This is part 2 of a diary series that paginates the House health care bill for ease of use.
Division A is here. Division B concerns changes to Medicare and Medicaid.
DIVISION B -- MEDICARE AND MEDICAID IMPROVEMENTS
page 366 Sec. 1001. Table of contents of division.
TITLE I—IMPROVING HEALTH CARE VALUE
Subtitle A—Provisions Related to Medicare Part A
PART 1—MARKET BASKET UPDATES
page 375 Sec. 1101. Skilled nursing facility payment update.
page 376 Sec. 1102. Inpatient rehabilitation facility payment update.
page 376 Sec. 1103. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements.
PART 2—OTHER MEDICARE PART A PROVISIONS
page 381 Sec. 1111. Payments to skilled nursing facilities.
page 387 Sec. 1112. Medicare DSH report and payment adjustments in response to coverage
expansion.
page 391 Sec. 1113. Extension of hospice regulation moratorium.
page 391 Sec. 1114. Permitting physician assistants to order post-hospital extended care services and to provide for recognition of attending physician assistants as attending physicians to serve hospice patients.
Subtitle B—Provisions Related to Part B
PART 1—PHYSICIANS’ SERVICES
Sec. 1121. Resource-based feedback program for physicians in Medicare.
page 397 Sec. 1122. Misvalued codes under the physician fee schedule.
page 403 Sec. 1123. Payments for efficient areas.
page 406 Sec. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI).
page 408 Sec. 1125. Adjustment to Medicare payment localities.
PART 2—MARKET BASKET UPDATES
page 413 Sec. 1131. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements.
PART 3—OTHER PROVISIONS
page 416 Sec. 1141. Rental and purchase of power-driven wheelchairs.
page 417 Sec. 1141A. Election to take ownership, or to decline ownership, of a certain item of complex durable medical equipment after the 13-month
capped rental period ends.
page 423 Sec. 1142. Extension of payment rule for brachytherapy.
page 423 Sec. 1143. Home infusion therapy report to Congress.
page 424 Sec. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and other data.
page 426 Sec. 1145. Treatment of certain cancer hospitals.
page 427 Sec. 1146. Payment for imaging services.
page 430 Sec. 1147. Durable medical equipment program improvements.
page 434 Sec. 1148. MedPAC study and report on bone mass measurement.
page 435 Sec. 1149. Timely access to post-mastectomy items.
page 436 Sec. 1149A. Payment for biosimilar biological products.
page 439 Sec. 1149B. Study and report on DME competitive bidding process.
Subtitle C—Provisions Related to Medicare Parts A and B
page 441 Sec. 1151. Reducing potentially preventable hospital readmissions.
page 462 Sec. 1152. Post acute care services payment reform plan and bundling pilot program.
page 474 Sec. 1153. Home health payment update for 2010.
page 475 Sec. 1154. Payment adjustments for home health care.
page 478 Sec. 1155. Incorporating productivity improvements into market basket update for home health services.
page 479 Sec. 1155A. MedPAC study on variation in home health margins.
page 480 Sec. 1155B. Permitting home health agencies to assign the most appropriate skilled service to make the initial assessment visit under a
Medicare home health plan of care for rehabilitation cases.
page 481 Sec. 1156. Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals.
page 497 Sec. 1157. Institute of Medicine study of geographic adjustment factors under Medicare.
page 499 Sec. 1158. Revision of medicare payment systems to address geographic inequities.
page 502 Sec. 1159. Institute of Medicine study of geographic variation in health care spending and promoting high-value health care.
page 508 Sec. 1160. Implementation, and Congressional review, of proposal to revise Medicare payments to promote high value health care.
Subtitle D—Medicare Advantage Reforms
PART 1—PAYMENT AND ADMINISTRATION
page 520 Sec. 1161. Phase-in of payment based on fee-for-service costs; quality bonus payments.
page 528 Sec. 1162. Authority for Secretarial coding intensity adjustment authority.
page 529 Sec. 1163. Simplification of annual beneficiary election periods.
page 530 Sec. 1164. Extension of reasonable cost contracts.
page 530 Sec. 1165. Limitation of waiver authority for employer group plans.
page 530 Sec. 1166. Improving risk adjustment for payments.
page 531 Sec. 1167. Elimination of MA Regional Plan Stabilization Fund.
page 532 Sec. 1168. Study regarding the effects of calculating Medicare Advantage payment rates on a regional average of Medicare fee for service
rates.
PART 2—BENEFICIARY PROTECTIONS AND ANTI-FRAUD
page 533 Sec. 1171. Limitation on cost-sharing for individual health services.
page 535 Sec. 1172. Continuous open enrollment for enrollees in plans with enrollment suspension.
page 536 Sec. 1173. Information for beneficiaries on MA plan administrative costs.
page 539 Sec. 1174. Strengthening audit authority.
page 540 Sec. 1175. Authority to deny plan bids.
page 541 Sec. 1175A. State authority to enforce standardized marketing requirements.
PART 3—TREATMENT OF SPECIAL NEEDS PLANS
Sec. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs
individuals.
page 546 Sec. 1177. Extension of authority of special needs plans to restrict enrollment; service area moratorium for certain SNPs.
page 548 Sec. 1178. Extension of Medicare senior housing plans.
Subtitle E—Improvements to Medicare Part D
page 550 Sec. 1181. Elimination of coverage gap.
page 571 Sec. 1182. Discounts for certain part D drugs in original coverage gap.
page 577 Sec. 1183. Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities.
page 578 Sec. 1184. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D.
page 580 Sec. 1185. No mid-year formulary changes permitted.
page 582 Sec. 1186. Negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries.
page 584 Sec. 1187. Accurate dispensing in long-term care facilities.
page 585 Sec. 1188. Free generic fill.
page 587 Sec. 1189. State certification prior to waiver of licensure requirements under Medicare prescription drug program.
Subtitle F—Medicare Rural Access Protections
page 589 Sec. 1191. Telehealth expansion and enhancements.
page 595 Sec. 1192. Extension of outpatient hold harmless provision.
page 596 Sec. 1193. Extension of section 508 hospital reclassifications.
page 597 Sec. 1194. Extension of geographic floor for work.
page 597 Sec. 1195. Extension of payment for technical component of certain physician pathology services.
page 597 Sec. 1196. Extension of ambulance add-ons.
TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS
Subtitle A—Improving and Simplifying Financial Assistance for Low Income
Medicare Beneficiaries
page 598 Sec. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program.
page 601 Sec. 1202. Elimination of part D cost-sharing for certain non-institutionalized full-benefit dual eligible individuals.
page 602 Sec. 1203. Eliminating barriers to enrollment.
page 604 Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment.
page 610 Sec. 1205. Intelligent assignment in enrollment.
page 611 Sec. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals.
page 612 Sec. 1207. Application of MA premiums prior to rebate and quality bonus payments in calculation of low income subsidy benchmark.
Subtitle B—Reducing Health Disparities
page 613 Sec. 1221. Ensuring effective communication in Medicare.
page 617 Sec. 1222. Demonstration to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services.
page 632 Sec. 1223. IOM report on impact of language access services.
page 633 Sec. 1224. Definitions.
Subtitle C—Miscellaneous Improvements
page 636 Sec. 1231. Extension of therapy caps exceptions process.
page 637 Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions.
page 641 Sec. 1233. Voluntary advance care planning consultation.
page 645 Sec. 1234. Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries.
page 648 Sec. 1235. Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium.
page 648 Sec. 1236. Demonstration program on use of patient decisions aids.
TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH
SERVICES, AND COORDINATED CARE
page 653 Sec. 1301. Accountable Care Organization pilot program.
page 672 Sec. 1302. Medical home pilot program.
page 693 Sec. 1303. Payment incentive for selected primary care services.
page 697 Sec. 1304. Increased reimbursement rate for certified nurse-midwives.
page 697 Sec. 1305. Coverage and waiver of cost-sharing for preventive services.
page 703 Sec. 1306. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal.
page 704 Sec. 1307. Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment.
page 704 Sec. 1308. Coverage of marriage and family therapist services and mental health counselor services.
page 713 Sec. 1309. Extension of physician fee schedule mental health add-on.
page 713 Sec. 1310. Expanding access to vaccines.
page 717 Sec. 1311. Expansion of Medicare-Covered Preventive Services at Federally Qualified Health Centers.
page 718 Sec. 1312. Independence at home demonstration program.
page 731 Sec. 1313. Recognition of certified diabetes educators as certified providers for purposes of Medicare diabetes outpatient self-management training services.
TITLE IV—QUALITY
Subtitle A—Comparative Effectiveness Research
page 733 Sec. 1401. Comparative effectiveness research.
Subtitle B—Nursing Home Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING
FACILITIES, NURSING FACILITIES, AND OTHER LONG-TERM CARE FACILITIES
page 762 Sec. 1411. Required disclosure of ownership and additional disclosable parties information.
page 771 Sec. 1412. Accountability requirements.
page 789 Sec. 1413. Nursing home compare Medicare website.
page 809 Sec. 1414. Reporting of expenditures.
page 811 Sec. 1415. Standardized complaint form.
page 822 Sec. 1416. Ensuring staffing accountability.
page 826 Sec. 1417. Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and
providers.
PART 2—TARGETING ENFORCEMENT
page 840 Sec. 1421. Civil money penalties.
page 859 Sec. 1422. National independent monitor pilot program.
page 864 Sec. 1423. Notification of facility closure.
PART 3—IMPROVING STAFF TRAINING
page 869 Sec. 1431. Dementia and abuse prevention training.
page 870 Sec. 1432. Study and report on training required for certified nurse aides and supervisory staff.
page 872 Sec. 1433. Qualification of director of food services of a skilled nursing facility or nursing facility.
Subtitle C—Quality Measurements
page 873 Sec. 1441. Establishment of national priorities for quality improvement.
page 876 Sec. 1442. Development of new quality measures; GAO evaluation of data collection process for quality measurement.
page 881 Sec. 1443. Multi-stakeholder pre-rulemaking input into selection of quality measures.
page 885 Sec. 1444. Application of quality measures.
page 888 Sec. 1445. Consensus-based entity funding.
Subtitle D—Physician Payments Sunshine Provision
page 889 Sec. 1451. Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and
other health care entities and between physicians and other health care entities.
Subtitle E—Public Reporting on Health Care-Associated Infections
page 913 Sec. 1461. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections.
TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION
page 918 Sec. 1501. Distribution of unused residency positions.
page 930 Sec. 1502. Increasing training in nonprovider settings.
page 935 Sec. 1503. Rules for counting resident time for didactic and scholarly activities and other activities.
page 939 Sec. 1504. Preservation of resident cap positions from closed hospitals.
page 942 Sec. 1505. Improving accountability for approved medical residency training.
TITLE VI—PROGRAM INTEGRITY
Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse
page 945 Sec. 1601. Increased funding and flexibility to fight fraud and abuse.
Subtitle B—Enhanced Penalties for Fraud and Abuse
page 946 Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications.
page 948 Sec. 1612. Enhanced penalties for submission of false statements material to a false claim.
page 949 Sec. 1613. Enhanced penalties for delaying inspections.
page 951 Sec. 1614. Enhanced hospice program safeguards.
page 956 Sec. 1615. Enhanced penalties for individuals excluded from program participation.
page 957 Sec. 1616. Enhanced penalties for provision of false information by Medicare Advantage and part D plans.
page 958 Sec. 1617. Enhanced penalties for Medicare Advantage and part D marketing violations.
page 959 Sec. 1618. Enhanced penalties for obstruction of program audits.
page 960 Sec. 1619. Exclusion of certain individuals and entities from participation in Medicare and State health care programs.
page 963 Sec. 1620. OIG authority to exclude from Federal health care programs officers and owners of entities convicted of fraud.
page 964 Sec. 1621. Self-referral disclosure protocol.
Subtitle C—Enhanced Program and Provider Protections
page 967 Sec. 1631. Enhanced CMS program protection authority.
page 972 Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations.
page 975 Sec. 1633. Required inclusion of payment modifier for certain evaluation and management services.
page 976 Sec. 1634. Evaluations and reports required under Medicare Integrity Program.
page 976 Sec. 1635. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse.
page 980 Sec. 1636. Maximum period for submission of Medicare claims reduced to not more than 12 months.
page 982 Sec. 1637. Physicians who order durable medical equipment or home health services required to be Medicare enrolled physicians or eligible professionals.
page 984 Sec. 1638. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse.
page 985 Sec. 1639. Face-to-face encounter with patient required before eligibility certifications for home health services or durable medical equipment.
page 988 Sec. 1640. Extension of testimonial subpoena authority to program exclusion investigations.
page 989 Sec. 1641. Required repayments of Medicare and Medicaid overpayments.
page 991 Sec. 1642. Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program.
page 992 Sec. 1643. Access to certain information on renal dialysis facilities.
page 992 Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to register under Medicare.
page 993 Sec. 1645. Conforming civil monetary penalties to False Claims Act amendments.
page 999 Sec. 1646. Requiring provider and supplier payments under Medicare to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions.
page 1000 Sec. 1647. Inspector General for the Health Choices Administration.
Subtitle D—Access to Information Needed to Prevent Fraud, Waste, and
Abuse
page 1003 Sec. 1651. Access to Information Necessary to Identify Fraud, Waste, and Abuse.
page 1006 Sec. 1652. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data
Bank.
page 1010 Sec. 1653. Compliance with HIPAA privacy and security standards.
TITLE VII—MEDICAID AND CHIP
Sec. 1. Table of contents øTemporary¿.
Subtitle A—Medicaid and Health Reform
page 1012 Sec. 1701. Eligibility for individuals with income below 150 percent of the Federal poverty level.
page 1021 Sec. 1702. Requirements and special rules for certain Medicaid eligible individuals.
page 1027 Sec. 1703. CHIP and Medicaid maintenance of eligibility.
page 1034 Sec. 1704. Reduction in Medicaid DSH.
page 1041 Sec. 1705. Expanded outstationing.
Subtitle B—Prevention
page 1042 Sec. 1711. Required coverage of preventive services.
page 1044Sec. 1712. Tobacco cessation.
page 1045 Sec. 1713. Optional coverage of nurse home visitation services.
page 1047 Sec. 1714. State eligibility option for family planning services.
Subtitle C—Access
page 1055 Sec. 1721. Payments to primary care practitioners.
page 1058 Sec. 1722. Medical home pilot program.
page 1061 Sec. 1723. Translation or interpretation services.
page 1062 Sec. 1724. Optional coverage for freestanding birth center services.
page 1063 Sec. 1725. Inclusion of public health clinics under the vaccines for children program.
page 1064 Sec. 1726. Requiring coverage of services of podiatrists.
page 1064 Sec. 1726A. Requiring coverage of services of optometrists.
page 1065 Sec. 1727. Therapeutic foster care.
page 1066 Sec. 1728. Assuring adequate payment levels for services.
page 1067 Sec. 1729. Preserving Medicaid coverage for youths upon release from public institutions.
page 1069 Sec. 1730. Quality measures for maternity and adult health services under Medicaid and CHIP.
page 1073 Sec. 1730A. Accountable care organization pilot program.
page 1075 Sec. 1730B. FQHC coverage.
Subtitle D—Coverage
page 1075 Sec. 1731. Optional Medicaid coverage of low-income HIV-infected individuals.
page 1078 Sec. 1732. Extending transitional Medicaid Assistance (TMA).
page 1078 Sec. 1733. Requirement of 12-month continuous coverage under certain CHIP programs.
page 1079 Sec. 1734. Preventing the application under CHIP of coverage waiting periods for certain children.
page 1081 Sec. 1735. Adult day health care services.
page 1082 Sec. 1736. Medicaid coverage for citizens of Freely Associated States.
page 1084 Sec. 1737. Continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary services.
page 1085 Sec. 1738. State option to disregard certain income in providing continued Medicaid coverage for certain individuals with extremely high prescription costs.
page 1088 Sec. 1739. Provisions relating to community living assistance services and supports
(CLASS).
Subtitle E—Financing
page 1092 Sec. 1741. Payments to pharmacists.
page 1096 Sec. 1742. Prescription drug rebates.
page 1101 Sec. 1743. Extension of prescription drug discounts to enrollees of Medicaid managed care organizations.
page 1103 Sec. 1744. Payments for graduate medical education.
page 1106 Sec. 1745. Nursing Facility Supplemental Payment Program.
page 1114 Sec. 1746. Report on Medicaid payments.
page 1115 Sec. 1747. Reviews of Medicaid.
page 1117 Sec. 1748. Extension of delay in managed care organization provider tax elimination.
page 1117 Sec. 1749. Extension of ARRA increase in FMAP.
Subtitle F—Waste, Fraud, and Abuse
page 1118 Sec. 1751. Health care acquired conditions.
page 1119 Sec. 1752. Evaluations and reports required under Medicaid Integrity Program.
page 1120 Sec. 1753. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse.
page 1121 Sec. 1754. Overpayments.
page 1121 Sec. 1755. Managed care organizations.
page 1123 Sec. 1756. Termination of provider participation under Medicaid and CHIP if terminated under Medicare or other State plan or child health
plan.
page 1124 Sec. 1757. Medicaid and CHIP exclusion from participation relating to certain ownership, control, and management affiliations.
page 1125 Sec. 1758. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse.
page 1126 Sec. 1759. Billing agents, clearinghouses, or other alternate payees required to register under Medicaid.
page 1127 Sec. 1760. Denial of payments for litigation-related misconduct.
page 1128 Sec. 1761. Mandatory State use of national correct coding initiative.
Subtitle G—Payments to the Territories
page 1130 Sec. 1771. Payment to territories.
Subtitle H—Miscellaneous
page 1136 Sec. 1781. Technical corrections.
page 1138 Sec. 1782. Extension of QI program.
page 1140 Sec. 1783. Assuring transparency of information.
page 1143 Sec. 1784. Medicaid and CHIP Payment and Access Commission.
page 1147 Sec. 1785. Outreach and enrollment of Medicaid and CHIP eligible individuals.
page 1149 Sec. 1786. Prohibitions on Federal Medicaid and CHIP payment for undocumented aliens.
page 1149 Sec. 1787. Demonstration project for stabilization of emergency medical conditions by institutions for mental diseases.
page 1156 Sec. 1788. Application of Medicaid Improvement Fund.
page 1156 Sec. 1789. Treatment of certain Medicaid brokers.
page 1157 Sec. 1790. Rule for changes requiring State legislation.
TITLE VIII—REVENUE-RELATED PROVISIONS
page 1158 Sec. 1801. Disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare prescription drug program to assist Social Security Administration’s outreach to eligible individuals.
page 1162 Sec. 1802. Comparative Effectiveness Research Trust Fund; financing for Trust Fund.
TITLE IX—MISCELLANEOUS PROVISIONS
page 1175 Sec. 1901. Repeal of trigger provision.
page 1175 Sec. 1902. Repeal of comparative cost adjustment (CCA) program.
page 1175 Sec. 1903. Extension of gainsharing demonstration.
page 1176 Sec. 1904. Grants to States for quality home visitation programs for families with young children and families expecting children.
page 1191 Sec. 1905. Improved coordination and protection for dual eligibles.
page 1196 Sec. 1906. Assessment of medicare cost-intensive diseases and conditions.
page 1198 Sec. 1907. Establishment of Center for Medicare and Medicaid Innovation within CMS.
page 1207 Sec. 1908. Application of emergency services laws.
page 1207 Sec. 1909. Disregard under the Supplemental Security Income program of compensation for participation in clinical trials for rare diseases or conditions.