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Bill - HR3200

This Document was obtained from The Library of Congress Thomas System as of July 14th, 2009

July 14, 2009

Sec. 1 Short Title; Table of Divisions, Titles, and Subtitles.

DIVISION A - AFFORDABLE HEALTH CARE CHOICES

Sec. 100. Purpose; TOC of Division; General Definitions.

TITLE I-PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS

Subtitle A-General Standards

Sec. 101. Requirements reforming health insurance marketplace.

Sec. 102. Protecting the choice to keep current coverage.

Subtitle B-Standards Guaranteeing Access to Affordable Coverage

Sec. 111. Prohibiting pre-existing condition exclusions.

Sec. 112. Guaranteed issue and renewal for insured plans.

Sec. 113. Insurance rating rules.

Sec. 114. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits.

Sec. 115. Ensuring adequacy of provider networks.

Sec. 116. Ensuring value and lower premiums.

Subtitle C-Standards Guaranteeing Access to Essential Benefits

Sec. 121. Coverage of essential benefits package.

Sec. 122. Essential benefits package defined.

Sec. 123. Health Benefits Advisory Committee.

Sec. 124. Process for adoption of recommendations; adoption of benefit standards.

Subtitle D-Additional Consumer Protections

Sec. 131. Requiring fair marketing practices by health insurers.

Sec. 132. Requiring fair grievance and appeals mechanisms.

Sec. 133. Requiring information transparency and plan disclosure.

Sec. 134. Application to qualified health benefits plans not offered through the Health Insurance Exchange.

Sec. 135. Timely payment of claims.

Sec. 136. Standardized rules for coordination and subrogation of benefits.

Sec. 137. Application of administrative simplification.

Subtitle E-Governance

Sec. 141. Health Choices Administration; Health Choices Commissioner.

Sec. 142. Duties and authority of Commissioner.

Sec. 143. Consultation and coordination.

Sec. 144. Health Insurance Ombudsman.

Subtitle F-Relation to Other Requirements; Miscellaneous

Sec. 151. Relation to other requirements.

Sec. 152. Prohibiting discrimination in health care.

Sec. 153. Whistleblower protection.

Sec. 154. Construction regarding collective bargaining.

Sec. 155. Severability.

Subtitle G-Early Investments

Sec. 161. Ensuring value and lower premiums.

Sec. 162. Ending health insurance rescission abuse.

Sec. 163. Administrative simplification.

Sec. 164. Reinsurance program for retirees.

DIVISION B-MEDICARE AND MEDICAID IMPROVEMENTS

Sec. 1001. Table of contents of division.

TITLE I-IMPROVING HEALTH CARE VALUE

Subtitle A-Provisions Related to Medicare Part A

PART 1-MARKET BASKET UPDATES

Sec. 1101. Skilled nursing facility payment update.

Sec. 1102. Inpatient rehabilitation facility payment update.

Sec. 1103. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements.

PART 2-OTHER MEDICARE PART A PROVISIONS

Sec. 1111. Payments to skilled nursing facilities.

Sec. 1112. Medicare DSH report and payment adjustments in response to coverage expansion.

Subtitle B-Provisions Related to Part B

PART 1-PHYSICIANS’ SERVICES

Sec. 1121. Sustainable growth rate reform.

Sec. 1122. Misvalued codes under the physician fee schedule.

Sec. 1123. Payments for efficient areas.

Sec. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI).

Sec. 1125. Adjustment to Medicare payment localities.

PART 2-MARKET BASKET UPDATES

Sec. 1131. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements.

PART 3-OTHER PROVISIONS

Sec. 1141. Rental and purchase of power-driven wheelchairs.

Sec. 1142. Extension of payment rule for brachytherapy.

Sec. 1143. Home infusion therapy report to congress.

Sec. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and other data.

Sec. 1145. Treatment of certain cancer hospitals.

Sec. 1146. Medicare Improvement Fund.

Sec. 1147. Payment for imaging services.

Sec. 1148. Durable medical equipment program improvements.

Sec. 1149. MedPAC study and report on bone mass measurement.

Subtitle C-Provisions Related to Medicare Parts A and B

Sec. 1151. Reducing potentially preventable hospital readmissions.

Sec. 1152. Post acute care services payment reform plan and bundling pilot program.

Sec. 1153. Home health payment update for 2010.

Sec. 1154. Payment adjustments for home health care.

Sec. 1155. Incorporating productivity improvements into market basket update for home health services.

Sec. 1156. Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals.

Sec. 1157. Institute of Medicine study of geographic adjustment factors under Medicare.

Sec. 1158. Revision of Medicare payment systems to address geographic inequities.

Subtitle D-Medicare Advantage Reforms

PART 1-PAYMENT AND ADMINISTRATION

Sec. 1161. Phase-in of payment based on fee-for-service costs.

Sec. 1162. Quality bonus payments.

Sec. 1163. Extension of Secretarial coding intensity adjustment authority.

Sec. 1164. Simplification of annual beneficiary election periods.

Sec. 1165. Extension of reasonable cost contracts.

Sec. 1166. Limitation of waiver authority for employer group plans.

Sec. 1167. Improving risk adjustment for payments.

Sec. 1168. Elimination of MA Regional Plan Stabilization Fund.

PART 2-BENEFICIARY PROTECTIONS AND ANTI-FRAUD

Sec. 1171. Limitation on cost-sharing for individual health services.

Sec. 1172. Continuous open enrollment for enrollees in plans with enrollment suspension.

Sec. 1173. Information for beneficiaries on MA plan administrative costs.

Sec. 1174. Strengthening audit authority.

Sec. 1175. Authority to deny plan bids.

PART 3-TREATMENT OF SPECIAL NEEDS PLANS

Sec. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs individuals.

Sec. 1177. Extension of authority of special needs plans to restrict enrollment.

Subtitle E-Improvements to Medicare Part D

Sec. 1181. Elimination of coverage gap.

Sec. 1182. Discounts for certain part D drugs in original coverage gap.

Sec. 1183. Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities.

Sec. 1184. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D.

Sec. 1185. Permitting mid-year changes in enrollment for formulary changes that adversely impact an enrollee.

Subtitle F--Medicare Rural Access Protections

Sec. 1191. Telehealth expansion and enhancements.

Sec. 1192. Extension of outpatient hold harmless provision.

Sec. 1193. Extension of section 508 hospital reclassifications.

Sec. 1194. Extension of geographic floor for work.

Sec. 1195. Extension of payment for technical component of certain physician pathology services.

Sec. 1196. Extension of ambulance add-ons.

TITLE II-MEDICARE BENEFICIARY IMPROVEMENTS

Subtitle A-Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries

Sec. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program.

Sec. 1202. Elimination of part D cost-sharing for certain non-institutionalized full-benefit dual eligible individuals.

Sec. 1203. Eliminating barriers to enrollment.

Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment.

Sec. 1205. Intelligent assignment in enrollment.

Sec. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals.

Sec. 1207. Application of MA premiums prior to rebate in calculation of low income subsidy benchmark.

Subtitle B-Reducing Health Disparities

Sec. 1221. Ensuring effective communication in Medicare.

Sec. 1222. Demonstration to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services.

Sec. 1223. IOM report on impact of language access services.

Sec. 1224. Definitions.

Subtitle C—Miscellaneous Improvements

Sec. 1231. Extension of therapy caps exceptions process.

Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions.

Sec. 1233. Advance care planning consultation.

Sec. 1234. Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries.

Sec. 1235. Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium.

Sec. 1236. Demonstration program on use of patient decisions aids.

TITLE IV-QUALITY

Subtitle A-Comparative Effectiveness Research

Sec. 1401. Comparative effectiveness research.

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.

Sec. 1412. Accountability requirements.

Sec. 1413. Nursing home compare Medicare website.

Sec. 1414. Reporting of expenditures.

Sec. 1415. Standardized complaint form.

Sec. 1416. Ensuring staffing accountability.

PART 2-TARGETING ENFORCEMENT

Sec. 1421. Civil money penalties.

Sec. 1422. National independent monitor pilot program.

Sec. 1423. Notification of facility closure.

PART 3-IMPROVING STAFF TRAINING

Sec. 1431. Dementia and abuse prevention training.

Sec. 1432. Study and report on training required for certified nurse aides and supervisory staff.

Subtitle C-Quality Measurements

Sec. 1441. Establishment of national priorities for quality improvement.

Sec. 1442. Development of new quality measures; GAO evaluation of data collection process for quality measurement.

Sec. 1443. Multi-stakeholder pre-rulemaking input into selection of quality measures.

Sec. 1444. Application of quality measures.

Sec. 1445. Consensus-based entity funding.

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.

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.

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.

Subtitle B-Enhanced Penalties for Fraud and Abuse

Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications.

Sec. 1612. Enhanced penalties for submission of false statements material to a false claim.

Sec. 1613. Enhanced penalties for delaying inspections.

Sec. 1614. Enhanced hospice program safeguards.

Sec. 1615. Enhanced penalties for individuals excluded from program participation.

Sec. 1616. Enhanced penalties for provision of false information by Medicare Advantage and part D plans.

Sec. 1617. Enhanced penalties for Medicare Advantage and part D marketing violations.

Sec. 1618. Enhanced penalties for obstruction of program audits.

Sec. 1619. Exclusion of certain individuals and entities from participation in Medicare and State health care programs.

Subtitle C-Enhanced Program and Provider Protections

Sec. 1631. Enhanced CMS program protection authority.

Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations.

Sec. 1633. Required inclusion of payment modifier for certain evaluation and management services.

Sec. 1634. Evaluations and reports required under Medicare Integrity Program.

Sec. 1635. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse.

Sec. 1636. Maximum period for submission of Medicare claims reduced to not more than 12 months.

Sec. 1637. Physicians who order durable medical equipment or home health services required to be Medicare enrolled physicians or eligible professionals.

Sec. 1638. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse.

Sec. 1639. Face to face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare.

Sec. 1640. Extension of testimonial subpoena authority to program exclusion investigations.

Sec. 1641. Required repayments of Medicare and Medicaid overpayments.

Sec. 1642. Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program.

Sec. 1643. Access to certain information on renal dialysis facilities.

Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to register under Medicare.

Sec. 1645. Conforming civil monetary penalties to False Claims Act amendments.

Subtitle D-Access to Information Needed to Prevent Fraud, Waste, and Abuse

Sec. 1651. Access to Information Necessary to Identify Fraud, Waste, and Abuse.

Sec. 1652. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank.

Sec. 1653. Compliance with HIPAA privacy and security standards.

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.

Sec. 1702. Requirements and special rules for certain Medicaid eligible individuals.

Sec. 1703. CHIP and Medicaid maintenance of effort.

Sec. 1704. Reduction in Medicaid DSH.

Sec. 1705. Expanded outstationing.

Subtitle B-Prevention

Sec. 1711. Required coverage of preventive services.

Sec. 1712. Tobacco cessation.

Sec. 1713. Optional coverage of nurse home visitation services.

Sec. 1714. State eligibility option for family planning services.

Subtitle C-Access

Sec. 1721. Payments to primary care practitioners.

Sec. 1722. Medical home pilot program.

Sec. 1723. Translation or interpretation services.

Sec. 1724. Optional coverage for freestanding birth center services.

Sec. 1725. Inclusion of public health clinics under the vaccines for children program.

Subtitle D-Coverage

Sec. 1731. Optional medicaid coverage of low-income HIV-infected individuals.

Sec. 1732. Extending transitional Medicaid Assistance (TMA).

Sec. 1733. Requirement of 12-month continuous coverage under certain CHIP programs.

Subtitle E-Financing

Sec. 1741. Payments to pharmacists.

Sec. 1742. Prescription drug rebates.

Sec. 1743. Extension of prescription drug discounts to enrollees of medicaid managed care organizations.

Sec. 1744. Payments for graduate medical education.

Subtitle F-Waste, Fraud, and Abuse

Sec. 1751. Health-care acquired conditions.

Sec. 1752. Evaluations and reports required under Medicaid Integrity Program.

Sec. 1753. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse.

Sec. 1754. Overpayments.

Sec. 1755. Managed Care Organizations.

Sec. 1756. Termination of provider participation under Medicaid and CHIP if terminated under Medicare or other State plan or child health plan.

Sec. 1757. Medicaid and CHIP exclusion from participation relating to certain ownership, control, and management affiliations.

Sec. 1758. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse.

Sec. 1759. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid.

Sec. 1760. Denial of payments for litigation-related misconduct.

Subtitle G-Puerto Rico and the Territories

Sec. 1771. Puerto Rico and territories.

Subtitle H-Miscellaneous

Sec. 1781. Technical corrections.

Sec. 1782. Extension of QI program.

DIVISION C-PUBLIC HEALTH AND WORKFORCE DEVELOPMENT

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.

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.

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 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.

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