[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6331 Engrossed in House (EH)]
110th CONGRESS
2d Session
H. R. 6331
_______________________________________________________________________
AN ACT
To amend titles XVIII and XIX of the Social Security Act to extend
expiring provisions under the Medicare Program, to improve beneficiary
access to preventive and mental health services, to enhance low-income
benefit programs, and to maintain access to care in rural areas,
including pharmacy access, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare
Improvements for Patients and Providers Act of 2008''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE
Subtitle A--Beneficiary Improvements
Part I--Prevention, Mental Health, and Marketing
Sec. 101. Improvements to coverage of preventive services.
Sec. 102. Elimination of discriminatory copayment rates for Medicare
outpatient psychiatric services.
Sec. 103. Prohibitions and limitations on certain sales and marketing
activities under Medicare Advantage plans
and prescription drug plans.
Sec. 104. Improvements to the Medigap program.
Part II--Low-Income Programs
Sec. 111. Extension of qualifying individual (QI) program.
Sec. 112. Application of full LIS subsidy assets test under Medicare
Savings Program.
Sec. 113. Eliminating barriers to enrollment.
Sec. 114. Elimination of Medicare part D late enrollment penalties paid
by subsidy eligible individuals.
Sec. 115. Eliminating application of estate recovery.
Sec. 116. Exemptions from income and resources for determination of
eligibility for low-income subsidy.
Sec. 117. Judicial review of decisions of the Commissioner of Social
Security under the Medicare part D low-
income subsidy program.
Sec. 118. Translation of model form.
Sec. 119. Medicare enrollment assistance.
Subtitle B--Provisions Relating to Part A
Sec. 121. Expansion and extension of the Medicare Rural Hospital
Flexibility Program.
Sec. 122. Rebasing for sole community hospitals.
Sec. 123. Demonstration project on community health integration models
in certain rural counties.
Sec. 124. Extension of the reclassification of certain hospitals.
Sec. 125. Revocation of unique deeming authority of the Joint
Commission.
Subtitle C--Provisions Relating to Part B
Part I--Physicians' Services
Sec. 131. Physician payment, efficiency, and quality improvements.
Sec. 132. Incentives for electronic prescribing.
Sec. 133. Expanding access to primary care services.
Sec. 134. Extension of floor on Medicare work geographic adjustment
under the Medicare physician fee schedule.
Sec. 135. Imaging provisions.
Sec. 136. Extension of treatment of certain physician pathology
services under Medicare.
Sec. 137. Accommodation of physicians ordered to active duty in the
Armed Services.
Sec. 138. Adjustment for Medicare mental health services.
Sec. 139. Improvements for Medicare anesthesia teaching programs.
Part II--Other Payment and Coverage Improvements
Sec. 141. Extension of exceptions process for Medicare therapy caps.
Sec. 142. Extension of payment rule for brachytherapy and therapeutic
radiopharmaceuticals.
Sec. 143. Speech-language pathology services.
Sec. 144. Payment and coverage improvements for patients with chronic
obstructive pulmonary disease and other
conditions.
Sec. 145. Clinical laboratory tests.
Sec. 146. Improved access to ambulance services.
Sec. 147. Extension and expansion of the Medicare hold harmless
provision under the prospective payment
system for hospital outpatient department
(HOPD) services for certain hospitals.
Sec. 148. Clarification of payment for clinical laboratory tests
furnished by critical access hospitals.
Sec. 149. Adding certain entities as originating sites for payment of
telehealth services.
Sec. 150. MedPAC study and report on improving chronic care
demonstration programs.
Sec. 151. Increase of FQHC payment limits.
Sec. 152. Kidney disease education and awareness provisions.
Sec. 153. Renal dialysis provisions.
Sec. 154. Delay in and reform of Medicare DMEPOS competitive
acquisition program.
Subtitle D--Provisions Relating to Part C
Sec. 161. Phase-out of indirect medical education (IME).
Sec. 162. Revisions to requirements for Medicare Advantage private fee-
for-service plans.
Sec. 163. Revisions to quality improvement programs.
Sec. 164. Revisions relating to specialized Medicare Advantage plans
for special needs individuals.
Sec. 165. Limitation on out-of-pocket costs for dual eligibles and
qualified medicare beneficiaries enrolled
in a specialized Medicare Advantage plan
for special needs individuals.
Sec. 166. Adjustment to the Medicare Advantage stabilization fund.
Sec. 167. Access to Medicare reasonable cost contract plans.
Sec. 168. MedPAC study and report on quality measures.
Sec. 169. MedPAC study and report on Medicare Advantage payments.
Subtitle E--Provisions Relating to Part D
Part I--Improving Pharmacy Access
Sec. 171. Prompt payment by prescription drug plans and MA-PD plans
under part D.
Sec. 172. Submission of claims by pharmacies located in or contracting
with long-term care facilities.
Sec. 173. Regular update of prescription drug pricing standard.
Part II--Other Provisions
Sec. 175. Inclusion of barbiturates and benzodiazepines as covered part
D drugs.
Sec. 176. Formulary requirements with respect to certain categories or
classes of drugs.
Subtitle F--Other Provisions
Sec. 181. Use of part D data.
Sec. 182. Revision of definition of medically accepted indication for
drugs.
Sec. 183. Contract with a consensus-based entity regarding performance
measurement.
Sec. 184. Cost-sharing for clinical trials.
Sec. 185. Addressing health care disparities.
Sec. 186. Demonstration to improve care to previously uninsured.
Sec. 187. Office of the Inspector General report on compliance with and
enforcement of national standards on
culturally and linguistically appropriate
services (CLAS) in Medicare.
Sec. 188. Medicare Improvement Funding.
Sec. 189. Inclusion of Medicare providers and suppliers in Federal
Payment Levy and Administrative Offset
Program.
TITLE II--MEDICAID
Sec. 201. Extension of transitional medical assistance (TMA) and
abstinence education program.
Sec. 202. Medicaid DSH extension.
Sec. 203. Pharmacy reimbursement under Medicaid.
Sec. 204. Review of administrative claim determinations.
Sec. 205. County medicaid health insuring organizations.
TITLE III--MISCELLANEOUS
Sec. 301. Extension of TANF supplemental grants.
Sec. 302. 70 percent federal matching for foster care and adoption
assistance for the District of Columbia.
Sec. 303. Extension of Special Diabetes Grant Programs.
Sec. 304. IOM reports on best practices for conducting systematic
reviews of clinical effectiveness research
and for developing clinical protocols.
TITLE I--MEDICARE
Subtitle A--Beneficiary Improvements
PART I--PREVENTION, MENTAL HEALTH, AND MARKETING
SEC. 101. IMPROVEMENTS TO COVERAGE OF PREVENTIVE SERVICES.
(a) Coverage of Additional Preventive Services.--
(1) Coverage.--Section 1861 of the Social Security Act (42
U.S.C. 1395x), as amended by section 114 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173),
is amended--
(A) in subsection (s)(2)--
(i) in subparagraph (Z), by striking
``and'' after the semicolon at the end;
(ii) in subparagraph (AA), by adding
``and'' after the semicolon at the end; and
(iii) by adding at the end the following
new subparagraph:
``(BB) additional preventive services (described in
subsection (ddd)(1));''; and
(B) by adding at the end the following new
subsection:
``Additional Preventive Services
``(ddd)(1) The term `additional preventive services' means services
not otherwise described in this title that identify medical conditions
or risk factors and that the Secretary determines are--
``(A) reasonable and necessary for the prevention or early
detection of an illness or disability;
``(B) recommended with a grade of A or B by the United
States Preventive Services Task Force; and
``(C) appropriate for individuals entitled to benefits
under part A or enrolled under part B.
``(2) In making determinations under paragraph (1) regarding the
coverage of a new service, the Secretary shall use the process for
making national coverage determinations (as defined in section
1869(f)(1)(B)) under this title. As part of the use of such process,
the Secretary may conduct an assessment of the relation between
predicted outcomes and the expenditures for such service and may take
into account the results of such assessment in making such
determination.''.
(2) Payment and coinsurance for additional preventive
services.--Section 1833(a)(1) of the Social Security Act (42
U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(V)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (W) with respect to additional
preventive services (as defined in section
1861(ddd)(1)), the amount paid shall be (i) in the case
of such services which are clinical diagnostic
laboratory tests, the amount determined under
subparagraph (D), and (ii) in the case of all other
such services, 80 percent of the lesser of the actual
charge for the service or the amount determined under a
fee schedule established by the Secretary for purposes
of this subparagraph''.
(3) Conforming amendment regarding coverage.--Section
1862(a)(1)(A) of the Social Security Act (42 U.S.C.
1395y(a)(1)(A)) is amended by inserting ``or additional
preventive services (as described in section 1861(ddd)(1))''
after ``succeeding subparagraph''.
(4) Rule of construction.--Nothing in the provisions of, or
amendments made by, this subsection shall be construed to
provide coverage under title XVIII of the Social Security Act
of items and services for the treatment of a medical condition
that is not otherwise covered under such title.
(b) Revisions to Initial Preventive Physical Examination.--
(1) In general.--Section 1861(ww) of the Social Security
Act (42 U.S.C. 1395x(ww)) is amended--
(A) in paragraph (1)--
(i) by inserting ``body mass index,'' after
``weight'';
(ii) by striking ``, and an
electrocardiogram''; and
(iii) by inserting ``and end-of-life
planning (as defined in paragraph (3)) upon the
agreement with the individual'' after
``paragraph (2)'';
(B) in paragraph (2), by adding at the end the
following new subparagraphs:
``(M) An electrocardiogram.
``(N) Additional preventive services (as defined in
subsection (ddd)(1)).''; and
(C) by adding at the end the following new
paragraph:
``(3) For purposes of paragraph (1), the term `end-of-life
planning' means verbal or written information regarding--
``(A) an individual's ability to prepare an advance
directive in the case that an injury or illness causes the
individual to be unable to make health care decisions; and
``(B) whether or not the physician is willing to follow the
individual's wishes as expressed in an advance directive.''.
(2) Waiver of application of deductible.--The first
sentence of section 1833(b) of the Social Security Act (42
U.S.C. 1395l(b)) is amended--
(A) by striking ``and'' before ``(8)''; and
(B) by inserting ``, and (9) such deductible shall
not apply with respect to an initial preventive
physical examination (as defined in section 1861(ww))''
before the period at the end.
(3) Extension of eligibility period from six months to one
year.--Section 1862(a)(1)(K) of the Social Security Act (42
U.S.C. 1395y(a)(1)(K)) is amended by striking ``6 months'' and
inserting ``1 year''.
(4) Technical correction.--Section 1862(a)(1)(K) of the
Social Security Act (42 U.S.C. 1395y(a)(1)(K)) is amended by
striking ``not later'' and inserting ``more''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2009.
SEC. 102. ELIMINATION OF DISCRIMINATORY COPAYMENT RATES FOR MEDICARE
OUTPATIENT PSYCHIATRIC SERVICES.
Section 1833(c) of the Social Security Act (42 U.S.C. 1395l(c)) is
amended to read as follows:
``(c)(1) Notwithstanding any other provision of this part, with
respect to expenses incurred in a calendar year in connection with the
treatment of mental, psychoneurotic, and personality disorders of an
individual who is not an inpatient of a hospital at the time such
expenses are incurred, there shall be considered as incurred expenses
for purposes of subsections (a) and (b)--
``(A) for expenses incurred in years prior to 2010, only
62\1/2\ percent of such expenses;
``(B) for expenses incurred in 2010 or 2011, only 68\3/4\
percent of such expenses;
``(C) for expenses incurred in 2012, only 75 percent of
such expenses;
``(D) for expenses incurred in 2013, only 81\1/4\ percent
of such expenses; and
``(E) for expenses incurred in 2014 or any subsequent
calendar year, 100 percent of such expenses.
``(2) For purposes of subparagraphs (A) through (D) of paragraph
(1), the term `treatment' does not include brief office visits (as
defined by the Secretary) for the sole purpose of monitoring or
changing drug prescriptions used in the treatment of such disorders or
partial hospitalization services that are not directly provided by a
physician.''.
SEC. 103. PROHIBITIONS AND LIMITATIONS ON CERTAIN SALES AND MARKETING
ACTIVITIES UNDER MEDICARE ADVANTAGE PLANS AND
PRESCRIPTION DRUG PLANS.
(a) Prohibitions.--
(1) Medicare advantage program.--
(A) In general.--Section 1851 of the Social
Security Act (42 U.S.C. 1395w-21) is amended--
(i) in subsection (h)(4)--
(I) in subparagraph (A)--
(aa) by striking ``cash or
other monetary rebates'' and
inserting ``, subject to
subsection (j)(2)(C), cash,
gifts, prizes, or other
monetary rebates''; and
(bb) by striking ``, and''
at the end and inserting a
semicolon;
(II) in subparagraph (B), by
striking the period at the end and
inserting a semicolon; and
(III) by adding at the end the
following new subparagraph:
``(C) shall not permit a Medicare Advantage
organization (or the agents, brokers, and other third
parties representing such organization) to conduct the
prohibited activities described in subsection (j)(1);
and''; and
(ii) by adding at the end the following new
subsection:
``(j) Prohibited Activities Described and Limitations on the
Conduct of Certain Other Activities.--
``(1) Prohibited activities described.--The following
prohibited activities are described in this paragraph:
``(A) Unsolicited means of direct contact.--Any
unsolicited means of direct contact of prospective
enrollees, including soliciting door-to-door or any
outbound telemarketing without the prospective enrollee
initiating contact.
``(B) Cross-selling.--The sale of other non-health
related products (such as annuities and life insurance)
during any sales or marketing activity or presentation
conducted with respect to a Medicare Advantage plan.
``(C) Meals.--The provision of meals of any sort,
regardless of value, to prospective enrollees at
promotional and sales activities.
``(D) Sales and marketing in health care settings
and at educational events.--Sales and marketing
activities for the enrollment of individuals in
Medicare Advantage plans that are conducted--
``(i) in health care settings in areas
where health care is delivered to individuals
(such as physician offices and pharmacies),
except in the case where such activities are
conducted in common areas in health care
settings; and
``(ii) at educational events.''.
(2) Medicare prescription drug program.--Section 1860D-4 of
the Social Security Act (42 U.S.C. 1395w-104) is amended by
adding at the end the following new subsection:
``(l) Requirements With Respect to Sales and Marketing
Activities.--The following provisions shall apply to a PDP sponsor (and
the agents, brokers, and other third parties representing such sponsor)
in the same manner as such provisions apply to a Medicare Advantage
organization (and the agents, brokers, and other third parties
representing such organization):
``(1) The prohibition under section 1851(h)(4)(C) on
conducting activities described in section 1851(j)(1).''.
(3) Effective date.--The amendments made by this subsection
shall apply to plan years beginning on or after January 1,
2009.
(b) Limitations.--
(1) Medicare advantage program.--Section 1851 of the Social
Security Act (42 U.S.C. 1395w-21), as amended by subsection
(a)(1), is amended--
(A) in subsection (h)(4), by adding at the end the
following new subparagraph:
``(D) shall only permit a Medicare Advantage
organization (and the agents, brokers, and other third
parties representing such organization) to conduct the
activities described in subsection (j)(2) in accordance
with the limitations established under such
subsection.''; and
(B) in subsection (j), by adding at the end the
following new paragraph:
``(2) Limitations.--The Secretary shall establish
limitations with respect to at least the following:
``(A) Scope of marketing appointments.--The scope
of any appointment with respect to the marketing of a
Medicare Advantage plan. Such limitation shall require
advance agreement with a prospective enrollee on the
scope of the marketing appointment and documentation of
such agreement by the Medicare Advantage organization.
In the case where the marketing appointment is in
person, such documentation shall be in writing.
``(B) Co-branding.--The use of the name or logo of
a co-branded network provider on Medicare Advantage
plan membership and marketing materials.
``(C) Limitation of gifts to nominal dollar
value.--The offering of gifts and other promotional
items other than those that are of nominal value (as
determined by the Secretary) to prospective enrollees
at promotional activities.
``(D) Compensation.--The use of compensation other
than as provided under guidelines established by the
Secretary. Such guidelines shall ensure that the use of
compensation creates incentives for agents and brokers
to enroll individuals in the Medicare Advantage plan
that is intended to best meet their health care needs.
``(E) Required training, annual retraining, and
testing of agents, brokers, and other third parties.--
The use by a Medicare Advantage organization of any
individual as an agent, broker, or other third party
representing the organization that has not completed an
initial training and testing program and does not
complete an annual retraining and testing program.''.
(2) Medicare prescription drug program.--Section 1860D-4(l)
of the Social Security Act, as added by subsection (a)(2), is
amended by adding at the end the following new paragraph:
``(2) The requirement under section 1851(h)(4)(D) to
conduct activities described in section 1851(j)(2) in
accordance with the limitations established under such
subsection.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on a date specified by the Secretary (but in
no case later than November 15, 2008).
(c) Required Inclusion of Plan Type in Plan Name.--
(1) Medicare advantage program.--Section 1851(h) of the
Social Security Act (42 U.S.C. 1395w-21(h)) is amended by
adding at the end following new paragraph:
``(6) Required inclusion of plan type in plan name.--For
plan years beginning on or after January 1, 2010, a Medicare
Advantage organization must ensure that the name of each
Medicare Advantage plan offered by the Medicare Advantage
organization includes the plan type of the plan (using standard
terminology developed by the Secretary).''.
(2) Prescription drug plans.--Section 1860D-4(l) of the
Social Security Act, as added by subsection (a)(2) and amended
by subsection (b)(2), is amended by adding at the end the
following new paragraph:
``(3) The inclusion of the plan type in the plan name under
section 1851(h)(6).''.
(d) Strengthening the Ability of States to Act in Collaboration
With the Secretary to Address Fraudulent or Inappropriate Marketing
Practices.--
(1) Medicare advantage program.--Section 1851(h) of the
Social Security Act (42 U.S.C. 1395w-21(h), as amended by
subsection (c)(1), is amended by adding at the end the
following new paragraph:
``(7) Strengthening the ability of states to act in
collaboration with the secretary to address fraudulent or
inappropriate marketing practices.--
``(A) Appointment of agents and brokers.--Each
Medicare Advantage organization shall--
``(i) only use agents and brokers who have
been licensed under State law to sell Medicare
Advantage plans offered by the Medicare
Advantage organization;
``(ii) in the case where a State has a
State appointment law, abide by such law; and
``(iii) report to the applicable State the
termination of any such agent or broker,
including the reasons for such termination (as
required under applicable State law).
``(B) Compliance with state information requests.--
Each Medicare Advantage organization shall comply in a
timely manner with any request by a State for
information regarding the performance of a licensed
agent, broker, or other third party representing the
Medicare Advantage organization as part of an
investigation by the State into the conduct of the
agent, broker, or other third party.''.
(2) Prescription drug plans.--Section 1860D-4(l) of the
Social Security Act, as amended by subsection (c)(2), is
amended by adding at the end the following new paragraph:
``(4) The requirements regarding the appointment of agents
and brokers and compliance with State information requests
under subparagraphs (A) and (B), respectively, of section
1851(h)(7).''.
(3) Effective date.--The amendments made by this subsection
shall apply to plan years beginning on or after January 1,
2009.
SEC. 104. IMPROVEMENTS TO THE MEDIGAP PROGRAM.
(a) Implementation of NAIC Recommendations.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
provide for implementation of the changes in the NAIC model law
and regulations approved by the National Association of
Insurance Commissioners in its Model #651 (``Model Regulation
to Implement the NAIC Medicare Supplement Insurance Minimum
Standards Model Act'') on March 11, 2007, as modified to
reflect the changes made under this Act and the Genetic
Information Nondiscrimination Act of 2008 (Public Law 110-233).
(2) Implementation dates.--
(A) In general.--The modifications to Model #651
required under paragraph (1) shall be completed by the
National Association of Insurance Commissioners not
later than October 31, 2008. Except as provided in
subparagraph (B), each State shall have 1 year from the
date the National Association of Insurance
Commissioners adopts the revised NAIC model law and
regulations (as changed by Model #651, as so modified)
to conform the regulatory program established by the
State to such revised NAIC model law and regulations.
(B) Extension of effective date for state law
amendment.--In the case of a State which the Secretary
determines requires State legislation in order to
conform the regulatory program established by the State
to such revised NAIC model law and regulations, the
State shall not be regarded as failing to comply with
the requirements of this section solely on the basis of
its failure to meet such requirements before the first
day of the first calendar quarter beginning after the
close of the first regular session of the State
legislature that begins after the date of the enactment
of this Act. For purposes of the previous sentence, in
the case of a State that has a 2-year legislative
session, each year of the session is considered to be a
separate regular session of the State legislature.
(C) Transition dates.--No carrier may issue a new
or revised medicare supplemental policy or certificate
under section 1882 of the Social Security Act (42
U.S.C. 1395ss) that meets the requirements of such
revised NAIC model law and regulations for coverage
effective prior to June 1, 2010. A carrier may continue
to offer or issue a medicare supplemental policy under
such section that meets the requirements of the NAIC
model law and regulations and State law (as in effect
prior to the adoption of such revised NAIC model law
and regulations) prior to June 1, 2010. Nothing shall
preclude carriers from marketing new or revised
medicare supplemental policies or certificates that
meet the requirements of such revised NAIC model law
and regulations on or after the date on which the State
conforms the regulatory program established by the
State to such revised NAIC model law and regulations.
(b) Required Offering of a Range of Policies.--Section 1882(o) of
the Social Security Act (42 U.S.C. 1395s(o)), as amended by section
104(b)(3) of the Genetic Information Nondiscrimination Act of 2008
(Public Law 110-233), is amended by adding at the end the following new
paragraph:
``(5) In addition to the requirement under paragraph (2),
the issuer of the policy must make available to the individual
at least Medicare supplemental policies with benefit packages
classified as `C' or `F'.''.
(c) Clarification.--Any health insurance policy that provides
reimbursement for expenses incurred for items and services for which
payment may be made under title XVIII of the Social Security Act but
which are not reimbursable by reason of the applicability of
deductibles, coinsurance, copayments or other limitations imposed by a
Medicare Advantage plan (including a Medicare Advantage private fee-
for-service plan) under part C of such title shall comply with the
requirements of section 1882(o) of the such Act (42 U.S.C. 1395ss(o)).
PART II--LOW-INCOME PROGRAMS
SEC. 111. EXTENSION OF QUALIFYING INDIVIDUAL (QI) PROGRAM.
(a) Extension.--Section 1902(a)(10)(E)(iv) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking ``June
2008'' and inserting ``December 2009''.
(b) Extending Total Amount Available for Allocation.--Section
1933(g) of such Act (42 U.S.C. 1396u-3(g)) is amended--
(1) in paragraph (2)--
(A) by striking ``and'' at the end of subparagraph
(H);
(B) in subparagraph (I)--
(i) by striking ``June 30'' and inserting
``September 30'';
(ii) by striking ``$200,000,000'' and
inserting ``$300,000,000''; and
(iii) by striking the period at the end and
inserting a semicolon; and
(C) by adding at the end the following new
subparagraphs:
``(J) for the period that begins on October 1,
2008, and ends on December 31, 2008, the total
allocation amount is $100,000,000;
``(K) for the period that begins on January 1,
2009, and ends on September 30, 2009, the total
allocation amount is $350,000,000; and
``(L) for the period that begins on October 1,
2009, and ends on December 31, 2009, the total
allocation amount is $150,000,000.''; and
(2) in paragraph (3), in the matter preceding subparagraph
(A), by striking ``or (H)'' and inserting ``(H), (J), or (L)''.
SEC. 112. APPLICATION OF FULL LIS SUBSIDY ASSETS TEST UNDER MEDICARE
SAVINGS PROGRAM.
Section 1905(p)(1)(C) of such Act (42 U.S.C. 1396d(p)(1)(C)) is
amended by inserting before the period at the end the following: ``or,
effective beginning with January 1, 2010, whose resources (as so
determined) do not exceed the maximum resource level applied for the
year under subparagraph (D) of section 1860D-14(a)(3) (determined
without regard to the life insurance policy exclusion provided under
subparagraph (G) of such section) applicable to an individual or to the
individual and the individual's spouse (as the case may be)''.
SEC. 113. ELIMINATING BARRIERS TO ENROLLMENT.
(a) SSA Assistance With Medicare Savings Program and Low-Income
Subsidy Program Applications.--Section 1144 of such Act (42 U.S.C.
1320b-14) is amended by adding at the end the following new subsection:
``(c) Assistance With Medicare Savings Program and Low-Income
Subsidy Program Applications.--
``(1) Distribution of applications and information to
individuals who are potentially eligible for low-income subsidy
program.--For each individual who submits an application for
low-income subsidies under section 1860D-14, requests an
application for such subsidies, or is otherwise identified as
an individual who is potentially eligible for such subsidies,
the Commissioner shall do the following:
``(A) Provide information describing the low-income
subsidy program under section 1860D-14 and the Medicare
Savings Program (as defined in paragraph (7)).
``(B) Provide an application for enrollment under
such low-income subsidy program (if not already
received by the Commissioner).
``(C) In accordance with paragraph (3), transmit
data from such an application for purposes of
initiating an application for benefits under the
Medicare Savings Program.
``(D) Provide information on how the individual may
obtain assistance in completing such application and an
application under the Medicare Savings Program,
including information on how the individual may contact
the State health insurance assistance program (SHIP).
``(E) Make the application described in
subparagraph (B) and the information described in
subparagraphs (A) and (D) available at local offices of
the Social Security Administration.
``(2) Training personnel in explaining benefit programs and
assisting in completing lis application.--The Commissioner
shall provide training to those employees of the Social
Security Administration who are involved in receiving
applications for benefits described in paragraph (1)(B) in
order that they may promote beneficiary understanding of the
low-income subsidy program and the Medicare Savings Program in
order to increase participation in these programs. Such
employees shall provide assistance in completing an application
described in paragraph (1)(B) upon request.
``(3) Transmittal of data to states.--Beginning on January
1, 2010, with the consent of an individual completing an
application for benefits described in paragraph (1)(B), the
Commissioner shall electronically transmit to the appropriate
State Medicaid agency data from such application, as determined
by the Commissioner, which transmittal shall initiate an
application of the individual for benefits under the Medicare
Savings Program with the State Medicaid agency. In order to
ensure that such data transmittal provides effective assistance
for purposes of State adjudication of applications for benefits
under the Medicare Savings Program, the Commissioner shall
consult with the Secretary, after the Secretary has consulted
with the States, regarding the content, form, frequency, and
manner in which data (on a uniform basis for all States) shall
be transmitted under this subparagraph.
``(4) Coordination with outreach.--The Commissioner shall
coordinate outreach activities under this subsection in
connection with the low-income subsidy program and the Medicare
Savings Program.
``(5) Reimbursement of social security administration
administrative costs.--
``(A) Initial medicare savings program costs;
additional low-income subsidy costs.--
``(i) Initial medicare savings program
costs.--There are hereby appropriated to the
Commissioner to carry out this subsection, out
of any funds in the Treasury not otherwise
appropriated, $24,100,000. The amount
appropriated under ths clause shall be
available on October 1, 2008, and shall remain
available until expended.
``(ii) Additional amount for low-income
subsidy activities.--There are hereby
appropriated to the Commissioner, out of any
funds in the Treasury not otherwise
appropriated, $24,800,000 for fiscal year 2009
to carry out low-income subsidy activities
under section 1860D-14 and the Medicare Savings
Program (in accordance with this subsection),
to remain available until expended. Such funds
shall be in addition to the Social Security
Administration's Limitation on Administrative
Expenditure appropriations for such fiscal
year.
``(B) Subsequent funding under agreements.--
``(i) In general.--Effective for fiscal
years beginning on or after October 1, 2010,
the Commissioner and the Secretary shall enter
into an agreement which shall provide funding
(subject to the amount appropriated under
clause (ii)) to cover the administrative costs
of the Commissioner's activities under this
subsection. Such agreement shall--
``(I) provide funds to the
Commissioner for the full cost of the
Social Security Administration's work
related to the Medicare Savings Program
required under this section;
``(II) provide such funding
quarterly in advance of the applicable
quarter based on estimating methodology
agreed to by the Commissioner and the
Secretary; and
``(III) require an annual
accounting and reconciliation of the
actual costs incurred and funds
provided under this subsection.
``(ii) Appropriation.--There are hereby
appropriated to the Secretary solely for the
purpose of providing payments to the
Commissioner pursuant to an agreement specified
in clause (i) that is in effect, out of any
funds in the Treasury not otherwise
appropriated, not more than $3,000,000 for
fiscal year 2011 and each fiscal year
thereafter.
``(C) Limitation.--In no case shall funds from the
Social Security Administration's Limitation on
Administrative Expenses be used to carry out activities
related to the Medicare Savings Program. For fiscal
years beginning on or after October 1, 2010, no such
activities shall be undertaken by the Social Security
Administration unless the agreement specified in
subparagraph (B) is in effect and full funding has been
provided to the Commissioner as specified in such
subparagraph.
``(6) GAO analysis and report.--
``(A) Analysis.--The Comptroller General of the
United States shall prepare an analysis of the impact
of this subsection--
``(i) in increasing participation in the
Medicare Savings Program, and
``(ii) on States and the Social Security
Administration.
``(B) Report.--Not later than January 1, 2012, the
Comptroller General shall submit to Congress, the
Commissioner, and the Secretary a report on the
analysis conducted under subparagraph (A).
``(7) Medicare savings program defined.--For purposes of
this subsection, the term `Medicare Savings Program' means the
program of medical assistance for payment of the cost of
medicare cost-sharing under the Medicaid program pursuant to
sections 1902(a)(10)(E) and 1933.''.
(b) Medicaid Agency Consideration of Data Transmittal.--
(1) In general.--Section 1935(a) of such Act (42 U.S.C.
1396u-5(a)) is amended by adding at the end the following new
paragraph:
``(4) Consideration of data transmitted by the social
security administration for purposes of medicare savings
program.--The State shall accept data transmitted under section
1144(c)(3) and act on such data in the same manner and in
accordance with the same deadlines as if the data constituted
an initiation of an application for benefits under the Medicare
Savings Program (as defined for purposes of such section) that
had been submitted directly by the applicant. The date of the
individual's application for the low income subsidy program
from which the data have been derived shall constitute the date
of filing of such application for benefits under the Medicare
Savings Program.''.
(2) Conforming amendments.--Section 1935(a) of such Act (42
U.S.C. 1396u-5(a)) is amended in the subsection heading by
striking ``and'' and by inserting ``, and Medicare Cost-
Sharing'' after ``Assistance''.
(c) Effective Date.--Except as otherwise provided, the amendments
made by this section shall take effect on January 1, 2010.
SEC. 114. ELIMINATION OF MEDICARE PART D LATE ENROLLMENT PENALTIES PAID
BY SUBSIDY ELIGIBLE INDIVIDUALS.
(a) Waiver of Late Enrollment Penalty.--
(1) In general.--Section 1860D-13(b) of the Social Security
Act (42 U.S.C. 1395w-113(b)) is amended by adding at the end
the following new paragraph:
``(8) Waiver of penalty for subsidy-eligible individuals.--
In no case shall a part D eligible individual who is determined
to be a subsidy eligible individual (as defined in section
1860D-14(a)(3)) be subject to an increase in the monthly
beneficiary premium established under subsection (a).''.
(2) Conforming amendment.--Section 1860D-14(a)(1)(A) of the
Social Security Act (42 U.S.C. 1395w-114(a)(1)(A)) is amended
by striking ``equal to'' and all that follows through the
period and inserting ``equal to 100 percent of the amount
described in subsection (b)(1), but not to exceed the premium
amount specified in subsection (b)(2)(B).''.
(b) Effective Date.--The amendments made by this section shall
apply to subsidies for months beginning with January 2009.
SEC. 115. ELIMINATING APPLICATION OF ESTATE RECOVERY.
(a) In General.--Section 1917(b)(1)(B)(ii) of the Social Security
Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amended by inserting ``(but not
including medical assistance for medicare cost-sharing or for benefits
described in section 1902(a)(10)(E))'' before the period at the end.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as of January 1, 2010.
SEC. 116. EXEMPTIONS FROM INCOME AND RESOURCES FOR DETERMINATION OF
ELIGIBILITY FOR LOW-INCOME SUBSIDY.
(a) In General.--Section 1860D-14(a)(3) of the Social Security Act
(42 U.S.C. 1395w-114(a)(3)) is amended--
(1) in subparagraph (C)(i), by inserting ``and except that
support and maintenance furnished in kind shall not be counted
as income'' after ``section 1902(r)(2)'';
(2) in subparagraph (D), in the matter before clause (i),
by inserting ``subject to the life insurance policy exclusion
provided under subparagraph (G)'' before ``)'';
(3) in subparagraph (E)(i), in the matter before subclause
(I), by inserting ``subject to the life insurance policy
exclusion provided under subparagraph (G)'' before ``)''; and
(4) by adding at the end the following new subparagraph:
``(G) Life insurance policy exclusion.--In
determining the resources of an individual (and the
eligible spouse of the individual, if any) under
section 1613 for purposes of subparagraphs (D) and (E)
no part of the value of any life insurance policy shall
be taken into account.''.
(b) Effective Date.--The amendments made by this section shall take
effect with respect to applications filed on or after January 1, 2010.
SEC. 117. JUDICIAL REVIEW OF DECISIONS OF THE COMMISSIONER OF SOCIAL
SECURITY UNDER THE MEDICARE PART D LOW-INCOME SUBSIDY
PROGRAM.
(a) In General.--Section 1860D-14(a)(3)(B)(iv) of the Social
Security Act (42 U.S.C. 1395w-114(a)(3)(B)(iv)) is amended--
(1) in subclause (I), by striking ``and'' at the end;
(2) in subclause (II), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subclause:
``(III) judicial review of the
final decision of the Commissioner made
after a hearing shall be available to
the same extent, and with the same
limitations, as provided in subsections
(g) and (h) of section 205.''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect as if included in the enactment of section 101 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
SEC. 118. TRANSLATION OF MODEL FORM.
(a) In General.--Section 1905(p)(5)(A) of the Social Security Act
(42 U.S.C. 1396d(p)(5)(A)) is amended by adding at the end the
following: ``The Secretary shall provide for the translation of such
application form into at least the 10 languages (other than English)
that are most often used by individuals applying for hospital insurance
benefits under section 226 or 226A and shall make the translated forms
available to the States and to the Commissioner of Social Security.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on January 1, 2010.
SEC. 119. MEDICARE ENROLLMENT ASSISTANCE.
(a) Additional Funding for State Health Insurance Assistance
Programs.--
(1) Grants.--
(A) In general.--The Secretary of Health and Human
Services (in this section referred to as the
``Secretary'') shall use amounts made available under
subparagraph (B) to make grants to States for State
health insurance assistance programs receiving
assistance under section 4360 of the Omnibus Budget
Reconciliation Act of 1990.
(B) Funding.--For purposes of making grants under
this subsection, the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary
determines under section 1853(f) of such Act (42 U.S.C.
1395w-23(f)), of $7,500,000 to the Centers for Medicare
& Medicaid Services Program Management Account for
fiscal year 2009, to remain available until expended.
(2) Amount of grants.--The amount of a grant to a State
under this subsection from the total amount made available
under paragraph (1) shall be equal to the sum of the amount
allocated to the State under paragraph (3)(A) and the amount
allocated to the State under subparagraph (3)(B).
(3) Allocation to states.--
(A) Allocation based on percentage of low-income
beneficiaries.--The amount allocated to a State under
this subparagraph from \2/3\ of the total amount made
available under paragraph (1) shall be based on the
number of individuals who meet the requirement under
subsection (a)(3)(A)(ii) of section 1860D-14 of the
Social Security Act (42 U.S.C. 1395w-114) but who have
not enrolled to receive a subsidy under such section
1860D-14 relative to the total number of individuals
who meet the requirement under such subsection
(a)(3)(A)(ii) in each State, as estimated by the
Secretary.
(B) Allocation based on percentage of rural
beneficiaries.--The amount allocated to a State under
this subparagraph from \1/3\ of the total amount made
available under paragraph (1) shall be based on the
number of part D eligible individuals (as defined in
section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-
101(a)(3)(A))) residing in a rural area relative to the
total number of such individuals in each State, as
estimated by the Secretary.
(4) Portion of grant based on percentage of low-income
beneficiaries to be used to provide outreach to individuals who
may be subsidy eligible individuals or eligible for the
medicare savings program.--Each grant awarded under this
subsection with respect to amounts allocated under paragraph
(3)(A) shall be used to provide outreach to individuals who may
be subsidy eligible individuals (as defined in section 1860D-
14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
114(a)(3)(A)) or eligible for the Medicare Savings Program (as
defined in subsection (f)).
(b) Additional Funding for Area Agencies on Aging.--
(1) Grants.--
(A) In general.--The Secretary, acting through the
Assistant Secretary for Aging, shall make grants to
States for area agencies on aging (as defined in
section 102 of the Older Americans Act of 1965 (42
U.S.C. 3002)) and Native American programs carried out
under the Older Americans Act of 1965 (42 U.S.C. 3001
et seq.).
(B) Funding.--For purposes of making grants under
this subsection, the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary
determines under section 1853(f) of such Act (42 U.S.C.
1395w-23(f)), of $7,500,000 to the Administration on
Aging for fiscal year 2009, to remain available until
expended.
(2) Amount of grant and allocation to states based on
percentage of low-income and rural beneficiaries.--The amount
of a grant to a State under this subsection from the total
amount made available under paragraph (1) shall be determined
in the same manner as the amount of a grant to a State under
subsection (a), from the total amount made available under
paragraph (1) of such subsection, is determined under paragraph
(2) and subparagraphs (A) and (B) of paragraph (3) of such
subsection.
(3) Required use of funds.--
(A) All funds.--Subject to subparagraph (B), each
grant awarded under this subsection shall be used to
provide outreach to eligible Medicare beneficiaries
regarding the benefits available under title XVIII of
the Social Security Act.
(B) Outreach to individuals who may be subsidy
eligible individuals or eligible for the medicare
savings program.--Subsection (a)(4) shall apply to each
grant awarded under this subsection in the same manner
as it applies to a grant under subsection (a).
(c) Additional Funding for Aging and Disability Resource Centers.--
(1) Grants.--
(A) In general.--The Secretary shall make grants to
Aging and Disability Resource Centers under the Aging
and Disability Resource Center grant program that are
established centers under such program on the date of
the enactment of this Act.
(B) Funding.--For purposes of making grants under
this subsection, the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary
determines under section 1853(f) of such Act (42 U.S.C.
1395w-23(f)), of $5,000,000 to the Administration on
Aging for fiscal year 2009, to remain available until
expended.
(2) Required use of funds.--Each grant awarded under this
subsection shall be used to provide outreach to individuals
regarding the benefits available under the Medicare
prescription drug benefit under part D of title XVIII of the
Social Security Act and under the Medicare Savings Program.
(d) Coordination of Efforts To Inform Older Americans About
Benefits Available Under Federal and State Programs.--
(1) In general.--The Secretary, acting through the
Assistant Secretary for Aging, in cooperation with related
Federal agency partners, shall make a grant to, or enter into a
contract with, a qualified, experienced entity under which the
entity shall--
(A) maintain and update web-based decision support
tools, and integrated, person-centered systems,
designed to inform older individuals (as defined in
section 102 of the Older Americans Act of 1965 (42
U.S.C. 3002)) about the full range of benefits for
which the individuals may be eligible under Federal and
State programs;
(B) utilize cost-effective strategies to find older
individuals with the greatest economic need (as defined
in such section 102) and inform the individuals of the
programs;
(C) develop and maintain an information
clearinghouse on best practices and the most cost-
effective methods for finding older individuals with
greatest economic need and informing the individuals of
the programs; and
(D) provide, in collaboration with related Federal
agency partners administering the Federal programs,
training and technical assistance on the most effective
outreach, screening, and follow-up strategies for the
Federal and State programs.
(2) Funding.--For purposes of making a grant or entering
into a contract under paragraph (1), the Secretary shall
provide for the transfer, from the Federal Hospital Insurance
Trust Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical Insurance
Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in
the same proportion as the Secretary determines under section
1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $5,000,000 to
the Administration on Aging for fiscal year 2009, to remain
available until expended.
(e) Reprogramming Funds From Medicare, Medicaid, and SCHIP
Extension Act of 2007.--The Secretary shall only use the $5,000,000 in
funds allocated to make grants to States for Area Agencies on Aging and
Aging Disability and Resource Centers for the period of fiscal years
2008 through 2009 under section 118 of the Medicare, Medicaid, and
SCHIP Extension Act of 2007 (Public Law 110-173) for the sole purpose
of providing outreach to individuals regarding the benefits available
under the Medicare prescription drug benefit under part D of title
XVIII of the Social Security Act. The Secretary shall republish the
request for proposals issued on April 17, 2008, in order to comply with
the preceding sentence.
(f) Medicare Savings Program Defined.--For purposes of this
section, the term ``Medicare Savings Program'' means the program of
medical assistance for payment of the cost of medicare cost-sharing
under the Medicaid program pursuant to sections 1902(a)(10)(E) and 1933
of the Social Security Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).
Subtitle B--Provisions Relating to Part A
SEC. 121. EXPANSION AND EXTENSION OF THE MEDICARE RURAL HOSPITAL
FLEXIBILITY PROGRAM.
(a) In General.--Section 1820(g) of the Social Security Act (42
U.S.C. 1395i-4(g)) is amended by adding at the end the following new
paragraph:
``(6) Providing mental health services and other health
services to veterans and other residents of rural areas.--
``(A) Grants to states.--The Secretary may award
grants to States that have submitted applications in
accordance with subparagraph (B) for increasing the
delivery of mental health services or other health care
services deemed necessary to meet the needs of veterans
of Operation Iraqi Freedom and Operation Enduring
Freedom living in rural areas (as defined for purposes
of section 1886(d) and including areas that are rural
census tracks, as defined by the Administrator of the
Health Resources and Services Administration),
including for the provision of crisis intervention
services and the detection of post-traumatic stress
disorder, traumatic brain injury, and other signature
injuries of veterans of Operation Iraqi Freedom and
Operation Enduring Freedom, and for referral of such
veterans to medical facilities operated by the
Department of Veterans Affairs, and for the delivery of
such services to other residents of such rural areas.
``(B) Application.--
``(i) In general.--An application is in
accordance with this subparagraph if the State
submits to the Secretary at such time and in
such form as the Secretary may require an
application containing the assurances described
in subparagraphs (A)(ii) and (A)(iii) of
subsection (b)(1).
``(ii) Consideration of regional
approaches, networks, or technology.--The
Secretary may, as appropriate in awarding
grants to States under subparagraph (A),
consider whether the application submitted by a
State under this subparagraph includes 1 or
more proposals that utilize regional
approaches, networks, health information
technology, telehealth, or telemedicine to
deliver services described in subparagraph (A)
to individuals described in that subparagraph.
For purposes of this clause, a network may, as
the Secretary determines appropriate, include
Federally qualified health centers (as defined
in section 1861(aa)(4)), rural health clinics
(as defined in section 1861(aa)(2)), home
health agencies (as defined in section
1861(o)), community mental health centers (as
defined in section 1861(ff)(3)(B)) and other
providers of mental health services,
pharmacists, local government, and other
providers deemed necessary to meet the needs of
veterans.
``(iii) Coordination at local level.--The
Secretary shall require, as appropriate, a
State to demonstrate consultation with the
hospital association of such State, rural
hospitals located in such State, providers of
mental health services, or other appropriate
stakeholders for the provision of services
under a grant awarded under this paragraph.
``(iv) Special consideration of certain
applications.--In awarding grants to States
under subparagraph (A), the Secretary shall
give special consideration to applications
submitted by States in which veterans make up a
high percentage (as determined by the
Secretary) of the total population of the
State. Such consideration shall be given
without regard to the number of veterans of
Operation Iraqi Freedom and Operation Enduring
Freedom living in the areas in which mental
health services and other health care services
would be delivered under the application.
``(C) Coordination with va.--The Secretary shall,
as appropriate, consult with the Director of the Office
of Rural Health of the Department of Veterans Affairs
in awarding and administering grants to States under
subparagraph (A).
``(D) Use of funds.--A State awarded a grant under
this paragraph may, as appropriate, use the funds to
reimburse providers of services described in
subparagraph (A) to individuals described in that
subparagraph.
``(E) Limitation on use of grant funds for
administrative expenses.--A State awarded a grant under
this paragraph may not expend more than 15 percent of
the amount of the grant for administrative expenses.
``(F) Independent evaluation and final report.--The
Secretary shall provide for an independent evaluation
of the grants awarded under subparagraph (A). Not later
than 1 year after the date on which the last grant is
awarded to a State under such subparagraph, the
Secretary shall submit a report to Congress on such
evaluation. Such report shall include an assessment of
the impact of such grants on increasing the delivery of
mental health services and other health services to
veterans of the United States Armed Forces living in
rural areas (as so defined and including such areas
that are rural census tracks), with particular emphasis
on the impact of such grants on the delivery of such
services to veterans of Operation Enduring Freedom and
Operation Iraqi Freedom, and to other individuals
living in such rural areas.''.
(b) Use of Funds for Federal Administrative Expenses.--Section
1820(g)(5) of the Social Security Act (42 U.S.C. 1395i-4(g)(5)) is
amended--
(1) by striking ``beginning with fiscal year 2005'' and
inserting ``for each of fiscal years 2005 through 2008''; and
(2) by inserting ``and, of the total amount appropriated
for grants under paragraphs (1), (2), and (6) for a fiscal year
(beginning with fiscal year 2009)'' after ``2005)''.
(c) Extension of Authorization for FLEX Grants.--Section 1820(j) of
the Social Security Act (42 U.S.C. 1395i-4(j)) is amended--
(1) by striking ``and for'' and inserting ``for''; and
(2) by inserting ``, for making grants to all States under
paragraphs (1) and (2) of subsection (g), $55,000,000 in each
of fiscal years 2009 and 2010, and for making grants to all
States under paragraph (6) of subsection (g), $50,000,000 in
each of fiscal years 2009 and 2010, to remain available until
expended'' before the period at the end.
(d) Medicare Rural Hospital Flexibility Program.--Section
1820(g)(1) of the Social Security Act (42 U.S.C. 1395i-4(g)(1)) is
amended--
(1) in subparagraph (B), by striking ``and'' at the end;
(2) in subparagraph (C), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(D) providing support for critical access
hospitals for quality improvement, quality reporting,
performance improvements, and benchmarking.''.
(e) Assistance to Small Critical Access Hospitals Transitioning to
Skilled Nursing Facilities and Assisted Living Facilities.--Section
1820(g) of the Social Security Act (42 U.S.C. 1395i-4(g)), as amended
by subsection (a), is amended by adding at the end the following new
paragraph:
``(7) Critical access hospitals transitioning to skilled
nursing facilities and assisted living facilities.--
``(A) Grants.--The Secretary may award grants to
eligible critical access hospitals that have submitted
applications in accordance with subparagraph (B) for
assisting such hospitals in the transition to skilled
nursing facilities and assisted living facilities.
``(B) Application.--An applicable critical access
hospital seeking a grant under this paragraph shall
submit an application to the Secretary on or before
such date and in such form and manner as the Secretary
specifies.
``(C) Additional requirements.--The Secretary may
not award a grant under this paragraph to an eligible
critical access hospital unless--
``(i) local organizations or the State in
which the hospital is located provides matching
funds; and
``(ii) the hospital provides assurances
that it will surrender critical access hospital
status under this title within 180 days of
receiving the grant.
``(D) Amount of grant.--A grant to an eligible
critical access hospital under this paragraph may not
exceed $1,000,000.
``(E) Funding.--There are appropriated from the
Federal Hospital Insurance Trust Fund under section
1817 for making grants under this paragraph, $5,000,000
for fiscal year 2008.
``(F) Eligible critical access hospital defined.--
For purposes of this paragraph, the term `eligible
critical access hospital' means a critical access
hospital that has an average daily acute census of less
than 0.5 and an average daily swing bed census of
greater than 10.0.''.
SEC. 122. REBASING FOR SOLE COMMUNITY HOSPITALS.
(a) Rebasing Permitted.--Section 1886(b)(3) of the Social Security
Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the
following new subparagraph:
``(L)(i) For cost reporting periods beginning on or after January
1, 2009, in the case of a sole community hospital there shall be
substituted for the amount otherwise determined under subsection
(d)(5)(D)(i) of this section, if such substitution results in a greater
amount of payment under this section for the hospital, the subparagraph
(L) rebased target amount.
``(ii) For purposes of this subparagraph, the term `subparagraph
(L) rebased target amount' has the meaning given the term `target
amount' in subparagraph (C), except that--
``(I) there shall be substituted for the base cost
reporting period the 12-month cost reporting period beginning
during fiscal year 2006;
``(II) any reference in subparagraph (C)(i) to the `first
cost reporting period' described in such subparagraph is deemed
a reference to the first cost reporting period beginning on or
after January 1, 2009; and
``(III) the applicable percentage increase shall only be
applied under subparagraph (C)(iv) for discharges occurring on
or after January 1, 2009.''.
(b) Conforming Amendments.--Section 1886(b)(3) of the Social
Security Act (42 U.S.C. 1395ww(b)(3)) is amended--
(1) in subparagraph (C), in the matter preceding clause
(i), by striking ``subparagraph (I)'' and inserting
``subparagraphs (I) and (L)''; and
(2) in subparagraph (I)(i), in the matter preceding
subclause (I), by striking ``For'' and inserting ``Subject to
subparagraph (L), for''.
SEC. 123. DEMONSTRATION PROJECT ON COMMUNITY HEALTH INTEGRATION MODELS
IN CERTAIN RURAL COUNTIES.
(a) In General.--The Secretary shall establish a demonstration
project to allow eligible entities to develop and test new models for
the delivery of health care services in eligible counties for the
purpose of improving access to, and better integrating the delivery of,
acute care, extended care, and other essential health care services to
Medicare beneficiaries.
(b) Purpose.--The purpose of the demonstration project under this
section is to--
(1) explore ways to increase access to, and improve the
adequacy of, payments for acute care, extended care, and other
essential health care services provided under the Medicare and
Medicaid programs in eligible counties; and
(2) evaluate regulatory challenges facing such providers
and the communities they serve.
(c) Requirements.--The following requirements shall apply under the
demonstration project:
(1) Health care providers in eligible counties selected to
participate in the demonstration project under subsection
(d)(3) shall (when determined appropriate by the Secretary),
instead of the payment rates otherwise applicable under the
Medicare program, be reimbursed at a rate that covers at least
the reasonable costs of the provider in furnishing acute care,
extended care, and other essential health care services to
Medicare beneficiaries.
(2) Methods to coordinate the survey and certification
process under the Medicare program and the Medicaid program
across all health service categories included in the
demonstration project shall be tested with the goal of assuring
quality and safety while reducing administrative burdens, as
appropriate, related to completing such survey and
certification process.
(3) Health care providers in eligible counties selected to
participate in the demonstration project under subsection
(d)(3) and the Secretary shall work with the State to explore
ways to revise reimbursement policies under the Medicaid
program to improve access to the range of health care services
available in such eligible counties.
(4) The Secretary shall identify regulatory requirements
that may be revised appropriately to improve access to care in
eligible counties.
(5) Other essential health care services necessary to
ensure access to the range of health care services in eligible
counties selected to participate in the demonstration project
under subsection (d)(3) shall be identified. Ways to ensure
adequate funding for such services shall also be explored.
(d) Application Process.--
(1) Eligibility.--
(A) In general.--Eligibility to participate in the
demonstration project under this section shall be
limited to eligible entities.
(B) Eligible entity defined.--In this section, the
term ``eligible entity'' means an entity that--
(i) is a Rural Hospital Flexibility Program
grantee under section 1820(g) of the Social
Security Act (42 U.S.C. 1395i-4(g)); and
(ii) is located in a State in which at
least 65 percent of the counties in the State
are counties that have 6 or less residents per
square mile.
(2) Application.--
(A) In general.--An eligible entity seeking to
participate in the demonstration project under this
section shall submit an application to the Secretary at
such time, in such manner, and containing such
information as the Secretary may require.
(B) Limitation.--The Secretary shall select
eligible entities located in not more than 4 States to
participate in the demonstration project under this
section.
(3) Selection of eligible counties.--An eligible entity
selected by the Secretary to participate in the demonstration
project under this section shall select not more than 6
eligible counties in the State in which the entity is located
in which to conduct the demonstration project.
(4) Eligible county defined.--In this section, the term
``eligible county'' means a county that meets the following
requirements:
(A) The county has 6 or less residents per square
mile.
(B) As of the date of the enactment of this Act, a
facility designated as a critical access hospital which
meets the following requirements was located in the
county:
(i) As of the date of the enactment of this
Act, the critical access hospital furnished 1
or more of the following:
(I) Home health services.
(II) Hospice care.
(III) Rural health clinic services.
(ii) As of the date of the enactment of
this Act, the critical access hospital has an
average daily inpatient census of 5 or less.
(C) As of the date of the enactment of this Act,
skilled nursing facility services were available in the
county in--
(i) a critical access hospital using swing
beds; or
(ii) a local nursing home.
(e) Administration.--
(1) In general.--The demonstration project under this
section shall be administered jointly by the Administrator of
the Office of Rural Health Policy of the Health Resources and
Services Administration and the Administrator of the Centers
for Medicare & Medicaid Services, in accordance with paragraphs
(2) and (3).
(2) HRSA duties.--In administering the demonstration
project under this section, the Administrator of the Office of
Rural Health Policy of the Health Resources and Services
Administration shall--
(A) award grants to the eligible entities selected
to participate in the demonstration project; and
(B) work with such entities to provide technical
assistance related to the requirements under the
project.
(3) CMS duties.--In administering the demonstration project
under this section, the Administrator of the Centers for
Medicare & Medicaid Services shall determine which provisions
of titles XVIII and XIX of the Social Security Act (42 U.S.C.
1395 et seq.; 1396 et seq.) the Secretary should waive under
the waiver authority under subsection (i) that are relevant to
the development of alternative reimbursement methodologies,
which may include, as appropriate, covering at least the
reasonable costs of the provider in furnishing acute care,
extended care, and other essential health care services to
Medicare beneficiaries and coordinating the survey and
certification process under the Medicare and Medicaid programs,
as appropriate, across all service categories included in the
demonstration project.
(f) Duration.--
(1) In general.--The demonstration project under this
section shall be conducted for a 3-year period beginning on
October 1, 2009.
(2) Beginning date of demonstration project.--The
demonstration project under this section shall be considered to
have begun in a State on the date on which the eligible
counties selected to participate in the demonstration project
under subsection (d)(3) begin operations in accordance with the
requirements under the demonstration project.
(g) Funding.--
(1) CMS.--
(A) In general.--The Secretary shall provide for
the transfer, in appropriate part from the Federal
Hospital Insurance Trust Fund established under section
1817 of the Social Security Act (42 U.S.C. 1395i) and
the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 of such Act (42 U.S.C.
1395t), of such sums as are necessary for the costs to
the Centers for Medicare & Medicaid Services of
carrying out its duties under the demonstration project
under this section.
(B) Budget neutrality.--In conducting the
demonstration project under this section, the Secretary
shall ensure that the aggregate payments made by the
Secretary do not exceed the amount which the Secretary
estimates would have been paid if the demonstration
project under this section was not implemented.
(2) HRSA.--There are authorized to be appropriated to the
Office of Rural Health Policy of the Health Resources and
Services Administration $800,000 for each of fiscal years 2010,
2011, and 2012 for the purpose of carrying out the duties of
such Office under the demonstration project under this section,
to remain available for the duration of the demonstration
project.
(h) Report.--
(1) Interim report.--Not later than the date that is 2
years after the date on which the demonstration project under
this section is implemented, the Administrator of the Office of
Rural Health Policy of the Health Resources and Services
Administration, in coordination with the Administrator of the
Centers for Medicare & Medicaid Services, shall submit a report
to Congress on the status of the demonstration project that
includes initial recommendations on ways to improve access to,
and the availability of, health care services in eligible
counties based on the findings of the demonstration project.
(2) Final report.--Not later than 1 year after the
completion of the demonstration project, the Administrator of
the Office of Rural Health Policy of the Health Resources and
Services Administration, in coordination with the Administrator
of the Centers for Medicare & Medicaid Services, shall submit a
report to Congress on such project, together with
recommendations for such legislation and administrative action
as the Secretary determines appropriate.
(i) Waiver Authority.--The Secretary may waive such requirements of
titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et
seq.; 1396 et seq.) as may be necessary and appropriate for the purpose
of carrying out the demonstration project under this section.
(j) Definitions.--In this section:
(1) Extended care services.--The term ``extended care
services'' means the following:
(A) Home health services.
(B) Covered skilled nursing facility services.
(C) Hospice care.
(2) Covered skilled nursing facility services.--The term
``covered skilled nursing facility services'' has the meaning
given such term in section 1888(e)(2)(A) of the Social Security
Act (42 U.S.C. 1395yy(e)(2)(A)).
(3) Critical access hospital.--The term ``critical access
hospital'' means a facility designated as a critical access
hospital under section 1820(c) of such Act (42 U.S.C. 1395i-
4(c)).
(4) Home health services.--The term ``home health
services'' has the meaning given such term in section 1861(m)
of such Act (42 U.S.C. 1395x(m)).
(5) Hospice care.--The term ``hospice care'' has the
meaning given such term in section 1861(dd) of such Act (42
U.S.C. 1395x(dd)).
(6) Medicaid program.--The term ``Medicaid program'' means
the program under title XIX of such Act (42 U.S.C. 1396 et
seq.).
(7) Medicare program.--The term ``Medicare program'' means
the program under title XVIII of such Act (42 U.S.C. 1395 et
seq.).
(8) Other essential health care services.--The term ``other
essential health care services'' means the following:
(A) Ambulance services (as described in section
1861(s)(7) of the Social Security Act (42 U.S.C.
1395x(s)(7))).
(B) Rural health clinic services.
(C) Public health services (as defined by the
Secretary).
(D) Other health care services determined
appropriate by the Secretary.
(9) Rural health clinic services.--The term ``rural health
clinic services'' has the meaning given such term in section
1861(aa)(1) of such Act (42 U.S.C. 1395x(aa)(1)).
(10) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 124. EXTENSION OF THE RECLASSIFICATION OF CERTAIN HOSPITALS.
(a) In General.--Subsection (a) of section 106 of division B of the
Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395 note), as
amended by section 117 of the Medicare, Medicaid, and SCHIP Extension
Act of 2007 (Public Law 110-173), is amended by striking ``September
30, 2008'' and inserting ``September 30, 2009''.
(b) Special Exception Reclassifications.--Section 117(a)(2) of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-
173)) is amended by striking ``September 30, 2008'' and inserting ``the
last date of the extension of reclassifications under section 106(a) of
the Medicare Improvement and Extension Act of 2006 (division B of
Public Law 109-432)''.
(c) Disregarding Section 508 Hospital Reclassifications for
Purposes of Group Reclassifications.--Section 508(g) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public
Law 108-173, 42 U.S.C. 1395ww note), as added by section 117(b) of the
Medicare, Medicaid, and SCHIP Extension Act of 2008 (Public Law 110-
173)), is amended by striking ``during fiscal year 2008'' and inserting
``beginning on October 1, 2007, and ending on the last date of the
extension of reclassifications under section 106(a) of the Medicare
Improvement and Extension Act of 2006 (division B of Public Law 109-
432)''.
SEC. 125. REVOCATION OF UNIQUE DEEMING AUTHORITY OF THE JOINT
COMMISSION.
(a) Revocation.--Section 1865 of the Social Security Act (42 U.S.C.
1395bb) is amended--
(1) by striking subsection (a); and
(2) by redesignating subsections (b), (c), (d), and (e) as
subsections (a), (b), (c), and (d), respectively.
(b) Conforming Amendments.--(1) Section 1865 of the Social Security
Act (42 U.S.C. 1395bb) is amended--
(A) in subsection (a)(1), as redesignated by subsection
(a)(2), by striking ``In addition, if'' and inserting ``If'';
(B) in subsection (b), as so redesignated--
(i) by striking ``released to him by the Joint
Commission on Accreditation of Hospitals,'' and
inserting ``released to the Secretary by''; and
(ii) by striking the comma after ``Association'';
(C) in subsection (c), as so redesignated, by striking
``pursuant to subsection (a) or (b)(1)'' and inserting
``pursuant to subsection (a)(1)''; and
(D) in subsection (d), as so redesignated, by striking
``pursuant to subsection (a) or (b)(1)'' and inserting
``pursuant to subsection (a)(1)''.
(2) Section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e))
is amended in the fourth sentence by striking ``and (ii) is accredited
by the Joint Commission on Accreditation of Hospitals, or is accredited
by or approved by a program of the country in which such institution is
located if the Secretary finds the accreditation or comparable approval
standards of such program to be essentially equivalent to those of the
Joint Commission on Accreditation of Hospitals'' and inserting ``and
(ii) is accredited by a national accreditation body recognized by the
Secretary under section 1865(a), or is accredited by or approved by a
program of the country in which such institution is located if the
Secretary finds the accreditation or comparable approval standards of
such program to be essentially equivalent to those of such a national
accreditation body.''.
(3) Section 1864(c) of the Social Security Act (42 U.S.C.
1395aa(c)) is amended by striking ``pursuant to subsection (a) or
(b)(1) of section 1865'' and inserting ``pursuant to section
1865(a)(1)''.
(4) Section 1875(b) of the Social Security Act (42 U.S.C.
1395ll(b)) is amended by striking ``the Joint Commission on
Accreditation of Hospitals,'' and inserting ``national accreditation
bodies under section 1865(a)''.
(5) Section 1834(a)(20)(B) of the Social Security Act (42 U.S.C.
1395m(a)(20)(B)) is amended by striking ``section 1865(b)'' and
inserting ``section 1865(a)''.
(6) Section 1852(e)(4)(C) of the Social Security Act (42 U.S.C.
1395w-22(e)(4)(C)) is amended by striking ``section 1865(b)(2)'' and
inserting ``section 1865(a)(2)''.
(c) Authority To Recognize the Joint Commission as a National
Accreditation Body.--The Secretary of Health and Human Services may
recognize the Joint Commission as a national accreditation body under
section 1865 of the Social Security Act (42 U.S.C. 1395bb), as amended
by this section, upon such terms and conditions, and upon submission of
such information, as the Secretary may require.
(d) Effective Date; Transition Rule.--(1) Subject to paragraph (2),
the amendments made by this section shall apply with respect to
accreditations of hospitals granted on or after the date that is 24
months after the date of the enactment of this Act.
(2) For purposes of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.), the amendments made by this section shall not
effect the accreditation of a hospital by the Joint Commission, or
under accreditation or comparable approval standards found to be
essentially equivalent to accreditation or approval standards of the
Joint Commission, for the period of time applicable under such
accreditation.
Subtitle C--Provisions Relating to Part B
PART I--PHYSICIANS' SERVICES
SEC. 131. PHYSICIAN PAYMENT, EFFICIENCY, AND QUALITY IMPROVEMENTS.
(a) In General.--
(1) Increase in update for the second half of 2008 and for
2009.--
(A) For the second half of 2008.--Section
1848(d)(8) of the Social Security Act (42 U.S.C. 1395w-
4(d)(8)), as added by section 101 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law
110-173), is amended--
(i) in the heading, by striking ``a portion
of'';
(ii) in subparagraph (A), by striking ``for
the period beginning on January 1, 2008, and
ending on June 30, 2008,''; and
(iii) in subparagraph (B)--
(I) in the heading, by striking
``the remaining portion of 2008 and'';
and
(II) by striking ``for the period
beginning on July 1, 2008, and ending
on December 31, 2008, and''.
(B) For 2009.--Section 1848(d) of the Social
Security Act (42 U.S.C. 1395w-4(d)), as amended by
section 101 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (Public Law 110-173), is amended
by adding at the end the following new paragraph:
``(9) Update for 2009.--
``(A) In general.--Subject to paragraphs (7)(B) and
(8)(B), in lieu of the update to the single conversion
factor established in paragraph (1)(C) that would
otherwise apply for 2009, the update to the single
conversion factor shall be 1.1 percent.
``(B) No effect on computation of conversion factor
for 2010 and subsequent years.--The conversion factor
under this subsection shall be computed under paragraph
(1)(A) for 2010 and subsequent years as if subparagraph
(A) had never applied.''.
(3) Revision of the physician assistance and quality
initiative fund.--
(A) In general.--Subject to subparagraph (B),
section 1848(l)(2) of the Social Security Act (42
U.S.C. 1395w-4(l)(2)), as amended by section 101(a)(2)
of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (Public Law 110-173), is amended--
(i) in subparagraph (A)--
(I) by striking clause (i)(III);
and
(II) by striking clause (ii)(III);
and
(ii) in subparagraph (B)--
(I) in clause (i), by adding
``and'' at the end;
(II) in clause (ii), by striking
``; and'' and inserting a period; and
(III) by striking clause (iii).
(B) Contingency.--If there is enacted, before, on,
or after the date of the enactment of this Act, a
Supplemental Appropriations Act, 2008 that includes a
provision amending section 1848(l) of the Social
Security Act, the alternative amendment described in
subparagraph (C)--
(i) shall apply instead of the amendments
made by subparagraph (A); and
(ii) shall be executed after such provision
in such Supplemental Appropriations Act.
(C) Alternative amendment described.--The
alternative amendment described in this subparagraph is
as follows: Section 1848(l)(2) of the Social Security
Act (42 U.S.C. 1395w-4(l)(2)), as amended by section
101(a)(2) of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (Public Law 110-173) and by the
Supplemental Appropriations Act, 2008, is amended--
(i) in subparagraph (A)--
(I) by striking subclauses (III)
and (IV) of clause (i); and
(II) by striking subclauses (III)
and (IV) of clause (ii); and
(ii) in subparagraph (B)--
(I) in clause (i), by adding
``and'' at the end;
(II) in clause (ii), by striking
the semicolon at the end and inserting
a period; and
(III) by striking clauses (iii) and
(iv).
(b) Extension and Improvement of the Quality Reporting System.--
(1) System.--Section 1848(k)(2) of the Social Security Act
(42 U.S.C. 1395w-4(k)(2)), as amended by section 101(b)(1) of
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public
Law 110-173), is amended by adding at the end the following new
subparagraphs:
``(C) For 2010 and subsequent years.--
``(i) In general.--Subject to clause (ii),
for purposes of reporting data on quality
measures for covered professional services
furnished during 2010 and each subsequent year,
subject to subsection (m)(3)(C), the quality
measures (including electronic prescribing
quality measures) specified under this
paragraph shall be such measures selected by
the Secretary from measures that have been
endorsed by the entity with a contract with the
Secretary under section 1890(a).
``(ii) Exception.--In the case of a
specified area or medical topic determined
appropriate by the Secretary for which a
feasible and practical measure has not been
endorsed by the entity with a contract under
section 1890(a), the Secretary may specify a
measure that is not so endorsed as long as due
consideration is given to measures that have
been endorsed or adopted by a consensus
organization identified by the Secretary, such
as the AQA alliance.
``(D) Opportunity to provide input on measures for
2009 and subsequent years.--For each quality measure
(including an electronic prescribing quality measure)
adopted by the Secretary under subparagraph (B) (with
respect to 2009) or subparagraph (C), the Secretary
shall ensure that eligible professionals have the
opportunity to provide input during the development,
endorsement, or selection of measures applicable to
services they furnish.''.
(2) Redesignation of reporting system.--Subsection (c) of
section 101 of division B of the Tax Relief and Health Care Act
of 2006 (42 U.S.C. 1395w-4 note), as amended by section
101(b)(2) of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (Public Law 110-173), is redesignated as subsection (m) of
section 1848 of the Social Security Act.
(3) Incentive payments under reporting system.--Section
1848(m) of the Social Security Act, as redesignated by
paragraph (2), is amended--
(A) by amending the heading to read as follows:
``Incentive Payments for Quality Reporting'';
(B) by striking paragraph (1) and inserting the
following:
``(1) Incentive payments.--
``(A) In general.--For 2007 through 2010, with
respect to covered professional services furnished
during a reporting period by an eligible professional,
if--
``(i) there are any quality measures that
have been established under the physician
reporting system that are applicable to any
such services furnished by such professional
for such reporting period; and
``(ii) the eligible professional
satisfactorily submits (as determined under
this subsection) to the Secretary data on such
quality measures in accordance with such
reporting system for such reporting period,
in addition to the amount otherwise paid under this
part, there also shall be paid to the eligible
professional (or to an employer or facility in the
cases described in clause (A) of section 1842(b)(6))
or, in the case of a group practice under paragraph
(3)(C), to the group practice, from the Federal
Supplementary Medical Insurance Trust Fund established
under section 1841 an amount equal to the applicable
quality percent of the Secretary's estimate (based on
claims submitted not later than 2 months after the end
of the reporting period) of the allowed charges under
this part for all such covered professional services
furnished by the eligible professional (or, in the case
of a group practice under paragraph (3)(C), by the
group practice) during the reporting period.
``(B) Applicable quality percent.--For purposes of
subparagraph (A), the term `applicable quality percent'
means--
``(i) for 2007 and 2008, 1.5 percent; and
``(ii) for 2009 and 2010, 2.0 percent.'';
(C) by striking paragraph (3) and redesignating
paragraph (2) as paragraph (3);
(D) in paragraph (3), as so redesignated--
(i) in the matter preceding subparagraph
(A), by striking ``For purposes'' and inserting
the following:
``(A) In general.--For purposes'';
(ii) by redesignating subparagraphs (A) and
(B) as clauses (i) and (ii), respectively, and
moving the indentation of such clauses 2 ems to
the right;
(iii) in subparagraph (A), as added by
clause (i), by adding at the end the following
flush sentence:
``For years after 2008, quality measures for purposes
of this subparagraph shall not include electronic
prescribing quality measures.''; and
(iv) by adding at the end the following new
subparagraphs:
``(C) Satisfactory reporting measures for group
practices.--
``(i) In general.--By January 1, 2010, the
Secretary shall establish and have in place a
process under which eligible professionals in a
group practice (as defined by the Secretary)
shall be treated as satisfactorily submitting
data on quality measures under subparagraph (A)
and as meeting the requirement described in
subparagraph (B)(ii) for covered professional
services for a reporting period (or, for
purposes of subsection (a)(5), for a reporting
period for a year) if, in lieu of reporting
measures under subsection (k)(2)(C), the group
practice reports measures determined
appropriate by the Secretary, such as measures
that target high-cost chronic conditions and
preventive care, in a form and manner, and at a
time, specified by the Secretary.
``(ii) Statistical sampling model.--The
process under clause (i) shall provide for the
use of a statistical sampling model to submit
data on measures, such as the model used under
the Physician Group Practice demonstration
project under section 1866A.
``(iii) No double payments.--Payments to a
group practice under this subsection by reason
of the process under clause (i) shall be in
lieu of the payments that would otherwise be
made under this subsection to eligible
professionals in the group practice for
satisfactorily submitting data on quality
measures.
``(D) Authority to revise satisfactorily reporting
data.--For years after 2009, the Secretary, in
consultation with stakeholders and experts, may revise
the criteria under this subsection for satisfactorily
submitting data on quality measures under subparagraph
(A) and the criteria for submitting data on electronic
prescribing quality measures under subparagraph
(B)(ii).'';
(E) in paragraph (5)--
(i) in subparagraph (C), by inserting ``for
2007, 2008, and 2009,'' after ``provision of
law,'';
(ii) in subparagraph (D)--
(I) in clause (i)--
(aa) by inserting ``for
2007 and 2008'' after ``under
this subsection''; and
(bb) by striking
``paragraph (2)'' and inserting
``this subsection'';
(II) in clause (ii), by striking
``shall'' and inserting ``may establish
procedures to''; and
(III) in clause (iii)--
(aa) by inserting ``(or, in
the case of a group practice
under paragraph (3)(C), the
group practice)'' after ``an
eligible professional'';
(bb) by striking ``bonus
incentive payment'' and
inserting ``incentive payment
under this subsection''; and
(cc) by adding at the end
the following new sentence:
``If such payments for such
period have already been made,
the Secretary shall recoup such
payments from the eligible
professional (or the group
practice).'';
(iii) in subparagraph (E)--
(I) by striking ``(i) in general.--
'';
(II) by striking clause (ii);
(III) by redesignating subclauses
(I) through (IV) as clauses (i) through
(iv), respectively, and moving the
indentation of such clauses 2 ems to
the left;
(IV) in clause (ii), as so
redesignated, by striking ``paragraph
(2)'' and inserting ``this
subsection''; and
(V) in clause (iv), as so
redesignated--
(aa) by striking ``the
bonus'' and inserting ``any'';
and
(bb) by inserting ``and the
payment adjustment under
subsection (a)(5)(A)'' before
the period at the end;
(iv) in subparagraph (F)--
(I) by striking ``2009, paragraph
(3) shall not apply, and'' and
inserting ``subsequent years,''; and
(II) by striking ``paragraph (2)''
and inserting ``this subsection''; and
(v) by adding at the end the following new
subparagraph:
``(G) Posting on website.--The Secretary shall post
on the Internet website of the Centers for Medicare &
Medicaid Services, in an easily understandable format,
a list of the names of the following:
``(i) The eligible professionals (or, in
the case of reporting under paragraph (3)(C),
the group practices) who satisfactorily
submitted data on quality measures under this
subsection.
``(ii) The eligible professionals (or, in
the case of reporting under paragraph (3)(C),
the group practices) who are successful
electronic prescribers.''; and
(F) in paragraph (6), by striking subparagraph (C)
and inserting the following:
``(C) Reporting period.--
``(i) In general.--Subject to clauses (ii)
and (iii), the term `reporting period' means--
``(I) for 2007, the period
beginning on July 1, 2007, and ending
on December 31, 2007; and
``(II) for 2008, 2009, 2010, and
2011, the entire year.
``(ii) Authority to revise reporting
period.--For years after 2009, the Secretary
may revise the reporting period under clause
(i) if the Secretary determines such revision
is appropriate, produces valid results on
measures reported, and is consistent with the
goals of maximizing scientific validity and
reducing administrative burden. If the
Secretary revises such period pursuant to the
preceding sentence, the term `reporting period'
shall mean such revised period.
``(iii) Reference.--Any reference in this
subsection to a reporting period with respect
to the application of subsection (a)(5) shall
be deemed a reference to the reporting period
under subparagraph (D)(iii) of such
subsection.''.
(4) Inclusion of qualified audiologists as eligible
professionals.--
(A) In general.--Section 1848(k)(3)(B) of the
Social Security Act (42 U.S.C. 1395w-4(k)(3)(B)), is
amended by adding at the end the following new clause:
``(iv) Beginning with 2009, a qualified
audiologist (as defined in section
1861(ll)(3)(B)).''.
(B) No change in billing.--Nothing in the amendment
made by subparagraph (A) shall be construed to change
the way in which billing for audiology services (as
defined in section 1861(ll)(2) of the Social Security
Act (42 U.S.C. 1395x(ll)(2))) occurs under title XVIII
of such Act as of July 1, 2008.
(5) Conforming amendments.--Section 1848(m) of the Social
Security Act, as added and amended by paragraphs (2) and (3),
is amended--
(A) in paragraph (5)--
(i) in subparagraph (A)--
(I) by striking ``section 1848(k)
of the Social Security Act, as added by
subsection (b),'' and inserting
``subsection (k)''; and
(II) by striking ``such section''
and inserting ``such subsection'';
(ii) in subparagraph (B), by striking ``of
the Social Security Act (42 U.S.C. 1395l)'';
(iii) in subparagraph (E), in the matter
preceding clause (i), by striking ``1869 or
1878 of the Social Security Act or otherwise''
and inserting ``1869, section 1878, or
otherwise''; and
(iv) in subparagraph (F)--
(I) by striking ``paragraph (2)(B)
of section 1848(k) of the Social
Security Act (42 U.S.C. 1395w-4(k))''
and inserting ``subsection (k)(2)(B)'';
and
(II) by striking ``paragraph (4) of
such section'' and inserting
``subsection (k)(4)'';
(B) in paragraph (6)--
(i) in subparagraph (A), by striking
``section 1848(k)(3) of the Social Security
Act, as added by subsection (b)'' and inserting
``subsection (k)(3)''; and
(ii) in subparagraph (B), by striking
``section 1848(k) of the Social Security Act,
as added by subsection (b)'' and inserting
``subsection (k)''; and
(C) by striking paragraph (6)(D).
(6) No affect on incentive payments for 2007 or 2008.--
Nothing in the amendments made by this subsection or section
132 shall affect the operation of the provisions of section
1848(m) of the Social Security Act, as redesignated and amended
by such subsection and section, with respect to 2007 or 2008.
(c) Physician Feedback Program To Improve Efficiency and Control
Costs.--
(1) In general.--Section 1848 of the Social Security Act
(42 U.S.C. 1395w-4), as amended by subsection (b), is amended
by adding at the end the following new subsection:
``(n) Physician Feedback Program.--
``(1) Establishment.--
``(A) In general.--The Secretary shall establish a
Physician Feedback Program (in this subsection referred
to as the `Program') under which the Secretary shall
use claims data under this title (and may use other
data) to provide confidential reports to physicians
(and, as determined appropriate by the Secretary, to
groups of physicians) that measure the resources
involved in furnishing care to individuals under this
title. If determined appropriate by the Secretary, the
Secretary may include information on the quality of
care furnished to individuals under this title by the
physician (or group of physicians) in such reports.
``(B) Resource use.--The resources described in
subparagraph (A) may be measured--
``(i) on an episode basis;
``(ii) on a per capita basis; or
``(iii) on both an episode and a per capita
basis.
``(2) Implementation.--The Secretary shall implement the
Program by not later than January 1, 2009.
``(3) Data for reports.--To the extent practicable, reports
under the Program shall be based on the most recent data
available.
``(4) Authority to focus application.--The Secretary may
focus the application of the Program as appropriate, such as
focusing the Program on--
``(A) physician specialties that account for a
certain percentage of all spending for physicians'
services under this title;
``(B) physicians who treat conditions that have a
high cost or a high volume, or both, under this title;
``(C) physicians who use a high amount of resources
compared to other physicians;
``(D) physicians practicing in certain geographic
areas; or
``(E) physicians who treat a minimum number of
individuals under this title.
``(5) Authority to exclude certain information if
insufficient information.--The Secretary may exclude certain
information regarding a service from a report under the Program
with respect to a physician (or group of physicians) if the
Secretary determines that there is insufficient information
relating to that service to provide a valid report on that
service.
``(6) Adjustment of data.--To the extent practicable, the
Secretary shall make appropriate adjustments to the data used
in preparing reports under the Program, such as adjustments to
take into account variations in health status and other patient
characteristics.
``(7) Education and outreach.--The Secretary shall provide
for education and outreach activities to physicians on the
operation of, and methodologies employed under, the Program.
``(8) Disclosure exemption.--Reports under the Program
shall be exempt from disclosure under section 552 of title 5,
United States Code.''.
(2) GAO study and report on the physician feedback
program.--
(A) Study.--The Comptroller General of the United
States shall conduct a study of the Physician Feedback
Program conducted under section 1848(n) of the Social
Security Act, as added by paragraph (1), including the
implementation of the Program.
(B) Report.--Not later than March 1, 2011, the
Comptroller General of the United States shall submit a
report to Congress containing the results of the study
conducted under subparagraph (A), together with
recommendations for such legislation and administrative
action as the Comptroller General determines
appropriate.
(d) Plan for Transition to Value-Based Purchasing Program for
Physicians and Other Practitioners.--
(1) In general.--The Secretary of Health and Human Services
shall develop a plan to transition to a value-based purchasing
program for payment under the Medicare program for covered
professional services (as defined in section 1848(k)(3)(A) of
the Social Security Act (42 U.S.C. 1395w-4(k)(3)(A))).
(2) Report.--Not later than May 1, 2010, the Secretary of
Health and Human Services shall submit a report to Congress
containing the plan developed under paragraph (1), together
with recommendations for such legislation and administrative
action as the Secretary determines appropriate.
SEC. 132. INCENTIVES FOR ELECTRONIC PRESCRIBING.
(a) Incentive Payments.--Section 1848(m) of the Social Security
Act, as added and amended by section 131(b), is amended--
(1) by inserting after paragraph (1), the following new
paragraph:
``(2) Incentive payments for electronic prescribing.--
``(A) In general.--For 2009 through 2013, with
respect to covered professional services furnished
during a reporting period by an eligible professional,
if the eligible professional is a successful electronic
prescriber for such reporting period, in addition to
the amount otherwise paid under this part, there also
shall be paid to the eligible professional (or to an
employer or facility in the cases described in clause
(A) of section 1842(b)(6)) or, in the case of a group
practice under paragraph (3)(C), to the group practice,
from the Federal Supplementary Medical Insurance Trust
Fund established under section 1841 an amount equal to
the applicable electronic prescribing percent of the
Secretary's estimate (based on claims submitted not
later than 2 months after the end of the reporting
period) of the allowed charges under this part for all
such covered professional services furnished by the
eligible professional (or, in the case of a group
practice under paragraph (3)(C), by the group practice)
during the reporting period.
``(B) Limitation with respect to electronic
prescribing quality measures.--The provisions of this
paragraph and subsection (a)(5) shall not apply to an
eligible professional (or, in the case of a group
practice under paragraph (3)(C), to the group practice)
if, for the reporting period (or, for purposes of
subsection (a)(5), for the reporting period for a
year)--
``(i) the allowed charges under this part
for all covered professional services furnished
by the eligible professional (or group, as
applicable) for the codes to which the
electronic prescribing quality measure applies
(as identified by the Secretary and published
on the Internet website of the Centers for
Medicare & Medicaid Services as of January 1,
2008, and as subsequently modified by the
Secretary) are less than 10 percent of the
total of the allowed charges under this part
for all such covered professional services
furnished by the eligible professional (or the
group, as applicable); or
``(ii) if determined appropriate by the
Secretary, the eligible professional does not
submit (including both electronically and
nonelectronically) a sufficient number (as
determined by the Secretary) of prescriptions
under part D.
If the Secretary makes the determination to apply
clause (ii) for a period, then clause (i) shall not
apply for such period.
``(C) Applicable electronic prescribing percent.--
For purposes of subparagraph (A), the term `applicable
electronic prescribing percent' means--
``(i) for 2009 and 2010, 2.0 percent;
``(ii) for 2011 and 2012, 1.0 percent; and
``(iii) for 2013, 0.5 percent.'';
(2) in paragraph (3), as redesignated by section 131(b)--
(A) in the heading, by inserting ``and successful
electronic prescriber'' after ``reporting''; and
(B) by inserting after subparagraph (A) the
following new subparagraph:
``(B) Successful electronic prescriber.--
``(i) In general.--For purposes of
paragraph (2) and subsection (a)(5), an
eligible professional shall be treated as a
successful electronic prescriber for a
reporting period (or, for purposes of
subsection (a)(5), for the reporting period for
a year) if the eligible professional meets the
requirement described in clause (ii), or, if
the Secretary determines appropriate, the
requirement described in clause (iii). If the
Secretary makes the determination under the
preceding sentence to apply the requirement
described in clause (iii) for a period, then
the requirement described in clause (ii) shall
not apply for such period.
``(ii) Requirement for submitting data on
electronic prescribing quality measures.--The
requirement described in this clause is that,
with respect to covered professional services
furnished by an eligible professional during a
reporting period (or, for purposes of
subsection (a)(5), for the reporting period for
a year), if there are any electronic
prescribing quality measures that have been
established under the physician reporting
system and are applicable to any such services
furnished by such professional for the period,
such professional reported each such measure
under such system in at least 50 percent of the
cases in which such measure is reportable by
such professional under such system.
``(iii) Requirement for electronically
prescribing under part d.--The requirement
described in this clause is that the eligible
professional electronically submitted a
sufficient number (as determined by the
Secretary) of prescriptions under part D during
the reporting period (or, for purposes of
subsection (a)(5), for the reporting period for
a year).
``(iv) Use of part d data.--Notwithstanding
sections 1860D-15(d)(2)(B) and 1860D-15(f)(2),
the Secretary may use data regarding drug
claims submitted for purposes of section 1860D-
15 that are necessary for purposes of clause
(iii), paragraph (2)(B)(ii), and paragraph
(5)(G).
``(v) Standards for electronic
prescribing.--To the extent practicable, in
determining whether eligible professionals meet
the requirements under clauses (ii) and (iii)
for purposes of clause (i), the Secretary shall
ensure that eligible professionals utilize
electronic prescribing systems in compliance
with standards established for such systems
pursuant to the Part D Electronic Prescribing
Program under section 1860D-4(e).''; and
(3) in paragraph (5)(E), by striking clause (iii) and
inserting the following new clause:
``(iii) the determination of a successful
electronic prescriber under paragraph (3), the
limitation under paragraph (2)(B), and the
exception under subsection (a)(5)(B); and''.
(b) Incentive Payment Adjustment.--Section 1848(a) of the Social
Security Act (42 U.S.C. 1395w-4(a)) is amended by adding at the end the
following new paragraph:
``(5) Incentives for electronic prescribing.--
``(A) Adjustment.--
``(i) In general.--Subject to subparagraph
(B) and subsection (m)(2)(B), with respect to
covered professional services furnished by an
eligible professional during 2012 or any
subsequent year, if the eligible professional
is not a successful electronic prescriber for
the reporting period for the year (as
determined under subsection (m)(3)(B)), the fee
schedule amount for such services furnished by
such professional during the year (including
the fee schedule amount for purposes of
determining a payment based on such amount)
shall be equal to the applicable percent of the
fee schedule amount that would otherwise apply
to such services under this subsection
(determined after application of paragraph (3)
but without regard to this paragraph).
``(ii) Applicable percent.--For purposes of
clause (i), the term `applicable percent'
means--
``(I) for 2012, 99 percent;
``(II) for 2013, 98.5 percent; and
``(III) for 2014 and each
subsequent year, 98 percent.
``(B) Significant hardship exception.--The
Secretary may, on a case-by-case basis, exempt an
eligible professional from the application of the
payment adjustment under subparagraph (A) if the
Secretary determines, subject to annual renewal, that
compliance with the requirement for being a successful
electronic prescriber would result in a significant
hardship, such as in the case of an eligible
professional who practices in a rural area without
sufficient Internet access.
``(C) Application.--
``(i) Physician reporting system rules.--
Paragraphs (5), (6), and (8) of subsection (k)
shall apply for purposes of this paragraph in
the same manner as they apply for purposes of
such subsection.
``(ii) Incentive payment validation
rules.--Clauses (ii) and (iii) of subsection
(m)(5)(D) shall apply for purposes of this
paragraph in a similar manner as they apply for
purposes of such subsection.
``(D) Definitions.--For purposes of this paragraph:
``(i) Eligible professional; covered
professional services.--The terms `eligible
professional' and `covered professional
services' have the meanings given such terms in
subsection (k)(3).
``(ii) Physician reporting system.--The
term `physician reporting system' means the
system established under subsection (k).
``(iii) Reporting period.--The term
`reporting period' means, with respect to a
year, a period specified by the Secretary.''.
(c) GAO Report on Electronic Prescribing.--Not later than September
1, 2012, the Comptroller General of the United States shall submit to
Congress a report on the implementation of the incentives for
electronic prescribing established under the provisions of, and
amendments made by, this section. Such report shall include information
regarding the following:
(1) The percentage of eligible professionals (as defined in
section 1848(k)(3) of the Social Security Act (42 U.S.C. 1395w-
4(k)(3)) that are using electronic prescribing systems,
including a determination of whether less than 50 percent of
eligible professionals are using electronic prescribing
systems.
(2) If less than 50 percent of eligible professionals are
using electronic prescribing systems, recommendations for
increasing the use of electronic prescribing systems by
eligible professionals, such as changes to the incentive
payment adjustments established under section 1848(a)(5) of
such Act, as added by subsection (b).
(3) The estimated savings to the Medicare program under
title XVIII of such Act resulting from the use of electronic
prescribing systems.
(4) Reductions in avoidable medical errors resulting from
the use of electronic prescribing systems.
(5) The extent to which the privacy and security of the
personal health information of Medicare beneficiaries is
protected when such beneficiaries' prescription drug data and
usage information is used for purposes other than their direct
clinical care, including--
(A) whether information identifying the beneficiary
is, and remains, removed from data regarding the
beneficiary's prescription drug utilization; and
(B) the extent to which current law requires
sufficient and appropriate oversight and audit
capabilities to monitor the practice of prescription
drug data mining.
(6) Such other recommendations and administrative action as
the Comptroller General determines to be appropriate.
SEC. 133. EXPANDING ACCESS TO PRIMARY CARE SERVICES.
(a) Revisions to the Medicare Medical Home Demonstration Project.--
(1) Authority to expand.--Section 204(b) of division B of
the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395b-1
note) is amended--
(A) in paragraph (1), by striking ``The project''
and inserting ``Subject to paragraph (3), the
project''; and
(B) by adding at the end the following new
paragraph:
``(3) Expansion.--The Secretary may expand the duration and
the scope of the project under paragraph (1), to an extent
determined appropriate by the Secretary, if the Secretary
determines that such expansion will result in any of the
following conditions being met:
``(A) The expansion of the project is expected to
improve the quality of patient care without increasing
spending under the Medicare program (not taking into
account amounts available under subsection (g)).
``(B) The expansion of the project is expected to
reduce spending under the Medicare program (not taking
into account amounts available under subsection (g))
without reducing the quality of patient care.''.
(2) Funding and application.--Section 204 of division B of
the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395b-1
note) is amended by adding at the end the following new
subsections:
``(g) Funding From SMI Trust Fund.--There shall be available, from
the Federal Supplementary Medical Insurance Trust Fund (under section
1841 of the Social Security Act (42 U.S.C. 1395t)), the amount of
$100,000,000 to carry out the project.
``(h) Application.--Chapter 35 of title 44, United States Code,
shall not apply to the conduct of the project.''.
(b) Application of Budget-Neutrality Adjustor to Conversion
Factor.--Section 1848(c)(2)(B) of the Social Security Act (42 U.S.C.
1395w-4(c)(2)(B)) is amended by adding at the end the following new
clause:
``(vi) Alternative application of budget-
neutrality adjustment.--Notwithstanding
subsection (d)(9)(A), effective for fee
schedules established beginning with 2009, with
respect to the 5-year review of work relative
value units used in fee schedules for 2007 and
2008, in lieu of continuing to apply budget-
neutrality adjustments required under clause
(ii) for 2007 and 2008 to work relative value
units, the Secretary shall apply such budget-
neutrality adjustments to the conversion factor
otherwise determined for years beginning with
2009.''.
SEC. 134. EXTENSION OF FLOOR ON MEDICARE WORK GEOGRAPHIC ADJUSTMENT
UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.
(a) In General.--Section 1848(e)(1)(E) of the Social Security Act
(42 U.S.C. 1395w-4(e)(1)(E)), as amended by section 103 of the
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-
173), is amended by striking ``before July 1, 2008'' and inserting
``before January 1, 2010''.
(b) Treatment of Physicians' Services Furnished in Certain Areas.--
Section 1848(e)(1)(G) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(G)) is amended by adding at the end the following new sentence:
``For purposes of payment for services furnished in the State described
in the preceding sentence on or after January 1, 2009, after
calculating the work geographic index in subparagraph (A)(iii), the
Secretary shall increase the work geographic index to 1.5 if such index
would otherwise be less than 1.5''.
(c) Technical Correction.--Section 602(1) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public
Law 108-173; 117 Stat. 2301) is amended to read as follows:
``(1) in subparagraph (A), by striking `subparagraphs (B),
(C), and (E)' and inserting `subparagraphs (B), (C), (E), and
(G)'; and''.
SEC. 135. IMAGING PROVISIONS.
(a) Accreditation Requirement.--
(1) Accreditation requirement.--Section 1834 of the Social
Security Act (42 U.S.C. 1395m) is amended by inserting after
subsection (d) the following new subsection:
``(e) Accreditation Requirement for Advanced Diagnostic Imaging
Services.--
``(1) In general.--
``(A) In general.--Beginning with January 1, 2012,
with respect to the technical component of advanced
diagnostic imaging services for which payment is made
under the fee schedule established under section
1848(b) and that are furnished by a supplier, payment
may only be made if such supplier is accredited by an
accreditation organization designated by the Secretary
under paragraph (2)(B)(i).
``(B) Advanced diagnostic imaging services
defined.--In this subsection, the term `advanced
diagnostic imaging services' includes--
``(i) diagnostic magnetic resonance
imaging, computed tomography, and nuclear
medicine (including positron emission
tomography); and
``(ii) such other diagnostic imaging
services, including services described in
section 1848(b)(4)(B) (excluding X-ray,
ultrasound, and fluoroscopy), as specified by
the Secretary in consultation with physician
specialty organizations and other stakeholders.
``(C) Supplier defined.--In this subsection, the
term `supplier' has the meaning given such term in
section 1861(d).
``(2) Accreditation organizations.--
``(A) Factors for designation of accreditation
organizations.--The Secretary shall consider the
following factors in designating accreditation
organizations under subparagraph (B)(i) and in
reviewing and modifying the list of accreditation
organizations designated pursuant to subparagraph (C):
``(i) The ability of the organization to
conduct timely reviews of accreditation
applications.
``(ii) Whether the organization has
established a process for the timely
integration of new advanced diagnostic imaging
services into the organization's accreditation
program.
``(iii) Whether the organization uses
random site visits, site audits, or other
strategies for ensuring accredited suppliers
maintain adherence to the criteria described in
paragraph (3).
``(iv) The ability of the organization to
take into account the capacities of suppliers
located in a rural area (as defined in section
1886(d)(2)(D)).
``(v) Whether the organization has
established reasonable fees to be charged to
suppliers applying for accreditation.
``(vi) Such other factors as the Secretary
determines appropriate.
``(B) Designation.--Not later than January 1, 2010,
the Secretary shall designate organizations to accredit
suppliers furnishing the technical component of
advanced diagnostic imaging services. The list of
accreditation organizations so designated may be
modified pursuant to subparagraph (C).
``(C) Review and modification of list of
accreditation organizations.--
``(i) In general.--The Secretary shall
review the list of accreditation organizations
designated under subparagraph (B) taking into
account the factors under subparagraph (A).
Taking into account the results of such review,
the Secretary may, by regulation, modify the
list of accreditation organizations designated
under subparagraph (B).
``(ii) Special rule for accreditations done
prior to removal from list of designated
accreditation organizations.--In the case where
the Secretary removes an organization from the
list of accreditation organizations designated
under subparagraph (B), any supplier that is
accredited by the organization during the
period beginning on the date on which the
organization is designated as an accreditation
organization under subparagraph (B) and ending
on the date on which the organization is
removed from such list shall be considered to
have been accredited by an organization
designated by the Secretary under subparagraph
(B) for the remaining period such accreditation
is in effect.
``(3) Criteria for accreditation.--The Secretary shall
establish procedures to ensure that the criteria used by an
accreditation organization designated under paragraph (2)(B) to
evaluate a supplier that furnishes the technical component of
advanced diagnostic imaging services for the purpose of
accreditation of such supplier is specific to each imaging
modality. Such criteria shall include--
``(A) standards for qualifications of medical
personnel who are not physicians and who furnish the
technical component of advanced diagnostic imaging
services;
``(B) standards for qualifications and
responsibilities of medical directors and supervising
physicians, including standards that recognize the
considerations described in paragraph (4);
``(C) procedures to ensure that equipment used in
furnishing the technical component of advanced
diagnostic imaging services meets performance
specifications;
``(D) standards that require the supplier have
procedures in place to ensure the safety of persons who
furnish the technical component of advanced diagnostic
imaging services and individuals to whom such services
are furnished;
``(E) standards that require the establishment and
maintenance of a quality assurance and quality control
program by the supplier that is adequate and
appropriate to ensure the reliability, clarity, and
accuracy of the technical quality of diagnostic images
produced by such supplier; and
``(F) any other standards or procedures the
Secretary determines appropriate.
``(4) Recognition in standards for the evaluation of
medical directors and supervising physicians.--The standards
described in paragraph (3)(B) shall recognize whether a medical
director or supervising physician--
``(A) in a particular specialty receives training
in advanced diagnostic imaging services in a residency
program;
``(B) has attained, through experience, the
necessary expertise to be a medical director or a
supervising physician;
``(C) has completed any continuing medical
education courses relating to such services; or
``(D) has met such other standards as the Secretary
determines appropriate.
``(5) Rule for accreditations made prior to designation.--
In the case of a supplier that is accredited before January 1,
2010, by an accreditation organization designated by the
Secretary under paragraph (2)(B) as of January 1, 2010, such
supplier shall be considered to have been accredited by an
organization designated by the Secretary under such paragraph
as of January 1, 2012, for the remaining period such
accreditation is in effect.''.
(2) Conforming amendments.--
(A) In general.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)) is amended--
(i) in paragraph (21), by striking ``or''
at the end;
(ii) in paragraph (22), by striking the
period at the end and inserting ``; or''; and
(iii) by inserting after paragraph (22) the
following new paragraph:
``(23) which are the technical component of advanced
diagnostic imaging services described in section 1834(e)(1)(B)
for which payment is made under the fee schedule established
under section 1848(b) and that are furnished by a supplier (as
defined in section 1861(d)), if such supplier is not accredited
by an accreditation organization designated by the Secretary
under section 1834(e)(2)(B).''.
(B) Effective date.--The amendments made by this
paragraph shall apply to advanced diagnostic imaging
services furnished on or after January 1, 2012.
(b) Demonstration Project To Assess the Appropriate Use of Imaging
Services.--
(1) Conduct of demonstration project.--
(A) In general.--The Secretary of Health and Human
Services (in this section referred to as the
``Secretary'') shall conduct a demonstration project
using the models described in paragraph (2)(E) to
collect data regarding physician compliance with
appropriateness criteria selected under paragraph
(2)(D) in order to determine the appropriateness of
advanced diagnostic imaging services furnished to
Medicare beneficiaries.
(B) Advanced diagnostic imaging services.--In this
subsection, the term ``advanced diagnostic imaging
services'' has the meaning given such term in section
1834(e)(1)(B) of the Social Security Act, as added by
subsection (a).
(C) Authority to focus demonstration project.--The
Secretary may focus the demonstration project with
respect to certain advanced diagnostic imaging
services, such as services that account for a large
amount of expenditures under the Medicare program,
services that have recently experienced a high rate of
growth, or services for which appropriateness criteria
exists.
(2) Implementation and design of demonstration project.--
(A) Implementation and duration.--
(i) Implementation.--The Secretary shall
implement the demonstration project under this
subsection not later than January 1, 2010.
(ii) Duration.--The Secretary shall conduct
the demonstration project under this subsection
for a 2-year period.
(B) Application and selection of participating
physicians.--
(i) Application.--Each physician that
desires to participate in the demonstration
project under this subsection shall submit an
application to the Secretary at such time, in
such manner, and containing such information as
the Secretary may require.
(ii) Selection.--The Secretary shall select
physicians to participate in the demonstration
project under this subsection from among
physicians submitting applications under clause
(i). The Secretary shall ensure that the
physicians selected--
(I) represent a wide range of
geographic areas, demographic
characteristics (such as urban, rural,
and suburban), and practice settings
(such as private and academic
practices); and
(II) have the capability to submit
data to the Secretary (or an entity
under a subcontract with the Secretary)
in an electronic format in accordance
with standards established by the
Secretary.
(C) Administrative costs and incentives.--The
Secretary shall--
(i) reimburse physicians for reasonable
administrative costs incurred in participating
in the demonstration project under this
subsection; and
(ii) provide reasonable incentives to
physicians to encourage participation in the
demonstration project under this subsection.
(D) Use of appropriateness criteria.--
(i) In general.--The Secretary, in
consultation with medical specialty societies
and other stakeholders, shall select criteria
with respect to the clinical appropriateness of
advanced diagnostic imaging services for use in
the demonstration project under this
subsection.
(ii) Criteria selected.--Any criteria
selected under clause (i) shall--
(I) be developed or endorsed by a
medical specialty society; and
(II) be developed in adherence to
appropriateness principles developed by
a consensus organization, such as the
AQA alliance.
(E) Models for collecting data regarding physician
compliance with selected criteria.--Subject to
subparagraph (H), in carrying out the demonstration
project under this subsection, the Secretary shall use
each of the following models for collecting data
regarding physician compliance with appropriateness
criteria selected under subparagraph (D):
(i) A model described in subparagraph (F).
(ii) A model described in subparagraph (G).
(iii) Any other model that the Secretary
determines to be useful in evaluating the use
of appropriateness criteria for advanced
diagnostic imaging services.
(F) Point of service model described.--A model
described in this subparagraph is a model that--
(i) uses an electronic or paper intake form
that--
(I) contains a certification by the
physician furnishing the imaging
service that the data on the intake
form was confirmed with the Medicare
beneficiary before the service was
furnished;
(II) contains standardized data
elements for diagnosis, service
ordered, service furnished, and such
other information determined by the
Secretary, in consultation with medical
specialty societies and other
stakeholders, to be germane to
evaluating the effectiveness of the use
of appropriateness criteria selected
under subparagraph (D); and
(III) is accessible to physicians
participating in the demonstration
project under this subsection in a
format that allows for the electronic
submission of such form; and
(ii) provides for feedback reports in
accordance with paragraph (3)(B).
(G) Point of order model described.--A model
described in this subparagraph is a model that--
(i) uses a computerized order-entry system
that requires the transmittal of relevant
supporting information at the time of referral
for advanced diagnostic imaging services and
provides automated decision-support feedback to
the referring physician regarding the
appropriateness of furnishing such imaging
services; and
(ii) provides for feedback reports in
accordance with paragraph (3)(B).
(H) Limitation.--In no case may the Secretary use
prior authorization--
(i) as a model for collecting data
regarding physician compliance with
appropriateness criteria selected under
subparagraph (D) under the demonstration
project under this subsection; or
(ii) under any model used for collecting
such data under the demonstration project.
(I) Required contracts and performance standards
for certain entities.--
(i) In general.--The Secretary shall enter
into contracts with entities to carry out the
model described in subparagraph (G).
(ii) Performance standards.--The Secretary
shall establish and enforce performance
standards for such entities under the contracts
entered into under clause (i), including
performance standards with respect to--
(I) the satisfaction of Medicare
beneficiaries who are furnished
advanced diagnostic imaging services by
a physician participating in the
demonstration project;
(II) the satisfaction of physicians
participating in the demonstration
project;
(III) if applicable, timelines for
the provision of feedback reports under
paragraph (3)(B); and
(IV) any other areas determined
appropriate by the Secretary.
(3) Comparison of utilization of advanced diagnostic
imaging services and feedback reports.--
(A) Comparison of utilization of advanced
diagnostic imaging services.--The Secretary shall
consult with medical specialty societies and other
stakeholders to develop mechanisms for comparing the
utilization of advanced diagnostic imaging services by
physicians participating in the demonstration project
under this subsection against--
(i) the appropriateness criteria selected
under paragraph (2)(D); and
(ii) to the extent feasible, the
utilization of such services by physicians not
participating in the demonstration project.
(B) Feedback reports.--The Secretary shall, in
consultation with medical specialty societies and other
stakeholders, develop mechanisms to provide feedback
reports to physicians participating in the
demonstration project under this subsection. Such
feedback reports shall include--
(i) a profile of the rate of compliance by
the physician with appropriateness criteria
selected under paragraph (2)(D), including a
comparison of--
(I) the rate of compliance by the
physician with such criteria; and
(II) the rate of compliance by the
physician's peers (as defined by the
Secretary) with such criteria; and
(ii) to the extent feasible, a comparison
of--
(I) the rate of utilization of
advanced diagnostic imaging services by
the physician; and
(II) the rate of utilization of
such services by the physician's peers
(as defined by the Secretary) who are
not participating in the demonstration
project.
(4) Conduct of demonstration project and waiver.--
(A) Conduct of demonstration project.--Chapter 35
of title 44, United States Code, shall not apply to the
conduct of the demonstration project under this
subsection.
(B) Waiver.--The Secretary may waive such
provisions of titles XI and XVIII of the Social
Security Act (42 U.S.C. 1301 et seq.; 1395 et seq.) as
may be necessary to carry out the demonstration project
under this subsection.
(5) Evaluation and report.--
(A) Evaluation.--The Secretary shall evaluate the
demonstration project under this subsection to--
(i) assess the timeliness and efficacy of
the demonstration project;
(ii) assess the performance of entities
under a contract entered into under paragraph
(2)(I)(i);
(iii) analyze data--
(I) on the rates of appropriate,
uncertain, and inappropriate advanced
diagnostic imaging services furnished
by physicians participating in the
demonstration project;
(II) on patterns and trends in the
appropriateness and inappropriateness
of such services furnished by such
physicians;
(III) on patterns and trends in
national and regional variations of
care with respect to the furnishing of
such services; and
(IV) on the correlation between the
appropriateness of the services
furnished and image results; and
(iv) address--
(I) the thresholds used under the
demonstration project to identify
acceptable and outlier levels of
performance with respect to the
appropriateness of advanced diagnostic
imaging services furnished;
(II) whether prospective use of
appropriateness criteria could have an
effect on the volume of such services
furnished;
(III) whether expansion of the use
of appropriateness criteria with
respect to such services to a broader
population of Medicare beneficiaries
would be advisable;
(IV) whether, under such an
expansion, physicians who demonstrate
consistent compliance with such
appropriateness criteria should be
exempted from certain requirements;
(V) the use of incident-specific
versus practice-specific outlier
information in formulating future
recommendations with respect to the use
of appropriateness criteria for such
services under the Medicare program;
and
(VI) the potential for using
methods (including financial
incentives), in addition to those used
under the models under the
demonstration project, to ensure
compliance with such criteria.
(B) Report.--Not later than 1 year after the
completion of the demonstration project under this
subsection, the Secretary shall submit to Congress a
report containing the results of the evaluation of the
demonstration project conducted under subparagraph (A),
together with recommendations for such legislation and
administrative action as the Secretary determines
appropriate.
(6) Funding.--The Secretary shall provide for the transfer
from the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 of the Social Security Act (42
U.S.C. 1395t) of $10,000,000, for carrying out the
demonstration project under this subsection (including costs
associated with administering the demonstration project,
reimbursing physicians for administrative costs and providing
incentives to encourage participation under paragraph (2)(C),
entering into contracts under paragraph (2)(I), and evaluating
the demonstration project under paragraph (5)).
(c) GAO Study and Reports on Accreditation Requirement for Advanced
Diagnostic Imaging Services.--
(1) Study.--
(A) In general.--The Comptroller General of the
United States (in this subsection referred to as the
``Comptroller General'') shall conduct a study, by
imaging modality, on--
(i) the effect of the accreditation
requirement under section 1834(e) of the Social
Security Act, as added by subsection (a); and
(ii) any other relevant questions involving
access to, and the value of, advanced
diagnostic imaging services for Medicare
beneficiaries.
(B) Issues.--The study conducted under subparagraph
(A) shall examine the following:
(i) The impact of such accreditation
requirement on the number, type, and quality of
imaging services furnished to Medicare
beneficiaries.
(ii) The cost of such accreditation
requirement, including costs to facilities of
compliance with such requirement and costs to
the Secretary of administering such
requirement.
(iii) Access to imaging services by
Medicare beneficiaries, especially in rural
areas, before and after implementation of such
accreditation requirement.
(iv) Such other issues as the Secretary
determines appropriate.
(2) Reports.--
(A) Preliminary report.--Not later than March 1,
2013, the Comptroller General shall submit a
preliminary report to Congress on the study conducted
under paragraph (1).
(B) Final report.--Not later than March 1, 2014,
the Comptroller General shall submit a final report to
Congress on the study conducted under paragraph (1),
together with recommendations for such legislation and
administrative action as the Comptroller General
determines appropriate.
SEC. 136. EXTENSION OF TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY
SERVICES UNDER MEDICARE.
Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (as enacted into law by section
1(a)(6) of Public Law 106-554), as amended by section 732 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(42 U.S.C. 1395w-4 note), section 104 of division B of the Tax Relief
and Health Care Act of 2006 (42 U.S.C. 1395w-4 note), and section 104
of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law
110-173), is amended by striking ``2007, and the first 6 months of
2008'' and inserting ``2007, 2008, and 2009''.
SEC. 137. ACCOMMODATION OF PHYSICIANS ORDERED TO ACTIVE DUTY IN THE
ARMED SERVICES.
Section 1842(b)(6)(D)(iii) of the Social Security Act (42 U.S.C.
1395u(b)(6)(D)(iii)), as amended by section 116 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is
amended by striking ``(before July 1, 2008)''.
SEC. 138. ADJUSTMENT FOR MEDICARE MENTAL HEALTH SERVICES.
(a) Payment Adjustment.--
(1) In general.--For purposes of payment for services
furnished under the physician fee schedule under section 1848
of the Social Security Act (42 U.S.C. 1395w-4) during the
period beginning on July 1, 2008, and ending on December 31,
2009, the Secretary of Health and Human Services shall increase
the fee schedule otherwise applicable for specified services by
5 percent.
(2) Nonapplication of budget-neutrality.--The budget-
neutrality provision of section 1848(c)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395w-4(c)(2)(B)(ii)) shall not apply
to the adjustments described in paragraph (1).
(b) Definition of Specified Services.--In this section, the term
``specified services'' means procedure codes for services in the
categories of the Health Care Common Procedure Coding System,
established by the Secretary of Health and Human Services under section
1848(c)(5) of the Social Security Act (42 U.S.C. 1395w-4(c)(5)), as of
July 1, 2007, and as subsequently modified by the Secretary, consisting
of psychiatric therapeutic procedures furnished in office or other
outpatient facility settings or in inpatient hospital, partial
hospital, or residential care facility settings, but only with respect
to such services in such categories that are in the subcategories of
services which are--
(1) insight oriented, behavior modifying, or supportive
psychotherapy; or
(2) interactive psychotherapy.
(c) Implementation.--Notwithstanding any other provision of law,
the Secretary may implement this section by program instruction or
otherwise.
SEC. 139. IMPROVEMENTS FOR MEDICARE ANESTHESIA TEACHING PROGRAMS.
(a) Special Payment Rule for Teaching Anesthesiologists.--Section
1848(a) of the Social Security Act (42 U.S.C. 1395w-4(a)), as amended
by section 132(b), is amended--
(1) in paragraph (4)(A), by inserting ``except as provided
in paragraph (5),'' after ``anesthesia cases,''; and
(2) by adding at the end the following new paragraph:
``(6) Special rule for teaching anesthesiologists.--With
respect to physicians' services furnished on or after January
1, 2010, in the case of teaching anesthesiologists involved in
the training of physician residents in a single anesthesia case
or two concurrent anesthesia cases, the fee schedule amount to
be applied shall be 100 percent of the fee schedule amount
otherwise applicable under this section if the anesthesia
services were personally performed by the teaching
anesthesiologist alone and paragraph (4) shall not apply if--
``(A) the teaching anesthesiologist is present
during all critical or key portions of the anesthesia
service or procedure involved; and
``(B) the teaching anesthesiologist (or another
anesthesiologist with whom the teaching
anesthesiologist has entered into an arrangement) is
immediately available to furnish anesthesia services
during the entire procedure.''.
(b) Treatment of Certified Registered Nurse Anesthetists.--With
respect to items and services furnished on or after January 1, 2010,
the Secretary of Health and Human Services shall make appropriate
adjustments to payments under the Medicare program under title XVIII of
the Social Security Act for teaching certified registered nurse
anesthetists to implement a policy with respect to teaching certified
registered nurse anesthetists that--
(1) is consistent with the adjustments made by the special
rule for teaching anesthesiologists under section 1848(a)(6) of
the Social Security Act, as added by subsection (a); and
(2) maintains the existing payment differences between
teaching anesthesiologists and teaching certified registered
nurse anesthetists.
PART II--OTHER PAYMENT AND COVERAGE IMPROVEMENTS
SEC. 141. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY CAPS.
Section 1833(g)(5) of the Social Security Act (42 U.S.C.
1395l(g)(5)), as amended by section 105 of the Medicare, Medicaid, and
SCHIP Extension Act of 2007 (Public Law 110-173), is amended by
striking ``June 30, 2008'' and inserting ``December 31, 2009''.
SEC. 142. EXTENSION OF PAYMENT RULE FOR BRACHYTHERAPY AND THERAPEUTIC
RADIOPHARMACEUTICALS.
Section 1833(t)(16)(C) of the Social Security Act (42 U.S.C.
1395l(t)(16)(C)), as amended by section 106 of the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (Public Law 110-173), is amended by
striking ``July 1, 2008'' each place it appears and inserting ``January
1, 2010''.
SEC. 143. SPEECH-LANGUAGE PATHOLOGY SERVICES.
(a) In General.--Section 1861(ll) of the Social Security Act (42
U.S.C. 1395x(ll)) is amended--
(1) by redesignating paragraphs (2) and (3) as paragraphs
(3) and (4), respectively; and
(2) by inserting after paragraph (1) the following new
paragraph:
``(2) The term `outpatient speech-language pathology services' has
the meaning given the term `outpatient physical therapy services' in
subsection (p), except that in applying such subsection--
``(A) `speech-language pathology' shall be substituted for
`physical therapy' each place it appears; and
``(B) `speech-language pathologist' shall be substituted
for `physical therapist' each place it appears.''.
(b) Conforming Amendments.--
(1) Section 1832(a)(2)(C) of the Social Security Act (42
U.S.C. 1395k(a)(2)(C)) is amended--
(A) by striking ``and outpatient'' and inserting
``, outpatient''; and
(B) by inserting before the semicolon at the end
the following: ``, and outpatient speech-language
pathology services (other than services to which the
second sentence of section 1861(p) applies through the
application of section 1861(ll)(2))''.
(2) Subparagraphs (A) and (B) of section 1833(a)(8) of the
Social Security Act (42 U.S.C. 1395l(a)(8)) are each amended by
striking ``(which includes outpatient speech-language pathology
services)'' and inserting ``, outpatient speech-language
pathology services,''.
(3) Section 1833(g)(1) of the Social Security Act (42
U.S.C. 1395l(g)(1)) is amended--
(A) by inserting ``and speech-language pathology
services of the type described in such section through
the application of section 1861(ll)(2)'' after
``1861(p)''; and
(B) by inserting ``and speech-language pathology
services'' after ``and physical therapy services''.
(4) The second sentence of section 1835(a) of the Social
Security Act (42 U.S.C. 1395n(a)) is amended--
(A) by striking ``section 1861(g)'' and inserting
``subsection (g) or (ll)(2) of section 1861'' each
place it appears; and
(B) by inserting ``or outpatient speech-language
pathology services, respectively'' after ``occupational
therapy services''.
(5) Section 1861(p) of the Social Security Act (42 U.S.C.
1395x(p)) is amended by striking the fourth sentence.
(6) Section 1861(s)(2)(D) of the Social Security Act (42
U.S.C. 1395x(s)(2)(D)) is amended by inserting ``, outpatient
speech-language pathology services,'' after ``physical therapy
services''.
(7) Section 1862(a)(20) of the Social Security Act (42
U.S.C. 1395y(a)(20)) is amended--
(A) by striking ``outpatient occupational therapy
services or outpatient physical therapy services'' and
inserting ``outpatient physical therapy services,
outpatient speech-language pathology services, or
outpatient occupational therapy services''; and
(B) by striking ``section 1861(g)'' and inserting
``subsection (g) or (ll)(2) of section 1861''.
(8) Section 1866(e)(1) of the Social Security Act (42
U.S.C. 1395cc(e)(1)) is amended--
(A) by striking ``section 1861(g)'' and inserting
``subsection (g) or (ll)(2) of section 1861'' the first
two places it appears;
(B) by striking ``defined) or'' and inserting
``defined),''; and
(C) by inserting before the semicolon at the end
the following: ``, or (through the operation of section
1861(ll)(2)) with respect to the furnishing of
outpatient speech-language pathology''.
(9) Section 1877(h)(6) of the Social Security Act (42
U.S.C. 1395nn(h)(6)) is amended by adding at the end the
following new subparagraph:
``(L) Outpatient speech-language pathology
services.''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after July 1, 2009.
(d) Construction.--Nothing in this section shall be construed to
affect existing regulations and policies of the Centers for Medicare &
Medicaid Services that require physician oversight of care as a
condition of payment for speech-language pathology services under part
B of the Medicare program.
SEC. 144. PAYMENT AND COVERAGE IMPROVEMENTS FOR PATIENTS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE AND OTHER CONDITIONS.
(a) Coverage of Pulmonary and Cardiac Rehabilitation.--
(1) In general.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x), as amended by section 101(a), is amended--
(A) in subsection (s)(2)--
(i) in subparagraph (AA), by striking
``and'' at the end;
(ii) by adding at the end the following new
subparagraphs:
``(CC) items and services furnished under a cardiac
rehabilitation program (as defined in subsection
(eee)(1)) or under a pulmonary rehabilitation program
(as defined in subsection (fff)(1)); and
``(DD) items and services furnished under an
intensive cardiac rehabilitation program (as defined in
subsection (eee)(4));''; and
(B) by adding at the end the following new
subsections:
``Cardiac Rehabilitation Program; Intensive Cardiac Rehabilitation
Program
``(eee)(1) The term `cardiac rehabilitation program' means a
physician-supervised program (as described in paragraph (2)) that
furnishes the items and services described in paragraph (3).
``(2) A program described in this paragraph is a program under
which--
``(A) items and services under the program are delivered--
``(i) in a physician's office;
``(ii) in a hospital on an outpatient basis; or
``(iii) in other settings determined appropriate by
the Secretary.
``(B) a physician is immediately available and accessible
for medical consultation and medical emergencies at all times
items and services are being furnished under the program,
except that, in the case of items and services furnished under
such a program in a hospital, such availability shall be
presumed; and
``(C) individualized treatment is furnished under a written
plan established, reviewed, and signed by a physician every 30
days that describes--
``(i) the individual's diagnosis;
``(ii) the type, amount, frequency, and duration of
the items and services furnished under the plan; and
``(iii) the goals set for the individual under the
plan.
``(3) The items and services described in this paragraph are--
``(A) physician-prescribed exercise;
``(B) cardiac risk factor modification, including
education, counseling, and behavioral intervention (to the
extent such education, counseling, and behavioral intervention
is closely related to the individual's care and treatment and
is tailored to the individual's needs);
``(C) psychosocial assessment;
``(D) outcomes assessment; and
``(E) such other items and services as the Secretary may
determine, but only if such items and services are--
``(i) reasonable and necessary for the diagnosis or
active treatment of the individual's condition;
``(ii) reasonably expected to improve or maintain
the individual's condition and functional level; and
``(iii) furnished under such guidelines relating to
the frequency and duration of such items and services
as the Secretary shall establish, taking into account
accepted norms of medical practice and the reasonable
expectation of improvement of the individual.
``(4)(A) The term `intensive cardiac rehabilitation program' means
a physician-supervised program (as described in paragraph (2)) that
furnishes the items and services described in paragraph (3) and has
shown, in peer-reviewed published research, that it accomplished--
``(i) one or more of the following:
``(I) positively affected the progression of
coronary heart disease; or
``(II) reduced the need for coronary bypass
surgery; or
``(III) reduced the need for percutaneous coronary
interventions; and
``(ii) a statistically significant reduction in 5 or more
of the following measures from their level before receipt of
cardiac rehabilitation services to their level after receipt of
such services:
``(I) low density lipoprotein;
``(II) triglycerides;
``(III) body mass index;
``(IV) systolic blood pressure;
``(V) diastolic blood pressure; or
``(VI) the need for cholesterol, blood pressure,
and diabetes medications.
``(B) To be eligible for an intensive cardiac rehabilitation
program, an individual must have--
``(i) had an acute myocardial infarction within the
preceding 12 months;
``(ii) had coronary bypass surgery;
``(iii) stable angina pectoris;
``(iv) had heart valve repair or replacement;
``(v) had percutaneous transluminal coronary angioplasty
(PTCA) or coronary stenting; or
``(vi) had a heart or heart-lung transplant.
``(C) An intensive cardiac rehabilitation program may be provided
in a series of 72 one-hour sessions (as defined in section 1848(b)(5)),
up to 6 sessions per day, over a period of up to 18 weeks.
``(5) The Secretary shall establish standards to ensure that a
physician with expertise in the management of individuals with cardiac
pathophysiology who is licensed to practice medicine in the State in
which a cardiac rehabilitation program (or the intensive cardiac
rehabilitation program, as the case may be) is offered--
``(A) is responsible for such program; and
``(B) in consultation with appropriate staff, is involved
substantially in directing the progress of individual in the
program.
``Pulmonary Rehabilitation Program
``(fff)(1) The term `pulmonary rehabilitation program' means a
physician-supervised program (as described in subsection (eee)(2) with
respect to a program under this subsection) that furnishes the items
and services described in paragraph (2).
``(2) The items and services described in this paragraph are--
``(A) physician-prescribed exercise;
``(B) education or training (to the extent the education or
training is closely and clearly related to the individual's
care and treatment and is tailored to such individual's needs);
``(C) psychosocial assessment;
``(D) outcomes assessment; and
``(E) such other items and services as the Secretary may
determine, but only if such items and services are--
``(i) reasonable and necessary for the diagnosis or
active treatment of the individual's condition;
``(ii) reasonably expected to improve or maintain
the individual's condition and functional level; and
``(iii) furnished under such guidelines relating to
the frequency and duration of such items and services
as the Secretary shall establish, taking into account
accepted norms of medical practice and the reasonable
expectation of improvement of the individual.
``(3) The Secretary shall establish standards to ensure that a
physician with expertise in the management of individuals with
respiratory pathophysiology who is licensed to practice medicine in the
State in which a pulmonary rehabilitation program is offered--
``(A) is responsible for such program; and
``(B) in consultation with appropriate staff, is involved
substantially in directing the progress of individual in the
program.''.
(2) Payment for intensive cardiac rehabilitation
programs.--
(A) Inclusion in physician fee schedule.--Section
1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-
4(j)(3)) is amended by inserting ``(2)(DD),'' after
``(2)(AA),''.
(B) Conforming amendment.--Section 1848(b) of the
Social Security Act (42 U.S.C. 1395w-4(b)) is amended
by adding at the end the following new paragraph:
``(5) Treatment of intensive cardiac rehabilitation
program.--
``(A) In general.--In the case of an intensive
cardiac rehabilitation program described in section
1861(eee)(4), the Secretary shall substitute the
Medicare OPD fee schedule amount established under the
prospective payment system for hospital outpatient
department service under paragraph (3)(D) of section
1833(t) for cardiac rehabilitation (under HCPCS codes
93797 and 93798 for calendar year 2007, or any
succeeding HCPCS codes for cardiac rehabilitation).
``(B) Definition of session.--Each of the services
described in subparagraphs (A) through (E) of section
1861(eee)(3), when furnished for one hour, is a
separate session of intensive cardiac rehabilitation.
``(C) Multiple sessions per day.--Payment may be
made for up to 6 sessions per day of the series of 72
one-hour sessions of intensive cardiac rehabilitation
services described in section 1861(eee)(4)(B).''.
(3) Effective date.--The amendments made by this subsection
shall apply to items and services furnished on or after January
1, 2010.
(b) Repeal of Transfer of Ownership of Oxygen Equipment.--
(1) In general.--Section 1834(a)(5)(F) of the Social
Security Act (42 U.S.C. 1395m(a)(5)(F)) is amended--
(A) in the heading, by striking ``OWNERSHIP of
equipment'' and inserting ``RENTAL cap''; and
(B) by striking clause (ii) and inserting the
following:
``(ii) Payments and rules after rental
cap.--After the 36th continuous month during
which payment is made for the equipment under
this paragraph--
``(I) the supplier furnishing such
equipment under this subsection shall
continue to furnish the equipment
during any period of medical need for
the remainder of the reasonable useful
lifetime of the equipment, as
determined by the Secretary;
``(II) payments for oxygen shall
continue to be made in the amount
recognized for oxygen under paragraph
(9) for the period of medical need; and
``(III) maintenance and servicing
payments shall, if the Secretary
determines such payments are reasonable
and necessary, be made (for parts and
labor not covered by the supplier's or
manufacturer's warranty, as determined
by the Secretary to be appropriate for
the equipment), and such payments shall
be in an amount determined to be
appropriate by the Secretary.''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect on January 1, 2009.
SEC. 145. CLINICAL LABORATORY TESTS.
(a) Repeal of Medicare Competitive Bidding Demonstration Project
for Clinical Laboratory Services.--
(1) In general.--Section 1847 of the Social Security Act
(42 U.S.C. 1395w-3) is amended by striking subsection (e).
(2) Conforming amendments.--Section 1833(a)(1)(D) of the
Social Security Act (42 U.S.C. 1395l(a)(1)(D)) is amended--
(A) by inserting ``or'' before ``(ii)''; and
(B) by striking ``or (iii) on the basis'' and all
that follows before the comma at the end.
(3) Effective date.--The amendments made by this subsection
shall take effect on the date of the enactment of this Act.
(b) Clinical Laboratory Test Fee Schedule Update Adjustment.--
Section 1833(h)(2)(A)(i) of the Social Security Act (42 U.S.C.
1395l(h)(2)(A)(ii)) is amended by inserting ``minus, for each of the
years 2009 through 2013, 0.5 percentage points'' after ``city
average)''.
SEC. 146. IMPROVED ACCESS TO AMBULANCE SERVICES.
(a) Extension of Increased Medicare Payments for Ground Ambulance
Services.--Section 1834(l)(13) of the Social Security Act (42 U.S.C.
1395m(l)(13)) is amended--
(1) in subparagraph (A)--
(A) in the matter preceding clause (i), by
inserting ``and for such services furnished on or after
July 1, 2008, and before January 1, 2010'' after
``2007,'';
(B) in clause (i), by inserting ``(or 3 percent if
such service is furnished on or after July 1, 2008, and
before January 1, 2010)'' after ``2 percent''; and
(C) in clause (ii), by inserting ``(or 2 percent if
such service is furnished on or after July 1, 2008, and
before January 1, 2010)'' after ``1 percent''; and
(2) in subparagraph (B)--
(A) in the heading, by striking ``2006'' and
inserting ``applicable period''; and
(B) by inserting ``applicable'' before ``period''.
(b) Air Ambulance Payment Improvements.--
(1) Treatment of certain areas for payment for air
ambulance services under the ambulance fee schedule.--
Notwithstanding any other provision of law, for purposes of
making payments under section 1834(l) of the Social Security
Act (42 U.S.C. 1395m(l)) for air ambulance services furnished
during the period beginning on July 1, 2008, and ending on
December 31, 2009, any area that was designated as a rural area
for purposes of making payments under such section for air
ambulance services furnished on December 31, 2006, shall be
treated as a rural area for purposes of making payments under
such section for air ambulance services furnished during such
period.
(2) Clarification regarding satisfaction of requirement of
medically necessary.--
(A) In general.--Section 1834(l)(14)(B)(i) of the
Social Security Act (42 U.S.C. 1395m(l)(14)(B)(i)) is
amended by striking ``reasonably determines or
certifies'' and inserting ``certifies or reasonably
determines''.
(B) Effective date.--The amendment made by
subparagraph (A) shall apply to services furnished on
or after the date of the enactment of this Act.
SEC. 147. EXTENSION AND EXPANSION OF THE MEDICARE HOLD HARMLESS
PROVISION UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR
HOSPITAL OUTPATIENT DEPARTMENT (HOPD) SERVICES FOR
CERTAIN HOSPITALS.
Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C.
1395l(t)(7)(D)(i)) is amended--
(1) in subclause (II)--
(A) in the first sentence, by striking ``2009'' and
inserting ``2010''; and
(B) by striking the second sentence and inserting
the following new sentence: ``For purposes of the
preceding sentence, the applicable percentage shall be
95 percent with respect to covered OPD services
furnished in 2006, 90 percent with respect to such
services furnished in 2007, and 85 percent with respect
to such services furnished in 2008 or 2009.''; and
(2) by adding at the end the following new subclause:
``(III) In the case of a sole community
hospital (as defined in section
1886(d)(5)(D)(iii)) that has not more than 100
beds, for covered OPD services furnished on or
after January 1, 2009, and before January 1,
2010, for which the PPS amount is less than the
pre-BBA amount, the amount of payment under
this subsection shall be increased by 85
percent of the amount of such difference.''.
SEC. 148. CLARIFICATION OF PAYMENT FOR CLINICAL LABORATORY TESTS
FURNISHED BY CRITICAL ACCESS HOSPITALS.
(a) In General.--Section 1834(g)(4) of the Social Security Act (42
U.S.C. 1395m(g)(4)) is amended--
(1) in the heading, by striking ``no beneficiary cost-
sharing for'' and inserting ``treatment of''; and
(2) by adding at the end the following new sentence: ``For
purposes of the preceding sentence and section 1861(mm)(3),
clinical diagnostic laboratory services furnished by a critical
access hospital shall be treated as being furnished as part of
outpatient critical access services without regard to whether
the individual with respect to whom such services are furnished
is physically present in the critical access hospital, or in a
skilled nursing facility or a clinic (including a rural health
clinic) that is operated by a critical access hospital, at the
time the specimen is collected.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services furnished on or after July 1, 2009.
SEC. 149. ADDING CERTAIN ENTITIES AS ORIGINATING SITES FOR PAYMENT OF
TELEHEALTH SERVICES.
(a) In General.--Section 1834(m)(4)(C)(ii) of the Social Security
Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the
following new subclauses:
``(VI) A hospital-based or critical
access hospital-based renal dialysis
center (including satellites).
``(VII) A skilled nursing facility
(as defined in section 1819(a)).
``(VIII) A community mental health
center (as defined in section
1861(ff)(3)(B)).''.
(b) Conforming Amendment.--Section 1888(e)(2)(A)(ii) of the Social
Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
``telehealth services furnished under section 1834(m)(4)(C)(ii)(VII),''
after ``section 1861(s)(2),''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2009.
SEC. 150. MEDPAC STUDY AND REPORT ON IMPROVING CHRONIC CARE
DEMONSTRATION PROGRAMS.
(a) Study.--The Medicare Payment Advisory Commission (in this
section referred to as the ``Commission'') shall conduct a study on the
feasability and advisability of establishing a Medicare Chronic Care
Practice Research Network that would serve as a standing network of
providers testing new models of care coordination and other care
approaches for chronically ill beneficiaries, including the initiation,
operation, evaluation, and, if appropriate, expansion of such models to
the broader Medicare patient population. In conducting such study, the
Commission shall take into account the structure, implementation, and
results of prior and existing care coordination and disease management
demonstrations and pilots, including the Medicare Coordinated Care
Demonstration Project under section 4016 of the Balanced Budget Act of
1997 (42 U.S.C. 1395b-1 note) and the chronic care improvement programs
under section 1807 of the Social Security Act (42 U.S.C. 1395b-8),
commonly known to as ``Medicare Health Support''.
(b) Report.--Not later than June 15, 2009, the Commission shall
submit to Congress a report containing the results of the study
conducted under subsection (a).
SEC. 151. INCREASE OF FQHC PAYMENT LIMITS.
(a) In General.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by adding at the end the following new subsection:
``(v) Increase of FQHC Payment Limits.--In the case of services
furnished by Federally qualified health centers (as defined in section
1861(aa)(4)), the Secretary shall establish payment limits with respect
to such services under this part for services furnished--
``(1) in 2010, at the limits otherwise established under
this part for such year increased by $5; and
``(2) in a subsequent year, at the limits established under
this subsection for the previous year increased by the
percentage increase in the MEI (as defined in section
1842(i)(3)) for such subsequent year.''.
(b) Study and Report on the Effects and Adequacy of the Medicare
Federally Qualified Health Center Payment Structure.--
(1) Study.--The Comptroller General of the United States
shall conduct a study to determine whether the structure for
payments for services furnished by Federally qualified health
centers (as defined in section 1861(aa)(4) of the Social
Security Act (42 U.S.C. 1395x(aa)(4)) under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.)
adequately reimburses Federally qualified health centers for
the care furnished to Medicare beneficiaries. In conducting
such study, the Comptroller General shall--
(A) use the most current cost report data
available;
(B) examine the effects of the payment limits
established with respect to such services under such
part B on the ability of Federally qualified health
centers to furnish care to Medicare beneficiaries; and
(C) examine the cost of furnishing services covered
under the Medicare program as of the date of the
enactment of this Act that were not covered under such
program as of the date on which the Secretary
determined the payment rate for Federally qualified
health centers in 1991.
(2) Report.--Not later than 15 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 study conducted
under paragraph (1), together with recommendations for such
legislation and administrative action the Comptroller General
determines appropriate, taking into consideration the structure
and adequacy of the prospective payment methodology used to
make payments to Federally qualified health centers under the
Medicaid program under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
SEC. 152. KIDNEY DISEASE EDUCATION AND AWARENESS PROVISIONS.
(a) Chronic Kidney Disease Initiatives.--Part P of title III of the
Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding
at the end the following new section:
``SEC. 399R. CHRONIC KIDNEY DISEASE INITIATIVES.
``(a) In General.--The Secretary shall establish pilot projects
to--
``(1) increase public and medical community awareness
(particularly of those who treat patients with diabetes and
hypertension) regarding chronic kidney disease, focusing on
prevention;
``(2) increase screening for chronic kidney disease,
focusing on Medicare beneficiaries at risk of chronic kidney
disease; and
``(3) enhance surveillance systems to better assess the
prevalence and incidence of chronic kidney disease.
``(b) Scope and Duration.--
``(1) Scope.--The Secretary shall select at least 3 States
in which to conduct pilot projects under this section.
``(2) Duration.--The pilot projects under this section
shall be conducted for a period that is not longer than 5 years
and shall begin on January 1, 2009.
``(c) Evaluation and Report.--The Comptroller General of the United
States shall conduct an evaluation of the pilot projects conducted
under this section. Not later than 12 months after the date on which
the pilot projects are completed, the Comptroller General shall submit
to Congress a report on the evaluation.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary for the purpose of carrying
out this section.''.
(b) Medicare Coverage of Kidney Disease Patient Education
Services.--
(1) Coverage of kidney disease education services.--
(A) Coverage.--Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)), as amended by
section 144(a), is amended--
(i) in subparagraph (CC), by striking
``and'' after the semicolon at the end;
(ii) in subparagraph (DD), by adding
``and'' after the semicolon at the end; and
(iii) by adding at the end the following
new subparagraph:
``(EE) kidney disease education services (as defined in
subsection (ggg));''.
(B) Services described.--Section 1861 of the Social
Security Act (42 U.S.C. 1395x), as amended by section
144(a), is amended by adding at the end the following
new subsection:
``Kidney Disease Education Services
``(ggg)(1) The term `kidney disease education services' means
educational services that are--
``(A) furnished to an individual with stage IV chronic
kidney disease who, according to accepted clinical guidelines
identified by the Secretary, will require dialysis or a kidney
transplant;
``(B) furnished, upon the referral of the physician
managing the individual's kidney condition, by a qualified
person (as defined in paragraph (2)); and
``(C) designed--
``(i) to provide comprehensive information
(consistent with the standards set under paragraph (3))
regarding--
``(I) the management of comorbidities,
including for purposes of delaying the need for
dialysis;
``(II) the prevention of uremic
complications; and
``(III) each option for renal replacement
therapy (including hemodialysis and peritoneal
dialysis at home and in-center as well as
vascular access options and transplantation);
``(ii) to ensure that the individual has the
opportunity to actively participate in the choice of
therapy; and
``(iii) to be tailored to meet the needs of the
individual involved.
``(2)(A) The term `qualified person' means--
``(i) a physician (as defined in section 1861(r)(1)) or a
physician assistant, nurse practitioner, or clinical nurse
specialist (as defined in section 1861(aa)(5)), who furnishes
services for which payment may be made under the fee schedule
established under section 1848; and
``(ii) a provider of services located in a rural area (as
defined in section 1886(d)(2)(D)).
``(B) Such term does not include a provider of services (other than
a provider of services described in subparagraph (A)(ii)) or a renal
dialysis facility.
``(3) The Secretary shall set standards for the content of such
information to be provided under paragraph (1)(C)(i) after consulting
with physicians, other health professionals, health educators,
professional organizations, accrediting organizations, kidney patient
organizations, dialysis facilities, transplant centers, network
organizations described in section 1881(c)(2), and other knowledgeable
persons. To the extent possible the Secretary shall consult with
persons or entities described in the previous sentence, other than a
dialysis facility, that has not received industry funding from a drug
or biological manufacturer or dialysis facility.
``(4) No individual shall be furnished more than 6 sessions of
kidney disease education services under this title.''.
(C) Payment under the physician fee schedule.--
Section 1848(j)(3) of the Social Security Act (42
U.S.C. 1395w-4(j)(3)), as amended by section 144(b), is
amended by inserting ``(2)(EE),'' after ``(2)(DD),''.
(D) Limitation on number of sessions.--Section
1862(a)(1) of the Social Security Act (42 U.S.C.
1395y(a)(1)) is amended--
(i) in subparagraph (M), by striking
``and'' at the end;
(ii) in subparagraph (N), by striking the
semicolon at the end and inserting ``, and'';
and
(iii) by adding at the end the following
new subparagraph:
``(O) in the case of kidney disease education services (as
defined in paragraph (1) of section 1861(ggg)), which are
furnished in excess of the number of sessions covered under
paragraph (4) of such section;''.
(2) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after January 1, 2010.
SEC. 153. RENAL DIALYSIS PROVISIONS.
(a) Composite Rate.--
(1) Update.--Section 1881(b)(12)(G) of the Social Security
Act (42 U.S.C. 1395rr(b)(12)(G)) is amended--
(A) in clause (i), by striking ``and'' at the end;
(B) in clause (ii)--
(i) by inserting ``and before January 1,
2009,'' after ``April 1, 2007,''; and
(ii) by striking the period at the end and
inserting a semicolon; and
(C) by adding at the end the following new clauses:
``(iii) furnished on or after January 1, 2009, and before
January 1, 2010, by 1.0 percent above the amount of such
composite rate component for such services furnished on
December 31, 2008; and
``(iv) furnished on or after January 1, 2010, by 1.0
percent above the amount of such composite rate component for
such services furnished on December 31, 2009.''.
(2) Site neutral composite rate.--Section 1881(b)(12)(A) of
the Social Security Act (42 U.S.C. 1395rr(b)(12)(A)) is amended
by adding at the end the following new sentence: ``Under such
system, the payment rate for dialysis services furnished on or
after January 1, 2009, by providers of services shall be the
same as the payment rate (computed without regard to this
sentence) for such services furnished by renal dialysis
facilities, and in applying the geographic index under
subparagraph (D) to providers of services, the labor share
shall be based on the labor share otherwise applied for renal
dialysis facilities.''.
(b) Development of ESRD Bundled Payment System.--
(1) In general.--Section 1881(b) of the Social Security Act
(42 U.S.C. 1395rr(b)) is amended by adding at the end the
following new paragraph:
``(14)(A)(i) Subject to subparagraph (E), for services furnished on
or after January 1, 2011, the Secretary shall implement a payment
system under which a single payment is made under this title to a
provider of services or a renal dialysis facility for renal dialysis
services (as defined in subparagraph (B)) in lieu of any other payment
(including a payment adjustment under paragraph (12)(B)(ii)) and for
such services and items furnished pursuant to paragraph (4).
``(ii) In implementing the system under this paragraph the
Secretary shall ensure that the estimated total amount of payments
under this title for 2011 for renal dialysis services shall equal 98
percent of the estimated total amount of payments for renal dialysis
services, including payments under paragraph (12)(B)(ii), that would
have been made under this title with respect to services furnished in
2011 if such system had not been implemented. In making the estimation
under subclause (I), the Secretary shall use per patient utilization
data from 2007, 2008, or 2009, whichever has the lowest per patient
utilization.
``(B) For purposes of this paragraph, the term `renal dialysis
services' includes--
``(i) items and services included in the composite rate for
renal dialysis services as of December 31, 2010;
``(ii) erythropoiesis stimulating agents and any oral form
of such agents that are furnished to individuals for the
treatment of end stage renal disease;
``(iii) other drugs and biologicals that are furnished to
individuals for the treatment of end stage renal disease and
for which payment was (before the application of this
paragraph) made separately under this title, and any oral
equivalent form of such drug or biological; and
``(iv) diagnostic laboratory tests and other items and
services not described in clause (i) that are furnished to
individuals for the treatment of end stage renal disease.
Such term does not include vaccines.
``(C) The system under this paragraph may provide for payment on
the basis of services furnished during a week or month or such other
appropriate unit of payment as the Secretary specifies.
``(D) Such system--
``(i) shall include a payment adjustment based on case mix
that may take into account patient weight, body mass index,
comorbidities, length of time on dialysis, age, race,
ethnicity, and other appropriate factors;
``(ii) shall include a payment adjustment for high cost
outliers due to unusual variations in the type or amount of
medically necessary care, including variations in the amount of
erythropoiesis stimulating agents necessary for anemia
management;
``(iii) shall include a payment adjustment that reflects
the extent to which costs incurred by low-volume facilities (as
defined by the Secretary) in furnishing renal dialysis services
exceed the costs incurred by other facilities in furnishing
such services, and for payment for renal dialysis services
furnished on or after January 1, 2011, and before January 1,
2014, such payment adjustment shall not be less than 10
percent; and
``(iv) may include such other payment adjustments as the
Secretary determines appropriate, such as a payment
adjustment--
``(I) for pediatric providers of services and renal
dialysis facilities;
``(II) by a geographic index, such as the index
referred to in paragraph (12)(D), as the Secretary
determines to be appropriate; and
``(III) for providers of services or renal dialysis
facilities located in rural areas.
The Secretary shall take into consideration the unique treatment needs
of children and young adults in establishing such system.
``(E)(i) The Secretary shall provide for a four-year phase-in (in
equal increments) of the payment amount under the payment system under
this paragraph, with such payment amount being fully implemented for
renal dialysis services furnished on or after January 1, 2014.
``(ii) A provider of services or renal dialysis facility may make a
one-time election to be excluded from the phase-in under clause (i) and
be paid entirely based on the payment amount under the payment system
under this paragraph. Such an election shall be made prior to January
1, 2011, in a form and manner specified by the Secretary, and is final
and may not be rescinded.
``(iii) The Secretary shall make an adjustment to the payments
under this paragraph for years during which the phase-in under clause
(i) is applicable so that the estimated total amount of payments under
this paragraph, including payments under this subparagraph, shall equal
the estimated total amount of payments that would otherwise occur under
this paragraph without such phase-in.
``(F)(i) Subject to clause (ii), beginning in 2012, the Secretary
shall annually increase payment amounts established under this
paragraph by an ESRD market basket percentage increase factor for a
bundled payment system for renal dialysis services that reflects
changes over time in the prices of an appropriate mix of goods and
services included in renal dialysis services minus 1.0 percentage
point.
``(ii) For years during which a phase-in of the payment system
pursuant to subparagraph (E) is applicable, the following rules shall
apply to the portion of the payment under the system that is based on
the payment of the composite rate that would otherwise apply if the
system under this paragraph had not been enacted:
``(I) The update under clause (i) shall not apply.
``(II) The Secretary shall annually increase such composite
rate by the ESRD market basket percentage increase factor
described in clause (i) minus 1.0 percentage point.
``(G) There shall be no administrative or judicial review under
section 1869, section 1878, or otherwise of the determination of
payment amounts under subparagraph (A), the establishment of an
appropriate unit of payment under subparagraph (C), the identification
of renal dialysis services included in the bundled payment, the
adjustments under subparagraph (D), the application of the phase-in
under subparagraph (E), and the establishment of the market basket
percentage increase factors under subparagraph (F).
``(H) Erythropoiesis stimulating agents and other drugs and
biologicals shall be treated as prescribed and dispensed or
administered and available only under part B if they are--
``(i) furnished to an individual for the treatment of end
stage renal disease; and
``(ii) included in subparagraph (B) for purposes of payment
under this paragraph.''.
(2) Prohibition of unbundling.--Section 1862(a) of the
Social Security Act (42 U.S.C. 1395y(a)), as amended by section
135(a)(2), is amended--
(A) in paragraph (22), by striking ``or'' at the
end;
(B) in paragraph (23), by striking the period at
the end and inserting ``; or''; and
(C) by inserting after paragraph (23) the following
new paragraph:
``(24) where such expenses are for renal dialysis services
(as defined in subparagraph (B) of section 1881(b)(14)) for
which payment is made under such section unless such payment is
made under such section to a provider of services or a renal
dialysis facility for such services.''.
(3) Conforming amendments.--(A) Section 1881(b) of the
Social Security Act (42 U.S.C. 1395rr(b)) is amended--
(i) in paragraph (12)(A), by striking ``In lieu of
payment'' and inserting ``Subject to paragraph (14), in
lieu of payment'';
(ii) in the second sentence of paragraph (12)(F)--
(I) by inserting ``or paragraph (14)''
after ``this paragraph''; and
(II) by inserting ``or under the system
under paragraph (14)'' after ``subparagraph
(B)''; and
(iii) in paragraph (13)--
(I) in subparagraph (A), in the matter
preceding clause (i), by striking ``The payment
amounts'' and inserting ``Subject to paragraph
(14), the payment amounts''; and
(II) in subparagraph (B)--
(aa) in clause (i), by striking
``(i)'' after ``(B)'' and by inserting
``, subject to paragraph (14)'' before
the period at the end; and
(bb) by striking clause (ii).
(B) Section 1861(s)(2)(F) of the Social Security Act (42
U.S.C. 1395x(s)(2)(F)) is amended by inserting ``, and, for
items and services furnished on or after January 1, 2011, renal
dialysis services (as defined in section 1881(b)(14)(B))''
before the semicolon at the end.
(C) Section 623(e) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (42 U.S.C. 1395rr
note) is repealed.
(4) Rule of construction.--Nothing in this subsection or
the amendments made by this subsection shall be construed as
authorizing or requiring the Secretary of Health and Human
Services to make payments under the payment system implemented
under paragraph (14)(A)(i) of section 1881(b) of the Social
Security Act (42 U.S.C. 1395rr(b)), as added by paragraph (1),
for any unrecovered amount for any bad debt attributable to
deductible and coinsurance on items and services not included
in the basic case-mix adjusted composite rate under paragraph
(12) of such section as in effect before the date of the
enactment of this Act.
(c) Quality Incentives in the End-Stage Renal Disease Program.--
Section 1881 of the Social Security Act (42 U.S.C. 1395rr) is amended
by adding at the end the following new subsection:
``(h) Quality Incentives in the End-Stage Renal Disease Program.--
``(1) Quality incentives.--
``(A) In general.--With respect to renal dialysis
services (as defined in subsection (b)(14)(B))
furnished on or after January 1, 2012, in the case of a
provider of services or a renal dialysis facility that
does not meet the requirement described in subparagraph
(B) with respect to the year, payments otherwise made
to such provider or facility under the system under
subsection (b)(14) for such services shall be reduced
by up to 2.0 percent, as determined appropriate by the
Secretary.
``(B) Requirement.--The requirement described in
this subparagraph is that the provider or facility
meets (or exceeds) the total performance score under
paragraph (3) with respect to performance standards
established by the Secretary with respect to measures
specified in paragraph (2).
``(C) No effect in subsequent years.--The reduction
under subparagraph (A) shall apply only with respect to
the year involved, and the Secretary shall not take
into account such reduction in computing the single
payment amount under the system under paragraph (14) in
a subsequent year.
``(2) Measures.--
``(A) In general.--The measures specified under
this paragraph with respect to the year involved shall
include--
``(i) measures on anemia management that
reflect the labeling approved by the Food and
Drug Administration for such management and
measures on dialysis adequacy;
``(ii) to the extent feasible, such measure
(or measures) of patient satisfaction as the
Secretary shall specify; and
``(iii) such other measures as the
Secretary specifies, including, to the extent
feasible, measures on--
``(I) iron management;
``(II) bone mineral metabolism; and
``(III) vascular access, including
for maximizing the placement of
arterial venous fistula.
``(B) Use of endorsed measures.--
``(i) In general.--Subject to clause (ii),
any measure specified by the Secretary under
subparagraph (A)(iii) must have been endorsed
by the entity with a contract under section
1890(a).
``(ii) Exception.--In the case of a
specified area or medical topic determined
appropriate by the Secretary for which a
feasible and practical measure has not been
endorsed by the entity with a contract under
section 1890(a), the Secretary may specify a
measure that is not so endorsed as long as due
consideration is given to measures that have
been endorsed or adopted by a consensus
organization identified by the Secretary.
``(C) Updating measures.--The Secretary shall
establish a process for updating the measures specified
under subparagraph (A) in consultation with interested
parties.
``(D) Consideration.--In specifying measures under
subparagraph (A), the Secretary shall consider the
availability of measures that address the unique
treatment needs of children and young adults with
kidney failure.
``(3) Performance scores.--
``(A) Total performance score.--
``(i) In general.--Subject to clause (ii),
the Secretary shall develop a methodology for
assessing the total performance of each
provider of services and renal dialysis
facility based on performance standards with
respect to the measures selected under
paragraph (2) for a performance period
established under paragraph (4)(D) (in this
subsection referred to as the `total
performance score').
``(ii) Application.--For providers of
services and renal dialysis facilities that do
not meet (or exceed) the total performance
score established by the Secretary, the
Secretary shall ensure that the application of
the methodology developed under clause (i)
results in an appropriate distribution of
reductions in payment under paragraph (1) among
providers and facilities achieving different
levels of total performance scores, with
providers and facilities achieving the lowest
total performance scores receiving the largest
reduction in payment under paragraph (1)(A).
``(iii) Weighting of measures.--In
calculating the total performance score, the
Secretary shall weight the scores with respect
to individual measures calculated under
subparagraph (B) to reflect priorities for
quality improvement, such as weighting scores
to ensure that providers of services and renal
dialysis facilities have strong incentives to
meet or exceed anemia management and dialysis
adequacy performance standards, as determined
appropriate by the Secretary.
``(B) Performance score with respect to individual
measures.--The Secretary shall also calculate separate
performance scores for each measure, including for
dialysis adequacy and anemia management.
``(4) Performance standards.--
``(A) Establishment.--Subject to subparagraph (E),
the Secretary shall establish performance standards
with respect to measures selected under paragraph (2)
for a performance period with respect to a year (as
established under subparagraph (D)).
``(B) Achievement and improvement.--The performance
standards established under subparagraph (A) shall
include levels of achievement and improvement, as
determined appropriate by the Secretary.
``(C) Timing.--The Secretary shall establish the
performance standards under subparagraph (A) prior to
the beginning of the performance period for the year
involved.
``(D) Performance period.--The Secretary shall
establish the performance period with respect to a
year. Such performance period shall occur prior to the
beginning of such year.
``(E) Special rule.--The Secretary shall initially
use as the performance standard for the measures
specified under paragraph (2)(A)(i) for a provider of
services or a renal dialysis facility the lesser of--
``(i) the performance of such provider or
facility for such measures in the year selected
by the Secretary under the second sentence of
subsection (b)(14)(A)(ii); or
``(ii) a performance standard based on the
national performance rates for such measures in
a period determined by the Secretary.
``(5) Limitation on review.--There shall be no
administrative or judicial review under section 1869, section
1878, or otherwise of the following:
``(A) The determination of the amount of the
payment reduction under paragraph (1).
``(B) The establishment of the performance
standards and the performance period under paragraph
(4).
``(C) The specification of measures under paragraph
(2).
``(D) The methodology developed under paragraph (3)
that is used to calculate total performance scores and
performance scores for individual measures.
``(6) Public reporting.--
``(A) In general.--The Secretary shall establish
procedures for making information regarding performance
under this subsection available to the public,
including--
``(i) the total performance score achieved
by the provider of services or renal dialysis
facility under paragraph (3) and appropriate
comparisons of providers of services and renal
dialysis facilities to the national average
with respect to such scores; and
``(ii) the performance score achieved by
the provider or facility with respect to
individual measures.
``(B) Opportunity to review.--The procedures
established under subparagraph (A) shall ensure that a
provider of services and a renal dialysis facility has
the opportunity to review the information that is to be
made public with respect to the provider or facility
prior to such data being made public.
``(C) Certificates.--
``(i) In general.--The Secretary shall
provide certificates to providers of services
and renal dialysis facilities who furnish renal
dialysis services under this section to display
in patient areas. The certificate shall
indicate the total performance score achieved
by the provider or facility under paragraph
(3).
``(ii) Display.--Each facility or provider
receiving a certificate under clause (i) shall
prominently display the certificate at the
provider or facility.
``(D) Web-based list.--The Secretary shall
establish a list of providers of services and renal
dialysis facilities who furnish renal dialysis services
under this section that indicates the total performance
score and the performance score for individual measures
achieved by the provider and facility under paragraph
(3). Such information shall be posted on the Internet
website of the Centers for Medicare & Medicaid Services
in an easily understandable format.''.
(d) GAO Report on ESRD Bundling System and Quality Initiative.--Not
later than March 1, 2013, the Comptroller General of the United States
shall submit to Congress a report on the implementation of the payment
system under subsection (b)(14) of section 1881 of the Social Security
Act (as added by subsection (b)) for renal dialysis services and
related services (defined in subparagraph (B) of such subsection
(b)(14)) and the quality initiative under subsection (h) of such
section 1881 (as added by subsection (b)). Such report shall include
the following information:
(1) The changes in utilization rates for erythropoiesis
stimulating agents.
(2) The mode of administering such agents, including
information on the proportion of individuals receiving such
agents intravenously as compared to subcutaneously.
(3) An analysis of the payment adjustment under
subparagraph (D)(iii) of such subsection (b)(14), including an
examination of the extent to which costs incurred by rural,
low-volume providers and facilities (as defined by the
Secretary) in furnishing renal dialysis services exceed the
costs incurred by other providers and facilities in furnishing
such services, and a recommendation regarding the
appropriateness of such adjustment.
(4) The changes, if any, in utilization rates of drugs and
biologicals that the Secretary identifies under subparagraph
(B)(iii) of such subsection (b)(14), and any oral equivalent or
oral substitutable forms of such drugs and biologicals or of
drugs and biologicals described in clause (ii), that have
occurred after implementation of the payment system under such
subsection (b)(14).
(5) Any other information or recommendations for
legislative and administrative actions determined appropriate
by the Comptroller General.
SEC. 154. DELAY IN AND REFORM OF MEDICARE DMEPOS COMPETITIVE
ACQUISITION PROGRAM.
(a) Temporary Delay and Reform.--
(1) In general.--Section 1847(a)(1) of the Social Security
Act (42 U.S.C. 1395w-3(a)(1)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (B)(i), in the matter
before subclause (I), by inserting ``consistent
with subparagraph (D)'' after ``in a manner'';
(ii) in subparagraph (B)(i)(II), by
striking ``80'' and ``in 2009'' and inserting
``an additional 70'' and ``in 2011'',
respectively;
(iii) in subparagraph (B)(i)(III), by
striking ``after 2009'' and inserting ``after
2011 (or, in the case of national mail order
for items and services, after 2010)''; and
(iv) by adding at the end the following new
subparagraphs:
``(D) Changes in competitive acquisition
programs.--
``(i) Round 1 of competitive acquisition
program.--Notwithstanding subparagraph
(B)(i)(I) and in implementing the first round
of the competitive acquisition programs under
this section--
``(I) the contracts awarded under
this section before the date of the
enactment of this subparagraph are
terminated, no payment shall be made
under this title on or after the date
of the enactment of this subparagraph
based on such a contract, and, to the
extent that any damages may be
applicable as a result of the
termination of such contracts, such
damages shall be payable from the
Federal Supplementary Medical Insurance
Trust Fund under section 1841;
``(II) the Secretary shall conduct
the competition for such round in a
manner so that it occurs in 2009 with
respect to the same items and services
and the same areas, except as provided
in subclauses (III) and (IV);
``(III) the Secretary shall exclude
Puerto Rico so that such round of
competition covers 9, instead of 10, of
the largest metropolitan statistical
areas; and
``(IV) there shall be excluded
negative pressure wound therapy items
and services.
Nothing in subclause (I) shall be construed to
provide an independent cause of action or right
to administrative or judicial review with
regard to the termination provided under such
subclause.
``(ii) Round 2 of competitive acquisition
program.--In implementing the second round of
the competitive acquisition programs under this
section described in subparagraph (B)(i)(II)--
``(I) the metropolitan statistical
areas to be included shall be those
metropolitan statistical areas selected
by the Secretary for such round as of
June 1, 2008; and
``(II) the Secretary may subdivide
metropolitan statistical areas with
populations (based upon the most recent
data from the Census Bureau) of at
least 8,000,000 into separate areas for
competitive acquisition purposes.
``(iii) Exclusion of certain areas in
subsequent rounds of competitive acquisition
programs.--In implementing subsequent rounds of
the competitive acquisition programs under this
section, including under subparagraph
(B)(i)(III), for competitions occurring before
2015, the Secretary shall exempt from the
competitive acquisition program (other than
national mail order) the following:
``(I) Rural areas.
``(II) Metropolitan statistical
areas not selected under round 1 or
round 2 with a population of less than
250,000.
``(III) Areas with a low population
density within a metropolitan
statistical area that is otherwise
selected, as determined for purposes of
paragraph (3)(A).
``(E) Verification by oig.--The Inspector General
of the Department of Health and Human Services shall,
through post-award audit, survey, or otherwise, assess
the process used by the Centers for Medicare & Medicaid
Services to conduct competitive bidding and subsequent
pricing determinations under this section that are the
basis for pivotal bid amounts and single payment
amounts for items and services in competitive bidding
areas under rounds 1 and 2 of the competitive
acquisition programs under this section and may
continue to verify such calculations for subsequent
rounds of such programs.
``(F) Supplier feedback on missing financial
documentation.--
``(i) In general.--In the case of a bid
where one or more covered documents in
connection with such bid have been submitted
not later than the covered document review date
specified in clause (ii), the Secretary--
``(I) shall provide, by not later
than 45 days (in the case of the first
round of the competitive acquisition
programs as described in subparagraph
(B)(i)(I)) or 90 days (in the case of a
subsequent round of such programs)
after the covered document review date,
for notice to the bidder of all such
documents that are missing as of the
covered document review date; and
``(II) may not reject the bid on
the basis that any covered document is
missing or has not been submitted on a
timely basis, if all such missing
documents identified in the notice
provided to the bidder under subclause
(I) are submitted to the Secretary not
later than 10 business days after the
date of such notice.
``(ii) Covered document review date.--The
covered document review date specified in this
clause with respect to a competitive
acquisition program is the later of--
``(I) the date that is 30 days
before the final date specified by the
Secretary for submission of bids under
such program; or
``(II) the date that is 30 days
after the first date specified by the
Secretary for submission of bids under
such program.
``(iii) Limitations of process.--The
process provided under this subparagraph--
``(I) applies only to the timely
submission of covered documents;
``(II) does not apply to any
determination as to the accuracy or
completeness of covered documents
submitted or whether such documents
meet applicable requirements;
``(III) shall not prevent the
Secretary from rejecting a bid based on
any basis not described in clause
(i)(II); and
``(IV) shall not be construed as
permitting a bidder to change bidding
amounts or to make other changes in a
bid submission.
``(iv) Covered document defined.--In this
subparagraph, the term `covered document' means
a financial, tax, or other document required to
be submitted by a bidder as part of an original
bid submission under a competitive acquisition
program in order to meet required financial
standards. Such term does not include other
documents, such as the bid itself or
accreditation documentation.''; and
(B) in paragraph (2)(A), by inserting before the
period at the end the following: ``and excluding
certain complex rehabilitative power wheelchairs
recognized by the Secretary as classified within group
3 or higher (and related accessories when furnished in
connection with such wheelchairs)''.
(2) Budget neutral offset.--
(A) In general.--Section 1834(a)(14) of such Act
(42 U.S.C. 1395m(a)(14)) is amended--
(i) by striking ``and'' at the end of
subparagraphs (H) and (I);
(ii) by redesignating subparagraph (J) as
subparagraph (M); and
(iii) by inserting after subparagraph (I)
the following new subparagraphs:
``(J) for 2009--
``(i) in the case of items and services
furnished in any geographic area, if such items
or services were selected for competitive
acquisition in any area under the competitive
acquisition program under section
1847(a)(1)(B)(i)(I) before July 1, 2008,
including related accessories but only if
furnished with such items and services selected
for such competition and diabetic supplies but
only if furnished through mail order, - 9.5
percent; or
``(ii) in the case of other items and
services, the percentage increase in the
consumer price index for all urban consumers
(U.S. urban average) for the 12-month period
ending with June 2008;
``(K) for 2010, 2011, 2012, and 2013, the
percentage increase in the consumer price index for all
urban consumers (U.S. urban average) for the 12-month
period ending with June of the previous year;
``(L) for 2014--
``(i) in the case of items and services
described in subparagraph (J)(i) for which a
payment adjustment has not been made under
subsection (a)(1)(F)(ii) in any previous year,
the percentage increase in the consumer price
index for all urban consumers (U.S. urban
average) for the 12-month period ending with
June 2013, plus 2.0 percentage points; or
``(ii) in the case of other items and
services, the percentage increase in the
consumer price index for all urban consumers
(U.S. urban average) for the 12-month period
ending with June 2013; and''.
(B) Conforming treatment for certain items and
services.--The second sentence of section 1842(s)(1) of
such Act (42 U.S.C. 1395u(s)(1)) is amended by striking
``except that'' and all that follows and inserting the
following: ``except that for items and services
described in paragraph (2)(D)--
``(A) for 2009 section 1834(a)(14)(J)(i) shall apply under
this paragraph instead of the percentage increase otherwise
applicable; and
``(B) for 2014, if subparagraph (A) is applied to the items
and services and there has not been a payment adjustment under
paragraph (3)(B) for the items and services for any previous
year, the percentage increase computed under section
1834(a)(14)(L)(i) shall apply instead of the percentage
increase otherwise applicable.''.
(3) Conforming delay.--Subsections (a)(1)(F) and (h)(1)(H)
of section 1834 of the Social Security Act (42 U.S.C. 1395m)
are each amended by striking ``January 1, 2009'' and inserting
``January 1, 2011''.
(4) Considerations in application.--Section 1834 of such
Act (42 U.S.C. 1395m) is amended--
(A) in subsection (a)(1)--
(i) in subparagraph (F), by inserting
``subject to subparagraph (G),'' before ``that
are included''; and
(ii) by adding at the end the following new
subparagraph:
``(G) Use of information on competitive bid
rates.--The Secretary shall specify by regulation the
methodology to be used in applying the provisions of
subparagraph (F)(ii) and subsection (h)(1)(H)(ii). In
promulgating such regulation, the Secretary shall
consider the costs of items and services in areas in
which such provisions would be applied compared to the
payment rates for such items and services in
competitive acquisition areas.''; and
(B) in subsection (h)(1)(H), by inserting ``subject
to subsection (a)(1)(G),'' before ``that are
included''.
(b) Quality Standards.--
(1) Application of accreditation requirement.--
(A) In general.--Section 1834(a)(20) of the Social
Security Act (42 U.S.C. 1395m(a)(20)) is amended--
(i) in subparagraph (E), by inserting
``including subparagraph (F),'' after ``under
this paragraph,''; and
(ii) by adding at the end the following new
subparagraph:
``(F) Application of accreditation requirement.--In
implementing quality standards under this paragraph--
``(i) subject to clause (ii), the Secretary
shall require suppliers furnishing items and
services described in subparagraph (D) on or
after October 1, 2009, directly or as a
subcontractor for another entity, to have
submitted to the Secretary evidence of
accreditation by an accreditation organization
designated under subparagraph (B) as meeting
applicable quality standards; and
``(ii) in applying such standards and the
accreditation requirement of clause (i) with
respect to eligible professionals (as defined
in section 1848(k)(3)(B)), and including such
other persons, such as orthotists and
prosthetists, as specified by the Secretary,
furnishing such items and services--
``(I) such standards and
accreditation requirement shall not
apply to such professionals and persons
unless the Secretary determines that
the standards being applied are
designed specifically to be applied to
such professionals and persons; and
``(II) the Secretary may exempt
such professionals and persons from
such standards and requirement if the
Secretary determines that licensing,
accreditation, or other mandatory
quality requirements apply to such
professionals and persons with respect
to the furnishing of such items and
services.''.
(B) Construction.--Section 1834(a)(20)(F)(ii) of
the Social Security Act, as added by subparagraph (A),
shall not be construed as preventing the Secretary of
Health and Human Services from implementing the first
round of competition under section 1847 of such Act on
a timely basis.
(2) Disclosure of subcontractors under competitive
acquisition program.--Section 1847(b)(3) of such Act (42 U.S.C.
1395w-3(b)(3)) is amended by adding at the end the following
new subparagraph:
``(C) Disclosure of subcontractors.--
``(i) Initial disclosure.--Not later than
10 days after the date a supplier enters into a
contract with the Secretary under this section,
such supplier shall disclose to the Secretary,
in a form and manner specified by the
Secretary, the information on--
``(I) each subcontracting
relationship that such supplier has in
furnishing items and services under the
contract; and
``(II) whether each such
subcontractor meets the requirement of
section 1834(a)(20)(F)(i), if
applicable to such subcontractor.
``(ii) Subsequent disclosure.--Not later
than 10 days after such a supplier subsequently
enters into a subcontracting relationship
described in clause (i)(II), such supplier
shall disclose to the Secretary, in such form
and manner, the information described in
subclauses (I) and (II) of clause (i).''.
(3) Competitive acquisition ombudsman.--Such section is
further amended by adding at the end the following new
subsection:
``(f) Competitive Acquisition Ombudsman.--The Secretary shall
provide for a competitive acquisition ombudsman within the Centers for
Medicare & Medicaid Services in order to respond to complaints and
inquiries made by suppliers and individuals relating to the application
of the competitive acquisition program under this section. The
ombudsman may be within the office of the Medicare Beneficiary
Ombudsman appointed under section 1808(c). The ombudsman shall submit
to Congress an annual report on the activities under this subsection,
which report shall be coordinated with the report provided under
section 1808(c)(2)(C).''.
(c) Change in Reports and Deadlines.--
(1) GAO report.--Section 302(b)(3) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003
(Public Law 108-173) is amended--
(A) in subparagraph (A)--
(i) by inserting ``and as amended by
section 2 of the Medicare DMEPOS Competitive
Acquisition Reform Act of 2008'' after ``as
amended by paragraph (1)''; and
(ii) by inserting before the period at the
end the following: ``and the topics specified
in subparagraph (C)'';
(B) in subparagraph (B), by striking ``Not later
than January 1, 2009,'' and inserting ``Not later than
1 year after the first date that payments are made
under section 1847 of the Social Security Act,''; and
(C) by adding at the end the following new
subparagraph:
``(C) Topics.--The topics specified in this
subparagraph, for the study under subparagraph (A)
concerning the competitive acquisition program, are the
following:
``(i) Beneficiary access to items and
services under the program, including the
impact on such access of awarding contracts to
bidders that--
``(I) did not have a physical
presence in an area where they received
a contract; or
``(II) had no previous experience
providing the product category they
were contracted to provide.
``(ii) Beneficiary satisfaction with the
program and cost savings to beneficiaries under
the program.
``(iii) Costs to suppliers of participating
in the program and recommendations about ways
to reduce those costs without compromising
quality standards or savings to the Medicare
program.
``(iv) Impact of the program on small
business suppliers.
``(v) Analysis of the impact on utilization
of different items and services paid within the
same Healthcare Common Procedure Coding System
(HCPCS) code.
``(vi) Costs to the Centers for Medicare &
Medicaid Services, including payments made to
contractors, for administering the program
compared with administration of a fee schedule,
in comparison with the relative savings of the
program.
``(vii) Impact on access, Medicare
spending, and beneficiary spending of any
difference in treatment for diabetic testing
supplies depending on how such supplies are
furnished.
``(viii) Such other topics as the
Comptroller General determines to be
appropriate.''.
(2) Delay in other deadlines.--
(A) Program advisory and oversight committee.--
Section 1847(c)(5) of the Social Security Act (42
U.S.C. 1395w-3(c)(5)) is amended by striking ``December
31, 2009'' and inserting ``December 31, 2011''.
(B) Secretarial report.--Section 1847(d) of such
Act (42 U.S.C. 1395w-3(d)) is amended by striking
``July 1, 2009'' and inserting ``July 1, 2011''.
(C) IG report.--Section 302(e) of the Medicare
Prescription Drug, Improvement, and Modernization Act
of 2003 (Public Law 108-173) is amended by striking
``July 1, 2009'' and inserting ``July 1, 2011''.
(3) Evaluation of certain code.--The Secretary of Health
and Human Services shall evaluate the existing Health Care
Common Procedure Coding System (HCPCS) codes for negative
pressure wound therapy to ensure accurate reporting and billing
for items and services under such codes. In carrying out such
evaluation, the Secretary shall use an existing process,
administered by the Durable Medical Equipment Medicare
Administrative Contractors, for the consideration of coding
changes and consider all relevant studies and information
furnished pursuant to such process.
(d) Other Provisions.--
(1) Exemption from competitive acquisition for certain off-
the-shelf orthotics.--Section 1847(a) of the Social Security
Act (42 U.S.C. 1395w-3(a)) is amended by adding at the end the
following new paragraph:
``(7) Exemption from competitive acquisition.--The programs
under this section shall not apply to the following:
``(A) Certain off-the-shelf orthotics.--Items and
services described in paragraph (2)(C) if furnished--
``(i) by a physician or other practitioner
(as defined by the Secretary) to the
physician's or practitioner's own patients as
part of the physician's or practitioner's
professional service; or
``(ii) by a hospital to the hospital's own
patients during an admission or on the date of
discharge.
``(B) Certain durable medical equipment.--Those
items and services described in paragraph (2)(A)--
``(i) that are furnished by a hospital to
the hospital's own patients during an admission
or on the date of discharge; and
``(ii) to which such programs would not
apply, as specified by the Secretary, if
furnished by a physician to the physician's own
patients as part of the physician's
professional service.''.
(2) Correction in face-to-face examination requirement.--
Section 1834(a)(1)(E)(ii) of such Act (42 U.S.C.
1395m(a)(1)(E)(ii)) is amended by striking ``1861(r)(1)'' and
inserting ``1861(r)''.
(3) Special rule in case of national mail-order competition
for diabetic testing strips.--Section 1847(b) of such Act (42
U.S.C. 1395w-3(b)) is amended--
(A) by redesignating paragraph (10) as paragraph
(11); and
(B) by inserting after paragraph (9) the following
new paragraph:
``(10) Special rule in case of competition for diabetic
testing strips.--
``(A) In general.--With respect to the competitive
acquisition program for diabetic testing strips
conducted after the first round of the competitive
acquisition programs, if an entity does not demonstrate
to the Secretary that its bid covers types of diabetic
testing strip products that, in the aggregate and
taking into account volume for the different products,
cover 50 percent (or such higher percentage as the
Secretary may specify) of all such types of products,
the Secretary shall reject such bid. The volume for
such types of products may be determined in accordance
with such data (which may be market based data) as the
Secretary recognizes.
``(B) Study of types of testing strip products.--
Before 2011, the Inspector General of the Department of
Health and Human Services shall conduct a study to
determine the types of diabetic testing strip products
by volume that could be used to make determinations
pursuant to subparagraph (A) for the first competition
under the competitive acquisition program described in
such subparagraph and submit to the Secretary a report
on the results of the study. The Inspector General
shall also conduct such a study and submit such a
report before the Secretary conducts a subsequent
competitive acquistion program described in
subparagraph (A).''.
(4) Other conforming amendments.--Section 1847(b)(11) of
such Act, as redesignated by paragraph (3), is amended--
(A) in subparagraph (C), by inserting ``and the
identification of areas under subsection
(a)(1)(D)(iii)'' after ``(a)(1)(A)'';
(B) in subparagraph (D), by inserting ``and
implementation of subsection (a)(1)(D)'' after
``(a)(1)(B)'';
(C) in subparagraph (E), by striking ``or'' at the
end;
(D) in subparagraph (F), by striking the period at
the end and inserting ``; or''; and
(E) by adding at the end the following new
subparagraph:
``(G) the implementation of the special rule
described in paragraph (10).''.
(5) Funding for implementation.--In addition to funds
otherwise available, for purposes of implementing the
provisions of, and amendments made by, this section, other than
the amendment made by subsection (c)(1) and other than section
1847(a)(1)(E) of the Social Security Act, the Secretary of
Health and Human Services shall provide for the transfer from
the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 of the Social Security Act (42
U.S.C. 1395t) to the Centers for Medicare & Medicaid Services
Program Management Account of $20,000,000 for fiscal year 2008,
and $25,000,000 for each of fiscal years 2009 through 2012.
Amounts transferred under this paragraph for a fiscal year
shall be available until expended.
(e) Effective Date.--The amendments made by this section shall take
effect as of June 30, 2008.
Subtitle D--Provisions Relating to Part C
SEC. 161. PHASE-OUT OF INDIRECT MEDICAL EDUCATION (IME).
(a) In General.--Section 1853(k) of the Social Security Act (42
U.S.C. 1395w-23(k)) is amended--
(1) in paragraph (1), in the matter preceding subparagraph
(A), by striking ``paragraph (2)'' and inserting ``paragraphs
(2) and (4)''; and
(2) by adding at the end the following new paragraph:
``(4) Phase-out of the indirect costs of medical education
from capitation rates.--
``(A) In general.--After determining the applicable
amount for an area for a year under paragraph (1)
(beginning with 2010), the Secretary shall adjust such
applicable amount to exclude from such applicable
amount the phase-in percentage (as defined in
subparagraph (B)(i)) for the year of the Secretary's
estimate of the standardized costs for payments under
section 1886(d)(5)(B) in the area for the year. Any
adjustment under the preceding sentence shall be made
prior to the application of paragraph (2).
``(B) Percentages defined.--For purposes of this
paragraph:
``(i) Phase-in percentage.--The term
`phase-in percentage' means, for an area for a
year, the ratio (expressed as a percentage, but
in no case greater than 100 percent) of--
``(I) the maximum cumulative
adjustment percentage for the year (as
defined in clause (ii)); to
``(II) the standardized IME cost
percentage (as defined in clause (iii))
for the area and year.
``(ii) Maximum cumulative adjustment
percentage.--The term `maximum cumulative
adjustment percentage' means, for--
``(I) 2010, 0.60 percent; and
``(II) a subsequent year, the
maximum cumulative adjustment
percentage for the previous year
increased by 0.60 percentage points.
``(iii) Standardized ime cost percentage.--
The term `standardized IME cost percentage'
means, for an area for a year, the per capita
costs for payments under section 1886(d)(5)(B)
(expressed as a percentage of the fee-for-
service amount specified in subparagraph (C))
for the area and the year.
``(C) Fee-for-service amount.--The fee-for-service
amount specified in this subparagraph for an area for a
year is the amount specified under subsection (c)(1)(D)
for the area and the year.''.
(b) Excluding Adjustment From the Update.--Section 1853(k)(1)(B)(i)
of the Social Security Act (42 U.S.C. 1395w-23(k)(1)(B)(i)) is amended
by striking ``paragraph (2)'' and inserting ``paragraphs (2) and (4)''.
(c) Hold Harmless for PACE Program Payments.--Section 1894(d) of
the Social Security Act (42 U.S.C. 1395eee(d)) is amended by adding at
the end the following new paragraph:
``(3) Capitation rates determined without regard to the
phase-out of the indirect costs of medical education from the
annual medicare advantage capitation rate.--Capitation amounts
under this subsection shall be determined without regard to the
application of section 1853(k)(4).''.
SEC. 162. REVISIONS TO REQUIREMENTS FOR MEDICARE ADVANTAGE PRIVATE FEE-
FOR-SERVICE PLANS.
(a) Requirements To Assure Access to Network Coverage.--
(1) Individual market.--Section 1852(d) of the Social
Security Act (42 U.S.C. 1395w-22(d)) is amended--
(A) in paragraph (4), in the second sentence, by
striking ``The Secretary'' and inserting ``Subject to
paragraph (5), the Secretary''; and
(B) by adding at the end the following new
paragraph:
``(5) Requirement of certain nonemployer medicare advantage
private fee-for-service plans to use contracts with
providers.--
``(A) In general.--For plan year 2011 and
subsequent plan years, in the case of a Medicare
Advantage private fee-for-service plan not described in
paragraph (1) or (2) of section 1857(i) operating in a
network area (as defined in subparagraph (B)), the plan
shall meet the access standards under paragraph (4) in
that area only through entering into written contracts
as provided for under subparagraph (B) of such
paragraph and not, in whole or in part, through the
establishment of payment rates meeting the requirements
under subparagraph (A) of such paragraph.
``(B) Network area defined.--For purposes of
subparagraph (A), the term `network area' means, for a
plan year, an area which the Secretary identifies (in
the Secretary's announcement of the proposed payment
rates for the previous plan year under section
1853(b)(1)(B)) as having at least 2 network-based plans
(as defined in subparagraph (C)) with enrollment under
this part as of the first day of the year in which such
announcement is made.
``(C) Network-based plan defined.--
``(i) In general.--For purposes of
subparagraph (B), the term `network-based plan'
means--
``(I) except as provided in clause
(ii), a Medicare Advantage plan that is
a coordinated care plan described in
section 1851(a)(2)(A)(i);
``(II) a network-based MSA plan;
and
``(III) a reasonable cost
reimbursement plan under section 1876.
``(ii) Exclusion of non-network regional
ppos.--The term `network-based plan' shall not
include an MA regional plan that, with respect
to the area, meets access adequacy standards
under this part substantially through the
authority of section 422.112(a)(1)(ii) of title
42, Code of Federal Regulations, rather than
through written contracts.''.
(2) Employer plans.--Section 1852(d) of the Social Security
Act (42 U.S.C. 1395w-22(d)), as amended by paragraph (1), is
amended--
(A) in paragraph (4), in the second sentence, by
striking ``paragraph (5)'' and inserting ``paragraphs
(5) and (6)''; and
(B) by adding at the end the following new
paragraph:
``(6) Requirement of all employer medicare advantage
private fee-for-service plans to use contracts with
providers.--For plan year 2011 and subsequent plan years, in
the case of a Medicare Advantage private fee-for-service plan
that is described in paragraph (1) or (2) of section 1857(i),
the plan shall meet the access standards under paragraph (4)
only through entering into written contracts as provided for
under subparagraph (B) of such paragraph and not, in whole or
in part, through the establishment of payment rates meeting the
requirements under subparagraph (A) of such paragraph.''.
(3) Access requirements.--
(A) In general.--Section 1852(d)(4)(B) of the
Social Security Act (42 U.S.C. 1395w-22(d)(4)(B)) is
amended by striking ``a sufficient number'' through
``terms of the plan'' and inserting ``a sufficient
number and range of providers within such category to
meet the access standards in subparagraphs (A) through
(E) of paragraph (1)''.
(B) Effective date.--The amendment made by
subparagraph (A) shall apply to plan year 2010 and
subsequent plan years.
(b) Clarification Regarding Utilization.--Section 1859(b)(2) of the
Social Security Act (42 U.S.C. 1395w-28(b)(2)) is amended by adding at
the end the following flush sentence:
``Nothing in subparagraph (B) shall be construed to preclude a
plan from varying rates for such a provider based on the
specialty of the provider, the location of the provider, or
other factors related to such provider that are not related to
utilization, or to preclude a plan from increasing rates for
such a provider based on increased utilization of specified
preventive or screening services.''.
SEC. 163. REVISIONS TO QUALITY IMPROVEMENT PROGRAMS.
(a) Requirement for MA Private Fee-for-Service and MSA Plans To
Have a Quality Improvement Program.--Section 1852(e)(1) of the Social
Security Act (42 U.S.C. 1395w-22(e)(1)) is amended by striking ``(other
than an MA private fee-for-service plan or an MSA plan)''.
(b) Data Collection Requirements for MA Regional Plans, MA Private
Fee-for-Service Plans, and MSA Plans.--Section 1852(e)(3)(A) of the
Social Security Act (42 U.S.C. 1395w-22(e)(3)(A)) is amended--
(1) in clause (i), by adding at the end the following new
sentence: ``With respect to MA private fee-for-service plans
and MSA plans, the requirements under the preceding sentence
may not exceed the requirements under this subparagraph with
respect to MA local plans that are preferred provider
organization plans, except that, for plan year 2010, the
limitation under clause (iii) shall not apply and such
requirements shall apply only with respect to administrative
claims data.''
(2) by striking clause (ii); and
(3) in clause (iii)--
(A) in the heading--
(i) by inserting ``local'' after ``to'';
and
(ii) by inserting ``and ma regional plans''
after ``organizations''; and
(B) by inserting ``and to MA regional plans'' after
``organization plans''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2010.
SEC. 164. REVISIONS RELATING TO SPECIALIZED MEDICARE ADVANTAGE PLANS
FOR SPECIAL NEEDS INDIVIDUALS.
(a) Extension of Authority To Restrict Enrollment.--Section 1859(f)
of the Social Security Act (42 U.S.C. 1395w-28(f)), as amended by
section 108(a) of the Medicare, Medicaid, and SCHIP Extension Act of
2007 (Public Law 110-173) is amended by striking ``2010'' and inserting
``2011''.
(b) Moratorium on Authority To Designate Other Plans as Specialized
MA Plans.--During the period beginning on January 1, 2010, and ending
on December 31, 2010, the Secretary of Health and Human Services may
not exercise the authority provided under section 231(d) of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(42 U.S.C. 1395w-21 note) to designate other plans as specialized MA
plans for special needs individuals.
(c) Requirements for Enrollment.--
(1) In general.--Section 1859 of the Social Security Act
(42 U.S.C. 1395w-28) is amended--
(A) in subsection (b)(6)(A), by inserting ``and
that, as of January 1, 2010, meets the applicable
requirements of paragraph (2), (3), or (4) of
subsection (f), as the case may be'' before the period
at the end; and
(B) in subsection (f)--
(i) by amending the heading to read as
follows: ``Requirements Regarding Enrollment in
Specialized MA Plans for Special Needs
Individuals'';
(ii) by designating the sentence beginning
``In the case of'' as paragraph (1) with the
heading ``Requirements for enrollment.--'' and
with appropriate indentation; and
(iii) by adding at the end the following
new paragraphs:
``(2) Additional requirements for institutional snps.--In
the case of a specialized MA plan for special needs individuals
described in subsection (b)(6)(B)(i), the applicable
requirements described in this paragraph are as follows:
``(A) Each individual that enrolls in the plan on
or after January 1, 2010, is a special needs
individuals described in subsection (b)(6)(B)(i). In
the case of an individual who is living in the
community but requires an institutional level of care,
such individual shall not be considered a special needs
individual described in subsection (b)(6)(B)(i) unless
the determination that the individual requires an
institutional level of care was made--
``(i) using a State assessment tool of the
State in which the individual resides; and
``(ii) by an entity other than the
organization offering the plan.
``(B) The plan meets the requirements described in
paragraph (5).
``(3) Additional requirements for dual snps.--In the case
of a specialized MA plan for special needs individuals
described in subsection (b)(6)(B)(ii), the applicable
requirements described in this paragraph are as follows:
``(A) Each individual that enrolls in the plan on
or after January 1, 2010, is a special needs
individuals described in subsection (b)(6)(B)(ii).
``(B) The plan meets the requirements described in
paragraph (5).
``(C) The plan provides each prospective enrollee,
prior to enrollment, with a comprehensive written
statement (using standardized content and format
established by the Secretary) that describes--
``(i) the benefits and cost-sharing
protections that the individual is entitled to
under the State Medicaid program under title
XIX; and
``(ii) which of such benefits and cost-
sharing protections are covered under the plan.
Such statement shall be included with any description
of benefits offered by the plan.
``(D) The plan has a contract with the State
Medicaid agency to provide benefits, or arrange for
benefits to be provided, for which such individual is
entitled to receive as medical assistance under title
XIX. Such benefits may include long-term care services
consistent with State policy.
``(4) Additional requirements for severe or disabling
chronic condition snps.--In the case of a specialized MA plan
for special needs individuals described in subsection
(b)(6)(B)(iii), the applicable requirements described in this
paragraph are as follows:
``(A) Each individual that enrolls in the plan on
or after January 1, 2010, is a special needs individual
described in subsection (b)(6)(B)(iii).
``(B) The plan meets the requirements described in
paragraph (5).''.
(2) Authority to operate but no service area expansion for
dual snps that do not meet certain requirements.--
Notwithstanding subsection (f) of section 1859 of the Social
Security Act (42 U.S.C. 1395w-28), during the period beginning
on January 1, 2010, and ending on December 31, 2010, in the
case of a specialized Medicare Advantage plan for special needs
individuals described in subsection (b)(6)(B)(ii) of such
section, as amended by this section, that does not meet the
requirement described in subsection (f)(3)(D) of such section,
the Secretary of Health and Human Services--
(A) shall permit such plan to be offered under part
C of title XVIII of such Act; and
(B) shall not permit an expansion of the service
area of the plan under such part C.
(3) Resources for state medicaid agencies.--The Secretary
of Health and Human Services shall provide for the designation
of appropriate staff and resources that can address State
inquiries with respect to the coordination of State and Federal
policies for specialized MA plans for special needs individuals
described in section 1859(b)(6)(B)(ii) of the Social Security
Act (42 U.S.C. 1395w-28(b)(6)(B)(ii)), as amended by this
section.
(4) No requirement for contract.--Nothing in the provisions
of, or amendments made by, this subsection shall require a
State to enter into a contract with a Medicare Advantage
organization with respect to a specialized MA plan for special
needs individuals described in section 1859(b)(6)(B)(ii) of the
Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(ii)), as
amended by this section.
(d) Care Management Requirements for All SNPs.--
(1) Requirements.--Section 1859(f) of the Social Security
Act (42 U.S.C. 1395w-28(f)), as amended by subsection (c)(1),
is amended by adding at the end the following new paragraph:
``(5) Care management requirements for all snps.--The
requirements described in this paragraph are that the
organization offering a specialized MA plan for special needs
individuals described in subsection (b)(6)(B)(i)--
``(A) have in place an evidenced-based model of
care with appropriate networks of providers and
specialists; and
``(B) with respect to each individual enrolled in
the plan--
``(i) conduct an initial assessment and an
annual reassessment of the individual's
physical, psychosocial, and functional needs;
``(ii) develop a plan, in consultation with
the individual as feasible, that identifies
goals and objectives, including measurable
outcomes as well as specific services and
benefits to be provided; and
``(iii) use an interdisciplinary team in
the management of care.''.
(2) Review to ensure compliance with care management
requirements.--Section 1857(d) of the Social Security Act (42
U.S.C. 1395w-27(d)) is amended by adding at the end the
following new paragraph:
``(6) Review to ensure compliance with care management
requirements for specialized medicare advantage plans for
special needs individuals.--In conjunction with the periodic
audit of a specialized Medicare Advantage plan for special
needs individuals under paragraph (1), the Secretary shall
conduct a review to ensure that such organization offering the
plan meets the requirements described in section 1859(f)(5).''.
(e) Clarification of the Definition of a Severe or Disabling
Chronic Conditions Specialized Needs Individual.--
(1) In general.--Section 1859(b)(6)(B)(iii) of the Social
Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)) is amended by
inserting ``who have one or more comorbid and medically complex
chronic conditions that are substantially disabling or life
threatening, have a high risk of hospitalization or other
significant adverse health outcomes, and require specialized
delivery systems across domains of care'' before the period at
the end.
(2) Panel.--The Secretary of Health and Human Services
shall convene a panel of clinical advisors to determine the
conditions that meet the definition of severe and disabling
chronic conditions under section 1859(b)(6)(B)(iii) of the
Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)), as
amended by paragraph (1). The panel shall include the Director
of the Agency for Healthcare Research and Quality (or the
Director's designee).
(f) Special Requirements Regarding Quality Reporting for
Specialized MA Plans for Special Needs Individuals.--
(1) In general.--Section 1852(e)(3)(A) of the Social
Security Act (42 U.S.C. 1395w-22(e)(3)(A)), as amended by
section 163, is amended by inserting after clause (i) the
following new clause:
``(ii) Special requirements for specialized
ma plans for special needs individuals.--In
addition to the data required to be collected,
analyzed, and reported under clause (i) and
notwithstanding the limitations under
subparagraph (B), as part of the quality
improvement program under paragraph (1), each
MA organization offering a specialized Medicare
Advantage plan for special needs individuals
shall provide for the collection, analysis, and
reporting of data that permits the measurement
of health outcomes and other indices of quality
with respect to the requirements described in
paragraphs (2) through (5) of subsection (f).
Such data may be based on claims data and shall
be at the plan level.''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect on a date specified by the Secretary of
Health and Human Services (but in no case later than January 1,
2010), and shall apply to all specialized Medicare Advantage
plans for special needs individuals regardless of when the plan
first entered the Medicare Advantage program under part C of
title XVIII of the Social Security Act.
(g) Effective Date and Application.--The amendments made by
subsections (c)(1), (d), and (e)(1) shall apply to plan years beginning
on or after January 1, 2010, and shall apply to all specialized
Medicare Advantage plans for special needs individuals regardless of
when the plan first entered the Medicare Advantage program under part C
of title XVIII of the Social Security Act.
(h) No Affect on Medicaid Benefits for Duals.--Nothing in the
provisions of, or amendments made by, this section shall affect the
benefits available under the Medicaid program under title XIX of the
Social Security Act for special needs individuals described in section
1859(b)(6)(B)(ii) of such Act (42 U.S.C. 1395w-28(b)(6)(B)(ii)).
SEC. 165. LIMITATION ON OUT-OF-POCKET COSTS FOR DUAL ELIGIBLES AND
QUALIFIED MEDICARE BENEFICIARIES ENROLLED IN A
SPECIALIZED MEDICARE ADVANTAGE PLAN FOR SPECIAL NEEDS
INDIVIDUALS.
(a) In General.--Section 1852(a) of the Social Security Act (42
U.S.C. 1395w-22(a)) is amended by adding at the end the following new
paragraph:
``(7) Limitation on cost-sharing for dual eligibles and
qualified medicare beneficiaries.--In the case of an individual
who is a full-benefit dual eligible individual (as defined in
section 1935(c)(6)) or a qualified medicare beneficiary (as
defined in section 1905(p)(1)) and who is enrolled in a
specialized Medicare Advantage plan for special needs
individuals described in section 1859(b)(6)(B)(ii), the plan
may not impose cost-sharing that exceeds the amount of cost-
sharing that would be permitted with respect to the individual
under title XIX if the individual were not enrolled in such
plan.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to plan years beginning on or after January 1, 2010.
SEC. 166. ADJUSTMENT TO THE MEDICARE ADVANTAGE STABILIZATION FUND.
Section 1858(e)(2)(A)(i) of the Social Security Act (42 U.S.C.
1395w-27a(e)(2)(A)(i)), as amended by section 110 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is
amended--
(1) by striking ``2013'' and inserting ``2014''; and
(2) by striking ``$1,790,000,000'' and inserting ``$1''.
SEC. 167. ACCESS TO MEDICARE REASONABLE COST CONTRACT PLANS.
(a) Extension of Reasonable Cost Contracts.--Section
1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C.
1395mm(h)(5)(C)(ii)), as amended by section 109 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is
amended by striking ``January 1, 2009'' and inserting ``January 1,
2010'' in the matter preceding subclause (I).
(b) Requirement for at Least Two Medicare Advantage Organizations
To Be Offering a Plan in an Area for the Prohibition To Be
Applicable.--Subclauses (I) and (II) of section 1876(h)(5)(C)(ii) of
the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)) are each
amended by inserting ``, provided that all such plans are not offered
by the same Medicare Advantage organization'' after ``clause (iii)''.
(c) Revision of Requirements for a Plan That Are Used To Determine
if Prohibition Is Applicable.--
(1) In general.--Section 1876(h)(5)(C)(iii)(I) of the
Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(iii)(I)) is
amended by inserting ``that are not in another Metropolitan
Statistical Area with a population of more than 250,000'' after
``such Metropolitan Statistical Area''.
(2) Clarification.--Section 1876(h)(5)(C)(iii)(I) of the
Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(iii)(I)) is
amended by adding at the end the following new sentence: ``If
the service area includes a portion in more than 1 Metropolitan
Statistical Area with a population of more than 250,000, the
minimum enrollment determination under the preceding sentence
shall be made with respect to each such Metropolitan
Statistical Area (and such applicable contiguous counties to
such Metropolitan Statistical Area).''.
(d) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study of the reasons (if any) why reasonable
cost contracts under section 1876(h) of the Social Security Act
(42 U.S.C. 1395mm(h)) are unable to become Medicare Advantage
plans under part C of title XVIII of such Act.
(2) Report.--Not later than December 31, 2009, the
Comptroller General of the United States shall submit to
Congress a report containing the results of the study conducted
under paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller
General determines appropriate.
SEC. 168. MEDPAC STUDY AND REPORT ON QUALITY MEASURES.
(a) Study.--The Medicare Payment Advisory Commission shall conduct
a study on how comparable measures of performance and patient
experience can be collected and reported by 2011 for the Medicare
Advantage program under part C of title XVIII of the Social Security
Act and the original Medicare fee-for-service program under parts A and
B of such title. Such study shall address technical issues, such as
data requirements, in addition to issues relating to appropriate
quality benchmarks that--
(1) compare the quality of care Medicare beneficiaries
receive across Medicare Advantage plans; and
(2) compare the quality of care Medicare beneficiaries
receive under Medicare Advantage plans and under the original
Medicare fee-for-service program.
(b) Report.--Not later than March 31, 2010, the Medicare Payment
Advisory Commission shall submit to Congress a report containing the
results of the study conducted under subsection (a), together with
recommendations for such legislation and administrative action as the
Medicare Payment Advisory Commission determines appropriate.
SEC. 169. MEDPAC STUDY AND REPORT ON MEDICARE ADVANTAGE PAYMENTS.
(a) Study.--The Medicare Payment Advisory Commission (in this
section referred to as the ``Commission'') shall conduct a study of the
following:
(1) The correlation between--
(A) the costs that Medicare Advantage organizations
with respect to Medicare Advantage plans incur in
providing coverage under the plan for items and
services covered under the original Medicare fee-for-
service program under parts A and B of title XVIII of
the Social Security Act, as reflected in plan bids; and
(B) county-level spending under such original
Medicare fee-for-service program on a per capita basis,
as calculated by the Chief Actuary of the Centers for
Medicare & Medicaid Services.
The study with respect to the issue described in the preceding
sentence shall include differences in correlation statistics by
plan type and geographic area.
(2) Based on these results of the study with respect to the
issue described in paragraph (1), and other data the Commission
determines appropriate--
(A) alternate approaches to payment with respect to
a Medicare beneficiary enrolled in a Medicare Advantage
plan other than through county-level payment area
equivalents.
(B) the accuracy and completeness of county-level
estimates of per capita spending under such original
Medicare fee-for-service program (including counties in
Puerto Rico), as used to determine the annual Medicare
Advantage capitation rate under section 1853 of the
Social Security Act (42 U.S.C. 1395w-23), and whether
such estimates include--
(i) expenditures with respect to Medicare
beneficiaries at facilities of the Department
of Veterans Affairs; and
(ii) all appropriate administrative
expenses, including claims processing.
(3) Ways to improve the accuracy and completeness of
county-level estimates of per capita spending described in
paragraph (2)(B).
(b) Report.--Not later than March 31, 2010, the Commission shall
submit to Congress a report containing the results of the study
conducted under subsection (a), together with recommendations for such
legislation and administrative action as the Commission determines
appropriate.
Subtitle E--Provisions Relating to Part D
PART I--IMPROVING PHARMACY ACCESS
SEC. 171. PROMPT PAYMENT BY PRESCRIPTION DRUG PLANS AND MA-PD PLANS
UNDER PART D.
(a) Prompt Payment by Prescription Drug Plans.--Section 1860D-12(b)
of the Social Security Act (42 U.S.C. 1395w-112(b)) is amended by
adding at the end the following new paragraph:
``(4) Prompt payment of clean claims.--
``(A) Prompt payment.--
``(i) In general.--Each contract entered
into with a PDP sponsor under this part with
respect to a prescription drug plan offered by
such sponsor shall provide that payment shall
be issued, mailed, or otherwise transmitted
with respect to all clean claims submitted by
pharmacies (other than pharmacies that dispense
drugs by mail order only or are located in, or
contract with, a long-term care facility) under
this part within the applicable number of
calendar days after the date on which the claim
is received.
``(ii) Clean claim defined.--In this
paragraph, the term `clean claim' means a claim
that has no defect or impropriety (including
any lack of any required substantiating
documentation) or particular circumstance
requiring special treatment that prevents
timely payment from being made on the claim
under this part.
``(iii) Date of receipt of claim.--In this
paragraph, a claim is considered to have been
received--
``(I) with respect to claims
submitted electronically, on the date
on which the claim is transferred; and
``(II) with respect to claims
submitted otherwise, on the 5th day
after the postmark date of the claim or
the date specified in the time stamp of
the transmission.
``(B) Applicable number of calendar days defined.--
In this paragraph, the term `applicable number of
calendar days' means--
``(i) with respect to claims submitted
electronically, 14 days; and
``(ii) with respect to claims submitted
otherwise, 30 days.
``(C) Interest payment.--
``(i) In general.--Subject to clause (ii),
if payment is not issued, mailed, or otherwise
transmitted within the applicable number of
calendar days (as defined in subparagraph (B))
after a clean claim is received, the PDP
sponsor shall pay interest to the pharmacy that
submitted the claim at a rate equal to the
weighted average of interest on 3-month
marketable Treasury securities determined for
such period, increased by 0.1 percentage point
for the period beginning on the day after the
required payment date and ending on the date on
which payment is made (as determined under
subparagraph (D)(iv)). Interest amounts paid
under this subparagraph shall not be counted
against the administrative costs of a
prescription drug plan or treated as allowable
risk corridor costs under section 1860D-15(e).
``(ii) Authority not to charge interest.--
The Secretary may provide that a PDP sponsor is
not charged interest under clause (i) in the
case where there are exigent circumstances,
including natural disasters and other unique
and unexpected events, that prevent the timely
processing of claims.
``(D) Procedures involving claims.--
``(i) Claim deemed to be clean.--A claim is
deemed to be a clean claim if the PDP sponsor
involved does not provide notice to the
claimant of any deficiency in the claim--
``(I) with respect to claims
submitted electronically, within 10
days after the date on which the claim
is received; and
``(II) with respect to claims
submitted otherwise, within 15 days
after the date on which the claim is
received.
``(ii) Claim determined to not be a clean
claim.--
``(I) In general.--If a PDP sponsor
determines that a submitted claim is
not a clean claim, the PDP sponsor
shall, not later than the end of the
period described in clause (i), notify
the claimant of such determination.
Such notification shall specify all
defects or improprieties in the claim
and shall list all additional
information or documents necessary for
the proper processing and payment of
the claim.
``(II) Determination after
submission of additional information.--
A claim is deemed to be a clean claim
under this paragraph if the PDP sponsor
involved does not provide notice to the
claimant of any defect or impropriety
in the claim within 10 days of the date
on which additional information is
received under subclause (I).
``(iii) Obligation to pay.--A claim
submitted to a PDP sponsor that is not paid or
contested by the sponsor within the applicable
number of days (as defined in subparagraph (B))
after the date on which the claim is received
shall be deemed to be a clean claim and shall
be paid by the PDP sponsor in accordance with
subparagraph (A).
``(iv) Date of payment of claim.--Payment
of a clean claim under such subparagraph is
considered to have been made on the date on
which--
``(I) with respect to claims paid
electronically, the payment is
transferred; and
``(II) with respect to claims paid
otherwise, the payment is submitted to
the United States Postal Service or
common carrier for delivery.
``(E) Electronic transfer of funds.--A PDP sponsor
shall pay all clean claims submitted electronically by
electronic transfer of funds if the pharmacy so
requests or has so requested previously. In the case
where such payment is made electronically, remittance
may be made by the PDP sponsor electronically as well.
``(F) Protecting the rights of claimants.--
``(i) In general.--Nothing in this
paragraph shall be construed to prohibit or
limit a claim or action not covered by the
subject matter of this section that any
individual or organization has against a
provider or a PDP sponsor.
``(ii) Anti-retaliation.--Consistent with
applicable Federal or State law, a PDP sponsor
shall not retaliate against an individual or
provider for exercising a right of action under
this subparagraph.
``(G) Rule of construction.--A determination under
this paragraph that a claim submitted by a pharmacy is
a clean claim shall not be construed as a positive
determination regarding eligibility for payment under
this title, nor is it an indication of government
approval of, or acquiescence regarding, the claim
submitted. The determination shall not relieve any
party of civil or criminal liability with respect to
the claim, nor does it offer a defense to any
administrative, civil, or criminal action with respect
to the claim.''.
(b) Prompt Payment by MA-PD Plans.--Section 1857(f) of the Social
Security Act (42 U.S.C. 1395w-27) is amended by adding at the end the
following new paragraph:
``(3) Incorporation of certain prescription drug plan
contract requirements.--The following provisions shall apply to
contracts with a Medicare Advantage organization offering an
MA-PD plan in the same manner as they apply to contracts with a
PDP sponsor offering a prescription drug plan under part D:
``(A) Prompt payment.--Section 1860D-12(b)(4).''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2010.
SEC. 172. SUBMISSION OF CLAIMS BY PHARMACIES LOCATED IN OR CONTRACTING
WITH LONG-TERM CARE FACILITIES.
(a) Submission of Claims by Pharmacies Located in or Contracting
With Long-Term Care Facilities.--
(1) Submission of claims to prescription drug plans.--
Section 1860D-12(b) of the Social Security Act (42 U.S.C.
1395w-112(b)), as amended by section 171(a), is amended by
adding at the end the following new paragraph:
``(5) Submission of claims by pharmacies located in or
contracting with long-term care facilities.--Each contract
entered into with a PDP sponsor under this part with respect to
a prescription drug plan offered by such sponsor shall provide
that a pharmacy located in, or having a contract with, a long-
term care facility shall have not less than 30 days (but not
more than 90 days) to submit claims to the sponsor for
reimbursement under the plan.''.
(2) Submission of claims to ma-pd plans.--Section
1857(f)(3) of the Social Security Act, as added by section
171(b), is amended by adding at the end the following new
subparagraph:
``(B) Submission of claims by pharmacies located in
or contracting with long-term care facilities.--Section
1860D-12(b)(5).''.
(b) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2010.
SEC. 173. REGULAR UPDATE OF PRESCRIPTION DRUG PRICING STANDARD.
(a) Requirement for Prescription Drug Plans.--Section 1860D-12(b)
of the Social Security Act (42 U.S.C. 1395w-112(b)), as amended by
section 172(a)(1), is amended by adding at the end the following new
paragraph:
``(6) Regular update of prescription drug pricing
standard.--If the PDP sponsor of a prescription drug plan uses
a standard for reimbursement of pharmacies based on the cost of
a drug, each contract entered into with such sponsor under this
part with respect to the plan shall provide that the sponsor
shall update such standard not less frequently than once every
7 days, beginning with an initial update on January 1 of each
year, to accurately reflect the market price of acquiring the
drug.''.
(b) Requirement for MA-PD Plans.--Section 1857(f)(3) of the Social
Security Act, as amended by section 172(a)(2), is amended by adding at
the end the following new subparagraph:
``(C) Regular update of prescription drug pricing
standard.--Section 1860D-12(b)(6).''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after January 1, 2009.
PART II--OTHER PROVISIONS
SEC. 175. INCLUSION OF BARBITURATES AND BENZODIAZEPINES AS COVERED PART
D DRUGS.
(a) In General.--Section 1860D-2(e)(2)(A) of the Social Security
Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended by inserting after
``agents),'' the following ``other than subparagraph (I) of such
section (relating to barbiturates) if the barbiturate is used in the
treatment of epilepsy, cancer, or a chronic mental health disorder, and
other than subparagraph (J) of such section (relating to
benzodiazepines),''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to prescriptions dispensed on or after January 1, 2013.
SEC. 176. FORMULARY REQUIREMENTS WITH RESPECT TO CERTAIN CATEGORIES OR
CLASSES OF DRUGS.
Section 1860D-4(b)(3) of the Social Security Act (42 U.S.C. 1395w-
104(b)(3)) is amended--
(1) in subparagraph (C)(i), by striking ``The formulary''
and inserting ``Subject to subparagraph (G), the formulary'';
and
(2) by inserting after subparagraph (F) the following new
subparagraph:
``(G) Required inclusion of drugs in certain
categories and classes.--
``(i) Identification of drugs in certain
categories and classes.--Beginning with plan
year 2010, the Secretary shall identify, as
appropriate, categories and classes of drugs
for which both of the following criteria are
met:
``(I) Restricted access to drugs in
the category or class would have major
or life threatening clinical
consequences for individuals who have a
disease or disorder treated by the
drugs in such category or class.
``(II) There is significant
clinical need for such individuals to
have access to multiple drugs within a
category or class due to unique
chemical actions and pharmacological
effects of the drugs within the
category or class, such as drugs used
in the treatment of cancer.
``(ii) Formulary requirements.--Subject to
clause (iii), PDP sponsors offering
prescription drug plans shall be required to
include all covered part D drugs in the
categories and classes identified by the
Secretary under clause (i).
``(iii) Exceptions.--The Secretary may
establish exceptions that permits a PDP sponsor
of a prescription drug plan to exclude from its
formulary a particular covered part D drug in a
category or class that is otherwise required to
be included in the formulary under clause (ii)
(or to otherwise limit access to such a drug,
including through prior authorization or
utilization management). Any exceptions
established under the preceding sentence shall
be provided under a process that--
``(I) ensures that any exception to
such requirement is based upon
scientific evidence and medical
standards of practice (and, in the case
of antiretroviral medications, is
consistent with the Department of
Health and Human Services Guidelines
for the Use of Antiretroviral Agents in
HIV-1-Infected Adults and Adolescents);
and
``(II) includes a public notice and
comment period.''.
Subtitle F--Other Provisions
SEC. 181. USE OF PART D DATA.
Section 1860D-12(b)(3)(D) of the Social Security Act (42 U.S.C.
1395w-112(b)(3)(D)) is amended by adding at the end the following
sentence: ``Notwithstanding any other provision of law, information
provided to the Secretary under the application of section 1857(e)(1)
to contracts under this section under the preceding sentence--
``(i) may be used for the purposes of
carrying out this part, improving public health
through research on the utilization, safety,
effectiveness, quality, and efficiency of
health care services (as the Secretary
determines appropriate); and
``(ii) shall be made available to
Congressional support agencies (in accordance
with their obligations to support Congress as
set out in their authorizing statutes) for the
purposes of conducting Congressional oversight,
monitoring, making recommendations, and
analysis of the program under this title.''.
SEC. 182. REVISION OF DEFINITION OF MEDICALLY ACCEPTED INDICATION FOR
DRUGS.
(a) Revision of Definition for Part D Drugs.--
(1) In general.--Section 1860D-2(e)(1) of the Social
Security Act (42 U.S.C. 1395w-102(e)(1)) is amended, in the
matter following subparagraph (B)--
(A) by striking ``(as defined in section
1927(k)(6))'' and inserting ``(as defined in paragraph
(4))''; and
(B) by adding at the end the following new
paragraph:
``(4) Medically accepted indication defined.--
``(A) In general.--For purposes of paragraph (1),
the term `medically accepted indication' has the
meaning given that term--
``(i) in the case of a covered part D drug
used in an anticancer chemotherapeutic regimen,
in section 1861(t)(2)(B), except that in
applying such section--
``(I) `prescription drug plan or
MA-PD plan' shall be substituted for
`carrier' each place it appears; and
``(II) subject to subparagraph (B),
the compendia described in section
1927(g)(1)(B)(i)(III) shall be included
in the list of compendia described in
clause (ii)(I) section 1861(t)(2)(B);
and
``(ii) in the case of any other covered
part D drug, in section 1927(k)(6).
``(B) Conflict of interest.--On and after January
1, 2010, subparagraph (A)(i)(II) shall not apply unless
the compendia described in section
1927(g)(1)(B)(i)(III) meets the requirement in the
third sentence of section 1861(t)(2)(B).
``(C) Update.--For purposes of applying
subparagraph (A)(ii), the Secretary shall revise the
list of compendia described in section 1927(g)(1)(B)(i)
as is appropriate for identifying medically accepted
indications for drugs. Any such revision shall be done
in a manner consistent with the process for revising
compendia under section 1861(t)(2)(B).''.
(2) Effective date.--The amendments made by this subsection
shall apply to plan years beginning on or after January 1,
2009.
(b) Conflicts of Interest.--Section 1861(t)(2)(B) of the Social
Security Act (42 U.S.C. 1395x(t)(2)(B)) is amended by adding at the end
the following new sentence: ``On and after January 1, 2010, no
compendia may be included on the list of compendia under this
subparagraph unless the compendia has a publicly transparent process
for evaluating therapies and for identifying potential conflicts of
interests.''.
SEC. 183. CONTRACT WITH A CONSENSUS-BASED ENTITY REGARDING PERFORMANCE
MEASUREMENT.
(a) Contract.--
(1) In general.--Part E of title XVIII of the Social
Security Act (42 U.S.C. 1395x et seq.) is amended by inserting
after section 1889 the following new section:
``contract with a consensus-based entity regarding performance
measurement
``Sec. 1890. (a) Contract.--
``(1) In general.--For purposes of activities conducted
under this Act, the Secretary shall identify and have in effect
a contract with a consensus-based entity, such as the National
Quality Forum, that meets the requirements described in
subsection (c). Such contract shall provide that the entity
will perform the duties described in subsection (b).
``(2) Timing for first contract.--As soon as practicable
after the date of the enactment of this subsection, the
Secretary shall enter into the first contract under paragraph
(1).
``(3) Period of contract.--A contract under paragraph (1)
shall be for a period of 4 years (except as may be renewed
after a subsequent bidding process).
``(4) Competitive procedures.--Competitive procedures (as
defined in section 4(5) of the Office of Federal Procurement
Policy Act (41 U.S.C. 403(5))) shall be used to enter into a
contract under paragraph (1).
``(b) Duties.--The duties described in this subsection are the
following:
``(1) Priority setting process.--The entity shall
synthesize evidence and convene key stakeholders to make
recommendations, with respect to activities conducted under
this Act, on an integrated national strategy and priorities for
health care performance measurement in all applicable settings.
In making such recommendations, the entity shall--
``(A) ensure that priority is given to measures--
``(i) that address the health care provided
to patients with prevalent, high-cost chronic
diseases;
``(ii) with the greatest potential for
improving the quality, efficiency, and patient-
centeredness of health care; and
``(iii) that may be implemented rapidly due
to existing evidence, standards of care, or
other reasons; and
``(B) take into account measures that--
``(i) may assist consumers and patients in
making informed health care decisions;
``(ii) address health disparities across
groups and areas; and
``(iii) address the continuum of care a
patient receives, including services furnished
by multiple health care providers or
practitioners and across multiple settings.
``(2) Endorsement of measures.--The entity shall provide
for the endorsement of standardized health care performance
measures. The endorsement process under the preceding sentence
shall consider whether a measure--
``(A) is evidence-based, reliable, valid,
verifiable, relevant to enhanced health outcomes,
actionable at the caregiver level, feasible to collect
and report, and responsive to variations in patient
characteristics, such as health status, language
capabilities, race or ethnicity, and income level; and
``(B) is consistent across types of health care
providers, including hospitals and physicians.
``(3) Maintenance of measures.--The entity shall establish
and implement a process to ensure that measures endorsed under
paragraph (2) are updated (or retired if obsolete) as new
evidence is developed.
``(4) Promotion of the development of electronic health
records.--The entity shall promote the development and use of
electronic health records that contain the functionality for
automated collection, aggregation, and transmission of
performance measurement information.
``(5) Annual report to congress and the secretary;
secretarial publication and comment.--
``(A) Annual report.--By not later than March 1 of
each year (beginning with 2009), the entity shall
submit to Congress and the Secretary a report
containing a description of--
``(i) the implementation of quality
measurement initiatives under this Act and the
coordination of such initiatives with quality
initiatives implemented by other payers;
``(ii) the recommendations made under
paragraph (1); and
``(iii) the performance by the entity of
the duties required under the contract entered
into with the Secretary under subsection (a).
``(B) Secretarial review and publication of annual
report.--Not later than 6 months after receiving a
report under subparagraph (A) for a year, the Secretary
shall--
``(i) review such report; and
``(ii) publish such report in the Federal
Register, together with any comments of the
Secretary on such report.
``(c) Requirements Described.--The requirements described in this
subsection are the following:
``(1) Private nonprofit.--The entity is a private nonprofit
entity governed by a board.
``(2) Board membership.--The members of the board of the
entity include--
``(A) representatives of health plans and health
care providers and practitioners or representatives of
groups representing such health plans and health care
providers and practitioners;
``(B) health care consumers or representatives of
groups representing health care consumers; and
``(C) representatives of purchasers and employers
or representatives of groups representing purchasers or
employers.
``(3) Entity membership.--The membership of the entity
includes persons who have experience with--
``(A) urban health care issues;
``(B) safety net health care issues;
``(C) rural and frontier health care issues; and
``(D) health care quality and safety issues.
``(4) Open and transparent.--With respect to matters
related to the contract with the Secretary under subsection
(a), the entity conducts its business in an open and
transparent manner and provides the opportunity for public
comment on its activities.
``(5) Voluntary consensus standards setting organization.--
The entity operates as a voluntary consensus standards setting
organization as defined for purposes of section 12(d) of the
National Technology Transfer and Advancement Act of 1995
(Public Law 104-113) and Office of Management and Budget
Revised Circular A-119 (published in the Federal Register on
February 10, 1998).
``(6) Experience.--The entity has at least 4 years of
experience in establishing national consensus standards.
``(7) Membership fees.--If the entity requires a membership
fee for participation in the functions of the entity, such fees
shall be reasonable and adjusted based on the capacity of the
potential member to pay the fee. In no case shall membership
fees pose a barrier to the participation of individuals or
groups with low or nominal resources to participate in the
functions of the entity.
``(d) Funding.--For purposes of carrying out this section, the
Secretary shall provide for the transfer, from the Federal Hospital
Insurance Trust Fund under section 1817 and the Federal Supplementary
Medical Insurance Trust Fund under section 1841 (in such proportion as
the Secretary determines appropriate), of $10,000,000 to the Centers
for Medicare & Medicaid Services Program Management Account for each of
fiscal years 2009 through 2012.''.
(2) Sense of the senate.--It is the Sense of the Senate
that the selection by the Secretary of Health and Human
Services of an entity to contract with under section 1890(a) of
the Social Security Act, as added by paragraph (1), should not
be construed as diminishing the significant contributions of
the Boards of Medicine, the quality alliances, and other
clinical and technical experts to efforts to measure and
improve the quality of health care services.
(b) GAO Study and Reports on the Performance and Costs of the
Consensus-Based Entity Under the Contract.--
(1) In general.--The Comptroller General of the United
States shall conduct a study on--
(A) the performance of the entity with a contract
with the Secretary of Health and Human Services under
section 1890(a) of the Social Security Act, as added by
subsection (a), of its duties under such contract; and
(B) the costs incurred by such entity in performing
such duties.
(2) Reports.--Not later than 18 months and 36 months after
the effective date of the first contract entered into under
such section 1890(a), the Comptroller General of the United
States shall submit to Congress a report containing the results
of the study conducted under paragraph (1), together with
recommendations for such legislation and administrative action
as the Comptroller General determines appropriate.
SEC. 184. COST-SHARING FOR CLINICAL TRIALS.
Section 1833 of the Social Security Act (42 U.S.C. 1395l), as
amended by section 151(a), is amended by adding at the end the
following new subsection:
``(w) Methods of Payment.--The Secretary may develop alternative
methods of payment for items and services provided under clinical
trials and comparative effectiveness studies sponsored or supported by
an agency of the Department of Health and Human Services, as determined
by the Secretary, to those that would otherwise apply under this
section, to the extent such alternative methods are necessary to
preserve the scientific validity of such trials or studies, such as in
the case where masking the identity of interventions from patients and
investigators is necessary to comply with the particular trial or study
design.''.
SEC. 185. ADDRESSING HEALTH CARE DISPARITIES.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1808 the following new section:
``addressing health care disparities
``Sec. 1809. (a) Evaluating Data Collection Approaches.--The
Secretary shall evaluate approaches for the collection of data under
this title, to be performed in conjunction with existing quality
reporting requirements and programs under this title, that allow for
the ongoing, accurate, and timely collection and evaluation of data on
disparities in health care services and performance on the basis of
race, ethnicity, and gender. In conducting such evaluation, the
Secretary shall consider the following objectives:
``(1) Protecting patient privacy.
``(2) Minimizing the administrative burdens of data
collection and reporting on providers and health plans
participating under this title.
``(3) Improving Medicare program data on race, ethnicity,
and gender.
``(b) Reports to Congress.--
``(1) Report on evaluation.--Not later than 18 months after
the date of the enactment of this section, the Secretary shall
submit to Congress a report on the evaluation conducted under
subsection (a). Such report shall, taking into consideration
the results of such evaluation--
``(A) identify approaches (including defining
methodologies) for identifying and collecting and
evaluating data on health care disparities on the basis
of race, ethnicity, and gender for the original
Medicare fee-for-service program under parts A and B,
the Medicare Advantage program under part C, and the
Medicare prescription drug program under part D; and
``(B) include recommendations on the most effective
strategies and approaches to reporting HEDIS quality
measures as required under section 1852(e)(3) and other
nationally recognized quality performance measures, as
appropriate, on the basis of race, ethnicity, and
gender.
``(2) Reports on data analyses.--Not later than 4 years
after the date of the enactment of this section, and 4 years
thereafter, the Secretary shall submit to Congress a report
that includes recommendations for improving the identification
of health care disparities for Medicare beneficiaries based on
analyses of the data collected under subsection (c).
``(c) Implementing Effective Approaches.--Not later than 24 months
after the date of the enactment of this section, the Secretary shall
implement the approaches identified in the report submitted under
subsection (b)(1) for the ongoing, accurate, and timely collection and
evaluation of data on health care disparities on the basis of race,
ethnicity, and gender.''.
SEC. 186. DEMONSTRATION TO IMPROVE CARE TO PREVIOUSLY UNINSURED.
(a) Establishment.--Within one year after the date of the enactment
of this Act, the Secretary (in this section referred to as the
``Secretary'') shall establish a demonstration project to determine the
greatest needs and most effective methods of outreach to medicare
beneficiaries who were previously uninsured.
(b) Scope.--The demonstration shall be in no fewer than 10 sites,
and shall include state health insurance assistance programs, community
health centers, community-based organizations, community health
workers, and other service providers under parts A, B, and C of title
XVIII of the Social Security Act. Grantees that are plans operating
under part C shall document that enrollees who were previously
uninsured receive the ``Welcome to Medicare'' physical exam.
(c) Duration.--The Secretary shall conduct the demonstration
project for a period of 2 years.
(d) Report and Evaluation.--The Secretary shall conduct an
evaluation of the demonstration and not later than 1 year after the
completion of the project shall submit to Congress a report including
the following:
(1) An analysis of the effectiveness of outreach activities
targeting beneficiaries who were previously uninsured, such as
revising outreach and enrollment materials (including the
potential for use of video information), providing one-on-one
counseling, working with community health workers, and amending
the Medicare and You handbook.
(2) The effect of such outreach on beneficiary access to
care, utilization of services, efficiency and cost-
effectiveness of health care delivery, patient satisfaction,
and select health outcomes.
SEC. 187. OFFICE OF THE INSPECTOR GENERAL REPORT ON COMPLIANCE WITH AND
ENFORCEMENT OF NATIONAL STANDARDS ON CULTURALLY AND
LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN MEDICARE.
(a) Report.--Not later than two years after the date of the
enactment of this Act, the Inspector General of the Department of
Health and Human Services shall prepare and publish a report on--
(1) the extent to which Medicare providers and plans are
complying with the Office for Civil Rights' Guidance to Federal
Financial Assistance Recipients Regarding Title VI Prohibition
Against National Origin Discrimination Affecting Limited
English Proficient Persons and the Office of Minority Health's
Culturally and Linguistically Appropriate Services Standards in
health care; and
(2) a description of the costs associated with or savings
related to the provision of language services.
Such report shall include recommendations on improving compliance with
CLAS Standards and recommendations on improving enforcement of CLAS
Standards.
(b) Implementation.--Not later than one year after the date of
publication of the report under subsection (a), the Department of
Health and Human Services shall implement changes responsive to any
deficiencies identified in the report.
SEC. 188. MEDICARE IMPROVEMENT FUNDING.
(a) Medicare Improvement Fund.--
(1) In general.--Subject to paragraph (2), title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.) is amended by
adding at the end the following new section:
``medicare improvement fund
``Sec. 1898. (a) Establishment.--
``The Secretary shall establish under this title a Medicare
Improvement Fund (in this section referred to as the `Fund')
which shall be available to the Secretary to make improvements
under the original fee-for-service program under parts A and B
for individuals entitled to, or enrolled for, benefits under
part A or enrolled under part B.
``(b) Funding.--
``(1) In general.--There shall be available to the Fund,
for expenditures from the Fund for services furnished during
fiscal years 2014 through 2017, $19,900,000,000.
``(2) Payment from trust funds.--The amount specified under
paragraph (1) shall be available to the Fund, as expenditures
are made from the Fund, from the Federal Hospital Insurance
Trust Fund and the Federal Supplementary Medical Insurance
Trust Fund in such proportion as the Secretary determines
appropriate.
``(3) Funding limitation.--Amounts in the Fund shall be
available in advance of appropriations but only if the total
amount obligated from the Fund does not exceed the amount
available to the Fund under paragraph (1). The Secretary may
obligate funds from the Fund only if the Secretary determines
(and the Chief Actuary of the Centers for Medicare & Medicaid
Services and the appropriate budget officer certify) that there
are available in the Fund sufficient amounts to cover all such
obligations incurred consistent with the previous sentence.''.
(2) Contingency.--
(A) In general.--If there is enacted, before, on,
or after the date of the enactment of this Act, a
Supplemental Appropriations Act, 2008 that includes a
provision providing for a Medicare Improvement Fund
under a section 1898 of the Social Security Act, the
alternative amendment described in subparagraph (B)--
(i) shall apply instead of the amendment
made by paragraph (1); and
(ii) shall be executed after such provision
in such Supplemental Appropriations Act.
(B) Alternative amendment described.--The
alternative amendment described in this subparagraph is
as follows: Section 1898(b)(1) of the Social Security
Act, as added by the Supplemental Appropriations Act,
2008, is amended by inserting before the period at the
end the following: `` and, in addition for services
furnished during fiscal years 2014 through 2017,
$19,900,000,000''.
(b) Implementation.--For purposes of carrying out the provisions
of, and amendments made by, this title, in addition to any other
amounts provided in such provisions and amendments, the Secretary of
Health and Human Services shall provide for the transfer, from the
Federal Hospital Insurance Trust Fund under section 1817 of the Social
Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t),
in the same proportion as the Secretary determines under section
1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $140,000,000 to the
Centers for Medicare & Medicaid Services Program Management Account for
the period of fiscal years 2009 through 2013.
SEC. 189. INCLUSION OF MEDICARE PROVIDERS AND SUPPLIERS IN FEDERAL
PAYMENT LEVY AND ADMINISTRATIVE OFFSET PROGRAM.
(a) In General.--Section 1874 of the Social Security Act (42 U.S.C.
1395kk) is amended by adding at the end the following new subsection:
``(d) Inclusion of Medicare Provider and Supplier Payments in
Federal Payment Levy Program.--
``(1) In general.--The Centers for Medicare & Medicaid
Services shall take all necessary steps to participate in the
Federal Payment Levy Program under section 6331(h) of the
Internal Revenue Code of 1986 as soon as possible and shall
ensure that--
``(A) at least 50 percent of all payments under
parts A and B are processed through such program
beginning within 1 year after the date of the enactment
of this section;
``(B) at least 75 percent of all payments under
parts A and B are processed through such program
beginning within 2 years after such date; and
``(C) all payments under parts A and B are
processed through such program beginning not later than
September 30, 2011.
``(2) Assistance.--The Financial Management Service and the
Internal Revenue Service shall provide assistance to the
Centers for Medicare & Medicaid Services to ensure that all
payments described in paragraph (1) are included in the Federal
Payment Levy Program by the deadlines specified in that
subsection.''.
(b) Application of Administrative Offset Provisions to Medicare
Provider or Supplier Payments.--Section 3716 of title 31, United States
Code, is amended--
(1) by inserting ``the Department of Health and Human
Services,'' after ``United States Postal Service,'' in
subsection (c)(1)(A); and
(2) by adding at the end of subsection (c)(3) the following
new subparagraph:
``(D) This section shall apply to payments made
after the date which is 90 days after the enactment of
this subparagraph (or such earlier date as designated
by the Secretary of Health and Human Services) with
respect to claims or debts, and to amounts payable,
under title XVIII of the Social Security Act.''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act.
TITLE II--MEDICAID
SEC. 201. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA) AND
ABSTINENCE EDUCATION PROGRAM.
Section 401 of division B of the Tax Relief and Health Care Act of
2006 (Public Law 109-432, 120 Stat. 2994), as amended by section 1 of
Public Law 110-48 (121 Stat. 244), section 2 of the TMA, Abstinence,
Education, and QI Programs Extension Act of 2007 (Public Law 110-90,
121 Stat. 984), and section 202 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (Public Law 110-173) is amended--
(1) by striking ``June 30, 2008'' and inserting ``June 30,
2009'';
(2) by striking ``the third quarter of fiscal year 2008''
and inserting ``the third quarter of fiscal year 2009''; and
(3) by striking ``the third quarter of fiscal year 2007''
and inserting ``the third quarter of fiscal year 2008''.
SEC. 202. MEDICAID DSH EXTENSION.
Section 1923(f)(6) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)) is amended--
(1) in the heading, by striking ``fiscal year 2007 and
portions of fiscal year 2008'' and inserting ``fiscal years
2007 through 2009 and the first calendar quarter of fiscal year
2010''; and
(2) in subparagraph (A)--
(A) in clause (i)--
(i) in the second sentence--
(I) by striking ``fiscal year 2008
for the period ending on June 30,
2008'' and inserting ``fiscal years
2008 and 2009''; and
(II) by striking ``\3/4\ of''; and
(ii) by adding at the end the following new
sentences: ``Only with respect to fiscal year
2010 for the period ending on December 31,
2009, the DSH allotment for Tennessee for such
portion of the fiscal year, notwithstanding
such table or terms, shall be \1/4\ of the
amount specified in the first sentence for
fiscal year 2007.'';
(B) in clause (ii), by striking ``or for a period
in fiscal year 2008'' and inserting ``, 2008, 2009, or
for a period in fiscal year 2010'';
(C) in clause (iv)--
(i) in the heading, by striking ``fiscal
year 2007 and fiscal year 2008'' and inserting
``fiscal years 2007 through 2009 and the first
calendar quarter of fiscal year 2010'';
(ii) in subclause (I), by striking ``or for
a period in fiscal year 2008'' and inserting
``, 2008, 2009, or for a period in fiscal year
2010''; and
(iii) in subclause (II), by striking ``or
for a period in fiscal year 2008'' and
inserting ``, 2008, 2009, or for a period in
fiscal year 2010''; and
(3) in subparagraph (B)(i)--
(A) in the first sentence, by striking ``fiscal
year 2007'' and inserting ``each of fiscal years 2007
through 2009''; and
(B) by striking the second sentence and inserting
the following: ``Only with respect to fiscal year 2010
for the period ending on December 31, 2009, the DSH
allotment for Hawaii for such portion of the fiscal
year, notwithstanding the table set forth in paragraph
(2), shall be $2,500,000.''.
SEC. 203. PHARMACY REIMBURSEMENT UNDER MEDICAID.
(a) Delay in Application of New Payment Limit for Multiple Source
Drugs Under Medicaid.--Notwithstanding paragraphs (4) and (5) of
subsection (e) of section 1927 of the Social Security Act (42 U.S.C.
1396r-8) or part 447 of title 42, Code of Federal Regulations, as
published on July 17, 2007 (72 Federal Register 39142)--
(1) the specific upper limit under section 447.332 of title
42, Code of Federal Regulations (as in effect on December 31,
2006) applicable to payments made by a State for multiple
source drugs under a State Medicaid plan shall continue to
apply through September 30, 2009, for purposes of the
availability of Federal financial participation for such
payments; and
(2) the Secretary of Health and Human Services shall not,
prior to October 1, 2009, finalize, implement, enforce, or
otherwise take any action (through promulgation of regulation,
issuance of regulatory guidance, use of Federal payment audit
procedures, or other administrative action, policy, or
practice, including a Medical Assistance Manual transmittal or
letter to State Medicaid directors) to impose the specific
upper limit established under section 447.514(b) of title 42,
Code of Federal Regulations as published on July 17, 2007 (72
Federal Register 39142).
(b) Temporary Suspension of Updated Publicly Available AMP Data.--
Notwithstanding clause (v) of section 1927(b)(3)(D) of the Social
Security Act (42 U.S.C. 1396r-8(b)(3)(D)), the Secretary of Health and
Human Services shall not, prior to October 1, 2009, make publicly
available any AMP disclosed to the Secretary.
(c) Definitions.--In this subsection:
(1) The term ``multiple source drug'' has the meaning given
that term in section 1927(k)(7)(A)(i) of the Social Security
Act (42 U.S.C. 1396r-8(k)(7)(A)(i)).
(2) The term ``AMP'' has the meaning given ``average
manufacturer price'' in section 1927(k)(1) of the Social
Security Act (42 U.S.C. 1396r-8(k)(1)) and ``AMP'' in section
447.504(a) of title 42, Code of Federal Regulations as
published on July 17, 2007 (72 Federal Register 39142).
SEC. 204. REVIEW OF ADMINISTRATIVE CLAIM DETERMINATIONS.
(a) In General.--Section 1116 of the Social Security Act (42 U.S.C.
1316) is amended by adding at the end the following new subsection:
``(e)(1) Whenever the Secretary determines that any item or class
of items on account of which Federal financial participation is claimed
under title XIX shall be disallowed for such participation, the State
shall be entitled to and upon request shall receive a reconsideration
of the disallowance, provided that such request is made during the 60-
day period that begins on the date the State receives notice of the
disallowance.
``(2)(A) A State may appeal a disallowance of a claim for federal
financial participation under title XIX by the Secretary, or an
unfavorable reconsideration of a disallowance, during the 60-day period
that begins on the date the State receives notice of the disallowance
or of the unfavorable reconsideration, in whole or in part, to the
Departmental Appeals Board, established in the Department of Health and
Human Services (in this paragraph referred to as the `Board'), by
filing a notice of appeal with the Board.
``(B) The Board shall consider a State's appeal of a disallowance
of such a claim (or of an unfavorable reconsideration of a
disallowance) on the basis of such documentation as the State may
submit and as the Board may require to support the final decision of
the Board. In deciding whether to uphold a disallowance of such a claim
or any portion thereof, the Board shall be bound by all applicable laws
and regulations and shall conduct a thorough review of the issues,
taking into account all relevant evidence. The Board's decision of an
appeal under subparagraph (A) shall be the final decision of the
Secretary and shall be subject to reconsideration by the Board only
upon motion of either party filed during the 60-day period that begins
on the date of the Board's decision or to judicial review in accordance
with subparagraph (C).
``(C) A State may obtain judicial review of a decision of the Board
by filing an action in any United States District Court located within
the appealing State (or, if several States jointly appeal the
disallowance of claims for Federal financial participation under
section 1903, in any United States District Court that is located
within any State that is a party to the appeal) or the United States
District Court for the District of Columbia. Such an action may only be
filed--
``(i) if no motion for reconsideration was filed within the
60-day period specified in subparagraph (B), during such 60-day
period; or
``(ii) if such a motion was filed within such period,
during the 60-day period that begins on the date of the Board's
decision on such motion.''.
(b) Conforming Amendment.--Section 1116(d) of such Act (42 U.S.C.
1316(d)) is amended by striking ``or XIX,''.
(c) Effective Date.--The amendments made by this section take
effect on the date of the enactment of this Act and apply to any
disallowance of a claim for Federal financial participation under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) made on or
after such date or during the 60-day period prior to such date.
SEC. 205. COUNTY MEDICAID HEALTH INSURING ORGANIZATIONS.
(a) In General.--Section 9517(c)(3) of the Consolidated Omnibus
Budget Reconciliation Act of 1985 (42 U.S.C. 1396b note), as added by
section 4734 of the Omnibus Budget Reconciliation Act of 1990 and as
amended by section 704 of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000, is amended--
(1) in subparagraph (A), by inserting ``, in the case of
any health insuring organization described in such subparagraph
that is operated by a public entity established by Ventura
County, and in the case of any health insuring organization
described in such subparagraph that is operated by a public
entity established by Merced County'' after ``described in
subparagraph (B)''; and
(2) in subparagraph (C), by striking ``14 percent'' and
inserting ``16 percent''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date of the enactment of this Act.
TITLE III--MISCELLANEOUS
SEC. 301. EXTENSION OF TANF SUPPLEMENTAL GRANTS.
(a) Extension Through Fiscal Year 2009.--Section 7101(a) of the
Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 135) is
amended by striking ``fiscal year 2008'' and inserting ``fiscal year
2009''.
(b) Conforming Amendment.--Section 403(a)(3)(H)(ii) of the Social
Security Act (42 U.S.C. 603(a)(3)(H)(ii)) is amended to read as
follows:
``(ii) subparagraph (G) shall be applied as
if `fiscal year 2009' were substituted for
`fiscal year 2001'; and''.
SEC. 302. 70 PERCENT FEDERAL MATCHING FOR FOSTER CARE AND ADOPTION
ASSISTANCE FOR THE DISTRICT OF COLUMBIA.
(a) In General.--Section 474(a) of the Social Security Act (42
U.S.C. 674(a)) is amended in each of paragraphs (1) and (2) by striking
``(as defined in section 1905(b) of this Act)'' and inserting ``(which
shall be as defined in section 1905(b), in the case of a State other
than the District of Columbia, or 70 percent, in the case of the
District of Columbia)''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on October 1, 2008, and shall apply to calendar quarters
beginning on or after that date.
SEC. 303. EXTENSION OF SPECIAL DIABETES GRANT PROGRAMS.
(a) Special Diabetes Programs for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-2(b)(2))
is amended by striking ``2009'' and inserting ``2011''.
(b) Special Diabetes Programs for Indians.--Section 330C(c)(2)(C)
of the Public Health Service Act (42 U.S.C. 254c-3(c)(2)(C)) is amended
by striking ``2009'' and inserting ``2011''.
(c) Report on Grant Programs.--Section 4923(b) of the Balanced
Budget Act of 1997 (42 U.S.C. 1254c-2 note), as amended by section
931(c) of the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000, as enacted into law by section 1(a)(6) of
Public Law 106-554, and section 1(c) of Public Law 107-360, is
amended--
(1) in paragraph (1), by striking ``and'' at the end;
(2) in paragraph (2)--
(A) by striking ``a final report'' and inserting
``a second interim report''; and
(B) by striking the period at the end and inserting
``; and''; and
(3) by adding at the end the following new paragraph:
``(3) a report on such evaluation not later than January 1,
2011.''.
SEC. 304. IOM REPORTS ON BEST PRACTICES FOR CONDUCTING SYSTEMATIC
REVIEWS OF CLINICAL EFFECTIVENESS RESEARCH AND FOR
DEVELOPING CLINICAL PROTOCOLS.
(a) Systematic Reviews of Clinical Effectiveness Research.--
(1) Study.--Not later than 60 days after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine of the National Academies (in this section referred to
as the ``Institute'') under which the Institute shall conduct a
study to identify the methodological standards for conducting
systematic reviews of clinical effectiveness research on health
and health care in order to ensure that organizations
conducting such reviews have information on methods that are
objective, scientifically valid, and consistent.
(2) Report.--Not later than 18 months after the effective
date of the contract under paragraph (1), the Institute, as
part of such contract, shall submit to the Secretary of Health
and Human Services and the appropriate committees of
jurisdiction of Congress a report containing the results of the
study conducted under paragraph (1), together with
recommendations for such legislation and administrative action
as the Institute determines appropriate.
(3) Participation.--The contract under paragraph (1) shall
require that stakeholders with expertise in conducting clinical
effectiveness research participate on the panel responsible for
conducting the study under paragraph (1) and preparing the
report under paragraph (2).
(b) Clinical Protocols.--
(1) Study.--Not later than 60 days after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine of the National Academies (in this section referred to
as the ``Institute'') under which the Institute shall conduct a
study on the best methods used in developing clinical practice
guidelines in order to ensure that organizations developing
such guidelines have information on approaches that are
objective, scientifically valid, and consistent.
(2) Report.--Not later than 18 months after the effective
date of the contract under paragraph (1), the Institute, as
part of such contract, shall submit to the Secretary of Health
and Human Services and the appropriate committees of
jurisdiction of Congress a report containing the results of the
study conducted under paragraph (1), together with
recommendations for such legislation and administrative action
as the Institute determines appropriate.
(3) Participation.--The contract under paragraph (1) shall
require that stakeholders with expertise in making clinical
recommendations participate on the panel responsible for
conducting the study under paragraph (1) and preparing the
report under paragraph (2).
(c) Funding.--Out of any funds in the Treasury not otherwise
appropriated, there are appropriated for the period of fiscal years
2009 and 2010, $3,000,000 to carry out this section.
Passed the House of Representatives June 24, 2008.
Attest:
Clerk.
110th CONGRESS
2d Session
H. R. 6331
_______________________________________________________________________
AN ACT
To amend titles XVIII and XIX of the Social Security Act to extend
expiring provisions under the Medicare Program, to improve beneficiary
access to preventive and mental health services, to enhance low-income
benefit programs, and to maintain access to care in rural areas,
including pharmacy access, and for other purposes.