House Bill – Table of Contents

AFFORDABLE HEALTH CARE FOR AMERICA ACT

H.R. 3962

DIVISION A – AFFORDABLE HEALTH CARE CHOICES_____________________________

Sec. 100. Purpose; table of contents of division; general definitions.

TITLE I – IMMEDIATE REFORMS

Sec. 101. National high-risk pool program.

Sec. 102. Ensuring value and lower premiums.

Sec. 103. Ending health insurance rescission abuse.

Sec. 104. Sunshine on price gouging by health insurance issuers.

Sec. 105. Requiring the option of extension of dependent coverage for uninsured young adults.

Sec. 106. Limitations on preexisting condition exclusions in group health plans in advance of applicability of new prohibition of preexisting condition exclusions.

Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions.

Sec. 108. Ending health insurance denials and delays of necessary treatment for children with deformities.

Sec. 109. Elimination of lifetime limits.

Sec. 110. Prohibition against postretirement reductions of retiree health benefits by group health plans.

Sec. 111. Reinsurance program for retirees.

Sec. 112. Wellness program grants.

Sec. 113. Extension of COBRA continuation coverage.

Sec. 114. State Health Access Program grants.

Sec. 115. Administrative simplification.

TITLE II – PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS

Subtitle A – General Standards

Sec. 201. Requirements reforming health insurance marketplace.

Sec. 202. Protecting the choice to keep current coverage.

Subtitle B – Standards Guaranteeing Access to Affordable Coverage

Sec. 211. Prohibiting preexisting condition exclusions.

Sec. 212. Guaranteed issue and renewal for insured plans and prohibiting rescissions.

Sec. 213. Insurance rating rules.

Sec. 214. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits.

Sec. 215. Ensuring adequacy of provider networks.

Sec. 216. Requiring the option of extension of dependent coverage for uninsured young adults.

Sec. 217. Consistency of costs and coverage under qualified health benefits plans during plan year.

Subtitle C – Standards Guaranteeing Access to Essential Benefits

Sec. 221. Coverage of essential benefits package.

Sec. 222. Essential benefits package defined.

Sec. 223. Health Benefits Advisory Committee.

Sec. 224. Process for adoption of recommendations; adoption of benefit standards.

Subtitle D – Additional Consumer Protections

Sec. 231. Requiring fair marketing practices by health insurers.

Sec. 232. Requiring fair grievance and appeals mechanisms.

Sec. 233. Requiring information transparency and plan disclosure.

Sec. 234. Application to qualified health benefits plans not offered through the Health Insurance Exchange.

Sec. 235. Timely payment of claims.

Sec. 236. Standardized rules for coordination and subrogation of benefits.

Sec. 237. Application of administrative simplification.

Sec. 238. State prohibitions on discrimination against health care providers.

Sec. 239. Protection of physician prescriber information.

Sec. 240. Dissemination of advance care planning information.

Subtitle E – Governance

Sec. 241. Health Choices Administration; Health Choices Commissioner.

Sec. 242. Duties and authority of Commissioner.

Sec. 243. Consultation and coordination.

Sec. 244. Health Insurance Ombudsman.

Subtitle F – Relation to Other Requirements; Miscellaneous

Sec. 251. Relation to other requirements.

Sec. 252. Prohibiting discrimination in health care.

Sec. 253. Whistleblower protection.

Sec. 254. Construction regarding collective bargaining.

Sec. 255. Severability.

Sec. 256. Treatment of Hawaii Prepaid Health Care Act.

Sec. 257. Actions by State attorneys general.

Sec. 258. Application of State and Federal laws regarding abortion.

Sec. 259. Nondiscrimination on abortion and respect for rights of conscience.

Sec. 260. Authority of Federal Trade Commission.

Sec. 261. Construction regarding standard of care.

Sec. 262. Restoring application of antitrust laws to health sector insurers.

Sec. 263. Study and report on methods to increase EHR use by small health care providers.

Sec. 264. Performance assessment and accountability: application of GPRA.

Sec. 265. Limitation on abortion funding.

TITLE III – HEALTH INSURANCE EXCHANGE AND RELATED PROVISIONS

Subtitle A – Health Insurance Exchange

Sec. 301. Establishment of Health Insurance Exchange; outline of duties; definitions.

Sec. 302. Exchange-eligible individuals and employers.

Sec. 303. Benefits package levels.

Sec. 304. Contracts for the offering of Exchange-participating health benefits plans.

Sec. 305. Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan.

Sec. 306. Other functions.

Sec. 307. Health Insurance Exchange Trust Fund.

Sec. 308. Optional operation of State-based health insurance exchanges.

Sec. 309. Interstate health insurance compacts.

Sec. 310. Health insurance cooperatives.

Sec. 311. Retention of DOD and VA authority.

Subtitle B – Public Health Insurance Option

Sec. 321. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan.

Sec. 322. Premiums and financing.

Sec. 323. Payment rates for items and services.

Sec. 324. Modernized payment initiatives and delivery system reform.

Sec. 325. Provider participation.

Sec. 326. Application of fraud and abuse provisions.

Sec. 327. Application of HIPAA insurance requirements.

Sec. 328. Application of health information privacy, security, and electronic transaction requirements.

Sec. 329. Enrollment in public health insurance option is voluntary.

Sec. 330. Enrollment in public health insurance option by Members of Congress.

Sec. 331. Reimbursement of Secretary of Veterans Affairs.

Subtitle C – Individual Affordability Credits

Sec. 341. Availability through Health Insurance Exchange.

Sec. 342. Affordable credit eligible individual.

Sec. 343. Affordability premium credit.

Sec. 344. Affordability cost-sharing credit.

Sec. 345. Income determinations.

Sec. 346. Special rules for application to territories.

Sec. 347. No Federal payment for undocumented aliens.

TITLE IV – SHARED RESPONSIBILITY

Subtitle A – Individual Responsibility

Sec. 401. Individual responsibility.

Subtitle B – Employer Responsibility

Part 1 – Health Coverage Participation Requirements

Sec. 411. Health coverage participation requirements.

Sec. 412. Employer responsibility to contribute toward employee and dependent coverage.

Sec. 413. Employer contributions in lieu of coverage.

Sec. 414. Authority related to improper steering.

Sec. 415. Impact study on employer responsibility requirements.

Sec. 416. Study on employer hardship exemption.

Part 2 – Satisfaction of Health Coverage Participation Requirements

Sec. 421. Satisfaction of health coverage participation requirements under the Employee Retirement Income Security Act of 1974.

Sec. 422. Satisfaction of health coverage participation requirements under the Internal Revenue Code of 1986.

Sec. 423. Satisfaction of health coverage participation requirements under the Public Health Service Act.

Sec. 424. Additional rules relating to health coverage participation requirements.

TITLE V – AMENDMENTS TO INTERNAL REVENUE CODE OF 1986

Subtitle A – Provisions Relating to Health Care Reform

Part 1 – Shared Responsibility

Subpart A Individual Responsibility

Sec. 501. Tax on individuals without acceptable health care coverage.

Subpart B – Employer Responsibility

Sec. 511. Election to satisfy health coverage participation requirements.

Sec. 512. Health care contributions of nonelecting employers.

Part 2 – Credit for Small Business Employee Health Coverage Expenses

Sec. 521. Credit for small business employee health coverage expenses.

Part 3 – Limitations on Health Care Related Expenditures

Sec. 531. Distributions for medicine qualified only if for prescribed drug or insulin.

Sec. 532. Limitation on health flexible spending arrangements under cafeteria plans.

Sec. 533. Increase in penalty for nonqualified distributions from health savings accounts.

Sec. 534. Denial of deduction for federal subsidies for prescription drug plans which have been excluded from gross income.

Part 4 – Other Provisions to Carry Out Health Insurance Reform

Sec. 541. Disclosures to carry out health insurance exchange subsidies.

Sec. 542. Offering of exchange-participating health benefits plans through cafeteria plans.

Sec. 543. Exclusion from gross income of payments made under reinsurance program for retirees.

Sec. 544. CLASS program treated in same manner as long-term care insurance.

Sec. 545. Exclusion from gross income for medical care provided for Indians.

Subtitle B – Other Revenue Provisions

Part 1 – General Provisions

Sec. 551. Surcharge on high income individuals.

Sec. 552. Excise tax on medical devices.

Sec. 553. Expansion of information reporting requirements.

Sec. 554. Repeal of worldwide allocation of interest.

Sec. 555. Exclusion of unprocessed fuels from the cellulosic biofuel producer credit.

Part 2 – Prevention of Tax Avoidance

Sec. 561. Limitation on treaty benefits for certain deductible payments.

Sec. 562. Codification of economic substance doctrine; penalties.

Sec. 563. Certain large or publicly traded persons made subject to a more likely than not standard for avoiding penalties on underpayments.

Part 3 – Parity in Health Benefits

Sec. 571. Certain health related benefits applicable to spouses and dependents extended to eligible beneficiaries.

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.

Sec. 1113. Extension of hospice regulation moratorium.

Sec. 1114. Permitting physician assistants to order post-hospital extended care services and to provide for recognition of attending physician assistants as attending physicians to serve hospice patients.

Subtitle B – Provisions Related to Part B

Part 1 – Physicians’ Services

Sec. 1121. Resource-based feedback program for physicians in Medicare.

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. 1141A. Election to take ownership, or to decline ownership, of a certain item of complex durable medical equipment after the 13-month capped rental period ends.

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. Payment for imaging services.

Sec. 1147. Durable medical equipment program improvements.

Sec. 1148. MedPAC study and report on bone mass measurement.

Sec. 1149. Timely access to post-mastectomy items.

Sec. 1149A. Payment for biosimilar biological products.

Sec. 1149B. Study and report on DME competitive bidding process.

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. 1155A. MedPAC study on variation in home health margins.

Sec. 1155B. Permitting home health agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation cases.

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.

Sec. 1159. Institute of Medicine study of geographic variation in health care spending and promoting high-value health care.

Sec. 1160. Implementation, and Congressional review, of proposal to revise Medicare payments to promote high value health care.

Subtitle D – Medicare Advantage Reforms

Part 1 – Payment and Administration

Sec. 1161. Phase-in of payment based on fee-for-service costs; quality bonus payments.

Sec. 1162. Authority for Secretarial coding intensity adjustment authority.

Sec. 1163. Simplification of annual beneficiary election periods.

Sec. 1164. Extension of reasonable cost contracts.

Sec. 1165. Limitation of waiver authority for employer group plans.

Sec. 1166. Improving risk adjustment for payments.

Sec. 1167. Elimination of MA Regional Plan Stabilization Fund.

Sec. 1168. Study regarding the effects of calculating Medicare Advantage payment rates on a regional average of Medicare fee for service rates.

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.

Sec. 1175A. State authority to enforce standardized marketing requirements.

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; service area moratorium for certain SNPs.

Sec. 1178. Extension of Medicare senior housing plans.

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. No mid-year formulary changes permitted.

Sec. 1186. Negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries.

Sec. 1187. Accurate dispensing in long-term care facilities.

Sec. 1188. Free generic fill.

Sec. 1189. State certification prior to waiver of licensure requirements under Medicare prescription drug program.

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 and quality bonus payments 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. Voluntary 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 II – PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE

Sec. 1301. Accountable Care Organization pilot program.

Sec. 1302. Medical home pilot program.

Sec. 1303. Payment incentive for selected primary care services.

Sec. 1304. Increased reimbursement rate for certified nurse-midwives.

Sec. 1305. Coverage and waiver of cost-sharing for preventive services.

Sec. 1306. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal.

Sec. 1307. Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment.

Sec. 1308. Coverage of marriage and family therapist services and mental health counselor services.

Sec. 1309. Extension of physician fee schedule mental health add-on.

Sec. 1310. Expanding access to vaccines.

Sec. 1311. Expansion of Medicare-Covered Preventive Services at Federally Qualified Health Centers.

Sec. 1312. Independence at home demonstration program.

Sec. 1313. Recognition of certified diabetes educators as certified providers for purposes of Medicare diabetes outpatient self-management training services.

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, Nursing Facilities, and Other Long-term Care 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.

Sec. 1417. Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers.

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.

Sec. 1433. Qualification of director of food services of a skilled nursing facility or nursing facility.

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.

Sec. 1446. Quality indicators for care of people with Alzheimer’s Disease.

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 V – MEDICARE GRADUATE MEDICAL EDUCATION


Sec. 1501. Distribution of unused residency positions.

Sec. 1502. Increasing training in nonprovider settings.

Sec. 1503. Rules for counting resident time for didactic and scholarly activities and other activities.

Sec. 1504. Preservation of resident cap positions from closed hospitals.

Sec. 1505. Improving accountability for approved medical residency training.

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.

Sec. 1620. OIG authority to exclude from Federal health care programs officers and owners of entities convicted of fraud.

Sec. 1621. Self-referral disclosure protocol.

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 eligibility certifications for home health services or durable medical equipment.

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.

Sec. 1646. Requiring provider and supplier payments under Medicare to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions.

Sec. 1647. Inspector General for the Health Choices Administration.

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.

Sec. 1654. Disclosure of Medicare fraud and abuse hotline number on explanation of benefits.

TITLE VII – MEDICAID AND CHIP

Subtitle A – Medicaid and Health Reform

Sec. 1701. Eligibility for individuals with income below 150 percent of the Federal poverty level.

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

Sec. 1703. CHIP and Medicaid maintenance of eligibility.

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.

Sec. 1726. Requiring coverage of services of podiatrists.

Sec. 1726A. Requiring coverage of services of optometrists.

Sec. 1727. Therapeutic foster care.

Sec. 1728. Assuring adequate payment levels for services.

Sec. 1729. Preserving Medicaid coverage for youths upon release from public institutions.

Sec. 1730. Quality measures for maternity and adult health services under Medicaid and CHIP.

Sec. 1730A. Accountable care organization pilot program.

Sec. 1730B. FQHC coverage.

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.

Sec. 1734. Preventing the application under CHIP of coverage waiting periods for certain children.

Sec. 1735. Adult day health care services.

Sec. 1736. Medicaid coverage for citizens of Freely Associated States.

Sec. 1737. Continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary services.

Sec. 1738. State option to disregard certain income in providing continued Medicaid coverage for certain individuals with extremely high prescription costs.

Sec. 1739. Provisions relating to community living assistance services and supports (CLASS).

Sec. 1739A. Sense of Congress regarding Community First Choice Option to provide medicaid coverage of community-based attendant services and supports.

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.

Sec. 1745. Nursing Facility Supplemental Payment Program.

Sec. 1746. Report on Medicaid payments.

Sec. 1747. Reviews of Medicaid.

Sec. 1748. Extension of delay in managed care organization provider tax elimination.

Sec. 1749. Extension of ARRA increase in FMAP.

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.

Sec. 1761. Mandatory State use of national correct coding initiative.

Subtitle G – Payments to the Territories

Sec. 1771. Payment to territories.

Subtitle H – Miscellaneous

Sec. 1781. Technical corrections.

Sec. 1782. Extension of QI program.

Sec. 1783. Assuring transparency of information.

Sec. 1784. Medicaid and CHIP Payment and Access Commission.

Sec. 1785. Outreach and enrollment of Medicaid and CHIP eligible individuals.

Sec. 1786. Prohibitions on Federal Medicaid and CHIP payment for undocumented aliens.

Sec. 1787. Demonstration project for stabilization of emergency medical conditions by institutions for mental diseases.

Sec. 1788. Application of Medicaid Improvement Fund.

Sec. 1789. Treatment of certain Medicaid brokers.

Sec. 1790. Rule for changes requiring State legislation.

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.

Sec. 1802. Comparative Effectiveness Research Trust Fund; financing for Trust Fund.

TITLE IX – MISCELLANEOUS PROVISIONS

Sec. 1901. Repeal of trigger provision.

Sec. 1902. Repeal of comparative cost adjustment (CCA) program.

Sec. 1903. Extension of gainsharing demonstration.

Sec. 1904. Grants to States for quality home visitation programs for families with young children and families expecting children.

Sec. 1905. Improved coordination and protection for dual eligibles.

Sec. 1906. Assessment of medicare cost-intensive diseases and conditions.

Sec. 1907. Establishment of Center for Medicare and Medicaid Innovation within CMS.

Sec. 1908. Application of emergency services laws.

Sec. 1909. Disregard under the Supplemental Security Income program of compensation for participation in clinical trials for rare diseases or conditions.

DIVISION C – PUBLIC HEALTH AND WORKFORCE DEVELOPMENT__________

Sec. 2001. Table of contents; references.

Sec. 2002. Public Health Investment Fund.

Sec. 2003. Deficit neutrality.

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 assistants.

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.

Sec. 2217. Study on effectiveness of scholarships and loan repayments.

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 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.

Sec. 3143. Research on subsidies and rewards to encourage wellness and healthy behaviors.

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; 340B Program Integrity

Sec. 2501. Expanded participation in 340B program.

Sec. 2502. Improvements to 340B program integrity.

Sec. 2503. Effective date.

Subtitle B – Programs

Part 1 – Grants for Clinics and Centers

Sec. 2511. School-based health clinics.

Sec. 2512. Nurse-Managed health centers.

Sec. 2513. Federally qualified behavioral health centers.

Part 2 – Other Grant Programs

Sec. 2521. Comprehensive programs to provide education to nurses and create a pipeline to nursing.

Sec. 2522. Mental and behavioral health training.

Sec. 2523. Reauthorization of telehealth and telemedicine grant programs.

Sec. 2524. No child left unimmunized against influenza: demonstration program using elementary and secondary schools as influenza vaccination centers.

Sec. 2525. Extension of Wisewoman Program.

Sec. 2526. Healthy teen initiative to prevent teen pregnancy.

Sec. 2527. National training initiatives on autism spectrum disorders.

Sec. 2528. Implementation of medication management services in treatment of chronic diseases.

Sec. 2529. Postpartum depression.

Sec. 2530. Grants to promote positive health behaviors and outcomes.

Sec. 2531. Medical liability alternatives.

Sec. 2532. Infant mortality pilot programs.

Sec. 2533. Secondary school health sciences training program.

Sec. 2534. Community-based collaborative care networks.

Sec. 2535. Community-based overweight and obesity prevention program.

Sec. 2536. Reducing student-to-school nurse ratios.

Sec. 2537. Medical-legal partnerships.

Sec. 2538. Screening, brief intervention, referral, and treatment for mental health and substance abuse disorders.

Sec. 2539. Grants to assist in developing medical schools in federally-designated health professional shortage areas.

Part 3 – Emergency Care-Related Programs

Sec. 2551. Trauma care centers.

Sec. 2552. Emergency care coordination.

Sec. 2553. Pilot programs to improve emergency medical care.

Sec. 2554. Assisting veterans with military emergency medical training to become State-licensed or certified emergency medical technicians (EMTs).

Sec. 2555. Dental emergency responders: public health and medical response.

Sec. 2556. Dental emergency responders: homeland security.

Part 4 – Pain Care and Management Programs

Sec. 2561. Institute of Medicine Conference on Pain.

Sec. 2562. Pain research at National Institutes of Health.

Sec. 2563. Public awareness campaign on pain management.

Subtitle C – Food and Drug Administration

Part 1 – In General

Sec. 2571. National medical device registry.

Sec. 2572. Nutrition labeling of standard menu items at chain restaurants and of articles of food sold from vending machines.

Sec. 2573. Protecting consumer access to generic drugs.

Part 2 – Biosimilars

Sec. 2575. Licensure pathway for biosimilar biological products.

Sec. 2576. Fees relating to biosimilar biological products.

Sec. 2577. Amendments to certain patent provisions.

Subtitle D – Community Living Assistance Services and Supports

Sec. 2581. Establishment of national voluntary insurance program for purchasing community living assistance services and support (CLASS program).

TITLE XXXII – COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

Sec. 3201. Purpose.

Sec. 3202. Definitions.

Sec. 3203. CLASS Independence Benefit Plan.

Sec. 3204. Enrollment and disenrollment requirements.

Sec. 3205. Benefits.

Sec. 3206. CLASS Independence Fund.

Sec. 3207. CLASS Independence Advisory Council.

Sec. 3208. Regulations; annual report.

Sec. 3209. Inspector General’s report.

Subtitle E – Miscellaneous

Sec. 2585. States failing to adhere to certain employment obligations.

Sec. 2586. Health centers under Public Health Service Act; liability protections for volunteer practitioners.

Sec. 2587. Report to Congress on the current state of parasitic diseases that have been overlooked among the poorest Americans.

Sec. 2588. Office of Women’s Health.

Sec. 2588A. Offices of Minority Health.

Sec. 2589. Long-Term Care and Family Caregiver Support.

Sec. 2590. Web site on health care labor market and related educational and training opportunities.

Sec. 2591. Online health workforce training programs.

Sec. 2592. Access for individuals with disabilities.

Sec. 2593. Duplicative grant programs.

Sec. 2594. Diabetes screening collaboration and outreach program.

Sec. 2595. Improvement of vital statistics collection.

Sec. 2596. National Health Services Corps demonstration on incentive payments.

DIVISION D – INDIAN HEALTH CARE IMPROVEMENT___________________

Sec. 3001. Short title; table of contents.

TITLE I – AMENDMENTS TO INDIAN LAWS

Sec. 3101. Indian Health Care Improvement Act amended.

Sec. 3102. Native American Health and Wellness Foundation.

Sec. 3103. GAO study and report on payments for contract health services.

TITLE II – IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL SECURITY ACT

Sec. 3201. Expansion of payments under Medicare, Medicaid, and SCHIP for all covered services furnished by Indian Health Programs.

Sec. 3202. Additional provisions to increase outreach to, and enrollment of, Indians in SCHIP and Medicaid.

Sec. 3203. Solicitation of proposals for safe harbors under the Social Security Act for facilities of Indian Health Programs and urban Indian organizations.

Sec. 3204. Annual report on Indians served by Social Security Act health benefit programs.

Sec. 3205. Development of recommendations to improve interstate coordination of Medicaid and SCHIP coverage of Indian children and other children who are outside of their State of residency because of educational or other needs.


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