ith congressst session to provide affordable quality health care for all americans and reducethe growth in health care spending and for other purposesin the house of representativesoctober mr dingell for himself mr rangel mr waxman mr george millerof california mr stark mr pallone and mr andrews introducedthe following bill which was referred to the committee on energy andcommerce and in addition to the committees on education and labor ways and means oversight and government reform the budget rules natural resources and the judiciary for a period to be subsequently determinedby the speaker in each case for consideration of such provisionsas fall within the jurisdiction of the committee concerneda billto provide affordable quality health care for all americansand reduce the growth in health care spending andfor other purposes be it enacted by the senate and house of representatives of the united states of america in congress assembled section short title table of divisions titles and subtitles a short title this act be cited as the affordable health care for america act with bills hr ih table of divisions titles and subtitles this act is divided into divisions titles and subtitles as follows division a affordable health care choicestitle immediate reformstitle protections and standards for qualifiedhealth benefits planssubtitle a general standardssubtitle standards guaranteeing access to affordable coveragesubtitle standards guaranteeing access to essential benefitssubtitle additional consumer protectionssubtitle governancesubtitle relation to other requirements miscellaneoustitle iii health insurance exchange and related provisionssubtitle a health insurance exchangesubtitle public health insurance optionsubtitle individual affordability creditstitle iv shared responsibilitysubtitle a individual responsibilitysubtitle employer responsibilitytitle amendments to internal revenue code of subtitle a shared responsibilitysubtitle credit for small business employee health coverage expensessubtitle disclosures to carry out health insurance exchange subsidiessubtitle other revenue provisionsdivision medicare and medicaid improvementstitle improving health care valuesubtitle a provisions related to medicare part asubtitle provisions related to part bsubtitle provisions related to medicare parts a and bsubtitle medicare advantage reformssubtitle improvements to medicare part dsubtitle medicare rural access protectionstitle medicare beneficiary improvementssubtitle a improving and simplifying financial assistance for low incomemedicare beneficiariessubtitle reducing health disparitiessubtitle miscellaneous improvementstitle iii promoting primary care mental health services and coordinated caretitle iv qualitysubtitle a comparative effectiveness researchsubtitle nursing home transparencysubtitle quality measurementssubtitle physician payments sunshine provisionsubtitle public reporting on health care associated infectionstitle medicare graduate medical educationtitle vi program integrity with bills hr ih subtitle a increased funding to fight waste fraud and abuse subtitle enhanced penalties for fraud and abuse subtitle enhanced program and provider protectionssubtitle access to information needed to prevent fraud waste and abusetitle vii medicaid and chipsubtitle a medicaid and health reformsubtitle preventionsubtitle accesssubtitle coveragesubtitle financingsubtitle waste fraud and abusesubtitle puerto rico and the territoriessubtitle miscellaneoustitle viii revenue related provisionstitle ix miscellaneous provisionsdivision public health and workforce developmenttitle community health centerstitle workforcesubtitle a primary care workforcesubtitle nursing workforcesubtitle public health workforcesubtitle adapting workforce to evolving health system needstitle iii prevention and wellnesstitle iv quality and surveillancetitle other provisionssubtitle a drug discount for rural and other hospitals program integritysubtitle programssubtitle food and drug administrationsubtitle community living assistance services and supportssubtitle miscellaneousdivision indian health care improvementtitle amendments to indian lawstitle improvement of indian health care providedunder the social security act division a affordable health care choices sec purpose table of contents of division general definitions a purpose in general the purpose of this division is to provide affordable quality health care for all with bills hr ih americans and reduce the growth in health care spending building on current system this division achieves this purpose by building on what works in today health care system while repairing the aspects that are broken insurance reforms this division a enacts strong insurance market reforms creates a new health insurance exchange with a public health insurance option alongside private plans includes sliding scale affordability credits and initiates shared responsibility among workers employers and the government so that all americans have coverage of essential health benefits health delivery reform this division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses families and government table of contents of division the table of contents of this division is as follows sec purpose table of contents of division general definitions with bills hr ihtitle immediate reformssec national high risk pool programsec ensuring value and lower premiumssec ending health insurance rescission abusesec sunshine on price gouging by health insurance issuerssec requiring the option of extension of dependent coverage for uninsuredyoung adultssec limitations on preexisting condition exclusions in group health plansin advance of applicability of new prohibition of preexistingcondition exclusionssec prohibiting acts of domestic violence from being treated as preexistingconditionssec ending health insurance denials and delays of necessary treatmentfor children with deformitiessec elimination of lifetime limitssec prohibition against postretirement reductions of retiree health benefitsby group health planssec reinsurance program for retireessec wellness program grantssec extension of cobra continuation coveragesec state health access program grantssec administrative simplificationtitle protections and standards for qualifiedhealth benefits planssubtitle a general standardssec requirements reforming health insurance marketplacesec protecting the choice to keep current coveragesubtitle standards guaranteeing access to affordable coveragesec prohibiting preexisting condition exclusionssec guaranteed issue and renewal for insured plans and prohibiting rescissionssec insurance rating rulessec nondiscrimination in benefits parity in mental health and substanceabuse disorder benefitssec ensuring adequacy of provider networkssec requiring the option of extension of dependent coverage for uninsuredyoung adultssec consistency of costs and coverage under qualified health benefitsplans during plan yearsubtitle standards guaranteeing access to essential benefitssec coverage of essential benefits packagesec essential benefits package definedsec health benefits advisory committeesec process for adoption of recommendations adoption of benefit standardssubtitle additional consumer protectionssec requiring fair marketing practices by health insurers with bills hr ihsec requiring fair grievance and appeals mechanismssec requiring information transparency and plan disclosuresec application to qualified health benefits plans not offered through thehealth insurance exchangesec timely payment of claimssec standardized rules for coordination and subrogation of benefitssec application of administrative simplificationsec state prohibitions on discrimination against health care providerssec protection of physician prescriber informationsec dissemination of advance care planning informationsubtitle governancesec health choices administration health choices commissionersec duties and authority of commissionersec consultation and coordinationsec health insurance ombudsmansubtitle relation to other requirements miscellaneoussec relation to other requirementssec prohibiting discrimination in health caresec whistleblower protectionsec construction regarding collective bargainingsec severabilitysec treatment of hawaii prepaid health care actsec actions by state attorneys generalsec application of state and federal laws regarding abortionsec nondiscrimination on abortion and respect for rights of consciencesec authority of federal trade commissionsec construction regarding standard of caresec restoring application of antitrust laws to health sector insurerssec study and report on methods to increase ehr use by small healthcare providerstitle iii health insurance exchange and relatedprovisionssubtitle a health insurance exchangesec establishment of health insurance exchange outline of duties definitionssec exchange eligible individuals and employerssec benefits package levelssec contracts for the offering of exchange participating health benefitsplanssec outreach and enrollment of exchange eligible individuals and employersin exchange participating health benefits plansec other functionssec health insurance exchange trust fundsec optional operation of state based health insurance exchangessec interstate health insurance compactssec health insurance cooperativessec retention of dod and va authoritysubtitle public health insurance option with bills hr ihsec establishment and administration of a public health insurance optionas an exchange qualified health benefits plansec premiums and financingsec payment rates for items and servicessec modernized payment initiatives and delivery system reformsec provider participationsec application of fraud and abuse provisionssec application of hipaa insurance requirementssec application of health information privacy security and electronictransaction requirementssec enrollment in public health insurance option is voluntarysec enrollment in public health insurance option by members of congresssec reimbursement of secretary of veterans affairssubtitle individual affordability creditssec availability through health insurance exchangesec affordable credit eligible individualsec affordability premium creditsec affordability cost sharing creditsec income determinationssec special rules for application to territoriessec no federal payment for undocumented alienstitle iv shared responsibilitysubtitle a individual responsibilitysec individual responsibilitysubtitle employer responsibilitypart health coverage participation requirementssec health coverage participation requirementssec employer responsibility to contribute toward employee and dependentcoveragesec employer contributions in lieu of coveragesec authority related to improper steeringsec impact study on employer responsibility requirementssec study on employer hardship exemptionpart satisfaction of health coverage participationrequirementssec satisfaction of health coverage participation requirements under theemployee retirement income security act of sec satisfaction of health coverage participation requirements under theinternal revenue code of sec satisfaction of health coverage participation requirements under thepublic health service actsec additional rules relating to health coverage participation requirementstitle amendments to internal revenue code of subtitle a provisions relating to health care reform with bills hr ihpart shared responsibilitysubpart a individual responsibilitysec tax on individuals without acceptable health care coveragesubpart employer responsibilitysec election to satisfy health coverage participation requirementssec health care contributions of nonelecting employerspart credit for small business employee health coverageexpensessec credit for small business employee health coverage expensespart limitations on health care related expendituressec distributions for medicine qualified only if for prescribed drug or insulinsec limitation on health flexible spending arrangements under cafeteriaplanssec increase in penalty for nonqualified distributions from health savingsaccountssec denial of deduction for federal subsidies for prescription drug planswhich have been excluded from gross incomepart other provisions to carry out health insurance reformsec disclosures to carry out health insurance exchange subsidiessec offering of exchange participating health benefits plans through cafeteriaplanssec exclusion from gross income of payments made under reinsuranceprogram for retireessec class program treated in same manner as long term care insurancesec exclusion from gross income for medical care provided for indianssubtitle other revenue provisionspart general provisionssec surcharge on high income individualssec excise tax on medical devicessec expansion of information reporting requirementssec delay in application of worldwide allocation of interestpart prevention of tax avoidancesec limitation on treaty benefits for certain deductible paymentssec codification of economic substance doctrine penaltiessec certain large or publicly traded persons made subject to a more likelythan not standard for avoiding penalties on underpaymentspart parity in health benefitssec certain health related benefits applicable to spouses and dependentsextended to eligible beneficiaries with bills hr ih general definitions except as otherwise provided in this division acceptable coverage the term acceptable coverage has the meaning given such term in section basic plan the term basic plan has the meaning given such term in section commissioner the term commissioner means the health choices commissioner established under section cost sharing the term cost sharing includes deductibles coinsurance copayments and similar charges but does not include premiums balance billing amounts for non network providers or spending for non covered services dependent the term dependent has the meaning given such term by the commissioner and includes a spouse employment based health plan the term employment based health plan a means a group health plan as defined in section a of the employee retirement income security act of includes such a plan that is the following with bills hr ih federal state and tribal governmental plans a governmental plan as defined in section of the employee retirement income security act of including a health benefits plan offered under chapter of title united states code church plans a church plan as defined in section of the employee retirement income security act of and excludes coverage described in section relating to tricare enhanced plan the term enhanced plan has the meaning given such term in section essential benefits package the term essential benefits package is defined in section a exchange participating health benefits plan the term exchange participating health benefits plan means a qualified health benefits plan that is offered through the health insurance exchange and be purchased directly from with bills hr ih the entity offering the plan or through enrollment agents and brokers family the term family means an individual and includes the individual dependents federal poverty level fpl the terms federal poverty level and fpl have the meaning given the term poverty line in section of the community services block grant act usc including any revision required by such section health benefits plan the term health benefits plan means health insurance coverage and an employment based health plan and includes the public health insurance option health insurance coverage the term health insurance coverage has the meaning given such term in section of the public health service act but does not include coverage in relation to its provision of excepted benefits a described in paragraph of subsection of such section or described in paragraph or of such subsection if the benefits are provided under a separate policy certificate or contract of insurance with bills hr ih health insurance issuer the term health insurance issuer has the meaning given such term in section of the public health service act health insurance exchange the term health insurance exchange means the health insurance exchange established under section indian the term indian has the meaning given such term in section of the indian health care improvement act usc indian health care provider the term indian health care provider means a health care program operated by the indian health service an indian tribe tribal organization or urban indian organization as such terms are defined in section of the indian health care improvement act usc medicaid the term medicaid means a state plan under title xix of the social security act whether or not the plan is operating under a waiver under section of such act medicaid eligible individual the term medicaid eligible individual means an indi with bills hr ih vidual who is eligible for medical assistance under medicaid medicare the term medicare means the health insurance programs under title xviii of the social security act plan sponsor the term plan sponsor has the meaning given such term in section of the employee retirement income security act of plan year the term plan year means a with respect to an employment based health plan a plan year as specified under such plan or with respect to a health benefits plan other than an employment based health plan a month period as specified by the commissioner premium plan premium plus plan the terms premium plan and premium plus plan have the meanings given such terms in section qhbp offering entity the terms qhbp offering entity means with respect to a health benefits plan that is with bills hr ih a a group health plan as defined subject to subsection in section a of the employee retirement income security act of the plan sponsor in relation to such group health plan except that in the case of a plan maintained jointly by or more employers and or more employee organizations and with respect to which an employer is the primary source of financing such term means such employer health insurance coverage the health insurance issuer offering the coverage the public health insurance option the secretary of health and human services a non federal governmental plan as defined in section of the public health service act the state or political subdivision of a state or agency or instrumentality of such state or subdivision which establishes or maintains such plan or a federal governmental plan as defined in section of the public health service act the appropriate federal official with bills hr ih qualified health benefits plan the term qualified health benefits plan means a health benefits plan that a meets the requirements for such a plan under title and includes the public health insurance option and is offered by a qhbp offering entity that meets the applicable requirements of such title with respect to such plan public health insurance option the term public health insurance option means the public health insurance option as provided under subtitle of title iii service area premium rating area the terms service area and premium rating area mean with respect to health insurance coverage a offered other than through the health insurance exchange such an area as established by the qhbp offering entity of such coverage in accordance with applicable state law and offered through the health insurance exchange such an area as established by such entity in accordance with applicable state law with bills hr ih and applicable rules of the commissioner for exchange participating health benefits plans state the term state means the states and the district of columbia and includes a for purposes of title puerto rico the virgin islands guam american samoa and the northern mariana islands and for purposes of titles and iii as elected under and subject to section puerto rico the virgin islands guam american samoa and the northern mariana islands state medicaid agency the term state medicaid agency means with respect to a medicaid plan the single state agency responsible for administering such plan under title xix of the social security act y etc the terms y y and similar subsequently numbered terms mean and subsequent years respectively title immediate reforms sec national high risk pool program a in general the secretary of health and human services in this section referred to as the secretary shall establish a temporary national high risk with bills hr ih pool program in this section referred to as the program to provide health benefits to eligible individuals during the period beginning on january and subject to subsection ending on the date on which the health insurance exchange is established administration the secretary carry out this section directly or pursuant to agreements grants or contracts with states through state high risk pool programs provided that the requirements of this section are met eligibility for purposes of this section the term eligible individual means an individual who a is not eligible for benefits under title xviii xix or xxi of the social security act or coverage under an employmentbased health plan not including coverage under a cobra continuation provision as defined in section and who is an eligible individual under section of the public health service act or with bills hr ih is medically eligible for the program by virtue of being an individual described in subsection at any time during the month period ending on the date the individual applies for high risk pool coverage under this section who is the spouse or dependent of an individual who is described in paragraph or who has not had health insurance coverage or coverage under an employment based health plan for at least the month period immediately preceding the date of the individual application for high risk pool coverage under this section for purposes of paragraph a a person who is in a waiting period as defined in section of the public health service act shall not be considered to be eligible for coverage under an employment based health plan medically eligible requirements for purposes of subsection an individual described in this subsection is an individual who during the month period ending on the date the individual applies for high risk pool coverage under this section applied for individual health insurance coverage and with bills hr ih a was denied such coverage because of a preexisting condition or health status or was offered such coverage under terms that limit the coverage for such a preexisting condition or at a premium rate that is above the premium rate for high risk pool coverage under this section or who has an eligible medical condition as defined by the secretary in making a determination under paragraph of whether an individual was offered individual coverage at a premium rate above the premium rate for high risk pool coverage the secretary shall make adjustments to offset differences in premium rating that are attributable solely to differences in age rating enrollment to enroll in coverage in the program an individual shall submit to the secretary an application for participation in the program at such time in such manner and containing such information as the secretary shall require attest that the individual is an eligible individual and is a resident of one of the states or the district of columbia and with bills hr ih if the individual had other prior health insurance coverage or coverage under an employmentbased health plan during the previous months provide information as to the nature and source of such coverage and reasons for its discontinuance protection against dumping risks by insurers in general the secretary shall establish criteria for determining whether health insurance issuers and employment based health plans have discouraged an individual from remaining enrolled in prior coverage based on that individual health status sanctions an issuer or employmentbased health plan shall be responsible for reimbursing the program for the medical expenses incurred by the program for an individual who based on criteria established by the secretary the secretary finds was encouraged by the issuer to disenroll from health benefits coverage prior to enrolling in the program the criteria shall include at least the following circumstances a in the case of prior coverage obtained through an employer the provision by the employer group health plan or the issuer of with bills hr ih money or other financial consideration for disenrolling from the coverage in the case of prior coverage obtained directly from an issuer or under an employment based health plan the provision by the issuer or plan of money or other financial consideration for disenrolling from the coverage or in the case of an individual whose premium for the prior coverage exceeded the premium required by the program adjusted based on the age factors applied to the prior coverage the prior coverage is a policy that is no longer being actively marketed as defined by the secretary by the issuer or the prior coverage is a policy for which duration of coverage form issue or health status are factors that can be considered in determining premiums at renewal construction nothing in this subsection shall be construed as constituting exclusive remedies for violations of criteria established under with bills hr ih paragraph or as preventing states from applying or enforcing such paragraph or other provisions under law with respect to health insurance issuers covered benefits cost sharing premiums and consumer protections premium the monthly premium charged to eligible individuals for coverage under the program a vary by age so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of to shall be set at a level that does not exceed percent of the prevailing standard rate for comparable coverage in the individual market and shall be adjusted for geographic variation in costs health insurance issuers shall provide such information as the secretary require to determine prevailing standard rates under this paragraph the secretary shall establish standard rates in consultation with the national association of insurance commissioners covered benefits covered benefits under the program shall be determined by the sec with bills hr ih retary and shall be consistent with the basic categories in the essential benefits package described in section under such benefits package a the annual deductible for such benefits not be higher than for an individual or such higher amount for a family as determined by the secretary there not be annual or lifetime limits and the maximum cost sharing with respect to an individual or family for a year shall not exceed for an individual or for a family no preexisting condition exclusion periods no preexisting condition exclusion period shall be imposed on coverage under the program appeals the secretary shall establish an appeals process for individuals to appeal a determination of the secretary a with respect to claims submitted under this section and with respect to eligibility determinations made by the secretary under this section state contribution maintenance of effort as a condition of providing health bene with bills hr ih fits under this section to eligible individual residing in a state a in the case of a state in which a qualified high risk pool as defined under section of the public health service act was in effect as of july the secretary shall require the state make a maintenance of effort payment each year that the high risk pool is in effect equal to an amount not less than the amount of all sources of funding for high risk pool coverage made by that state in the year ending july and in the case of a state which required health insurance issuers to contribute to a state high risk pool or similar arrangement for the assessment against such issuers for pool losses the state shall maintain such a contribution arrangement among such issuers limiting program expenditures the secretary shall with respect to the program a establish procedures to protect against fraud waste and abuse under the program and provide for other program integrity methods with bills hr ih treatment as creditable coverage coverage under the program shall be treated for purposes of applying the definition of creditable coverage under the provisions of title xxvii of the public health service act part of subtitle of title of employee retirement income security act of and chapter of the internal revenue code of and any other provision of law that references such provisions in the same manner as if it were coverage under a state health benefits risk pool described in section of the public health service act funding termination of authority in general there is appropriated to the secretary out of any moneys in the treasury not otherwise appropriated to pay claims against and administrative costs of the high risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high risk pool such funds shall be available without fiscal year limitation insufficient funds if the secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high risk pool will be less than the amount of the ex with bills hr ih penses the secretary shall make such adjustments as are necessary to eliminate such deficit including reducing benefits increasing premiums or establishing waiting lists termination of authority a in general except as provided in subparagraph coverage of eligible individuals under a high risk pool shall terminate as of the date on which the health insurance exchange is established transition to exchange the secretary shall develop procedures to provide for the transition of eligible individuals who are enrolled in health insurance coverage offered through a high risk pool established under this section to be enrolled in acceptable coverage such procedures shall ensure that there is no lapse in coverage with respect to the individual and extend coverage offered through such a high risk pool beyond if the secretary determines necessary to avoid such a lapse sec ensuring value and lower premiums a group health insurance coverage title xxvii of the public health service act is amended by inserting after section the following new section with bills hr ih sec ensuring value and lower premiums a in general each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the secretary but not less than percent the issuer shall provide in a manner specified by the secretary for rebates to enrollees of the amount by which the issuer medical loss ratio is less than the level so specified implementation the secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate it based on the average medical loss ratio in a health insurance issuer book of business for the small and large group market such methodology shall be designed to take into account the special circumstances of smaller plans different types of plans and newer plans in determining the medical loss ratio the secretary shall exclude state taxes and licensing or regulatory fees such methodology shall be designed and exceptions shall be established to ensure adequate participation by health insurance issuers competition in the health insurance market and value for consumers so that their premiums are used for services sunset subsections a and shall not apply to health insurance coverage on and after the first with bills hr ih date that health insurance coverage is offered through the health insurance exchange individual health insurance coverage such title is further amended by inserting after section the following new section sec ensuring value and lower premiums the provisions of section shall apply to health insurance coverage offered in the individual market in the same manner as such provisions apply to health insurance coverage offered in the small or large group market except to the extent the secretary determines that the application of such section destabilize the existing individual market immediate implementation the amendments made by this section shall apply in the group and individual market for plan years beginning on or after january or as soon as practicable after such date sec ending health insurance rescission abuse a clarification regarding application of guaranteed renewability of individual and group health insurance coverage sections and of the public health service act usc gg– gg– are each amended in its heading by inserting and continuation in force including prohibiverdatenov oct jkt po frm fmt sfmt bills hih with bills hr ih tion of rescission after guaranteed renewability and in subsection a by inserting including without rescission after continue in force secretarial guidance regarding rescissions group health insurance market section of such act usc gg– is amended by adding at the end the following rescission a health insurance issuer rescind group health insurance coverage only upon clear and convincing evidence of fraud described in subsection under procedures that provide for independent external third party review individual health market section of such act usc gg– is amended by adding at the end the following rescission a health insurance issuer rescind individual health insurance coverage only upon clear and convincing evidence of fraud described in subsection under procedures that provide for independent external third party review guidance the secretary of health and human services no later than days after the date of the enactment of this act shall issue guid with bills hr ih ance implementing the amendments made by paragraphs and including procedures for independent external third party review opportunity for independent external third party review in certain cases individual market subpart of part of title xxvii of such act usc gg– et seq is amended by adding at the end the following sec opportunity for independent external third party review in cases of rescission a notice and review right if a health insurance issuer determines to rescind health insurance coverage for an individual in the individual market before such rescission take effect the issuer shall provide the individual with notice of such proposed rescission and an opportunity for a review of such determination by an independent external third party under procedures specified by the secretary under section independent determination if the individual requests such review by an independent external third party of a rescission of health insurance coverage the coverage shall remain in effect until such third party determines that the coverage be rescinded under the guidance issued by the secretary under section with bills hr ih application to group health insurance such title is further amended by adding after section the following new section sec opportunity for independent external third party review in cases of rescission the provisions of section shall apply to group health insurance coverage in the same manner as such provisions apply to individual health insurance coverage except that any reference to section is deemed a reference to section effective date the amendments made by this section shall take effect on the date of the enactment of this act and shall apply to rescissions occurring on and after july with respect to health insurance coverage issued before on or after such date sec sunshine on price gouging by health insurance issuers the secretary of health and human services in conjunction with states shall establish a process for the annual review of increases in premiums for health insurance coverage such process shall require health insurance issuers to submit a justification for any premium increases prior to implementation of the increase with bills hr ih sec requiring the option of extension of dependent coverage for uninsured young adults a under group health plans phsa title xxvii of the public health service act is amended by inserting after section the following new section sec requiring the option of extension of dependent coverage for uninsured young adults a in general a group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan that provides coverage for dependent children shall make available such coverage at the option of the participant involved for one or more qualified children as defined in subsection of the participant qualified child defined in this section the term qualified child means with respect to a participant in a group health plan or group health insurance coverage an individual who but for age would be treated as a dependent child of the participant under such plan or coverage and who is under years of age and is not enrolled as a participant beneficiary or enrollee other than under this section with bills hr ih section or section of the employee retirement income security act of under any health insurance coverage or group health plan premiums nothing in this section shall be construed as preventing a group health plan or health insurance issuer with respect to group health insurance coverage from increasing the premiums otherwise required for coverage provided under this section consistent with standards established by the secretary based upon family size employee retirement income security act of a in general part of subtitle of title of the employee retirement income security act of is amended by inserting after section the following new section sec requiring the option of extension of dependent coverage for uninsured young adults a in general a group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan that provides coverage for dependent children shall make available such coverage at the option of the participant involved for one or more with bills hr ih qualified children as defined in subsection of the participant qualified child defined in this section the term qualified child means with respect to a participant in a group health plan or group health insurance coverage an individual who but for age would be treated as a dependent child of the participant under such plan or coverage and who is under years of age and is not enrolled as a participant beneficiary or enrollee other than under this section under any health insurance coverage or group health plan premiums nothing in this section shall be construed as preventing a group health plan or health insurance issuer with respect to group health insurance coverage from increasing the premiums otherwise required for coverage provided under this section consistent with standards established by the secretary based upon family size clerical amendment the table of contents of such act is amended by inserting after the item relating to section the following new item sec requiring the option of extension of dependent coverage for uninsuredyoung adults with bills hr ih irc a in general subchapter a of chapter of the internal revenue code of is amended by adding at the end the following new section sec requiring the option of extension of dependent coverage for uninsured young adults a in general a group health plan that provides coverage for dependent children shall make available such coverage at the option of the participant involved for one or more qualified children as defined in subsection of the participant qualified child defined in this section the term qualified child means with respect to a participant in a group health plan an individual who but for age would be treated as a dependent child of the participant under such plan and who is under years of age and is not enrolled as a participant beneficiary or enrollee other than under this section section of the employee retirement income security act of or section or of the public health service act under any health insurance coverage or group health plan with bills hr ih premiums nothing in this section shall be construed as preventing a group health plan from increasing the premiums otherwise required for coverage provided under this section consistent with standards established by the secretary based upon family size clerical amendment the table of sections of such chapter is amended by inserting after the item relating to section the following sec requiring the option of extension of dependent coverage for uninsuredyoung adults individual health insurance coverage title xxvii of the public health service act is amended by inserting after section the following new section sec requiring the option of extension of dependent coverage for uninsured young adults the provisions of section shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market effective dates group health plans the amendments made by subsection a shall apply to group health with bills hr ih plans for plan years beginning on or after january individual health insurance coverage section of the public health service act as inserted by subsection shall apply with respect to health insurance coverage offered sold issued renewed in effect or operated in the individual market on or after january sec limitations on preexisting condition exclusions in group health plans in advance of applicability of new prohibition of preexisting condition exclusions a amendments to the employee retirement income security act of reduction in look back period section a of the employee retirement income security act of usc a is amended by striking month period and inserting day period reduction in permitted preexisting condition limitation period section a of such act usc a is amended by striking months and inserting months with bills hr ih and by striking months and inserting months sunset of interim limitation section of such act usc is amended by adding at the end the following new subsection termination this section shall cease to apply to any group health plan as of the date that such plan becomes subject to the requirements of section of the relating to prohibiting preexisting condition exclusions amendments to the internal revenue code of reduction in look back period section a of the internal revenue code of is amended by striking month period and inserting day period reduction in permitted preexisting condition limitation period section a of such code is amended by striking months and inserting months and by striking months and inserting months sunset of interim limitation section of such code is amended by adding at the end the following new subsection with bills hr ih termination this section shall cease to apply to any group health plan as of the date that such plan becomes subject to the requirements of section of the relating to prohibiting preexisting condition exclusions amendments to public health service act reduction in look back period section a of the public health service act usc gg a is amended by striking month period and inserting day period reduction in permitted preexisting condition limitation period section a of such act usc gg a is amended by striking months and inserting months and by striking months and inserting months sunset of interim limitation section of such act usc gg is amended by adding at the end the following new subsection termination this section shall cease to apply to any group health plan as of the date that such plan becomes subject to the requirements of section of the relating to prohibiting preexisting condition exclusions with bills hr ih miscellaneous technical amendment section a of such act usc gg– is amended by striking and inserting effective date in general except as provided in paragraph the amendments made by this section shall apply with respect to group health plans for plan years beginning on or after january special rule for collective bargaining agreements in the case of a group health plan maintained pursuant to or more collective bargaining agreements between employee representatives and or more employers ratified before the date of the enactment of this act the amendments made by this section shall not apply to plan years beginning before the earlier of a the date on which the last of the collective bargaining agreements relating to the plan terminates determined without regard to any extension thereof agreed to after the date of the enactment of this act years after the date of the enactment of this act with bills hr ih sec prohibiting acts of domestic violence from being treated as preexisting conditions a erisa section of the employee retirement income security act of usc is amended in the heading by inserting or domestic violence after pregnancy and by inserting or domestic violence after relating to pregnancy phsa group market section of the public health service act usc gg is amended a in the heading by inserting or domestic violence after pregnancy and by inserting or domestic violence after relating to pregnancy individual market title xxvii of such act is amended by inserting after section the following new section sec prohibition on domestic violence as preexisting condition a health insurance issuer offering health insurance coverage in the individual market not on the basis of domestic violence impose any preexisting condition ex with bills hr ih clusion as defined in section a with respect to such coverage irc section of the internal revenue code of is amended in the heading by inserting or domestic violence after pregnancy and by inserting or domestic violence after relating to pregnancy effective dates except as otherwise provided in this subsection the amendments made by this section shall apply with respect to group health plans and health insurance issuers offering group health insurance coverage for plan years beginning on or after january the amendment made by subsection shall apply with respect to health insurance coverage offered sold issued renewed in effect or operated in the individual market on or after such date sec ending health insurance denials and delays of necessary treatment for children with deformities a amendments to the employee retirement income security act of with bills hr ih in general subpart of part of subtitle of title of the employee retirement income security act of is amended by adding at the end the following new section sec standards relating to benefits for minor child congenital or developmental deformity or disorder a requirements for treatment for children with deformities in general a group health plan and a health insurance issuer offering group health insurance coverage that provides coverage for surgical benefits shall provide coverage for outpatient and inpatient diagnosis and treatment of a minor child congenital or developmental deformity disease or injury a minor child shall include any individual who is years of age or younger treatment defined a in general in this section the term treatment includes reconstructive surgical procedures procedures that are generally performed to improve function but also be performed to approximate a normal appearance that are performed on abnormal structures of the body caused by congenital defects with bills hr ih developmental abnormalities trauma infection tumors or disease including procedures that do not materially affect the function of the body part being treated and procedures for secondary conditions and follow up treatment exception such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self esteem notice a group health plan under this part shall comply with the notice requirement under section other than paragraph with respect to the requirements of this section conforming amendment a subsection of section of such act is amended by striking section and inserting sections and the table of contents in section of such act is amended by inserting after the item relating to section the following new item sec standards relating to benefits for minor child congenital or developmentaldeformity or disorder amendments to the internal revenue code of with bills hr ih in general subchapter of chapter of the internal revenue code of is amended by adding at the end the following new section sec standards relating to benefits for minor child congenital or developmental deformity or disorder a requirements for treatment for children with deformities a group health plan that provides coverage for surgical benefits shall provide coverage for outpatient and inpatient diagnosis and treatment of a minor child congenital or developmental deformity disease or injury a minor child shall include any individual who is years of age or younger treatment defined in general in this section the term treatment includes reconstructive surgical procedures procedures that are generally performed to improve function but also be performed to approximate a normal appearance that are performed on abnormal structures of the body caused by congenital defects developmental abnormalities trauma infection tumors or disease including a procedures that do not materially affect the function of the body part being treated and with bills hr ih procedures for secondary conditions and follow up treatment exception such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self esteem clerical amendment the table of sections for subchapter of chapter of such code is amended by adding at the end the following new item sec standards relating to benefits for minor child congenital or developmentaldeformity or disorder amendments to the public health service act in general subpart of part a of title xxvii of the public health service act is amended by adding at the end the following new section sec standards relating to benefits for minor child congenital or developmental deformity or disorder a requirements for treatment for children with deformities in general a group health plan and a health insurance issuer offering group health insurance coverage that provides coverage for surgical benefits shall provide coverage for outpatient and in with bills hr ih patient diagnosis and treatment of a minor child congenital or developmental deformity disease or injury a minor child shall include any individual who is years of age or younger treatment defined a in general in this section the term treatment includes reconstructive surgical procedures procedures that are generally performed to improve function but also be performed to approximate a normal appearance that are performed on abnormal structures of the body caused by congenital defects developmental abnormalities trauma infection tumors or disease including procedures that do not materially affect the function of the body part being treated and procedures for secondary conditions and follow up treatment exception such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self esteem notice a group health plan under this part shall comply with the notice requirement under section with bills hr ih of the employee retirement income security act of with respect to the requirements of this section as if such section applied to such plan individual health insurance subpart of part of title xxvii of the public health service act as amended by section is further amended by adding at the end the following new section sec standards relating to benefits for minor child congenital or developmental deformity or disorder the provisions of section shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as such provisions apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market conforming amendments a section of such act usc gg– is amended by striking section and inserting sections and section of such act usc gg– is amended by striking with bills hr ih section and inserting sections and effective dates the amendments made by this section shall apply with respect to group health plans and health insurance issuers offering group health insurance coverage for plan years beginning on or after january the amendment made by subsection shall apply with respect to health insurance coverage offered sold issued renewed in effect or operated in the individual market on or after such date coordination section of the health insurance portability and accountability act of is amended by striking and the amendments made by this subtitle and section and inserting part of subtitle of title of the employee retirement income security act of parts a and of title xxvii of the public health service act and chapter of the internal revenue code of sec elimination of lifetime limits a amendments to the employee retirement income security act of in general subpart of part of subtitle of title of the employee retirement income with bills hr ih security act of usc et seq as amended by section is amended by adding at the end the following sec elimination of lifetime aggregate limits a in general a group health plan and a health insurance issuer providing health insurance coverage in connection with a group health plan not impose an aggregate dollar lifetime limit with respect to benefits payable under the plan or coverage definition in this section the term aggregate dollar lifetime limit means with respect to benefits under a group health plan or health insurance coverage offered in connection with a group health plan a dollar limitation on the total amount that be paid with respect to such benefits under the plan or health insurance coverage with respect to an individual or other coverage unit on a lifetime basis clerical amendment the table of contents in section of such act is amended by inserting after the item relating to section the following new item sec elimination of lifetime aggregate limits amendments to the internal revenue code of in general subchapter of chapter of the internal revenue code of as with bills hr ih amended by section is amended by adding at the end the following new section sec elimination of lifetime aggregate limits a in general a group health plan not impose an aggregate dollar lifetime limit with respect to benefits payable under the plan definition in this section the term aggregate dollar lifetime limit means with respect to benefits under a group health plan a dollar limitation on the total amount that be paid with respect to such benefits under the plan with respect to an individual or other coverage unit on a lifetime basis clerical amendment the table of sections for subchapter of chapter of such code as amended by section is amended by adding at the end the following new item sec standards relating to benefits for minor child congenital or developmentaldeformity or disorder amendment to the public health service act relating to the group market in general subpart of part a of title xxvii of the public health service act usc gg– et seq as amended by section is amended by adding at the end the following with bills hr ih sec elimination of lifetime aggregate limits a in general a group health plan and a health insurance issuer providing health insurance coverage in connection with a group health plan not impose an aggregate dollar lifetime limit with respect to benefits payable under the plan or coverage definition in this section the term aggregate dollar lifetime limit means with respect to benefits under a group health plan or health insurance coverage a dollar limitation on the total amount that be paid with respect to such benefits under the plan or health insurance coverage with respect to an individual or other coverage unit on a lifetime basis individual market subpart of part of title xxvii of the public health service act usc gg– et seq as amended by section is amended by adding at the end the following sec elimination of annual or lifetime aggregate limits the provisions of section shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance with bills hr ih issuer in connection with a group health plan in the small or large group market effective dates the amendments made by this section shall apply with respect to group health plans and health insurance issuers offering group health insurance coverage for plan years beginning on or after january the amendment made by subsection shall apply with respect to health insurance coverage offered sold issued renewed in effect or operated in the individual market on or after such date sec prohibition against postretirement reductions of retiree health benefits by group health plans a in general part of subtitle of title of the employee retirement income security act of as amended by sections and is amended by inserting after section the following new section sec protection against postretirement reduction of retiree health benefits a in general every group health plan shall contain a provision which expressly bars the plan or any fiduciary of the plan from reducing the benefits provided under the plan to a retired participant or beneficiary of with bills hr ih such participant if such reduction affects the benefits provided to the participant or beneficiary as of the date the participant retired for purposes of the plan and such reduction occurs after the participant retirement unless such reduction is also made with respect to active participants nothing in this section shall prohibit a plan from enforcing a total aggregate cap on amounts paid for retiree health coverage that is part of the plan at the time of retirement no reduction notwithstanding that a group health plan contain a provision reserving the general power to amend or terminate the plan or a provision specifically authorizing the plan to make post retirement reductions in retiree health benefits it shall be prohibited for any group health plan whether through amendment or otherwise to reduce the benefits provided to a retired participant or the participant beneficiary under the terms of the plan if such reduction of benefits occurs after the date the participant retired for purposes of the plan and reduces benefits that were provided to the participant or the participant beneficiary as of the date the participant retired unless such reduction is also made with respect to active participants reduction described for purposes of this section a reduction in benefits with bills hr ih with respect to premiums occurs under a group health plan when a participant or beneficiary share of the total premium or in the case of a self insured plan the costs of coverage of the plan substantially increases or with respect to other cost sharing and benefits under a group health plan occurs when there is a substantial decrease in the actuarial value of the benefit package under the plan for purposes of this section the term substantial means an increase in the total premium share or a decrease in the actuarial value of the benefit package that is greater than percent conforming amendment the table of contents in section of such act as amended by sections and is amended by inserting after the item relating to section the following new item sec protection against postretirement reduction of retiree health benefits waiver an employer in a form and manner which shall be prescribed by the secretary of labor apply for a waiver from this provision if the employer can reasonably demonstrate that meeting the requirements of this section would impose an undue hardship on the employer with bills hr ih effective date the amendments made by this section shall take effect on the date of the enactment of this act sec reinsurance program for retirees a establishment in general not later than days after the date of the enactment of this act the secretary of health and human services shall establish a temporary reinsurance program in this section referred to as the reinsurance program to provide reimbursement to assist participating employment based plans with the cost of providing health benefits to retirees and to eligible spouses surviving spouses and dependents of such retirees definitions for purposes of this section a the term eligible employment based plan means a group health plan or employment based health plan that is maintained by one or more employers including without limitation any state or political subdivision thereof or any agency or instrumentality of any of the foregoing former with bills hr ih employers or employee organizations or associations or a voluntary employees beneficiary association or a committee or board of individuals appointed to administer such plan or a multiemployer plan as defined in section of the employee retirement income security act of and provides health benefits to retirees the term health benefits means medical surgical hospital prescription drug and such other benefits as shall be determined by the secretary whether self funded or delivered through the purchase of insurance or otherwise the term participating employmentbased plan means an eligible employmentbased plan that is participating in the reinsurance program the term retiree means with respect to a participating employment benefit plan an individual who is years of age or older with bills hr ih is not eligible for coverage under title xviii of the social security act and iii is not an active employee of an employer maintaining the plan or of any employer that makes or has made substantial contributions to fund such plan the term secretary means secretary of health and human services participation to be eligible to participate in the reinsurance program an eligible employment based plan shall submit to the secretary an application for participation in the program at such time in such manner and containing such information as the secretary shall require payment submission of claims a in general under the reinsurance program a participating employment based plan shall submit claims for reimbursement to the secretary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted basis for claims each claim submitted under subparagraph a shall be based on the actual amount expended by the partici with bills hr ih pating employment based plan involved within the plan year for the appropriate employment based health benefits provided to a retiree or to the spouse surviving spouse or dependent of a retiree in determining the amount of any claim for purposes of this subsection the participating employment based plan shall take into account any negotiated price concessions such as discounts direct or indirect subsidies rebates and direct or indirect remunerations obtained by such plan with respect to such health benefits for purposes of calculating the amount of any claim the costs paid by the retiree or by the spouse surviving spouse or dependent of the retiree in the form of deductibles copayments and coinsurance shall be included along with the amounts paid by the participating employment based plan program payments and limit if the secretary determines that a participating employment based plan has submitted a valid claim under paragraph the secretary shall reimburse such plan for percent of that portion of the costs attributable to such claim that exceeds but is less than such amounts shall be adjusted with bills hr ih each year based on the percentage increase in the medical care component of the consumer price index rounded to the nearest multiple of for the year involved use of payments amounts paid to a participating employment based plan under this subsection shall only be used to reduce the costs of health care provided by the plan by reducing premium costs for the employer or employee association maintaining the plan and reducing premium contributions deductibles copayments coinsurance or other out of pocket costs for plan participants and beneficiaries where the benefits are provided by an employer to members of a represented bargaining unit the allocation of payments among these purposes shall be subject to collective bargaining amounts paid to the plan under this subsection shall not be used as general revenues by the employer or employee association maintaining the plan or for any other purposes the secretary shall develop a mechanism to monitor the appropriate use of such payments by such plans appeals and program protections the secretary shall establish with bills hr ih a an appeals process to permit participating employment based plans to appeal a determination of the secretary with respect to claims submitted under this section and procedures to protect against fraud waste and abuse under the program audits the secretary shall conduct annual audits of claims data submitted by participating employment based plans under this section to ensure that they are in compliance with the requirements of this section retiree reserve trust fund establishment a in general there is established in the treasury of the united states a trust fund to be known as the retiree reserve trust fund referred to in this section as the trust fund that shall consist of such amounts as be appropriated or credited to the trust fund as provided for in this subsection to enable the secretary to carry out the reinsurance program such amounts shall remain available until expended funding there are hereby appropriated to the trust fund out of any moneys with bills hr ih in the treasury not otherwise appropriated an amount requested by the secretary as necessary to carry out this section except that the total of all such amounts requested shall not exceed appropriations from the trust fund in general amounts in the trust fund are appropriated to provide funding to carry out the reinsurance program and shall be used to carry out such program limitation to available funds the secretary has the authority to stop taking applications for participation in the program or take such other steps in reducing expenditures under the reinsurance program in order to ensure that expenditures under the reinsurance program do not exceed the funds available under this subsection sec wellness program grants a allowance of grant in general for purposes of this section the secretaries of health and human services and with bills hr ih labor shall jointly award wellness grants as determined under this section wellness program grants shall be awarded to small employers as defined by the secretary for any plan year in an amount equal to percent of the costs paid or incurred by such employers in connection with a qualified wellness program during the plan year for purposes of the preceding sentence in the case of any qualified wellness program offered as part of an employmentbased health plan only costs attributable to the qualified wellness program and not to the health plan or health insurance coverage offered in connection with such a plan be taken into account limitations a period a wellness grant awarded to an employer under this section shall be for up to years amount the amount of the grant under paragraph for an employer shall not exceed the product of and the number of employees of the employer for any plan year and for the entire period of the grant with bills hr ih qualified wellness program for purposes of this section qualified wellness program the term qualified wellness program means a program that a includes any wellness components described in subsection and is to be certified jointly by the secretary of health and human services and the secretary of labor in coordination with the director of the centers for disease control and prevention as a qualified wellness program under this section programs must be consistent with research and best practices a in general the secretary of health and human services and the secretary of labor shall not certify a program as a qualified wellness program unless the program is consistent with evidence based research and best practices as identified by persons with expertise in employer health promotion and wellness programs includes multiple evidence based strategies which are based on the existing with bills hr ih and emerging research and careful scientific reviews including the guide to community preventative services the guide to clinical preventative services and the national registry for effective programs and iii includes strategies which focus on prevention and support for employee populations at risk of poor health outcomes periodic updating and review the secretaries of health and human services and labor in consultation with other appropriate agencies shall jointly establish procedures for periodic review evaluation and update of the programs under this subsection health literacy and accessibility the secretaries of health and human services and labor shall jointly as part of the certification process a ensure that employers make the programs culturally competent physically and programmatically accessible including for individuals with disabilities and appropriate to the health literacy needs of the employees covered by the programs with bills hr ih require a health literacy component to provide special assistance and materials to employees with low literacy skills limited english and from underserved populations and require the secretaries to compile and disseminate to employer health plans information on model health literacy curricula instructional programs and effective intervention strategies wellness program components for purposes of this section the wellness program components described in this subsection are the following health awareness component a health awareness component which provides for the following a health education the dissemination of health information which addresses the specific needs and health risks of employees health screenings the opportunity for periodic screenings for health problems and referrals for appropriate follow up measures employee engagement component an employee engagement component which provides for the active engagement of employees in worksite with bills hr ih wellness programs through worksite assessments and program planning onsite delivery evaluation and improvement efforts behavioral change component a behavioral change component which encourages healthy living through counseling seminars on line programs self help materials or other programs which provide technical assistance and problem solving skills such component include programs relating to a tobacco use obesity stress management physical fitness nutrition substance abuse depression and mental health promotion supportive environment component a supportive environment component which includes the following a on site policies policies and services at the worksite which promote a healthy lifestyle including policies relating to tobacco use at the worksite with bills hr ih the nutrition of food available at the worksite through cafeterias and vending options iii minimizing stress and promoting positive mental health in the workplace and iv the encouragement of physical activity before during and after work hours participation requirement no grant shall be allowed under subsection a unless the secretaries of health and human services and labor in consultation with other appropriate agencies jointly certify as a part of any certification described in subsection that each wellness program component of the qualified wellness program shall be available to all employees of the employer shall not mandate participation by employees and provide a financial reward for participation of an individual in such program so long as such reward is not tied to the premium or cost sharing of the individual under the health benefits plan privacy protections data gathered for purposes of the employer wellness program be used solely with bills hr ih for the purposes of administering the program the secretaries of health and human services and labor shall develop standards to ensure such data remain confidential and are not used for purposes beyond those for administering the program certain costs not included for purposes of this section costs paid or incurred by an employer for food or health insurance shall not be taken into account under subsection a outreach the secretaries of health and human services and labor in conjunction with other appropriate agencies and members of the business community shall jointly institute an outreach program to inform businesses about the availability of the wellness program grant as well as to educate businesses on how to develop programs according to recognized and promising practices and on how to measure the success of implemented programs effective date this section shall take effect on july authorization of appropriations there are authorized to be appropriated such sums as are necessary to carry out this section with bills hr ih sec extension of cobra continuation coverage a extension of current periods of continuation coverage in general in the case of any individual who is under a cobra continuation coverage provision covered under cobra continuation coverage on or after the date of the enactment of this act the required period of any such coverage which has not subsequently terminated under the terms of such provision for any reason other than the expiration of a period of a specified number of months shall notwithstanding such provision and subject to subsection extend to the earlier of the date on which such individual becomes eligible for acceptable coverage or the date on which such individual becomes eligible for health insurance coverage through the health insurance exchange or a state based health insurance exchange operating in a state or group of states notice as soon as practicable after the date of the enactment of this act the secretary of labor in consultation with the secretary of the treasury and the secretary of health and human services shall in consultation with administrators of the group health plans or other entities that with bills hr ih provide or administer the cobra continuation coverage involved provide rules setting forth the form and manner in which prompt notice to individuals of the continued availability of cobra continuation coverage to such individuals under paragraph continued effect of other terminating events notwithstanding subsection a any required period of cobra continuation coverage which is extended under such subsection shall terminate upon the occurrence prior to the date of termination otherwise provided in such subsection of any terminating event specified in the applicable continuation coverage provision other than the expiration of a period of a specified number of months access to state health benefits risk pools this section shall supersede any provision of the law of a state or political subdivision thereof to the extent that such provision has the effect of limiting or precluding access by a qualified beneficiary whose cobra continuation coverage has been extended under this section to a state health benefits risk pool recognized by the commissioner for purposes of this section solely by reason of the extension of such coverage beyond the date on which such coverage otherwise would have expired definitions for purposes of this section with bills hr ih cobra continuation coverage the term cobra continuation coverage means continuation coverage provided pursuant to part of subtitle of title of the employee retirement income security act of other than under section title xxii of the public health service act section of the internal revenue code of other than subsection of such section insofar as it relates to pediatric vaccines or section a of title united states code or under a state program that provides comparable continuation coverage such term does not include coverage under a health flexible spending arrangement under a cafeteria plan within the meaning of section of the internal revenue code of cobra continuation provision the term cobra continuation provision means the provisions of law described in paragraph sec state health access program grants a in general the secretary of health and human services in this section referred to as the secretary shall provide grants to states as defined for purposes of title xix of the social security act to establish programs to expand access to affordable health care coverage for the uninsured populations in that state in a with bills hr ih manner consistent with reforms to take effect under this division in types of programs the types of programs for which grants are available under subsection a include the following state insurance exchanges state insurance exchanges that develop new less expensive portable benefit packages for small employers and part time and seasonal workers community coverage program community coverage with shared responsibility between employers governmental or nonprofit entity and the individual reinsurance plan program reinsurance plans that subsidize a certain share of carrier losses within a certain risk corridor health insurance premium assistance transparent marketplace program transparent marketplace that provides an organized structure for the sale of insurance products such as a web exchange or portal automated enrollment program statewide or automated enrollment systems for public assistance programs with bills hr ih innovative strategies innovative strategies to insure low income childless adults purchasing collaboratives business consumer collaborative that provides direct contract health care service purchasing options for group plan sponsors eligibility and administration implementation of key statutory or regulatory changes in order to be awarded a grant under this section for a program a state shall demonstrate that a it has achieved the key state and local statutory or regulatory changes required to begin implementing the new program within year after the initiation of funding under the grant and it will be able to sustain the program without federal funding after the end of the period of the grant ineligibility a state that has already developed a comprehensive health insurance access program is not eligible for a grant under this section application required no state shall receive a grant under this section unless the state with bills hr ih has approved by the secretary such an application in such form and manner as the secretary specifies administration based on current program the program under this section is intended to build on the state health access program funded under the omnibus appropriations act public law – funding limitations in general a grant under this section shall a only be available for expenditures before and only be used to supplement and not supplant funds otherwise provided matching fund requirement a in general subject to subparagraph no grant be awarded to a state unless the state demonstrates the seriousness of its effort by matching at least percent of the grant amount through non federal resources which be a combination of state local private dollars from insurers providers and other private organizations waiver the secretary waive the requirement of subparagraph a if the with bills hr ih state demonstrates to the secretary financial hardship in complying with such requirement study the secretary shall review study and benchmark the progress and results of the programs funded under this section report each state receiving a grant under this section shall submit to the secretary a report on best practices and lessons learned through the grant to inform the health reform coverage expansions under this division beginning in funding there are authorized to be appropriated such sums as be necessary to carry out this section sec administrative simplification a standardizing electronic administrative transactions in general part of title xi of the social security act usc et seq is amended by inserting after section the following new sections sec a standardize electronic administrative transactions a standards for financial and administrative transactions with bills hr ih in general the secretary shall adopt and regularly update standards consistent with the goals described in paragraph goals for financial and administrative transactions the goals for standards under paragraph are that such standards shall to the extent practicable a be unique with no conflicting or redundant standards be authoritative permitting no additions or constraints for electronic transactions including companion guides be comprehensive efficient and robust requiring minimal augmentation by paper transactions or clarification by further communications enable the real time or near realtime determination of an individual financial responsibility at the point of service and to the extent possible prior to service including whether the individual is eligible for a specific service with a specific physician at a specific facility on a specific date or range of dates include utilization of a machine readable health with bills hr ih plan beneficiary identification card or similar mechanism enable where feasible near real time adjudication of claims provide for timely acknowledgment response and status reporting applicable to any electronic transaction deemed appropriate by the secretary describe all data elements such as reason and remark codes in unambiguous terms not permit optional fields require that data elements be either required or conditioned upon set values in other fields and prohibit additional conditions except where required by or to implement state or federal law or to protect against fraud and abuse and harmonize all common data elements across administrative and clinical transaction standards time for adoption not later than years after the date of the enactment of this section the secretary shall adopt standards under this section by interim final rule with bills hr ih requirements for specific standards the standards under this section shall be developed adopted and enforced so as to a clarify refine complete and expand as needed the standards required under section require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant equivalent electronic transaction can be populated from the data from a paper version enable electronic funds transfers in order to allow automated reconciliation with the related health care payment and remittance advice require timely and transparent claim and denial management processes including uniform claim edits uniform reason and remark denial codes tracking adjudication and appeal processing require the use of a standard electronic transaction with which health care providers quickly and efficiently enroll with a with bills hr ih health plan to conduct the other electronic transactions provided for in this part and provide for other requirements relating to administrative simplification as identified by the secretary in consultation with stakeholders building on existing standards in adopting the standards under this section the secretary shall consider existing and planned standards implementation and enforcement not later than months after the date of the enactment of this section the secretary shall submit to the appropriate committees of congress a plan for the implementation and enforcement by not later than years after such date of enactment of the standards under this section such plan shall include a a process and timeframe with milestones for developing the complete set of standards a proposal for accommodating necessary changes between version changes and a process for upgrading standards as often as annually by interim final rulemaking with bills hr ih programs to provide incentives for and ease the burden of implementation for certain health care providers with special consideration given to such providers serving rural or underserved areas and ensure coordination with standards implementation specifications and certification criteria being adopted under the hitech act programs to provide incentives for and ease the burden of health care providers who volunteer to participate in the process of setting standards for electronic transactions an estimate of total funds needed to ensure timely completion of the implementation plan and an enforcement process that includes timely investigation of complaints random audits to ensure compliance civil monetary and programmatic penalties for noncompliance consistent with existing laws and regulations and a fair and reasonable appeals process building off of enforcement provisions under this part and concurrent state enforcement jurisdiction the secretary promulgate an annual audit and certification process to ensure that all health plans with bills hr ih and clearinghouses are both syntactically and functionally compliant with all the standard transactions mandated pursuant to the administrative simplification provisions of this part and the health insurance portability and accountability act of limitations on use of data nothing in this section shall be construed to permit the use of information collected under this section in a manner that would violate state or federal law protection of data the secretary shall ensure through the promulgation of regulations or otherwise that all data collected pursuant to subsection a are used and disclosed in a manner that meets the hipaa privacy and security law as defined in section a of the public health service act including any privacy or security standard adopted under section of such act sec interim companion guides including operating rules a in general the secretary shall adopt a single binding comprehensive companion guide that includes operating rules for each version transaction described in section a to be effective until the new version of these transactions which comply with section a are adopted and implemented with bills hr ih companion guide and operating rules development in adopting such interim companion guide and rules the secretary shall comply with section except that a nonprofit entity that meets the following criteria shall also be consulted the entity focuses its mission on administrative simplification the entity uses a multistakeholder process that creates consensus based companion guides including operating rules using a voting process that ensures balanced representation by the critical stakeholders including health plans and health care providers so that no one group dominates the entity and shall include others such as standards development organizations and relevant federal or state agencies the entity has in place a public set of guiding principles that ensure the companion guide and operating rules and process are open and transparent the entity coordinates its activities with the hit policy committee and the hit standards committee established under title xxx of the public health service act and complements the efforts with bills hr ih of the office of the national healthcare coordinator and its related health information exchange goals the entity incorporates the standards issued under health insurance portability and accountability act of and this part and in developing the companion guide and operating rules does not change the definition data condition or use of a data element or segment in a standard add any elements or segments to the maximum defined data set use any codes or data elements that are either marked not used in the standard implementation specifications or are not in the standard implementation specifications or change the meaning or intent of the standard implementation specifications the entity uses existing market research and proven best practices the entity has a set of measures that allow for the evaluation of their market impact and public reporting of aggregate stakeholder impact the entity supports nondiscrimination and conflict of interest policies that demonstrate a commitment to open fair and nondiscriminatory practices with bills hr ih the entity allows for public reviews and comment on updates of the companion guide including the operating rules implementation the secretary shall adopt a single binding companion guide including operating rules under this section for each transaction to become effective with the version transaction implementation or as soon thereafter as feasible the companion guide including operating rules for the transactions for eligibility for health plan and health claims status under this section shall be adopted not later than october in a manner such that such set of rules is effective beginning not later than january the companion guide including operating rules for the remainder of the transactions described in section a shall be adopted not later than october in a manner such that such set of rules is effective beginning not later than january definitions section of such act usc is amended a in paragraph by inserting and associated operational guidelines and instructions as determined appropriate by the secretary after medical procedure codes and with bills hr ih by adding at the end the following new paragraph operating rules the term operating rules means business rules for using and processing transactions such as service level requirements which do not impact the implementation specifications or other data content requirements conforming amendment section a of such act usc d– a is amended in the matter before paragraph a by inserting on behalf of an individual after and by inserting on behalf of an individual after for a financial institution and standards for claims attachments and coordination of benefits standard for health claims attachments not later than year after the date of the enactment of this act the secretary of health and human services shall promulgate an interim final rule to establish a standard for health claims attachment transaction described in section a of the social security act usc d– a and coordination of benefits with bills hr ih revision in processing payment transactions by financial institutions a in general section of the social security act usc d– is amended in the matter before paragraph by striking or is engaged and inserting and is engaged and by inserting other than as a business associate for a covered entity after for a financial institution compliance date the amendments made by subparagraph a shall apply to transactions occurring on or after such date not later than january as the secretary of health and human services shall specify standards for first report of injury not later than january the secretary of health and human services shall promulgate an interim final rule to establish a standard for the first report of injury transaction described in section a of the social security act usc d– a unique health plan identifier not later october the secretary of health and human services shall promulgate an interim final rule to establish with bills hr ih a unique health plan identifier described in section of the social security act usc d– based on the input of the national committee of vital and health statistics and consultation with health plans health care providers and other interested parties expansion of electronic transactions in medicare section a of the social security act usc a is amended in paragraph by striking or at the end in paragraph by striking the period and inserting or and by inserting after paragraph the following new paragraph subject to subsection not later than january for which the payment is other than by electronic funds transfer eft so long as the secretary has adopted and implemented a standard for electronic funds transfer under section a expansion of penalties section of such act usc d– is amended by adding at the end the following new subsection expansion of penalty authority the secretary in addition to the penalties provided under with bills hr ih subsections a and provide for the imposition of penalties for violations of this part that are comparable in the case of health plans to the sanctions the secretary is authorized to impose under part or of title xviii in the case of a plan that violates a provision of such part or in the case of a health care provider to the sanctions the secretary is authorized to impose under part a or of title xviii in the case of a health care provider that violations a provision of such part with respect to that provider title protections and standards for qualified health benefits plans subtitle a general standards sec requirements reforming health insurance marketplace a purpose the purpose of this title is to establish standards to ensure that new health insurance coverage and employment based health plans that are offered meet standards guaranteeing access to affordable coverage essential benefits and other consumer protections requirements for qualified health benefits plans on or after the first day of a health benefits plan shall not be a qualified health benefits plan with bills hr ih under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved subtitle relating to affordable coverage subtitle relating to essential benefits subtitle relating to consumer protection terminology in this division enrollment in employment based health plans an individual shall be treated as being enrolled in an employment based health plan if the individual is a participant or beneficiary as such terms are defined in section and respectively of the employee retirement income security act of in such plan individual and group health insurance coverage the terms individual health insurance coverage and group health insurance coverage mean health insurance coverage offered in the individual market or large or small group market respectively as defined in section of the public health service act with bills hr ih sec protecting the choice to keep current coverage a grandfathered health insurance coverage defined subject to the succeeding provisions of this section for purposes of establishing acceptable coverage under this division the term grandfathered health insurance coverage means individual health insurance coverage that is offered and in force and effect before the first day of if the following conditions are met limitation on new enrollment a in general except as provided in this paragraph the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of dependent coverage permitted subparagraph a shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day limitation on changes in terms or conditions subject to paragraph and except as required by law the issuer does not change any of its terms or conditions including benefits and cost sharing from those in effect as of the day before the first day of with bills hr ih restrictions on premium increases the issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate as specified by the commissioner grace period for current employmentbased health plans grace period a in general the commissioner shall establish a grace period whereby for plan years beginning after the end of the year period beginning with an employment based health plan in operation as of the day before the first day of must meet the same requirements as apply to a qualified health benefits plan under section including the essential benefit package requirement under section exception for limited benefits plans subparagraph a shall not apply to an employment based health plan in which the coverage consists only of one or more of the following with bills hr ih any coverage described in section a iv of division of the american recovery and reinvestment act of public law – excepted benefits as defined in section of the employee retirement income security act of including coverage under a specified disease or illness policy described in paragraph a of such section iii such other limited benefits as the commissioner specify in no case shall an employment based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses through iii be treated as acceptable coverage under this division transitional treatment as acceptable coverage during the grace period specified in paragraph a an employment based health plan which be a high deducible health plan as defined in section of the internal revenue code of that is described in such paragraph shall be treated as acceptable coverage under this division with bills hr ih limitation on individual health insurance coverage in general individual health insurance coverage that is not grandfathered health insurance coverage under subsection a only be offered on or after the first day of as an exchange participating health benefits plan separate excepted coverage permitted nothing in a paragraph shall prevent the offering of excepted benefits described in section of the public health service act so long as such benefits are offered outside the health insurance exchange and are priced separately from health insurance coverage and this division shall be construed to prevent the offering of a standalone plan that offers coverage of excepted benefits described in section a of the public health service act relating to limited scope dental or vision benefits for individuals and families from a statelicensed dental and vision carrier or as applying requirements for a qualified health benefits plan to such a with bills hr ih stand alone plan that is offered and priced separately from a qualified health benefits plan subtitle standards guaranteeing access to affordable coverage sec prohibiting preexisting condition exclusions a qualified health benefits plan not impose any preexisting condition exclusion as defined in section a of the public health service act or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any of the following health status medical condition claims experience receipt of health care medical history genetic information evidence of insurability disability or source of injury including conditions arising out of acts of domestic violence or any similar factors sec guaranteed issue and renewal for insured plans and prohibiting rescissions the requirements of sections other than subsections and and other than paragraphs and of subsection and subsection of the public health service act relating to guaranteed availability and with bills hr ih renewability of health insurance coverage shall apply to individuals and employers in all individual and group health insurance coverage whether offered to individuals or employers through the health insurance exchange through any employment based health plan or otherwise in the same manner as such sections apply to employers and health insurance coverage offered in the small group market except that such section shall apply only if before nonrenewal or discontinuation of coverage the issuer has provided the enrollee with notice of nonpayment of premiums and there is a grace period during which the enrollee has an opportunity to correct such nonpayment rescissions of such coverage shall be prohibited except in cases of fraud as defined in section of such act sec insurance rating rules a in general the premium rate charged for a qualified health benefits plan that is health insurance coverage not vary except as follows limited age variation permitted by age within such age categories as the commissioner shall specify so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of to with bills hr ih by area by premium rating area as permitted by state insurance regulators or in the case of exchange participating health benefits plans as specified by the commissioner in consultation with such regulators by family enrollment by family enrollment such as variations within categories and compositions of families so long as the ratio of the premium for family enrollment or enrollments to the premium for individual enrollment is uniform as specified under state law and consistent with rules of the commissioner actuarial value of optional service coverage in general the commissioner shall estimate the basic per enrollee per month cost determined on an average actuarial basis for including coverage under a basic plan of the services described in section a considerations in making such estimate the commissioner a take into account the impact on overall costs of the inclusion of such coverage but not take into account any cost reduction estimated to result from such services in with bills hr ih cluding prenatal care delivery or postnatal care shall estimate such costs as if such coverage were included for the entire population covered and not estimate such a cost at less than per enrollee per month study and reports study the commissioner in coordination with the secretary of health and human services and the secretary of labor shall conduct a study of the large group insured and self insured employer health care markets such study shall examine the following a the types of employers by key characteristics including size that purchase insured products versus those that self insure the similarities and differences between typical insured and self insured health plans the financial solvency and capital reserve levels of employers that self insure by employer size with bills hr ih the risk of self insured employers not being able to pay obligations or otherwise becoming financially insolvent the extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self insure reports not later than months after the date of the enactment of this act the commissioner shall submit to congress and the applicable agencies a report on the study conducted under paragraph such report shall include any recommendations the commissioner deems appropriate to ensure that the law does not provide incentives for small and midsize employers to self insure or create adverse selection in the risk pools of large group insurers and self insured employers not later than months after the first day of the commissioner shall submit to congress and the applicable agencies an updated report on such study including updates on such recommendations with bills hr ih sec nondiscrimination in benefits parity in mental health and substance abuse disorder benefits a nondiscrimination in benefits a qualified health benefits plan shall comply with standards established by the commissioner to prohibit discrimination in health benefits or benefit structures for qualifying health benefits plans building from section of the employee retirement income security act of section of the public health service act and section of the internal revenue code of parity in mental health and substance abuse disorder benefits to the extent such provisions are not superceded by or inconsistent with subtitle the provisions of section other than subsections a a and of the public health service act shall apply to a qualified health benefits plan regardless of whether it is offered in the individual or group market in the same manner as such provisions apply to health insurance coverage offered in the large group market sec ensuring adequacy of provider networks a in general a qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the commissioner establish to assure the adequacy of such networks in ensuring enrollee access to such items with bills hr ih and services and transparency in the cost sharing differentials among providers participating in the network and policies for accessing out of network providers internet access to information a qualified health benefits plan that uses a provider network shall provide a current listing of all providers in its network on its website and such data shall be available on the health insurance exchange website as a part of the basic information on that plan the commissioner shall also establish an on line system whereby an individual select by name any medical provider as defined by the commissioner and be informed of the plan or plans with which that provider is contracting provider network defined in this division the term provider network means the providers with respect to which covered benefits treatments and services are available under a health benefits plan sec requiring the option of extension of dependent coverage for uninsured young adults a in general a qualified health benefits plan shall make available at the option of the principal enrollee under the plan coverage for one or more qualified children as defined in subsection of the enrollee with bills hr ih qualified child defined in this section the term qualified child means with respect to a principal enrollee in a qualified health benefits plan an individual who but for age would be treated as a dependent child of the enrollee under such plan and who is under years of age and is not enrolled in a health benefits plan other than under this section premiums nothing in this section shall be construed as preventing a qualified health benefits plan from increasing the premiums otherwise required for coverage provided under this section consistent with standards established by the commissioner based upon family size under section a sec consistency of costs and coverage under qualified health benefits plans during plan year in the case of health insurance coverage offered under a qualified health benefits plan if the coverage decreases or the cost sharing increases the issuer of the coverage shall notify enrollees of the change at least days before the change takes effect or such shorter period of time in cases where the change is necessary to ensure the health and safety of enrollees with bills hr ih subtitle standards guaranteeing access to essential benefits sec coverage of essential benefits package a in general a qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section for the essential benefits package described in section for the plan year involved choice of coverage non exchange participating health benefits plans in the case of a qualified health benefits plan that is not an exchange participating health benefits plan such plan offer such coverage in addition to the essential benefits package as the qhbp offering entity specify exchange participating health benefits plans in the case of an exchange participating health benefits plan such plan is required under section to provide specified levels of benefits and in the case of a plan offering a premiumplus level of benefits provide additional benefits continuation of offering of separate excepted benefits coverage nothing in this division shall be construed as affecting the offering with bills hr ih outside of the health insurance exchange and under state law of health benefits in the form of excepted benefits described in section if such benefits are offered under a separate policy contract or certificate of insurance clinical appropriateness nothing in this act shall be construed to prohibit a group health plan or health insurance issuer from using medical management practices so long as such management practices are based on valid medical evidence and are relevant to the patient whose medical treatment is under review provision of benefits nothing in this division shall be construed as prohibiting a qualified health benefits plan from subcontracting with stand alone health insurance issuers or insurers for the provision of dental vision mental health and other benefits and services sec essential benefits package defined a in general in this division the term essential benefits package means health benefits coverage consistent with standards adopted under section to ensure the provision of quality health care and financial security that provides payment for the items and services described in subsection in accordance with gen with bills hr ih erally accepted standards of medical or other appropriate clinical or professional practice limits cost sharing for such covered health care items and services in accordance with such benefit standards consistent with subsection does not impose any annual or lifetime limit on the coverage of covered health care items and services complies with section a relating to network adequacy and is equivalent in its scope of benefits as certified by office of the actuary of the centers for medicare medicaid services to the average prevailing employer sponsored coverage in in order to carry out paragraph the secretary of labor shall conduct a survey of employer sponsored coverage to determine the benefits typically covered by employers including multiemployer plans and provide a report on such survey to the health benefits advisory committee and to the secretary of health and human services minimum services to be covered subject to subsection the items and services described in this subsection are the following hospitalization with bills hr ih outpatient hospital and outpatient clinic services including emergency department services professional services of physicians and other health professionals such services equipment and supplies incident to the services of a physician or a health professional delivery of care in institutional settings physician offices patients homes or place of residence or other settings as appropriate prescription drugs rehabilitative and habilitative services mental health and substance use disorder services including behavioral health treatments preventive services including those services recommended with a grade of a or by the task force on clinical preventive services and those vaccines recommended for use by the director of the centers for disease control and prevention maternity care well baby and well child care and oral health vision and hearing services equipment and supplies for children under years of age durable medical equipment prosthetics orthotics and related supplies with bills hr ih requirements relating to cost sharing and minimum actuarial value no cost sharing for preventive services there shall be no cost sharing under the essential benefits package for a preventive items and services recommended with a grade of a or by the task force on clinical preventive services and those vaccines recommended for use by the director of the centers for disease control and prevention or well baby and well child care annual limitation a annual limitation the cost sharing incurred under the essential benefits package with respect to an individual or family for a year does not exceed the applicable level specified in subparagraph applicable level the applicable level specified in this subparagraph for is not to exceed for an individual and not to exceed for a family such levels shall be increased rounded to the nearest for each subsequent year by the annual percentage increase in the enrollment weighted with bills hr ih average of premium increases for basic plans applicable to such year except that secretary shall adjust such increase to ensure that the applicable level specified in this subparagraph meets the minimum actuarial value required under paragraph use of copayments in establishing cost sharing levels for basic enhanced and premium plans under this subsection the secretary shall to the maximum extent possible use only copayments and not coinsurance minimum actuarial value a in general the cost sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph reference benefits package described the reference benefits package described in this subparagraph is the essential benefits package if there were no cost sharing imposed with bills hr ih assessment and counseling for domestic violence the secretary shall support the need for an assessment and brief counseling for domestic violence as part of a behavioral health assessment or primary care visit and determine the appropriate coverage for such assessment and counseling abortion coverage prohibited as part of minimum benefits package prohibition of required coverage the health benefits advisory committee not recommend under section and the secretary not adopt in standards under section the services described in paragraph a or as part of the essential benefits package and the commissioner not require such services for qualified health benefits plans to participate in the health insurance exchange voluntary choice of coverage by plan in the case of a qualified health benefits plan the plan is not required or prohibited under this act from providing coverage of services described in paragraph a or and the qhbp offering entity shall determine whether such coverage is provided with bills hr ih coverage under public health insurance option the public health insurance option shall provide coverage for services described in paragraph nothing in this act shall be construed as preventing the public health insurance option from providing for or prohibiting coverage of services described in paragraph a abortion services a abortions for which public funding is prohibited the services described in this subparagraph are abortions for which the expenditure of federal funds appropriated for the department of health and human services is not permitted based on the law as in effect as of the date that is months before the beginning of the plan year involved abortions for which public funding is allowed the services described in this subparagraph are abortions for which the expenditure of federal funds appropriated for the department of health and human services is permitted based on the law as in effect as of the date that is months before the beginning of the plan year involved with bills hr ih report regarding inclusion of oral health care in essential benefits package not later than year after the date of the enactment of this act the secretary of health and human services shall submit to congress a report containing the results of a study determining the need and cost of providing accessible and affordable oral health care to adults as part of the essential benefits package sec health benefits advisory committee a establishment in general there is established a private public advisory committee which shall be a panel of medical and other experts to be known as the health benefits advisory committee to recommend covered benefits and essential enhanced and premium plans chair the surgeon general shall be a member and the chair of the health benefits advisory committee membership the health benefits advisory committee shall be composed of the following members in addition to the surgeon general a nine members who are not federal employees or officers and who are appointed by the president with bills hr ih nine members who are not federal employees or officers and who are appointed by the comptroller general of the united states in a manner similar to the manner in which the comptroller general appoints members to the medicare payment advisory commission under section of the social security act such even number of members not to exceed who are federal employees and officers as the president appoint such initial appointments shall be made not later than days after the date of the enactment of this act terms each member of the health benefits advisory committee shall serve a year term on the committee except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members participation the membership of the health benefits advisory committee shall at least reflect providers patient representatives employers including small employers labor health insurance issuers experts in health care financing and delivery experts in oral health care experts in racial and with bills hr ih ethnic disparities experts on health care needs and disparities of individuals with disabilities representatives of relevant governmental agencies and at least one practicing physician or other health professional and an expert in child and adolescent health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such committee duties recommendations on benefit standards the health benefits advisory committee shall recommend to the secretary of health and human services in this subtitle referred to as the secretary benefit standards as defined in paragraph and periodic updates to such standards in developing such recommendations the committee shall take into account innovation in health care and consider how such standards could reduce health disparities deadline the health benefits advisory committee shall recommend initial benefit standards to the secretary not later than year after the date of the enactment of this act with bills hr ih state input the health benefits advisory committee shall examine the health coverage laws and benefits of each state in developing recommendations under this subsection and incorporate such coverage and benefits as the committee determines to be appropriate and consistent with this act the health benefits advisory committee shall also seek input from the states and consider recommendations on how to ensure quality of health coverage in all states public input the health benefits advisory committee shall allow for public input as a part of developing recommendations under this subsection benefit standards defined in this subtitle the term benefit standards means standards respecting a the essential benefits package described in section including categories of covered treatments items and services within benefit classes and cost sharing consistent with subsection of such section and the cost sharing levels for enhanced plans and premium plans as provided under section consistent with paragraph with bills hr ih levels of cost sharing for enhanced and premium plans a enhanced plan the level of costsharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately percent of the actuarial value of the benefits provided under the reference benefits package described in section premium plan the level of costsharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately percent of the actuarial value of the benefits provided under the reference benefits package described in section c operations per diem pay each member of the health benefits advisory committee shall receive travel expenses including per diem in accordance with applicable provisions under subchapter of chapter of title united states code and shall otherwise serve without additional pay members not treated as federal employees members of the health benefits advi with bills hr ih sory committee shall not be considered employees of the federal government solely by reason of any service on the committee except such members shall be considered to be within the meaning of section a of title united states code for the purposes of disclosure and management of conflicts of interest application of faca the federal advisory committee act usc app other than section shall apply to the health benefits advisory committee publication the secretary shall provide for publication in the federal register and the posting on the internet website of the department of health and human services of all recommendations made by the health benefits advisory committee under this section sec process for adoption of recommendations adoption of benefit standards a process for adoption of recommendations review of recommended standards not later than days after the date of receipt of benefit standards recommended under section including such standards as modified under paragraph the secretary shall review such with bills hr ih standards and shall determine whether to propose adoption of such standards as a package determination to adopt standards if the secretary determines a to propose adoption of benefit standards so recommended as a package the secretary shall by regulation under section of title united states code propose adoption of such standards or not to propose adoption of such standards as a package the secretary shall notify the health benefits advisory committee in writing of such determination and the reasons for not proposing the adoption of such recommendation and provide the committee with a further opportunity to modify its previous recommendations and submit new recommendations to the secretary on a timely basis contingency if because of the application of paragraph the secretary would otherwise be unable to propose initial adoption of such recommended standards by the deadline specified in subsection the secretary shall by regulation under section of title united states code with bills hr ih propose adoption of initial benefit standards by such deadline publication the secretary shall provide for publication in the federal register of all determinations made by the secretary under this subsection adoption of standards initial standards not later than months after the date of the enactment of this act the secretary shall through the rulemaking process consistent with subsection a adopt an initial set of benefit standards periodic updating standards under subsection a the secretary shall provide for the periodic updating of the benefit standards previously adopted under this section requirement the secretary not adopt any benefit standards for an essential benefits package or for level of cost sharing that are inconsistent with the requirements for such a package or level under sections including subsection and with bills hr ih subtitle additional consumer protections sec requiring fair marketing practices by health insurers the commissioner shall establish uniform marketing standards that all qhbp offering entities shall meet with respect to qualified health benefits plans that are health insurance coverage sec requiring fair grievance and appeals mechanisms a in general a qhbp offering entity shall provide for timely grievance and appeals mechanisms with respect to qualified health benefits plans that the commissioner shall establish consistent with this section the commissioner shall establish time limits for each of such mechanisms and implement them in a manner that is protective to the needs of patients internal claims and appeals process under a qualified health benefits plan the qhbp offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures including urgent claims set forth at section – of title code of federal regulations as published on november fed reg with bills hr ih and shall update such process in accordance with any standards that the commissioner establish external review process in general the commissioner shall establish an external review process including procedures for expedited reviews of urgent claims that provides for an impartial independent and de novo review of denied claims under this division requiring fair grievance and appeals mechanisms a determination made with respect to a qualified health benefits plan offered by a qhbp offering entity under the external review process established under this subsection shall be binding on the plan and the entity time limits the commissioner shall establish time limits for each of these processes and implement them in a manner that is protective to the patient construction nothing in this section shall be construed as affecting the availability of judicial review under state law for adverse decisions under subsection or subject to section sec requiring information transparency and plan disclosure a accurate and timely disclosure with bills hr ih for exchange participating health benefits plans a qhbp offering entity offering an exchange participating health benefits plan shall comply with standards established by the commissioner for the accurate and timely disclosure to the commissioner and the public of plan documents plan terms and conditions claims payment policies and practices periodic financial disclosure data on enrollment data on disenrollment data on the number of claims denials data on rating practices information on cost sharing and payments with respect to any out of network coverage and other information as determined appropriate by the commissioner employment based health plans the secretary of labor shall update and harmonize the secretary rules concerning the accurate and timely disclosure to participants by group health plans of plan disclosure plan terms and conditions and periodic financial disclosure with the standards established by the commissioner under paragraph use of plain language a in general the disclosures under paragraphs and shall be provided in plain language with bills hr ih definition in this paragraph the term plain language means language that the intended audience including individuals with limited english proficiency can readily understand and use because that language is concise well organized and follows other best practices of plain language writing guidance the commissioner and the secretary of labor shall jointly develop and issue guidance on best practices of plain language writing information on rights the information disclosed under this subsection shall include information on enrollee and participant rights under this division cost sharing transparency a qualified health benefits plan shall allow individuals to learn the amount of cost sharing including deductibles copayments and coinsurance under the individual plan or coverage that the individual would be responsible for paying with respect to the furnishing of a specific item or service by a participating provider in a timely manner upon request at a minimum this information shall be made available with bills hr ih to such individual via an internet website and other means for individuals without access to the internet contracting reimbursement a qualified health benefits plan shall comply with standards established by the commissioner to ensure transparency to each health care provider relating to reimbursement arrangements between such plan and such provider pharmacy benefit managers transparency requirements in general if a qhbp offering entity contracts with a pharmacy benefit manager or other entity in this subsection referred to as a pbm to manage prescription drug coverage or otherwise control prescription drug costs under a qualified health benefits plan the pbm shall provide at least annually to the commissioner and to the qhbp offering entity offering such plan the following information in a form and manner to be determined by the commissioner a information on the number and total cost of prescriptions under the contract that are filled via mail order and at retail pharmacies an estimate of aggregate average payments under the contract per prescription weighted by prescription volume made to mail with bills hr ih order and retail pharmacies and the average amount per prescription that the pbm was paid by the plan for prescriptions filled at mail order and retail pharmacists an estimate of the aggregate average payment per prescription weighted by prescription volume under the contract received from pharmaceutical manufacturers including all rebates discounts prices concessions or administrative and other payments from pharmaceutical manufacturers and a description of the types of payments and the amount of these payments that were shared with the plan and a description of the percentage of prescriptions for which the pbm received such payments information on the overall percentage of generic drugs dispensed under the contract at retail and mail order pharmacies and the percentage of cases in which a generic drug is dispensed when available information on the percentage and number of cases under the contract in which individuals were switched because of pbm policies or at the direct or indirect control of the pbm from a prescribed drug that had a lower with bills hr ih cost for the qhbp offering entity to a drug that had a higher cost for the qhbp offering entity the rationale for these switches and a description of the pbm policies governing such switches confidentiality of information information disclosed by a pbm to the commissioner or a qhbp offering entity under this subsection is confidential and shall not be disclosed by the commissioner or the qhbp offering entity in a form which discloses the identity of a specific pbm or prices charged by such pbm or a specific retailer manufacturer or wholesaler except only by the commissioner a to permit state or federal law enforcement authorities to use the information provided for program compliance purposes and for the purpose of combating waste fraud and abuse to permit the comptroller general the medicare payment advisory commission or the secretary of health and human services to review the information provided and with bills hr ih to permit the director of the congressional budget office to review the information provided annual public report on an annual basis the commissioner shall prepare a public report providing industrywide aggregate or average information to be used in assessing the overall impact of pbms on prescription drug prices and spending such report shall not disclose the identity of a specific pbm or prices charged by such pbm or a specific retailer manufacturer or wholesaler or any other confidential or trade secret information penalties the provisions of subsection of section shall apply to a pbm that fails to provide information required under subsection a or that knowingly provides false information in the same manner as such provisions apply to a manufacturer with an agreement under such section that fails to provide information under subsection a of such section or knowingly provides false information under such section respectively with bills hr ih sec application to qualified health benefits plans not offered through the health insurance exchange the requirements of the previous provisions of this subtitle shall apply to qualified health benefits plans that are not being offered through the health insurance exchange only to the extent specified by the commissioner sec timely payment of claims a qhbp offering entity shall comply with the requirements of section of the social security act with respect to a qualified health benefits plan it offers in the same manner as a medicare advantage organization is required to comply with such requirements with respect to a medicare advantage plan it offers under part of medicare sec standardized rules for coordination and subrogation of benefits the commissioner shall establish standards for the coordination and subrogation of benefits and reimbursement of payments in cases of qualified health benefits plans involving individuals and multiple plan coverage sec application of administrative simplification a qhbp offering entity is required to comply with administrative simplification provisions under part of with bills hr ih title xi of the social security act with respect to qualified health benefits plans it offers sec state prohibitions on discrimination against health care providers this act and the amendments made by this act shall not be construed as superseding laws as they now or hereinafter exist of any state or jurisdiction designed to prohibit a qualified health benefits plan from discriminating with respect to participation reimbursement covered services indemnification or related requirements under such plan against a health care provider that is acting within the scope of that provider license or certification under applicable state law sec protection of physician prescriber information a study the secretary of health and human services shall conduct a study on the use of physician prescriber information in sales and marketing practices of pharmaceutical manufacturers report based on the study conducted under subsection a the secretary shall submit to congress a report on actions needed to be taken by the congress or the secretary to protect providers from biased marketing and sales practices with bills hr ih sec dissemination of advance care planning information a in general the qhbp offering entity shall provide for the dissemination of information related to end of life planning to individuals seeking enrollment in exchange participating health benefits plans offered through the exchange shall present such individuals with a the option to establish advanced directives and physician orders for life sustaining treatment according to the laws of the state in which the individual resides and information related to other planning tools and shall not promote suicide assisted suicide euthanasia or mercy killing the information presented under paragraph shall not presume the withdrawal of treatment and shall include end of life planning information that includes options to maintain all or most medical interventions construction nothing in this section shall be construed to require an individual to complete an advanced directive or a physician order for life sustaining treatment or other end of life planning document with bills hr ih to require an individual to consent to restrictions on the amount duration or scope of medical benefits otherwise covered under a qualified health benefits plan or to promote suicide assisted suicide euthanasia or mercy killing advanced directive defined in this section the term advanced directive includes a living will a comfort care order or a durable power of attorney for health care prohibition on the promotion of assisted suicide in general subject to paragraph information provided to meet the requirements of subsection a shall not include advanced directives or other planning tools that list or describe as an option suicide assisted suicide euthanasia or mercy killing regardless of legality construction nothing in paragraph shall be construed to apply to or affect any option to a withhold or withdraw of medical treatment or medical care withhold or withdraw of nutrition or hydration and with bills hr ih provide palliative or hospice care or use an item good benefit or service furnished for the purpose of alleviating pain or discomfort even if such use increase the risk of death so long as such item good benefit or service is not also furnished for the purpose of causing or the purpose of assisting in causing death for any reason no preemption of state law nothing in this section shall be construed to preempt or otherwise have any effect on state laws regarding advance care planning palliative care or end of life decision making subtitle governance sec health choices administration health choices commissioner a in general there is hereby established as an independent agency in the executive branch of the government a health choices administration in this division referred to as the administration commissioner in general the administration shall be headed by a health choices commissioner in this division referred to as the commissioner who with bills hr ih shall be appointed by the president by and with the advice and consent of the senate compensation etc the provisions of paragraphs and of subsection a relating to compensation terms general powers rulemaking and delegation of section of the social security act usc shall apply to the commissioner and the administration in the same manner as such provisions apply to the commissioner of social security and the social security administration inspector general for provision establishing an office of the inspector general for the health choices administration see section sec duties and authority of commissioner a duties the commissioner is responsible for carrying out the following functions under this division qualified plan standards the establishment of qualified health benefits plan standards under this title including the enforcement of such standards in coordination with state insurance regulators and the secretaries of labor and the treasury with bills hr ih health insurance exchange the establishment and operation of a health insurance exchange under subtitle a of title iii individual affordability credits the administration of individual affordability credits under subtitle of title iii including determination of eligibility for such credits additional functions such additional functions as be specified in this division promoting accountability in general the commissioner shall undertake activities in accordance with this subtitle to promote accountability of qhbp offering entities in meeting federal health insurance requirements regardless of whether such accountability is with respect to qualified health benefits plans offered through the health insurance exchange or outside of such exchange compliance examination and audits a in general the commissioner shall in coordination with states conduct audits of qualified health benefits plan compliance with federal requirements such audits include random compliance audits and targeted with bills hr ih audits in response to complaints or other suspected noncompliance recoupment of costs in connection with examination and audits the commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such qhbp offering entities data collection the commissioner shall collect data for purposes of carrying out the commissioner duties including for purposes of promoting quality and value protecting consumers and addressing disparities in health and health care and share such data with the secretary of health and human services sanctions authority in general in the case that the commissioner determines that a qhbp offering entity violates a requirement of this title the commissioner in coordination with state insurance regulators and the secretary of labor provide in addition to any other remedies authorized by law for any of the remedies described in paragraph remedies the remedies described in this paragraph with respect to a qualified health benefits plan offered by a qhbp offering entity are with bills hr ih a civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section of the social security act suspension of enrollment of individuals under such plan after the date the commissioner notifies the entity of a determination under paragraph and until the commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur in the case of an exchange participating health benefits plan suspension of payment to the entity under the health insurance exchange for individuals enrolled in such plan after the date the commissioner notifies the entity of a determination under paragraph and until the secretary is satisfied that the basis for such determination has been corrected and is not likely to recur or working with state insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title with bills hr ih standard definitions of insurance and medical terms the commissioner shall provide for the development of standards for the definitions of terms used in health insurance coverage including insurance related terms efficiency in administration the commissioner shall issue regulations for the effective and efficient administration of the health insurance exchange and affordability credits under subtitle including with respect to the determination of eligibility for affordability credits the use of personnel who are employed in accordance with the requirements of title united states code to carry out the duties of the commissioner or in the case of sections and the use of state personnel who are employed in accordance with standards prescribed by the office of personnel management pursuant to section of the intergovernmental personnel act of usc sec consultation and coordination a consultation in carrying out the commissioner duties under this division the commissioner as appropriate shall consult at least with the following state attorneys general and state insurance regulators including concerning the standards for health insurance coverage that is a qualified health with bills hr ih benefits plan under this title and enforcement of such standards the national association of insurance commissioners including for purposes of using model guidelines established by such association for purposes of subtitles and appropriate state agencies specifically concerning the administration of individual affordability credits under subtitle of title iii and the offering of exchange participating health benefits plans to medicaid eligible individuals under subtitle a of such title the federal trade commission specifically concerning the development and issuance of guidance rules or standards regarding fair marketing practices under section or otherwise or any consumer disclosure requirements under section or otherwise other appropriate federal agencies indian tribes and tribal organizations coordination in general in carrying out the functions of the commissioner including with respect to the enforcement of the provisions of this division the commissioner shall work in coordination with with bills hr ih existing federal and state entities to the maximum extent feasible consistent with this division and in a manner that prevents conflicts of interest in duties and ensures effective enforcement uniform standards the commissioner in coordination with such entities shall seek to achieve uniform standards that adequately protect consumers in a manner that does not unreasonably affect employers and insurers sec health insurance ombudsman a in general the commissioner shall appoint within the health choices administration a qualified health benefits plan ombudsman who shall have expertise and experience in the fields of health care and education of and assistance to individuals duties the qualified health benefits plan ombudsman shall in a linguistically appropriate manner receive complaints grievances and requests for information submitted by individuals through means such as the mail by telephone electronically and in person provide assistance with respect to complaints grievances and requests referred to in paragraph including with bills hr ih a helping individuals determine the relevant information needed to seek an appeal of a decision or determination assistance to such individuals in choosing a qualified health benefits plan in which to enroll assistance to such individuals with any problems arising from disenrollment from such a plan and assistance to such individuals in presenting information under subtitle relating to affordability credits and submit annual reports to congress and the commissioner that describe the activities of the ombudsman and that include such recommendations for improvement in the administration of this division as the ombudsman determines appropriate the ombudsman shall not serve as an advocate for any increases in payments or new coverage of services but identify issues and problems in payment or coverage policies with bills hr ih subtitle relation to other requirements miscellaneous sec relation to other requirements a coverage not offered through exchange in general in the case of health insurance coverage not offered through the health insurance exchange whether or not offered in connection with an employment based health plan and in the case of employment based health plans the requirements of this title do not supercede any requirements applicable under titles xxii and xxvii of the public health service act parts and of subtitle of title of the employee retirement income security act of or state law except insofar as such requirements prevent the application of a requirement of this division as determined by the commissioner construction nothing in paragraphs or shall be construed as affecting the application of section of the employee retirement income security act of coverage offered through exchange with bills hr ih in general in the case of health insurance coverage offered through the health insurance exchange a the requirements of this title do not supercede any requirements including requirements relating to genetic information nondiscrimination and mental health parity applicable under title xxvii of the public health service act or under state law except insofar as such requirements prevent the application of a requirement of this division as determined by the commissioner and individual rights and remedies under state laws shall apply construction in the case of coverage described in paragraph nothing in such paragraph shall be construed as preventing the application of rights and remedies under state laws to health insurance issuers generally with respect to any requirement referred to in paragraph a the previous sentence shall not be construed as providing for the applicability of rights or remedies under state laws with respect to requirements applicable to employers or other plan sponsors in connection with arrangements which are treated as group with bills hr ih health plans under section a of the employee retirement income security act of sec prohibiting discrimination in health care a in general except as otherwise explicitly permitted by this act and by subsequent regulations consistent with this act all health care and related services including insurance coverage and public health activities covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services implementation to implement the requirement set forth in subsection a the secretary of health and human services shall not later than months after the date of the enactment of this act promulgate such regulations as are necessary or appropriate to insure that all health care and related services including insurance coverage and public health activities covered by this act are provided whether directly or through contractual licensing or other arrangements without regard to personal characteristics extraneous to the provision of high quality health care or related services sec whistleblower protection a retaliation prohibited no employer discharge any employee or otherwise discriminate against any employee with respect to his compensation terms with bills hr ih conditions or other privileges of employment because the employee or any person acting pursuant to a request of the employee provided caused to be provided or is about to provide or cause to be provided to the employer the federal government or the attorney general of a state information relating to any violation of or any act or omission the employee reasonably believes to be a violation of any provision of this act or any order rule or regulation promulgated under this act testified or is about to testify in a proceeding concerning such violation assisted or participated or is about to assist or participate in such a proceeding or objected to or refused to participate in any activity policy practice or assigned task that the employee or other such person reasonably believed to be in violation of any provision of this act or any order rule or regulation promulgated under this act enforcement action an employee covered by this section who alleges discrimination by an employer in violation of subsection a bring an action governed by the rules procedures legal burdens of proof and rem with bills hr ih edies set forth in section of the consumer product safety act usc employer defined as used in this section the term employer means any person including one or more individuals partnerships associations corporations trusts professional membership organization including a certification disciplinary or other professional body unincorporated organizations nongovernmental organizations or trustees engaged in profit or nonprofit business or industry whose activities are governed by this act and any agent contractor subcontractor grantee or consultant of such person rule of construction the rule of construction set forth in section of title united states code shall also apply to this section sec construction regarding collective bargaining nothing in this division shall be construed to alter or supersede any statutory or other obligation to engage in collective bargaining over the terms or conditions of employment related to health care any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this division shall not be with bills hr ih treated as a termination of such collective bargaining agreement sec severability if any provision of this act or any application of such provision to any person or circumstance is held to be unconstitutional the remainder of the provisions of this act and the application of the provision to any other person or circumstance shall not be affected sec treatment of hawaii prepaid health care act a in general subject to this section nothing in this division or an amendment made by this division shall be construed to modify or limit the application of the exemption for the hawaii prepaid health care act haw rev stat §§ – et seq as provided for under section of the employee retirement income security act of usc and such exemption shall also apply with respect to the provisions of this division and for purposes of this division and the amendments made by this division coverage provided pursuant to the hawaii prepaid health care act shall be treated as a qualified health benefits plan providing acceptable coverage so long as the with bills hr ih secretary of labor determines that such coverage for employees taking into account the benefits and the cost to employees for such benefits is substantially equivalent to or greater than the coverage provided for employees pursuant to the essential benefits package coordination with state law of hawaii the commissioner shall based on ongoing consultation with the appropriate officials of the state of hawaii make adjustments to rules and regulations of the commissioner under this division as be necessary as determined by the commissioner to most effectively coordinate the provisions of this division with the provisions of the hawaii prepaid health care act taking into account any changes made from time to time to the hawaii prepaid health care act and related laws of such state sec actions by state attorneys general any state attorney general bring a civil action in the name of such state as parens patriae on behalf of natural persons residing in such state in any district court of the united states or state court having jurisdiction of the defendant to secure monetary or equitable relief for violation of any provisions of this title or regulations issued thereunder nothing in this section shall be con with bills hr ih strued as affecting the application of section of the employee retirement income security act of sec application of state and federal laws regarding abortion a no preemption of state laws regarding abortion nothing in this act shall be construed to preempt or otherwise have any effect on state laws regarding the prohibition of or requirement of coverage funding or procedural requirements on abortions including parental notification or consent for the performance of an abortion on a minor no effect on federal laws regarding abortion in general nothing in this act shall be construed to have any effect on federal laws regarding a conscience protection willingness or refusal to provide abortion and discrimination on the basis of the willingness or refusal to provide pay for cover or refer for abortion or to provide or participate in training to provide abortion no effect on federal civil rights law nothing in this section shall alter the rights and obliga with bills hr ih tions of employees and employers under title vii of the civil rights act of sec nondiscrimination on abortion and respect for rights of conscience a nondiscrimination a federal agency or program and any state or local government that receives federal financial assistance under this act or an amendment made by this act not subject any individual or institutional health care entity to discrimination or require any health plan created or regulated under this act or an amendment made by this act to subject any individual or institutional health care entity to discrimination on the basis that the health care entity does not provide pay for provide coverage of or refer for abortions definition in this section the term health care entity includes an individual physician or other health care professional a hospital a provider sponsored organization a health maintenance organization a health insurance plan or any other kind of health care facility organization or plan administration the office for civil rights of the department of health and human services is designated to receive complaints of discrimination based on with bills hr ih this section and coordinate the investigation of such complaints sec authority of federal trade commission section of the federal trade commission act usc is amended by striking and prepare reports and all that follows and inserting the following and prepare reports and to share information under clauses and relating to the business of insurance notwithstanding section such authority shall include the authority to conduct studies and prepare reports and to share information under clauses and relating to the business of insurance without regard to whether the entity or entities that is the subject of such studies reports or information is a for profit or not for profit entity sec construction regarding standard of care a in general the development recognition or implementation of any guideline or other standard under a provision described in subsection shall not be construed to establish the standard of care or duty of care owed by health care providers to their patients in any medical malpractice action or claim as defined in section of the health care quality improvement act of usc with bills hr ih provisions described the provisions described in this subsection are the following section relating to modernized payment initiatives and delivery system reform under the public health option the amendments made by section relating to reducing potentially preventable hospital readmissions the amendments made by section relating to health care acquired conditions section of the public health service act relating to the task force on clinical preventive services added by section part of title ix of the public health service act relating to implementation of best practices in the delivery of health care added by section sec restoring application of antitrust laws to health sector insurers a amendment to mccarran ferguson act section of the act of march usc commonly known as the mccarran ferguson act is amended by adding at the end the following except as provided in paragraph nothing contained in this act shall modify impair or supersede with bills hr ih the operation of any of the antitrust laws with respect to price fixing market allocation or monopolization or attempting to monopolize by a a person engaged in the business of health insurance in connection with providing health insurance or a person engaged in the business of medical malpractice insurance in connection with providing medical malpractice insurance paragraph shall not apply to a collecting compiling classifying or disseminating historical loss data determining a loss development factor applicable to historical loss data performing actuarial services if doing so does not involve a restraint of trade or information gathering and rate setting activities of a state insurance commission or other state regulatory entity with authority to set insurance rates for purposes of this subsection a the term antitrust laws has the meaning given it in subsection a of the first section of the clayton act except that such term includes section of the federal trade commission act to the ex with bills hr ih tent that such section applies to unfair methods of competition the term historical loss data means information respecting claims paid or reserves held for claims reported by any person engaged in the business of insurance and the term loss development factor means an adjustment to be made to the aggregate of losses incurred during a prior period of time that have been paid or for which claims have been received and reserves are being held in order to estimate the aggregate of the losses incurred during such period that will ultimately be paid related provision for purposes of section of the federal trade commission act usc to the extent such section applies to unfair methods of competition section of the mccarran ferguson act shall apply with respect to the business of health insurance and with respect to the business of medical malpractice insurance without regard to whether such business is carried on for profit notwithstanding the definition of corporation contained in section of the federal trade commission act related preservation of antitrust laws except as provided in subsections a and with bills hr ih nothing in this act or in the amendments made by this act shall be construed to modify impair or supersede the operation of any of the antitrust laws for purposes of the preceding sentence the term antitrust laws has the meaning given it in subsection a of the first section of the clayton act except that it includes section of the federal trade commission act to the extent that such section applies to unfair methods of competition sec study and report on methods to increase ehr use by small health care providers a study the secretary of health and human services shall conduct a study of potential methods to increase the use of qualified electronic health records as defined in section of the public health service act by small health care providers such study shall consider at least the following methods providing for higher rates of reimbursement or other incentives for such health care providers to use electronic health records taking into consideration initiatives by private health insurance companies and incentives provided under medicare under title xviii of the social security act medicaid under title xix of such act and other programs with bills hr ih promoting low cost electronic health record software packages that are available for use by such health care providers including software packages that are available to health care providers through the veterans administration and other sources training and education of such health care providers on the use of electronic health records providing assistance to such health care providers on the implementation of electronic health records report not later than december the secretary of health and human services shall submit to congress a report containing the results of the study conducted under subsection a including recommendations for legislation or administrative action to increase the use of electronic health records by small health care providers that include the use of both public and private funding sources with bills hr ih title iii health insurance exchange and related provisions subtitle a health insurance exchange sec establishment of health insurance exchange outline of duties definitions a establishment there is established within the health choices administration and under the direction of the commissioner a health insurance exchange in order to facilitate access of individuals and employers through a transparent process to a variety of choices of affordable quality health insurance coverage including a public health insurance option outline of duties of commissioner in accordance with this subtitle and in coordination with appropriate federal and state officials as provided under section the commissioner shall under section establish standards for accept bids from and negotiate and enter into contracts with qhbp offering entities for the offering of health benefits plans through the health insurance exchange with different levels of benefits required under section and including with respect to oversight and enforcement with bills hr ih under section facilitate outreach and enrollment in such plans of exchange eligible individuals and employers described in section and conduct such activities related to the health insurance exchange as required including establishment of a risk pooling mechanism under section and consumer protections under subtitle of title sec exchange eligible individuals and employers a access to coverage in accordance with this section all individuals are eligible to obtain coverage through enrollment in an exchange participating health benefits plan offered through the health insurance exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage definitions in this division exchange eligible individual the term exchange eligible individual means an individual who is eligible under this section to be enrolled through the health insurance exchange in an exchange participating health benefits plan and with respect to family coverage includes dependents of such individual with bills hr ih exchange eligible employer the term exchange eligible employer means an employer that is eligible under this section to enroll through the health insurance exchange employees of the employer and their dependents in exchangeeligible health benefits plans employment related definitions the terms employer employee full time employee and part time employee have the meanings given such terms by the commissioner for purposes of this division transition individuals and employers shall only be eligible to enroll or participate in the health insurance exchange in accordance with the following transition schedule first year in as defined in section a individuals described in subsection including individuals described in subsection and smallest employers described in subsection second year in a individuals and employers described in paragraph and with bills hr ih smaller employers described in subsection third and subsequent years in a individuals and employers described in paragraph small employers described in subsection and larger employers as permitted by the commissioner under subsection individuals individual described subject to the succeeding provisions of this subsection an individual described in this paragraph is an individual who a is not enrolled in coverage described in subparagraph or of paragraph and is not enrolled in coverage as a fulltime employee or as a dependent of such an employee under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section for purposes of subparagraph in the case of an individual who is self employed who has at least employee and who meets the requirements of section with bills hr ih such individual shall be deemed a full time employee described in such subparagraph acceptable coverage for purposes of this division the term acceptable coverage means any of the following a qualified health benefits plan coverage coverage under a qualified health benefits plan grandfathered health insurance coverage coverage under current group health plan coverage under a grandfathered health insurance coverage as defined in subsection a of section or under a current group health plan described in subsection of such section medicare coverage under part a of title xviii of the social security act medicaid coverage for medical assistance under title xix of the social security act excluding such coverage that is only available because of the application of subsection or aa of section of such act members of the armed forces and dependents including tricare coverage under chapter of title united with bills hr ih states code including similar coverage furnished under section of title of such code va coverage under the veteran health care program under chapter of title united states code other coverage such other health benefits coverage such as a state health benefits risk pool as the commissioner in coordination with the secretary of the treasury recognizes for purposes of this paragraph the commissioner shall make determinations under this paragraph in coordination with the secretary of the treasury continuing eligibility permitted a in general except as provided in subparagraph once an individual qualifies as an exchange eligible individual under this subsection including as an employee or dependent of an employee of an exchange eligible employer and enrolls under an exchange participating health benefits plan through the health insurance exchange the individual shall continue to be treated as an exchange eligible individual until the individual is no longer enrolled with bills hr ih with an exchange participating health benefits plan exceptions in general subparagraph a shall not apply to an individual once the individual becomes eligible for coverage under part a of the medicare program under the medicaid program as a medicaid eligible individual except as permitted under clause or iii in such other circumstances as the commissioner provide transition period in the case described in clause the commissioner shall permit the individual to continue treatment under subparagraph a until such limited time as the commissioner determines it is administratively feasible consistent with minimizing disruption in the individual access to health care transition for chip eligibles an individual who is eligible for child health assistance under title xxi of the social security act for a pe with bills hr ih riod during shall not be an exchange eligible individual during such period employers smallest employer subject to paragraph smallest employers described in this paragraph are employers with or fewer employees smaller employers subject to paragraph smaller employers described in this paragraph are employers that are not smallest employers described in paragraph and have or fewer employees small employers subject to paragraph small employers described in this paragraph are employers that are not described in paragraph or and have or fewer employees larger employers a in general beginning with the commissioner permit employers not described in paragraph or to be exchange eligible employers phase in in applying subparagraph a the commissioner phase in the application of such subparagraph based on the number of full time employees of an employer and with bills hr ih such other considerations as the commissioner deems appropriate continuing eligibility once an employer is permitted to be an exchange eligible employer under this subsection and enrolls employees through the health insurance exchange the employer shall continue to be treated as an exchangeeligible employer for each subsequent plan year regardless of the number of employees involved unless and until the employer meets the requirement of section a through paragraph of such section by offering a group health plan and not through offering an exchange participating health benefits plan employer participation and contributions a satisfaction of employer responsibility for any year in which an employer is an exchange eligible employer such employer meet the requirements of section with respect to employees of such employer by offering such employees the option of enrolling with exchange participating health benefits plans through the health insurance exchange con with bills hr ih sistent with the provisions of subtitle of title iv employee choice any employee offered exchange participating health benefits plans by the employer of such employee under subparagraph a choose coverage under any such plan that choice includes with respect to family coverage coverage of the dependents of such employee affiliated groups any employer which is part of a group of employers who are treated as a single employer under subsection or of section of the internal revenue code of shall be treated for purposes of this subtitle as a single employer treatment of multi employer plans the plan sponsor of a group health plan as defined in section a of the employee retirement income security act of that is a multi employer plan as defined in section of such act obtain health insurance coverage with respect to participants in the plan through the exchange to the same extent that an employer not described in paragraph or is permitted by the commissioner to obtain health insurance coverage with bills hr ih through the exchange as an exchange eligible employer other counting rules the commissioner shall establish rules relating to how employees are counted for purposes of carrying out this subsection special situation authority the commissioner shall have the authority to establish such rules as be necessary to deal with special situations with regard to uninsured individuals and employers participating as exchange eligible individuals and employers such as transition periods for individuals and employers who gain or lose exchange eligible participation status and to establish grace periods for premium payment surveys of individuals and employers the commissioner shall provide for periodic surveys of exchange eligible individuals and employers concerning satisfaction of such individuals and employers with the health insurance exchange and exchange participating health benefits plans exchange access study in general the commissioner shall conduct a study of access to the health insurance exchange for individuals and for employers including individuals and employers who are not eligible and with bills hr ih enrolled in exchange participating health benefits plans the goal of the study is to determine if there are significant groups and types of individuals and employers who are not exchange eligible individuals or employers but who would have improved benefits and affordability if made eligible for coverage in the exchange items included in study such study also shall examine a the terms conditions and affordability of group health coverage offered by employers and qhbp offering entities outside of the exchange compared to exchange participating health benefits plans and the affordability test standard for access of certain employed individuals to coverage in the health insurance exchange report not later than january of in and thereafter the commissioner shall submit to congress a report on the study conducted under this subsection and shall include in such report recommendations regarding changes in standards for exchange eligibility for individuals and employers with bills hr ih sec benefits package levels a in general the commissioner shall specify the benefits to be made available under exchange participating health benefits plans during each plan year consistent with subtitle of title and this section limitation on health benefits plans offered by offering entities the commissioner not enter into a contract with a qhbp offering entity under section for the offering of an exchange participating health benefits plan in a service area unless the following requirements are met required offering of basic plan the entity offers only one basic plan for such service area optional offering of enhanced plan if and only if the entity offers a basic plan for such service area the entity offer one enhanced plan for such area optional offering of premium plan if and only if the entity offers an enhanced plan for such service area the entity offer one premium plan for such area optional offering of premium plus plans if and only if the entity offers a premium plan for such service area the entity offer one or more premium plus plans for such area with bills hr ih all such plans be offered under a single contract with the commissioner specification of benefit levels for plans in general the commissioner shall establish the following standards consistent with this subsection and title a basic enhanced and premium plans standards for levels of exchangeparticipating health benefits plans basic enhanced and premium in this division referred to as a basic plan enhanced plan and premium plan respectively premium plus plan benefits standards for additional benefits that be offered consistent with this subsection and subtitle of title under a premium plan such a plan with additional benefits referred to in this division as a premium plus plan basic plan a in general a basic plan shall offer the essential benefits package required under title for a qualified health benefits plan with an actuarial value of percent of the full ac with bills hr ih tuarial value of the benefits provided under the reference benefits package tiered cost sharing for affordable credit eligible individuals in the case of an affordable credit eligible individual as defined in section a enrolled in an exchange participating health benefits plan the benefits under a basic plan are modified to provide for the reduced cost sharing for the income tier applicable to the individual under section enhanced plan an enhanced plan shall offer in addition to the level of benefits under the basic plan a lower level of cost sharing as provided under title consistent with section a premium plan a premium plan shall offer in addition to the level of benefits under the basic plan a lower level of cost sharing as provided under title consistent with section premium plus plan a premium plus plan is a premium plan that also provides additional benefits such as adult oral health and vision care approved by the commissioner the portion of the premium that is attributable to such additional benefits shall be separately specified with bills hr ih range of permissible variation in cost sharing the commissioner shall establish a permissible range of variation of cost sharing for each basic enhanced and premium plan except with respect to any benefit for which there is no costsharing permitted under the essential benefits package such variation shall permit a variation of not more than plus or minus percent in cost sharing with respect to each benefit category specified under section nothing in this subtitle shall be construed as prohibiting tiering in cost sharing including through preferred and participating providers and prescription drugs in applying this paragraph a health benefits plan increase the costsharing by percent within each category or tier as applicable and decrease or eliminate costsharing in any category or tier as compared to the essential benefits package treatment of state benefit mandates insofar as a state requires a health insurance issuer offering health insurance coverage to include benefits beyond the essential benefits package such requirement shall continue to apply to an exchange participating health benefits plan if the state has entered into an arrangement satisfactory to the commissioner to reimburse the com with bills hr ih missioner for the amount of any net increase in affordability premium credits under subtitle as a result of an increase in premium in basic plans as a result of application of such requirement rules regarding coverage of and affordability credits for specified services assured availability of varied coverage through the health insurance exchange the commissioner shall assure that of the exchange participating health benefits plan offered in each premium rating area of the health insurance exchange a there is at least one such plan that provides coverage of services described in subparagraphs a and of section and there is at least one such plan that does not provide coverage of services described in section a which plan also be one that does not provide coverage of services described in section segregation of funds if a qualified health benefits plan provides coverage of services described in section a the plan shall pro with bills hr ih vide assurances satisfactory to the commissioner that a any affordability credits provided under subtitle of title are not used for purposes of paying for such services and only premium amounts attributable to the actuarial value described in section are used for such purpose sec contracts for the offering of exchangeparticipating health benefits plans a contracting duties in carrying out section and consistent with this subtitle offering entity and plan standards the commissioner shall a establish standards necessary to implement the requirements of this title and title for qhbp offering entities for the offering of an exchange participating health benefits plan and exchange participating health benefits plans and certify qhbp offering entities and qualified health benefits plans as meeting such with bills hr ih standards and requirements of this title and title for purposes of this subtitle soliciting and negotiating bids contracts a bid solicitation the commissioner shall solicit bids from qhbp offering entities for the offering of exchange participating health benefits plans such bids shall include justification for proposed premiums bid review and negotiation the commissioner shall based upon a review of such bids including the premiums and their affordability negotiate with such entities for the offering of such plans denial of excessive premiums the commissioner shall deny excessive premiums and premium increases contracts the commissioner shall enter into contracts with such entities for the offering of such plans through the health insurance exchange under terms consistent with this title negotiated between the commissioner and such entities federal acquisition regulation in carrying out this subtitle the commissioner with bills hr ih waive such provisions of the federal acquisition regulation that the commissioner determines to be inconsistent with the furtherance of this subtitle other than provisions relating to confidentiality of information competitive procedures shall be used in awarding contracts under this subtitle to the extent that such procedures are consistent with this subtitle standards for qhbp offering entities to offer exchange participating health benefits plans the standards established under subsection a a shall require that in order for a qhbp offering entity to offer an exchange participating health benefits plan the entity must meet the following requirements licensed the entity shall be licensed to offer health insurance coverage under state law for each state in which it is offering such coverage data reporting the entity shall provide for the reporting of such information as the commissioner specify including information necessary to administer the risk pooling mechanism described in section and information to address disparities in health and health care affordability the entity shall provide for affordable premiums with bills hr ih implementing affordability credits the entity shall provide for implementation of the affordability credits provided for enrollees under subtitle including the reduction in cost sharing under section enrollment the entity shall accept all enrollments under this subtitle subject to such exceptions such as capacity limitations in accordance with the requirements under title for a qualified health benefits plan the entity shall notify the commissioner if the entity projects or anticipates reaching such a capacity limitation that would result in a limitation in enrollment risk pooling participation the entity shall participate in such risk pooling mechanism as the commissioner establishes under section essential community providers with respect to the basic plan offered by the entity the entity shall include within the plan network those essential community providers where available that serve predominantly low income medically underserved individuals such as health care providers defined in section a of the public health service act and providers described in section iv of the social security act as with bills hr ih amended by section of public law – the commissioner shall specify the extent to which and manner in which the previous sentence shall apply in the case of a basic plan with respect to which the commissioner determines provides substantially all benefits through a health maintenance organization as defined in section of the public health service act this paragraph shall not be construed to require a basic plan to contract with a provider if such provider refuses to accept the generally applicable payment rates of such plan culturally and linguistically appropriate services and communications the entity shall provide for culturally and linguistically appropriate communication and health services special rules with respect to indian enrollees and indian health care providers a choice of providers the entity shall demonstrate to the satisfaction of the commissioner that it has contracted with a sufficient number of indian health care providers to ensure timely access to covered services furnished by such pro with bills hr ih viders to individual indians through the entity exchange participating health benefits plan and agree to pay indian health care providers whether such providers are participating or nonparticipating providers with respect to the entity for covered services provided to those enrollees who are eligible to receive services from such providers at a rate that is not less than the level and amount of payment which the entity would make for the services of a participating provider which is not an indian health care provider special rule relating to indian health care providers provision of services by an indian health care provider exclusively to indians and their dependents shall not constitute discrimination under this act program integrity standards the entity shall establish and operate a program to protect and promote the integrity of exchange participating health benefits plans it offers in accordance with standards and functions established by the commissioner with bills hr ih additional requirements the entity shall comply with other applicable requirements of this title as specified by the commissioner which shall include standards regarding billing and collection practices for premiums and related grace periods and which include standards to ensure that the entity does not use coercive practices to force providers not to contract with other entities offering coverage through the health insurance exchange contracts bid application to be eligible to enter into a contract under this section a qhbp offering entity shall submit to the commissioner a bid at such time in such manner and containing such information as the commissioner require term each contract with a qhbp offering entity under this section shall be for a term of not less than one year but be made automatically renewable from term to term in the absence of notice of termination by either party enforcement of network adequacy in the case of a health benefits plan of a qhbp offering entity that uses a provider network the contract under this section with the entity shall provide that if with bills hr ih a the commissioner determines that such provider network does not meet such standards as the commissioner shall establish under section and an individual enrolled in such plan receives an item or service from a provider that is not within such network then any cost sharing for such item or service shall be equal to the amount of such cost sharing that would be imposed if such item or service was furnished by a provider within such network oversight and enforcement responsibilities the commissioner shall establish processes in coordination with state insurance regulators to oversee monitor and enforce applicable requirements of this title with respect to qhbp offering entities offering exchange participating health benefits plans including the marketing of such plans such processes shall include the following a grievance and complaint mechanisms the commissioner shall establish in coordination with state insurance regulators a process under which exchange eligible individuals and employers file complaints concerning violations of such standards with bills hr ih enforcement in carrying out authorities under this division relating to the health insurance exchange the commissioner impose one or more of the intermediate sanctions described in section termination in general the commissioner terminate a contract with a qhbp offering entity under this section for the offering of an exchange participating health benefits plan if such entity fails to comply with the applicable requirements of this title any determination by the commissioner to terminate a contract shall be made in accordance with formal investigation and compliance procedures established by the commissioner under which the commissioner provides the entity with the reasonable opportunity to develop and implement a corrective action plan to correct the deficiencies that were the basis of the commissioner determination and the commissioner provides the entity with reasonable notice and with bills hr ih opportunity for hearing including the right to appeal an initial decision before terminating the contract exception for imminent and serious risk to health clause shall not apply if the commissioner determines that a delay in termination resulting from compliance with the procedures specified in such clause prior to termination would pose an imminent and serious risk to the health of individuals enrolled under the qualified health benefits plan of the qhbp offering entity construction nothing in this subsection shall be construed as preventing the application of other sanctions under subtitle of title with respect to an entity for a violation of such a requirement special rule related to cost sharing and indian health care providers the contract under this section with a qhbp offering entity for a health benefits plan shall provide that if an individual who is an indian is enrolled in such a plan and such individual receives a covered item or service from an indian health care provider regardless with bills hr ih of whether such provider is in the plan provider network the cost sharing for such item or service shall be equal to the amount of cost sharing that would be imposed if such item or service a had been furnished by another provider in the plan provider network or in the case that the plan has no such network was furnished by a non indian provider national plan nothing in this section shall be construed as preventing the commissioner from entering into a contract under this subsection with a qhbp offering entity for the offering of a health benefits plan with the same benefits in every state so long as such entity is licensed to offer such plan in each state and the benefits meet the applicable requirements in each such state no discrimination on the basis of provision of abortion no exchange participating health benefits plan discriminate against any individual health care provider or health care facility because of its willingness or unwillingness to provide pay for provide coverage of or refer for abortions with bills hr ih sec outreach and enrollment of exchange eligible individuals and employers in exchange participating health benefits plan a in general outreach the commissioner shall conduct outreach activities consistent with subsection including through use of appropriate entities as described in paragraph of such subsection to inform and educate individuals and employers about the health insurance exchange and exchange participating health benefits plan options such outreach shall include outreach specific to vulnerable populations such as children individuals with disabilities individuals with mental illness and individuals with other cognitive impairments eligibility the commissioner shall make timely determinations of whether individuals and employers are exchange eligible individuals and employers as defined in section enrollment the commissioner shall establish and carry out an enrollment process for exchange eligible individuals and employers including at community locations in accordance with subsection enrollment process with bills hr ih in general the commissioner shall establish a process consistent with this title for enrollments in exchange participating health benefits plans such process shall provide for enrollment through means such as the mail by telephone electronically and in person enrollment periods a open enrollment period the commissioner shall establish an annual open enrollment period during which an exchange eligible individual or employer elect to enroll in an exchange participating health benefits plan for the following plan year and an enrollment period for affordability credits under subtitle such periods shall be during september through november of each year or such other time that would maximize timeliness of income verification for purposes of such subtitle the open enrollment period shall not be less than days special enrollment the commissioner shall also provide for special enrollment periods to take into account special circumstances of individuals and employers such as an individual who with bills hr ih loses acceptable coverage experiences a change in marital or other dependent status iii moves outside the service area of the exchange participating health benefits plan in which the individual is enrolled or iv experiences a significant change in income enrollment information the commissioner shall provide for the broad dissemination of information to prospective enrollees on the enrollment process including before each open enrollment period in carrying out the previous sentence the commissioner work with other appropriate entities to facilitate such provision of information automatic enrollment for non medicaid eligible individuals a in general the commissioner shall provide for a process under which individuals who are exchange eligible individuals described in subparagraph are automatically enrolled under an appropriate exchange participating health benefits plan such process involve a random assignment or some other with bills hr ih form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors as the commissioner specify subsidized individuals described an individual described in this subparagraph is an exchange eligible individual who is either of the following affordability credit eligible individuals the individual has applied for and been determined eligible for affordability credits under subtitle has not opted out from receiving such affordability credit and iii does not otherwise enroll in another exchange participating health benefits plan individuals enrolled in a terminated plan the individual who is enrolled in an exchange participating health benefits plan that is terminated during or at the end of a plan year and who does not otherwise enroll in another with bills hr ih exchange participating health benefits plan direct payment of premiums to plans under the enrollment process individuals enrolled in an exchange participating health benefits plan shall pay such plans directly and not through the commissioner or the health insurance exchange coverage information and assistance coverage information the commissioner shall provide for the broad dissemination of information on exchange participating health benefits plans offered under this title such information shall be provided in a comparative manner and shall include information on benefits premiums costsharing quality provider networks and consumer satisfaction consumer assistance with choice to provide assistance to exchange eligible individuals and employers the commissioner shall a provide for the operation of a toll free telephone hotline to respond to requests for assistance and maintain an internet web site through which individuals obtain informa with bills hr ih tion on coverage under exchange participating health benefits plans and file complaints develop and disseminate information to exchange eligible enrollees on their rights and responsibilities assist exchange eligible individuals in selecting exchange participating health benefits plans and obtaining benefits through such plans and ensure that the internet web site described in subparagraph a and the information described in subparagraph is developed using plain language as defined in section a use of other entities in carrying out this subsection the commissioner work with other appropriate entities to facilitate the dissemination of information under this subsection and to provide assistance as described in paragraph coverage for certain newborns under medicaid in general in the case of a child born in the united states who at the time of birth is not otherwise covered under acceptable coverage for the period of time beginning on the date of birth and with bills hr ih ending on the date the child otherwise is covered under acceptable coverage or if earlier the end of the month in which the day period beginning on the date of birth ends the child shall be deemed a to be a medicaid eligible individual for purposes of this division and medicaid and to be automatically enrolled in medicaid as a traditional medicaid eligible individual as defined in section of the social security act extended treatment as medicaid eligible individual in the case of a child described in paragraph who at the end of the period referred to in such paragraph 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 eligibility for medical assistance under its medicaid plan pursuant to section of the social security act to be a medicaid eligible individual described in section of such act medicaid coverage for medicaid eligible individuals with bills hr ih medicaid enrollment obligation an individual apply in the manner described in section for a determination of whether the individual is a medicaid eligible individual if the individual is determined to be so eligible the commissioner through the medicaid memorandum of understanding under paragraph shall provide for the enrollment of the individual under the state medicaid plan in accordance with such memorandum of understanding in the case of such an enrollment the state shall provide for the same periodic redetermination of eligibility under medicaid as would otherwise apply if the individual had directly applied for medical assistance to the state medicaid agency coordinated enrollment with state through memorandum of understanding the commissioner in consultation with the secretary of health and human services shall enter into a memorandum of understanding with each state with respect to coordinating enrollment of individuals in exchange participating health benefits plans and under the state medicaid program consistent with this section and to otherwise coordinate the implementation of the provisions of this division with respect to the medicaid program such memo with bills hr ih randum shall permit the exchange of information consistent with the limitations described in section a of the social security act nothing in this section shall be construed as permitting such memorandum to modify or vitiate any requirement of a state medicaid plan effective culturally and linguistically appropriate communication in carrying out this section the commissioner shall establish effective methods for communicating in plain language and a culturally and linguistically appropriate manner role for enrollment agents and brokers nothing in this division shall be construed to affect the role of enrollment agents and brokers under state law including with regard to the enrollment of individuals and employers in qualified health benefits plans including the public health insurance option assistance for small employers in general the commissioner in consultation with the small business administration shall establish and carry out a program to provide to small employers counseling and technical assistance with respect to the provision of health insurance to employees of such employers through the health insurance exchange with bills hr ih duties the program established under paragraph shall include the following services a educational activities to increase awareness of the health insurance exchange and available small employer health plan options distribution of information to small employers with respect to the enrollment and selection process for health plans available under the health insurance exchange including standardized comparative information on the health plans available under the health insurance exchange distribution of information to small employers with respect to available affordability credits or other financial assistance referrals to appropriate entities of complaints and questions relating to the health insurance exchange enrollment and plan selection assistance for employers with respect to the health insurance exchange responses to questions relating to the health insurance exchange and the program established under paragraph with bills hr ih authority to provide services directly or by contract the commissioner provide services under paragraph directly or by contract with nonprofit entities that the commissioner determines capable of carrying out such services small employer defined in this subsection the term small employer means an employer with less than employees participation of small employer benefit arrangements in general the commissioner enter into contracts with small employer benefit arrangements to provide consumer information outreach and assistance in the enrollment of small employers and their employees who are members of such an arrangement under exchange participating health benefits plans small employer benefit arrangement defined in this subsection the term small employer benefit arrangement means a not for profit agricultural or other cooperative that a consists solely of its members and is operated for the primary purpose of providing affordable employee benefits to its members with bills hr ih only has as members small employers in the same industry or line of business has no member that has more than a percent voting interest in the cooperative and is governed by a board of directors elected by its members sec other functions a coordination of affordability credits the commissioner shall coordinate the distribution of affordability premium and cost sharing credits under subtitle to qhbp offering entities offering exchange participating health benefits plans coordination of risk pooling the commissioner shall establish a mechanism whereby there is an adjustment made of the premium amounts payable among qhbp offering entities offering exchange participating health benefits plans of premiums collected for such plans that takes into account in a manner specified by the commissioner the differences in the risk characteristics of individuals and employees enrolled under the different exchange participating health benefits plans offered by such entities so as to minimize the impact of adverse selection of enrollees among the plans offered by such entities for purposes of the previous sentence the commissioner utilize data regarding enrollee demographics inpatient with bills hr ih and outpatient diagnoses in a similar manner as such data are used under parts and of title xviii of the social security act and such other information as the secretary determines be necessary such as the actual medical costs of enrollees during the previous year sec health insurance exchange trust fund a establishment of health insurance exchange trust fund there is created within the treasury of the united states a trust fund to be known as the health insurance exchange trust fund in this section referred to as the trust fund consisting of such amounts as be appropriated or credited to the trust fund under this section or any other provision of law payments from trust fund the commissioner shall pay from time to time from the trust fund such amounts as the commissioner determines are necessary to make payments to operate the health insurance exchange including payments under subtitle relating to affordability credits transfers to trust fund dedicated payments there are hereby appropriated to the trust fund amounts equivalent to the following with bills hr ih a taxes on individuals not obtaining acceptable coverage the amounts received in the treasury under section of the internal revenue code of relating to requirement of health insurance coverage for individuals employment taxes on employers not providing acceptable coverage the amounts received in the treasury under sections and of the internal revenue code of relating to employers electing to not provide health benefits excise tax on failures to meet certain health coverage requirements the amounts received in the treasury under section relating to excise tax with respect to failure to meet health coverage participation requirements appropriations to cover government contributions there are hereby appropriated out of any moneys in the treasury not otherwise appropriated to the trust fund an amount equivalent to the amount of payments made from the trust fund under subsection plus such amounts as are with bills hr ih necessary reduced by the amounts deposited under paragraph application of certain rules rules similar to the rules of subchapter of chapter of the internal revenue code of shall apply with respect to the trust fund sec optional operation of state based health insurance exchanges a in general if a state or group of states subject to the approval of the commissioner applies to the commissioner for approval of a state based health insurance exchange to operate in the state or group of states and the commissioner approves such statebased health insurance exchange then subject to subsections and the state based health insurance exchange shall operate instead of the health insurance exchange with respect to such state or group of states the commissioner shall approve a state based health insurance exchange if it meets the requirements for approval under subsection requirements for approval in general the commissioner not approve a state based health insurance exchange with bills hr ih under this section unless the following requirements are met a the state based health insurance exchange must demonstrate the capacity to and provide assurances satisfactory to the commissioner that the state based health insurance exchange will carry out the functions specified for the health insurance exchange in the state or states involved including negotiating and contracting with qhbp offering entities for the offering of exchange participating health benefits plans which satisfy the standards and requirements of this title and title ii enrolling exchange eligible individuals and employers in such state in such plans iii the establishment of sufficient local offices to meet the needs of exchange eligible individuals and employers iv administering affordability credits under subtitle using the same methodologies and at least the same income verification methods as would otherwise apply under such subtitle and at a cost to with bills hr ih the federal government which does exceed the cost to the federal government if this section did not apply and enforcement activities consistent with federal requirements there is no more than one health insurance exchange operating with respect to any one state the state provides assurances satisfactory to the commissioner that approval of such an exchange will not result in any net increase in expenditures to the federal government the state provides for reporting of such information as the commissioner determines and assurances satisfactory to the commissioner that it will vigorously enforce violations of applicable requirements such other requirements as the commissioner specify presumption for certain state operated exchanges a in general in the case of a state operating an exchange prior to january that seeks to operate the state based health insurance exchange under this section with bills hr ih the commissioner shall presume that such exchange meets the standards under this section unless the commissioner determines after completion of the process established under subparagraph that the exchange does not comply with such standards process the commissioner shall establish a process to work with a state described in subparagraph a to provide assistance necessary to assure that the state exchange comes into compliance with the standards for approval under this section ceasing operation in general a state based health insurance exchange at the option of each state involved and only after providing timely and reasonable notice to the commissioner cease operation as such an exchange in which case the health insurance exchange shall operate instead of such statebased health insurance exchange with respect to such state or states termination health insurance exchange resumption of functions the commissioner terminate the approval for some or all functions of a state based health insurance ex with bills hr ih change under this section if the commissioner determines that such exchange no longer meets the requirements of subsection or is no longer capable of carrying out such functions in accordance with the requirements of this subtitle in lieu of terminating such approval the commissioner temporarily assume some or all functions of the statebased health insurance exchange until such time as the commissioner determines the state based health insurance exchange meets such requirements of subsection and is capable of carrying out such functions in accordance with the requirements of this subtitle effectiveness the ceasing or termination of a state based health insurance exchange under this subsection shall be effective in such time and manner as the commissioner shall specify retention of authority authority retained enforcement authorities of the commissioner shall be retained by the commissioner discretion to retain additional authority the commissioner specify functions of the health insurance exchange that with bills hr ih a not be performed by a statebased health insurance exchange under this section or be performed by the commissioner and by such a state based health insurance exchange references in the case of a state based health insurance exchange except as the commissioner otherwise specify under subsection any references in this subtitle to the health insurance exchange or to the commissioner in the area in which the state based health insurance exchange operates shall be deemed a reference to the state based health insurance exchange and the head of such exchange respectively funding in the case of a state based health insurance exchange there shall be assistance provided for the operation of such exchange in the form of a matching grant with a state share of expenditures required sec interstate health insurance compacts a in general effective january or more states form health care choice compacts in this section referred to as compacts to facilitate the purchase of individual health insurance coverage across state lines with bills hr ih model guidelines the secretary of health and human services in this section referred to as the secretary shall request the national association of insurance commissioners in this section referred to as naic to develop model guidelines for the creation of compacts in developing such guidelines the naic shall consult with consumers health insurance issuers the secretary and other interested parties such guidelines shall provide for the sale of health insurance coverage to residents of all compacting states subject to the laws and regulations of a primary state designated by the health insurance issuer require health insurance issuers issuing health insurance coverage in secondary states to maintain licensure in every such state preserve the authority of the state of an individual residence to address a market conduct unfair trade practices network adequacy consumer protection standards grievance and appeals fair claims payment requirements and prompt payment of claims with bills hr ih permit state insurance commissioners and other state agencies in secondary states access to the records of a health insurance issuer to the same extent as if the policy were written in that state and provide for clear and conspicuous disclosure to consumers that the policy not be subject to all the laws and regulations of the state in which the purchaser resides required consideration if model guidelines developed under subsection are submitted to the secretary by january the secretary shall issue them as regulations if the naic fails to submit such model guidelines by such date the secretary shall no later than october develop and promulgate the regulations implementing model guidelines described in subsection no requirement to compact nothing in this section shall be construed to require a state to join a compact state authority a state not enter into a compact under this subsection unless the state enacts a law after the date of enactment of this act that specifically authorizes the state to enter into such compact consumer protections if a state enters into a compact it must retain responsibility for the consumer with bills hr ih protections of its residents and its residents retain the right to bring a claim in a state court in the state in which the resident resides assistance to compacting states in general beginning january the secretary shall make awards from amounts appropriated under paragraph to states in the amount specified in paragraph for the uses described in paragraph amount specified a in general for each fiscal year the secretary shall determine the total amount that the secretary will make available for grants under this subsection state amount for each state that is awarded a grant under paragraph the amount of such grants shall be based on a formula established by the secretary not to exceed million per state under which states shall receive an award in the amount that is based on the following two components a minimum amount for each state an additional amount based on population of the state with bills hr ih use of funds a state shall use amounts awarded under this subsection for activities including planning activities related regulating health insurance coverage sold in secondary states renewability of grant the secretary renew a grant award under paragraph if the state receiving the grant continues to be a member of a compact authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this subsection in each of fiscal years through sec health insurance cooperatives a establishment not later than months after the date of the enactment of this act the commissioner in consultation with the secretary of the treasury shall establish a consumer operated and oriented plan program in this section referred to as the co–op program under which the commissioner make grants and loans for the establishment and initial operation of not for profit member–run health insurance cooperatives in this section individually referred to as a cooperative that provide insurance through the health insurance exchange or a state based health insurance exchange with bills hr ih under section nothing in this section shall be construed as requiring a state to establish such a cooperative start up and solvency grants and loans in general not later than months after the date of the enactment of this act the commissioner acting through the co–op program make a loans of such period and with such terms as the secretary specify to cooperatives to assist such cooperatives with start up costs and grants to cooperatives to assist such cooperatives in meeting state solvency requirements in the states in which such cooperative offers or issues insurance coverage conditions a grant or loan not be awarded under this subsection with respect to a cooperative unless the following conditions are met a the cooperative is structured as a notfor profit member organization under the law of each state in which such cooperative offers intends to offer or issues insurance coverage with the membership of the cooperative being with bills hr ih made up entirely of beneficiaries of the insurance coverage offered by such cooperative the cooperative did not offer insurance on or before july and the cooperative is not an affiliate or successor to an insurance company offering insurance on or before such date the governing documents of the cooperative incorporate ethical and conflict of interest standards designed to protect against insurance industry involvement and interference in the governance of the cooperative the cooperative is not sponsored by a state government substantially all of the activities of the cooperative consist of the issuance of qualified health benefits plans through the health insurance exchange or a state based health insurance exchange the cooperative is licensed to offer insurance in each state in which it offers insurance the governance of the cooperative must be subject to a majority vote of its members with bills hr ih as provided in guidance issued by the secretary of health and human services the cooperative operates with a strong consumer focus including timeliness responsiveness and accountability to members any profits made by the cooperative are used to lower premiums improve benefits or to otherwise improve the quality of health care delivered to members priority the commissioner in making grants and loans under this subsection shall give priority to cooperatives that a operate on a statewide basis use an integrated delivery system or have a significant level of financial support from nongovernmental sources rules of construction nothing in this section shall be construed to prevent a cooperative established in one state from integrating with a cooperative established in another state the administration issuance of coverage or other activities related to acting as a qhbp offering entity nothing in this section shall be construed as preventing state governments from taking actions to permit such integration with bills hr ih amortization of grants and loans the secretary shall provide for the repayment of grants or loans provided under this subsection to the treasury in an amortized manner over a year period repayment for violations of terms of program if a cooperative violates the terms of the co–op program and fails to correct the violation within a reasonable period of time as determined by the commissioner the cooperative shall repay the total amount of any loan or grant received by such cooperative under this section plus interest at a rate determined by the secretary authorization of appropriations there is authorized to be appropriated for the period of fiscal years through to provide for grants and loans under this subsection definitions for purposes of this section state the term state means each of the states and the district of columbia member the term member with respect to a cooperative means an individual who after the cooperative offers health insurance coverage is enrolled in such coverage with bills hr ih sec retention of dod and va authority nothing in this subtitle shall be construed as affecting any authority under title united states code or chapter of title united states code subtitle public health insurance option sec establishment and administration of a public health insurance option as an exchange qualified health benefits plan a establishment for years beginning with the secretary of health and human services in this subtitle referred to as the secretary shall provide for the offering of an exchange participating health benefits plan in this division referred to as the public health insurance option that ensures choice competition and stability of affordable high quality coverage throughout the united states in accordance with this subtitle in designing the option the secretary primary responsibility is to create a low cost plan without compromising quality or access to care offering as an exchange participating health benefits plan exclusive to the exchange the public health insurance option shall only be made available through the health insurance exchange with bills hr ih ensuring a level playing field consistent with this subtitle the public health insurance option shall comply with requirements that are applicable under this title to an exchange participating health benefits plan including requirements related to benefits benefit levels provider networks notices consumer protections and cost sharing provision of benefit levels the public health insurance option a shall offer basic enhanced and premium plans and offer premium plus plans administrative contracting the secretary enter into contracts for the purpose of performing administrative functions including functions described in subsection a of section a of the social security act with respect to the public health insurance option in the same manner as the secretary enter into contracts under subsection a of such section the secretary has the same authority with respect to the public health insurance option as the secretary has under subsections a and of section a of the social security act with respect to title xviii of such act contracts under this subsection shall not involve the transfer of insurance risk to such entity with bills hr ih ombudsman the secretary shall establish an office of the ombudsman for the public health insurance option which shall have duties with respect to the public health insurance option similar to the duties of the medicare beneficiary ombudsman under section of the social security act data collection the secretary shall collect such data as be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle including to improve quality and to reduce racial ethnic and other disparities in health and health care nothing in this subtitle be construed as authorizing the secretary or any employee or contractor to create or maintain lists of nonmedical personal property treatment of public health insurance option with respect to the public health insurance option the secretary shall be treated as a qhbp offering entity offering an exchange participating health benefits plan access to federal courts the provisions of medicare and related provisions of title of the social security act relating to access of medicare beneficiaries to federal courts for the enforcement of rights under medicare including with respect to amounts in controversy shall apply to the public health insurance option with bills hr ih and individuals enrolled under such option under this title in the same manner as such provisions apply to medicare and medicare beneficiaries sec premiums and financing a establishment of premiums in general the secretary shall establish geographically adjusted premium rates for the public health insurance option a in a manner that complies with the premium rules established by the commissioner under section for exchange participating health benefits plans and at a level sufficient to fully finance the costs of health benefits provided by the public health insurance option and administrative costs related to operating the public health insurance option contingency margin in establishing premium rates under paragraph the secretary shall include an appropriate amount for a contingency margin which shall be not less than days of estimated claims before setting such appropriate amount for years starting with the secretary with bills hr ih shall solicit a recommendation on such amount from the american academy of actuaries account establishment there is established in the treasury of the united states an account for the receipts and disbursements attributable to the operation of the public health insurance option including the start up funding under paragraph section of the social security act shall apply to receipts described in the previous sentence in the same manner as such section applies to payments or premiums described in such section start up funding a in general in order to provide for the establishment of the public health insurance option there is hereby appropriated to the secretary out of any funds in the treasury not otherwise appropriated in order to provide for initial claims reserves before the collection of premiums there are hereby appropriated to the secretary out of any funds in the treasury not otherwise appropriated such sums as necessary to cover days worth of claims reserves based on projected enrollment with bills hr ih amortization of start up funding the secretary shall provide for the repayment of the startup funding provided under subparagraph a to the treasury in an amortized manner over the year period beginning with limitation on funding nothing in this section shall be construed as authorizing any additional appropriations to the account other than such amounts as are otherwise provided with respect to other exchange participating health benefits plans no bailouts in no case shall the public health insurance option receive any federal funds for purposes of insolvency in any manner similar to the manner in which entities receive federal funding under the troubled assets relief program of the secretary of the treasury sec payment rates for items and services a negotiation of payment rates in general the secretary shall negotiate payment for the public health insurance option for health care providers and items and services including prescription drugs consistent with this section and section with bills hr ih manner of negotiation the secretary shall negotiate such rates in a manner that results in payment rates that are not lower in the aggregate than rates under title xviii of the social security act and not higher in the aggregate than the average rates paid by other qhbp offering entities for services and health care providers innovative payment methods nothing in this subsection shall be construed as preventing the use of innovative payment methods such as those described in section in connection with the negotiation of payment rates under this subsection establishment of a provider network in general health care providers including physicians and hospitals participating in medicare are participating providers in the public health insurance option unless they opt out in a process established by the secretary consistent with this subsection requirements for opt out process under the process established under paragraph a providers described in such paragraph shall be provided at least a year period prior with bills hr ih to the first day of to opt out of participating in the public health insurance option no provider shall be subject to a penalty for not participating in the public health insurance option the secretary shall include information on how providers participating in medicare who chose to opt out of participating in the public health insurance option opt back in and there shall be an annual enrollment period in which providers decide whether to participate in the public health insurance option rulemaking not later than months before the first day of the secretary shall promulgate rules pursuant to notice and comment for the process described in paragraph limitations on review there shall be no administrative or judicial review of a payment rate or methodology established under this section or under section sec modernized payment initiatives and delivery system reform a in general for plan years beginning with the secretary utilize innovative payment mechanisms with bills hr ih and policies to determine payments for items and services under the public health insurance option the payment mechanisms and policies under this section include patient centered medical home and other care management payments accountable care organizations valuebased purchasing bundling of services differential payment rates performance or utilization based payments partial capitation and direct contracting with providers requirements for innovative payments the secretary shall design and implement the payment mechanisms and policies under this section in a manner that seeks to a improve health outcomes reduce health disparities including racial ethnic and other disparities provide efficient and affordable care address geographic variation in the provision of health services or prevent or manage chronic illness and promotes care that is integrated patientcentered quality and efficient encouraging the use of high value services to the extent allowed by the benefit standards applied to all exchange participating health benefits plans with bills hr ih the public health insurance option modify cost sharing and payment rates to encourage the use of services that promote health and value promotion of delivery system reform the secretary shall monitor and evaluate the progress of payment and delivery system reforms under this act and shall seek to implement such reforms subject to the following to the extent that the secretary finds a payment and delivery system reform successful in improving quality and reducing costs the secretary shall implement such reform on as large a geographic scale as practical and economical the secretary delay the implementation of such a reform in geographic areas in which such implementation would place the public health insurance option at a competitive disadvantage the secretary prioritize implementation of such a reform in high cost geographic areas or otherwise in order to reduce total program costs or to promote high value care non uniformity permitted nothing in this subtitle shall prevent the secretary from varying payments based on different payment structure models such as accountable care organizations and medical homes under with bills hr ih the public health insurance option for different geographic areas sec provider participation a in general the secretary shall establish conditions of participation for health care providers under the public health insurance option licensure or certification in general except as provided in paragraph the secretary shall not allow a health care provider to participate in the public health insurance option unless such provider is appropriately licensed certified or otherwise permitted to practice under state law special rule for ihs facilities and providers the requirements under paragraph shall not apply to a a facility that is operated by the indian health service a facility operated by an indian tribe or tribal organization under the indian self determination act public law – a health care professional employed by the indian health service or a health care professional with bills hr ih who is employed to provide health care services in a facility operated by an indian tribe or tribal organization under the indian self determination act and who is licensed or certified in any state payment terms for providers physicians the secretary shall provide for the annual participation of physicians under the public health insurance option for which payment be made for services furnished during the year in one of classes a preferred physicians those physicians who agree to accept the payment under section without regard to cost sharing as the payment in full participating non preferred physicians those physicians who agree not to impose charges in relation to the payment described in section for such physicians that exceed the sum of the in network costsharing plus percent of the total payment for each item and service the secretary shall reduce the payment described in section for such physicians with bills hr ih other providers the secretary shall provide for the participation on an annual or other basis specified by the secretary of health care providers other than physicians under the public health insurance option under which payment shall only be available if the provider agrees to accept the payment under section without regard to costsharing as the payment in full exclusion of certain providers the secretary shall exclude from participation under the public health insurance option a health care provider that is excluded from participation in a federal health care program as defined in section of the social security act sec application of fraud and abuse provisions provisions of civil law identified by the secretary by regulation in consultation with the inspector general of the department of health and human services that impose sanctions with respect to waste fraud and abuse under medicare such as sections through of title united states code commonly known as the false claims act shall also apply to the public health insurance option with bills hr ih sec application of hipaa insurance requirements the requirements of sections through of the public health service act shall apply to the public health insurance option in the same manner as they apply to health insurance coverage offered by a health insurance issuer in the individual market sec application of health information privacy security and electronic transaction requirements part of title xi of the social security act relating to standards for protections against the wrongful disclosure of individually identifiable health information health information security and the electronic exchange of health care information shall apply to the public health insurance option in the same manner as such part applies to other health plans as defined in section of such act sec enrollment in public health insurance option is voluntary nothing in this division shall be construed as requiring anyone to enroll in the public health insurance option enrollment in such option is voluntary with bills hr ih sec enrollment in public health insurance option by members of congress notwithstanding any other provision of this act members of congress enroll in the public health insurance option sec reimbursement of secretary of veterans affairs the secretary of health and human services shall seek to enter into a memorandum of understanding with the secretary of veterans affairs regarding the recovery of costs related to non service connected care or services provided by the secretary of veterans affairs to an individual covered under the public health insurance option in a manner consistent with recovery of costs related to non service connected care from private health insurance plans subtitle individual affordability credits sec availability through health insurance exchange a in general subject to the succeeding provisions of this subtitle in the case of an affordable credit eligible individual enrolled in an exchange participating health benefits plan with bills hr ih the individual shall be eligible for in accordance with this subtitle affordability credits consisting of a an affordability premium credit under section to be applied against the premium for the exchange participating health benefits plan in which the individual is enrolled and an affordability cost sharing credit under section to be applied as a reduction of the cost sharing otherwise applicable to such plan and the commissioner shall pay the qhbp offering entity that offers such plan from the health insurance exchange trust fund the aggregate amount of affordability credits for all affordable credit eligible individuals enrolled in such plan application in general an exchange eligible individual apply to the commissioner through the health insurance exchange or through another entity under an arrangement made with the commissioner in a form and manner specified by the commissioner the commissioner through the health insurance exchange or through another public entity under an arrangement made with the commis with bills hr ih sioner shall make a determination as to eligibility of an individual for affordability credits under this subtitle the commissioner shall establish a process whereby on the basis of information otherwise available individuals be deemed to be affordable credit eligible individuals in carrying this subtitle the commissioner shall establish effective methods that ensure that individuals with limited english proficiency are able to apply for affordability credits use of state medicaid agencies if the commissioner determines that a state medicaid agency has the capacity to make a determination of eligibility for affordability credits under this subtitle and under the same standards as used by the commissioner under the medicaid memorandum of understanding under section a the state medicaid agency is authorized to conduct such determinations for any exchange eligible individual who requests such a determination and the commissioner shall reimburse the state medicaid agency for the costs of conducting such determinations medicaid screen and enroll obligation in the case of an application made under with bills hr ih paragraph there shall be a determination of whether the individual is a medicaid eligible individual if the individual is determined to be so eligible the commissioner through the medicaid memorandum of understanding under section shall provide for the enrollment of the individual under the state medicaid plan in accordance with such medicaid memorandum of understanding in the case of such an enrollment the state shall provide for the same periodic redetermination of eligibility under medicaid as would otherwise apply if the individual had directly applied for medical assistance to the state medicaid agency application and verification of requirement of citizenship or lawful presence in the united states a requirement no individual shall be an affordable credit eligible individual as defined in section a unless the individual is a citizen or national of the united states or is lawfully present in a state in the united states other than as a nonimmigrant described in a subparagraph excluding subparagraphs and of section with bills hr ih a of the immigration and nationality act declaration of citizenship or lawful immigration status no individual shall be an affordable credit eligible individual unless there has been a declaration made in a form and manner specified by the health choices commissioner similar to the manner required under section of the social security act and under penalty of perjury that the individual is a citizen or national of the united states or is not such a citizen or national but is lawfully present in a state in the united states other than as a nonimmigrant described in a subparagraph excluding subparagraphs and of section a of the immigration and nationality act such declaration shall be verified in accordance with subparagraph or as the case be verification process for citizens with bills hr ih in general in the case of an individual making the declaration described in subparagraph subject to clause section ee of the social security act shall apply to such declaration in the same manner as such section applies to a declaration described in paragraph of such section special rules in applying section ee of such act under clause any reference in such section to a state is deemed a reference to the commissioner or other public entity making the eligibility determination any reference to medical assistance or enrollment under a state plan is deemed a reference to provision of affordability credits under this subtitle iii a reference to a newly enrolled individual under paragraph a of such section is deemed a reference to an individual newly in re with bills hr ih ceipt of an affordability credit under this subtitle iv approval by the secretary shall not be required in applying paragraph of such section paragraph of such section shall not apply and vi before the end of the health choices commissioner in consultation with the commissioner of social security extend the periods specified in paragraph of such section verification process for noncitizens in general in the case of an individual making the declaration described in subparagraph subject to clause the verification procedures of paragraphs through of section of the social security act shall apply to such declaration in the same manner as such procedures apply to a declaration described in paragraph of such section with bills hr ih special rules in applying such paragraphs of section of such act under clause any reference in such paragraphs to a state is deemed a reference to the health choices commissioner and any reference to benefits under a program is deemed a reference to affordability credits under this subtitle iii application to state based exchanges in the case of the application of the verification process under this subparagraph to a state based health insurance exchange approved under section section of such act shall apply to the health choices commissioner in relation to the state annual reports the health choices commissioner shall report to congress annually on the number of applicants for affordability credits under this subtitle their citizenship or immigration status and the disposition of their applications such report shall be with bills hr ih made publicly available and shall include information on the number of applicants whose declaration of citizenship or immigration status name or social security account number was not consistent with records maintained by the commissioner of social security or the department of homeland security and of such applicants the number who contested the inconsistency and sought to document their citizenship or immigration status name or social security account number or to correct the information maintained in such records and of those the results of such contestations and the administrative costs of conducting the status verification under this paragraph gao report not later than the end of the comptroller general of the united states shall submit to the committee on ways and means the committee on energy and commerce the committee on education and labor and the committee on the judiciary of with bills hr ih the house of representatives and the committee on finance the committee on health education labor and pensions and the committee on the judiciary of the senate a report examining the effectiveness of the citizenship and immigration verification systems applied under this paragraph such report shall include an analysis of the following the causes of erroneous determinations under such systems the effectiveness of the processes used in remedying such erroneous determinations iii the impact of such systems on individuals health care providers and federal and state agencies including the effect of erroneous determinations under such systems iv the effectiveness of such systems in preventing ineligible individuals from receiving for affordability credits the characteristics of applicants described in subparagraph prohibition of database nothing in this paragraph or the amendments made by with bills hr ih paragraph shall be construed as authorizing the health choices commissioner or the commissioner of social security to establish a database of information on citizenship or immigration status initial funding in general out of any funds in the treasury not otherwise appropriated there is appropriated to the commissioner of social security to be available without fiscal year limit to carry out this paragraph and section of the social security act funding limitation in no case shall funds from the social security administration limitation on administrative expenses be used to carry out activities related to this paragraph or section of the social security act agreement with social security commissioner a in general the health choices commissioner shall enter into and maintain an agreement described in section of the with bills hr ih social security act with the commissioner of social security funding the agreement entered into under subparagraph a shall for each fiscal year beginning with fiscal year provide funds to the commissioner of social security for the full costs of the responsibilities of the commissioner of social security under paragraph including acquiring installing and maintaining technological equipment and systems necessary for the fulfillment of the responsibilities of the commissioner of social security under paragraph but only that portion of such costs that are attributable to such responsibilities and responding to individuals who contest with the commissioner of social security a reported inconsistency with records maintained by the commissioner of social security or the department of homeland security relating to citizenship or immigration with bills hr ih status name or social security account number under paragraph based on an estimating methodology agreed to by the commissioner of social security and the health choices commissioner provide such funds within calendar days of the beginning of the fiscal year for the first quarter and in advance for all subsequent quarters in that fiscal year and iii provide for an annual accounting and reconciliation of the actual costs incurred and the funds provided under the agreement review of accounting the annual accounting and reconciliation conducted pursuant to subparagraph iii shall be reviewed by the inspectors general of the social security administration and the health choices administration including an analysis of consistency with the requirements of paragraph contingency in any case in which agreement with respect to the provisions required under subparagraph for any fiscal year has not been reached as of the first day with bills hr ih of such fiscal year the latest agreement with respect to such provisions shall be deemed in effect on an interim basis for such fiscal year until such time as an agreement relating to such provisions is subsequently reached in any case in which an interim agreement applies for any fiscal year under this subparagraph the commissioner of social security shall not later than the first day of such fiscal year notify the appropriate committees of the congress of the failure to reach the agreement with respect to such provisions for such fiscal year until such time as the agreement with respect to such provisions has been reached for such fiscal year the commissioner of social security shall not later than the end of each day period after october of such fiscal year notify such committees of the status of negotiations between such commissioner and the health choices commissioner in order to reach such an agreement application to public entities administering affordability credits if the health choices commissioner provides for the conduct of verifications under paragraph with bills hr ih through a public entity the health choices commissioner shall require the public entity to enter into an agreement with the commissioner of social security which provides the same terms as the agreement described in this paragraph and section of the social security act between the health choices commissioner and the commissioner of social security except that the health choices commissioner shall be responsible for providing funds for the commissioner of social security in accordance with subparagraphs through amendments to social security act a coordination of information between social security administration and health choices administration in general section of the social security act usc is amended by adding at the end the following new subsection coordination of information with health choices administration the health choices commissioner collect and use the names and social security account numbers of individuals as required to provide for verification with bills hr ih of citizenship under subsection of section of the affordable health care for america act in connection with determinations of eligibility for affordability credits under such section a the commissioner of social security shall enter into and maintain an agreement with the health choices commissioner for the purpose of establishing in compliance with the requirements of section ee as applied pursuant to section of the affordable health care for america act a program for verifying information required to be collected by the health choices commissioner under such section the agreement entered into pursuant to subparagraph a shall include such safeguards as are necessary to ensure the maintenance of confidentiality of any information disclosed for purposes of verifying information described in subparagraph a and to provide procedures for permitting the health choices commissioner to use the information for purposes of maintaining the records of the health choices administration the agreement entered into pursuant to subparagraph a shall provide that information provided by the commissioner of social security to the health choices commissioner pursuant to the agreement shall be provided with bills hr ih at such time at such place and in such manner as the commissioner of social security determines appropriate information provided by the commissioner of social security to the health choices commissioner pursuant to an agreement entered into pursuant to subparagraph a shall be considered as strictly confidential and shall be used only for the purposes described in this paragraph and for carrying out such agreement any officer or employee or former officer or employee of the health choices commissioner or any officer or employee or former officer or employee of a contractor of the health choices commissioner who without the written authority of the commissioner of social security publishes or communicates any information in such individual possession by reason of such employment or position as such an officer shall be guilty of a felony and upon conviction thereof shall be fined or imprisoned or both as described in section the agreement entered into under paragraph shall provide for funding to the commissioner of social security consistent with section of affordable health care for america act this subsection shall apply in the case of a public entity that conducts verifications under section of the affordable health care for america act with bills hr ih and the obligations of this subsection shall apply to such an entity in the same manner as such obligations apply to the health choices commissioner when such commissioner is conducting such verifications conforming amendment section c of such act usc c is amended by adding at the end the following new clause for purposes of the administration of the verification procedures described in section of the affordable health care for america act the health choices commissioner collect and use social security account numbers as provided for in section improving the integrity of data and effectiveness of save section of the social security act usc b– is amended by adding at the end the following new paragraphs a with respect to the use by any agency of the system described in subsection by programs specified in subsection or any other use of such system the us citizenship and immigration services and any other agency charged with the management of the system shall establish appropriate safeguards necessary to protect and with bills hr ih improve the integrity and accuracy of data relating to individuals by establishing a process though which such individuals are provided access to and the ability to amend correct and update their own personally identifiable information contained within the system providing a written response without undue delay to any individual who has made such a request to amend correct or update such individual own personally identifiable information contained within the system and iii developing a written notice for user agencies to provide to individuals who are denied a benefit due to a determination of ineligibility based on a final verification determination under the system the notice described in subparagraph a shall include information about the reason for such notice a description of the right of the recipient of the notice under subparagraph a to contest such notice iii a description of the right of the recipient under subparagraph a to access and attempt to amend correct and update the recipient own per with bills hr ih sonally identifiable information contained within records of the system described in paragraph and iv instructions on how to contest such notice and attempt to correct records of such system relating to the recipient including contact information for relevant agencies streamlining administration of verification process for united states citizens section ee of the social security act usc a ee is amended by adding at the end the following in carrying out the verification procedures under this subsection with respect to a state if the commissioner of social security determines that the records maintained by such commissioner are not consistent with an individual allegation of united states citizenship pursuant to procedures which shall be established by the state in coordination with the commissioner of social security the secretary of homeland security and the secretary of health and human services the commissioner of social security shall inform the state of the inconsistency upon being so informed of the inconsistency the state shall submit the information on the with bills hr ih individual to the secretary of homeland security for a determination of whether the records of the department of homeland security indicate that the individual is a citizen iii upon making such determination the department of homeland security shall inform the state of such determination and iv information provided by the commissioner of social security shall be considered as strictly confidential and shall only be used by the state and the secretary of homeland security for the purposes of such verification procedures verification of status eligibility pursuant to the procedures established under this subsection shall be deemed a verification of status eligibility for purposes of this title title xxi and affordability credits under section of the affordable health care for america act regardless of the program in which the individual is applying for benefits use of affordability credits in general in and an affordable credit eligible individual use an affordability credit only with respect to a basic plan flexibility in plan enrollment authorized beginning with the commissioner with bills hr ih shall establish a process to allow an affordability premium credit under section but not the affordability cost sharing credit under section to be used for enrollees in enhanced or premium plans in the case of an affordable credit eligible individual who enrolls in an enhanced or premium plan the individual shall be responsible for any difference between the premium for such plan and the affordability credit amount otherwise applicable if the individual had enrolled in a basic plan prohibition of use of public funds for abortion coverage an affordability credit not be used for payment for services described in section a access to data in carrying out this subtitle the commissioner shall request from the secretary of the treasury consistent with section of the internal revenue code of such information as be required to carry out this subtitle no cash rebates in no case shall an affordable credit eligible individual receive any cash payment as a result of the application of this subtitle sec affordable credit eligible individual a definition with bills hr ih in general for purposes of this division the term affordable credit eligible individual means subject to subsection and section an individual who is lawfully present in a state in the united states other than as a nonimmigrant described in a subparagraph excluding subparagraphs and of section a of the immigration and nationality act a who is enrolled under an exchangeparticipating health benefits plan and is not enrolled under such plan as an employee or dependent of an employee through an employer qualified health benefits plan that meets the requirements of section with modified adjusted gross income below percent of the federal poverty level for a family of the size involved who is not a medicaid eligible individual other than an individual during a transition period under section and subject to paragraph who is not enrolled in acceptable coverage other than an exchange participating health benefits plan treatment of family except as the commissioner otherwise provide members of with bills hr ih the same family who are affordable credit eligible individuals shall be treated as a single affordable credit individual eligible for the applicable credit for such a family under this subtitle special rule for indians subparagraph of paragraph shall not apply to an individual who has coverage that is treated as acceptable coverage for purposes of section of the internal revenue code of but is not treated as acceptable coverage for purposes of this division limitations on employee and dependent disqualification in general subject to paragraph the term affordable credit eligible individual does not include a full time employee of an employer if the employer offers the employee coverage for the employee and dependents as a full time employee under a group health plan if the coverage and employer contribution under the plan meet the requirements of section exceptions a for certain family circumstances the commissioner shall establish such exceptions and special rules in the with bills hr ih case described in paragraph as be appropriate in the case of a divorced or separated individual or such a dependent of an employee who would otherwise be an affordable credit eligible individual for unaffordable employer coverage beginning in in the case of fulltime employees for which the cost of the employee premium for coverage under a group health plan would exceed percent of current modified adjusted gross income determined by the commissioner on the basis of verifiable documentation paragraph shall not apply income defined in general in this title the term income means modified adjusted gross income as defined in section of the internal revenue code of study of income disregards the commissioner shall conduct a study that examines the application of income disregards for purposes of this subtitle not later than the first day of the commissioner shall submit to congress a report on such study and shall include such recommendations as the commissioner determines appropriate with bills hr ih clarification of treatment of affordability credits affordability credits under this subtitle shall not be treated for purposes of title iv of the personal responsibility and work opportunity reconciliation act of to be a benefit provided under section of such title sec affordability premium credit a in general the affordability premium credit under this section for an affordable credit eligible individual enrolled in an exchange participating health benefits plan is in an amount equal to the amount if any by which the reference premium amount specified in subsection exceeds the affordable premium amount specified in subsection for the individual except that in no case shall the affordable premium credit exceed the premium for the plan affordable premium amount in general the affordable premium amount specified in this subsection for an individual for the annual premium in a plan year shall be equal to the product of a the premium percentage limit specified in paragraph for the individual based upon the individual modified adjusted gross income for the plan year and with bills hr ih the individual modified adjusted gross income for such plan year premium percentage limits based on table the commissioner shall establish premium percentage limits so that for individuals whose modified adjusted gross income is within an income tier specified in the table in subsection such percentage limits shall increase on a sliding scale in a linear manner from the initial premium percentage to the final premium percentage specified in such table for such income tier reference premium amount the reference premium amount specified in this subsection for a plan year for an individual in a premium rating area is equal to the average premium for the basic plans in the area for the plan year with the lowest premium levels in computing such amount the commissioner exclude plans with extremely limited enrollments table of premium percentage limits actuarial value percentages and out of pocket limits for based on income tier in general for purposes of this subtitle subject to paragraph and section the table specified in this subsection is as follows with bills hr ihin the case ofmodified adjustedgross income expressedas a percentof fpl withinthe following incometier the initialpremiumpercentageis the finalpremiumpercentageis the actuarialvaluepercentageis the out ofpocketlimitfor is % through%% % % % through%% % % % through%% % % % through%% % % % through%% % % % through%% % % special rules for purposes of applying the table under paragraph a for lowest level of income in the case of an individual with income that does not exceed percent of fpl the individual shall be considered to have income that is percent of fpl application of higher actuarial value percentage at tier transition points if two actuarial value percentages be determined with respect to an individual the actuarial value percentage shall be the higher of such percentages indexing for years after the commissioner shall adjust the initial and final premium percentages to maintain the ratio of governmental to with bills hr ih enrollee shares of premiums over time for each income tier identified in the table in paragraph sec affordability cost sharing credit a in general the affordability cost sharing credit under this section for an affordable credit eligible individual enrolled in an exchange participating health benefits plan is in the form of the cost sharing reduction described in subsection provided under this section for the income tier in which the individual is classified based on the individual modified adjusted gross income cost sharing reductions the commissioner shall specify a reduction in cost sharing amounts and the annual limitation on cost sharing specified in section under a basic plan for each income tier specified in the table under section with respect to a year in a manner so that as estimated by the commissioner the actuarial value of the coverage with such reduced cost sharing amounts and the reduced annual cost sharing limit is equal to the actuarial value percentage specified in the table under section for the income tier involved of the full actuarial value if there were no cost sharing imposed under the plan and with bills hr ih the annual limitation on cost sharing specified in section is reduced to a level that does not exceed the maximum out of pocket limit specified in subsection c maximum out of pocket limit in general subject to paragraph the maximum out of pocket limit specified in this subsection for an individual within an income tier a for individual coverage for is the out of pocket limit for specified in subsection in the table under section for the income tier involved or for a subsequent year is such outof pocket limit for the previous year under this subparagraph increased rounded to the nearest for each subsequent year by the percentage increase in the enrollment weighted average of premium increases for basic plans applicable to such year or for family coverage is twice the maximum out of pocket limit under subparagraph a for the year involved with bills hr ih adjustment the commissioner shall adjust the maximum out of pocket limits under paragraph to ensure that such limits meet the actuarial value percentage specified in the table under section for the income tier involved determination and payment of cost sharing affordability credit in the case of an affordable credit eligible individual in a tier enrolled in an exchange participating health benefits plan offered by a qhbp offering entity the commissioner shall provide for payment to the offering entity of an amount equivalent to the increased actuarial value of the benefits under the plan provided under section resulting from the reduction in cost sharing described in subsections and sec income determinations a in general in applying this subtitle for an affordability credit for an individual for a plan year the individual income shall be the income as defined in section for the individual for the most recent taxable year as determined in accordance with rules of the commissioner the federal poverty level applied shall be such level in effect as of the date of the application program integrity income verification procedures with bills hr ih program integrity the commissioner shall take such steps as be appropriate to ensure the accuracy of determinations and redeterminations under this subtitle income verification a in general upon an initial application of an individual for an affordability credit under this subtitle or in applying section or upon an application for a change in the affordability credit based upon a significant change in modified adjusted gross income described in subsection the commissioner shall request from the secretary of the treasury the disclosure to the commissioner of such information as be permitted to verify the information contained in such application and the commissioner shall use the information so disclosed to verify such information alternative procedures the commissioner shall establish procedures for the verification of income for purposes of this sub with bills hr ih title if no income tax return is available for the most recent completed tax year special rules changes in income as a percent of fpl in the case that an individual income expressed as a percentage of the federal poverty level for a family of the size involved for a plan year is expected in a manner specified by the commissioner to be significantly different from the income as so expressed used under subsection a the commissioner shall establish rules requiring an individual to report consistent with the mechanism established under paragraph significant changes in such income including a significant change in family composition to the commissioner and requiring the substitution of such income for the income otherwise applicable reporting of significant changes in income the commissioner shall establish rules under which an individual determined to be an affordable credit eligible individual would be required to inform the commissioner when there is a significant change in the modified adjusted gross income of the individual expressed as a percentage of the fpl for a family of the size involved and of the in with bills hr ih formation regarding such change such mechanism shall provide for guidelines that specify the circumstances that qualify as a significant change the verifiable information required to document such a change and the process for submission of such information if the commissioner receives new information from an individual regarding the modified adjusted gross income of the individual the commissioner shall provide for a redetermination of the individual eligibility to be an affordable credit eligible individual transition for chip in the case of a child described in section the commissioner shall establish rules under which the modified adjusted gross income of the child is deemed to be no greater than the family income of the child as most recently determined before by the state under title xxi of the social security act study of geographic variation in application of fpl a in general the secretary of health and human services shall conduct a study to examine the feasibility and implication of adjusting the application of the federal poverty level under this subtitle for different geo with bills hr ih graphic areas so as to reflect the variations in cost of living among different areas within the united states if the secretary determines that an adjustment is feasible the study should include a methodology to make such an adjustment not later than the first day of the secretary shall submit to congress a report on such study and shall include such recommendations as the secretary determines appropriate inclusion of territories in general the secretary shall ensure that the study under subparagraph a covers the territories of the united states and that special attention is paid to the disparity that exists among poverty levels and the cost of living in such territories and to the impact of such disparity on efforts to expand health coverage and ensure health care territories defined in this subparagraph the term territories of the united states includes the commonwealth of puerto rico the united states virgin islands guam the northern mar with bills hr ih iana islands and any other territory or possession of the united states penalties for misrepresentation in the case of an individual who intentionally misrepresents modified adjusted gross income or the individual fails without regard to intent to disclose to the commissioner a significant change in modified adjusted gross income under subsection in a manner that results in the individual becoming an affordable credit eligible individual when the individual is not or in the amount of the affordability credit exceeding the correct amount the individual is liable for repayment of the amount of the improper affordability credit and in the case of such an intentional misrepresentation or other egregious circumstances specified by the commissioner the commissioner impose an additional penalty sec special rules for application to territories a one time election for treatment and application of funding in general a territory elect in a form and manner specified by the commissioner in consultation with the secretary of health and with bills hr ih human services and the secretary of the treasury and not later than october either a to be treated as a state for purposes of applying this title and title or not to be so treated but instead to have the dollar limitation otherwise applicable to the territory under subsections and of section of the social security act usc for a fiscal year increased by a dollar amount equivalent to the cap amount determined under subsection for the territory as applied by the secretary for the fiscal year involved conditions for acceptance the commissioner has the nonreviewable authority to accept or reject an election described in paragraph a any such acceptance is a contingent upon entering into an agreement described in subsection between the commissioner and the territory and subsection and subject to the approval of the secretary of health and human services and the secretary of the treasury and subject to such other terms and conditions as the commis with bills hr ih sioner in consultation with such secretaries specify default rule a territory failing to make such an election or having an election under paragraph a not accepted under paragraph shall be treated as having made the election described in paragraph agreement for substitution of percentages for affordability credits negotiation in the case of a territory making an election under subsection a a in this section referred to as an electing territory the commissioner in consultation with the secretaries of health and human services and the treasury shall enter into negotiations with the government of such territory so that before there is an agreement reached between the parties on the percentages that shall be applied under paragraph for that territory the commissioner shall not enter into such an agreement unless a payments made under this subtitle with respect to residents of the territory are consistent with the cap established under subsection for such territory and with subsection and with bills hr ih the requirements of paragraphs and are met application of substitute percentages and dollar amounts in the case of an electing territory there shall be substituted in section a and in the table in section for percent percent and other percentages and dollar amounts specified in such table such respective percentages and dollar amounts as are established under the agreement under paragraph consistent with the following a no income gap between medicaid and affordability credits the substituted percentages shall be specified in a manner so as to prevent any gap in coverage for individuals between income level at which medical assistance is available through medicaid and the income level at which affordability credits are available adjustment for out of pocket responsibility for premiums and costsharing in relation to income the substituted percentages of fpl for income tiers under such table shall be specified in a manner so that with bills hr ih affordable credit eligible individuals residing in the territory bear the same out of pocket responsibility for premiums and cost sharing in relation to average income for residents in that territory as the out of pocket responsibility for premiums and cost sharing for affordable credit eligible individuals residing in the states or the district of columbia in relation to average income for such residents special rules with respect to application of tax and penalty provisions the electing territory shall enact one or more laws under which provisions similar to the following provisions apply with respect to such territory a section of the internal revenue code of except that any resident of the territory who is not an affordable credit eligible individual but who would be an affordable credit eligible individual if such resident were a resident of one of the states and any qualifying child residing with such individual be treated as covered by acceptable coverage section of the internal revenue code of and section of with bills hr ih the employee retirement income security act of section of the internal revenue code of implementation of insurance reform and consumer protection requirements the electing territory shall enact and implement such laws and regulations as be required to apply the requirements of title with respect to health insurance coverage offered in the territory cap on additional expenditures in general in entering into an agreement with an electing territory under subsection the commissioner shall ensure that the aggregate expenditures under this subtitle with respect to residents of such territory during the period beginning with and ending with will not exceed the cap amount specified in paragraph for such territory the commissioner shall adjust from time to time the percentages applicable under such agreement as needed in order to carry out the previous sentence cap amount a in general the cap amount specified in this paragraph with bills hr ih for puerto rico is increased by the amount if any elected under subparagraph or for another territory is the portion of negotiated for such territory under subparagraph negotiation for certain territories the commissioner in consultation with the secretary of health and human services shall negotiate with the governments of the territories other than puerto rico to allocate the amount specified in subparagraph a among such territories optional supplementation for puerto rico in general puerto rico elect in a form and manner specified by the secretary of health and human services in consultation with the commissioner to increase the dollar amount specified in subparagraph a by up to offset in medicaid cap if puerto rico makes the election described in clause the secretary shall decrease with bills hr ih the dollar limitation otherwise applicable to puerto rico under subsections and of section of the social security act usc for a fiscal year by the additional aggregate payments the secretary estimates will be payable under this section for the fiscal year because of such election limitation on funding in no case shall this section including the agreement under subsection permit the obligation of funds for expenditures under this subtitle for periods beginning on or after january or any increase in the dollar limitation described in subsection a for any portion of any fiscal year occurring on or after such date sec no federal payment for undocumented aliens nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the united states with bills hr ih title iv shared responsibility subtitle a individual responsibility sec individual responsibility for an individual responsibility to obtain acceptable coverage see section of the internal revenue code of as added by section of this act subtitle employer responsibility part health coverage participation requirements sec health coverage participation requirements an employer meets the requirements of this section if such employer does all of the following offer of coverage the employer offers each employee individual and family coverage under a qualified health benefits plan or under a current employment based health plan within the meaning of section in accordance with section contribution towards coverage if an employee accepts such offer of coverage the em with bills hr ih ployer makes timely contributions towards such coverage in accordance with section contribution in lieu of coverage beginning with if an employee declines such offer but otherwise obtains coverage in an exchangeparticipating health benefits plan other than by reason of being covered by family coverage as a spouse or dependent of the primary insured the employer shall make a timely contribution to the health insurance exchange with respect to each such employee in accordance with section sec employer responsibility to contribute toward employee and dependent coverage a in general an employer meets the requirements of this section with respect to an employee if the following requirements are met offering of coverage the employer offers the coverage described in section in the case of an exchange eligible employer the employer offer such coverage either through an exchange participating health benefits plan or other than through such a plan employer required contribution the employer timely pays to the issuer of such cov with bills hr ih erage an amount not less than the employer required contribution specified in subsection for such coverage provision of information the employer provides the health choices commissioner the secretary of labor the secretary of health and human services and the secretary of the treasury as applicable with such information as the commissioner require to ascertain compliance with the requirements of this section including the following a the name date and employer identification number of the employer a certification as to whether the employer offers to its full time employees and their dependents the opportunity to enroll in a qualified health benefits plan or a current employment based health plan within the meaning of section if the employer certifies that the employer did offer to its full time employees and their dependents the opportunity to so enroll the months during the calendar year for which such coverage was available and with bills hr ih the monthly premium for the lowest cost option in each of the enrollment categories under each such plan offered to employees the name address and tin of each full time employee during the calendar year and the months if any during which such employee and any dependents were covered under any such plans autoenrollment of employees the employer provides for autoenrollment of the employee in accordance with subsection this subsection shall supersede any law of a state which would prevent automatic payroll deduction of employee contributions to an employment based health plan reduction of employee premiums through minimum employer contribution full time employees the minimum employer contribution described in this subsection for coverage of a full time employee and if any the employee spouse and qualifying children as defined in section of the internal revenue code of under a qualified health benefits plan or current employment based health plan is equal to with bills hr ih a in case of individual coverage not less than percent of the applicable premium as defined in section of such code subject to paragraph of the lowest cost plan offered by the employer that is a qualified health benefits plan or is such current employment based health plan and in the case of family coverage which includes coverage of such spouse and children not less percent of such applicable premium of such lowest cost plan applicable premium for exchange coverage in this subtitle the amount of the applicable premium of the lowest cost plan with respect to coverage of an employee under an exchange participating health benefits plan is the reference premium amount under section for individual coverage or if elected family coverage for the premium rating area in which the individual or family resides minimum employer contribution for employees other than full time employees in the case of coverage for an employee who is not a full time employee the amount of the minimum employer contribution under this subsection shall be a proportion as determined in accordance with bills hr ih with rules of the health choices commissioner the secretary of labor the secretary of health and human services and the secretary of the treasury as applicable of the minimum employer contribution under this subsection with respect to a full time employee that reflects the proportion of a the average weekly hours of employment of the employee by the employer to the minimum weekly hours specified by the commissioner for an employee to be a full time employee salary reductions not treated as employer contributions for purposes of this section any contribution on behalf of an employee with respect to which there is a corresponding reduction in the compensation of the employee shall not be treated as an amount paid by the employer automatic enrollment for employer sponsored health benefits in general the requirement of this subsection with respect to an employer and an employee is that the employer automatically enroll such employee into the employment based health benefits plan for individual coverage under the plan option with the lowest applicable employee premium with bills hr ih opt out in no case an employer automatically enroll an employee in a plan under paragraph if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment based health benefits plan offered by such employer an employer shall provide an employee with a day period to make such an affirmative election before the employer automatically enroll the employee in such a plan notice requirements a in general each employer described in paragraph who automatically enrolls an employee into a plan as described in such paragraph shall provide the employees within a reasonable period before the beginning of each plan year or in the case of new employees within a reasonable period before the end of the enrollment period for such a new employee written notice of the employees rights and obligations relating to the automatic enrollment requirement under such paragraph such notice must be comprehensive and understood by the average employee to whom the automatic enrollment requirement applies with bills hr ih inclusion of specific information the written notice under subparagraph a must explain an employee right to opt out of being automatically enrolled in a plan and in the case that more than one level of benefits or employee premium level is offered by the employer involved the notice must explain which level of benefits and employee premium level the employee will be automatically enrolled in the absence of an affirmative election by the employee sec employer contributions in lieu of coverage a in general a contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to percent of the average wages paid by the employer during the period of enrollment determined by taking into account all employees of the employer and in such manner as the commissioner provides including rules providing for the appropriate aggregation of related employers but not to exceed the minimum employer contribution described in section a any such contribution with bills hr ih shall be paid to the health choices commissioner for deposit into the health insurance exchange trust fund and shall not be applied against the premium of the employee under the exchange participating health benefits plan in which the employee is enrolled special rules for small employers in general in the case of any employer who is a small employer for any calendar year subsection a shall be applied by substituting the applicable percentage determined in accordance with the following table for percent if the annual payroll of such employer forthe preceding calendar year the applicablepercentage is does not exceed percentexceeds but does not exceed percentexceeds but does not exceed percentexceeds but does not exceed percent small employer for purposes of this subsection the term small employer means any employer for any calendar year if the annual payroll of such employer for the preceding calendar year does not exceed annual payroll for purposes of this paragraph the term annual payroll means with respect to any employer for any calendar year the with bills hr ih aggregate wages paid by the employer during such calendar year aggregation rules related employers and predecessors shall be treated as a single employer for purposes of this subsection sec authority related to improper steering the health choices commissioner in coordination with the secretary of labor the secretary of health and human services and the secretary of the treasury shall have authority to set standards for determining whether employers or insurers are undertaking any actions to affect the risk pool within the health insurance exchange by inducing individuals to decline coverage under a qualified health benefits plan or current employment based health plan within the meaning of section offered by the employer and instead to enroll in an exchange participating health benefits plan an employer violating such standards shall be treated as not meeting the requirements of this section sec impact study on employer responsibility requirements a in general the secretary of labor shall conduct a study to examine the effect of the exemptions under section a and coverage thresholds under this division in this section referred to collectively as ?employer re with bills hr ih sponsibility requirements on employment based health plan sponsorship generally and within specific industries and the effect of such requirements and thresholds on employers employment based health plans and employees in each industry annual report the secretary of labor annually shall submit to congress a report on findings on how employer responsibility requirements have impacted and are likely to impact employers plans and employees during the previous year and projected trends legislative recommendations no later than january and on an annual basis thereafter the secretary of labor shall submit legislative recommendations to congress to modify the employer responsibility requirements if the secretary determines that the requirements are detrimentally affecting or will detrimentally affect employer plan sponsorship or otherwise creating inequities among employers health plans and employees the secretary also submit such recommendations as the secretary determines necessary to improve and strengthen employment based health plan sponsorship employer responsibility and related proposals that would enhance the delivery of health care benefits between employers and employees with bills hr ih sec study on employer hardship exemption a in general the secretary of labor together with the secretary of treasury the secretary of health and human services and the commissioner shall conduct a study to examine the impact of the employer responsibility requirements described in section a and make a recommendation to congress about whether an employer hardship exemption would be appropriate items included in study within such study the secretaries and commissioner shall examine cases where such employer responsibility requirements pose a particular hardship and specifically look at employers by industry profit margin length of time in business and size in this examination the economic conditions shall be considered including the rate of increase in business costs the availability of short term credit lines and abilities to restructure debt in addition the study shall examine the impact an employer hardship waiver could have on employees report not later than january the secretaries and commissioner shall report to congress on their findings and make a recommendation regarding the need or lack of need for a partial or complete employer hardship waiver the secretaries and commissioner also submit recommendations about the criteria congress should include when developing eligibility requirements for with bills hr ih the employer hardship waiver and what safeguards are necessary to protect the employees of that employer part satisfaction of health coverage participation requirements sec satisfaction of health coverage participation requirements under the employee retirement income security act of a in general subtitle of title of the employee retirement income security act of is amended by adding at the end the following new part part national health coverage participation requirements sec election of employer to be subject to national health coverage participation requirements a in general an employer make an election with the secretary to be subject to the health coverage participation requirements time and manner an election under subsection a be made at such time and in such form and manner as the secretary prescribe with bills hr ih sec treatment of coverage resulting from election a in general if an employer makes an election to the secretary under section such election shall be treated as the establishment and maintenance of a group health plan as defined in section a for purposes of this title subject to section of the and the health coverage participation requirements shall be deemed to be included as terms and conditions of such plan periodic investigations to discover noncompliance the secretary shall regularly audit a representative sampling of employers and group health plans and conduct investigations and other activities under section with respect to such sampling of plans so as to discover noncompliance with the health coverage participation requirements in connection with such plans the secretary shall communicate findings of noncompliance made by the secretary under this subsection to the secretary of the treasury and the health choices commissioner the secretary shall take such timely enforcement action as appropriate to achieve compliance recordkeeping to facilitate the audits described in subsection the secretary shall promulgate recordkeeping requirements for employers to account for with bills hr ih both employees of the employer and individuals whom the employer has not treated as employees of the employer but with whom the employer in the course of its trade or business has engaged for the performance of labor or services the scope and content of such recordkeeping requirements shall be determined by the secretary and shall be designed to ensure that employees who are not properly treated as such be identified and properly treated sec health coverage participation requirements for purposes of this part the term health coverage participation requirements means the requirements of part of subtitle of title iv of division a of as in effect on the date of the enactment of such act sec rules for applying requirements a affiliated groups in the case of any employer which is part of a group of employers who are treated as a single employer under subsection or of section of the internal revenue code of the election under section shall be made by such employer as the secretary provide any such election once made shall apply to all members of such group separate elections under regulations prescribed by the secretary separate elections be made under section with respect to with bills hr ih separate lines of business and full time employees and employees who are not full time employees sec termination of election in cases of substantial noncompliance the secretary terminate the election of any employer under section if the secretary in coordination with the health choices commissioner determines that such employer is in substantial noncompliance with the health coverage participation requirements and shall refer any such determination to the secretary of the treasury as appropriate sec regulations the secretary promulgate such regulations as be necessary or appropriate to carry out the provisions of this part in accordance with section a of the the secretary promulgate any interim final rules as the secretary determines are appropriate to carry out this part enforcement of health coverage participation requirements section of such act usc is amended in subsection a by striking paragraph and all that follows through subsection with bills hr ih and inserting paragraph or of subsection and in subsection by redesignating the second paragraph as paragraph and by inserting after the first paragraph the following new paragraph health coverage participation requirements a civil penalties in the case of any employer who fails during any period with respect to which an election under section a is in effect to satisfy the health coverage participation requirements with respect to any employee the secretary assess a civil penalty against the employer of for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected health coverage participation requirements for purposes of this paragraph the term health coverage participation requirements has the meaning provided in section limitations on amount of penalty with bills hr ih penalty not to apply where failure not discovered exercising reasonable diligence no penalty shall be assessed under subparagraph a with respect to any failure during any period for which it is established to the satisfaction of the secretary that the employer did not know or exercising reasonable diligence would not have known that such failure existed penalty not to apply to failures corrected within days no penalty shall be assessed under subparagraph a with respect to any failure if such failure was due to reasonable cause and not to willful neglect and such failure is corrected during the day period beginning on the st date that the employer knew or exercising reasonable diligence would have known that such failure existed with bills hr ih iii overall limitation for unintentional failures in the case of failures which are due to reasonable cause and not to willful neglect the penalty assessed under subparagraph a for failures during any year period shall not exceed the amount equal to the lesser of percent of the aggregate amount paid or incurred by the employer or predecessor employer during the preceding year period for group health plans or advance notification of failure prior to assessment before a reasonable time prior to the assessment of any penalty under this paragraph with respect to any failure by an employer the secretary shall inform the employer in writing of such failure and shall provide the employer information regarding efforts and procedures which be undertaken by the employer to correct such failure coordination with excise tax under regulations prescribed in accordance with section of the the secretary and the with bills hr ih secretary of the treasury shall coordinate the assessment of penalties under this section in connection with failures to satisfy health coverage participation requirements with the imposition of excise taxes on such failures under section of the internal revenue code of so as to avoid duplication of penalties with respect to such failures deposit of penalty collected any amount of penalty collected under this paragraph shall be deposited as miscellaneous receipts in the treasury of the united states clerical amendments the table of contents in section of such act is amended by inserting after the item relating to section the following new items part national health coverage participation requirements sec election of employer to be subject to national health coverage participationrequirements sec treatment of coverage resulting from election sec health coverage participation requirements sec rules for applying requirements sec termination of election in cases of substantial noncompliance sec regulations effective date the amendments made by this section shall apply to periods beginning after december with bills hr ih sec satisfaction of health coverage participation requirements under the internal revenue code of a failure to elect or substantially comply with health coverage participation requirements for employment tax on employers who fail to elect or substantially comply with the health coverage participation requirements described in part see section of the internal revenue code of as added by section of this act other failures for excise tax on other failures of electing employers to comply with such requirements see section of the internal revenue code of as added by section of this act sec satisfaction of health coverage participation requirements under the public health service act a in general part of title xxvii of the public health service act is amended by adding at the end the following new section sec national health coverage participation requirements a election of employer to be subject to national health coverage participation requirements with bills hr ih in general an employer make an election with the secretary to be subject to the health coverage participation requirements time and manner an election under paragraph be made at such time and in such form and manner as the secretary prescribe treatment of coverage resulting from election in general if an employer makes an election to the secretary under subsection a a such election shall be treated as the establishment and maintenance of a group health plan for purposes of this title subject to section of the affordable health care for america act and the health coverage participation requirements shall be deemed to be included as terms and conditions of such plan periodic investigations to determine compliance with health coverage participation requirements the secretary shall regularly audit a representative sampling of employers and conduct investigations and other activities with respect to such sampling of employers so as to dis with bills hr ih cover noncompliance with the health coverage participation requirements in connection with such employers during any period with respect to which an election under subsection a is in effect the secretary shall communicate findings of noncompliance made by the secretary under this subsection to the secretary of the treasury and the health choices commissioner the secretary shall take such timely enforcement action as appropriate to achieve compliance recordkeeping to facilitate the audits described in subsection the secretary shall promulgate recordkeeping requirements for employers to account for both employees of the employer and individuals whom the employer has not treated as employees of the employer but with whom the employer in the course of its trade or business has engaged for the performance of labor or services the scope and content of such recordkeeping requirements shall be determined by the secretary and shall be designed to ensure that employees who are not properly treated as such be identified and properly treated health coverage participation requirements for purposes of this section the term health with bills hr ih coverage participation requirements means the requirements of part of subtitle of title iv of division a of the as in effect on the date of the enactment of this section separate elections under regulations prescribed by the secretary separate elections be made under subsection a with respect to full time employees and employees who are not full time employees termination of election in cases of substantial noncompliance the secretary terminate the election of any employer under subsection a if the secretary in coordination with the health choices commissioner determines that such employer is in substantial noncompliance with the health coverage participation requirements and shall refer any such determination to the secretary of the treasury as appropriate enforcement of health coverage participation requirements civil penalties in the case of any employer who fails during any period with respect to which the election under subsection a is in effect to satisfy the health coverage participation requirements with respect to any employee the secretary assess a civil penalty against the employer of for each day in the period beginning on the with bills hr ih date such failure first occurs and ending on the date such failure is corrected limitations on amount of penalty a penalty not to apply where failure not discovered exercising reasonable diligence no penalty shall be assessed under paragraph with respect to any failure during any period for which it is established to the satisfaction of the secretary that the employer did not know or exercising reasonable diligence would not have known that such failure existed penalty not to apply to failures corrected within days no penalty shall be assessed under paragraph with respect to any failure if such failure was due to reasonable cause and not to willful neglect and such failure is corrected during the day period beginning on the st date that the employer knew or exercising reasonable diligence would have known that such failure existed overall limitation for unintentional failures in the case of failures with bills hr ih which are due to reasonable cause and not to willful neglect the penalty assessed under paragraph for failures during any year period shall not exceed the amount equal to the lesser of percent of the aggregate amount paid or incurred by the employer or predecessor employer during the preceding taxable year for group health plans or advance notification of failure prior to assessment before a reasonable time prior to the assessment of any penalty under paragraph with respect to any failure by an employer the secretary shall inform the employer in writing of such failure and shall provide the employer information regarding efforts and procedures which be undertaken by the employer to correct such failure actions to enforce assessments the secretary bring a civil action in any district court of the united states to collect any civil penalty under this subsection with bills hr ih coordination with excise tax under regulations prescribed in accordance with section of the the secretary and the secretary of the treasury shall coordinate the assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with the imposition of excise taxes on such failures under section of the internal revenue code of so as to avoid duplication of penalties with respect to such failures deposit of penalty collected any amount of penalty collected under this subsection shall be deposited as miscellaneous receipts in the treasury of the united states regulations the secretary promulgate such regulations as be necessary or appropriate to carry out the provisions of this section in accordance with section a of the the secretary promulgate any interim final rules as the secretary determines are appropriate to carry out this section effective date the amendments made by subsection a shall apply to periods beginning after december with bills hr ih sec additional rules relating to health coverage participation requirements a assuring coordination the officers consisting of the secretary of labor the secretary of the treasury the secretary of health and human services and the health choices commissioner shall ensure through the execution of an interagency memorandum of understanding among such officers that regulations rulings and interpretations issued by such officers relating to the same matter over which two or more of such officers have responsibility under subpart of part of subtitle of title of the employee retirement income security act of section of the internal revenue code of and section of the public health service act are administered so as to have the same effect at all times and coordination of policies relating to enforcing the same requirements through such officers in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement multiemployer plans in the case of a group health plan that is a multiemployer plan as defined in section of the employee retirement income security act of the regulations prescribed in accordance with bills hr ih with subsection a by the officers referred to in subsection a shall provide for the application of the health coverage participation requirements to the plan sponsor and contributing employers of such plan for purposes of this division contributions made pursuant to a collective bargaining agreement or other agreement to such a group health plan shall be treated as amounts paid by the employer title amendments to internal revenue code of subtitle a provisions relating to health care reform part shared responsibility subpart a individual responsibility sec tax on individuals without acceptable health care coverage a in general subchapter a of chapter of the internal revenue code of is amended by adding at the end the following new part part viii health care related taxes subpart a tax on individuals without acceptable health carecoverage subpart a tax on individuals without acceptable health care coverage sec tax on individuals without acceptable health care coverage with bills hr ih sec tax on individuals without acceptable health care coverage a tax imposed in the case of any individual who does not meet the requirements of subsection at any time during the taxable year there is hereby imposed a tax equal to percent of the excess of the taxpayer modified adjusted gross income for the taxable year over the amount of gross income specified in section a with respect to the taxpayer limitations tax limited to average premium a in general the tax imposed under subsection a with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year applicable national average premium in general for purposes of subparagraph a the applicable national average premium means with respect to any taxable year the average premium as determined by the secretary in coordination with the health choices commissioner for self only coverage under a basic with bills hr ih plan which is offered in a health insurance exchange for the calendar year in which such taxable year begins failure to provide coverage for more than one individual in the case of any taxpayer who fails to meet the requirements of subsection with respect to more than one individual during the taxable year clause shall be applied by substituting family coverage for self only coverage proration for part year failures the tax imposed under subsection a with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the amount of tax so imposed determined without regard to this paragraph and after application of paragraph as a the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection bears to the entire taxable year exceptions with bills hr ih dependents subsection a shall not apply to any individual for any taxable year if a deduction is allowable under section with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as such taxable year nonresident aliens subsection a shall not apply to any individual who is a nonresident alien individuals residing outside united states any qualified individual as defined in section and any qualifying child residing with such individual shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph a or of section whichever is applicable individuals residing in possessions of the united states any individual who is a bona fide resident of any possession of the united states as determined under section a for any taxable year and any qualifying child residing with such individual shall be treated for purposes of this section as covered by acceptable coverage during such taxable year religious conscience exemption with bills hr ih a in general subsection a shall not apply to any individual and any qualifying child residing with such individual for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section and an adherent of established tenets or teachings of such sect or division as described in such section exemption an application for the exemption described in subparagraph a shall be filed with the secretary at such time and in such form and manner as the secretary prescribe the secretary treat an application for exemption under section as an application for exemption under this section or otherwise coordinate applications under such sections as the secretary determines appropriate any such exemption granted by the secretary shall be effective for such period as the secretary determines appropriate acceptable coverage requirement in general the requirements of this subsection are met with respect to any individual for with bills hr ih any period if such individual and each qualifying child of such individual is covered by acceptable coverage at all times during such period acceptable coverage for purposes of this section the term acceptable coverage means any of the following a qualified health benefits plan coverage coverage under a qualified health benefits plan as defined in section of the grandfathered health insurance coverage coverage under grandfathered employment based health plan coverage under a grandfathered health insurance coverage as defined in subsection a of section of the or under a current employment based health plan within the meaning of subsection of such section medicare coverage under part a of title xviii of the social security act medicaid coverage for medical assistance under title xix of the social security act members of the armed forces and dependents including tricare with bills hr ih coverage under chapter of title united states code including similar coverage furnished under section of title of such code va coverage under the veteran health care program under chapter of title united states code members of indian tribes health care services made available through the indian health service a tribal organization as defined in section of the indian health care improvement act or an urban indian organization as defined in such section to members of an indian tribe as defined in such section other coverage such other health benefits coverage as the secretary in coordination with the health choices commissioner recognizes for purposes of this subsection other definitions and special rules qualifying child for purposes of this section the term qualifying child has the meaning given such term by section with respect to any period during which health coverage for a child must be provided by an individual pursuant to a with bills hr ih child support order such child shall be treated as a qualifying child of such individual and not as a qualifying child of any other individual basic plan for purposes of this section the term basic plan has the meaning given such term under section of the health insurance exchange for purposes of this section the term health insurance exchange has the meaning given such term under section of the including any state based health insurance exchange approved for operation under section of such act family coverage for purposes of this section the term family coverage means any coverage other than self only coverage modified adjusted gross income for purposes of this section the term modified adjusted gross income means adjusted gross income increased by a any amount excluded from gross income under section and any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax with bills hr ih not treated as tax imposed by this chapter for certain purposes the tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section regulations the secretary shall prescribe such regulations or other guidance as be necessary or appropriate to carry out the purposes of this section including regulations or other guidance developed in coordination with the health choices commissioner which provide exemption from the tax imposed under subsection a in cases of de minimis lapses of acceptable coverage and a waiver of the application of subsection a in cases of hardship including a process for applying for such a waiver information reporting in general subpart of part iii of subchapter a of chapter of such code is amended by inserting after section the following new section with bills hr ih sec returns relating to health insurance coverage a requirement of reporting every person who provides acceptable coverage as defined in section to any individual during any calendar year shall at such time as the secretary prescribe make the return described in subsection with respect to such individual form and manner of returns a return is described in this subsection if such return is in such form as the secretary prescribe and contains a the name address and tin of the primary insured and the name of each other individual obtaining coverage under the policy the period for which each such individual was provided with the coverage referred to in subsection a and such other information as the secretary require statements to be furnished to individuals with respect to whom information is required every person required to make a return under subsection a shall furnish to each primary insured whose with bills hr ih name is required to be set forth in such return a written statement showing the name and address of the person required to make such return and the phone number of the information contact for such person and the information required to be shown on the return with respect to such individual the written statement required under the preceding sentence shall be furnished on or before january of the year following the calendar year for which the return under subsection a is required to be made coverage provided by governmental units in the case of coverage provided by any governmental unit or any agency or instrumentality thereof the officer or employee who enters into the agreement to provide such coverage or the person appropriately designated for purposes of this section shall make the returns and statements required by this section penalty for failure to file a return subparagraph of section of such code is amended by striking or at the end of clause xxii by striking and at the end of clause xxiii and inserting or and by adding at the end the following new clause with bills hr ih xxiv section relating to returns relating to health insurance coverage and statement paragraph of section of such code is amended by striking or at the end of subparagraph ee by striking the period at the end of subparagraph ff and inserting or and by inserting after subparagraph ff the following new subparagraph gg section relating to returns relating to health insurance coverage return requirement subsection a of section of such code is amended by inserting after paragraph the following new paragraph every individual to whom section a applies and who fails to meet the requirements of section with respect to such individual or any qualifying child as defined in section of such individual clerical amendments the table of parts for subchapter a of chapter of the internal revenue code of is amended by adding at the end the following new item part viii health care related taxes with bills hr ih the table of sections for subpart of part iii of subchapter a of chapter is amended by adding at the end the following new item sec returns relating to health insurance coverage section not to apply the amendment made by subsection a shall not be treated as a change in a rate of tax for purposes of section of the internal revenue code of effective date in general the amendments made by this section shall apply to taxable years beginning after december returns the amendments made by subsection shall apply to calendar years beginning after december subpart employer responsibility sec election to satisfy health coverage participation requirements a in general chapter of the internal revenue code of is amended by adding at the end the following new section sec election with respect to health coverage participation requirements a election of employer responsibility to provide health coverage with bills hr ih in general subsection shall apply to any employer with respect to whom an election under paragraph is in effect time and manner an employer make an election under this paragraph at such time and in such form and manner as the secretary prescribe affiliated groups in the case of any employer which is part of a group of employers who are treated as a single employer under subsection or of section the election under paragraph shall be made by such person as the secretary provide any such election once made shall apply to all members of such group separate elections under regulations prescribed by the secretary separate elections be made under paragraph with respect to a separate lines of business and full time employees and employees who are not full time employees termination of election in cases of substantial noncompliance the secretary terminate the election of any employer under paragraph if the secretary in coordination with with bills hr ih the health choices commissioner determines that such employer is in substantial noncompliance with the health coverage participation requirements excise tax with respect to failure to meet health coverage participation requirements in general in the case of any employer who fails during any period with respect to which the election under subsection a is in effect to satisfy the health coverage participation requirements with respect to any employee to whom such election applies there is hereby imposed on each such failure with respect to each such employee a tax of for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected limitations on amount of tax a tax not to apply where failure not discovered exercising reasonable diligence no tax shall be imposed by paragraph on any failure during any period for which it is established to the satisfaction of the secretary that the employer neither knew nor exercising reasonable diligence would have known that such failure existed with bills hr ih tax not to apply to failures corrected within days no tax shall be imposed by paragraph on any failure if such failure was due to reasonable cause and not to willful neglect and such failure is corrected during the day period beginning on the st date that the employer knew or exercising reasonable diligence would have known that such failure existed overall limitation for unintentional failures in the case of failures which are due to reasonable cause and not to willful neglect the tax imposed by subsection a for failures during the taxable year of the employer shall not exceed the amount equal to the lesser of percent of the aggregate amount paid or incurred by the employer or predecessor employer during the preceding taxable year for employment based health plans or coordination with other enforcement provisions the tax imposed with bills hr ih under paragraph with respect to any failure shall be reduced but not below zero by the amount of any civil penalty collected under section of the employee retirement income security act of or section of the public health service act with respect to such failure health coverage participation requirements for purposes of this section the term health coverage participation requirements means the requirements of part of subtitle of title iv of the as in effect on the date of the enactment of this section clerical amendment the table of sections for chapter of such code is amended by adding at the end the following new item sec election with respect to health coverage participation requirements effective date the amendments made by this section shall apply to periods beginning after december sec health care contributions of nonelecting employers a in general section of the internal revenue code of is amended by redesignating subsection as subsection and by inserting after subsection the following new subsection with bills hr ih employers electing not to provide health benefits in general in addition to other taxes there is hereby imposed on every nonelecting employer an excise tax with respect to having individuals in his employ equal to percent of the wages as defined in section a paid by him with respect to employment as defined in section special rules for small employers a in general in the case of any employer who is small employer for any calendar year paragraph shall be applied by substituting the applicable percentage determined in accordance with the following table for percent if the annual payroll of such employer forthe preceding calendar year the applicablepercentage is does not exceed percentexceeds but does not exceed percentexceeds but does not exceed percentexceeds but does not exceed percent small employer for purposes of this paragraph the term small employer means any employer for any calendar year if the annual payroll of such employer for the preceding calendar year does not exceed with bills hr ih annual payroll for purposes of this paragraph the term annual payroll means with respect to any employer for any calendar year the aggregate wages as defined in section a paid by him with respect to employment as defined in section during such calendar year nonelecting employer for purposes of paragraph the term nonelecting employer means any employer for any period with respect to which such employer does not have an election under section a in effect special rule for separate elections in the case of an employer who makes a separate election described in section a for any period paragraph shall be applied for such period by taking into account only the wages paid to employees who are not subject to such election aggregation predecessors for purposes of this subsection a all persons treated as a single employer under subsection or of section shall be treated as employer and with bills hr ih any reference to any person shall be treated as including a reference to any predecessor of such person definitions section of such code is amended by adding at the end the following new subsection aa special rules for tax on employers electing not to provide health benefits for purposes of section paragraphs and of subsection shall not apply paragraph of subsection shall apply by treating all services as not covered by the retirement systems referred to in subparagraphs and thereof subsection shall not apply and the term state shall include the district of columbia conforming amendment subsection of section of such code as redesignated by this section is amended by striking this section and inserting subsections a and application to railroads in general section of such code is amended by redesignating subsection as sub with bills hr ih section and by inserting after subsection the following new subsection employers electing not to provide health benefits in general in addition to other taxes there is hereby imposed on every nonelecting employer an excise tax with respect to having individuals in his employ equal to percent of the compensation paid during any calendar year by such employer for services rendered to such employer exception for small employers rules similar to the rules of section shall apply for purposes of this subsection nonelecting employer for purposes of paragraph the term nonelecting employer means any employer for any period with respect to which such employer does not have an election under section a in effect special rule for separate elections in the case of an employer who makes a separate election described in section a for any period subsection a shall be applied for such period by taking into account only the compensation paid to employees who are not subject to such election with bills hr ih definitions subsection of section of such code is amended by adding at the end the following new paragraph special rules for tax on employers electing not to provide health benefits for purposes of section a paragraph shall be applied without regard to the third sentence thereof paragraph shall not apply conforming amendment subsection of section of such code as redesignated by this section is amended by striking subsections a and see section and inserting this section see paragraphs and of section effective date the amendments made by this section shall apply to periods beginning after december part credit for small business employee health coverage expenses sec credit for small business employee health coverage expenses a in general subpart of part iv of subchapter a of chapter of the internal revenue code of with bills hr ih relating to business related credits is amended by adding at the end the following new section sec small business employee health coverage credit a in general for purposes of section in the case of a qualified small employer the small business employee health coverage credit determined under this section for the taxable year is an amount equal to the applicable percentage of the qualified employee health coverage expenses of such employer for such taxable year applicable percentage in general for purposes of this section the applicable percentage is percent phaseout based on average compensation of employees in the case of an employer whose average annual employee compensation for the taxable year exceeds the percentage specified in paragraph shall be reduced by a number of percentage points which bears the same ratio to as such excess bears to limitations phaseout based on employer size in the case of an employer who employs more than qualified employees during the taxable year the credit determined under subsection a shall be re with bills hr ih duced by an amount which bears the same ratio to the amount of such credit determined without regard to this paragraph and after the application of the other provisions of this section as a the excess of the number of qualified employees employed by the employer during the taxable year over bears to credit not allowed with respect to certain highly compensated employees no credit shall be determined under subsection a with respect to qualified employee health coverage expenses paid or incurred with respect to any employee for any taxable year if the aggregate compensation paid by the employer to such employee during such taxable year exceeds credit allowed for only taxable years no credit shall be determined under subsection a with respect to any employer for any taxable year unless the employer elects to have this section apply for such taxable year an employer elect the application of this section with respect to not more than taxable years with bills hr ih qualified employee health coverage expenses for purposes of this section in general the term qualified employee health coverage expenses means with respect to any employer for any taxable year the aggregate amount paid or incurred by such employer during such taxable year for coverage of any qualified employee of the employer including any family coverage which covers such employee under qualified health coverage qualified health coverage the term qualified health coverage means acceptable coverage as defined in section which a is provided pursuant to an election under section a and satisfies the requirements referred to in section other definitions for purposes of this section qualified small employer for purposes of this section the term qualified small employer means any employer for any taxable year if with bills hr ih a the number of qualified employees employed by such employer during the taxable year does not exceed and the average annual employee compensation of such employer for such taxable year does not exceed the sum of the dollar amounts in effect under subsection qualified employee the term qualified employee means any employee of an employer for any taxable year of the employer if such employee received at least of compensation from such employer for services performed in the trade or business of such employer during such taxable year average annual employee compensation the term average annual employee compensation means with respect to any employer for any taxable year the average amount of compensation paid by such employer to qualified employees of such employer during such taxable year compensation the term compensation has the meaning given such term in section a family coverage the term family coverage means any coverage other than self only coverage with bills hr ih special rules for purposes of this section special rule for partnerships and self employed in the case of a partnership or a trade or business carried on by an individual which has one or more qualified employees determined without regard to this paragraph with respect to whom the election under section a applies each partner or in the case of a trade or business carried on by an individual such individual shall be treated as an employee aggregation rule all persons treated as a single employer under subsection or of section shall be treated as employer predecessors any reference in this section to an employer shall include a reference to any predecessor of such employer denial of double benefit any deduction otherwise allowable with respect to amounts paid or incurred for health insurance coverage to which subsection a applies shall be reduced by the amount of the credit determined under this section inflation adjustment in the case of any taxable year beginning after each of the with bills hr ih dollar amounts in subsections and shall be increased by an amount equal to a such dollar amount multiplied by the cost of living adjustment determined under section for the calendar year in which the taxable year begins determined by substituting calendar year for calendar year in subparagraph thereof if any increase determined under this paragraph is not a multiple of such increase shall be rounded to the next lowest multiple of credit to be part of general business credit subsection of section of such code relating to general business credit is amended by striking plus at the end of paragraph by striking the period at the end of paragraph and inserting plus and by adding at the end the following new paragraph in the case of a qualified small employer as defined in section the small business employee health coverage credit determined under section a clerical amendment the table of sections for subpart of part iv of subchapter a of chapter with bills hr ih of such code is amended by inserting after the item relating to section the following new item sec small business employee health coverage credit effective date the amendments made by this section shall apply to taxable years beginning after december part limitations on health care related expenditures sec distributions for medicine qualified only if for prescribed drug or insulin a hsas subparagraph a of section of the internal revenue code of is amended by adding at the end the following such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin archer msas subparagraph a of section of such code is amended by adding at the end the following such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin health flexible spending arrangements and health reimbursement arrangements section of such code is amended by adding at the end the following new subsection reimbursements for medicine restricted to prescribed drugs and insulin for purposes of with bills hr ih this section and section reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug or is insulin effective dates the amendment made by this section shall apply to expenses incurred after december sec limitation on health flexible spending arrangements under cafeteria plans a in general section of the internal revenue code of is amended by redesignating subsections and as subsections and respectively and by inserting after subsection the following new subsection limitation on health flexible spending arrangements in general for purposes of this section if a benefit is provided under a cafeteria plan through employer contributions to a health flexible spending arrangement such benefit shall not be treated as a qualified benefit unless the cafeteria plan provides that an employee not elect for any taxable year to have salary reduction contributions in excess of made to such arrangement with bills hr ih inflation adjustment in the case of any taxable year beginning after the dollar amount in paragraph shall be increased by an amount equal to a such dollar amount multiplied by the cost of living adjustment determined under section for the calendar year in which the taxable year begins determined by substituting calendar year for calendar year in subparagraph thereof if any increase determined under this paragraph is not a multiple of such increase shall be rounded to the next lowest multiple of effective date the amendments made by this section shall apply to taxable years beginning after december sec increase in penalty for nonqualified distributions from health savings accounts a in general subparagraph a of section of the internal revenue code of is amended by striking percent and inserting percent with bills hr ih effective date the amendment made by this section shall apply to taxable years beginning after december sec denial of deduction for federal subsidies for prescription drug plans which have been excluded from gross income a in general section a of the internal revenue code of is amended by striking the second sentence effective date the amendment made by this section shall apply to taxable years beginning after december part other provisions to carry out health insurance reform sec disclosures to carry out health insurance exchange subsidies a in general subsection of section of the internal revenue code of is amended by adding at the end the following new paragraph disclosure of return information to carry out health insurance exchange subsidies a in general the secretary upon written request from the health choices com with bills hr ih missioner or the head of a state based health insurance exchange approved for operation under section of the shall disclose to officers and employees of the health choices administration or such state based health insurance exchange as the case be return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle of title iii of the such return information shall be limited to taxpayer identity information with respect to such taxpayer the filing status of such taxpayer iii the modified adjusted gross income of such taxpayer as defined in section iv the number of dependents of the taxpayer such other information as is prescribed by the secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits and the amount thereof and with bills hr ih vi the taxable year with respect to which the preceding information relates or if applicable the fact that such information is not available restriction on use of disclosed information return information disclosed under subparagraph a be used by officers and employees of the health choices administration or such state based health insurance exchange as the case be only for the purposes of and to the extent necessary in establishing and verifying the appropriate amount of any affordability credit described in subtitle of title iii of the and providing for the repayment of any such credit which was in excess of such appropriate amount procedures and recordkeeping related to disclosures paragraph of section of such code is amended by inserting or any entity described in subsection after or in the matter preceding subparagraph a by inserting or any entity described in subsection after or a in subparagraph and with bills hr ih by inserting or any entity described in subsection after or both places it appears in the matter after subparagraph unauthorized disclosure or inspection paragraph of section a of such code is amended by striking or and inserting or sec offering of exchange participating health benefits plans through cafeteria plans a in general subsection of section of the internal revenue code of is amended by adding at the end the following new paragraph certain exchange participating health benefits plans not qualified a in general the term qualified benefit shall not include any exchange participating health benefits plan as defined in section of the exception for exchange eligible employers subparagraph a shall not apply with respect to any employee if such employee employer is an exchange eligible employer as defined in section of the conforming amendments subsection of section of such code is amended with bills hr ih by striking for purposes of this section the term and inserting for purposes of this section in general the term and by striking such term shall not include and inserting the following long term care insurance not qualified the term qualified benefit shall not include effective date the amendments made by this section shall apply to taxable years beginning after december sec exclusion from gross income of payments made under reinsurance program for retirees a in general section a of the internal revenue code of is amended by striking gross income and inserting the following a federal subsidies for prescription drug plans gross income and by adding at the end the following new subsection federal reinsurance program for retirees a rule similar to the rule of subsection a shall with bills hr ih apply with respect to payments made under section of the affordable health care for america act conforming amendment the heading of section a of such code and the item relating to such section in the table of sections for part iii of subchapter of chapter of such code is amended by inserting and retiree health plans after prescription drug plans effective date the amendments made by this section shall apply to taxable years ending after the date of the enactment of this act sec class program treated in same manner as long term care insurance a in general subsection of section of the internal revenue code of is amended by striking state long term care plan in paragraph a and inserting government longterm care plan by redesignating paragraph as paragraph and by inserting after paragraph the following new paragraph government long term care plan for purposes of this subsection the term government long term care plan means with bills hr ih a the class program established under title xxxii of the public health service act and any state long term care plan conforming amendments paragraph of section of such code as redesignated by subsection a is amended by striking paragraph and inserting this subsection subsection of section of such code is amended by striking state maintained in the heading thereof and inserting government effective date the amendments made by this section shall apply to taxable years ending after december sec exclusion from gross income for medical care provided for indians a in general part iii of subchapter of chapter of the internal revenue code of relating to items specifically excluded from gross income is amended by inserting after section the following new section sec medical care provided for indians a in general gross income does not include with bills hr ih health services or benefits provided or purchased by the indian health service either directly or indirectly through a grant to or a contract or compact with an indian tribe or tribal organization or through programs of third parties funded by the indian health service medical care provided by an indian tribe or tribal organization to a member of an indian tribe including for this purpose to the member spouse or dependents through any one of the following provided or purchased medical care services accident or health insurance or an arrangement having the effect of accident or health insurance or amounts paid directly or indirectly to reimburse the member for expenses incurred for medical care the value of accident or health plan coverage provided by an indian tribe or tribal organization for medical care to a member of an indian tribe including for this purpose coverage that extends to such member spouse or dependents under an accident or health plan or through an arrangement having the effect of accident or health insurance and any other medical care provided by an indian tribe that supplements replaces or substitutes with bills hr ih for the programs and services provided by the federal government to indian tribes or indians definitions for purposes of this section in general the terms accident or health insurance and accident or health plan have the same meaning as when used in sections and medical care the term medical care has the meaning given such term in section dependent the term dependent has the meaning given such term in section determined without regard to subsections and indian tribe the term indian tribe means any indian tribe band nation pueblo or other organized group or community including any alaska native village or regional or village corporation as defined in or established pursuant to the alaska native claims settlement act usc et seq which is recognized as eligible for the special programs and services provided by the united states to indians because of their status as indians tribal organization the term tribal organization has the meaning given such term in with bills hr ih section of the indian self determination and education assistance act usc clerical amendment the table of sections for such part iii is amended by inserting after the item relating to section the following new item sec medical care provided for indians effective date the amendments made by this section shall apply to health benefits and coverage provided after the date of enactment of this act no inference nothing in the amendments made by this section shall be construed to create an inference with respect to the exclusion from gross income of benefits provided by indian tribes that are not within the scope of this section and health benefits or coverage provided by indian tribes prior to the effective date of this section subtitle other revenue provisions part general provisions sec surcharge on high income individuals a in general part viii of subchapter a of chapter of the internal revenue code of as added by this title is amended by adding at the end the following new subpart subpart surcharge on high income individuals sec surcharge on high income individuals with bills hr ih sec surcharge on high income individuals a general rule in the case of a taxpayer other than a corporation there is hereby imposed in addition to any other tax imposed by this subtitle a tax equal to percent of so much of the modified adjusted gross income of the taxpayer as exceeds taxpayers not making a joint return in the case of any taxpayer other than a taxpayer making a joint return under section or a surviving spouse as defined in section a subsection a shall be applied by substituting for modified adjusted gross income for purposes of this section the term modified adjusted gross income means adjusted gross income reduced by any deduction not taken into account in determining adjusted gross income allowed for investment interest as defined in section in the case of an estate or trust adjusted gross income shall be determined as provided in section special rules nonresident alien in the case of a nonresident alien individual only amounts taken into account in connection with the tax imposed under section shall be taken into account under this section with bills hr ih citizens and residents living abroad the dollar amount in effect under subsection a after the application of subsection shall be decreased by the excess of a the amounts excluded from the taxpayer gross income under section over the amounts of any deductions or exclusions disallowed under section with respect to the amounts described in subparagraph a charitable trusts subsection a shall not apply to a trust all the unexpired interests in which are devoted to one or more of the purposes described in section not treated as tax imposed by this chapter for certain purposes the tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section clerical amendment the table of subparts for part viii of subchapter a of chapter of such code as added by this title is amended by inserting after the item relating to subpart a the following new item subpart surcharge on high income individuals with bills hr ih section not to apply the amendment made by subsection a shall not be treated as a change in a rate of tax for purposes of section of the internal revenue code of effective date the amendments made by this section shall apply to taxable years beginning after december sec excise tax on medical devices a in general chapter of the internal revenue code of is amended by adding at the end the following new subchapter subchapter medical devices sec medical devices sec medical devices a in general there is hereby imposed on the first taxable sale of any medical device a tax equal to percent of the price for which so sold first taxable sale for purposes of this section in general the term first taxable sale means the first sale for a purpose other than for resale after production manufacture or importation with bills hr ih exception for sales at retail establishments such term shall not include the sale of any medical device if a such sale is made at a retail establishment on terms which are available to the general public and such medical device is of a type and purchased in a quantity which is purchased by the general public exception for exports etc rules similar to the rules of sections other than paragraphs and of subsection a thereof and shall apply for purposes of this section to the extent provided by the secretary section be extended to and made applicable with respect to the exemption provided by paragraph sales to patients not treated as resales if a medical device is sold for use in connection with providing any health care service to an individual such sale shall not be treated as being for the purpose of resale even if such device is sold to such individual other definitions and special rules for purposes of this section with bills hr ih medical device the term medical device means any device as defined in section of the federal food drug and cosmetic act intended for humans lease treated as sale rules similar to the rules of section shall apply use treated as sale a in general if any person uses a medical device before the first taxable sale of such device then such person shall be liable for tax under such subsection in the same manner as if such use were the first taxable sale of such device exceptions the preceding sentence shall not apply to use of a medical device as material in the manufacture or production of or as a component part of another medical device to be manufactured or produced by such person or use of a medical device after a sale described in subsection determination of price with bills hr ih a in general rules similar to the rules of subsections a and of section shall apply for purposes of this section constructive sale price if a medical device is sold otherwise than through an arm length transaction at less than the fair market price or a person is liable for tax for a use described in paragraph the tax under this section shall be computed on the price for which such or similar devices are sold in the ordinary course of trade as determined by the secretary resales pursuant to certain contract arrangements a in general in the case of a specified contract sale of a medical device the seller referred to in subparagraph shall be entitled to recover from the producer manufacturer or importer referred to in subparagraph the amount of the tax paid by such seller under this section with respect to such sale specified contract sale for purposes of this paragraph the term specified contract sale means with respect to any med with bills hr ih ical device the first taxable sale of such device if the seller is not the producer manufacturer or importer of such device the price at which such device is so sold is determined in accordance with a contract between the producer manufacturer or importer of such device and the person to whom such device is so sold special rules related to credits and refunds in the case of any credit or refund under section of the tax imposed under this section on a specified contract sale of a medical device such credit or refund shall be allowed or made only if the seller has filed with the secretary the written consent of the producer manufacturer or importer referred to in subparagraph to the allowance of such credit or the making of such refund and the amount of tax taken into account under subparagraph a shall be reduced by the amount of such credit or refund with bills hr ih conforming amendments paragraph of section of such code is amended a by inserting or after under section and by adding at the end the following in the case of the tax imposed by section subparagraphs and shall not apply the table of subchapters for chapter of such code is amended by adding at the end the following new item subchapter medical devices effective date the amendments made by this section shall apply to sales and leases and uses treated as sales after december sec expansion of information reporting requirements a in general section of the internal revenue code of is amended by adding at the end the following new subsections application to corporations notwithstanding any regulation prescribed by the secretary before the date of the enactment of this subsection for purposes of this section the term person includes any corporation with bills hr ih that is not an organization exempt from tax under section a regulations the secretary prescribe such regulations and other guidance as be appropriate or necessary to carry out the purposes of this section including rules to prevent duplicative reporting of transactions payments for property and other gross proceeds subsection a of section of the internal revenue code of is amended by inserting amounts in consideration for property after wages by inserting gross proceeds after emoluments or other and by inserting gross proceeds after setting forth the amount of such effective date the amendments made by this section shall apply to payments made after december sec delay in application of worldwide allocation of interest a in general paragraphs and of section of the internal revenue code of are each amended by striking december and inserting december with bills hr ih transition subsection of section of such code is amended by striking paragraph part prevention of tax avoidance sec limitation on treaty benefits for certain deductible payments a in general section of the internal revenue code of relating to income affected by treaty is amended by adding at the end the following new subsection limitation on treaty benefits for certain deductible payments in general in the case of any deductible related party payment any withholding tax imposed under chapter and any tax imposed under subpart a or of this part with respect to such payment not be reduced under any treaty of the united states unless any such withholding tax would be reduced under a treaty of the united states if such payment were made directly to the foreign parent corporation deductible related party payment for purposes of this subsection the term deductible related party payment means any payment made directly or indirectly by any person to any other person if the payment is allowable as a de with bills hr ih duction under this chapter and both persons are members of the same foreign controlled group of entities foreign controlled group of entities for purposes of this subsection a in general the term foreign controlled group of entities means a controlled group of entities the common parent of which is a foreign corporation controlled group of entities the term controlled group of entities means a controlled group of corporations as defined in section a except that more than percent shall be substituted for at least percent each place it appears therein and the determination shall be made without regard to subsections a and of section a partnership or any other entity other than a corporation shall be treated as a member of a controlled group of entities if such entity is controlled within the meaning of section by members of such group includ with bills hr ih ing any entity treated as a member of such group by reason of this sentence foreign parent corporation for purposes of this subsection the term foreign parent corporation means with respect to any deductible related party payment the common parent of the foreign controlled group of entities referred to in paragraph a regulations the secretary prescribe such regulations or other guidance as are necessary or appropriate to carry out the purposes of this subsection including regulations or other guidance which provide for a the treatment of two or more persons as members of a foreign controlled group of entities if such persons would be the common parent of such group if treated as one corporation and the treatment of any member of a foreign controlled group of entities as the common parent of such group if such treatment is appropriate taking into account the economic relationships among such entities with bills hr ih effective date the amendment made by this section shall apply to payments made after the date of the enactment of this act sec codification of economic substance doctrine penalties a in general section of the internal revenue code of is amended by redesignating subsection as subsection and by inserting after subsection the following new subsection clarification of economic substance doctrine application of doctrine in the case of any transaction to which the economic substance doctrine is relevant such transaction shall be treated as having economic substance only if a the transaction changes in a meaningful way apart from federal income tax effects the taxpayer economic position and the taxpayer has a substantial purpose apart from federal income tax effects for entering into such transaction special rule where taxpayer relies on profit potential a in general the potential for profit of a transaction shall be taken into ac with bills hr ih count in determining whether the requirements of subparagraphs a and of paragraph are met with respect to the transaction only if the present value of the reasonably expected pre tax profit from the transaction is substantial in relation to the present value of the expected net tax benefits that would be allowed if the transaction were respected treatment of fees and foreign taxes fees and other transaction expenses and foreign taxes shall be taken into account as expenses in determining pre tax profit under subparagraph a state and local tax benefits for purposes of paragraph any state or local income tax effect which is related to a federal income tax effect shall be treated in the same manner as a federal income tax effect financial accounting benefits for purposes of paragraph achieving a financial accounting benefit shall not be taken into account as a purpose for entering into a transaction if the origin of such financial accounting benefit is a reduction of federal income tax with bills hr ih definitions and special rules for purposes of this subsection a economic substance doctrine the term economic substance doctrine means the common law doctrine under which tax benefits under subtitle a with respect to a transaction are not allowable if the transaction does not have economic substance or lacks a business purpose exception for personal transactions of individuals in the case of an individual paragraph shall apply only to transactions entered into in connection with a trade or business or an activity engaged in for the production of income other common law doctrines not affected except as specifically provided in this subsection the provisions of this subsection shall not be construed as altering or supplanting any other rule of law and the requirements of this subsection shall be construed as being in addition to any such other rule of law determination of application of doctrine not affected the determination with bills hr ih of whether the economic substance doctrine is relevant to a transaction or series of transactions shall be made in the same manner as if this subsection had never been enacted regulations the secretary shall prescribe such regulations as be necessary or appropriate to carry out the purposes of this subsection penalty for underpayments attributable to transactions lacking economic substance in general subsection of section of such code is amended by inserting after paragraph the following new paragraph any disallowance of claimed tax benefits by reason of a transaction lacking economic substance within the meaning of section or failing to meet the requirements of any similar rule of law increased penalty for nondisclosed transactions section of such code is amended by adding at the end the following new subsection increase in penalty in case of nondisclosed noneconomic substance transactions with bills hr ih in general in the case of any portion of an underpayment which is attributable to one or more nondisclosed noneconomic substance transactions subsection a shall be applied with respect to such portion by substituting percent for percent nondisclosed noneconomic substance transactions for purposes of this subsection the term nondisclosed noneconomic substance transaction means any portion of a transaction described in subsection with respect to which the relevant facts affecting the tax treatment are not adequately disclosed in the return nor in a statement attached to the return special rule for amended returns except as provided in regulations in no event shall any amendment or supplement to a return of tax be taken into account for purposes of this subsection if the amendment or supplement is filed after the earlier of the date the taxpayer is first contacted by the secretary regarding the examination of the return or such other date as is specified by the secretary with bills hr ih conforming amendment subparagraph of section a of such code is amended a by striking section and inserting subsections or of section and by striking gross valuation misstatement penalty in the heading and inserting certain increased underpayment penalties reasonable cause exception not applicable to noneconomic substance transactions and tax shelters reasonable cause exception for underpayments subsection of section of such code is amended a by redesignating paragraphs and as paragraphs and respectively by striking paragraph in paragraph a as so redesignated and inserting paragraph and by inserting after paragraph the following new paragraph exception paragraph shall not apply to any portion of an underpayment which is with bills hr ih attributable to one or more tax shelters as defined in section or transactions described in section reasonable cause exception for reportable transaction understatements subsection of section of such code is amended a by redesignating paragraphs and as paragraphs and respectively by striking paragraph in paragraph as so redesignated and inserting paragraph and by inserting after paragraph the following new paragraph exception paragraph shall not apply to any portion of a reportable transaction understatement which is attributable to one or more tax shelters as defined in section or transactions described in section application of penalty for erroneous claim for refund or credit to noneconomic substance transactions section of such code is amended by redesignating subsection as subsection and inserting after subsection the following new subsection with bills hr ih noneconomic substance transactions treated as lacking reasonable basis for purposes of this section any excessive amount which is attributable to any transaction described in section shall not be treated as having a reasonable basis effective date in general except as otherwise provided in this subsection the amendments made by this section shall apply to transactions entered into after the date of the enactment of this act underpayments the amendments made by subsections and shall apply to underpayments attributable to transactions entered into after the date of the enactment of this act understatements the amendments made by subsection shall apply to understatements attributable to transactions entered into after the date of the enactment of this act refunds and credits the amendment made by subsection shall apply to refunds and credits attributable to transactions entered into after the date of the enactment of this act with bills hr ih sec certain large or publicly traded persons made subject to a more likely than not standard for avoiding penalties on underpayments a in general subsection of section of the internal revenue code of as amended by section is amended by redesignating paragraphs and as paragraphs and respectively by striking paragraph in paragraph a as so redesignated and inserting paragraph and by inserting after paragraph the following new paragraph special rule for certain large or publicly traded persons a in general in the case of any specified person paragraph shall apply to the portion of an underpayment which is attributable to any item only if such person has a reasonable belief that the tax treatment of such item by such person is more likely than not the proper tax treatment of such item specified person for purposes of this paragraph the term specified person means with bills hr ih any person required to file periodic or other reports under section of the securities exchange act of and any corporation with gross receipts in excess of for the taxable year involved all persons treated as a single employer under section a shall be treated as one person for purposes of clause nonapplication of substantial authority and reasonable basis standards for reducing understatements paragraph of section of such code is amended by adding at the end the following new subparagraph reduction not to apply to certain large or publicly traded persons subparagraph shall not apply to any specified person as defined in section c effective date in general except as provided in paragraph the amendments made by this section shall apply to underpayments attributable to transactions entered into after the date of the enactment of this act with bills hr ih nonapplication of understatement reduction the amendment made by subsection shall apply to understatements attributable to transactions entered into after the date of the enactment of this act part parity in health benefits sec certain health related benefits applicable to spouses and dependents extended to eligible beneficiaries a application of accident and health plans to eligible beneficiaries exclusion of contributions section of the internal revenue code of relating to contributions by employer to accident and health plans as amended by section is amended by adding at the end the following new subsection coverage provided for eligible beneficiaries of employees in general subsection a shall apply with respect to any eligible beneficiary of the employee eligible beneficiary for purposes of this subsection the term eligible beneficiary means any individual who is eligible to receive benefits or coverage under an accident or health plan with bills hr ih exclusion of amounts expended for medical care the first sentence of section of such code relating to amounts expended for medical care is amended a by striking and his dependents and inserting his dependents and by inserting before the period the following and any eligible beneficiary within the meaning of section with respect to the taxpayer payroll taxes a section a of such code is amended by striking or any of his dependents in the matter preceding subparagraph a and inserting any of his dependents or any eligible beneficiary within the meaning of section with respect to the employee by striking or any of his dependents in subparagraph a and inserting any of his dependents or any eligible beneficiary within the meaning of section with respect to the employee and with bills hr ih iii by striking and their dependents both places it appears and inserting and such employees dependents and eligible beneficiaries within the meaning of section section of such code is amended by striking or any of his dependents and inserting any of his dependents or any eligible beneficiary within the meaning of section with respect to the employee and by striking and their dependents both places it appears and inserting and such employees dependents and eligible beneficiaries within the meaning of section section of such code is amended by striking or any of his dependents in the matter preceding subparagraph a and inserting any of his dependents or any eligible beneficiary within the meaning of section with respect to the employee with bills hr ih by striking or any of his dependents in subparagraph a and inserting any of his dependents or any eligible beneficiary within the meaning of section with respect to the employee and iii by striking and their dependents both places it appears and inserting and such employees dependents and eligible beneficiaries within the meaning of section section a of such code is amended by striking or at the end of paragraph by striking the period at the end of paragraph and inserting or and by inserting after paragraph the following new paragraph for any payment made to or for the benefit of an employee or any eligible beneficiary within the meaning of section if at the time of such payment it is reasonable to believe that the employee will be able to exclude such payment from income under section or under section by reference in section to section with bills hr ih expansion of dependency for purposes of deduction for health insurance costs of selfemployed individuals in general paragraph of section of the internal revenue code of relating to special rules for health insurance costs of selfemployed individuals is amended to read as follows allowance of deduction in the case of a taxpayer who is an employee within the meaning of section there shall be allowed as a deduction under this section an amount equal to the amount paid during the taxable year for insurance which constitutes medical care for a the taxpayer the taxpayer spouse the taxpayer dependents any individual who satisfies the age requirements of section a bears a relationship to the taxpayer described in section and iii meets the requirements of section and one individual who with bills hr ih does not satisfy the age requirements of section a bears a relationship to the taxpayer described in section iii meets the requirements of section d and iv is not the spouse of the taxpayer and does not bear any relationship to the taxpayer described in subparagraphs a through of section conforming amendment subparagraph of section of such code is amended by inserting any dependent or individual described in subparagraph or of paragraph with respect to after spouse extension to eligible beneficiaries of sick and accident benefits provided to members of a voluntary employees beneficiary association and their dependents section of the internal revenue code of relating to list of exempt organizations is amended by adding at the end the following new sentence for purposes of providing for the payment of sick and accident benefits to members of such an association and their dependents the term dependents shall include any individual who is an eligible beneficiary with bills hr ih within the meaning of section as determined under the terms of a medical benefit health insurance or other program under which members and their dependents are entitled to sick and accident benefits flexible spending arrangements and health reimbursement arrangements the secretary of treasury shall issue guidance of general applicability providing that medical expenses that otherwise qualify for reimbursement from a flexible spending arrangement under regulations in effect on the date of the enactment of this act be reimbursed from an employee flexible spending arrangement notwithstanding the fact that such expenses are attributable to any individual who is not the employee spouse or dependent within the meaning of section of the internal revenue code of but is an eligible beneficiary within the meaning of section of such code under the flexible spending arrangement with respect to the employee and for reimbursement from a health reimbursement arrangement under regulations in effect on the date of the enactment of this act be reimbursed from an employee health reimbursement arrange with bills hr ih ment notwithstanding the fact that such expenses are attributable to an individual who is not a spouse or dependent within the meaning of section of such code but is an eligible beneficiary within the meaning of section of such code under the health reimbursement arrangement with respect to the employee effective date the amendments made by this section shall apply to taxable years beginning after december division medicare and medicaid improvements sec table of contents of division the table of contents of this division is as follows sec table of contents of divisiontitle improving health care valuesubtitle a provisions related to medicare part apart market basket updatessec skilled nursing facility payment updatesec inpatient rehabilitation facility payment updatesec incorporating productivity improvements into market basket updatesthat do not already incorporate such improvementspart other medicare part a provisionssec payments to skilled nursing facilitiessec medicare dsh report and payment adjustments in response to coverageexpansionsec extension of hospice regulation moratoriumsec permitting physician assistants to order post hospital extended careservices and to provide for recognition of attending physicianassistants as attending physicians to serve hospice patientssubtitle provisions related to part bpart physicians services with bills hr ihsec resource based feedback program for physicians in medicaresec misvalued codes under the physician fee schedulesec payments for efficient areassec modifications to the physician quality reporting initiative pqri sec adjustment to medicare payment localitiespart market basket updatessec incorporating productivity improvements into market basket updatesthat do not already incorporate such improvementspart other provisionssec rental and purchase of power driven wheelchairssec a election to take ownership or to decline ownership of a certainitem of complex durable medical equipment after the monthcapped rental period endssec extension of payment rule for brachytherapysec home infusion therapy report to congresssec require ambulatory surgical centers ascs to submit cost data andother datasec treatment of certain cancer hospitalssec payment for imaging servicessec durable medical equipment program improvementssec medpac study and report on bone mass measurementsec timely access to post mastectomy itemssec a payment for biosimilar biological productssec study and report on dme competitive bidding processsubtitle provisions related to medicare parts a and bsec reducing potentially preventable hospital readmissionssec post acute care services payment reform plan and bundling pilotprogramsec home health payment update for sec payment adjustments for home health caresec incorporating productivity improvements into market basket updatefor home health servicessec a medpac study on variation in home health marginssec permitting home health agencies to assign the most appropriateskilled service to make the initial assessment visit under amedicare home health plan of care for rehabilitation casessec limitation on medicare exceptions to the prohibition on certain physicianreferrals made to hospitalssec institute of medicine study of geographic adjustment factors undermedicaresec revision of medicare payment systems to address geographic inequitiessec institute of medicine study of geographic variation in health carespending and promoting high value health caresec implementation and congressional review of proposal to revisemedicare payments to promote high value health caresubtitle medicare advantage reformspart payment and administration with bills hr ihsec phase in of payment based on fee for service costs quality bonuspaymentssec authority for secretarial coding intensity adjustment authoritysec simplification of annual beneficiary election periodssec extension of reasonable cost contractssec limitation of waiver authority for employer group planssec improving risk adjustment for paymentssec elimination of ma regional plan stabilization fundsec study regarding the effects of calculating medicare advantage paymentrates on a regional average of medicare fee for serviceratespart beneficiary protections and anti fraudsec limitation on cost sharing for individual health servicessec continuous open enrollment for enrollees in plans with enrollmentsuspensionsec information for beneficiaries on ma plan administrative costssec strengthening audit authoritysec authority to deny plan bidssec a state authority to enforce standardized marketing requirementspart treatment of special needs planssec limitation on enrollment outside open enrollment period of individualsinto chronic care specialized ma plans for special needsindividualssec extension of authority of special needs plans to restrict enrollment service area moratorium for certain snpssec extension of medicare senior housing planssubtitle improvements to medicare part dsec elimination of coverage gapsec discounts for certain part drugs in original coverage gapsec repeal of provision relating to submission of claims by pharmacieslocated in or contracting with long term care facilitiessec including costs incurred by aids drug assistance programs and indianhealth service in providing prescription drugs toward theannual out of pocket threshold under part dsec no mid year formulary changes permittedsec negotiation of lower covered part drug prices on behalf of medicarebeneficiariessec accurate dispensing in long term care facilitiessec free generic fillsec state certification prior to waiver of licensure requirements undermedicare prescription drug programsubtitle medicare rural access protectionssec telehealth expansion and enhancementssec extension of outpatient hold harmless provisionsec extension of section hospital reclassificationssec extension of geographic floor for worksec extension of payment for technical component of certain physicianpathology servicessec extension of ambulance add ons with bills hr ihtitle medicare beneficiary improvementssubtitle a improving and simplifying financial assistance for low incomemedicare beneficiariessec improving assets tests for medicare savings program and low incomesubsidy programsec elimination of part cost sharing for certain non institutionalizedfull benefit dual eligible individualssec eliminating barriers to enrollmentsec enhanced oversight relating to reimbursements for retroactive lowincome subsidy enrollmentsec intelligent assignment in enrollmentsec special enrollment period and automatic enrollment process for certainsubsidy eligible individualssec application of ma premiums prior to rebate and quality bonus paymentsin calculation of low income subsidy benchmarksubtitle reducing health disparitiessec ensuring effective communication in medicaresec demonstration to promote access for medicare beneficiaries withlimited english proficiency by providing reimbursement for culturallyand linguistically appropriate servicessec iom report on impact of language access servicessec definitionssubtitle miscellaneous improvementssec extension of therapy caps exceptions processsec extended months of coverage of immunosuppressive drugs for kidneytransplant patients and other renal dialysis provisionssec voluntary advance care planning consultationsec part special enrollment period and waiver of limited enrollmentpenalty for tricare beneficiariessec exception for use of more recent tax year in case of gains from saleof primary residence in computing part income related premiumsec demonstration program on use of patient decisions aidstitle iii promoting primary care mental healthservices and coordinated caresec accountable care organization pilot programsec medical home pilot programsec payment incentive for selected primary care servicessec increased reimbursement rate for certified nurse midwivessec coverage and waiver of cost sharing for preventive servicessec waiver of deductible for colorectal cancer screening tests regardlessof coding subsequent diagnosis or ancillary tissue removalsec excluding clinical social worker services from coverage under themedicare skilled nursing facility prospective payment systemand consolidated paymentsec coverage of marriage and family therapist services and mentalhealth counselor servicessec extension of physician fee schedule mental health add onsec expanding access to vaccines with bills hr ihsec expansion of medicare covered preventive services at federallyqualified health centerssec independence at home demonstration programsec recognition of certified diabetes educators as certified providers forpurposes of medicare diabetes outpatient self managementtraining servicestitle iv qualitysubtitle a comparative effectiveness researchsec comparative effectiveness researchsubtitle nursing home transparencypart improving transparency of information on skilled nursingfacilities nursing facilities and other long term care facilitiessec required disclosure of ownership and additional disclosable partiesinformationsec accountability requirementssec nursing home compare medicare websitesec reporting of expendituressec standardized complaint formsec ensuring staffing accountabilitysec nationwide program for national and state background checks ondirect patient access employees of long term care facilities andproviderspart targeting enforcementsec civil money penaltiessec national independent monitor pilot programsec notification of facility closurepart improving staff trainingsec dementia and abuse prevention trainingsec study and report on training required for certified nurse aides andsupervisory staffsec qualification of director of food services of a skilled nursing facilityor nursing facilitysubtitle quality measurementssec establishment of national priorities for quality improvementsec development of new quality measures gao evaluation of data collectionprocess for quality measurementsec multi stakeholder pre rulemaking input into selection of qualitymeasuressec application of quality measuressec consensus based entity fundingsubtitle physician payments sunshine provision with bills hr ihsec reports on financial relationships between manufacturers and distributorsof covered drugs devices biologicals or medical suppliesunder medicare medicaid or chip and physicians andother health care entities and between physicians and otherhealth care entitiessubtitle public reporting on health care associated infectionssec requirement for public reporting by hospitals and ambulatory surgicalcenters on health care associated infectionstitle medicare graduate medical educationsec distribution of unused residency positionssec increasing training in nonprovider settingssec rules for counting resident time for didactic and scholarly activitiesand other activitiessec preservation of resident cap positions from closed hospitalssec improving accountability for approved medical residency trainingtitle vi program integritysubtitle a increased funding to fight waste fraud and abusesec increased funding and flexibility to fight fraud and abusesubtitle enhanced penalties for fraud and abusesec enhanced penalties for false statements on provider or supplier enrollmentapplicationssec enhanced penalties for submission of false statements material toa false claimsec enhanced penalties for delaying inspectionssec enhanced hospice program safeguardssec enhanced penalties for individuals excluded from program participationsec enhanced penalties for provision of false information by medicareadvantage and part planssec enhanced penalties for medicare advantage and part marketingviolationssec enhanced penalties for obstruction of program auditssec exclusion of certain individuals and entities from participation inmedicare and state health care programssec oig authority to exclude from federal health care programs officersand owners of entities convicted of fraudsec self referral disclosure protocolsubtitle enhanced program and provider protectionssec enhanced cms program protection authoritysec enhanced medicare medicaid and chip program disclosure requirementsrelating to previous affiliationssec required inclusion of payment modifier for certain evaluation andmanagement servicessec evaluations and reports required under medicare integrity programsec require providers and suppliers to adopt programs to reduce waste fraud and abuse with bills hr ihsec maximum period for submission of medicare claims reduced to notmore than monthssec physicians who order durable medical equipment or home healthservices required to be medicare enrolled physicians or eligibleprofessionalssec requirement for physicians to provide documentation on referrals toprograms at high risk of waste and abusesec face to face encounter with patient required before eligibility certificationsfor home health services or durable medical equipmentsec extension of testimonial subpoena authority to program exclusioninvestigationssec required repayments of medicare and medicaid overpaymentssec expanded application of hardship waivers for oig exclusions tobeneficiaries of any federal health care programsec access to certain information on renal dialysis facilitiessec billing agents clearinghouses or other alternate payees required toregister under medicaresec conforming civil monetary penalties to false claims act amendmentssec requiring provider and supplier payments under medicare to bemade through direct deposit or electronic funds transfer eft at insured depository institutionssec inspector general for the health choices administrationsubtitle access to information needed to prevent fraud waste andabusesec access to information necessary to identify fraud waste andabusesec elimination of duplication between the healthcare integrity andprotection data bank and the national practitioner databanksec compliance with hipaa privacy and security standardstitle vii medicaid and chipsec table of contents øtemporary¿subtitle a medicaid and health reformsec eligibility for individuals with income below percent of the federalpoverty levelsec requirements and special rules for certain medicaid eligible individualssec chip and medicaid maintenance of eligibilitysec reduction in medicaid dshsec expanded outstationingsubtitle preventionsec required coverage of preventive servicessec tobacco cessationsec optional coverage of nurse home visitation servicessec state eligibility option for family planning servicessubtitle access with bills hr ihsec payments to primary care practitionerssec medical home pilot programsec translation or interpretation servicessec optional coverage for freestanding birth center servicessec inclusion of public health clinics under the vaccines for children programsec requiring coverage of services of podiatristssec a requiring coverage of services of optometristssec therapeutic foster caresec assuring adequate payment levels for servicessec preserving medicaid coverage for youths upon release from publicinstitutionssec quality measures for maternity and adult health services undermedicaid and chipsec a accountable care organization pilot programsec fqhc coveragesubtitle coveragesec optional medicaid coverage of low income hiv infected individualssec extending transitional medicaid assistance tma sec requirement of month continuous coverage under certain chipprogramssec preventing the application under chip of coverage waiting periodsfor certain childrensec adult day health care servicessec medicaid coverage for citizens of freely associated statessec continuing requirement of medicaid coverage of nonemergencytransportation to medically necessary servicessec state option to disregard certain income in providing continuedmedicaid coverage for certain individuals with extremely highprescription costssec provisions relating to community living assistance services and supports class subtitle financingsec payments to pharmacistssec prescription drug rebatessec extension of prescription drug discounts to enrollees of medicaidmanaged care organizationssec payments for graduate medical educationsec nursing facility supplemental payment programsec report on medicaid paymentssec reviews of medicaidsec extension of delay in managed care organization provider tax eliminationsec extension of arra increase in fmapsubtitle waste fraud and abusesec health care acquired conditionssec evaluations and reports required under medicaid integrity programsec require providers and suppliers to adopt programs to reduce waste fraud and abusesec overpayments with bills hr ihsec managed care organizationssec termination of provider participation under medicaid and chip ifterminated under medicare or other state plan or child healthplansec medicaid and chip exclusion from participation relating to certainownership control and management affiliationssec requirement to report expanded set of data elements under mmisto detect fraud and abusesec billing agents clearinghouses or other alternate payees required toregister under medicaidsec denial of payments for litigation related misconductsec mandatory state use of national correct coding initiativesubtitle payments to the territoriessec payment to territoriessubtitle miscellaneoussec technical correctionssec extension of qi programsec assuring transparency of informationsec medicaid and chip payment and access commissionsec outreach and enrollment of medicaid and chip eligible individualssec prohibitions on federal medicaid and chip payment for undocumentedalienssec demonstration project for stabilization of emergency medical conditionsby institutions for mental diseasessec application of medicaid improvement fundsec treatment of certain medicaid brokerssec rule for changes requiring state legislationtitle viii revenue related provisionssec disclosures to facilitate identification of individuals likely to be ineligiblefor the low income assistance under the medicare prescriptiondrug program to assist social security administration soutreach to eligible individualssec comparative effectiveness research trust fund financing fortrust fundtitle ix miscellaneous provisionssec repeal of trigger provisionsec repeal of comparative cost adjustment cca programsec extension of gainsharing demonstrationsec grants to states for quality home visitation programs for familieswith young children and families expecting childrensec improved coordination and protection for dual eligiblessec assessment of medicare cost intensive diseases and conditionssec establishment of center for medicare and medicaid innovationwithin cmssec application of emergency services lawssec disregard under the supplemental security income program of compensationfor participation in clinical trials for rare diseases orconditions with bills hr ih title improving health care value subtitle a provisions related to medicare part a part market basket updates sec skilled nursing facility payment update a in general section of the social security act usc yy is amended in subclause iii by striking and at the end by redesignating subclause iv as subclause vi and by inserting after subclause iii the following new subclauses iv for each of fiscal years through the rate computed for the previous fiscal year increased by the skilled nursing facility market basket percentage change for the fiscal year involved for fiscal year the rate computed for the previous fiscal year and with bills hr ih delayed effective date section of the social security act as inserted by subsection a shall not apply to payment for days before january sec inpatient rehabilitation facility payment update a in general section of the social security act usc ww is amended by striking and and inserting through delayed effective date the amendment made by subsection a shall not apply to payment units occurring before january sec incorporating productivity improvements into market basket updates that do not already incorporate such improvements a inpatient acute hospitals section of the social security act usc ww is amended in clause iii a by striking iii for purposes of this subparagraph and inserting iii for purposes of this subparagraph subject to the productivity adjustment described in subclause and with bills hr ih by adding at the end the following new subclause the productivity adjustment described in this subclause with respect to an increase or change for a fiscal year or year or cost reporting period or other annual period is a productivity offset in the form of a reduction in such increase or change equal to the percentage change in the year moving average of annual economy wide private nonfarm business multi factor productivity as recently published in final form before the promulgation or publication of such increase for the year or period involved except as otherwise provided any reference to the increase described in this clause shall be a reference to the percentage increase described in subclause minus the percentage change under this subclause in the first sentence of clause viii by inserting but not below zero after shall be reduced and in the first sentence of clause ix a by inserting determined without regard to clause iii after clause the second time it appears and by inserting but not below zero after reduced with bills hr ih skilled nursing facilities section of such act usc yy is amended by inserting subject to the productivity adjustment described in section iii after as calculated by the secretary long term care hospitals section of the social security act usc ww is amended by adding at the end the following new paragraph productivity adjustment in implementing the system described in paragraph for discharges occurring on or after january during the rate year ending in or any subsequent rate year for a hospital to the extent that an annual percentage increase factor applies to a standard federal rate for such discharges for the hospital such factor shall be subject to the productivity adjustment described in subsection iii inpatient rehabilitation facilities the second sentence of section of the social security act usc ww is amended by inserting subject to the productivity adjustment described in subsection iii after appropriate percentage increase with bills hr ih psychiatric hospitals section of the social security act usc ww is amended by adding at the end the following new subsection prospective payment for psychiatric hospitals reference to establishment and implementation of system for provisions related to the establishment and implementation of a prospective payment system for payments under this title for inpatient hospital services furnished by psychiatric hospitals as described in clause of subsection and psychiatric units as described in the matter following clause of such subsection see section of the medicare medicaid and schip balanced budget refinement act of productivity adjustment in implementing the system described in paragraph for days occurring during the rate year ending in or any subsequent rate year for a psychiatric hospital or unit described in such paragraph to the extent that an annual percentage increase factor applies to a base rate for such days for the hospital or unit respectively such factor shall be subject to with bills hr ih the productivity adjustment described in subsection iii hospice care subclause vii of section of the social security act usc is amended by inserting after the market basket percentage increase the following which is subject to the productivity adjustment described in section iii effective dates ipps the amendments made by subsection a shall apply to annual increases effected for fiscal years beginning with fiscal year but only with respect to discharges occurring on or after january snf and irf the amendments made by subsections and shall apply to annual increases effected for fiscal years beginning with fiscal year hospice care the amendment made by subsection shall apply to annual increases effected for fiscal years beginning with fiscal year but only with respect to days of care occurring on or after january with bills hr ih part other medicare part a provisions sec payments to skilled nursing facilities a change in recalibration factor analysis the secretary of health and human services shall conduct using calendar year claims data an initial analysis comparing total payments under title xviii of the social security act for skilled nursing facility services under the rug– and under the rug– classification systems adjustment in recalibration factor based on the initial analysis under paragraph the secretary shall adjust the case mix indexes under section of the social security act usc yy for fiscal year by the appropriate recalibration factor as proposed in the proposed rule for medicare skilled nursing facilities issued by such secretary on may federal register et seq change in payment for nontherapy ancillary nta services and therapy services changes under current snf classification system a in general subject to subparagraph the secretary of health and human services shall under the system for payment of with bills hr ih skilled nursing facility services under section of the social security act usc yy increase payment by percent for non therapy ancillary services as specified by the secretary in the notice issued on november federal register et seq and shall decrease payment for the therapy case mix component of such rates by percent effective date the changes in payment described in subparagraph a shall apply for days on or after january and until the secretary implements an alternative case mix classification system for payment of skilled nursing facility services under section of the social security act usc yy implementation notwithstanding any other provision of law the secretary implement by program instruction or otherwise the provisions of this paragraph changes under a future snf case mix classification system a analysis in general the secretary of health and human services shall analyze with bills hr ih payments for non therapy ancillary services under a future skilled nursing facility classification system to ensure the accuracy of payment for non therapy ancillary services such analysis shall consider use of appropriate predictors which include age physical and mental status ability to perform activities of daily living prior nursing home stay diagnoses broad rug category and a proxy for length of stay application such analysis shall be conducted in a manner such that the future skilled nursing facility classification system is implemented to apply to services furnished during a fiscal year beginning with fiscal year consultation in conducting the analysis under subparagraph a the secretary shall consult with interested parties including the medicare payment advisory commission and other interested stakeholders to identify appropriate predictors of nontherapy ancillary costs rulemaking the secretary shall include the result of the analysis under sub with bills hr ih paragraph a in the fiscal year rulemaking cycle for purposes of implementation beginning for such fiscal year implementation subject to subparagraph and consistent with subparagraph a the secretary shall implement changes to payments for non therapy ancillary services which shall include a separate rate component for non therapy ancillary services and include use of a model that predicts payment amounts applicable for non therapy ancillary services under such future skilled nursing facility services classification system as the secretary determines appropriate based on the analysis conducted pursuant to subparagraph a budget neutrality the secretary shall implement changes described in subparagraph in a manner such that the estimated expenditures under such future skilled nursing facility services classification system for a fiscal year beginning with fiscal year with such changes would be equal to the estimated expenditures that would otherwise occur under title xviii of the social security act under with bills hr ih such future skilled nursing facility services classification system for such year without such changes outlier policy for nta and therapy section of the social security act usc yy is amended by adding at the end the following new paragraph outliers for nta and therapy a in general with respect to outliers because of unusual variations in the type or amount of medically necessary care beginning with october the secretary shall provide for an addition or adjustment to the payment amount otherwise made under this section with respect to non therapy ancillary services in the case of such outliers and provide for such an addition or adjustment to the payment amount otherwise made under this section with respect to therapy services in the case of such outliers outliers based on aggregate costs outlier adjustments or additional payments described in subparagraph a shall be with bills hr ih based on aggregate costs during a stay in a skilled nursing facility and not on the number of days in such stay budget neutrality the secretary shall reduce estimated payments that would otherwise be made under the prospective payment system under this subsection with respect to a fiscal year by percent the total amount of the additional payments or payment adjustments for outliers made under this paragraph with respect to a fiscal year not exceed percent of the total payments projected or estimated to be made based on the prospective payment system under this subsection for the fiscal year conforming amendments section of such act usc yy is amended in subparagraph a a by striking and before adjustments and by inserting and adjustment under section of the affordable health care for america act before the semicolon at the end with bills hr ih in subparagraph by striking and in subparagraph by striking the period and inserting and and by adding at the end the following new subparagraph the establishment of outliers under paragraph sec medicare dsh report and payment adjustments in response to coverage expansion a dsh report in general not later than january the secretary of health and human services shall submit to congress a report on medicare dsh taking into account the impact of the health care reforms carried out under division a in reducing the number of uninsured individuals the report shall include recommendations relating to the following a the appropriate amount targeting and distribution of medicare dsh to compensate for higher medicare costs associated with serving low income beneficiaries taking into account variations in the empirical justification for medicare dsh attributable to hospital characteristics including bed size con with bills hr ih sistent with the original intent of medicare dsh the appropriate amount targeting and distribution of medicare dsh to hospitals given their continued uncompensated care costs to the extent such costs remain coordination with medicaid dsh report the secretary shall coordinate the report under this subsection with the report on medicaid dsh under section a payment adjustments in response to coverage expansion in general if there is a significant decrease in the national rate of uninsurance as a result of this act as determined under paragraph a then the secretary of health and human services shall beginning in fiscal year implement the following adjustments to medicare dsh a in lieu of the amount of medicare dsh payment that would otherwise be made under section of the social security act the amount of medicare dsh payment shall be an amount based on the recommendations of the report under subsection a a and shall take into account variations in the with bills hr ih empirical justification for medicare dsh attributable to hospital characteristics including bed size subject to paragraph make an additional payment to a hospital by an amount that is estimated based on the amount of uncompensated care provided by the hospital based on criteria for uncompensated care as determined by the secretary which shall exclude bad debt significant decrease in national rate of uninsurance as a result of this act for purposes of this subsection a in general there is a significant decrease in the national rate of uninsurance as a result of this act if there is a decrease in the national rate of uninsurance as defined in subparagraph from to that exceeds percentage points national rate of uninsurance defined the term national rate of uninsurance means for a year such rate for the under population for the year as determined and published by the bureau of the cen with bills hr ih sus in its current population survey in or about september of the succeeding year uncompensated care increase a computation of dsh savings for each fiscal year beginning with fiscal year the secretary shall estimate the aggregate reduction in the amount of medicare dsh payment that would be expected to result from the adjustment under paragraph a structure of payment increase the secretary shall compute the additional payment to a hospital as described in paragraph for a fiscal year in accordance with a formula established by the secretary that provides that the estimated aggregate amount of such increase for the fiscal year does not exceed percent of the aggregate reduction in medicare dsh estimated by the secretary for such fiscal year and hospitals with higher levels of uncompensated care receive a greater increase medicare dsh in this section the term medicare dsh means adjustments in payments under with bills hr ih section of the social security act usc ww for inpatient hospital services furnished by disproportionate share hospitals sec extension of hospice regulation moratorium section a of division of the american recovery and reinvestment act of public law – is amended by striking october and inserting october and by striking for fiscal year and inserting for fiscal years and sec 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 a ordering post hospital extended care services section a of the social security act usc a is amended in paragraph in the matter preceding subparagraph a is amended by striking nurse practitioner or clinical nurse specialist and insert with bills hr ih ing nurse practitioner a clinical nurse specialist or a physician assistant in the second sentence by striking or clinical nurse specialist and inserting clinical nurse specialist or physician assistant recognition of attending physician assistants as attending physicians to serve hospice patients in general section dd of such act usc dd is amended a by striking or nurse and inserting the nurse and by inserting or the physician assistant as defined in such subsection after subsection aa conforming amendment section a a of such act usc a a is amended by inserting or a physician assistant after a nurse practitioner construction nothing in the amendments made by this subsection shall be construed as changing the requirements of section of the social security act usc with respect to payment for serv with bills hr ih ices of physician assistants under part of title xviii of such act effective date the amendments made by this section shall apply to items and services furnished on or after january subtitle provisions related to part part physicians services sec resource based feedback program for physicians in medicare section of the social security act usc w– is amended by adding at the end the following new paragraph feedback implementation plan a timeline for feedback program evaluation during the secretary shall conduct the evaluation specified in subparagraph expansion the secretary shall expand the program under this subsection as specified in subparagraph establishment of nature of reports with bills hr ih in general the secretary shall develop and specify the nature of the reports that will be disseminated under this subsection based on results and findings from the program under this subsection as in existence before the date of the enactment of this paragraph such reports be based on a per capita basis an episode basis that combines separate but clinically related physicians services and other items and services furnished or ordered by a physician into an episode of care as appropriate or both timeline for development the nature of the reports described in clause shall be developed by not later than january iii public availability the secretary shall make the details of the nature of the reports developed under clause available to the public analysis of data the secretary shall for purposes of preparing reports under this subsection establish methodologies as appropriate such as to with bills hr ih attribute items and services in whole or in part to physicians identify appropriate physicians for purposes of comparison under subparagraph and iii aggregate items and services attributed to a physician under clause into a composite measure per individual feedback program the secretary shall engage in efforts to disseminate reports under this subsection in disseminating such reports the secretary shall consider the following direct meetings between contracted physicians facilitated by the secretary to discuss the contents of reports under this subsection including any reasons for divergence from local or national averages contract with local non profit entities engaged in quality improvement efforts at the community level such entities shall use the reports under this subsection or such equivalent tool as specified by the secretary any exchange of data under this with bills hr ih paragraph shall be protected by appropriate privacy safeguards iii mailings or other methods of communication that facilitate large scale dissemination iv other methods specified by the secretary evaluation and expansion evaluation the secretary shall evaluate the methods specified in subparagraph with regard to their efficacy in changing practice patterns to improve quality and decrease costs expansion taking into account the cost of each method specified in subparagraph the secretary shall develop a plan to disseminate reports under this subsection in a significant manner in the regions and cities of the country with the highest utilization of services under this title to the extent practicable reports under this subsection shall be disseminated to increasing numbers of physicians each year such that during and subsequent years reports are disseminated at with bills hr ih least to physicians with utilization rates among the highest percent of the nation subject the authority to focus under paragraph administration chapter of title united states code shall not apply to this paragraph notwithstanding any other provision of law the secretary implement the provisions of this paragraph by program instruction or otherwise sec misvalued codes under the physician fee schedule a in general section of the social security act usc is amended by adding at the end the following new subparagraphs potentially misvalued codes in general the secretary shall periodically identify services as being potentially misvalued using criteria specified in clause and review and make appropriate adjustments to the relative val with bills hr ih ues established under this paragraph for services identified as being potentially misvalued under subclause identification of potentially misvalued codes for purposes of identifying potentially misvalued services pursuant to clause the secretary shall examine as the secretary determines to be appropriate codes and families of codes as appropriate for which there has been the fastest growth codes and families of codes as appropriate that have experienced substantial changes in practice expenses codes for new technologies or services within an appropriate period such as three years after the relative values are initially established for such codes multiple codes that are frequently billed in conjunction with furnishing a single service codes with low relative values particularly those that are often billed multiple times for a single treatment codes which have not been subject to review since the implementation of the rbrvs the socalled harvard valued codes and such with bills hr ih other codes determined to be appropriate by the secretary iii review and adjustments the secretary use existing processes to receive recommendations on the review and appropriate adjustment of potentially misvalued services described clause ii the secretary conduct surveys other data collection activities studies or other analyses as the secretary determines to be appropriate to facilitate the review and appropriate adjustment described in clause iii the secretary use analytic contractors to identify and analyze services identified under clause conduct surveys or collect data and make recommendations on the review and appropriate adjustment of services described in clause with bills hr ih iv the secretary coordinate the review and appropriate adjustment described in clause with the periodic review described in subparagraph as part of the review and adjustment described in clause including with respect to codes with low relative values described in clause the secretary make appropriate coding revisions including using existing processes for consideration of coding changes which include consolidation of individual services into bundled codes for payment under the fee schedule under subsection vi the provisions of subparagraph ii shall apply to adjustments to relative value units made pursuant to this subparagraph in the same manner as such provisions apply to adjustments under subparagraph ii with bills hr ih validating relative value units in general the secretary shall establish a process to validate relative value units under the fee schedule under subsection components and elements of work the process described in clause include validation of work elements such as time mental effort and professional judgment technical skill and physical effort and stress due to risk involved with furnishing a service and include validation of the pre post and intra service components of work iii scope of codes the validation of work relative value units shall include a sampling of codes for services that is the same as the codes listed under subparagraph iv methods the secretary conduct the validation under this subparagraph using methods described in subclauses through of subparagraph with bills hr ih iii as the secretary determines to be appropriate adjustments the secretary shall make appropriate adjustments to the work relative value units under the fee schedule under subsection the provisions of subparagraph ii shall apply to adjustments to relative value units made pursuant to this subparagraph in the same manner as such provisions apply to adjustments under subparagraph ii implementation funding for purposes of carrying out the provisions of subparagraphs and of of the social security act as added by subsection a in addition to funds otherwise available out of any funds in the treasury not otherwise appropriated there are appropriated to the secretary of health and human services for the center for medicare medicaid services program management account for fiscal year and each subsequent fiscal year amounts appropriated under this paragraph for a fiscal year shall be available until expended with bills hr ih administration a chapter of title united states code and the provisions of the federal advisory committee act usc app shall not apply to this section or the amendment made by this section notwithstanding any other provision of law the secretary implement subparagraphs and of of the social security act as added by subsection a by program instruction or otherwise section of the balanced budget act of is repealed except for provisions related to confidentiality of information the provisions of the federal acquisition regulation shall not apply to this section or the amendment made by this section focusing cms resources on potentially overvalued codes section a of the social security act ee a is repealed sec payments for efficient areas section of the social security act usc is amended by adding at the end the following new subsection with bills hr ih incentive payments for efficient areas in general in the case of services furnished under the physician fee schedule under section on or after january and before january by a supplier that is paid under such fee schedule in an efficient area as identified under paragraph in addition to the amount of payment that would otherwise be made for such services under this part there also shall be paid on a monthly or quarterly basis an amount equal to percent of the payment amount for the services under this part identification of efficient areas a in general based upon available data the secretary shall identify those counties or equivalent areas in the united states in the lowest fifth percentile of utilization based on per capita spending under this part and part a for services provided in the most recent year for which data are available as of the date of the enactment of this subsection as standardized to eliminate the effect of geographic adjustments in payment rates with bills hr ih identification of counties where service is furnished for purposes of paying the additional amount specified in paragraph if the secretary uses the digit postal zip code where the service is furnished the dominant county of the postal zip code as determined by the united states postal service or otherwise shall be used to determine whether the postal zip code is in a county described in subparagraph a limitation on review there shall be no administrative or judicial review under section or otherwise respecting the identification of a county or other area under subparagraph a or the assignment of a postal zip code to a county or other area under subparagraph publication of list of counties posting on website with respect to a year for which a county or area is identified under this paragraph the secretary shall identify such counties or areas as part of the proposed and final rule to implement the physician fee with bills hr ih schedule under section for the applicable year the secretary shall post the list of counties identified under this paragraph on the internet website of the centers for medicare medicaid services sec modifications to the physician quality reporting initiative pqri a feedback section of the social security act usc w– is amended by adding at the end the following new subparagraph feedback the secretary shall provide timely feedback to eligible professionals on the performance of the eligible professional with respect to satisfactorily submitting data on quality measures under this subsection appeals such section is further amended in subparagraph by striking there shall be and inserting except as provided in subparagraph there shall be and by adding at the end the following new subparagraph informal appeals process by not later than january the secretary shall establish and have in place an informal process for eligible professionals to seek a re with bills hr ih view of the determination that an eligible professional did not satisfactorily submit data on quality measures under this subsection integration of physician quality reporting and ehr reporting section of such act is amended by adding at the end the following new paragraph integration of physician quality reporting and ehr reporting not later than january the secretary shall develop a plan to integrate clinical reporting on quality measures under this subsection with reporting requirements under subsection relating to the meaningful use of electronic health records such integration shall consist of the following a the development of measures the reporting of which would both demonstrate meaningful use of an electronic health record for purposes of subsection and clinical quality of care furnished to an individual the collection of health data to identify deficiencies in the quality and coordination with bills hr ih of care for individuals eligible for benefits under this part such other activities as specified by the secretary extension of incentive payments section of such act usc w– is amended in subparagraph a by striking and inserting and in subparagraph by striking and and inserting for each of the years through sec adjustment to medicare payment localities a in general section of the social security act uscw– is amended by adding at the end the following new paragraph transition to use of msas as fee schedule areas in california a in general revision subject to clause and notwithstanding the previous provisions of this subsection for services furnished on or after january the secretary shall revise the fee schedule with bills hr ih areas used for payment under this section applicable to the state of california using the metropolitan statistical area msa iterative geographic adjustment factor methodology as follows the secretary shall configure the physician fee schedule areas using the metropolitan statistical areas each in this paragraph referred to as an msa as defined by the director of the office of management and budget and published in the federal register using the most recent available decennial population data as of the date of the enactment of the affordable health care for america act as the basis for the fee schedule areas for purposes of this clause the secretary shall treat all areas not included in an msa as a single rest of the state msa iii the secretary shall list all msas within the state by geographic adjustment factor described in para with bills hr ih graph in this paragraph referred to as a gaf in descending order iv in the first iteration the secretary shall compare the gaf of the highest cost msa in the state to the weighted average gaf of all the remaining msas in the state including the rest of state msa described in subclause if the ratio of the gaf of the highest cost msa to the weighted average of the gaf of remaining lower cost msas is or greater the highest cost msa shall be a separate fee schedule area in the next iteration the secretary shall compare the gaf of the msa with the second highest gaf to the weighted average gaf of the all the remaining msas excluding msas that become separate fee schedule areas if the ratio of the secondhighest msa gaf to the weightedaverage of the remaining lower cost msas is or greater the secondhighest msa shall be a separate fee with bills hr ih schedule area vi the iterative process shall continue until the ratio of the gaf of the msa with highest remaining gaf to the weighted average of the remaining msas with lower gafs is less than and the remaining group of msas with lower gafs shall be treated as a single fee schedule area vi for purposes of the iterative process described in this clause if two msas have identical gafs they shall be combined transition for services furnished on or after january and before january in the state of california after calculating the work practice expense and malpractice geographic indices that would otherwise be determined under clauses and iii of paragraph a for a fee schedule area determined under clause if the index for a county within a fee schedule area is less than the index in effect for such county on december the secretary shall in with bills hr ih stead apply the index in effect for such county on such date subsequent revisions after the transition described in subparagraph a not less than every years the secretary shall review and update the fee schedule areas using the methodology described in subparagraph a and any updated msas as defined by the director of the office of management and budget and published in the federal register the secretary shall review and make any changes pursuant to such reviews concurrent with the application of the periodic review of the adjustment factors required under paragraph for california references to fee schedule areas effective for services furnished on or after january for the state of california any reference in this section to a fee schedule area shall be deemed a reference to an msa in the state including the single rest of state msa described in subparagraph a conforming amendment to definition of fee schedule area section of the social with bills hr ih security act usc is amended by striking the term and inserting except as provided in subsection the term part market basket updates sec incorporating productivity improvements into market basket updates that do not already incorporate such improvements a outpatient hospitals in general section iv of the social security act usc iv is amended a in the first sentence by inserting which is subject to the productivity adjustment described in subclause of such section after iii and by inserting but not below after reduced and in the second sentence by inserting and which is subject beginning with to the productivity adjustment described in section iii with bills hr ih effective date the amendments made by this subsection shall apply to increase factors for services furnished in years beginning with ambulance services section of such act usc is amended by inserting before the period at the end the following and in the case of years beginning with subject to the productivity adjustment described in section iii ambulatory surgical center services section of such act usc is amended by redesignating clause as clause vi and by inserting after clause iv the following new clause in implementing the system described in clause for services furnished during or any subsequent year to the extent that an annual percentage change factor applies such factor shall be subject to the productivity adjustment described in section iii laboratory services section a of such act usc a is amended with bills hr ih in clause by striking for each of the years through and inserting for and clause a by striking and at the end of subclause iii by striking the period at the end of subclause iv and inserting and and by adding at the end the following new subclause the annual adjustment in the fee schedules determined under clause for years beginning with shall be subject to the productivity adjustment described in section iii certain durable medical equipment section a of such act usc a is amended in subparagraph by inserting before the semicolon at the end the following subject to the productivity adjustment described in section iii in subparagraph by inserting after june the following subject to the productivity adjustment described in section iii with bills hr ih in subparagraph by inserting after june the following subject to the productivity adjustment described in section iii and in subparagraph by inserting before the period at the end the following subject to the productivity adjustment described in section iii part other provisions sec rental and purchase of power driven wheelchairs a in general section a a iii of the social security act usc a a iii is amended in the heading by inserting certain complex rehabilitative after option for and by striking power driven wheelchair and inserting complex rehabilitative power driven wheelchair recognized by the secretary as classified within group or higher effective date the amendments made by subsection a shall take effect on january and shall apply to power driven wheelchairs furnished on or after such date such amendments shall not apply to contracts entered into under section of the social secu with bills hr ih rity act usc w– pursuant to a bid submitted under such section before october under subsection a of such section sec a election to take ownership or to decline ownership of a certain item of complex durable medical equipment after the month capped rental period ends a in general section a a of the social security act usc a a is amended in clause a by striking rental on and inserting rental in general except as provided in subclause on and by adding at the end the following new subclause option to accept or reject transfer of title to group support surface aa in general during the th continuous month during which payment is made for the rental of a group support with bills hr ih surface under clause the supplier of such item shall offer the individual the option to accept or reject transfer of title to a group support surface after the th continuous month during which payment is made for the rental of the group support surface under clause such title shall be transferred to the individual only if the individual notifies the supplier not later than month after the supplier makes such offer that the individual agrees to accept transfer of the title to the group support surface unless the individual accepts transfer of title to the group support surface in the manner set forth in this subclause the individual shall be deemed to have rejected transfer of title if the individual agrees to accept the transfer of the title to the group support surface the supplier shall trans with bills hr ih fer such title to the individual on the first day that begins after the th continuous month during which payment is made for the rental of the group support surface under clause bb special rule if on the effective date of this subclause an individual rental period for a group support surface has exceeded continuous months but the first day that begins after the th continuous month during which payment is made for the rental under clause has not been reached the supplier shall within month following such effective date offer the individual the option to accept or reject transfer of title to a group support surface such title shall be transferred to the individual only if the individual notifies the supplier not later than month after the supplier with bills hr ih makes such offer that the individual agrees to accept transfer of title to the group support surface unless the individual accepts transfer of title to the group support surface in the manner set forth in this subclause the individual shall be deemed to have rejected transfer of title if the individual agrees to accept the transfer of the title to the group support surface the supplier shall transfer such title to the individual on the first day that begins after the th continuous month during which payment is made for the rental of the group support surface under clause unless that day has passed in which case the supplier shall transfer such title to the individual not later than month after notification that the individual accepts transfer of title with bills hr ih cc treatment of subsequent resupply within period of reasonable useful lifetime of group support surface in case of need if an individual rejects transfer of title to a group support surface under this subclause and the individual requires such support surface at any subsequent time during the period of the reasonable useful lifetime of such equipment as defined by the secretary beginning with the first month for which payment is made for the rental of such equipment under clause the supplier shall supply the equipment without charge to the individual or the program under this title during the remainder of such period other than payment for maintenance and servicing during such period which would otherwise have been paid if the with bills hr ih individual had accepted title to such equipment the previous sentence shall not affect the payment of amounts under this part for such equipment after the end of such period of the reasonable useful lifetime of the equipment dd payments maintenance and servicing payments shall be made in accordance with clause iv in the case of a supplier that transfers title to the group support surface under this subclause after such transfer and in the case of an individual who rejects transfer of title under this subclause after the end of the period of medical need during which payment is made under clause and in clause iv by inserting or in the case of an individual who rejects transfer of title to a group support surface under clause after the end of the period of medical need during which pay with bills hr ih ment is made under clause after under clause effective date the amendments made by this section shall apply with respect to durable medical equipment not later than january sec extension of payment rule for brachytherapy section of the social security act usc as amended by section of the medicare improvements for patients and providers act of public law – is amended by striking the first place it appears january and inserting january sec home infusion therapy report to congress not later than july the medicare payment advisory commission shall submit to congress a report on the following the scope of coverage for home infusion therapy in the fee for service medicare program under title xviii of the social security act medicare advantage under part of such title the veteran health care program under chapter of title united states code and among private payers including an analysis of the scope of services pro with bills hr ih vided by home infusion therapy providers to their patients in such programs the benefits and costs of providing such coverage under the medicare program including a calculation of the potential savings achieved through avoided or shortened hospital and nursing home stays as a result of medicare coverage of home infusion therapy an assessment of sources of data on the costs of home infusion therapy that might be used to construct payment mechanisms in the medicare program recommendations if any on the structure of a payment system under the medicare program for home infusion therapy including an analysis of the payment methodologies used under medicare advantage plans and private health plans for the provision of home infusion therapy and their applicability to the medicare program sec require ambulatory surgical centers ascs to submit cost data and other data a cost reporting with bills hr ih in general section of the social security act usc is amended by adding at the end the following new paragraph the secretary shall require as a condition of the agreement described in section a the submission of such cost report as the secretary specify taking into account the requirements for such reports under section in the case of a hospital development of cost report not later than years after the date of the enactment of this act the secretary of health and human services shall develop a cost report form for use under section of the social security act as added by paragraph audit requirement the secretary shall provide for periodic auditing of cost reports submitted under section of the social security act as added by paragraph effective date the amendment made by paragraph shall apply to agreements applicable to cost reporting periods beginning months after the date the secretary develops the cost report form under paragraph additional data on quality with bills hr ih in general section of such act usc is amended a in subparagraph by inserting subject to subparagraph after otherwise provide and by adding at the end the following new subparagraph under subparagraph the secretary shall require the reporting of such additional data relating to quality of services furnished in an ambulatory surgical facility including data on health care associated infections as the secretary specify effective date the amendment made by paragraph shall to reporting for years beginning with sec treatment of certain cancer hospitals section of the social security act usc is amended by adding at the end the following new paragraph authorization of adjustment for cancer hospitals a study the secretary shall conduct a study to determine if under the system under this subsection costs incurred by hospitals described in section with respect with bills hr ih to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection as determined appropriate by the secretary authorization of adjustment insofar as the secretary determines under subparagraph a that costs incurred by hospitals described in section exceed those costs incurred by other hospitals furnishing services under this subsection the secretary shall provide for an appropriate adjustment under paragraph to reflect those higher costs effective for services furnished on or after january sec payment for imaging services a adjustment in practice expense to reflect a presumed level of utilization section of the social security act usc w– is amended in subsection a in subparagraph by striking subparagraph a and inserting this paragraph and by adding at the end the following new subparagraph with bills hr ih adjustment in practice expense to reflect a presumed level of utilization consistent with the methodology for computing the number of practice expense relative value units under subsection c with respect to advanced diagnostic imaging services as defined in section furnished on or after january the secretary shall adjust such number of units so it reflects a presumed rate of utilization of imaging equipment of percent and in subsection by adding at the end the following new subclause iii change in presumed utilization level of certain advanced diagnostic imaging services effective for fee schedules established beginning with reduced expenditures attributable to the presumed utilization of percent under subsection instead of a presumed utilization of imaging equipment of percent adjustment in technical component discount on single session imaging to consecutive with bills hr ih body parts section of such act usc w– is further amended in subsection by adding at the end the following new subparagraph adjustment in technical component discount on single session imaging involving consecutive body parts for services furnished on or after january the secretary shall increase the reduction in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging under the final rule published by the secretary in the federal register on november part of title code of federal regulations from percent to percent and in subsection by adding at the end the following new subclause iii additional reduced payment for multiple imaging procedures effective for fee schedules established beginning with reduced expenditures attributable to the increase in the multiple procedure payment reduction from with bills hr ih percent to percent as described in subsection sec durable medical equipment program improvements a waiver of surety bond requirement section a of the social security act usc a is amended by adding at the end the following sentence the requirement for a surety bond described in subparagraph shall not apply in the case of a pharmacy or supplier that exclusively furnishes eyeglasses or contact lenses described in section if the pharmacy or supply has been enrolled under section as a supplier of durable medical equipment prosthetics orthotics and supplies and has been issued which include renewal of a supplier number as described in the first sentence of this paragraph for at least years and if a final adverse action as defined in section a of title code of federal regulations has never been imposed for such pharmacy or supplier ensuring supply of oxygen equipment in general section a of the social security act usc a is amended with bills hr ih a in clause by striking after the and inserting except as provided in clause iii after the and by adding at the end the following new clause iii continuation of supply in the case of a supplier furnishing such equipment to an individual under this subsection as of the th month of the months described in clause the supplier furnishing such equipment as of such month shall continue to furnish such equipment to such individual either directly or though arrangements with other suppliers of such equipment during any subsequent period of medical need for the remainder of the reasonable useful lifetime of the equipment as determined by the secretary regardless of the location of the individual unless another supplier has accepted responsibility for continuing to furnish such equipment during the remainder of such period effective date the amendments made by paragraph shall take effect as of the date of with bills hr ih the enactment of this act and shall apply to the furnishing of equipment to individuals for whom the th month of a continuous period of use of oxygen equipment described in section a of the social security act occurs on or after july treatment of current accreditation applications section a of such act usc a is amended in clause a by striking clause and inserting clauses and iii and by striking and at the end by striking the period at the end of clause ii and by inserting a semicolon by inserting after clause the following new clauses iii the requirement for accreditation described in clause shall not apply for purposes of supplying diabetic testing supplies canes and crutches in the case of a pharmacy that is enrolled under section as a supplier of durable medical equipment prosthetics orthotics and supplies and with bills hr ih iv a supplier that has submitted an application for accreditation before august shall retain the supplier provider or supplier number until an independent accreditation organization determines if such supplier complies with requirements under this paragraph and by adding at the end the following new sentence nothing in clauses iii and iv shall be construed as affecting the application of an accreditation requirement for suppliers to qualify for bidding in a competitive acquisition area under section restoring month oxygen rental period in case of supplier bankruptcy for certain individuals section a of such act usc a as amended by subsection is further amended by adding at the end the following new clause iv exception for bankruptcy if a supplier who furnishes oxygen and oxygen equipment to an individual is declared bankrupt and its assets are liquidated and at the time of such declaration and liquidation more than months of rental payments have been made such in with bills hr ih dividual begin a new month rental period under this subparagraph with another supplier of oxygen sec medpac study and report on bone mass measurement a in general the medicare payment advisory commission shall conduct a study regarding bone mass measurement including computed tomography duel energy ray absorptriometry and vertebral fracture assessment the study shall focus on the following an assessment of the adequacy of medicare payment rates for such services taking into account costs of acquiring the necessary equipment professional work time and practice expense costs the impact of medicare payment changes since on beneficiary access to bone mass measurement benefits in general and in rural and minority communities specifically a review of the clinically appropriate and recommended use among medicare beneficiaries and how usage rates among such beneficiaries compares to such recommendations in conjunction with the findings under recommendations if necessary regarding methods with bills hr ih for reaching appropriate use of bone mass measurement studies among medicare beneficiaries report the commission shall submit a report to the congress not later than months after the date of the enactment of this act containing a description of the results of the study conducted under subsection a and the conclusions and recommendations if any regarding each of the issues described in paragraphs and of such subsection sec timely access to post mastectomy items a in general section of the social security act usc is amended by redesignating subparagraph as subparagraph and by inserting after subparagraph the following new subparagraph special payment rule for postmastectomy external breast prosthesis garments payment for post mastectomy external breast prosthesis garments shall be made regardless of whether such items are supplied to the beneficiary prior to or after the mastectomy procedure or other breast cancer surgical procedure the secretary shall develop policies to ensure appropriate beneficiary access and utiliza with bills hr ih tion safeguards for such items supplied to a beneficiary prior to the mastectomy or other breast cancer surgical procedure effective date this amendment shall apply not later than january sec a payment for biosimilar biological products a in general section a of the social security act usc w–a is amended in subsection a in subparagraph a by striking or at the end in subparagraph by striking the period at the end and inserting or and by adding at the end the following new subparagraph in the case of one or more interchangeable biological products as defined in subsection and their reference biological product as defined in subsection which shall be included in the same billing and payment code the sum of the average sales price as determined using the methodology described in paragraph applied to such interchange with bills hr ih able and reference products for all national drug codes assigned to such products in the same manner as such paragraph is applied to multiple source drugs and percent of the amount determined under clause in the case of a biosimilar biological product as defined in subsection the sum of the average sales price as determined using the methodology described in paragraph applied to such biosimilar biological product for all national drug codes assigned to such product in the same manner as such paragraph is applied to a single source drug and percent of the amount determined under paragraph or the amount determined under subparagraph as the case be for the reference biological product as defined in subsection or in the case of a reference biological product for both an interchangeable biological with bills hr ih product and a biosimilar product the amount determined in subparagraph and in subsection a by amending subparagraph to read as follows a biological including a reference biological product for a biosimilar product but excluding a biosimilar biological product an interchangeable biological product iii a reference biological product for an interchangeable biological product and iv a reference biological product for both an interchangeable biological product and a biosimilar product or and by adding at the end the following new subparagraphs biosimilar biological product the term biosimilar biological product means a biological product licensed as a biosimilar bio with bills hr ih logical product under section of the public health service act interchangeable biological product the term interchangeable biological product means a biological product licensed as an interchangeable biological product under section of the public health service act reference biological product the term reference biological product means the biological product that is referred to in the application for a biosimilar or interchangeable biological product licensed under section of the public health service act effective date the amendments made by subsection a shall apply to payments for biosimilar biological products interchangeable biological products and reference biological products beginning with the first day of the second calendar quarter after the date of the enactment of this act sec study and report on dme competitive bidding process a study the comptroller general of the united states shall conduct a study to evaluate the potential establishment of a program under medicare under title xviii of the social security act to acquire durable med with bills hr ih ical equipment and supplies through a competitive bidding process among manufacturers of such equipment and supplies such study shall address the following identification of types of durable medical equipment and supplies that would be appropriate for bidding under such a program recommendations on how to structure such an acquisition program in order to promote fiscal responsibility while also ensuring beneficiary access to high quality equipment and supplies recommendations on how such a program could be phased in and on what geographic level would bidding be most appropriate in addition to price recommendations on criteria that could be factored into the bidding process recommendations on how suppliers could be compensated for furnishing and servicing equipment and supplies acquired under such a program comparison of such a program to the current competitive bidding program under medicare for durable medical equipment as well as any other similar federal acquisition programs such as the general services administration vehicle purchasing program with bills hr ih any other consideration relevant to the acquisition supply and service of durable medical equipment and supplies that is deemed appropriate by the comptroller general report not later than 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 findings of the study under subsection a subtitle provisions related to medicare parts a and sec reducing potentially preventable hospital readmissions a hospitals in general section of the social security act usc ww as amended by section a is amended by adding at the end the following new subsection adjustment to hospital payments for excess readmissions in general with respect to payment for discharges from an applicable hospital as defined in paragraph occurring during a fiscal year beginning on or after october in order to account for excess readmissions in the hospital the secretary shall reduce the payments that would with bills hr ih otherwise be made to such hospital under subsection or section as the case be for such a discharge by an amount equal to the product of a the base operating drg payment amount as defined in paragraph for the discharge and the adjustment factor described in paragraph a for the hospital for the fiscal year base operating drg payment amount a in general except as provided in subparagraph for purposes of this subsection the term base operating drg payment amount means with respect to a hospital for a fiscal year the payment amount that would otherwise be made under subsection for a discharge if this subsection did not apply reduced by any portion of such amount that is attributable to payments under subparagraphs and of paragraph adjustments for purposes of subparagraph a in the case of a hospital that is paid under section the term base with bills hr ih operating drg payment amount means the payment amount under such section adjustment factor a in general for purposes of paragraph the adjustment factor under this paragraph for an applicable hospital for a fiscal year is equal to the greater of the ratio described in subparagraph for the hospital for the applicable period as defined in paragraph for such fiscal year or the floor adjustment factor specified in subparagraph ratio the ratio described in this subparagraph for a hospital for an applicable period is equal to minus the ratio of the aggregate payments for excess readmissions as defined in paragraph a with respect to an applicable hospital for the applicable period and the aggregate payments for all discharges as defined in paragraph with respect to such applicable hospital for such applicable period with bills hr ih floor adjustment factor for purposes of subparagraph a the floor adjustment factor specified in this subparagraph for fiscal year is fiscal year is iii fiscal year is or iv a subsequent fiscal year is aggregate payments excess readmission ratio defined for purposes of this subsection a aggregate payments for excess readmissions the term aggregate payments for excess readmissions means for a hospital for a fiscal year the sum for applicable conditions as defined in paragraph a of the product for each applicable condition of the base operating drg payment amount for such hospital for such fiscal year for such condition the number of admissions for such condition for such hospital for such fiscal year and iii the excess readmissions ratio as defined in subparagraph for such hos with bills hr ih pital for the applicable period for such fiscal year minus aggregate payments for all discharges the term aggregate payments for all discharges means for a hospital for a fiscal year the sum of the base operating drg payment amounts for all discharges for all conditions from such hospital for such fiscal year excess readmission ratio in general subject to clauses and iii the term excess readmissions ratio means with respect to an applicable condition for a hospital for an applicable period the ratio but not less than of the risk adjusted readmissions based on actual readmissions as determined consistent with a readmission measure methodology that has been endorsed under paragraph a for an applicable hospital for such condition with respect to the applicable period to the risk adjusted expected readmissions as determined con verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sistent with such a methodology for such hospital for such condition with respect to such applicable period exclusion of certain readmissions for purposes of clause with respect to a hospital excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number as determined by the secretary of discharges for such applicable condition for the applicable period and such hospital iii adjustment in order to promote a reduction over time in the overall rate of readmissions for applicable conditions the secretary provide beginning with discharges for fiscal year for the determination of the excess readmissions ratio under subparagraph to be based on a ranking of hospitals by readmission ratios from lower to higher readmission ratios normalized to a benchmark that is lower than the th percentile definitions for purposes of this subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a applicable condition the term applicable condition means subject to subparagraph a condition or procedure selected by the secretary among conditions and procedures for which readmissions as defined in subparagraph that represent conditions or procedures that are high volume or high expenditures under this title or other criteria specified by the secretary and measures of such readmissions have been endorsed by the entity with a contract under section a and such endorsed measures have appropriate exclusions for readmissions that are unrelated to the prior discharge such as a planned readmission or transfer to another applicable hospital expansion of applicable conditions beginning with fiscal year the secretary shall expand the applicable conditions beyond the conditions for which measures have been endorsed as described in subpara verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih graph a as of the date of the enactment of this subsection to the additional conditions that have been so identified by the medicare payment advisory commission in its report to congress in june and to other conditions and procedures which include an all condition measure of readmissions as determined appropriate by the secretary in expanding such applicable conditions the secretary shall seek the endorsement described in subparagraph a but apply such measures without such an endorsement applicable hospital the term applicable hospital means a subsection hospital or a hospital that is paid under section applicable period the term applicable period means with respect to a fiscal year such period as the secretary shall specify for purposes of determining excess readmissions readmission the term readmission means in the case of an individual who is discharged from an applicable hospital the admission of the individual to the same or anotherverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applicable hospital within a time period specified by the secretary from the date of such discharge insofar as the discharge relates to an applicable condition for which there is an endorsed measure described in subparagraph a such time period such as days shall be consistent with the time period specified for such measure limitations on review there shall be no administrative or judicial review under section section or otherwise of a the determination of base operating drg payment amounts the methodology for determining the adjustment factor under paragraph including excess readmissions ratio under paragraph aggregate payments for excess readmissions under paragraph a and aggregate payments for all discharges under paragraph and applicable periods and applicable conditions under paragraph the measures of readmissions as described in paragraph a and the determination of a targeted hospital under paragraph the increase inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih payment under paragraph the aggregate cap under paragraph the hospital specific limit under paragraph and the form of payment made by the secretary under paragraph monitoring inappropriate changes in admissions practices the secretary shall monitor the activities of applicable hospitals to determine if such hospitals have taken steps to avoid patients at risk in order to reduce the likelihood of increasing readmissions for applicable conditions or taken other inappropriate steps involving readmissions or transfers if the secretary determines that such a hospital has taken such a step after notice to the hospital and opportunity for the hospital to undertake action to alleviate such steps the secretary impose an appropriate sanction assistance to certain hospitals a in general for purposes of providing funds to applicable hospitals to take steps described in subparagraph to address factors that impact readmissions of individuals who are discharged from such a hospital for fiscal years beginning on or after october the secretary shall make a pay verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ment adjustment for a hospital described in subparagraph with respect to each such fiscal year by a percent estimated by the secretary to be consistent with subparagraph the secretary shall provide priority to hospitals that serve medicare beneficiaries at highest risk for readmission or for a poor transition from such a hospital to a post hospital site of care targeted hospitals subparagraph a shall apply to an applicable hospital that had or in the case of an hospital otherwise would have had a disproportionate patient percentage as defined in section of at least percent using the latest available data as estimated by the secretary and provides assurances satisfactory to the secretary that the increase in payment under this paragraph shall be used for purposes described in subparagraph caps aggregate cap the aggregate amount of the payment adjustment underverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih this paragraph for a fiscal year shall not exceed percent of the estimated difference in the spending that would occur for such fiscal year with and without application of the adjustment factor described in paragraph and applied pursuant to paragraph hospital specific limit the aggregate amount of the payment adjustment for a hospital under this paragraph shall not exceed the estimated difference in spending that would occur for such fiscal year for such hospital with and without application of the adjustment factor described in paragraph and applied pursuant to paragraph form of payment the secretary make the additional payments under this paragraph on a lump sum basis a periodic basis a claim by claim basis or otherwise use of additional payment in general funding under this paragraph shall be used by targeted hospitals for activities designed to address the patient noncompliance issues that re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sult in higher than normal readmission rates including transitional care services described in clause and any or all of the other activities described in clause iii transitional care services the transitional care services described in this clause are transitional care services furnished by a qualified transitional care provider such as a nurse or other health professional who meets relevant experience and training requirements as specified by the secretary that support a beneficiary under this section beginning on the date of an individual admission to a hospital for inpatient hospital services and ending at the latest on the last day of the day period beginning on the date of the individual discharge from the applicable hospital the secretary shall determine and update services to be included in transitional care services under this clause as appropriate based on evidence of their effectiveness in reducing hospital readmissions and improving health outcomes such services shall include the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conduct of an assessment prior to discharge which assessment include an assessment of the individual physical and mental condition cognitive and functional capacities medication regimen and adherence social and environmental needs and primary caregiver needs and resources development of a evidencebased plan of transitional care for the individual developed after consultation with the individual and the individual primary caregiver and other health team members as appropriate such plan shall include a list of current therapies prescribed treatment goals and include other items or elements as determined by the secretary such as identifying list of potential health risks and future services for both the individual and any primary caregiververdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii other activities the other activities described in this clause are the following providing other care coordination services not described under clause ii hiring translators and interpreters iii increasing services offered by discharge planners iv ensuring that individuals receive a summary of care and medication orders upon discharge developing a quality improvement plan to assess and remedy preventable readmission rates vi assigning appropriate follow up care for discharged individuals vii doing other activities as determined appropriate by the secretary gao report on use of funds not later than years after the date on which funds are first made available under this paragraph the comptroller general of the unitedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih states shall submit to congress a report on the use of such funds such report shall consider information on the effective uses of such funds how the uses of such funds affected hospital readmission rates including at months postdischarge health outcomes and quality reductions in expenditures under this title and the experiences of beneficiaries primary caregivers and providers as well as any appropriate recommendations application to critical access hospitals section of the social security act usc is amended in paragraph a by striking and at the end of subparagraph by striking the period at the end of subparagraph and inserting and by inserting at the end the following new subparagraph the methodology for determining the adjustment factor under paragraph including the determination of aggregate payments for actual and expected readmissions applicable periods applicable conditions and measures of readmissions andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by redesignating such paragraph as paragraph and by inserting after paragraph the following new paragraph the adjustment factor described in section shall apply to payments with respect to a critical access hospital with respect to a cost reporting period beginning in fiscal year and each subsequent fiscal year after application of paragraph of this subsection in a manner similar to the manner in which such section applies with respect to a fiscal year to an applicable hospital as described in section post acute care providers interim policy a in general with respect to a readmission to an applicable hospital or a critical access hospital as described in section of the social security act from a post acute care provider as defined in paragraph and such a readmission is not governed by section of title code of federal regulations if the claim submitted by such a postacute care provider under title xviii of the social security act indicates that the individual was readmitted to a hospital from such a post verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih acute care provider or admitted from home and under the care of a home health agency within days of an initial discharge from an applicable hospital or critical access hospital the payment under such title on such claim shall be the applicable percent specified in subparagraph of the payment that would otherwise be made under the respective payment system under such title for such post acute care provider if this subsection did not apply in applying the previous sentence the secretary shall exclude a period of day from the date the individual is first admitted to or under the care of the post acute care provider applicable percent defined for purposes of subparagraph a the applicable percent is for fiscal or rate year is for fiscal or rate year is and iii for fiscal or rate year is effective date subparagraph shall apply to discharges or services furnishedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as the case be with respect to the applicable post acute care provider on or after the first day of the fiscal year or rate year beginning on or after october with respect to the applicable post acute care provider development and application of performance measures a in general the secretary of health and human services shall develop appropriate measures of readmission rates for post acute care providers the secretary shall seek endorsement of such measures by the entity with a contract under section a of the social security act but adopt and apply such measures under this paragraph without such an endorsement the secretary shall expand such measures in a manner similar to the manner in which applicable conditions are expanded under paragraph of section of the social security act as added by subsection a implementation the secretary shall apply on or after october with respect to post acute care providers policies similar to the policies applied with respect toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applicable hospitals and critical access hospitals under the amendments made by subsection a the provisions of paragraph shall apply with respect to any period on or after october and before such application date described in the previous sentence in the same manner as such provisions apply with respect to fiscal or rate year monitoring and penalties the provisions of paragraph of such section shall apply to providers under this paragraph in the same manner as they apply to hospitals under such section definitions for purposes of this subsection a post acute care provider the term post acute care provider means a skilled nursing facility as defined in section a of the social security act an inpatient rehabilitation facility described in section a of such act iii a home health agency as defined in section of such act andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv a long term care hospital as defined in section ccc of such act other terms the terms applicable condition applicable hospital and readmission have the meanings given such terms in section of the social security act as added by subsection a physicians study the secretary of health and human services shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians considerations in conducting the study the secretary shall consider approaches such as a creating a new code or codes and payment amount or amounts under the fee schedule in section of the social security act in a budget neutral manner for services furnished by an appropriate physician who sees an individual within the first week after discharge from a hospital or critical access hospital developing measures of rates of readmission for individuals treated by physicians verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applying a payment reduction for physicians who treat the patient during the initial admission that results in a readmission and methods for attributing payments or payment reductions to the appropriate physician or physicians report the secretary shall issue a public report on such study not later than the date that is one year after the date of the enactment of this act funding for purposes of carrying out the provisions of this section in addition to funds otherwise available out of any funds in the treasury not otherwise appropriated there are appropriated to the secretary of health and human services for the center for medicare medicaid services program management account for each fiscal year beginning with amounts appropriated under this subsection for a fiscal year shall be available until expended sec post acute care services payment reform plan and bundling pilot program a plan in general the secretary of health and human services in this section referred to as the secretary shall develop a detailed plan to reformverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih payment for post acute care pac services under the medicare program under title xviii of the social security act in this section referred to as the medicare program the goals of such payment reform are to a improve the coordination quality and efficiency of such services and improve outcomes for individuals such as reducing the need for readmission to hospitals from providers of such services bundling post acute services the plan described in paragraph shall include detailed specifications for a bundled payment for post acute services in this section referred to as the post acute care bundle and include other approaches determined appropriate by the secretary post acute services for purposes of this section the term post acute services means services for which payment be made under the medicare program that are furnished by skilled nursing facilities inpatient rehabilitation facilities long term care hospitals hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual fromverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a hospital and such other services determined appropriate by the secretary details the plan described in subsection a shall include consideration of the following issues the nature of payments under a post acute care bundle including the type of provider or entity to whom payment should be made the scope of activities and services included in the bundle whether payment for physicians services should be included in the bundle and the period covered by the bundle whether the payment should be consolidated with the payment under the inpatient prospective system under section of the social security act in this section referred to as ms–drgs or a separate payment should be established for such bundle and if a separate payment is established whether it should be made only upon use of post acute care services or for every discharge whether the bundle should be applied across all categories of providers of inpatient services including critical access hospitals and post acute care services or whether it should be limited to certain categories of providers services or discharges such as high volume or high cost ms– drgsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the extent to which payment rates could be established to achieve offsets for efficiencies that could be expected to be achieved with a bundle payment whether such rates should be established on a national basis or for different geographic areas should vary according to discharge case mix outliers and geographic differences in wages or other appropriate adjustments and how to update such rates the nature of protections needed for individuals under a system of bundled payments to ensure that individuals receive quality care are furnished the level and amount of services needed as determined by an appropriate assessment instrument are offered choice of provider and the extent to which transitional care services would improve quality of care for individuals and the functioning of a bundled post acute system the nature of relationships that be required between hospitals and providers of post acute care services to facilitate bundled payments including the application of gainsharing anti referral anti kickback and anti trust laws quality measures that would be appropriate for reporting by hospitals and post acute providersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such as measures that assess changes in functional status and quality measures appropriate for each type of post acute services provider including how the reporting of such quality measures could be coordinated with other reporting of such quality measures by such providers otherwise required how cost sharing for a post acute care bundle should be treated relative to current rules for cost sharing for inpatient hospital home health skilled nursing facility and other services how other programmatic issues should be treated in a post acute care bundle including rules specific to various types of post acute providers such as the post acute transfer policy three day hospital stay to qualify for services furnished by skilled nursing facilities and the coordination of payments and care under the medicare program and the medicaid program such other issues as the secretary deems appropriate consultations and analysis consultation with stakeholders in developing the plan under subsection a the secretary shall consult with relevant stakeholders and shall consider experience with such research studiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and demonstrations that the secretary determines appropriate analysis and data collection in developing such plan the secretary shall a analyze the issues described in subsection and other issues that the secretary determines appropriate analyze the impacts including geographic impacts of post acute service reform approaches including bundling of such services on individuals hospitals post acute care providers and physicians use existing data such as data submitted on claims and collect such data as the secretary determines are appropriate to develop such plan required in this section and if patient functional status measures are appropriate for the analysis to the extent practical build upon the care tool being developed pursuant to section of the deficit reduction act of administration funding for purposes of carrying out the provisions of this section in addition to funds otherwise available out of any funds in the treasuryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not otherwise appropriated there are appropriated to the secretary for the center for medicare medicaid services program management account for each of the fiscal years through amounts appropriated under this paragraph for a fiscal year shall be available until expended expedited data collection chapter of title united states code shall not apply to this section public reports interim reports the secretary shall issue interim public reports on a periodic basis on the plan described in subsection a the issues described in subsection and impact analyses as the secretary determines appropriate final report not later than the date that is years after the date of the enactment of this act the secretary shall issue a final public report on such plan including analysis of issues described in subsection and impact analyses conversion of acute care episode demonstration to pilot program and expansion to include post acute services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general part of title xviii of the social security act is amended by inserting after section the following new section conversion of acute care episode demonstration to pilot program and expansion to include post acute services sec a conversion and expansion in general by not later than january the secretary shall for the purpose of promoting the use of bundled payments to promote efficient coordinated and high quality delivery of care a convert the acute care episode demonstration program conducted under section to a pilot program and subject to subsection expand such program as so converted to include post acute services and such other services the secretary determines to be appropriate which include transitional services bundled payment structures a in general in carrying out paragraph the secretary apply bundled payments with respect to hospitals and physicians verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih hospitals and post acute care providers iii hospitals physicians and postacute care providers or iv combinations of post acute providers further application in general in carrying out paragraph the secretary shall apply bundled payments in a manner so as to include collaborative care networks and continuing care hospitals collaborative care network defined for purposes of this subparagraph the term collaborative care network means a consortium of health care providers that provides a comprehensive range of coordinated and integrated health care services to low income patient populations including the uninsured which include coordinated and comprehensive care by safety net providers to reduce any unnecessary use of items and services furnished in emergency departments manage chronic conditions improve quality andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih efficiency of care increase preventive services and promote adherence to post acute and follow up care plans iii continuing care hospital defined for purposes of this subparagraph the term continuing care hospital means an entity that has demonstrated the ability to meet patient care and patient safety standards and that provides under common management the medical and rehabilitation services provided in inpatient rehabilitation hospitals and units as defined in section longterm care hospitals as defined in section iv and skilled nursing facilities as defined in section a that are located in a hospital described in section scope the secretary shall set specific goals for the number of acute and post acute bundling test sites under the pilot program to ensure that over time the pilot program is of sufficient size and scope to test the approaches under the pilot program in a variety of settings including urban rural and underserved areas verdate nov oct jkt po frm fmt sfmt bills hih ih include geographic areas and additional conditions that account for significant program spending as defined by the secretary and subject to subsection disseminate the pilot program rapidly on a national basis to the extent that the secretary finds inpatient and post acute care bundling to be successful in improving quality and reducing costs the secretary shall implement such mechanisms and reforms under the pilot program on as large a geographic scale as practical and economical consistent with subsection nothing in this subsection shall be construed as limiting the number of hospital and physician groups or the number of hospital and post acute provider groups that participate in the pilot program limitation the secretary shall only expand the pilot program under subsection a if the secretary finds that the demonstration program under section and pilot program under this section maintain or increase the quality of care received by individuals enrolled under this title and such demonstration program and pilot program reduce program expenditures and based on the certification under subsection that the expansion of such pilot program would result in esti verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mated spending that would be less than what spending would otherwise be in the absence of this section certification for purposes of subsection the chief actuary of the centers for medicare medicaid services shall certify whether expansion of the pilot program under this section would result in estimated spending that would be less than what spending would otherwise be in the absence of this section voluntary participation nothing in this paragraph shall be construed as requiring the participation of an entity in the pilot program under this section evaluation on cost and quality of care the secretary shall conduct an evaluation of the pilot program under subsection a to study the effect of such program on costs and quality of care the findings of such evaluation shall be included in the final report required under section of the affordable health care for america act study of additional bundling and episode based payment for physicians services in general the secretary shall provide for a study of and development of a plan for testing additional ways to increase bundling of payments for physicians in connection with an episode of care such as in connection with outpatient hospital serv verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ices or services rendered in physicians offices other than those provided under the pilot program application the secretary implement such a plan through a demonstration program conforming amendment section of the social security act usc cc– is amended by striking the secretary and inserting subject to section the secretary sec home health payment update for section of the social security act usc fff is amended in subclause iv by striking and by redesignating subclause as subclause vii and by inserting after subclause iv the following new subclauses and subject to clause the home health market basket percentage increase vi subject to clause percent and verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec payment adjustments for home health care a acceleration of adjustment for case mix changes section of the social security act usc fff is amended in clause iv by striking insofar as and inserting subject to clause vi insofar as and by adding at the end the following new clause vi special rule for case mix changes for in general with respect to the case mix adjustments established in section a of title code of federal regulations the secretary shall apply in the adjustment established in paragraph of such section for in addition to applying the adjustment established in paragraph for construction nothing in this clause shall be construed as limiting the amount of adjustment for case mix for or if more recent data indicate an appropriate adjustment that is greater than theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amount established in the section described in subclause rebasing home health prospective payment amount section a of the social security act usc fff a is amended in clause a in subclause iii by inserting and before after after the period described in subclause and by inserting after subclause iii the following new subclauses iv subject to clause iii for such amount or amounts shall be adjusted by a uniform percentage determined to be appropriate by the secretary based on analysis of factors such as changes in the average number and types of visits in an episode the change in intensity of visits in an episode growth in cost per episode and other factors that the secretary considers to be relevant subject to clause iii for a year after such a amount or amounts shall be equal to theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amount or amounts determined under this clause for the previous year updated under subparagraph and by adding at the end the following new clause iii special rule in case of inability to effect timely rebasing application of proxy amount for if the secretary is not able to compute the amount or amounts under clause iv so as to permit on a timely basis the application of such clause for the secretary shall substitute for such amount or amounts percent of the amount or amounts that would otherwise be specified under clause iii if it applied for adjustment for subsequent years based on data if the secretary applies subclause the secretary before july shall compare the amount or amounts applied under such sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih clause with the amount or amounts that should have been applied under clause iv the secretary shall decrease or increase the prospective payment amount or amounts under clause for or at the secretary discretion over a period of several years beginning with by the amount if any by which the amount or amounts applied under subclause is greater or less respectively than the amount or amounts that should have been applied under clause iv sec incorporating productivity improvements into market basket update for home health services a in general section of the social security act usc fff is amended in clause iii by inserting including being subject to the productivity adjustment described in section iii after in the same manner andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in clause by inserting but not below after reduced effective date the amendments made by subsection a shall apply to home health market basket percentage increases for years beginning with sec a medpac study on variation in home health margins a in general the medicare payment advisory commission shall conduct a study regarding variation in performance of home health agencies in an effort to explain variation in medicare margins for such agencies such study shall include an examination of at least the following issues the demographic characteristics of individuals served and the geographic distribution associated with transportation costs the characteristics of such agencies such as whether such agencies operate hours each day provide charity care or are part of an integrated health system the socio economic status of individuals served such as the proportion of such individuals who are dually eligible for medicare and medicaid benefitsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the presence of severe and or chronic disease or disability in individuals served as evidenced by multiple discontinuous home health episodes with a high number of visits per episode the differences in services provided such as therapy and non therapy services report not later than june the commission shall submit a report to the congress on the results of the study conducted under subsection a and shall include in the report the commission conclusions and recommendations if appropriate regarding each of the issues described in paragraphs and of such subsection sec 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 a in general notwithstanding section a of title of the code of federal regulations or any other provision of law a home health agency determine the most appropriate skilled therapist to make the initial assessment visit for an individual who is referred and be eligible for home health services under title xviii of the social security act but who doesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not require skilled nursing care as long as the skilled service for which that therapist is qualified to provide the service is included as part of the plan of care for home health services for such individual rule of construction nothing in subsection a shall be construed to provide for initial eligibility for coverage of home health services under title xviii of the social security act on the basis of a need for occupational therapy sec limitation on medicare exceptions to the prohibition on certain physician referrals made to hospitals a in general section of the social security act usc nn is amended in subsection a in subparagraph a by striking and at the end in subparagraph by striking the period at the end and inserting and and by adding at the end the following new subparagraph in the case where the entity is a hospital the hospital meets the requirements of paragraph in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in subparagraph by striking and at the end in subparagraph by striking the period at the end and inserting and and by adding at the end the following new subparagraph the hospital meets the requirements described in subsection by amending subsection to read as follows reporting and disclosure requirements in general each entity providing covered items or services for which payment be made under this title shall provide the secretary with the information concerning the entity ownership investment and compensation arrangements including a the covered items and services provided by the entity and the names and unique physician identification numbers of all physicians with an ownership or investment interest as described in subsection a a or with a compensation arrangement as described in subsectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in the entity or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity such information shall be provided in such form manner and at such times as the secretary shall specify the requirement of this subsection shall not apply to designated health services provided outside the united states or to entities which the secretary determines provide services for which payment be made under this title very infrequently requirements for hospitals with physician ownership or investment in the case of a hospital that meets the requirements described in subsection the hospital shall a submit to the secretary an initial report and periodic updates at a frequency determined by the secretary containing a detailed description of the identity of each physician owner and physician investor and any other owners or investors of the hospital require that any referring physician owner or investor discloses to the individual being referred by a time that permits the individual to make a meaningful decision regardingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the receipt of services as determined by the secretary the ownership or investment interest as applicable of such referring physician in the hospital and disclose the fact that the hospital is partially or wholly owned by one or more physicians or has one or more physician investors on any public website for the hospital and in any public advertising for the hospital the information to be reported or disclosed under this paragraph shall be provided in such form manner and at such times as the secretary shall specify the requirements of this paragraph shall not apply to designated health services furnished outside the united states or to entities which the secretary determines provide services for which payment be made under this title very infrequently publication of information the secretary shall publish and periodically update the information submitted by hospitals under paragraph a on the public internet website of the centers for medicare medicaid services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by amending subsection to read as follows failure to report or disclose information a reporting any person who is required but fails to meet a reporting requirement of paragraphs and a of subsection is subject to a civil money penalty of not more than for each day for which reporting is required to have been made disclosure any physician who is required but fails to meet a disclosure requirement of subsection or a hospital that is required but fails to meet a disclosure requirement of subsection is subject to a civil money penalty of not more than for each case in which disclosure is required to have been made application the provisions of section a other than the first sentence of subsection a and other than subsection shall apply to a civil money penalty under subparagraphs a and in the same manner as such provisions apply to a penalty or proceeding under section a a andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end the following new subsection requirements to qualify for rural provider and hospital ownership exceptions to self referral prohibition requirements described for purposes of subsection d the requirements described in this paragraph are as follows a provider agreement the hospital had physician ownership or investment on january and a provider agreement under section in effect on such date prohibition on physician ownership or investment the percentage of the total value of the ownership or investment interests held in the hospital or in an entity whose assets include the hospital by physician owners or investors in the aggregate does not exceed such percentage as of the date of enactment of this subsection prohibition on expansion of facility capacity except as provided in paragraph the number of operating rooms pro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cedure rooms or beds of the hospital at any time on or after the date of the enactment of this subsection are no greater than the number of operating rooms procedure rooms or beds respectively as of such date ensuring bona fide ownership and investment any ownership or investment interests that the hospital offers to a physician are not offered on more favorable terms than the terms offered to a person who is not in a position to refer patients or otherwise generate business for the hospital the hospital or any investors in the hospital does not directly or indirectly provide loans or financing for any physician owner or investor in the hospital iii the hospital or any investors in the hospital does not directly or indirectly guarantee a loan make a payment toward a loan or otherwise subsidize a loan for any physician owner or investor or group of physician owners or investors that is re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih lated to acquiring any ownership or investment interest in the hospital iv ownership or investment returns are distributed to each owner or investor in the hospital in an amount that is directly proportional to the ownership or investment interest of such owner or investor in the hospital the investment interest of the owner or investor is directly proportional to the owner or investor capital contributions made at the time the ownership or investment interest is obtained vi physician owners and investors do not receive directly or indirectly any guaranteed receipt of or right to purchase other business interests related to the hospital including the purchase or lease of any property under the control of other owners or investors in the hospital or located near the premises of the hospital vii the hospital does not offer a physician owner or investor the opportunity to purchase or lease any property under the control of the hospital or anyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih other owner or investor in the hospital on more favorable terms than the terms offered to a person that is not a physician owner or investor viii the hospital does not condition any physician ownership or investment interests either directly or indirectly on the physician owner or investor making or influencing referrals to the hospital or otherwise generating business for the hospital patient safety in the case of a hospital that does not offer emergency services the hospital has the capacity to provide assessment and initial treatment for medical emergencies and if the hospital lacks additional capabilities required to treat the emergency involved refer and transfer the patient with the medical emergency to a hospital with the required capability limitation on application to certain converted facilities the hospital was not converted from an ambulatory surgical center to a hospital on or after the date of enactment of this subsectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih exception to prohibition on expansion of facility capacity a process establishment the secretary shall establish and implement a process under which a hospital apply for an exception from the requirement under paragraph opportunity for community input the process under clause shall provide persons and entities in the community in which the hospital applying for an exception is located with the opportunity to provide input with respect to the application iii timing for implementation the secretary shall implement the process under clause on the date that is one month after the promulgation of regulations described in clause iv iv regulations not later than the first day of the month beginning months after the date of the enactment of this subsection the secretary shall promulgate regulations to carry out the processverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under clause the secretary issue such regulations as interim final regulations frequency the process described in subparagraph a shall permit a hospital to apply for an exception up to once every years permitted increase in general subject to clause and subparagraph a hospital granted an exception under the process described in subparagraph a increase the number of operating rooms procedure rooms or beds of the hospital above the baseline number of operating rooms procedure rooms or beds respectively of the hospital or if the hospital has been granted a previous exception under this paragraph above the number of operating rooms procedure rooms or beds respectively of the hospital after the application of the most recent increase under such an exception percent increase limitation the secretary shall not permit an increase in the number of operating rooms verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih procedure rooms or beds of a hospital under clause to the extent such increase would result in the number of operating rooms procedure rooms or beds of the hospital exceeding percent of the baseline number of operating rooms procedure rooms or beds of the hospital iii baseline number of operating rooms procedure rooms or beds in this paragraph the term baseline number of operating rooms procedure rooms or beds means the number of operating rooms procedure rooms or beds of a hospital as of the date of enactment of this subsection increase limited to facilities on the main campus of the hospital any increase in the number of operating rooms procedure rooms or beds of a hospital pursuant to this paragraph only occur in facilities on the main campus of the hospital conditions for approval of an increase in facility capacity the secretary grant an exception under the proc verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ess described in subparagraph a only to a hospital that is located in a county in which the percentage increase in the population during the most recent year period for which data are available is estimated to be at least percent of the percentage increase in the population growth of the state in which the hospital is located during that period as estimated by bureau of the census and available to the secretary whose annual percent of total inpatient admissions that represent inpatient admissions under the program under title xix is estimated to be equal to or greater than the average percent with respect to such admissions for all hospitals located in the county in which the hospital is located iii that does not discriminate against beneficiaries of federal health care programs and does not permit physicians practicing at the hospital to discriminate against such beneficiaries iv that is located in a state in which the average bed capacity in theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih state is estimated to be less than the national average bed capacity that has an average bed occupancy rate that is estimated to be greater than the average bed occupancy rate in the state in which the hospital is located and vi that meets other conditions as determined by the secretary procedure rooms in this subsection the term procedure rooms includes rooms in which catheterizations angiographies angiograms and endoscopies are furnished but such term shall not include emergency rooms or departments except for rooms in which catheterizations angiographies angiograms and endoscopies are furnished publication of final decisions not later than days after receiving a complete application under this paragraph the secretary shall publish on the public internet website of the centers for medicare medicaid services the final decision with respect to such application limitation on review there shall be no administrative or judicial reviewverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under section section or otherwise of the exception process under this paragraph including the establishment of such process and any determination made under such process physician owner or investor defined for purposes of this subsection and subsection the term physician owner or investor means a physician or an immediate family member of such physician with a direct or an indirect ownership or investment interest in the hospital patient safety requirement in the case of a hospital to which the requirements of paragraph apply insofar as the hospital admits a patient and does not have any physician available on the premises hours per day days per week before admitting the patient a the hospital shall disclose such fact to the patient and following such disclosure the hospital shall receive from the patient a signed acknowledgment that the patient understands such fact clarification nothing in this subsection shall be construed as preventing the secretary from terminating a hospital provider agree verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ment if the hospital is not in compliance with regulations pursuant to section verifying compliance the secretary of health and human services shall establish policies and procedures to verify compliance with the requirements described in subsections and of section of the social security act as added by subsection a the secretary use unannounced site reviews of hospitals and audits to verify compliance with such requirements implementation funding for purposes of carrying out the amendments made by subsection a and the provisions of 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 for the centers for medicare medicaid services program management account for each fiscal year beginning with fiscal year amounts appropriated under this paragraph for a fiscal year shall be available until expended administration chapter of title united states code shall not apply to the amend verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ments made by subsection a and the provisions of subsection sec institute of medicine study of geographic adjustment factors under medicare a in general the secretary of health and human services shall enter into a contract with the institute of medicine of the national academy of science to conduct a comprehensive empirical study and provide recommendations as appropriate on the accuracy of the geographic adjustment factors established under sections and of the social security act usc w– ww matters included such study shall include an evaluation and assessment of the following with respect to such adjustment factors empirical validity of the adjustment factors methodology used to determine the adjustment factors measures used for the adjustment factors taking into account a timeliness of data and frequency of revisions to such data sources of data and the degree to which such data are representative of costs andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih operational costs of providers who participate in medicare evaluation such study shall within the context of the united states health care marketplace evaluate and consider the following the effect of the adjustment factors on the level and distribution of the health care workforce and resources including a recruitment and retention that takes into account workforce mobility between urban and rural areas ability of hospitals and other facilities to maintain an adequate and skilled workforce and patient access to providers and needed medical technologies the effect of the adjustment factors on population health and quality of care the effect of the adjustment factors on the ability of providers to furnish efficient high value care report the contract under subsection a shall provide for the institute of medicine to submit not later than year after the date of the enactment of this act to the secretary and the congress a report containingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih results and recommendations of the study conducted under this section funding there are authorized to be appropriated to carry out this section such sums as be necessary sec revision of medicare payment systems to address geographic inequities a revision of medicare payment systems taking into account the recommendations described in the report under section and notwithstanding the geographic adjustments that would otherwise apply under section and section of the social security act usc w– ww the secretary of health and human services shall include in proposed rules applicable to the rulemaking cycle for payment systems for physicians services and inpatient hospital services under sections and section of such act respectively proposals as the secretary determines to be appropriate to revise the geographic adjustment factors used in such systems such proposals rules shall be contained in the next rulemaking cycle following the submission to the secretary of the report described in section payment adjustments verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih funding for improvements for years before the secretary shall ensure that the additional expenditures resulting from the implementation of the provisions of this section as estimated by the secretary do not exceed and do not exceed half of such amount in any payment year hold harmless in carrying out this subsection a for payment years before the secretary shall not reduce the geographic adjustment below the factor that applied for such payment system in the payment year before such changes and for payment years beginning with the secretary shall implement the geographic adjustment in a manner that does not result in any net change in aggregate expenditures under title xviii of the social security act from the amount of such expenditures that the secretary estimates would have occurred if no geographic adjustment had occurred under this section medicare improvement fund amounts in the medicare improvement fund under section of the social security act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as amended by paragraph shall be available to the secretary to make changes to the geographic adjustments factors as described in subsections a and with respect to services furnished before january no more than one half of such amounts shall be available with respect to services furnished in any one payment year section of the social security act usc iii is amended a by amending paragraph a to read as follows a the period beginning with fiscal year and ending with fiscal year and and by adding at the end the following new paragraph adjustment for underfunding for fiscal year or a subsequent fiscal year specified by the secretary the amount available to the fund under subsection a shall be increased by the secretary estimate of the amount based on data on actual expenditures by which a the additional expenditures resulting from the implementation of subsection a of section of the affordable health care forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih america act for the period before fiscal year is less than the maximum amount of funds available under subsection a of such section for funding for such expenditures sec institute of medicine study of geographic variation in health care spending and promoting high value health care a in general the secretary of health and human services in this section and the succeeding section referred to as the secretary shall enter into an agreement with the institute of medicine of the national academies referred to in this section as the institute to conduct a study on geographic variation and growth in volume and intensity of services in per capita health care spending among the medicare medicaid privately insured and uninsured populations such study draw on recent relevant reports of the institute and shall include each of the following an evaluation of the extent and range of such variation using various units of geographic measurement including micro areas within larger areasverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an evaluation of the extent to which geographic variation can be attributed to differences in input prices health status practice patterns access to medical services supply of medical services socioeconomic factors including race ethnicity gender age income and educational status and provider and payer organizational models an evaluation of the extent to which variations in spending are correlated with patient access to care insurance status distribution of health care resources health care outcomes and consensusbased measures of health care quality an evaluation of the extent to which variation can be attributed to physician and practitioner discretion in making treatment decisions and the degree to which discretionary treatment decisions are made that could be characterized as different from the best available medical evidence an evaluation of the extent to which variation can be attributed to patient preferences and patient compliance with treatment protocols an assessment of the degree to which variation cannot be explained by empirical evidence for medicare beneficiaries an evaluation of the extent to which variations in spending are cor verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih related with insurance status prior to enrollment in the medicare program under title xviii of the social security act and institutionalization status whether beneficiaries are dually eligible for the medicare program and medicaid under title xix of such act and whether beneficiaries are enrolled in fee for service medicare or medicare advantage an evaluation of such other factors as the institute deems appropriate the institute shall conduct public hearings and provide an opportunity for comments prior to completion of the reports under subsection recommendations taking into account the findings under subsection a and the changes to the payment systems made by this act the institute shall recommend changes to payment for items and services under parts a and of title xviii of the social security act for addressing variation in medicare per capita spending for items and services not including add ons for graduate medical education disproportionate share payments and health information technology as specified in sections and respectively of such act by promoting highvalue care as defined in subsection with particular attention to high volume high cost conditions in makingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such recommendations the institute shall consider each of the following measurement and reporting on quality and population health reducing fragmented and duplicative care promoting the practice of evidence based medicine empowering patients to make value based care decisions leveraging the use of health information technology the role of financial and other incentives affecting provision of care variation in input costs the characteristics of the patient population including socio economic factors including race ethnicity gender age income and educational status and whether the beneficiaries are dually eligible for the medicare program under title xviii of the social security act and medicaid under title xix of such act other topics the institute deems appropriate in making such recommendations the institute shall consider an appropriate phase in that takes into account theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih impact of payment changes on providers and facilities and preserves access to care for medicare beneficiaries specific considerations in making the recommendations under subsection the institute shall specifically address whether payment systems under title xviii of the social security act for physicians and hospitals should be further modified to incentivize high value care in so doing the institute shall consider the adoption of a value index based on a composite of appropriate measures of quality and cost that would adjust provider payments on a regional or provider level basis if the institute finds that application of such a value index would significantly incentivize providers to furnish high value care it shall make specific recommendations on how such an index would be designed and implemented in so doing it should identify specific measures of quality and cost appropriate for use in such an index and include a thorough analysis including on a geographic basis of how payments and spending under such title would be affected by such an index additional considerations the institute shall consider the experience of governmental and community based programs that promote high value care reports verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not later than april the institute shall submit to the secretary and each house of congress a report containing findings and recommendations of the study conducted under this section following submission of the report under paragraph the institute shall use the data collected and analyzed in this section to issue a subsequent report or series of reports on how best to address geographic variation or efforts to promote high value care for items and services reimbursed by private insurance or other programs such reports shall include a comparison to the institute findings and recommendations regarding the medicare program such reports and any recommendations would not be subject to the procedures outlined in section high value care defined for purposes of this section the term high value care means the efficient delivery of high quality evidence based patient centered care appropriations there is appropriated from amounts in the general fund of the treasury not otherwise appropriated to carry out this section such sums are authorized to remain available until expendedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec implementation and congressional review of proposal to revise medicare payments to promote high value health care a preparation and submission of implementation plans final implementation plan not later than days after the date of receipt by the secretary and each house of congress of the report under section the secretary shall submit to each house of congress a final implementation plan describing proposed changes to payment for items and services under parts a and of title xviii of the social security act which include payment for inpatient and outpatient hospital services for services furnished in pps and pps exempt hospitals physicians services dialysis facility services skilled nursing facility services home health services hospice care clinical laboratory services durable medical equipment and other items and services but which shall exclude add on payments for graduate medical education disproportionate share payments and health information technology as specified in sections and respectively of the social security act taking intoverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consideration as appropriate the recommendations of the report submitted under section and the changes to the payment systems made by this act to the extent such implementation plan requires a substantial change to the payment system it shall include a transition phase in that takes into consideration possible disruption to provider participation in the medicare program under title xviii of the social security act and preserves access to care for medicare beneficiaries preliminary implementation plan not later than days after the date the institute of medicine submits to each house of congress the report under section the secretary shall submit to each house of congress a preliminary version of the implementation plan provided for under paragraph a no increase in budget expenditures the secretary shall include with the submission of the final implementation plan under paragraph a certification by the chief actuary of the centers for medicare medicaid services that over the initial year period in which the plan is implemented the aggregate level of net expenditures under the medicare program under title xviii ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the social security act will not exceed the aggregate level of such expenditures that would have occurred if the plan were not implemented waivers required to the extent the final implementation plan under paragraph proposes changes that are not otherwise permitted under title xviii of the social security act the secretary shall specify in the plan the specific waivers required under such title to implement such changes except as provided in subsection the secretary is authorized to waive the requirements so specified in order to implement such changes assessment of impact in addition both the preliminary and final implementation plans under this subsection shall include a detailed assessment of the effects of the proposed payment changes by provider or supplier type and state relative to the payments that would otherwise apply review by medpac and gao not later than days after the date the preliminary implementation plan is received by each house of congress under subsection a the medicare payment advisory committee and the comptroller general of the united states shall each evaluate such plan and submit to each house of congress a report containing its analysis and recommenda verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tions regarding implementation of the plan including an analysis of the effects of the proposed changes in the plan on payments and projected spending implementation in general the secretary shall include in applicable proposed rules for the next rulemaking cycle beginning after the congressional action deadline appropriate proposals to revise payments under title xviii of the social security act in accordance with the final implementation plan submitted under subsection a and the waivers specified in subsection a to the extent required to carry out such plan are effective unless a joint resolution described in subsection a with respect to such plan is enacted by not later than such deadline if such a joint resolution is enacted the secretary is not authorized to implement such plan and the waiver authority provided under subsection a shall no longer be effective congressional action deadline for purposes of this section the term congressional action deadline means with respect to a final implementation plan under subsection a may or if later the date that is days after theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih date of receipt of such plan by each house of congress under subsection a congressional procedures introduction on the day on which the final implementation plan is received by the house of representatives and the senate under subsection a a joint resolution specified in paragraph a shall be introduced in the house of representatives by the majority leader and minority leader of the house of representatives and in the senate by the majority leader and minority leader of the senate if either house is not in session on the day on which such a plan is received the joint resolution with respect to such plan shall be introduced in that house as provided in the preceding sentence on the first day thereafter on which that house is in session consideration in the house of representatives a reporting and discharge any committee of the house of representatives to which a joint resolution introduced under paragraph is referred shall report such joint resolution to the house not later than legislative days after the applicable date of introduction of the joint resolution if a committee failsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to report such joint resolution within that period a motion to discharge the committee from further consideration of the joint resolution shall be in order such a motion shall be in order only at a time designated by the speaker in the legislative schedule within two legislative days after the day on which the proponent announces an intention to offer the motion notice not be given on an anticipatory basis such a motion shall not be in order after the last committee authorized to consider the joint resolution reports it to the house or after the house has disposed of a motion to discharge the joint resolution the previous question shall be considered as ordered on the motion to its adoption without intervening motion except minutes of debate equally divided and controlled by the proponent and an opponent a motion to reconsider the vote by which the motion is disposed of shall not be in order proceeding to consideration after each committee authorized to consider a joint resolution reports such joint resolution to the house of representatives or has been discharged from its consideration a motion to pro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ceed to consider such joint resolution shall be in order such a motion shall be in order only at a time designated by the speaker in the legislative schedule within two legislative days after the day on which the proponent announces an intention to offer the motion notice not be given on an anticipatory basis such a motion shall not be in order after the house of representatives has disposed of a motion to proceed on the joint resolution the previous question shall be considered as ordered on the motion to its adoption without intervening motion a motion to reconsider the vote by which the motion is disposed of shall not be in order consideration the joint resolution shall be considered in the house and shall be considered as read all points of order against a joint resolution and against its consideration are waived the previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent a motion to reconsider the vote on passage of a joint resolution shall not be in orderverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consideration in the senate a reporting and discharge any committee of the senate to which a joint resolution introduced under paragraph is referred shall report such joint resolution to the senate within legislative days if a committee fails to report such joint resolution at the close of the th legislative day after its receipt by the senate such committee shall be automatically discharged from further consideration of such joint resolution and such joint resolution or joint resolutions shall be placed on the calendar a vote on final passage of such joint resolution shall be taken in the senate on or before the close of the second legislative day after such joint resolution is reported by the committee or committees of the senate to which it was referred or after such committee or committees have been discharged from further consideration of such joint resolution proceeding to consideration a motion in the senate to proceed to the consideration of a joint resolution shall be privileged and not debatable an amendment to such a motion shall not be in order nor shall it be inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih order to move to reconsider the vote by which such a motion is agreed to or disagreed to consideration debate in the senate on a joint resolution and all debatable motions and appeals in connection therewith shall be limited to not more than hours the time shall be equally divided between and controlled by the majority leader and the minority leader or their designees debate in the senate on any debatable motion or appeal in connection with a joint resolution shall be limited to not more than hour to be equally divided between and controlled by the mover and the manager of the resolution except that in the event the manager of the joint resolution is in favor of any such motion or appeal the time in opposition thereto shall be controlled by the minority leader or a designee such leaders or either of them from time under their control on the passage of a joint resolution allot additional time to any senatorverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih during the consideration of any debatable motion or appeal iii a motion in the senate to further limit debate is not debatable a motion to recommit a joint resolution is not in order rules relating to senate and house of representatives a coordination with action by other house if before the passage by one house of a joint resolution of that house that house receives from the other house a joint resolution then the following procedures shall apply the joint resolution of the other house shall not be referred to a committee with respect to the joint resolution of the house receiving the resolution the procedure in that house shall be the same as if no such joint resolution had been received from the other house but the vote on passage shall be on the joint resolution of the other house treatment of companion measures if following passage of a joint resolu verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion in the senate the senate then receives the companion measure from the house of representatives the companion measure shall not be debatable rules of house of representatives and senate this paragraph and the preceding paragraphs are enacted by congress as an exercise of the rulemaking power of the senate and house of representatives respectively and as such it is deemed a part of the rules of each house respectively but applicable only with respect to the procedure to be followed in that house in the case of a joint resolution and it supersedes other rules only to the extent that it is inconsistent with such rules and with full recognition of the constitutional right of either house to change the rules so far as relating to the procedure of that house at any time in the same manner and to the same extent as in the case of any other rule of that house definitions in this section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a joint resolution the term joint resolution means only a joint resolution which does not have a preamble the title of which is as follows joint resolution disapproving a medicare final implementation plan of the secretary of health and human services submitted under section a of the affordable health care for america act and iii the sole matter after the resolving clause of which is as follows that the congress disapproves the final implementation plan of the secretary of health and human services transmitted to the congress on the blank space being filled with the appropriate date legislative day the term legislative day means any calendar day excluding any day on which that house was not in session budgetary treatment for the purposes of consideration of a joint resolution the chairmen of the house of representatives and senate committees on the budget shall exclude from the evaluation of the budgetary effects of the meas verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ure any such effects that are directly attributable to disapproving a medicare final implementation plan of the secretary submitted under subsection a subtitle medicare advantage reforms part payment and administration sec phase in of payment based on fee forservice costs quality bonus payments a phase in of payment based on fee forservice costs section of the social security act usc w– is amended in subsection a a by striking beginning with and inserting for and and by inserting after the following or beginning with of the blended benchmark amount determined under subsection and by adding at the end the following new subsection determination of blended benchmark amount verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general for purposes of subsection subject to paragraphs and the term blended benchmark amount means for an area a for the sum of of the applicable amount as defined in subsection for the area and year and of the amount specified in paragraph for the area and year for the sum of of the applicable amount for the area and year and of the amount specified in paragraph for the area and year and for a subsequent year the amount specified in paragraph for the area and year specified amount the amount specified in this paragraph for an area and year is the amount specified in subsection for the area and year adjusted in a manner specified by the secretary to take into account the phase out in the indirect costs of medical education from capitation rates described in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fee for service payment floor in no case shall the blended benchmark amount for an area and year be less than the amount specified in paragraph exception for pace plans this subsection shall not apply to payments to a pace program under section quality bonus payments section of the social security act usc as amended by subsection a is amended in subsection by inserting subject to subsection after for purposes of this part and by adding at the end the following new subsection quality based payment adjustment in general in the case of a qualifying plan in a qualifying county with respect to a year beginning with the blended benchmark amount under subsection shall be increased a for by percent for by percent and for a subsequent year by percent qualifying plan and qualifying county defined for purposes of this subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a qualifying plan the term qualifying plan means for a year and subject to paragraph a plan that in a preceding year specified by the secretary had a quality ranking based on the quality ranking system established by the centers for medicare medicaid services for medicare advantage plans of stars or higher qualifying county the term qualifying county means for a year a county that ranked within the lowest third of counties in the amount specified in subsection for a year specified by the secretary and for which as of june of a year specified by the secretary of the medicare advantage eligible individuals residing in the county at least percent of such individuals were enrolled in medicare advantage plans determinations of quality a quality performance the secretary shall provide for the computation of averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih quality performance score for each medicare advantage plan to be applied for each year computation of score quality performance sore for years before a year specified by the secretary the quality performance score for a medicare advantage plan shall be computed based on a blend as designated by the secretary of the plan performance on hedis effectiveness of care quality measures cahps quality measures and iii such other measures of clinical quality as the secretary specify such measures shall be risk adjusted as the secretary deems appropriate establishment of outcomebased measures by not later than for a year specified by the secretary the secretary shall implement reporting requirements for quality under this section on measures selected under clause iii thatverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih reflect the outcomes of care experienced by individuals enrolled in medicare advantage plans in addition to measures described in clause such measures include measures of rates of admission and readmission to a hospital measures of prevention quality such as those established by the agency for healthcare research and quality that include hospital admission rates for specified conditions iii measures of patient mortality and morbidity following surgery iv measures of health functioning such as limitations on activities of daily living and survival for patients with chronic diseases measures of patient safety and vi other measure of outcomes and patient quality of life as determined by the secretary such measures shall be risk adjusted as the secretary deems appropriate in determining the quality measures to be usedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under this clause the secretary shall take into consideration the recommendations of the medicare payment advisory commission in its report to congress under section of the medicare improvements for patients and providers act of public law – and shall provide preference to measures collected on and comparable to measures used in measuring quality under parts a and iii rules for selection of measures the secretary shall select measures for purposes of clause consistent with the following the secretary shall provide preference to clinical quality measures that have been endorsed by the entity with a contract with the secretary under section a prior to any measure being selected under this clause the secretary shall publish in the federal register such measure and provide for a period of public comment on such measureverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv transitional use of blend for payments for years specified by the secretary the secretary compute the quality performance score for a medicare advantage plan based on a blend of the measures specified in clause and the measures described in clause and selected under clause iii use of quality outcomes measures for payments beginning with a year specified by the secretary beginning after the years specified for section iv the preponderance of measures used under this paragraph shall be quality outcomes measures described in clause and selected under clause iii reporting of data each medicare advantage organization shall provide for the reporting to the secretary of quality performance data described in this paragraph in order to determine a quality performance score under this paragraph in such time and manner as the secretary shall specify notification the secretary in the annual announcement required under subsectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in and each succeeding year shall notify the medicare advantage organization that is offering a qualifying plan in a qualifying county of such identification for the year the secretary shall provide for publication on the website for the medicare program of the information described in the previous sentence authority to disqualify deficient plans the secretary determine that a medicare advantage plan is not a qualifying plan if the secretary has identified deficiencies in the plan compliance with rules for medicare advantage plans under this part sec authority for secretarial coding intensity adjustment authority section a of the social security act usc w– a is amended in the matter before subclause by striking through and inserting and each subsequent year and in subclause a by inserting periodically before conduct an analysis by inserting on a timely basis after are incorporated andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking only for and and inserting for and subsequent years sec simplification of annual beneficiary election periods a week processing period for annual enrollment period aep paragraph of section of the social security act usc w– is amended by striking and at the end of clause iii in clause iv a by striking and succeeding years and inserting and and by striking the period at the end and inserting and and by adding at the end the following new clause with respect to and succeeding years the period beginning on november and ending on december of the year before such year elimination of month additional open enrollment period oep effective for plan years beginning with paragraph of such section is amended by striking subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec extension of reasonable cost contracts section of the social security act usc mm is amended in clause by striking january and inserting january and in clause iii by striking the service area for the year and inserting the portion of the plan service area for the year that is within the service area of a reasonable cost reimbursement contract sec limitation of waiver authority for employer group plans a in general the first sentence of each of paragraphs and of section of the social security act usc w– is amended by inserting before the period at the end the following but only if percent of the medicare advantage eligible individuals enrolled under such plan reside in a county in which the ma organization offers an ma local plan effective date the amendment made by subsection a shall apply for plan years beginning on or after january and shall not apply to plans which were in effect as of december sec improving risk adjustment for payments a report to congress not later than year after the date of the enactment of this act the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of health and human services shall submit to congress a report that evaluates the adequacy of the risk adjustment system under section a of the social security act usc – a in predicting costs for beneficiaries with chronic or co morbid conditions beneficiaries dually eligible for medicare and medicaid and non medicaid eligible low income beneficiaries and the need and feasibility of including further gradations of diseases or conditions and multiple years of beneficiary data improvements to risk adjustment not later than january the secretary shall implement necessary improvements to the risk adjustment system under section a of the social security act usc – a taking into account the evaluation under subsection a sec elimination of ma regional plan stabilization fund a in general section of the social security act usc w–a is amended by striking subsection transition any amount contained in the ma regional plan stabilization fund as of the date of the enactment of this act shall be transferred to the federal supplementary medical insurance trust fundverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec study regarding the effects of calculating medicare advantage payment rates on a regional average of medicare fee for service rates a in general the administrator of the centers for medicare and medicaid services shall conduct a study to determine the potential effects of calculating medicare advantage payment rates on a more aggregated geographic basis such as metropolitan statistical areas or other regional delineations rather than using county boundaries in conducting such study the administrator shall consider the effect of such alternative geographic basis on the following the quality of care received by medicare advantage enrollees the networks of medicare advantage plans including any implications for providers contracting with medicare advantage plans the predictability of benchmark amounts for medicare advantage plans consultations in conducting the study the administrator shall consult with the following experts in health care financing representatives of foundations and other nonprofit entities that have conducted or supported research on medicare financing issuesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih representatives from medicare advantage plans such other entities or people as determined by the secretary report not later than one year after the date of the enactment of this act the administrator shall transmit a report to the congress on the study conducted under this section the report shall contain a detailed statement of findings and conclusions of the study together with its recommendations for such legislation and administrative actions as the administrator considers appropriate part beneficiary protections and antifraud sec limitation on cost sharing for individual health services a in general section a of the social security act usc w– a is amended in subparagraph a by inserting before the period at the end the following with cost sharing that is no greater and be less than the costsharing that would otherwise be imposed under such program option verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in subparagraph by striking or an actuarially equivalent level of cost sharing as determined in this part and by amending clause of subparagraph to read as follows permitting use of flat copayment or per diem rate nothing in clause shall be construed as prohibiting a medicare advantage plan from using a flat copayment or per diem rate in lieu of the cost sharing that would be imposed under part a or so long as the amount of the cost sharing imposed does not exceed the amount of the cost sharing that would be imposed under the respective part if the individual were not enrolled in a plan under this part limitation for dual eligibles and qualified medicare beneficiaries section a of such act is amended to read as follows limitation on cost sharing for dual eligibles and qualified medicare beneficiaries in the case of a individual who is a fullbenefit dual eligible individual as defined in section or a qualified medicare beneficiary asverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih defined in section who is enrolled in a medicare advantage plan the plan not impose cost sharing that exceeds the amount of cost sharing that would be permitted with respect to the individual under this title and title xix if the individual were not enrolled with such plan effective dates the amendments made by subsection a shall apply to plan years beginning on or after january the amendments made by subsection shall apply to plan years beginning on or after january sec continuous open enrollment for enrollees in plans with enrollment suspension section of the social security act usc is amended in subparagraph by striking at the end or in subparagraph a by inserting taking into account the health or well being of the individual before the period andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by redesignating such subparagraph as subparagraph and by inserting after subparagraph the following new subparagraph the individual is enrolled in an ma plan and enrollment in the plan is suspended under paragraph or of section because of a failure of the plan to meet applicable requirements or sec information for beneficiaries on ma plan administrative costs a disclosure of medical loss ratios and other expense data section of the social security act usc w– as previously amended by this subtitle is amended by adding at the end the following new subsection publication of medical loss ratios and other cost related information in general the secretary shall publish not later than november of each year beginning with for each ma plan contract the medical loss ratio of the plan in the previous year submission of data a in general each ma organization shall submit to the secretary in a form andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih manner specified by the secretary data necessary for the secretary to publish the medical loss ratio on a timely basis data for and the data submitted under subparagraph a for and for shall be consistent in content with the data reported as part of the ma plan bid in june for use of standardized elements and definitions the data to be submitted under subparagraph a relating to medical loss ratio for a year beginning with shall be submitted based on the standardized elements and definitions developed under paragraph development of data reporting standards a in general the secretary shall develop and implement standardized data elements and definitions for reporting under this subsection for contract years beginning with of data necessary for the calculation of the medical loss ratio for ma plans not later than december the secretary shall publish a report describing the elements and definitions so developedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consultation the secretary shall consult with the health choices commissioner representatives of ma organizations experts on health plan accounting systems and representatives of the national association of insurance commissioners in the development of such data elements and definitions medical loss ratio to be defined for purposes of this part the term medical loss ratio has the meaning given such term by the secretary taking into account the meaning given such term by the health choices commissioner under section of the affordable health care for america act minimum medical loss ratio section of the social security act usc w– is amended by adding at the end the following new paragraph requirement for minimum medical loss ratio if the secretary determines for a contract year beginning with that an ma plan has failed to have a medical loss ratio as defined in section of at least a the secretary shall require the medicare advantage organization offering the planverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to give enrollees a rebate in the second succeeding contract year of premiums under this part or part or part if applicable by such amount as would provide for a benefits ratio of at least for consecutive contract years the secretary shall not permit the enrollment of new enrollees under the plan for coverage during the second succeeding contract year and the secretary shall terminate the plan contract if the plan fails to have such a medical loss ratio for consecutive contract years sec strengthening audit authority a for part payments risk adjustment section of the social security act usc w– is amended by inserting after section the following and data submitted with respect to risk adjustment under section a enforcement of audits and deficiencies in general section of such act as amended by section is amended by adding at the end the following new paragraph enforcement of audits and deficiencies verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a information in contract the secretary shall require that each contract with an ma organization under this section shall include terms that inform the organization of the provisions in subsection enforcement authority the secretary is authorized in connection with conducting audits and other activities under subsection to take such actions including pursuit of financial recoveries necessary to address deficiencies identified in such audits or other activities application under part for provision applying the amendment made by paragraph to prescription drug plans under part see section d– of the social security act effective date the amendments made by this section shall take effect on the date of the enactment of this act and shall apply to audits and activities conducted for contract years beginning on or after january sec authority to deny plan bids a in general section a of the social security act usc w– a is amended by adding at the end the following new subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih rejection of bids nothing in this section shall be construed as requiring the secretary to accept any or every bid by an ma organization under this subsection application under part section d– of such act usc w– is amended by adding at the end the following new paragraph rejection of bids paragraph of section a shall apply with respect to bids under this section in the same manner as it applies to bids by an ma organization under such section effective date the amendments made by this section shall apply to bids for contract years beginning on or after january sec a state authority to enforce standardized marketing requirements section of the social security act usc w– is amended by striking the standards and inserting a in general the standards with appropriate indentation that is the same as for the subparagraph added by paragraph and by adding at the end the following new subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih enforcement of federal standards permitted in general subject to the subsequent provision of this subparagraph nothing in this title shall be construed to prohibit a state from conducting a market conduct examination or from imposing civil monetary penalties in accordance with laws and procedures of the state against medicare advantage organizations pdp sponsors or agents or brokers of such organizations or sponsors for violations of the marketing requirements under subsections h and of section and section additional remedies resulting from federal state cooperation state recommendation a state recommend to the secretary the imposition of an intermediate sanction not described in clause such as those available under section against a medicare advantage organization verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pdp sponsor or agent or broker of such an organization or sponsor for a violation described in such clause response to recommendation not later than days after receipt of a recommendation under subclause from a state with respect to a violation described in clause the secretary shall respond in writing to the state indicating the progress of any investigation involving such violation whether the secretary intends to pursue the recommendation from the state and in the case the secretary does not intend to pursue such recommendation the reason for such decision iii non duplication of penalties in the case that an action has been initiated against a medicare advantage organization pdp sponsor or agent or broker of such an organization or sponsor for a violation of a marketing requirement under subsection h or of section or section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the case such action has been initiated by the secretary no state bring an action under such applicable subsection or section against such organization sponsor agent or broker with respect to such violation during the pendency period of the action initiated by the secretary and if a penalty is imposed pursuant to such action after such period and in the case such action has been initiated by a state the secretary not bring an action under such applicable subsection or section against such organization sponsor agent or broker with respect to such violation during the pendency period of the action initiated by the secretary and if a penalty is imposed pursuant to such action after such period nothing in this clause shall be construed as limiting the ability of the secretary to impose any sanction other than a civilverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih monetary penalty under section against a medicare advantage organization pdp sponsor or agent or broker of such an organization or sponsor for a violation described in clause iv construction nothing in this subparagraph shall be construed as affecting any state authority to regulate brokers described in this paragraph or any other conduct of a medicare advantage organization or pdp sponsor part treatment of special needs plans sec limitation on enrollment outside open enrollment period of individuals into chronic care specialized ma plans for special needs individuals section of the social security act usc w– is amended by adding at the end the following new subparagraph the plan does not enroll an individual on or after january other than during an annual coordinated open enrollment period or during a special election period consisting of the period for which the indi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vidual has a chronic condition that qualifies the individual as an individual described in subsection iii for such plan and ending on the date on which the individual enrolls in such a plan on the basis of such condition if an individual is enrolled in such a plan on the basis of a chronic condition and becomes eligible for another such plan on the basis of another chronic condition the other plan enroll the individual on the basis of such other chronic condition during a special enrollment period described in clause an individual is eligible to apply such clause only once on the basis of any specific chronic condition sec extension of authority of special needs plans to restrict enrollment service area moratorium for certain snps a in general section of the social security act usc w– is amended by striking january and inserting january or january in the case of a plan described in section of the affordable health care for america act extension of certain plans verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plans described for purposes of section of the social security act usc a plan described in this paragraph is a medicare advantage dual eligible special needs plan that a whose sponsoring medicare advantage organization as of the date enactment of the affordable health care for america act has a contract with a state medicaid agency that participated in the demonstrations serving those dually eligible for medicare and medicaid under the medicare program and that has been approved by the centers for medicare medicaid services as a dual eligible special needs plan and that offers integrated medicare and medicaid services under a contract with the state medicaid agency analysis report a analysis the secretary of health and human services shall provide through a contract with an independent health services evaluation organization for an analysis of the plans described in paragraph with regard to the impact of such plans on cost quality of care patient satisfaction and other subjectsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih specified by the secretary such report also will identify statutory changes needed to simplify access to needed services improve coordination of benefits and services and ensure protection for dual eligibles as appropriate report not later than december the secretary shall submit to the congress a report on the analysis under subparagraph a and shall include in such report such recommendations with regard to the treatment of such plans as the secretary deems appropriate extension of service area moratorium for certain snps section of the medicare improvements for patients and providers act of is amended by striking december and inserting december sec extension of medicare senior housing plans section of the social security act usc is amended by adding at the end the following new subsection special rules for senior housing facility plans verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general notwithstanding any other provision of this part in the case of a medicare advantage senior housing facility plan described in paragraph and for periods before january a the service area of such plan be limited to a senior housing facility in a geographic area the service area of such plan not be expanded and additional senior housing facilities not be serviced by such plan medicare advantage senior housing facility plan described for purposes of this subsection a medicare advantage senior housing facility plan is a medicare advantage plan that a restricts enrollment of individuals under this part to individuals who reside in a continuing care retirement community as defined in section provides primary care services onsite and has a ratio of accessible providers to beneficiaries that the secretary determines is adequate taking into consideration the number of residents onsite the health needs of those resi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dents and the accessibility of providers offsite and iii provides transportation services for beneficiaries to providers outside of the facility and is offered by a medicare advantage organization that has offered at least plan described in subparagraph a for at least year prior to january under a demonstration project established by the secretary subtitle improvements to medicare part sec elimination of coverage gap a immediate reduction in coverage gap in section d– of the social security act usc w– is amended in paragraph a by striking paragraph and inserting paragraphs and and by adding at the end the following new paragraph increase in initial coverage limit in a in general for plan years beginning during the initial coverage limit de verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih scribed in paragraph otherwise applicable shall be increased by application in applying subparagraph a except as otherwise provided in this subparagraph there shall be no change in the premiums bids or any other parameters under this part or part costs that would be treated as incurred costs for purposes of applying paragraph but for the application of subparagraph a shall continue to be treated as incurred costs iii the secretary shall establish procedures which include a reconciliation process to fully reimburse pdp sponsors with respect to prescription drug plans and ma organizations with respect to ma–pd plans for the reduction in beneficiary cost sharing associated with the application of subparagraph a iv the secretary shall develop an estimate of the additional increased costs attributable to the application of this paragraph for increased drug utilization and fi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nancing and administrative costs and shall use such estimate to adjust payments to pdp sponsors with respect to prescription drug plans under this part and ma organizations with respect to ma–pd plans under part and the secretary shall establish procedures for retroactive reimbursement of part eligible individuals who are covered under such a plan for costs which are incurred before the date of initial implementation of subparagraph a and which would be reimbursed under such a plan if such implementation occurred as of january additional closure in gap beginning in section d– of such act usc w– as amended by subsection a is further amended in paragraph a by striking and and inserting and in paragraph by inserting subject to paragraph after purposes of this part andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end the following new paragraph phased in elimination of coverage gap a in general for each year beginning with the secretary shall consistent with this paragraph progressively increase the initial coverage limit described in subsection and decrease the annual out of pocket threshold from the amounts otherwise computed until beginning in there is a continuation of coverage from the initial coverage limit for expenditures incurred through the total amount of expenditures at which benefits are available under paragraph increase in initial coverage limit in general for a year beginning with subject to clause the initial coverage limit otherwise computed without regard to this paragraph shall be increased by the cumulative icl phase in percentage as defined in clause iii for the year times the out of pocket gapverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amount as defined in subparagraph for the year maintenance of initial coverage limit level if for a year the initial coverage limit otherwise computed under this paragraph would be less than the initial coverage limit applied during taking into account paragraph the initial coverage limit for that year shall be such initial coverage limit as so applied during iii cumulative phase in percentage in general for purposes of this paragraph subject to subclause the term cumulative icl phase in percentage means for a year the sum of the annual icl phase in percentage as defined in clause iv for the year and the annual icl phase in percentages for each previous year beginning with limitation if the sum of the cumulative icl phase in percentage and the cumulative optverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih phase in percentage as defined in subparagraph iii for a year would otherwise exceed percent each such percentage shall be reduced in a proportional amount so the sum does not exceed percent iv annual icl phase in percentage for purposes of this paragraph the term annual icl phase in percentage means for percent for and percent iii for and percent iv for percent for percent and vi for percent or such other percent as be necessary to provide for a full continuation of coverage as described in subparagraph a in that year decrease in annual out of pocket threshold verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general for a year beginning with subject to clause the annual out of pocket threshold otherwise computed without regard to this paragraph shall be decreased by the cumulative opt phase in percentage as defined in clause iii for the year of the out of pocket gap amount for the year multiplied by maintenance the secretary shall adjust the annual out of pocket threshold for a year to the extent necessary to ensure that the sum of the initial coverage limit described in subparagraph a and the out of pocket gap amount defined in subparagraph as determined for the year pursuant to the provisions of this paragraph for such year does not exceed such sum that would have applied if this paragraph did not apply iii cumulative opt phase in percentage for purposes of this paragraph subject to subparagraph iii the term cumulative opt phase in percentage means for a year the sum of the annual opt phase in percentage as de verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fined in clause iv for the year and the annual opt phase in percentages for each previous year beginning with iv annual opt phase in percentage for purposes of this paragraph the term annual opt phase in percentage means for percent for and percent iii for and percent iv for percent and for and percent out of pocket gap amount for purposes of this paragraph the term out ofpocket gap amount means for a year the amount by which the annual out of pocket threshold specified in paragraph for the year as determined as if this paragraph did not apply exceeds the sum of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the annual deductible under paragraph for the year and of the amount by which the initial coverage limit under paragraph for the year as determined as if this paragraph did not apply exceeds such annual deductible relation to aahca transitional increase except as otherwise specifically provided this paragraph shall be applied as if no increase had been made in the initial coverage limit under paragraph requiring drug manufacturers to provide drug rebates for rebate eligible individuals in general section d– of the social security act usc w– is amended a in subsection in the matter before subparagraph a by inserting and subsection after this subsection and by adding at the end the following new subsection prescription drug rebate agreement for rebate eligible individuals requirement verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general for plan years beginning on or after january in this part the term covered part drug does not include any drug or biological product that is manufactured by a manufacturer that has not entered into and have in effect a rebate agreement described in paragraph plan year requirement any drug or biological product manufactured by a manufacturer that declines to enter into a rebate agreement described in paragraph for the period beginning on january and ending on december shall not be included as a covered part drug for the subsequent plan year rebate agreement a rebate agreement under this subsection shall require the manufacturer to provide to the secretary a rebate for each rebate period as defined in paragraph ending after december in the amount specified in paragraph for any covered part drug of the manufacturer dispensed after december to any rebate eligible individual as defined in paragraph a for which payment was made by a pdp sponsor under part or a ma or verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ganization under part for such period including payments passed through the low income and reinsurance subsidies under sections d– and d– respectively such rebate shall be paid by the manufacturer to the secretary not later than days after the date of receipt of the information described in section d– including as such section is applied under section or days after the receipt of information under subparagraph of paragraph as determined by the secretary insofar as not inconsistent with this subsection the secretary shall establish terms and conditions of such agreement relating to compliance penalties and program evaluations investigations and audits that are similar to the terms and conditions for rebate agreements under paragraphs and of section rebate for rebate eligible medicare drug plan enrollees a in general the amount of the rebate specified under this paragraph for a manufacturer for a rebate period with respect to each dosage form and strength of any covered part drug provided by such manufacturerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and dispensed to a rebate eligible individual shall be equal to the product of the total number of units of such dosage form and strength of the drug so provided and dispensed for which payment was made by a pdp sponsor under part or a ma organization under part for the rebate period including payments passed through the low income and reinsurance subsidies under sections d– and d– respectively and the amount if any by which the medicaid rebate amount as defined in subparagraph for such form strength and period exceeds the average medicare drug program rebate eligible rebate amount as defined in subparagraph for such form strength and period medicaid rebate amount for purposes of this paragraph the term medicaid rebate amount means with respect to each dosage form and strength of a covered part dverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih drug provided by the manufacturer for a rebate period in the case of a single source drug or an innovator multiple source drug the amount specified in paragraph a of section plus the amount if any specified in paragraph a of such section for such form strength and period or in the case of any other covered outpatient drug the amount specified in paragraph a of such section for such form strength and period average medicare drug program rebate eligible rebate amount for purposes of this subsection the term average medicare drug program rebate eligible rebate amount means with respect to each dosage form and strength of a covered part drug provided by a manufacturer for a rebate period the sum for all pdp sponsors under part and ma organizations administering a ma–pd plan under part of the product for each such sponsor or organization of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the sum of all rebates discounts or other price concessions not taking into account any rebate provided under paragraph for such dosage form and strength of the drug dispensed calculated on a per unit basis but only to the extent that any such rebate discount or other price concession applies equally to drugs dispensed to rebate eligible medicare drug plan enrollees and drugs dispensed to pdp and ma–pd enrollees who are not rebate eligible individuals and the number of the units of such dosage and strength of the drug dispensed during the rebate period to rebate eligible individuals enrolled in the prescription drug plans administered by the pdp sponsor or the ma– pd plans administered by the ma organization divided by the total number of units of such dosage and strength of the drug dispensed during the rebate period to rebate eligibleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih individuals enrolled in all prescription drug plans administered by pdp sponsors and all ma–pd plans administered by ma organizations use of estimates the secretary establish a methodology for estimating the average medicare drug program rebate eligible rebate amounts for each rebate period based on bid and utilization information under this part and use these estimates as the basis for determining the rebates under this section if the secretary elects to estimate the average medicare drug program rebate eligible rebate amounts the secretary shall establish a reconciliation process for adjusting manufacturer rebate payments not later than months after the date that manufacturers receive the information collected under section length of agreement the provisions of paragraph of section other than clauses iv and of subparagraph shall apply to rebate agreements under this subsection in the same manner as such paragraph applies to a rebate agreement under such sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih other terms and conditions the secretary shall establish other terms and conditions of the rebate agreement under this subsection including terms and conditions related to compliance that are consistent with this subsection definitions in this subsection and section d– a rebate eligible individual the term rebate eligible individual means a full benefit dual eligible individual as defined in section and includes for drugs dispensed after december a subsidy eligible individual as defined in section d– a a rebate period the term rebate period has the meaning given such term in section waiver chapter of title united states code shall not apply to the requirements under this subsection for the period beginning on january and ending on december verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih reporting requirement for the determination and payment of rebates by manufactures related to rebate for rebate eligible medicare drug plan enrollees a requirements for pdp sponsors section d– of the social security act usc w– is amended by adding at the end the following new paragraph reporting requirement for the determination and payment of rebates by manufacturers related to rebate for rebate eligible medicare drug plan enrollees a in general for purposes of the rebate under section d– for contract years beginning on or after january each contract entered into with a pdp sponsor under this part with respect to a prescription drug plan shall require that the sponsor comply with subparagraphs and report form and contents not later than a date specified by the secretary a pdp sponsor of a prescription drug plan under this part shall report to each manufacturer verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih information by national drug code number on the total number of units of each dosage form and strength of each drug of such manufacturer dispensed to rebate eligible medicare drug plan enrollees under any prescription drug plan operated by the pdp sponsor during the rebate period information on the price discounts price concessions and rebates for such drugs for such form strength and period iii information on the extent to which such price discounts price concessions and rebates apply equally to rebate eligible medicare drug plan enrollees and pdp enrollees who are not rebate eligible medicare drug plan enrollees and iv any additional information that the secretary determines is necessary to enable the secretary to calculate the average medicare drug program rebate eligible rebate amount as defined in paragraph of such section and to determine the amount of the rebate required underverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih this section for such form strength and period such report shall be in a form consistent with a standard reporting format established by the secretary submission to secretary each pdp sponsor shall promptly transmit a copy of the information reported under subparagraph to the secretary for the purpose of audit oversight and evaluation confidentiality of information the provisions of subparagraph of section relating to confidentiality of information shall apply to information reported by pdp sponsors under this paragraph in the same manner that such provisions apply to information disclosed by manufacturers or wholesalers under such section except that any reference to this section in clause of such subparagraph shall be treated as being a reference to this section the reference to the director of the congressional budget office in clause iii of such subparagraph shall be treated on dsksybprod with bills hr ih as including a reference to the medicare payment advisory commission and iii clause iv of such subparagraph shall not apply oversight information reported under this paragraph be used by the inspector general of the department of health and human services for the statutorily authorized purposes of audit investigation and evaluations penalties for failure to provide timely information and provision of false information in the case of a pdp sponsor that fails to provide information required under subparagraph on a timely basis the sponsor is subject to a civil money penalty in the amount of for each day in which such information has not been provided or that knowingly as defined in section a provides false information under such subparagraph the sponsor is subject to a civil money penalty in anverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amount not to exceed for each item of false information such civil money penalties are in addition to other penalties as be prescribed by law the provisions of section a other than subsections a and shall apply to a civil money penalty under this subparagraph in the same manner as such provisions apply to a penalty or proceeding under section a a application to ma organizations section of the social security act usc w– is amended by adding at the end the following reporting requirement related to rebate for rebate eligible medicare drug plan enrollees section d– deposit of rebates into medicare prescription drug account section d– of such act usc w– is amended by adding at the end the following new paragraph rebate for rebate eligible medicare drug plan enrollees amounts paid under a rebate agreement under section d– shall be deposited into the account and shall be used to payverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for all or part of the gradual elimination of the coverage gap under section d– sec discounts for certain part drugs in original coverage gap section d– of the social security act usc w– as amended by section is amended in subsection by inserting subject to subsection after in subsection in the matter before subparagraph a by striking subsection and inserting subsections and after this subsection and by adding at the end the following new subsection requirement for manufacturer discount agreement for certain qualifying drugs in general in this part the term covered part drug does not include any drug or biological product that is manufactured by a manufacturer that has not entered into and have in effect for all qualifying drugs as defined in paragraph a a discount agreement described in paragraph discount agreement verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a periodic discounts a discount agreement under this paragraph shall require the manufacturer involved to provide to each pdp sponsor with respect to a prescription drug plan or each ma organization with respect to each ma–pd plan a discount in an amount specified in paragraph for qualifying drugs as defined in paragraph a of the manufacturer dispensed to a qualifying enrollee after january insofar as the individual is in the original gap in coverage as defined in paragraph discount agreement insofar as not inconsistent with this subsection the secretary shall establish terms and conditions of such agreement including terms and conditions relating to compliance similar to the terms and conditions for rebate agreements under paragraphs and of section except that discounts shall be applied under this subsection to prescription drug plans and ma–pd plans instead of state plans under title xix verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pdp sponsors and ma organizations shall be responsible instead of states for provision of necessary utilization information to drug manufacturers and iii sponsors and ma organizations shall be responsible for reporting information on drug component negotiated price counting discount toward true out of pocket costs under the discount agreement in applying subsection with regard to subparagraph of such subsection if a qualified enrollee purchases the qualified drug insofar as the enrollee is in an actual gap of coverage as defined in paragraph the amount of the discount under the agreement shall be treated and counted as costs incurred by the plan enrollee discount amount the amount of the discount specified in this paragraph for a discount period for a plan is equal to percent of the amount of the drug component negotiated price as defined in paragraph for qualifying drugs for the period involvedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih additional terms in the case of a discount provided under this subsection with respect to a prescription drug plan offered by a pdp sponsor or an ma–pd plan offered by an ma organization if a qualified enrollee purchases the qualified drug a insofar as the enrollee is in an actual gap of coverage as defined in paragraph the sponsor or plan shall provide the discount to the enrollee at the time the enrollee pays for the drug and insofar as the enrollee is in the portion of the original gap in coverage as defined in paragraph that is not in the actual gap in coverage the discount shall not be applied against the negotiated price as defined in subsection for the purpose of calculating the beneficiary payment definitions in this subsection a qualifying drug the term qualifying drug means with respect to a prescription drug plan or ma–pd plan a drug or biological product that is a drug produced or distributed under an original new drug application approved by the food and drug ad verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ministration including a drug product marketed by any cross licensed producers or distributors operating under the new drug application is a drug that was originally marketed under an original new drug application approved by the food and drug administration or iii is a biological product as approved under section a of the public health services act is covered under the formulary of the plan or is treated as covered under the formulary of the plan as a result of a coverage determination or appeal under subsection or of section d– and iii is dispensed to an individual who is in the original gap in coverage qualifying enrollee the term qualifying enrollee means an individual enrolled in a prescription drug plan or ma–pd plan other than such an individual who is a subsidy eligible individual as defined in section d– a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih drug component negotiated price the term drug component negotiated price means with respect to a qualifying drug the negotiated price as defined in section of title code of federal regulations as in effect on the date of enactment of this subsection as determined without regard to any dispensing fee of the drug under the prescription drug plan or ma–pd plan involved actual gap in coverage the term actual gap in coverage means the gap in prescription drug coverage that occurs between the initial coverage limit as modified under paragraph and subparagraph of paragraph of subsection and the annual out of pocket threshold as modified under subparagraph of such subsection original gap in coverage the term original in gap coverage means the gap in prescription drug coverage that would occur between the initial coverage limit described in subsection and the out of pocket threshold as defined in subsection if subsections and did not applyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih special rule for for the period beginning january and ending december the secretary a enter into agreements with manufacturers to directly receive the discount amount described in paragraph collect the necessary information from prescription drug plans and ma pd plans to calculate the discount amount described in such paragraph and provide the discount described in such paragraph to beneficiaries as close as practicable after the point of sale waiver chapter of title united states code shall not apply to the requirements under this subsection for the period beginning on january and ending on december sec repeal of provision relating to submission of claims by pharmacies located in or contracting with long term care facilities a part submission section d– of the social security act usc w– as amended by section a of public law – isverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amended by striking paragraph and redesignating paragraph and paragraph as added by section a as paragraph and paragraph respectively submission to ma–pd plans section of the social security act usc as added by section of public law – and amended by section a of such public law and section of this act is amended by striking subparagraph and redesignating subparagraphs and as subparagraphs and respectively effective date the amendments made by this section shall apply for contract years beginning with sec 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 a in general section d– of the social security act usc w– is amended in clause by striking and at the end in clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by striking such costs shall be treated as incurred only if and inserting and subject to clause iii such costs shall be treated as incurred only if by striking under section d– or under a state pharmaceutical assistance program and by striking the period at the end and inserting and and by inserting after clause the following new clause iii such costs shall be treated as incurred and shall not be considered to be reimbursed under clause if such costs are borne or paid under section d– under a state pharmaceutical assistance program iii by the indian health service an indian tribe or tribal organization or an urban indian organization as defined in section of the indian health care improvement act or iv under an aids drug assistance program under part ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih title xxvi of the public health service act effective date the amendments made by subsection a shall apply to costs incurred on or after january sec no mid year formulary changes permitted a in general section d– of the social security act usc w– is amended in the heading by inserting certain formulary changes only before initiating marketing for a plan year after status of drug by striking any removal and inserting notice any removal with the same indentation as the clause added by paragraph by adding at the end the following new clause certain changes in formulary only before initiating marketing for a plan year any removal of a covered part drug from a formulary used by a pdp sponsor of a prescription drug plan or ma organization of a ma–verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pd plan or any other material change to the formulary so as to reduce the coverage or increase the cost sharing of the drug under the plan for a plan year shall take effect by a date specified by the secretary but no later than the start of plan marketing activities for the plan year in addition to any exceptions to the previous sentence specified by the secretary the previous sentence shall not apply in the case that a drug is removed from the formulary of a plan because of a recall or withdrawal of the drug issued by the food and drug administration because the drug is replaced with a generic drug that is a therapeutic equivalent or because of utilization management applied to a drug whose labeling includes a boxed warning required by the food and drug administration under section of title code of federal regulations or a successor regulation or a drug required under subsection of section – of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih federal food drug and cosmetic act to have a risk evaluation and management strategy that includes elements under subsection of such section effective date the amendments made by subsection a shall apply to contract years beginning on or after january sec negotiation of lower covered part drug prices on behalf of medicare beneficiaries a negotiation by secretary section d– of the social security act usc w– is amended by striking subsection relating to noninterference and inserting the following negotiation of lower drug prices in general notwithstanding any other provision of law the secretary shall negotiate with pharmaceutical manufacturers the prices including discounts rebates and other price concessions that be charged to pdp sponsors and ma organizations for covered part drugs for part eligible individuals who are enrolled under a prescription drug plan or under an ma pd planverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih no change in rules for formularies a in general nothing in paragraph shall be construed to authorize the secretary to establish or require a particular formulary construction subparagraph a shall not be construed as affecting the secretary authority to ensure appropriate and adequate access to covered part drugs under prescription drug plans and under ma pd plans including compliance of such plans with formulary requirements under section d– construction nothing in this subsection shall be construed as preventing the sponsor of a prescription drug plan or an organization offering an ma pd plan from obtaining a discount or reduction of the price for a covered part drug below the price negotiated under paragraph annual reports to congress not later than june and annually thereafter the secretary shall submit to the committees on ways and means energy and commerce and oversight and government reform of the house of rep verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih resentatives and the committee on finance of the senate a report on negotiations conducted by the secretary to achieve lower prices for medicare beneficiaries and the prices and price discounts achieved by the secretary as a result of such negotiations effective date the amendment made by subsection a shall take effect on the date of the enactment of this act and shall first apply to negotiations and prices for plan years beginning on january sec accurate dispensing in long term care facilities section d– of the social security act usc w– is amended by adding at the end the following new paragraph reduction of wasteful dispensing a in general for plan years beginning on or after january a pdp sponsor offering a prescription drug plan and ma organization offering a ma–pd plan under part shall have in place the utilization management techniques established under subparagraph requirements the secretary shall establish utilization management techniques such as daily weekly or automatedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dose dispensing to apply to pdp sponsors and ma organizations to reduce the quantities of covered part drugs dispensed to enrollees who are residing in long term care facilities in order to reduce waste associated with unused medications consultation in establishing the requirements under subparagraph a the secretary shall consult with the administrator of the environmental protection agency administrator of the food and drug administration administrator of the drug enforcement administration state boards of pharmacy pharmacy and physician organizations and other appropriate stakeholders to study and determine additional methods for prescription drug plans to reduce waste associated with unused prescription drugs sec free generic fill a in general section a of the social security act usc a–a is amended in subparagraph by striking of and all that follows and inserting of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the first subparagraph by striking promulgated and all that follows and inserting promulgated by redesignating the second subparagraph as a subparagraph and by striking the period at the end of such subparagraph and inserting and and by adding at the end the following new subparagraph with regard to a prescription drug plan offered by a pdp sponsor or an ma–pd plan offered by an ma organization a reduction in or waiver of the copayment amount under the plan given to an individual to induce the individual to switch to a generic bioequivalent drug or biosimilar effective date the amendments made by this subsection shall take effect on the date of the enactment of this act and shall first apply with respect to remuneration offered paid solicited or received on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec state certification prior to waiver of licensure requirements under medicare prescription drug program a in general section d– of the social security act usc w– is amended in paragraph a by striking in the case and inserting subject to paragraph in the case and by adding at the end the following new paragraph state certification required a in general except as provided in section d– the secretary only grant a waiver under paragraph a if the secretary has received a certification from the state insurance commissioner that the prescription drug plan has a substantially complete application pending in the state revocation of waiver upon finding of fraud and abuse the secretary shall revoke a waiver granted under paragraph a if the state insurance commissioner submits a certification to the secretary that the recipient of such a waiver has committed fraud or abuse with respect to such waiver verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has failed to make a good faith effort to satisfy state licensing requirements or iii was determined ineligible for licensure by the state exception for pace programs section d– of such act usc w– is amended in paragraph by striking paragraphs and and inserting the succeeding paragraphs and by adding at the end the following new paragraph inapplicability of certain licensure waiver requirements the provisions of paragraph of section d– relating to waiver of licensure under certain circumstances shall apply without regard to paragraph of such section in the case of a pace program that elects to provide qualified prescription drug coverage to a part eligible individual who is enrolled under such program effective date the amendments made by this section shall apply with respect to plan years beginning on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle medicare rural access protections sec telehealth expansion and enhancements a additional telehealth site in general paragraph of section of the social security act usc m is amended by adding at the end the following new subclause ix a renal dialysis facility effective date the amendment made by paragraph shall apply to services furnished on or after january telehealth advisory committee establishment section of the social security act usc ee is amended a in the heading by adding at the end the following telehealth advisory committee and by adding at the end the following new subsection telehealth advisory committee in general the secretary shall appoint a telehealth advisory committee in this subsection referred to as the advisory committee to make recommendations to the secretary on policies of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih centers for medicare medicaid services regarding telehealth services as established under section including the appropriate addition or deletion of services and hcpcs codes to those specified in paragraphs and of such section and for authorized payment under paragraph of such section membership terms a membership in general the advisory committee shall be composed of members to be appointed by the secretary of whom shall be practicing physicians shall be practicing nonphysician health care practitioners and iii shall be administrators of telehealth programs requirements for appointing members in appointing members of the advisory committee the secretary shall verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ensure that each member has prior experience with the practice of telemedicine or telehealth give preference to individuals who are currently providing telemedicine or telehealth services or who are involved in telemedicine or telehealth programs iii ensure that the membership of the advisory committee represents a balance of specialties and geographic regions and iv take into account the recommendations of stakeholders terms the members of the advisory committee shall serve for such term as the secretary specify conflicts of interest an advisory committee member not participate with respect to a particular matter considered in an advisory committee meeting if such member or an immediate family member of such member has a financial interest that could be affected by the advice given to the secretary with respect to such matterverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih meetings the advisory committee shall meet twice each calendar year and at such other times as the secretary provide permanent committee section of the federal advisory committee act usc app shall not apply to the advisory committee following recommendations section of such act usc m is amended by adding at the end the following new clause iii recommendations of the telehealth advisory committee in making determinations under clauses and the secretary shall take into account the recommendations of the telehealth advisory committee established under section when adding or deleting services and hcpcs codes and in establishing policies of the centers for medicare medicaid services regarding the delivery of telehealth services if the secretary does not implement such a recommendation the secretary shall publish in the federal register a statement re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih garding the reason such recommendation was not implemented waiver of administrative limitation the secretary of health and human services shall establish the telehealth advisory committee under the amendment made by paragraph notwithstanding any limitation that apply to the number of advisory committees that be established within the department of health and human services or otherwise hospital credentialing of telemedicine physicians and practitioners in general not later than days after the date of the enactment of this act the secretary of health and human services shall issue guidance for hospitals as defined in paragraph to simplify requirements regarding compiling practitioner credentials for the purpose of rendering a medical staff privileging decision under bylaws of the type described in section of the social security act for physicians and practitioners as defined in paragraph delivering telehealth services that are furnished via a telecommunications systemverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih flexibility in accepting credentialing by another medicare participating hospital a in general such guidance shall permit a hospital to accept credentialing packages compiled by another hospital participating under medicare with regard to physicians and practitioners who seek medical staff privileges in the hospital to provide telehealth services via a telecommunications system from a site other than the hospital where the patient is located construction nothing in this subsection shall be construed to require a hospital to accept the credentialing package compiled by another facility no oversight required if a hospital does accept the credentialing materials prepared by another hospital the hospital shall not be required to exercise oversight over the other hospital process for compiling and verifying credentials privileging this paragraph shall only apply to credentialing and does not relieve a hospital from any applicable privileging requirementsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih construction this subsection shall not be construed as limiting the ability of the secretary to issue additional guidance regarding the requirements for the compilation of credentials for physicians and practitioners not described in paragraph definitions in this subsection a the term hospital has the meaning given such term in subsection of section of the social security act usc and includes a critical access hospital as defined in subsection mm of such section the term physician has the meaning given such term in subsection of such section the term practitioner means a practitioner described in section of the social security act usc sec extension of outpatient hold harmless provision section of the social security act usc is amended in subclause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in the first sentence by striking and inserting and in the second sentence by striking or and inserting or and in subclause iii by striking january and inserting january sec extension of section hospital reclassifications a in general subsection a of section of division of the tax relief and health care act of usc note as amended by section of the medicare medicaid and schip extension act of public law – and section of the medicare improvements for patients and providers act of public law – is amended by striking september and inserting september use of particular wage index for fiscal year for purposes of implementation of the amendment made by subsection a for fiscal year the secretary shall use the hospital wage index that was promulgated by the secretary in the federal register on august fed reg and any subsequent correctionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec extension of geographic floor for work section of the social security act usc w– is amended by striking before january and inserting before january sec extension of payment for technical component of certain physician pathology services section of the medicare medicaid and schip benefits improvement and protection act of as enacted into law by section a of public law – as amended by section of the medicare prescription drug improvement and modernization act of usc w– note section of division of the tax relief and health care act of usc w– note section of the medicare medicaid and schip extension act of public law – and section of the medicare improvements for patients and providers act of public law – is amended by striking and and inserting and sec extension of ambulance add ons a in general section of the social security act usc is amended in subparagraph a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in the matter preceding clause by striking before january and inserting before january and in each of clauses and by striking before january and inserting before january air ambulance improvements section of the medicare improvements for patients and providers act of public law – is amended by striking ending on december and inserting ending on december title medicare beneficiary improvements subtitle a improving and simplifying financial assistance for low income medicare beneficiaries sec improving assets tests for medicare savings program and low income subsidy program a application of highest level permitted under lis to all subsidy eligible individuals in general section d– a of the social security act usc w– a is amended in the matter before subpara verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih graph a by inserting or beginning with paragraph after paragraph annual increase in lis resource test section d– a of such act usc w– a is amended a by striking and at the end of subclause in subclause by inserting before after subsequent year by striking the period at the end of subclause and inserting a semicolon by inserting after subclause the following new subclauses iii for or in the case of the combined value of the individual assets or resources and the assets or resources of the individual spouse and iv for a subsequent year the dollar amounts specified in this subclause or subclause iii for the previous year increased by the annual percentage increase in the consumer price index all items us city aver verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih age as of september of such previous year and in the last sentence by inserting or iv after subclause application of lis test under medicare savings program section of such act usc is amended a by striking effective beginning with january and inserting effective for the period beginning with january and ending with december and by inserting before the period at the end the following or effective beginning with january whose resources as so determined do not exceed the maximum resource level applied for the year under subparagraph of section d– a determined without regard to the life insurance policy exclusion provided under subparagraph of such section applicable to an individual or to the individual and the individual spouse as the case be effective date the amendments made by subsection a shall apply to eligibility determinations forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih income related subsidies and medicare cost sharing furnished for periods beginning on or after january sec elimination of part cost sharing for certain non institutionalized fullbenefit dual eligible individuals a in general section d– a of the social security act usc w– a is amended by striking institutionalized individuals in and inserting elimination of costsharing for certain full benefit dual eligible individuals institutionalized individuals in and by adding at the end the following new subclause certain other individuals in the case of an individual who is a full benefit dual eligible individual and with respect to whom there has been a determination that but for the provision of home and community based care whether under section or under a waiver under section the individual would re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih quire the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded the cost of which could be reimbursed under the state plan under title xix the elimination of any beneficiary coinsurance described in section d– for all amounts through the total amount of expenditures at which benefits are available under section d– effective date the amendments made by subsection a shall apply to drugs dispensed on or after january sec eliminating barriers to enrollment a administrative verification of income and resources under the low income subsidy program in general clause iii of section d– a of the social security act usc w– a is amended to read as follows iii certification of income and resources for purposes of applying this section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an individual shall be permitted to apply on the basis of selfcertification of income and resources and matters attested to in the application shall be subject to appropriate methods of verification without the need of the individual to provide additional documentation except in extraordinary situations as determined by the commissioner effective date the amendment made by paragraph shall apply beginning january 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 outreach to eligible individuals for provision authorizing disclosure of return information to facilitate identification of individuals likely to be ineligible for low income subsidies under medicare prescription drug program see section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment a in general in the case of a retroactive lis enrollment beneficiary who is enrolled under a prescription drug plan under part of title xviii of the social security act or an ma–pd plan under part of such title the beneficiary or any eligible third party is entitled to reimbursement by the plan for covered drug costs incurred by the beneficiary during the retroactive coverage period of the beneficiary in accordance with subsection and in the case of such a beneficiary described in subsection a such reimbursement shall be made automatically by the plan upon receipt of appropriate notice the beneficiary is eligible for assistance described in such subsection a without further information required to be filed with the plan by the beneficiary administrative requirements relating to reimbursements line item description each reimbursement made by a prescription drug plan or ma–pd plan under subsection a shall include a line item description of the items for which the reimbursement is made timing of reimbursements a prescription drug plan or ma–pd plan must make a reim verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih bursement under subsection a to a retroactive lis enrollment beneficiary with respect to a claim not later than days after a in the case of a beneficiary described in subsection a the date on which the plan receives notice from the secretary that the beneficiary is eligible for assistance described in such subsection or in the case of a beneficiary described in subsection a the date on which the beneficiary files the claim with the plan reporting requirement for each month beginning with january each prescription drug plan and each ma–pd plan shall report to the secretary the following a the number of claims the plan has readjudicated during the month due to a beneficiary becoming retroactively eligible for subsidies available under section d– of the social security act the total value of the readjudicated claim amount for the month the medicare health insurance claims number of beneficiaries for whom claims were readjudicatedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for the claims described in subparagraphs a and an attestation to the administrator of the centers for medicare medicaid services of the total amount of reimbursement the plan has provided to beneficiaries for premiums and cost sharing that the beneficiary overpaid for which the plan received payment from the centers for medicare medicaid services definitions for purposes of this section covered drug costs the term covered drug costs means with respect to a retroactive lis enrollment beneficiary enrolled under a prescription drug plan under part of title xviii of the social security act or an ma–pd plan under part of such title the amount by which a the costs incurred by such beneficiary during the retroactive coverage period of the beneficiary for covered part drugs premiums and cost sharing under such title exceeds such costs that would have been incurred by such beneficiary during such period if the beneficiary had been both enrolled in the plan and recognized by such plan as qualified during such period for the low income subsidyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under section d– of the social security act to which the individual is entitled eligible third party the term eligible third party means with respect to a retroactive lis enrollment beneficiary an organization or other third party that is owed payment on behalf of such beneficiary for covered drug costs incurred by such beneficiary during the retroactive coverage period of such beneficiary retroactive coverage period the term retroactive coverage period means a with respect to a retroactive lis enrollment beneficiary described in paragraph a the period beginning on the effective date of the assistance described in such paragraph for which the individual is eligible and ending on the date the plan effectuates the status of such individual as so eligible and with respect to a retroactive lis enrollment beneficiary described in paragraph a the period beginning on the date the individual is both entitled to benefits underverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih part a or enrolled under part of title xviii of the social security act and eligible for medical assistance under a state plan under title xix of such act and ending on the date the plan effectuates the status of such individual as a full benefit dual eligible individual as defined in section of such act retroactive lis enrollment beneficiary a in general the term retroactive lis enrollment beneficiary means an individual who is enrolled in a prescription drug plan under part of title xviii of the social security act or an ma–pd plan under part of such title and subsequently becomes eligible as a full benefit dual eligible individual as defined in section of such act an individual receiving a low income subsidy under section d– of such act an individual receiving assistance under the medicare savings program implemented under clauses iii and iv of sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a of such act or an individual receiving assistance under the supplemental security income program under section of such act or subject to subparagraph is a full benefit dual eligible individual as defined in section of such act who is automatically enrolled in such a plan under section d– of such act exception for beneficiaries enrolled in rfp plan in general in no case shall an individual described in subparagraph a include an individual who is enrolled pursuant to a rfp contract described in clause in a prescription drug plan offered by the sponsor of such plan awarded such contract rfp contract described the rfp contract described in this section is a contract entered into between the secretary and a sponsor of a prescription drug plan pursuant to the centers for medicare medicaid services request for proposalsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih issued on february relating to medicare part retroactive coverage for certain low income beneficiaries or a similar subsequent request for proposals sec intelligent assignment in enrollment a in general section d– of the social security act usc w– is amended by adding after pdp region the following or through use of an intelligent assignment process that is designed to maximize the access of such individual to necessary prescription drugs while minimizing costs to such individual and to the program under this part to the greatest extent possible in the case the secretary enrolls such individuals through use of an intelligent assignment process such process shall take into account the extent to which prescription drugs necessary for the individual are covered in the case of a pdp sponsor of a prescription drug plan that uses a formulary the use of prior authorization or other restrictions on access to coverage of such prescription drugs by such a sponsor and the overall quality of a prescription drug plan as measured by quality ratings established by the secretary effective date the amendment made by subsection a shall take effect for contract years beginning with verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec special enrollment period and automatic enrollment process for certain subsidy eligible individuals a special enrollment period section d– of the social security act usc w– is amended to read as follows subsidy eligible individuals in the case of an individual as determined by the secretary who is determined under subparagraph of section d– a to be a subsidy eligible individual automatic enrollment section d– of the social security act usc w– is amended by adding at the end the following new subparagraph special rule for subsidy eligible individuals the process established under subparagraph a shall include in the case of an individual described in section d– who fails to enroll in a prescription drug plan or an ma–pd plan during the special enrollment established under such section applicable to such individual the application of the assignment process described in subparagraph to such individual in the same manner as such assignment process ap verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plies to a part eligible individual described in such subparagraph nothing in the previous sentence shall prevent an individual described in such sentence from declining enrollment in a plan determined appropriate by the secretary or in the program under this part or from changing such enrollment effective date the amendments made by this section shall apply to subsidy determinations made for months beginning with january sec application of ma premiums prior to rebate and quality bonus payments in calculation of low income subsidy benchmark a in general section d– iii of the social security act usc w– iii is amended by inserting before the period the following before the application of the monthly rebate computed under section for that plan and year involved and in the case of a qualifying plan in a qualifying county before the application of the increase under section for that plan and year involved verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendment made by subsection a shall apply to subsidy determinations made for months beginning with january subtitle reducing health disparities sec ensuring effective communication in medicare a ensuring effective communication by the centers for medicare medicaid services study on medicare payments for language services the secretary of health and human services shall conduct a study that examines the extent to which medicare service providers utilize offer or make available language services for beneficiaries who are limited english proficient and ways that medicare should develop payment systems for language services analyses the study shall include an analysis of each of the following a how to develop and structure appropriate payment systems for language services for all medicare service providers the feasibility of adopting a payment methodology for on site interpreters including interpreters who work as independent contrac verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tors and interpreters who work for agencies that provide on site interpretation pursuant to which such interpreters could directly bill medicare for services provided in support of physician office services for an lep medicare patient the feasibility of medicare contracting directly with agencies that provide off site interpretation including telephonic and video interpretation pursuant to which such contractors could directly bill medicare for the services provided in support of physician office services for an lep medicare patient the feasibility of modifying the existing medicare resource based relative value scale rbrvs by using adjustments such as multipliers or add ons when a patient is lep how each of options described in a previous paragraph would be funded and how such funding would affect physician payments a physician practice and beneficiary costsharing the extent to which providers under parts a and of title xviii of the social security act ma organizations offering medicareverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih advantage plans under part of such title and pdp sponsors of a prescription drug plan under part of such title utilize offer or make available language services for beneficiaries with limited english proficiency the nature and type of language services provided by states under title xix of the social security act and the extent to which such services could be utilized by beneficiaries and providers under title xviii of such act the extent to which interpreters and translators providing services to medicare beneficiaries under title xviii of such act are trained or accredited variation in payment system described the payment systems described in paragraph a allow variations based upon types of service providers available delivery methods and costs for providing language services including such factors as a the type of language services provided such as provision of health care or health care related services directly in a non english language by a bilingual provider or use of an interpreter verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih type of interpretation services provided such as in person telephonic video interpretation the methods and costs of providing language services including the costs of providing language services with internal staff or through contract with external independent contractors or agencies or both providing services for languages not frequently encountered in the united states and providing services in rural areas report the secretary shall submit a report on the study conducted under subsection a to appropriate committees of congress not later than months after the date of the enactment of this act exemption from paperwork reduction act chapter of title united states code commonly known as the paperwork reduction act shall not apply for purposes of carrying out this subsection authorization of appropriations the secretary shall provide for the transfer from the federal supplementary medical insurance trustverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fund under section of the social security act usc of for purposes of carrying out this subsection health plans section of the social security act usc w– is amended by striking or at the end of subparagraph by adding or at the end of subparagraph and by inserting after subparagraph the following new subparagraph fails substantially to provide language services to limited english proficient beneficiaries enrolled in the plan that are required under law sec demonstration to promote access for medicare beneficiaries with limited english proficiency by providing reimbursement for culturally and linguistically appropriate services a in general not later than months after the date of the completion of the study described in section a of this act the secretary acting through the centers for medicare medicaid services and the centerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for medicare and medicaid innovation established under section a of the social security act as added by section and consistent with the applicable provisions of such section shall carry out a demonstration program under which the secretary shall award not fewer than year grants to eligible medicare service providers as described in subsection to improve effective communication between such providers and medicare beneficiaries who are living in communities where racial and ethnic minorities including populations that face language barriers are underserved with respect to such services in designing and carrying out the demonstration the secretary shall take into consideration the results of the study conducted under section a of this act and adjust as appropriate the distribution of grants so as to better target medicare beneficiaries who are in the greatest need of language services the secretary shall not authorize a grant larger than over three years for any grantee eligibility priority eligibility to be eligible to receive a grant under subsection a an entity shall a be a provider of services under part a of title xviii of the social security act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a service provider under part of such title iii a part organization offering a medicare part plan under part of such title or iv a pdp sponsor of a prescription drug plan under part of such title and prepare and submit to the secretary an application at such time in such manner and accompanied by such additional information as the secretary require priority a distribution to the extent feasible in awarding grants under this section the secretary shall award at least grants to providers of services described in paragraph a at least grants to service providers described in paragraph a iii at least grants to organizations described in paragraph a iii and iv at least grants to sponsors described in paragraph a iv for community organizations the secretary shall give priority to applicantsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that have developed partnerships with community organizations or with agencies with experience in language access variation in grantees the secretary shall also ensure that the grantees under this section represent among other factors different types of language services provided and of service providers and organizations under parts a through of title xviii of the social security act variations in languages needed and their frequency of use iii urban and rural settings iv at least two geographic regions as defined by the secretary and at least two large metropolitan statistical areas with diverse populations use of funds in general a grantee shall use grant funds received under this section to pay for the provision of competent language services to medicare beneficiaries who are limited english proficient competent interpreter services be provided through on site interpretation telephonic interpretation or video interpretation or direct provision ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health care or health care related services by a bilingual health care provider a grantee use bilingual providers staff or contract interpreters a grantee use grant funds to pay for competent translation services a grantee use up to percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under subsection organizations grantees that are part organizations or pdp sponsors must ensure that their network providers receive at least percent of the grant funds to pay for the provision of competent language services to medicare beneficiaries who are limited english proficient including physicians and pharmacies determination of payments for language services payments to grantees shall be calculated based on the estimated numbers of limited english proficient medicare beneficiaries in a grantee service area utilizing a data on the numbers of limited english proficient individuals who speak english less than very well from the most recently available data from the bureau of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih census or other state based study the secretary determines likely to yield accurate data regarding the number of such individuals served by the grantee or the grantee own data if the grantee routinely collects data on medicare beneficiaries primary language in a manner determined by the secretary to yield accurate data and such data shows greater numbers of limited english proficient individuals than the data listed in subparagraph a limitations a reporting payments shall only be provided under this section to grantees that report their costs of providing language services as required under subsection and be modified annually at the discretion of the secretary if a grantee fails to provide the reports under such section for the first year of a grant the secretary terminate the grant and solicit applications from new grantees to participate in the subsequent two years of the demonstration program type of services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general subject to clause payments shall be provided under this section only to grantees that utilize competent bilingual staff or competent interpreter or translation services which if the grantee operates in a state that has statewide health care interpreter standards meet the state standards currently in effect or if the grantee operates in a state that does not have statewide health care interpreter standards utilizes competent interpreters who follow the national council on interpreting in health care code of ethics and standards of practice exemptions the requirements of clause shall not apply in the case of a medicare beneficiary who is limited english proficient who has been informed in the beneficiary primary language of the availability of free interpreter and translation services and who requests the use of family friends or otherverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih persons untrained in interpretation or translation and the grantee documents the request in the beneficiary record and in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient nothing in clause ii shall be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies from having in place systems to provide competent interpreter and translation services without undue delay assurances grantees under this section shall ensure that appropriate clinical and support staff receive ongoing education and training in linguistically appropriate service delivery ensure the linguistic competence of bilingual providers verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih offer and provide appropriate language services at no additional charge to each patient with limited english proficiency at all points of contact in a timely manner during all hours of operation notify medicare beneficiaries of their right to receive language services in their primary language post signage in the languages of the commonly encountered group or groups present in the service area of the organization and ensure that a primary language data are collected for recipients of language services and are consistent with standards developed under section iv of the public health service act as added by section of this act to the extent such standards are available upon the initiation of the demonstration and consistent with the privacy protections provided under the regulations promulgated pursuant to section of the health insurance portability and accountability act of usc d– note if the recipient of language services is a minor or is incapacitated verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the primary language of the parent or legal guardian is collected and utilized reporting requirements grantees under this section shall provide the secretary with reports at the conclusion of the each year of a grant under this section each report shall include at least the following information the number of medicare beneficiaries to whom language services are provided the languages of those medicare beneficiaries the types of language services provided such as provision of services directly in non english language by a bilingual health care provider or use of an interpreter type of interpretation such as in person telephonic or video interpretation the methods of providing language services such as staff or contract with external independent contractors or agencies the length of time for each interpretation encounter the costs of providing language services which be actual or estimated as determined by the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an account of the training or accreditation of bilingual staff interpreters or translators providing services under this demonstration no cost sharing limited english proficient medicare beneficiaries shall not have to pay cost sharing or co pays for language services provided through this demonstration program evaluation and report the secretary shall conduct an evaluation of the demonstration program under this section and shall submit to the appropriate committees of congress a report not later than year after the completion of the program the report shall include the following an analysis of the patient outcomes and costs of furnishing care to the limited english proficient medicare beneficiaries participating in the project as compared to such outcomes and costs for limited english proficient medicare beneficiaries not participating the effect of delivering culturally and linguistically appropriate services on beneficiary access to care utilization of services efficiency and cost effectiveness of health care delivery patient satisfaction and select health outcomesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the extent to which bilingual staff interpreters and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider service or other category as determined by the secretary to ensure the provision of high quality interpretation translation or other language services to medicare beneficiaries if such services are expanded pursuant to subsection of section of this act recommendations if any regarding the extension of such project to the entire medicare program accreditation or training for providers of interpretation translation or language services in medicare in general a designation of standards if the secretary pursuant to section of this act expands the model initially developed through the demonstration program under this section the secretary shall use the results of the study under section and the demonstration under this section to designate standards for training or accreditation theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih secretary designate one or more training or accreditation organizations as appropriate for the nature and type of interpretation and translation services provided to medicare beneficiaries to ensure that payments are made only for approved services by trained or accredited language services providers alternatives to training or accreditation if the secretary designates one or more training or accreditation organizations but determines that accreditation is not available in all languages for which payments be initiated the secretary shall provide payments for and accept alternatives to training or accreditation for certain languages including languages of lesser diffusion the secretary must ensure that the alternatives to training or accreditation provide at a minimum a determination that the interpreter is proficient and able to communicate information accurately in both english and in the language for which interpreting is needed verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an attestation from the interpreter to comply with and adhere to the role of an interpreter as defined by the national code of ethics and national standards of practice as published by the national council on interpreting in health care and iii an attestation to adhere to hipaa privacy and security law as defined in section a of the public health service act to the same extent as the healthcare provider for whom interpreting is provided modifiers add ons and other forms of payment if the secretary decides that modifiers add ons or other forms of payment be made for the provision of services directly by bilingual providers the secretary shall designate standards to ensure the competency of such providers delivering such services in a non english language consultation with stakeholders and considerations for accreditation or training verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a consultation in designating accreditation or training requirements under this subsection the secretary shall consult with patients providers organizations that advocate on behalf of limited english proficient individuals and other individuals or entities determined appropriate by the secretary considerations in designating accreditation or training requirements under this section the secretary shall consider as appropriate standards for qualifications of health care interpreters who interpret infrequently encountered languages standards for qualifications of health care interpreters who interpret in languages of lesser diffusion iii standards for training of interpreters and iv standards for continuing education of interpreters general provisions nothing in this section shall be construed to limit otherwise existing obligations of recipients of federal financial assistance under title viverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of the civil rights act of usc et seq or any other statute appropriations there are appropriated to carry out this section in equal parts from the federal hospital insurance trust fund and the federal supplementary medical insurance trust fund for each fiscal year of the demonstration program sec iom report on impact of language access services a in general the secretary of health and human services shall enter into an arrangement with the institute of medicine under which the institute will prepare and publish not later than years after the date of the enactment of this act a report on the impact of language access services on the health and health care of limited english proficient populations contents such report shall include recommendations on the development and implementation of policies and practices by health care organizations and providers for limited english proficient patient populations a description of the effect of providing language access services on quality of health care and access to care and reduced medical error andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a description of the costs associated with or savings related to provision of language access services sec definitions in this subtitle bilingual the term bilingual with respect to an individual means a person who has sufficient degree of proficiency in two languages and can ensure effective communication can occur in both languages competent interpreter services the term competent interpreter services means a trans language rendition of a spoken message in which the interpreter comprehends the source language and can speak comprehensively in the target language to convey the meaning intended in the source language the interpreter knows health and health related terminology and provides accurate interpretations by choosing equivalent expressions that convey the best matching and meaning to the source language and captures to the greatest possible extent all nuances intended in the source message competent translation services the term competent translation services means a trans language rendition of a written document inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih which the translator comprehends the source language and can write comprehensively in the target language to convey the meaning intended in the source language the translator knows health and health related terminology and provides accurate translations by choosing equivalent expressions that convey the best matching and meaning to the source language and captures to the greatest possible extent all nuances intended in the source document effective communication the term effective communication means an exchange of information between the provider of health care or health care related services and the limited english proficient recipient of such services that enables limited english proficient individuals to access understand and benefit from health care or health carerelated services interpreting interpretation the terms interpreting and interpretation mean the transmission of a spoken message from one language into another faithfully accurately and objectively health care services the term health care services means services that address physical as well as mental health conditions in all care settingsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health care related services the term health care related services means human or social services programs or activities that provide access referrals or links to health care language access the term language access means the provision of language services to an lep individual designed to enhance that individual access to understanding of or benefit from health care or health care related services language services the term language services means provision of health care services directly in a non english language interpretation translation and non english signage limited english proficient the term limited english proficient or lep with respect to an individual means an individual who speaks a primary language other than english and who cannot speak read write or understand the english language at a level that permits the individual to effectively communicate with clinical or nonclinical staff at an entity providing health care or health care related services medicare beneficiary the term medicare beneficiary means an individual entitledverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to benefits under part a of title xviii of the social security act or enrolled under part of such title medicare program the term medicare program means the programs under parts a through of title xviii of the social security act service provider the term service provider includes all suppliers providers of services or entities under contract to provide coverage items or services under any part of title xviii of the social security act subtitle miscellaneous improvements sec extension of therapy caps exceptions process section of the social security act usc as amended by section of the medicare improvements for patients and providers act of public law – is amended by striking december and inserting december verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions a provision of appropriate coverage of immunosuppressive drugs under the medicare program for kidney transplant recipients continued entitlement to immunosuppressive drugs a kidney transplant recipients section a of the social security act usc – is amended by inserting except for coverage of immunosuppressive drugs under section before with the thirty sixth month application section of such act usc is amended by striking every individual who and inserting a in general every individual who and by adding at the end the following new subsection special rules applicable to individuals only eligible for coverage of immunosuppressive drugs verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general in the case of an individual whose eligibility for benefits under this title has ended on or after january except for the coverage of immunosuppressive drugs by reason of section a the following rules shall apply a the individual shall be deemed to be enrolled under this part for purposes of receiving coverage of such drugs the individual shall be responsible for providing for payment of the portion of the premium under section which is not covered under the medicare savings program as defined in section in order to receive such coverage the provision of such drugs shall be subject to the application of the deductible under section and the coinsurance amount applicable for such drugs as determined under this part if the individual is an inpatient of a hospital or other entity the individual is entitled to receive coverage of such drugs under this partverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih establishment of procedures in order to implement coverage the secretary shall establish procedures for a identifying individuals that are entitled to coverage of immunosuppressive drugs by reason of section a and distinguishing such individuals from individuals that are enrolled under this part for the complete package of benefits under this part technical amendment to correct duplicate subsection designation subsection of section a of such act usc – as added by section a of the social security independence and program improvements act of public law – stat is redesignated as subsection extension of secondary payer requirements for esrd beneficiaries section of such act usc is amended by adding at the end the following new sentence with regard to immunosuppressive drugs furnished on or after the date of the enactment of the affordable health careverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for america act this subparagraph shall be applied without regard to any time limitation medicare coverage for esrd patients section of such act is further amended in subsection iii by inserting including oral drugs that are not the oral equivalent of an intravenous drug such as oral phosphate binders and calcimimetics after other drugs and biologicals in subsection a in the first sentence by striking a one time election to be excluded from the phase in and inserting an election with respect to or to be excluded from the phase in or the remainder of the phasein and by adding before the period at the end the following for such year and for each subsequent year during the phase in described in clause and in the second sentence by striking january and inserting the first date of such year andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by inserting and at a time after form and manner and in subsection by striking lesser and inserting greater sec voluntary advance care planning consultation a in general section of the social security act usc is amended in subsection a by striking and at the end of subparagraph dd by adding and at the end of subparagraph ee and by adding at the end the following new subparagraph ff voluntary advance care planning consultation as defined in subsection hhh and by adding at the end the following new subsection voluntary advance care planning consultation hhh subject to paragraphs and the term voluntary advance care planning consultation means an optional consultation between the individual and a practitioner described in paragraph regarding ad verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vance care planning such consultation include the following as specified by the secretary a an explanation by the practitioner of advance care planning including a review of key questions and considerations advance directives including living wills and durable powers of attorney and their uses an explanation by the practitioner of the role and responsibilities of a health care proxy and of the continuum of end of life services and supports available including palliative care and hospice and benefits for such services and supports that are available under this title an explanation by the practitioner of physician orders regarding life sustaining treatment or similar orders in states where such orders or similar orders exist a practitioner described in this paragraph is a a physician as defined in subsection and another health care professional as specified by the secretary and who has the authority under state law to sign orders for life sustaining treatments such as a nurse practitioner or physician assistant verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an individual receive the voluntary advance care planning care planning consultation provided for under this subsection no more than once every years unless there is a significant change in the health or healthrelated condition of the individual for purposes of this section the term order regarding life sustaining treatment means with respect to an individual an actionable medical order relating to the treatment of that individual that effectively communicates the individual preferences regarding life sustaining treatment is signed and dated by a practitioner and is in a form that permits it to be followed by health care professionals across the continuum of care construction the voluntary advance care planning consultation described in section hhh of the social security act as added by subsection a shall be completely optional nothing in this section shall require an individual to complete an advance directive an order for life sustaining treatment or other advance care planning document require an individual to consent to restrictions on the amount duration or scope of medical benefits an individual is entitled to receive under this title orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih encourage the promotion of suicide or assisted suicide payment section of such act usc is amended by inserting ff after ee frequency limitation section a of such act usc a is amended in paragraph a in subparagraph by striking and at the end in subparagraph by striking the semicolon at the end and inserting and and by adding at the end the following new subparagraph in the case of voluntary advance care planning consultations as defined in paragraph of section hhh which are performed more frequently than is covered under such section and in paragraph by striking or and inserting or effective date the amendments made by this section shall apply to consultations furnished on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec part special enrollment period and waiver of limited enrollment penalty for tricare beneficiaries a part special enrollment period in general section of the social security act usc is amended by adding at the end the following new subsection in the case of any individual who is a covered beneficiary as defined in section of title united states code at the time the individual is entitled to hospital insurance benefits under part a under section or section a and who is eligible to enroll but who has elected not to enroll or to be deemed enrolled during the individual initial enrollment period there shall be a special enrollment period described in paragraph the special enrollment period described in this paragraph with respect to an individual is the month period beginning on the day after the last day of the initial enrollment period of the individual or if later the month period beginning with the month the individual is notified of enrollment under this section in the case of an individual who enrolls during the special enrollment period provided under paragraph the coverage period under this part shall begin on the first day of the month in which the individual enrolls or verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih at the option of the individual on the first day of the second month following the last month of the individual initial enrollment period the secretary of defense shall establish a method for identifying individuals described in paragraph and providing notice to them of their eligibility for enrollment during the special enrollment period described in paragraph effective date the amendment made by paragraph shall apply to elections made on or after the date of the enactment of this act waiver of increase of premium in general section of the social security act usc is amended by striking section and inserting subsection or of section effective date a in general the amendment made by paragraph shall apply with respect to elections made on or after the date of the enactment of this act rebates for certain disabled and esrd beneficiaries in general with respect to premiums for months on or after januaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and before the month of the enactment of this act no increase in the premium shall be effected for a month in the case of any individual who is a covered beneficiary as defined in section of title united states code at the time the individual is entitled to hospital insurance benefits under part a of title xviii of the social security act under section or a of such act and who is eligible to enroll but who has elected not to enroll or to be deemed enrolled during the individual initial enrollment period and who enrolls under this part within the month period that begins on the first day of the month after the month of notification of entitlement under this part consultation with department of defense the secretary of health and human services shall consult with the secretary of defense in identifying individuals described in this paragraph iii rebates the secretary of health and human services shall establishverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a method for providing rebates of premium increases paid for months on or after january and before the month of the enactment of this act for which a penalty was applied and collected sec exception for use of more recent tax year in case of gains from sale of primary residence in computing part income related premium a in general section ii of the social security act usc ii is amended by inserting sale of primary residence after divorce of such individual effective date the amendment made by subsection a shall apply to premiums and payments for years beginning with sec demonstration program on use of patient decisions aids a in general the secretary of health and human services acting through the center for medicare and medicaid innovation established under section a of the social security act as added by section and consistent with the applicable provisions of such section shall establish a shared decision making demonstration program in this subsection referred to as the program verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under the medicare program using patient decision aids to meet the objective of improving the understanding by medicare beneficiaries of their medical treatment options as compared to comparable medicare beneficiaries who do not participate in a shared decision making process using patient decision aids sites enrollment the secretary shall enroll in the program not more than eligible providers who have experience in implementing and have invested in the necessary infrastructure to implement shared decision making using patient decision aids application an eligible provider seeking to participate in the program shall submit to the secretary an application at such time and containing such information as the secretary require preference in enrolling eligible providers in the program the secretary shall give preference to eligible providers that a have documented experience in using patient decision aids for the conditions identified by the secretary and in using shared decision making have the necessary information technology infrastructure to collect the informationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih required by the secretary for reporting purposes and are trained in how to use patient decision aids and shared decision making follow up counseling visit in general an eligible provider participating in the program shall routinely schedule medicare beneficiaries for a counseling visit after the viewing of such a patient decision aid to answer any questions the beneficiary have with respect to the medical care of the condition involved and to assist the beneficiary in thinking through how their preferences and concerns relate to their medical care payment for follow up counseling visit the secretary shall establish procedures for making payments for such counseling visits provided to medicare beneficiaries under the program such procedures shall provide for the establishment a of a code or codes to represent such services and of a single payment amount for such service that includes the professional time of the health care provider and a portion of the reasonable costs of the infrastructure of the eli verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gible provider such as would be made under the applicable payment systems to that provider for similar covered services costs of aids an eligible provider participating in the program shall be responsible for the costs of selecting purchasing and incorporating such patient decision aids into the provider practice and reporting data on quality and outcome measures under the program funding the secretary shall provide for the transfer from the federal supplementary medical insurance trust fund established under section of the social security act usc of such funds as are necessary for the costs of carrying out the program waiver authority the secretary waive such requirements of titles xi and xviii of the social security act usc et seq and et seq as be necessary for the purpose of carrying out the program report not later than months after the date of completion of the program the secretary shall submit to congress a report on such program together with recommendations for such legislation and administrative action as the secretary determines to be appropriate the final report shall include an evaluation of the impact of the use of the program on health quality utilization ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health care services and on improving the quality of life of such beneficiaries definitions in this section eligible provider the term eligible provider means the following a a primary care practice a specialty practice a multispecialty group practice a hospital a rural health clinic a federally qualified health center as defined in section aa of the social security act usc aa an integrated delivery system a state cooperative entity that includes the state government and at least one other health care provider which is set up for the purpose of testing shared decision making and patient decision aids patient decision aid the term patient decision aid means an educational tool such as the internet a video or a pamphlet that helps patients or if appropriate the family caregiver of the patient understand and communicate their beliefs and preferences related to their treatment op verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tions and to decide with their health care provider what treatments are best for them based on their treatment options scientific evidence circumstances beliefs and preferences shared decision making the term shared decision making means a collaborative process between patient and clinician that engages the patient in decision making provides patients with information about trade offs among treatment options and facilitates the incorporation of patient preferences and values into the medical plan title iii promoting primary care mental health services and coordinated care sec accountable care organization pilot program title xviii of the social security act is amended by inserting after section as added by section the following new section accountable care organization pilot program sec a establishment in general the secretary shall conduct a pilot program in this section referred to as the pilot program to test different payment incentive models including to the extent practicable the specific payment incen verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tive models described in subsection designed to reduce the growth of expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries as defined in subsection by qualifying accountable care organizations as defined in subsection in order to a promote accountability for a patient population and coordinate items and services under parts a and and include part if the secretary determines appropriate encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery and reward physician practices and other physician organizational models for the provision of high quality and efficient health care services scope the secretary shall set specific goals for the number of accountable care organizations participating practitioners and patients served in the initial tests under the pilot program to ensure that the pilot program is of sufficient size and scope to a test the approach involved in a variety of settings including urban rural and underserved areas andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subject to subsection disseminate such approach rapidly on a national basis to the extent that the secretary finds a qualifying accountable care organization model to be successful in improving quality and reducing costs the secretary shall seek to implement such models on as large a geographic scale as practical and economical qualifying accountable care organizations acos qualifying aco defined in this section a in general the terms qualifying accountable care organization and qualifying aco mean a group of physicians or other physician organizational model as defined in subparagraph that is organized at least in part for the purpose of providing physicians services and meets such criteria as the secretary determines to be appropriate to participate in the pilot program including the criteria specified in paragraph inclusion of other providers of services and suppliers nothing in thisverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subsection shall be construed as preventing a qualifying aco from including a hospital or any other provider of services or supplier furnishing items or services for which payment be made under this title that is affiliated with the aco under an arrangement structured so that such provider or supplier participates in the pilot program and shares in any incentive payments under the pilot program physician the term physician includes except as the secretary otherwise provide any individual who furnishes services for which payment be made as physicians services under this title other physician organizational model the term other physician organization model means with respect to a qualifying aco any model of organization under which physicians enter into agreements with other providers of services for the purposes of participation in the pilot program in order to provide high quality and efficient health care services and share in any incentive payments under such programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih other services nothing in this paragraph shall be construed as preventing a qualifying aco from furnishing items or services for which payment not be made under this title for purposes of achieving performance goals under the pilot program qualifying criteria the following are criteria described in this paragraph for an organized group of physicians to be a qualifying aco a the group has a legal structure that would allow the group to receive and distribute incentive payments under this section the group includes a sufficient number of primary care physicians regardless of specialty for the applicable beneficiaries for whose care the group is accountable as determined by the secretary the group reports on quality measures in such form manner and frequency as specified by the secretary which be for the group for providers of services and suppliers or both the group reports to the secretary in a form manner and frequency as specified by the secretary such data as the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih determines appropriate to monitor and evaluate the pilot program the group provides notice to applicable beneficiaries regarding the pilot program as determined appropriate by the secretary the group contributes to a best practices network or website that shall be maintained by the secretary for the purpose of sharing strategies on quality improvement care coordination and efficiency that the groups believe are effective the group utilizes patient centered processes of care including those that emphasize patient and caregiver involvement in planning and monitoring of ongoing care management plan the group meets other criteria determined to be appropriate by the secretary specific payment incentive models the specific payment incentive models described in this subsection are the following performance target model under the performance target model under this paragraph in this paragraph referred to as the performance target model verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general a qualifying aco qualifies to receive an incentive payment if expenditures for items and services for applicable beneficiaries are less than a target spending level or a target rate of growth the incentive payment shall be made only if savings are greater than would result from normal variation in expenditures for items and services covered under parts a and and include part if the secretary determines appropriate computation of performance target in general the secretary shall establish a performance target for each qualifying aco comprised of a base amount described in clause increased to the current year by an adjustment factor described in clause iii such a target be established on a per capita basis or adjusted for risk as the secretary determines to be appropriate base amount for purposes of clause the base amount in this subparagraph is equal to the average total payments or allowed charges under partsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a and and include part if the secretary determines appropriate for applicable beneficiaries for whom the qualifying aco furnishes items and services in a base period determined by the secretary such base amount be determined on a per capita basis or adjusted for risk iii adjustment factor for purposes of clause the adjustment factor in this clause equal an annual per capita amount that reflects changes in expenditures from the period of the base amount to the current year that would represent an appropriate performance target for applicable beneficiaries as determined by the secretary iv rebasing under this model the secretary shall periodically rebase the base expenditure amount described in clause meeting target in general subject to clause a qualifying aco that meets or exceeds annual quality and performance targets for a year shall receive an incentiveverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih payment for such year equal to a portion as determined appropriate by the secretary of the amount by which payments under this title for such year are estimated to be below the performance target for such year as determined by the secretary the secretary establish a cap on incentive payments for a year for a qualifying aco limitation the secretary shall limit incentive payments to each qualifying aco under this paragraph as necessary to ensure that the aggregate expenditures with respect to applicable beneficiaries for such acos under this title inclusive of incentive payments described in this subparagraph do not exceed the amount that the secretary estimates would be expended for such aco for such beneficiaries if the pilot program under this section were not implemented reporting and other requirements in carrying out such model the secretary as the secretary determines to be appropriate incorporate reporting require verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ments incentive payments and penalties related to the physician quality reporting initiative pqri electronic prescribing electronic health records and other similar initiatives under section and use alternative criteria than would otherwise apply under such section for determining whether to make such payments the incentive payments described in this subparagraph shall not be included in the limit described in subparagraph or in the performance target model described in this paragraph partial capitation model a in general subject to subparagraph a partial capitation model described in this paragraph in this paragraph referred to as a partial capitation model is a model in which a qualifying aco would be at financial risk for some but not all of the items and services covered under parts a and and include part if the secretary determines appropriate such as at risk for some or all physicians services or all items and services under part the secretary limit a partial capitation model to acos that are highly integratedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih systems of care and to acos capable of bearing risk as determined to be appropriate by the secretary no additional program expenditures payments to a qualifying aco for items and services under this title for applicable beneficiaries for a year under the partial capitation model shall be established in a manner that does not result in spending more for such aco for such beneficiaries than would otherwise be expended for such aco for such beneficiaries for such year if the pilot program were not implemented as estimated by the secretary other payment models a in general subject to subparagraph the secretary develop other payment models that meet the goals of this pilot program to improve quality and efficiency no additional program expenditures subparagraph of paragraph shall apply to a payment model under subparagraph a in a similar manner as such subparagraph applies to the payment model under paragraph annual quality targets verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general the secretary shall establish annual quality targets that qualifying acos must meet to receive incentive payments operate at financial risk or otherwise participate in alternative financing models under this section the secretary shall establish a process for developing annual targets based on aco reporting of multiple quality measures in selecting measures the secretary shall a for years one and two of each acos participation in the pilot program established by this section require reporting of a starter set of measures focused on clinical care care coordination and patient experience of care and for each subsequent year require reporting of a more comprehensive set of clinical outcomes measures care coordination measures and patient experience of care measures measure selection to the extent feasible the secretary shall select measures that reflect national priorities for quality improvement and patient centered care consistent with the measures developed under section applicable beneficiaries verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general in this section the term applicable beneficiary means with respect to a qualifying aco an individual who a is enrolled under part and entitled to benefits under part a is not enrolled in a medicare advantage plan under part or a pace program under section and meets such other criteria as the secretary determines appropriate which include criteria relating to frequency of contact with physicians in the aco following applicable beneficiaries the secretary monitor data on expenditures and quality of services under this title after an applicable beneficiary discontinues receiving services under this title through a qualifying aco implementation starting date the pilot program shall begin no later than january an agreement with a qualifying aco under the pilot program cover a multi year period of between and years waiver the secretary waive such provisions of this title including section andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih title xi in the manner the secretary determines necessary in order implement the pilot program performance results reports the secretary shall report performance results to qualifying acos under the pilot program at least annually limitations on review there shall be no administrative or judicial review under section section or otherwise of a the elements parameters scope and duration of the pilot program the selection of qualifying acos for the pilot program the establishment of targets measurement of performance determinations with respect to whether savings have been achieved and the amount of savings determinations regarding whether to whom and in what amounts incentive payments are paid and decisions about the extension of the program under subsection expansion of the program under subsection or extensions under subsections or verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih administration chapter of title united states code shall not apply to this section evaluation monitoring in general the secretary shall evaluate the payment incentive model for each qualifying aco under the pilot program to assess impacts on beneficiaries providers of services suppliers and the program under this title the secretary shall make such evaluation publicly available within days of the date of completion of such report monitoring the inspector general of the department of health and human services shall provide for monitoring of the operation of acos under the pilot program with regard to violations of section popularly known as the stark law extension of pilot agreement with successful organizations reports to congress not later than years after the date the first agreement is entered into under this section and biennially thereafter for six years the secretary shall submit to congress and make publicly available a report on the use of aco payment models under the pilot program each report shall address the impact of the use of thoseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih models on expenditures access and quality under this title extension subject to the report provided under paragraph with respect to a qualifying aco the secretary extend the duration of the agreement for such aco under the pilot program as the secretary determines appropriate if a the aco receives incentive payments with respect to any of the first years of the pilot agreement and is consistently meeting quality standards or the aco is consistently exceeding quality standards and is not increasing spending under the program termination the secretary terminate an agreement with a qualifying aco under the pilot program if such aco did not receive incentive payments or consistently failed to meet quality standards in any of the first years under the program expansion to additional acos testing and refinement of payment incentive models subject to the evaluation described in subsection the secretary enter into agreements under the pilot program with addi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tional qualifying acos to further test and refine payment incentive models with respect to qualifying acos expanding use of successful models to program implementation a in general subject to subparagraph the secretary issue regulations to implement on a permanent basis or more models if and to the extent that such models are beneficial to the program under this title as determined by the secretary certification the chief actuary of the centers for medicare medicaid services shall certify that or more of such models described in subparagraph a would result in estimated spending that would be less than what spending would otherwise be estimated to be in the absence of such expansion treatment of physician group practice demonstration extension the secretary enter in to an agreement with a qualifying aco under the demonstration under section a subject to rebasing and other modifications deemed appropriateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by the secretary until the pilot program under this section is operational transition for purposes of extension of an agreement with a qualifying aco under subsection the secretary shall treat receipt of an incentive payment for a year by an organization under the physician group practice demonstration pursuant to section a as a year for which an incentive payment is made under such subsection as long as such practice group practice organization meets the criteria under subsection additional provisions authority for separate incentive arrangements the secretary create separate incentive arrangements including using multiple years of data varying thresholds varying shared savings amounts and varying shared savings limits for different categories of qualifying acos to reflect variation in average annual attributable expenditures and other matters the secretary deems appropriate encouragement of participation of smaller organizations in order to encourage the participation of smaller accountable care organizations under the pilot program the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih limit a qualifying aco exposure to high cost patients under the program involvement in private payer and other third party arrangements the secretary give preference to acos who are participating in similar arrangements with other payers antidiscrimination limitation the secretary shall not enter into an agreement with an entity to provide health care items or services under the pilot program or with an entity to administer the program unless such entity guarantees that it will not deny limit or condition the coverage or provision of benefits under the program for individuals eligible to be enrolled under such program based on any health status related factor described in section a of the public health service act funding for purposes of administering and carrying out the pilot program other than for payments for items and services furnished under this title and incentive payments under subsection in addition to funds otherwise appropriated there are appropriated to the secretary for the center for medicare medicaid services program management account for each of fiscal years through and for fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amounts appropriated under this paragraph for a fiscal year shall be available until expended no duplication in payments to physicians in multiple pilots the secretary shall not make payments under this section to any physician group that is paid under section relating to medical homes or section relating to independence at home sec medical home pilot program a in general title xviii of the social security act is amended by inserting after section as inserted by section the following new section medical home pilot program sec a establishment and medical home models establishment of pilot program the secretary shall establish a medical home pilot program in this section referred to as the pilot program for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient centered medical homes for furnishing medical home services as defined under subsection to beneficiaries as defined in subsection and to targeted high need beneficiaries as defined in subsection c verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih scope subject to subsection the secretary shall set specific goals for the number of practices and communities and the number of patients served under the pilot program in the initial tests to ensure that the pilot program is of sufficient size and scope to a test the approach involved in a variety of settings including urban rural and underserved areas and subject to subsection disseminate such approach rapidly on a national basis to the extent that the secretary finds a medical home model to be successful in improving quality and reducing costs the secretary shall implement such model on as large a geographic scale as practical and economical models of medical homes in the pilot program the pilot program shall evaluate each of the following medical home models a independent patient centered medical home model independent patientcentered medical home model under subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih community based medical home model community based medical home model under subsection participation of nurse practitioners and physician assistants a nothing in this section shall be construed as preventing a nurse practitioner from leading a patient centered medical home so long as all the requirements of this section are met and the nurse practitioner is acting in a manner that is consistent with state law nothing in this section shall be construed as preventing a physician assistant from participating in a patient centered medical home so long as all the requirements of this section are met and the physician assistant is acting in a manner that is consistent with state law definitions for purposes of this section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih patient centered medical home services the term patient centered medical home services means services that a provide beneficiaries with direct and ongoing access to a primary care or principal care physician or nurse practitioner who accepts responsibility for providing first contact continuous and comprehensive care to such beneficiary coordinate the care provided to a beneficiary by a team of individuals at the practice level across office provider of services and home settings led by a primary care or principal care physician or nurse practitioner as needed and appropriate provide for all the patient health care needs or take responsibility for appropriately arranging care with other qualified physicians or providers for all stages of life provide continuous access to care and communication with participating beneficiaries provide support for patient self management proactive and regular patient monitoring support for family caregivers use pa verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tient centered processes and coordination with community resources integrate readily accessible clinically useful information on participating patients that enables the practice to treat such patients comprehensively and systematically and implement evidence based guidelines and apply such guidelines to the identified needs of beneficiaries over time and with the intensity needed by such beneficiaries primary care the term primary care means health care that is provided by a physician nurse practitioner or physician assistant who practices in the field of family medicine general internal medicine geriatric medicine or pediatric medicine principal care the term principal care means integrated accessible health care that is provided by a physician who is a medical specialist or subspecialist that addresses the majority of the personal health care needs of patients with chronic conditions requiring the specialist or subspecialist expertise and for whom the specialist or subspecialist assumes care managementverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih beneficiaries the term beneficiaries means with respect to a qualifying medical home an individual who a is enrolled under part and entitled to benefits under part a is not enrolled in a medicare advantage plan under part or a pace program under section and meets such other criteria as the secretary determines appropriate independent patient centered medical home model in general a payment authority under the independent patient centered medical home model under this subsection the secretary shall make payments for medical home services furnished by an independent patient centered medical home as defined in subparagraph pursuant to paragraph for targeted high need beneficiaries as defined in subparagraph independent patient centered medical home defined in this section the term independent patient centered medicalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih home means a physician directed or nursepractitioner directed practice that is qualified under paragraph as providing beneficiaries with patient centered medical home services and meets such other requirements as the secretary specify targeted high need beneficiary defined for purposes of this subsection the term targeted high need beneficiary means a beneficiary who based on a risk score as specified by the secretary is generally within the upper th percentile of medicare beneficiaries beneficiary election to participate the secretary shall determine an appropriate method of ensuring that beneficiaries have agreed to participate in the pilot program implementation the pilot program under this subsection shall begin no later than months after the date of the enactment of this section and shall operate for years qualification process for patientcentered medical homes the secretary shall establish a process for practices to qualify as medical homesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih payment a establishment of methodology the secretary shall establish a methodology for the payment for medical home services furnished by independent patient centered medical homes under such methodology the secretary shall adjust payments to medical homes based on beneficiary risk scores to ensure that higher payments are made for higher risk beneficiaries per beneficiary per month payments under such payment methodology the secretary shall pay independent patient centered medical homes a monthly fee for each targeted high need beneficiary who consents to receive medical home services through such medical home prospective payment the fee under subparagraph shall be paid on a prospective basis amount of payment in determining the amount of such fee the secretary shall consider the following the clinical work and practice expenses involved in providing the medicalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih home services provided by the independent patient centered medical home such as providing increased access care coordination population disease management and teaching self care skills for managing chronic illnesses for which payment is not made under this title as of the date of the enactment of this section allow for differential payments based on capabilities of the independent patient centered medical home iii use appropriate risk adjustment in determining the amount of the per beneficiary per month payment under this paragraph in a manner that ensures that higher payments are made for higher risk beneficiaries encouraging participation of variety of practices the pilot program under this subsection shall be designed to include the participation of physicians in practices with fewer than full time equivalent physicians as well as physicians in larger practices particularly in underserved and rural areas as well as federally qualified health centers and rural health centersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih community based medical home model in general a authority for payments under the community based medical home model under this subsection in this section referred to as the cbmh model the secretary shall make payments for the furnishing of medical home services by a community based medical home as defined in subparagraph pursuant to paragraph for beneficiaries community based medical home defined in this section the term community based medical home means a nonprofit community based or state based organization or a state that is certified under paragraph as meeting the following requirements the organization provides beneficiaries with medical home services the organization provides medical home services under the supervision of and in close collaboration with the primary care or principal care physician nurse practitioner or physician assistant designated by the beneficiary as his or her community based medical home providerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii the organization employs community health workers including nurses or other non physician practitioners lay health workers or other persons as determined appropriate by the secretary that assist the primary or principal care physician nurse practitioner or physician assistant in chronic care management activities such as teaching self care skills for managing chronic illnesses transitional care services care plan setting nutritional counseling medication therapy management services for patients with multiple chronic diseases or help beneficiaries access the health care and community based resources in their local geographic area iv the organization meets such other requirements as the secretary specify qualification process for community based medical homes the secretary shall establish a process to provide for the review and qualification of community based medical homes pursuant to criteria established by the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih duration the pilot program for community based medical homes under this subsection shall start no later than years after the date of the enactment of this section each demonstration site under the pilot program shall operate for a period of up to years after the initial implementation phase without regard to the receipt of a initial implementation funding under paragraph preference in selecting sites for the cbmh model the secretary shall give preference to applications which seek to eliminate health disparities as defined in section of the public health service act and give preference to any of the following a applications that propose to coordinate health care items and services under this title for chronically ill beneficiaries who rely for primary care on small physician or nurse practitioner practices federally qualified health centers rural health clinics or other settings with limited resources and scope of services applications that include other thirdparty payors that furnish medical home services for chronically ill patients covered by such third party payorsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applications from states that propose to use the medical home model to coordinate health care services for individuals enrolled under this title individuals enrolled under title xix and iii full benefit dual eligible individuals as defined in section with chronic diseases across a variety of health care settings payments a establishment of methodology the secretary shall establish a methodology for the payment for medical home services furnished under the cbmh model per beneficiary per month payments under such payment methodology the secretary shall make two separate monthly payments for each beneficiary who consents to receive medical home services through such medical home as follows payment to community based organization one monthly payment toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a community based or state based organization or state payment to primary or principal care practice one monthly payment to the primary or principal care practice for such beneficiary prospective payment the payments under subparagraph shall be paid on a prospective basis amount of payment in determining the amount of such payment under subparagraph the secretary shall consider the following the clinical work and practice expenses involved in providing the medical home services provided by the primary or principal care practice such as providing increased access care coordination care planning population disease management and teaching self care skills for managing chronic illnesses for which payment is not made under this title as of the date of the enactment of this section use appropriate risk adjustment in determining the amount of the per bene verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ficiary per month payment under this paragraph iii in the case of the models described in subparagraphs and of paragraph the secretary determine an appropriate payment amount initial implementation funding the secretary make available initial implementation funding to a non profit community based or state based organization or a state that is participating in the pilot program under this subsection such organization shall provide the secretary with a detailed implementation plan that includes how such funds will be used the secretary shall select a territory of the united states as one of the locations in which to implement the pilot program under this subsection unless no organization in a territory is able to comply with the requirements under paragraph expansion of program evaluation of cost and quality the secretary shall evaluate the pilot program to determine a the extent to which medical homes result in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih improvement in the quality and coordination of items and services under this title particularly with regard to the care of complex patients improvement in reducing health disparities iii reductions in preventable hospitalizations iv prevention of readmissions reductions in emergency room visits vi improvement in health outcomes including patient functional status where applicable vii improvement in patient satisfaction viii improved efficiency of care such as reducing duplicative diagnostic tests and laboratory tests and ix reductions in health care expenditures and the feasability and advisability of reimbursing medical homes for medical home services under this title on a permanent basisverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih report not later than days after the date of completion of the evaluation under paragraph the secretary shall submit to congress and make available to the public a report on the findings of the evaluation under paragraph and the extent to which standards for the certification of medical homes need to be periodically updated expansion of program a in general subject to the results of the evaluation under paragraph and subparagraph the secretary issue regulations to implement on a permanent basis one or more models if and to the extent that such model or models are beneficial to the program under this title including that such implementation will improve quality of care as determined by the secretary certification requirement the secretary not issue such regulations unless the chief actuary of the centers for medicare medicaid services certifies that the expansion of the components of the pilot program described in subparagraph a would result in estimated spending under this title that would be no more than the level of spending that theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih secretary estimates would otherwise be spent under this title in the absence of such expansion updated standards the secretary shall periodically review and update the standards for qualification as an independent patient centered medical home and as a community based medical home and shall establish a process for ensuring that medical homes meet such updated standards as applicable administrative provisions no duplication in payments for individuals in medical homes during any month the secretary not make payments under this section under more than one model or through more than one medical home under any model for the furnishing of medical home services to an individual no effect on payment for medical visits payments made under this section are in addition to and have no effect on the amount of payment for medical visits made under this title administration chapter of title united states code shall not apply to this section no duplication in physician pilot participation the secretary shall not make pay verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ments to an independent or community based medical home both under this section and section or unless the pilot program under this section has been implemented on a permanent basis under subsection waiver the secretary waive such provisions of this title and title xi in the manner the secretary determines necessary in order to implement this section funding operational costs for purposes of administering and carrying out the pilot program including the design implementation technical assistance for and evaluation of such program in addition to funds otherwise available there shall be transferred from the federal supplementary medical insurance trust fund under section to the secretary for the centers for medicare medicaid services program management account for each of fiscal years through amounts appropriated under this paragraph for a fiscal year shall be available until expended patient centered medical home services in addition to funds otherwise available there shall be available to the secretary for the cen verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ters for medicare medicaid services from the federal supplementary medical insurance trust fund under section a for each of fiscal years through for payments for medical home services under subsection and for each of fiscal years through for payments under subsection amounts available under this paragraph for a fiscal year shall be available until expended initial implementation in addition to funds otherwise available there shall be available to the secretary for the centers for medicare medicaid services from the federal supplementary medical insurance trust fund under section for each of fiscal years through under subsection amounts available under this paragraph for a fiscal year shall be available until expended treatment of trhca medicare medical home demonstration funding in addition to funds otherwise available for payment of medical home services under subsection there shall also be available the amount pro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vided in subsection of section of division of the tax relief and health care act of usc b– note as added by section of the medicare improvements for patients and providers act of public law notwithstanding section of the affordable health care for america act in addition to funds provided in paragraph and subsection a the funding for medical home services that would otherwise have been available if such section medical home demonstration had been implemented without regard to subsection of such section shall be available to the independent patient centered medical home model described in subsection effective date the amendment made by this section shall apply to services furnished on or after the date of the enactment of this act conforming repeal section of division of the tax relief and health care act of usc b– note as amended by section a of the medicare improvements for patients and providers act of public law – is repealedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec payment incentive for selected primary care services a in general section of the social security act is amended by inserting after subsection the following new subsection primary care payment incentives in general in the case of primary care services as defined in paragraph furnished on or after january by a primary care practitioner as defined in paragraph for which amounts are payable under section in addition to the amount otherwise paid under this part there shall also be paid to the practitioner or to an employer or facility in the cases described in clause a of section on a monthly or quarterly basis from the federal supplementary medical insurance trust fund an amount equal percent or percent if the practitioner predominately furnishes such services in an area that is designated under section a a of the public health service act as a primary care health professional shortage area primary care services defined in this subsection the term primary care services a mean evaluation and management services without regard to the specialty of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih physician furnishing the services that are procedure codes for services covered under this title for services in the category designated evaluation and management in the health care common procedure coding system established by the secretary under section as of december and as subsequently modified by the secretary and preventive services as defined in section iii for which payment is made under this section and includes services furnished by another health care professional that would be described in subparagraph a if furnished by a physician primary care practitioner defined in this subsection the term primary care practitioner a means a physician or other health care practitioner including a nurse practitioner who specializes in family medicine general internal medicine general pediat verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih rics geriatrics or obstetrics and gynecology and has allowed charges for primary care services that account for at least percent of the physician or practitioner total allowed charges under section as determined by the secretary for the most recent period for which data are available and includes a physician assistant who is under the supervision of a physician described in subparagraph a limitation on review there shall be no administrative or judicial review under section section or otherwise respecting a any determination or designation under this subsection the identification of services as primary care services under this subsection and the identification of a practitioner as a primary care practitioner under this subsection coordination with other payments verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a with other primary care incentives the provisions of this subsection shall not be taken into account in applying subsections and and any payment under such subsections shall not be taken into account in computing payments under this subsection with quality incentives payments under this subsection shall not be taken into account in determining the amounts that would otherwise be paid under this part for purposes of section conforming amendments section of such act usc is amended by redesignating paragraph as paragraph and by inserting after paragraph the following new paragraph the provisions of this subsection shall not be taken into account in applying subsections or and any payment under such subsections shall not be taken into account in computing payments under this subsection section of such act usc w– is amended by inserting after verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section iv of such act usc w– iv is amended by inserting primary care before health professional shortage area sec increased reimbursement rate for certified nurse midwives a in general section a of the social security act uscl a is amended by striking but in no event and all that follows through performed by a physician effective date the amendment made by subsection a shall apply to services furnished on or after january sec coverage and waiver of cost sharing for preventive services a medicare covered preventive services defined section of the social security act usc as amended by section a is amended by adding at the end the following new subsection medicare covered preventive services iii subject to the succeeding provisions of this subsection the term medicare covered preventive services means the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a prostate cancer screening tests as defined in subsection oo colorectal cancer screening tests as defined in subsection pp diabetes outpatient self management training services as defined in subsection qq screening for glaucoma for certain individuals as described in subsection medical nutrition therapy services for certain individuals as described in subsection an initial preventive physical examination as defined in subsection ww cardiovascular screening blood tests as defined in subsection xx diabetes screening tests as defined in subsection yy ultrasound screening for abdominal aortic aneurysm for certain individuals as described in subsection aa federally approved and recommended vaccines and their administration as described in subsection screening mammography as defined in subsection jj verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih screening pap smear and screening pelvic exam as defined in subsection nn bone mass measurement as defined in subsection rr kidney disease education services as defined in subsection ggg additional preventive services as defined in subsection ddd with respect to specific medicare covered preventive services the limitations and conditions described in the provisions referenced in paragraph with respect to such services shall apply payment and elimination of cost sharing in general a in general section a of the social security act usc a is amended by adding after and below paragraph the following with respect to medicare covered preventive services in any case in which the payment rate otherwise provided under this part is computed as a percent of less than percent of an actual charge fee schedule rate or other rate such percentage shall be increased to percent verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih application to sigmoidoscopies and colonoscopies section of such act usc is amended in paragraph by amending clause to read as follows no coinsurance in the case of a beneficiary who receives services described in clause there shall be no coinsurance applied and in paragraph by amending clause to read as follows no coinsurance in the case of a beneficiary who receives services described in clause there shall be no coinsurance applied elimination of coinsurance in outpatient hospital settings a exclusion from opd fee schedule section iv of the social security act usc iv is amended by striking screening mammography as defined in section jj and diagnostic mammography and inserting diagnostic mammograms and medicare covered preventive services as defined in section iii verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conforming amendments section a of the social security act usc a is amended in subparagraph by striking and after the semicolon at the end in subparagraph by adding and at the end and iii by adding at the end the following new subparagraph with respect to additional preventive services as defined in section ddd furnished by an outpatient department of a hospital the amount determined under paragraph waiver of application of deductible for all preventive services the first sentence of section of the social security act usc is amended a in clause by striking items and services described in section a and inserting medicare covered preventive services as defined in section iii by inserting and before and by striking clauses through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih application to providers of services section a a of such act usc cc a a is amended by inserting other than for medicare covered preventive services and after for such items and services effective date the amendments made by this section shall apply to services furnished on or after january preventive services report to congress on barriers to preventive services not later than months after the date of the enactment of this act the secretary of health and human services shall report to congress on barriers if any facing medicare beneficiaries in accessing the benefit to abdominal aortic aneurysm screening and other preventative services through the welcome to medicare physical exam abdominal aortic aneurysm screen access the secretary shall to the extent practical identify and implement policies promoting proper use of abdominal aortic aneurysm screening among medicare beneficiaries at risk for such aneurysmsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec waiver of deductible for colorectal cancer screening tests regardless of coding subsequent diagnosis or ancillary tissue removal a in general section of the social security act usc as amended by section is further amended in subsection a in the sentence added by section a by inserting including services described in the last sentence of section after preventive services and in subsection by adding at the end the following new sentence clause of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test or for the removal of tissue or other matter or other procedure that is furnished in connection with as a result of and in the same clinical encounter as the screening test effective date the amendment made by subsection a shall apply to items and services furnished on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment a in general section a of the social security act usc yy a is amended by inserting clinical social worker services after qualified psychologist services conforming amendment section hh of the social security act usc hh is amended by striking and other than services furnished to an inpatient of a skilled nursing facility which the facility is required to provide as a requirement for participation effective date the amendments made by this section shall apply to items and services furnished on or after october sec coverage of marriage and family therapist services and mental health counselor services a coverage of marriage and family therapist services coverage of services section of the social security act uscverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as amended by section is amended a in subparagraph ee by striking and at the end in subparagraph ff by adding and at the end and by adding at the end the following new subparagraph gg marriage and family therapist services as defined in subsection jjj definition section of the social security act usc as amended by sections and is amended by adding at the end the following new subsection marriage and family therapist services jjj the term marriage and family therapist services means services performed by a marriage and family therapist as defined in paragraph for the diagnosis and treatment of mental illnesses which the marriage and family therapist is legally authorized to perform under state law or the state regulatory mechanism provided by state law of the state in which such services are performed as would otherwise be covered if furnished by a physician or as incident to a physician professional service but only if no facility or other provider chargesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or is paid any amounts with respect to the furnishing of such services the term marriage and family therapist means an individual who a possesses a master or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to state law after obtaining such degree has performed at least years of clinical supervised experience in marriage and family therapy and is licensed or certified as a marriage and family therapist in the state in which marriage and family therapist services are performed provision for payment under part section a of the social security act usc a is amended by adding at the end the following new clause marriage and family therapist services amount of payment a in general section a of the social security act usc a is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking and before and by inserting before the semicolon at the end the following and with respect to marriage and family therapist services under section gg the amounts paid shall be percent of the lesser of the actual charge for the services or percent of the amount determined for payment of a psychologist under clause development of criteria with respect to consultation with a health care professional the secretary of health and human services shall taking into consideration concerns for patient confidentiality develop criteria with respect to payment for marriage and family therapist services for which payment be made directly to the marriage and family therapist under part of title xviii of the social security act usc et seq under which such a therapist must agree to consult with a patient attending or primary care physician or nurse practitioner in accordance with such criteriaverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih exclusion of marriage and family therapist services from skilled nursing facility prospective payment system section a of the social security act usc yy a as amended by section a is amended by inserting marriage and family therapist services as defined in subsection jjj after clinical social worker services coverage of marriage and family therapist services provided in rural health clinics and federally qualified health centers section aa of the social security act usc aa is amended by striking or by a clinical social worker as defined in subsection hh and inserting by a clinical social worker as defined in subsection hh or by a marriage and family therapist as defined in subsection jjj inclusion of marriage and family therapists as practitioners for assignment of claims section of the social security act usc is amended by adding at the end the following new clause vii a marriage and family therapist as defined in section jjj verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih coverage of mental health counselor services coverage of services section of the social security act usc as previously amended is further amended a in subparagraph ff by striking and at the end in subparagraph gg by inserting and at the end and by adding at the end the following new subparagraph hh mental health counselor services as defined in subsection kkk definition section of the social security act usc as previously amended is amended by adding at the end the following new subsection mental health counselor services kkk the term mental health counselor services means services performed by a mental health counselor as defined in paragraph for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under state law or the state regulatory mechanism provided by the state law ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the state in which such services are performed as would otherwise be covered if furnished by a physician or as incident to a physician professional service but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services the term mental health counselor means an individual who a possesses a master or doctor degree which qualifies the individual for licensure or certification for the practice of mental health counseling in the state in which the services are performed after obtaining such a degree has performed at least years of supervised mental health counselor practice and is licensed or certified as a mental health counselor or professional counselor by the state in which the services are performed provision for payment under part section a of the social security act usc a as amended by subsection a is further amended a by striking and at the end of clause iv by adding and at the end of clause andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end the following new clause vi mental health counselor services amount of payment a in general section a of the social security act usc a as amended by subsection a is further amended by striking and before and by inserting before the semicolon at the end the following and with respect to mental health counselor services under section hh the amounts paid shall be percent of the lesser of the actual charge for the services or percent of the amount determined for payment of a psychologist under clause development of criteria with respect to consultation with a physician the secretary of health and human services shall taking into consideration concerns for patient confidentiality develop criteria with re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih spect to payment for mental health counselor services for which payment be made directly to the mental health counselor under part of title xviii of the social security act usc et seq under which such a counselor must agree to consult with a patient attending or primary care physician in accordance with such criteria exclusion of mental health counselor services from skilled nursing facility prospective payment system section a of the social security act usc yy a as amended by section a and subsection a is amended by inserting mental health counselor services as defined in section kkk after marriage and family therapist services as defined in subsection jjj coverage of mental health counselor services provided in rural health clinics and federally qualified health centers section aa of the social security act usc aa as amended by subsection a is amended by striking or by a marriage and family therapist as defined in sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section jjj and inserting by a marriage and family therapist as defined in subsection jjj or a mental health counselor as defined in subsection kkk inclusion of mental health counselors as practitioners for assignment of claims section of the social security act usc as amended by subsection a is amended by adding at the end the following new clause viii a mental health counselor as defined in section kkk effective date the amendments made by this section shall apply to items and services furnished on or after january sec extension of physician fee schedule mental health add on section a of the medicare improvements for patients and providers act of public law – is amended by striking december and inserting december sec expanding access to vaccines a in general paragraph of section of the social security act usc is amended to read as follows verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih federally approved and recommended vaccines as defined in subsection lll and their respective administration federally approved and recommended vaccines defined section of such act is further amended by adding at the end the following new subsection federally approved and recommended vaccines lll the term federally approved and recommended vaccine means a vaccine that is licensed under section of the public health service act approved under the federal food drug and cosmetic act or authorized for emergency use under section of the federal food drug and cosmetic act and is recommended by the director of the centers for disease control and prevention conforming amendments section of such act usc is amended in each of subsections a a and a a by striking a and inserting each place it appears section a iv of such act usc a iv is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by striking subparagraph a or of and by inserting before the period the following and before january and influenza vaccines furnished on or after january section a of such act usc w–a is amended a in subparagraph by inserting including a vaccine furnished on or after january and by the following new paragraph implementation chapter of title united states code shall not apply to manufacturer provision of information pursuant to section a iii or subsection for purposes of implementation of this section section d– of such act usc w– is amended by striking such term includes a vaccine and all that follows through its administration and section ww a of such act usc ww a is amended by striking pneumococcal influenza and hepatitis vaccineverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and administration and inserting federally approved or authorized vaccines as defined in subsection lll and their respective administration section a iii of such act usc r– a iii is amended in the matter following subclause iii by inserting a iv including influenza vaccines furnished on or after january after described in subparagraph section a of such act usc w–a is amended a by striking for and inserting in general for by indenting paragraph as redesignated in subparagraph a ems to the left and by adding at the end the following new paragraph treatment of certain manufacturers in the case of a manufacturer of a drug or biological described in subparagraphs a iv or of section that does not have a rebate agreement under section a no payment be made under this part for such drug or biological if such manufacturer does not submitverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the information described in section a iii in the same manner as if the manufacturer had such a rebate agreement in effect subparagraphs and of section shall apply to information reported pursuant to the previous sentence in the same manner as such subparagraphs apply with respect to information reported pursuant to such section effective dates the amendments made by this section other than by subsection shall apply to vaccines administered on or after january and by subsection shall apply to calendar quarters beginning on or after january sec expansion of medicare covered preventive services at federally qualified health centers a in general section aa a of the social security act usc aa a is amended to read as follows a services of the type described subparagraphs a through of paragraph and services described in section iii and verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendment made by subsection a shall apply not later than january sec independence at home demonstration program title xviii of the social security act is amended by inserting after section as inserted by section the following new section independence at home medical practice demonstration program sec a establishment in general the secretary shall conduct a demonstration program in this section referred to as the demonstration program to test a payment incentive and service delivery model that utilizes physician and nurse practitioner directed home based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries as defined in subsection requirement the demonstration program shall test whether a model described in paragraph which is accountable for providing comprehensive coordinated continuous and accessible care to high need populations at home and coordinating health care across all treatment settings results in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a reducing preventable hospitalizations preventing hospital readmissions reducing emergency room visits improving health outcomes commensurate with the beneficiaries stage of chronic illness improving the efficiency of care such as by reducing duplicative diagnostic and laboratory tests reducing the cost of health care services covered under this title and achieving beneficiary and family caregiver satisfaction independence at home medical practice independence at home medical practice defined in this section a in general the term independence at home medical practice means a legal entity that is comprised of an individual physician or nurse practitioner or group of physicians and nurse practitioners that provides care as part of a team that includes physicians nurses physician assist verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ants pharmacists and other health and social services staff as appropriate who have experience providing home based primary care to applicable beneficiaries make in home visits and are available hours per day days per week to carry out plans of care that are tailored to the individual beneficiary chronic conditions and designed to achieve the results in subsection a is organized at least in part for the purpose of providing physicians services iii has documented experience in providing home based primary care services to high cost chronically ill beneficiaries as determined appropriate by the secretary iv includes at least applicable beneficiaries as defined in subsection has entered into an agreement with the secretary vi uses electronic health information systems remote monitoring and mobile diagnostic technology andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vii meets such other criteria as the secretary determines to be appropriate to participate in the demonstration program physician the term physician includes except as the secretary otherwise provide any individual who furnishes services for which payment be made as physicians services and has the medical training or experience to fulfill the physician role described in subparagraph a participation of nurse practitioners and physician assistants nothing in this section shall be construed to prevent a nurse practitioner or physician assistant from participating in or leading a home based primary care team as part of an independence at home medical practice if a all the requirements of this section are met the nurse practitioner or physician assistant as the case be is acting consistent with state law and the nurse practitioner or physician assistant has the medical training or experience to fulfill the nurse practitioner or physician assistant role described in paragraph a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih inclusion of providers and practitioners nothing in this subsection shall be construed as preventing an independence at home medical practice from including a provider of services or a participating practitioner described in section that is affiliated with the practice under an arrangement structured so that such provider of services or practitioner participates in the demonstration program and shares in any savings under the demonstration program quality and performance standards a in general an independence at home medical practice participating in the demonstration program shall report on quality measures in such form manner and frequency as specified by the secretary which be for the group for providers of services and suppliers or both and report to the secretary in a form manner and frequency as specified by the secretary such data as the secretary determines appropriate to monitor and evaluate the demonstration program development of quality performance standards the secretary shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih develop quality performance standards for independence at home medical practices participating in the demonstration program shared savings payment methodology establishment of target spending level the secretary shall establish annual target spending levels for items and services covered under parts a and furnished to applicable beneficiaries by qualifying independence at home medical practices under this section the secretary set an aggregate target spending level for all qualifying practices or set different target spending levels for groups of practices or a single practice such target spending levels be determined on a per capita basis and shall take into account normal variation in expenditures for items and services covered under parts a and furnished to such beneficiaries the target shall also be adjusted for the size of the practice number of practices included in the target spending level characteristics of applicable beneficiaries and such other factors as the secretary determines appropriate the secretary periodically adjust or rebase the target spending level under this paragraph shared savings amounts verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general subject to subparagraph qualifying independence at home medical practices are eligible to receive an incentive payment under this section if aggregate expenditures for a year for applicable beneficiaries are less than the target spending level for qualifying independence at home medical practices for such year an incentive payment for such year shall be equal to a portion as determined by the secretary of the amount by which total payments for applicable beneficiaries under parts a and for such year are estimated to be less than percent less than the target spending level for such year as determined by the secretary apportionment of savings the secretary shall designate how and to what extent an incentive payment under this section is to be apportioned among qualifying independence at home medical practices taking into account the size of the practice characteristics of the individuals enrolled in each practice performance on quality performance measures and such other factors as the secretary determines appropriateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih savings to the medicare program the secretary shall limit incentive payments to each qualifying independence at home medical practice under this paragraph with respect to a year as necessary to ensure that the aggregate expenditures for items and services under parts a and with respect to applicable beneficiaries for such independence at home medical practice inclusive of shared savings payments do not exceed the amount that the secretary estimates would be expended for such items and services for such beneficiaries during such year taking into account normal variation in expenditures and other factors the secretary deems appropriate if the demonstration program under this section were not implemented minus percent applicable beneficiaries definition in this section the term applicable beneficiary means with respect to a qualifying independence at home medical practice an individual who the practice has determined a is entitled to benefits under part a and enrolled for benefits under part is not enrolled in a medicare advantage plan under part or a pace program under section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has or more chronic illnesses such as congestive heart failure diabetes other dementias designated by the secretary chronic obstructive pulmonary disease ischemic heart disease stroke alzheimer disease and neurodegenerative diseases and other diseases and conditions designated by the secretary which result in high costs under this title within the past months has had a nonelective hospital admission within the past months has received acute or subacute rehabilitation services has or more functional dependencies requiring the assistance of another person such as bathing dressing toileting walking or feeding and meets such other criteria as the secretary determines appropriate patient election to participate the secretary shall determine an appropriate method of ensuring that applicable beneficiaries have agreed to enroll in an independence at home medical practice under the demonstration program enrollment in the demonstration program shall be voluntaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih beneficiary access to services nothing in this section shall be construed as encouraging physicians or nurse practitioners to limit applicable beneficiary access to services covered under this title and applicable beneficiaries shall not be required to relinquish access to any benefit under this title as a condition of receiving services from an independence at home medical practice implementation starting date the demonstration program shall begin not later than january an agreement with an independence at home medical practice under the demonstration program cover not more than a year period no physician duplication in demonstration participation the secretary shall not pay an independence at home medical practice under this section that participates in section or section no beneficiary duplication in demonstration participation the secretary shall ensure that no applicable beneficiary enrolled in an independence at home medical practice under this section is participating in the programs under section or section everdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih preference in approving an independence at home medical practice the secretary shall give preference to practices that are a located in high cost areas of the country have experience in furnishing health care services to applicable beneficiaries in the home and use electronic medical records health information technology and individualized plans of care number of practices a in general subject to subparagraph the secretary shall enter into agreements with as many independence at home medial practices as practicable and consistent with this subsection to test the potential of the independence at home medical practice model under this section in order to achieve the results described in subsection a across practices serving varying numbers of applicable beneficiaries limitation in selecting qualified independence at home medial practices to participate under the demonstration program the secretary shall limit the number of applicableverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih beneficiaries that participate in the demonstration program to waiver the secretary waive such provisions of this title and title xi as the secretary determines necessary in order to implement the demonstration program administration chapter of title united states code shall not apply to this section evaluation and monitoring in general the secretary shall evaluate each independence at home medical practice under the demonstration program to assess whether the practice achieved the results described in subsection a following applicable beneficiaries the secretary monitor data on expenditures and quality of services under this title after an applicable beneficiary discontinues receiving services under this title through a qualifying independence at home medical practice reports to congress the secretary shall conduct an independent evaluation of the demonstration program and submit to congress a final report including best practices under the demonstration program such report shall include an analysis of the demonstration pro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gram on coordination of care expenditures under this title applicable beneficiary access to services and the quality of health care services provided to applicable beneficiaries funding for purposes of administering and carrying out the demonstration program other than for payments for items and services furnished under this title and shared savings under subsection in addition to funds otherwise appropriated there shall be transferred to the secretary for the center for medicare medicaid services program management account from the federal hospital insurance trust fund under section and the federal supplementary medical insurance trust fund under section for each of fiscal years through amounts transferred under this subsection for a fiscal year shall be available until expended antidiscrimination limitation the secretary shall not enter into an agreement with an entity to provide health care items or services under the demonstration program unless such entity guarantees that for individuals eligible to be enrolled in such program the entity will not deny limit or condition the coverage or provision of benefits to which the individual would have other verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih wise been entitled to on the basis of health status if not included in this program termination the secretary terminate an agreement with an independence at home medical practice if such practice does not receive incentive payments under subsection or consistently fails to meet quality standards sec recognition of certified diabetes educators as certified providers for purposes of medicare diabetes outpatient self management training services a in general section qq of the social security act usc qq is amended in paragraph by inserting or by a certified diabetes educator as defined in paragraph after paragraph and by adding at the end the following new paragraphs for purposes of paragraph the term certified diabetes educator means an individual who a is licensed or registered by the state in which the services are performed as a health care professional verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih specializes in teaching individuals with diabetes to develop the necessary skills and knowledge to manage the individual diabetic condition and is certified as a diabetes educator by a recognized certifying body as defined in paragraph a for purposes of paragraph the term recognized certifying body means the national certification board for diabetes educators or a certifying body for diabetes educators which is recognized by the secretary as authorized to grant certification of diabetes educators for purposes of this subsection pursuant to standards established by the secretary if the secretary determines such board or body respectively meets the requirement of subparagraph the national certification board for diabetes educators or a certifying body for diabetes educators meets the requirement of this subparagraph with respect to the certification of an individual if the board or body respectively is incorporated and registered to do business in the unitedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih states and requires as a condition of such certification each of the following the individual has a qualifying credential in a specified health care profession the individual has professional practice experience in diabetes self management training that includes a minimum number of hours and years of experience in such training iii the individual has successfully completed a national certification examination offered by such entity iv the individual periodically renews certification status following initial certification effective date the amendments made by subsection a shall apply to diabetes outpatient self management training services furnished on or after the first day of the first calendar year that is at least months after the date of the enactment of this act title iv quality subtitle a comparative effectiveness research sec comparative effectiveness research a in general title xi of the social security act is amended by adding at the end the following new part verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih part comparative effectiveness research comparative effectiveness research sec a center for comparative effectiveness research established 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 of the medicare prescription drug improvement and modernization act of 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 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conduct and support systematic reviews of clinical research including original research conducted subsequent to the date of the enactment of this section continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies and use such methodologies appropriately submit to the comparative effectiveness research commission the secretary and congress appropriate relevant reports described in subsection 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 highly credible research 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 andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih appoint clinical perspective advisory panels for research priorities under this section which shall consult with patients and other stakeholders 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 powers a obtaining official data the center 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 such department or agency shall furnish that information to the center on an agreed upon schedule data collection in order to carry out its functions the center shall utilize existing information both published and unpublished where possible collected and assessed either by its ownverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih staff or under other arrangements made in accordance with this section 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 in making reports and recommendations in carrying out clause the center award grants or contracts or provide for intergovernmental transfers as applicable to private entities and governmental agencies with experience in conducting comparative effectiveness research such as the national institutes of health and other relevant federal health agencies 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 immediately upon request periodic audit the center and commission under subsection shall be sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ject to periodic audit by the comptroller general comparative effectiveness research commission in general there is established an independent comparative effectiveness research commission in this section referred to as the commission to advise the center and evaluate the activities carried out by the center under subsection a to ensure such activities result in highly credible research and information resulting from such research duties the commission shall a recommend to the center national priorities for research described in subsection a which shall take into account disease incidence prevalence and burden in the united states evidence gaps in terms of clinical outcomes iii variations in practice delivery and outcomes by geography treatment site provider type disability variation in age group including children adolescents adults and seniors racial and ethnicverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih background gender genetic and molecular subtypes and other appropriate populations or subpopulations and iv the potential for new evidence concerning certain categories health care services or treatments to improve patient health and well being and the quality of care and in making such recommendations consult with a broad array of public and private stakeholders including patients and health care providers and payers monitor the appropriateness of use of the certf described in subsection with respect to the timely production of comparative effectiveness research recommended to be a national priority under subparagraph a identify highly credible research methods and standards of evidence for such research to be considered by the center review the methodologies developed by the center under subsection a support forums to increase stakeholder awareness and permit stakeholder feedback on the efforts of the center to advanceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih methods and standards that promote highly credible research make recommendations to the center 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 make recommendations to the center for the priority for periodic reviews of previous comparative effectiveness research and studies conducted by the center under subsection a at least annually review the processes of the center and make reports to congress and the president regarding research conducted supported or synthesized by the center to confirm that the information produced by such research is objective credible consistent with standards of evidence developed under this section and developed through a transparent process that includes consultations with appropriate stakeholders make recommendations to the center for the broad dissemination consistent with subsection of the findings of research con verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ducted and supported under this section that enables clinicians patients consumers and payers to make more informed health care decisions that improve quality and value and at least twice each year hold a public meeting with an opportunity for stakeholder input the reports under subparagraph shall not be submitted to the office of management and budget or to any other federal agency or executive department for any purpose prior to transmittal to congress and the president such reports shall be published on the public internet website of the commission after the date of such transmittal composition of commission a in general the members of the commission shall consist of the director of the agency for healthcare research and quality or their designee the chief medical officer of the centers for medicare medicaid services or their designee iii the director of the national institutes of health or their designee andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv additional members who shall represent broad constituencies of stakeholders including clinicians patients researchers third party payers and consumers of federal and state beneficiary programs of such members at least shall be practicing physicians health care practitioners consumers or patients qualifications 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 epidemiology health services research iii bioethics iv decision sciences health disparities vi health economics diverse representation of health care community at least one member shall represent each of the following health care communities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih patients health care consumers iii practicing physicians including surgeons iv other health care practitioners engaged in clinical care organizations with proven expertise in racial and ethnic minority health research vi employers vii public payers viii insurance plans ix clinical researchers who conduct research on behalf of pharmaceutical or device manufacturers limitation no more than of the members of the commission be representatives of pharmaceutical or device manufacturers and such representatives shall be clinical researchers described under subparagraph ix appointment the comptroller general shall appoint the members of the commission chairman vice chairman the comptroller general shall designate a member of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 comptroller general designate another member for the remainder of that member 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 of the public health service act terms a in general except as provided in subparagraph each member of the commission shall be appointed for a term of years terms of initial appointees of the members first appointed shall be appointed for a term of years and shall be appointed for a term of years 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 rateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provided for level iv of the executive schedule under section of title united states code and while so serving away from home and the member regular place of business a member be allowed travel expenses as authorized by the director of the commission director and staff experts and consultants subject to such review as the comptroller general deems necessary to assure the efficient administration of the commission the commission a appoint and set the compensation for an executive director subject to the approval of the comptroller general and such other personnel as federal employees under section of title united states code as be necessary to carry out its duties without regard to the provisions of title united states code governing appointments in the competitive service seek such assistance and support as be required in the performance of its duties from appropriate federal departments and agencies verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih enter into contracts or make other arrangements as be necessary for the conduct of the work of the commission without regard to section of the revised statutes usc make advance progress and other payments which relate to the work of the commission provide transportation and subsistence for persons serving without compensation and prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the commission obtaining official data the commission secure directly from any department or agency of the united states information necessary to enable the commission to carry out this section upon request of the chairman of the commission the head of such department or agency shall furnish the information to the commission on an agreed upon schedule availability of reports the commission shall transmit to the secretary a copy ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih each report submitted under this subsection and shall make such reports available to the public 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 conflicts of interest a in general in appointing the members of the commission or a clinical perspective advisory panel described in subsection a the comptroller general or the secretary respectively shall take into consideration any financial interest as defined in subparagraph consistent with this paragraph and develop a plan for managing any identified conflicts evaluation and criteria when considering an appointment to the commission or a clinical perspective advisory panel described subsection a the comptroller general or the secretary respectively shall review the expertise of the individual and the financial disclosure report filed by the individualverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pursuant to the ethics in government act of 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 of title united states code a written certification as referred to in section of title united states code or a waiver as referred to in subparagraph iii for service on the commission at a meeting of the commission disclosures prohibitions on participation waivers disclosure of financial interest prior to a meeting of the commission or a clinical perspective advisory panel described in subsection a regarding a particular matter as that term is used in section of title 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 comptroller general or secretary respectively financial interestsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in accordance with requiring a waiver under section of title united states code or other interests as deemed relevant by the secretary prohibitions on participation except as provided under clause iii a member of the commission or a clinical perspective advisory panel described in subsection a not participate with respect to a particular matter considered in meeting of the commission or the clinical perspective advisory panel if 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 comptroller general or secretary as applicable determines it necessary to afford the commission or a clinical perspective advisory panelverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih described in subsection a essential expertise the comptroller general or secretary respectively grant a waiver of the prohibition in clause to permit a member described in such subparagraph to participate as a non voting member with respect to a particular matter considered in a meeting of the commission or a clinical perspective advisory panel respectively or participate as a voting member with respect to a particular matter considered in a meeting of the commission iv limitation on waivers and other exceptions 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 commissionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 financial interest defined for purposes of this paragraph the term financial interest means a financial interest under section a of title united states code application of faca the federal advisory committee act other than section of such act shall apply to the commission to the extent that the provisions of such act do not conflict with the requirements of this subsection research requirements any research conducted supported or synthesized under this section shall meet the following requirements ensuring transparency credibility and access a the establishment of a research agenda by the center shall be informed by the na verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tional priorities for research recommended under subsection a the establishment of the agenda and conduct of the research shall be insulated from inappropriate political or stakeholder influence methods of conducting such research shall be scientifically based consistent with applicable law 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 consistent with applicable law the process and methods for conducting such research shall be publicly documented and available to all stakeholders 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 such research shall consider advice given to the center by the clinical perspective advisory panel for the particular national research priorityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 specific areas of consultation consultation shall include where deemed appropriate by the commission recommending research priorities and questions recommending research methodologies and iii advising on and assisting with efforts to disseminate research findings ombudsman the secretary shall designate a patient ombudsman the ombudsman shall serve as an available point of contact for any patients with an interest in proposed comparative effectiveness studies by the center and ensure that any comments from patients regarding proposed comparativeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effectiveness studies are reviewed by the center 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 services and systems used with various subpopulations such as racial and ethnic minorities women different age groups including children adolescents adults and seniors individuals with disabilities and individuals with different comorbidities and genetic and molecular subtypes and seek as feasible and appropriate to include members of such subpopulations as subjects in the research public access to comparative effectiveness information in general not later than days after receipt by the center or commission as applicable of a relevant report described in paragraph made by the center commission or clinical perspective advisory panel under this section appropriate information contained in such report shall beverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih posted on the official public internet site of the center and of the commission as applicable 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 stakeholder comments a final report dissemination and incorporation of comparative effectiveness information 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 relevant expert organizations as defined in subsection a 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih discuss findings and other considerations specific to certain sub populations risk factors and comorbidities as appropriate include considerations such as limitations of research and what further research be needed as appropriate 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 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 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 strat verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih egies the center shall consult with stakeholders concerning the types of dissemination that will be most useful to the end users of information and provide for the utilization of multiple formats for conveying findings to different audiences including dissemination to individuals with limited english proficiency reports to congress 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 shall submit to congress an annual report on the activities of the center as well as the research conducted under this section each such report shall include a discussion of the center compliance with subsection including any reasons for lack of compliance with such subsection recommendation for fair share per capita amount for all payer financing beginning not later than december the secretary shall submit to congress an annual recommendation for a fair share per capita amount described in subsection of section of the internal revenue code of for purposes of funding the certf under such sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih analysis and review not later than december 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 center but not funded funding of comparative effectiveness research for fiscal year and each subsequent fiscal year amounts in the comparative effectiveness research trust fund referred to in this section as the certf under section of the internal revenue code of shall be available in accordance with such section without the need for further appropriations and without fiscal year limitation to carry out this section construction coverage nothing in this section shall be construed a to permit the center or commission to mandate coverage reimbursement or other policies for any public or private payer or as preventing the secretary from covering the routine costs of clinical care receivedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by an individual entitled to or enrolled for benefits under title xviii xix or xxi in the case where such individual is participating in a clinical trial and such costs would otherwise be covered under such title with respect to the beneficiary reports and findings none of the reports submitted under this section or research findings disseminated by the center or commission shall be construed as mandates for payment coverage or treatment protecting the physician patient relationship nothing in this section shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine consultation with relevant expert organizations consultation prior to initiation of research prior to recommending priorities or initiating research described in this section the commission or the center shall consult with the relevant expert organizations responsible for standards and protocols of clinical excellence such consulta verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion shall be consistent with the processes established under subsection consultation in dissemination of research any dissemination of research from the commission or the center and findings made by the commission or the center shall be consistent with processes established under subsection and shall a be based upon evidence based medicine and take into consideration standards and protocols of clinical excellence developed by relevant expert organizations definitions for purposes of this subsection a relevant expert organizations the term relevant expert organization means an organization with expertise in the rigorous application of evidence based scientific methods for the design of clinical studies the interpretation of clinical data and the development of national clinical practice guidelines including a voluntary health organization clinical specialty or other professional organization that represents physicians based on the field ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medicine in which each such physician practices or is board certified standards and protocols of clinical excellence the term standards and protocols of clinical excellence means clinical or practice guidelines that consist of a set of directions or principles that is based on evidence and is designed to assist a health care practitioner with decisions about appropriate diagnostic therapeutic or other clinical procedures for specific clinical circumstances research may not be used to deny or ration care nothing in this section shall be construed to make more stringent or otherwise change the standards or requirements for coverage of items and services under this act comparative effectiveness research trust fund financing for the trust fund for the provision establishing a comparative effectiveness research trust fund and financing such trust fund see section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle nursing home transparency part improving transparency of information on skilled nursing facilities nursing facilities and other longterm care facilities sec required disclosure of ownership and additional disclosable parties information a in general section of the social security act usc a– is amended by adding at the end the following new subsection required disclosure of ownership and additional disclosable parties information disclosure a facility as defined in paragraph shall have the information described in paragraph 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 of the affordable health care for america act for submission to the secretary the inspector general of the department of health and human services the state in which the facilityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is located and the state long term care ombudsman in the case where the secretary the inspector general the state or the state longterm care ombudsman requests such information and beginning on the effective date of the final regulations promulgated under paragraph 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 a public availability of information during the period described in paragraph a a facility shall a make the information described in paragraph available to the public upon request and update such information as be necessary to reflect changes in such information and post a notice of the availability of such information in the lobby of the facility in a prominent mannerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih information described a in general the following information is described in this paragraph the information described in subsections a and subject to subparagraph the identity of and information on each member of the governing body of the facility including the name title and period of service of each such member 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 a description of the organizational structure and the relationship of each person and entity described in sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih clauses and iii of clause to the facility and to one another 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 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 or iii of subparagraph a the secretary allow to the extent practicable such form or such information to meet the requirements of paragraph and to be submitted in a manner specified by the secretary special rule in applying subparagraph a with respect to subsections a and ownership or control interest shall include direct or indirect interests including such interests in intermediate entities and subsection a a shall include the owner of a whole or part interestverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 percent of the total property or assets of the entirety reporting a in general not later than the date that is years after the date of the enactment of this subsection the secretary shall promulgate regulations requiring a facility to report the information described in paragraph to the secretary in a standardized format and such other regulations as are necessary to carry out this subsection such regulations shall specify the frequency of reporting as determined by the secretary such final regulations shall also require the reporting of such information on or after the first day of the first calendar quarter beginning after the date that is days after the date on which such final regulations are published in the federal register and verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the certification as a condition of participation under the program under title xviii or xix that such information is accurate and current guidance the secretary shall provide guidance and technical assistance to states on how to adopt the standardized format under subparagraph a 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 definitions in this subsection a additional disclosable party the term additional disclosable party means with respect to a facility any person or entity who through ownership interest partnership interest contract or otherwise directly or indirectly exercises operational financial administrative or managerial control or direction over the facility or a part thereof or provides policies or procedures for any of the operations ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the facility or provides financial or cash management services to the facility leases or subleases real property to the facility or owns a whole or part interest equal to or exceeding 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 or iv provides management or administrative services clinical consulting services or accounting or financial services to the facility facility the term facility means a disclosing entity which is a skilled nursing facility as defined in section a or a nursing facility as defined in section a 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 man verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ages advises or supervises any element of the practices finances or operations of the facility organizational structure the term organizational structure means in the case of a corporation the officers directors and shareholders of the corporation who have an ownership interest in the corporation which is equal to or exceeds percent 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 percent a trust the trustees of the trust verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vi an individual contact information for the individual and vii any other person or entity such information as the secretary determines appropriate public availability of information not later than the date that is year after the date on which the final regulations promulgated under section 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 of health and human services a conforming amendments skilled nursing facilities section of the social security act usc i– is amended by striking subparagraph and redesignating subparagraph as subparagraph nursing facilities section of the social security act usc is amended by striking subparagraph and redesignating subparagraph as subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec accountability requirements a effective compliance and ethics programs skilled nursing facilities section of the social security act usc i– as amended by section is amended by adding at the end the following new subparagraph compliance and ethics programs requirement on or after the first day of the first calendar quarter beginning after the date that is year after the date on which regulations developed under clause are published in the federal register a skilled nursing facility shall with respect to the entity that operates or controls 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 such regulationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih development of regulations in general not later than the date that is years after the date of the enactment of this subparagraph 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 include a model compliance program design of regulations such regulations with respect to specific elements or formality of a program 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 theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih corporate level management of multiunit nursing home chains iii evaluation not later than years after the date on which compliance and ethics programs established under this subparagraph are in operation pursuant to clause the secretary shall complete an evaluation of such programs 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 averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih skilled nursing facility a program of the operating organization that 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 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 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 actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 requiredverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 coordination the provisions of this subparagraph shall apply with respect to a skilled nursing facility in lieu of section nursing facilities section of the social security act usc as amended by section is amended by adding at the end the following new subparagraph compliance and ethics program requirement on or after the first day of the first calendar quarter beginning after the date that is year after the date on which regulations developedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under clause are published in the federal register a skilled nursing facility shall with respect to the entity that operates or controls 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 such regulations iii development of regulations in general not later than the date that is years after the date of the enactment of this subparagraph 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 include a model compliance programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih design of regulations such regulations with respect to specific elements or formality of a program 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 multiunit nursing home chains iii evaluation not later than years after the date on which compliance and ethics programs established under this subparagraph are in operation pursuant to clause the secretary shall complete an evaluation of such programs 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 shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 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 includes at least the required components specified in clause iv vi required components of program the required components of averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih compliance and ethics program of an organization are the following 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 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 actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 vii coordination the provisions of this subparagraph shall apply with respect to a nursing facility in lieu of section a quality assurance and performance improvement program verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih skilled nursing facilities section of the social security act usc is amended a by striking assurance and inserting assurance and quality assurance and performance improvement program by designating the matter beginning with a skilled nursing facility as a clause with the heading in general and the appropriate indentation in clause as so designated by subparagraph by redesignating clauses and as subclauses and respectively and by adding at the end the following new clause quality assurance and performance improvement program in general not later than december 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 includingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 year after the date on which the regulations are promulgated under subclause 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 regulations the secretary shall promulgate regulations to carry out this clause nursing facilities section of the social security act usc is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by striking assurance and inserting assurance and quality assurance and performance improvement program by designating the matter beginning with a nursing facility as a clause with the heading in general and the appropriate indentation and by adding at the end the following new clause quality assurance and performance improvement program in general not later than december 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 multiunit 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih year after the date on which the regulations are promulgated under subclause 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 regulations the secretary shall promulgate regulations to carry out this clause proposal to revise quality assurance and performance improvement programs the secretary shall implement policies that modify and strengthen quality assurance and performance improvement programs in skilled nursing facilities and nursing facilities on a periodic basis as determined by the secretary facility plan not later than year after the date on which the regulations are promulgated under subclause of clause of sections and of the social security act as added by paragraphs and averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 of such sections gao study on nursing facility undercapitalization 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 the effects of such undercapitalization on quality of care including staffing and food costs at such facilities options to address such undercapitalization such as requirements relating to surety bonds liability insurance or minimum capitalizationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih report not later than 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 nursing facility in this subsection the term nursing facility includes a skilled nursing facility sec nursing home compare medicare website a skilled nursing facilities in general section of the social security act usc i– is amended a by redesignating subsection as subsection and by inserting after subsection the following new subsection nursing home compare website 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 homeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 information that is reported to the secretary under section 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 were newly enrolled in the program 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 andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 concise explanations of how to interpret the data such as a plain english explanation of data reflecting nursing home staff hours per resident day 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 andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 the standardized complaint form developed under subsection 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 nursing facility verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that were committed inside the facility 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 viii the number of civil monetary penalties levied against the facility employees contractors and other agents ix any other information that the secretary determines appropriate the facility shall not make available under clause iv identifying information on complainants or residents deadline for provision of information in general except as provided in clause the secretary shall ensure that the information described in subparagraph a is included on such website or a successor website not later than verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih year after the date of the enactment of this subsection exception the secretary shall ensure that the information described in subparagraph a and a iii is included on such website or a successor website not later than year after the dates on which the data are submitted to the secretary pursuant to section and subsection respectively review and modification of website a in general the secretary shall establish a process 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 not later than year after the date of the enactment of this subsection to modify or revamp such website in accordance with the review conducted under clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consultation in conducting the review under subparagraph a the secretary shall consult with state long term care ombudsman programs consumer advocacy groups iii provider stakeholder groups and iv any other representatives of programs or groups the secretary determines appropriate timeliness of submission of survey and certification information a in general section of the social security act usc i– is amended by adding at the end the following new subparagraph 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 each state shall submit information respecting any survey or certification recommendation made respecting a skilled nursingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih facility including any enforcement actions taken by the state or any federal enforcement action recommended 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 effective date the amendment made by this paragraph shall take effect year after the date of the enactment of this act special focus facility program section of such act is amended by adding at the end the following new paragraph 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 a poor compliance history or that substantially failed to meet applicable requirements of this actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih periodic surveys under such program the secretary shall conduct surveys of each facility in the program not less than once every months nursing facilities in general section of the social security act usc is amended a by redesignating subsection as subsection and by inserting after subsection the following new subsection nursing home compare website 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 un verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih derstandable to consumers of long term care services and searchable information that is reported to the secretary under section information on the special focus facility program or a successor program established by the centers for medicare 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 were newly enrolled in the program 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 have closed voluntarily or no longer participate under this titleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 concise explanations of how to interpret the data such as plain english explanation of data reflecting nursing home staff hours per resident day 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 andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 the standardized complaint form developed under subsection 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 nursing facility verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that were committed inside of the facility and 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 viii the number of civil monetary penalties levied against the facility employees contractors and other agents ix any other information that the secretary determines appropriate the facility shall not make available under clause identifying information about complainants or residents deadline for provision of information in general except as provided in clause the secretary shall ensure that the information described in subparagraph a is included on such website or a successor website not later than verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih year after the date of the enactment of this subsection exception the secretary shall ensure that the information described in subparagraph a and a iii is included on such website or a successor website not later than year after the dates on which the data are submitted to the secretary pursuant to section and subsection respectively review and modification of website a in general the secretary shall establish a process 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 not later than year after the date of the enactment of this subsection to modify or revamp such website in accordance with the review conducted under clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consultation in conducting the review under subparagraph a the secretary shall consult with state long term care ombudsman programs consumer advocacy groups iii provider stakeholder groups iv skilled nursing facility employees and their representatives and any other representatives of programs or groups the secretary determines appropriate timeliness of submission of survey and certification information a in general section of the social security act usc is amended by adding at the end the following new subparagraph 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 each state shall submit informationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih respecting any survey or certification recommendation made respecting a nursing facility including any enforcement actions taken by the state or any federal enforcement action recommended 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 effective date the amendment made by this paragraph shall take effect year after the date of the enactment of this act special focus facility program section of such act is amended by adding at the end of the following new paragraph 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 a poor compliance history or that substantiallyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih failed to meet applicable requirements of this act periodic surveys under such program the secretary shall conduct surveys of each facility in the program not less often than once every months availability of reports on surveys certifications and complaint investigations skilled nursing facilities section of the social security act usc i– as amended by sections and is amended by adding at the end the following new subparagraph availability of survey certification and complaint investigation reports a skilled nursing facility must have reports with respect to any surveys certifications and complaint investigations made respecting the facility during the preceding years available for any individual to review upon request and post notice of the availability of such reports in areas of the facility that are prominent and accessible to the publicverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the facility shall not make available under clause identifying information about complainants or residents nursing facilities section of the social security act usc as amended by sections and is amended by adding at the end the following new subparagraph availability of survey certification and complaint investigation reports a nursing facility must have reports with respect to any surveys certifications and complaint investigations made respecting the facility during the preceding years available for any individual to review upon request and 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 identifying information about complainants or residents effective date the amendments made by this subsection shall take effect year after the date of the enactment of this actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih guidance to states on form state inspection reports and complaint investigation reports 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 state inspection reports or a successor form complaint investigation reports and a facility plan of correction or other response to such form 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 requirement section a of the social security act usc a a is amended a by striking and at the end of subparagraph by striking the semicolon at the end of subparagraph and inserting and and by adding at the end the following new subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that the state maintain a consumeroriented website providing useful information to consumers regarding all skilled nursing facilities and all nursing facilities in the state including for each facility form state inspection reports or a successor form complaint investigation reports the facility 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 definitions in this subsection a nursing facility the term nursing facility has the meaning given such term in section a of the social security act usc a secretary the term secretary means the secretary of health and human services skilled nursing facility the term skilled nursing facility has the meaning given such term in section a of the social security act usc i– a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec reporting of expenditures section of the social security act usc yy is amended by adding at the end the following new subsection reporting of direct care expenditures in general for cost reports submitted under this title for cost reporting periods beginning on or after the date that is no more than two years after the redesign of the report specified in subparagraph skilled nursing facilities shall a 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 and take into account agency and contract staff in a manner to be determined by the administrator 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 not later than years after the date of the enactment of this subsectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih categorization by functional accounts beginning with cost reports submitted under paragraph 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 categorize the expenditures listed on cost reports as modified under paragraph submitted by skilled nursing facilities 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 spending on indirect care including housekeeping and dietary services capital assets including building and land costs administrative services costs 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 requirementsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as the secretary specify under the procedures established under this paragraph sec standardized complaint form a skilled nursing facilities development by the secretary section of the social security act usc i– as amended by section a is amended by adding at the end the following new paragraph standardized complaint form the secretary shall develop a standardized complaint form for use by a resident or a person acting on the resident behalf in filing a complaint with a state survey and certification agency and a state longterm care ombudsman program with respect to a skilled nursing facility state requirements section of the social security act usc i– is amended by adding at the end the following new paragraph complaint processes and whistleblower protection a complaint forms the state must make the standardized complaint form devel verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih oped under subsection available upon request to a resident of a skilled nursing facility any person acting on the resident behalf and iii any person who works at a skilled nursing facility or is a representative of such a worker 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 or some other method for submitting the complaint such complaint resolution process shall include procedures to assure accurate tracking of complaints received including notification to the complainant that a complaint has been received 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 confidentialverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih whistleblower protection prohibition against retaliation no person who works at a skilled nursing facility 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 request complained in good faith about the quality of care or services provided by a skilled nursing facility or about other issues relating to quality of care or services whether using the form developed under subsection or some other method for submitting the complaint retaliatory reporting a skilled nursing facility 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 request complained in good faith as described in clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii relief any person aggrieved by a violation of clause or clause in a civil action obtain all appropriate relief including reinstatement reimbursement of lost wages compensation and benefits and exemplary damages where warranted and such other relief as the court deems appropriate as well as costs of suit and reasonable attorney and expert witness fees iv rights not waivable the rights protected by this paragraph 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 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 employeeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 behalf from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection including submitting a complaint orally 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 the information reported or disclosed in the complaint is true and the violation of this title has occurred or occur in relation to such information nursing facilities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih development by the secretary section of the social security act usc i– as amended by section is amended by adding at the end the following new paragraph standardized complaint form the secretary shall develop a standardized complaint form for use by a resident or a person acting on the resident behalf in filing a complaint with a state survey and certification agency and a state longterm care ombudsman program with respect to a nursing facility state requirements section of the social security act usc i– is amended by adding at the end the following new paragraph complaint processes and whistleblower protection a complaint forms the state must make the standardized complaint form developed under subsection available upon request to a resident of a nursing facility any person acting on the resident behalf andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii any person who works at a nursing facility or a representative of such a worker 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 theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih form developed under subsection or some other method for submitting the complaint such complaint resolution process shall include procedures to assure accurate tracking of complaints received including notification to the complainant that a complaint has been received 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 whistleblower protection prohibition against retaliation no person who works at a nursing facility be penalized discriminated or retaliated against with respect to any aspect of employment including discharge promotion compensation terms condi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tions or privileges of employment or have a contract for services terminated because the person or anyone acting at the person 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 or some other method for submitting the complaint retaliatory reporting a nursing facility 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 request complained in good faith as described in clause iii relief any person aggrieved by a violation of clause or clause in a civil action obtain all appropriate relief including reinstatement reimbursement of lost wages compensation and benefits and exemplary damages where warranted and such other relief asverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the court deems appropriate as well as costs of suit and reasonable attorney and expert witness fees iv rights not waivable the rights protected by this paragraph 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 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 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 rule of construction nothing in this paragraph shall be construed as pre verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih venting a resident of a nursing facility or a person acting on the resident behalf from submitting a complaint in a manner or format other than by using the standardized complaint form developed under subsection including submitting a complaint orally 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 the information reported or disclosed in the complaint is true and the violation of this title has occurred or occur in relation to such information effective date the amendments made by this section shall take effect year after the date of the enactment of this act sec ensuring staffing accountability a skilled nursing facilities section of the social security act usc i– is amended by adding at the end the following new subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih submission of staffing information based on payroll data in a uniform format on and after the first day of the first calendar quarter beginning after the date that is years after the date of 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 specify the category of work a certified employee performs such as whether the employee is a registered nurse licensed practical nurse licensed vocationalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nurse certified nursing assistant therapist or other medical personnel 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 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 nursing facilities section of the social security act usc is amended by adding at the end the following new subparagraph submission of staffing information based on payroll data in a uniform format on and after the first day of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih first calendar quarter beginning after the date that is years after the date of 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 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 sec nationwide program for national and state background checks on direct patient access employees of long term care facilities and providers a in general the secretary of health and human services in this section referred to as the secretary shall establish a program to identify efficient effective and economical procedures for long term care fa verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cilities or providers to conduct background checks on prospective direct patient access employees on a nationwide basis in this subsection such program shall be referred to as the nationwide program the secretary shall carry out the nationwide program under similar terms and conditions as the pilot program under section of the medicare prescription drug improvement and modernization act of public law – stat including the prohibition on hiring abusive workers and the authorization of the imposition of penalties by a participating state under subsections a and respectively of such section the program under this subsection shall contain the following modifications to such pilot program agreements a newly participating states the secretary shall enter into agreements with each state that the secretary has not entered into an agreement with under subsection of such section that agrees to conduct background checks under the nationwide program on a statewide basis andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii that submits an application to the secretary containing such information and at such time as the secretary specify certain previously participating states the secretary shall enter into agreements with each state that the secretary has entered into an agreement with under such subsection that agrees to conduct background checks under the nationwide program on a statewide basis and iii that submits an application to the secretary containing such information and at such time as the secretary specify nonapplication of selection criteria the selection criteria required under subsection of such section shall not apply required fingerprint check as part of criminal background check the procedures established under subsection of such section shall a require that the long term care facility or provider or the designated agent of the long term care facility or provider obtain stateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and national criminal or other background checks on the prospective employee through such means as the secretary determines appropriate that utilize a search of state based abuse and neglect registries and databases including the abuse and neglect registries of another state in the case where a prospective employee previously resided in that state state criminal history records the records of any proceedings in the state that contain disqualifying information about prospective employees such as proceedings conducted by state professional licensing and disciplinary boards and state medicaid fraud control units and federal criminal history records including a fingerprint check using the integrated automated fingerprint identification system of the federal bureau of investigation and require states to describe and test methods that reduce duplicative fingerprinting including providing for the development of rap back capability by the state such that if a direct patient access employee of a long term care facility or provider is convicted of a crime following the initial criminal history backgroundverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih check conducted with respect to such employee and the employee fingerprints match the prints on file with the state law enforcement department the department will immediately inform the state and the state will immediately inform the long term care facility or provider which employs the direct patient access employee of such conviction state requirements an agreement entered into under paragraph shall require that a participating state a be responsible for monitoring compliance with the requirements of the nationwide program have procedures in place to conduct screening and criminal or other background checks under the nationwide program in accordance with the requirements of this section monitor compliance by long term care facilities and providers with the procedures and requirements of the nationwide program iii as appropriate provide for a provisional period of employment by a long verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih term care facility or provider of a direct patient access employee not to exceed days pending completion of the required criminal history background check and in the case where the employee has appealed the results of such background check pending completion of the appeals process during which the employee shall be subject to direct on site supervision in accordance with procedures established by the state to ensure that a long term care facility or provider furnishes such direct on site supervision iv provide an independent process by which a provisional employee or an employee appeal or dispute the accuracy of the information obtained in a background check performed under the nationwide program including the specification of criteria for appeals for direct patient access employees found to have disqualifying information which shall include consideration of the passage of time extenuating circumstances demonstration of rehabilitation and relevancy of the particular dis verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih qualifying information with respect to the current employment of the individual provide for the designation of a single state agency as responsible for overseeing the coordination of any state and national criminal history background checks requested by a long term care facility or provider or the designated agent of the longterm care facility or provider utilizing a search of state and federal criminal history records including a fingerprint check of such records overseeing the design of appropriate privacy and security safeguards for use in the review of the results of any state or national criminal history background checks conducted regarding a prospective direct patient access employee to determine whether the employee has any conviction for a relevant crime iii immediately reporting to the long term care facility or provider that requested the criminal historyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih background check the results of such review and iv in the case of an employee with a conviction for a relevant crime that is subject to reporting under section of the social security act usc a–e reporting the existence of such conviction to the database established under that section vi determine which individuals are direct patient access employees as defined in paragraph for purposes of the nationwide program vii as appropriate specify offenses including convictions for violent crimes for purposes of the nationwide program and viii describe and test methods that reduce duplicative fingerprinting including providing for the development of rap back capability such that if a direct patient access employee of a long term care facility or provider is convicted of a crime following the initial criminal history background check conducted with respect toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such employee and the employee fingerprints match the prints on file with the state law enforcement department the department will immediately inform the state agency designated under clause and such agency will immediately inform the facility or provider which employs the direct patient access employee of such conviction and the state will provide or will require the facility to provide to the employee a copy of the results of the criminal history background check conducted with respect to the employee at no charge in the case where the individual requests such a copy background checks and screenings under this subsection shall be valid for a period of no longer than years as determined by the state and approved by the secretary payments a newly participating states verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general as part of the application submitted by a state under paragraph a iii the state shall guarantee with respect to the costs to be incurred by the state in carrying out the nationwide program that the state will make available directly or through donations from public or private entities a particular amount of non federal contributions as a condition of receiving the federal match under clause ii federal match the payment amount to each state that the secretary enters into an agreement with under paragraph a shall be times the amount that the state guarantees to make available under clause previously participating states in general as part of the application submitted by a state under paragraph iii the state shall guarantee with respect to the costs to be incurred by the state in carrying out the nationwide program that the state will makeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih available directly or through donations from public or private entities a particular amount of non federal contributions as a condition of receiving the federal match under clause ii federal match the payment amount to each state that the secretary enters into an agreement with under paragraph shall be times the amount that the state guarantees to make available under clause definitions under the nationwide program a long term care facility or provider the term long term care facility or provider means the following facilities or providers which receive payment for services under title xviii or xix of the social security act a skilled nursing facility as defined in section a of the social security act usc i– a a nursing facility as defined in section a of such act usc a iii a home health agencyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv a provider of hospice care as defined in section dd of such act usc dd a long term care hospital as described in section iv of such act usc ww iv vi a provider of personal care services vii a provider of adult day care viii a residential care provider that arranges for or directly provides longterm care services including an assisted living facility that provides a nursing home level of care conveyed by state licensure or state definition ix an intermediate care facility for the mentally retarded as defined in section of such act usc d any other facility or provider of long term care services under such titles as the participating state determines appropriateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih direct patient access employee the term direct patient access employee means any individual who has access to a patient or resident of a long term care facility or provider through employment or through a contract with such facility or provider and has duties that involve or involve one on one contact with a patient or resident of the facility or provider as determined by the state for purposes of the nationwide program such term does not include a volunteer unless the volunteer has duties that are equivalent to the duties of a direct patient access employee and those duties involve or involve one on one contact with a patient or resident of the long term care facility or provider evaluation and report a evaluation the inspector general of the department of health and human services shall conduct an evaluation of the nationwide program such evaluation shall include a review of the various procedures implemented by participating states for long term care facilities or providers including staffing agencies to conduct back verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ground checks of direct patient access employees and identify the most efficient effective and economical procedures for conducting such background checks an assessment of the costs of conducting such background checks including start up and administrative costs iii a determination of the extent to which conducting such background checks leads to any unintended consequences including a reduction in the available workforce for such facilities or providers iv an assessment of the impact of the program on reducing the number of incidents of neglect abuse and misappropriation of resident property to the extent practicable and an evaluation of other aspects of the program as determined appropriate by the secretary report not later than days after the completion of the nationwide program the inspector general of the department of health and human services shall submit a re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih port to congress containing the results of the evaluation conducted under subparagraph a funding notification the secretary of health and human services shall notify the secretary of the treasury of the amount necessary to carry out the nationwide program under this section including costs for the department of health and human services to administer and evaluate the program for the period of fiscal years through except that in no case shall such amount exceed transfer of funds out of any funds in the treasury not otherwise appropriated the secretary of the treasury shall provide for the transfer to the secretary of health and human services of the amount specified as necessary to carry out the nationwide program under paragraph such amount shall remain available until expended part targeting enforcement sec civil money penalties a skilled nursing facilities in general section of the social security act usc i– is amended to read as follows verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authority with respect to civil money penalties amount the secretary impose a civil money penalty in the applicable per instance or per day amount as defined in subclause and iii for each day or instance respectively of noncompliance as determined appropriate by the secretary 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 bb in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy an amount not less than and not more than andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cc in each case of any other deficiency an amount not less than and not to exceed 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 and not more than and bb in each case of any other deficiency an amount not less than and not to exceed iv reduction of civil money penalties in certain circumstances subject to subclauses 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 calendar days after theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih date of such imposition the secretary reduce the amount of the penalty imposed by not more than percent prohibition on reduction for certain deficiencies aa repeat deficiencies the secretary not reduce under subclause iv the amount of a penalty if the deficiency is a repeat deficiency bb certain other deficiencies the secretary not reduce under subclause iv the amount of a penalty if the penalty is imposed for a deficiency described in subclause 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 bb verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vi limitation on aggregate reductions the aggregate reduction in a penalty under subclause iv not exceed percent on the basis of self reporting on the basis of a waiver of an appeal as provided for under regulations under section of title 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 days after the date of imposition of the penalty provide the opportunity for the facility to participate in an independent informal dispute resolution process established by the state survey agency which generates a written record prior to the collection of such penalty but such oppor verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tunity 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 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 days after theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih date of the imposition of the penalty dd 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 provide for the return of such amounts collected plus interest to the facility and ff in the case where all such appeals are unsuccessful provide that some portion of such amounts collected 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 familyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 a other than subsections a and 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 a a conforming amendment the second sentence of section of the social securityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih act usc i– is amended by inserting after nursing facilities penalties imposed by the state a in general section of the social security act usc is amended in subparagraph a by striking the first sentence and inserting the following a civil money penalty in accordance with subparagraph and by adding at the end the following new subparagraph civil money penalties in general the state impose a civil money penalty under subparagraph a in the applicable per instance or per day amount as defined in subclause and iii for each day or instance respectively of noncompliance as determined appropriate by the secretary applicable per instance amount in this subparagraph the term applicable per instance amount means verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy an amount not less than and not more than and iii in each case of any other deficiency an amount not less than and not to exceed iii applicable per day amount in this subparagraph the term applicable per day amount means in each case of a deficiency where the facility is cited for actual harm or immediate jeopardy an amount not less than and not more than and in each case of any other deficiency an amount not less than and not to exceed verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv reduction of civil money penalties in certain circumstances subject to clauses and vi in the case where a facility self reports and promptly corrects a deficiency for which a penalty was imposed under subparagraph a not later than calendar days after the date of such imposition the state reduce the amount of the penalty imposed by not more than percent prohibition on reduction for certain deficiencies repeat deficiencies the state 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 certain other deficiencies the state not reduce under clause iv the amount of a penalty if the penalty is imposed for a deficiency described in clause ii orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii 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 iii limitation on aggregate reductions the aggregate reduction in a penalty under clause iv not exceed percent on the basis of self reporting on the basis of a waiver of an appeal as provided for under regulations under section of title code of federal regulations or on the basis of both vi collection of civil money penalties in the case of a civil money penalty imposed under subparagraph a the state subject to subclause iii shall not later than days after the date of imposition of the penalty provide the opportunity for the facility to participate in an independent informal dispute resolution process establishedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by the state survey agency 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 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 is completed iii 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 is completed or the dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that is days after the date of the imposition of the penalty iv provide that such amounts collected are kept in such account pending the resolution of any subsequent appeals in the case where the facility successfully appeals the penalty provide for the return of such amounts collected plus interest to the facility and vi in the case where all such appeals are unsuccessful provide that such funds collected shall be used for the purposes described in the second sentence of subparagraph a conforming amendment the second sentence of section a of the social security act usc a is amended by inserting before the period at the end the following and some portion of such funds be used to support activities that benefit residents including assistance to support and protect residents of averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih facility that closes voluntarily or involuntarily or is decertified including offsetting costs of relocating residents to home and communitybased 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 penalties imposed by the secretary a in general section of the social security act usc is amended to read as follows authority with respect to civil money penalties amount subject to subclause the secretary impose a civil money penalty in an amount not to exceed for each day orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih each instance of noncompliance as determined appropriate by the secretary reduction of civil money penalties in certain circumstances subject to subclause iii in the case where a facility selfreports and promptly corrects a deficiency for which a penalty was imposed under this clause not later than calendar days after the date of such imposition the secretary reduce the amount of the penalty imposed by not more than percent iii prohibition on reduction for repeat deficiencies the secretary not reduce the amount of a penalty under subclause 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 averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih civil money penalty imposed under this clause the secretary aa subject to item bb shall not later than 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 provide for the collection of such civil money penalty and the placement of such amounts collected in an es verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih crow 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 days after the date of the imposition of the penalty dd 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 provide for the return of such amounts collected plus interest to the facility and ff in the case where all such appeals are unsuccessful provide that some portion of such amounts collected be used to support activities that benefit residents including assistance to support and protect residents of a facility that closesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 procedure the provisions of section a other than subsections a and 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 clauseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the same manner as such provisions apply to a penalty or proceeding under section a a conforming amendment section of the social security act usc is amended by inserting and in paragraph after paragraph a effective date the amendments made by this section shall take effect year after the date of the enactment of this act sec national independent monitor pilot program a establishment 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 selection the secretary shall select chains of skilled nursing facilities and nursing facilities described in paragraph to participate in theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 require duration the secretary shall conduct the pilot program for a two year period implementation the secretary shall implement the pilot program not later than one year after the date of the enactment of this act 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 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 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 conduct periodic reviews and prepare rootcause quality and deficiency analyses of a chain toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih assess if facilities of the chain are in compliance with state and federal laws and regulations applicable to the facilities 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 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 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 publish the results of such reviews analyses and oversight implementation of recommendations receipt of finding by chain not later than days after receipt of a finding of an independent monitor under subsection a chain participating in the pilot program shall submit to the independent monitor a report verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a outlining corrective actions the chain will take to implement the recommendations in such report or indicating that the chain will not implement such recommendations and why it will not do so receipt of report by independent monitor not later than days after the date of receipt of a report submitted by a chain under paragraph 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 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 waiver authority the secretary waive such requirements of titles xviii and xix of the social security act usc et seq et seq as be necessary for the purpose of carrying out the pilot programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this section definitions in this section facility the term facility means a skilled nursing facility or a nursing facility nursing facility the term nursing facility has the meaning given such term in section a of the social security act usc a secretary the term secretary means the secretary of health and human services acting through the assistant secretary for planning and evaluation skilled nursing facility the term skilled nursing facility has the meaning given such term in section a of the social security act usc a evaluation and report 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 andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 report not later than 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 together with recommendations for such legislation and administrative action as the inspector general determines appropriate sec notification of facility closure a skilled nursing facilities in general section of the social security act usc i– is amended by adding at the end the following new paragraph notification of facility closure a in general any individual who is the administrator of a skilled nursing facility must submit to the secretary the state long term care ombudsman residents of the facility and the legal representatives ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such residents or other responsible parties written notification of an impending closure subject to subclause not later than the date that is days prior to the date of such closure and in the case of a facility where the secretary terminates the facility participation under this title not later than the date that the secretary determines appropriate 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 residentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih relocation 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 continuation of payments until residents relocated the secretary 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 conforming amendments section of the social security act usc i– is amended a in the first sentence by striking the secretary shall terminate and inserting the secretary subject to subsection shall terminate andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the second sentence by striking subsection and inserting paragraphs and of subsection nursing facilities in general section of the social security act usc is amended by adding at the end the following new paragraph notification of facility closure a in general any individual who is an administrator of a nursing facility must 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 subject to subclause not later than the date that is days prior to the date of such closure and in the case of a facility where the secretary terminates the facility participation under this title not later than the date that the secretary determines appropriate verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 relocation 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 continuation of payments until residents relocated the secretary as the secretary determines appropriate continue to make paymentsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 effective date the amendments made by this section shall take effect year after the date of the enactment of this act part improving staff training sec dementia and abuse prevention training a skilled nursing facilities section a of the social security act usc i– a 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 nursing facilities section a of the social security act usc a 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendments made by this section shall take effect year after the date of the enactment of this act sec study and report on training required for certified nurse aides and supervisory staff a study 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 a and a of the social security act usc i– a a should be increased from 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 whether requirements for ongoing training under such sections a and a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih should be increased from hours per year including any recommendations for the content of such training consultation in conducting the analysis under paragraph a the secretary shall consult with states that as of the date of the enactment of this act require more than hours of training for certified nurse aides definitions in this section a nursing facility the term nursing facility has the meaning given such term in section a of the social security act usc a secretary the term secretary means the secretary of health and human services acting through the assistant secretary for planning and evaluation skilled nursing facility the term skilled nursing facility has the meaning given such term in section a of the social security act usc a report not later than 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 rec verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ommendations for such legislation and administrative action as the secretary determines appropriate sec qualification of director of food services of a skilled nursing facility or nursing facility a medicare section a of the social security act usc i– a is amended by adding at the end the following with respect to meeting the staffing requirement imposed by the secretary to carry out clause iv the full time director of food services of the facility if not a qualified dietitian as defined in section a of title code of federal regulations as in effect as of the date of the enactment of this sentence shall be a certified dietary manager meeting the requirements of the certifying board for dietary managers or a dietetic technician registered meeting the requirements of the commission on dietetic registration or have equivalent military academic or other qualifications as specified by the secretary medicaid section a of the social security act usc a is amended by adding at the end the following with respect to meeting the staffing requirement imposed by the secretary to carry out clause iv the full time director of food services of the facility if not a qualified dietitian as defined in sec verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion a of title code of federal regulations as in effect as of the date of the enactment of this sentence shall be a certified dietary manager meeting the requirements of the certifying board for dietary managers or a dietetic technician registered meeting the requirements of the commission on dietetic registration or have equivalent military academic or other qualifications as specified by the secretary effective date the amendments made by this section shall take effect on the date that is days after the date of enactment of this act subtitle quality measurements sec establishment of national priorities for quality improvement title xi of the social security act as amended by section a is further amended by adding at the end the following new part part quality improvement establishment of national priorities for performance improvement sec a establishment of national priorities by the secretary the secretary shall establish and periodically update not less frequently than triennially national priorities for performance improvementverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih recommendations for national priorities in establishing and updating national priorities under subsection a the secretary shall solicit and consider recommendations from multiple outside stakeholders 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 contribute to a large burden of disease including those that address the health care provided to patients with prevalent high cost chronic diseases have the greatest potential to decrease morbidity and mortality in this country including those that are designed to eliminate harm to patients have the greatest potential for improving the performance affordability and patientcenteredness of health care including those due to variations in care address health disparities across groups and areas andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih have the potential for rapid improvement due to existing evidence standards of care or other reasons definitions in this part consensus based entity the term consensus based entity means an entity with a contract with the secretary under section 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 funding in general the secretary shall provide for the transfer from the federal hospital insurance trust fund under section and the federal supplementary medical insurance trust fund under section in such proportion as the secretary determines appropriate of for the activities under this section for each of the fiscal years through authorization of appropriations for purposes of carrying out the provisions of this section in addition to funds otherwise available outverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of any funds in the treasury not otherwise appropriated there are appropriated to the secretary of health and human services for each of the fiscal years through sec development of new quality measures gao evaluation of data collection process for quality measurement part of title xi of the social security act as added by section is amended by adding at the end the following new sections sec development of new quality measures a agreements with qualified entities 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 form of agreements the secretary carry out paragraph by contract grant or otherwise recommendations of consensusbased entity in carrying out this section the secretary shall a seek public input andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih take into consideration recommendations of the consensus based entity with a contract with the secretary under section a 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 development of quality measures patient centered and populationbased measures in entering into agreements under subsection a the secretary shall give priority to the development of quality measures that allow the assessment of a health outcomes presence of impairment and functional status of patients the continuity and coordination of care and care transitions for patients across providers and health care settings including end of life care patient experience and patient engagement verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the safety effectiveness and timeliness of care health disparities including those associated with individual race ethnicity age gender place of residence or language and the efficiency and resource use in the provision of care use of funds an entity that enters into an agreement under subsection a shall develop quality measures that a to the extent feasible have the ability to be collected through the use of health information technologies supporting better delivery of health care services and are available free of charge to users for the use of such measures availability of measures the secretary shall make quality measures developed under this section available to the public testing of proposed measures the secretary use amounts made available under subsection 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 measuresverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih updating of endorsed measures the secretary use amounts made available under subsection 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 qualified entities before entering into agreements with a qualified entity the secretary shall ensure that the entity is a public private or academic institution with technical expertise in the area of health quality measurement application for grant a grant 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 funding in general the secretary shall provide for the transfer from the federal hospital insurance trust fund under section and the federal supplementary medical insurance trust fund under section in such proportion as the secretary determines appropriate of toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary for purposes of carrying out this section for each of the fiscal years through 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 for each of the fiscal years through sec 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 considerations in carrying out the evaluation under subsection a the comptroller general shall determine whether the system for the collection of data for quality measures provides for validation of data as relevant and scientifically credible 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 thatverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih adequately protects the privacy of patients personal health information and provides data security 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 the extent to which quality measures are consistent with section or result in direct or indirect costs to users of such measures 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 multi stakeholder pre rulemaking input into selection of quality measures section of the social security act usc b– is amended by adding at the end the following new subsection multi stakeholder pre rulemaking input into selection of quality measures list of measures not later than december before each year beginning with the secretary shall make public a list of measures being considered for selection for quality measurement by the secretary in rulemaking with respect toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 be consultation on selection of endorsed quality measures a consensus based entity that has entered into a contract under section shall as part of such contract convene multistakeholder 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 multi stakeholder input not later than february of each year beginning with the consensus based entity described in paragraph shall transmit to the secretary the recommendations of multi stakeholder groups provided under paragraph such recommendations shall be included in the transmissions the consensus based entity makes to the secretary under the contract provided for under section requirement for transparency in process verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general in convening multistakeholder groups under paragraph 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 selection of organizations participating in multi stakeholder groups the process under paragraph 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 use of input the respective proposed rule shall contain a summary of the recommendations made by the multi stakeholder groups under paragraph 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 multi stakeholder groups for purposes of this subsection the term multi stakeholder groups means with respect to a quality measure averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 physicians health care quality alliances nurses and other health care practitioners health plans patient advocates and consumer groups employers public and private purchasers of health care items and services labor organizations relevant departments or agencies of the united states biopharmaceutical companies and manufacturers of medical devices licensing credentialing and accrediting bodies funding a in general the secretary shall provide for the transfer from the federal hos verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pital insurance trust fund under section and the federal supplementary medical insurance trust fund under section in such proportion as the secretary determines appropriate of to the secretary for purposes of carrying out this subsection for each of the fiscal years through 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 for each of the fiscal years through sec application of quality measures a inpatient hospital services section of such act usc ww is amended by adding at the end the following new clause subject to subclause for purposes of reporting data on quality measures for inpatient hospital services furnished during fiscal year and each subsequent fiscal year the quality measures specified under clause viii shall be measures selected by the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih from measures that have been endorsed by the entity with a contract with the secretary under section a 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 a the secretary 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 outpatient hospital services section of such act usc is amended by adding at the end the following new subparagraph use of endorsed quality measures the provisions of clause of section shall apply to quality measures for covered opd services under this paragraph in the same manner as such provisions apply toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih quality measures for inpatient hospital services physicians services section of such act usc 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 renal dialysis services section of such act usc rr 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 endorsement of standards section of the social security act usc aaa is amended by adding after and below subparagraph the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 effective date except as otherwise provided the amendments made by this section shall apply to quality measures applied for payment years beginning with or fiscal year as the case be sec consensus based entity funding section of the social security act usc aaa is amended by striking for each of fiscal years through and inserting for fiscal year and for each of the fiscal years through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle physician payments sunshine provision sec 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 usc et seq as amended by section a is further amended by inserting after section the following new section sec 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 in general except as provided in this subsection not later than march and an verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nually 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 name business address physician specialty and national provider identifier with respect to the payment or other transfer of value other than a drug sample its value and date the name of the related drug device or supply if available to the level of specificity available and iii a description of its form indicated as appropriate for all that apply as cash or a cash equivalent in kind items or services iii stock a stock option or any other ownership interest divi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dend profit or other return on investment or iv any other form as defined by the secretary with respect to a drug sample the name number date and dosage units of the sample aggregate reporting information submitted by an applicable manufacturer or distributor under paragraph 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 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 otherverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih transfer of value under the name of the covered recipient 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 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 two calendar years after the date such payment or other transfer of value was made delayed reporting for payments made pursuant to clinical investigations in the case of a payment or other transfer of valueverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 of the food and drug administration amendments act of two calendar years after the date such payment or other transfer of value was made confidentiality information described in paragraph or shall be considered confidential and shall not be subject to disclosure under section of title 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 physicians in self insured health plans nothing in this subsection shall be construed to require the disclosure of a payment orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih other transfer of value to a physician by a self insured health plan reporting of ownership interest by physicians hospitals and other entities that bill medicare not later than march of each year beginning with each hospital or other health care entity not including a medicare advantage organization that bills the secretary under part a or part of title xviii for services shall report on the ownership shares other than ownership shares described in section of each physician who directly or indirectly owns an interest in the entity additional physician ownership not later than march of each year beginning with in addition to the requirement under subsection a any applicable manufacturer applicable group purchasing organization or applicable distributor shall submit to the secretary in such electronic form as the secretary shall require the following information regarding any ownership or investment interest other than an ownership or investment interest in a publicly traded security and mutual fund as described in section heldverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by a physician or an immediate family member of such physician as defined for purposes of section a in the applicable manufacturer applicable group purchasing organization or applicable distributor during the preceding year a the dollar amount invested by each physician holding such an ownership or investment interest the value and terms of each such ownership or investment interest any payment or other transfer of value provided to a physician holding such an ownership or investment interest or to an entity or individual at the request of or designated on behalf of a physician holding such an ownership or investment interest including the information described in clauses through iii of paragraph a and information described in subsection a and any other information regarding the ownership or investment interest the secretary determines appropriate definitions in this subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a physician the term physician includes a physician immediate family members as defined for purposes of section a applicable group purchasing organization the term applicable group purchasing organization means any organization or other entity as defined by the secretary that purchases arranges for or negotiates the purchase of a covered drug device biological or medical supply study of practice patterns in advanced diagnostic imaging and radiation oncology services the comptroller general of the united states shall conduct a study to evaluate the extent of use of physician self referral arrangements and the effects of such arrangements on the cost of providing advanced diagnostic imaging and radiation oncology services to medicare beneficiaries under title xviii the study shall be completed and submitted to congress not later than july public availability in general the secretary shall establish procedures to ensure that not later than september and on june of each year beginning thereafter the information submitted underverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subsections a and 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 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 the nature of the payment or other transfer of value indicated as appropriate under subsection a iii and the name of the covered drug device biological or medical supply as applicable contains information that is able to be easily aggregated and downloaded verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih contains a description of any enforcement actions taken to carry out this section including any penalties imposed under subsection during the preceding year contains background information on industry physician relationships in the case of information submitted with respect to a payment or other transfer of value described in subsection a lists such information separately from the other information submitted under subsection a and designates such separately listed information as funding for clinical research contains any other information the secretary determines would be helpful to the average consumer and provides the covered recipient an opportunity to submit corrections to the information made available to the public with respect to the covered recipient accuracy of reporting the accuracy of the information that is submitted under subsections a and and made available under paragraph shall be the responsibility of the reporting entity reporting under subsection a or as ap verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plicable the secretary shall establish procedures to ensure that the covered recipient is provided with an opportunity to submit corrections to the applicable reporting entity with regard to information made public with respect to the covered recipient and under such procedures the corrections shall be transmitted to the secretary 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 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 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 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 penalties for noncompliance failure to report verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general subject to subparagraph except as provided in paragraph any reporting entity that fails to submit information required under subsection a or as applicable in a timely manner in accordance with regulations promulgated to carry out such applicable subsection shall be subject to a civil money penalty of not less than but not more than 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 a are imposed and collected under that section limitation the total amount of civil money penalties imposed under subparagraph a with respect to each annual submission of information under subsection a by a reporting entity shall not exceed knowing failure to report a in general subject to subparagraph any reporting entity that knowingly fails to submit information required under subsection a or as applicable in a timelyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih manner in accordance with regulations promulgated to carry out such applicable subsection shall be subject to a civil money penalty of not less than but not more than 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 a are imposed and collected under that section limitation the total amount of civil money penalties imposed under subparagraph a with respect to each annual submission of information under subsection a or by an applicable reporting entity shall not exceed or if greater percentage of the total annual revenues of the reporting entity 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 enforcement through state attorneys general the attorney general of a state verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 proceed under this subsection against an applicable manufacturer or distributor in the state annual report to congress not later than april of each year beginning with the secretary shall submit to congress a report that includes the following the information submitted under this section during the preceding year aggregated for each applicable reporting entity that submitted such information during such year a description of any enforcement actions taken to carry out this section including any penalties imposed under subsection during the preceding year definitions in this section applicable distributor the term applicable distributor means a any entity other than an applicable group purchasing organization that buys and resells or receives a commission or other simi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih lar form of payment from another seller for selling or arranging for the sale of a covered drug device biological or medical supply or any entity under common ownership with such an entity described in subparagraph a and which provides assistance or support to such entity so described with respect to the production preparation propagation compounding conversion processing marketing or distribution of a covered drug device biological or medical supply such term does not include a wholesale pharmaceutical distributor applicable manufacturer the term applicable manufacturer means any entity which is engaged in the production preparation propagation compounding conversion processing marketing or manufacturer direct distribution of a covered drug device biological or medical supply or any entity under common ownership with such entity and which provides assistance or support to such entity with respect to the production preparation propagation compounding conversion processing marketing or distribution or a covered drug device biological or medical supply for purposes of this section only verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such term does not include a retail pharmacy licensed under state law 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 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 covered recipient the term covered recipient means the following a a physician a physician group practice any other prescriber of a covered drug device biological or medical supply a pharmacy or pharmacist a health insurance issuer group health plan or other entity offering a health benefits plan including any employee of such an issuer plan or entityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a pharmacy benefit manager including any employee of such a manager a hospital a medical school a sponsor of a continuing medical education program a patient advocacy or disease specific group a organization of health care professionals a biomedical researcher a group purchasing organization employee the term employee has the meaning given such term in section knowingly the term knowingly has the meaning given such term in section of title united states code 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 gift food or entertainment travel or trip iii honorariaverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv research funding or grant education or conference funding vi consulting fees vii ownership or investment interest and royalties or license fee inclusions subject to subparagraph 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 c exclusions the term payment or other transfer of value does not include the following 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the loan of a covered device for a short term trial period not to exceed 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 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 vii compensation paid by an applicable manufacturer or distributor to a covered recipient who is directly employed byverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and works solely for such manufacturer or distributor viii payments made to a covered recipient by an applicable manufacturer or by a health plan affiliated with an applicable manufacturer for medical care provided to employees of such manufacturer or their dependents ix any discount including a rebate any payment or other transfer of value that is made to a covered recipient indirectly through an entity other than the applicable manufacturer in connection with an activity or service in which the applicable manufacturer is unaware of the identity of the covered recipient and is not using such activity or service to market its product to the covered recipient and that is not designed to market or promote the product to the covered recipient xi in the case of an applicable manufacturer who offers a self insuredverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plan payments for the provision of health care to employees under the plan physician the term physician has the meaning given that term in section 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 reporting entity the term reporting entity means a with respect to the reporting requirement under subsection a an applicable manufacturer or distributor of a covered drug device biological or medical supply required to report under such subsection and with respect to the reporting requirement under subsection a hospital other health care entity applicable manufacturer applicable distributor or applicable group purchasing organization required to report physician ownership under such subsection annual reports to states not later than april of each year beginning with the secretary shall submit to states a report that includes a summary of the information submitted under subsections a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and during the preceding year with respect to covered recipients or other hospitals and entities in the state relation to state laws in general effective on january subject to paragraph 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 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 no preemption of additional requirements paragraph shall not preempt any statute or regulation of a state or 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 the disclosure or reporting in any format of information described in subsection except in the case of information described in clause of subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the disclosure or reporting in any format of the type of information by any person or entity other than an applicable manufacturer as so defined or a covered recipient as defined in subsection 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 nothing in paragraph shall be construed to limit the discovery or admissibility of information described in this paragraph in a criminal civil or administrative proceeding 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 of the deficit reduction act of such report shall be submitted to congress not later than the date that is months after the date such surveys are collected and shall be made pub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih licly available on an internet website of the department of health and human services gao report not later than december the comptroller general of the united states shall submit to congress a report on section of the social security act as added by subsection a such report shall address the extent to which important transfers of value are being adequately reported under such section including unreported transfers required by such section as well as transfers not required to be reported by such section the impact on states of the federal preemption provision under subsection of such section whether changes have occurred in the pattern of payments as a result of efforts to evade reporting requirements a description of the financial relationships subject to delayed reporting under subsection a of such section and any recommended improvements to the collection or the analysis of data reported under such sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle public reporting on health care associated infections sec 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 the following section sec a requirement for public reporting by hospitals and ambulatory surgical centers on health care associated infections a reporting requirement in general the secretary shall provide that a hospital as defined in subsection or ambulatory surgical center meeting the requirements of titles xviii or xix participate in the programs established under such titles 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 specifiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 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 reportingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih implementation not later than year after the date of enactment of this section the secretary through the director of cdc shall promulgate regulations to carry out this section 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 among hospitals and ambulatory surgical centers and by demographic information annual report to congress on an annual basis the secretary shall submit to the congress a report that summarizes each of the following the number and types of health care associated infections reported under subsection a in hospitals and ambulatory surgical centers during such year factors that contribute to the occurrence of such infections including health care worker immunization ratesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 recommendations in coordination with the center for quality improvement established under section 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 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 health care associated infection for purposes of this section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 application to critical access hospitals for purposes of this section the term hospital includes a critical access hospital as defined in section mm effective date with respect to section a 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 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 implement such section through guidance or other instructions gao report not later than months after the date of the enactment of this act the comptrollerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih general of the united states shall submit to congress a report on the program established under section a 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 report on additional data not later than 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 medicare graduate medical education sec distribution of unused residency positions a in general section of the social security act usc ww is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by striking paragraph and inserting paragraphs and in paragraph by striking paragraph and inserting paragraphs and in paragraph by inserting and paragraph after this paragraph and by adding at the end the following new paragraph additional redistribution of unused residency positions a reductions in limit based on unused positions programs subject to reduction if a hospital reference resident level specified in clause is less than the otherwise applicable resident limit as defined in subparagraph effective for portions of cost reporting periods occurring on or after july the otherwise applicable resident limit shall be reduced by percent of the difference between such otherwise applicable resident limit and such reference resident level reference resident level verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 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 residentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 – 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 the reference resident level specified in this clause is the limitation applicable under subclause 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 para verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih graph that are not otherwise taken into account under a previous subclause iii affiliation the provisions of clause shall be applied to hospitals which are members of the same affiliated group as defined by the secretary under paragraph 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 of the social security amendments of to be aggregated for purposes of applying the resident position limitations under this subsection redistribution 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 secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih approve for portions of cost reporting periods occurring on or after july the estimated aggregate number of increases in the otherwise applicable resident limit under this subparagraph not exceed the secretary estimate of the aggregate reduction in such limits attributable to subparagraph a requirements for qualifying hospitals a hospital is not a qualifying hospital for purposes of this paragraph unless the following requirements are met 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 residentsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 and iii of subparagraph a 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 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 oth verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih erwise 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 cost reporting periods beginning on or after july 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 the secretary shall give preference to hospitals that had a reduction in resident training positions under subparagraph a the secretary shall give preference to hospitals with year primary care residency training programs such as family practice and general internal medicineverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 and emphasize training in an outpatient department iv the secretary shall give preference to hospitals with a number of positions as of july in excess of the otherwise applicable resident limit for such period the secretary shall give preference to hospitals that place greater emphasis upon training in a health professional shortage area designated under section of the public health service act or a health professional needs area designated under section of such act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 topopulation ratios limitation in no case shall more than 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 for that hospital vii distribution the secretary shall distribute the increase in resident training positions to qualifying hospitalsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under this subparagraph not later than july resident level and limit defined in this paragraph the term resident level has the meaning given such term in paragraph the term otherwise applicable resident limit means with respect to a hospital the limit otherwise applicable under subparagraphs and of paragraph on the resident level for the hospital determined without regard to this paragraph but taking into account paragraph a maintenance of primary care resident level in carrying out this paragraph the secretary shall require hospitals that receive additional resident positions under subparagraph to maintain records and periodically report to the secretary on the number of primary care residents in its residency training programs andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 the base level of primary care resident positions as determined under subparagraph before receiving such additional positions and the number of such additional positions ime in general section of the social security act usc ww in the third sentence is amended a by striking subsection and inserting subsections and and by striking it applies and inserting they apply conforming provision section of the social security act usc ww is amended by adding at the end the following clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for discharges occurring on or after july insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection the indirect teaching adjustment factor shall be computed in the same manner as provided under clause with respect to such resident positions conforming amendment section of the medicare prescription drug improvement and modernization act of public law – is amended by striking section and all that follows and inserting paragraphs and of subsection of section of the social security act sec increasing training in nonprovider settings a direct gme section of the social security act usc ww is amended by designating the first sentence as a clause with the heading in general and appropriate indentation by striking shall be counted and that all the time and inserting shall be counted and that verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective for cost reporting periods beginning before july all the time in subclause as inserted by paragraph by striking the period at the end and inserting and and a by inserting after subclause as so inserted the following effective for cost reporting periods beginning on or after july 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 inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such base year as the secretary shall specify ime section iv of the social security act usc ww iv is amended by striking iv effective for discharges occurring on or after october and inserting iv effective for discharges occurring on or after october and before july and by inserting after subclause as inserted by paragraph the following new subclause effective for discharges occurring on or after july 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 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 ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 years after the date of the enactment of this act the inspector general shall submit a report to congress on such analysis and assessment demonstration project for approved teaching health centers 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 would be eligible for payment under subsections and of section of the social security act usc ww 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 conditions under the demonstration project verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 costs of the salary and fringe benefits for residents in the program the number of primary care residents of the center shall not count against the contracting hospital resident limit and the contracting hospital shall agree not to diminish the number of residents in its primary care residency training program 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 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 hospitalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec rules for counting resident time for didactic and scholarly activities and other activities a direct gme section of the social security act usc ww is amended in paragraph as amended by section a a in clause by striking such rules and inserting subject to clause such rules and by adding at the end the following new clause 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 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall be counted toward the determination of full time equivalency in paragraph by adding at the end the following new subparagraph treatment of certain time in approved medical residency training programing in determining the hospital 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 in paragraph by adding at the end the following new subparagraph 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 pri verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mary activity is the care and treatment of patients as defined by the secretary ime determinations section of such act usc ww as amended by section is amended by adding at the end the following new clause xi the provisions of subparagraph of subsection shall apply under this subparagraph in the same manner as they apply under such subsection in determining the hospital number of fulltime 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 hospital bb is recognized as a subsection puerto rico hospital cc is reimbursed under a reimbursement system authorized under section or dd is a provider based hospital outpatient departmentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii in determining the hospital number of fulltime 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 effective dates application 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 direct gme section of the social security act as added by subsection a shall apply to cost reporting periods beginning on or after july ime section iii of the social security act as added by subsection shall apply to cost reporting periods beginning on or after october such section as so added shall not give rise to any inference on how the law in effect prior to such date should be interpretedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 of the social security act or for direct graduate medical education costs under section of such act sec preservation of resident cap positions from closed hospitals a direct gme section h of the social security act usc section ww h is amended by adding at the end the following new clause vi redistribution of residency slots after a hospital closes in general the secretary shall by regulation establish a process consistent with subclauses and iii under which in the case where a hospital other than a hospital described in clause with an approved medical residency program in a state closes on or after the dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that is 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 process for hospitals in certain areas in determining for which hospitals the increase in the otherwise applicable resident limit described in subclause 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 days after the date of the hospital closure involved or in the case of a hospital that closed after the date that is years before the date of the enactment of this clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 no effect on temporary fte cap adjustments the amendments made by this section shall not effect any temporary adjustment to a hospital fte cap under section of title code of federal regulations as in effect on the date of enactment of this act and shall not affect the application of section h of the social security act conforming amendments section of the medicare prescription drug improvement and modernization act of public law – as amended by section is amended by striking and and inserting vi and verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section of the social security act usc ww is amended by inserting or under paragraph vi after under this paragraph sec improving accountability for approved medical residency training a specification of goals for approved medical residency training programs section of the social security act usc ww is amended by designating the matter beginning with notwithstanding as a subparagraph a with the heading in general and with appropriate indentation and by adding at the end the following new subparagraph 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 work effectively in various health care delivery settings such as nonprovider settingsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 in the delivery of care and in improving the quality of the health of the community and the individuals that the hospital serves verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gao study on evaluation of training programs 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 of the social security act as added by subsection a in a range of residency programs including primary care and other specialties and have the appropriate faculty expertise to teach the topics required to achieve such goals report not later than 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 assessment of the accreditation processes of the accreditation council for graduateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 a title vi program integrity subtitle a increased funding to fight waste fraud and abuse sec increased funding and flexibility to fight fraud and abuse a in general section of the social security act usc is amended by adding at the end the following new paragraph additional funding in addition to the funds otherwise appropriated to the account from the trust fund under paragraphs and and for purposes described in paragraphs and a there are hereby appropriated an additional to such account from such trust fund for each fiscal year beginning with the funds appropriated under this paragraph shall be allocated in the same proportion as the total funding appropriated with respect to paragraphs a and a was allocated with respect to fiscal yearverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and shall be available without further appropriation until expended in paragraph a a by inserting for activities described in paragraph and after necessary and by inserting until expended after appropriation flexibility in pursuing fraud and abuse section a of the social security act usc ddd a is amended by inserting or otherwise after entities subtitle enhanced penalties for fraud and abuse sec enhanced penalties for false statements on provider or supplier enrollment applications a in general section a a of the social security act usc a–a a is amended in paragraph 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 by striking or at the end of paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by inserting at the end or by inserting after paragraph the following new paragraph 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 of title xviii prescription drug plan sponsors under part of title xviii and entities that apply to participate as providers of services or suppliers in such managed care organizations and such plans in the matter following paragraph as inserted by paragraph by striking or in cases under paragraph for each such act and inserting in cases under paragraph for each such act or in cases under paragraph for each false statement omission or misrepresentation of a material fact and in the second sentence by striking for a lawful purpose and inserting for a lawful pur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pose or in cases under paragraph an assessment of not more than 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 effective date the amendments made by subsection a shall apply to acts committed on or after january sec enhanced penalties for submission of false statements material to a false claim a in general section a a of the social security act usc a–a a as amended by section is further amended in paragraph by striking or at the end in paragraph by inserting or at the end and by inserting after paragraph the following new paragraph 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 itemsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and services furnished under a federal health care program and in the matter following paragraph as inserted by paragraph a by striking or in cases under paragraph and inserting in cases under paragraph and by striking a material fact and inserting a material fact in cases under paragraph for each false record or statement effective date the amendments made by subsection a shall apply to acts committed on or after january sec enhanced penalties for delaying inspections a in general section a a of the social security act usc a–a a as amended by sections and is further amended in paragraph by striking or at the end in paragraph by inserting or at the end by inserting after paragraph the following new paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 in the matter following paragraph as inserted by paragraph by inserting or in cases under paragraph for each day of the failure described in such paragraph after false record or statement ensuring timely inspections relating to contracts with ma organizations section of such act usc w– is amended in subparagraph a by inserting timely before inspect and in subparagraph by inserting timely before audit and inspect effective date the amendments made by subsection a shall apply to violations committed on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec enhanced hospice program safeguards a medicare part a of title xviii of the social security act is amended by inserting after section the following new section sec a 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 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 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 a iii or terminate the certification of the program and provide in addition for or more of the other remedies described in subsection a or that the deficiencies involved do not immediately jeopardize the health and safety of the indi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih viduals to whom the program furnishes items and services the secretary a impose intermediate sanctions developed pursuant to subsection in lieu of terminating the certification of the program and 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 provide for a civil money penalty under subsection a for the days in which it finds that the program was not in compliance with such requirements intermediate sanctions development and implementation the secretary shall develop and implement by not later than july a a range of intermediate sanctions to apply to hospice programs under the conditions described in subsection a andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih appropriate procedures for appealing determinations relating to the imposition of such sanctions specified sanctions a in general the intermediate sanctions developed under paragraph include civil money penalties in an amount not to exceed for each day of noncompliance or in the case of a per instance penalty applied by the secretary not to exceed 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 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 individ verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih uals under the care of the program while improvements are made iv corrective action plans and in service training for staff the provisions of section a other than subsections a and shall apply to a civil money penalty under clause in the same manner as such provisions apply to a penalty or proceeding under section a 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 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 commencement of payment a denial of payment under subparagraph a shall terminate when the secretary determines that the hospice program no longer demonstrates a substandard quality of care andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih meets such other requirements as the secretary 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 secretarial authority the secretary shall develop and implement by not later than july specific procedures with respect to the conditions under which each of the intermediate sanctions developed under paragraph 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 application to medicaid section of the social security act usc is amended by adding at the end the following new paragraph the provisions of section a 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih application to chip title xxi of the social security act is amended by adding at the end the following new section sec assuring quality of care in hospice care the provisions of section a 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 enhanced penalties for individuals excluded from program participation a in general section a a of the social security act usc a–a a as amended by the previous sections is further amended by striking or at the end of paragraph by inserting or at the end of paragraph by inserting after paragraph the following new paragraph 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 beenverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 in the matter following paragraph as inserted by paragraph by striking for each day of the failure described in such paragraph and inserting for each day of the failure described in such paragraph or in cases under paragraph for each order or prescription for an item or service by an excluded individual effective date the amendments made by subsection a shall apply to violations committed on or after january sec enhanced penalties for provision of false information by medicare advantage and part plans a in general section a of the social security act usc a is amended by inserting except with respect to a determination under subparagraph an assessment of not more than times the amount claimed by such plan or plan sponsor based upon the misrepresentation or falsified information involved after for each such determination verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendment made by subsection a shall apply to violations committed on or after january sec enhanced penalties for medicare advantage and part marketing violations a in general section of the social security act usc as amended by section is amended in subparagraph by striking or at the end by inserting after subparagraph the following new subparagraphs except as provided under subparagraph or of section d– enrolls an individual in any plan under this part without the prior consent of the individual or the designee of the individual 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 fails to comply with marketing restrictions described in subsections and ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section or applicable implementing regulations or guidance or employs or contracts with any individual or entity who engages in the conduct described in subparagraphs a through of this paragraph and by adding at the end the following new sentence the secretary provide in addition to any other remedies authorized by law for any of the remedies described in paragraph 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 of this paragraph effective date the amendments made by subsection a shall apply to violations committed on or after january sec enhanced penalties for obstruction of program audits a in general section of the social security act usc a– is amended in the heading by inserting or audit after investigation andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking investigation into and all that follows through the period and inserting investigation or audit related to any offense described in paragraph or in subsection a or the use of funds received directly or indirectly from any federal health care program as defined in section effective date the amendments made by subsection a shall apply to violations committed on or after january sec exclusion of certain individuals and entities from participation in medicare and state health care programs a in general section of the social security act as previously amended by this division is further amended in the heading by striking and period and inserting period and effect and by adding at the end the following new paragraph a for purposes of this act subject to subparagraph the effect of exclusion is that no payment be made by any federal health care program as definedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in section with respect to any item or service furnished by an excluded individual or entity or 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 for purposes of this section and sections a and subject to subparagraph 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 payment 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 exclusion in the case that an individual eligible for benefits under title xviii or xix submits a claim for paymentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 waive repayment of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 sec oig authority to exclude from federal health care programs officers and owners of entities convicted of fraud section a of the social security act usc a– a is amended in clause a by striking has and inserting had and by striking sanctioned entity and who knows or should know as defined in section a of and inserting sanctioned entity at the time of and who knew or should have known as defined in section a of and in clause a by striking is an officer and inserting was an officer andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by inserting before the period the following at the time of the action constituting the basis for the conviction or exclusion described in subparagraph sec self referral disclosure protocol a development of self referral disclosure protocol in general the secretary of health and human services in cooperation with the inspector general of the department of health and human services shall establish not later than months after the date of the enactment of this act a protocol to enable health care providers of services and suppliers to disclose an actual or potential violation of section of the social security act usc nn pursuant to a self referral disclosure protocol in this section referred to as an srdp the srdp shall include direction to health care providers of services and suppliers on a a specific person official or office to whom such disclosures shall be made and instruction on the implication of the srdp on corporate integrity agreements and corporate compliance agreementsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih publication on internet website of srdp information the secretary shall post information on the public internet website of the centers for medicare medicaid services to inform relevant stakeholders of how to disclose actual or potential violations pursuant to an srdp relation to advisory opinions the srdp shall be separate from the advisory opinion process set forth in regulations implementing section of the social security act reduction in amounts owed the secretary is authorized to reduce the amount due and owing for all violations under section of the social security act to an amount less than that specified in subsection of such section in establishing such amount for a violation the secretary consider the following factors the nature and extent of the improper or illegal practice the timeliness of such self disclosure the cooperation in providing additional information related to the disclosure such other factors as the secretary considers appropriate report not later than months after the date on which the srdp protocol is established under sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section a the secretary shall submit to congress a report on the implementation of this section such report shall include the number of health care providers of services and suppliers making disclosures pursuant to an srdp the amounts collected pursuant to the srdp the types of violations reported under the srdp and such other information as be necessary to evaluate the impact of this section relation to other law and regulation nothing in this section shall affect the application of section of the social security act as added by section except in the case of a health care provider of services or supplier who is a person as defined in paragraph of such section who discloses an overpayment as defined in such paragraph to the secretary of health and human services pursuant to a srdp established under this section the day period described in paragraph of such section shall be extended with respect to the return of an overpayment to the extent necessary for the secretary to determine pursuant to the srdp the amount due and owingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle enhanced program and provider protections sec enhanced cms program protection authority a in general title xi of the social security act usc et seq is amended by inserting after section the following new section sec enhanced program and provider protections in the medicare medicaid and chip programs a certain authorized screening enhanced oversight periods and enrollment moratoria in general for periods beginning after january 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 impose any of the following requirements with respect to a provider of services or a supplier whether such pro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vider or supplier is initially enrolling in the program or is renewing such enrollment a screening under paragraph enhanced oversight periods under paragraph enrollment moratoria under paragraph in applying this subsection for purposes of title xix and xxi the secretary 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 screening for purposes of paragraph the secretary shall establish procedures under which screening is conducted with respect to providers of services and suppliers described in such paragraph such screening include a licensing board checks screening against the list of individuals and entities excluded from the program under title xviii xix or xxi the excluded provider list system background checks andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih unannounced pre enrollment or other site visits enhanced oversight period for purposes of paragraph the secretary shall establish procedures to provide for a period of not less than days and not more than 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 extend such period for more than days if the secretary determines that after the initial period such additional period of oversight is necessary moratorium on enrollment of providers and suppliers for purposes of paragraph the secretary based upon a finding of a risk of serious ongoing fraud within a program under title xviii xix or xxi impose a moratorium on the enrollment of providers of services and suppliers within a category of providers of serv verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ices and suppliers including a category within a specific geographic area under such title such a moratorium only be imposed if the secretary makes a determination that the moratorium would not adversely impact access of individuals to care under such program 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 conforming amendments medicaid section a of the social security act usc usc a a is amended a in paragraph by inserting before the semicolon at the end the following or by a person to whom or entity to which a moratorium under section a is applied during the period of such moratorium in paragraph by striking at the end and in paragraph by striking the period at the end and inserting and andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding after paragraph the following new paragraph provide that the state will enforce any determination made by the secretary under subsection a of section 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 chip section of such act usc bb is amended by adding at the end the following new subsection program integrity a state child health plan shall include a description of the procedures to be used by the state to enforce any determination made by the secretary under subsection a of section 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 to carry out any activities as required by the secretary for purposes of such subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medicare section of such act usc cc is amended by adding at the end the following new paragraph program integrity the provisions of section a apply to enrollments and renewals of enrollments of providers of services and suppliers under this title sec enhanced medicare medicaid and chip program disclosure requirements relating to previous affiliations a in general section of the social security act as inserted by section is amended by adding at the end the following new subsection enhanced program disclosure requirements disclosure a provider of services or supplier who submits on or after july 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 year period with a provider of services or supplier that has uncollected debt or with a person or entity that has been suspended or ex verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cluded under such program subject to a payment suspension or has had its billing privileges revoked 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 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 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 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 deny the application of such provider or supplier conforming amendments verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medicaid paragraph of section a of such act usc a a as added by section is amended a by inserting or subsection of such section relating to disclosure requirements before and that the state and by inserting before the period the following and apply any enhanced safeguards with respect to a provider or supplier described in such subsection as the secretary determines necessary under such subsection chip subsection of section of such act usc bb as added by section is amended a in paragraph by striking at the end and in paragraph by striking the period at the end and inserting and and by adding at the end the following new paragraph to enforce any determination made by the secretary under subsection of section relating to disclosure requirements and to apply any enhanced safeguards with respect to a provider orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih supplier described in such subsection as the secretary determines necessary under such subsection sec required inclusion of payment modifier for certain evaluation and management services section of the social security act usc w– as amended by section of the hitech act public law – is amended by adding at the end the following new subsection 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 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 require providers of services or suppliers to report such modifier in claims submitted for payment verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec evaluations and reports required under medicare integrity program a in general section of the social security act usc ddd is amended in paragraph by striking at the end and by redesignating paragraph as paragraph and by inserting after paragraph the following new paragraph for the contract year beginning in 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 reference to medicaid integrity program for a similar provision with respect to the medicaid integrity program see section sec require providers and suppliers to adopt programs to reduce waste fraud and abuse a in general section of the social security act usc usc cc as amendedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by section is further amended by adding at the end the following new paragraph compliance programs for providers of services and suppliers a in general the secretary not enroll or renew the enrollment of a provider of services or a supplier other than a physician or a skilled nursing facility under this title if such provider of services or supplier fails to subject to subparagraph establish a compliance program that contains the core elements established under subparagraph and certify in a manner determined by the secretary that the provider or suppler has established such a program 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 subparagraph a such elements 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 abuseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for the organization 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 timeline for implementation the secretary shall determine a timeline for the establishment of the core elements under subparagraph and the date on which a provider of services and suppliers other than physicians and skilled nursing facilities shall be required to have established such a program for purposes of this subsection pilot program the secretary conduct a pilot program on the application of this subsection with respect to a category of providers of services or suppliers other thanverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih physicians and skilled nursing facilities 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 subparagraph treatment of skilled nursing facilities for the requirement for skilled nursing facilities to establish compliance and ethics programs see section construction nothing in this subsection exempts a physician from participating in a compliance program established by a health care provider or other entity with which the physician is employed under contract or affiliated if such compliance is required by such provider or entity 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec maximum period for submission of medicare claims reduced to not more than months a purpose in general the month period currently allowed for claims filing under parts a and 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 reducing maximum period for submission part a section a of the social security act usc a is amended a in paragraph by striking period of calendar years and all that follows and inserting period of calendar year from which such services are furnished and and by adding at the end the following new sentence in applying paragraph the secretary specify exceptions to the calendar year period specified in such paragraph part section a of such act usc a is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in paragraph by striking period of calendar years and all that follows and inserting period of calendar year from which such services are furnished and and by adding at the end the following new sentence in applying paragraph the secretary specify exceptions to the calendar year period specified in such paragraph parts and section of such act is amended by adding at the end the following new paragraph 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 by regulation prescribe no later than the close of the calendar year period after such items andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih services are furnished in applying the previous sentence the secretary specify exceptions to the calendar year period specified effective date the amendments made by subsection shall be effective for items and services furnished on or after january sec physicians who order durable medical equipment or home health services required to be medicare enrolled physicians or eligible professionals a dme section a of the social security act usc a is amended by striking physician and inserting physician enrolled under section or other professional as determined by the secretary home health services part a section a of such act usc a is amended in the matter preceding subparagraph a by inserting in the case of services described in subparagraph a physician enrolled under section or other professional as determined by the secretary before or in the case of services part section a of such act usc a is amended in the matterverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih preceding subparagraph a by inserting or in the case of services described in subparagraph a a physician enrolled under section or other professional as determined by the secretary after a physician discretion to expand application the secretary extend the requirement applied by the amendments made by subsections a and 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 drugs as defined in section d– 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 effective date the amendments made by this section shall apply to written orders and certifications made on or after july verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse a physicians and other suppliers section of the social security act is further amended by adding at the end the following new paragraph the secretary disenroll for a period of not more than one year for each act a physician or supplier under section 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 providers of services section a of such act usc cc is amended in subparagraph by striking at the end and in subparagraph by striking the period at the end and adding and and by adding at the end the following new subparagraph maintain and upon request of the secretary provide access to documentation relating to written orders or requests for paymentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 oig permissive exclusion authority section of the social security act usc a– is amended by inserting ordering referring for furnishing or certifying the need for after furnishing effective date the amendments made by this section shall apply to orders certifications and referrals made on or after january sec face to face encounter with patient required before eligibility certifications for home health services or durable medical equipment a condition of payment for home health services part a section a of such act is amended a by striking and such services and inserting such services and by inserting after care of a physician the following and in the case of a cer verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tification or recertification made by a physician after january 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 month period preceding such certification or other reasonable timeframe as determined by the secretary part section a a of the social security act is amended a by striking and before iii and by inserting after care of a physician the following and iv in the case of a certification or recertification after january 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 month period preceding such certification or recertification or other reasonable timeframe as determined by the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih condition of payment for durable medical equipment section a of the social security act usc a is amended by adding before the period at the end the following and shall require that any written order required for payment under this subsection be written only pursuant to the eligible health care professional authorized to make such written order documenting that such professional 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 month period preceding such written order or other reasonable timeframe as determined by the secretary application to other areas under medicare the secretary apply a face to face encounter requirement similar to the requirement described in the amendments made by subsections a and to other items and services for which payment is provided under title xviii of the social security act based upon a finding that such a decision would reduce the risk of waste fraud or abuse application to medicaid and chip the face to face encounter requirements described in the amendments made by subsections a and and any ex verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih panded application of similar requirements pursuant to subsection shall apply with respect to a certification or recertification for home health services under title xix or xxi of the social security act a written order for durable medical equipment under such title and any other applicable item or service identified pursuant to subsection for which payment is made under such title respectively in the same manner and to the same extent as such requirements apply in the case of such a certification or recertification written order or other applicable item or service so identified respectively under title xviii of such act sec extension of testimonial subpoena authority to program exclusion investigations a in general section of the social security act usc a is amended by adding at the end the following new paragraph the provisions of subsections and of section shall apply with respect to this section to the same extent as they are applicable with respect to title the secretary delegate the authority granted by section as made applicable to this section to the inspector general of the department of health and human services or the administrator of the centers forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medicare medicaid services for purposes of any investigation under this section effective date the amendment made by subsection a shall apply to investigations beginning on or after january sec required repayments of medicare and medicaid overpayments section of the social security act as inserted by section and amended by section is further amended by adding at the end the following new subsection reports on and repayment of overpayments identified through internal audits and reviews 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 notify the secretary the state intermediary carrier or contractor to whom the overpayment was returned in writing of the reason for the overpaymentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih timing subject to section of the affordable health care for america act an overpayment must be reported and returned under paragraph a by not later than the date that is 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 of title of the united states code 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 potential liability for administrative obligations such as applicable interests fines and penalties or civil or criminal sanctions involving the same claim if it is determined later that the reason for the overpayment was related to fraud or other intentional conduct by the provider or supplier or the employees or agents of such provider or supplier definitions in this subsection a knows the term knows has the meaning given the terms knowing and know verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ingly in section of title of the united states code overpayment the term overpayment means any funds that a person receives or retains under title xviii xix or xxi to which the person after applicable reconciliation pursuant to the applicable existing process under the respective title is not entitled under such title person the term person means a provider of services supplier medicaid managed care organization as defined in section a medicare advantage organization as defined in section a or pdp sponsor as defined in section d– a but excluding a beneficiary sec expanded application of hardship waivers for oig exclusions to beneficiaries of any federal health care program section of the social security act usc a– is amended by striking individuals entitled to benefits under part a of title xviii or enrolled under part of such title or both and insert verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ing beneficiaries as defined in section a of that program sec access to certain information on renal dialysis facilities section of the social security act usc rr is amended by adding at the end the following new paragraph for purposes of evaluating or auditing payments made to renal dialysis facilities for items and services under this section under paragraph 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 billing agents clearinghouses or other alternate payees required to register under medicare a medicare section of the social security act usc cc is amended by adding at the end the following new subparagraph billing agents and clearinghouses required to be registered under medicare any agent clearinghouse or other alternate payee that submits claims on behalf ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a health care provider must be registered with the secretary in a form and manner specified by the secretary medicaid for a similar provision with respect to the medicaid program under title xix of the social security act see section effective date the amendment made by subsection a shall apply to claims submitted on or after january sec conforming civil monetary penalties to false claims act amendments section a of the social security act as amended by sections and is further amended in subsection a a in paragraph 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 in paragraph in the matter preceding subparagraph a by striking participating in a program under title xviii or a state health care program and inserting par verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ticipating in a federal health care program as defined in section and in subparagraph a by striking title xviii or a state health care program and inserting a federal health care program as defined in section by striking or at the end of paragraph by inserting after paragraph the following new paragraphs conspires to commit a violation of this section or 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 in the matter following paragraph as inserted by subparagraph by striking or before in cases under paragraph andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by inserting in cases under paragraph for any violation described in this section committed in furtherance of the conspiracy involved or in cases under paragraph for each false record or statement or concealment avoidance or decrease after by an excluded individual and in the second sentence by striking such false statement omission or misrepresentation and inserting such false statement or misrepresentation in cases under paragraph an assessment of not more than 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 an assessment of not more than times the total amount of the obligation to which the false record or statement was material or that was avoided or decreased in subsection by striking six years and inserting years and in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by amending paragraph to read as follows 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 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 or 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 behalf or to advance a federal health care program interest and if the federal health care program provides or has provided any portion of the money or property requested or demanded or will reimburse such contractor grantee or other recipient for any portionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of the money or property which is requested or demanded by amending paragraph to read as follows 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 in paragraph in subparagraph by striking at the end or in the first subparagraph by striking at the end the period and inserting or and iii by redesignating the second subparagraph as a subparagraph by amending paragraph to read as follows the terms knowing knowingly and should know mean that a person with respect to information a has actual knowledge of the information verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih acts in deliberate ignorance of the truth or falsity of the information or acts in reckless disregard of the truth or falsity of the information and require no proof of specific intent to defraud and by adding at the end the following new paragraphs the term obligation means an established duty whether or not fixed arising from an express or implied contractual grantor grantee or licensorlicensee relationship from a fee based or similar relationship from statute or regulation or from the retention of any overpayment the term material means having a natural tendency to influence or be capable of influencing the payment or receipt of money or property verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec requiring provider and supplier payments under medicare to be made through direct deposit or electronic funds transfer eft at insured depository institutions a medicare section of the social security act usc kk is amended by adding at the end the following new subsection limitation on payment to providers of services and suppliers no payment shall be made under this title for items and services furnished by a provider of services or supplier unless each payment to the provider of services or supplier is in the form of direct deposit or electronic funds transfer to the provider of services or supplier account as applicable at a depository institution as defined in section a of the federal reserve act effective date the amendments made by this section shall apply to each payment made to a provider of services provider or supplier on or after such date not later than july as the secretary of health and human services shall specify regardless of when the items and services for which such payment is made were furnishedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec inspector general for the health choices administration a establishment appointment there is hereby established an office of inspector general for the health choices administration to be headed by the inspector general for the health choices administration to be appointed by the president by and with the advice and consent of the senate amendments to the inspector general act of application to health choices administration section of the inspector general act of usc app is amended a in paragraph by striking or the federal cochairpersons of the commissions established under section of title united states code and inserting the federal cochairpersons of the commissions established under section of title united states code or the commissioner of the health choices administration established under section of the affordable health care for america act and in paragraph by striking or the commissions established under section of title united states code and insertingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the commissions established under section of title united states code or the health choices administration established under section of the affordable health care for america act special provisions relating to health choices administration and hhs the inspector general act of usc app is further amended by inserting after section the following new section sec special provisions relating to the health choices administration and the department of health and human services a the inspector general of the health choices administration shall have the authority to conduct supervise and coordinate audits evaluations and investigations of the programs and operations of the health choices administration established under section of the affordable health care for america act including matters relating to fraud abuse and misconduct in connection with the admission and continued participation of any health benefits plan par verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ticipating in the health insurance exchange established under section of such act have the authority to conduct audits evaluations and investigations relating to any private exchange participating health benefits plan as defined in section of such act have the authority in consultation with the office of inspector general for the department of health and human services and subject to subsection to conduct audits evaluations and investigations relating to the public health insurance option established under section of such act and have access to all relevant records necessary to carry out this section including records relating to claims paid by exchange participating health benefits plans authority granted to the health choices administration and the inspector general of the health choices administration by the affordable health care for america act does not limit the duties authorities and responsibilities of the office of inspector general for the department of health and human services as in existence as of the date of the enactment of the affordable health care for america act to oversee programs and operations of suchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih department the office of inspector general for the department of health and human services retains primary jurisdiction over fraud and abuse in connection with payments made under the public health insurance option established under section of such act and administered by the department of health and human services application of rule of construction section of the inspector general act of usc app is amended by striking or and inserting or effective date the provisions of and amendments made by this section shall take effect on the date of the enactment of this act subtitle access to information needed to prevent fraud waste and abuse sec access to information necessary to identify fraud waste and abuse a gao access subchapter of chapter of title united states code is amended by adding at the end the following § access to certain information no provision of the social security act shall be construed to limit amend or supersede the authority of the comptroller general to obtain any information to inspectverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih any record or to interview any officer or employee under section of this title including with respect to any information disclosed to or obtained by the secretary of health and human services under part or of title xviii of the social security act access to medicare part data program integrity purposes provision of information as condition of payment section d– of the social security act usc w– is amended a by striking be used by officers and all that follows through the period and inserting be used by and by adding at the end the following clauses officers employees and contractors of the department of health and human services only for the purposes of and to the extent necessary in carrying out this section and the inspector general of the department of health and human services the administrator of the centers for medicare medicaid services and the attorneyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih general only for the purposes of protecting the integrity of the programs under this title and title xix conducting the activities described in section and subparagraphs a through of section a and for investigation audit evaluation oversight and law enforcement purposes to the extent consistent with applicable law general disclosure of information section d– of the social security act usc w– is amended a by striking be used by officers and all that follows through the period and inserting be used by and by adding at the end the following subparagraphs a officers employees and contractors of the department of health and human services only for the purposes of and to the extent necessary in carrying out this section and the inspector general of the department of health and human services the administrator of the centers for medicare medicaid services and the attorney general onlyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for the purposes of protecting the integrity of the programs under this title and title xix conducting the activities described in section and subparagraphs a through of section a and for investigation audit evaluation oversight and law enforcement purposes to the extent consistent with applicable law sec 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 of the social security act and the national practitioner data bank npbd established under the health care quality improvement act of section of the social security act usc a is amended in subsection a by striking not later than and inserting subject to subsection not later than in the first sentence of subsection by striking other than with respect to requests by federal agencies andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end the following new subsection 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 and section 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 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih elimination of the responsibility of the hhs office of the inspector general section a of the social security act usc a a is amended in subparagraph by adding at the end and in subparagraph by striking at the end and and inserting a period and by striking subparagraph special provision for access to the national practitioner data bank by the department of veterans affairs in general notwithstanding any other provision of law during the one year period that begins on the effective date specified in subsection the information described in paragraph shall be available from the national practitioner data bank described in section of the social security act to the secretary of veterans affairs without charge information described for purposes of paragraph the information described in this paragraph is the information that would but for the amendments made by this section have been avail verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih able to the secretary of veterans affairs from the healthcare integrity and protection data bank funding notwithstanding any provisions of this act sections and of the social security act or any other provision of law there shall be available for carrying out the transition process under section 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 any fees collected pursuant to section of such act and 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 and respectively of section a of such act for costs of such activities during the first months following the date of the enactment of this act effective date the amendments made by subsection a shall take effect on the first day after the secretary of health and human services certifies that the process implemented pur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih suant to section of the social security act as added by subsection a is complete and by subsection shall take effect on the earlier of the date specified in paragraph or the first day of the second succeeding fiscal year after the fiscal year during which this act is enacted sec compliance with hipaa privacy and security standards the provisions of sections a and of the health insurance portability and accountability act of and standards promulgated pursuant to such sections and the privacy act of shall apply with respect to the provisions of this subtitle and amendments made by this subtitle title vii medicaid and chip sec table of contents øtemporary¿sec table of contents øtemporary¿subtitle a medicaid and health reformsec eligibility for individuals with income below percent of the federalpoverty levelsec requirements and special rules for certain medicaid eligible individualssec chip and medicaid maintenance of eligibilitysec reduction in medicaid dshsec expanded outstationingsubtitle preventionsec required coverage of preventive servicessec tobacco cessationsec optional coverage of nurse home visitation servicessec state eligibility option for family planning servicessubtitle accessverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ihsec payments to primary care practitionerssec medical home pilot programsec translation or interpretation servicessec optional coverage for freestanding birth center servicessec inclusion of public health clinics under the vaccines for children programsec requiring coverage of services of podiatristssec a requiring coverage of services of optometristssec therapeutic foster caresec assuring adequate payment levels for servicessec preserving medicaid coverage for youths upon release from publicinstitutionssec quality measures for maternity and adult health services undermedicaid and chipsec a accountable care organization pilot programsec fqhc coveragesubtitle coveragesec optional medicaid coverage of low income hiv infected individualssec extending transitional medicaid assistance tma sec requirement of month continuous coverage under certain chipprogramssec preventing the application under chip of coverage waiting periodsfor certain childrensec adult day health care servicessec medicaid coverage for citizens of freely associated statessec continuing requirement of medicaid coverage of nonemergencytransportation to medically necessary servicessec state option to disregard certain income in providing continuedmedicaid coverage for certain individuals with extremely highprescription costssec provisions relating to community living assistance services and supports class subtitle financingsec payments to pharmacistssec prescription drug rebatessec extension of prescription drug discounts to enrollees of medicaidmanaged care organizationssec payments for graduate medical educationsec nursing facility supplemental payment programsec report on medicaid paymentssec reviews of medicaidsec extension of delay in managed care organization provider tax eliminationsec extension of arra increase in fmapsubtitle waste fraud and abusesec health care acquired conditionssec evaluations and reports required under medicaid integrity programsec require providers and suppliers to adopt programs to reduce waste fraud and abusesec overpaymentsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ihsec managed care organizationssec termination of provider participation under medicaid and chip ifterminated under medicare or other state plan or child healthplansec medicaid and chip exclusion from participation relating to certainownership control and management affiliationssec requirement to report expanded set of data elements under mmisto detect fraud and abusesec billing agents clearinghouses or other alternate payees required toregister under medicaidsec denial of payments for litigation related misconductsec mandatory state use of national correct coding initiativesubtitle payments to the territoriessec payment to territoriessubtitle miscellaneoussec technical correctionssec extension of qi programsec assuring transparency of informationsec medicaid and chip payment and access commissionsec outreach and enrollment of medicaid and chip eligible individualssec prohibitions on federal medicaid and chip payment for undocumentedalienssec demonstration project for stabilization of emergency medical conditionsby institutions for mental diseasessec application of medicaid improvement fundsec treatment of certain medicaid brokerssec rule for changes requiring state legislation subtitle a medicaid and health reform sec eligibility for individuals with income below percent of the federal poverty level a eligibility for non traditional individuals with income below percent of the federal poverty level full medicaid benefits for non medicare eligible individuals sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a a of the social security act usc a a is amended a by striking or at the end of subclause vi by adding or at the end of subclause vii and by adding at the end the following new subclause viii who are under years of age who are not described in a previous subclause of this clause who are not entitled to hospital insurance benefits under part a of title xviii and whose family income determined using methodologies and procedures specified by the secretary in consultation with the health choices commissioner does not exceed percent of the income official poverty line as defined by the office of management and budget and revised annually in accordance with section of the omnibus budget reconciliation act of applicable to a family of the size involved verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medicare cost sharing assistance for medicare eligible individuals section a of such act usc a is amended a in clause iii by striking and at the end in clause iv by adding and at the end and by adding at the end the following new clause for making medical assistance available for medicare cost sharing described in subparagraphs and of section for individuals under years of age who would be qualified medicare beneficiaries described in section but for the fact that their income exceeds the income level established by the state under section but is less than percent of the official poverty line referred to in such section for a family of the size involved and increased fmap for non traditional full medicaid eligible individuals section of such act usc is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in the first sentence of subsection by striking and before and by inserting before the period at the end the following and percent for periods before and percent for periods beginning with with respect to amounts described in subsection and by adding at the end the following new subsection additional expenditures subject to increased fmap for purposes of section the amounts described in this subsection are the following amounts expended for medical assistance for individuals described in subclause viii of section a a construction nothing in this subsection shall be construed as not providing for coverage under subparagraph a viii or of section a of the social security act as added by paragraphs and or an increased fmap under the amendments made by paragraph for an individual who has been provided medical assistance under title xix of the act under a demonstration waiver approved under section of such act or with state fundsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conforming amendments a section of the social security act usc is amended by inserting a a viii after a a vii and by inserting a before section a of such act usc a as amended by sections a and is further amended in the matter preceding paragraph by striking or at the end of clause xiv by adding or at the end of clause xv and iii by inserting after clause xv the following xvi individuals described in section a a viii eligibility for traditional medicaid eligible individuals with income not exceeding percent of the federal poverty level in general section a a of the social security act uscverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a a as amended by subsection a is amended a by striking or at the end of subclause vii and by adding at the end the following new subclause ix who are over and under years of age who would be eligible for medical assistance under the state plan under subclause or section based on the income standards methodologies and procedures in effect as of june but for income who are in families whose income does not exceed percent of the income official poverty line as defined by the office of management and budget and revised annually in accordance with section of the omnibus budget reconciliation act of applicable to a family of the size involved or beginning with who are over and under years of age who would be eligible for medicalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih assistance under the state plan under subclause or vii based on the income standards methodologies and procedures in effect as of june but for income who are in families whose income does not exceed percent of the income official poverty line as defined by the office of management and budget and revised annually in accordance with section of the omnibus budget reconciliation act of applicable to a family of the size involved or xi beginning with who are under years of age who are not described in subclause and who would be eligible for child health assistance under a state child health plan insofar as such plan provides benefits under this title as described in section a based on such plan as in effect as of june or increased fmap for certain traditional medicaid eligible individuals verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a increased fmap for adults section of such act usc as added by subsection a is amended by inserting or ix after viii enhanced fmap for children section of such act is amended by inserting a a a a xi or after on the basis of section construction nothing in this subsection shall be construed as not providing for coverage under subclause ix or xi of section a a of the social security act as added by paragraph or an increased or enhanced fmap under the amendments made by paragraph for an individual who has been provided medical assistance under title xix of the act under a demonstration waiver approved under section of such act or with state funds conforming amendment section of the social security act usc as amended by subsection a is amended by inserting a a ix a a a a xi after a a viii verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih increased matching rate for temporary coverage of certain newborns section of such act as added by subsection a is amended by adding at the end the following amounts expended for medical assistance for children described in section of the affordable health care for america act during the time period specified in such section network adequacy section a of the social security act usc u– a is amended by adding at the end the following new subparagraph enrollment of non traditional medicaid eligibles a state not require under paragraph the enrollment in a managed care entity of an individual described in section a a 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 effective date the amendments made by this section shall take effect on the first day of andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall apply with respect to items and services furnished on or after such date sec 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 a coordination with nhi exchange through memorandum of understanding in general the state shall enter into a medicaid memorandum of understanding described in section of the affordable health care for america act 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 titleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 of title of division a of the affordable health care for america act as specified under such memorandum 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 traditional medicaid eligible individual the state do redeterminations of eligibility of such individual consistent with such section and the memorandumverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 of title of division a of the affordable health care for america act under such memorandum a the state medicaid agency shall conduct such determinations for any exchange eligible individual who requests such a determination 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 the commissioner shall reimburse the state medicaid agency for the costs of conducting such determinations referrals under memorandum pursuant to such memorandum if an individual applies to the state for assistance in obtaining health coverage and the state determines that the individual is not eligible for medical assistance under this titleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and is not authorized under such memorandum to make an determination with respect to eligibility for coverage and affordability credits through the health insurance exchange the state shall refer the individual to the commissioner for a determination of such eligibility and with the individual authorization provide to the commissioner information obtained by the state as part of the application process additional terms such memorandum shall include such additional provisions as are necessary to implement efficiently the provisions of this section and title of division a of the affordable health care for america act treatment of certain newborns in general in the case of a child who is deemed under section of the affordable health care for america act to be a 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 paragraph of such section of the child eligibility for medical assistance under this titleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih extended treatment as traditional medicaid eligible individual in accordance with paragraph of section of the affordable health care for america act in the case of a child described in paragraph of such section who at the end of the period referred to in such paragraph 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 eligibility for medical assistance under its plan under this title pursuant to paragraph to be a medicaid eligible individual described in section definitions in this section medicaid eligible individual the term medicaid eligible individual means an individual who is eligible for medical assistance under medicaid traditional medicaid eligible individual the term traditional medicaid eligible individual means a medicaid eligible individual other than an individual who is a a medicaid eligible individual by reason of the application of subclause viii ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section a a of the social security act or a childless adult not described in section a a or of such act as in effect as of the day before the date of the enactment of this act non traditional medicaid eligible individual the term non traditional medicaid eligible individual means a medicaid eligible individual who is not a traditional medicaid eligible individual memorandum the term memorandum means a medicaid memorandum of understanding under section of the affordable health care for america act the term has the meaning given such term in section of the affordable health care for america act conforming amendments to error rate section of the social security act usc 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 eligi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih bility determination under subtitle of title of division a of the affordable health care for america act section of such act usc ee is amended by adding at the end the following new sentence clause vi of section shall apply with respect to the application of such requirements under this title and title xix sec chip and medicaid maintenance of eligibility a chip maintenance of eligibility section of the social security act usc a is amended in subsection a as amended by section a by striking and at the end of paragraph by striking the period at the end of paragraph and inserting and and by inserting after paragraph the following new paragraph provide for maintenance of effort under the state child health plan under title xxi in accordance with subsection gg andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end the following new subsection gg chip maintenance of eligibility requirement in general subject to paragraph as a condition of its state plan under this title under subsection a and receipt of any federal financial assistance under section a for calendar quarters beginning after the date of the enactment of this subsection and before chip moe termination date specified in paragraph 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 demonstration project under section that are more restrictive than the eligibility standards methodologies or procedures respectively under such plan or waiver as in effect on june limitation paragraph shall not be construed as preventing a state from imposing a limitation described in section for a fiscal year in order to limit expenditures under its state child health plan under title xxi to thoseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for which federal financial participation is available under section for the fiscal year chip moe termination date in paragraph the chip moe termination date for a state is the date that is the last day of as defined in section of the affordable health care for america act chip transition report not later than december the secretary shall submit to congress a report a that compares the benefits packages offered under an average state child health plan under title xxi in and to the benefit standards initially adopted under section of the affordable health care for america act and for affordability credits under subtitle of title of division of such act and that includes such recommendations as be necessary to ensure that such coverage is at least comparable to the coverage provided to children under such an average state child health plan and there are procedures in effect for the enrollment of chip enrollees includ verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ing chip eligible pregnant women at the end of under this title into a qualified health benefits plan offered through the health insurance exchange or into other acceptable coverage as defined for purposes of such act without interruption of coverage or a written plan of treatment medicaid maintenance of effort simplifying and coordinating eligibility rules between exchange and medicaid in general section of such act usc 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 maintenance of effort a in general subject to subparagraph 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 orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih demonstration project under section that are more restrictive than the eligibility standards methodologies or procedures respectively under such plan or waiver as in effect on june the secretary shall extend such a waiver including the availability of federal financial participation under such waiver for such period as be required for a state to meet the requirement of the previous sentence exception for certain demonstration projects in the case of a state demonstration project under section in effect on june that permits individuals to be eligible solely to receive a premium or cost sharing subsidy for individual or group health insurance coverage effective for coverage provided in the secretary shall permit the state to amend such waiver to apply more restrictive eligibility standards methodologies or procedures with respect to such individuals under such waiver and the application of such more restrictive standards methodologies or procedures under such an amendment shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not be considered in violation of the requirement of subparagraph a 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 as defined in section of the affordable health care for america act 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 subclause iii iv vi viii ix or xi of section a a subclause ix xiv or xvii of section a a iii section 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 waivedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 conforming amendments a section a a of such act usc a a a is amended in the matter before clause by inserting subject to section aa after a section of such act usc u– is amended by inserting and section aa after and standards for benchmark packages section of such act usc u– is amended in each of paragraphs and by inserting subject to paragraph after subsection a and by adding at the end the following new paragraph minimum standards effective january any benchmark benefit package or benchmark equivalent coverage under paragraph must meet the minimum benefits and cost sharingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih standards of a basic plan offered through the health insurance exchange repeal of chip section a of the social security act is amended by inserting at the end the following no funds shall be appropriated or authorized to be appropriated under this section for fiscal year and subsequent years sec reduction in medicaid dsh a report in general not later than january 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 matters to be included the report shall include the following a recommendations recommendations regarding verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the appropriate targeting of medicaid dsh within states and the distribution of medicaid dsh among the states taking into account the ratio of the amount of dsh funds allocated to a state to the number of uninsured individuals in such state specification of dsh health reform methodology the dsh health reform methodology described in paragraph of subsection for purposes of implementing the requirements of such subsection coordination with medicare dsh report the secretary shall coordinate the report under this subsection with the report on medicare dsh under section medicaid dsh in this section the term medicaid dsh means adjustments in payments under section of the social security act for inpatient hospital services furnished by disproportionate share hospitals medicaid dsh reductions reductions verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general for each of fiscal years through the secretary shall effect the following reductions reduction dsh allotments the secretary shall reduce dsh allotments to states in the amount specified under the dsh health reform methodology under paragraph for the state for the fiscal year reductions in payments the secretary shall reduce payments to states under section a of the social security act usc a for each calendar quarter in the fiscal year in the manner specified in subparagraph in an amount equal to of the dsh allotment reduction under clause for the state for the fiscal year aggregate reductions the aggregate reductions in dsh allotments for all states under subparagraph a shall be equal to for fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for fiscal year and iii for fiscal year the secretary shall distribute such aggregate reduction among states in accordance with paragraph manner of payment reduction the amount of the payment reduction under subparagraph a for a state for a quarter shall be deemed an overpayment to the state under title xix of the social security act to be disallowed against the state regular quarterly draw for all medicaid spending under section of such act usc such a disallowance is not subject to a reconsideration under of such act usc d definitions in this section state the term state means the states and the district of columbia dsh allotment the term dsh allotment means with respect to a state for a fiscal year the allotment madeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under section of the social security act usc r– to the state for the fiscal year dsh health reform methodology the secretary shall carry out paragraph 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 do not target their dsh payments on hospitals with high volumes of medicaid inpatients as defined in section a of the social security act usc r– a and hospitals that have high levels of uncompensated care excluding bad debt dsh allotment publications a in general not later than the publication deadline specified in subparagraph the secretary shall publish in the federal reg verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ister a notice specifying the dsh allotment to each state under 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 publication deadline the publication deadline specified in this subparagraph is january with respect to dsh allotments described in subparagraph a for fiscal year january with respect to dsh allotments described in subparagraph a for fiscal year and iii january with respect to dsh allotments described in subparagraph a for fiscal year conforming amendments section of the social security act usc r– is amended a by redesignating paragraph as paragraph and by inserting after paragraph the following new paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih special rule for fiscal years and for each of fiscal years and the dsh allotments under this subsection are subject to reduction under section of the affordable health care for america act the second sentence of section of such act usc r– is amended by inserting before the period the following or to affect the authority of the secretary to issue and implement the dsh health reform methodology under section of the affordable health care for america act disproportionate share hospitals dsh and essential access hospital eah non discrimination in general section of the social security act usc is amended by adding at the end the following new paragraph no hospital be defined or deemed as a disproportionate share hospital or as an essential access hospital for purposes of subsection a iv under a state plan under this title or subsection of this section including any dem verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih onstration project under section 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 need for the services or the availability of the needed services in the hospital and makes arrangements for and accepts reimbursement under this title for services provided to eligible beneficiaries under this title effective date the amendment made by paragraph shall apply to expenditures made on or after july sec expanded outstationing a in general section a of the social security act usc a a is amended by striking under subsection a a iv a a vi a a vii or a a ix and inserting including receipt and processing of applications of individuals for affordability credits under subtitle of title of division a of the affordable health care for america act pursuant to a med verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih icaid memorandum of understanding under section a effective date except as provided in section the amendment made by subsection a shall apply to services furnished on or after july without regard to whether or not final regulations to carry out such amendment have been promulgated by such date subtitle prevention sec required coverage of preventive services a coverage section of the social security act usc as amended by section a is amended in subsection a a by striking and before and by inserting before the semicolon at the end the following and preventive services described in subsection and by adding at the end the following new subsection preventive services the preventive services described in this subsection are services not otherwise described in subsection a or that the secretary determines are verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a recommended with a grade of a or by the task force for clinical preventive services or vaccines recommended for use as appropriate by the director of the centers for disease control and prevention and appropriate for individuals entitled to medical assistance under this title elimination of cost sharing subsections a and of section of such act usc are each amended by inserting preventive services described in section after emergency services as defined by the secretary section a a of such act usc o– a is amended by inserting preventive services described in section after subsection c conforming amendment section of such act usc is amended in subsection by striking the advisory committee referred to in subsection and inserting the director of the centers for disease control and prevention verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in subsection by striking advisory committee and all that follows and inserting director of the centers for disease control and prevention and by striking subsection effective date except as provided in section the amendments made by this section shall apply to services furnished on or after july without regard to whether or not final regulations to carry out such amendments have been promulgated by such date sec tobacco cessation a dropping tobacco cessation exclusion from covered outpatient drugs section of the social security act usc r– is amended by striking subparagraph in subparagraph 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 by redesignating subparagraphs through as subparagraphs through respectivelyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendments made by this section shall apply to drugs and services furnished on or after january sec optional coverage of nurse home visitation services a in general section of the social security act usc as amended by sections a and a is amended in subsection a a in paragraph by striking and at the end by redesignating paragraph as paragraph and by inserting after paragraph the following new paragraph nurse home visitation services as defined in subsection aa and and 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 years of age who is eligible for medical assistance under this title but only to the extent determined by the secretary basedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih upon evidence that such services are effective in one or more of the following improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies 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 increasing economic self sufficiency employment advancement school readiness and educational achievement or reducing dependence on public assistance effective date the amendments made by this section shall apply to services furnished on or after january 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 sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a or a of such act respectively on or after the date of the enactment of this act sec state eligibility option for family planning services a coverage as optional categorically needy group in general section a a of the social security act usc a a a is amended a in subclause xviii by striking or at the end in subclause xix by adding or at the end and by adding at the end the following new subclause xx who are described in subsection hh relating to individuals who meet certain income standards group described section of such act usc a as amended by section is amended by adding at the end the following new subsection hh individuals described in this subsection are individuals verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 who are not pregnant at the option of a state individuals described in this subsection include individuals who had individuals applied on or before january 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 of section subsection a pursuant to a demonstration project waiver granted under section at the option of a state for purposes of subsection a in determining eligibility for services under this subsection the state consider only the income of the applicant or recipient limitation on benefits section a of such act usc a a is amended in the matter following subparagraph a by striking and xiv and inserting xiv andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 a including medical diagnosis and treatment services that are provided pursuant to a family planning service in a family planning setting after cervical cancer conforming amendments section a of such act usc a as amended by section is amended in the matter preceding paragraph a in clause xiii by striking or at the end in clause xiv by adding or at the end and by inserting after clause xiv the following xv individuals described in section hh presumptive eligibility in general title xix of the social security act usc et seq is amended by inserting after section the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih presumptive eligibility for family planning services sec a state option state plan approved under section provide for making medical assistance available to an individual described in section hh relating to individuals who meet certain income eligibility standard during a presumptive eligibility period in the case of an individual described in section hh such medical assistance shall be limited to family planning services and supplies described in a and at the state option medical diagnosis and treatment services that are provided in conjunction with a family planning service in a family planning setting definitions for purposes of this section 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 hh and ends with and includes the earlier of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the day on which a determination is made with respect to the eligibility of such individual for services under the state plan or 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 qualified entity a in general subject to subparagraph the term qualified entity means any entity that is eligible for payments under a state plan approved under this title and is determined by the state agency to be capable of making determinations of the type described in paragraph a rule of construction nothing in this paragraph shall be construed as preventing a state from limiting the classes of entities that become qualified entities in order to prevent fraud and abuse administration verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 information on how to assist such individuals in completing and filing such forms notification requirements a qualified entity that determines under subsection 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 working days after the date on which determination is made and 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 application for medical assistance in the case of an individual described in subsection a who is determined by a qualified enti verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ty 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 payment notwithstanding any other provision of law medical assistance that is furnished to an individual described in subsection a a during a presumptive eligibility period by a entity that is eligible for payments under the state plan and 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 of the first sentence of section conforming amendments a section a of the social security act usc a a 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 during a pre verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sumptive eligibility period in accordance with such section section of such act usc is amended by striking or for and inserting for and by inserting before the period the following or for medical assistance provided to an individual described in subsection a of section during a presumptive eligibility period under such section clarification of coverage of family planning services and supplies section of the social security act usc u– as amended by section is amended by adding at the end the following coverage of family planning services and supplies notwithstanding the previous provisions of this section a state 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 a medical assistance for family plan verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ning services and supplies in accordance with such section 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 access sec payments to primary care practitioners a in general fee for service payments section of the social security act usc as amended by sections a a a and is amended a in subsection a by striking and at the end of subparagraph a by adding and at the end of subparagraph and iii by adding at the end the following new subparagraph payment for primary care services as defined in subsection kk furnished by physicians or for services furnished by other health care professionals that would be primary care services under such section if furnished byverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a physician at a rate not less than percent of the payment rate that would be applicable if the adjustment described in subsection kk were to apply to such services and physicians or professionals as the case be under part of title xviii for services furnished in percent of such adjusted payment rate for services and physicians or professionals furnished in or percent of such adjusted payment rate for services and physicians or professionals furnished in and each subsequent year and by adding at the end the following new subsection kk increased payment for primary care services for purposes of subsection a primary care services defined the term primary care services means evaluation and management services without regard to the specialty of the physician furnishing the services that are procedure codes for services covered under title xviii for services in the category designated evaluation and management in the health care common procedure coding system established by the secretary under section as of decemberverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and as subsequently modified by the secretary adjustment the adjustment described in this paragraph is the substitution of percent for the update otherwise provided under section for each year beginning with under medicaid managed care plans section of such act usc u– is amended a in the heading by adding at the end the following adequacy of payment for primary care services and by inserting before the period at the end the following and in the case of primary care services described in section a 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 increase in payment using increased fmap section of the social security act as added by section a and as amended by section is amended by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a the portion of the amounts expended for medical assistance for services described in section a furnished on or after january that is attributable to the amount by which the minimum payment rate required under such section or by application section exceeds the payment rate applicable to such services under the state plan as of june subparagraph 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 subparagraph effective date the amendments made by this section shall apply to services furnished on or after january sec 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 apply to the secretary for approval of a medical home pilot project described in subsection in this section referred to as a pilot project for the application of the medical home concept under title xix of the social security actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the pilot program shall operate for a period of up to years pilot project described in general a pilot project is a project that applies one or more of the medical home models described in section a of the social security act as inserted by section a or such other model as the secretary approve to individuals 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 of such act limitation a pilot project shall be for a duration of not more than years consideration for certain technologies in considering applications for pilots projects under this section the secretary approve a project which tests the effectiveness of applications and devices such as wireless patient management technologies that are approved by the food and drug administration and enable providers andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih practitioners to communicate directly with their patients in managing chronic illness additional incentives in the case of a pilot project the secretary waive the requirements of section a of the social security act relating to statewideness and section a of such act relating to comparability and increase to up to percent for the first years of the pilot program or percent for the next years the matching percentage for administrative expenditures such as those for community care workers 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 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 enrollment ceases for any reason evaluation report evaluation the secretary using the criteria described in section of the so verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cial security act as inserted by section shall conduct an evaluation of the pilot program under this section report not later than days after the date of completion of the evaluation under paragraph the secretary shall submit to congress and make available to the public a report on the findings of the evaluation under such paragraph funding the additional federal financial participation resulting from the implementation of the pilot program under this section not exceed in the aggregate over the year period of the program sec translation or interpretation services a in general section a of the social security act usc a as added by section a of the children health insurance program reauthorization act of public law – is amended by inserting and other individuals after children of families effective date the amendment made by subsection a shall apply to payment for translation or interpretation services furnished on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec optional coverage for freestanding birth center services a in general section of the social security act usc as amended by section a is amended in subsection a a by redesignating paragraph as paragraph in paragraph by striking at the end and and by inserting after paragraph the following new paragraph freestanding birth center services as defined in subsection a and other ambulatory services that are offered by a freestanding birth center as defined in subsection and that are otherwise included in the plan and and in subsection by adding at the end the following new paragraph a the term freestanding birth center services means services furnished to an individual at a freestanding birth center as defined in subparagraph including by a licensed birth attendant as defined in subparagraph at such center the term freestanding birth center means a health facility verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that is not a hospital and where childbirth is planned to occur away from the pregnant woman residence 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 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 inclusion of public health clinics under the vaccines for children program section a iii of the social security act usc a iii is amended by striking or a rural health clinic and inserting a rural health clinic and by inserting or a public health clinic after verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec requiring coverage of services of podiatrists a in general section a a of the social security act usc a a is amended by striking section and inserting paragraphs and of section effective date except as provided in section the amendment made by subsection a shall apply to services furnished on or after january sec a requiring coverage of services of optometrists a in general section a of the social security act usc a is amended by striking and before and by inserting before the semicolon at the end the following and medical and other health services as defined in section as authorized by state law furnished by an optometrist described in section to the extent such services be performed under state law effective date except as provided in section the amendments made by subsection a shall take effect days after the date of the enactment of this act and shall apply to services furnished or other actions required on or after such dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec therapeutic foster care a rule of construction nothing in this title shall prevent or limit a state from covering therapeutic foster care for eligible children in out of home placements under section a of the social security act usc a therapeutic foster care defined for purposes of this section the term therapeutic foster care means a foster care program that provides to the child a structured daily activities that develop improve monitor and reinforce age appropriate social communications and behavioral skills crisis intervention and crisis support services medication monitoring counseling and case management services and specialized training for the foster parent and consultation with the foster parent on the management of children with mental illnesses and related health and developmental conditionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec assuring adequate payment levels for services a in general title xix of the social security act is amended by inserting after section the following new section assuring adequate payment levels for services sec a in general a state plan under this title shall not be considered to meet the requirement of section a a for a year beginning with unless by not later than april before the beginning of such year the state submits to the secretary an amendment to the plan that specifies the payment rates to be used for such services under the plan in such year and includes in such submission such additional data as will assist the secretary in evaluating the state compliance with such requirement including data relating to how rates established for payments to medicaid managed care organizations under sections and take into account such payment rates secretarial review the secretary by not later than days after the date of submission of a plan amendment under subsection a shall review each such amendment for compliance with the requirement of section a a andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih approve or disapprove each such amendment if the secretary disapproves such an amendment the state shall immediately submit a revised amendment that meets such requirement effective date the amendment made by subsection a shall take effect on the date of the enactment of this act sec preserving medicaid coverage for youths upon release from public institutions section a of the social security act usc a as amended by section and a is amended by striking and at the end of paragraph by striking the period at the end of paragraph and inserting and and by inserting after paragraph the following new paragraph provide that in the case of any youth who is years of age or younger was enrolled for medical assistance under the state plan immediately before becoming an inmate of a public institution is years of age or younger upon release from suchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih institution and is eligible for such medical assistance under the state plan at the time of release from such institution a during the period such youth is incarcerated in a public institution the state shall not terminate eligibility for medical assistance under the state plan for such youth during the period such youth is incarcerated in a public institution the state shall establish a process that ensures that the state does not claim federal financial participation for services that are provided to such youth and that are excluded under subsection a a and that the youth receives medical assistance for which federal participation is available under this title on or before the date such youth is released from such institution the state shall ensure that such youth is enrolled for medical assistance under this title unless and until there is a determination that the individual is no longer eligible to be so enrolled andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the state shall ensure that enrollment under subparagraph will be completed before such date so that the youth can access medical assistance under this title immediately upon leaving the institution sec quality measures for maternity and adult health services under medicaid and chip title xi of the social security act usc et seq is amended by inserting after section a the following new section sec quality measures for maternity and adult health services under medicaid and chip a maternity care quality measures under medicaid and chip development of measures no later than january the secretary shall develop and publish for comment a proposed set of measures that accurately describe the quality of maternity care provided under state plans under titles xix and xxi the secretary shall publish a final recommended set of such measures no later than july verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih standardized reporting format no later than january the secretary shall develop and publish a standardized reporting format for maternity care quality measures for use by state programs under titles xix and xxi to collect data from managed care entities and providers and practitioners that participate in such programs and to report maternity care quality measures to the secretary other adult health quality measures under medicaid development of measures the secretary shall develop quality measures that are not otherwise developed under section for services received under state plans under title xix by individuals who are years of age or older but have not attained age the secretary shall publish such quality measures through notice and comment rulemaking standardized reporting format the secretary shall develop and publish a standardized reporting format for quality measures developed under paragraph and section for services furnished under state plans under title xix to individuals who are years of age or older but haveverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not attained age for use under such plans and state plans under title xxi the format shall enable state agencies administering such plans to collect data from managed care entities and providers and practitioners that participate in such plans and to report quality measures to the secretary development process with respect to the development of quality measures under subsections a and use of qualified entities the secretary enter into agreements with public nonprofit or academic institutions with technical expertise in the area of health quality measurement to assist in such development the secretary carry out these agreements by contract grant or otherwise multi stakeholder pre rulemaking input the secretary shall obtain the input of stakeholders with respect to such quality measures using a process similar to that described in section coordination the secretary shall coordinate the development of such measures under such subsections and with the development of child health quality measures under section averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih annual report to congress no later than january and annually thereafter the secretary shall report to the committee on energy and commerce of the house of representatives the committee on finance of the senate regarding the availability of reliable data relating to the quality of maternity care furnished under state plans under titles xix and xxi the availability of reliable data relating to the quality of services furnished under state plans under title xix to adults who are years of age or older but have not attained age and recommendations for improving the quality of such care and services furnished under such state plans rule of construction notwithstanding any other provision in this section no quality measure developed published or used as a basis of measurement or reporting under this section be used to establish an irrebuttable presumption regarding either the medical necessity of care or the maximum permissible coverage for any individual who receives medical assistance under title xix or child health assistance under title xxi appropriation for purposes of carrying out this section in addition to funds otherwise available outverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of any funds in the treasury not otherwise appropriated there are appropriated for the fiscal year period beginning with fiscal year funds appropriated under this subsection shall remain available until expended sec a accountable care organization pilot program a in general the secretary of health and human services shall establish under this section an accountable care program under which a state apply to the secretary for approval of an accountable care organization pilot program described in subsection in this section referred to as a pilot program for the application of the accountable care organization concept under title xix of the social security act pilot program described in general the pilot program described in this subsection is a program that applies one or more of the accountable care organization models described in section of the social security act as added by section of this act limitation the pilot program shall operate for a period of not more than years additional incentives in the case of the pilot program under this section the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih waive the requirements of a section a of the social security act relating to statewideness section a of such act relating to comparability and increase the matching percentage for administrative expenditures up to a percent for the first years of the pilot program and percent for the next years evaluation report evaluation the secretary shall conduct an evaluation of the pilot program under this section in conducting such evaluation the secretary shall use the criteria used under subsection of section of the social security act as inserted by section of this act to evaluate pilot programs under such section report not later than days after the date of completion of the evaluation under paragraph the secretary shall submit to congress and make available to the public a report on the findings of the evaluation under such paragraphverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec fqhc coverage section of the social security act usc is amended by striking or at the end of clause iii by striking the semicolon at the end of clause iv and inserting and and by inserting after clause iv the following new clause is receiving a grant under section z– of the public health service act subtitle coverage sec optional medicaid coverage of low income hiv infected individuals a in general section of the social security act usc a as amended by section a is amended in subsection a a a by striking or at the end of subclause xix by adding or at the end of subclause xx and by adding at the end the following xxi who are described in subsection relating to hiv infected individuals andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end as amended by sections and a the following individuals described in this subsection are individuals not described in subsection a a who have hiv infection 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 a have and obtain medical assistance under the plan and 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 a have and obtain medical assistance under the plan enhanced match the first sentence of section of such act usc is amended by striking section a a xviii and inserting subclause xviii or xxi of section a a conforming amendments section a of such act usc a is amended in the matter preceding paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking or at the end of clause xii by adding or at the end of clause xiii and by inserting after clause xiii the following xiv individuals described in section exemption from funding limitation for territories section of the social security act usc is amended by adding at the end the following disregarding medical assistance for optional low income hiv infected individuals the limitations under subsection and the previous provisions of this subsection shall not apply to amounts expended for medical assistance for individuals described in section who are only eligible for such assistance on the basis of section a a xxi 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 without regard to whether or not final regulations to carry out such amendments have been promulgated by such dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec extending transitional medicaid assistance tma sections and of the social security act usc a r– as amended by section a of the american recovery and reinvestment act of public law – are each amended by striking december and inserting december sec requirement of month continuous coverage under certain chip programs a in general section of the social security act usc bb is amended by adding at the end the following new paragraph requirement for 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 a the plan shall provide for implementation under this title of the month continuous eligibility option described in section for targeted low income children whose family income is below percent of the poverty line effective date the amendment made by subsection a shall apply to determinations and redeterminations of eligibility made on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec preventing the application under chip of coverage waiting periods for certain children a in general section of the social security act usc bb is amended in subparagraph a in clause iii by striking and at the end in clause iv by striking the period at the end and inserting and and by adding at the end the following new clause not apply a waiting period including a waiting period to carry out paragraph in the case of a child described in subparagraph and by adding at the end the following new subparagraph description of children not subject to waiting period for purposes of this paragraph a child described in this subparagraph is a child who on the date an application is submitted for such child for child health assistance under this title meets any of the following requirements verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih infants and toddlers the child is under two years of age loss of group health plan coverage the child previously had private health insurance coverage through a group health plan or health insurance coverage offered through an employer and lost such coverage due to termination of an individual employment a reduction in hours that an individual works for an employer iii elimination of an individual retiree health benefits or iv termination of an individual group health plan or health insurance coverage offered through an employer iii unaffordable private coverage in general the family of the child demonstrates that the cost of health insurance coverage including the cost of premiums co payments deductibles and other costverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sharing for such family exceeds percent of the income of such family determination of family income for purposes of subclause family income shall be determined in the same manner specified by the state for purposes of determining a child eligibility for child health assistance under this title effective date the amendments made by this section shall take effect as of the date that is days after the date of the enactment of this act sec adult day health care services a in general the secretary of health and human services shall not withhold suspend disallow or otherwise deny federal financial participation under section a of the social security act usc a for the provision of adult day health care services day activity and health services or adult medical day care services as defined under a state medicaid plan approved during or before during such period if such services are provided consistent with such definition and the requirements of such plan orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih withdraw federal approval of any such state plan or part thereof regarding the provision of such services by regulation or otherwise effective date subsection a shall apply with respect to services provided on or after october sec medicaid coverage for citizens of freely associated states a in general section of the personal responsibility and work opportunity reconciliation act of usc is amended by adding at the end the following medicaid exception for citizens of freely associated states with respect to eligibility for benefits for the designated federal program defined in paragraph relating to the medicaid program section a and paragraph shall not apply to any individual who lawfully resides in of the states or the district of columbia in accordance with the compacts of free association between the government of the united states and the governments of the federated states of micronesia the republic of the marshall islands and the republic of palau verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih exception to year limited eligibility section of such act usc is amended in paragraph by striking or at the end in paragraph by striking the period at the end and inserting or and by adding at the end the following an individual described in section but only with respect to the designated federal program defined in section c definition of qualified alien section of such act usc is amended in paragraph by striking or at the end and inserting a comma in paragraph by striking the period at the end and inserting or and by adding at the end the following an individual who lawfully resides in the united states in accordance with a compact of free association referred to in section but only with respect to the designated federal program defined in section relating to the medicaid program verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec continuing requirement of medicaid coverage of nonemergency transportation to medically necessary services a requirement section a of the social security act usc a a is amended in subparagraph a in the matter preceding clause by striking and and inserting and and in subparagraph iv by striking and and inserting and description of services section a of such act usc a as amended by sections a and a is amended in paragraph by striking and at the end by redesignating paragraph as paragraph and by striking the comma at the end and inserting a semicolon and by inserting after paragraph the following new paragraph nonemergency transportation to medically necessary services consistent with the requirement of section of title code of federal regulations as in effect as of june and verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendments made by this section shall take effect on the date of the enactment of this act and shall apply to transportation on or after such date sec state option to disregard certain income in providing continued medicaid coverage for certain individuals with extremely high prescription costs section of the social security act usc as amended by section a of the children health insurance program reauthorization act of public law – is amended by adding at the end the following new paragraph a at the option of the state in the case of an individual with extremely high prescription drug costs described in subparagraph who has been determined without the application of this paragraph to be eligible for medical assistance under this title the state in redetermining the individual eligibility for medical assistance under this title disregard any family income of the individual to the extent such income is less than an amount that is specified by the state and does not exceed the amount specified in subparagraph or if greater income equal to the cost of the orphan drugs described in subparagraph iii verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an individual with extremely high prescription drug costs described in this subparagraph for a month period is an individual who is covered under health insurance or a health benefits plan that has a maximum lifetime limit of not less than which includes all prescription drug coverage who has exhausted all available prescription drug coverage under the plan as of the beginning of such period iii who incurs or is reasonably expected to incur on an annual basis during the period costs for orphan drugs in excess of the amount specified in subparagraph for the period and iv whose annual family income determined without regard to this paragraph as of the beginning of the period does not exceed percent of the amount incurred for such drugs as described in clause iii the amount specified in this subparagraph for a month period beginning in or is or a subsequent year is the amount specified in clause or this subparagraph for the previous year increased by the annual rate of increase in theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medical care component of the consumer price index us city average for the month period ending in august of the previous year any amount computed under clause that is not a multiple of shall be rounded to the nearest multiple of in applying this paragraph amounts incurred for prescription drugs for cosmetic purposes shall not be taken into account with respect to an individual described in subparagraph a notwithstanding section the state plan shall provide for the application of costsharing that is at least nominal as determined under section and provide consistent with section a for such additional cost sharing as does not exceed a maximum level of cost sharing that is specified by the secretary and is adjusted by the secretary on an annual basis a state electing the option under this paragraph shall provide for a determination on an individual application for continued medical assistance under this title within days of the date the application if filed with the stateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in this paragraph the term orphan drugs means prescription drugs designated under section of the federal food drug and cosmetic act usc bb as a drug for a rare disease or condition the term health benefits plan includes coverage under a plan offered under a state high risk pool sec provisions relating to community living assistance services and supports class a coordination with class provisions section a of the social security act usc a a as amended by sections a a a a and is amended in paragraph by striking and at the end in paragraph by striking the period and inserting and and by inserting after paragraph the following provide that the state will comply with such regulations regarding the application of primary and secondary payor rules with respect to indi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih viduals who are eligible for medical assistance under this title and are eligible beneficiaries under the class program established under title xxxii of the public health service act as the secretary shall establish assurance of adequate infrastructure for the provision of personal care attendant workers section a of such act usc a a as amended by subsection a is amended in paragraph by striking and at the end in paragraph by striking the period at the end and inserting and and by inserting after paragraph the following provide that not later than years after the date of enactment of this paragraph each state shall a assess the extent to which entities such as providers of home care home health services home and community service providers public authorities created to provide personal care services to individuals eligible for medical assistance under the state plan and nonprofit organizations are serving or have the capacityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to serve as fiscal agents for employers of and providers of employment related benefits for personal care attendant workers who provide personal care services to individuals receiving benefits under the class program established under title xxxii of the public health service act including in rural and underserved areas designate or create such entities to serve as fiscal agents for employers of and providers of employment related benefits for such workers to ensure an adequate supply of the workers for individuals receiving benefits under the class program including in rural and underserved areas and ensure that the designation or creation of such entities will not negatively alter or impede existing programs models methods or administration of service delivery that provide for consumer controlled or self directed home and community services and further ensure that such entities will not impede the ability of individuals to direct and control their home and community services including the ability to select manage dismiss co employ or employ such workers or inhibit such individuals fromverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih relying on family members for the provision of personal care services inclusion of information on supplemental coverage in the national clearinghouse for long term care information extension of funding section of the deficit reduction act of usc note is amended in paragraph a a in clause by striking and at the end in clause iii by striking the period at the end and inserting and and by adding at the end the following iv include information regarding the class program established under title xxxii of the public health service act and in paragraph a by striking and inserting and by adding at the end the following in addition to the amount appropriated under the previous sentence there are authorized to be appropriated to carry out this subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for each of fiscal years and effective date the amendments made by this section take effect on january subtitle financing sec payments to pharmacists a pharmacy reimbursement limits in general section of the social security act usc r– is amended a by striking paragraph and inserting the following use of amp in upper payment limits the secretary shall calculate the federal upper reimbursement limit established under paragraph as percent of the weighted average determined on the basis of manufacturer utilization of monthly average manufacturer prices nothing in the previous sentence shall be construed as preventing the secretary from performing such calculation using a smoothing process in order to reduce significant variations from month to month as a result of rebates discounts and other pricing practices such as in the manner such a process is used by the secretary in determining the averageverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sales price of a drug or biological under section a definition of amp section of such act usc r– is amended in the heading by striking extended to wholesalers and inserting and other payments and by striking regard to and all that follows through the period and inserting the following regard to customary prompt pay discounts extended to wholesalers 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 managedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 and of section d– verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih manufacturer reporting requirements section a of such act usc r– a is amended a in clause by striking and at the end by striking the period at the end of clause iii and inserting and and by inserting after clause iii the following new clause iv not later than days after the last day of each month of a rebate period under the agreement on the manufacturer total number of units that are used to calculate the monthly average manufacturer price for each covered outpatient drug authority to promulgate regulation the secretary of health and human services 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 become effective on an interim final basis pending opportunity for public commentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pharmacy reimbursements through december the specific upper limit under section of title code of federal regulations as in effect on december applicable to payments made by a state for multiple source drugs under a state medicaid plan shall continue to apply through december for purposes of the availability of federal financial participation for such payments disclosure of price information to the public section of such act usc r– is amended in subparagraph a a in clause in the matter preceding subclause by inserting month of a after each and in the last sentence by striking and shall and all that follows up to the period and in subparagraph by inserting weighted before average manufacturer prices sec prescription drug rebates a additional rebate for new formulations of existing drugs verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general section of the social security act usc r– is amended by adding at the end the following new subparagraph 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 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 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 stateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plan in the rebate period as reported by the state in this subparagraph the term line extension means with respect to a drug a new formulation of the drug such as an extended release formulation effective date the amendment made by paragraph shall apply to drugs dispensed after december increase minimum rebate percentage for single source drugs in general section of the social security act usc r– is amended a in subclause iv by striking and at the end in subclause by inserting and before january after december and by striking the period at the end and inserting and and by adding at the end the following new subclause vi after december is percent verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih recapture of total savings due to increase section of such act is amended by adding at the end the following new subparagraph special rule for increased minimum rebate percentage in general in addition to the amounts applied as a reduction under subparagraph for rebate periods beginning on or after january during a fiscal year the secretary shall reduce payments to a state under section a in the manner specified in clause in an amount equal to the product of percent minus the federal medical assistance percentage applicable to the rebate period for the state and the amounts received by the state under such subparagraph that are attributable as estimated by the secretary based on utilization and other data to the increase in the minimum rebate percentage effected by the amendments made by sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of the affordable health care for america act taking into account the additional drugs included under the amendments made by section of such act the secretary shall adjust such payment reduction for a calendar quarter to the extent the secretary determines based upon subsequent utilization and other data that the reduction for such quarter was greater or less than the amount of payment reduction that should have been made manner of payment reduction the amount of the payment reduction under clause for a state for a quarter shall be deemed an overpayment to the state under this title to be disallowed against the state regular quarterly draw for all medicaid spending under section such a disallowance is not subject to a reconsideration under verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec extension of prescription drug discounts to enrollees of medicaid managed care organizations a in general section a of the social security act usc a is amended in clause xi by striking and at the end in clause xii by striking the period at the end and inserting and and 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 require in order to include in the information submitted by the state to a manufacturer under section a and to the secretary under section 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 conforming amendments section of such act usc is amended in the first sentence of subsection a by inserting before the period at the end the following including such drugs dispensed to individ verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih uals enrolled with a medicaid managed care organization if the organization is responsible for coverage of such drugs in subsection by adding at the end the following new subparagraph 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 and such other information as the secretary require to carry out paragraph with respect to such rebates and in subsection a in the heading by striking exemption and inserting special rules and in paragraph by striking are not subject to the requirements of this section and inserting are subject to the requirements of this section unless such drugs are subject to discounts under section of the public health service act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih effective date the amendments made by this section take effect on january 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 payments for graduate medical education a in general section of the social security act usc as amended by sections a a and a is amended by adding at the end the following new subsection bb payment for graduate medical education 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 submission of information for purposes of paragraph and section a a 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 howverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such payments are being used for graduate medical education including the institutions and programs eligible for receiving the funding 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 state progress in meeting such goals and vi such other information as the secretary determines will assist in carrying out paragraphs and and such expenditures are made consistent with such goals and requirements as are established under paragraph review of information the secretary shall make the information submitted under paragraph available to the advisory committee on health workforce evaluation and assessment established under section of the public health service act the secretary and the advisory committee shall independently review the informationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih submitted under paragraph taking into account state and local workforce needs specification of goals and requirements the secretary shall specify by rule initially published by not later than december a program goals for the use of funds described in paragraph taking into account recommendations of the such advisory committee and the goals for approved medical residency training programs described in section and requirements for use of such funds consistent with such goals such rule be effective on an interim basis pending revision after an opportunity for public comment conforming amendment section a a of such act usc a a a as amended by section a a is amended by striking and at the end of clause iii by striking the semicolon in clause iv and inserting and and by adding at the end the following new clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the case of hospitals and at the option of a state such rates include to the extent consistent with section bb payment for graduate medical education and 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 sec nursing facility supplemental payment program a total amount available for payments in general out of any funds in the treasury not otherwise appropriated there are appropriated to the secretary of health and human services in this section referred to as the secretary to carry out this section of which the following amounts shall be available for obligation in the following years a shall be available beginning in shall be available beginning in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall be available beginning in shall be available beginning in availability funds appropriated under paragraph shall remain available until all eligible dually certified facilities as defined in subsection have been reimbursed for underpayments under this section during cost reporting periods ending during calendar years through limitation of authority the secretary not payments under this section that exceed the funds appropriated under paragraph disposition of remaining funds into mif any funds appropriated under paragraph which remain available after the application of paragraph shall be deposited into the medicaid improvement fund under section of the social security act use of funds authority to make payments from the amounts available for obligation in a year under subsection a the secretary acting through the administrator of the centers for medicare medicaidverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih services shall pay the amount determined under paragraph directly to an eligible dually certified facility for the purpose of providing funding to reimburse such facility for furnishing quality care to medicaid eligible individuals determination of payment amounts a in general subject to subparagraphs and the payment amount determined under this paragraph for a year for an eligible dually certified facility shall be an amount determined by the secretary as reported on the facility latest available medicare cost report limitation on payment amount in no case shall the payment amount for an eligible dually certified facility for a year under subparagraph a be more than the payment deficit described in paragraph for such facility as reported on the facility latest available medicare cost report pro rata reduction if the amount available for obligation under subsection a for a year as reduced by allowable administrative costs under this section is insufficient to ensure that each eligible dually cer verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tified facility receives the amount of payment calculated under subparagraph a the secretary shall reduce that amount of payment with respect to each such facility in a pro rata manner to ensure that the entire amount available for such payments for the year be paid no required match the secretary not require that a state provide matching funds for any payment made under this subsection eligible dually certified facility defined for purposes of this section the term eligible dually certified facility means for a cost reporting period ending during a year beginning no earlier than that is covered by the latest available medicare cost report a nursing facility that meets all of the following requirements a the facility is participating as a nursing facility under title xix of the social security act and as a skilled nursing facility under title xviii of such act during the entire year the base medicaid payment rate excluding any supplemental payments to the facility is not less than the base medicaid pay verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ment rate excluding any supplemental payments to such facility as of june as reported on the facility latest medicare cost report the medicaid share of patient days for such facility is not less than percent of the combined medicare and medicaid share of resident days for such facility and the combined medicare and medicaid share of resident days for such facility as reported on the facility latest available medicare cost report is not less than percent of the total resident days for such facility the facility has received medicaid reimbursement including any supplemental payments for the provision of covered services to medicaid eligible individuals as reported on the facility latest available medicare cost report that is significantly less as determined by the secretary than the allowable costs as determined by the secretary incurred by the facility in providing such services the facility is not in the highest quartile of costs costs per day as determined by theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih secretary and as adjusted for case mix wages and type of facility the facility provides quality care as determined by the secretary to medicaid eligible individuals and individuals who are entitled to items and services under part a of title xviii of the social security act in the most recent standard survey available the facility was not cited for any immediate jeopardy deficiencies as defined by the secretary in the most recent standard survey available the facility maintains an appropriate staffing level to attain or maintain the highest practicable well being of each resident as defined by the secretary the facility complies with all the requirements as determined by the secretary contained in sections through and the amendments made by such sections the facility was not listed as a centers for medicare medicaid services special focus facility sff nor as a sff on a state based listverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih frequency of payment payment of an amount under this subsection to an eligible duallycertified facility shall be made for a year in a lump sum or in such periodic payments in such frequency as the secretary determines appropriate direct payments such payment a shall be made directly by the secretary to an eligible dually certified facility or a contractor designated by such facility and shall not be made through a state administration annual applications deadlines the secretary shall establish a process including deadlines under which facilities apply on an annual basis to qualify as eligible dually certified facilities for payment under subsection contracting authority the secretary enter into one or more contracts with entities for the purpose of implementation of this section limitation the secretary not spend more than percent of the amount made available under subsection a in any year on the costs of administering the program of payments under this section for the yearverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih implementation notwithstanding any other provision of law the secretary implement by program instruction or otherwise the provisions of this section limitations on review there shall be no administrative or judicial review of a the determination of the eligibility of a facility for payments under subsection or the determination of the amount of any payment made to a facility under such subsection annual reports the secretary shall submit an annual report to the committees with jurisdiction in the congress on payments made under subsection each such report shall include information on the facilities receiving such payments the amount of such payments to such facilities and the basis for selecting such facilities and the amount of such payments reference to report for report by the medicaid and chip payment and access commission on the adequacy of payments to nursing facilities under the medicaid program see section of the social security act as amended by section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih definitions for purposes of this section dually certified facility the term dually certified facility means a facility that is participating as a nursing facility under title xix of the social security act and as a skilled nursing facility under title xviii of such act medicaid eligible individual the term medicaid eligible individual means an individual who is eligible for medical assistance with respect to nursing facility services as defined in section of the social security act under title xix of the such act state the term state means the states and the district of columbia sec report on medicaid payments section of the social security act usc as amended by sections a a and a is amended by adding at the end the following new subsection jj report on medicaid payments each year on or before a date determined by the secretary a state participating in the medicaid program under this title shall submit to the administrator of the centers for medicare medicaid services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih information on the determination of rates of payment to providers for covered services under the state plan including a the final rates the methodologies used to determine such rates and justifications for the rates and an explanation of the process used by the state to allow providers beneficiaries and their representatives and other concerned state residents a reasonable opportunity to review and comment on such rates methodologies and justifications before the state made such rates final sec reviews of medicaid a gao study on fmap study the comptroller general of the united states shall conduct a study regarding federal payments made to the state medicaid programs under title xix of the social security act for the purposes of making recommendations to congress report not later than february the comptroller general shall submit to the appropriate committees of congress a report on the study conducted under paragraph and the effectverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih on the federal government states providers and beneficiaries of a removing the percent floor or percent ceiling or both in the federal medical assistance percentage under section of the social security act and revising the current formula for such federal medical assistance percentage to better reflect state fiscal capacity and state effort to pay for health and long term care services and to better adjust for national or regional economic downturns gao study on medicaid administrative costs study the comptroller general of the united states shall conduct a study of the administration of the medicaid program by the department of health and human services state medicaid agencies and local government agencies the report shall address the following issues a the extent to which federal funds for each administrative function such as survey and certification and claims processing are being used effectively and efficientlyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the administrative functions on which federal medicaid funds are expended and the amounts of such expenditures whether spent directly or by contract report not later than february the comptroller general shall submit to the appropriate committees of congress a report on the study conducted under paragraph sec extension of delay in managed care organization provider tax elimination effective as if included in the enactment of section of the deficit reduction act of public law – subsection a of such section is amended by striking october and inserting october sec extension of arra increase in fmap section of the american recovery and reinvestment act of public law – is amended in subsection a by striking first calendar quarter and inserting first calendar quarters in subsection by inserting before the period at the end the following and such paragraph shall not apply to calendar quarters beginning on or after october verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in subsection c by striking december and january and inserting june and july respectively in subsection by inserting ending before october after entire fiscal years and after with respect to fiscal years in subsection by striking september and inserting december and in subsection by striking december and inserting june subtitle waste fraud and abuse sec health care acquired conditions a medicaid non payment for certain health care acquired conditions section of the social security act usc is amended by striking or at the end of paragraph by striking the period at the end of paragraph and inserting or and by inserting after paragraph the following new paragraph with respect to amounts expended for services related to the presence of a condition that could be identified by a secondary diagnostic codeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih described in section d iv and for any health care acquired condition determined as a noncovered service under title xviii application to chip section of such act usc gg is amended by striking and and inserting and 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 effective date the amendments made by this section shall apply to discharges occurring on or after january sec evaluations and reports required under medicaid integrity program section of the social security act usc u– is amended by redesignating subparagraph as subparagraph and by inserting after subparagraph the following new subparagraph for the contract year beginning in and each subsequent contract year the entity provides assurances to the satisfaction ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 require providers and suppliers to adopt programs to reduce waste fraud and abuse section a of such act usc usc a a as amended by sections and is further amended in paragraph by striking at the end and in paragraph by striking at the end the period and inserting and and by inserting after paragraph the following new paragraph provide that any provider or supplier other than a physician or nursing facility providing services under such plan shall subject to paragraph of section establish a compliance program described in paragraph of such section in accordance with such section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec overpayments a in general section of the social security act usc is amended in the first sentence by inserting or of year in the case of overpayments due to fraud after days and in the second sentence by striking the days and inserting such period effective date the amendments made by subsection a shall apply in the case of overpayments discovered on or after the date of the enactment of this act sec managed care organizations a minimum medical loss ratio medicaid section a of the social security act usc a as amended by section a is amended a by striking and at the end of clause xii by striking the period at the end of clause xiii and inserting and and by adding at the end the following new clause xiv such contract has a medical loss ratio as determined in accordance with a methodology speci verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fied by the secretary that is a percentage not less than percent as specified by the secretary chip section of such act usc gg is amended a by redesignating subparagraphs through as subparagraphs through and by inserting after subparagraph the following new subparagraph section a xiv relating to application of minimum loss ratios with respect to comparable contracts under this title effective date the amendments made by this subsection shall apply to contracts entered into or renewed on or after july patient encounter data in general section a xi of the social security act usc 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 effective date the amendment made by paragraph shall apply with respect to contract years beginning on or after january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec 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 a of the social security act usc usc a a is amended by inserting after a the following terminate the participation of any individual or entity in such program if subject to such exceptions are permitted with respect to exclusion under sections and 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 application to chip section a of such act usc gg a is amended by inserting before the period at the end the following and section a relating to exclusion and termination of participation effective date except as provided in section the amendments made by this section shall apply to services furnished on or after january without regard to whether or not final regulations to carry out such amendments have been promulgated by such dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec medicaid and chip exclusion from participation relating to certain ownership control and management affiliations a state plan requirement section a of the social security act usc a a as amended by sections a and is further amended in paragraph by striking at the end and in paragraph by striking at the end the period and inserting and and by inserting after paragraph the following new paragraph provide that the state agency described in paragraph 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 is suspended or excluded from participation under or whose participation is terminated under this title during such period orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 child health plan requirement section a of such act usc gg a as amended by section is amended by striking section a and inserting sections a and a effective date except as provided in section the amendments made by this section shall apply to services furnished on or after january without regard to whether or not final regulations to carry out such amendments have been promulgated by such date sec requirement to report expanded set of data elements under mmis to detect fraud and abuse section of the social security act usc is amended by inserting after necessary the following and including for data submitted to the secretary on or after july data elements from the automated data system that the secretary determines to be necessary for detection of waste fraud and abuse verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec billing agents clearinghouses or other alternate payees required to register under medicaid a in general section a of the social security act usc usc a a as amended by sections a and a is further amended in paragraph by striking at the end and in paragraph by striking the period at the end and inserting and and by inserting after paragraph the following new paragraph 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 denial of payment section of such act usc as amended by section is amended by striking or at the end of paragraph by striking the period at the end of paragraph and inserting or andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by inserting after paragraph the following new paragraph 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 a effective date except as provided in section the amendments made by this section shall apply to claims submitted on or after january without regard to whether or not final regulations to carry out such amendments have been promulgated by such date sec denial of payments for litigation related misconduct a in general section of the social security act usc as amended by sections a and is amended by striking or at the end of paragraph by striking the period at the end of paragraph and inserting or and by inserting after paragraph the following new paragraph with respect to any amount expended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a on litigation in which a court imposes sanctions on the state its employees or its counsel for litigation related misconduct or 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 effective date the amendments made by subsection a shall apply to amounts expended on or after january sec mandatory state use of national correct coding initiative section of the social security act usc is amended in paragraph a in clause by striking and at the end in clause iii by adding and at the end and by adding at the end the following new clause iv effective for claims filed on or after october incorporate compat verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ible methodologies of the national correct coding initiative administered by the secretary or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment and such other methodologies of that initiative or such other national correct coding methodologies as the secretary identifies in accordance with paragraph and by adding at the end the following new paragraph not later than september the secretary shall do the following a identify those methodologies of the national correct coding initiative administered by the secretary or any successor initiative to promote correct coding and to control improper coding leading to inappropriate payment which are compatible to claims filed under this title identify those methodologies of such initiative or such other national correct coding methodologies that should be incorporated into claims filed under this title with respect to items or services for which states provide medical assistance underverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih this title and no national correct coding methodologies have been established under such initiative with respect to title xviii notify states of the methodologies identified under subparagraphs a and and of any other national correct coding methodologies identified under subparagraph and how states are to incorporate such methodologies into claims filed under this title submit a report to congress that includes the notice to states under subparagraph and an analysis supporting the identification of the methodologies made under subparagraphs a and subtitle payments to the territories sec payment to territories a increase in cap section of the social security act usc is amended in subsection by striking subsection and inserting subsections and in subsection by striking with respect to and inserting subject to subsection with respect to andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by adding at the end the following new subsection additional increase for fiscal years through subject to section of the affordable health care for america act with respect to fiscal years through the amounts otherwise determined under subsections and for puerto rico the virgin islands guam the northern mariana islands and american samoa shall be increased by the following amounts for puerto rico for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year for the virgin islands for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fiscal year for fiscal year and for fiscal year for guam for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year for the northern mariana islands for fiscal year fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year for american samoa fiscal year fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year report on achieving medicaid parity payments beginning with fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general not later than october the secretary of health and human services shall submit to congress a report that details a plan for the transition of each territory to full parity in medicaid with the states and the district of columbia in fiscal year by modifying their existing medicaid programs and outlining actions the secretary and the governments of each territory must take by fiscal year to ensure parity in financing such report shall include what the federal medical assistance percentages would be for each territory if the formula applicable to the states were applied such report shall also include any recommendations that the secretary have as to whether the mandatory ceiling amounts for each territory provided for in section of the social security act usc should be increased any time before fiscal year due to any factors that the secretary deems relevant per capita data as part of such report the secretary shall include information about per capita income data that could be used to calculate federal medical assistance percentages under section of the social security act under section a of such act for each territory on howverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such data differ from the per capita income data used to promulgate federal medical assistance percentages for the states the report under this subsection shall include recommendations on how the federal medical assistance percentages can be calculated for the territories beginning in fiscal year to ensure parity with the states subsequent reports the secretary shall submit subsequent reports to congress in and detailing the progress that the secretary and the governments of each territory have made in fulfilling the actions outlined in the plan submitted under paragraph application of fmap for additional funds section of such act usc is amended by adding at the end the following sentence notwithstanding the first sentence of this subsection and any other provision of law for fiscal years through the federal medical assistance percentage for puerto rico the virgin islands guam the northern mariana islands and american samoa shall be the highest federal medical assistance percentage applicable to any of the states or the district of columbia for the fiscal year involved taking into account the application of subsections a and of section of di verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vision of the american recovery and reinvestment act of public law – to such states and the district for calendar quarters during such fiscal years for which such subsections apply waivers in general section of the social security act usc a is amended a by striking american samoa and the northern mariana islands and inserting puerto rico the virgin islands guam the northern mariana islands and american samoa and by striking american samoa or the northern mariana islands and inserting puerto rico the virgin islands guam the northern mariana islands or american samoa effective date the amendments made by paragraph shall apply beginning with fiscal year technical assistance the secretary shall provide nonmonetary technical assistance to the governments of puerto rico the virgin islands guam the northern mariana islands and american samoa in upgrading their existing computer systems in order to antici verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pate meeting reporting requirements necessary to implement the plan contained in the report under subsection subtitle miscellaneous sec technical corrections a technical correction to section of the social security act the first sentence of section of the social security act usc is amended by striking transmittal and by inserting before the period the following as specified in section a clarifying amendment to section of the social security act section a of the social security act usc a as amended by section of public law – is amended by striking the second sentence by redesignating the first sentence as a subparagraph a with appropriate indentation and with the following heading in general by adding at the end the following subparagraphs furnishing medical assistance with reasonable promptness for theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih purpose of a state obligation under section a to furnish medical assistance with reasonable promptness the date of the electronic transmission of low income subsidy program data as described in section 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 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 application for the low income subsidy program to constitute the date of filing for benefits under the medicare savings program effective date relating to medicaid agency consideration of low income subsidy application and data transmittal the amendments made by subsections a and shall be effective as if included in the enactment of section of public law – technical correction to section of chipra section of the children health insur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ance program reauthorization act of public law – is amended by striking legal residents and inserting lawfully residing in the united states technical correction to section of the social security act section a of the social security act usc a is amended by inserting or the care and services themselves or both before if provided in or after clarifying amendment to section of the social security act section a of the social security act usc 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 extension of qi program a in general section a iv of the social security act usc a iv is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking sections and and by inserting section and by striking december and inserting december elimination of funding limitation in general section of such act usc u– is amended a in subsection a by striking who are selected to receive such assistance under subsection by striking subsections and in subsection by striking furnished in a state and all that follows and inserting the federal medical assistance percentage shall be equal to percent and by redesignating subsections and as subsections and respectively conforming amendment section of such act usc is amended by striking and inserting effective date the amendments made by paragraph shall take effect on january verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec assuring transparency of information a in general section a of the social security act usc a a as amended by sections a a a and is amended by striking and at the end of paragraph by striking the period at the end of paragraph and inserting and and by inserting after paragraph the following new paragraph provide that the state will establish and maintain laws in accordance with the requirements of section a to require disclosure of information on hospital charges and quality and to make such information available to the public and the secretary and by inserting after section the following new section hospital price transparency sec a a in general the requirements referred to in section a are that the laws of a state must require reporting to the state or its agent by each hospital located therein of information on verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a the charges for the most common inpatient and outpatient hospital services the medicare and medicaid reimbursement amount for such services and if the hospitals allows for or provides reduced charges for individuals based on financial need the factors considered in making determinations for reductions in charges including any formula for such determination and the contact information for the specific department of a hospital that responds to such inquiries provide for notice to individuals seeking or requiring such services of the availability of information on charges described in paragraph provide for timely access to such information including at least through an internet website by individuals seeking or requiring such services and provide for timely access to information regarding the quality of care at each hospital made publicly available in accordance with section of the medicare prescription drug improvement and modernization act of public law – section a or section bverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary shall consult with stakeholders including those entities in section and the national governors association through a formal process to obtain guidance prior to issuing implementing policies under this section hospital defined for purposes of this section the term hospital means an institution that meets the requirements of paragraphs and of section and includes those to which section applies effective date administration in general except as provided in paragraphs and section the amendments made by subsection a shall take effect on october existing programs a in general the secretary of health and human services shall establish a process by which a state with an existing program certify to the secretary that its program satisfies the requirements of section a of the social security act as inserted by subsection a year period to become in compliance states that as of the date of the en verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih actment of this act administer hospital price transparency policies that do not meet such requirements shall have years from such date to make necessary modifications to come into compliance and shall not be regarded as failing to comply with such requirements during such year period sec medicaid and chip payment and access commission a report on nursing facility payment policies section of the social security act usc is amended by adding at the end the following new paragraph reports on special topics on payment policies a nursing facility payment policies not later than january the commission shall submit to congress a report on nursing facility payment policies under medicaid that includes information on the difference between the amount paid by each state to nursing facilities in such state under the medicaid program under this title and the cost to such facilities of providing efficientverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih quality care to medicaid eligible individuals an evaluation of patient outcomes and quality as a result of the supplemental payments under section of the affordable health care for america act and iii whether adjustments should be made under the medicaid program to the rates that states pay skilled nursing facilities to ensure that such rates are sufficient to provide efficient quality care to medicaid eligible individuals pediatric subspecialist payment policies section of the social security act as added by subsection a is amended by adding at the end the following new subparagraph pediatric subspecialist payment policies not later than january the commission shall submit to congress a report on payment policies for pediatric subspecialist services under medicaid that includes a comprehensive review of each state medicaid payment rates for inpa verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tient and outpatient pediatric speciality services a comparison on a state by state basis of the rates under clause to medicare payments for similar services iii information on any limitations in patient access to pediatric speciality care such as delays in receiving care or wait times for receiving care iv an analysis of the extent to which low medicaid payment rates in any state contributes to limits in access to pediatric subspecialty services in such state and recommendations to ameliorate any problems found with such payment rates or with access to such services additional amendments commission status section a of the social security act is amended by inserting as an agency of congress after established expansion of scope section a of the social security act is amended by striking children access and inserting accessverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by low income children and other eligible individuals change in report deadlines subparagraphs and of section of such act are amended by striking and inserting each place it appears report in health reform section of such act is amended a in subparagraph a by striking skilled by striking subparagraph by redesignating subparagraph as subparagraph and by adding at the end the following new subparagraph implementation of health reform the implementation of the provisions of the affordable health care for america act that relate to medicaid or chip by the secretary the health choices commissioner and the states including the effect of such implementation on the access to needed health care items and services by low income individuals and families verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih clarification of membership section of such act is amended by striking consumers and inserting individuals authorization of appropriations a current authorization section of such act is amended in the heading by inserting of appropriations prior to after authorization and by striking there are and inserting prior to january there are future authorization section of such act is further amended by adding at the end the following new paragraph after the period the following authorization of appropriations for beginning on january there is authorized to be appropriated to carry out the provisions of this section such funds shall remain available until expended sec outreach and enrollment of medicaid and chip eligible individuals a in general not later than months after date of enactment of this act the secretary of health andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih human services shall issue guidance regarding standards and best practices for conducting outreach to inform eligible individuals about healthcare coverage under medicaid under title xix of the social security act or for child health assistance under chip under title xxi of such act providing assistance to such individuals for enrollment in applicable programs and establishing methods or procedures for eliminating application and enrollment barriers such guidance shall include provisions to ensure that outreach enrollment assistance and administrative simplification efforts are targeted specifically to vulnerable populations such as children unaccompanied homeless youth victims of abuse or trauma individuals with mental health or substance related disorders and individuals with hiv aids guidance issued pursuant to this section relating to methods to increase outreach and enrollment provided for under titles xix and xxi of the social security act shall specifically target such vulnerable and underserved populations and shall include but not be limited to guidance on outstationing of eligibility workers express lane eligibility residence requirements documentation of income and assets presumptive eligibility continuous eligibility and automatic renewal implementation in implementing the requirements under subsection a the secretary useverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such authorities as are available under law and work with such entities as the secretary deems appropriate to facilitate effective implementation of such programs not later than years after the enactment of this act and annually thereafter the secretary shall review and report to congress on progress in implementing targeted outreach application and enrollment assistance and administrative simplification methods for such vulnerable and underserved populations as are specified in subsection a sec prohibitions on federal medicaid and chip payment for undocumented aliens nothing in this title shall change current prohibitions against federal medicaid and chip payments under titles xix and xxi of the social security act on behalf of individuals who are not lawfully present in the united states sec demonstration project for stabilization of emergency medical conditions by institutions for mental diseases a authority to conduct demonstration project the secretary of health and human services in this section referred to as the secretary shall establish a demonstration project under which an eligible state as described in subsection shall provide reimbursement under the state medicaid plan under title xix ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the social security act to an institution for mental diseases that is subject to the requirements of section of the social security act usc dd for the provision of medical assistance available under such plan to an individual who has attained age but has not attained age is eligible for medical assistance under such plan and requires such medical assistance to stabilize an emergency medical condition in stay review the secretary shall establish a mechanism for in stay review to determine whether or not the patient has been stabilized as defined in subsection this mechanism shall commence before the third day of the inpatient stay states participating in the demonstration project manage the provision of these benefits under the project through utilization review authorization or management practices or the application of medical necessity and appropriateness criteria applicable to behavioral health eligible state defined application upon approval of an application submitted by a state described in paragraph the state shall be an eligible state for purposesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of conducting a demonstration project under this section state described states shall be selected by the secretary in a manner so as to provide geographic diversity on the basis of the application to conduct a demonstration project under this section submitted by such states length of demonstration project the demonstration project established under this section shall be conducted for a period of consecutive years limitations on federal funding appropriation a in general out of any funds in the treasury not otherwise appropriated there is appropriated to carry out this section for fiscal year budget authority subparagraph a constitutes budget authority in advance of appropriations act and represents the obligation of the federal government to provide for the payment of the amounts appropriated under that subparagraph year availability funds appropriated under paragraph shall remain available for obligation through december verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih limitation on payments in no case a the aggregate amount of payments made by the secretary to eligible states under this section exceed or payments be provided by the secretary under this section after december funds allocated to states the secretary shall allocate funds to eligible states based on their applications and the availability of funds payments to states the secretary shall pay to each eligible state from its allocation under paragraph an amount each quarter equal to the federal medical assistance percentage of expenditures in the quarter for medical assistance described in subsection a reports annual progress reports the secretary shall submit annual reports to congress on the progress of the demonstration project conducted under this section final report and recommendation an evaluation shall be conducted of the demonstration project impact on the functioning of the health and mental health service system and on individualsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih enrolled in the medicaid program this evaluation shall include collection of baseline data for one year prior to the initiation of the demonstration project as well as collection of data from matched comparison states not participating in the demonstration the evaluation measures shall include the following a a determination by state as to whether the demonstration project resulted in increased access to inpatient mental health services under the medicaid program and whether average length of stays were longer or shorter for individuals admitted under the demonstration project compared with individuals otherwise admitted in comparison sites an analysis by state regarding whether the demonstration project produced a significant reduction in emergency room visits for individuals eligible for assistance under the medicaid program or in the duration of emergency room lengths of stay an assessment of discharge planning by participating hospitals that ensures access to further non emergency inpatient or residential care as well as continuity of care for those discharged to outpatient careverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an assessment of the impact of the demonstration project on the costs of the full range of mental health services including inpatient emergency and ambulatory care under the plan as contrasted with the comparison areas data on the percentage of consumers with medicaid coverage who are admitted to inpatient facilities as a result of the demonstration project as compared to those admitted to these same facilities through other means a recommendation regarding whether the demonstration project should be continued after december and expanded on a national basis waiver authority in general the secretary shall waive the limitation of subdivision following paragraph of section a of the social security act usc a relating to limitations on payments for care or services for individuals under years of age who are patients in an institution for mental diseases for purposes of carrying out the demonstration project under this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih limited other waiver authority the secretary waive other requirements of title xix of the social security act including the requirements of sections a relating to statewideness and relating to comparability only to extent necessary to carry out the demonstration project under this section definitions in this section emergency medical condition the term emergency medical condition means with respect to an individual an individual who expresses suicidal or homicidal thoughts or gestures if determined dangerous to self or others federal medical assistance percentage the term federal medical assistance percentage has the meaning given that term with respect to a state under section of the social security act usc institution for mental diseases the term institution for mental diseases has the meaning given to that term in section of the social security act usc medical assistance the term medical assistance has the meaning given to that term inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section a of the social security act usc a stabilized the term stabilized means with respect to an individual that the emergency medical condition no longer exists with respect to the individual and the individual is no longer dangerous to self or others state the term state has the meaning given that term for purposes of title xix of the social security act usc et seq sec application of medicaid improvement fund section of the social security act usc w– is amended by striking from the fund and all that follows and inserting from the fund only such amounts as be appropriated or otherwise made available by law sec treatment of certain medicaid brokers section of the social security act usc is amended in the matter before subparagraph a by inserting after respect to the broker the following or in the case of subparagraph a and subparagraph if the inspector general of department of health and human services finds that the brokerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has established and maintains procedures to ensure the independence of its enrollment activities from the interests of any managed care entity or provider and in subparagraph a by inserting after either and by inserting after health care provider or sec rule for changes requiring state legislation 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 an additional requirement imposed by an amendment made by this title the state plan shall not be regarded as failing to comply with the requirements of such title xix 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 year legislative session each year ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such session shall be deemed to be a separate regular session of the state legislature title viii revenue related provisions sec 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 outreach to eligible individuals a in general paragraph of section of the internal revenue code of is amended to read as follows disclosures to facilitate identification of individuals likely to be ineligible for low income subsidies under medicare prescription drug program to assist social security administration 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 or shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih be disclosed to officers and employees of the social security administration with respect to any taxpayer identified by the commissioner of social security return information for the applicable year from returns with respect to wages as defined in section a or a and payments of retirement income as described in paragraph of this subsection unearned income information and income information of the taxpayer from partnerships trusts estates and subchapter 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 corporations of the individual spouse on such return and vi such other return information relating to the individual or the individual 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 d– of the social security act 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 taxpayer information records restriction on individuals for whom disclosure may be requested the commissioner of social security shall request information under this paragraph only with respect to verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 d– of the social security act and who have not applied for such subsidy and any individual the social security administration has identified as a spouse of an individual described in clause restriction on use of disclosed information return information disclosed under this paragraph 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 d– of the social security act for use in outreach efforts under section of the social security act safeguards paragraph of section of such code is amended by striking each place it appears andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking or each place it appears and inserting or conforming amendment paragraph of section a of such code is amended by striking effective date the amendments made by this section shall apply to disclosures made after the date which is months after the date of the enactment of this act sec comparative effectiveness research trust fund financing for trust fund a establishment of trust fund in general subchapter a of chapter of the internal revenue code of relating to trust fund code is amended by adding at the end the following new section sec 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 be appropriated or credited to such trust fund as provided in this section and section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih transfers to fund in general there are hereby appropriated to the trust fund the following a for fiscal year for fiscal year for fiscal year for each fiscal year beginning with fiscal year an amount equivalent to the net revenues received in the treasury from the fees imposed under subchapter of chapter relating to fees on health insurance and self insured plans for such fiscal year and subject to subsection amounts determined by the secretary of health and human services to be equivalent to the fair share per capita amount computed under subsection for the fiscal year multiplied by the average number of individuals entitled to benefits under part a or enrolled under part of title xviii of the social security act during such fiscal year administrative provisions verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a transfers from other trust funds the amounts appropriated by subparagraphs a and of paragraph shall be transferred from the federal hospital insurance trust fund and from the federal supplementary medical insurance trust fund established under section 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 appropriations not subject to fiscal year limitation the amounts appropriated by paragraph shall not be subject to any fiscal year limitation periodic transfers estimates and adjustments except as provided in subparagraph a the provisions of section shall apply to the amounts appropriated by paragraph fair share per capita amount computation verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general subject to subparagraph the fair share per capita amount under this paragraph for a fiscal year beginning with fiscal year is an amount computed by the secretary of health and human services for such fiscal year that when applied under this section and subchapter of chapter of the internal revenue code of will result in revenues to the certf of for the fiscal year alternative computation 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 for the fiscal year default amount the default amount under this clause for fiscal year is equal to or a subsequent year is equal to the default amount under this clause for the preceding fiscal year in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih creased by the annual percentage increase in the medical care component of the consumer price index united states city average for the month period ending with april of the preceding fiscal year any amount determined under subclause shall be rounded to the nearest penny limitation on medicare funding in no case shall the amount transferred under subsection for any fiscal year exceed expenditures from fund in general subject to paragraph 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 to carry out section of the social security act allocation for commission the following amounts in the certf shall be available without the need for further appropriations and without fiscal year limitation to the commission to carry out the activities of the comparative effective verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ness research commission established under section of the social security act a for fiscal year for fiscal year for each fiscal year beginning with percent of the total amount appropriated to the certf under subsection for the fiscal year net revenues for purposes of this section the term net revenues means the amount estimated by the secretary based on the excess of the fees received in the treasury under subchapter of chapter over the decrease in the tax imposed by chapter resulting from the fees imposed by such subchapter clerical amendment the table of sections for such subchapter a is amended by adding at the end thereof the following new item sec health care comparative effectiveness research trust fund financing for fund from fees on insured and self insured health plans general rule chapter of the internal revenue code of is amended by adding at the end the following new subchapter verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subchapter insured and self insured health plans sec health insurance sec self insured health plans sec definitions and special rules sec 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 multiplied by the average number of lives covered under the policy liability for fee the fee imposed by subsection a shall be paid by the issuer of the policy specified health insurance policy for purposes of this section 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 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 treatment of prepaid health coverage arrangements verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general in the case of any arrangement described in subparagraph such arrangement shall be treated as a specified health insurance policy and the person referred to in such subparagraph shall be treated as the issuer 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 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 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 multiplied by the average number of lives covered under the plan liability for fee in general the fee imposed by subsection a shall be paid by the plan sponsorverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plan sponsor for purposes of paragraph the term plan sponsor means a the employer in the case of a plan established or maintained by a single employer the employee organization in the case of a plan established or maintained by an employee organization in the case of a plan established or maintained by or more employers or jointly by or more employers and or more employee organizations a multiple employer welfare arrangement or iii a voluntary employees beneficiary association described in section the association committee joint board of trustees or other similar group of representatives of the parties who establish or maintain the plan or the cooperative or association described in subsection in the case of a plan established or maintained by such a cooperative or associationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 any portion of such coverage is provided other than through an insurance policy and such plan is established or maintained a by one or more employers for the benefit of their employees or former employees by one or more employee organizations for the benefit of their members or former members jointly by or more employers and or more employee organizations for the benefit of employees or former employees by a voluntary employees beneficiary association described in section by any organization described in section or in the case of a plan not described in the preceding subparagraphs by a multiple employer welfare arrangement as defined in section of employee retirement income security act of a rural electric cooperative as defined in section iv of such act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or a rural telephone cooperative association as defined in section of such act sec definitions and special rules a definitions for purposes of this subchapter 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 insurance policy the term insurance policy means any policy or other instrument whereby a contract of insurance is issued renewed or extended united states the term united states includes any possession of the united states treatment of governmental entities in general for purposes of this subchapter a the term person includes any governmental entity and 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih treatment of exempt governmental programs in the case of an exempt governmental program no fee shall be imposed under section or section on any covered life under such program 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 the medical assistance program established by title xix or xxi of the social security act 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 members of the armed forces of the united states or veterans and any program established by federal law for providing medical care other than through insurance policies to members of in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dian tribes as defined in section of the indian health care improvement act treatment as tax for purposes of subtitle the fees imposed by this subchapter shall be treated as if they were taxes 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 clerical amendments a chapter of such code is amended by striking the chapter heading and inserting the following chapter taxes on certain insurance policies subchapter a policies issued by foreign insurers subchapter insured and self insured health plans subchapter a policies issued by foreign insurers the table of chapters for subtitle of such code is amended by striking the item relating to chapter and inserting the following new item chapter taxes on certain insurance policies effective date the amendments made by this subsection shall apply with respect to policiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and plans for portions of policy or plan years beginning on or after october title ix miscellaneous provisions sec repeal of trigger provision subtitle a of title viii of the medicare prescription drug improvement and modernization act of public law – is repealed and the provisions of law amended by such subtitle are restored as if such subtitle had never been enacted sec repeal of comparative cost adjustment cca program section c– of the social security act usc w– as added by section a of the medicare prescription drug improvement and modernization act of public law – is repealed sec extension of gainsharing demonstration a in general subsection of section of the deficit reduction act of public law – is amended by inserting or september in the case of a demonstration project in operation as of october after december funding verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general subsection of such section is amended by inserting and for fiscal year after availability subsection of such section is amended by striking and inserting or until expended reports quality improvement and savings subsection of such section is amended by striking december and inserting march final report subsection of such section is amended by striking may and inserting march sec grants to states for quality home visitation programs for families with young children and families expecting children part of title iv of the social security act usc –i is amended by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subpart support for quality home visitation programs sec 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 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 require an application for the grant that includes the following 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 results of needs assessment the results of a statewide needs assessment that describes verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a the number quality and capacity of home visitation programs for families with young children and families expecting children in the state the number and types of families who are receiving services under the programs the sources and amount of funding provided to the programs the gaps in home visitation in the state including identification of communities that are in high need of the services and training and technical assistance activities designed to achieve or support the goals of the programs 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 the state will reserve percent of the grant funds for training and technical assist verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ance to the home visitation programs using such funds 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 home visitation programs supported using such funds will when appropriate provide referrals to other programs serving children and families and the state will comply with subsection and cooperate with any evaluation conducted under subsection other information such other information as the secretary require allotments indian tribes from the amount reserved under subsection for a fiscal year the secretary shall allot to each indian tribe that meets the requirement of subsection if applicable for the fiscal year the amount that bears the same ratioverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to the amount so reserved as the number of children in the indian tribe whose families have income that does not exceed percent of the poverty line bears to the total number of children in such indian tribes whose families have income that does not exceed percent of the poverty line states and territories from the amount appropriated under subsection for a fiscal year that remains after making the reservations required by subsection the secretary shall allot to each state that is not an indian tribe and that meets the requirement of subsection 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 percent of the poverty line bears to the total number of children in such states whose families have income that does not exceed percent of the poverty line 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 inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that paragraph any amount so reallotted to a state is deemed part of the allotment of the state under this subsection maintenance of effort beginning with fiscal year 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 percent of such aggregate expenditures for the then nd preceding fiscal year payment of grant in general the secretary shall make a grant to each state that meets the requirements of subsections and if applicable for a fiscal year for which funds are appropriated under subsection 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 for the fiscal year reimbursable percentage defined in paragraph the term reimbursable percentage means with respect to a fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a percent in the case of fiscal year percent in the case of fiscal year or percent in the case of fiscal year and any succeeding fiscal year eligible expenditures 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 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 employ well trained and competent staff maintain high quality super verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vision 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 provide parents with 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 knowledge of realistic expectations of age appropriate child behaviors iii knowledge of health and wellness issues for children and parents verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv modeling consulting and coaching on parenting practices 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 includes expenditures for training technical assistance and evaluations related to the programs and does not include any expenditure with respect to which a state has submitted a claim for payment under any other provision of federal law priority funding for programs with strongest evidence a in general the expenditures described in paragraph of a state for a fiscal year that are attributable to the cost of programs that do not adhere to a model of homeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 for the fiscal year applicable percentage defined in subparagraph a the term applicable percentage means with respect to a fiscal year percent for fiscal year percent for fiscal year iii percent for fiscal year iv percent for fiscal year or percent for fiscal year no use of other federal funds for state match a state to which a grant is made under this section 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 waiver authority in general the secretary waive or modify the application of any provision of thisverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section other than subsection or to an indian tribe if the failure to do so would impose an undue burden on the indian tribe special rule an indian tribe is deemed to meet the requirement of subsection for purposes of subsections and if a the secretary waives the requirement or the secretary modifies the requirement and the indian tribe meets the modified requirement 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 the services delivered by the programs that received funds from the grant the characteristics of each such program including information on the service model used by the program and the performance of the program the characteristics of the providers of services through the program including staff qualifications work experience and demographic characteristics verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 the annual cost of implementing the program including the cost per family served under the program the outcomes experienced by recipients of services through the program 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 the indicators and methods used to monitor whether the program is being implemented as designed and other information as determined necessary by the secretary evaluation 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 reports to the congress a interim report within 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 final report within 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 annual reports to the congress the secretary shall submit annually to the congress a report on the activities carried out using funds made availableverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under this section which shall include a description of the following the high need communities targeted by states for programs carried out under this section the service delivery models used in the programs receiving funds provided under this section the characteristics of the programs including a the qualifications and demographic characteristics of program staff and recipient characteristics including the number of families served the demographic characteristics of the families served and family retention and duration of services the outcomes reported by the programs the research based instruction materials and activities being used in the activities funded under the grant the training and technical activities including on going professional development provided to the programs the annual costs of implementing the programs including the cost per family served under the programsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the indicators and methods used by states to monitor whether the programs are being been implemented as designed reservations of funds from the amounts appropriated for a fiscal year under subsection the secretary shall reserve an amount equal to percent of the amounts to pay the cost of the evaluation provided for in subsection and the provision to states of training and technical assistance including the dissemination of best practices in early childhood home visitation and after making the reservation required by paragraph an amount equal to percent of the amount so appropriated to pay for grants to indian tribes under this section 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 for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih indian tribes treated as states in this section paragraphs and of section a shall apply sec improved coordination and protection for dual eligibles title xi of the social security act is amended by inserting after section the following new section improved coordination and protection for dual eligibles sec a 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 the office or program shall review medicare and medicaid policies related to enrollment benefits service delivery payment and grievance and appeals processes under parts a and of title xviii under the medicare advantage program under part of such title and under title xix identify areas of such policies where better coordination and protection could improve care and costs andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih issue guidance to states regarding improving such coordination and protection elements the improved coordination and protection under this section shall include efforts to simplify access of dual eligibles to benefits and services under medicare and medicaid to improve care continuity for dual eligibles and ensure safe and effective care transitions to harmonize regulatory conflicts between medicare and medicaid rules with regard to dual eligibles and to improve total cost and quality performance under medicare and medicaid for dual eligibles responsibilities in carrying out this section the secretary shall provide for the following an examination of medicare and medicaid payment systems to develop strategies to foster more integrated and higher quality care 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 a study of enrollment of dual eligibles in the medicare savings program as defined in section under medicaid and in the low incomeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subsidy program under section d– to identify methods to more efficiently and effectively reach and enroll dual eligibles 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 – –medicare and the medicare handbook 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 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 support for coordination of state and federal contracting and oversight for dual coordination programs supportive of the goals described in subsection support for state medicaid agencies through the provision of technical assistance for medicare and medicaid coordination initiatives de verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih signed to improve acute and long term care for dual eligibles 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 coordination of activities relating to medicare advantage plans under and medicaid reporting the office or program shall work with relevant state agencies and any appropriate quality measurement entities to improve and coordinate reporting requirements for medicare and medicaid in addition the office or program shall seek to minimize duplication in reporting requirements where appropriate and to identify opportunities to combine assessment requirements where appropriate the office or program shall seek to identify quality metrics and assessment requirements that facilitate comparisons of the quality of care received by beneficiaries enrolled in or entitled to benefits under fee forservice medicare the medicare advantage program feefor service medicaid and medicaid managed care and combinations thereof including integrated medicare medicaid programs for dual eligibles verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih endorsement the secretary shall seek endorsement by the entity with a contract under section a of quality measures and benchmarks developed under this section consultation with stakeholders the office or program shall consult with relevant stakeholders including dual eligible beneficiaries representatives for dual eligible beneficiaries health plans providers and relevant state agencies in the development of policies related to integrated medicare medicaid programs for dual eligibles periodic reports not later than year after the date of the enactment of this section and every years thereafter the secretary shall submit to congress a report on progress in activities conducted under this section definitions in this section 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medicare medicaid the terms medicare and medicaid mean the programs under titles xviii and xix respectively sec assessment of medicare cost intensive diseases and conditions a initial assessment in general the secretary of health and human services shall conduct an assessment of the diseases and conditions that are the most cost intensive for the medicare program and to the extent possible assess the diseases and conditions that could become cost intensive for medicare in the future in conducting the assessment the secretary shall include the input of relevant research agencies including the national institutes of health the agency for healthcare research and quality the food and drug administration and the centers for medicare medicaid services report not later than january the secretary shall transmit a report to the committees on energy and commerce ways and means and appropriations of the house of representatives and the committees on health education labor and pensions finance and appropriations of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih senate on the assessment conducted under paragraph such report shall a include the assessment of current and future trends of cost intensive diseases and conditions described in such paragraph address whether current research priorities are appropriately addressing current and future cost intensive conditions so identified and include recommendations concerning research in the department of health and human services that should be funded to improve the prevention treatment or cure of such cost intensive diseases and conditions updates of assessment not later than january and biennially thereafter the secretary shall review and update the assessment and recommendations described in subsection a and submit a report described in subsection a to the committees specified in subsection a on such updated assessment and recommendationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec establishment of center for medicare and medicaid innovation within cms a in general title xi of the social security act is amended by inserting after section the following new section center for medicare and medicaid innovation sec a a center for medicare and medicaid innovation established in general there is created within the centers for medicare medicaid services a center for medicare and medicaid innovation in this section referred to as the cmi to carry out the duties described in this section the purpose of the cmi is to test innovative payment and service delivery models to improve the coordination quality and efficiency of health care services provided to applicable individuals defined in paragraph a deadline the secretary shall ensure that the cmi is carrying out the duties described in this section by not later than january consultation in carrying out the duties under this section the cmi shall consult representatives of relevant federal agencies clinical and analytical experts with expertise in medicine and health care management and states the cmi shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih use open door forums or other mechanisms to seek input from interested parties definitions in this section a applicable individual the term applicable individual means an individual who is enrolled under part and entitled to benefits under part a of title xviii an individual who is eligible for medical assistance under title xix or iii an individual who meets the criteria of both clauses and applicable title the term applicable title means title xviii title xix or both testing of models phase in general the cmi shall test payment and service delivery models in accordance with selection criteria under paragraph to determine the effect of applying such models under the applicable title as defined in subsection a on program expenditures under such titles and the quality of care received by individuals receiving benefits under such title selection of models to be tested verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general the secretary shall give preference to testing models for which as determined by the administrator of the centers for medicare medicaid services and using such input from outside the centers as the administrator determines appropriate there is evidence that the model addresses a defined population for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures the administrator shall focus on models expected to reduce program costs under the applicable title while preserving or enhancing the quality of care received by individuals receiving benefits under such title application to other demonstrations the secretary shall operate the demonstration programs under sections and of the affordable health care for america act through the cmi in accordance with the rules applicable under this section including those relating to evaluations terminations and expansions budget neutrality a initial period the secretary shall not require as a condition for testing averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih model under paragraph that the design of such model ensure that such model is budget neutral initially with respect to expenditures under the applicable title termination the secretary shall terminate or modify the design and implementation of a model unless the secretary determines and the chief actuary of the centers for medicare medicaid services with respect to spending under the applicable title certifies after testing has begun that the model is expected to improve the quality of care as determined by the administrator of the centers for medicare medicaid services without increasing spending under such title reduce spending under such titles without reducing the quality of care or iii do both such termination occur at any time after such testing has begun and before completion of the testing evaluation verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general the secretary shall conduct an evaluation of each model tested under this subsection such evaluation shall include an analysis of the quality of care furnished under the model including through the use of patient level outcomes measures and the changes in spending under the applicable titles by reason of the model the secretary shall make the results of each evaluation under this paragraph available to the public in a timely fashion measure selection to the extent feasible the secretary shall select measures under this paragraph that reflect national priorities for quality improvement and patientcentered care consistent with the measures developed under section testing period in no case shall a model be tested under this subsection for more than a year period expansion of models phase the secretary expand the duration and the scope of a modelverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that is being tested under subsection including implementation on a nationwide basis to the extent determined appropriate by the secretary if the secretary determines that such expansion is expected a to improve the quality of patient care without increasing spending under the applicable titles to reduce spending under applicable titles without reducing the quality of care or to do both the chief actuary of the centers for medicare medicaid services certifies that such expansion would reduce or not result in any increase in net program spending under applicable titles and the secretary determines that such expansion would not deny or limit the coverage or provision of benefits under the applicable title for applicable individuals implementation waiver authority the secretary waive such requirements of titles xi and xviii and of sections and as be necessary solely for purposes of carrying out this section with respect to testing models described in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih limitations on review there shall be no administrative or judicial review under section section or otherwise of a the selection of models for testing or expansion under this section the elements parameters scope and duration of such models for testing or dissemination the termination or modification of the design and implementation of a model under subsection and determinations about expansion of the duration and scope of a model under subsection including the determination that a model is not expected to meet criteria described in paragraphs or of such subsection administration chapter of title united states code shall not apply to the testing and evaluation of models or expansion of such models under this section funding for testing items and services and administrative costs a additional benefits there shall be available until expended equally divided from the federal supplementary hospital in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih surance trust fund and federal supplementary medical insurance trust fund for payments for additional benefits for items and services under models tested under subsection not otherwise covered under this title and applicable to benefits under this title and for researching designing implementing and evaluating such models for fiscal year for fiscal year for fiscal year and for a subsequent fiscal year the amount determined under this subparagraph for the preceding fiscal year increased by the annual percentage rate of increase in total expenditures under this title for the subsequent fiscal year as estimated in the latest available annual report of the board of trustees as described in section medicaid for administrative costs of the centers for medicare medicaid services for administering this section with respect to title xix from any amounts in the treasury not otherwise appropriated there are appropriated to the secretary for the centers for medicare medicaid services program man verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agement account for each fiscal year beginning with fiscal year amounts appropriated under this subparagraph for a fiscal year shall be available until expended report to congress beginning in and not less than once every other year thereafter the secretary shall submit to congress a report on activities under this section each such report shall describe the payment models tested under subsection including the number of individuals described in subsection a a and of individuals described in subsection a a participating in such models and payments made under applicable titles for services on behalf of such individuals any models chosen for expansion under subsection and the results from evaluations under subsection in addition each such report shall provide such recommendations as the secretary believes are appropriate for legislative action to facilitate the development and expansion of successful payment models medicaid conforming amendment section a of the social security act usc a a as amended by sections a a and a is amended in paragraph by striking and at the end verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by striking the period at the end and inserting and and by inserting after paragraph the following new paragraph provide for implementation of the payment models specified by the secretary under section a for implementation on a nationwide basis unless the state demonstrates to the satisfaction of the secretary that implementation would not be administratively feasible or appropriate to the health care delivery system of the state sec application of emergency services laws nothing in this act shall be construed to relieve any health care provider from providing emergency services as required by state or federal law including section of the social security act popularly known as ?emtala? sec disregard under the supplemental security income program of compensation for participation in clinical trials for rare diseases or conditions a income disregard section of the social security act usc a is amended by striking and at the end of paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking the period at the end of paragraph and inserting and and by adding at the end the following the first per year received by such individual or such spouse for participation in a clinical trial to test a treatment for a rare disease or condition within the meaning of section of the orphan drug act public law – that a has been reviewed and approved by an institutional review board that is established to protect the rights and welfare of human subjects participating in research and meet the standards for such bodies set forth in part of title code of federal regulations and meets the standards for protection of human subjects for clinical research as set forth in such part resource disregard section a of such act usc a is amended by striking and at the end of paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking the period at the end of paragraph and inserting and and by inserting after paragraph the following the first per year received by such individual or such spouse for participation in a clinical trial as described in section effective date the amendments made by this section shall apply to benefits payable for calendar months beginning after the earlier of the date the commissioner of social security promulgates regulations to carry out the amendments or the day period that begins with the date of the enactment of this act division public health and workforce development sec table of contents references a table of contents the table of contents of this division is as follows sec table of contents referencessec public health investment fundsec deficit neutralitytitle community health centerssec increased fundingtitle workforceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ihsubtitle a primary care workforcepart national health service corpssec national health service corpssec authorizations of appropriationspart promotion of primary care and dentistrysec frontline health providers subpart xi health professional needs areas sec in general sec loan repayments sec report sec allocationsec primary care student loan fundssec training in family medicine general internal medicine general pediatrics geriatrics and physician assistantssec training of medical residents in community based settingssec training for general pediatric and public health dentists and dentalhygienistssec authorization of appropriationssec study on effectiveness of scholarships and loan repaymentssubtitle nursing workforcesec amendments to public health service actsubtitle public health workforcesec public health workforce corps subpart xii public health workforce sec public health workforce corps sec public health workforce scholarship program sec public health workforce loan repayment programsec enhancing the public health workforcesec public health training centerssec preventive medicine and public health training grant programsec authorization of appropriationssubtitle adapting workforce to evolving health system needspart health professions training for diversitysec scholarships for disadvantaged students loan repayments and fellowshipsregarding faculty positions and educational assistancein the health professions regarding individuals from disadvantagedbackgroundssec nursing workforce diversity grantssec coordination of diversity and cultural competency programspart interdisciplinary training programssec cultural and linguistic competency training for health professionalssec innovations in interdisciplinary care trainingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ihpart advisory committee on health workforce evaluation andassessmentsec health workforce evaluation and assessmentpart health workforce assessmentsec health workforce assessmentpart authorization of appropriationssec authorization of appropriationstitle iii prevention and wellnesssec prevention and wellness title xxxi prevention and wellness subtitle a prevention and wellness trust sec prevention and wellness trust subtitle national prevention and wellness strategy sec national prevention and wellness strategy subtitle prevention task forces sec task force on clinical preventive services sec task force on community preventive services subtitle prevention and wellness research sec prevention and wellness research activity coordination sec community prevention and wellness research grants sec research on subsidies and rewards to encourage wellness andhealthy behaviors subtitle delivery of community prevention and wellness services sec community prevention and wellness services grants subtitle core public health infrastructure sec core public health infrastructure for state local and tribalhealth departments sec core public health infrastructure and activities for cdc subtitle general provisions sec definitionstitle iv quality and surveillancesec implementation of best practices in the delivery of health caresec assistant secretary for health informationsec authorization of appropriationstitle other provisionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ihsubtitle a drug discount for rural and other hospitals programintegritysec expanded participation in programsec improvements to program integritysec effective datesubtitle programspart grants for clinics and centerssec school based health clinicssec nurse managed health centerssec federally qualified behavioral health centerspart other grant programssec comprehensive programs to provide education to nurses and createa pipeline to nursingsec mental and behavioral health trainingsec reauthorization of telehealth and telemedicine grant programssec no child left unimmunized against influenza demonstration programusing elementary and secondary schools as influenza vaccinationcenterssec extension of wisewoman programsec healthy teen initiative to prevent teen pregnancysec national training initiatives on autism spectrum disorderssec implementation of medication management services in treatment ofchronic diseasessec postpartum depressionsec grants to promote positive health behaviors and outcomessec medical liability alternativessec infant mortality pilot programssec secondary school health sciences training programsec community based collaborative care networkssec community based overweight and obesity prevention programsec reducing student to school nurse ratiossec medical legal partnershipspart emergency care related programssec trauma care centerssec emergency care coordinationsec pilot programs to improve emergency medical caresec assisting veterans with military emergency medical training to becomestate licensed or certified emergency medical technicians emts sec dental emergency responders public health and medical responsesec dental emergency responders homeland securitypart pain care and management programssec institute of medicine conference on painsec pain research at national institutes of healthsec public awareness campaign on pain managementsubtitle food and drug administrationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ihpart in generalsec national medical device registrysec nutrition labeling of standard menu items at chain restaurants andof articles of food sold from vending machinessec protecting consumer access to generic drugspart biosimilarssec licensure pathway for biosimilar biological productssec fees relating to biosimilar biological productssec amendments to certain patent provisionssubtitle community living assistance services and supportssec establishment of national voluntary insurance program for purchasingcommunity living assistance services and support class program title xxxii community living assistance services andsupports sec purpose sec definitions sec class independence benefit plan sec enrollment and disenrollment requirements sec benefits sec class independence fund sec class independence advisory council sec regulations annual report sec inspector general reportsubtitle miscellaneoussec states failing to adhere to certain employment obligationssec health centers under public health service act liability protectionsfor volunteer practitionerssec report to congress on the current state of parasitic diseases thathave been overlooked among the poorest americanssec office of women healthsec long term care and family caregiver supportsec web site on health care labor market and related educational andtraining opportunitiessec online health workforce training programssec access for individuals with disabilities 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 sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or other provision of the public health service act usc et seq sec public health investment fund a establishment of funds in general subject to section there is hereby established in the treasury a separate account to be known as the public health investment fund referred to in this section and section as the fund funding a there shall be deposited into the fund for fiscal year for fiscal year iii for fiscal year iv for fiscal year and for fiscal year amounts deposited into the fund shall be derived from general revenues of the treasury only for the fiscal years set forth in thisverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section and amounts appropriated from the fund shall remain available until expended authorization of appropriations from the fund new funding a in general subject to section amounts in the fund are authorized to be appropriated for carrying out activities under designated public health provisions 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 h– or of the public health service act as added by this division baseline funding a in general amounts in the fund are authorized to be appropriated as described in paragraph for a fiscal year only if excluding any amounts in or appropriated from the fund the amounts specified in subparagraph for the fiscal year involved are equal to or greater than the amounts spec verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ified in subparagraph for fiscal year and the amounts appropriated out of the general fund of the treasury to the prevention and wellness trust under section a of the public health service act as added by this division for the fiscal year involved are equal to or greater than the funds appropriated under the heading prevention and wellness fund in title viii of division a of the american recovery and reinvestment act of public law – and allocated by the second proviso under such heading for evidencebased clinical and community based prevention and wellness strategies amounts specified the amounts specified in this subparagraph with respect to a fiscal year are the amounts appropriated for the following community health centers including funds appropriated under the authorityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of section of the public health service act usc the national health service corps program including funds appropriated under the authority of section of such act usc iii the national health service corps scholarship and loan repayment programs including funds appropriated under the authority of section of such act usc iv primary care education programs including funds appropriated under the authority of sections and of such act usc and sections and of such act usc and vi nursing workforce development including funds appropriated under the authority of title viii of such act usc et seq vii the national center for health statistics including funds appropriated under the authority of sections verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and of such act usc and viii the agency for healthcare research and quality including funds appropriated under the authority of title ix of such act usc et seq sec deficit neutrality a availability funds appropriated or made available pursuant to sections h– or of the public health service act as added by this division are only available for the purposes set forth in this act appropriations shall not be available and are precluded from obligation for any other purpose estimation of budgetary impact for the purposes of estimating the spending effects of this act the authorization of appropriations from the fund to the extent amounts in the fund are derived from the general revenues of the treasury shall be treated as new direct spending and attributed to this act budgetary treatment for the purposes of section of the balanced budget and emergency deficit control act of the fund to the extent amounts in the fund are derived from the general revenues of the treasury and not in excess of amounts subsequently appropriated from the fund shall be deemed to be includedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih on the list of appropriations referenced under section of that act title community health centers sec increased funding section of the public health service act usc is amended in subsection a in subparagraph by striking and at the end in subparagraph by striking the period at the end and inserting and and by inserting at the end the following such sums as be necessary for each of fiscal years through and by inserting after subsection the following 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 for fiscal year for fiscal year for fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for fiscal year for fiscal year title workforce subtitle a primary care workforce part national health service corps sec national health service corps a fulfillment of obligated service requirement through half time service waivers subsection of section usc is amended a in paragraph by striking in carrying out subpart iii and all that follows through the period and inserting in carrying out subpart iii the secretary 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 in paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in subparagraphs a and by striking less than full time each place it appears and inserting half time in subparagraphs and by striking less than full time service each place it appears and inserting half time service and iii by amending subparagraphs and to read as follows the entity and the corps member agree in writing that the corps member will perform halftime clinical practice the corps member agrees in writing to fulfill all of the service obligations under section through half time clinical practice and either double the period of obligated service that would otherwise be required or in the case of contracts entered into under section accept a minimum service obligation of years with an award amount equal to percent of the amount that would otherwise be payable for full time service and andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by striking in evaluating a demonstration project described in paragraph and inserting in evaluating waivers issued under paragraph definitions subsection of section usc is amended by adding at the end the following the terms full time and full time mean a minimum of hours per week in a clinical practice for a minimum of weeks per year the terms half time and half time mean a minimum of hours per week not to exceed hours per week in a clinical practice for a minimum of weeks per year reappointment to national advisory council section usc is amended by striking members not be reappointed to the council loan repayment amount section a usc l– a is amended by striking and inserting plus beginning with fiscal year an amount determined by the secretary on an annual basis to reflect inflation treatment of teaching as obligated service subsection a of section usc verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is amended by adding at the end the following the secretary treat teaching as clinical practice for up to percent of such period of obligated service sec authorizations of appropriations a national health service corps program section usc is amended in subsection a by striking and inserting and by adding at the end the following 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 for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year scholarship and loan repayment programs subpart iii of part of title iii of the public health service act usc et seq is amended in section a a in paragraph by striking and at the end verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by striking the period at the end and inserting and and by adding at the end the following for each of fiscal years through such sums as be necessary and by inserting after section the following sec h– 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 for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year part promotion of primary care and dentistry sec frontline health providers part of title iii usc et seq is amended by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subpart xi health professional needs areas sec 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 designation of health professional needs areas 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 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 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih insufficient capacity of health professionals or high needs for health services including services to address health disparities 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 except that the area population or facility include such a health professional shortage area in which there is an unmet need for such services eligibility to be eligible to participate in the program an individual shall hold a degree in a course of study or program approved by the secretary from a school defined in section a other than a school of public health hold a degree in a course of study or program approved by the secretary from a school or program defined in subparagraph or of section as designated by the secretary be enrolled as a full time student verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in a school or program defined in subparagraph or of section as designated by the secretary or a school described in paragraph and 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 or of section be a practitioner described in section or iii or iv of the social security act or be a practitioner in the field of respiratory therapy medical technology or radiologic technology definitions in this subpart the term health disparities has the meaning given to the term in section the term primary health services has the meaning given to such term in section a sec loan repayments a loan repayments the secretary acting through the administrator of the health resources andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih services administration shall enter into contracts with individuals under which 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 years or such longer period as the individual agree to 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 and in the case of an individual described in section who is in the final year of study and who has accepted employment as a primary health services provider or provider of other health services in accordance with subparagraphs a and 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 the secretary agrees to pay for each year of such service an amount on the principal and in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih terest of the undergraduate or graduate educational loans or both of the individual that is not more than percent of the average award made under the national health service corps loan repayment program under subpart iii in that year 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 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 application of certain provisions the provisions of subpart iii of part 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 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 recruiting applicants and entering into contracts with indi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih viduals so as to ensure a sufficient number of participants in the national health service corps for the following year sec report the secretary shall submit to the congress an annual report on the program carried out under this subpart sec allocation of the amount of funds obligated under this subpart each fiscal year for loan repayments percent shall be for physicians and other health professionals providing primary health services and percent shall be for health professionals not described in paragraph sec primary care student loan funds a in general section usc is amended by redesignating subsection as subsection and by inserting after subsection the following determination of financial need the secretary require or authorize a school or other entity to require the submission of financial infor verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mation to determine the financial resources available to any individual seeking assistance under this subpart and 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 family members revised guidelines the secretary of health and human services shall strike the second sentence of section of title code of federal regulations and make such other revisions to guidelines and regulations in effect as of the date of the enactment of this act as be necessary for consistency with the amendments made by paragraph sec training in family medicine general internal medicine general pediatrics geriatrics and physician assistants section usc is amended by amending the section heading to read as follows primary care training and enhancement verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by redesignating subsection as subsection and by striking subsections a through 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 and support and development of primary care training programs 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 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 inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih family medicine general internal medicine general pediatrics or geriatrics 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 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 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 eligibility to be eligible for a grant or contract under paragraph an entity shall be a an accredited school of medicine or osteopathic medicine public or nonprofit privateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih hospital or physician assistant training program a public or private nonprofit entity or a consortium of or more entities described in subparagraphs a and capacity building in primary care 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 programs that improve clinical teaching in such specialties eligibility to be eligible for a grant or contract under paragraph an entity shall be an accredited school of medicine or osteopathic medicine preference in awarding grants or contracts under this section the secretary shall give preference to entities that have a demonstrated record of at least one of the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih training a high or significantly improved percentage of health professionals who provide primary care training individuals who are from disadvantaged backgrounds including racial and ethnic minorities underrepresented among primary care professionals 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 supporting teaching programs that address the health care needs of vulnerable populations report the secretary shall submit to the congress an annual report on the program carried out under this section definition in this section the term health disparities has the meaning given the term in section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec training of medical residents in community based settings title vii usc et seq is amended by redesignating section as a and by inserting after section the following sec training of medical residents in community based settings a program the secretary shall establish a program for the training of medical residents in communitybased settings consisting of awarding grants and contracts under this section development and operation of community based programs the secretary shall make grants to or enter into contracts with eligible entities to plan and develop a new primary care residency training program which include a planning and developing curricula recruiting and training residents and faculty and other activities designated to result in accreditation of such a program or to operate or participate in an established primary care residency training program which include a planning and developing curricula verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih recruitment and training of residents and retention of faculty eligible entity to be eligible to receive a grant or contract under subsection an entity shall be designated as a recipient of payment for the direct costs of medical education under section of the social security act be designated as an approved teaching health center under section of the affordable health care for america act and continuing to participate in the demonstration project under such section be an applicant for designation described in paragraph or 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 or be eligible to be designated as described in paragraph or not be an applicant as described in paragraph and have demonstrated appropriate involvement of an accredited teaching hospital to carry out the inpatient responsibilities asso verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ciated with a primary care residency training program preferences in awarding grants and contracts under paragraph or of subsection the secretary shall give preference to entities that support teaching programs that address the health care needs of vulnerable populations or are a federally qualified health center as defined in section aa of the social security act or a rural health clinic as defined in section aa of such act additional preferences for established programs in awarding grants and contracts under subsection the secretary shall give preference to entities that have a demonstrated record of training a high or significantly improved percentage of health professionals who provide primary care individuals who are from disadvantaged backgrounds including racial and ethnic minorities underrepresented among primary care professionals or 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 underverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 period of awards in general the period of a grant or contract under this section a shall not exceed years for awards under subsection and shall not exceed years for awards under subsection special rules a an award of a grant or contract under subsection shall not be renewed the period of a grant or contract awarded to an entity under subsection shall not overlap with the period of any grant or contact awarded to the same entity under subsection report the secretary shall submit to the congress an annual report on the program carried out under this section definitions in this section health disparities the term health disparities has the meaning given the term in section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih primary care resident the term primary care resident has the meaning given the term in section h of the social security act primary care residency training program the term primary care residency training program means an approved medical residency training program described in section a of the social security act for primary care residents that is a in the case of entities seeking awards under subsection actively applying to be accredited by the accreditation council for graduate medical education or the american osteopathic association or in the case of entities seeking awards under subsection so accredited allocation of funds of the amount appropriated pursuant to section a for a fiscal year not more than percent of such amount shall be made available to carry out this section sec training for general pediatric and public health dentists and dental hygienists title vii usc et seq is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in section a by striking and and inserting and and by inserting after section as added the following sec training for general pediatric and public health dentists and dental hygienists a program the secretary shall establish a training program for oral health professionals consisting of awarding grants and contracts under this section support and development of oral health training programs the secretary shall make grants to or enter into contracts with eligible entities to plan develop operate or participate in an accredited professional training program for oral health professionals 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 health dentistry or dental hygiene to plan develop operate or participate in a program for the training of oral health profes verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sionals who plan to teach in general pediatric or public health dentistry or dental hygiene 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 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 programs that improve clinical teaching in such specialties to plan develop operate or participate in predoctoral and postdoctoral training in general pediatric or public health dentistry programs 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 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 diseaseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih management of all pediatric populations with an emphasis on underserved children eligibility to be eligible for a grant or contract under this section an entity shall be an accredited school of dentistry training program in dental hygiene or public or nonprofit private hospital a training program in dental hygiene at an accredited institution of higher education a public or private nonprofit entity or a consortium of a or more of the entities described in paragraphs through and an accredited school of public health preference in awarding grants or contracts under this section the secretary shall give preference to entities that have a demonstrated record of at least one of the following training a high or significantly improved percentage of oral health professionals who practice general pediatric or public health dentistry training individuals who are from disadvantaged backgrounds including racial and ethnic minorities underrepresented among oral health professionals verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 supporting teaching programs that address the oral health needs of vulnerable populations providing instruction regarding the oral health status oral health care needs and risk based clinical disease management of all pediatric populations with an emphasis on underserved children report the secretary shall submit to the congress an annual report on the program carried out under this section definitions in this section the term health disparities has the meaning given the term in section the term oral health professional means an individual training or practicing verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general dentistry pediatric dentistry public health dentistry or dental hygiene or another oral health specialty as deemed appropriate by the secretary sec authorization of appropriations a in general part of title vii usc et seq is amended by adding at the end the following sec funding through public health investment fund a promotion of primary care and dentistry for the purpose of carrying out subpart xi of part of title iii and sections and 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 for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year existing authorization of appropriations subsection as so redesignated of sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih usc is amended by striking and inserting sec study on effectiveness of scholarships and loan repayments a study the comptroller general of the united states shall conduct a study to determine the effectiveness of scholarship and loan repayment programs under subparts iii and xi of part of title iii of the public health service act as amended or added by sections and including whether scholarships or loan repayments are more effective in incentivizing physicians and other providers to pursue careers in primary care specialties retaining such primary care providers and encouraging such primary care providers to practice in underserved areas report not later than months after the date of the enactment of this act the comptroller general shall submit to the congress a report on the results of the study under subsection a subtitle nursing workforce sec amendments to public health service act a definitions section usc et seq is amended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by inserting nurse managed health centers after nursing centers and by adding at the end the following nurse managed health center the term nurse managed health center a means a nurse practice arrangement managed by one or more 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 and shall not be construed as changing state law requirements applicable to an advanced practice nurse or the authorized scope of practice of such a nurse grants for health professions education title viii usc et seq is amended by striking section reports part a of title viii usc et seq is amended by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec reports the secretary shall submit to the congress a separate annual report on the activities carried out under each of sections a and advanced education nursing grants section usc is amended by striking paragraph by redesignating paragraph as paragraph and in paragraph 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 or to increase diversity among advanced education nurses nurse education practice and retention grants section usc is amended in subsection by amending paragraph to read as follows providing coordinated care quality care and other skills needed to practice nursing or andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by striking subsection and redesignating subsections through as subsections through respectively student loans subsection a of section usc is amended by striking and inserting by striking and inserting by striking and inserting and by adding at the end the following beginning with fiscal year the dollar amounts specified in this subsection shall be adjusted by an amount determined by the secretary on an annual basis to reflect inflation loan repayment section usc is amended in subsection a by amending paragraph to read as follows who enters into an agreement with the secretary to serve for a period of not less than years a as a nurse at a health care facility with a critical shortage of nurses orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as a faculty member at an accredited school of nursing and in subsection by striking to provide health services each place it appears and inserting to provide health services or serve as a faculty member nurse faculty loan program paragraph of section a usc n– is amended by striking and all that follows through the semicolon and inserting plus beginning with fiscal year an amount determined by the secretary on an annual basis to reflect inflation public service announcements title viii usc et seq is amended by striking part technical and conforming amendments title viii usc et seq is amended by moving section relating to prohibition against discrimination by schools on the basis of sex so that it follows section as added by subsection in sections and by striking the term this subpart each place it appears and inserting this part in section by striking the last sentence verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in section by redesignating subsection as subsection in section by striking and all that follows through a and inserting a in section by striking each place it appears and inserting by redesignating section as section moving part to the end of the title and redesignating such part as part in part a by redesignating section as section and by redesignating part as part and in part a by redesignating section as section and by redesignating part as part funding in general part as redesignated of title viii is amended by adding at the end the following sec funding through public health investment fund for the purpose of carrying out this title in addition to any other amounts authorized to be appropriatedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for such purpose there are authorized to be appropriated out of any monies in the public health investment fund the following for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year existing authorizations of appropriations a sections a and sections as so redesignated usc a usc n– and as so redesignated are amended by striking each place it appears and inserting section section as so redesignated by subsection is amended to read as follows sec funding for the purpose of carrying out parts and subject to section there are authorized to be appropriated such sums as be necessary for each fiscal year through fiscal year verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle public health workforce sec public health workforce corps part of title iii usc et seq as amended by section is amended by adding at the end the following subpart xii public health workforce sec 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 such officers of the regular and reserve corps of the service as the secretary designate such civilian employees of the united states as the secretary appoint and such other individuals who are not employees of the united states administration except as provided in subsection the secretary shall carry out this subpart acting through the administrator of the health resources and services administration placement and assignment the secretary acting through the director of the centers for diseaseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih control and prevention shall develop a methodology for placing and assigning corps participants as public health professionals such methodology allow for placing and assigning such participants in state local and tribal health departments and federally qualified health centers as defined in section aa of the social security act application of certain provisions the provisions of subpart 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 report the secretary shall submit to the congress an annual report on the programs carried out under this subpart sec 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 a eligibility to be eligible to participate in the program an individual shall verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 an accredited graduate school or program of nursing health administration management or policy preventive medicine laboratory science veterinary medicine or dental medicine or another accredited graduate school or program as deemed appropriate by the secretary 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 sign and submit to the secretary a written contract described in subsection to serve fulltime as a public health professional upon the com verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pletion of the course of study or program involved for the period of obligated service described in subsection c contract the written contract between the secretary and an individual under subsection shall contain 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 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 accept subject to the availability of appropriated funds the individual into the corps an agreement on the part of the individual that the individual will a accept provision of such scholarship to the individual maintain full time or part time enrollment in the approved course of study or program described in subsection until the in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dividual completes that course of study or program 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 if applicable complete a residency or internship and serve full time as a public health professional for a period of time equal to the greater of year for each academic year for which the individual was provided a scholarship under the program or years and an agreement by both parties as to the nature and extent of the scholarship assistance which include a payment of reasonable educational expenses of the individual including tuition fees books equipment and laboratory expenses and payment of a stipend of not more than plus beginning with fiscal year an amount determined by the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 fulltime or part time 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 a sec 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 a eligibility to be eligible to participate in the program an individual shall a have a graduate degree from an accredited school or program of public health have demonstrated expertise in public health and have a graduate degree in a course ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih study or program approved by the secretary from an accredited school or program of nursing health administration management or policy preventive medicine laboratory science veterinary medicine or dental medicine or another accredited school or program approved by the secretary or 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 leading to a graduate degree 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 if applicable complete a residency or internship and sign and submit to the secretary a written contract described in subsection to serve fulltime as a public health professional for the period of obligated service described in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih contract the written contract between the secretary and an individual under subsection shall contain 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 an agreement by the individual to serve full time as a public health professional for a period of time equal to years or such longer period as the individual agree to and in the case of an individual described in subsection who is in the final year of study and who has accepted employment as a public health professional in accordance with section 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 payments in general a loan repayment provided for an individual under a written contract under theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih program shall consist of payment in accordance with paragraph 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 payments for years served a in general for each year of obligated service that an individual contracts to serve under subsection the secretary pay up to plus beginning with fiscal year an amount determined by the secretary on an annual basis to reflect inflation on behalf of the individual for loans described in paragraph 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 serviceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 sec enhancing the public health workforce section usc is amended to read as follows sec 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 grants and contracts the secretary shall award grants to or enter into contracts with eligible entities 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 pol verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih icy preventive medicine laboratory science veterinary medicine or dental medicine for members of the public health workforce including midcareer professionals 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 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 and to provide financial assistance in the form of traineeships and fellowships to public health professionals who are participants in any program described in paragraph 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 eligibility to be eligible for a grant or contract under this section an entity shall be an accredited health professions school including an accredited school or program of public health nursing health administration management verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or policy preventive medicine laboratory science veterinary medicine or dental medicine a state local or tribal health department a public or private nonprofit entity or a consortium of or more entities described in paragraphs through preference in awarding grants or contracts under this section the secretary shall give preference to entities that have a demonstrated record of at least one of the following training a high or significantly improved percentage of public health professionals who serve in underserved communities training individuals who are from disadvantaged backgrounds including racial and ethnic minorities underrepresented among public health professionals training individuals in public health specialties experiencing a significant shortage of public health professionals as determined by the secretary training a high or significantly improved percentage of public health professionals serving in the federal government or a state local or tribal governmentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih report the secretary shall submit to the congress an annual report on the program carried out under this section sec public health training centers section usc a is amended in subsection by striking in furtherance of the goals established by the secretary for the year and inserting in furtherance of the goals established by the secretary in the national prevention and wellness strategy under section and by adding at the end the following report the secretary shall submit to the congress an annual report on the program carried out under this section sec preventive medicine and public health training grant program section usc is amended to read as follows sec 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 awardverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties eligibility to be eligible for a grant or contract under subsection a an entity shall be an accredited school of public health or school of medicine or osteopathic medicine an accredited public or private nonprofit hospital a state local or tribal health department or a consortium of or more entities described in paragraphs through use of funds amounts received under a grant or contract under this section shall be used to plan develop including the development of curricula operate or participate in an accredited residency or internship program in preventive medicine or public health defray the costs of practicum experiences as required in such a program and establish maintain or improve a academic administrative units including departments divisions or other appro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih priate units in preventive medicine and public health or programs that improve clinical teaching in preventive medicine and public health report the secretary shall submit to the congress an annual report on the program carried out under this section sec authorization of appropriations a in general section as added by section of this act is amended by adding at the end the following public health workforce for the purpose of carrying out subpart xii of part of title iii and sections and 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 for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year existing authorization of appropriations subsection a of section usc is amended by striking and inserting verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle adapting workforce to evolving health system needs part health professions training for diversity sec scholarships for disadvantaged students loan repayments and fellowships regarding faculty positions and educational assistance in the health professions regarding individuals from disadvantaged backgrounds paragraph of section a usc a is amended by striking not more than and all that follows through the end of the paragraph and inserting not more than plus beginning with fiscal year 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 nursing workforce diversity grants subsection of section usc is amended in the heading by striking guidance and inserting consultation and by striking shall take into consideration and all that follows through consult with nursingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih associations and inserting shall as appropriate consult with nursing associations sec coordination of diversity and cultural competency programs a in general title vii usc et seq is amended by inserting after section the following sec a coordination of diversity and cultural competency programs the secretary shall to the extent practicable coordinate the activities carried out under this part and section in order to enhance the effectiveness of such activities and avoid duplication of effort report section usc is amended by redesignating subsection as subsection and by inserting after subsection the following report the secretary shall submit to the congress an annual report on the activities carried out under this section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih part interdisciplinary training programs sec cultural and linguistic competency training for health professionals section usc is amended in the section heading by striking grants for health professions education and inserting cultural and linguistic competency training for health professionals by redesignating subsection as subsection and by striking subsection a and inserting the following a program the secretary shall establish a cultural and linguistic competency training program for health professionals including nurse professionals consisting of awarding grants and contracts under subsection cultural and linguistic competency training the secretary shall award grants to or enter into contracts with eligible entities to test develop and evaluate models of cultural and linguistic competency training including continuing education for health professionals andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to implement cultural and linguistic competency training programs for health professionals developed under paragraph or otherwise eligibility to be eligible for a grant or contract under subsection an entity shall be an accredited health professions school or program an academic health center a public or private nonprofit entity or a consortium of or more entities described in paragraphs through preference in awarding grants and contracts under this section the secretary shall give preference to entities that have a demonstrated record of at least one of the following 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 addressing health disparities placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations including communities along the united states mexico borderverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih carrying out activities described in subsection with respect to more than one health profession discipline specialty or subspecialty 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 and the national center on minority health and health disparities definition in this section the term health disparities has the meaning given to the term in section report the secretary shall submit to the congress an annual report on the program carried out under this section sec innovations in interdisciplinary care training part of title vii usc et seq is amended by adding at the end the following sec 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih training programs the secretary shall award grants to or enter into contracts with eligible entities 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 include patient centered medical home models medication therapy management models and models integrating physical mental or oral health services and coordination of the delivery of health care within and across settings including health care institutions community based settings and the patient home and to implement such training programs developed under paragraph or otherwise eligibility to be eligible for a grant or contract under subsection an entity shall be an accredited health professions school or program an academic health center verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a public or private nonprofit entity including an area health education center or a geriatric education center or a consortium of or more entities described in paragraphs through preferences in awarding grants and contracts under this section the secretary shall give preference to entities that have a demonstrated record of at least one of the following training a high or significantly improved percentage of health professionals who serve in underserved communities broad interdisciplinary team based collaborations addressing health disparities report the secretary shall submit to the congress an annual report on the program carried out under this section definitions in this section the term health disparities has the meaning given the term in section the term interdisciplinary means collaboration across health professions and specialties which include public health nursing alliedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health dietetics or nutrition and appropriate health specialties part advisory committee on health workforce evaluation and assessment sec health workforce evaluation and assessment subpart of part of title vii usc et seq is amended by adding at the end the following sec 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 to develop and implement an integrated coordinated and strategic national health workforce policy reflective of current and evolving health workforce needs responsibilities the advisory committee shall not later than year after the date of the establishment of the advisory committee submit recommendations to the secretary on verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a classifications of the health workforce to ensure consistency of data collection on the health workforce and based on such classifications standardized methodologies and procedures to enumerate the health workforce not later than 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 the retention and expansion of the health workforce on a short and long term basis to ensure quality and adequacy of such workforce and policies to carry out the recommendations made pursuant to subparagraphs a and and not later than years after the date of the establishment of the advisory committee and every years thereafter submit updated recommendations to the secretary under paragraphs and role of agency the secretary shall provide ongoing administrative research and technical support for the operations of the advisory committee includingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih coordinating and supporting the dissemination of the recommendations of the advisory committee membership number appointment the secretary shall appoint members to serve on the advisory committee terms a in general the secretary shall appoint members of the advisory committee for a term of years and reappoint such members but the secretary not appoint any member to serve more than a total of years staggered terms notwithstanding subparagraph a of the members first appointed to the advisory committee under paragraph shall be appointed for a term of year shall be appointed for a term of years and iii shall be appointed for a term of years qualifications members of the advisory committee shall be appointed from among indi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih viduals 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 conducting and interpreting health finance and economics research delivering and administering health care services delivering and administering health workforce education and training representation in appointing members of the advisory committee the secretary shall a include no less than one representative of each of health professionals within the health workforce health care patients and consumers iii employers iv labor unions and third party health payors and ensure that verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih all areas of expertise described in paragraph are represented the members of the advisory committee include members who collectively have significant experience working with populations in urban and federally designated rural and nonmetropolitan areas and 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 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 of the ethics in government act of usc app and sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of title united states code for the purposes of disclosure and management of conflicts of interest under those sections no pay receipt of travel expenses members of the advisory committee shall not receive any pay for service on the committee but receive travel expenses including a per diem in accordance with applicable provisions of subchapter of chapter of title united states code consultation in carrying out this section the secretary shall consult with the secretary of education and the secretary of labor 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 the advisory committee on training in primary care medicine and dentistry as authorized in section a the advisory committee on interdisciplinary community based linkages as authorized in section the advisory council on graduate medical education as authorized in section and the national advisory council on nurse education and practice as authorized in section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih faca the federal advisory committee act usc app except for section 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 report the secretary shall submit to the congress an annual report on the activities of the advisory committee 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 allied health professionals mental and behavioral health professionals as defined in section and public health professionals including veterinarians engaged in public health practice part health workforce assessment sec health workforce assessment a in general section usc is amended by redesignating subsection as subsection and by striking subsections a and and inserting the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 collect data on the health workforce as defined in section disaggregated by field discipline and specialty with respect to a the supply including retention of health professionals relative to the demand for such professionals the diversity of health professionals including with respect to race ethnic background and sex and the geographic distribution of health professionals and collect such data on individuals participating in the programs authorized by subtitles a and and part of subtitle of title of division of the affordable health care for america act grants and contracts for health workforce analysis in general the secretary award grants to or enter into contracts with eligible entities to carry out subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih eligibility to be eligible for a grant or contract under this subsection an entity shall be a an accredited health professions school or program an academic health center a state local or tribal government a public or private entity or a consortium of or more entities described in subparagraphs a through 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 report the secretary shall submit to the congress an annual report on the data collected under subsection a 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 of the public health service act as added by section the secretary ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health and human services acting through the administrator of the health resources and services administration and in consultation with such advisory committee make a judgment about the classifications methodologies and procedures to be used for collection of data under section a of the public health service act as amended by this section part authorization of appropriations sec authorization of appropriations a in general section as added and amended is further amended by adding at the end the following health professions training for diversity for the purpose of carrying out sections and a 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 for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year interdisciplinary training programs advisory committee on health workforce evaluaverdatenov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion and assessment and health workforce assessment for the purpose of carrying out sections and 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 for fiscal year for fiscal year for fiscal year for fiscal year for fiscal year existing authorizations of appropriations section paragraph of section usc as redesignated is amended by striking and inserting sections and subsections a and of section are amended by striking each place it appears and inserting section subsection as so redesignated of section is amended a by striking and after fiscal year andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by inserting and such sums as be necessary for each subsequent fiscal year through the end of fiscal year before the period at the end section subsection as so redesignated of section is amended by striking and inserting title iii prevention and wellness sec prevention and wellness a in general the public health service act usc et seq is amended by inserting after title xxx the following title xxxi prevention and wellness subtitle a prevention and wellness trust sec 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 out of the general fund of the treasury amounts described in section a of the affordable health care for america act for each fiscal year andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in addition out of any monies in the public health investment fund a for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year 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 allocation of the amounts authorized to be appropriated in subsection a there are authorized to be appropriated for carrying out subtitle prevention task forces for each of fiscal years through for carrying out subtitle prevention and wellness research a for fiscal year for fiscal year for fiscal year for fiscal year andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for fiscal year for carrying out subtitle delivery of community preventive and wellness services a for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year for carrying out section core public health infrastructure for state local and tribal health departments a for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year and for carrying out section core public health infrastructure and activities for cdc for each of fiscal years through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle national prevention and wellness strategy sec 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 years thereafter a national strategy that is designed to improve the nation 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 contents the strategy under subsection a shall include each of the following 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 establishment of national priorities for prevention and wellness taking into account unmet prevention and wellness needs establishment of national priorities for research on prevention and wellness taking into ac verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih count unanswered research questions on prevention and wellness identification of health disparities in prevention and wellness review of prevention payment incentives the prevention workforce and prevention delivery system capacity a plan for addressing and implementing paragraphs through consultation in developing or revising the strategy under subsection a the secretary shall consult with the following 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 the office on women health and the substance abuse and mental health services administration as appropriate the heads of other federal departments and agencies whose programs have a significant impact upon health as determined by the secretary as appropriate nonprofit and for profit entitiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the association of state and territorial health officials and the national association of county and city health officials the task force on community preventive services and the task force on clinical preventive services subtitle prevention task forces sec 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 responsibilities the task force shall identify clinical preventive services for review review the scientific evidence related to the benefits effectiveness appropriateness and costs of clinical preventive services identified under paragraph for the purpose of developing updating publishing and disseminating evidence based recommendations on the use of such services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as appropriate take into account health disparities in developing updating publishing and disseminating evidence based recommendations on the use of such services identify gaps in clinical preventive services research and evaluation and recommend priority areas for such research and evaluation pursuant to section determine whether subsidies and rewards meet the task force standards for a grade of a or as appropriate consult with the clinical prevention stakeholders board in accordance with subsection consult with the task force on community preventive services established under section and as appropriate in carrying out this section consider the national strategy under section 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 membership verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih number appointment the task force shall be composed of members appointed by the secretary terms a in general the secretary shall appoint members of the task force for a term of years and reappoint such members but the secretary not appoint any member to serve more than a total of years staggered terms notwithstanding subparagraph a of the members first appointed to serve on the task force after the enactment of this title shall be appointed for a term of years shall be appointed for a term of years and iii shall be appointed for a term of years 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 preventionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih evaluation of research and systematic evidence reviews application of systematic evidence reviews to clinical decisionmaking or health policy clinical primary care in child and adolescent health clinical primary care in adult health including women health clinical primary care in geriatrics clinical counseling and behavioral services for primary care patients representation in appointing members of the task force the secretary shall ensure that a all areas of expertise described in paragraph are represented and the members of the task force include individuals with expertise in health disparities subgroups as appropriate to maximize efficiency the task force delegate authority for conducting reviews and making recommendations to subgroups consisting of task force members subject to final approval by the task forceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih clinical prevention stakeholders board 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 membership the members of the clinical prevention stakeholders board shall include representatives of the following a health care consumers and patient groups providers of clinical preventive services including community based providers federal departments and agencies including 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 the national center on minorityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health and health disparities and the office on women health and as appropriate other federal departments and agencies whose programs have a significant impact upon health as determined by the secretary private health care payors responsibilities in accordance with subsection the clinical prevention stakeholders board shall a recommend clinical preventive services for review by the task force suggest scientific evidence for consideration by the task force related to reviews undertaken by the task force provide feedback regarding draft recommendations by the task force and assist with efforts regarding dissemination of recommendations by the director of the agency for healthcare research and quality 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 taskverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih force or the clinical prevention stakeholders board except members of the task force or the clinical prevention stakeholders board shall be considered to be special government employees within the meaning of section of the ethics in government act of usc app and section of title united states code for the purposes of disclosure and management of conflicts of interest under those sections 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 receive travel expenses including a per diem in accordance with applicable provisions of subchapter of chapter of title united states code application of faca the federal advisory committee act usc app except for section 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 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec 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 responsibilities the task force shall identify community preventive services for review review the scientific evidence related to the benefits effectiveness appropriateness and costs of community preventive services identified under paragraph for the purpose of developing updating publishing and disseminating evidence based recommendations on the use of such services as appropriate take into account health disparities in developing updating publishing and disseminating evidence based recommendations on the use of such services identify gaps in community preventive services research and evaluation and recommend priority areas for such research and evaluation pursuant to section determine whether subsidies and rewards are effective verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as appropriate consult with the community prevention stakeholders board in accordance with subsection consult with the task force on clinical preventive services established under section and as appropriate in carrying out this section consider the national strategy under section 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 membership number appointment the task force shall be composed of members appointed by the secretary terms a in general the secretary shall appoint members of the task force for a term of years and reappoint such members but the secretary not appoint any member to serve more than a total of yearsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih staggered terms notwithstanding subparagraph a of the members first appointed to serve on the task force after the enactment of this section shall be appointed for a term of years shall be appointed for a term of years and iii shall be appointed for a term of years 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 evaluation of research and systematic evidence reviews disciplines relevant to community preventive services including health promotion disease prevention chronic disease worksite health school site health qualitative and quantitative analysis and health economics policy law and statistics representation in appointing members of the task force the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a shall ensure that all areas of expertise described in paragraph are represented shall ensure that such members include sufficient representatives of each of state health officers local health officers iii health care practitioners and iv public health practitioners and shall appoint individuals who have expertise in health disparities subgroups as appropriate to maximize efficiency the task force delegate authority for conducting reviews and making recommendations to subgroups consisting of task force members subject to final approval by the task force community prevention stakeholders board 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 servicesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih membership the members of the community prevention stakeholders board shall include representatives of the following a health care consumers and patient groups providers of community preventive services including community based providers federal departments and agencies including 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 the national center on minority health and health disparities and the office on women health and as appropriate other federal departments and agencies whose programs have a significant impact upon health as determined by the secretary private health care payors responsibilities in accordance with subsection the community prevention stakeholders board shall verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a recommend community preventive services for review by the task force suggest scientific evidence for consideration by the task force related to reviews undertaken by the task force provide feedback regarding draft recommendations by the task force and assist with efforts regarding dissemination of recommendations by the director of the centers for disease control and prevention 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 or the community prevention stakeholders board except members of the task force or the community prevention stakeholders board shall be considered to be special government employees within the meaning of section of the ethics in government act of usc app and section of title united states code for the purposes of disclosure and management of conflicts of interest under those sections no pay receipt of travel expenses members of the task force or the community prevention stakeholders board shall not receive any pay for serviceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih on the task force but receive travel expenses including a per diem in accordance with applicable provisions of subchapter of chapter of title united states code application of faca the federal advisory committee act usc app except for section 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 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 subtitle prevention and wellness research sec 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 and the recommendations of the task force on clinical pre verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ventive services under section and the task force on community preventive services under section sec 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 or by the task force on community preventive services as required by section eligibility to be eligible for a grant under this section an entity shall be a state local or tribal department of health a public or private nonprofit entity or a consortium of or more entities described in paragraphs and report the secretary shall submit to the congress an annual report on the program of research under this section sec research on subsidies and rewards to encourage wellness and healthy behaviors a research and demonstration projects verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general the secretary shall conduct or award grants to public or nonprofit private entities to conduct research and demonstration projects on the use of financial and in kind subsidies and rewards to encourage individuals and communities to promote wellness adopt healthy behaviors and use evidence based preventive health services focus research and demonstration projects under paragraph shall focus on a tobacco use obesity and other prevention and wellness priorities identified by the secretary in the national strategy under section the initiation maintenance and longterm sustainability of wellness promotion adoption of healthy behaviors and use of evidencebased preventive health services and populations at high risk of preventable diseases and conditions findings report submission of findings the secretary shall submit the findings of research and demonstration projects under subsection a to a the task force on clinical preventive services established under section or theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih task force on community preventive services established under section as appropriate and the health benefits advisory committee established by section of the affordable health care for america act report to congress not later than months after the initiation of research and demonstration projects under subsection a the secretary shall submit a report to the congress on the progress of such research and projects including any preliminary findings inclusion in essential benefits package if on the basis of the findings of research and demonstration projects under subsection a or other sources consistent with section the task force on clinical preventive services determines that a subsidy or reward meets the task force standards for a grade a or the secretary shall ensure that the subsidy or reward is included in the essential benefits package under section inclusion as allowable use of community prevention and wellness services grants if on the basis of the findings of research and demonstration projects under subsection a or other sources consistentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih with section the task force on community preventive services determines that a subsidy or reward is effective the secretary shall ensure that the subsidy or reward becomes an allowable use of grant funds under section nondiscrimination no tie to premium or cost sharing in carrying out this section the secretary shall ensure that any subsidy or reward does not have a discriminatory effect on the basis of any personal characteristic extraneous to the provision of high quality health care or related services and is not tied to the premium or cost sharing of an individual under any qualified health benefits plan as defined in section subtitle delivery of community prevention and wellness services sec 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 prevention and wellness services consisting of awarding grants to eligible entities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to provide evidence based community prevention and wellness services in priority areas identified by the secretary in the national strategy under section or to plan such services eligibility definition to be eligible for a grant under this section an entity shall be a a state local or tribal department of health a public or private entity or a consortium that consists of or more entities described in subparagraph a or and be a community partnership representing a health empowerment zone health empowerment zone in this subsection the term health empowerment zone means an area a in which multiple community prevention 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 andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih which is represented by a community partnership that demonstrates community support and coordination with state local or tribal health departments and includes a broad cross section of stakeholders residents of the community and iii representatives of entities that have a history of working within and serving the community preferences in awarding grants under this section the secretary shall give preference to entities that will address one or more goals or objectives identified by the secretary in the national strategy under section will address significant health disparities including those identified by the secretary in the national strategy under section will address unmet community prevention and wellness needs and avoid duplication of effort have been demonstrated to be effective in communities comparable to the proposed target community verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih will contribute to the evidence base for community prevention and wellness services demonstrate that the community prevention and wellness services to be funded will be sustainable and demonstrate coordination or collaboration across governmental and nongovernmental partners health disparities of the funds awarded under this section for a fiscal year the secretary shall award not less than percent for planning or implementing community prevention 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 emphasis on recommended services for fiscal year 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 or deemed effective based on a review of comparable rigor as determined by the director of the centers for disease control and prevention verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih prohibited uses of funds an entity that receives a grant under this section not use funds provided through the grant to build or acquire real property or for construction or 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 under any federal or state health benefits program including titles xix and xxi of the social security act or by an entity which provides health services on a prepaid basis report the secretary shall submit to the congress an annual report on the program of grants awarded under this section 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 preventionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subtitle core public health infrastructure sec 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 grants award for the purpose of addressing core public health infrastructure needs the secretary a shall award a grant to each state health department and award grants on a competitive basis to state local or tribal health departments allocation of the total amount of funds awarded as grants under this subsection for a fiscal year a not less than percent shall be for grants to state health departments under paragraph a andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not less than percent shall be for grants to state local or tribal health departments under paragraph use of funds the secretary award a grant to an entity under subsection 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 formula grants to state health departments in making grants under subsection a the secretary shall award funds to each state health department in accordance with 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 and 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 health department will a address its highest priority core public health infrastructure needs andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih as appropriate allocate funds to local health departments within the state competitive grants to state local and tribal health departments in making grants under subsection the secretary shall give priority to applicants demonstrating core public health infrastructure needs identified in the accreditation process under subsection maintenance of effort the secretary award a grant to an entity under subsection only if the entity 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 entity for the purpose of addressing core public health infrastructure needs and 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 grantverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih establishment of a public health accreditation program 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 implement a program to accredit such health departments and laboratories in accordance with such standards cooperative agreement the secretary enter into a cooperative agreement with a private nonprofit entity to carry out paragraph report the secretary shall submit to the congress an annual report on progress being made to accredit entities under subsection including a strategy including goals and objectives for accrediting entities under subsection and achieving the purpose described in subsection andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih identification of gaps in research related to core public health infrastructure and recommendations of priority areas for such research sec 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 report the secretary shall submit to the congress an annual report on the activities funded through this section subtitle general provisions sec definitions in this title 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 activitiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the terms department and departmental refer to the department of health and human services 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 be delineated by race ethnicity primary language sex sexual orientation gender identity disability socioeconomic status or rural urban or other geographic setting and any other population or subpopulation determined by the secretary to experience significant gaps in disease health outcomes or access to health care the term tribal refers to an indian tribe a tribal organization or an urban indian organization as such terms are defined in section of the indian health care improvement act transition provisions applicable to task forces functions personnel assets liabilities and administrative actions all functions personnel assets and liabilities of and administrative actions applicable to the preventiveverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih services task force convened under section 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 and of the public health service act as added by subsection a 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 and of the public health service act as added by subsection a members already serving a initial members the secretary of health and human services select those individuals already serving on the preventive services task force and the task force onverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 and of the public health service act as added by subsection a calculation of total service in calculating the total years of service of a member of a task force for purposes of section a or 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 period before completion of national strategy pending completion of the national strategy under section of the public health service act as added by subsection a the secretary of health and human services acting through the relevant agency head make a judgment about how the strategy will addressverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an issue and rely on such judgment in carrying out any provision of subtitle or of title xxxi of such act as added by subsection a that requires the secretary to take into consideration such strategy to conduct or support research or provide services in priority areas identified in such strategy or to take any other action in reliance on such strategy conforming amendments paragraph of section of the indian health care improvement act usc is amended by striking united states preventive services task force and inserting task force on clinical preventive services section of the medicare medicaid and schip benefits improvement and protection act of appendix of public law – is amended by striking united states preventive services task force each place it appears and inserting task force on clinical preventive services paragraph of section a of the public health service act usc b– a isverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amended by striking united states preventive services task force and inserting task force on clinical preventive services section of the public health service act usc b– is amended by striking subsection a subsections aa iii xx and ddd of section of the social security act usc 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 implementation of best practices in the delivery of health care a in general title ix of the public health service act usc et seq is amended by redesignating part as part by redesignating sections through as sections through respectively in section as redesignated by striking and inserting and by inserting after part the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih part implementation of best practices in the delivery of health care sec 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 prioritization 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 considerations in prioritizing areas under paragraph the director shall consider a the priorities established under section of the social security act and the key health indicators identified by the assistant secretary for health information under section limitations in conducting its duties under this subsection the center for quality improvement shall not develop quality adjusted life year measures or any other methodologies that can be used to deny benefits to a beneficiary against theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih beneficiary wishes on the basis of the beneficiary age life expectancy present or predicted disability or expected quality of life other responsibilities the director acting directly or by awarding a grant or contract to an eligible entity shall identify existing best practices under subsection develop new best practices under subsection evaluate best practices under subsection implement best practices under subsection ensure that best practices are identified developed evaluated and implemented under this section consistent with standards adopted by the secretary under section 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 and respectively of the social security act andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provide for dissemination of information and reporting under subsections and eligibility to be eligible for a grant or contract under subsection an entity shall be a nonprofit entity agree to work with a variety of institutional health care providers physicians nurses and other health care practitioners and if the entity is not the organization holding a contract under section of the social security act for the area to be served agree to cooperate with and avoid duplication of the activities of such organization identifying existing best practices the director shall identify best practices that are 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 easily adapted for use by other health care providers and for use across a variety of health care settings developing new best practices the director shall develop best practices that are verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih based on a review of existing scientific evidence sufficiently detailed for implementation and incorporation into the workflow of health care providers and designed to be easily adapted for use by health care providers across a variety of health care settings evaluation of best practices the director shall evaluate best practices identified or developed under this section such evaluation shall include determinations of which best practices a most reliably and effectively achieve significant progress in improving the quality of patient care and are easily adapted for use by health care providers across a variety of health care settings shall include regular review updating and improvement of such best practices and 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 enti verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ties and simulations of such best practices for determinations under paragraph implementation of best practices in general the director shall enter into arrangements with entities in a state or region to implement best practices identified or developed under this section such implementation a include forming collaborative multi institutional teams and 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 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 are the most easily adapted for use by health care providers across a variety of health care settings promote coordination of health care practitioners across the continuum of care andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih engage patients and their families in improving patient care and outcomes 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 report in general the director shall submit an annual report to the congress and the secretary on activities under this section content each report under paragraph shall include a information on activities conducted pursuant to grants and contracts awarded summary data on patient outcomes before during and after implementation of best practices and recommendations on the adaptability of best practices for use by health providers initial quality improvement activities and initiatives to be implemented until the director of the agency for healthcare research and quality hasverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih established initial priorities under section of the public health service act as added by subsection a the director shall for purposes of such section prioritize the following health care associated infections reducing health care associated infections including infections in nursing homes and outpatient settings 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 emergency room improving care in hospital emergency rooms including through the use of principles of efficiency of design and delivery to improve patient flow 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 pediatrics improving the provision of preventive and developmental child health services including interventions that can reduce child health disparities as defined in section of the publicverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health service act as added by section and reduce the risk of developing chronic health threatening conditions that affect an individual life course development report not later than months after the date of the enactment of this act the director of the agency for healthcare research and quality shall submit a report to the congress on the impact of the nurse topatient ratio on the quality of care and patient outcomes including recommendations for further integration into quality measurement and quality improvement activities sec assistant secretary for health information a establishment title xvii usc et seq is amended by redesignating sections and as sections and respectively and by inserting after section the following sec 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 secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih responsibilities the assistant secretary shall ensure the collection collation reporting and publishing of information including full and complete statistics on key health indicators regarding the nation health and the performance of the nation health care facilitate and coordinate the collection collation reporting and publishing of information regarding the nation health and the performance of the nation health care other than information described in paragraph a develop standards for the collection of data regarding the nation health and the performance of the nation health care and in carrying out subparagraph a ensure appropriate specificity and standardization for data collection at the national regional state and local levels include standards as appropriate for the collection of accurate data on health disparities iii ensure with respect to data on race and ethnicity consistency with the office of management and budget standards forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 primary language 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 and ensure the sharing of information described in paragraphs and among the agencies of the department facilitate the sharing of information described in paragraphs and by federal departments and agencies whose programs have a significant impact upon health as determined by the secretary identify gaps in information described in paragraphs and and the appropriate agency or entity to address such gaps verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih facilitate and coordinate identification and monitoring of health disparities by the agencies of the department 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 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 award grants or contracts for the collection and collation of information described in paragraphs and including through statewide surveys that provide standardized information key health indicators in general in carrying out subsection the assistant secretary shall a identify and reassess at least once every years key health indicators described in such subsection publish statistics on such key health indicators for the public verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not less than annually and on a supplemental basis whenever warranted by the rate of change for a key health indicator or the need to inform policy regarding the nation health and the performance of the nation health care and ensure consistency with the national strategy developed by the secretary under section and consideration of the indicators specified in the reports under sections a and 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 statisticsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih coordination in carrying out this section the assistant secretary shall coordinate with public and private entities that collect and disseminate information on health and health care including foundations and the head of the office of the national coordinator for health information technology to ensure optimal use of health information technology request for information from departments and agencies consistent with applicable law the assistant secretary secure directly from any federal department or agency information necessary to enable the assistant secretary to carry out this section report 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 a description of gaps in the collection collation reporting and publishing of information regarding the nation health and the performance of the nation health care verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih recommendations for addressing such gaps and identification of the appropriate agency within the department or other entity to address such gaps 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 a plan for actions to be taken by the assistant secretary to address gaps described in subparagraph consideration in preparing a report under paragraph the assistant secretary shall take into consideration the findings and conclusions in the reports under sections a and proprietary and privacy protections nothing in this section shall be construed to affect applicable proprietary or privacy protections consultation in carrying out this section the assistant secretary shall consult with the heads of appropriate health agencies and offices in the department including the office of the surgeon general of the public health service verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the office of minority health and the office on women health and as appropriate the heads of other federal departments and agencies whose programs have a significant impact upon health as determined by the secretary definition in this section the terms agency and agencies include an epidemiology center established under section of the indian health care improvement act the term department means the department of health and human services the term health disparities has the meaning given to such term in section other coordination responsibilities title iii usc et seq is amended in paragraphs and of section usc by inserting acting through the assistant secretary for health information after the secretary each place it appears and in section usc by inserting acting through the assistant secretary for health information after of this section the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec authorization of appropriations section as added and amended is further amended by adding at the end the following quality and surveillance for the purpose of carrying out part of title ix and 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 for each of fiscal years through title other provisions subtitle a drug discount for rural and other hospitals program integrity sec expanded participation in program a expansion of covered entities receiving discounted prices section a usc a is amended by adding at the end the following a children hospital excluded from the medicare prospective payment system pursuant to section iii of the social security act or a free standing cancer hospital excluded from the medicare prospective payment system pursuant to section of the social security actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that would meet the requirements of subparagraph including the disproportionate share adjustment percentage requirement under clause of such subparagraph if the hospital were a subsection hospital as defined by section of the social security act an entity that is a critical access hospital as determined under section of the social security act an entity receiving funds under title of the social security act relating to maternal and child health for the provision of health services an entity receiving funds under subpart of part of title xix of the public health service act relating to comprehensive mental health services for the provision of community mental health services an entity receiving funds under subpart of such part relating to the prevention and treatment of substance abuse for the provision of treatment services for substance abuseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an entity that is a medicare dependent small rural hospital as defined in section iv of the social security act an entity that is a sole community hospital as defined in section d iii of the social security act an entity that is classified as a rural referral center under section of the social security act prohibition on group purchasing arrangements section a usc a is amended in paragraph a by adding and at the end of clause by striking and at the end of clause and inserting a period and by striking clause iii and in paragraph by redesignating subparagraphs and as subparagraphs and respectively and by inserting after subparagraph the following prohibiting use of group purchasing arrangements a hospital described in subparagraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or of paragraph shall not obtain covered outpatient drugs through a group purchasing organization or other group purchasing arrangement sec improvements to program integrity a integrity improvements section usc is amended by striking subsections and and by inserting after subsection the following improvements in program integrity manufacturer compliance a in general from amounts appropriated under paragraph the secretary shall provide for improvements in compliance by manufacturers with the requirements of this section in order to prevent overcharges and other violations of the discounted pricing requirements specified in this section improvements the improvements described in subparagraph a shall include the following the establishment of a process to enable the secretary to verify the accuracy of ceiling prices calculated by manufactur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ers under subsection a and charged to covered entities which shall include the following developing and publishing through an appropriate policy or regulatory issuance standards and methodology for the calculation of ceiling prices under such subsection comparing regularly the ceiling prices calculated by the secretary with the quarterly pricing data that is reported by manufacturers to the secretary iii conducting periodic monitoring of sales transactions to covered entities iv inquiring into any discrepancies between ceiling prices and manufacturer pricing data that be identified and taking or requiring manufacturers to take corrective action in response to such discrepancies including the issuance of refunds pursuant to the procedures set forth in clause verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the establishment of procedures for the issuance of refunds to covered entities by manufacturers in the event that the secretary finds there has been an overcharge including the following submission to the secretary by manufacturers of an explanation of why and how the overcharge occurred how the refunds will be calculated and to whom the refunds will be issued oversight by the secretary to ensure that the refunds are issued accurately and within a reasonable period of time iii notwithstanding any other provision of law prohibiting the disclosure of ceiling prices or data used to calculate the ceiling price the provision of access to covered entities and state medicaid agencies through an internet website of the department of health and human services or contractor to the applicable ceiling prices for covered drugs as calculated and verified by the secretary in a manner that ensuresverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih protection of privileged pricing data from unauthorized disclosure iv the development of a mechanism by which rebates discounts or other price concessions provided by manufacturers to other purchasers subsequent to the sale of covered drugs to covered entities are reported to the secretary and appropriate credits and refunds are issued to covered entities if such rebates discounts or other price concessions have the effect of lowering the applicable ceiling price for the relevant quarter for the drugs involved in addition to authorities under section of the social security act the secretary conduct audits of manufacturers and wholesalers to ensure the integrity of the program under this section including audits on the market price of covered drugs vi the establishment of a requirement that manufacturers and wholesalersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih use the identification system developed by the secretary for purposes of facilitating the ordering purchasing and delivery of covered drugs under this section including the processing of chargebacks for such drugs vii the imposition of sanctions in the form of civil monetary penalties which shall be assessed according to standards and procedures established in regulations to be promulgated by the secretary within one year of the date of the enactment of the affordable health care for america act and shall apply to any manufacturer with an agreement under this section and shall not exceed for each instance where a manufacturer knowingly charges a covered entity a price for purchase of a drug that exceeds the maximum applicable price under subsection a or that knowingly violates any other provisionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of this section or withholds or provides false information to the secretary or to covered entities under this section covered entity compliance a in general from amounts appropriated under paragraph the secretary shall provide for improvements in compliance by covered entities with the requirements of this section in order to prevent diversion and violations of the duplicate discount provision and other requirements under subsection a improvements the improvements described in subparagraph a shall include the following the development of procedures to enable and require covered entities to update at least annually the information on the internet web site of the department of health and human services relating to this section the development of procedures for the secretary to verify the accuracy of information regarding covered entities thatverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is listed on the web site described in clause iii the development of more detailed guidance describing methodologies and options available to covered entities for billing covered drugs to state medicaid agencies in a manner that avoids duplicate discounts pursuant to subsection a a iv the establishment of a single universal and standardized identification system by which each covered entity site can be identified by manufacturers distributors covered entities and the secretary for purposes of facilitating the ordering purchasing and delivery of covered drugs under this section including the processing of chargebacks for such drugs the imposition of sanctions in the form of civil monetary penalties which shall be assessed according to standards and procedures established in regulations promulgated by the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall not exceed for each violation and iii shall apply to any covered entity that knowingly violates subparagraph a or knowingly violates any other provision of this section vi the exclusion of a covered entity from participation in the program under this section for a period of time to be determined by the secretary in cases in which the secretary determines in accordance with standards and procedures established in regulations that a violation of a requirement of this section was repeated and knowing and imposition of a monetary penalty would be insufficient to reasonably ensure compliance vii the referral of matters as appropriate to the food and drug administration the office of inspector general of department of health and human services or other federal agenciesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih administrative dispute resolution process from amounts appropriated under paragraph the secretary establish and implement an administrative process for the resolution of the following a claims by covered entities that manufacturers have violated the terms of their agreement with the secretary under subsection a claims by manufacturers that covered entities have violated subsection a a or a authorization of appropriations there are authorized to be appropriated to carry out this subsection such sums as be necessary for fiscal year and each succeeding fiscal year conforming amendments section a usc a is amended a by adding at the end of paragraph the following such agreement shall require that the manufacturer offer each covered entity covered drugs for purchase at or below the applicable ceiling price if such drug is made available to any other purchaser at any price suchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agreement shall require that if the supply of a covered drug is insufficient to meet demand then the manufacturer utilize an allocation method that is reported in writing to the secretary and does not discriminate on the basis of the price paid by covered entities or on any other basis related to an entity participation in the program under this section notwithstanding any other provision of law if the secretary requests a manufacturer to enter into a new or amended agreement under this section that complies with current law and if the manufacturer opts not to sign the new or amended agreement then any existing agreement between the manufacturer and the secretary under this section is deemed to no longer meet the requirements of this section for purposes of this section and section of the social security act and by adding at the end the following paragraph quarterly reports an agreement described in paragraph shall require that the manufacturer furnish the secretary with reports onverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a quarterly basis that include the following information a the price for each covered drug subject to the agreement that according to the manufacturer represents the maximum price that covered entities permissibly be required to pay for the drug referred to in this section as the ceiling price the component information used to calculate the ceiling price as determined necessary to administer the requirements of the program under this section rebates discounts and other price concessions provided by manufacturers to other purchasers subsequent to the sale of covered drugs to covered entities section a of the social security act usc r– a is amended by striking subparagraph sec effective date a in general the amendments made by this subtitle shall take effect on the date of the enactment of this act and sections a and shall apply to drugs dispensed on or after such dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 a of the public health service act usc a and of section a of the social security act usc r– a notwithstanding any other provision of law subtitle programs part grants for clinics and centers sec school based health clinics a in general part of title iii usc et seq is amended by adding at the end the following sec z– 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 eligibility to be eligible for a grant under this section an entity shall be an sbhc as defined in subsection and submit an application at such time in such manner and containing such information asverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary require including at a minimum a evidence that the applicant meets all criteria necessary to be designated as an sbhc evidence of local need for the services to be provided by the sbhc an assurance that sbhc services will be provided in accordance with federal state and local laws 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 onsite 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 per verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sonnel and other community providers colocated at the school and the sbhc sponsoring facility assumes all responsibility for the sbhc administration operations and oversight and such other information as the secretary require use of funds funds awarded under a grant under this section be used for a providing training related to the provision of comprehensive primary health services and additional health services the management and operation of sbhc programs including through subcontracts and the payment of salaries for health professionals and other appropriate sbhc personnel and not be used to provide abortions consideration of need in determining the amount of a grant under this section the secretary shall take into consideration the financial need of the sbhc verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih state local or other sources of funding provided to the sbhc and other factors as determined appropriate by the secretary preferences in awarding grants under this section the secretary shall give preference to sbhcs that have a demonstrated record of service to at least one of the following a high percentage of medically underserved children and adolescents communities or populations in which children and adolescents have difficulty accessing health and mental health services 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 matching requirement the secretary award a grant to an sbhc under this section only if the sbhc agrees to provide from non federal sources an amount equal to percent of the amount of the grant which be provided in cash or in kind to carry out the activities supported by the grantverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih supplement not supplant the secretary 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 or of subsection payor of last resort the secretary 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 under any insurance policy under any federal or state health benefits program including titles xix and xxi of the social security act or by an entity which provides health services on a prepaid basis 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 includingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih reimbursement under any insurance policy or any federal or state health benefits program including titles xix and xxi of the social security act 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 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 evaluation report the secretary shall develop and implement a plan for evaluating sbhcs and monitoring quality performances under the awards made under this section and submit to the congress on an annual basis a report on the program under this section definitions in this section comprehensive primary health services the term comprehensive primary health services means the core services offered by sbhcs which verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a shall include comprehensive health assessments diagnosis and treatment of minor acute and chronic medical conditions and referrals to and followup for specialty care and 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 and include additional services such as oral health social and age appropriate health education services including nutritional counseling 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 adolescentsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 is organized through school community and health provider relationships is administered by a sponsoring facility provides 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 and does not perform abortion services sponsoring facility the term sponsoring facility is a a hospital a public health department a community health center a nonprofit health care entity whose mission is to provide access to comprehensive primary health care services a local educational agency orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 of the indian health care improvement act authorization of appropriations for purposes of carrying out this section there are authorized to be appropriated for fiscal year and such sums as be necessary for each of fiscal years through effective date the secretary of health and human services shall begin awarding grants under section z– of the public health service act as added by subsection a not later than july without regard to whether or not final regulations have been issued under section z– of such act termination of study section of the health care safety net act of usc note is amended by striking paragraph relating to a school based health center study verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec nurse managed health centers title iii usc et seq is amended by adding at the end the following part nurse managed health centers sec ff nurse managed health centers a program the secretary acting through the administrator of the health resources and services administration shall establish a nurse managed health center program consisting of awarding grants to entities under subsection grant the secretary shall award grants to entities to plan and develop a nurse managed health center or to operate a nurse managed health center use of funds amounts received as a grant under subsection be used for activities including the following purchasing or leasing equipment training and technical assistance related to the provision of comprehensive primary care services and wellness services other activities for planning developing or operating as applicable a nurse managed health centerverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih assurances applicable to both planning and operation grants in general the secretary award a grant under this section to an entity only if the entity demonstrates to the secretary satisfaction that a nurses in addition to managing the center will be adequately represented as providers at the center and not later than days after receiving the grant the entity will establish a community advisory committee composed of individuals a majority of whom are being served by the center to provide input into the nurse managed health center operations matching requirement the secretary award a grant under this section to an entity only if the entity agrees to provide from non federal sources an amount equal to percent of the amount of the grant which be provided in cash or in kind to carry out the activities supported by the grant payor of last resort the secretary award a grant under this section to an entity only if the entity demonstrates to the satisfaction ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 a under any insurance policy under any federal or state health benefits program including titles xix and xxi of the social security act or by an entity which provides health services on a prepaid basis maintenance of effort the secretary award a grant under this section to an entity only if the entity demonstrates to the satisfaction of the secretary that a 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 activities to be funded through the grant and with respect to such activities the entity will maintain expenditures of non federal amounts for such activities at a level not less than the lesser of such expenditures maintained by the entity for the fiscal year preceding theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fiscal year for which the entity receives the grant additional assurance for planning grants the secretary award a grant under subsection to an entity only if the entity agrees to assess the needs of the medically underserved populations proposed to be served by the nurse managed health center and to design services and operations of the nurse managed health center for such populations based on such assessment additional assurance for operation grants the secretary award a grant under subsection to an entity only if the entity assures that the nurse managed health center will provide comprehensive primary care services wellness services and other health care services deemed appropriate by the secretary care without respect to insurance status or income of the patient and direct access to client centered services offered by advanced practice nurses other nurses physicians physician assistants or other qualified health professionalsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih technical assistance the secretary shall provide either directly or by grant or contract technical and other assistance to nurse managed health centers to assist such centers in meeting the requirements of this section such assistance include fiscal and program management assistance training in fiscal and program management operational and administrative support and the provision of information to nurse managed health centers regarding the various resources available under this section and how those resources can best be used to meet the health needs of the communities served by nurse managed health centers report the secretary shall submit to the congress an annual report on the program under this section definitions in this section comprehensive primary care services the term comprehensive primary care services has the meaning given to the term required primary health services in section medically underserved population the term medically underserved population has the meaning given to such term in section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nurse managed health center the term nurse managed health center has the meaning given to such term in section wellness services the term wellness services means any health related service or intervention not including primary care which is designed to reduce identifiable health risks and increase healthy behaviors intended to prevent the onset of disease or lessen the impact of existing chronic conditions by teaching more effective management techniques that focus on individual self care and patient driven decisionmaking authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through sec federally qualified behavioral health centers section usc x– is amended in subsection a a by striking community mental health services and inserting behavioral health services of the type offered by federally qualified behavioral health centers consistent with subsection in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by striking paragraph and inserting the following services under the plan will be provided only through appropriate qualified community programs which include federally qualified behavioral health centers child mental health programs psychosocial rehabilitation programs mental health peer support programs and mental health primary consumer directed programs and and in paragraph by striking community mental health centers and inserting federally qualified behavioral health centers and by striking subsection and inserting the following criteria for federally qualified behavioral health centers in general the administrator shall certify and recertify at least every years federally qualified behavioral health centers as meeting the criteria specified in this subsection regulations not later than months after the date of the enactment of the affordable health care for america act the administrator shall issue final regulations for certifying centers under paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih criteria the criteria referred to in subsection are that the center performs each of the following a provide services in locations that ensure services will be available and accessible promptly and in a manner which preserves human dignity and assures continuity of care provide services in a mode of service delivery appropriate for the target population provide individuals with a choice of service options where there is more than one efficacious treatment employ a core staff of clinical staff that is multidisciplinary and culturally and linguistically competent provide services within the limits of the capacities of the center to any individual residing or employed in the service area of the center provide directly or through contract to the extent covered for adults in the state medicaid plan and for children in accordance with section of the social security act regarding early and periodic screening diag verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nosis and treatment each of the following services screening assessment and diagnosis including risk assessment person centered treatment planning or similar processes including risk assessment and crisis planning iii outpatient clinic mental health services including screening assessment diagnosis psychotherapy substance abuse counseling medication management and integrated treatment for mental illness and substance abuse which shall be evidencebased including cognitive behavioral therapy dialectical behavioral therapy motivational interviewing and other such therapies which are evidence based iv outpatient clinic primary care services including screening and monitoring of key health indicators and health risk including screening for diabetes hypertension and cardiovascular disease and monitoring of weight height body mass index bmi blood pressure blood glucose or hbac and lipid profile verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih crisis mental health services including hour mobile crisis teams emergency crisis intervention services and crisis stabilization vi targeted case management services to assist individuals gaining access to needed medical social educational and other services and applying for income security and other benefits to which they be entitled vii psychiatric rehabilitation services including skills training assertive community treatment family psychoeducation disability self management supported employment supported housing services therapeutic foster care services multisystemic therapy and such other evidencebased practices as the secretary require viii peer support and counselor services and family supports maintain linkages and where possible enter into formal contracts with inpatient psychiatric facilities and substance abuse detoxification and residential programsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih make available to individuals served by the center directly through contract or through linkages with other programs each of the following adult and youth peer support and counselor services family support services for families of children with serious mental disorders iii other community or regional services supports and providers including schools child welfare agencies juvenile and criminal justice agencies and facilities housing agencies and programs employers and other social services iv onsite or offsite access to primary care services enabling services including outreach transportation and translation vi health and wellness services including services for tobacco cessation verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih part other grant programs sec comprehensive programs to provide education to nurses and create a pipeline to nursing a purposes it is the purpose of this section to authorize grants to 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 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 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 grants not later than months after the date of the enactment of this act the secretary of labor re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ferred 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 eligibility to be eligible for a grant under this section an entity shall be 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 labormanagement training funds as provided for under section of the labor management relations act usc 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 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 haveverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih direct input as to the leadership of the organization 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 include representatives from local governments worker investment agency one stop career centers community based organizations community colleges and accredited schools of nursing or a school of nursing as defined in section of the public health service act usc additional requirements for health care employer described in subsection to be eligible for a grant under this section a health care employer described in subsection shall demonstrate that it has an established program within its facility to encourage the retention of existing nurses provides wages and benefits to its nurses that are competitive for its market or that have been collectively bargained with a labor organization and supports programs funded under this section through or more of the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 contributions to a joint labor management training fund which administers the program involved 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 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 the payment of tuition assistance which is managed by a joint labor management training fund or other jointly administered program other requirements matching requirement verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general the secretary 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 toward such costs in an amount equal to not less than for each of federal funds provided in the grant such contributions be made directly or through donations from public or private entities or be provided through the cash equivalent of paid release time provided to incumbent worker students determination of amount of nonfederal contribution non federal contributions required in subparagraph a 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 not be included in determining the amount of such non federal contributionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 include community colleges and other academic institutions providing associate bachelor or advanced nursing degree programs or specialty training or certification programs use of funds amounts awarded to an entity under a grant under this section shall be used for the following 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 secondlanguage education ged education precollege counseling college preparation classes and support with entry level college classes that are a prerequisite to nursingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih providing tuition assistance with preference for dedicated cohort classes in community colleges universities and accredited schools of nursing with supportive services including tutoring and counseling providing assistance in preparing for and meeting all nursing licensure tests and requirements 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 providing stipends for release time and continued health care coverage to enable incumbent health care workers to participate in these programs 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 verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih 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 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 collaboration with accredited schools of nursing which include community colleges and other academic institutions providing associate bachelor 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 preference in awarding grants under this section the secretary shall give preference to programs that provide for improving nurse retention provide for improving the diversity of the new nurse graduates to reflect changes in the demographics of the patient population verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provide for improving the quality of nursing education to improve patient care and safety 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 are modeled after or affiliated with such programs described in paragraph evaluation 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 include a an increased number of incumbent workers entering an accredited school of nursing and in the pipeline for nursing programs an increasing number of graduating nurses and improved nurse graduation and licensure rates improved nurse retention an increase in the number of staff nurses at the health care facility involved verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an increase in the number of nurses with advanced degrees in nursing an increase in the number of nurse faculty improved measures of patient quality which include staffing ratios of nurses patient satisfaction rates and patient safety measures and an increase in the diversity of new nurse graduates relative to the patient population general report not later than 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 submit to the congress a report concerning the overall effectiveness of the grant program carried out under this section authorization of appropriations there are authorized to be appropriated to carry out this section such sums as be necessary for each of fiscal years through sec mental and behavioral health training part of title vii usc et seq is amended by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih subpart mental and behavioral health training sec mental and behavioral health training program a program the secretary acting through the administrator of the health resources and services administration and in consultation with the administrator of the substance abuse and mental health services administration shall establish an interdisciplinary mental and behavioral health training program consisting of awarding grants and contracts under subsection support and development of mental and behavioral health training programs the secretary shall make grants to or enter into contracts with eligible entities to plan develop operate or participate in an accredited professional training program for mental and behavioral health professionals to promote a interdisciplinary training and coordination of the delivery of health care within and across settings including health care institutions community based settings and the patient home to provide financial assistance to mental and behavioral health professionals who are participants in any such program and who plan to work in the field of mental and behavioral health verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to plan develop operate or participate in an accredited program for the training of mental and behavioral health professionals who plan to teach in the field of mental and behavioral health and to provide financial assistance in the form of traineeships and fellowships to mental and behavioral health professionals who are participants in any such program and who plan to teach in the field of mental and behavioral health eligibility to be eligible for a grant or contract under subsection an entity shall be an accredited health professions school including an accredited school or program of psychology psychiatry social work marriage and family therapy professional mental health or substance abuse counseling or addiction medicine an accredited public or nonprofit private hospital a public or private nonprofit entity or a consortium of or more entities described in paragraphs through preference in awarding grants or contracts under this section the secretary shall give preference toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih entities that have a demonstrated record of at least one of the following training a high or significantly improved percentage of health professionals who serve in underserved communities supporting teaching programs that address the health care needs of vulnerable populations training individuals who are from disadvantaged backgrounds including racial and ethnic minorities underrepresented among mental and behavioral health professionals training individuals who serve geriatric populations with an emphasis on underserved elderly training individuals who serve pediatric populations with an emphasis on underserved children report the secretary shall submit to the congress an annual report on the program under this section definition in this section the term interdisciplinary means collaboration across health professions specialties and subspecialties which include public health nursing verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih allied health dietetics or nutrition and appropriate health specialties the term mental and behavioral health professional means an individual training or practicing a in psychology general geriatric child or adolescent psychiatry social work marriage and family therapy professional mental health or substance abuse counseling or addiction medicine or another mental and behavioral health specialty as deemed appropriate by the secretary authorization of appropriations to carry out this section there is authorized to be appropriated for each of fiscal years through of the amounts appropriated to carry out this section for a fiscal year not less than percent shall be used for training programs in psychology sec reauthorization of telehealth and telemedicine grant programs a telehealth network and telehealth resource centers grant programs section usc c– is amended in subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by striking paragraph relating to frontier communities and by inserting after paragraph the following health disparities the term health disparities has the meaning given such term in section in subsection a in subparagraph by striking and at the end in subparagraph by striking the period at the end and inserting and and by adding at the end the following reduce health disparities in subsection iii a in subclause vii by inserting including skilled nursing facilities before the period at the end in subclause ix by inserting including county mental health and public mental health facilities before the period at the end and by adding at the end the following xiii renal dialysis facilities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by amending subsection to read as follows preferences telehealth networks in awarding grants under subsection for projects involving telehealth networks the secretary shall give preference to eligible entities meeting at least one of the following a network the eligible entity is a health care provider in or proposing to form a health care network that furnishes services in a medically underserved area or a health professional shortage area broad geographic coverage the eligible entity demonstrates broad geographic coverage in the rural or medically underserved areas of the state or states in which the entity is located health disparities the eligible entity demonstrates how the project to be funded through the grant will address health disparities linkages the eligible entity agrees to use the grant to establish or develop plans for telehealth systems that will link ruralverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih hospitals and rural health care providers to other hospitals health care providers and patients efficiency the eligible entity agrees to use the grant to promote greater efficiency in the use of health care resources viability the eligible entity demonstrates the long term viability of projects through availability of non federal funding sources or institutional and community support for the telehealth network services the eligible entity provides a plan for coordinating system use by eligible entities and prioritizes use of grant funds for health care services over nonclinical uses telehealth resource centers in awarding grants under subsection for projects involving telehealth resource centers the secretary shall give preference to eligible entities meeting at least one of the following a provision of a broad range of services the eligible entity has a record of success in the provision of a broad range ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih telehealth services to medically underserved areas or populations provision of telehealth technical assistance the eligible entity has a record of success in the provision of technical assistance to providers serving medically underserved communities or populations in the establishment and implementation of telehealth services collaboration and sharing of expertise the eligible entity has a demonstrated record of collaborating and sharing expertise with providers of telehealth services at the national regional state and local levels in subsection by striking such projects for fiscal year and all that follows through the period and inserting such projects for fiscal year in subsection a in subparagraph by striking transmission of medical data and inserting transmission and electronic archival of medical data and by amending subparagraph to read as follows verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih developing projects to use telehealth technology to facilitate collaboration between health care providers promote telenursing services or iii promote patient understanding and adherence to national guidelines for chronic disease and self management of such conditions in subsection by striking not later than september and inserting not later than year after the date of the enactment of the affordable health care for america act and annually thereafter by striking subsection by redesignating subsection as subsection and in subsection as so redesignated a in paragraph by striking and before such sums and by inserting for fiscal year and such sums as be necessary for each of fiscal years through before the semicolon andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in paragraph by striking and before such sums and by inserting for fiscal year and such sums as be necessary for each of fiscal years through before the period telemedicine incentive grants regarding coordination among states subsection of section usc c– is amended by inserting for fiscal year and such sums as be necessary for each of fiscal years through before the period at the end sec no child left unimmunized against influenza demonstration program using elementary and secondary schools as influenza vaccination centers a purpose the secretary of health and human services in consultation with the secretary of education shall award grants to eligible partnerships to carry out demonstration programs designed to test the feasibility of using the nation elementary schools and secondary schools as influenza vaccination centers in general the secretary shall coordinate with the secretary of labor the secretary of education verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih state medicaid agencies state insurance agencies and private insurers to carry out a program consisting of awarding grants under subsection to ensure that children have coverage for all reasonable and customary expenses related to influenza vaccinations including the costs of purchasing and administering the vaccine incurred when influenza vaccine is administered outside of the physician office in a school or other related setting program description grants from amounts appropriated pursuant to subsection the secretary shall award grants to eligible partnerships to be used to provide influenza vaccinations to children in elementary and secondary schools in coordination with school nurses school health care programs community health care providers state insurance agencies or private insurers acip recommendations the program under this section shall be designed to administer vaccines consistent with the recommendations of the centers for disease control and prevention advisory committee on immunization practices acip for the annual vaccination of all children through years of ageverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih participation voluntary participation by a school or an individual shall be voluntary use of funds eligible partnerships receiving a grant under this section shall ensure the maximum number of children access influenza vaccinations as follows covered children to the extent to which payment of the costs of purchasing or administering the influenza vaccine for children is not covered through other federally funded programs or through private insurance eligible partnerships receiving a grant shall use funds to purchase and administer influenza vaccinations children covered by other federal programs for children who are eligible under other federally funded programs for payment of the costs of purchasing or administering the influenza vaccine eligible partnerships receiving a grant shall not use funds provided under this section for such costs children covered by private health insurance for children who have private insurance eligible partnerships receiving a grant shall offer assistance in accessing coverage for vaccinations administered through the program under this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih privacy the secretary shall ensure that the program under this section adheres to confidentiality and privacy requirements of section of the health insurance portability and accountability act of usc d– note and section of the general education provisions act usc commonly referred to as the family educational rights and privacy act of application an eligible partnership desiring a grant under this section shall submit an application to the secretary at such time in such manner and containing such information as the secretary require duration eligible partnerships receiving a grant shall administer a demonstration program funded through this section over a period of consecutive school years choice of vaccine the program under this section shall not restrict the discretion of a health care provider to administer any influenza vaccine approved by the food and drug administration for use in pediatric populations awards the secretary shall award a minimum of grants in different states to eligible partnerships that each include oneverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or more public schools serving primarily low income students and a minimum of grants in different states to eligible partnerships that each include one or more public schools located in a rural local educational agency report not later than days following the completion of the program under this section the secretary shall submit to the committees on education and labor energy and commerce and appropriations of the house of representatives and to the committees on health education labor and pensions and appropriations of the senate a report on the results of the program the report shall include an assessment of the influenza vaccination rates of school age children in localities where the program is implemented compared to the national average influenza vaccination rates for school aged children including whether school based vaccination assists in achieving the recommendations of the advisory committee on immunization practices an assessment of the utility of employing elementary schools and secondary schools as a part of a multistate community based pandemic responseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih program that is consistent with existing federal and state pandemic response plans an assessment of the feasibility of using existing federal and private insurance funding in establishing a multistate school based vaccination program for seasonal influenza vaccination an assessment of the number of education days gained by students as a result of seasonal vaccinations based on absenteeism rates a determination of whether the program under this section a increased vaccination rates in the participating localities and was implemented for sufficient time for gathering enough valid data and a recommendation on whether the program should be continued expanded or terminated definitions in this section eligible partnership the term eligible partnership means a local public health department or another health organization defined by the secretary as eligible to submit an application and one or more elementary and secondary schools elementary school the terms elementary school and secondary school have theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih meanings given such terms in section of the elementary and secondary education act of usc low income the term low income means a student age through eligible for free or reduced price lunch under the national school lunch act usc et seq rural local educational agency the term rural local educational agency means an eligible local educational agency described in section of the elementary and secondary education act of usc secretary except as otherwise specified the term secretary means the secretary of health and human services authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through sec extension of wisewoman program section of the public health service act usc n–a is amended in subsection a a by striking the heading and inserting in general andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the matter preceding paragraph by striking make grants and all that follows through purpose and inserting the following make grants to such states for the purpose and in subsection by striking there are authorized and all that follows through the period and inserting there are authorized to be appropriated for fiscal year for fiscal year for fiscal year for fiscal year and for fiscal year sec healthy teen initiative to prevent teen pregnancy part of title iii usc et seq is amended by inserting after section the following sec healthy teen initiative to prevent teen pregnancy a program to the extent and in the amount of appropriations made in advance in appropriations acts the secretary acting through the director of the centers for disease control and prevention shall establish a program consisting of making grants in amounts determined under subsection to each state that submits an appli verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cation in accordance with subsection for an evidencebased education program described in subsection use of funds amounts received by a state under this section shall be used to conduct or support evidence based education programs directly or through grants or contracts to public or private nonprofit entities including schools and community based and faith based organizations to reduce teen pregnancy or sexually transmitted diseases distribution of funds the director shall for fiscal year and each subsequent fiscal year make a grant to each state described in subsection a in an amount equal to the product of the amount appropriated to carry out this section for the fiscal year and the percentage determined for the state under section of the social security act application to seek a grant under this section a state shall submit an application at such time in such manner and containing such information and assurance of compliance with this section as the secretary require at a minimum an application shall to the satisfaction of the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih describe how the state proposal will address the needs of at risk teens in the state identify the evidence based education program or programs selected from the registry developed under subsection that will be used to address risks in priority populations describe how the program or programs will be implemented and any adaptations to the evidencebased model that will be made list any private and public entities with whom the state proposes to work including schools and community based and faith based organizations and demonstrate their capacity to implement the proposed program or programs and identify an independent entity that will evaluate the impact of the program or programs evaluation requirement as a condition on receipt of a grant under this section a state shall agree a to arrange for an independent evaluation of the impact of the programs to be conducted or supported through the grant and submit reports to the secretary on such programs and the results of evaluation of such programsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih funding limitation of the amounts made available to a state through a grant under this section for any fiscal year not more than percent be used for such evaluation rule of construction this section shall not be construed to preempt or limit any state law regarding parental involvement and decisionmaking in children education registry of eligible programs the secretary shall develop not later than days after the date of the enactment of the affordable health care for america act and periodically update thereafter a publicly available registry of programs described in subsection that as determined by the secretary meet the definition of the term evidencebased in subsection are medically and scientifically accurate and provide age appropriate information matching funds the secretary award a grant to a state under this section for a fiscal year only if the state agrees to provide from non federal sources an amount equal to in cash or in kind for each provided through the grant to carry out the activities supported by the grantverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih definition in this section the term evidence based means based on a model that has been found in methodologically sound research to delay initiation of sex to decrease number of partners to reduce teen pregnancy to reduce sexually transmitted infection rates or to improve rates of contraceptive use authorization of appropriations to carry out this section there is authorized to be appropriated for each of fiscal years through sec national training initiatives on autism spectrum disorders title of the developmental disabilities assistance and bill of rights act of usc et seq is amended by adding at the end the following subtitle national training initiative on autism spectrum disorders sec national training initiative a grants and technical assistance grants verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general the secretary in consultation with the interagency autism coordinating committee shall award multiyear grants to eligible entities to provide individuals including parents and health allied health vocational and educational professionals with interdisciplinary training continuing education technical assistance and information for the purpose of improving services rendered to children and adults with autism and their families to address unmet needs related to autism eligible entity to be eligible to receive a grant under this subsection an entity shall be a university center for excellence in developmental disabilities education research and service or a comparable interdisciplinary education research and service entity application requirements an entity that desires to receive a grant for a program under this paragraph shall submit to the secretary an application demonstrating that the entity has capacity to verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provide training and technical assistance in evidence based practices to evaluate and provide effective interventions services treatments and supports to children and adults with autism and their families include individuals with autism and their families as part of the program to ensure that an individualand family centered approach is used iii share and disseminate materials and practices that are developed for and evaluated to be effective in the provision of training and technical assistance and iv provide training technical assistance interventions services treatments and supports under this subsection statewide providing assurances that the entity will provide trainees under this subsection with an appropriate balance of interdisciplinary academic and community based experiences andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provide to the secretary in the manner prescribed by the secretary data regarding the number of individuals who have benefitted from and outcomes of the provision of training and technical assistance under this subsection iii providing assurances that training technical assistance dissemination of information and services under this subsection will be consistent with the goals of this act the americans with disabilities act of the individuals with disabilities education act and the elementary and secondary education act of and conducted in coordination with relevant state agencies institutions of higher education and service providers and iv containing such other information and assurances as the secretary requireverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih use of funds a grant received under this subsection shall be used to provide individuals including parents and health allied health vocational and educational professionals with interdisciplinary training continuing education technical assistance and information for the purpose of improving services rendered to children and adults with autism and their families to address unmet needs related to autism such training education assistance and information shall include each of the following training health allied health vocational and educational professionals to identify evaluate the needs of and develop interventions services treatments and supports for children and adults with autism developing model services and supports that demonstrate evidence based practices iii developing systems and products that allow for the interventions services treatments and supports to be evaluated for fidelity of implementationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv working to expand the availability of evidence based lifelong interventions educational employment and transition services and community supports providing statewide technical assistance in collaboration with relevant state agencies institutions of higher education autism advocacy groups and community based service providers vi working to develop comprehensive systems of supports and services for individuals with autism and their families including seamless transitions between education and health systems across the lifespan vii promoting training technical assistance dissemination of information supports and services viii developing mechanisms to provide training and technical assistance including for credit courses intensive summer institutes continuing education programs distance based programs and webbased information dissemination strategiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ix promoting activities that support community based family and individual services and enable individuals with autism and related developmental disabilities to fully participate in society and achieve good quality of life outcomes collecting data on the outcomes of training and technical assistance programs to meet statewide needs for the expansion of services to children and adults with autism amount of grants the amount of a grant to any entity for a fiscal year under this section shall be not less than technical assistance the secretary shall reserve percent of the amount appropriated to carry out this subsection for a fiscal year to make a grant to a national organization with demonstrated capacity for providing training and technical assistance to a assist in national dissemination of specific information including evidence based best practices from interdisciplinary training programs and when appropriate other entitiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih whose findings would inform the work performed by entities awarded grants compile and disseminate strategies and materials that prove to be effective in the provision of training and technical assistance so that the entire network can benefit from the models materials and practices developed in individual centers assist in the coordination of activities of grantees under this subsection develop a web portal that will provide linkages to each of the individual training initiatives and provide access to training modules promising training and technical assistance practices and other materials developed by grantees serve as a research based resource for federal and state policymakers on information concerning the provision of training and technical assistance for the assessment and provision of supports and services for children and adults with autism convene experts from multiple interdisciplinary training programs individuals with autism and the families of such individuals toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih discuss and make recommendations with regard to training issues related to assessment interventions services treatment and supports for children and adults with autism and undertake any other functions that the secretary determines to be appropriate authorization of appropriations to carry out this subsection there are authorized to be appropriated for fiscal year and such sums as be necessary for each of fiscal years through expansion of the number of university centers for excellence in developmental disabilities education research and service grants to provide for the establishment of up to new university centers for excellence in developmental disabilities education research and service the secretary shall award up to grants to institutions of higher education applicable provisions except for subsection a the provisions of subsection a shall apply with respect to grants under this subsection to the same extent and in the same manner as such provisions apply with respect to grants under subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih priority in awarding grants under this subsection the secretary shall give priority to applicants that a are minority institutions that have demonstrated capacity to meet the requirements of this section and provide services to individuals with autism and their families or are located in a state with one or more underserved populations authorization of appropriations to carry out this subsection there is authorized to be appropriated for each of fiscal years through definitions in this section the term autism means an autism spectrum disorder or a related developmental disability the term interventions means educational methods and positive behavioral support strategies designed to improve or ameliorate symptoms associated with autism the term minority institution has the meaning given to such term in section of the higher education act of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term services means services to assist individuals with autism to live more independently in their communities the term treatments means health services including mental health services designed to improve or ameliorate symptoms associated with autism the term university center for excellence in developmental disabilities education research and service means a university center for excellence in development disabilities education research and service that has been or is funded through subtitle or subsection sec implementation of medication management services in treatment of chronic diseases a in general the secretary of health and human services referred to in this section as the secretary acting through the director of the agency for health care research and quality shall establish a program to provide grants to eligible entities to implement medication management services referred to in this section as mtm services provided by licensed pharmacists as a part of a collaborative multidisciplinary interprofessional approach to the treatment of chronic dis verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih eases for targeted individuals to improve the quality of care and reduce overall cost in the treatment of such diseases the secretary shall commence the grant program not later than may eligible entities to be eligible to receive a grant under subsection a an entity shall provide a setting appropriate for mtm services as recommended by the experts described in subsection submit to the secretary a plan for achieving long term financial sustainability where applicable submit a plan for coordinating mtm services with other local providers and where applicable through or in collaboration with the medicare medical home pilot program as established by section of the social security act as added by section a of this act submit a plan for meeting the requirements under subsection and submit to the secretary such other information as the secretary require mtm services to targeted individuals the mtm services provided with the assistance of a grant awarded under subsection a shall as allowed by stateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih law including applicable collaborative pharmacy practice agreements include performing or obtaining necessary assessments of the health and functional status of each patient receiving such mtm services formulating a medication treatment plan according to therapeutic goals agreed upon by the prescriber and the patient or caregiver or authorized representative of the patient selecting initiating modifying recommending changes to or administering medication therapy monitoring which include access to ordering or performing laboratory assessments and evaluating the response of the patient to therapy including safety and effectiveness performing an initial comprehensive medication review to identify resolve and prevent medication related problems including adverse drug events quarterly targeted medication reviews for ongoing monitoring and additional followup interventions on a schedule developed collaboratively with the prescriber documenting the care delivered and communicating essential information about such care in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cluding a summary of the medication review and the recommendations of the pharmacist to other appropriate health care providers of the patient in a timely fashion providing education and training designed to enhance the understanding and appropriate use of the medications by the patient caregiver and other authorized representative providing information support services and resources and strategies designed to enhance patient adherence with therapeutic regimens coordinating and integrating mtm services within the broader health care management services provided to the patient and such other patient care services as are allowed under the scopes of practice for pharmacists for purposes of other federal programs targeted individuals mtm services provided by licensed pharmacists under a grant awarded under subsection a shall be offered to targeted individuals who take or more prescribed medications including over the counter and dietary supplements take any high risk medications verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih have or more chronic diseases as identified by the secretary or have undergone a transition of care or other factors as determined by the secretary that are likely to create a high risk of medication related problems consultation with experts in designing and implementing mtm services provided under grants awarded under subsection a the secretary shall consult with federal state private public private and academic entities pharmacy and pharmacist organizations health care organizations consumer advocates chronic disease groups and other stakeholders involved with the research dissemination and implementation of pharmacist delivered mtm services as the secretary determines appropriate the secretary in collaboration with this group shall determine whether it is possible to incorporate rapid cycle process improvement concepts in use in other federal programs that have implemented mtm services reporting to the secretary an entity that receives a grant under subsection a shall submit to the secretary a report that describes and evaluates as requested by the secretary the activities carried out under subsection including quality measures as determined by the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih evaluation and report the secretary shall submit to the relevant committees of congress a report which shall assess the clinical effectiveness of pharmacist provided services under the mtm services program as compared to usual care including an evaluation of whether enrollees maintained better health with fewer hospitalizations and emergency room visits than similar patients not enrolled in the program assess changes in overall health care resource of targeted individuals assess patient and prescriber satisfaction with mtm services assess the impact of patient cost sharing requirements on medication adherence and recommendations for modifications identify and evaluate other factors that impact clinical and economic outcomes including demographic characteristics clinical characteristics and health services use of the patient as well as characteristics of the regimen pharmacy benefit and mtm services provided and evaluate the extent to which participating pharmacists who maintain a dispensing role have averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conflict of interest in the provision of mtm services and if such conflict is found provide recommendations on how such a conflict might be appropriately addressed grant to fund development of performance measures the secretary award grants or contracts to eligible entities for the purpose of funding the development of performance measures that assess the use and effectiveness of medication therapy management services sec postpartum depression a expansion and intensification of activities continuation of activities the secretary is encouraged to expand and intensify activities on postpartum conditions programs for postpartum conditions in carrying out paragraph the secretary is encouraged to continue research to expand the understanding of the causes of and treatments for postpartum conditions including conducting and supporting the following a basic research concerning the etiology and causes of the conditionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih epidemiological studies to address the frequency and natural history of the conditions and the differences among racial and ethnic groups with respect to the conditions the development of improved screening and diagnostic techniques clinical research for the development and evaluation of new treatments information and education programs for health professionals and the public which include a coordinated national campaign that is designed to increase the awareness and knowledge of postpartum conditions include public service announcements through television radio and other means and iii focus on raising awareness about screening educating new mothers and their families about postpartum conditions to promote earlier diagnosis and treatment andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii ensuring that such education includes complete information concerning postpartum conditions including its symptoms methods of coping with the illness and treatment resources report by the secretary study the secretary shall conduct a study on the benefits of screening for postpartum conditions report not later than years after the date of the enactment of this act the secretary shall complete the study required by paragraph and submit a report to the congress on the results of such study sense of congress regarding longitudinal study of relative mental health consequences for women of resolving a pregnancy sense of congress it is the sense of the congress that the director of the national institute of mental health conduct a nationally representative longitudinal study during the period of fiscal years through on the relative mental health consequences for women of resolving averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pregnancy intended and unintended in various ways including carrying the pregnancy to term and parenting the child carrying the pregnancy to term and placing the child for adoption miscarriage and having an abortion this study assess the incidence timing magnitude and duration of the immediate and long term mental health consequences positive or negative of these pregnancy outcomes report beginning not later than years after the date of the enactment of this act and periodically thereafter for the duration of the study such director prepare and submit to the congress reports on the findings of the study definitions in this section the term postpartum condition means postpartum depression or postpartum psychosis the term secretary means the secretary of health and human services authorization of appropriations 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 such sums as be necessary for each of fiscal years through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec grants to promote positive health behaviors and outcomes part of title iii usc et seq is amended by adding at the end the following sec grants to promote positive health behaviors and outcomes a grants authorized the secretary in collaboration with the director of the centers for disease control and prevention and other federal officials determined appropriate by the secretary is authorized to award grants to eligible entities to promote positive health behaviors for populations in medically underserved communities through the use of community health workers use of funds grants awarded under subsection a shall be used to support community health workers to educate guide and provide outreach in a community setting regarding health problems prevalent in medically underserved communities especially racial and ethnic minority populations to educate guide and provide experiential learning opportunities that target behavioral risk factors including a poor nutrition physical inactivity being overweight or obese verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tobacco use alcohol and substance use injury and violence risky sexual behavior untreated mental health problems untreated dental and oral health problems and understanding informed consent to educate and provide guidance regarding effective strategies to promote positive health behaviors within the family to educate and provide outreach regarding enrollment in health insurance including the state children health insurance program under title xxi of the social security act medicare under title xviii of such act and medicaid under title xix of such act to educate and refer underserved populations to appropriate health care agencies and community based programs and organizations in order to increase access to quality health care services including preventive health services and to eliminate duplicative care orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to educate guide and provide home visitation services regarding maternal health and prenatal care application in general each eligible entity that desires to receive a grant under subsection a shall submit an application to the secretary at such time in such manner and accompanied by such information as the secretary require contents each application submitted pursuant to paragraph shall a describe the activities for which assistance is sought under this section contain an assurance that with respect to each community health worker program receiving funds under the grant such program will provide training and supervision to community health workers to enable such workers to provide authorized program services contain an assurance that the applicant will evaluate the effectiveness of community health worker programs receiving funds under the grant contain an assurance that each community health worker program receiving fundsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under the grant will provide services in the cultural context most appropriate for the individuals served by the program contain a plan to document and disseminate project descriptions and results to other states and organizations as identified by the secretary and describe plans to enhance the capacity of individuals to utilize health services and health related social services under federal state and local programs by assisting individuals in establishing eligibility under the programs and in receiving the services or other benefits of the programs and providing other services as the secretary determines to be appropriate that include transportation and translation services priority in awarding grants under subsection a the secretary shall give priority to applicants that propose to target geographic areas verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a with a high percentage of residents who are eligible for health insurance but are uninsured or underinsured with a high percentage of residents who suffer from chronic diseases including pulmonary conditions hypertension heart disease mental disorders diabetes and asthma and with a high infant mortality rate have experience in providing health or health related social services to individuals who are underserved with respect to such services and have documented community activity and experience with community health workers collaboration with academic institutions the secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions especially those that graduate a disproportionate number of health and health care students from underrepresented racial and ethnic minority backgrounds nothing in this section shall be construed to require such collaboration evidence based interventions the secretary shall encourage community health worker programs receiving funding under this section to implement an outcome based payment system that rewards communityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih health workers for connecting underserved populations with the most appropriate services at the most appropriate time nothing in this section shall be construed to require such payment quality assurance and cost effectiveness the secretary shall establish guidelines for assuring the quality of the training and supervision of community health workers under the programs funded under this section and for assuring the cost effectiveness of such programs monitoring the secretary shall monitor community health worker programs identified in approved applications under this section and shall determine whether such programs are in compliance with the guidelines established under subsection technical assistance the secretary provide technical assistance to community health worker programs identified in approved applications under this section with respect to planning developing and operating programs under the grant report to congress in general not later than years after the date on which the secretary first awards grants under subsection a the secretary shall sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mit to congress a report regarding the grant project contents the report required under paragraph shall include the following a a description of the programs for which grant funds were used the number of individuals served under such programs an evaluation of the effectiveness of such programs the cost of such programs and iii the impact of the programs on the health outcomes of the community residents recommendations for sustaining the community health worker programs developed or assisted under this section recommendations regarding training to enhance career opportunities for community health workers definitions in this section community health worker the term community health worker means an individual whoverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih promotes health or nutrition within the community in which the individual resides a by serving as a liaison between communities and health care agencies by providing guidance and social assistance to community residents by enhancing community residents ability to effectively communicate with health care providers by providing culturally and linguistically appropriate health or nutrition education by advocating for individual and community health including oral and mental or nutrition needs and by providing referral and followup services or otherwise coordinating care community setting the term community setting means a home or a community organization located in the neighborhood in which a participant resides medically underserved community the term medically underserved community means a community identified by a state united statesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih territory or possession or federally recognized indian tribe a that has a substantial number of individuals who are members of a medically underserved population as defined by section and a significant portion of which is a health professional shortage area as designated under section support the term support means the provision of training supervision and materials needed to effectively deliver the services described in subsection reimbursement for services and other benefits eligible entity the term eligible entity means a public or private nonprofit entity including a state or public subdivision of a state a public health department or a federally qualified health center or a consortium of any of such entities located in the united states or territory thereof authorization of appropriations there is authorized to be appropriated to carry out this section for each of fiscal years through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec medical liability alternatives a incentive payments for medical liability reform in general to the extent and in the amounts made available in advance in appropriations acts the secretary shall make an incentive payment in an amount determined by the secretary to each state that has an alternative medical liability law in compliance with this section determination by secretary the secretary shall determine that a state has an alternative medical liability law in compliance with this section if the secretary is satisfied that a the state enacted the law after the date of the enactment of this act and is implementing the law the law is effective and the contents of the law are in accordance with paragraph considerations for determining effectiveness in determining whether an alternative medical liability law is effective under paragraph the secretary shall consider whether the law verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a makes the medical liability system more reliable through prevention of or prompt and fair resolution of disputes encourages the disclosure of health care errors and maintains access to affordable liability insurance contents of alternative medical liability law the contents of an alternative liability law are in accordance with this paragraph if a the litigation alternatives contained in the law consist of certificate of merit early offer or both and the law does not limit attorneys fees or impose caps on damages use of incentive payments amounts received by a state as an incentive payment under this section shall be used to improve health care in that state technical assistance the secretary provide technical assistance to the states applying for or receiving an incentive payment under this section reports beginning not later than one year after the date of the enactment of this act the secretary shall submit to the congress an annual report on the progress states have made in enacting and implementingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih alternative medical liability laws in compliance with this section such reports shall contain sufficient documentation regarding the effectiveness of such laws to enable an objective comparative analysis of such laws definition in this section the term secretary means the secretary of health and human services and the term state includes the several states district of columbia the commonwealth of puerto rico and each other territory or possession of the united states authorization of appropriations there are authorized to be appropriated to carry out this section such sums as be necessary to remain available until expended sec infant mortality pilot programs a in general the secretary of health and human services in this section referred to as the secretary acting through the director shall award grants to eligible entities to create implement and oversee infant mortality pilot programs period of a grant the period of a grant under this section shall be consecutive fiscal years preference in awarding grants under this section the secretary shall give preference to eligible enti verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ties proposing to serve any of the counties or groups of counties with the highest rates of infant mortality in the united states in the past years use of funds any infant mortality pilot program funded under this section include the development of a plan that identifies the individual needs of each community to be served and strategies to address those needs provide outreach to at risk mothers through programs deemed appropriate by the director develop and implement standardized systems for improved access utilization and quality of social educational and clinical services to promote healthy pregnancies full term births and healthy infancies delivered to women and their infants such as a counseling on infant care feeding and parenting postpartum care prevention of premature delivery and additional counseling for at risk mothers including smoking cessation programs drug treatment programs alcohol treatment programs nutrition and physical activity programs postpartum depression and domestic vio verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih lence programs social and psychological services dental care and parenting programs establish a rural outreach program to provide care to at risk mothers in rural areas establish a regional public education campaign including a campaign to a prevent preterm births and educate the public about infant mortality and provide for any other activities programs or strategies as identified by the community plan limitation of the funds received through a grant under this section for a fiscal year an eligible entity shall not use more than percent for program evaluation reports on pilot programs in general not later than year after receiving a grant and annually thereafter for the duration of the grant period each entity that receives a grant under subsection a shall submit a report to the secretary detailing its infant mortality pilot program contents of report the reports required under paragraph shall include information such as the methodology of and outcomes andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih statistics from the grantee infant mortality pilot program evaluation the secretary shall use the reports required under paragraph to evaluate and conduct statistical research on infant mortality pilot programs funded through this section definitions for the purposes of this section director the term director means the director of the centers for disease control and prevention eligible entity the term eligible entity means a state county city territorial or tribal health department that has submitted a proposal to the secretary that the secretary deems likely to reduce infant mortality rates within the standard metropolitan statistical area involved tribal the term tribal refers to an indian tribe a tribal organization or an urban indian organization as such terms are defined in section of the indian health care improvement act authorization of appropriations to carry out this section there are authorized to be appropriated for each of fiscal years through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec secondary school health sciences training program a program the secretary of health and human services acting through the administrator of the health resources and services administration and in consultation with the secretary of education establish a health sciences training program consisting of awarding grants and contracts under subsection to prepare secondary school students for careers in health professions development and implementation of health sciences curricula the secretary make grants to or enter into contracts with eligible entities to plan develop or implement secondary school health sciences curricula including curricula in biology chemistry physiology mathematics nutrition and other courses deemed appropriate by the secretary to prepare students for associate or bachelor degree programs in health professions or bachelor degree programs in health professions related majors and to increase the interest of secondary school students in applying to and enrolling in accredited associate or bachelor degree programs in health professions or bachelor degree programs in health professions related majors including through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a work study programs programs to increase awareness of careers in health professions and other activities to increase such interest eligibility to be eligible for a grant or contract under subsection an entity shall be a local educational agency and provide assurances that activities under the grant or contract will be carried out in partnership with an accredited health professions school or program public or private nonprofit hospital or public or private nonprofit entity preference in awarding grants and contracts under subsection the secretary shall give preference to entities that have a demonstrated record of at least one of the following graduating a high or significantly improved percentage of students who have exhibited mastery in secondary school state science standards graduating students from disadvantaged backgrounds including racial and ethnic minorities who are underrepresented in a associate or bachelor degree programs in health professions or bachelor degreeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih programs in health professions related majors or health professions report the secretary shall submit to the congress an annual report on the program carried out under this section definitions in this section the term health profession means the profession of any member of the health workforce as defined in section of the public health service act as added by section the term local educational agency has the meaning given to the term in section of the elementary and secondary education act of usc the term secondary school a means a secondary school as defined in section of the elementary and secondary education act of usc and includes any such school that is a middle school the term secretary means the secretary of health and human services except as otherwise specifiedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through sec community based collaborative care networks a purpose the purpose of this subtitle is to establish and provide assistance to community based collaborative care networks to develop or strengthen coordination of services to allow all individuals including the uninsured and low income to receive efficient and higher quality care and to gain entry into and receive services from a comprehensive system of care to develop efficient and sustainable infrastructure for a health care delivery system characterized by effective collaboration information sharing and clinical and financial coordination among providers of care in the community to develop or strengthen activities related to providing coordinated care for individuals with chronic conditions and to reduce the use of emergency departments inpatient and other expensive resources of hospitals and other providersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih creation of the community based collaborative care network program part of title iii usc et seq as amended is further amended by inserting after subpart xii the following new subpart subpart xiii community based collaborative care network program sec community based collaborative care network program a in general the secretary award grants to eligible entities for the purpose of establishing model projects to accomplish the following goals to reduce unnecessary use of items and services furnished in emergency departments of hospitals especially to ensure that individuals without health insurance coverage or with inadequate health insurance coverage do not use the services of such department instead of the services of a primary care provider through methods such as a screening individuals who seek emergency department services for possible eligibility under relevant governmental health programs or for subsidies under such programs and providing such individuals referrals for followup care and chronic condition careverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to manage chronic conditions to reduce their severity negative health outcomes and expense to encourage health care providers to coordinate their efforts so that the most vulnerable patient populations seek and obtain primary care to provide more comprehensive and coordinated care to vulnerable low income individuals and individuals without health insurance coverage or with inadequate coverage to provide mechanisms for improving both quality and efficiency of care for low income individuals and families with an emphasis on those most likely to remain uninsured despite the existence of government programs to make health insurance more affordable to increase preventive services including screening and counseling to those who would otherwise not receive such screening in order to improve health status and reduce long term complications and costs to ensure the availability of communitywide safety net services including emergency and trauma care eligibility and grantee selection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih application a community based collaborative care network described in subsection shall submit to the secretary an application in such form and manner and containing such information as specified by the secretary such information shall at least a identify the health care providers participating in the community based collaborative care network proposed by the applicant and if a provider designated in paragraph is not included the reason such provider is not so included include a description of how the providers plan to collaborate to provide comprehensive and integrated care for low income individuals including uninsured and underinsured individuals include a description of the organizational and joint governance structure of the community based collaborative care network in a manner so that it is clear how decisions will be made and how the decisionmaking process of the network will include appropriate representation of the participating entities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih define the geographic areas and populations that the network intends to serve define the scope of services that the network intends to provide and identify any reasons why such services would not include a suggested core service identified by the secretary under paragraph demonstrate the network ability to meet the requirements of this section and provide assurances that grant funds received shall be used to support the entire community based collaborative care network selection of grantees a in general the secretary shall select community based collaborative care networks to receive grants from applications submitted under paragraph on the basis of quality of the proposal involved geographic diversity including different states and regions served and urban and rural diversity and the number of low income and uninsured individuals that the proposal intends to serve priority the secretary shall give priority to proposals from community based collaborative care networks that verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih include the capability to provide the broadest range of services to low income individuals and include providers that currently serve a high volume of low income individuals renewal in subsequent years based on the performance of grantees the secretary provide renewal grants to prior year grant recipients suggested core services for purposes of paragraph the secretary shall develop a list of suggested core patient and core network services to be provided by a community based collaborative care network the secretary select a community based collaborative care network under paragraph the application of which does not include all such services if such application provides a reasonable explanation why such services are not proposed to be included and the secretary determines that the application is otherwise high quality termination authority the secretary terminate selection of a communitybased collaborative care network under this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for good cause such good cause shall include a determination that the network a has failed to provide a comprehensive range of coordinated and integrated health care services as required under subsection has failed to meet reasonable quality standards has misappropriated funds provided under this section or has failed to make progress toward accomplishing goals set out in subsection a use of funds use by grantees grant funds are provided to community based collaborative care networks to carry out the following activities a assist low income individuals without adequate health care coverage to access and appropriately use health services enroll in applicable public or private health insurance programs iii obtain referrals to and see a primary care provider in case such an individual does not have a primary care provider andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv obtain appropriate care for chronic conditions improve heath care by providing case management application assistance and appropriate referrals such as through methods to create and meaningfully use a health information technology network to track patients across collaborative providers perform health outreach such as by using neighborhood health workers who inform individuals about the availability of safety net and primary care providers available through the communitybased collaborative care network iii provide for followup outreach to remind patients of appointments or followup care instructions iv provide transportation to individuals to and from the site of care expand the capacity to provide care at any provider participating in the community based collaborative care network including telehealth hiring new clinical or administrative staff providing ac verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cess to services after hours on weekends or otherwise providing an urgent care alternative to an emergency department and vi provide a primary care provider or medical home for each network patient provide direct patient care services as described in their application and approved by the secretary grant funds to hrsa grantees the secretary limit the percent of grant funding that be spent on direct care services provided by grantees of programs administered by the health resources and services administration in this section referred to as hrsa or impose other requirements on hrsa grantees participating in a community based collaborative care network as be necessary for consistency with the requirements of such programs reservation of funds for national program purposes the secretary use not more than percent of funds appropriated to carry out this section for providing technical assistance to grantees obtaining assistance of experts and consultants holding meetings developing of tools disseminating of information and evaluationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih community based collaborative care networks in general a description a community based collaborative care network described in this subsection is a consortium of health care providers with a joint governance structure that provides a comprehensive range of coordinated and integrated health care services for low income patient populations or medically underserved communities whether or not such individuals receive benefits under title xviii xix or xxi of the social security act private or other health insurance or are uninsured or underinsured and that complies with any applicable minimum eligibility requirements that the secretary determine appropriate required inclusion each such network shall include the following providers that serve the community unless such provider does not exist within the community declines or refuses to participate or places unreasonable conditions on their participation a safety net hospital that provides services to a high volume of low in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih come patients as demonstrated by meeting the criteria in section of the social security act or other similar criteria determined by the secretary and all federally qualified health centers as defined in section aa of the social security act usc aa located in the geographic area served by the coordinated care network additional inclusions each such network include any of the following additional providers a hospital including a critical access hospital as defined in section of the social security act usc i– a county or municipal department of health iii a rural health clinic or a rural health network as defined in sections aa and of the social security act respectively usc aa i– verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iv a community clinic including a mental health clinic substance abuse clinic or a reproductive health clinic a health center controlled network as defined by section of the public health service act vi a private practice physician or group practice vii a nurse or physician assistant or group practice viii an adult day care center ix a home health provider any other type of provider specified by the secretary which has a desire to serve low income and uninsured patients construction nothing in this section shall prohibit a single entity from qualifying as community based collaborative care network so long as such single entity meets the criteria of a community based collaborative care network if the network does not include the providers referenced in clauses and of subparagraph of this paragraph the application must ex verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plain the reason pursuant to subsection a participation in a communitybased collaborative care network shall not affect federally qualified health centers obligation to comply with the governance requirements under section of the public health service act usc iii federally qualified health centers participating in a community based collaborative care network not be required to provide services beyond their federal health center scope of project approved by hrsa iv nothing in this section shall be construed to expand medical malpractice liability protection under the federal tort claims act for section funded federally qualified health centers comprehensive range of coordinated and integrated health care services the secretary shall define criteria for evaluating whether the services offered by a community based collaborative care network qualify as a comprehensive rangeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of coordinated and integrated health care services such criteria vary based on the needs of the geographic areas and populations to be served by the network and include the following a requiring community based collaborative care networks to include at least the suggested core services identified under subsection or whichever subset of the suggested core services is applicable to a particular network requiring such networks to assign each patient of the network to a primary care provider responsible for managing that patient care requiring the services provided by a community based collaborative care network to include support services appropriate to meet the health needs of low income populations in the network community which include chronic care management nutritional counseling transportation language services enrollment counselors social services and other services as proposed by the network providing that the services provided by a community based collaborative care net verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih work also include long term care services and other services not specified in this subsection providing for the approval by the secretary of a scope of community based collaborative care network services for each network that addresses an appropriate minimum scope of work consistent with the setting of the network and the health professionals available in the community the network serves clarification participation in a community based collaborative care network shall not disqualify a health care provider from reimbursement under title xviii xix or xxi of the social security act with respect to services otherwise reimbursable under such title nothing in this section shall prevent a community based collaborative care network that is otherwise eligible to contract with medicare a private health insurer or any other appropriate entity to provide care under medicare under health insurance coverage offered by the insurer or otherwise evaluations grantee reports beginning in the third year following an initial grant each commu verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nity based collaborative care network shall submit to the secretary with respect to each year the grantee has received a grant an evaluation on the activities carried out by the community based collaborative care network under the community based collaborative care network program and shall include a the number of people served the most common health problems treated any reductions in emergency department use any improvements in access to primary care an accounting of how amounts received were used including identification of amounts used for patient care services as be required for hrsa grantees and to the extent requested by the secretary any quality measures or any other measures specified by the secretary program reports the secretary shall submit to congress an annual evaluation beginning not later than months after the first reports under paragraph are submitted on the extent to which emergency department use was reduced as a resultverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of the activities carried out by the community based collaborative care network under the program each such evaluation shall also include information on a the prevalence of certain chronic conditions in various populations including a comparison of such prevalence in the general population versus in the population of individuals with inadequate health insurance coverage demographic characteristics of the population of uninsured and underinsured individuals served by the community based collaborative care network involved and the conditions of such individuals for whom services were requested at such emergency departments of participating hospitals audit authority the secretary conduct periodic audits and request periodic spending reports of community based collaborative care networks under the community based collaborative care network program clarification nothing in this section requires a provider to report individually identifiable information of an individual to government agencies unless the individual consents consistent with hipaa privacy and security law as defined in section a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorization of appropriations there are authorized to be appropriated to carry out this section such sums as be necessary for each of fiscal years through sec community based overweight and obesity prevention program part of title iii usc et seq is amended by inserting after section the following sec w– community based overweight and obesity prevention program a program the secretary shall establish a community based overweight and obesity prevention program consisting of awarding grants and contracts under subsection grants the secretary shall award grants to or enter into contracts with eligible entities to plan evidence based programs for the prevention of overweight and obesity among children and their families through improved nutrition and increased physical activity or to implement such programs eligibility to be eligible for a grant or contract under subsection an entity shall be a community partnership that demonstrates community support and includes verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a broad cross section of stakeholders such as a hospitals health care systems community health centers or other health care providers universities local educational agencies or childcare providers state local and tribal health departments state local and tribal park and recreation departments employers and health insurance companies residents of the community and representatives of public and private entities that have a history of working within and serving the community period of awards in general the period of a grant or contract under this section shall be years subject to renewal under paragraph renewal at the end of each fiscal year the secretary renew a grant or contract award under this section only if the grant or contract recipient demonstrates to the secretary satisfactionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that the recipient has made appropriate measurable progress in preventing overweight and obesity requirements in general the secretary award a grant or contract under this section to an entity only if the entity demonstrates to the secretary satisfaction that a not later than days after receiving the grant or contract the entity will establish a steering committee to provide input on the assessment of and recommendations on improvements to the entity program funded through the grant or contract and the entity has conducted or will conduct an assessment of the overweight and obesity problem in its community including the extent of the problem and factors contributing to the problem matching requirement the secretary award a grant or contract to an eligible entity under this section only if the entity agrees to provide from non federal sources an amount equal to in cash or in kind for each provided through the grant or contract to carry out the activities supported by the grant or contractverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih payor of last resort the secretary award a grant or contract under this section to an entity only if the entity demonstrates to the satisfaction of the secretary that funds received through the grant or contract will not be expended for any activity to the extent that payment has been made or can reasonably be expected to be made a under any insurance policy under any federal or state health benefits program including titles xix and xxi of the social security act or by an entity which provides health services on a prepaid basis maintenance of effort the secretary award a grant or contract under this section to an entity only if the entity demonstrates to the satisfaction of the secretary that a funds received through the grant or contract will be expended only to supplement and not supplant non federal and federal funds otherwise available to the entity for the activities to be funded through the grant or contract and with respect to such activities the entity will maintain expenditures of non federalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amounts for such activities at a level not less than the lesser of such expenditures maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the grant or contract preferences in awarding grants and contracts under this section the secretary shall give preference to eligible entities that will serve communities with high levels of overweight and obesity and related chronic diseases or will plan or implement activities for the prevention of overweight and obesity in school or workplace settings report the secretary shall submit to the congress an annual report on the program of grants and contracts awarded under this section definitions in this section the term evidence based means that methodologically sound research has demonstrated a beneficial health effect in the judgment of the secretary and includes the ways to enhance children activity and nutrition we can program and curriculum of the national institutes of healthverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term local educational agency has the meaning given to the term in section of the elementary and secondary education act of authorization of appropriations to carry out this section there are authorized to be appropriated for fiscal year and such sums as be necessary for each of fiscal years through sec reducing student to school nurse ratios a demonstration grants in general the secretary of education in consultation with the secretary of health and human services and the director of the centers for disease control and prevention make demonstration grants to eligible local educational agencies for the purpose of reducing the student toschool nurse ratio in public elementary and secondary schools special consideration in awarding grants under this section the secretary of education shall give special consideration to applications submitted by high need local educational agencies that demonstrate the greatest need for new or additional nursing services among children in the public elementary and secondary schools served by theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agency in part by providing information on current ratios of students to school nurses matching funds the secretary of education require recipients of grants under this subsection to provide matching funds from non federal sources and shall permit the recipients to match funds in whole or in part with in kind contributions report not later than months after the date on which assistance is first made available to local educational agencies under this section the secretary of education shall submit to the congress a report on the results of the demonstration grant program carried out under this section including an evaluation of the effectiveness of the program in improving the student to school nurse ratios described in subsection a and an evaluation of the impact of any resulting enhanced health of students on learning definitions for purposes of this section the terms elementary school local educational agency and secondary school have the meanings given to those terms in section of the elementary and secondary education act of usc verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term eligible local educational agency means a local educational agency in which the student to school nurse ratio in the public elementary and secondary schools served by the agency is or more students to every school nurse the term high need local educational agency means a local educational agency a that serves not fewer than children from families with incomes below the poverty line or for which not less than percent of the children served by the agency are from families with incomes below the poverty line the term nurse means a licensed nurse as defined under state law authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through sec medical legal partnerships a in general the secretary shall establish a nationwide demonstration project consisting of awarding grants to and entering into contracts with medical legal partnerships to assist pa verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tients and their families to navigate health related programs and activities and evaluating the effectiveness of such partnerships use of funds amounts received as a grant or contract under this section shall be used to assist patients and their families to navigate health care related programs and activities and thereby achieve one or more of the following goals enhancing access to health care services improving health outcomes for low income individuals reducing health disparities enhancing wellness and prevention of chronic conditions prohibition no funds under this section be used for any medical malpractice or other civil action or proceeding or to assist individuals who are not lawfully present in the united states report not later than years after the date of the enactment of this act the secretary shall submit a report to the congress on the results of the demonstra verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion project under this section such report shall include the following a description of the extent to which medical legal partnerships funded through this section achieved the goals described in subsection recommendations on the possibility of extending or expanding the demonstration project definitions in this section the term health disparities has the meaning given to the term in section of the public health service act as added by section the term medical legal partnership means an entity a that is a collaboration between a community health center public hospital children hospital or other provider of health care services to a significant number of low income beneficiaries and one or more attorneys and whose primary mission is to assist patients and their families navigate health care related programs and activitiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term secretary means the secretary of health and human services authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through part emergency care related programs sec trauma care centers a grants for trauma care centers section usc d– is amended to read as follows sec grants for certain trauma centers a in general the secretary shall establish a trauma center program consisting of awarding grants under section grants the secretary shall award grants as follows existing centers grants to public private nonprofit indian health service indian tribal and urban indian trauma centers a to further the core missions of such centers or to provide emergency relief to ensure the continued and future availability of trauma services by trauma centers verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih at risk of closing or operating in an area where a closing has occurred within their primary service area or in need of financial assistance following a natural disaster or other catastrophic event such as a terrorist attack new centers grants to local governments and public or private nonprofit entities to establish new trauma centers in urban areas with a substantial degree of trauma resulting from violent crimes minimum qualifications of trauma centers participation in trauma care system operating under certain professional guidelines a limitation subject to subparagraph the secretary not award a grant to an existing trauma center under this section unless the center is a participant in a trauma care system that substantially complies with section exemption subparagraph a shall not apply to trauma centers that are lo verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cated in states with no existing trauma care system designation the secretary not award a grant under this section to an existing trauma center unless the center is a verified as a trauma center by the american college of surgeons or designated as a trauma center by the applicable state health or emergency medical services authority considerations in making grants section usc d– is amended to read as follows sec considerations in making grants a core mission awards in general in awarding grants under section a the secretary shall a reserve a minimum of percent of the amount allocated for such grants for level iii and level iv trauma centers in rural or underserved areas reserve a minimum of percent of the amount allocated for such grants for level and level trauma centers in urban areas andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih give preference to any application made by a trauma center in a geographic area where growth in demand for trauma services exceeds capacity that demonstrates the financial support of the state or political subdivision involved iii that has at least graduate medical education fellowship in trauma or trauma related specialties including neurological surgery surgical critical care vascular surgery and spinal cord injury for which demand is exceeding supply or iv that demonstrates a substantial commitment to serving vulnerable populations financial support for purposes of paragraph financial support be demonstrated by state or political subdivision funding for the trauma center capital or operating expenses including through state trauma regional advisory coordination activities medicaid funding designated for trauma services or other governmental funding state funding derived from federal support shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not constitute state or local financial support for purposes of preferential treatment under this subsection use of funds the recipient of a grant under section a shall carry out consistent with furthering the core missions of the center one or more of the following activities a providing hour a day day aweek trauma care availability reducing overcrowding related to throughput of trauma patients enhancing trauma surge capacity ensuring physician and essential personnel availability trauma education and outreach coordination with local and regional trauma care systems such other activities as the secretary deem appropriate emergency awards new centers in awarding grants under paragraphs and of section the secretary shall give preference to any application submitted by an applicant that demonstrates the financial support in accordance with subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of the state or political subdivision involved for the activities to be funded through the grant for each fiscal year during which payments are made to the center under the grant and give preference to any application submitted for a trauma center that a is providing or will provide trauma care in a geographic area in which the availability of trauma care has either significantly decreased as a result of a trauma center in the area permanently ceasing participation in a system described in section as of a date occurring during the year period preceding the fiscal year for which the trauma center is applying to receive a grant or in geographic areas where growth in demand for trauma services exceeds capacity will in providing trauma care during the year period beginning on the date on which the application for the grant is submitted incur substantial uncompensated care costs in an amount that renders the center unable to continue participation in such system and results in a significant decrease in theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih availability of trauma care in the geographic area operates or will operate in rural areas where trauma care availability will significantly decrease if the center is forced to close or downgrade service and substantial costs are contributing to a likelihood of such closure or downgradation is in a geographic location substantially affected by a natural disaster or other catastrophic event such as a terrorist attack or will establish a new trauma service in an urban area with a substantial degree of trauma resulting from violent crimes designations of levels of trauma centers in certain states in the case of a state which has not designated levels of trauma centers any reference in this section to a level or level trauma center is deemed to be a reference to a trauma center within the highest levels of trauma centers designated under state guidelines and a level iii or iv trauma center is deemed to be a reference to a trauma center not within such highest levels verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih certain agreements section usc d– is amended to read as follows sec certain agreements a commitment regarding continued participation in trauma care system the secretary not award a grant to an applicant under section unless the applicant agrees that the trauma center involved will continue participation or in the case of a new center will participate in the system described in section except as provided in section throughout the grant period beginning on the date that the center first receives payments under the grant and if the agreement made pursuant to paragraph is violated by the center the center will be liable to the united states for an amount equal to the sum of a the amount of assistance provided to the center under section and an amount representing interest on the amount specified in subparagraph a maintenance of financial support with respect to activities for which funds awarded through a grant under section are authorized to be expended verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary not award such a grant unless the applicant agrees that during the period in which the trauma center involved is receiving payments under the grant the center will maintain access to trauma services at levels not less than the levels for the prior year taking into account reasonable volume fluctuation that is not caused by intentional trauma boundary reduction downgrading of the level of services and whether such center diverts its incoming patients away from such center percent or more of the time during which the center is in operation over the course of the year trauma care registry the secretary not award a grant to a trauma center under section unless the center agrees that not later than months after the date on which the center submits a grant application to the secretary the center will establish and operate a registry of trauma cases in accordance with guidelines developed by the american college of surgeons and in carrying out paragraph the center will maintain information on the number of trauma cases treated by the center and for each such case verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the extent to which the center incurs uncompensated costs in providing trauma care general provisions section usc d– is amended to read as follows sec general provisions a limitation on duration of support the period during which a trauma center receives payments under a grant under section shall be for fiscal years except that the secretary waive such requirement for the center and authorize the center to receive such payments for additional fiscal year eligibility the acquisition of or eligibility for a grant under section shall not preclude a trauma center eligibility for another grant described in such section funding distribution of the total amount appropriated for a fiscal year under section percent shall be used for grants under paragraph a of section and percent shall be used for grants under paragraphs and of section report beginning years after the date of the enactment of the affordable health care for america act and every years thereafter the secretary shall biennially verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih report to congress on the status of the grants made pursuant to section evaluate and report to congress on the overall financial stability of trauma centers in the united states report on the populations using trauma care centers and include aggregate patient data on income race ethnicity and geography and evaluate the effectiveness and efficiency of trauma care center activities using standard public health measures and evaluation methodologies authorization of appropriations section usc d– is amended to read as follows sec authorization of appropriations a in general for the purpose of carrying out this part there are authorized to be appropriated for fiscal year and such sums as be necessary for each of fiscal years through such authorization of appropriations is in addition to any other authorization of appropriations or amounts that are available for such purpose reallocation the secretary shall reallocate for grants under section a any funds appropriated for grants under paragraph or of sec verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion but not obligated due to insufficient applications eligible for funding sec emergency care coordination a in general subtitle of title xxviii usc hh– et seq is amended by adding at the end the following sec emergency care coordination a emergency care coordination center establishment the secretary shall establish within the office of the assistant secretary for preparedness and response an emergency care coordination center in this section referred to as the center to be headed by a director duties the secretary acting through the director of the center in coordination with the federal interagency committee on emergency medical services shall a promote and fund research in emergency medicine and trauma health care promote regional partnerships and more effective emergency medical systems in order to enhance appropriate triage distribution and care of routine community patients andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih promote local regional and state emergency medical systems preparedness for and response to public health events council of emergency care establishment the secretary acting through the director of the center shall establish a council of emergency care to provide advice and recommendations to the director on carrying out this section composition the council shall be comprised of employees of the departments and agencies of the federal government who are experts in emergency care and management report submission not later than months after the date of the enactment of the affordable health care for america act the secretary shall submit to the congress an annual report on the activities carried out under this section considerations in preparing a report under paragraph the secretary shall consider factors including a emergency department crowding and boarding and delays in care following presentationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through functions personnel assets liabilities and administrative actions all functions personnel assets and liabilities of and administrative actions applicable to the emergency care coordination center as in existence on the day before the date of the enactment of this act shall be transferred to the emergency care coordination center established under section a of the public health service act as added by subsection a sec pilot programs to improve emergency medical care part of title iii usc et seq is amended by inserting after section the following sec regionalized communication systems for emergency care response a in general the secretary acting through the assistant secretary for preparedness and response shall award not fewer than multiyear contracts or competitive grants to eligible entities to support demonstration programs that design implement and evaluate innovative models of regionalized comprehensive and accountable emergency care systemsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih eligible entity region eligible entity in this section the term eligible entity means a state or a partnership of or more states and or more local governments region in this section the term region means an area within a state an area that lies within multiple states or a similar area such as a multicounty area as determined by the secretary demonstration program the secretary shall award a contract or grant under subsection a to an eligible entity that proposes a demonstration program to design implement and evaluate an emergency medical system that coordinates with public safety services public health services emergency medical services medical facilities and other entities within a region coordinates an approach to emergency medical system access throughout the region including –– public safety answering points and emergency medical dispatch includes a mechanism such as a regional medical direction or transport communications system that operates throughout the region to ensure that the correct patient is taken to the medically ap verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih propriate facility whether an initial facility or a higher level facility in a timely fashion allows for the tracking of prehospital and hospital resources including inpatient bed capacity emergency department capacity on call specialist coverage ambulance diversion status and the coordination of such tracking with regional communications and hospital destination decisions and includes a consistent regionwide prehospital hospital and interfacility data management system that a complies with the national ems information system the national trauma data bank and others reports data to appropriate federal and state databanks and registries and contains information sufficient to evaluate key elements of prehospital care hospital destination decisions including initial hospital and interfacility decisions and relevant outcomes of hospital care application in general an eligible entity that seeks a contract or grant described in subsection a shall submit to the secretary an application at suchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih time and in such manner as the secretary require application information each application shall include a an assurance from the eligible entity that the proposed system has been coordinated with the applicable state office of emergency medical services or equivalent state office is compatible with the applicable state emergency medical services system iii includes consistent indirect and direct medical oversight of prehospital hospital and interfacility transport throughout the region iv coordinates prehospital treatment and triage hospital destination and interfacility transport throughout the region includes a categorization or designation system for special medical facilities throughout the region that is consistent with state laws and regulations andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih integrated with the protocols for transport and destination throughout the region and vi includes a regional medical direction system a patient tracking system and a resource allocation system that support day to day emergency care system operation can manage surge capacity during a major event or disaster and iii are integrated with other components of the national and state emergency preparedness system an agreement to make available non federal contributions in accordance with subsection and such other information as the secretary require matching funds in general with respect to the costs of the activities to be carried out each year with a contract or grant under subsection a a condition for the receipt of the contract or grant is that the eligible entity involved agrees to make available directly or through donations from public or private entities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih non federal contributions toward such costs in an amount that is not less than percent of such costs determination of amount contributed non federal contributions required in paragraph be in cash or in kind fairly evaluated including plant equipment or services amounts provided by the federal government or services assisted or subsidized to any significant extent by the federal government not be included in determining the amount of such non federal contributions priority the secretary shall give priority for the award of the contracts or grants described in subsection a to any eligible entity that serves a medically underserved population as defined in section report not later than days after the completion of a demonstration program under subsection a the recipient of such contract or grant described in subsing an identification of the impact of the regional accountable emergency care system on patient outcomes for varverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bill hr ious critical care categories such as trauma stroke cardiac emergencies and pediatric emergencies the system characteristics that contribute to the effectiveness and efficiency of the program or lack thereof methods of assuring the long term financial sustainability of the emergency care system the state and local legislation necessary to implement and to maintain the system and the barriers to developing regionalized accountable emergency care systems as well as the methods to overcome such barriers evaluation the secretary acting through the assistant secretary for preparedness and response shall enter into a contract with an academic institution or other entity to conduct an independent evaluation of the demonstration programs funded under subsection a including an evaluation of the performance of the eligible entities receiving the funds and the impact of the demonstration programs dissemination of findings the secretary shall as appropriate disseminate to the public and to the appropriate committees of the congress the information contained in a report made under subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorization of appropriations in general there is authorized to be appropriated to carry out this section for each of fiscal years through reservation of the amount appropriated to carry out this section for a fiscal year the secretary shall reserve percent of such amount to carry out subsection relating to an independent evaluation sec assisting veterans with military emergency medical training to become state licensed or certified emergency medical technicians emts a in general part of title iii usc et seq as amended is amended by inserting after section the following sec a assisting veterans with military emergency medical training to become state licensed or certified emergency medical technicians emts a program the secretary shall establish a program consisting of awarding grants to states to assist veterans who received and completed military emergency medical training while serving in the armed forces of the united states to become upon their discharge or releaseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih from active duty service state licensed or certified emergency medical technicians use of funds amounts received as a grant under this section be used to assist veterans described in subsection a to become state licensed or certified emergency medical technicians as follows providing training providing reimbursement for costs associated with a training or applying for licensure or certification expediting the licensing or certification process eligibility to be eligible for a grant under this section a state shall demonstrate to the secretary satisfaction that the state has a shortage of emergency medical technicians report the secretary shall submit to the congress an annual report on the program under this section authorization of appropriations to carry out this section there are authorized to be appropriated such sums as be necessary for each of fiscal years through verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gao study and report the comptroller general of the united states shall conduct a study on the barriers experienced by veterans who received training as medical personnel while serving in the armed forces of the united states and upon their discharge or release from active duty service seek to become licensed or certified in a state as civilian health professionals and not later than years after the date of the enactment of this act submit to the congress a report on the results of such study including recommendations on whether the program established under section a of the public health service act as added by subsection a should be expanded to assist veterans seeking to become licensed or certified in a state as health providers other than emergency medical technicians sec dental emergency responders public health and medical response a national health security strategy section usc hh– is amended in the matter preceding subparagraph a by inserting dental and before mental health facilities andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in subparagraph by inserting and dental after medical all hazards public health and medical response curricula and training section a usc d– a is amended by striking public health or medical and inserting public health medical or dental sec dental emergency responders homeland security a national response framework paragraph of section of the homeland security act of usc is amended by inserting and dental after emergency medical national preparedness system subparagraph of section of the post katrina emergency management reform act of usc is amended by striking public health and medical and inserting public health medical and dental chief medical officer paragraph of section of the homeland security act of usc is amended by striking medical community and inserting medical and dental communities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih part pain care and management programs sec institute of medicine conference on pain a convening not later than june the secretary of health and human services shall seek to enter into an agreement with the institute of medicine of the national academies to convene a conference on pain in this section referred to as the conference purposes the purposes of the conference shall be to increase the recognition of pain as a significant public health problem in the united states evaluate the adequacy of assessment diagnosis treatment and management of acute and chronic pain in the general population and in identified racial ethnic gender age and other demographic groups that be disproportionately affected by inadequacies in the assessment diagnosis treatment and management of pain identify barriers to appropriate pain care including a lack of understanding and education among employers patients health care providers regulators and third party payors verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih barriers to access to care at the primary specialty and tertiary care levels including barriers specific to those populations that are disproportionately undertreated for pain related to physician concerns over regulatory and law enforcement policies applicable to some pain therapies and iii attributable to benefit coverage and payment policies in both the public and private sectors and gaps in basic and clinical research on the symptoms and causes of pain and potential assessment methods and new treatments to improve pain care and establish an agenda for action in both the public and private sectors that will reduce such barriers and significantly improve the state of pain care research education and clinical care in the united states other appropriate entity if the institute of medicine declines to enter into an agreement under subsection a the secretary of health and human servicesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih enter into such agreement with another appropriate entity report a report summarizing the conference findings and recommendations shall be submitted to the congress not later than june authorization of appropriations for the purpose of carrying out this section there is authorized to be appropriated for each of fiscal years and sec pain research at national institutes of health part of title iv usc et seq is amended by adding at the end the following sec pain research a research initiatives in general the director of nih is encouraged to continue and expand through the pain consortium an aggressive program of basic and clinical research on the causes of and potential treatments for pain annual recommendations not less than annually the pain consortium in consultation with the division of program coordination planning and strategic initiatives shall develop and submit to the director of nih recommendations onverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih appropriate pain research initiatives that could be undertaken with funds reserved under section a for the common fund or otherwise available for such initiatives definition in this subsection the term pain consortium means the pain consortium of the national institutes of health or a similar trans national institutes of health coordinating entity designated by the secretary for purposes of this subsection interagency pain research coordinating committee establishment the secretary shall establish not later than year after the date of the enactment of this section and as necessary maintain a committee to be known as the interagency pain research coordinating committee in this section referred to as the committee to coordinate all efforts within the department of health and human services and other federal agencies that relate to pain research membership a in general the committee shall be composed of the following voting members verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not more than voting federal representatives as follows the director of the centers for disease control and prevention the director of the national institutes of health and the directors of such national research institutes and national centers as the secretary determines appropriate iii the heads of such other agencies of the department of health and human services as the secretary determines appropriate iv representatives of other federal agencies that conduct or support pain care research and treatment including the department of defense and the department of veterans affairs twelve additional voting members appointed under subparagraph additional members the committee shall include additional voting members appointed by the secretary as follows verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih six members shall be appointed from among scientists physicians and other health professionals who are not officers or employees of the united states represent multiple disciplines including clinical basic and public health sciences iii represent different geographical regions of the united states and iv are from practice settings academia manufacturers or other research settings six members shall be appointed from members of the general public who are representatives of leading research advocacy and service organizations for individuals with pain related conditions nonvoting members the committee shall include such nonvoting members as the secretary determines to be appropriate chairperson the voting members of the committee shall select a chairperson from among such members the selection of a chairpersonverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall be subject to the approval of the director of nih meetings the committee shall meet at the call of the chairperson of the committee or upon the request of the director of nih but in no case less often than once each year duties the committee shall a develop a summary of advances in pain care research supported or conducted by the federal agencies relevant to the diagnosis prevention and treatment of pain and diseases and disorders associated with pain identify critical gaps in basic and clinical research on the symptoms and causes of pain make recommendations to ensure that the activities of the national institutes of health and other federal agencies including the department of defense and the department of veteran affairs are free of unnecessary duplication of effort make recommendations on how best to disseminate information on pain care and make recommendations on how to expand partnerships between public entities in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cluding federal agencies and private entities to expand collaborative crosscutting research review the secretary shall review the necessity of the committee at least once every years sec public awareness campaign on pain management part of title usc et seq is amended by adding at the end the following sec national education outreach and awareness campaign on pain management a establishment not later than months after the date of the enactment of this section the secretary shall establish and implement a national pain care education outreach and awareness campaign described in subsection requirements the secretary shall design the public awareness campaign under this section to educate consumers patients their families and other caregivers with respect to the incidence and importance of pain as a national public health problem the adverse physical psychological emotional societal and financial consequences that canverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih result if pain is not appropriately assessed diagnosed treated or managed the availability benefits and risks of all pain treatment and management options having pain promptly assessed appropriately diagnosed treated and managed and regularly reassessed with treatment adjusted as needed the role of credentialed pain management specialists and subspecialists and of comprehensive interdisciplinary centers of treatment expertise the availability in the public nonprofit and private sectors of pain management related information services and resources for consumers employers third party payors patients their families and caregivers including information on a appropriate assessment diagnosis treatment and management options for all types of pain and pain related symptoms and conditions for which no treatment options are yet recognized and other issues the secretary deems appropriate consultation in designing and implementing the public awareness campaign required by this section the secretary shall consult with organizations rep verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih resenting patients in pain and other consumers employers physicians including physicians specializing in pain care other pain management professionals medical device manufacturers and pharmaceutical companies coordination lead official the secretary shall designate one official in the department of health and human services to oversee the campaign established under this section agency coordination the secretary shall ensure the involvement in the public awareness campaign under this section of the surgeon general of the public health service the director of the centers for disease control and prevention and such other representatives of offices and agencies of the department of health and human services as the secretary determines appropriate underserved areas and populations in designing the public awareness campaign under this section the secretary shall take into account the special needs of geographic areas and racial ethnic gender age and other demographic groups that are currently underserved andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provide resources that will reduce disparities in access to appropriate diagnosis assessment and treatment grants and contracts the secretary make awards of grants cooperative agreements and contracts to public agencies and private nonprofit organizations to assist with the development and implementation of the public awareness campaign under this section evaluation and report not later than the end of fiscal year the secretary shall prepare and submit to the congress a report evaluating the effectiveness of the public awareness campaign under this section in educating the general public with respect to the matters described in subsection authorization of appropriations for purposes of carrying out this section there are authorized to be appropriated for fiscal year and for each of fiscal years and subtitle food and drug administration part in general sec national medical device registry a registry verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general section of the federal food drug and cosmetic act usc is amended a by redesignating subsection as subsection and by inserting after subsection the following national medical device registry a 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 covered device in this subsection the term covered device shall include each class iii device and include as the secretary determines appropriate and specifies in regulation a class device that is life supporting or life sustaining notwithstanding subparagraph the secretary by order exempt a class iii device from the provisions of this subsection if the secretary concludes that inclusion of information on the device in the registry will not provide useful information on safety or effectiveness in developing the registry the secretary shall in consultation with the commissioner of food and drugs verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the administrator of the centers for medicare medicaid services the administrator of the agency for healthcare research and quality 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 appropriate information to identify each covered device by type model and serial number or other unique identifier 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 data provided to the secretary under other provisions of this chapter and information from public and private sources identified under paragraph integrating the activities described in this subsection so as to avoid duplication with activities under paragraph of section relating to active postmarket risk identification verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih activities under paragraph of section relating to advanced analysis of drug safety data iii other postmarket device surveillance activities of the secretary authorized by this chapter and iv registries carried out by or for the agency for healthcare research and quality and 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 a to facilitate analyses of postmarket safety and patient outcomes for covered devices the secretary shall in collaboration with public academic and private entities develop methods to obtain access to disparate sources of patient safety and outcomes data including federal health related electronic data such as data from the medicare program under title xviii of the social secu verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih rity act or from the health systems of the department of veterans affairs 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 link data obtained under clause with information in the registry in this paragraph the term data refers to information respecting a covered device 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 the secretary shall promulgate regulations for establishment and operation of the registry under paragraph such regulations a in the case of covered devices that are sold on or after the date of the enactment of this subsection shall require manufacturers of such devices to submit information to the registry includ verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ing for each such device the type model and serial number or if required under subsection other unique device identifier and in the case of covered devices that are sold before such date require manufacturers of such devices to submit such information to the registry if deemed necessary by the secretary to protect the public health shall establish procedures to permit linkage of information submitted pursuant to subparagraph a with patient safety and outcomes data obtained under paragraph and to permit analyses of linked data require covered device manufacturers to submit such other information as is necessary to facilitate postmarket assessments of device safety and effectiveness and notification of device risks 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 includeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih data on comparative safety and outcomes trends and 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 a the secretary shall promulgate final regulations under paragraph not later than months after the date of the enactment of this subsection before issuing the notice of proposed rulemaking preceding the final regulations described in subparagraph a the secretary shall hold a public hearing before an advisory committee on the issue of which class devices to include in the definition of covered devices the secretary shall include in any regulation under this subsection an explanation demonstrating that the requirements of such regulation do not duplicate other federal requirements and do not impose an undue burden on device manufacturers with respect to any entity that submits or is required to submit a safety report or other informationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in connection with the safety of a device under this section and any release by the secretary of that report or information such report or information shall not be construed to reflect necessarily a conclusion by the entity or the secretary that the report or information constitutes an admission that the product involved malfunctioned caused or contributed to an adverse experience or otherwise caused or contributed to a death serious injury or serious illness such an entity need not admit and deny that the report or information submitted by the entity constitutes an admission that the product involved malfunctioned caused or contributed to an adverse experience or caused or contributed to a death serious injury or serious illness to carry out this subsection there are authorized to be appropriated such sums as be necessary for each of fiscal years and effective date the secretary of health and human services shall establish and begin implementation of the registry under section of the federal food drug and cosmetic act as added by paragraph by not later than the date that is 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 dateverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conforming amendment section of the federal food drug and cosmetic act usc is amended by striking and inserting electronic exchange and use in certified electronic health records of unique device identifiers recommendations the hit policy committee established under section of the public health service act usc jj– 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 covered device as defined under section of the federal food drug and cosmetic act as added by subsection a standards implementation criteria and certification criteria the secretary of health and human services acting through the head of the office of the national coordinator for health information technology shall adopt standards implementation specifications and certificationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih criteria for the electronic exchange and use in certified electronic health records of a unique device identifier for each covered device referred to in paragraph if such an identifier is required by section of the federal food drug and cosmetic act usc for the device unique device identification system the secretary of health and human services acting through the commissioner of food and drugs shall issue proposed regulations to implement section of the federal food drug and cosmetic act usc not later than months after the date of the enactment of this act sec nutrition labeling of standard menu items at chain restaurants and of articles of food sold from vending machines a technical amendments section a of the federal food drug and cosmetic act usc a is amended in subclause by inserting except as provided in clause iii after and in subclause by inserting except as provided in clause iii after verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih labeling requirements section of the federal food drug and cosmetic act usc is amended by adding at the end the following restaurants retail food establishments and vending machines general requirements for restaurants and similar retail food establishments except for food described in subclause vii in the case of food that is a standard menu item that is offered for sale in a restaurant or similar retail food establishment that is part of a chain with or more locations doing business under the same name regardless of the type of ownership of the locations and offering for sale substantially the same menu items the restaurant or similar retail food establishment shall disclose the information described in subclauses and iii information required to be disclosed by restaurants and retail food establishments except as provided in subclause vii the restaurant or similar retail food establishment shall disclose in a clear and conspicuous manner aa in a nutrient content disclosure statement adjacent to the name of the standardverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih menu item so as to be clearly associated with the standard menu item on the menu listing the item for sale the number of calories contained in the standard menu item as usually prepared and offered for sale and bb a succinct statement concerning suggested daily caloric intake as specified by the secretary by regulation and posted prominently on the menu and designed to enable the public to understand in the context of a total daily diet the significance of the caloric information that is provided on the menu aa in a nutrient content disclosure statement adjacent to the name of the standard menu item so as to be clearly associated with the standard menu item on the menu board including a drive through menu board the number of calories contained in the standard menu item as usually prepared and offered for sale and bb a succinct statement concerning suggested daily caloric intake as specified by the secretary by regulation and posted prominently on the menu board designed to enable the public to understand in the context of a total dailyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih diet the significance of the nutrition information that is provided on the menu board iii in a written form available on the premises of the restaurant or similar retail establishment and to the consumer upon request the nutrition information required under clauses and of subparagraph and iv on the menu or menu board a prominent clear and conspicuous statement regarding the availability of the information described in item iii iii self service food and food on display except as provided in subclause vii in the case of food sold at a salad bar buffet line cafeteria line or similar self service facility and for self service beverages or food that is on display and that is visible to customers a restaurant or similar retail food establishment shall place adjacent to each food offered a sign that lists calories per displayed food item or per serving iv reasonable basis for the purposes of this clause a restaurant or similar retail food establishment shall have a reasonable basis for its nutrient content disclosures including nutrient databases cookbooks laboratory analyses and other reasonableverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih means as described in section of title code of federal regulations or any successor regulation or in a related guidance of the food and drug administration menu variability and combination meals the secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors varieties or combinations but which are listed as a single menu item such as soft drinks ice cream pizza doughnuts or children combination meals through means determined by the secretary including ranges averages or other methods vi additional information if the secretary determines that a nutrient other than a nutrient required under subclause iii should be disclosed for the purpose of providing information to assist consumers in maintaining healthy dietary practices the secretary require by regulation disclosure of such nutrient in the written form required under subclause iii vii nonapplicability to certain food in general subclauses through vi do not apply to verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih aa items that are not listed on a menu or menu board such as condiments and other items placed on the table or counter for general use bb daily specials temporary menu items appearing on the menu for less than days per calendar year or custom orders or cc such other food that is part of a customary market test appearing on the menu for less than days under terms and conditions established by the secretary written forms clause shall apply to any regulations promulgated under subclauses iii and vi viii vending machines in the case of an article of food sold from a vending machine that does not permit a prospective purchaser to examine the nutrition facts panel before purchasing the article or does not otherwise provide visible nutrition information at the point of purchase andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is operated by a person who is engaged in the business of owning or operating or more vending machines the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories contained in the article ix voluntary provision of nutrition information in general an authorized official of any restaurant or similar retail food establishment or vending machine operator not subject to the requirements of this clause elect to be subject to the requirements of such clause by registering biannually the name and address of such restaurant or similar retail food establishment or vending machine operator with the secretary as specified by the secretary by regulation registration within days of the enactment of this clause the secretary shal publish a notice in the federal register specifying the terms and conditions for implementa verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills tion of item pending promulgation of regulations iii rule of construction nothing in this subclause shall be construed to authorize the secretary to require an application review or licensing process for any entity to register with the secretary as described in such item regulations proposed regulation not later than year after the date of the enactment of this clause the secretary shall promulgate proposed regulations to carry out this clause contents in promulgating regulations the secretary shall aa consider standardization of recipes and methods of preparation reasonable variation in serving size and formulation of menu items space on menus and menu boards inadvertent human error training of food service workers variations in ingredients and other factors as the secretary determines and bb specify the format and manner of the nutrient content disclosure requirements under this subclauseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii reporting the secretary shall submit to the committee on health education labor and pensions of the senate and the committee on energy and commerce of the house of representatives a quarterly report that describes the secretary progress toward promulgating final regulations under this subparagraph xi definition in this clause the term menu or menu board means the primary writing of the restaurant or other similar retail food establishment from which a consumer makes an order selection national uniformity section a a of the federal food drug and cosmetic act usc – a is amended by striking except a requirement for nutrition labeling of food which is exempt under subclause or of section a and inserting except that this paragraph does not apply to food that is offered for sale in a restaurant or similar retail food establishment that is not part of a chain with or more locations doing business under the same name regardless of the type of ownership of the locations and offering for sale substantially the same menu items unless such restaurant or similar retail food establishment complies withverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the voluntary provision of nutrition information requirements under section ix rule of construction nothing in the amendments made by this section shall be construed to preempt any provision of state or local law unless such provision establishes or continues into effect nutrient content disclosures of the type required under section of the federal food drug and cosmetic act as added by subsection and is expressly preempted under section a a of such act to apply to any state or local requirement respecting a statement in the labeling of food that provides for a warning concerning the safety of the food or component of the food or except as provided in section ix of the federal food drug and cosmetic act as added by subsection to apply to any restaurant or similar retail food establishment other than a restaurant or similar retail food establishment described in section of such act sec protecting consumer access to generic drugs a findings purpose verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih findings the congress finds the following a in the drug price competition and patent term restoration act pub – in this subsection referred to as the act was enacted with the intent of facilitating the early entry of generic drugs while preserving incentives for innovation prescription drugs make up percent of national health care spending but for the past decade have been one of the fastest growing segments of health care expenditures until recently the act was successful in facilitating generic competition to the benefit of consumers and health care payers although percent of all prescriptions dispensed in the united states are generic drugs they account for only percent of all expenditures in recent years the intent of the act has been subverted by certain settlement agreements between brand companies and their potential generic competitors that make reverse payments ie payments by the brand company to the generic companyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih these settlement agreements have unduly delayed the marketing of low cost generic drugs contrary to free competition and the interests of consumers the state of antitrust law relating to such settlement agreements is unsettled purpose the purpose of this section is to provide an additional means to effectuate the intent of the act by enhancing competition in the pharmaceutical market by stopping agreements between brand name and generic drug manufacturers that limit delay or otherwise prevent competition from generic drugs in general section of the federal food drug and cosmetic act usc is amended by adding at the end the following protecting consumer access to generic drugs unfair and deceptive acts and practices related to new drug applications a conduct prohibited it shall be unlawful for any person to directly or indirectly be a party to any agreement resolving or settling a patent infringement claim in which verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an anda filer receives anything of value and the anda filer agrees to limit or forego research development manufacturing marketing or sales for any period of time of the drug that is to be manufactured under the anda involved and is the subject of the patent infringement claim exceptions notwithstanding subparagraph a subparagraph a does not prohibit a resolution or settlement of a patent infringement claim in which the value received by the anda filer includes no more than the right to market the drug that is to be manufactured under the anda involved and is the subject of the patent infringement claim before the expiration of the patent that is the basis for the patent infringement claim or any other statutory exclusivity that would prevent the marketing of such drug andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the waiver of a patent infringement claim for damages based on prior marketing of such drug enforcement in general a violation of subparagraph a shall be treated as an unfair and deceptive act or practice and an unfair method of competition in or affecting interstate commerce prohibited under section of the federal trade commission act and shall be enforced by the federal trade commission in the same manner by the same means and with the same jurisdiction as though all applicable terms and provisions of the federal trade commission act were incorporated into and made a part of this subsection inapplicability subchapter a of chapter vii shall not apply with respect to this subsection definitions in this subsection agreement the term agreement means anything that would constitute an agreement under section of the federal trade commission actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agreement resolving or settling the term agreement resolving or settling in reference to a patent infringement claim includes any agreement that is contingent upon provides a contingent condition for or is otherwise related to the resolution or settlement of the claim iii anda the term anda means an abbreviated new drug application for the approval of a new drug under section iv anda filer the term anda filer means a party that has filed an anda with the food and drug administration patent infringement the term patent infringement means infringement of any patent or of any filed patent application extension reissuance renewal division continuation continuation in part reexamination patent term restoration patent of addition or extension thereof vi patent infringement claim the term patent infringement claim means any allegation made to anverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih anda filer whether or not included in a complaint filed with a court of law that its anda or drug to be manufactured under such anda infringe any patent ftc rulemaking the federal trade commission by rule promulgated under section of title united states code exempt certain agreements described in paragraph from the requirements of this subsection if the commission finds such agreements to be in furtherance of market competition and for the benefit of consumers consistent with the authority of the commission such rules include interpretive rules and general statements of policy with respect to the practices prohibited under paragraph notice and certification of agreements notice of all agreements section of the medicare prescription drug improvement and modernization act of usc note is amended by a striking the commission the and inserting the following the commission a the striking the period at the end and inserting and andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih adding at the end the following any other agreement the parties enter into within days of entering into an agreement covered by subsection a or certification of agreements section of such act is amended by adding at the end the following certification the chief executive officer or the company official responsible for negotiating any agreement required to be filed under subsection a or shall execute and file with the assistant attorney general and the commission a certification as follows declare under penalty of perjury that the following is true and correct the materials filed with the federal trade commission and the department of justice under section of subtitle of title xi of the medicare prescription drug improvement and modernization act of with respect to the agreement referenced in this certification represent the complete final and exclusive agreement between the parties include any ancillary agreements that are contingent upon provide a contingent condition for or are otherwise related to the referenced agreement and include written descriptions of any oral agreements representations commitments or promises between the parties that are responsive to subsection a orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of such section and have not been reduced to writing gao study study beginning years after the date of enactment of this act and each year for a period of years thereafter the comptroller general shall conduct a study on the litigation in united states courts during the period beginning years prior to the date of enactment of this act relating to patent infringement claims involving generic drugs the number of patent challenges initiated by manufacturers of generic drugs and the number of settlements of such litigation the comptroller general shall transmit to congress a report of the findings of such a study and an analysis of the effect of the amendments made by subsections and on such litigation whether such amendments have had an effect on the number and frequency of claims settled and whether such amendments resulted in earlier or delayed entry of generic drugs to market including whether any harm or benefit to consumers has resulted disclosure of agreements notwithstanding any other law agreements filed under section of the medicare prescription drug im verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provement and modernization act of usc note or unaggregated information from such agreements shall be disclosed to the comptroller general for purposes of the study under paragraph within days of a request by the comptroller general part biosimilars sec licensure pathway for biosimilar biological products a licensure of biological products as biosimilar or interchangeable section of the public health service act usc is amended in subsection a a by inserting under this subsection or subsection after biologics license and by adding at the end the following licensure of biological products as biosimilar or interchangeable in general any person submit an application for licensure of a biological product under this subsection content a in general required information an application submitted under this subsectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall include information demonstrating that the biological product is biosimilar to a reference product based upon data derived from aa analytical studies that demonstrate that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components bb animal studies including the assessment of toxicity and cc a clinical study or studies including the assessment of immunogenicity and pharmacokinetics or pharmacodynamics that are sufficient to demonstrate safety purity and potency in or more appropriate conditions of use for which the reference product is licensed and intended to be usedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and for which licensure is sought for the biological product the biological product and reference product utilize the same mechanism or mechanisms of action for the condition or conditions of use prescribed recommended or suggested in the proposed labeling but only to the extent the mechanism or mechanisms of action are known for the reference product iii the condition or conditions of use prescribed recommended or suggested in the labeling proposed for the biological product have been previously approved for the reference product iv the route of administration the dosage form and the strength of the biological product are the same as those of the reference product and the facility in which the biological product is manufactured processed packed or held meets stand verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ards designed to assure that the biological product continues to be safe pure and potent determination by secretary the secretary determine in the secretary discretion that an element described in clause is unnecessary in an application submitted under this subsection iii additional information an application submitted under this subsection shall include publicly available information regarding the secretary previous determination that the reference product is safe pure and potent and include any additional information in support of the application including publicly available information with respect to the reference product or another biological product interchangeability an application or a supplement to an application submitted under this subsection include infor verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mation demonstrating that the biological product meets the standards described in paragraph evaluation by secretary upon review of an application or a supplement to an application submitted under this subsection the secretary shall license the biological product under this subsection if a the secretary determines that the information submitted in the application or the supplement is sufficient to show that the biological product is biosimilar to the reference product or meets the standards described in paragraph and therefore is interchangeable with the reference product and the applicant or other appropriate person consents to the inspection of the facility that is the subject of the application in accordance with subsection safety standards for determining interchangeability upon review of an application submitted under this subsection or any supplement to such application the secretary shall deter verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mine the biological product to be interchangeable with the reference product if the secretary determines that the information submitted in the application or a supplement to such application is sufficient to show that a the biological product is biosimilar to the reference product and can be expected to produce the same clinical result as the reference product in any given patient and for a biological product that is administered more than once to an individual the risk in terms of safety or diminished efficacy of alternating or switching between use of the biological product and the reference product is not greater than the risk of using the reference product without such alternation or switch general rules a one reference product per application a biological product in an application submitted under this subsection not be evaluated against more than reference productverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih review an application submitted under this subsection shall be reviewed by the division within the food and drug administration that is responsible for the review and approval of the application under which the reference product is licensed risk evaluation and mitigation strategies the authority of the secretary with respect to risk evaluation and mitigation strategies under the federal food drug and cosmetic act shall apply to biological products licensed under this subsection in the same manner as such authority applies to biological products licensed under subsection a restrictions on biological products containing dangerous ingredients if information in an application submitted under this subsection in a supplement to such an application or otherwise available to the secretary shows that a biological product is bears or contains a select agent or toxin listed in section or of title section or of title or section of title code ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih federal regulations or any successor regulations or is bears or contains a controlled substance in schedule or of section of the controlled substances act as listed in part of title code of federal regulations or any successor regulations the secretary shall not license the biological product under this subsection unless the secretary determines after consultation with appropriate national security and drug enforcement agencies that there would be no increased risk to the security or health of the public from licensing such biological product under this subsection exclusivity for first interchangeable biological product upon review of an application submitted under this subsection relying on the same reference product for which a prior biological product has received a determination of interchangeability for any condition of use the secretary shall not make a determination under paragraph that the second or subsequent biological product isverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih interchangeable for any condition of use until the earlier of a year after the first commercial marketing of the first interchangeable biosimilar biological product to be approved as interchangeable for that reference product months after a final court decision on all patents in suit in an action instituted under subsection against the applicant that submitted the application for the first approved interchangeable biosimilar biological product or the dismissal with or without prejudice of an action instituted under subsection against the applicant that submitted the application for the first approved interchangeable biosimilar biological product or months after approval of the first interchangeable biosimilar biological product if the applicant that submitted such application has been sued under subsection and such litigation is still ongoing within such month period orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih months after approval of the first interchangeable biosimilar biological product if the applicant that submitted such application has not been sued under subsection for purposes of this paragraph the term final court decision means a final decision of a court from which no appeal other than a petition to the united states supreme court for a writ of certiorari has been or can be taken exclusivity for reference product a effective date of biosimilar application approval approval of an application under this subsection not be made effective by the secretary until the date that is years after the date on which the reference product was first licensed under subsection a filing period an application under this subsection not be submitted to the secretary until the date that is years after the date on which the reference product was first licensed under subsection a first licensure subparagraphs a and shall not apply to a license for or approval of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a supplement for the biological product that is the reference product or a subsequent application filed by the same sponsor or manufacturer of the biological product that is the reference product or a licensor predecessor in interest or other related entity for a change not including a modification to the structure of the biological product that results in a new indication route of administration dosing schedule dosage form delivery system delivery device or strength or a modification to the structure of the biological product that does not result in a change in safety purity or potency pediatric studies a exclusivity if before or after licensure of the reference product under subsection a of this section the secretary determines that information relating to the use of such product in the pediatric population produce health benefits in that population the secretary makes a written request for pediatricverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih studies which shall include a timeframe for completing such studies the applicant or holder of the approved application agrees to the request such studies are completed using appropriate formulations for each age group for which the study is requested within any such timeframe and the reports thereof are submitted and accepted in accordance with section a of the federal food drug and cosmetic act the period referred to in paragraph a of this subsection is deemed to be years and months rather than years exception the secretary shall not extend the period referred to in subparagraph a of this paragraph if the determination under section a of the federal food drug and cosmetic act is made later than months prior to the expiration of such period application of certain provisions the provisions of subsections a and of section a of the federal food drug and cosmetic act shall apply with respect to the extension of a period under subparagraph a of this para verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih graph to the same extent and in the same manner as such provisions apply with respect to the extension of a period under subsection or of section a of the federal food drug and cosmetic act guidance documents a in general the secretary after opportunity for public comment issue guidance in accordance except as provided in subparagraph with section of the federal food drug and cosmetic act with respect to the licensure of a biological product under this subsection any such guidance be general or specific public comment in general the secretary shall provide the public an opportunity to comment on any proposed guidance issued under subparagraph a before issuing final guidance input regarding most valuable guidance the secretary shall establish a process through which the public provide the secretary with input regarding priorities for issuing guidanceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih no requirement for application consideration the issuance or nonissuance of guidance under subparagraph a shall not preclude the review of or action on an application submitted under this subsection requirement for product classspecific guidance if the secretary issues product class specific guidance under subparagraph a such guidance shall include a description of the criteria that the secretary will use to determine whether a biological product is highly similar to a reference product in such product class and the criteria if available that the secretary will use to determine whether a biological product meets the standards described in paragraph certain product classes guidance the secretary indicate in a guidance document that the science and experience as of the date of such guidance with respect to a product or product class not including any recombinant protein does not allow approval ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an application for a license as provided under this subsection for such product or product class modification or reversal the secretary issue a subsequent guidance document under subparagraph a to modify or reverse a guidance document under clause iii no effect on ability to deny license clause shall not be construed to require the secretary to approve a product with respect to which the secretary has not indicated in a guidance document that the science and experience as described in clause does not allow approval of such an application naming the secretary shall ensure that the labeling and packaging of each biological product licensed under this subsection bears a name that uniquely identifies the biological product and distinguishes it from the reference product and any other biological products licensed under this subsection following evaluation against such reference productverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih patent notices relationship to final approval definitions for the purposes of this subsection the term a biosimilar product means the biological product that is the subject of the application under subsection relevant patent means a patent that expires after the date specified in subsection a that applies to the reference product and could reasonably be asserted against the applicant due to the unauthorized making use sale or offer for sale within the united states or the importation into the united states of the biosimilar product or materials used in the manufacture of the biosimilar product or due to a use of the biosimilar product in a method of treatment that is indicated in the application reference product sponsor means the holder of an approved application or license for the reference product andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih interested third party means a person other than the reference product sponsor that owns a relevant patent or has the right to commence or participate in an action for infringement of a relevant patent handling of confidential information any entity receiving confidential information pursuant to this subsection shall designate one or more individuals to receive such information each individual so designated shall execute an agreement in accordance with regulations promulgated by the secretary the regulations shall require each such individual to take reasonable steps to maintain the confidentiality of information received pursuant to this subsection and use the information solely for purposes authorized by this subsection the obligations imposed on an individual who has received confidential information pursuant to this subsection shall continue until the individual returns or destroys the confidential information a court imposes a protective order that governs the use or handling of the confidential information or the party providing the confidential information agrees to other terms or conditions regarding the handling or use of the confidential informationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih public notice by secretary within days of acceptance by the secretary of an application filed under subsection the secretary shall publish a notice identifying a the reference product identified in the application and the name and address of an agent designated by the applicant to receive notices pursuant to paragraph exchanges concerning patents a exchanges with reference product sponsor within days of the date of acceptance of the application by the secretary the applicant shall provide the reference product sponsor with a copy of the application and information concerning the biosimilar product and its production this information shall include a detailed description of the biosimilar product its method of manufacture and the materials used in the manufacture of the product within days of the date of receipt of the information required to be provided under clause the reference prod verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih uct sponsor shall provide to the applicant a list of relevant patents owned by the reference product sponsor or in respect of which the reference product sponsor has the right to commence an action of infringement or otherwise has an interest in the patent as such patent concerns the biosimilar product iii if the reference product sponsor is issued or acquires an interest in a relevant patent after the date on which the reference product sponsor provides the list required by clause to the applicant the reference product sponsor shall identify that patent to the applicant within days of the date of issue of the patent or the date of acquisition of the interest in the patent as applicable exchanges with interested third parties at any time after the date on which the secretary publishes a notice for an application under paragraph any interested third party provide notice to the designated agent of the applicantverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih that the interested third party owns or has rights under or more patents that be relevant patents the notice shall identify at least patent and shall designate an individual who has executed an agreement in accordance with paragraph to receive confidential information from the applicant within days of the date of receiving notice pursuant to clause the applicant shall send to the individual designated by the interested third party the information specified in subparagraph a unless the applicant and interested third party otherwise agree iii within days of the date of receiving information pursuant to clause the interested third party shall provide to the applicant a list of relevant patents which the interested third party owns or in respect of which the interested third party has the right to commence or participate in an action for infringement iv if the interested third party is issued or acquires an interest in a relevantverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih patent after the date on which the interested third party provides the list required by clause iii the interested third party shall identify that patent within days of the date of issue of the patent or the date of acquisition of the interest in the patent as applicable identification of basis for infringement for any patent identified under clause or iii of subparagraph a or under clause iii or iv of subparagraph the reference product sponsor or the interested third party as applicable shall explain in writing why the sponsor or the interested third party believes the relevant patent would be infringed by the making use sale or offer for sale within the united states or importation into the united states of the biosimilar product or by a use of the biosimilar product in treatment that is indicated in the application specify whether the relevant patent is available for licensing andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii shall specify the number and date of expiration of the relevant patent certification by applicant concerning identified relevant patents not later than days after the date on which a patent is identified under clause or iii of subparagraph a or under clause iii or iv of subparagraph the applicant shall send a written statement regarding each identified patent to the party that identified the patent such statement shall either state that the applicant will not commence marketing of the biosimilar product and has requested the secretary to not grant final approval of the application before the date of expiration of the noticed patent or provide a detailed written explanation setting forth the reasons why the applicant believes the making use sale or offer for sale within the united states or the importation into the united states of the biosimilar product or the use of the biosimilar prod verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih uct in a treatment indicated in the application would not infringe the patent or the patent is invalid or unenforceable action for infringement involving reference product sponsor if an action for infringement concerning a relevant patent identified by the reference product sponsor under clause or iii of paragraph a or by an interested third party under clause iii or iv of paragraph is brought within days of the date of receipt of a statement under paragraph and the court in which such action has been commenced determines the patent is infringed prior to the date applicable under subsection a or the secretary shall make approval of the application effective on the day after the date of expiration of the patent that has been found to be infringed if more than one such patent is found to be infringed by the court the approval of the application shall be made effective on the day after the date that the last such patent expires notification of agreements a requirements verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agreement between biosimilar product applicant and reference product sponsor if a biosimilar product applicant under subsection and the reference product sponsor enter into an agreement described in subparagraph the applicant and sponsor shall each file the agreement in accordance with subparagraph agreement between biosimilar product applicants if or more biosimilar product applicants submit an application under subsection for biosimilar products with the same reference product and enter into an agreement described in subparagraph the applicants shall each file the agreement in accordance with subparagraph subject matter of agreement an agreement described in this subparagraph is an agreement between the biosimilar product applicant under subsection and the reference product sponsor or between or more biosimilar product ap verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih plicants under subsection regarding the manufacture marketing or sale of the biosimilar product or biosimilar products for which an application was submitted or the reference product includes any agreement between the biosimilar product applicant under subsection and the reference product sponsor or between or more biosimilar product applicants under subsection that is contingent upon provides a contingent condition for or otherwise relates to an agreement described in clause and iii excludes any agreement that solely concerns purchase orders for raw material supplies equipment and facility contracts iii employment or consulting contracts or iv packaging and labeling contracts filing verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general the text of an agreement required to be filed by subparagraph a shall be filed with the assistant attorney general and the federal trade commission not later than business days after the date on which the agreement is executed and prior to the date of the first commercial marketing of for agreements described in subparagraph a the biosimilar product that is the subject of the application or for agreements described in subparagraph a any biosimilar product that is the subject of an application described in such subparagraph if agreement not reduced to text if an agreement required to be filed by subparagraph a has not been reduced to text the persons required to file the agreement shall each file written descriptions of the agreement that are sufficient to disclose all the terms and conditions of the agreementverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii certification the chief executive officer or the company official responsible for negotiating any agreement required to be filed by subparagraph a shall include in any filing under this paragraph a certification as follows declare under penalty of perjury that the following is true and correct the materials filed with the federal trade commission and the department of justice under section of the public health service act with respect to the agreement referenced in this certification represent the complete final and exclusive agreement between the parties include any ancillary agreements that are contingent upon provide a contingent condition for or are otherwise related to the referenced agreement and include written descriptions of any oral agreements representations commitments or promises between the parties that are responsive to such section and have not been reduced to writing disclosure exemption any information or documentary material filed withverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the assistant attorney general or the federal trade commission pursuant to this paragraph shall be exempt from disclosure under section of title united states code and no such information or documentary material be made public except as be relevant to any administrative or judicial action or proceeding nothing in this subparagraph prevents disclosure of information or documentary material to either body of the congress or to any duly authorized committee or subcommittee of the congress enforcement civil penalty any person that violates a provision of this paragraph shall be liable for a civil penalty of not more than for each day on which the violation occurs such penalty be recovered in a civil action brought by the united states or brought by the federal trade commission in accordance with the procedures established in sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a of the federal trade commission act compliance and equitable relief if any person violates any provision of this paragraph the united states district court order compliance and grant such other equitable relief as the court in its discretion determines necessary or appropriate upon application of the assistant attorney general or the federal trade commission rulemaking the federal trade commission with the concurrence of the assistant attorney general and by rule in accordance with section of title united states code consistent with the purposes of this paragraph define the terms used in this paragraph exempt classes of persons or agreements from the requirements of this paragraph and iii prescribe such other rules as be necessary and appropriate to carry out the purposes of this paragraphverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih savings clause any action taken by the assistant attorney general or the federal trade commission or any failure of the assistant attorney general or the commission to take action under this paragraph shall not at any time bar any proceeding or any action with respect to any agreement between a biosimilar product applicant under subsection and the reference product sponsor or any agreement between biosimilar product applicants under subsection under any other provision of law nor shall any filing under this paragraph constitute or create a presumption of any violation of any competition laws definitions section of the public health service act usc is amended by striking in this section the term biological product means and inserting the following in this section the term biological product means in paragraph as so designated by inserting protein except any chemically synthesized polypeptide after allergenic product and by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term biosimilar or biosimilarity in reference to a biological product that is the subject of an application under subsection means a that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components and there are no clinically meaningful differences between the biological product and the reference product in terms of the safety purity and potency of the product the term interchangeable or interchangeability in reference to a biological product that is shown to meet the standards described in subsection means that the biological product be substituted for the reference product without the intervention of the health care provider who prescribed the reference product the term reference product means the single biological product licensed under subsection a against which a biological product is evaluated in an application submitted under subsection products previously approved under section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih requirement to follow section except as provided in paragraph an application for a biological product shall be submitted under section of the public health service act usc as amended by this act exception an application for a biological product be submitted under section of the federal food drug and cosmetic act usc if a such biological product is in a product class for which a biological product in such product class is the subject of an application approved under such section not later than the date of enactment of this act and such application has been submitted to the secretary of health and human services referred to in this act as the secretary before the date of enactment of this act or is submitted to the secretary not later than the date that is years after the date of enactment of this act limitation notwithstanding paragraph an application for a biological product notverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih be submitted under section of the federal food drug and cosmetic act usc if there is another biological product approved under subsection a of section of the public health service act that could be a reference product with respect to such application within the meaning of such section if such application were submitted under subsection of such section deemed approved under section an approved application for a biological product under section of the federal food drug and cosmetic act usc shall be deemed to be a license for the biological product under such section on the date that is years after the date of enactment of this act definitions for purposes of this subsection the term biological product has the meaning given such term under section of the public health service act usc as amended by this act sec fees relating to biosimilar biological products subparagraph of section of the federal food drug and cosmetic act usc is amended by inserting including licensure of a biologicalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih product under section of such act before the period at the end sec amendments to certain patent provisions a section of title united states code is amended in subparagraph a by striking or after patent in subparagraph by adding or after the comma at the end by inserting the following after subparagraph a statement under section of the public health service act and in the matter following subparagraph as added by paragraph by inserting before the period the following or if the statement described in subparagraph is provided in connection with an application to obtain a license to engage in the commercial manufacture use or sale of a biological product claimed in a patent or the use of which is claimed in a patent before the expiration of such patent verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section of title united states code is amended by striking in paragraph in both places it appears and inserting in paragraph a or subtitle community living assistance services and supports sec establishment of national voluntary insurance program for purchasing community living assistance services and support class program a establishment of class program the public health service act usc et seq as amended by section is amended by adding at the end the following title xxxii community living assistance services and supports sec purpose the purpose of this title is to establish a national voluntary insurance program for purchasing community living assistance services and supports in order to provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence and live in the community through a new financing strategy for community living assistance services and supports verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih establish an infrastructure that will help address the nation community living assistance services and supports needs alleviate burdens on family caregivers and address institutional bias by providing a financing mechanism that supports personal choice and independence to live in the community sec definitions in this title active enrollee the term active enrollee means an individual who is enrolled in the class program in accordance with section and who has paid any premiums due to maintain such enrollment actively employed the term actively employed means an individual who a is reporting for work at the individual usual place of employment or at another location to which the individual is required to travel because of the individual employment or in the case of an individual who is a member of the uniformed services is on active duty and is physically able to perform the duties of the individual position andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is able to perform all the usual and customary duties of the individual employment on the individual regular work schedule activities of daily living the term activities of daily living has the meaning given the term in section of the internal revenue code of class program the term class program means the program established under this title eligibility assessment system the term eligibility assessment system means the entity designated by the secretary under section a a eligible beneficiary a in general the term eligible beneficiary means any individual who is an active enrollee in the class program and as of the date described in subparagraph has paid premiums for enrollment in such program for at least months has earned for each calendar year that occurs during the first months for which the individual has paid premiums for enrollment in the program verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih at least an amount equal to the amount of wages and self employment income which an individual must have in order to be credited with a quarter of coverage under section of the social security act for that year and iii has paid premiums for enrollment in such program for at least consecutive months if a lapse in premium payments of more than months has occurred during the period that begins on the date of the individual enrollment and ends on the date of such determination date described for purposes of subparagraph a the date described in this subparagraph is the date on which the individual is determined to have a functional limitation described in section a that is expected to last for a continuous period of more than days regulations the secretary shall promulgate regulations specifying exceptions to the minimum earnings requirements under subparagraph a for purposes of being consid verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ered an eligible beneficiary for certain populations hospital nursing facility intermediate care facility for the mentally retarded institution for mental diseases the terms hospital nursing facility intermediate care facility for the mentally retarded and institution for mental diseases have the meanings given such terms for purposes of medicaid class independence advisory council the term class independence advisory council or council means the advisory council established under section to advise the secretary class independence benefit plan the term class independence benefit plan means the benefit plan developed and designated by the secretary in accordance with section class independence fund the term class independence fund or fund means the fund established under section medicaid the term medicaid means the program established under title xix of the social security act protection and advocacy system the term protection and advocacy system meansverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the system for each state established under section of the developmental disabilities assistance and bill of rights act of sec class independence benefit plan a process for development in general the secretary in consultation with appropriate actuaries and other experts shall develop at least actuarially sound benefit plans as alternatives for consideration for designation by the secretary as the class independence benefit plan under which eligible beneficiaries shall receive benefits under this title each of the plan alternatives developed shall be designed to provide eligible beneficiaries with the benefits described in section consistent with the following requirements a premiums beginning with the first year of the class program and for each year thereafter the secretary shall establish all premiums to be paid by enrollees for the year based on an actuarial analysis of the year costs of the program that ensures solvency throughout such year period vesting period a year vesting period for eligibility for benefitsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih benefit triggers a benefit trigger for provision of benefits that requires a determination that an individual has a functional limitation as certified by a licensed health care practitioner described in any of the following clauses that is expected to last for a continuous period of more than days the individual is determined to be unable to perform at least the minimum number which be or of activities of daily living as are required under the plan for the provision of benefits without substantial assistance as defined by the secretary from another individual the individual requires substantial supervision to protect the individual from threats to health and safety due to substantial cognitive impairment iii the individual has a level of functional limitation similar as determined under regulations prescribed by the secretary to the level of functional limitation described in clause or cash benefit payment of a cash benefit that satisfies the following requirements verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih minimum required amount the benefit amount provides an eligible beneficiary with not less than an average of per day as determined based on the reasonably expected distribution of beneficiaries receiving benefits at various benefit levels amount scaled to functional ability the benefit amount is varied based on a scale of functional ability with not less than and not more than benefit level amounts iii daily or weekly the benefit is paid on a daily or weekly basis iv no lifetime or aggregate limit the benefit is not subject to any lifetime or aggregate limit review and recommendation by the class independence advisory council the class independence advisory council shall a evaluate the alternative benefit plans developed under paragraph and recommend for designation as the class independence benefit plan for offering to the public the plan that the council deter verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mines best balances price and benefits to meet enrollees needs in an actuarially sound manner while optimizing the probability of the longterm sustainability of the class program designation by the secretary not later than october the secretary taking into consideration the recommendation of the class independence advisory council under paragraph shall designate a benefit plan as the class independence benefit plan the secretary shall publish such designation along with details of the plan and the reasons for the selection by the secretary in a final rule that allows for a period of public comment additional premium requirements adjustment of premiums a in general except as provided in subparagraphs and the amount of the monthly premium determined for an individual upon such individual enrollment in the class program shall remain the same for as long as the individual is an active enrollee in the program recalculated premium if required for program solvency verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general subject to clause if the secretary determines based on the most recent report of the board of trustees of the class independence fund the advice of the class independence advisory council and the annual report of the inspector general of the department of health and human services and waste fraud and abuse or such other information as the secretary determines appropriate that the monthly premiums and income to the class independence fund for a year are projected to be insufficient with respect to the year period that begins with that year the secretary shall adjust the monthly premiums for individuals enrolled in the class program as necessary exemption from increase any increase in a monthly premium imposed as result of a determination described in clause shall not apply with respect to the monthly premium of any active enrollee who has attained age verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has paid premiums for enrollment in the program for at least years and iii is not actively employed recalculated premium if reenrollment after more than a month lapse in general the reenrollment of an individual after a day period during which the individual failed to pay the monthly premium required to maintain the individual enrollment in the class program shall be treated as an initial enrollment for purposes of age adjusting the premium for enrollment in the program credit for prior months if reenrolled within years an individual who reenrolls in the class program after such a day period and before the end of the year period that begins with the first month for which the individual failed to pay the monthly premium required to maintain the individual enrollment in the program shall be verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih credited with any months of paid premiums that accrued prior to the individual lapse in enrollment and notwithstanding the total amount of any such credited months required to satisfy section a before being eligible to receive benefits penalty for reenrollment after year lapse in the case of an individual who reenrolls in the class program after the end of the year period described in subparagraph the monthly premium required for the individual shall be the age adjusted premium that would be applicable to an initially enrolling individual who is the same age as the reenrolling individual increased by the greater of an amount that the secretary determines is actuarially sound for each month that occurs during the period that begins with the first month for which the individual failed to pay the monthly premium required to maintain the individual sverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih enrollment in the class program and ends with the month preceding the month in which the reenrollment is effective or percent of the applicable ageadjusted premium for each such month occurring in such period administrative expenses in determining the monthly premiums for the class program the secretary factor in costs for administering the program not to exceed a in the case of the first years in which the program is in effect under this title an amount equal to percent of all premiums paid during each such year and in the case of subsequent years an amount equal to percent of the total amount of all expenditures including benefits paid under this title with respect to that year no underwriting requirements no underwriting other than on the basis of age in accordance with paragraph shall be used to a determine the monthly premium for enrollment in the class program or prevent an individual from enrolling in the programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec enrollment and disenrollment requirements a automatic enrollment in general subject to paragraph the secretary shall establish procedures under which each individual described in subsection shall be automatically enrolled in the class program by an employer of such individual under rules similar to the rules of sections and of the internal revenue code of alternative enrollment procedures the procedures established under paragraph shall provide for an alternative enrollment process for an individual described in subsection in the case of such an individual a who is self employed who has more than employer whose employer does not elect to participate in the automatic enrollment process established by the secretary or who is a spouse described in subsection of who is not subject to automatic enrollment administration a in general the secretary shall by regulation establish procedures to verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ensure that an individual is not automatically enrolled in the class program by more than employer and allow for an individual employer to deduct a premium for a spouse described in subsection who is not subject to automatic enrollment form enrollment in the class program shall be made in such manner as the secretary prescribe in order to ensure ease of administration election to opt out an individual described in subsection elect to waive enrollment in the class program at any time in such form and manner as the secretary shall prescribe individual described for purposes of enrolling in the class program an individual described in this paragraph is an individual a who has attained age who receives wages on which there is imposed a tax under section a or a of the internal revenue code of who is actively employed and who is not verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a patient in a hospital or nursing facility an intermediate care facility for the mentally retarded or an institution for mental diseases and receiving medical assistance under medicaid or confined in a jail prison other penal institution or correctional facility or by court order pursuant to conviction of a criminal offense or in connection with a verdict or finding described in section a of the social security act or the spouse of an individual described in paragraph and who would be an individual so described but for subparagraph or of that paragraph rule of construction nothing in this title shall be construed as requiring an active enrollee to continue to satisfy subparagraph or of subsection in order to maintain enrollment in the class program payment payroll deduction an amount equal to the monthly premium for the enrollment in the class program of an individual shall be deductedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih from the wages of such individual in accordance with such procedures as the secretary shall establish for employers who elect to deduct and withhold such premiums on behalf of enrolled employees alternative payment mechanism the secretary shall establish alternative procedures for the payment of monthly premiums by an individual enrolled in the class program who does not have an employer who elects to deduct and withhold premiums in accordance with subparagraph a transfer of premiums collected in general during each calendar year the secretary of the treasury shall deposit into the class independence fund a total amount equal in the aggregate to percent of the premiums collected during that year transfers based on estimates the amount deposited pursuant to paragraph shall be transferred in at least monthly payments to the class independence fund on the basis of estimates by the secretary and certified to the secretary of the treasury of the amounts collected in accordance with this section proper adjustments shall be made in amounts subsequently transferredverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to the fund to the extent prior estimates were in excess of or were less than actual amounts collected other enrollment and disenrollment opportunities the secretary shall establish procedures under which an individual who in the year of the individual initial eligibility to enroll in the class program has elected to waive enrollment in the program is eligible to elect to enroll in the program in such form and manner as the secretary shall establish only during an open enrollment period established by the secretary that is specific to the individual and that not occur more frequently than biennially after the date on which the individual first elected to waive enrollment in the program and an individual shall only be permitted to disenroll from the program during an annual disenrollment period established by the secretary and in such form and manner as the secretary shall establish sec benefits a determination of eligibility application for receipt of benefits the secretary shall establish procedures under which an active enrollee shall apply for receiptverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of benefits under the class independence benefit plan eligibility assessments a in general not later than january the secretary shall designate an entity other than a service with which the commissioner of social security has entered into an agreement with respect to any state to make disability determinations for purposes of title or xvi of the social security act to serve as an eligibility assessment system by providing for eligibility assessments of active enrollees who apply for receipt of benefits enter into an agreement with the protection and advocacy system for each state to provide advocacy services in accordance with subsection and iii enter into an agreement with public and private entities to provide advice and assistance counseling in accordance with subsection regulations the secretary shall promulgate regulations to develop an expeditedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nationally equitable eligibility determination process as certified by a licensed health care practitioner an appeals process and a redetermination process as certified by a licensed health care practitioner including whether an applicant is eligible for a cash benefit under the program and if so the amount of the cash benefit in accordance the sliding scale established under the plan presumptive eligibility for certain institutionalized enrollees planning to discharge an active enrollee shall be deemed presumptively eligible if the enrollee has applied for and attests is eligible for the maximum cash benefit available under the sliding scale established under the class independence benefit plan is a patient in a hospital but only if the hospitalization is for long term care nursing facility intermediate care facility for the mentally retarded or an institution for mental diseases andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih iii is in the process of or about to being the process of planning to discharge from the hospital facility or institution or within days from the date of discharge from the hospital facility or institution appeals the secretary shall establish procedures under which an applicant for benefits under the class independence benefit plan shall be guaranteed the right to appeal an adverse determination benefits an eligible beneficiary shall receive the following benefits under the class independence benefit plan cash benefit a cash benefit established by the secretary in accordance with the requirements of section a that a the first year in which beneficiaries receive the benefits under the plan is not less than the average dollar amount specified in clause of such section and for any subsequent year is not less than the average per day dollar limit applicable under this subparagraph for the preceding year increased by the percentage increase in the con verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sumer price index for all urban consumers us city average over the previous year advocacy services advocacy services in accordance with subsection advice and assistance counseling advice and assistance counseling in accordance with subsection administrative expenses advocacy services and advise and assistance counseling services under paragraphs and of this subsection shall be included as administrative expenses under section payment of benefits life independence account a in general the secretary shall establish procedures for administering the provision of benefits to eligible beneficiaries under the class independence benefit plan including the payment of the cash benefit for the beneficiary into a life independence account established by the secretary on behalf of each eligible beneficiary use of cash benefits cash benefits paid into a life independence account of an eligible beneficiary shall be used to purchaseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nonmedical services and supports that the beneficiary needs to maintain his or her independence at home or in another residential setting of their choice in the community including but not limited to home modifications assistive technology accessible transportation homemaker services respite care personal assistance services home care aides and nursing support nothing in the preceding sentence shall prevent an eligible beneficiary from using cash benefits paid into a life independence account for obtaining assistance with decisionmaking concerning medical care including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives or other written instructions recognized under state law such as a living will or durable power of attorney for health care in the case that an injury or illness causes the individual to be unable to make health care decisions electronic management of funds the secretary shall establish procedures for verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih crediting an account established on behalf of a beneficiary with the beneficiary cash daily benefit allowing the beneficiary to access such account through debit cards and iii accounting for withdrawals by the beneficiary from such account primary payor rules for beneficiaries who are enrolled in medicaid in the case of an eligible beneficiary who is enrolled in medicaid the following payment rules shall apply institutionalized beneficiary if the beneficiary is a patient in a hospital nursing facility intermediate care facility for the mentally retarded or an institution for mental diseases the beneficiary shall retain an amount equal to percent of the beneficiary daily or weekly cash benefit as applicable which shall be in addition to the amount of the beneficiary personal needs allowance provided under medicaid and the remainder of such benefit shall be applied toward the facility cost of providing the beneficiary sverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih care and medicaid shall provide secondary coverage for such care beneficiaries receiving home and community based services percent of benefit retained by beneficiary subject to subclause if a beneficiary is receiving medical assistance under medicaid for home and communitybased services the beneficiary shall retain an amount equal to percent of the beneficiary daily or weekly cash benefit as applicable and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the state of providing such assistance and shall not be used to claim federal matching funds under medicaid and medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance requirement for state offset a state shall be paid theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih remainder of a beneficiary daily or weekly cash benefit under subclause only if the state home and community based waiver under section of the social security act or subsection or of section of such act or the state plan amendment under subsection of such section does not include a waiver of the requirements of section a of the social security act relating to statewideness or of section a of such act relating to comparability and the state offers at a minimum case management services personal care services habilitation services and respite care under such a waiver or state plan amendment iii definition of home and community based services in this clause the term home and community based services means any services which be offered under a home and community based waiververdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorized for a state under section of the social security act or subsection or of section of such act or under a state plan amendment under subsection of such section iii beneficiaries enrolled in programs of all inclusive care for the elderly pace in general subject to subclause if a beneficiary is receiving medical assistance under medicaid for pace program services under section of the social security act the beneficiary shall retain an amount equal to percent of the beneficiary daily or weekly cash benefit as applicable and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the state of providing such assistance and shall not be used to claim federal matching funds under medicaid and medicaid shall provide secondary coverage for the remainder of anyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih costs incurred in providing such assistance institutionalized recipients of pace program services if a beneficiary receiving assistance under medicaid for pace program services is a patient in a hospital nursing facility intermediate care facility for the mentally retarded or an institution for mental diseases the beneficiary shall be treated as in institutionalized beneficiary under clause authorized representatives a in general the secretary shall establish procedures to allow access to a beneficiary cash benefits by an authorized representative of the eligible beneficiary on whose behalf such benefits are paid quality assurance and protection against fraud and abuse the procedures established under subparagraph a shall ensure that authorized representatives of eligible beneficiaries comply with standards of conduct established by the secretary includingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih standards requiring that such representatives provide quality services on behalf of such beneficiaries do not have conflicts of interest and do not misuse benefits paid on behalf of such beneficiaries or otherwise engage in fraud or abuse commencement of benefits benefits shall be paid to or on behalf of an eligible beneficiary beginning with the first month in which an application for such benefits is approved rollover option for lump sum payment an eligible beneficiary elect to a defer payment of their daily or weekly benefit and to rollover any such deferred benefits from month to month but not from year toyear and receive a lump sum payment of such deferred benefits in an amount that not exceed the lesser of the total amount of the accrued deferred benefits or the applicable annual benefit period for determination of annual benefits verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general the applicable period for determining with respect to an eligible beneficiary the applicable annual benefit and the amount of any accrued deferred benefits is the month period that commences with the first month in which the beneficiary began to receive such benefits and each month period thereafter inclusion of increased benefits the secretary shall establish procedures under which cash benefits paid to an eligible beneficiary that increase or decrease as a result of a change in the functional status of the beneficiary before the end of a month benefit period shall be included in the determination of the applicable annual benefit paid to the eligible beneficiary recoupment of unpaid accrued benefits in general the secretary in coordination with the secretary of the treasury shall recoup any accrued benefits in the event of the death of a beneficiary orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the failure of a beneficiary to elect under paragraph to receive such benefits as a lump sum payment before the end of the month period in which such benefits accrued payment into class independence fund any benefits recouped in accordance with clause shall be paid into the class independence fund and used in accordance with section requirement to recertify eligibility for receipt of benefits an eligible beneficiary shall periodically as determined by the secretary a recertify by submission of medical evidence the beneficiary continued eligibility for receipt of benefits and submit records of expenditures attributable to the aggregate cash benefit received by the beneficiary during the preceding year supplement not supplant other health care benefits subject to the medicaid payment rules under paragraph benefits received by an eligible beneficiary shall supplement but not supplant other health care benefits forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih which the beneficiary is eligible under medicaid or any other federally funded program that provides health care benefits or assistance advocacy services an agreement entered into under subsection a a shall require the protection and advocacy system for the state to assign as needed an advocacy counselor to each eligible beneficiary that is covered by such agreement and who shall provide an eligible beneficiary with a information regarding how to access the appeals process established for the program assistance with respect to the annual recertification and notification required under subsection and such other assistance with obtaining services as the secretary by regulation shall require and ensure that the system and such counselors comply with the requirements of subsection advice and assistance counseling an agreement entered into under subsection a a iii shall require the entity to assign as requested by an eligible beneficiary that is covered by such agreement an ad verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vice and assistance counselor who shall provide an eligible beneficiary with information regarding accessing and coordinating long term services and supports in the most integrated setting possible eligibility for other benefits and services development of a service and support plan information about programs established under the assistive technology act of and the services offered under such programs available assistance with decisionmaking concerning medical care including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives or other written instructions recognized under state law such as a living will or durable power of attorney for health care in the case that an injury or illness causes the individual to be unable to make health care decisions and such other services as the secretary by regulation require no effect on eligibility for other benefits benefits paid to an eligible beneficiary under the class program shall be disregarded for purposes of determining or continuing the beneficiary eligibility for re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ceipt of benefits under any other federal state or locally funded assistance program including benefits paid under titles xvi xviii xix or xxi of the social security act under the laws administered by the secretary of veterans affairs under low income housing assistance programs or under the supplemental nutrition assistance program established under the food and nutrition act of rule of construction nothing in this title shall be construed as prohibiting benefits paid under the class independence benefit plan from being used to compensate a family caregiver for providing community living assistance services and supports to an eligible beneficiary protection against conflicts of interest the secretary shall establish procedures to ensure that the eligibility assessment system the protection and advocacy system for a state advocacy counselors for eligible beneficiaries and any other entities that provide services to active enrollees and eligible beneficiaries under the class program comply with the following if the entity provides counseling or planning services such services are provided in a manner that fosters the best interests of the active enrollee or beneficiaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the entity has established operating procedures that are designed to avoid or minimize conflicts of interest between the entity and an active enrollee or beneficiary the entity provides information about all services and options available to the active enrollee or beneficiary to the best of its knowledge including services available through other entities or providers the entity assists the active enrollee or beneficiary to access desired services regardless of the provider the entity reports the number of active enrollees and beneficiaries provided with assistance by age disability and whether such enrollees and beneficiaries received services from the entity or another entity if the entity provides counseling or planning services the entity ensures that an active enrollee or beneficiary is informed of any financial interest that the entity has in a service provider the entity provides an active enrollee or beneficiary with a list of available service providers that can meet the needs of the active enrollee or beneficiaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec class independence fund a establishment of class independence fund there is established in the treasury of the united states a trust fund to be known as the class independence fund the secretary of the treasury shall serve as managing trustee of such fund the fund shall consist of all amounts derived from payments into the fund under sections and c and remaining after investment of such amounts under subsection including additional amounts derived as income from such investments the amounts held in the fund are appropriated and shall remain available without fiscal year limitation to be held for investment on behalf of individuals enrolled in the class program to pay the administrative expenses related to the fund and to investment under subsection and to pay cash benefits to eligible beneficiaries under the class independence benefit plan investment of fund balance the secretary of the treasury shall invest and manage the class independence fund in the same manner and to the same extent as the federal supplementary medical insurance trust fund be invested and managedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih under subsections and of section of the social security act board of trustees in general with respect to the class independence fund there is hereby created a body to be known as the board of trustees of the class independence fund hereinafter in this section referred to as the board of trustees composed of the secretary of the treasury the secretary of labor and the secretary of health and human services all ex officio and of two members of the public both of whom not be from the same political party who shall be nominated by the president for a term of years and subject to confirmation by the senate a member of the board of trustees serving as a member of the public and nominated and confirmed to fill a vacancy occurring during a term shall be nominated and confirmed only for the remainder of such term an individual nominated and confirmed as a member of the public serve in such position after the expiration of such member term until the earlier of the time at which the member successor takes office or the time at which a report of the board is first issued under paragraph after the expiration of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih member term the secretary of the treasury shall be the managing trustee of the board of trustees the board of trustees shall meet not less frequently than once each calendar year a person serving on the board of trustees shall not be considered to be a fiduciary and shall not be personally liable for actions taken in such capacity with respect to the trust fund duties a in general it shall be the duty of the board of trustees to do the following hold the class independence fund report to the congress not later than the first day of april of each year on the operation and status of the class independence fund during the preceding fiscal year and on its expected operation and status during the current fiscal year and the next fiscal years iii report immediately to the congress whenever the board is of the opinion that the amount of the class independence fund is not actuarially sound in re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gards to the projections under section iv review the general policies followed in managing the class independence fund and recommend changes in such policies including necessary changes in the provisions of law which govern the way in which the class independence fund is to be managed report the report provided for in subparagraph a shall include a statement of the assets of and the disbursements made from the class independence fund during the preceding fiscal year an estimate of the expected income to and disbursements to be made from the class independence fund during the current fiscal year and each of the next fiscal years iii a statement of the actuarial status of the class independence fund for the current fiscal year each of the next fiscal years and asverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih projected over the year period beginning with the current fiscal year and iv an actuarial opinion certifying that the techniques and methodologies used are generally accepted within the actuarial profession and that the assumptions and cost estimates used are reasonable and be printed as a house document of the session of the congress to which the report is made recommendations if the board of trustees determines that enrollment trends and expected future benefit claims on the class independence fund are not actuarially sound in regards to the projections under section and are unlikely to be resolved with reasonable premium increases or through other means the board of trustees shall include in the report provided for in subparagraph a recommendations for such legislative action as the board of trustees determine to be appropriate including whether toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih adjust monthly premiums or impose a temporary moratorium on new enrollments sec class independence advisory council a establishment there is hereby created an advisory committee to be known as the class independence advisory council membership in general the class independence advisory council shall be composed of not more than individuals not otherwise in the employ of the united states a who shall be appointed by the president without regard to the civil service laws and regulations and a majority of whom shall be representatives of individuals who participate or are likely to participate in the class program and shall include representatives of older and younger workers individuals with disabilities family caregivers of individuals who require services and supports to maintain their independence at home or in another residential setting of their choice in the community individuals with expertise in long term care or disability insurance actuarial science economics verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and other relevant disciplines as determined by the secretary terms a in general the members of the class independence advisory council shall serve overlapping terms of years unless appointed to fill a vacancy occurring prior to the expiration of a term in which case the individual shall serve for the remainder of the term limitation a member shall not be eligible to serve for more than consecutive terms chair the president shall from time to time appoint one of the members of the class independence advisory council to serve as the chair duties the class independence advisory council shall advise the secretary on matters of general policy in the administration of the class program established under this title and in the formulation of regulations under this title including with respect to the development of the class independence benefit plan under section andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the determination of monthly premiums under such plan application of faca the federal advisory committee act other than section of that act shall apply to the class independence advisory council authorization of appropriations in general there are authorized to be appropriated to the class independence advisory council to carry out its duties under this section such sums as be necessary for fiscal year and for each fiscal year thereafter availability any sums appropriated under the authorization contained in this section shall remain available without fiscal year limitation until expended sec regulations annual report a regulations the secretary shall promulgate such regulations as are necessary to carry out the class program in accordance with this title such regulations shall include provisions to prevent fraud and abuse under the program annual report beginning january the secretary shall submit an annual report to congress on the class program each report shall include the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the total number of enrollees in the program the total number of eligible beneficiaries during the fiscal year the total amount of cash benefits provided during the fiscal year a description of instances of fraud or abuse identified during the fiscal year recommendations for such administrative or legislative action as the secretary determines is necessary to improve the program or to prevent the occurrence of fraud or abuse sec inspector general report the inspector general of the department of health and human services shall submit an annual report to the secretary and congress relating to the overall progress of the class program and of the existence of waste fraud and abuse in the class program each such report shall include findings in the following areas the eligibility determination process the provision of cash benefits quality assurance and protection against waste fraud and abuse recouping of unpaid and accrued benefits verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih conforming amendments to medicaid for conforming provisions amending the medicaid program see section subtitle miscellaneous sec states failing to adhere to certain employment obligations a state is eligible for federal funds under the provisions of the public health service act usc et seq only if the state 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 assures that all political subdivisions in the state will do the same sec health centers under public health service act liability protections for volunteer practitioners a in general section usc is amended in subsection a a in the first sentence by striking or employee and inserting employee or subjectverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to subsection volunteer practitioner and in the second sentence by inserting and subsection after subject to paragraph and in each of subsections and by striking the term employee or contractor each place such term appears and inserting employee volunteer practitioner or contractor in subsection by striking the term employee and contractor each place such term appears and inserting employee volunteer practitioner and contractor in subsection by striking the term employee or any contractor and inserting employee volunteer practitioner or contractor and in subsections and by striking the term employees or contractors each place such term appears and inserting employees volunteer practitioners or contractors applicability definition section usc is amended by adding at the end the following paragraph a subsections through apply with respect to volunteer practitioners beginning with the firstverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fiscal year for which an appropriations act provides that amounts in the fund under paragraph are available with respect to such practitioners for purposes of subsections through the term volunteer practitioner means a practitioner who with respect to an entity described in subsection meets the following conditions the practitioner is a licensed physician a licensed clinical psychologist or other licensed or certified health care practitioner at the request of such entity the practitioner provides services to patients of the entity at a site at which the entity operates or at a site designated by the entity the weekly number of hours of services provided to the patients by the practitioner is not a factor with respect to meeting conditions under this subparagraph iii the practitioner does not for the provision of such services receive any compensation from such patients from the entity or from third party payors including reimbursement under any insurance policy or health plan or under any federal or state health benefits program verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec report to congress on the current state of parasitic diseases that have been overlooked among the poorest americans not later than months after the date of the enactment of this act the secretary of health and human services shall report to congress on the epidemiology of impact of and appropriate funding required to address neglected diseases of poverty including neglected parasitic diseases identified as chagas disease cysticercosis toxocariasis toxoplasmosis trichomoniasis the soil transmitted helminths and others the report should provide the information necessary to enhance health policy to accurately evaluate and address the threat of these diseases sec office of women health a health and human services office on women health establishment part a of title usc et seq is amended by adding at the end the following sec health and human services office on women health a establishment of office there is established within the office of the secretary an office on women health referred to in this section as the office the office shall be headed by a deputy assistantverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih secretary for women health who report to the secretary duties the secretary acting through the office with respect to the health concerns of women shall establish short range and long range goals and objectives within the department of health and human services and as relevant and appropriate coordinate with other appropriate offices on activities within the department that relate to disease prevention health promotion service delivery research and public and health care professional education for issues of particular concern to women throughout their lifespan provide expert advice and consultation to the secretary concerning scientific legal ethical and policy issues relating to women health monitor the department of health and human services offices agencies and regional activities regarding women health and identify needs regarding the coordination of activities including intramural and extramural multidisciplinary activities establish a department of health and human services coordinating committee on women health which shall be chaired by the deputy assistant secretary for women health and com verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih posed of senior level representatives from each of the agencies and offices of the department of health and human services establish a national women health information center to a facilitate the exchange of information regarding matters relating to health information health promotion preventive health services research advances and education in the appropriate use of health care facilitate access to such information assist in the analysis of issues and problems relating to the matters described in this paragraph and provide technical assistance with respect to the exchange of information including facilitating the development of materials for such technical assistance coordinate efforts to promote women health programs and policies with the private sector and through publications and any other means appropriate provide for the exchange of information between the office and recipients of grants contracts and agreements under subsection and be verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tween the office and health professionals and the general public grants and contracts regarding duties authority in carrying out subsection the secretary make grants to and enter into cooperative agreements contracts and interagency agreements with public and private entities agencies and organizations evaluation and dissemination the secretary shall directly or through contracts with public and private entities agencies and organizations provide for evaluations of projects carried out with financial assistance provided under paragraph and for the dissemination of information developed as a result of such projects reports not later than year after the date of enactment of this section and every second year thereafter the secretary shall prepare and submit to the appropriate committees of congress a report describing the activities carried out under this section during the period for which the report is being prepared transfer of functions there are transferred to the office on women health established under section of the public health serv verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ice act as added by this section all functions exercised by the office on women health of the public health service prior to the date of enactment of this section including all personnel and compensation authority all delegation and assignment authority and all remaining appropriations all orders determinations rules regulations permits agreements grants contracts certificates licenses registrations privileges and other administrative actions that a have been issued made granted or allowed to become effective by the president any federal agency or official thereof or by a court of competent jurisdiction in the performance of functions transferred under this paragraph and are in effect at the time this section takes effect or were final before the date of enactment of this section and are to become effective on or after such date shall continue in effect according to their terms until modified terminated superseded set aside or revoked in accordance with law by the president the secretary or other authorized official a court of competent jurisdiction or by operation of law centers for disease control and prevention office of women health part a of title iiiverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih usc et seq is amended by adding at the end the following sec a centers for disease control and prevention office of women health a establishment there is established within the office of the director of the centers for disease control and prevention an office to be known as the office of women health referred to in this section as the office the office shall be headed by a director who shall be appointed by the director of such centers purpose the director of the office shall report to the director of the centers for disease control and prevention on the current level of the centers activity regarding women health conditions across where appropriate age biological and sociocultural contexts in all aspects of the centers work including prevention programs public and professional education services and treatment establish short range and long range goals and objectives within the centers for women health and as relevant and appropriate coordinate with other appropriate offices on activities within the centers that relate to prevention research education and training service delivery and policy de verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih velopment for issues of particular concern to women identify projects in women health that should be conducted or supported by the centers consult with health professionals nongovernmental organizations consumer organizations women health professionals and other individuals and groups as appropriate on the policy of the centers with regard to women and serve as a member of the department of health and human services coordinating committee on women health established under section definition as used in this section the term women health conditions with respect to women of all age ethnic and racial groups means diseases disorders and conditions unique to significantly more serious for or significantly more prevalent in women and for which the factors of medical risk or type of medical intervention are different for women or for which there is reasonable evidence that indicates that such factors or types be different for women verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih office of women health research section a usc a is amended by inserting and who shall report directly to the director before the period at the end thereof substance abuse and mental health services administration section usc aa is amended in paragraph by inserting who shall report directly to the administrator before the period by redesignating paragraph as paragraph and by inserting after paragraph the following office nothing in this subsection shall be construed to preclude the secretary from establishing within the substance abuse and mental health administration an office of women health agency for healthcare research and quality activities regarding women health part of title ix usc et seq is amended by redesignating sections and as sections and respectively by inserting after section the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec activities regarding women health a establishment there is established within the office of the director an office of women health and gender based research referred to in this section as the office the office shall be headed by a director who shall be appointed by the director of healthcare and research quality purpose the official designated under subsection a shall report to the director on the current agency level of activity regarding women health across where appropriate age biological and sociocultural contexts in all aspects of agency work including the development of evidence reports and clinical practice protocols and the conduct of research into patient outcomes delivery of health care services quality of care and access to health care establish short range and long range goals and objectives within the agency for research important to women health and as relevant and appropriate coordinate with other appropriate offices on activities within the agency that relate to health services and medical effectiveness research for issues of particular concern to women identify projects in women health that should be conducted or supported by the agency verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consult with health professionals nongovernmental organizations consumer organizations women health professionals and other individuals and groups as appropriate on agency policy with regard to women and serve as a member of the department of health and human services coordinating committee on women health established under section and by adding at the end of section as redesignated by paragraph the following women health for the purpose of carrying out section regarding women health there are authorized to be appropriated such sums as be necessary for each of fiscal years through health resources and services administration office of women health title vii of the social security act usc et seq is amended by adding at the end the following sec office of women health a establishment the secretary shall establish within the office of the administrator of the health resources and services administration an office to be known as the office of women health the office shallverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih be headed by a director who shall be appointed by the administrator purpose the director of the office shall report to the administrator on the current administration level of activity regarding women health across where appropriate age biological and sociocultural contexts establish short range and long range goals and objectives within the health resources and services administration for women health and as relevant and appropriate coordinate with other appropriate offices on activities within the administration that relate to health care provider training health service delivery research and demonstration projects for issues of particular concern to women identify projects in women health that should be conducted or supported by the bureaus of the administration consult with health professionals nongovernmental organizations consumer organizations women health professionals and other individuals and groups as appropriate on administration policy with regard to women and serve as a member of the department of health and human services coordinating com verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih mittee on women health established under section of the public health service act continued administration of existing programs the director of the office shall assume the authority for the development implementation administration and evaluation of any projects carried out through the health resources and services administration relating to women health on the date of enactment of this section definitions for purposes of this section administration the term administration means the health resources and services administration administrator the term administrator means the administrator of the health resources and services administration office the term office means the office of women health established under this section in the administration food and drug administration office of women health chapter ix of the federal food drug and cosmetic act usc et seq is amended by adding at the end the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec office of women health a establishment there is established within the office of the commissioner an office to be known as the office of women health referred to in this section as the office the office shall be headed by a director who shall be appointed by the commissioner of food and drugs purpose the director of the office shall report to the commissioner of food and drugs on current food and drug administration referred to in this section as the administration levels of activity regarding women participation in clinical trials and the analysis of data by sex in the testing of drugs medical devices and biological products across where appropriate age biological and sociocultural contexts establish short range and long range goals and objectives within the administration for issues of particular concern to women health within the jurisdiction of the administration including where relevant and appropriate adequate inclusion of women and analysis of data by sex in administration protocols and policies provide information to women and health care providers on those areas in which differences between men and women exist verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih consult with pharmaceutical biologics and device manufacturers health professionals with expertise in women issues consumer organizations and women health professionals on administration policy with regard to women make annual estimates of funds needed to monitor clinical trials and analysis of data by sex in accordance with needs that are identified and serve as a member of the department of health and human services coordinating committee on women health established under section of the public health service act no new regulatory authority nothing in this section and the amendments made by this section be construed as establishing regulatory authority or modifying any existing regulatory authority limitation on termination notwithstanding any other provision of law a federal office of women health including the office of research on women health of the national institutes of health or federal appointive position with primary responsibility over women health issues including the associate administrator for women services under the substance abuse and mental health services administration that is in existence on the date of enactment of this section shall notverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih be terminated reorganized or have any of its powers or duties transferred unless such termination reorganization or transfer is approved by an act of congress rule of construction nothing in this section or the amendments made by this section shall be construed to limit the authority of the secretary of health and human services with respect to women health or with respect to activities carried out through the department of health and human services on the date of enactment of this section sec long term care and family caregiver support a amendments to the older americans act of promotion of direct care workforce section of the older americans act of usc is amended by inserting before the semicolon the following and in carrying out the purposes of this paragraph shall make recommendations to other federal entities regarding appropriate and effective means of identifying promoting and implementing investments in the direct care workforce necessary to meet the growing demand for long term health services and supports and of assisting states in developing averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih comprehensive state workforce development plan with respect to such workforce including assisting efforts to systematically assess track and report on workforce adequacy and capacity personal care attendant workforce advisory panel section of such act usc is amended by adding at the end the following not later than days after the date of the enactment of this subsection the assistant secretary shall establish a personal care attendant workforce advisory panel to examine and formulate recommendations on a working conditions and training for workers providing long term services and supports including home health aides certified nurse aides and personal care attendants and other workforce issues related to such workers including with respect to the adequacy of the number of such workers the salaries wages and benefits of such workers and access to the services provided by such workers the panel shall include representatives of a relevant home and community based service providers health care agencies and facilities including personal or home care agencies home healthverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih care agencies nursing homes assisted living facilities and residential care facilities the disability community including individuals with disabilities and family caregivers the nursing community direct care workers which include unions and national organizations older individuals including senior individuals and family caregivers state and federal health care entities and experts in workforce development and adult learning within one year after the establishment of the panel the panel shall submit a report to the assistant secretary and the congress on workforce issues related to providing long term services and supports including information on core competencies for eligible personal or home care aides necessary to successfully provide longterm services and supports to eligible consumers as well as recommended training curricula and resources within days after receipt by the assistant secretary of the report under paragraph the assistant secretary shall establish a year demonstration program in states to pilot and evaluate the effectiveness of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih competencies articulated by the panel and the training curricula and training methods recommended by the panel not later than year after the completion of the demonstration program under paragraph the assistant secretary shall submit to the congress a report containing the results of the evaluations by the assistant secretary pursuant to paragraph together with such recommendations for legislation or administrative action as the assistant secretary determines appropriate authorization of additional appropriations for the family caregiver support program under the older americans act of section of the older americans act of usc is amended by striking and all that follows through and inserting and for each of fiscal years and sec web site on health care labor market and related educational and training opportunities a in general the secretary of labor in consultation with the national center for health workforce analysis shall establish and maintain a web site to serve as a comprehensive source of information searchable byverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih workforce region on the health care labor market and related educational and training opportunities contents the web site maintained under this section shall include the following information on the types of jobs that are currently or are projected to be in high demand in the health care field including a salary information and training requirements such as requirements for educational credentials licensure or certification information on training and educational opportunities within each region for the type of jobs described in paragraph including by a type of provider or program such as public private nonprofit or private for profit duration cost such as tuition fees books laboratory expenses and other mandatory costs performance outcomes such as graduation rates job placement average salary job retention and wage progression federal financial aid participation average graduate loan debt student loan default rates verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih average institutional grant aid provided federal and state accreditation information and other information determined by the secretary a mechanism for searching and comparing training and educational options for specific health care occupations to facilitate informed career and education choices financial aid information including with respect to loan forgiveness loan cancellation loan repayment stipends scholarships and grants or other assistance authorized by this act or other federal or state programs public accessibility the web site maintained under this section shall be publicly accessible be user friendly and convey information in a manner that is easily understandable and be in english and the second most prevalent language spoken based on the latest census informationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec online health workforce training programs section of the workforce investment act of usc is amended by adding at the end the following online health workforce training program grant program a in general the secretary in consultation with the secretary of health and human services shall award national health workforce online training grants on a competitive basis to eligible entities to enable such entities to carry out training for individuals to attain or advance in health care occupations an entity leverage such grant with other federal state local and private resources in order to expand the participation of businesses employees and individuals in such training programs eligibility in order to receive a grant under the program established under this paragraph an entity shall be an educational institution community based organization nonprofit organization workforce invest verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ment board or local or county government and an entity shall provide online workforce training for individuals seeking to attain or advance in health care occupations including nursing nursing assistants dentistry pharmacy health care management and administration public health health information systems analysis medical assistants and other health care practitioner and support occupations priority priority in awarding grants under this paragraph shall be given to entities that have demonstrated experience in implementing and operating online worker skills training and education programs have demonstrated experience coordinating activities where appropriate with the workforce investment system and iii conduct training for occupations with national or local shortages data collection grantees under this paragraph shall collect and report information on verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the number of participants the services received by the participants iii program completion rates iv factors determined as significantly interfering with program participation or completion the rate of job placement and vi other information as determined as needed by the secretary outreach grantees under this paragraph shall conduct outreach activities to disseminate information about their program and results to workforce investment boards local governments educational institutions and other workforce training organizations performance levels the secretary shall establish indicators of performance that will be used to evaluate the performance of grantees under this paragraph in carrying out the activities described in this paragraph the secretary shall negotiate and reach agreement with each grantee regarding the levels of performance expected to be achieved by the grantee on the indicators of performanceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authorization of appropriations there are authorized to be appropriated to the secretary to carry out this subsection for fiscal years through online health professions training program clearinghouse a description of grant the secretary award one or more grants to eligible postsecondary educational institutions to provide the services described in this paragraph eligibility to be eligible to receive a grant under this paragraph a postsecondary educational institution shall have demonstrated the ability to disseminate research on best practices for implementing workforce investment programs and be a national leader in producing cutting edge research on technology related to workforce investment systems under subtitle services the postsecondary educational institution that receives a grant under this paragraph shall use such grant verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to provide technical assistance to entities that receive grants under paragraph to collect and nationally disseminate the data gathered by entities that receive grants under paragraph and iii to disseminate the best practices identified by the national health workforce online training grant program to other workforce training organizations authorization of appropriations there are authorized to be appropriated to the secretary to carry out this subsection for fiscal years through sec access for individuals with disabilities title of the rehabilitation act of usc et seq is amended by adding at the end of the following sec standards for accessibility of medical diagnostic equipment a standards not later than months after the date of enactment of the affordable health care for america act the architectural and transportation barriers compliance board access board shall issue guide verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih lines setting forth the minimum technical criteria for new medical diagnostic equipment to be purchased for use in or in conjunction with physician offices clinics emergency rooms hospitals and other medical settings the guidelines shall ensure that such equipment is accessible to and usable by individuals with disabilities including provisions to ensure independent entry to use of and exit from the equipment by such individuals to the maximum extent possible medical diagnostic equipment covered the guidelines issued under subsection a for medical diagnostic equipment shall apply to new purchases of equipment that includes examination tables examination chairs including chairs used for eye examinations or procedures and dental examinations or procedures weight scales mammography equipment ray machines and other equipment commonly used for diagnostic or examination purposes by health professionals regulations not later than months after the date of the issuance of the guidelines under subsection a each appropriate federal agency authorized to promulgate regulations under this act or under the americans with disabilities act shall prescribe regulations in an accessible format as necessary to carry out the provisions of suchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih act and section of this act that include accessibility standards that are consistent with the guidelines issued under subsection a and ensure that health care providers and health care plans covered by the affordable health care for america act meet the requirements of the americans with disabilities act and section including provisions ensuring that individuals with disabilities receive equal access to all aspects of the health care delivery system review and amend the architectural and transportation barriers compliance board access board shall periodically review and as appropriate amend the guidelines as prescribed under subsection a not later than months after the date of the issuance of such revised guidelines revised regulations consistent with such guidelines shall be promulgated in an accessible format by the appropriate federal agencies described in subsection division indian health care improvement sec short title table of contents a short title this division be cited as the indian health care improvement act amendments of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih table of contents the table of contents of this division is as follows division indian health care improvementsec short title table of contentstitle amendments to indian lawssec indian health care improvement at amendedsec soboba sanitation facilitiessec native american health and wellness foundationsec gao study and report on payments for contract health servicestitle improvement of indian health care providedunder the social security actsec expansion of payments under medicare medicaid and schip forall covered services furnished by indian health programssec additional provisions to increase outreach to and enrollment of indiansin schip and medicaidsec solicitation of proposals for safe harbors under the social securityact for facilities of indian health programs and urban indianorganizationssec annual report on indians served by social security act health benefitprogramssec development of recommendations to improve interstate coordinationof medicaid and schip coverage of indian children and otherchildren who are outside of their state of residency because ofeducational or other needs title amendments to indian laws sec indian health care improvement amended a in general the indian health care improvement act usc et seq is amended to read as follows section short title table of contents a short title this act be cited as the indian health care improvement act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih table of contents the table of contents for this act is as follows sec short title table of contents sec findings sec declaration of national indian health policy sec definitions title indian health human resources anddevelopment sec purpose sec health professions recruitment program for indians sec health professions preparatory scholarship program for indians sec indian health professions scholarships sec american indians into psychology program sec scholarship programs for indian tribes sec indian health service extern programs sec continuing education allowances sec community health representative program sec indian health service loan repayment program sec scholarship and loan repayment recovery fund sec recruitment activities sec indian recruitment and retention program sec advanced training and research sec quentin burdick american indians into nursing program sec tribal cultural orientation sec inmed program sec health training programs of community colleges sec retention bonus sec nursing residency program sec community health aide program sec tribal health program administration sec health professional chronic shortage demonstration programs sec national health service corps sec substance abuse counselor educational curricula demonstration programs sec behavioral health training and community education programs sec exemption from payment of certain fees sec authorization of appropriations title health services sec indian health care improvement fund sec health promotion and disease prevention services sec diabetes prevention treatment and control sec shared services for long term care sec health services research sec mammography and other cancer screening sec patient travel costs sec epidemiology centers sec comprehensive school health education programs sec indian youth program sec prevention control and elimination of communicable and infectiousdiseasesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec other authority for provision of services sec indian women health care sec environmental and nuclear health hazards sec arizona as a contract health service delivery area sec north dakota and south dakota as contract health service deliveryarea sec california contract health services program sec california as a contract health service delivery area sec contract health services for the trenton service area sec programs operated by indian tribes and tribal organizations sec licensing sec notification of provision of emergency contract health services sec prompt action on payment of claims sec liability for payment sec office of indian men health sec catastrophic health emergency fund sec authorization of appropriations title iii facilities sec consultation construction and renovation of facilities reports sec sanitation facilities sec preference to indians and indian firms sec expenditure of non service funds for renovation sec funding for the construction expansion and modernization of smallambulatory care facilities sec indian health care delivery demonstration project sec land transfer sec leases contracts and other agreements sec study on loans loan guarantees and loan repayment sec tribal leasing sec indian health service tribal facilities joint venture program sec location of facilities sec maintenance and improvement of health care facilities sec tribal management of federally owned quarters sec applicability of buy american act requirement sec other funding for facilities sec authorization of appropriations title iv access to health services sec treatment of payments under social security act health benefitsprograms sec grants to and contracts with the service indian tribes tribal organizations and urban indian organizations to facilitate outreach enrollment and coverage of indians under social securityact health benefit programs sec reimbursement from certain third parties of costs of health services sec crediting of reimbursements sec purchasing health care coverage sec sharing arrangements with federal agencies sec eligible indian veteran services sec payor of last resort sec consultation sec state children health insurance program schip verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec premium and cost sharing protections and eligibility determinationsunder medicaid and schip and protection of certain indianproperty from medicaid estate recovery sec treatment under medicaid and schip managed care sec navajo nation medicaid agency feasibility study sec exception for excepted benefits sec authorization of appropriations title health services for urban indians sec purpose sec contracts with and grants to urban indian organizations sec contracts and grants for the provision of health care and referralservices sec use of federal government facilities and sources of supply sec contracts and grants for the determination of unmet health careneeds sec evaluations renewals sec other contract and grant requirements sec reports and records sec limitation on contract authority sec facilities sec division of urban indian health sec grants for alcohol and substance abuse related services sec treatment of certain demonstration projects sec urban niaaa transferred programs sec conferring with urban indian organizations sec urban youth treatment center demonstration sec grants for diabetes prevention treatment and control sec community health representatives sec effective date sec eligibility for services sec authorization of appropriations sec health information technology title vi organizational improvements sec establishment of the indian health service as an agency of thepublic health service sec automated management information system sec authorization of appropriations title vii behavioral health programs sec behavioral health prevention and treatment services sec memoranda of agreement with the department of the interior sec comprehensive behavioral health prevention and treatment program sec mental health technician program sec licensing requirement for mental health care workers sec indian women treatment programs sec indian youth program sec indian youth telemental health demonstration project sec inpatient and community based mental health facilities design construction and staffing sec training and community education sec behavioral health programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec fetal alcohol disorder programs sec child sexual abuse and prevention treatment programs sec domestic and sexual violence prevention and treatment sec behavioral health research sec definitions sec authorization of appropriations title viii miscellaneous sec reports sec regulations sec plan of implementation sec limitation on use of funds appropriated to indian health service sec eligibility of california indians sec health services for ineligible persons sec reallocation of base resources sec results of demonstration projects sec provision of services in montana sec moratorium sec severability provisions sec use of patient safety organizations sec confidentiality of medical quality assurance records qualified immunityfor participants sec claremore indian hospital sec sense of congress regarding law enforcement and methamphetamineissues in indian country sec permitting implementation through contracts with tribal healthprograms sec authorization of appropriations availability sec findings congress makes the following findings federal health services to maintain and improve the health of the indians are consonant with and required by the federal government historical and unique legal relationship with and resulting responsibility to the american indian people a major national goal of the united states is to provide the resources processes and structure that will enable indian tribes and tribal members to obtain the quantity and quality of health care serv verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ices and opportunities that will eradicate the health disparities between indians the general population a major national goal of the united states is to provide the quantity and quality of health services which will permit the health status of indians to be raised to the highest possible level and to encourage the maximum participation of indians in the planning and management of those services federal health services to indians have resulted in a reduction in the prevalence and incidence of preventable illnesses among and unnecessary and premature deaths of indians despite such services the unmet health needs of the american indian people are severe and the health status of the indians is far below that of the general population of the united states sec declaration of national indian health policy congress declares that it is the policy of this nation in fulfillment of its special trust responsibilities and legal obligations to indians to assure the highest possible health status for indians and urban indians and to provide all resources necessary to effect that policy verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to raise the health status of indians and urban indians to at least the levels set forth in the goals contained within the health people or successor objectives to the greatest extent possible to allow indians to set their own health care priorities and establish goals that reflect their unmet needs to increase the proportion of all degrees in the health professions and allied and associated health professions awarded to indians so that the proportion of indian health professionals in each service area is raised to at least the level of that of the general population to require meaningful consultation with indian tribes tribal organizations and urban indian organizations to implement this act and the national policy of indian self determination and to provide funding for programs and facilities operated by indian tribes tribal organizations and urban indian organizations in amounts that are not less than the amounts provided to programs and facilities operated directly by the service sec definitions for purposes of this act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term accredited and accessible means on or near a reservation and accredited by a national or regional organization with accrediting authority the term area office means an administrative entity including a program office within the service through which services and funds are provided to the service units within a defined geographic area the term assistant secretary means the assistant secretary of indian health a the term behavioral health means the blending of substance including alcohol drugs inhalants and tobacco abuse and mental health prevention and treatment for the purpose of providing comprehensive services the term behavioral health includes the joint development of substance abuse and mental health treatment planning and coordinated case management using a multidisciplinary approach the term california indians means those indians who are eligible for health services of the service pursuant to section the term community college means a a tribal college or university orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a junior or community college the term contract health service means health services provided at the expense of the service or a tribal health program by public or private medical providers or hospitals other than the service unit or the tribal health program at whose expense the services are provided the term department means unless otherwise designated the department of health and human services the term disease prevention means the reduction limitation and prevention of disease and its complications and reduction in the consequences of disease including a controlling the development of diabetes high blood pressure iii infectious agents iv injuries occupational hazards and disabilities vi sexually transmittable diseases and vii toxic agents and providing verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fluoridation of water and immunizations the term health profession means allopathic medicine family medicine internal medicine pediatrics geriatric medicine obstetrics and gynecology podiatric medicine nursing public health nursing dentistry psychiatry osteopathy optometry pharmacy psychology public health social work marriage and family therapy chiropractic medicine environmental health and engineering allied health professions naturopathic medicine and any other health profession the term health promotion means a fostering social economic environmental and personal factors conducive to health including raising public awareness about health matters and enabling the people to cope with health problems by increasing their knowledge and providing them with valid information encouraging adequate and appropriate diet exercise and sleep promoting education and work in conformity with physical and mental capacity making available safe water and sanitary facilities verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih improving the physical economic cultural psychological and social environment promoting culturally competent care and providing adequate and appropriate programs which include abuse prevention mental and physical community health iii community safety iv consumer health education diet and nutrition vi immunization and other prevention of communicable diseases including hiv aids vii environmental health viii exercise and physical fitness ix avoidance of fetal alcohol disorders first aid and cpr education xi human growth and development xii injury prevention and personal safety xiii behavioral health verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih xiv monitoring of disease indicators between health care provider visits through appropriate means including internet based health care management systems xv personal health and wellness practices xvi personal capacity building xvii prenatal pregnancy and infant care xviii psychological well being xix reproductive health and family planning xx safe and adequate water xxi healthy work environments xxii elimination reduction and prevention of contaminants that create unhealthy household conditions including mold and other allergens xxiii stress control xxiv substance abuse xxv sanitary facilities xxvi sudden infant death syndrome prevention verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih xxvii tobacco use cessation and reduction xxviii violence prevention and xxix activities to promote achievement of any of the objectives described in section the term indian unless otherwise designated means any person who is a member of an indian tribe or is eligible for health services under section except that for the purpose of sections and the term also means any individual who a irrespective of whether the individual lives on or near a reservation is a member of a tribe band or other organized group of indians including those tribes bands or groups terminated since and those recognized now or in the future by the state in which they reside or is a descendant in the first or second degree of any such member is an eskimo or aleut or other alaska native is considered by the secretary of the interior to be an indian for any purpose orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is determined to be an indian under regulations promulgated by the secretary the term indian health program means a any health program administered directly by the service any tribal health program or any indian tribe or tribal organization to which the secretary provides funding pursuant to section of the act of june usc commonly known as the buy indian act the term indian tribe has the meaning given the term in the indian self determination and education assistance act usc et seq the term junior or community college has the meaning given the term by section of the higher education act of usc the term reservation means any federally recognized indian tribe reservation pueblo or colony including former reservations in oklahoma indian allotments and alaska native regions established pursuant to the alaska native claims settlement act usc et seq verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term secretary unless otherwise designated means the secretary of health and human services the term service means the indian health service the term service area means the geographical area served by each area office the term service unit means an administrative entity of the service or a tribal health program through which services are provided directly or by contract to eligible indians within a defined geographic area the term telehealth has the meaning given the term in section a of the public health service act usc c– a the term telemedicine means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio video graphic or other format for the purpose of providing improved health care servicesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term tribal college or university has the meaning given the term in section of the higher education act usc the term tribal health program means an indian tribe or tribal organization that operates any health program service function activity or facility funded in whole or part by the service through or provided for in a contract or compact with the service under the indian self determination and education assistance act usc et seq the term tribal organization has the meaning given the term in the indian self determination and education assistance act usc et seq the term urban center means any community which has a sufficient urban indian population with unmet health needs to warrant assistance under title of this act as determined by the secretary the term urban indian means any individual who resides in an urban center and who meets or more of the following criteria a irrespective of whether the individual lives on or near a reservation the individual isverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a member of a tribe band or other organized group of indians including those tribes bands or groups terminated since and those tribes bands or groups that are recognized by the states in which they reside or who is a descendant in the first or second degree of any such member the individual is an eskimo aleut or other alaska native the individual is considered by the secretary of the interior to be an indian for any purpose the individual is determined to be an indian under regulations promulgated by the secretary the term urban indian organization means a nonprofit corporate body that a is situated in an urban center is governed by an urban indian controlled board of directors provides for the participation of all interested indian groups and individuals and is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in section a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih title indian health human resources and development sec purpose the purpose of this title is to increase to the maximum extent feasible the number of indians entering the health professions and providing health services and to assure an optimum supply of health professionals to the indian health programs and urban indian organizations involved in the provision of health services to indians sec health professions recruitment program for indians a in general the secretary acting through the service shall make grants to public or nonprofit private health or educational entities tribal health programs or urban indian organizations to assist such entities in meeting the costs of identifying indians with a potential for education or training in the health professions and encouraging and assisting them a to enroll in courses of study in such health professions or if they are not qualified to enroll in any such courses of study to undertake suchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih postsecondary education or training as be required to qualify them for enrollment publicizing existing sources of financial aid available to indians enrolled in any course of study referred to in paragraph or who are undertaking training necessary to qualify them to enroll in any such course of study or establishing other programs which the secretary determines will enhance and facilitate the enrollment of indians in and the subsequent pursuit and completion by them of courses of study referred to in paragraph grants application no grant be made under this section unless an application has been submitted to and approved by the secretary such application shall be in such form submitted in such manner and contain such information as the secretary shall by regulation prescribe pursuant to this act the secretary shall give a preference to applications submitted by tribal health programs or urban indian organizations amount of grants payment the amount of a grant under this section shall be determined by the secretary payments pursuant to thisverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section be made in advance or by way of reimbursement and at such intervals and on such conditions as provided for in regulations issued pursuant to this act to the extent not otherwise prohibited by law grants shall be for years as provided in regulations issued pursuant to this act sec health professions preparatory scholarship program for indians a scholarships authorized the secretary acting through the service shall provide scholarship grants to indians who have successfully completed their high school education or high school equivalency and have demonstrated the potential to successfully complete courses of study in the health professions purposes scholarship grants provided pursuant to this section shall be for the following purposes compensatory preprofessional education of any recipient such scholarship not to exceed years on a full time basis or the part time equivalent thereof as determined by the secretary pursuant to regulations issued under this act pregraduate education of any recipient leading to a baccalaureate degree in an approvedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih course of study preparatory to a field of study in a health profession such scholarship not to exceed years an extension of up to years or the parttime equivalent thereof as determined by the secretary pursuant to regulations issued pursuant to this act be approved other conditions scholarships under this section cover costs of tuition books transportation board and other necessary related expenses of a recipient while attending school shall not be denied solely on the basis of the applicant scholastic achievement if such applicant has been admitted to or maintained good standing at an accredited institution and shall not be denied solely by reason of such applicant eligibility for assistance or benefits under any other federal program sec indian health professions scholarships a in general authority the secretary acting through the service shall make scholarship grants to indians who are enrolled full or part time in accredited schools pursuing courses of study in the health professions such scholarships shall be des verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ignated indian health scholarships and shall be made in accordance with section a of the public health services act usc except as provided in subsection of this section determinations by secretary the secretary acting through the service shall determine a who shall receive scholarship grants under subsection a and the distribution of the scholarships among health professions on the basis of the relative needs of indians for additional service in the health professions certain delegation not allowed the administration of this section shall be a responsibility of the assistant secretary and shall not be delegated in a contract or compact under the indian self determination and education assistance act usc et seq active duty service obligation obligation met the active duty service obligation under a written contract with the secretary under this section that an indian has entered into shall if that individual is a recipient of an indian health scholarship be met in full time practiceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih equal to year for each school year for which the participant receives a scholarship award under this part or years whichever is greater by service in or more of the following a in an indian health program in a program assisted under title of this act in the private practice of the applicable profession if as determined by the secretary in accordance with guidelines promulgated by the secretary such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of indians in a teaching capacity in a tribal college or university nursing program or a related health profession program if as determined by the secretary the health service provided to indians would not decrease obligation deferred at the request of any individual who has entered into a contract referred to in paragraph and who receives a health professions degree requiring postgraduate training for licensure or to improve clinical skills the secretary shall defer the active duty service obligationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of that individual under that contract in order that such individual complete any internship residency or other advanced clinical training that is required for the practice of that health profession for an appropriate period in years as determined by the secretary subject to the following conditions a no period of internship residency or other advanced clinical training shall be counted as satisfying any period of obligated service under this subsection the active duty service obligation of that individual shall commence not later than days after the completion of that advanced clinical training or by a date specified by the secretary the active duty service obligation will be served in the health profession of that individual in a manner consistent with paragraph a recipient of a scholarship under this section at the election of the recipient meet the active duty service obligation described in paragraph by service in a program specified under that paragraph that verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih is located on the reservation of the indian tribe in which the recipient is enrolled or serves the indian tribe in which the recipient is enrolled priority when making assignments subject to paragraph the secretary in making assignments of indian health scholarship recipients required to meet the active duty service obligation described in paragraph shall give priority to assigning individuals to service in those programs specified in paragraph that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section part time students in the case of an individual receiving a scholarship under this section who is enrolled part time in an approved course of study such scholarship shall be for a period of years not to exceed the part time equivalent of years as determined by the secretary the period of obligated service described in subsection shall be equal to the greater of a the part time equivalent of year for each year for which the individual was providedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a scholarship as determined by the secretary or years and the amount of the monthly stipend specified in section a of the public health service act usc shall be reduced pro rata as determined by the secretary based on the number of hours such student is enrolled breach of contract specified breaches an individual shall be liable to the united states for the amount which has been paid to the individual or on behalf of the individual under a contract entered into with the secretary under this section on or after the date of enactment of the indian health care improvement act amendments of if that individual a fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled such level determined by the educational institution under regulations of the secretary is dismissed from such educational institution for disciplinary reasons verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih voluntarily terminates the training in such an educational institution for which he or she is provided a scholarship under such contract before the completion of such training or fails to accept payment or instructs the educational institution in which he or she is enrolled not to accept payment in whole or in part of a scholarship under such contract in lieu of any service obligation arising under such contract other breaches if for any reason not specified in paragraph an individual breaches a written contract by failing either to begin such individual service obligation required under such contract or to complete such service obligation the united states shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection of section in the manner provided for in such subsection cancellation upon death of recipient upon the death of an individual who receives an indian health scholarship any outstanding obligation of that individual for service or payment that relates to that scholarship shall be canceledverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih waivers and suspensions the secretary shall provide for the partial or total waiver or suspension of any obligation of service or payment of a recipient of an indian health scholarship if the secretary determines that a it is not possible for the recipient to meet that obligation or make that payment requiring that recipient to meet that obligation or make that payment would result in extreme hardship to the recipient or the enforcement of the requirement to meet the obligation or make the payment would be unconscionable extreme hardship notwithstanding any other provision of law in any case of extreme hardship or for other good cause shown the secretary waive in whole or in part the right of the united states to recover funds made available under this section bankruptcy notwithstanding any other provision of law with respect to a recipient of an indian health scholarship no obligation for payment be released by a discharge in bankruptcy under title united states code unless that discharge is granted after the expiration of the yearverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih period beginning on the initial date on which that payment is due and only if the bankruptcy court finds that the nondischarge of the obligation would be unconscionable sec american indians into psychology program a grants authorized the secretary acting through the service shall make grants of not more than to each of colleges and universities for the purpose of developing and maintaining indian psychology career recruitment programs as a means of encouraging indians to enter the behavioral health field these programs shall be located at various locations throughout the country to maximize their availability to indian students and new programs shall be established in different locations from time to time quentin burdick program grant the secretary shall provide a grant authorized under subsection a to develop and maintain a program at the university of north dakota to be known as the quentin burdick american indians into psychology program such program shall to the maximum extent feasible coordinate with the quentin burdick indian health programs authorized under section the quentin burdick american indians into nursing program author verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ized under section and existing university research and communications networks regulations the secretary shall issue regulations pursuant to this act for the competitive awarding of grants provided under this section conditions of grant applicants under this section shall agree to provide a program which at a minimum provides outreach and recruitment for health professions to indian communities including elementary secondary and accredited and accessible community colleges that will be served by the program incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program provides summer enrichment programs to expose indian students to the various fields of psychology through research clinical and experimental activities provides stipends to undergraduate and graduate students to pursue a career in psychology develops affiliation agreements with tribal colleges and universities the service university affiliated programs and other appropriate accreditedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and accessible entities to enhance the education of indian students to the maximum extent feasible uses existing university tutoring counseling and student support services and to the maximum extent feasible employs qualified indians in the program active duty service requirement the active duty service obligation prescribed under section of the public health service act usc shall be met by each graduate who receives a stipend described in subsection that is funded under this section such obligation shall be met by service in an indian health program in a program assisted under title of this act or in the private practice of psychology if as determined by the secretary in accordance with guidelines promulgated by the secretary such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of indians authorization of appropriations there is authorized to be appropriated such sums as be necessary to carry out this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec scholarship programs for indian tribes a in general grants authorized the secretary acting through the service shall make grants to tribal health programs for the purpose of providing scholarships for indians to serve as health professionals in indian communities amount amounts available under paragraph for any fiscal year shall not exceed percent of the amounts available for each fiscal year for indian health scholarships under section application an application for a grant under paragraph shall be in such form and contain such agreements assurances and information as consistent with this section requirements in general a tribal health program receiving a grant under subsection a shall provide scholarships to indians in accordance with the requirements of this section costs with respect to costs of providing any scholarship pursuant to subsection a a percent of the costs of the scholarship shall be paid from the funds made available pursuant to subsection a provided to the tribal health program andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih percent of such costs be paid from any other source of funds course of study a tribal health program shall provide scholarships under this section only to indians enrolled or accepted for enrollment in a course of study approved by the secretary in of the health professions contemplated by this act contract in general in providing scholarships under subsection the secretary and the tribal health program shall enter into a written contract with each recipient of such scholarship requirements such contract shall a obligate such recipient to provide service in an indian health program or urban indian organization in the same service area where the tribal health program providing the scholarship is located for a number of years for which the scholarship is provided or the part time equivalent thereof as determined by the secretary or for a period of years whichever period is greater orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such greater period of time as the recipient and the tribal health program agree provide that the amount of the scholarship only be expended for tuition expenses other reasonable educational expenses and reasonable living expenses incurred in attendance at the educational institution and payment to the recipient of a monthly stipend of not more than the amount authorized by section of the public health service act usc with such amount to be reduced pro rata as determined by the secretary based on the number of hours such student is enrolled and not to exceed for any year of attendance for which the scholarship is provided the total amount required for the year for the purposes authorized in this clause andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not exceed for any year of attendance for which the scholarship is provided the total amount required for the year for the purposes authorized in clause require the recipient of such scholarship to maintain an acceptable level of academic standing as determined by the educational institution in accordance with regulations issued pursuant to this act and require the recipient of such scholarship to meet the educational and licensure requirements appropriate to each health profession service in other service areas the contract allow the recipient to serve in another service area provided the tribal health program and secretary approve and services are not diminished to indians in the service area where the tribal health program providing the scholarship is located breach of contract specific breaches an individual who has entered into a written contract with the secretary and a tribal health program under sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section shall be liable to the united states for the federal share of the amount which has been paid to him or her or on his or her behalf under the contract if that individual a fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled such level as determined by the educational institution under regulations of the secretary is dismissed from such educational institution for disciplinary reasons voluntarily terminates the training in such an educational institution for which he or she is provided a scholarship under such contract before the completion of such training or fails to accept payment or instructs the educational institution in which he or she is enrolled not to accept payment in whole or in part of a scholarship under such contract in lieu of any service obligation arising under such contract other breaches if for any reason not specified in paragraph an individual breaches a written contract by failing to either begin such individual service obligation required under such con verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tract or to complete such service obligation the united states shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection of section in the manner provided for in such subsection cancellation upon death of recipient upon the death of an individual who receives an indian health scholarship any outstanding obligation of that individual for service or payment that relates to that scholarship shall be canceled information the secretary carry out this subsection on the basis of information received from tribal health programs involved or on the basis of information collected through such other means as the secretary deems appropriate relation to social security act the recipient of a scholarship under this section shall agree in providing health care pursuant to the requirements herein not to discriminate against an individual seeking care on the basis of the ability of the individual to pay for such care or on the basis that payment for such care will be made pursuant to a program established in title xviii of the social secu verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih rity act or pursuant to the programs established in title xix or title xxi of such act and to accept assignment under section of the social security act for all services for which payment be made under part of title xviii of such act and to enter into an appropriate agreement with the state agency that administers the state plan for medical assistance under title xix or the state child health plan under title xxi of such act to provide service to individuals entitled to medical assistance or child health assistance respectively under the plan continuance of funding the secretary shall make payments under this section to a tribal health program for any fiscal year subsequent to the first fiscal year of such payments unless the secretary determines that for the immediately preceding fiscal year the tribal health program has not complied with the requirements of this section sec indian health service extern programs a employment preference any individual who receives a scholarship pursuant to section or shall be given preference for employment in the service or be employed by a tribal health program or an urban indian organization or other agencies of the de verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih partment as available during any nonacademic period of the year not counted toward active duty service obligation periods of employment pursuant to this subsection shall not be counted in determining fulfillment of the service obligation incurred as a condition of the scholarship timing length of employment any individual enrolled in a program including a high school program authorized under section a be employed by the service or by a tribal health program or an urban indian organization during any nonacademic period of the year any such employment shall not exceed days during any calendar year nonapplicability of competitive personnel system any employment pursuant to this section shall be made without regard to any competitive personnel system or agency personnel limitation and to a position which will enable the individual so employed to receive practical experience in the health profession in which he or she is engaged in study any individual so employed shall receive payment for his or her services comparable to the salary he or she would receive if he or she were employed in the competitive system any individual so em verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ployed shall not be counted against any employment ceiling affecting the service or the department sec continuing education allowances in order to encourage scholarship and stipend recipients under sections and and health professionals including community health representatives and emergency medical technicians to join or continue in an indian health program and to provide their services in the rural and remote areas where a significant portion of indians reside the secretary acting through the service provide programs or allowances to transition into an indian health program including licensing board or certification examination assistance and technical assistance in fulfilling service obligations under sections and and provide programs or allowances to health professionals employed in an indian health program to enable them for a period of time each year prescribed by regulation of the secretary to take leave of their duty stations for professional consultation management leadership and refresher training coursesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec community health representative program a in general under the authority of the act of november usc commonly known as the snyder act the secretary acting through the service shall maintain a community health representative program under which indian health programs provide for the training of indians as community health representatives and use such community health representatives in the provision of health care health promotion and disease prevention services to indian communities duties the community health representative program of the service shall provide a high standard of training for community health representatives to ensure that the community health representatives provide quality health care health promotion and disease prevention services to the indian communities served by the program in order to provide such training develop and maintain a curriculum that a combines education in the theory of health care with supervised practical experience in the provision of health care andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provides instruction and practical experience in health promotion and disease prevention activities with appropriate consideration given to lifestyle factors that have an impact on indian health status such as alcoholism family dysfunction and poverty maintain a system which identifies the needs of community health representatives for continuing education in health care health promotion and disease prevention and develop programs that meet the needs for continuing education maintain a system that provides close supervision of community health representatives maintain a system under which the work of community health representatives is reviewed and evaluated and promote traditional health care practices of the indian tribes served consistent with the service standards for the provision of health care health promotion and disease prevention sec indian health service loan repayment program a establishment the secretary acting through the service shall establish and administer a program to be known as the service loan repayment pro verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gram hereinafter referred to as the loan repayment program in order to ensure an adequate supply of trained health professionals necessary to maintain accreditation of and provide health care services to indians through indian health programs and urban indian organizations eligible individuals to be eligible to participate in the loan repayment program an individual must a be enrolled in a course of study or program in an accredited educational institution as determined by the secretary under section of the public health service act usc l– and be scheduled to complete such course of study in the same year such individual applies to participate in such program or in an approved graduate training program in a health profession or have a degree in a health profession and a license to practice a health profession verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a be eligible for or hold an appointment as a commissioned officer in the regular or reserve corps of the public health service meet the professional standards for civil service employment in the service or be employed in an indian health program or urban indian organization without a service obligation and submit to the secretary an application for a contract described in subsection application information to be included with forms in disseminating application forms and contract forms to individuals desiring to participate in the loan repayment program the secretary shall include with such forms a fair summary of the rights and liabilities of an individual whose application is approved and whose contract is accepted by the secretary including in the summary a clear explanation of the damages to which the united states is entitled under subsection in the case of the individual breach of contract the secretary shall provide such individuals with sufficient information regarding the advantages and disadvantages of service as a commissioned officer in the regular or re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih serve corps of the public health service or a civilian employee of the service to enable the individual to make a decision on an informed basis clear language the application form contract form and all other information furnished by the secretary under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the loan repayment program timely availability of forms the secretary shall make such application forms contract forms and other information available to individuals desiring to participate in the loan repayment program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information priorities list consistent with subsection the secretary shall annually a identify the positions in each indian health program or urban indian organization for which there is a need or a vacancy and rank those positions in order of priorityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih approvals consistent with the priority determined under paragraph the secretary in determining which applications under the loan repayment program to approve and which contracts to accept shall a give first priority to applications made by individual indians and after making determinations on all applications submitted by individual indians as required under subparagraph a give priority to individuals recruited through the efforts of an indian health program or urban indian organization and other individuals based on the priority rankings under paragraph recipient contracts contract required an individual becomes a participant in the loan repayment program only upon the secretary and the individual entering into a written contract described in paragraph contents of contract the written contract referred to in this section between the secretary and an individual shall contain verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a an agreement under which subject to subparagraph th secretary agrees to pay loans on behalf of the individual in accordance with the pvisions of this section and to accept subject to the availability of appropriated funds for carrying out this section the individual into the service or place the individual with a tribal health program or urban indian organization as provided in clause iii and subject to subparagraph the individual agrees to accept loan payments on behalf of the individual in the case of an individual described in subsection aa to maintain enrollment in a course of study or trainin described in subsection a until the individual completes the course of study or training anverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih bb while enrolled in such course of study or training to maintain an acceptable level academic standing as determined under regulations of the secretary by the educational institution offering such course of study or training and iii to serve for a time period in this section referred to as the period of obligated service equal to years or such longer period as the individual agree to serve in the full time clinical practice of such individual profession in an indian health program or urban indian oganization to which the individual be assigned by the secretary a provision permitting the secretar to extend for such longer additional periods as the individual agree to the period of obligated service agreed to by the individual under subparagraph a iii a provision that any financial obligation of the united states arising out of a con verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tract entered into under this section and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments under this sectio a statement of the damages to which the united states is entitled under subsection for the individual breach of the contract and such other statements of the rights and liabilities of the secretary and of the individual not inconsistent with this section deadline for decision on application the secretary shall provide written notice to an individua within days on the secretary approving under subsection of the individual participation in loan repayment program including extensions resulting in an aggregate period of obligated service in excess of years the secretary disapproving an individual participation in such program payments in general a loan repayment provided for an individual under a written contract under the loan repayment program shall consist of payment verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in accordance with paragraph on behalf of the individual of the principal interest and related penses 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 a tuition expenses all other reasonable educational penses including fees books and laboratory expenses incurred by the individual and reasonable living expenses as determined by the secretary amount for each year of obligated service that an individual contracts to serve und subsection the secretary pay up to or an amount equal to the amount specified in section a of the public health service act whichever is more on behalf of the individual for loans described in paragraph in making a determination of the amount to pay for a year such service by an individual the secretary shall consider the extent to which each such determination a affects the ability of the secretary to maximize the number of contracts that can beverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bill hr ih provided under the loan repayment program from the amounts appropriated for such contracts provides an incentive to serve in indian health programs and urban indian organizations with the greatest shortages of health professionals and provides an incentive with respect to the health professional involved remaining in an indian health program or urban indian organization with such a health professional shortage and continuing to provide primary health seices after the completion of the period of obligated service under the loan repayment progr timing 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 reimbursements for tax liability for the purpose of providing reimbursements for ta liability resulting from a payment under paragraph on behalf of an individual the secretary verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in addition to such payments make payments to the individual in an amount equal to not less than percent and not more than percent of the total amount of loan repayments made for the taxable year involved and make such additional payments as the secretary determines to be appropriate with respect to such purpose payment schedule the secretary enter into an agreement with the holder of any loan for which payments are made under the loan repayment program to establish a schedule for the making of such payments employment ceiling notwithstanding any other provision of law individuals who have entered into written contracts with the secretary under this section shall not be counted against any employment ceiling affecting the department while those individuals are undergoing academic training recruitment the secretary shall conduct recruiting programs for the loan repayment program and other manpower programs of the service at educational institutions training health professionals or specialists identified in subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applicability of law section of the public health service act usc shall not apply to individuals during their period of obligated service under the loan repayment program assignment of individuals the secretary in assigning individuals to serve in indian health programs or urban indian organizations pursuant to contracts entered into under this section shall ensure that the staffing needs of tribal health programs and urban indian organizations receive consideration on an equal basis with programs that are administered directly by the service and give priority to assigning individuals to indian health programs and urban indian organizations that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section breach of contract specific breaches an individual who has entered into a written contract with the secretary under this section and has not received a waiver under subsection shall be liable in lieu of any service obligation arising under such contract verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to the united states for the amount which has been paid on such individual behalf under the contract if that individual a is enrolled in the final year of a course of study and fails to maintain an acceptable level of academic standing in the educational institution in which he or she is enrolled such level determined by the educational institution under regulations of the secretary voluntarily terminates such enrollment or iii is dismissed from such educational institution before completion of such course of study or is enrolled in a graduate training program and fails to complete such training program other breaches formula for amount owed if for any reason not specified in paragraph an individual breaches his or her written contract under this section by failing either to begin or complete such individual period of obligated service in accordance with subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the united states shall be entitled to recover from such individual an amount to be determined in accordance with the following formula a=z t¥s in which a a is the amount the united states is entitled to recover is the sum of the amounts paid under this section to or on behalf of the individual and the interest on such amounts which would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate as determined by the secretary of the treasury is the total number of months in the individual period of obligated service and is the number of months of such period served by such individual in accordance with this section time period for repayment any amount of damages which the united states is entitled to recover under this subsection shall be paid to the united states within the year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih deductions in medicare payments amounts not paid within such period shall be subject to collection through deductions in medicare payments pursuant to section of the social security act recovery of delinquency a in general if damages described in paragraph are delinquent for months the secretary shall for the purpose of recovering such damages use collection agencies contracted with by the administrator of general services or enter into contracts for the recovery of such damages with collection agencies selected by the secretary report each contract for recovering damages pursuant to this subsection shall provide that the contractor will not less than once each months submit to the secretary a status report on the success of the contractor in collecting such damages section of title united states code shall apply to any such contract to the extent not inconsistent with this subsectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih waiver or suspension of obligation in general the secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the loan repayment program whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable canceled upon death any obligation of an individual under the loan repayment program for service or payment of damages shall be canceled upon the death of the individual hardship waiver the secretary waive in whole or in part the rights of the united states to recover amounts under this section in any case of extreme hardship or other good cause shown as determined by the secretary bankruptcy any obligation of an individual under the loan repayment program for payment of damages be released by a discharge in bankruptcy under title of the united states code only if such discharge is granted after the expiration of the year period beginning on the first date that payment of such damages is required and only ifverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the bankruptcy court finds that nondischarge of the obligation would be unconscionable report the secretary shall submit to the president for inclusion in the report required to be submitted to congress under section a report concerning the previous fiscal year which sets forth by service area the following a list of the health professional positions maintained by indian health programs and urban indian organizations for which recruitment or retention is difficult the number of loan repayment program applications filed with respect to each type of health profession the number of contracts described in subsection that are entered into with respect to each health profession the amount of loan payments made under this section in total and by health profession the number of scholarships that are provided under sections and with respect to each health profession the amount of scholarship grants provided under sections and in total and by health professionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the number of providers of health care that will be needed by indian health programs and urban indian organizations by location and profession during the fiscal years beginning after the date the report is filed the measures the secretary plans to take to fill the health professional positions maintained by indian health programs or urban indian organizations for which recruitment or retention is difficult sec scholarship and loan repayment recovery fund a establishment there is established in the treasury of the united states a fund to be known as the indian health scholarship and loan repayment recovery fund hereafter in this section referred to as the lrrf the lrrf shall consist of such amounts as be collected from individuals under section section and section for breach of contract such funds as be appropriated to the lrrf and interest earned on amounts in the lrrf all amounts collected appropriated or earned relative to the lrrf shall remain available until expended use of funds verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by secretary amounts in the lrrf be expended by the secretary acting through the service to make payments to an indian health program a to which a scholarship recipient under section and or a loan repayment program participant under section has been assigned to meet the obligated service requirements pursuant to such sections and that has a need for a health professional to provide health care services as a result of such recipient or participant having breached the contract entered into under section or by tribal health programs a tribal health program receiving payments pursuant to paragraph expend the payments to provide scholarships or recruit and employ directly or by contract health professionals to provide health care services investment of funds the secretary of the treasury shall invest such amounts of the lrrf as the secretary of health and human services determines are not required to meet current withdrawals from the lrrf such investments be made only in interest bearingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih obligations of the united states for such purpose such obligations be acquired on original issue at the issue price or by purchase of outstanding obligations at the market price sale of obligations any obligation acquired by the lrrf be sold by the secretary of the treasury at the market price sec recruitment activities a reimbursement for travel the secretary acting through the service reimburse health professionals seeking positions with indian health programs or urban indian organizations including individuals considering entering into a contract under section and their spouses for actual and reasonable expenses incurred in traveling to and from their places of residence to an area in which they be assigned for the purpose of evaluating such area with respect to such assignment recruitment personnel the secretary acting through the service shall assign individual in each area office to be responsible on a full time basis for recruitment activities sec indian recruitment and retention program a in general the secretary acting through the service shall fund on a competitive basis innovativeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih demonstration projects for a period not to exceed years to enable indian health programs and urban indian organizations to recruit place and retain health professionals to meet their staffing needs eligible entities application any indian health program or urban indian organization submit an application for funding of a project pursuant to this section sec advanced training and research a demonstration program the secretary acting through the service shall establish a demonstration project to enable health professionals who have worked in an indian health program or urban indian organization for a substantial period of time to pursue advanced training or research areas of study for which the secretary determines a need exists service obligation an individual who participates in a program under subsection a where the educational costs are borne by the service shall incur an obligation to serve in an indian health program or urban indian organization for a period of obligated service equal to at least the period of time during which the individual participates in such program in the event that the individual fails to complete such obligated service the individual shall be liable to the united states for the periodverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of service remaining in such event with respect to individuals entering the program after the date of enactment of the indian health care improvement act amendments of the united states shall be entitled to recover from such individual an amount to be determined in accordance with the formula specified in subsection of section in the manner provided for in such subsection equal opportunity for participation health professionals from tribal health programs and urban indian organizations shall be given an equal opportunity to participate in the program under subsection a sec quentin burdick american indians into nursing program a grants authorized for the purpose of increasing the number of nurses nurse midwives and nurse practitioners who deliver health care services to indians the secretary acting through the service shall provide grants to the following public or private schools of nursing tribal colleges or universities nurse midwife programs and advanced practice nurse programs that are provided by any tribal college or university accredited nursing program or in the absence of such any other public or private institutionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih use of grants grants provided under subsection a be used for or more of the following to recruit individuals for programs which train individuals to be nurses nurse midwives or advanced practice nurses to provide scholarships to indians enrolled in such programs that pay the tuition charged for such program and other expenses incurred in connection with such program including books fees room and board and stipends for living expenses to provide a program that encourages nurses nurse midwives and advanced practice nurses to provide or continue to provide health care services to indians to provide a program that increases the skills of and provides continuing education to nurses nurse midwives and advanced practice nurses to provide any program that is designed to achieve the purpose described in subsection a applications each application for a grant under subsection a shall include such information as the secretary require to establish the connection between the program of the applicant and a health care facility that primarily serves indiansverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih preferences for grant recipients in providing grants under subsection a the secretary shall extend a preference to the following programs that provide a preference to indians programs that train nurse midwives or advanced practice nurses programs that are interdisciplinary programs that are conducted in cooperation with a program for gifted and talented indian students programs conducted by tribal colleges and universities quentin burdick program grant the secretary shall provide of the grants authorized under subsection a to establish and maintain a program at the university of north dakota to be known as the quentin burdick american indians into nursing program such program shall to the maximum extent feasible coordinate with the quentin burdick indian health programs established under section and the quentin burdick american indians into psychology program established under section active duty service obligation the active duty service obligation prescribed under section cverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih of the public health service act usc shall be met by each individual who receives training or assistance described in paragraph or of subsection that is funded by a grant provided under subsection a such obligation shall be met by service in the service in a program of an indian tribe or tribal organization conducted under the indian self determination and education assistance act usc et seq including programs under agreements with the bureau of indian affairs in a program assisted under title of this act in the private practice of nursing if as determined by the secretary in accordance with guidelines promulgated by the secretary such practice is situated in a physician or other health shortage area and addresses the health care needs of a substantial number of indians or in a teaching capacity in a tribal college or university nursing program or a related health profession program if as determined by the secretary health services provided to indians would not decreaseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec tribal cultural orientation a cultural education of employees the secretary acting through the service shall require that appropriate employees of the service who serve indian tribes in each service area receive educational instruction in the history and culture of such indian tribes and their relationship to the service program in carrying out subsection a the secretary shall establish a program which shall to the extent feasible be developed in consultation with the affected indian tribes tribal organizations and urban indian organizations be carried out through tribal colleges or universities include instruction in american indian studies and describe the use and place of traditional health care practices of the indian tribes in the service area sec inmed program a grants authorized the secretary acting through the service is authorized to provide grants to colleges and universities for the purpose of maintaining and expanding the indian health careers recruitment program known as the indians into medicine program herein verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih after in this section referred to as inmed as a means of encouraging indians to enter the health professions quentin burdick grant the secretary shall provide of the grants authorized under subsection a to maintain the inmed program at the university of north dakota to be known as the quentin burdick indian health programs unless the secretary makes a determination based upon program reviews that the program is not meeting the purposes of this section such program shall to the maximum extent feasible coordinate with the quentin burdick american indians into psychology program established under section and the quentin burdick american indians into nursing program established under section regulations the secretary pursuant to this act shall develop regulations to govern grants pursuant to this section requirements applicants for grants provided under this section shall agree to provide a program which provides outreach and recruitment for health professions to indian communities including elementary and secondary schools and community colleges located on reservations which will be served by the program verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih incorporates a program advisory board comprised of representatives from the indian tribes and indian communities which will be served by the program provides summer preparatory programs for indian students who need enrichment in the subjects of math and science in order to pursue training in the health professions provides tutoring counseling and support to students who are enrolled in a health career program of study at the respective college or university and to the maximum extent feasible employs qualified indians in the program sec health training programs of community colleges a grants to establish programs in general the secretary acting through the service shall award grants to accredited and accessible community colleges for the purpose of assisting such community colleges in the establishment of programs which provide education in a health profession leading to a degree or diploma in a health profession for individuals who desire toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih practice such profession on or near a reservation or in an indian health program amount of grants the amount of any grant awarded to a community college under paragraph for the first year in which such a grant is provided to the community college shall not exceed grants for maintenance and recruiting in general the secretary acting through the service shall award grants to accredited and accessible community colleges that have established a program described in subsection a for the purpose of maintaining the program and recruiting students for the program requirements grants only be made under this section to a community college which a is accredited has a relationship with a hospital facility service facility or hospital that could provide training of nurses or health professionals verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has entered into an agreement with an accredited college or university medical school the terms of which provide a program that enhances the transition and recruitment of students into advanced baccalaureate or graduate programs that train health professionals and stipulate certifications necessary to approve internship and field placement opportunities at indian health programs has a qualified staff which has the appropriate certifications is capable of obtaining state or regional accreditation of the program described in subsection a and agrees to provide for indian preference for applicants for programs under this section technical assistance the secretary shall encourage community colleges described in subsection to establish and maintain programs described in subsection a by entering into agreements with such colleges for the provision of qualified personnel of theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih service to teach courses of study in such programs and providing technical assistance and support to such colleges advanced training required any program receiving assistance under this section that is conducted with respect to a health profession shall also offer courses of study which provide advanced training for any health professional who a has already received a degree or diploma in such health profession and provides clinical services on or near a reservation or for an indian health program may be offered at alternate site such courses of study be offered in conjunction with the college or university with which the community college has entered into the agreement required under subsection priority where the requirements of subsection are met grant award priority shall be provided to tribal colleges and universities in service areas where they existverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec retention bonus a bonus authorized the secretary pay a retention bonus to any health professional employed by or assigned to and serving in an indian health program or urban indian organization either as a civilian employee or as a commissioned officer in the regular or reserve corps of the public health service who is assigned to and serving in a position for which recruitment or retention of personnel is difficult the secretary determines is needed by indian health programs and urban indian organizations has a completed years of employment with an indian health program or urban indian organization or completed any service obligations incurred as a requirement of any federal scholarship program or any federal education loan repayment program and enters into an agreement with an indian health program or urban indian organization forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih continued employment for a period of not less than year rates the secretary establish rates for the retention bonus which shall provide for a higher annual rate for multiyear agreements than for single year agreements referred to in subsection a but in no event shall the annual rate be more than per annum default of retention agreement any health professional failing to complete the agreed upon term of service except where such failure is through no fault of the individual shall be obligated to refund to the government the full amount of the retention bonus for the period covered by the agreement plus interest as determined by the secretary in accordance with section other retention bonus the secretary pay a retention bonus to any health professional employed by a tribal health program if such health professional is serving in a position which the secretary determines is a position for which recruitment or retention is difficult and necessary for providing health care services to indiansverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec nursing residency program a establishment of program the secretary acting through the service shall establish a program to enable indians who are licensed practical nurses licensed vocational nurses and registered nurses who are working in an indian health program or urban indian organization and have done so for a period of not less than year to pursue advanced training such program shall include a combination of education and work study in an indian health program or urban indian organization leading to an associate or bachelor degree in the case of a licensed practical nurse or licensed vocational nurse a bachelor degree in the case of a registered nurse or advanced degrees or certifications in nursing and public health service obligation an individual who participates in a program under subsection a where the educational costs are paid by the service shall incur an obligation to serve in an indian health program or urban indian organization for a period of obligated service equal to year for every year that nonprofessional employee licensed practical nurses licensed vocational nurses nursing assistants and various health care technicians or years for every year that professional nurse associate degree and bachelor prepared registered nurses participates in such program in the event that the individualverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fails to complete such obligated service the united states shall be entitled to recover from such individual an amount determined in accordance with the formula specified subsection of section for individuals failing to graduate from their degree program and subsection of section for individuals failing to start or complete the obligated service sec community health aide program a general purposes of program under the authority of the act of november usc commonly known as the snyder act the secretary acting through the service shall develop and operate a community health aide program in alaska under which the service provides for the training of alaska natives as health aides or community health practitioners uses such aides or practitioners in the provision of health care health promotion and disease prevention services to alaska natives living in villages in rural alaska and provides for the establishment of teleconferencing capacity in health clinics located in or near such villages for use by community health aides or community health practitionersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih specific program requirements the secretary acting through the community health aide program of the service shall using trainers accredited by the program provide a high standard of training to community health aides and community health practitioners to ensure that such aides and practitioners provide quality health care health promotion and disease prevention services to the villages served by the program in order to provide such training develop a curriculum that a combines education in the theory of health care with supervised practical experience in the provision of health care provides instruction and practical experience in the provision of acute care emergency care health promotion disease prevention and the efficient and effective management of clinic pharmacies supplies equipment and facilities and promotes the achievement of the health status objectives specified in section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih establish and maintain a community health aide certification board to certify as community health aides or community health practitioners individuals who have successfully completed the training described in paragraph or can demonstrate equivalent experience develop and maintain a system which identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care including the areas described in paragraph and develop programs that meet the needs for such continuing education develop and maintain a system that provides close supervision of community health aides and community health practitioners develop a system under which the work of community health aides and community health practitioners is reviewed and evaluated to assure the provision of quality health care health promotion and disease prevention services and ensure that pulpal therapy not including pulpotomies on deciduous teeth or extraction of adult teeth can be performed by a dental health aide therapist only after consultation with a licensed den verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment and further that dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries provided that uncomplicated extractions shall not be considered oral surgery under this section program review neutral panel a establishment the secretary acting through the service shall establish a neutral panel to carry out the study under paragraph membership members of the neutral panel shall be appointed by the secretary from among clinicians economists community practitioners oral epidemiologists and alaska natives study a in general the neutral panel established under paragraph shall conduct a study of the dental health aide therapist services provided by the community health aide program under this section to ensure that theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih quality of care provided through those services is adequate and appropriate parameters of study the secretary in consultation with interested parties including professional dental organizations shall develop the parameters of the study inclusions the study shall include a determination by the neutral panel with respect to the ability of the dental health aide therapist services under this section to address the dental care needs of alaska natives the quality of care provided through those services including any training improvement or additional oversight required to improve the quality of care and iii whether safer and less costly alternatives to the dental health aide therapist services exist consultation in carrying out the study under this paragraph the neutral panel shall consult with alaska tribal organizationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih with respect to the adequacy and accuracy of the study report the neutral panel shall submit to the secretary the committee on indian affairs of the senate and the committee on natural resources of the house of representatives a report describing the results of the study under paragraph including a description of a any determination of the neutral panel under paragraph and any comments received from an alaska tribal organization under paragraph d nationalization of program in general except as provided in paragraph the secretary acting through the service establish a national community health aide program in accordance with the program under this section as the secretary determines to be appropriate exception the national community health aide program under paragraph shall not include dental health aide therapist services requirement in establishing a national program under paragraph the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall not reduce the amount of funds provided for the community health aide program described in subsections a and sec tribal health program administration the secretary shall by contract or otherwise provide training for individuals in the administration and planning of tribal health programs with priority to indians sec health professional chronic shortage demonstration programs a demonstration programs authorized the secretary acting through the service fund demonstration programs for tribal health programs to address the chronic shortages of health professionals purposes of programs the purposes of demonstration programs funded under subsection a shall be to provide direct clinical and practical experience at a service unit to health profession students and residents from medical schools to improve the quality of health care for indians by assuring access to qualified health care professionals and to provide academic and scholarly opportunities for health professionals serving indians byverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih identifying all academic and scholarly resources of the region advisory board the demonstration programs established pursuant to subsection a shall incorporate a program advisory board composed of representatives from the indian tribes and indian communities in the area which will be served by the program sec national health service corps a no reduction in services the secretary shall not remove a member of the national health service corps from an indian health program or urban indian organization or withdraw funding used to support such member unless the secretary acting through the service has ensured that the indians receiving services from such member will experience no reduction in services treatment of indian health programs at the request of an indian health program the services of a member of the national health service corps assigned to an indian health program be limited to the persons who are eligible for services from such programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec substance abuse counselor educational curricula demonstration programs a contracts and grants the secretary acting through the service enter into contracts with or make grants to accredited tribal colleges and universities and eligible accredited and accessible community colleges to establish demonstration programs to develop educational curricula for substance abuse counseling use of funds funds provided under this section shall be used only for developing and providing educational curriculum for substance abuse counseling including paying salaries for instructors such curricula be provided through satellite campus programs time period of assistance renewal a contract entered into or a grant provided under this section shall be for a period of years such contract or grant be renewed for an additional year period upon the approval of the secretary criteria for review and approval of applications not later than days after the date of enactment of the indian health care improvement act amendments of the secretary after consultation with indian tribes and administrators of tribal colleges and universities and eligible accredited and accessible community colleges shall develop and issue criteria for the review and approval of applications for funding includingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applications for renewals of funding under this section such criteria shall ensure that demonstration programs established under this section promote the development of the capacity of such entities to educate substance abuse counselors assistance the secretary shall provide such technical and other assistance as be necessary to enable grant recipients to comply with the provisions of this section report each fiscal year the secretary shall submit to the president for inclusion in the report which is required to be submitted under section for that fiscal year a report on the findings and conclusions derived from the demonstration programs conducted under this section during that fiscal year definition for the purposes of this section the term educational curriculum means or more of the following classroom education clinical work experience continuing education workshops sec behavioral health training and community education programs a study list the secretary acting through the service and the secretary of the interior in consulta verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion with indian tribes and tribal organizations shall conduct a study and compile a list of the types of staff positions specified in subsection whose qualifications include or should include training in the identification prevention education referral or treatment of mental illness or dysfunctional and self destructive behavior positions the positions referred to in subsection a are staff positions within the bureau of indian affairs including existing positions in the fields of a elementary and secondary education social services and family and child welfare law enforcement and judicial services and alcohol and substance abuse staff positions within the service and staff positions similar to those identified in paragraphs and established and maintained by indian tribes tribal organizations without regard to the funding source and urban indian organizations training criteria verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general the appropriate secretary shall provide training criteria appropriate to each type of position identified in subsection and and ensure that appropriate training has been or shall be provided to any individual in any such position with respect to any such individual in a position identified pursuant to subsection the respective secretaries shall provide appropriate training to or provide funds to an indian tribe tribal organization or urban indian organization for training of appropriate individuals in the case of positions funded under a contract or compact under the indian self determination and education assistance act usc et seq the appropriate secretary shall ensure that such training costs are included in the contract or compact as the secretary determines necessary position specific training criteria position specific training criteria shall be culturally relevant to indians and indian tribes and shall ensure that appropriate information regarding traditional health care practices is provided community education on mental illness the service shall develop and implement on request of an indian tribe tribal organization or urbanverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih indian organization or assist the indian tribe tribal organization or urban indian organization to develop and implement a program of community education on mental illness in carrying out this subsection the service shall upon request of an indian tribe tribal organization or urban indian organization provide technical assistance to the indian tribe tribal organization or urban indian organization to obtain and develop community educational materials on the identification prevention referral and treatment of mental illness and dysfunctional and self destructive behavior plan not later than days after the date of enactment of the indian health care improvement act amendments of the secretary shall develop a plan under which the service will increase the health care staff providing behavioral health services by at least positions within years after the date of enactment of this section with at least of such positions devoted to child adolescent and family services the plan developed under this subsection shall be implemented under the act of november usc commonly known as the snyder act sec exemption from payment of certain fees employees of a tribal health program or an urban indian organization shall be exempt from payment of li verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih censing registration and other fees imposed by a federal agency to the same extent that commissioned corps officers or other employees of the indian health service are exempt from such fees sec authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this title title health services sec indian health care improvement fund a use of funds the secretary acting through the service is authorized to expend funds directly or under the authority of the indian self determination and education assistance act usc et seq which are appropriated under the authority of this section for the purposes of eliminating the deficiencies in health status and health resources of all indian tribes eliminating backlogs in the provision of health care services to indians meeting the health needs of indians in an efficient and equitable manner including the use of telehealth and telemedicine when appropriate eliminating inequities in funding for both direct care and contract health service programs andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih augmenting the ability of the service to meet the following health service responsibilities with respect to those indian tribes with the highest levels of health status deficiencies and resource deficiencies a clinical care including inpatient care outpatient care including audiology clinical eye and vision care primary care secondary and tertiary care and long term care preventive health including mammography and other cancer screening in accordance with section dental care mental health including community mental health services inpatient mental health services dormitory mental health services therapeutic and residential treatment centers and training of traditional health care practitioners emergency medical services treatment and control of and rehabilitative care related to alcoholism and drug abuse including fetal alcohol syndrome among indiansverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih injury prevention programs including data collection and evaluation demonstration projects training and capacity building home health care community health representatives maintenance and improvement no offset or limitation any funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the service under this act or the act of november usc commonly known as the snyder act or any other provision of law allocation use in general funds appropriated under the authority of this section shall be allocated to service units indian tribes or tribal organizations the funds allocated to each indian tribe tribal organization or service unit under this paragraph shall be used by the indian tribe tribal organization or service unit under this paragraph to improve the health status and reduce the resource deficiency of each indian tribe served by such service unit indian tribe or tribal organization apportionment of allocated funds the apportionment of funds allocated to averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih service unit indian tribe or tribal organization under paragraph among the health service responsibilities described in subsection a shall be determined by the service in consultation with and with the active participation of the affected indian tribes and tribal organizations provisions relating to health status and resource deficiencies for the purposes of this section the following definitions apply definition the term health status and resource deficiency means the extent to which a the health status objectives set forth in section are not being achieved and the indian tribe or tribal organization does not have available to it the health resources it needs taking into account the actual cost of providing health care services given local geographic climatic rural or other circumstances available resources the health resources available to an indian tribe or tribal organization include health resources provided by the service as well as health resources used by the indian tribe or tribal organization including servicesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and financing systems provided by any federal programs private insurance and programs of state or local governments process for review of determinations the secretary shall establish procedures which allow any indian tribe or tribal organization to petition the secretary for a review of any determination of the extent of the health status and resource deficiency of such indian tribe or tribal organization eligibility for funds tribal health programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the service report by no later than the date that is years after the date of enactment of the indian health care improvement act amendments of the secretary shall submit to congress the current health status and resource deficiency report of the service for each service unit including newly recognized or acknowledged indian tribes such report shall set out the methodology then in use by the service for determining tribal health status and resource deficiencies as well as the most recent application of that methodology verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the extent of the health status and resource deficiency of each indian tribe served by the service or a tribal health program the amount of funds necessary to eliminate the health status and resource deficiencies of all indian tribes served by the service or a tribal health program and an estimate of a the amount of health service funds appropriated under the authority of this act or any other act including the amount of any funds transferred to the service for the preceding fiscal year which is allocated to each service unit indian tribe or tribal organization the number of indians eligible for health services in each service unit or indian tribe or tribal organization and the number of indians using the service resources made available to each service unit indian tribe or tribal organization and to the extent available information on the waiting lists and number of indians turned away for services due to lack of resourcesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih inclusion in base budget funds appropriated under this section for any fiscal year shall be included in the base budget of the service for the purpose of determining appropriations under this section in subsequent fiscal years clarification nothing in this section is intended to diminish the primary responsibility of the service to eliminate existing backlogs in unmet health care needs nor are the provisions of this section intended to discourage the service from undertaking additional efforts to achieve equity among indian tribes and tribal organizations funding designation any funds appropriated under the authority of this section shall be designated as the indian health care improvement fund sec health promotion and disease prevention services a findings congress finds that health promotion and disease prevention activities improve the health and well being of indians and reduce the expenses for health care of indians provision of services the secretary acting through the service shall provide health promotionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and disease prevention services to indians to achieve the health status objectives set forth in section evaluation the secretary after obtaining input from the affected tribal health programs shall submit to the president for inclusion in the report which is required to be submitted to congress under section an evaluation of the health promotion and disease prevention needs of indians the health promotion and disease prevention activities which would best meet such needs the internal capacity of the service and tribal health programs to meet such needs and the resources which would be required to enable the service and tribal health programs to undertake the health promotion and disease prevention activities necessary to meet such needs sec diabetes prevention treatment and control a determinations regarding diabetes the secretary acting through the service and in consultation with indian tribes and tribal organizations shall determine verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by indian tribe and by service unit the incidence of and the types of complications resulting from diabetes among indians and based on the determinations made pursuant to paragraph the measures including patient education and effective ongoing monitoring of disease indicators each service unit should take to reduce the incidence of and prevent treat and control the complications resulting from diabetes among indian tribes within that service unit diabetes screening to the extent medically indicated and with informed consent the secretary shall screen each indian who receives services from the service for diabetes and for conditions which indicate a high risk that the individual will become diabetic and establish a cost effective approach to ensure ongoing monitoring of disease indicators such screening and monitoring be conducted by a tribal health program and be conducted through appropriate internet based health care management programs diabetes projects the secretary shall continue to maintain each model diabetes project in existence on the date of enactment of the indian health care improvement act amendments of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dialysis programs the secretary is authorized to provide through the service indian tribes and tribal organizations dialysis programs including the purchase of dialysis equipment and the provision of necessary staffing other duties of the secretary in general the secretary shall to the extent funding is available a in each area office consult with indian tribes and tribal organizations regarding programs for the prevention treatment and control of diabetes establish in each area office a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area and ensure that data collected in each area office regarding diabetes and related complications among indians are disseminated to all other area offices subject to applicable patient privacy laws diabetes control officers a in general the secretary establish and maintain in each area office a position of diabetes control officer to coordinate andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih manage any activity of that area office relating to the prevention treatment or control of diabetes to assist the secretary in carrying out a program under this section or section of the public health service act usc c– certain activities any activity carried out by a diabetes control officer under subparagraph a that is the subject of a contract or compact under the indian self determination and education assistance act usc et seq and any funds made available to carry out such an activity shall not be divisible for purposes of that act sec shared services for long term care a long term care notwithstanding any other provision of law the secretary acting through the service is authorized to provide directly or enter into contracts or compacts under the indian self determination and education assistance act usc et seq with indian tribes or tribal organizations for the delivery of long term care including health care services associated with long term care provided in a facility to indians such agreements shall provide for the sharing of staff or other services between the service or a tribal health programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and a long term care or related facility owned and operated directly or through a contract or compact under the indian self determination and education assistance act usc et seq by such indian tribe or tribal organization contents of agreements an agreement entered into pursuant to subsection a at the request of the indian tribe or tribal organization delegate to such indian tribe or tribal organization such powers of supervision and control over service employees as the secretary deems necessary to carry out the purposes of this section shall provide that expenses including salaries relating to services that are shared between the service and the tribal health program be allocated proportionately between the service and the indian tribe or tribal organization and authorize such indian tribe or tribal organization to construct renovate or expand a long term care or other similar facility including the construction of a facility attached to a service facility minimum requirement any nursing facility provided for under this section shall meet the require verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ments for nursing facilities under section of the social security act other assistance the secretary shall provide such technical and other assistance as be necessary to enable applicants to comply with the provisions of this section use of existing or underused facilities the secretary shall encourage the use of existing facilities that are underused or allow the use of swing beds for long term or similar care sec health services research a in general the secretary acting through the service shall make funding available for research to further the performance of the health service responsibilities of indian health programs coordination of resources and activities the secretary shall also to the maximum extent practicable coordinate departmental research resources and activities to address relevant indian health program research needs availability tribal health programs shall be given an equal opportunity to compete for and receive research funds under this section use of funds this funding be used for both clinical and nonclinical researchverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih evaluation and dissemination the secretary shall periodically evaluate the impact of research conducted under this section and disseminate to tribal health programs information regarding that research as the secretary determines to be appropriate sec mammography and other cancer screening the secretary acting through the service shall provide for screening as follows screening mammography as defined in section jj of the social security act for indian women at a frequency appropriate to such women under accepted and appropriate national standards and under such terms and conditions as are consistent with standards established by the secretary to ensure the safety and accuracy of screening mammography under part of title xviii of such act other cancer screening that receives an a or rating as recommended by the united states preventive services task force established under section a of the public health service act usc b– a the secretary shall en verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sure that screening provided for under this paragraph complies with the recommendations of the task force with respect to a frequency the population to be served the procedure or technology to be used evidence of effectiveness and other matters that the secretary determines appropriate sec patient travel costs a definition of qualified escort in this section the term qualified escort means an adult escort including a parent guardian or other family member who is required because of the physical or mental condition or age of the applicable patient a health professional for the purpose of providing necessary medical care during travel by the applicable patient or other escorts as the secretary or applicable indian health program determines to be appropriate provision of funds the secretary acting through the service is authorized to provide funds for theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih following patient travel costs including qualified escorts associated with receiving health care services provided either through direct or contract care or through a contract or compact under the indian self determination and education assistance act usc et seq under this act emergency air transportation and nonemergency air transportation where ground transportation is infeasible transportation by private vehicle where no other means of transportation is available specially equipped vehicle and ambulance and transportation by such other means as be available and required when air or motor vehicle transportation is not available sec epidemiology centers a establishment of centers the secretary shall establish an epidemiology center in each service area to carry out the functions described in subsection any new center established after the date of enactment of the indian health care improvement act amendments of be operated under a grant authorized by subsection but funding under such a grant shall not be divisibleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih functions of centers in consultation with and upon the request of indian tribes tribal organizations and urban indian communities each service area epidemiology center established under this section shall with respect to such service area collect data relating to and monitor progress made toward meeting each of the health status objectives of the service the indian tribes tribal organizations and urban indian communities in the service area evaluate existing delivery systems data systems and other systems that impact the improvement of indian health assist indian tribes tribal organizations and urban indian organizations in identifying their highest priority health status objectives and the services needed to achieve such objectives based on epidemiological data make recommendations for the targeting of services needed by the populations served make recommendations to improve health care delivery systems for indians and urban indians provide requested technical assistance to indian tribes tribal organizations and urban in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community and provide disease surveillance and assist indian tribes tribal organizations and urban indian communities to promote public health technical assistance the director of the centers for disease control and prevention shall provide technical assistance to the centers in carrying out the requirements of this section grants for studies in general the secretary make grants to indian tribes tribal organizations indian organizations and eligible intertribal consortia to conduct epidemiological studies of indian communities eligible intertribal consortia an intertribal consortium or indian organization is eligible to receive a grant under this subsection if a the intertribal consortium is incorporated for the primary purpose of improving indian health and the intertribal consortium is representative of the indian tribes or urban in verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dian communities in which the intertribal consortium is located applications an application for a grant under this subsection shall be submitted in such manner and at such time as the secretary shall prescribe requirements an applicant for a grant under this subsection shall a demonstrate the technical administrative and financial expertise necessary to carry out the functions described in paragraph consult and cooperate with providers of related health and social services in order to avoid duplication of existing services and demonstrate cooperation from indian tribes or urban indian organizations in the area to be served use of funds a grant awarded under paragraph be used a to carry out the functions described in subsection to provide information to and consult with tribal leaders urban indian communityverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih leaders and related health staff on health care and health service management issues and in collaboration with indian tribes tribal organizations and urban indian communities to provide the service with information regarding ways to improve the health status of indians access to information an epidemiology center operated by a grantee pursuant to a grant awarded under subsection shall be treated as a public health authority for purposes of the health insurance portability and accountability act of as such entities are defined in part of title code of federal regulations the secretary shall grant to such epidemiology center access to use of the data data sets monitoring systems delivery systems and other protected health information in the possession of the secretary the activities of such an epidemiology center shall be for the purposes of research and for preventing and controlling disease injury or disability for purposes of the health insurance portability and accountability act of public law – verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih stat as such activities are described in part of title code of federal regulations or a successor regulation funds not divisible an epidemiology center established under this section shall be subject to the provisions of the indian self determination and education assistance act usc et seq but the funds for such center shall not be divisible sec comprehensive school health education programs a funding for development of programs in addition to carrying out any other program for health promotion or disease prevention the secretary acting through the service is authorized to award grants to indian tribes and tribal organizations to develop comprehensive school health education programs for children from pre school through grade in schools for the benefit of indian children use of grant funds a grant awarded under this section be used for purposes which include but are not limited to the following developing health education materials both for regular school programs and afterschool programsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih training teachers in comprehensive school health education materials integrating school based communitybased and other public and private health promotion efforts encouraging healthy tobacco free school environments coordinating school based health programs with existing services and programs available in the community developing school programs on nutrition education personal health oral health and fitness developing behavioral health wellness programs developing chronic disease prevention programs developing substance abuse prevention programs developing injury prevention and safety education programs developing activities for the prevention and control of communicable diseases developing community and environmental health education programs that include traditional health care practitionersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih violence prevention such other health issues as are appropriate technical assistance upon request the secretary acting through the service shall provide technical assistance to indian tribes and tribal organizations in the development of comprehensive health education plans and the dissemination of comprehensive health education materials and information on existing health programs and resources criteria for review and approval of applications the secretary acting through the service and in consultation with indian tribes and tribal organizations shall establish criteria for the review and approval of applications for grants awarded under this section development of program for bia funded schools in general the secretary of the interior acting through the bureau of indian affairs and in cooperation with the secretary acting through the service shall develop a comprehensive school health education program for children from preschool through grade in schools for which support is provided by the bureau of indian affairsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih requirements for programs such programs shall include a school programs on nutrition education personal health oral health and fitness behavioral health wellness programs chronic disease prevention programs substance abuse prevention programs injury prevention and safety education programs and activities for the prevention and control of communicable diseases duties of the secretary the secretary of the interior shall a provide training to teachers in comprehensive school health education materials ensure the integration and coordination of school based programs with existing services and health programs available in the community and encourage healthy tobacco free school environments sec indian youth program a program authorized the secretary acting through the service is authorized to establish and admin verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ister a program to provide grants to indian tribes tribal organizations and urban indian organizations for innovative mental and physical disease prevention and health promotion and treatment programs for indian and urban indian preadolescent and adolescent youths use of funds allowable uses funds made available under this section be used to a develop prevention and treatment programs for indian youth which promote mental and physical health and incorporate cultural values community and family involvement and traditional health care practitioners and develop and provide community training and education prohibited use funds made available under this section not be used to provide services described in section c duties of the secretary the secretary shall disseminate to indian tribes tribal organizations and urban indian organizations information regarding models for the delivery of comprehensive health care services to indian and urban indian adolescents verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih encourage the implementation of such models and at the request of an indian tribe tribal organization or urban indian organization provide technical assistance in the implementation of such models criteria for review and approval of applications the secretary in consultation with indian tribes tribal organizations and urban indian organizations shall establish criteria for the review and approval of applications or proposals under this section sec prevention control and elimination of communicable and infectious diseases a grants authorized the secretary acting through the service and after consultation with the centers for disease control and prevention make grants available to indian tribes tribal organizations and urban indian organizations for the following projects for the prevention control and elimination of communicable and infectious diseases including tuberculosis hepatitis hiv respiratory syncytial virus hanta virus sexually transmitted diseases and pyloriverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih public information and education programs for the prevention control and elimination of communicable and infectious diseases education training and clinical skills improvement activities in the prevention control and elimination of communicable and infectious diseases for health professionals including allied health professionals demonstration projects for the screening treatment and prevention of hepatitis virus hcv application required the secretary provide funding under subsection a only if an application or proposal for funding is submitted to the secretary coordination with health agencies indian tribes tribal organizations and urban indian organizations receiving funding under this section are encouraged to coordinate their activities with the centers for disease control and prevention and state and local health agencies technical assistance report in carrying out this section the secretary at the request of an indian tribe tribal organization or urban indian organization provide technical assistance andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall prepare and submit a report to congress biennially on the use of funds under this section and on the progress made toward the prevention control and elimination of communicable and infectious diseases among indians and urban indians sec other authority for provision of services a funding authorized the secretary provide funding under this act to meet the objectives set forth in section of this act through health care related services and programs of the service indian tribes and tribal organizations not otherwise described in this act for the following services hospice care assisted living services long term care services home and community based services eligibility the following individuals shall be eligible to receive long term care under this section individuals who are unable to perform a certain number of activities of daily living without assistance individuals with a mental impairment such as dementia alzheimer disease or anotherverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih disabling mental illness who be able to perform activities of daily living under supervision such other individuals as an applicable indian health program determines to be appropriate definitions for the purposes of this section the following definitions shall apply the term assisted living services means any service provided by an assisted living facility as defined in section of the national housing act usc except that such an assisted living facility a shall not be required to obtain a license but shall meet all applicable standards for licensure the term home and community based services means or more of the services specified in paragraphs through of section a of the social security act usc a whether provided by the service or by an indian tribe or tribal organization pursuant to the indian self determination and education assistance act usc et seq that are or will be provided in accordance with applicable standardsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the term hospice care means the items and services specified in subparagraphs a through of section dd of the social security act usc dd and such other services which an indian tribe or tribal organization determines are necessary and appropriate to provide in furtherance of this care the term long term care services has the meaning given the term qualified long term care services in section of the internal revenue code of authorization of convenient care services the secretary acting through the service indian tribes and tribal organizations also provide funding under this act to meet the objectives set forth in section of this act for convenient care services programs pursuant to section a sec indian women health care the secretary acting through the service and indian tribes tribal organizations and urban indian organizations shall monitor and improve the quality of health care for indian women of all ages through the planning and delivery of programs administered by the service in order to improve and enhance the treatment models of care for indian womenverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec environmental and nuclear health hazards a studies and monitoring the secretary and the service shall conduct in conjunction with other appropriate federal agencies and in consultation with concerned indian tribes and tribal organizations studies and ongoing monitoring programs to determine trends in the health hazards to indian miners and to indians on or near reservations and indian communities as a result of environmental hazards which result in chronic or life threatening health problems such as nuclear resource development petroleum contamination and contamination of water source and of the food chain such studies shall include an evaluation of the nature and extent of health problems caused by environmental hazards currently exhibited among indians and the causes of such health problems an analysis of the potential effect of ongoing and future environmental resource development on or near reservations and indian communities including the cumulative effect over time on health an evaluation of the types and nature of activities practices and conditions causing or affecting such health problems including uranium mining and milling uranium mine tailing deposits nuclearverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih power plant operation and construction and nuclear waste disposal oil and gas production or transportation on or near reservations or indian communities and other development that could affect the health of indians and their water supply and food chain a summary of any findings and recommendations provided in federal and state studies reports investigations and inspections during the years prior to the date of enactment of the indian health care improvement act amendments of that directly or indirectly relate to the activities practices and conditions affecting the health or safety of such indians and the efforts that have been made by federal and state agencies and resource and economic development companies to effectively carry out an education program for such indians regarding the health and safety hazards of such development health care plans upon completion of such studies the secretary and the service shall take into account the results of such studies and develop health care plans to address the health problems studied under subsection a the plans shall include verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih methods for diagnosing and treating indians currently exhibiting such health problems preventive care and testing for indians who be exposed to such health hazards including the monitoring of the health of individuals who have or have been exposed to excessive amounts of radiation or affected by other activities that have had or could have a serious impact upon the health of such individuals and a program of education for indians who by reason of their work or geographic proximity to such nuclear or other development activities experience health problems submission of report and plan to congress the secretary and the service shall submit to congress the study prepared under subsection a no later than months after the date of enactment of the indian health care improvement act amendments of the health care plan prepared under subsection shall be submitted in a report no later than year after the study prepared under subsection a is submitted to congress such report shall include recommended activities for the implementation of the plan as well as an evaluation of any activities previously undertaken by the service to address such health problemsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih intergovernmental task force establishment members there is established an intergovernmental task force to be composed of the following individuals or their designees a the secretary of energy the secretary of the environmental protection agency the director of the bureau of mines the assistant secretary for occupational safety and health the secretary of the interior the secretary of health and human services the director of the indian health service duties the task force shall a identify existing and potential operations related to nuclear resource development or other environmental hazards that affect or affect the health of indians on or near a reservation or in an indian community and enter into activities to correct existing health hazards and ensure that current and future health problems resulting from nuclearverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih resource or other development activities are minimized or reduced chairman meetings the secretary of health and human services shall be the chairman of the task force the task force shall meet at least twice each year health services to certain employees in the case of any indian who as a result of employment in or near a uranium mine or mill or near any other environmental hazard suffers from a work related illness or condition is eligible to receive diagnosis and treatment services from an indian health program and by reason of such indian employment is entitled to medical care at the expense of such mine or mill operator or entity responsible for the environmental hazard the indian health program shall at the request of such indian render appropriate medical care to such indian for such illness or condition and be reimbursed for any medical care so rendered to which such indian is entitled at the expense of such operator or entity from such operator or entity nothing in this subsection shall affect the rights of such indian to recover damages other thanverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such amounts paid to the indian health program from the employer for providing medical care for such illness or condition sec arizona as a contract health service delivery area a in general for fiscal years beginning with the fiscal year ending september and ending with the fiscal year ending september the state of arizona shall be designated as a contract health service delivery area by the service for the purpose of providing contract health care services to members of federally recognized indian tribes of arizona maintenance of services the service shall not curtail any health care services provided to indians residing on reservations in the state of arizona if such curtailment is due to the provision of contract services in such state pursuant to the designation of such state as a contract health service delivery area pursuant to subsection a sec north dakota and south dakota as contract health service delivery area a in general beginning in fiscal year the states of north dakota and south dakota shall be designated as a contract health service delivery area by the service for the purpose of providing contract healthverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih care services to members of federally recognized indian tribes of north dakota and south dakota limitation the service shall not curtail any health care services provided to indians residing on any reservation or in any county that has a common boundary with any reservation in the state of north dakota or south dakota if such curtailment is due to the provision of contract services in such states pursuant to the designation of such states as a contract health service delivery area pursuant to subsection a sec california contract health services program a funding authorized the secretary is authorized to fund a program using the california rural indian health board hereafter in this section referred to as the crihb as a contract care intermediary to improve the accessibility of health services to california indians reimbursement contract the secretary shall enter into an agreement with the crihb to reimburse the crihb for costs including reasonable administrative costs incurred pursuant to this section in providing medical treatment under contract to california indians described in section a throughout the cali verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fornia contract health services delivery area described in section with respect to high cost contract care cases administrative expenses not more than percent of the amounts provided to the crihb under this section for any fiscal year be for reimbursement for administrative expenses incurred by the crihb during such fiscal year limitation on payment no payment be made for treatment provided hereunder to the extent payment be made for such treatment under the indian catastrophic health emergency fund described in section or from amounts appropriated or otherwise made available to the california contract health service delivery area for a fiscal year advisory board there is established an advisory board which shall advise the crihb in carrying out this section the advisory board shall be composed of representatives selected by the crihb from not less than tribal health programs serving california indians covered under this section at least of whom of whom are not affiliated with the crihb sec california as a contract health service delivery area the state of california excluding the counties of alameda contra costa los angeles marin orange sac verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ramento san francisco san mateo santa clara kern merced monterey napa san benito san joaquin san luis obispo santa cruz solano stanislaus and ventura shall be designated as a contract health service delivery area by the service for the purpose of providing contract health services to california indians however any of the counties listed herein only be included in the contract health services delivery area if funding is specifically provided by the service for such services in those counties sec contract health services for the trenton service area a authorization for services the secretary acting through the service is directed to provide contract health services to members of the turtle mountain band of chippewa indians that reside in the trenton service area of divide mckenzie and williams counties in the state of north dakota and the adjoining counties of richland roosevelt and sheridan in the state of montana no expansion of eligibility nothing in this section be construed as expanding the eligibility of members of the turtle mountain band of chippewa indians for health services provided by the service beyondverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the scope of eligibility for such health services that applied on may sec programs operated by indian tribes and tribal organizations the service shall provide funds for health care programs functions services activities information technology and facilities operated by tribal health programs on the same basis as such funds are provided to programs functions services activities information technology and facilities operated directly by the service sec licensing licensed health care professionals employed by a tribal health program shall if licensed in any state be exempt from the licensing requirements of the state in which the tribal health program performs the services described in its contract or compact under the indian self determination and education assistance act usc et seq while performing such services sec notification of provision of emergency contract health services with respect to an elderly indian or an indian with a disability receiving emergency medical care or services from a non service provider or in a non service facility under the authority of this act the time limitation asverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a condition of payment for notifying the service of such treatment or admission shall be days sec prompt action on payment of claims a deadline for response the service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within working days after the receipt of such notification effect of untimely response if the service fails to respond to a notification of a claim in accordance with subsection a the service shall accept as valid the claim submitted by the provider of a contract care service deadline for payment of valid claim the service shall pay a valid contract care service claim within days after the completion of the claim sec liability for payment a no patient liability a patient who receives contract health care services that are authorized by the service shall not be liable for the payment of any charges or costs associated with the provision of such services notification the secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the service thatverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such patient is not liable for the payment of any charges or costs associated with the provision of such services not later than business days after receipt of a notification of a claim by a provider of contract care services no recourse following receipt of the notice provided under subsection or if a claim has been deemed accepted under section the provider shall have no further recourse against the patient who received the services sec office of indian men health a establishment the secretary establish within the service an office to be known as the office of indian men health referred to in this section as the office director in general the office shall be headed by a director to be appointed by the secretary duties the director shall coordinate and promote the status of the health of indian men in the united states report not later than years after the date of enactment of the indian health care improvement act amendments of the secretary acting through the director of the office shall submit to congress a report describing verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih any activity carried out by the director as of the date on which the report is prepared and any finding of the director with respect to the health of indian men sec catastrophic health emergency fund a establishment there is established an indian catastrophic health emergency fund hereafter in this section referred to as the chef consisting of the amounts deposited under subsection and the amounts appropriated to chef under this section administration chef shall be administered by the secretary acting through the headquarters of the service solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the service conditions on use of fund no part of chef or its administration shall be subject to contract or grant under any law including the indian self determination and education assistance act usc et seq nor shall chef funds be allocated apportioned or delegated on an area office service unit or other similar basisverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih regulations the secretary shall promulgate regulations consistent with the provisions of this section to establish a definition of disasters and catastrophic illnesses for which the cost of the treatment provided under contract would qualify for payment from chef provide that a service unit shall not be eligible for reimbursement for the cost of treatment from chef until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the secretary shall establish at a the level of and for any subsequent year not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers united states city average for the month period ending with december of the previous year establish a procedure for the reimbursement of the portion of the costs that exceeds such threshold cost incurred by a service units orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih whenever otherwise authorized by the service non service facilities or providers establish a procedure for payment from chef in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the service and establish a procedure that will ensure that no payment shall be made from chef to any provider of treatment to the extent that such provider is eligible to receive payment for the treatment from any other federal state local or private source of reimbursement for which the patient is eligible no offset or limitation amounts appropriated to chef under this section shall not be used to offset or limit appropriations made to the service under the authority of the act of november usc commonly known as the snyder act or any other law deposit of reimbursement funds there shall be deposited into chef all reimbursements to which the service is entitled from any federal state local or private source including third party insurance by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from chefverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this title title iii facilities sec consultation construction and renovation of facilities reports a prerequisites for expenditure of funds prior to the expenditure of or the making of any binding commitment to expend any funds appropriated for the planning design construction or renovation of facilities pursuant to the act of november usc commonly known as the snyder act the secretary acting through the service shall consult with any indian tribe that would be significantly affected by such expenditure for the purpose of determining and whenever practicable honoring tribal preferences concerning size location type and other characteristics of any facility on which such expenditure is to be made and ensure whenever practicable and applicable that such facility meets the construction standards of any accrediting body recognized by the secretary for the purposes of the medicare medicaid and schip programs under titles xviii xix and xxi of the social security act by not later than verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih year after the date on which the construction or renovation of such facility is completed closures evaluation required notwithstanding any other provision of law no facility operated by the service be closed if the secretary has not submitted to congress not less than year and not more than years before the date of the proposed closure an evaluation completed not more than years before such submission of the impact of the proposed closure that specifies in addition to other considerations a the accessibility of alternative health care resources for the population served by such facility the cost effectiveness of such closure the quality of health care to be provided to the population served by such facility after such closure the availability of contract health care funds to maintain existing levels of service the views of the indian tribes served by such facility concerning such closure the level of use of such facility by all eligible indians andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the distance between such facility and the nearest operating service hospital exception for certain temporary closures paragraph shall not apply to any temporary closure of a facility or any portion of a facility if such closure is necessary for medical environmental or construction safety reasons health care facility priority system in general a priority system the secretary acting through the service shall maintain a health care facility priority system which shall be developed in consultation with indian tribes and tribal organizations shall give indian tribes needs the highest priority iii include the lists required in paragraph and shall include the methodology required in paragraph and iii include such other facilities and such renovation or expansion needs of any health care facility as theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih service indian tribes and tribal organizations identify and iv shall provide an opportunity for the nomination of planning design and construction projects by the service indian tribes and tribal organizations for consideration under the priority system at least once every years or more frequently as the secretary determines to be appropriate needs of facilities under isdeaa agreements the secretary shall ensure that the planning design construction renovation and expansion needs of service and non service facilities operated under contracts or compacts in accordance with the indian self determination and education assistance act usc et seq are fully and equitably integrated into the health care facility priority system criteria for evaluating needs for purposes of this subsection the secretary in evaluating the needs of facilities operated under a contract or compact under the indian self determination and education as verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sistance act usc et seq shall use the criteria used by the secretary in evaluating the needs of facilities operated directly by the service priority of certain projects protected the priority of any project established under the construction priority system in effect on the date of enactment of the indian health care improvement act amendments of shall not be affected by any change in the construction priority system taking place after that date if the project was identified in the fiscal year service budget justification as of the top priority inpatient projects of the top priority outpatient projects iii of the top priority staff quarters developments or iv of the top priority youth regional treatment centers had completed both phase and phase of the construction priority sys verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tem in effect on the date of enactment of such act or iii is not included in clause or and is selected as determined by the secretary on the initiative of the secretary or pursuant to a request of an indian tribe or tribal organization report contents a initial comprehensive report definitions in this subparagraph facilities appropriation advisory board the term facilities appropriation advisory board means the advisory board comprised of members representing indian tribes and members representing the service established at the discretion of the assistant secretary aa to provide advice and recommendations for policies and procedures of the programs fund verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ed pursuant to facilities appropriations and bb to address other facilities issues facilities needs assessment workgroup the term facilities needs assessment workgroup means the workgroup established at the discretion of the assistant secretary aa to review the health care facilities construction priority system and bb to make recommendations to the facilities appropriation advisory board for revising the priority system initial report in general not later than year after the date of enactment of the indian health care improvement act amendments of the secretary shall submit to the committee on indian affairs of the senate and the committee on naturalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih resources of the house of representatives a report that describes the comprehensive national ranked list of all health care facilities needs for the service indian tribes and tribal organizations including inpatient health care facilities outpatient health care facilities specialized health care facilities such as for long term care and alcohol and drug abuse treatment wellness centers staff quarters and hostels associated with health care facilities and the renovation and expansion needs if any of such facilities developed by the service indian tribes and tribal organizations for the facilities needs assessment workgroup and the facilities appropriation advisory board inclusions the initial report shall include aa the methodology and criteria used by the service in determining the needs and estab verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih lishing the ranking of the facilities needs and bb such other information as the secretary determines to be appropriate iii updates of report beginning in calendar year the secretary shall update the report under clause not less frequently that once every years and include the updated report in the appropriate annual report under subparagraph for submission to congress under section annual reports the secretary shall submit to the president for inclusion in the report required to be transmitted to congress under section a report which sets forth the following a description of the health care facility priority system of the service established under paragraph health care facilities lists which include verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the top priority inpatient health care facilities the top priority outpatient health care facilities iii the top priority specialized health care facilities such as long term care and alcohol and drug abuse treatment iv the top priority staff quarters developments associated with health care facilities and the top priority hostels associated with health care facilities iii the justification for such order of priority iv the projected cost of such projects the methodology adopted by the service in establishing priorities under its health care facility priority system requirements for preparation of reports in preparing the report required under paragraph the secretary shall a consult with and obtain information on all health care facilities needs from indianverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tribes tribal organizations and urban indian organizations and review the total unmet needs of all indian tribes tribal organizations and urban indian organizations for health care facilities including hostels and staff quarters including needs for renovation and expansion of existing facilities review of methodology used for health facilities construction priority system in general not later than year after the establishment of the priority system under subsection a the comptroller general of the united states shall prepare and finalize a report reviewing the methodologies applied and the processes followed by the service in making each assessment of needs for the list under subsection a and developing the priority system under subsection including a review of a the recommendations of the facilities appropriation advisory board and the facilities needs assessment workgroup as those terms are defined in subsection a andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics submission to congress the comptroller general of the united states shall submit the report under paragraph to a the committees on indian affairs and appropriations of the senate the committees on natural resources and appropriations of the house of representatives and the secretary funding condition all funds appropriated under the act of november usc commonly known as the snyder act for the planning design construction or renovation of health facilities for the benefit of or more indian tribes shall be subject to the provisions of the indian self determination and education assistance act usc et seq development of innovative approaches the secretary shall consult and cooperate with indian tribes tribal organizations and urban indian organizations in developing innovative approaches to address all or part of the total unmet need for construction of healthverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih facilities including those provided for in other sections of this title and other approaches sec sanitation facilities a findings congress finds the following the provision of sanitation facilities is primarily a health consideration and function indian people suffer an inordinately high incidence of disease injury and illness directly attributable to the absence or inadequacy of sanitation facilities the long term cost to the united states of treating and curing such disease injury and illness is substantially greater than the short term cost of providing sanitation facilities and other preventive health measures many indian homes and indian communities still lack sanitation facilities it is in the interest of the united states and it is the policy of the united states that all indian communities and indian homes new and existing be provided with sanitation facilities facilities and services in furtherance of the findings made in subsection a congress reaffirms the primary responsibility and authority of the service to provide the necessary sanitation facilities and services asverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provided in section of the act of august usc a under such authority the secretary acting through the service is authorized to provide the following financial and technical assistance to indian tribes tribal organizations and indian communities in the establishment training and equipping of utility organizations to operate and maintain sanitation facilities including the provision of existing plans standard details and specifications available in the department to be used at the option of the indian tribe tribal organization or indian community ongoing technical assistance and training to indian tribes tribal organizations and indian communities in the management of utility organizations which operate and maintain sanitation facilities priority funding for operation and maintenance assistance for and emergency repairs to sanitation facilities operated by an indian tribe tribal organization or indian community when necessary to avoid an imminent health threat or to protect the investment in sanitation facilities and the investmentverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in the health benefits gained through the provision of sanitation facilities funding notwithstanding any other provision of law the secretary of housing and urban development is authorized to transfer funds appropriated under the native american housing assistance and self determination act of usc et seq to the secretary of health and human services the secretary of health and human services is authorized to accept and use such funds for the purpose of providing sanitation facilities and services for indians under section of the act of august usc a unless specifically authorized when funds are appropriated the secretary shall not use funds appropriated under section of the act of august usc a to provide sanitation facilities to new homes constructed using funds provided by the department of housing and urban development the secretary of health and human services is authorized to accept from any source including federal and state agencies funds for the pur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pose of providing sanitation facilities and services and place these funds into contracts or compacts under the indian self determination and education assistance act usc et seq except as otherwise prohibited by this section the secretary use funds appropriated under the authority of section of the act of august usc a to fund up to percent of the amount of an indian tribe loan obtained under any federal program for new projects to construct eligible sanitation facilities to serve indian homes except as otherwise prohibited by this section the secretary use funds appropriated under the authority of section of the act of august usc a to meet matching or cost participation requirements under other federal and non federal programs for new projects to construct eligible sanitation facilities all federal agencies are authorized to transfer to the secretary funds identified granted loaned or appropriated whereby the department applicable policies rules and regulations shall apply in the implementation of such projects verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary of health and human services shall enter into interagency agreements with federal and state agencies for the purpose of providing financial assistance for sanitation facilities and services under this act the secretary of health and human services shall by regulation establish standards applicable to the planning design and construction of sanitation facilities funded under this act and the secretary of health and human services is authorized to accept payments for goods and services furnished by the service from appropriate public authorities nonprofit organizations or agencies or indian tribes as contributions by that authority organization agency or tribe to agreements made under section of the act of august usc a and such payments shall be credited to the same or subsequent appropriation account as funds appropriated under the authority of section of the act of august usc a certain capabilities not prerequisite the financial and technical capability of an indian tribe tribal organization or indian community to safely operate manage and maintain a sanitation facility shall notverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih be a prerequisite to the provision or construction of sanitation facilities by the secretary financial assistance the secretary is authorized to provide financial assistance to indian tribes tribal organizations and indian communities in an amount equal to the federal share of the costs of operating managing and maintaining the facilities provided under the plan described in subsection f operation management and maintenance of facilities the indian tribe has the primary responsibility to establish collect and use reasonable user fees or otherwise set aside funding for the purpose of operating managing and maintaining sanitation facilities if a sanitation facility serving a community that is operated by an indian tribe or tribal organization is threatened with imminent failure and such operator lacks capacity to maintain the integrity or the health benefits of the sanitation facility then the secretary is authorized to assist the indian tribe tribal organization or indian community in the resolution of the problem on a short term basis through cooperation with the emergency coordinator or by providing operation management and maintenance service isdeaa program funded on equal basis tribal health programs shall be eligible on anverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih equal basis with programs that are administered directly by the service for any funds appropriated pursuant to this section and any funds appropriated for the purpose of providing sanitation facilities report required contents the secretary in consultation with the secretary of housing and urban development indian tribes tribal organizations and tribally designated housing entities as defined in section of the native american housing assistance and self determination act of usc shall submit to the president for inclusion in the report required to be transmitted to congress under section a report which sets forth a the current indian sanitation facility priority system of the service the methodology for determining sanitation deficiencies and needs the criteria on which the deficiencies and needs will be evaluated the level of initial and final sanitation deficiency for each type of sanitation facility forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih each project of each indian tribe or indian community the amount and most effective use of funds derived from whatever source necessary to accommodate the sanitation facilities needs of new homes assisted with funds under the native american housing assistance and self determination act usc et seq and to reduce the identified sanitation deficiency levels of all indian tribes and indian communities to level sanitation deficiency as defined in paragraph a and a year plan to provide sanitation facilities to serve existing indian homes and indian communities and new and renovated indian homes uniform methodology the methodology used by the secretary in determining preparing cost estimates for and reporting sanitation deficiencies for purposes of paragraph shall be applied uniformly to all indian tribes and indian communities sanitation deficiency levels for purposes of this subsection the sanitation deficiency levels for an individual indian tribe or indian com verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih munity sanitation facility to serve indian homes are determined as follows a a level deficiency exists if a sanitation facility serving an individual indian tribe or indian community complies with all applicable water supply pollution control and solid waste disposal laws and deficiencies relate to routine replacement repair or maintenance needs a level deficiency exists if a sanitation facility serving an individual indian tribe or indian community substantially or recently complied with all applicable water supply pollution control and solid waste laws and any deficiencies relate to small or minor capital improvements needed to bring the facility back into compliance capital improvements that are necessary to enlarge or improve the facilities in order to meet the current needs for domestic sanitation facilities or iii the lack of equipment or training by an indian tribe tribal organiza verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion or an indian community to properly operate and maintain the sanitation facilities a level iii deficiency exists if a sanitation facility serving an individual indian tribe or indian community meets or more of the following conditions water or sewer service in the home is provided by a haul system with holding tanks and interior plumbing major significant interruptions to water supply or sewage disposal occur frequently requiring major capital improvements to correct the deficiencies or iii there is no access to or no approved or permitted solid waste facility available a level iv deficiency exists if a sanitation facility for an individual home an indian tribe or an indian community exists but lacks aa a safe water supply system orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih bb a waste disposal system contains no piped water or sewer facilities or iii has become inoperable due to a major component failure or if only a washeteria or central facility exists in the community a level deficiency exists in the absence of a sanitation facility where individual homes do not have access to safe drinking water or adequate wastewater including sewage disposal definitions for purposes of this section the following terms apply indian community the term indian community means a geographic area a significant proportion of whose inhabitants are indians and which is served by or capable of being served by a facility described in this section sanitation facilities the terms sanitation facility and sanitation facilities mean safe and adequate water supply systems sanitary sewage disposal systems and sanitary solid wasteverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih systems and all related equipment and support infrastructure sec preference to indians and indian firms a buy indian act the secretary acting through the service use the negotiating authority of section of the act of june usc commonly known as the buy indian act to give preference to any indian or any enterprise partnership corporation or other type of business organization owned and controlled by an indian or indians including former or currently federally recognized indian tribes in the state of new york hereinafter referred to as an indian firm in the construction and renovation of service facilities pursuant to section and in the construction of sanitation facilities pursuant to section such preference be accorded by the secretary unless the secretary finds pursuant to regulations that the project or function to be contracted for will not be satisfactory or such project or function cannot be properly completed or maintained under the proposed contract the secretary in arriving at such a finding shall consider whether the indian or indian firm will be deficient with respect to ownership and control by indians equipment bookkeeping and accounting procedures verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih substantive knowledge of the project or function to be contracted for adequately trained personnel or other necessary components of contract performance pay rates for the purposes of implementing the provisions of this title the secretary shall assure that the rates of pay for personnel engaged in the construction or renovation of facilities constructed or renovated in whole or in part by funds made available pursuant to this title are not less than the prevailing local wage rates for similar work as determined in accordance with the act of march usc a–a known as the davis bacon act labor standards for the purposes of implementing the provisions of this title contracts for the construction or renovation of health care facilities staff quarters and sanitation facilities and related support infrastructure funded in whole or in part with funds made available pursuant to this title shall contain a provision requiring compliance with subchapter iv of chapter of title united states code commonly known as the davis bacon act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec expenditure of non service funds for renovation a in general notwithstanding any other provision of law if the requirements of subsection are met the secretary acting through the service is authorized to accept any major expansion renovation or modernization by any indian tribe or tribal organization of any service facility or of any other indian health facility operated pursuant to a contract or compact under the indian self determination and education assistance act usc et seq including any plans or designs for such expansion renovation or modernization and any expansion renovation or modernization for which funds appropriated under any federal law were lawfully expended priority list in general the secretary shall maintain a separate priority list to address the needs for increased operating expenses personnel or equipment for such facilities the methodology for establishing priorities shall be developed through regulations the list of priority facilities will be revised annually in consultation with indian tribes and tribal organizationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih report the secretary shall submit to the president for inclusion in the report required to be transmitted to congress under section the priority list maintained pursuant to paragraph requirements the requirements of this subsection are met with respect to any expansion renovation or modernization if the indian tribe or tribal organization a provides notice to the secretary of its intent to expand renovate or modernize and applies to the secretary to be placed on a separate priority list to address the needs of such new facilities for increased operating expenses personnel or equipment and the expansion renovation or modernization a is approved by the appropriate area director of the service for federal facilities and is administered by the indian tribe or tribal organization in accordance with any applicable regulations prescribed by the secretary with respect to construction or renovation of service facilities additional requirement for expansion in addition to the requirements under subsection forverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih any expansion the indian tribe or tribal organization shall provide to the secretary additional information pursuant to regulations including additional staffing equipment and other costs associated with the expansion closure or conversion of facilities if any service facility which has been expanded renovated or modernized by an indian tribe or tribal organization under this section ceases to be used as a service facility during the year period beginning on the date such expansion renovation or modernization is completed such indian tribe or tribal organization shall be entitled to recover from the united states an amount which bears the same ratio to the value of such facility at the time of such cessation as the value of such expansion renovation or modernization less the total amount of any funds provided specifically for such facility under any federal program that were expended for such expansion renovation or modernization bore to the value of such facility at the time of the completion of such expansion renovation or modernization sec funding for the construction expansion and modernization of small ambulatory care facilities a grants verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general the secretary acting through the service shall make grants to indian tribes and tribal organizations for the construction expansion or modernization of facilities for the provision of ambulatory care services to eligible indians and noneligible persons pursuant to subsections and c a grant made under this section cover up to percent of the costs of such construction expansion or modernization for the purposes of this section the term construction includes the replacement of an existing facility grant agreement required a grant under paragraph only be made available to a tribal health program operating an indian health facility other than a facility owned or constructed by the service including a facility originally owned or constructed by the service and transferred to an indian tribe or tribal organization use of grant funds allowable uses a grant awarded under this section be used for the construction expansion or modernization including the planning and design of such construction expansion or modernization of an ambulatory care facility a located apart from a hospital verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih not funded under section or section and which upon completion of such construction or modernization will have a total capacity appropriate to its projected service population provide annually no fewer than patient visits by eligible indians and other users who are eligible for services in such facility in accordance with section and iii provide ambulatory care in a service area specified in the contract or compact under the indian self determination and education assistance act usc et seq with a population of no fewer than eligible indians and other users who are eligible for services in such facility in accordance with section additional allowable use the secretary also reserve a portion of the funding provided under this section and use those reserved funds to reduce an outstanding debt incurred by indian tribes or tribal organizations for the con verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih struction expansion or modernization of an ambulatory care facility that meets the requirements under paragraph the provisions of this section shall apply except that such applications for funding under this paragraph shall be considered separately from applications for funding under paragraph use only for certain portion of costs a grant provided under this section be used only for the cost of that portion of a construction expansion or modernization project that benefits the service population identified above in subsection and iii the requirements of clauses and iii of paragraph shall not apply to an indian tribe or tribal organization applying for a grant under this section for a health care facility located or to be constructed on an island or when such facility is not located on a road system providing direct access to an inpatient hospital where care is available to the service population grants application no grant be made under this section unless an application or proposal for the grant has been approved by the secretary in accordance with applicable regulations and has setverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih forth reasonable assurance by the applicant that at all times after the construction expansion or modernization of a facility carried out using a grant received under this section a adequate financial support will be available for the provision of services at such facility such facility will be available to eligible indians without regard to ability to pay or source of payment and such facility will as feasible without diminishing the quality or quantity of services provided to eligible indians serve noneligible persons on a cost basis priority in awarding grants under this section the secretary shall give priority to indian tribes and tribal organizations that demonstrate a a need for increased ambulatory care services and insufficient capacity to deliver such services peer review panels the secretary provide for the establishment of peer review panels as necessary to review and evaluate applications and proposals and to advise the secretary re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih garding such applications using the criteria developed pursuant to subsection a reversion of facilities if any facility or portion thereof with respect to which funds have been paid under this section ceases at any time after completion of the construction expansion or modernization carried out with such funds to be used for the purposes of providing health care services to eligible indians all of the right title and interest in and to such facility or portion thereof shall transfer to the united states unless otherwise negotiated by the service and the indian tribe or tribal organization funding nonrecurring funding provided under this section shall be nonrecurring and shall not be available for inclusion in any individual indian tribe tribal share for an award under the indian self determination and education assistance act usc et seq or for reallocation or redesign thereunder sec indian health care delivery demonstration project a health care demonstration projects the secretary acting through the service is authorized to make grants to and enter into construction contracts or construction project agreements with indian tribes or tribal organizations under the indian self determinationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and education assistance act usc et seq for the purpose of carrying out a health care delivery demonstration project to test alternative means of delivering health care and services to indians through facilities use of funds the secretary in approving projects pursuant to this section authorize such contracts for the construction and renovation of hospitals health centers health stations and other facilities to deliver health care services and is authorized to waive any leasing prohibition permit carryover of funds appropriated for the provision of health care services permit the use of other available funds permit the use of funds or property donated from any source for project purposes provide for the reversion of donated real or personal property to the donor and permit the use of service funds to match other funds including federal funds regulations the secretary shall develop and promulgate regulations not later than year after the date of enactment of the indian health care improvement act amendments of for the review and approval of applications submitted under this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih criteria the secretary approve projects that meet the following criteria there is a need for a new facility or program or the reorientation of an existing facility or program a significant number of indians including those with low health status will be served by the project the project has the potential to deliver services in an efficient and effective manner the project is economically viable the indian tribe or tribal organization has the administrative and financial capability to administer the project the project is integrated with providers of related health and social services and is coordinated with and avoids duplication of existing services peer review panels the secretary provide for the establishment of peer review panels as necessary to review and evaluate applications using the criteria developed pursuant to subsection priority the secretary shall give priority to applications for demonstration projects in each of the following service units to the extent that such applicationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih are timely filed and meet the criteria specified in subsection cass lake minnesota mescalero new mexico owyhee nevada schurz nevada ft yuma california technical assistance the secretary shall provide such technical and other assistance as be necessary to enable applicants to comply with the provisions of this section service to ineligible persons subject to section the authority to provide services to persons otherwise ineligible for the health care benefits of the service and the authority to extend hospital privileges in service facilities to non service health practitioners as provided in section be included subject to the terms of such section in any demonstration project approved pursuant to this section equitable treatment for purposes of subsection the secretary shall in evaluating facilities operated under any contract or compact under the indian self determination and education assistance act usc et seq use the same criteria that the sec verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih retary uses in evaluating facilities operated directly by the service equitable integration of facilities the secretary shall ensure that the planning design construction renovation and expansion needs of service and non service facilities which are the subject of a contract or compact under the indian self determination and education assistance act usc et seq for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section sec land transfer notwithstanding any other provision of law the bureau of indian affairs and all other agencies and departments of the united states are authorized to transfer at no cost land and improvements to the service for the provision of health care services the secretary is authorized to accept such land and improvements for such purposes sec leases contracts and other agreements the secretary acting through the service enter into leases contracts and other agreements with indian tribes and tribal organizations which hold title to a leasehold interest in or a beneficial interest in when title is held by the united states in trust for the benefit of an indian tribe facilities used or to be usedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih for the administration and delivery of health services by an indian health program such leases contracts or agreements include provisions for construction or renovation and provide for compensation to the indian tribe or tribal organization of rental and other costs consistent with section of the indian self determination and education assistance act usc and regulations thereunder sec study on loans loan guarantees and loan repayment a in general the secretary in consultation with the secretary of the treasury indian tribes and tribal organizations shall carry out a study to determine the feasibility of establishing a loan fund to provide to indian tribes and tribal organizations direct loans or guarantees for loans for the construction of health care facilities including inpatient facilities outpatient facilities staff quarters hostels and specialized care facilities such as behavioral health and elder care facilities determinations in carrying out the study under subsection a the secretary shall determine verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the maximum principal amount of a loan or loan guarantee that should be offered to a recipient from the loan fund the percentage of eligible costs not to exceed percent that be covered by a loan or loan guarantee from the loan fund including costs relating to planning design financing site land development construction rehabilitation renovation conversion improvements medical equipment and furnishings and other facility related costs and capital purchase but excluding staffing the cumulative total of the principal of direct loans and loan guarantees respectively that be outstanding at any time the maximum term of a loan or loan guarantee that be made for a facility from the loan fund the maximum percentage of funds from the loan fund that should be allocated for payment of costs associated with planning and applying for a loan or loan guarantee whether acceptance by the secretary of an assignment of the revenue of an indian tribe or tribal organization as security for any direct loanverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih or loan guarantee from the loan fund would be appropriate whether in the planning and design of health facilities under this section users eligible under section be included in any projection of patient population whether funds of the service provided through loans or loan guarantees from the loan fund should be eligible for use in matching other federal funds under other programs the appropriateness of and best methods for coordinating the loan fund with the health care priority system of the service under section and any legislative or regulatory changes required to implement recommendations of the secretary based on results of the study report not later than september the secretary shall submit to the committee on indian affairs of the senate and the committee on natural resources and the committee on energy and commerce of the house of representatives a report that describes the manner of consultation made as required by subsection a andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the results of the study including any recommendations of the secretary based on results of the study sec tribal leasing a tribal health program lease permanent structures for the purpose of providing health care services without obtaining advance approval in appropriation acts sec indian health service tribal facilities joint venture program a in general the secretary acting through the service shall make arrangements with indian tribes and tribal organizations to establish joint venture demonstration projects under which an indian tribe or tribal organization shall expend tribal private or other available funds for the acquisition or construction of a health facility for a minimum of years under a no cost lease in exchange for agreement by the service to provide the equipment supplies and staffing for the operation and maintenance of such a health facility an indian tribe or tribal organization use tribal funds private sector or other available resources including loan guarantees to fulfill its commitment under a joint venture entered into under this subsection an indian tribe or tribal organization shall be eligible to establish a joint venture project if when it submits a letter of intent it verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has begun but not completed the process of acquisition or construction of a health facility to be used in the joint venture project has not begun the process of acquisition or construction of a health facility for use in the joint venture project or in its application for a joint venture agreement agrees a to construct a facility for the joint venture which complies with the size and space criteria established by the service or if the facility it proposes for the joint venture is already in existence or under construction that only the portion of such facility which complies with the size and space criteria of the service will be eligible for the joint venture agreement requirements the secretary shall make such an arrangement with an indian tribe or tribal organization only if the secretary first determines that the indian tribe or tribal organization has the administrative and financial capabilities necessary to complete the timely acquisition or construction of the relevant health facility andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the indian tribe or tribal organization meets the need criteria determined using the criteria developed under the health care facility priority system under section unless the secretary determines pursuant to regulations that other criteria will result in a more cost effective and efficient method of facilitating and completing construction of health care facilities continued operation the secretary shall negotiate an agreement with the indian tribe or tribal organization regarding the continued operation of the facility at the end of the initial year no cost lease period breach of agreement an indian tribe or tribal organization that has entered into a written agreement with the secretary under this section and that breaches or terminates without cause such agreement shall be liable to the united states for the amount that has been paid to the indian tribe or tribal organization or paid to a third party on the indian tribe or tribal organization behalf under the agreement the secretary has the right to recover tangible property including supplies and equipment less depreciation and any funds expended for operations and maintenance under this section the preceding sentence does not apply to any fundsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih expended for the delivery of health care services personnel or staffing recovery for nonuse an indian tribe or tribal organization that has entered into a written agreement with the secretary under this subsection shall be entitled to recover from the united states an amount that is proportional to the value of such facility if at any time within the year term of the agreement the service ceases to use the facility or otherwise breaches the agreement definition for the purposes of this section the term health facility or health facilities includes quarters needed to provide housing for staff of the relevant tribal health program sec location of facilities a in general in all matters involving the reorganization or development of service facilities or in the establishment of related employment projects to address unemployment conditions in economically depressed areas the bureau of indian affairs and the service shall give priority to locating such facilities and projects on indian lands or lands in alaska owned by any alaska native village or village or regional corporation under the alaska native claims settlement act usc et seq or any land allotted to any alaska native if requestedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by the indian owner and the indian tribe with jurisdiction over such lands or other lands owned or leased by the indian tribe or tribal organization top priority shall be given to indian land owned by or more indian tribes definition for purposes of this section the term indian lands means all lands within the exterior boundaries of any reservation and any lands title to which is held in trust by the united states for the benefit of any indian tribe or individual indian or held by any indian tribe or individual indian subject to restriction by the united states against alienation sec maintenance and improvement of health care facilities a report the secretary shall submit to the president for inclusion in the report required to be transmitted to congress under section a report which identifies the backlog of maintenance and repair work required at both service and tribal health care facilities including new health care facilities expected to be in operation in the next fiscal year the report shall also identify the need for renovation and expansion of existing facilities to support the growth of health care programsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih maintenance of newly constructed space the secretary acting through the service is authorized to expend maintenance and improvement funds to support maintenance of newly constructed space only if such space falls within the approved supportable space allocation for the indian tribe or tribal organization supportable space allocation shall be defined through the health care facility priority system under section c replacement facilities in addition to using maintenance and improvement funds for renovation modernization and expansion of facilities an indian tribe or tribal organization use maintenance and improvement funds for construction of a replacement facility if the costs of renovation of such facility would exceed a maximum renovation cost threshold the secretary shall consult with indian tribes and tribal organizations in determining the maximum renovation cost threshold sec tribal management of federally owned quarters a rental rates establishment notwithstanding any other provision of law a tribal health program which operates a hospital or other health facility and the federally owned quarters associated therewith pursuant to a contract or compact under the indianverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih self determination and education assistance act usc et seq shall have the authority to establish the rental rates charged to the occupants of such quarters by providing notice to the secretary of its election to exercise such authority objectives in establishing rental rates pursuant to authority of this subsection a tribal health program shall endeavor to achieve the following objectives a to base such rental rates on the reasonable value of the quarters to the occupants thereof to generate sufficient funds to prudently provide for the operation and maintenance of the quarters and subject to the discretion of the tribal health program to supply reserve funds for capital repairs and replacement of the quarters equitable funding any quarters whose rental rates are established by a tribal health program pursuant to this subsection shall remain eligible for quarters improvement and repair funds to the same extent as all federally owned quarters used to house personnel in services supported programsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih notice of rate change a tribal health program which exercises the authority provided under this subsection shall provide occupants with no less than days notice of any change in rental rates direct collection of rent in general notwithstanding any other provision of law and subject to paragraph a tribal health program shall have the authority to collect rents directly from federal employees who occupy such quarters in accordance with the following a the tribal health program shall notify the secretary and the subject federal employees of its election to exercise its authority to collect rents directly from such federal employees upon receipt of a notice described in subparagraph a the federal employees shall pay rents for occupancy of such quarters directly to the tribal health program and the secretary shall have no further authority to collect rents from such employees through payroll deduction or otherwise such rent payments shall be retained by the tribal health program and shall not beverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih made payable to or otherwise be deposited with the united states such rent payments shall be deposited into a separate account which shall be used by the tribal health program for the maintenance including capital repairs and replacement and operation of the quarters and facilities as the tribal health program shall determine retrocession of authority if a tribal health program which has made an election under paragraph requests retrocession of its authority to directly collect rents from federal employees occupying federally owned quarters such retrocession shall become effective on the earlier of a the first day of the month that begins no less than days after the tribal health program notifies the secretary of its desire to retrocede or such other date as be mutually agreed by the secretary and the tribal health program rates in alaska to the extent that a tribal health program pursuant to authority granted in subsection a establishes rental rates for federally ownedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih quarters provided to a federal employee in alaska such rents be based on the cost of comparable private rental housing in the nearest established community with a year round population of or more individuals sec applicability of buy american act requirement a applicability the secretary shall ensure that the requirements of the buy american act apply to all procurements made with funds provided pursuant to section indian tribes and tribal organizations shall be exempt from these requirements effect of violation if it has been finally determined by a court or federal agency that any person intentionally affixed a label bearing a made in america inscription or any inscription with the same meaning to any product sold in or shipped to the united states that is not made in the united states such person shall be ineligible to receive any contract or subcontract made with funds provided pursuant to section pursuant to the debarment suspension and ineligibility procedures described in sections through of title code of federal regulations definitions for purposes of this section the term buy american act means title iii of the act entitled an act making appropriations for the treasury andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih post office departments for the fiscal year ending june and for other purposes approved march usc a et seq sec other funding for facilities a authority to accept funds the secretary is authorized to accept from any source including federal and state agencies funds that are available for the construction of health care facilities and use such funds to plan design and construct health care facilities for indians and to place such funds into a contract or compact under the indian self determination and education assistance act usc et seq receipt of such funds shall have no effect on the priorities established pursuant to section interagency agreements the secretary is authorized to enter into interagency agreements with other federal agencies or state agencies and other entities and to accept funds from such federal or state agencies or other sources to provide for the planning design and construction of health care facilities to be administered by indian health programs in order to carry out the purposes of this act and the purposes for which the funds were appropriated or for which the funds were otherwise providedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih transferred funds any federal agency to which funds for the construction of health care facilities are appropriated is authorized to transfer such funds to the secretary for the construction of health care facilities to carry out the purposes of this act as well as the purposes for which such funds are appropriated to such other federal agency establishment of standards the secretary through the service shall establish standards by regulation for the planning design and construction of health care facilities serving indians under this act sec authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this title title iv access to health services sec treatment of payments under social security act health benefits programs a disregard of medicare medicaid and schip payments in determining appropriations any payments received by an indian health program or by an urban indian organization under title xviii xix or xxi of the social security act for services provided to indians eligible for benefits under such respective titlesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall not be considered in determining appropriations for the provision of health care and services to indians nonpreferential treatment nothing in this act authorizes the secretary to provide services to an indian with coverage under title xviii xix or xxi of the social security act in preference to an indian without such coverage use of funds special fund a percent pass through of payments due to facilities notwithstanding any other provision of law but subject to paragraph payments to which a facility of the service is entitled by reason of a provision of title xviii or xix of the social security act shall be placed in a special fund to be held by the secretary in making payments from such fund the secretary shall ensure that each service unit of the service receives percent of the amount to which the facilities of the service for which such service unit makes collections are entitled by reason of a provision of either such title use of funds amounts received by a facility of the service under subparagraphverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a by reason of a provision of title xviii or xix of the social security act shall first be used to such extent or in such amounts as are provided in appropriation acts for the purpose of making any improvements in the programs of the service operated by or through such facility which be necessary to achieve or maintain compliance with the applicable conditions and requirements of such respective title any amounts so received that are in excess of the amount necessary to achieve or maintain such conditions and requirements shall subject to consultation with the indian tribes being served by the service unit be used for increasing the facility capacity to provide or improving the quality or accessibility of services direct payment option paragraph shall not apply to a tribal health program upon the election of such program under subsection to receive payments directly no payment be made out of the special fund described in such paragraph with respect to reimbursement made for services provided by such program during the period of such election direct billing verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in general subject to complying with the requirements of paragraph a tribal health program elect to directly bill for and receive payment for health care items and services provided by such program for which payment is made under title xviii xix or xxi of the social security act direct reimbursement a use of funds each tribal health program making the election described in paragraph with respect to a program under title xviii xix or xxi of the social security act shall be reimbursed directly by that program for items and services furnished without regard to subsection but all amounts so reimbursed shall be used by the tribal health program for the same purposes with respect to such program for which payment under subparagraph a of subsection to a facility of the service be used pursuant to subparagraph of such subsection with respect to the service audits the amounts paid to a tribal health program making the election described in paragraph with respect to a program under title xviii xix or xxi of the so verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cial security act shall be subject to all auditing requirements applicable to the program under such title as well as all auditing requirements applicable to programs administered by an indian health program nothing in the preceding sentence shall be construed as limiting the application of auditing requirements applicable to amounts paid under title xviii xix or xxi of the social security act identification of source of payments any tribal health program that receives reimbursements or payments under title xviii xix or xxi of the social security act shall provide to the service a list of each provider enrollment number or other identifier under which such program receives such reimbursements or payments examination and implementation of changes a in general the secretary acting through the service and with the assistance of the administrator of the centers for medicare medicaid services shall examine on an ongoing basis and implement any administrative changes that be necessary to facilitate di verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih rect billing and reimbursement under the program established under this subsection including any agreements with states that be necessary to provide for direct billing under a program under title xix or xxi of the social security act coordination of information the service shall provide the administrator of the centers for medicare medicaid services with copies of the lists submitted to the service under paragraph enrollment data regarding patients served by the service and by tribal health programs to the extent such data is available to the service and such other information as the administrator require for purposes of administering title xviii xix or xxi of the social security act withdrawal from program a tribal health program that bills directly under the program established under this subsection withdraw from participation in the same manner and under the same conditions that an indian tribe or tribal organization retrocede a contracted program to the secretary under the authority of the indian self determination and education assistanceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih act usc et seq all cost accounting and billing authority under the program established under this subsection shall be returned to the secretary upon the secretary acceptance of the withdrawal of participation in this program termination for failure to comply with requirements the secretary terminate the participation of a tribal health program or in the direct billing program established under this subsection if the secretary determines that the program has failed to comply with the requirements of paragraph the secretary shall provide a tribal health program with notice of a determination that the program has failed to comply with any such requirement and a reasonable opportunity to correct such noncompliance prior to terminating the program participation in the direct billing program established under this subsection related provisions under the social security act for provisions related to subsections and see sections and of the social security actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec grants to and contracts with the service indian tribes tribal organizations and urban indian organizations to facilitate outreach enrollment and coverage of indians under social security act health benefit programs a indian tribes and tribal organizations the secretary acting through the service shall make grants to or enter into contracts with indian tribes and tribal organizations to assist such tribes and tribal organizations in establishing and administering programs on or near reservations trust lands and alaska native villages including programs to provide outreach and enrollment through video electronic delivery methods or telecommunication devices that allow real time or time delayed communication between individual indians and the benefit program to assist individual indians to enroll for benefits under a program established under title xviii xix or xxi of the social security act and with respect to such programs for which the charging of premiums and cost sharing is not prohibited under such programs to pay premiums or cost sharing for coverage for such benefits which be based on financial need as determined by the indian tribe or tribes or tribal organizationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih being served based on a schedule of income levels developed or implemented by such tribe tribes or tribal organizations conditions the secretary acting through the service shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the secretary makes with any indian tribe or tribal organization pursuant to this section such conditions shall include requirements that the indian tribe or tribal organization successfully undertake to determine the population of indians eligible for the benefits described in subsection a to educate indians with respect to the benefits available under the respective programs to provide transportation for such individual indians to the appropriate offices for enrollment or applications for such benefits and to develop and implement methods of improving the participation of indians in receiving benefits under such programs application to urban indian organizations in general the provisions of subsection a shall apply with respect to grants and other funding to urban indian organizations with re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih spect to populations served by such organizations in the same manner they apply to grants and contracts with indian tribes and tribal organizations with respect to programs on or near reservations requirements the secretary shall include in the grants or contracts made or provided under paragraph requirements that are a consistent with the requirements imposed by the secretary under subsection appropriate to urban indian organizations and urban indians and necessary to effect the purposes of this section facilitating cooperation in enrollment and retention the secretary acting through the centers for medicare medicaid services shall consult with states the service indian tribes tribal organizations and urban indian organizations to develop and disseminate best practices with respect to facilitating agreements between the states and indian tribes tribal organizations and urban indian organizations relating to enrollment and retention of indians in programs established under titles xviii xix and xxi of the social security actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agreements to improve enrollment of indians under social security act health benefits programs for provisions relating to agreements between the secretary and the service indian tribes tribal organizations and urban indian organizations for the collection preparation and submission of applications by indians for assistance under the medicaid and children health insurance programs established under titles xix and xxi of the social security act and benefits under the medicare program established under title xviii of such act see subsections a and of section of the social security act definitions in this section premium the term premium includes any enrollment fee or similar charge cost sharing the term cost sharing includes any deduction deductible copayment coinsurance or similar charge benefits the term benefits means with respect to a title xviii of the social security act benefits under such title title xix of such act medical assistance under such title andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih title xxi of such act assistance under such title sec reimbursement from certain third parties of costs of health services a right of recovery except as provided in subsection the united states an indian tribe or tribal organization shall have the right to recover from an insurance company health maintenance organization employee benefit plan third party tortfeasor or any other responsible or liable third party including a political subdivision or local governmental entity of a state the reasonable charges incurred by the secretary an indian tribe or tribal organization or if higher the highest amount the third party would pay for care and services furnished by providers other than governmental entities in providing health services through the service an indian tribe or tribal organization to any individual to the same extent that such individual or any nongovernmental provider of such services would be eligible to receive damages reimbursement or indemnification for such charges if such services had been provided by a nongovernmental provider andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih such individual had been required to pay such charges or expenses and did pay such charges or expenses limitations on recoveries from states subsection a shall provide a right of recovery against any state only if the injury illness or disability for which health services were provided is covered under workers compensation laws or a no fault automobile accident insurance plan or program nonapplication of other laws no law of any state or of any political subdivision of a state and no provision of any contract insurance or health maintenance organization policy employee benefit plan self insurance plan managed care plan or other health care plan or program entered into or renewed after the date of the enactment of the indian health care amendments of shall prevent or hinder the right of recovery of the united states an indian tribe or tribal organization under subsection a no effect on private rights of action no action taken by the united states an indian tribe or tribal organization to enforce the right of recovery provided under this section shall operate to deny to theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih injured person the recovery for that portion of the person damage not covered hereunder enforcement in general the united states an indian tribe or tribal organization enforce the right of recovery provided under subsection a by a intervening or joining in any civil action or proceeding brought by the individual for whom health services were provided by the secretary an indian tribe or tribal organization or by any representative or heirs of such individual or instituting a civil action including a civil action for injunctive relief and other relief and including with respect to a political subdivision or local governmental entity of a state such an action against an official thereof notice all reasonable efforts shall be made to provide notice of action instituted under paragraph to the individual to whom health services were provided either before or during the pendency of such action recovery from tortfeasors verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general in any case in which an indian tribe or tribal organization that is authorized or required under a compact or contract issued pursuant to the indian self determination and education assistance act usc et seq to furnish or pay for health services to a person who is injured or suffers a disease on or after the date of enactment of the indian health care improvement act amendments of under circumstances that establish grounds for a claim of liability against the tortfeasor with respect to the injury or disease the indian tribe or tribal organization shall have a right to recover from the tortfeasor or an insurer of the tortfeasor the reasonable value of the health services so furnished paid for or to be paid for in accordance with the federal medical care recovery act usc et seq to the same extent and under the same circumstances as the united states recover under that act treatment the right of an indian tribe or tribal organization to recover under subparagraph a shall be independent of the rights of the injured or diseased personverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih served by the indian tribe or tribal organization limitation absent specific written authorization by the governing body of an indian tribe for the period of such authorization which not be for a period of more than year and which be revoked at any time upon written notice by the governing body to the service the united states shall not have a right of recovery under this section if the injury illness or disability for which health services were provided is covered under a self insurance plan funded by an indian tribe tribal organization or urban indian organization where such authorization is provided the service receive and expend such amounts for the provision of additional health services consistent with such authorization costs and attorneys fees in any action brought to enforce the provisions of this section a prevailing plaintiff shall be awarded its reasonable attorneys fees and costs of litigation nonapplication of claims filing requirements an insurance company health maintenance organization self insurance plan managed care plan or other health care plan or program under the social security act or otherwise not deny a claim for benefits submitted by the service or by an indian tribe or tribalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih organization based on the format in which the claim is submitted if such format complies with the format required for submission of claims under title xviii of the social security act or recognized under section of such act application to urban indian organizations the previous provisions of this section shall apply to urban indian organizations with respect to populations served by such organizations in the same manner they apply to indian tribes and tribal organizations with respect to populations served by such indian tribes and tribal organizations statute of limitations the provisions of section of title united states code shall apply to all actions commenced under this section and the references therein to the united states are deemed to include indian tribes tribal organizations and urban indian organizations savings nothing in this section shall be construed to limit any right of recovery available to the united states an indian tribe or tribal organization under the provisions of any applicable federal state or tribal law including medical lien lawsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec crediting of reimbursements a retention of amounts for use by program except as provided in section relating to the catastrophic health emergency fund and section relating to health services for ineligible persons all reimbursements received or recovered including under section by reason of the provision of health services by the service by an indian tribe or tribal organization or by an urban indian organization shall be credited to the service such indian tribe or tribal organization or such urban indian organization respectively and be used as provided in section in the case of such a service provided by or through a service unit such amounts shall be credited to such unit and used for such purposes no offset of amounts the service not offset or limit any amount obligated to any service unit or entity receiving funding from the service because of the receipt of reimbursements under subsection a sec purchasing health care coverage a purchasing coverage in general insofar as amounts are made available under law including a provision of the social security act the indian self determination and education assistance act usc et seq or other law other than under section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to indian tribes tribal organizations and urban indian organizations for health benefits for service beneficiaries indian tribes tribal organizations and urban indian organizations use such amounts to purchase health benefits coverage that qualifies as creditable coverage under section of the public health service act for such beneficiaries including subject to paragraph through a a tribally owned and operated health care plan a state or locally authorized or licensed health care plan a health insurance provider or managed care organization or a self insured plan exception the coverage provided under paragraph not include coverage consisting of a benefits provided under a health flexible spending arrangement as defined in section of the internal revenue code of or a high deductible health plan as defined in section of such code with verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih out regard to whether the plan is purchased in conjunction with a health savings account as defined under section of such code permitting purchase of coverage based on financial need the purchase of coverage by an indian tribe tribal organization or urban indian organization under this subsection be based on the financial needs of beneficiaries as determined by the indian tribe or tribes being served based on a schedule of income levels developed or implemented by such indian tribe or tribes expenses for self insured plan in the case of a self insured plan under subsection a the amounts be used for expenses of operating the plan including administration and insurance to limit the financial risks to the entity offering the plan construction nothing in this section shall be construed as affecting the use of any amounts not referred to in subsection a sec sharing arrangements with federal agencies a authority in general the secretary enter into or expand arrangements for the sharing ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih medical facilities and services between the service indian tribes and tribal organizations and the department of veterans affairs and the department of defense consultation by secretary required the secretary not finalize any arrangement between the service and a department described in paragraph without first consulting with the indian tribes which will be significantly affected by the arrangement limitations the secretary shall not take any action under this section or under subchapter iv of chapter of title united states code which would impair the priority access of any indian to health care services provided through the service and the eligibility of any indian to receive health services through the service the quality of health care services provided to any indian through the service the priority access of any veteran to health care services provided by the department of veterans affairs verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the quality of health care services provided by the department of veterans affairs or the department of defense or the eligibility of any indian who is a veteran to receive health services through the department of veterans affairs reimbursement the service indian tribe or tribal organization shall be reimbursed by the department of veterans affairs or the department of defense as the case be where services are provided through the service an indian tribe or a tribal organization to beneficiaries eligible for services from either such department notwithstanding any other provision of law construction nothing in this section be construed as creating any right of a non indian veteran to obtain health services from the service sec eligible indian veteran services a findings purpose findings congress finds that a collaborations between the secretary and the secretary of veterans affairs regarding the treatment of indian veterans at facilities of the service should be encouraged to the maximum extent practicable andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih increased enrollment for services of the department of veterans affairs by veterans who are members of indian tribes should be encouraged to the maximum extent practicable purpose the purpose of this section is to reaffirm the goals stated in the document entitled memorandum of understanding between the va veterans health administration and hhs indian health service and dated february relating to cooperation and resource sharing between the veterans health administration and service definitions in this section eligible indian veteran the term eligible indian veteran means an indian or alaska native veteran who receives any medical service that is a authorized under the laws administered by the secretary of veterans affairs and administered at a facility of the service including a facility operated by an indian tribe or tribal organization through a contract or compact with the service under the indian self determination and education assistance act usc et seq pursuant to a local memorandum of understandingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih local memorandum of understanding the term local memorandum of understanding means a memorandum of understanding between the secretary or a designee including the director of any area office of the service and the secretary of veterans affairs or a designee to implement the document entitled memorandum of understanding between the va veterans health administration and hhs indian health service and dated february relating to cooperation and resource sharing between the veterans health administration and indian health service eligible indian veterans expenses in general notwithstanding any other provision of law the secretary shall provide for veteran related expenses incurred by eligible indian veterans as described in subsection method of payment the secretary shall establish such guidelines as the secretary determines to be appropriate regarding the method of payments to the secretary of veterans affairs under paragraph tribal approval of memoranda in negotiating a local memorandum of understanding with the secretary of veterans affairs regarding the provision ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih services to eligible indian veterans the secretary shall consult with each indian tribe that would be affected by the local memorandum of understanding funding treatment expenses incurred by the secretary in carrying out subsection shall not be considered to be contract health service expenses use of funds of funds made available to the secretary in appropriations acts for the service excluding funds made available for facilities contract health services or contract support costs the secretary shall use such sums as are necessary to carry out this section sec payor of last resort indian health programs and health care programs operated by urban indian organizations shall be the payor of last resort for services provided to persons eligible for services from indian health programs and urban indian organizations notwithstanding any federal state or local law to the contrary sec consultation for provisions related to consultation with representatives of indian health programs and urban indian organizations with respect to the health care programs es verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tablished under titles xviii xix and xxi of the social security act see section of the social security act usc b– sec state children health insurance program schip for provisions relating to outreach to families of indian children likely to be eligible for child health assistance under the state children health insurance program established under title xxi of the social security act see sections c and a of such act usc ee b– and ensuring that child health assistance is provided under such program to targeted low income children who are indians and that payments are made under such program to indian health programs and urban indian organizations operating in the state that provide such assistance see sections and of such act usc bb ee verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec premium and cost sharing protections and eligibility determinations under medicaid and schip and protection of certain indian property from medicaid estate recovery for provisions relating to premiums or cost sharing protections for indians furnished items or services directly by indian health programs or through referral under the contract health service under the medicaid program established under title xix of the social security act see sections and a a of the social security act usc o– a rules regarding the treatment of certain property for purposes of determining eligibility under such programs see sections and of such act usc a gg and the protection of certain property from estate recovery provisions under the medicaid program see section of such act usc verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec treatment under medicaid and schip managed care for provisions relating to the treatment of indians enrolled in a managed care entity under the medicaid program under title xix of the social security act and indian health programs and urban indian organizations that are providers of items or services to such indian enrollees see sections and of the social security act usc u– gg sec navajo nation medicaid agency feasibility study a study the secretary shall conduct a study to determine the feasibility of treating the navajo nation as a state for the purposes of title xix of the social security act to provide services to indians living within the boundaries of the navajo nation through an entity established having the same authority and performing the same functions as single state medicaid agencies responsible for the administration of the state plan under title xix of the social security act considerations in conducting the study the secretary shall consider the feasibility of assigning and paying all expenditures for the provision of services and related administration funds under title xix of the social security act toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih indians living within the boundaries of the navajo nation that are currently paid to or would otherwise be paid to the state of arizona new mexico or utah providing assistance to the navajo nation in the development and implementation of such entity for the administration eligibility payment and delivery of medical assistance under title xix of the social security act providing an appropriate level of matching funds for federal medical assistance with respect to amounts such entity expends for medical assistance for services and related administrative costs and authorizing the secretary at the option of the navajo nation to treat the navajo nation as a state for the purposes of title xix of the social security act relating to the state children health insurance program under terms equivalent to those described in paragraphs through report not later than years after the date of enactment of the indian health care improvement act amendments of the secretary shall submit to the committee on indian affairs and committee on finance of the senate and the committee on natural resourcesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and committee on energy and commerce of the house of representatives a report that includes the results of the study under this section a summary of any consultation that occurred between the secretary and the navajo nation other indian tribes the states of arizona new mexico and utah counties which include navajo lands and other interested parties in conducting this study projected costs or savings associated with establishment of such entity and any estimated impact on services provided as described in this section in relation to probable costs or savings and legislative actions that would be required to authorize the establishment of such entity if such entity is determined by the secretary to be feasible sec exception for excepted benefits the previous provisions of this title shall not apply to the provision of excepted benefits described in paragraph a or of section of the public health service act usc gg– sec authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this titleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih title health services for urban indians sec purpose the purpose of this title is to establish and maintain programs in urban centers to make health services more accessible and available to urban indians sec contracts with and grants to urban indian organizations under authority of the act of november usc commonly known as the snyder act the secretary acting through the service shall enter into contracts with or make grants to urban indian organizations to assist such organizations in the establishment and administration within urban centers of programs which meet the requirements set forth in this title subject to section the secretary acting through the service shall include such conditions as the secretary considers necessary to effect the purpose of this title in any contract into which the secretary enters with or in any grant the secretary makes to any urban indian organization pursuant to this title sec contracts and grants for the provision of health care and referral services a requirements for grants and contracts under authority of the act of november verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih usc commonly known as the snyder act the secretary acting through the service shall enter into contracts with and make grants to urban indian organizations for the provision of health care and referral services for urban indians any such contract or grant shall include requirements that the urban indian organization successfully undertake to estimate the population of urban indians residing in the urban center or centers that the organization proposes to serve who are or could be recipients of health care or referral services estimate the current health status of urban indians residing in such urban center or centers estimate the current health care needs of urban indians residing in such urban center or centers provide basic health education including health promotion and disease prevention education to urban indians make recommendations to the secretary and federal state local and other resource agencies on methods of improving health service programs to meet the needs of urban indians andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih where necessary provide or enter into contracts for the provision of health care services for urban indians criteria the secretary acting through the service shall by regulation prescribe the criteria for selecting urban indian organizations to enter into contracts or receive grants under this section such criteria shall among other factors include the extent of unmet health care needs of urban indians in the urban center or centers involved the size of the urban indian population in the urban center or centers involved the extent if any to which the activities set forth in subsection a would duplicate any project funded under this title or under any current public health service project funded in a manner other than pursuant to this title the capability of an urban indian organization to perform the activities set forth in subsection a and to enter into a contract with the secretary or to meet the requirements for receiving a grant under this section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the satisfactory performance and successful completion by an urban indian organization of other contracts with the secretary under this title the appropriateness and likely effectiveness of conducting the activities set forth in subsection a in an urban center or centers and the extent of existing or likely future participation in the activities set forth in subsection a by appropriate health and health related federal state local and other agencies access to health promotion and disease prevention programs the secretary acting through the service shall facilitate access to or provide health promotion and disease prevention services for urban indians through grants made to urban indian organizations administering contracts entered into or receiving grants under subsection a immunization services access or services provided the secretary acting through the service shall facilitate access to or provide immunization services for urban indians through grants made to urban indian organizations administering contracts entered into or receiving grants under this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih definition for purposes of this subsection the term immunization services means services to provide without charge immunizations against vaccine preventable diseases behavioral health services access or services provided the secretary acting through the service shall facilitate access to or provide behavioral health services for urban indians through grants made to urban indian organizations administering contracts entered into or receiving grants under subsection a assessment required except as provided by paragraph a a grant not be made under this subsection to an urban indian organization until that organization has prepared and the service has approved an assessment of the following a the behavioral health needs of the urban indian population concerned the behavioral health services and other related resources available to that population the barriers to obtaining those services and resourcesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the needs that are unmet by such services and resources purposes of grants grants be made under this subsection for the following a to prepare assessments required under paragraph to provide outreach educational and referral services to urban indians regarding the availability of direct behavioral health services to educate urban indians about behavioral health issues and services and effect coordination with existing behavioral health providers in order to improve services to urban indians to provide outpatient behavioral health services to urban indians including the identification and assessment of illness therapeutic treatments case management support groups family treatment and other treatment to develop innovative behavioral health service delivery models which incorporate indian cultural support systems and resources prevention of child abuse access or services provided the secretary acting through the service shall facilitate access to or provide services for urban indiansverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih through grants to urban indian organizations administering contracts entered into or receiving grants under subsection a to prevent and treat child abuse including sexual abuse among urban indians evaluation required except as provided by paragraph a a grant not be made under this subsection to an urban indian organization until that organization has prepared and the service has approved an assessment that documents the prevalence of child abuse in the urban indian population concerned and specifies the services and programs which not duplicate existing services and programs for which the grant is requested purposes of grants grants be made under this subsection for the following a to prepare assessments required under paragraph for the development of prevention training and education programs for urban indians including child education parent education provider training on identification and intervention education on reporting requirements prevention campaigns and establishingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih service networks of all those involved in indian child protection to provide direct outpatient treatment services including individual treatment family treatment group therapy and support groups to urban indians who are child victims of abuse including sexual abuse or adult survivors of child sexual abuse to the families of such child victims and to urban indian perpetrators of child abuse including sexual abuse considerations when making grants in making grants to carry out this subsection the secretary shall take into consideration a the support for the urban indian organization demonstrated by the child protection authorities in the area including committees or other services funded under the indian child welfare act of usc et seq if any the capability and expertise demonstrated by the urban indian organization to address the complex problem of child sexual abuse in the community andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the assessment required under paragraph other grants the secretary acting through the service enter into a contract with or make grants to an urban indian organization that provides or arranges for the provision of health care services through satellite facilities provider networks or otherwise to urban indians in more than urban center sec use of federal government facilities and sources of supply a in general the secretary permit an urban indian organization that has entered into a contract or received a grant pursuant to this title in carrying out such contract or grant to use existing facilities and all equipment therein or pertaining thereto and other personal property owned by the federal government within the secretary jurisdiction under such terms and conditions as be agreed upon for their use and maintenance donations subject to subsection the secretary donate to an urban indian organization that has entered into a contract or received a grant pursuant to this title any personal or real property determined to be excess to the needs of the indian health service orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the general services administration for the purposes of carrying out the contract or grant acquisition of property the secretary acquire excess or surplus government personal or real property for donation subject to subsection to an urban indian organization that has entered into a contract or received a grant pursuant to this title if the secretary determines that the property is appropriate for use by the urban indian organization for a purpose for which a contract or grant is authorized under this title priority in the event that the secretary receives a request for a specific item of personal or real property described in subsections or from an urban indian organization and from an indian tribe or tribal organization the secretary shall give priority to the request for donation to the indian tribe or tribal organization if the secretary receives the request from the indian tribe or tribal organization before the date the secretary transfers title to the property or if earlier the date the secretary transfers the property physically to the urban indian organization executive agency status for purposes of section a of the federal property and administrative services act of usc a relating to federal sources of supply an urban indian organization thatverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih has entered into a contract or received a grant pursuant to this title be deemed to be an executive agency when carrying out such contract or grant sec contracts and grants for the determination of unmet health care needs a grants and contracts authorized under authority of the act of november usc commonly known as the snyder act the secretary acting through the service enter into contracts with or make grants to urban indian organizations situated in urban centers for which contracts have not been entered into or grants have not been made under section purpose the purpose of a contract or grant made under this section shall be the determination of the matters described in subsection in order to assist the secretary in assessing the health status and health care needs of urban indians in the urban center involved and determining whether the secretary should enter into a contract or make a grant under section with respect to the urban indian organization which the secretary has entered into a contract with or made a grant to under this sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih grant and contract requirements any contract entered into or grant made by the secretary under this section shall include requirements that the urban indian organization successfully undertakes to a document the health care status and unmet health care needs of urban indians in the urban center involved and with respect to urban indians in the urban center involved determine the matters described in paragraphs and of section and the urban indian organization complete performance of the contract or carry out the requirements of the grant within year after the date on which the secretary and such organization enter into such contract or within year after such organization receives such grant whichever is applicable no renewals the secretary not renew any contract entered into or grant made under this section sec evaluations renewals a procedures for evaluations the secretary acting through the service shall develop procedures to evaluate compliance with grant requirements andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih compliance with and performance of contracts entered into by urban indian organizations under this title such procedures shall include provisions for carrying out the requirements of this section evaluations the secretary acting through the service shall evaluate the compliance of each urban indian organization which has entered into a contract or received a grant under section with the terms of such contract or grant for purposes of this evaluation the secretary shall acting through the service conduct an annual onsite evaluation of the organization or accept in lieu of such onsite evaluation evidence of the organization provisional or full accreditation by a private independent entity recognized by the secretary for purposes of conducting quality reviews of providers participating in the medicare program under title xviii of the social security act noncompliance unsatisfactory performance if as a result of the evaluations conducted under this section the secretary determines that an urban indian organization has not complied with the requirements of a grant or complied with or satisfactorily performed a contract under section the secretary shall prior to renewing such contract or grant attempt to resolve withverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the organization the areas of noncompliance or unsatisfactory performance and modify the contract or grant to prevent future occurrences of noncompliance or unsatisfactory performance if the secretary determines that the noncompliance or unsatisfactory performance cannot be resolved and prevented in the future the secretary shall not renew the contract or grant with the organization and is authorized to enter into a contract or make a grant under section with another urban indian organization which is situated in the same urban center as the urban indian organization whose contract or grant is not renewed under this section considerations for renewals in determining whether to renew a contract or grant with an urban indian organization under section which has completed performance of a contract or grant under section the secretary shall review the records of the urban indian organization the reports submitted under section and shall consider the results of the onsite evaluations or accreditations under subsection sec other contract and grant requirements a procurement contracts with urban indian organizations entered into pursuant to this title shall be in accordance with all federal contracting laws and regulations relating to procurement except that in the discre verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion of the secretary such contracts be negotiated without advertising and need not conform to the provisions of sections and through of title united states code payments under contracts or grants in general payments under any contracts or grants pursuant to this title notwithstanding any term or condition of such contract or grant a be made in a single advance payment by the secretary to the urban indian organization by no later than the end of the first days of the funding period with respect to which the payments apply unless the secretary determines through an evaluation under section that the organization is not capable of administering such a single advance payment and if any portion thereof is unexpended by the urban indian organization during the funding period with respect to which the payments initially apply shall be carried forward for expenditure with respect to allowable or reimbursable costs incurred by the organization during or more subsequent funding periods without additional justification or documenta verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih tion by the organization as a condition of carrying forward the availability for expenditure of such funds semiannual and quarterly payments and reimbursements if the secretary determines under paragraph a that an urban indian organization is not capable of administering an entire single advance payment on request of the urban indian organization the payments be made a in semiannual or quarterly payments by not later than days after the date on which the funding period with respect to which the payments apply begins or by way of reimbursement revision or amendment of contracts notwithstanding any provision of law to the contrary the secretary at the request and consent of an urban indian organization revise or amend any contract entered into by the secretary with such organization under this title as necessary to carry out the purposes of this title fair and uniform services and assistance contracts with or grants to urban indian organizations and regulations adopted pursuant to this title shall include provisions to assure the fair and uniform provisionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to urban indians of services and assistance under such contracts or grants by such organizations sec reports and records a reports in general for each fiscal year during which an urban indian organization receives or expends funds pursuant to a contract entered into or a grant received pursuant to this title such urban indian organization shall submit to the secretary not more frequently than every months a report that includes the following a in the case of a contract or grant under section recommendations pursuant to section a information on activities conducted by the organization pursuant to the contract or grant an accounting of the amounts and purpose for which federal funds were expended a minimum set of data using uniformly defined elements as specified by the secretary after consultation with urban indian organizations health status and services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general not later than months after the date of enactment of the indian health care improvement act amendments of the secretary acting through the service shall submit to congress a report evaluating the health status of urban indians the services provided to indians pursuant to this title and iii areas of unmet needs in the delivery of health services to urban indians consultation and contracts in preparing the report under paragraph the secretary shall consult with urban indian organizations and enter into a contract with a national organization representing urban indian organizations to conduct any aspect of the report audit the reports and records of the urban indian organization with respect to a contract or grant under this title shall be subject to audit by the secretary and the comptroller general of the united statesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih costs of audits the secretary shall allow as a cost of any contract or grant entered into or awarded under section or the cost of an annual independent financial audit conducted by a certified public accountant or a certified public accounting firm qualified to conduct federal compliance audits sec limitation on contract authority the authority of the secretary to enter into contracts or to award grants under this title shall be to the extent and in an amount provided for in appropriation acts sec facilities a grants the secretary acting through the service make grants to contractors or grant recipients under this title for the lease purchase renovation construction or expansion of facilities including leased facilities in order to assist such contractors or grant recipients in complying with applicable licensure or certification requirements loan fund study the secretary acting through the service carry out a study to determine the feasibility of establishing a loan fund to provide to urban indian organizations direct loans or guarantees for loans for the construction of health care facilities in averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih manner consistent with section including by submitting a report in accordance with subsection of that section sec division of urban indian health there is established within the service a division of urban indian health which shall be responsible for carrying out the provisions of this title providing central oversight of the programs and services authorized under this title and providing technical assistance to urban indian organizations sec grants for alcohol and substance abuserelated services a grants authorized the secretary acting through the service make grants for the provision of health related services in prevention of treatment of rehabilitation of or school and community based education regarding alcohol and substance abuse in urban centers to those urban indian organizations with which the secretary has entered into a contract under this title or under section goals each grant made pursuant to subsection a shall set forth the goals to be accomplished pursuant to the grant the goals shall be specific to each grant as agreed to between the secretary and the granteeverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih criteria the secretary shall establish criteria for the grants made under subsection a including criteria relating to the following the size of the urban indian population capability of the organization to adequately perform the activities required under the grant satisfactory performance standards for the organization in meeting the goals set forth in such grant the standards shall be negotiated and agreed to between the secretary and the grantee on a grant by grant basis identification of the need for services allocation of grants the secretary shall develop a methodology for allocating grants made pursuant to this section based on the criteria established pursuant to subsection grants subject to criteria any grant received by an urban indian organization under this act for substance abuse prevention treatment and rehabilitation shall be subject to the criteria set forth in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec treatment of certain demonstration projects notwithstanding any other provision of law the tulsa clinic and oklahoma city clinic demonstration projects shall be permanent programs within the service direct care program continue to be treated as service units and operating units in the allocation of resources and coordination of care and continue to meet the requirements and definitions of an urban indian organization in this act and shall not be subject to the provisions of the indian self determination and education assistance act usc et seq sec urban niaaa transferred programs a grants and contracts the secretary through the division of urban indian health shall make grants or enter into contracts with urban indian organizations to take effect not later than september for the administration of urban indian alcohol programs that were originally established under the national institute on alcoholism and alcohol abuse hereafter in this section referred to as niaaa and transferred to the serviceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih use of funds grants provided or contracts entered into under this section shall be used to provide support for the continuation of alcohol prevention and treatment services for urban indian populations and such other objectives as are agreed upon between the service and a recipient of a grant or contract under this section eligibility urban indian organizations that operate indian alcohol programs originally funded under the niaaa and subsequently transferred to the service are eligible for grants or contracts under this section report the secretary shall evaluate and report to congress on the activities of programs funded under this section not less than every years sec conferring with urban indian organizations a in general the secretary shall ensure that the service confers or conferences to the greatest extent practicable with urban indian organizations definition of confer conference in this section the terms confer and conference mean an open and free exchange of information and opinions that leads to mutual understanding and comprehension andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih emphasizes trust respect and shared responsibility sec urban youth treatment center demonstration a construction and operation in general the secretary acting through the service through grant or contract shall fund the construction and operation of at least residential treatment center in each service area that meets the eligibility requirements set forth in subsection to demonstrate the provision of alcohol and substance abuse treatment services to urban indian youth in a culturally competent residential setting treatment each residential treatment center described in paragraph shall be in addition to any facilities constructed under section eligibility requirements to be eligible to obtain a facility under subsection a a service area shall meet the following requirements there is an urban indian organization in the service areaverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih there reside in the service area urban indian youth with need for alcohol and substance abuse treatment services in a residential setting there is a significant shortage of culturally competent residential treatment services for urban indian youth in the service area sec grants for diabetes prevention treatment and control a grants authorized the secretary make grants to those urban indian organizations that have entered into a contract or have received a grant under this title for the provision of services for the prevention and treatment of and control of the complications resulting from diabetes among urban indians goals each grant made pursuant to subsection a shall set forth the goals to be accomplished under the grant the goals shall be specific to each grant as agreed to between the secretary and the grantee establishment of criteria the secretary shall establish criteria for the grants made under subsection a relating to the size and location of the urban indian population to be served the need for prevention of and treatment of and control of the complications resulting from verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih diabetes among the urban indian population to be served performance standards for the organization in meeting the goals set forth in such grant that are negotiated and agreed to by the secretary and the grantee the capability of the organization to adequately perform the activities required under the grant and the willingness of the organization to collaborate with the registry if any established by the secretary under section in the area office of the service in which the organization is located funds subject to criteria any funds received by an urban indian organization under this act for the prevention treatment and control of diabetes among urban indians shall be subject to the criteria developed by the secretary under subsection sec community health representatives the secretary acting through the service enter into contracts with and make grants to urban indian organizations for the employment of indians trained as health service providers through the community health representatives program under section in the provi verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sion of health care health promotion and disease prevention services to urban indians sec effective date the amendments made by the indian health care improvement act amendments of to this title shall take effect beginning on the date of enactment of that act regardless of whether the secretary has promulgated regulations implementing such amendments sec eligibility for services urban indians shall be eligible for and the ultimate beneficiaries of health care or referral services provided pursuant to this title sec authorization of appropriations a in general there are authorized to be appropriated such sums as be necessary to carry out this title urban indian organizations the secretary acting through the service is authorized to establish programs including programs for the awarding of grants for urban indian organizations that are identical to any programs established pursuant to section behavioral health training section school health education section prevention of communicable diseases section behavioral health prevention andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih treatment services and section multidrug abuse program sec health information technology the secretary acting through the service make grants to urban indian organizations under this title for the development adoption and implementation of health information technology as defined in section of the american recovery and reinvestment act telemedicine services development and related infrastructure title vi organizational improvements sec establishment of the indian health service as an agency of the public health service a establishment in general in order to more effectively and efficiently carry out the responsibilities authorities and functions of the united states to provide health care services to indians and indian tribes as are or be hereafter provided by federal statute or treaties there is established within the public health service of the department the indian health serviceverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih assistant secretary of indian health the service shall be administered by an assistant secretary of indian health who shall be appointed by the president by and with the advice and consent of the senate the assistant secretary shall report to the secretary effective with respect to an individual appointed by the president by and with the advice and consent of the senate after january the term of service of the assistant secretary shall be years an assistant secretary serve more than term incumbent the individual serving in the position of director of the service on the day before the date of enactment of the indian health care improvement act amendments of shall serve as assistant secretary advocacy and consultation the position of assistant secretary is established to in a manner consistent with the government to government relationship between the united states and indian tribes a facilitate advocacy for the development of appropriate indian health policy and promote consultation on matters relating to indian healthverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih agency the service shall be an agency within the public health service of the department and shall not be an office component or unit of any other agency of the department duties the assistant secretary shall perform all functions that were on the day before the date of enactment of the indian health care improvement act amendments of carried out by or under the direction of the individual serving as director of the service on that day perform all functions of the secretary relating to the maintenance and operation of hospital and health facilities for indians and the planning for and provision and utilization of health services for indians administer all health programs under which health care is provided to indians based upon their status as indians which are administered by the secretary including programs under a this act the act of november usc the act of august usc et seq verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the act of august usc et seq and the indian self determination and education assistance act usc et seq administer all scholarship and loan functions carried out under title report directly to the secretary concerning all policy and budget related matters affecting indian health collaborate with the assistant secretary for health concerning appropriate matters of indian health that affect the agencies of the public health service advise each assistant secretary of the department concerning matters of indian health with respect to which that assistant secretary has authority and responsibility advise the heads of other agencies and programs of the department concerning matters of indian health with respect to which those heads have authority and responsibility coordinate the activities of the department concerning matters of indian health andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih perform such other functions as the secretary designate authority in general the secretary acting through the assistant secretary shall have the authority a except to the extent provided for in paragraph to appoint and compensate employees for the service in accordance with title united states code to enter into contracts for the procurement of goods and services to carry out the functions of the service and to manage expend and obligate all funds appropriated for the service personnel actions notwithstanding any other provision of law the provisions of section of the act of june stat usc shall apply to all personnel actions taken with respect to new positions created within the service as a result of its establishment under subsection a references any reference to the director of the indian health service in any other federal law executive order rule regulation or delegation of authority orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in any document of or relating to the director of the indian health service shall be deemed to refer to the assistant secretary sec automated management information system a establishment in general the secretary shall establish an automated management information system for the service requirements of system the information system established under paragraph shall include a a financial management system a patient care information system for each area served by the service privacy protections consistent with the regulations promulgated under section of the health insurance portability and accountability act of or to the extent consistent with such regulations other federal rules applicable to privacy of automated management information systems of a federal agency a services based cost accounting component that provides estimates of the costs as verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sociated with the provision of specific medical treatments or services in each area office of the service an interface mechanism for patient billing and accounts receivable system and a training component provision of systems to tribes and organizations the secretary shall provide each tribal health program automated management information systems which meet the management information needs of such tribal health program with respect to the treatment by the tribal health program of patients of the service and meet the management information needs of the service access to records the service shall provide access of patients to their medical or health records which are held by or on behalf of the service in accordance with the regulations promulgated under section of the health insurance portability and accountability act of or to the extent consistent with such regulations other federal rules applicable to access to health care recordsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih authority to enhance information technology the secretary acting through the assistant secretary shall have the authority to enter into contracts agreements or joint ventures with other federal agencies states private and nonprofit organizations for the purpose of enhancing information technology in indian health programs and facilities sec authorization of appropriations there is authorized to be appropriated such sums as be necessary to carry out this title title vii behavioral health programs sec behavioral health prevention and treatment services a purposes the purposes of this section are as follows to authorize and direct the secretary acting through the service to develop a comprehensive behavioral health prevention and treatment program which emphasizes collaboration among alcohol and substance abuse social services and mental health programs to provide information direction and guidance relating to mental illness and dysfunction and self destructive behavior including child abuseverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and family violence to those federal tribal state and local agencies responsible for programs in indian communities in areas of health care education social services child and family welfare alcohol and substance abuse law enforcement and judicial services to assist indian tribes to identify services and resources available to address mental illness and dysfunctional and self destructive behavior to provide authority and opportunities for indian tribes and tribal organizations to develop implement and coordinate with community based programs which include identification prevention education referral and treatment services including through multidisciplinary resource teams to ensure that indians as citizens of the united states and of the states in which they reside have the same access to behavioral health services to which all citizens have access to modify or supplement existing programs and authorities in the areas identified in paragraph plans development the secretary acting through the service shall encourage indian tribesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and tribal organizations to develop tribal plans and urban indian organizations to develop local plans and for all such groups to participate in developing areawide plans for indian behavioral health services the plans shall include to the extent feasible the following components a an assessment of the scope of alcohol or other substance abuse mental illness and dysfunctional and self destructive behavior including suicide child abuse and family violence among indians including the number of indians served who are directly or indirectly affected by such illness or behavior or an estimate of the financial and human cost attributable to such illness or behavior an assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior including an assessment of the progress toward achieving the availability of the full continuum of care described in subsection c an estimate of the additional funding needed by the service indian tribes tribalverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih organizations and urban indian organizations to meet their responsibilities under the plans national clearinghouse the secretary acting through the service shall coordinate with existing national clearinghouses and information centers to include at the clearinghouses and centers plans and reports on the outcomes of such plans developed by indian tribes tribal organizations urban indian organizations and service areas relating to behavioral health the secretary shall ensure access to these plans and outcomes by any indian tribe tribal organization urban indian organization or the service technical assistance the secretary shall provide technical assistance to indian tribes tribal organizations and urban indian organizations in preparation of plans under this section and in developing standards of care that be used and adopted locally programs the secretary acting through the service shall provide to the extent feasible and if funding is available programs including the following comprehensive care a comprehensive continuum of behavioral health care which provides verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a community based prevention intervention outpatient and behavioral health aftercare detoxification social and medical acute hospitalization intensive outpatient day treatment residential treatment transitional living for those needing a temporary stable living environment that is supportive of treatment and recovery goals emergency shelter intensive case management and diagnostic services child care behavioral health services for indians from birth through age including a preschool and school age fetal alcohol disorder services including assessment and behavioral intervention mental health and substance abuse services emotional organic alcohol drug inhalant and tobacco identification and treatment of co occurring disorders and comorbidity prevention of alcohol drug inhalant and tobacco use verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih early intervention treatment and aftercare promotion of healthy approaches to risk and safety issues and identification and treatment of neglect and physical mental and sexual abuse adult care behavioral health services for indians from age through including a early intervention treatment and aftercare mental health and substance abuse services emotional alcohol drug inhalant and tobacco including sex specific services identification and treatment of co occurring disorders dual diagnosis and comorbidity promotion of healthy approaches for risk related behavior treatment services for women at risk of giving birth to a child with a fetal alcohol disorder and sex specific treatment for sexual assault and domestic violence family care behavioral health services for families including verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a early intervention treatment and aftercare for affected families treatment for sexual assault and domestic violence and promotion of healthy approaches relating to parenting domestic violence and other abuse issues elder care behavioral health services for indians years of age and older including a early intervention treatment and aftercare mental health and substance abuse services emotional alcohol drug inhalant and tobacco including sex specific services identification and treatment of co occurring disorders dual diagnosis and comorbidity promotion of healthy approaches to managing conditions related to aging sex specific treatment for sexual assault domestic violence neglect physical and mental abuse and exploitation and identification and treatment of dementias regardless of cause community behavioral health plan verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih establishment the governing body of any indian tribe tribal organization or urban indian organization adopt a resolution for the establishment of a community behavioral health plan providing for the identification and coordination of available resources and programs to identify prevent or treat substance abuse mental illness or dysfunctional and self destructive behavior including child abuse and family violence among its members or its service population this plan should include behavioral health services social services intensive outpatient services and continuing aftercare technical assistance at the request of an indian tribe tribal organization or urban indian organization the bureau of indian affairs and the service shall cooperate with and provide technical assistance to the indian tribe tribal organization or urban indian organization in the development and implementation of such plan funding the secretary acting through the service make funding available to indian tribes and tribal organizations which adopt a resolution pursuant to paragraph to obtain technical assistance for the development of a community be verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih havioral health plan and to provide administrative support in the implementation of such plan coordination for availability of services the secretary acting through the service shall coordinate behavioral health planning to the extent feasible with other federal agencies and with state agencies to encourage comprehensive behavioral health services for indians regardless of their place of residence mental health care need assessment not later than year after the date of enactment of the indian health care improvement act amendments of the secretary acting through the service shall make an assessment of the need for inpatient mental health care among indians and the availability and cost of inpatient mental health facilities which can meet such need in making such assessment the secretary shall consider the possible conversion of existing underused service hospital beds into psychiatric units to meet such need sec memoranda of agreement with the department of the interior a contents not later than months after the date of enactment of the indian health care improvement act amendments of the secretary acting through the service and the secretary of the interior shall develop and enter into a memoranda of agreement or review andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih update any existing memoranda of agreement as required by section of the indian alcohol and substance abuse prevention and treatment act of usc under which the secretaries address the following the scope and nature of mental illness and dysfunctional and self destructive behavior including child abuse and family violence among indians the existing federal tribal state local and private services resources and programs available to provide behavioral health services for indians the unmet need for additional services resources and programs necessary to meet the needs identified pursuant to paragraph a the right of indians as citizens of the united states and of the states in which they reside to have access to behavioral health services to which all citizens have access the right of indians to participate in and receive the benefit of such services the actions necessary to protect the exercise of such right the responsibilities of the bureau of indian affairs and the service including mental illness identification prevention education referral andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih treatment services including services through multidisciplinary resource teams at the central area and agency and service unit service area and headquarters levels to address the problems identified in paragraph a strategy for the comprehensive coordination of the behavioral health services provided by the bureau of indian affairs and the service to meet the problems identified pursuant to paragraph including a the coordination of alcohol and substance abuse programs of the service the bureau of indian affairs and indian tribes and tribal organizations developed under the indian alcohol and substance abuse prevention and treatment act of usc et seq with behavioral health initiatives pursuant to this act particularly with respect to the referral and treatment of dually diagnosed individuals requiring behavioral health and substance abuse treatment and ensuring that the bureau of indian affairs and service programs and services including multidisciplinary resource teams addressing child abuse and family violence are co verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ordinated with such non federal programs and services directing appropriate officials of the bureau of indian affairs and the service particularly at the agency and service unit levels to cooperate fully with tribal requests made pursuant to community behavioral health plans adopted under section and section of the indian alcohol and substance abuse prevention and treatment act of usc providing for an annual review of such agreement by the secretaries which shall be provided to congress and indian tribes and tribal organizations specific provisions required the memoranda of agreement updated or entered into pursuant to subsection a shall include specific provisions pursuant to which the service shall assume responsibility for the determination of the scope of the problem of alcohol and substance abuse among indians including the number of indians within the jurisdiction of the service who are directly or indirectly affected by alcohol and substance abuse and the financial and human cost verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih an assessment of the existing and needed resources necessary for the prevention of alcohol and substance abuse and the treatment of indians affected by alcohol and substance abuse and an estimate of the funding necessary to adequately support a program of prevention of alcohol and substance abuse and treatment of indians affected by alcohol and substance abuse publication each memorandum of agreement entered into or renewed and amendments or modifications thereto under subsection a shall be published in the federal register at the same time as publication in the federal register the secretary shall provide a copy of such memoranda amendment or modification to each indian tribe tribal organization and urban indian organization sec comprehensive behavioral health prevention and treatment program a establishment in general the secretary acting through the service shall provide a program of comprehensive behavioral health prevention treatment and aftercare including systems of care which shall include verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a prevention through educational intervention in indian communities acute detoxification psychiatric hospitalization residential and intensive outpatient treatment community based rehabilitation and aftercare community education and involvement including extensive training of health care educational and community based personnel specialized residential treatment programs for high risk populations including pregnant and postpartum women and their children and diagnostic services target populations the target population of such programs shall be members of indian tribes efforts to train and educate key members of the indian community shall also target employees of health education judicial law enforcement legal and social service programs contract health services in general the secretary acting through the service enter into contracts withverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih public or private providers of behavioral health treatment services for the purpose of carrying out the program required under subsection a provision of assistance in carrying out this subsection the secretary shall provide assistance to indian tribes and tribal organizations to develop criteria for the certification of behavioral health service providers and accreditation of service facilities which meet minimum standards for such services and facilities sec mental health technician program a in general under the authority of the act of november usc commonly known as the snyder act the secretary shall establish and maintain a mental health technician program within the service which provides for the training of indians as mental health technicians and employs such technicians in the provision of community based mental health care that includes identification prevention education referral and treatment services paraprofessional training in carrying out subsection a the secretary acting through the service shall provide high standard paraprofessional trainingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in mental health care necessary to provide quality care to the indian communities to be served such training shall be based upon a curriculum developed or approved by the secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care supervision and evaluation of technicians the secretary acting through the service shall supervise and evaluate the mental health technicians in the training program traditional health care practices the secretary acting through the service shall ensure that the program established pursuant to this subsection involves the use and promotion of the traditional health care practices of the indian tribes to be served sec licensing requirement for mental health care workers a in general subject to the provisions of section and except as provided in subsection any individual employed as a psychologist social worker or marriage and family therapist for the purpose of providing mental health care services to indians in a clinical setting under this act is required to be licensed as a psychologist social worker or marriage and family therapist respectivelyverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih trainees an individual be employed as a trainee in psychology social work or marriage and family therapy to provide mental health care services described in subsection a if such individual works under the direct supervision of a licensed psychologist social worker or marriage and family therapist respectively is enrolled in or has completed at least years of course work at a post secondary accredited education program for psychology social work marriage and family therapy or counseling and meets such other training supervision and quality review requirements as the secretary establish sec indian women treatment programs a grants the secretary consistent with section make grants to indian tribes tribal organizations and urban indian organizations to develop and implement a comprehensive behavioral health program of prevention intervention treatment and relapse prevention services that specifically addresses the cultural historical social and child care needs of indian women regardless of age use of grant funds a grant made pursuant to this section be used to verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih develop and provide community training education and prevention programs for indian women relating to behavioral health issues including fetal alcohol disorders identify and provide psychological services counseling advocacy support and relapse prevention to indian women and their families and develop prevention and intervention models for indian women which incorporate traditional health care practices cultural values and community and family involvement criteria the secretary in consultation with indian tribes and tribal organizations shall establish criteria for the review and approval of applications and proposals for funding under this section allocation of funds for urban indian organizations twenty percent of the funds appropriated pursuant to this section shall be used to make grants to urban indian organizations sec indian youth program a detoxification and rehabilitation the secretary acting through the service consistent with section shall develop and implement a program for acute detoxification and treatment for indian youths including behavioral health services the program shall include re verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih gional treatment centers designed to include detoxification and rehabilitation for both sexes on a referral basis and programs developed and implemented by indian tribes or tribal organizations at the local level under the indian self determination and education assistance act usc et seq regional centers shall be integrated with the intake and rehabilitation programs based in the referring indian community alcohol and substance abuse treatment centers or facilities establishment a in general the secretary acting through the service shall construct renovate or as necessary purchase and appropriately staff and operate at least youth regional treatment center or treatment network in each area under the jurisdiction of an area office area office in california for the purposes of this subsection the area office in california shall be considered to be area offices office whose jurisdiction shall be considered to encompass the northern area of the state of california and office whose jurisdiction shall be considered to encompass the remainder of the state of california for the pur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih pose of implementing california treatment networks funding for the purpose of staffing and operating such centers or facilities funding shall be pursuant to the act of november usc location a youth treatment center constructed or purchased under this subsection shall be constructed or purchased at a location within the area described in paragraph agreed upon by appropriate tribal resolution by a majority of the indian tribes to be served by such center specific provision of funds a in general notwithstanding any other provision of this title the secretary from amounts authorized to be appropriated for the purposes of carrying out this section make funds available to the tanana chiefs conference incorporated for the purpose of leasing constructing renovating operating and maintaining a residential youth treatment facility in fairbanks alaska and the southeast alaska regional health corporation to staff and operate averdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih residential youth treatment facility without regard to the proviso set forth in section of the indian self determination and education assistance act usc provision of services to eligible youths until additional residential youth treatment facilities are established in alaska pursuant to this section the facilities specified in subparagraph a shall make every effort to provide services to all eligible indian youths residing in alaska intermediate adolescent behavioral health services in general the secretary acting through the service provide intermediate behavioral health services which incorporate systems of care to indian children and adolescents including a pretreatment assistance inpatient outpatient and aftercare services emergency care suicide prevention and crisis intervention andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih prevention and treatment of mental illness and dysfunctional and self destructive behavior including child abuse and family violence use of funds funds provided under this subsection be used a to construct or renovate an existing health facility to provide intermediate behavioral health services to hire behavioral health professionals to staff operate and maintain an intermediate mental health facility group home sober housing transitional housing or similar facilities or youth shelter where intermediate behavioral health services are being provided to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units and for intensive home and communitybased services criteria the secretary acting through the service shall in consultation with indian tribes and tribal organizations establish criteria for theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih review and approval of applications or proposals for funding made available pursuant to this subsection federally owned structures in general the secretary in consultation with indian tribes and tribal organizations shall a identify and use where appropriate federally owned structures suitable for local residential or regional behavioral health treatment for indian youths and establish guidelines for determining the suitability of any such federally owned structure to be used for local residential or regional behavioral health treatment for indian youths terms and conditions for use of structure any structure described in paragraph be used under such terms and conditions as be agreed upon by the secretary and the agency having responsibility for the structure and any indian tribe or tribal organization operating the program rehabilitation and aftercare services in general the secretary indian tribes or tribal organizations in cooperation withverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary of the interior shall develop and implement within each service unit community based rehabilitation and follow up services for indian youths who are having significant behavioral health problems and require long term treatment community reintegration and monitoring to support the indian youths after their return to their home community administration services under paragraph shall be provided by trained staff within the community who can assist the indian youths in their continuing development of self image positive problem solving skills and nonalcohol or substance abusing behaviors such staff include alcohol and substance abuse counselors mental health professionals and other health professionals and paraprofessionals including community health representatives inclusion of family in youth treatment program in providing the treatment and other services to indian youths authorized by this section the secretary acting through the service shall provide for the inclusion of family members of such youths in the treatment programs or other services as be appropriate not less than percent of the funds appropriated for the pur verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih poses of carrying out subsection shall be used for outpatient care of adult family members related to the treatment of an indian youth under that subsection multidrug abuse program the secretary acting through the service shall provide consistent with section programs and services to prevent and treat the abuse of multiple forms of substances including alcohol drugs inhalants and tobacco among indian youths residing in indian communities on or near reservations and in urban areas and provide appropriate mental health services to address the incidence of mental illness among such youths indian youth mental health the secretary acting through the service shall collect data for the report under section with respect to the number of indian youth who are being provided mental health services through the service and tribal health programs a description of and costs associated with the mental health services provided for indian youth through the service and tribal health programs the number of youth referred to the service or tribal health programs for mental health services verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the number of indian youth provided residential treatment for mental health and behavioral problems through the service and tribal health programs reported separately for on and off reservation facilities and the costs of the services described in paragraph sec indian youth telemental health demonstration project a purpose the purpose of this section is to authorize the secretary to carry out a demonstration project to test the use of telemental health services in suicide prevention intervention and treatment of indian youth including through the use of psychotherapy psychiatric assessments diagnostic interviews therapies for mental health conditions predisposing to suicide and alcohol and substance abuse treatment the provision of clinical expertise to consultation services with and medical advice and training for frontline health care providers working with indian youth training and related support for community leaders family members and health and education workers who work with indian youth verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the development of culturally relevant educational materials on suicide and data collection and reporting definitions for the purpose of this section the following definitions shall apply demonstration project the term demonstration project means the indian youth telemental health demonstration project authorized under subsection telemental health the term telemental health means the use of electronic information and telecommunications technologies to support long distance mental health care patient and professional related education public health and health administration authorization in general the secretary is authorized to award grants under the demonstration project for the provision of telemental health services to indian youth who a have expressed suicidal ideas have attempted suicide or have mental health conditions that increase or could increase the risk of suicideverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih eligibility for grants such grants shall be awarded to indian tribes and tribal organizations that operate or more facilities a located in alaska and part of the alaska federal health care access network reporting active clinical telehealth capabilities or offering school based telemental health services relating to psychiatry to indian youth grant period the secretary shall award grants under this section for a period of up to years awarding of grants not more than grants shall be provided under paragraph with priority consideration given to indian tribes and tribal organizations that a serve a particular community or geographic area where there is a demonstrated need to address indian youth suicide enter in to collaborative partnerships with indian health service or tribal health programs or facilities to provide services under this demonstration project verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih serve an isolated community or geographic area which has limited or no access to behavioral health services or operate a detention facility at which indian youth are detained use of funds in general an indian tribe or tribal organization shall use a grant received under subsection for the following purposes a to provide telemental health services to indian youth including the provision of psychotherapy psychiatric assessments and diagnostic interviews therapies for mental health conditions predisposing to suicide and treatment and iii alcohol and substance abuse treatment to provide clinician interactive medical advice guidance and training assistance in diagnosis and interpretation crisis counseling and intervention and related assistance to service tribal or urban clinicians and health services providers working with youth being served under this demonstration projectverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to assist educate and train community leaders health education professionals and paraprofessionals tribal outreach workers and family members who work with the youth receiving telemental health services under this demonstration project including with identification of suicidal tendencies crisis intervention and suicide prevention emergency skill development and building and expanding networks among these individuals and with state and local health services providers to develop and distribute culturally appropriate community educational materials on suicide prevention suicide education iii suicide screening iv suicide intervention and ways to mobilize communities with respect to the identification of risk factors for suicide for data collection and reporting related to indian youth suicide prevention efforts traditional health care practices in carrying out the purposes described inverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih paragraph an indian tribe or tribal organization use and promote the traditional health care practices of the indian tribes of the youth to be served applications to be eligible to receive a grant under subsection an indian tribe or tribal organization shall prepare and submit to the secretary an application at such time in such manner and containing such information as the secretary require including a description of the project that the indian tribe or tribal organization will carry out using the funds provided under the grant a description of the manner in which the project funded under the grant would a meet the telemental health care needs of the indian youth population to be served by the project or improve the access of the indian youth population to be served to suicide prevention and treatment services evidence of support for the project from the local community to be served by the project a description of how the families and leadership of the communities or populations to beverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih served by the project would be involved in the development and ongoing operations of the project a plan to involve the tribal community of the youth who are provided services by the project in planning and evaluating the mental health care and suicide prevention efforts provided in order to ensure the integration of community clinical environmental and cultural components of the treatment and a plan for sustaining the project after federal assistance for the demonstration project has terminated collaboration reporting to national clearinghouse collaboration the secretary acting through the service shall encourage indian tribes and tribal organizations receiving grants under this section to collaborate to enable comparisons about best practices across projects reporting to national clearinghouse the secretary acting through the service shall also encourage indian tribes and tribal organizations receiving grants under this section to submit relevant declassified project information to the national clearinghouse authorized under sectionverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in order to better facilitate program performance and improve suicide prevention intervention and treatment services annual report each grant recipient shall submit to the secretary an annual report that describes the number of telemental health services provided and includes any other information that the secretary require report to congress not later than days after the termination of the demonstration project the secretary shall submit to the committee on indian affairs of the senate and the committee on natural resources and committee on energy and commerce of the house of representatives a final report based on the annual reports provided by grant recipients under subsection that describes the results of the projects funded by grants awarded under this section including any data available which indicates the number of attempted suicides evaluates the impact of the telemental health services funded by the grants in reducing the number of completed suicides among indian youth verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih evaluates whether the demonstration project should be a expanded to provide more than grants and designated a permanent program and evaluates the benefits of expanding the demonstration project to include urban indian organizations authorization of appropriations there is authorized to be appropriated such sums as be necessary to carry out this section sec inpatient and community based mental health facilities design construction and staffing not later than year after the date of enactment of the indian health care improvement act amendments of the secretary acting through the service provide in each area of the service not less than inpatient mental health care facility or the equivalent for indians with behavioral health problems for the purposes of this subsection california shall be considered to be area offices office whose location shall be considered to encompass the northern area of the state of california and office whose jurisdiction shall be considered to en verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih compass the remainder of the state of california the secretary shall consider the possible conversion of existing underused service hospital beds into psychiatric units to meet such need sec training and community education a program the secretary in cooperation with the secretary of the interior shall develop and implement or assist indian tribes and tribal organizations to develop and implement within each service unit or tribal program a program of community education and involvement which shall be designed to provide concise and timely information to the community leadership of each tribal community such program shall include education about behavioral health issues to political leaders tribal judges law enforcement personnel members of tribal health and education boards health care providers including traditional practitioners and other critical members of each tribal community such program also include community based training to develop local capacity and tribal community provider training for prevention intervention treatment and aftercare instruction the secretary acting through the service shall provide instruction in the area of behavioral health issues including instruction in crisis intervention and family relations in the context of alcohol and sub verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih stance abuse child sexual abuse youth alcohol and substance abuse and the causes and effects of fetal alcohol disorders to appropriate employees of the bureau of indian affairs and the service and to personnel in schools or programs operated under any contract with the bureau of indian affairs or the service including supervisors of emergency shelters and halfway houses described in section of the indian alcohol and substance abuse prevention and treatment act of usc training models in carrying out the education and training programs required by this section the secretary in consultation with indian tribes tribal organizations indian behavioral health experts and indian alcohol and substance abuse prevention experts shall develop and provide community based training models such models shall address the elevated risk of alcohol and behavioral health problems faced by children of alcoholics the cultural spiritual and multigenerational aspects of behavioral health problem prevention and recovery and community based and multidisciplinary strategies including systems of care for preventing and treating behavioral health problemsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec behavioral health program a innovative programs the secretary acting through the service consistent with section plan develop implement and carry out programs to deliver innovative community based behavioral health services to indians awards criteria the secretary award a grant for a project under subsection a to an indian tribe or tribal organization and consider the following criteria the project will address significant unmet behavioral health needs among indians the project will serve a significant number of indians the project has the potential to deliver services in an efficient and effective manner the indian tribe or tribal organization has the administrative and financial capability to administer the project the project deliver services in a manner consistent with traditional health care practices the project is coordinated with and avoids duplication of existing services equitable treatment for purposes of this subsection the secretary shall in evaluating project applications or proposals use the same criteria that the sec verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih retary uses in evaluating any other application or proposal for such funding sec fetal alcohol disorder programs a programs establishment the secretary consistent with section and acting through the service is authorized to establish and operate fetal alcohol disorder programs as provided in this section for the purposes of meeting the health status objectives specified in section use of funds a in general funding provided pursuant to this section shall be used for the following to develop and provide for indians community and in school training education and prevention programs relating to fetal alcohol disorders to identify and provide behavioral health treatment to high risk indian women and high risk women pregnant with an indian child iii to identify and provide appropriate psychological services educational and vocational support counseling advo verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih cacy and information to fetal alcohol disorder affected indians and their families or caretakers iv to develop and implement counseling and support programs in schools for fetal alcohol disorder affected indian children to develop prevention and intervention models which incorporate practitioners of traditional health care practices cultural values and community involvement vi to develop print and disseminate education and prevention materials on fetal alcohol disorder vii to develop and implement in consultation with indian tribes tribal organizations and urban indian organizations culturally sensitive assessment and diagnostic tools including dysmorphology clinics and multidisciplinary fetal alcohol disorder clinics for use in indian communities and urban centers additional uses in addition to any purpose under subparagraph a fundingverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih provided pursuant to this section be used for or more of the following early childhood intervention projects from birth on to mitigate the effects of fetal alcohol disorder among indians community based support services for indians and women pregnant with indian children iii community based housing for adult indians with fetal alcohol disorder criteria for applications the secretary shall establish criteria for the review and approval of applications for funding under this section services the secretary acting through the service shall develop and provide services for the prevention intervention treatment and aftercare for those affected by fetal alcohol disorder in indian communities and provide supportive services including services to meet the special educational vocational school to work transition and independent living needs of adolescent and adult indians with fetal alcohol disorderverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih task force the secretary shall establish a task force to be known as the fetal alcohol disorder task force to advise the secretary in carrying out subsection such task force shall be composed of representatives from the following the national institute on drug abuse the national institute on alcohol and alcoholism the office of substance abuse prevention the national institute of mental health the service the office of minority health of the department of health and human services the administration for native americans the national institute of child health and human development nichd the centers for disease control and prevention the bureau of indian affairs indian tribes tribal organizations urban indian organizations indian fetal alcohol spectrum disorders expertsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih applied research projects the secretary acting through the substance abuse and mental health services administration shall make grants to indian tribes tribal organizations and urban indian organizations for applied research projects which propose to elevate the understanding of methods to prevent intervene treat or provide rehabilitation and behavioral health aftercare for indians and urban indians affected by fetal alcohol spectrum disorders funding for urban indian organizations ten percent of the funds appropriated pursuant to this section shall be used to make grants to urban indian organizations funded under title sec child sexual abuse and prevention treatment programs a establishment the secretary acting through the service shall establish consistent with section in every service area programs involving treatment for victims of sexual abuse who are indian children or children in an indian household and perpetrators of child sexual abuse who are indian or members of an indian household use of funds funding provided pursuant to this section shall be used for the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to develop and provide community education and prevention programs related to sexual abuse of indian children or children in an indian household to identify and provide behavioral health treatment to victims of sexual abuse who are indian children or children in an indian household and to their family members who are affected by sexual abuse to develop prevention and intervention models which incorporate traditional health care practices cultural values and community involvement to develop and implement culturally sensitive assessment and diagnostic tools for use in indian communities and urban centers to identify and provide behavioral health treatment to indian perpetrators and perpetrators who are members of an indian household a making efforts to begin offender and behavioral health treatment while the perpetrator is incarcerated or at the earliest possible date if the perpetrator is not incarcerated andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih providing treatment after the perpetrator is released until it is determined that the perpetrator is not a threat to children coordination the programs established under subsection a shall be carried out in coordination with programs and services authorized under the indian child protection and family violence prevention act usc et seq sec domestic and sexual violence prevention and treatment a in general the secretary in accordance with section is authorized to establish in each service area programs involving the prevention and treatment of indian victims of domestic violence or sexual abuse and perpetrators of domestic violence or sexual abuse who are indian or members of an indian household use of funds funds made available to carry out this section shall be used to develop and implement prevention programs and community education programs relating to domestic violence and sexual abuse verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to provide behavioral health services including victim support services and medical treatment including examinations performed by sexual assault nurse examiners to indian victims of domestic violence or sexual abuse to purchase rape kits to develop prevention and intervention models which incorporate traditional health care practices and to identify and provide behavioral health treatment to perpetrators who are indian or members of an indian household training and certification in general not later than year after the date of enactment of the indian health care improvement act amendments of the secretary shall establish appropriate protocols policies procedures standards of practice and if not available elsewhere training curricula and training and certification requirements for services for victims of domestic violence and sexual abuse report not later than months after the date of enactment of the indian health care improvement act amendments of the secretary shall submit to the committee on indian affairs ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the senate and the committee on natural resources of the house of representatives a report that describes the means and extent to which the secretary has carried out paragraph coordination in general the secretary in coordination with the attorney general federal and tribal law enforcement agencies indian health programs and domestic violence or sexual assault victim organizations shall develop appropriate victim services and victim advocate training programs a to improve domestic violence or sexual abuse responses to improve forensic examinations and collection to identify problems or obstacles in the prosecution of domestic violence or sexual abuse and to meet other needs or carry out other activities required to prevent treat and improve prosecutions of domestic violence and sexual abuse report not later than years after the date of enactment of the indian health care improvement act amendments of the secretaryverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall submit to the committee on indian affairs of the senate and the committee on natural resources of the house of representatives a report that describes with respect to the matters described in paragraph the improvements made and needed problems or obstacles identified and costs necessary to address the problems or obstacles and any other recommendations that the secretary determines to be appropriate sec behavioral health research the secretary in consultation with appropriate federal agencies shall make grants to or enter into contracts with indian tribes tribal organizations and urban indian organizations or enter into contracts with or make grants to appropriate institutions for the conduct of research on the incidence and prevalence of behavioral health problems among indians served by the service indian tribes or tribal organizations and among indians in urban areas research priorities under this section shall include the multifactorial causes of indian youth suicide including a protective and risk factors and scientific data that identifies those factors andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the effects of loss of cultural identity and the development of scientific data on those effects the interrelationship and interdependence of behavioral health problems with alcoholism and other substance abuse suicide homicides other injuries and the incidence of family violence and the development of models of prevention techniques the effect of the interrelationships and interdependencies referred to in paragraph on children and the development of prevention techniques under paragraph applicable to children shall be emphasized sec definitions for the purpose of this title the following definitions shall apply assessment the term assessment means the systematic collection analysis and dissemination of information on health status health needs and health problems alcohol related neurodevelopmental disorders or arnd the term alcohol related neurodevelopmental disorders or arnd means with a history of maternal alcohol consumption during pregnancy central nervousverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih system involvement such as developmental delay intellectual deficit or neurologic abnormalities behaviorally there can be problems with irritability and failure to thrive as infants as children become older there will likely be hyperactivity attention deficit language dysfunction and perceptual and judgment problems behavioral health aftercare the term behavioral health aftercare includes those activities and resources used to support recovery following inpatient residential intensive substance abuse or mental health outpatient or outpatient treatment the purpose is to help prevent or deal with relapse by ensuring that by the time a client or patient is discharged from a level of care such as outpatient treatment an aftercare plan has been developed with the client an aftercare plan use such resources as a community based therapeutic group transitional living facilities a step sponsor a local step or other related support group and other community based providers dual diagnosis the term dual diagnosis means coexisting substance abuse and mental illness conditions or diagnosis such clients areverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sometimes referred to as mentally ill chemical abusers micas fetal alcohol spectrum disorders a in general the term fetal alcohol spectrum disorders includes a range of effects that can occur in an individual whose mother drank alcohol during pregnancy including physical mental behavioral and or learning disabilities with possible lifelong implications inclusions the term fetal alcohol spectrum disorders include fetal alcohol syndrome fas fetal alcohol effect fae iii alcohol related birth defects and iv alcohol related neurodevelopmental disorders arnd fetal alcohol syndrome or fas the term fetal alcohol syndrome or fas means any of a spectrum of effects that occur when a woman drinks alcohol during pregnancy the diagnosis of which involves the confirmed presence of the following criteria a craniofacial abnormalities growth deficitsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih central nervous system abnormalities rehabilitation the term rehabilitation means medical and health care services that a are recommended by a physician or licensed practitioner of the healing arts within the scope of their practice under applicable law are furnished in a facility home or other setting in accordance with applicable standards and have as their purpose any of the following the maximum attainment of physical mental and developmental functioning averting deterioration in physical or mental functional status iii the maintenance of physical or mental health functional status substance abuse the term substance abuse includes inhalant abuse systems of care the term systems of care means a system for delivering services to children and their families that is child centered familyfocused and family driven community based and culturally competent and responsive to the needs ofverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the children and families being served the systems of care approach values prevention and early identification smooth transitions for children and families child and family participation and advocacy comprehensive array of services individualized service planning services in the least restrictive environment and integrated services with coordinated planning across the child serving systems sec authorization of appropriations there is authorized to be appropriated such sums as be necessary to carry out the provisions of this title title viii miscellaneous sec reports for each fiscal year following the date of enactment of the indian health care improvement act amendments of the secretary shall transmit to congress a report containing the following a report on the progress made in meeting the objectives of this act including a review of programs established or assisted pursuant to this act and assessments and recommendations of additional programs or additional assistance necessary to at a minimum provide health services to indians and ensure a health status for indians which are at a par verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ity with the health services available to and the health status of the general population a report on whether and to what extent new national health care programs benefits initiatives or financing systems have had an impact on the purposes of this act and any steps that the secretary have taken to consult with indian tribes tribal organizations and urban indian organizations to address such impact including a report on proposed changes in allocation of funding pursuant to section a report on the use of health services by indians a on a national and area or other relevant geographical basis by gender and age by source of payment and type of service comparing such rates of use with rates of use among comparable non indian populations and provided under contracts a report of contractors to the secretary on health care educational loan repayments every months required by section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a general audit report of the secretary on the health care educational loan repayment program as required by section a report of the findings and conclusions of demonstration programs on development of educational curricula for substance abuse counseling as required in section a separate statement which specifies the amount of funds requested to carry out the provisions of section a report of the evaluations of health promotion and disease prevention as required in section a biennial report to congress on infectious diseases as required by section a report on environmental and nuclear health hazards as required by section an annual report on the status of all health care facilities needs as required by section and reports on safe water and sanitary waste disposal facilities as required by section an annual report on the expenditure of non service funds for renovation as required by sections verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a report identifying the backlog of maintenance and repair required at service and tribal facilities required by section a a report providing an accounting of reimbursement funds made available to the secretary under titles xviii xix and xxi of the social security act a report on any arrangements for the sharing of medical facilities or services as authorized by section a report on evaluation and renewal of urban indian programs under section a report on the evaluation of programs as required by section a report on alcohol and substance abuse as required by section a report on indian youth mental health services as required by section a report on the reallocation of base resources if required by section a report on the movement of patients between service units including a a list of those service units that have a net increase and those that have a net decrease of patients due to patients assigned toverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih one service unit voluntarily choosing to receive service at another service unit an analysis of the effect of patient movement on the quality of services for those service units experiencing an increase in the number of patients served and what funding changes are necessary to maintain a consistent quality of service at service units that have an increase in the number of patients served a report on the extent to which health care facilities of the service indian tribes tribal organizations and urban indian organizations comply with credentialing requirements of the service or licensure requirements of states sec regulations a deadlines procedures not later than days after the date of enactment of the indian health care improvement act amendments of the secretary shall initiate procedures under subchapter iii of chapter of title united states code to negotiate and promulgate such regulations or amendments thereto that are necessary to carry out this act except sections andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih through the secretary promulgate regulations to carry out such sections using the procedures required by chapter of title united states code commonly known as the administrative procedure act proposed regulations proposed regulations to implement this act shall be published in the federal register by the secretary no later than years after the date of enactment of the indian health care improvement act amendments of and shall have no less than a day comment period final regulations the secretary shall publish in the federal register final regulations to implement this act by not later than years after the date of enactment of the indian health care improvement act amendments of committee a negotiated rulemaking committee established pursuant to section of title united states code to carry out this section shall have as its members only representatives of the federal government and representatives of indian tribes and tribal organizations a majority of whom shall be nominated by and be representatives of indian tribes and tribal organizations from each service areaverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih adaptation of procedures the secretary shall adapt the negotiated rulemaking procedures to the unique context of self governance and the government togovernment relationship between the united states and indian tribes lack of regulations the lack of promulgated regulations shall not limit the effect of this act sec plan of implementation a in general not later than year after the date of enactment of the indian health care improvement act amendments of the secretary in consultation with indian tribes tribal organizations and urban indian organizations shall submit to congress a plan explaining the manner and schedule by title and section by which the secretary will implement the provisions of this act this consultation be conducted jointly with the annual budget consultation pursuant to the indian self determination and education assistance act usc et seq lack of plan the lack of or failure to submit such a plan shall not limit the effect or prevent the implementation of this actverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec limitation on use of funds appropriated to indian health service any limitation on the use of funds contained in an act providing appropriations for the department for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an act providing appropriations for the service sec eligibility of california indians a in general the following california indians shall be eligible for health services provided by the service any member of a federally recognized indian tribe any descendant of an indian who was residing in california on june if such descendant a is a member of the indian community served by a local program of the service and is regarded as an indian by the community in which such descendant lives any indian who holds trust interests in public domain national forest or reservation allotments in california any indian in california who is listed on the plans for distribution of the assets of rancherias and reservations located within the state of cali verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih fornia under the act of august stat and any descendant of such an indian clarification nothing in this section be construed as expanding the eligibility of california indians for health services provided by the service beyond the scope of eligibility for such health services that applied on may sec health services for ineligible persons a children any individual who has not attained years of age is the natural or adopted child stepchild foster child legal ward or orphan of an eligible indian and is not otherwise eligible for health services provided by the service shall be eligible for all health services provided by the service on the same basis and subject to the same rules that apply to eligible indians until such individual attains years of age the existing and potential health needs of all such individuals shall be taken into consideration by the service in determining the need for or the allocation of the health resources of the service if such an individual has been determined to be legally incompetent prior to attaining years of age such individual shall remainverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih eligible for such services until year after the date of a determination of competency spouses any spouse of an eligible indian who is not an indian or who is of indian descent but is not otherwise eligible for the health services provided by the service shall be eligible for such health services if all such spouses or spouses who are married to members of each indian tribe being served are made eligible as a class by an appropriate resolution of the governing body of the indian tribe or tribal organization providing such services the health needs of persons made eligible under this paragraph shall not be taken into consideration by the service in determining the need for or allocation of its health resources provision of services to other individuals in general the secretary is authorized to provide health services under this subsection through health programs operated directly by the service to individuals who reside within the service area of the service unit and who are not otherwise eligible for such health services if a the indian tribes served by such service unit request such provision of health services to such individuals andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih the secretary and the served indian tribes have jointly determined that the provision of such health services will not result in a denial or diminution of health services to eligible indians and there is no reasonable alternative health facilities or services within or without the service unit available to meet the health needs of such individuals isdeaa programs in the case of health programs and facilities operated under a contract or compact entered into under the indian self determination and education assistance act usc et seq the governing body of the indian tribe or tribal organization providing health services under such contract or compact is authorized to determine whether health services should be provided under such contract to individuals who are not eligible for such health services under any other subsection of this section or under any other provision of law in making such determinations the governing body of the indian tribe or tribal organization shall take into account the considerations described in paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih payment for services a in general persons receiving health services provided by the service under this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the secretary which in the judgment of the secretary results in reimbursement in an amount not less than the actual cost of providing the health services notwithstanding section of this act or any other provision of law amounts collected under this subsection including medicare medicaid or schip reimbursements under titles xviii xix and xxi of the social security act shall be credited to the account of the program providing the service and shall be used for the purposes listed in section and amounts collected under this subsection shall be available for expenditure within such program indigent people health services be provided by the secretary through the service under this subsection to an indigent individual who would not be otherwise eligible for such health services but for the provisions of paragraph only if an agreement has beenverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih entered into with a state or local government under which the state or local government agrees to reimburse the service for the expenses incurred by the service in providing such health services to such indigent individual revocation of consent for services a single tribe service area in the case of a service area which serves only indian tribe the authority of the secretary to provide health services under paragraph shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the indian tribe revokes its concurrence to the provision of such health services multitribal service area in the case of a multitribal service area the authority of the secretary to provide health services under paragraph shall terminate at the end of the fiscal year succeeding the fiscal year in which at least percent of the number of indian tribes in the service area revoke their concurrence to the provisions of such health servicesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih other services the service provide health services under this subsection to individuals who are not eligible for health services provided by the service under any other provision of law in order to achieve stability in a medical emergency prevent the spread of a communicable disease or otherwise deal with a public health hazard provide care to non indian women pregnant with an eligible indian child for the duration of the pregnancy through postpartum or provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual hospital privileges for practitioners in general hospital privileges in health facilities operated and maintained by the service or operated under a contract or compact pursuant to the indian self determination and education assistance act usc et seq be extended to non service health care practitioners who provide services to individuals described in subsection a or such non service health care practitioners as part of the privileging process be designated as employees of the federal government for purposes of section andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih chapter of title united states code relating to federal tort claims only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such hospital privileges are extended definition for purposes of this subsection the term non service health care practitioner means a practitioner who is not a an employee of the service or an employee of an indian tribe or tribal organization operating a contract or compact under the indian self determination and education assistance act or an individual who provides health care services pursuant to a personal services contract with such indian tribe or tribal organization eligible indian for purposes of this section the term eligible indian means any indian who is eligible for health services provided by the service without regard to the provisions of this section sec reallocation of base resources a report required notwithstanding any other provision of law any allocation of service funds for a fiscal year that reduces by percent or more from theverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih previous fiscal year the funding for any recurring program project or activity of a service unit be implemented only after the secretary has submitted to congress under section a report on the proposed change in allocation of funding including the reasons for the change and its likely effects exception subsection a shall not apply if the total amount appropriated to the service for a fiscal year is at least percent less than the amount appropriated to the service for the previous fiscal year sec results of demonstration projects the secretary shall provide for the dissemination to indian tribes tribal organizations and urban indian organizations of the findings and results of demonstration projects conducted under this act sec provision of services in montana a consistent with court decision the secretary acting through the service shall provide services and benefits for indians in montana in a manner consistent with the decision of the united states court of appeals for the ninth circuit in mcnabb for mcnabb bowen fd th cir clarification the provisions of subsection a shall not be construed to be an expression of the sense of congress on the application of the decision describedverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih in subsection a with respect to the provision of services or benefits for indians living in any state other than montana sec moratorium during the period of the moratorium imposed on implementation of the final rule published in the federal register on september by the department of health and human services relating to eligibility for the health care services of the indian health service the indian health service shall provide services pursuant to the criteria for eligibility for such services that were in effect on september subject to the provisions of sections and until the service has submitted to the committees on appropriations of the senate and the house of representatives a budget request reflecting the increased costs associated with the proposed final rule and the request has been included in an appropriations act and enacted into law sec severability provisions if any provision of this act any amendment made by the act or the application of such provision or amendment to any person or circumstances is held to be invalid the remainder of this act the remaining amendments made by this act and the application of such provisionsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih to persons or circumstances other than those to which it is held invalid shall not be affected thereby sec use of patient safety organizations the service an indian tribe tribal organization or urban indian organization provide for quality assurance activities through the use of a patient safety organization in accordance with title ix of the public health service act sec confidentiality of medical quality assurance records qualified immunity for participants a confidentiality of records medical quality assurance records created by or for any indian health program or a health program of an urban indian organization as part of a medical quality assurance program are confidential and privileged such records not be disclosed to any person or entity except as provided in subsection prohibition on disclosure and testimony in general no part of any medical quality assurance record described in subsection a be subject to discovery or admitted into evidence in any judicial or administrative proceeding except as provided in subsection verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih testimony a person who reviews or creates medical quality assurance records for any indian health program or urban indian organization who participates in any proceeding that reviews or creates such records not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding recommendation evaluation opinion or action taken by such person or body in connection with such records except as provided in this section authorized disclosure and testimony in general subject to paragraph a medical quality assurance record described in subsection a be disclosed and a person referred to in subsection give testimony in connection with such a record only as follows a to a federal executive agency or private organization if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to any indian health program or to a health program of an urban indian organization to perform moni verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih toring required by law of such program or organization to an administrative or judicial proceeding commenced by a present or former indian health program or urban indian organization provider concerning the termination suspension or limitation of clinical privileges of such health care provider to a governmental board or agency or to a professional health care society or organization if such medical quality assurance record or testimony is needed by such board agency society or organization to perform licensing credentialing or the monitoring of professional standards with respect to any health care provider who is or was an employee of any indian health program or urban indian organization to a hospital medical center or other institution that provides health care services if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was an employee of any indian health program or urban indian orga verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih nization and who has applied for or been granted authority or employment to provide health care services in or on behalf of such program or organization to an officer employee or contractor of the indian health program or urban indian organization that created the records or for which the records were created if that officer employee or contractor has a need for such record or testimony to perform official duties to a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law in an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph but only with respect to the subject of such proceeding identity of participants with the exception of the subject of a quality assurance action the identity of any person receiving health careverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih services from any indian health program or urban indian organization or the identity of any other person associated with such program or organization for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection a shall be deleted from that record or document before any disclosure of such record is made outside such program or organization disclosure for certain purposes in general nothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of any indian health program or urban indian organizations medical quality assurance programs withholding from congress nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either house of congress any joint committee of congress or the government accountability office if such record pertains to any matter within their respective jurisdictions prohibition on disclosure of record or testimony a person or entity having possession of orverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih access to a record or testimony described by this section not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section exemption from freedom of information act medical quality assurance records described in subsection a not be made available to any person under section of title united states code limitation on civil liability a person who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection a shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place application to information in certain other records nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program including a patient medical records on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance programverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih regulations the secretary acting through the service shall promulgate regulations pursuant to section definitions in this section the term health care provider means any health care professional including community health aides and practitioners certified under section who are granted clinical practice privileges or employed to provide health care services in an indian health program or health program of an urban indian organization who is licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization the term medical quality assurance program means any activity carried out before on or after the date of enactment of this act by or for any indian health program or urban indian organization to assess the quality of medical care including activities conducted by or on behalf of individuals indian health program or urban indian organization medical or dental treatment review committees or other review bodies responsible for quality assurance credentials infection control patient safety patient care assessment including treatment proce verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih dures blood drugs and therapeutics medical records health resources management review and identification and prevention of medical or dental incidents and risks the term medical quality assurance record means the proceedings records minutes and reports that emanate from quality assurance program activities described in paragraph and are produced or compiled by or for an indian health program or urban indian organization as part of a medical quality assurance program continued protection disclosure under subsection does not permit redisclosure except to the extent such further disclosure is authorized under subsection or is otherwise authorized to be disclosed under this section inconsistencies to the extent that the protections under the patient safety and quality improvement act of and this section are inconsistent the provisions of whichever is more protective shall control relationship to other law this section shall continue in force and effect except as otherwise specifically provided in any federal law enacted after the date of enactment of the indian health care improvement act amendments of verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec claremore indian hospital the claremore indian hospital shall be deemed to be a dependant indian community for the purposes of section of title united states code sec sense of congress regarding law enforcement and methamphetamine issues in indian country it is the sense of congress that congress encourages state local and indian tribal law enforcement agencies to enter into memoranda of agreement between and among those agencies for purposes of streamlining law enforcement activities and maximizing the use of limited resources to improve law enforcement services provided to indian tribal communities and to increase the effectiveness of measures to address problems relating to methamphetamine use in indian country as defined in section of title united states code sec permitting implementation through contracts with tribal health programs nothing in this act shall be construed as preventing the secretary from carrying out any section of this act through contracts with tribal health programs andverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih carrying out sections through a and through contracts with urban indian organizations the previous sentence shall not affect the authority the secretary otherwise have to carry out other provisions of this act through such contracts sec authorization of appropriations availability a authorization of appropriations there are authorized to be appropriated such sums as be necessary to carry out this title limitation on new spending authority any new spending authority described in subparagraph a or of section of the congressional budget act of public law – stat which is provided under this act shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation acts availability the funds appropriated pursuant to this act shall remain available until expended rate of pay positions at level iv section of title united states code is amended by striking assistant secretaries of health and human serv verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih ices and inserting assistant secretaries of health and human services positions at level section of title united states code is amended by striking director indian health service department of health and human services amendments to other provisions of law section of the children health act of usc note public law – is amended by striking director of the indian health service and inserting assistant secretary for indian health the indian lands open dump cleanup act of is amended a in section usc by striking paragraph by redesignating paragraphs and as paragraphs and respectively and moving those paragraphs so as to appear in numerical order and iii by inserting before paragraph as redesignated by subclause the following verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih assistant secretary the term assistant secretary means the assistant secretary for indian health in section usc by striking the section designation and heading and inserting the following sec authority of assistant secretary for indian health in section a usc a in the subsection heading by striking director and inserting assistant secretary in section a usc a in the subsection heading by striking director and inserting assistant secretary and by striking director each place it appears and inserting assistant secretary section of the augustus hawkins robert stafford elementary and secondary school improvement amendments of usc note public law – is amended by striking director of the indian health service and inserting assistant secretary for indian health verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section a of the rehabilitation act of usc a is amended by striking director of the indian health service and inserting assistant secretary for indian health subsections and of section of the federal water pollution control act usc are amended by striking director of the indian health service each place it appears and inserting assistant secretary for indian health section of the public health service act usc b– is amended a by striking director of the indian health service each place it appears and inserting assistant secretary for indian health and in paragraph a by striking the directors referred to in such paragraph and inserting the director of the centers for disease control and prevention and the assistant secretary for indian health section of the public health service act usc – is amended by striking director of the indian health service and inserting assistant secretary for indian health verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih section of the safe drinking water act usc j– is amended by striking director of the indian health service each place it appears and inserting assistant secretary for indian health section of the native american programs act of usc b– is amended in the last sentence by striking director of the indian health service and inserting assistant secretary for indian health section of the michigan indian land claims settlement act public law – stat is amended by striking director of the indian health service and inserting assistant secretary for indian health sec soboba sanitation facilities the act of december stat is amended by adding at the end the following sec nothing in this act shall preclude the soboba band of mission indians and the soboba indian reservation from being provided with sanitation facilities and services under the authority of section of the act of august stat as amended by the act of july stat verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec native american health and wellness foundation a in general the indian self determination and education assistance act usc et seq is amended by adding at the end the following title viii native american health and wellness foundation sec definitions in this title board the term board means the board of directors of the foundation committee the term committee means the committee for the establishment of native american health and wellness foundation established under section foundation the term foundation means the native american health and wellness foundation established under section secretary the term secretary means the secretary of health and human services service the term service means the indian health service of the department of health and human servicesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec native american health and wellness foundation a establishment in general as soon as practicable after the date of enactment of this title the secretary shall establish under the laws of the district of columbia and in accordance with this title the native american health and wellness foundation funding determinations no funds gift property or other item of value including any interest accrued on such an item acquired by the foundation shall a be taken into consideration for purposes of determining federal appropriations relating to the provision of health care and services to indians or otherwise limit diminish or affect the federal responsibility for the provision of health care and services to indians perpetual existence the foundation shall have perpetual existence nature of corporation the foundation shall be a charitable and nonprofit federally chartered corporation and shall not be an agency or instrumentality of the united statesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih place of incorporation and domicile the foundation shall be incorporated and domiciled in the district of columbia duties the foundation shall encourage accept and administer private gifts of real and personal property and any income from or interest in such gifts for the benefit of or in support of the mission of the service undertake and conduct such other activities as will further the health and wellness activities and opportunities of native americans and participate with and assist federal state and tribal governments agencies entities and individuals in undertaking and conducting activities that will further the health and wellness activities and opportunities of native americans committee for the establishment of native american health and wellness foundation in general the secretary shall establish the committee for the establishment of native american health and wellness foundation to assist the secretary in establishing the foundationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih duties not later than days after the date of enactment of this section the committee shall a carry out such activities as are necessary to incorporate the foundation under the laws of the district of columbia including acting as incorporators of the foundation ensure that the foundation qualifies for and maintains the status required to carry out this section until the board is established establish the constitution and initial bylaws of the foundation provide for the initial operation of the foundation including providing for temporary or interim quarters equipment and staff and appoint the initial members of the board in accordance with the constitution and initial bylaws of the foundation board of directors in general the board of directors shall be the governing body of the foundation powers the board exercise or provide for the exercise of the powers of the foundationverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih selection a in general subject to subparagraph the number of members of the board the manner of selection of the members including the filling of vacancies and the terms of office of the members shall be as provided in the constitution and bylaws of the foundation requirements number of members the board shall have at least members who shall have staggered terms initial voting members the initial voting members of the board shall be appointed by the committee not later than days after the date on which the foundation is established and shall have staggered terms iii qualification the members of the board shall be united states citizens who are knowledgeable or experienced in native american health care and related mattersverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih compensation a member of the board shall not receive compensation for service as a member but shall be reimbursed for actual and necessary travel and subsistence expenses incurred in the performance of the duties of the foundation officers in general the officers of the foundation shall be a a secretary elected from among the members of the board and any other officers provided for in the constitution and bylaws of the foundation chief operating officer the secretary of the foundation serve at the direction of the board as the chief operating officer of the foundation or the board appoint a chief operating officer who shall serve at the direction of the board election the manner of election term of office and duties of the officers of the foundation shall be as provided in the constitution and bylaws of the foundation powers the foundation verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall adopt a constitution and bylaws for the management of the property of the foundation and the regulation of the affairs of the foundation adopt and alter a corporate seal enter into contracts acquire through a gift or otherwise own lease encumber and transfer real or personal property as necessary or convenient to carry out the purposes of the foundation sue and be sued and perform any other act necessary and proper to carry out the purposes of the foundation principal office in general the principal office of the foundation shall be in the district of columbia activities offices the activities of the foundation be conducted and offices be maintained throughout the united states in accordance with the constitution and bylaws of the foundation service of process the foundation shall comply with the law on service of process of each state in which the foundation is incorporated and of each state in which the foundation carries on activitiesverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih liability of officers employees and agents in general the foundation shall be liable for the acts of the officers employees and agents of the foundation acting within the scope of their authority personal liability a member of the board shall be personally liable only for gross negligence in the performance of the duties of the member restrictions limitation on spending beginning with the fiscal year following the first full fiscal year during which the foundation is in operation the administrative costs of the foundation shall not exceed the percentage described in paragraph of the sum of a the amounts transferred to the foundation under subsection during the preceding fiscal year and donations received from private sources during the preceding fiscal year percentages the percentages referred to in paragraph are verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a for the first fiscal year described in that paragraph percent for the following fiscal year percent and for each fiscal year thereafter percent appointment and hiring the appointment of officers and employees of the foundation shall be subject to the availability of funds status a member of the board or officer employee or agent of the foundation shall not by reason of association with the foundation be considered to be an officer employee or agent of the united states audits the foundation shall comply with section of title united states code as if the foundation were a corporation under part of subtitle of that title funding authorization of appropriations there is authorized to be appropriated to carry out subsection for each fiscal year as adjusted to reflect changes in the consumer price index for all urban consumers published by the department of labor verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih transfer of donated funds the secretary shall transfer to the foundation funds held by the department of health and human services under the act of august usc et seq if the transfer or use of the funds is not prohibited by any term under which the funds were donated sec administrative services and support a provision of support by secretary subject to subsection during the year period beginning on the date on which the foundation is established the secretary provide personnel facilities and other administrative support services to the foundation provide funds for initial operating costs and to reimburse the travel expenses of the members of the board and shall require and accept reimbursements from the foundation for a services provided under paragraph and funds provided under paragraph reimbursement reimbursements accepted under subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih shall be deposited in the treasury of the united states to the credit of the applicable appropriations account and shall be chargeable for the cost of providing services described in subsection a and travel expenses described in subsection a continuation of certain services the secretary continue to provide facilities and necessary support services to the foundation after the termination of the year period specified in subsection a if the facilities and services are available and are provided on reimbursable cost basis technical amendments the indian self determination and education assistance act is amended by redesignating title usc bbb et seq as title vii by redesignating sections and usc bbb bbb– bbb– as sections and respectively and in subsection a of section and paragraph of section as redesignated by paragraph by striking section and inserting section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec gao study and report on payments for contract health services a study in general the comptroller general of the united states in this section referred to as the comptroller general shall conduct a study on the utilization of health care furnished by health care providers under the contract health services program funded by the indian health service and operated by the indian health service an indian tribe or a tribal organization as those terms are defined in section of the indian health care improvement act analysis the study conducted under paragraph shall include an analysis of a the amounts reimbursed under the contract health services program described in paragraph for health care furnished by entities individual providers and suppliers including a comparison of reimbursement for such health care through other public programs and in the private sector barriers to accessing care under such contract health services program including but not limited to barriers relating to travel distances cultural differences and public and pri verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih vate sector reluctance to furnish care to patients under such program the adequacy of existing federal funding for health care under such contract health services program and any other items determined appropriate by the comptroller general report not later than months after the date of enactment of this act the comptroller general shall submit to congress a report on the study conducted under subsection a together with recommendations regarding the appropriate level of federal funding that should be established for health care under the contract health services program described in subsection a and how to most efficiently utilize such funding consultation in conducting the study under subsection a and preparing the report under subsection the comptroller general shall consult with the indian health service indian tribes and tribal organizationsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih title improvement of indian health care provided under the social security act sec expansion of payments under medicare medicaid and schip for all covered services furnished by indian health programs a medicaid expansion to all covered services section of the social security act usc is amended a by amending the heading to read as follows sec indian health programs and by amending subsection a to read as follows a eligibility for payment for medical assistance an indian health program shall be eligible for payment for medical assistance provided under a state plan or under waiver authority with respect to items and services furnished by the program if the furnishing of such services meets all the conditions and requirements which are applicable generally to the furnishing of itemsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih and services under this title and under such plan or waiver authority repeal of obsolete provision subsection of such section is repealed revision of authority to enter into agreements subsection of such section is amended to read as follows authority to enter into agreements the secretary enter into an agreement with a state for the purpose of reimbursing the state for medical assistance provided by the indian health service an indian tribe tribal organization or an urban indian organization as so defined directly through referral or under contracts or other arrangements between the indian health service an indian tribe tribal organization or an urban indian organization and another health care provider to indians who are eligible for medical assistance under the state plan or under waiver authority this subsection shall not be construed to impair the entitlement of a state to reimbursement for such medical assistance under this title cross references to special fund for improvement of ihs facilities direct billing option definitions such section is furtherverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih amended by striking subsection and adding at the end the following new subsections special fund for improvement of ihs facilities for provisions relating to the authority of the secretary to place payments to which a facility of the indian health service is eligible for payment under this title into a special fund established under section of the indian health care improvement act see subparagraphs a and of section of such act direct billing for provisions relating to the authority of an tribal health program to elect to directly bill for and receive payment for health care items and services provided by such program for which payment is made under this title see section of the indian health care improvement act definitions section a of such act usc a is amended by adding at the end the following new paragraph for purposes of this title and titles xviii xix and xxi the terms indian health program indian tribe and indian tribe tribal health program tribal organization and tribal organization and urban indian organization and urban indian organization have the meaningsverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih given those terms in section of the indian health care improvement act medicare expansion to all covered services section of such act usc qq is amended a by amending the heading to read as follows sec indian health programs and by amending subsection a to read as follows a eligibility for payments subject to subsection an indian health program shall be eligible for payments under this title with respect to items and services furnished by the program if the furnishing of such services meets all the conditions and requirements which are applicable generally to the furnishing of items and services under this title repeal of obsolete provision subsection of such section is repealed cross references to special fund for improvement of ihs facilities direct billing option definitions verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih a in general such section is further amended by striking subsections and and inserting the following new subsections special fund for improvement of ihs facilities for provisions relating to the authority of the secretary to place payments to which a facility of the indian health service is eligible for payment under this title into a special fund established under section of the indian health care improvement act and the requirement to use amounts paid from such fund for making improvements in accordance with subsection see subparagraphs a and of section of such act direct billing for provisions relating to the authority of a tribal health program to elect to directly bill for and receive payment for health care items and services provided by such program for which payment is made under this title see section of the indian health care improvement act conforming amendments such section is further amended in subsection by striking subsection and inserting subsection and section of the indian health care improvement act verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih by redesignating subsection as subsection and iii by striking subsection definitions such section is further amended by amending adding at the end the following new subsection definitions in this section the terms indian health program indian tribe service unit tribal health program tribal organization and urban indian organization have the meanings given those terms in section of the indian health care improvement act application to schip section of the social security act usc gg is amended by redesignating subparagraphs through as subparagraphs through respectively and by inserting after subparagraph the following new subparagraph section relating to indian health programs other than subsection of such section verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec additional provisions to increase outreach to and enrollment of indians in schip and medicaid a assurance of payments to indian health care providers for child health assistance section of the social security act usc bb is amended by striking as defined in section of the indian health care improvement act usc and inserting including how the state will ensure that payments are made to indian health programs and urban indian organizations operating in the state for the provision of such assistance inclusion of other indian financed health care programs in exemption from prohibition on certain payments section of such act usc ee is amended by striking insurance program other than an insurance program operated or financed by the indian health service and inserting program other than a health care program operated or financed by the indian health service or by an indian tribe tribal organization or urban indian organization definitions section of such act usc jj is amended by adding at the end the following new paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih indian indian health program indian tribe etc the terms indian indian health program indian tribe tribal organization and urban indian organization have the meanings given those terms in section of the indian health care improvement act sec solicitation of proposals for safe harbors under the social security act for facilities of indian health programs and urban indian organizations the secretary of health and human services acting through the office of the inspector general of the department of health and human services shall publish a notice described in section a a of the social security act usc a–d a a soliciting a proposal not later than july on the development of safe harbors described in such section relating to health care items and services provided by facilities of indian health programs or an urban indian organization as such terms are defined in section of the indian health care improvement act such a safe harbor relate to areas such as transportation housing or cost sharing assistance provided through such facilities or contract health services for indiansverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec annual report on indians served by social security act health benefit programs section of the social security act usc b– as amended by the sections and is amended by redesignating subsection as subsection and inserting after subsection the following new subsection annual report on indians served by health benefit programs funded under this act beginning january and annually thereafter the secretary acting through the administrator of the centers for medicare medicaid services and the director of the indian health service shall submit a report to congress regarding the enrollment and health status of indians receiving items or services under health benefit programs funded under this act during the preceding year each such report shall include the following the total number of indians enrolled in or receiving items or services under such programs disaggregated with respect to each such program the number of indians described in paragraph that also received health benefits under programs funded by the indian health service general information regarding the health status of the indians described in paragraph verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih disaggregated with respect to specific diseases or conditions and presented in a manner that is consistent with protections for privacy of individually identifiable health information under section of the health insurance portability and accountability act of a detailed statement of the status of facilities of the indian health service or an indian tribe tribal organization or an urban indian organization with respect to such facilities compliance with the applicable conditions and requirements of titles xviii xix and xxi and in the case of title xix or xxi under a state plan under such title under waiver authority and of the progress being made by such facilities under plans submitted under or otherwise toward the achievement and maintenance of such compliance such other information as the secretary determines is appropriate verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih sec 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 a study the secretary shall conduct a study to identify barriers to interstate coordination of enrollment and coverage under the medicaid program under title xix of the social security act and the state children health insurance program under title xxi of such act of children who are eligible for medical assistance or child health assistance under such programs and who because of educational needs migration of families emergency evacuations or otherwise frequently change their state of residency or otherwise are temporarily present outside of the state of their residency such study shall include an examination of the enrollment and coverage coordination issues faced by indian children who are eligible for medical assistance or child health assistance under such programs in their state of residence and who temporarily reside in an out of state boarding school or peripheral dormitory funded by the bureau of indian affairs report not later than months after the date of enactment of this act the secretary in consultation with directors of state medicaid programs under titleverdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills hr ih xix of the social security act and directors of state children health insurance programs under title xxi of such act shall submit a report to congress that contains recommendations for such legislative and administrative actions as the secretary determines appropriate to address the enrollment and coverage coordination barriers identified through the study required under subsection a verdate nov oct jkt po frm fmt sfmt bills hih rmajette on dsksybprod with bills