex Alimentarius : Ian Crane
- COINTELPRO: The FBI's War on Black America
- Dark Secrets Inside Bohemian Grove
- Endgame- Blueprint For Global Enslavement
- Former CIA/DEA Drug Trafficker Speaks Out
- Freeman Perspective: Pop Star Mind Control Slaves
- Gladio, Part 1: The Ringmasters - 47 min
- Gladio, Part 2: The Puppeteers - 50 min
- Gladio, Part 3: The Foot Soldiers - 49 min
- Hour Of Time - The Legacy Of William Bill Cooper
- In Lies We Trust : The CIA, Hollywood & Bioterrorism
- Inside Hamas
- Invisible Children
- Iraq For Sale - The War Profiteers
- Iraq's Missing Billions
- Matrix Of Power
- Mercury, Autism & The Global Vaccine Program
- Mike Ruppert On The CIA's Drug Trafficing
- Mind Control - America's Secret War
- Mind-Control Victims Speaking Out
- Money As Debt
- Nazi-Concentration Camps In 1945
- Occupation 101
- One Man's Journey From Hell
- Plan Colombia
- Population Control, Pandemics, H5N1, Biological Warfare & Colloidal Silver [Part 1]
- Population Control, Pandemics, H5N1, Biological Warfare & Colloidal Silver [Part 2]
- Population Control, Pandemics, H5N1, Biological Warfare & Colloidal Silver [Part 3]
- Population Control, Pandemics, H5N1, Biological Warfare & Colloidal Silver [Part 4]
- Population Control, Pandemics, H5N1, Biological Warfare & Colloidal Silver [Part 5]
- Secret Spies & Remote Viewing
- Secrets Of The 3rd Reich
- Secrets Of The CIA
- Sicko
- Spin By Brian Springer [Media Manipulation]
- The 11th Day - The Battle Of Crete"
- The 13 Bloodlines Of The Illuminati
- The Cocaïne Cowboys 1
- The Cocaïne Cowboys [Part 2]
- The Codex Alimentarius: Dr. Rema Laibow
- The Drugging of our Children
- The Esoteric Agenda
- The Freeman Perspective" On Corporate Logo's And Masonry
- The Missing Secrets Of Nikola Tesla
- The Secret Rulers Of The World - The Bilderberg Group
- The Secrets Of The CIA 2
- The True Story Of Che Guevara
- The Unreported World - Brazil Slum Warfare
- The Unreported World - Egypt
- The Unreported World - India
- The Unreported World - Israel's Wild West
- The Unreported World - Kosovo
- The Unreported World - Russia
- The Unreported World - Sri Lanka
- The Unreported World - Turkey
- The Unreported World - Voodoo Children
- The Unreported World - Zimbabwe
- The Unreported World: Gaza
- The US vs. John Lennon
- The World According To Monsanto
- Thirteen Bloodlines Of The Illuminati
- Uncovered - The Whole Truth About The Iraq War
- Wake Up Call - Remastered
- Weapons Of Mass-Deception
- Why The War On Drugs Is A Scam
- William Cooper Exposing The Illuminati & The Secret Government
- William Cooper:JFK Assassin Unmasked
- World System & The Illuminati
Loose Change
This is one of the early versions, I know there is final cut but love the Statue of Liberty with that music, im resistant to change, but not loose change :P
Links
Free Europe
Free Europe
The Occult History of the Third Reich
Charles H. Fort
"Almost all people are hypnotics. The proper authority saw to it that the proper belief should be induced, and the people believed properly."
- Charles H. Fort
We Are Change Chicago
MySpace Page
Attorney At Law
Makes Blogs Yummy
Government of The United Kingdom:Official Documents
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