HR 3970 IHCommentsClose CommentsPermalink

To protect the doctor-patient relationship, improve the quality of health care services, lower the costs of health care services, expand access to health care services, and for other purposes.CommentsClose CommentsPermalink

October 29, 2009CommentsClose CommentsPermalink

Mr. KIRK (for himself, Mr. BURGESS, Mrs. BIGGERT, Mr. LEE of New York, Mr. LANCE, Mr. SCHOCK, Mr. MICA, Mrs. CAPITO, Mr. FRELINGHUYSEN, and Mr. MACK) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on the Judiciary, Ways and Means, Education and Labor, Appropriations, and Financial Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

To protect the doctor-patient relationship, improve the quality of health care services, lower the costs of health care services, expand access to health care services, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Medical Rights and Reform Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. TABLE OF CONTENTS.

Sec. 1. Short title.CommentsClose CommentsPermalink





Sec. 2. Table of contents.CommentsClose CommentsPermalink

TITLE I--PROTECTING THE DOCTOR-PATIENT RELATIONSHIP

Sec. 101. Prohibition on restrictions on the practice of medicine and other health care professions.CommentsClose CommentsPermalink





Sec. 102. Right to contract for health care services and health insurance.CommentsClose CommentsPermalink





Sec. 103. Prohibition on mandating State restrictions.CommentsClose CommentsPermalink





Sec. 104. Clarification.CommentsClose CommentsPermalink





Sec. 105. Conforming amendment.CommentsClose CommentsPermalink





Sec. 106. Definitions.CommentsClose CommentsPermalink





Sec. 107. Effective date.CommentsClose CommentsPermalink

TITLE II--IMPROVING QUALITY AND LOWERING THE COST OF HEALTH CARE

Subtitle A--Equity for Our Nation’s Self-Employed

Sec. 201. SECA tax deduction for health insurance costs.CommentsClose CommentsPermalink

Subtitle B--Help Efficient, Accessible, Low-cost, Timely Healthcare

Sec. 211. Findings and purpose.CommentsClose CommentsPermalink





Sec. 212. Encouraging speedy resolution of claims.CommentsClose CommentsPermalink





Sec. 213. Compensating patient injury.CommentsClose CommentsPermalink





Sec. 214. Maximizing patient recovery.CommentsClose CommentsPermalink





Sec. 215. Additional HEALTH benefits.CommentsClose CommentsPermalink





Sec. 216. Punitive damages.CommentsClose CommentsPermalink





Sec. 217. Authorization of payment of future damages to claimants in HEALTH care lawsuits.CommentsClose CommentsPermalink





Sec. 218. Definitions.CommentsClose CommentsPermalink





Sec. 219. Effect on other laws.CommentsClose CommentsPermalink





Sec. 220. State flexibility and protection Sf states’ rights.CommentsClose CommentsPermalink





Sec. 221. Applicability; effective date.CommentsClose CommentsPermalink





Sec. 222. Sense of Congress.CommentsClose CommentsPermalink

Subtitle C--Accelerating the Deployment of Health Information Technology

Part 1--Enhanced Coordination and Adoption of Health Information Technology

Sec. 231. Strategic plan for coordinating implementation of Medicare and Medicaid health information technology incentive payments.CommentsClose CommentsPermalink





Sec. 232. Procedures to ensure timely updating of standards that enable electronic exchanges.CommentsClose CommentsPermalink





Sec. 233. Study to improve preservation and protection of security and confidentiality of health information.CommentsClose CommentsPermalink





Sec. 234. Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology.CommentsClose CommentsPermalink





Sec. 235. Expansion of Stark and anti-kickback exceptions for electronic health records arrangements.CommentsClose CommentsPermalink





Sec. 236. Application of Medicare EHR incentives and adjustments to additional providers.CommentsClose CommentsPermalink

Part 2--Telehealth Enhancement

subpart a--medicare program

Sec. 241. Expansion and improvement of telehealth services.CommentsClose CommentsPermalink





Sec. 242. Increase in number of types of originating sites; clarification.CommentsClose CommentsPermalink





Sec. 243. Expansion of eligible telehealth providers and credentialing of telemedicine practitioners.CommentsClose CommentsPermalink





Sec. 244. Access to telehealth services in the home.CommentsClose CommentsPermalink





Sec. 245. Coverage of home health remote patient management services for chronic health conditions.CommentsClose CommentsPermalink





Sec. 246. Sense of Congress on the use of remote patient management services.CommentsClose CommentsPermalink





Sec. 247. Telehealth Advisory Committee.CommentsClose CommentsPermalink

subpart b--hrsa grant program

Sec. 250. Grant program for the development of telehealth networks.CommentsClose CommentsPermalink





Sec. 251. Reauthorization of telehealth network and telehealth resource centers grant programs.CommentsClose CommentsPermalink

Subtitle D--Eliminating Waste, Fraud, and Abuse

Sec. 261. Site inspections; background checks; denial and suspension of billing privileges.CommentsClose CommentsPermalink





Sec. 262. Registration and background checks of billing agencies and individuals.CommentsClose CommentsPermalink





Sec. 263. Expanded access to the healthcare integrity and protection data bank (HIPDB).CommentsClose CommentsPermalink





Sec. 264. Liability of Medicare administrative contractors for claims submitted by excluded providers.CommentsClose CommentsPermalink





Sec. 265. Community mental health centers.CommentsClose CommentsPermalink





Sec. 266. Limiting the discharge of debts in bankruptcy proceedings in cases where a health care provider or a supplier engages in fraudulent activity.CommentsClose CommentsPermalink





Sec. 267. Illegal distribution of a Medicare or Medicaid beneficiary identification or billing privileges.CommentsClose CommentsPermalink





Sec. 268. Treatment of certain Social Security Act crimes as Federal health care offenses.CommentsClose CommentsPermalink





Sec. 269. Authority of Office of Inspector General of the Department of Health and Human Services.CommentsClose CommentsPermalink





Sec. 270. Universal product numbers on claims forms for reimbursement under the Medicare Program.CommentsClose CommentsPermalink

Subtitle E--Promoting Health and Preventing Chronic Disease Through Prevention and Wellness Programs

Sec. 281. Findings.CommentsClose CommentsPermalink





Sec. 282. Tax credit to employers for costs of implementing prevention and wellness programs.CommentsClose CommentsPermalink





Sec. 283. Grants to increase physical activity and emotional wellness, improve nutrition, and promote healthy eating behaviors.CommentsClose CommentsPermalink





Sec. 284. Prevention and wellness programs for individuals and families.CommentsClose CommentsPermalink

TITLE III--EXPANDING ACCESS TO HEALTH CARE

Subtitle A--State Innovation Program

Sec. 301. Ensuring affordability and access through universal access programs.CommentsClose CommentsPermalink





Sec. 302. Enhanced Federal funding and reduced red-tape for State efforts to improve access to health insurance coverage.CommentsClose CommentsPermalink





Sec. 303. State innovation program described.CommentsClose CommentsPermalink





Sec. 304. State transparency program described.CommentsClose CommentsPermalink





Sec. 305. Health plan finder.CommentsClose CommentsPermalink





Sec. 306. Small business health plans.CommentsClose CommentsPermalink





Sec. 307. Interstate compacts on health insurance regulation.CommentsClose CommentsPermalink





Sec. 308. Definitions.CommentsClose CommentsPermalink





Sec. 309. Authorization for appropriations.CommentsClose CommentsPermalink

Subtitle B--Interstate Market for Health Insurance

Sec. 311. Specification of constitutional authority for enactment of law.CommentsClose CommentsPermalink





Sec. 312. Findings.CommentsClose CommentsPermalink





Sec. 313. Cooperative governing of individual health insurance coverage.CommentsClose CommentsPermalink





Sec. 314. Severability.CommentsClose CommentsPermalink

Subtitle C--Young Adult Healthcare Coverage

Sec. 321. Requiring the option of extension of dependent coverage for certain unmarried, uninsured young adults.CommentsClose CommentsPermalink

TITLE IV--OFFSETS

Sec. 401. Transfer of unobilgated stimulus funds.CommentsClose CommentsPermalink

TITLE I--PROTECTING THE DOCTOR-PATIENT RELATIONSHIPCommentsClose CommentsPermalink

SEC. 101. PROHIBITION ON RESTRICTIONS ON THE PRACTICE OF MEDICINE AND OTHER HEALTH CARE PROFESSIONS.

(a) In General- Subject to subsection (b), no Federal funds shall be used to permit any Federal officer or employee to exercise any supervision or control over--CommentsClose CommentsPermalink





(1) the practice of medicine, the practice of other health care professions, or the manner in which health care services are provided;CommentsClose CommentsPermalink





(2) the provision, by a physician or a health care practitioner, of advice to a patient about the patient’s health status or recommended treatment for a condition or disease;CommentsClose CommentsPermalink





(3) the selection, tenure, or compensation of any officer, employee, or contractor of any institution, business, non-Federal agency, or individual providing health care services; orCommentsClose CommentsPermalink





(4) the administration or operation of any such institution, business, non-Federal agency, or individual, with respect to the provision of health care services to a patient.CommentsClose CommentsPermalink





(b) Preserving Certain Current Programs- Subsection (a) shall not prohibit the Federal Government from operating, managing, supervising employees of, or defining the scope of services provided by Federal entities when directly providing health care services and products, only with respect to the following:CommentsClose CommentsPermalink





(1) The Veterans Health Administration--CommentsClose CommentsPermalink





(A) in the case of directly providing health care services through its own facilities and by its own employees; orCommentsClose CommentsPermalink





(B) in the case of coordinating health care services not described in subparagraph (A) and paid for with Federal funds under programs operated by the Veterans Health Administration.CommentsClose CommentsPermalink





(2) The Department of Defense--CommentsClose CommentsPermalink





(A) in the case of directly providing health care services through military treatment facilities;CommentsClose CommentsPermalink





(B) in the case of paying for health care services for active-duty members of the Armed Forces or members of the Reserve component when called to active duty;CommentsClose CommentsPermalink





(C) in the case of directly providing health care services to the public in the event of emergency or under other lawful circumstances; orCommentsClose CommentsPermalink





(D) when necessary to determine whether health care services provided to those who are not active-duty members of the Armed Forces are eligible for payment with Federal funds or to coordinate health care services for patients who are served by both non-Federal entities and military treatment facilities.CommentsClose CommentsPermalink





(3) The United States Public Health Service--CommentsClose CommentsPermalink





(A) in the case of providing health care services through its own facilities or by its officers or civilian Federal employees;CommentsClose CommentsPermalink





(B) in the case of providing or paying for health care services to active-duty members of uniformed services or to Reserve members of such services when called to active duty; orCommentsClose CommentsPermalink





(C) when necessary to determine whether health care services provided to those who are not active-duty members of uniformed services are eligible for payment with Federal funds or to coordinate health care services for patients who are served by both non-Federal entities and Public Health Service treatment facilities.CommentsClose CommentsPermalink





(4) The Indian Health Service--CommentsClose CommentsPermalink





(A) in the case of directly providing health care services through its own facilities or Federal employees; orCommentsClose CommentsPermalink





(B) in the case of providing care by non-Federal entities, to the extent necessary to administer contracts and grants pursuant to the Indian Health Care Improvement Act.CommentsClose CommentsPermalink





(5) The National Institutes of Health--CommentsClose CommentsPermalink





(A) in the case of providing direct patient care incident to medical research; orCommentsClose CommentsPermalink





(B) in the case of administering grants for medical research, but in no case shall a non-Federal entity be required or requested to waive the protections of subsection (a) for health care services not incident to medical research funded by the National Institutes of Health as a condition of receiving research grant funding from the National Institutes of Health.CommentsClose CommentsPermalink





(6) The Health Resources and Services Administration--CommentsClose CommentsPermalink





(A) in the case of certifying federally qualified health centers, as defined by section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)), certifying FQHC look-alike status, as defined in section 413.65(n) of title 45 of the Code of Federal Regulations, or providing grants under section 330 of the Public Health Service Act (42 U.S.C. 254b), but only to the extent necessary to determine eligibility for such certification and grant funding and the appropriate amounts of such funding; orCommentsClose CommentsPermalink





(B) in the case of operating the nation’s human organ, bone marrow, and umbilical cord blood donation and transplantation systems, as and to the extent authorized by law and necessary for the operation of those programs.CommentsClose CommentsPermalink

SEC. 102. RIGHT TO CONTRACT FOR HEALTH CARE SERVICES AND HEALTH INSURANCE.

(a) Receipt of Health Services- No Federal funds shall be used by any Federal officer or employee to prohibit any individual from receiving health care services from any provider of health care services--CommentsClose CommentsPermalink





(1) under terms and conditions mutually acceptable to the patient and the provider; orCommentsClose CommentsPermalink





(2) under terms and conditions mutually acceptable to the patient, the provider, and any group health plan or health insurance issuer that is obligated to provide health insurance coverage to the patient or any other entity indemnifying the patient’s consumption of health care services;CommentsClose CommentsPermalink





provided that any such agreement shall be subject to the requirements of section 1802(b) of the Social Security Act (42 U.S.C. 1395a(b)), as amended by section 105.CommentsClose CommentsPermalink





(b) Health Insurance Coverage- No Federal funds shall be used by any Federal officer or employee to prohibit any person from entering into a contract with any group health plan, health insurance issuer, or other business, for the provision of, or payment to other parties for, health care services to be determined and provided subsequent to the effective date of the contract, according to terms, conditions, and procedures specified in such contract.CommentsClose CommentsPermalink





(c) Eligibility for Federal Benefits- No person’s eligibility for benefits under any program operated by or funded wholly or partly by the Federal Government shall be adversely affected as a result of having received services in a manner described by subsection (a) or having entered into a contract described in subsection (b).CommentsClose CommentsPermalink





(d) Federal Program Participation- No provider of health care services--CommentsClose CommentsPermalink





(1) shall be denied participation in a Federal program for which it would otherwise be eligible as a result of having provided services in a manner described in subsection (a); orCommentsClose CommentsPermalink





(2) shall be denied payment for services otherwise eligible for payment under a Federal program as a result of having provided services in a manner described in subsection (a), except to the extent required by subsection (a)(1).CommentsClose CommentsPermalink

SEC. 103. PROHIBITION ON MANDATING STATE RESTRICTIONS.

(a) In General- No Federal funds shall be used by any Federal officer or employee to induce or encourage any State or other jurisdiction of the United States to enact any restriction or prohibition prohibited to the Federal Government by this title.CommentsClose CommentsPermalink





(b) Protecting State Eligibility for Federal Funds- No State’s eligibility for participation in any program operated by or funded wholly or partly by the Federal Government, or for receiving funds from the Federal Government shall be conditioned on that State enacting any restriction or prohibition prohibited to the Federal Government by this title, nor adversely affected by that State’s failure to enact any restriction or prohibition prohibited to the Federal Government by this title.CommentsClose CommentsPermalink

SEC. 104. CLARIFICATION.

Nothing in this subtitle shall be construed to permit the expenditure of funds otherwise prohibited by law.CommentsClose CommentsPermalink

SEC. 105. CONFORMING AMENDMENT.

Section 1802(b)(3) of the Social Security Act (42 U.S.C. 1395a(b)(3)) is hereby repealed.CommentsClose CommentsPermalink

SEC. 106. DEFINITIONS.

For purposes of this title:CommentsClose CommentsPermalink





(1) HEALTH CARE SERVICES- The term ‘health care services’ means any lawful service intended to diagnose, cure, prevent, or mitigate the adverse effects of any disease, injury, infirmity, or physical or mental disability, including the provision of any lawful product the use of which is so intended.CommentsClose CommentsPermalink





(2) PHYSICIAN- The term ‘physician’ means--CommentsClose CommentsPermalink





(A) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such practice and surgery;CommentsClose CommentsPermalink





(B) a doctor of dental surgery or of dental medicine who is legally authorized to practice dentistry by the State in which he performs such function and who is acting within the scope of his license when he performs such functions;CommentsClose CommentsPermalink





(C) a doctor of podiatric medicine but only with respect to functions which he is legally authorized to perform as such by the State in which he performs them;CommentsClose CommentsPermalink





(D) a doctor of optometry with respect to the provision of items or services which he is legally authorized to perform as a doctor of optometry by the State in which he performs them; orCommentsClose CommentsPermalink





(E) a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), but only with respect to treatment which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided.CommentsClose CommentsPermalink





(3) PRACTICE OF MEDICINE- The term ‘practice of medicine’ means--CommentsClose CommentsPermalink





(A) health care services that are performed by physicians; andCommentsClose CommentsPermalink





(B) services and supplies furnished as an incident to a physician’s professional service.CommentsClose CommentsPermalink





(4) HEALTH CARE PRACTITIONER- The term ‘health care practitioner’ means a physician assistant, registered nurse, nurse practitioner, psychologist, clinical social worker, midwife, or other individual (other than a physician) licensed or legally authorized to perform health care services in the State in which the individual performs such services.CommentsClose CommentsPermalink





(5) PRACTICE OF OTHER HEALTH CARE PROFESSIONS- The term ‘practice of other health care professions’ means--CommentsClose CommentsPermalink





(A) health care services performed by a health care practitioner; andCommentsClose CommentsPermalink





(B) services and supplies furnished as an incident to a health care practitioner’s professional service.CommentsClose CommentsPermalink





(6) GROUP HEALTH PLAN- The term ‘group health plan’ has the meaning given such term in section 733(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(a)(1)).CommentsClose CommentsPermalink





(7) HEALTH INSURANCE ISSUER- The term ‘health insurance issuer’ has the meaning given such term in section 733(b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(b)(2)).CommentsClose CommentsPermalink





(8) BUSINESS- The term ‘business’ means any sole proprietorship, partnership, for-profit corporation, or not-for-profit corporation.CommentsClose CommentsPermalink





(9) STATE- The term ‘State’ means any of the United States, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Guam, American Samoa, or the District of Columbia.CommentsClose CommentsPermalink

SEC. 107. EFFECTIVE DATE.

The provisions of this title shall apply to Federal entities, including employees and officials of such entities, beginning on January 1, 2009.CommentsClose CommentsPermalink

TITLE II--IMPROVING QUALITY AND LOWERING THE COST OF HEALTH CARECommentsClose CommentsPermalink

Subtitle A--Equity for Our Nation’s Self-EmployedCommentsClose CommentsPermalink

SEC. 201. SECA TAX DEDUCTION FOR HEALTH INSURANCE COSTS.

(a) In General- Subsection (l) of section 162 of the Internal Revenue Code of 1986 (relating to special rules for health insurance costs of self-employed individuals) is amended by striking paragraph (4) and by redesignating paragraph (5) as paragraph (4).CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by this section shall apply to taxable years beginning after the date of the enactment of this subtitle.CommentsClose CommentsPermalink

Subtitle B--Help Efficient, Accessible, Low-cost, Timely HealthcareCommentsClose CommentsPermalink

SEC. 211. FINDINGS AND PURPOSE.

(a) Findings-CommentsClose CommentsPermalink





(1) EFFECT ON HEALTH CARE ACCESS AND COSTS- Congress finds that our current civil justice system is adversely affecting patient access to health care services, better patient care, and cost-efficient health care, in that the health care liability system is a costly and ineffective mechanism for resolving claims of health care liability and compensating injured patients, and is a deterrent to the sharing of information among health care professionals which impedes efforts to improve patient safety and quality of care.CommentsClose CommentsPermalink





(2) EFFECT ON INTERSTATE COMMERCE- Congress finds that the health care and insurance industries are industries affecting interstate commerce and the health care liability litigation systems existing throughout the United States are activities that affect interstate commerce by contributing to the high costs of health care and premiums for health care liability insurance purchased by health care system providers.CommentsClose CommentsPermalink





(3) EFFECT ON FEDERAL SPENDING- Congress finds that the health care liability litigation systems existing throughout the United States have a significant effect on the amount, distribution, and use of Federal funds because of--CommentsClose CommentsPermalink





(A) the large number of individuals who receive health care benefits under programs operated or financed by the Federal Government;CommentsClose CommentsPermalink





(B) the large number of individuals who benefit because of the exclusion from Federal taxes of the amounts spent to provide them with health insurance benefits; andCommentsClose CommentsPermalink





(C) the large number of health care providers who provide items or services for which the Federal Government makes payments.CommentsClose CommentsPermalink





(b) Purpose- It is the purpose of this subtitle to implement reasonable, comprehensive, and effective health care liability reforms designed to--CommentsClose CommentsPermalink





(1) improve the availability of health care services in cases in which health care liability actions have been shown to be a factor in the decreased availability of services;CommentsClose CommentsPermalink





(2) reduce the incidence of ‘defensive medicine’ and lower the cost of health care liability insurance, all of which contribute to the escalation of health care costs;CommentsClose CommentsPermalink





(3) ensure that persons with meritorious health care injury claims receive fair and adequate compensation, including reasonable noneconomic damages;CommentsClose CommentsPermalink





(4) improve the fairness and cost-effectiveness of our current health care liability system to resolve disputes over, and provide compensation for, health care liability by reducing uncertainty in the amount of compensation provided to injured individuals; andCommentsClose CommentsPermalink





(5) provide an increased sharing of information in the health care system which will reduce unintended injury and improve patient care.CommentsClose CommentsPermalink

SEC. 212. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS.

The time for the commencement of a health care lawsuit shall be 3 years after the date of manifestation of injury or 1 year after the claimant discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first. In no event shall the time for commencement of a health care lawsuit exceed 3 years after the date of manifestation of injury unless tolled for any of the following--CommentsClose CommentsPermalink





(1) upon proof of fraud;CommentsClose CommentsPermalink





(2) intentional concealment; orCommentsClose CommentsPermalink





(3) the presence of a foreign body, which has no therapeutic or diagnostic purpose or effect, in the person of the injured person.CommentsClose CommentsPermalink





Actions by a minor shall be commenced within 3 years from the date of the alleged manifestation of injury except that actions by a minor under the full age of 6 years shall be commenced within 3 years of manifestation of injury or prior to the minor’s 8th birthday, whichever provides a longer period. Such time limitation shall be tolled for minors for any period during which a parent or guardian and a health care provider or health care organization have committed fraud or collusion in the failure to bring an action on behalf of the injured minor.CommentsClose CommentsPermalink

SEC. 213. COMPENSATING PATIENT INJURY.

(a) Unlimited Amount of Damages for Actual Economic Losses in Health Care Lawsuits- In any health care lawsuit, nothing in this subtitle shall limit a claimant’s recovery of the full amount of the available economic damages, notwithstanding the limitation in subsection (b).CommentsClose CommentsPermalink





(b) Additional Noneconomic Damages- In any health care lawsuit, the amount of noneconomic damages, if available, may be as much as $250,000, regardless of the number of parties against whom the action is brought or the number of separate claims or actions brought with respect to the same injury.CommentsClose CommentsPermalink





(c) No Discount of Award for Noneconomic Damages- For purposes of applying the limitation in subsection (b), future noneconomic damages shall not be discounted to present value. The jury shall not be informed about the maximum award for noneconomic damages. An award for noneconomic damages in excess of $250,000 shall be reduced either before the entry of judgment, or by amendment of the judgment after entry of judgment, and such reduction shall be made before accounting for any other reduction in damages required by law. If separate awards are rendered for past and future noneconomic damages and the combined awards exceed $250,000, the future noneconomic damages shall be reduced first.CommentsClose CommentsPermalink





(d) Fair Share Rule- In any health care lawsuit, each party shall be liable for that party’s several share of any damages only and not for the share of any other person. Each party shall be liable only for the amount of damages allocated to such party in direct proportion to such party’s percentage of responsibility. Whenever a judgment of liability is rendered as to any party, a separate judgment shall be rendered against each such party for the amount allocated to such party. For purposes of this section, the trier of fact shall determine the proportion of responsibility of each party for the claimant’s harm.CommentsClose CommentsPermalink

SEC. 214. MAXIMIZING PATIENT RECOVERY.

(a) Court Supervision of Share of Damages Actually Paid to Claimants- In any health care lawsuit, the court shall supervise the arrangements for payment of damages to protect against conflicts of interest that may have the effect of reducing the amount of damages awarded that are actually paid to claimants. In particular, in any health care lawsuit in which the attorney for a party claims a financial stake in the outcome by virtue of a contingent fee, the court shall have the power to restrict the payment of a claimant’s damage recovery to such attorney, and to redirect such damages to the claimant based upon the interests of justice and principles of equity. In no event shall the total of all contingent fees for representing all claimants in a health care lawsuit exceed the following limits:CommentsClose CommentsPermalink





(1) 40 percent of the first $50,000 recovered by the claimant(s).CommentsClose CommentsPermalink





(2) 33 1/3 percent of the next $50,000 recovered by the claimant(s).CommentsClose CommentsPermalink





(3) 25 percent of the next $500,000 recovered by the claimant(s).CommentsClose CommentsPermalink





(4) 15 percent of any amount by which the recovery by the claimant(s) is in excess of $600,000.CommentsClose CommentsPermalink





(b) Applicability- The limitations in this section shall apply whether the recovery is by judgment, settlement, mediation, arbitration, or any other form of alternative dispute resolution. In a health care lawsuit involving a minor or incompetent person, a court retains the authority to authorize or approve a fee that is less than the maximum permitted under this section. The requirement for court supervision in the first two sentences of subsection (a) applies only in civil actions.CommentsClose CommentsPermalink

SEC. 215. ADDITIONAL HEALTH BENEFITS.

In any health care lawsuit involving injury or wrongful death, any party may introduce evidence of collateral source benefits. If a party elects to introduce such evidence, any opposing party may introduce evidence of any amount paid or contributed or reasonably likely to be paid or contributed in the future by or on behalf of the opposing party to secure the right to such collateral source benefits. No provider of collateral source benefits shall recover any amount against the claimant or receive any lien or credit against the claimant’s recovery or be equitably or legally subrogated to the right of the claimant in a health care lawsuit involving injury or wrongful death. This section shall apply to any health care lawsuit that is settled as well as a health care lawsuit that is resolved by a fact finder. This section shall not apply to section 1862(b) (42 U.S.C. 1395y(b)) or section 1902(a)(25) (42 U.S.C. 1396a(a)(25)) of the Social Security Act.CommentsClose CommentsPermalink

SEC. 216. PUNITIVE DAMAGES.

(a) In General- Punitive damages may, if otherwise permitted by applicable State or Federal law, be awarded against any person in a health care lawsuit only if it is proven by clear and convincing evidence that such person acted with malicious intent to injure the claimant, or that such person deliberately failed to avoid unnecessary injury that such person knew the claimant was substantially certain to suffer. In any health care lawsuit where no judgment for compensatory damages is rendered against such person, no punitive damages may be awarded with respect to the claim in such lawsuit. No demand for punitive damages shall be included in a health care lawsuit as initially filed. A court may allow a claimant to file an amended pleading for punitive damages only upon a motion by the claimant and after a finding by the court, upon review of supporting and opposing affidavits or after a hearing, after weighing the evidence, that the claimant has established by a substantial probability that the claimant will prevail on the claim for punitive damages. At the request of any party in a health care lawsuit, the trier of fact shall consider in a separate proceeding--CommentsClose CommentsPermalink





(1) whether punitive damages are to be awarded and the amount of such award; andCommentsClose CommentsPermalink





(2) the amount of punitive damages following a determination of punitive liability.CommentsClose CommentsPermalink





If a separate proceeding is requested, evidence relevant only to the claim for punitive damages, as determined by applicable State law, shall be inadmissible in any proceeding to determine whether compensatory damages are to be awarded.CommentsClose CommentsPermalink





(b) Determining Amount of Punitive Damages-CommentsClose CommentsPermalink





(1) FACTORS CONSIDERED- In determining the amount of punitive damages, if awarded, in a health care lawsuit, the trier of fact shall consider only the following--CommentsClose CommentsPermalink





(A) the severity of the harm caused by the conduct of such party;CommentsClose CommentsPermalink





(B) the duration of the conduct or any concealment of it by such party;CommentsClose CommentsPermalink





(C) the profitability of the conduct to such party;CommentsClose CommentsPermalink





(D) the number of products sold or medical procedures rendered for compensation, as the case may be, by such party, of the kind causing the harm complained of by the claimant;CommentsClose CommentsPermalink





(E) any criminal penalties imposed on such party, as a result of the conduct complained of by the claimant; andCommentsClose CommentsPermalink





(F) the amount of any civil fines assessed against such party as a result of the conduct complained of by the claimant.CommentsClose CommentsPermalink





(2) MAXIMUM AWARD- The amount of punitive damages, if awarded, in a health care lawsuit may be as much as $250,000 or as much as two times the amount of economic damages awarded, whichever is greater. The jury shall not be informed of this limitation.CommentsClose CommentsPermalink





(c) No Punitive Damages for Products That Comply With FDA Standards-CommentsClose CommentsPermalink





(1) IN GENERAL-CommentsClose CommentsPermalink





(A) No punitive damages may be awarded against the manufacturer or distributor of a medical product, or a supplier of any component or raw material of such medical product, based on a claim that such product caused the claimant’s harm where--CommentsClose CommentsPermalink





(i)(I) such medical product was subject to premarket approval, clearance, or licensure by the Food and Drug Administration with respect to the safety of the formulation or performance of the aspect of such medical product which caused the claimant’s harm or the adequacy of the packaging or labeling of such medical product; andCommentsClose CommentsPermalink





(II) such medical product was so approved, cleared, or licensed; orCommentsClose CommentsPermalink





(ii) such medical product is generally recognized among qualified experts as safe and effective pursuant to conditions established by the Food and Drug Administration and applicable Food and Drug Administration regulations, including without limitation those related to packaging and labeling, unless the Food and Drug Administration has determined that such medical product was not manufactured or distributed in substantial compliance with applicable Food and Drug Administration statutes and regulations.CommentsClose CommentsPermalink





(B) RULE OF CONSTRUCTION- Subparagraph (A) may not be construed as establishing the obligation of the Food and Drug Administration to demonstrate affirmatively that a manufacturer, distributor, or supplier referred to in such subparagraph meets any of the conditions described in such subparagraph.CommentsClose CommentsPermalink





(2) LIABILITY OF HEALTH CARE PROVIDERS- A health care provider who prescribes, or who dispenses pursuant to a prescription, a medical product approved, licensed, or cleared by the Food and Drug Administration shall not be named as a party to a product liability lawsuit involving such product and shall not be liable to a claimant in a class action lawsuit against the manufacturer, distributor, or seller of such product. Nothing in this paragraph prevents a court from consolidating cases involving health care providers and cases involving products liability claims against the manufacturer, distributor, or product seller of such medical product.CommentsClose CommentsPermalink





(3) PACKAGING- In a health care lawsuit for harm which is alleged to relate to the adequacy of the packaging or labeling of a drug which is required to have tamper-resistant packaging under regulations of the Secretary of Health and Human Services (including labeling regulations related to such packaging), the manufacturer or product seller of the drug shall not be held liable for punitive damages unless such packaging or labeling is found by the trier of fact by clear and convincing evidence to be substantially out of compliance with such regulations.CommentsClose CommentsPermalink





(4) EXCEPTION- Paragraph (1) shall not apply in any health care lawsuit in which--CommentsClose CommentsPermalink





(A) a person, before or after premarket approval, clearance, or licensure of such medical product, knowingly misrepresented to or withheld from the Food and Drug Administration information that is required to be submitted under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) or section 351 of the Public Health Service Act (42 U.S.C. 262) that is material and is causally related to the harm which the claimant allegedly suffered; orCommentsClose CommentsPermalink





(B) a person made an illegal payment to an official of the Food and Drug Administration for the purpose of either securing or maintaining approval, clearance, or licensure of such medical product.CommentsClose CommentsPermalink

SEC. 217. AUTHORIZATION OF PAYMENT OF FUTURE DAMAGES TO CLAIMANTS IN HEALTH CARE LAWSUITS.

(a) In General- In any health care lawsuit, if an award of future damages, without reduction to present value, equaling or exceeding $50,000 is made against a party with sufficient insurance or other assets to fund a periodic payment of such a judgment, the court shall, at the request of any party, enter a judgment ordering that the future damages be paid by periodic payments. In any health care lawsuit, the court may be guided by the Uniform Periodic Payment of Judgments Act promulgated by the National Conference of Commissioners on Uniform State Laws.CommentsClose CommentsPermalink





(b) Applicability- This section applies to all actions which have not been first set for trial or retrial before the effective date of this subtitle.CommentsClose CommentsPermalink

SEC. 218. DEFINITIONS.

In this subtitle:CommentsClose CommentsPermalink





(1) ALTERNATIVE DISPUTE RESOLUTION SYSTEM; ADR- The term ‘alternative dispute resolution system’ or ‘ADR’ means a system that provides for the resolution of health care lawsuits in a manner other than through a civil action brought in a State or Federal court.CommentsClose CommentsPermalink





(2) CLAIMANT- The term ‘claimant’ means any person who brings a health care lawsuit, including a person who asserts or claims a right to legal or equitable contribution, indemnity, or subrogation, arising out of a health care liability claim or action, and any person on whose behalf such a claim is asserted or such an action is brought, whether deceased, incompetent, or a minor.CommentsClose CommentsPermalink





(3) COLLATERAL SOURCE BENEFITS- The term ‘collateral source benefits’ means any amount paid or reasonably likely to be paid in the future to or on behalf of the claimant, or any service, product, or other benefit provided or reasonably likely to be provided in the future to or on behalf of the claimant, as a result of the injury or wrongful death, pursuant to--CommentsClose CommentsPermalink





(A) any State or Federal health, sickness, income-disability, accident, or workers’ compensation law;CommentsClose CommentsPermalink





(B) any health, sickness, income-disability, or accident insurance that provides health benefits or income-disability coverage;CommentsClose CommentsPermalink





(C) any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the cost of medical, hospital, dental, or income-disability benefits; andCommentsClose CommentsPermalink





(D) any other publicly or privately funded program.CommentsClose CommentsPermalink





(4) COMPENSATORY DAMAGES- The term ‘compensatory damages’ means objectively verifiable monetary losses incurred as a result of the provision of, use of, or payment for (or failure to provide, use, or pay for) health care services or medical products, such as past and future medical expenses, loss of past and future earnings, cost of obtaining domestic services, loss of employment, and loss of business or employment opportunities, damages for physical and emotional pain, suffering, inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium (other than loss of domestic service), hedonic damages, injury to reputation, and all other nonpecuniary losses of any kind or nature. The term ‘compensatory damages’ includes economic damages and noneconomic damages, as such terms are defined in this section.CommentsClose CommentsPermalink





(5) CONTINGENT FEE- The term ‘contingent fee’ includes all compensation to any person or persons which is payable only if a recovery is effected on behalf of one or more claimants.CommentsClose CommentsPermalink





(6) ECONOMIC DAMAGES- The term ‘economic damages’ means objectively verifiable monetary losses incurred as a result of the provision of, use of, or payment for (or failure to provide, use, or pay for) health care services or medical products, such as past and future medical expenses, loss of past and future earnings, cost of obtaining domestic services, loss of employment, and loss of business or employment opportunities.CommentsClose CommentsPermalink





(7) HEALTH CARE LAWSUIT- The term ‘health care lawsuit’ means any health care liability claim concerning the provision of health care goods or services or any medical product affecting interstate commerce, or any health care liability action concerning the provision of health care goods or services or any medical product affecting interstate commerce, brought in a State or Federal court or pursuant to an alternative dispute resolution system, against a health care provider, a health care organization, or the manufacturer, distributor, supplier, marketer, promoter, or seller of a medical product, regardless of the theory of liability on which the claim is based, or the number of claimants, plaintiffs, defendants, or other parties, or the number of claims or causes of action, in which the claimant alleges a health care liability claim. Such term does not include a claim or action which is based on criminal liability; which seeks civil fines or penalties paid to Federal, State, or local government; or which is grounded in antitrust.CommentsClose CommentsPermalink





(8) HEALTH CARE LIABILITY ACTION- The term ‘health care liability action’ means a civil action brought in a State or Federal court or pursuant to an alternative dispute resolution system, against a health care provider, a health care organization, or the manufacturer, distributor, supplier, marketer, promoter, or seller of a medical product, regardless of the theory of liability on which the claim is based, or the number of plaintiffs, defendants, or other parties, or the number of causes of action, in which the claimant alleges a health care liability claim.CommentsClose CommentsPermalink





(9) HEALTH CARE LIABILITY CLAIM- The term ‘health care liability claim’ means a demand by any person, whether or not pursuant to ADR, against a health care provider, health care organization, or the manufacturer, distributor, supplier, marketer, promoter, or seller of a medical product, including, but not limited to, third-party claims, cross-claims, counter-claims, or contribution claims, which are based upon the provision of, use of, or payment for (or the failure to provide, use, or pay for) health care services or medical products, regardless of the theory of liability on which the claim is based, or the number of plaintiffs, defendants, or other parties, or the number of causes of action.CommentsClose CommentsPermalink





(10) HEALTH CARE ORGANIZATION- The term ‘health care organization’ means any person or entity which is obligated to provide or pay for health benefits under any health plan, including any person or entity acting under a contract or arrangement with a health care organization to provide or administer any health benefit.CommentsClose CommentsPermalink





(11) HEALTH CARE PROVIDER- The term ‘health care provider’ means any person or entity required by State or Federal laws or regulations to be licensed, registered, or certified to provide health care services, and being either so licensed, registered, or certified, or exempted from such requirement by other statute or regulation.CommentsClose CommentsPermalink





(12) HEALTH CARE GOODS OR SERVICES- The term ‘health care goods or services’ means any goods or services provided by a health care organization, provider, or by any individual working under the supervision of a health care provider, that relates to the diagnosis, prevention, or treatment of any human disease or impairment, or the assessment or care of the health of human beings.CommentsClose CommentsPermalink





(13) MALICIOUS INTENT TO INJURE- The term ‘malicious intent to injure’ means intentionally causing or attempting to cause physical injury other than providing health care goods or services.CommentsClose CommentsPermalink





(14) MEDICAL PRODUCT- The term ‘medical product’ means a drug, device, or biological product intended for humans, and the terms ‘drug’, ‘device’, and ‘biological product’ have the meanings given such terms in sections 201(g)(1) and 201(h) of the Federal Food, Drug and Cosmetic Act (21 U.S.C. 321(g)(1) and (h)) and section 351(a) of the Public Health Service Act (42 U.S.C. 262(a)), respectively, including any component or raw material used therein, but excluding health care services.CommentsClose CommentsPermalink





(15) NONECONOMIC DAMAGES- The term ‘noneconomic damages’ means damages for physical and emotional pain, suffering, inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium (other than loss of domestic service), hedonic damages, injury to reputation, and all other nonpecuniary losses of any kind or nature.CommentsClose CommentsPermalink





(16) PUNITIVE DAMAGES- The term ‘punitive damages’ means damages awarded, for the purpose of punishment or deterrence, and not solely for compensatory purposes, against a health care provider, health care organization, or a manufacturer, distributor, or supplier of a medical product. Punitive damages are neither economic nor noneconomic damages.CommentsClose CommentsPermalink





(17) RECOVERY- The term ‘recovery’ means the net sum recovered after deducting any disbursements or costs incurred in connection with prosecution or settlement of the claim, including all costs paid or advanced by any person. Costs of health care incurred by the plaintiff and the attorneys’ office overhead costs or charges for legal services are not deductible disbursements or costs for such purpose.CommentsClose CommentsPermalink





(18) STATE- The term ‘State’ means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific Islands, and any other territory or possession of the United States, or any political subdivision thereof.CommentsClose CommentsPermalink

SEC. 219. EFFECT ON OTHER LAWS.

(a) Vaccine Injury-CommentsClose CommentsPermalink





(1) To the extent that title XXI of the Public Health Service Act establishes a Federal rule of law applicable to a civil action brought for a vaccine-related injury or death--CommentsClose CommentsPermalink





(A) this subtitle does not affect the application of the rule of law to such an action; andCommentsClose CommentsPermalink





(B) any rule of law prescribed by this subtitle in conflict with a rule of law of such title XXI shall not apply to such action.CommentsClose CommentsPermalink





(2) If there is an aspect of a civil action brought for a vaccine-related injury or death to which a Federal rule of law under title XXI of the Public Health Service Act does not apply, then this subtitle or otherwise applicable law (as determined under this subtitle) will apply to such aspect of such action.CommentsClose CommentsPermalink





(b) Other Federal Law- Except as provided in this section, nothing in this subtitle shall be deemed to affect any defense available to a defendant in a health care lawsuit or action under any other provision of Federal law.CommentsClose CommentsPermalink

SEC. 220. STATE FLEXIBILITY AND PROTECTION OF STATES’ RIGHTS.

(a) Health Care Lawsuits- The provisions governing health care lawsuits set forth in this subtitle preempt, subject to subsections (b) and (c), State law to the extent that State law prevents the application of any provisions of law established by or under this subtitle. The provisions governing health care lawsuits set forth in this subtitle supersede chapter 171 of title 28, United States Code, to the extent that such chapter--CommentsClose CommentsPermalink





(1) provides for a greater amount of damages or contingent fees, a longer period in which a health care lawsuit may be commenced, or a reduced applicability or scope of periodic payment of future damages, than provided in this subtitle; orCommentsClose CommentsPermalink





(2) prohibits the introduction of evidence regarding collateral source benefits, or mandates or permits subrogation or a lien on collateral source benefits.CommentsClose CommentsPermalink





(b) Protection of States’ Rights and Other Laws- (1) Any issue that is not governed by any provision of law established by or under this subtitle (including State standards of negligence) shall be governed by otherwise applicable State or Federal law.CommentsClose CommentsPermalink





(2) This subtitle shall not preempt or supersede any State or Federal law that imposes greater procedural or substantive protections for health care providers and health care organizations from liability, loss, or damages than those provided by this subtitle or create a cause of action.CommentsClose CommentsPermalink





(c) State Flexibility- No provision of this subtitle shall be construed to preempt--CommentsClose CommentsPermalink





(1) any State law (whether effective before, on, or after the date of the enactment of this subtitle) that specifies a particular monetary amount of compensatory or punitive damages (or the total amount of damages) that may be awarded in a health care lawsuit, regardless of whether such monetary amount is greater or lesser than is provided for under this subtitle, notwithstanding section 4(a); orCommentsClose CommentsPermalink





(2) any defense available to a party in a health care lawsuit under any other provision of State or Federal law.CommentsClose CommentsPermalink

SEC. 221. APPLICABILITY; EFFECTIVE DATE.

This subtitle shall apply to any health care lawsuit brought in a Federal or State court, or subject to an alternative dispute resolution system, that is initiated on or after the date of the enactment of this subtitle, except that any health care lawsuit arising from an injury occurring prior to the date of the enactment of this subtitle shall be governed by the applicable statute of limitations provisions in effect at the time the injury occurred.CommentsClose CommentsPermalink

SEC. 222. SENSE OF CONGRESS.

It is the sense of Congress that a health insurer should be liable for damages for harm caused when it makes a decision as to what care is medically necessary and appropriate.CommentsClose CommentsPermalink

Subtitle C--Accelerating the Deployment of Health Information TechnologyCommentsClose CommentsPermalink

PART 1--ENHANCED COORDINATION AND ADOPTION OF HEALTH INFORMATION TECHNOLOGY

SEC. 231. STRATEGIC PLAN FOR COORDINATING IMPLEMENTATION OF MEDICARE AND MEDICAID HEALTH INFORMATION TECHNOLOGY INCENTIVE PAYMENTS.

Section 3001(c) of the Public Health Service Act (42 U.S.C. 300jj-11(c)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(9) STRATEGIC PLAN FOR MEDICARE AND MEDICAID EHR PAYMENT INCENTIVES AND ADJUSTMENTS- Not later than 90 days after the date of the enactment of the Medical Rights and Reform Act of 2009, the National Coordinator shall publish a strategic plan including--CommentsClose CommentsPermalink





‘(A) timelines for applying the incentive payments and incentive adjustments applicable to eligible providers, eligible hospitals, and eligible professionals under sections 1848(a), 1848(o), 1853(l), 1853(m), 1886(n), 1814(l)(3), 1886(b)(3)(B)(ix), and 1903(a)(3)(F) during the 18-month period following such date of enactment, including specifying specific steps by date that providers and hospitals must take to be eligible for such incentive payments; andCommentsClose CommentsPermalink





‘(B) a specific plan to educate health care providers, consumers, and vendors of health information technology about how eligible providers, eligible hospitals, and eligible professionals may become compliant with requirements under such sections for purposes of eligibility for incentive payments under such sections.’.CommentsClose CommentsPermalink

SEC. 232. PROCEDURES TO ENSURE TIMELY UPDATING OF STANDARDS THAT ENABLE ELECTRONIC EXCHANGES.

Section 1174(b) of the Social Security Act (42 U.S.C. 1320d-3(b)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)--CommentsClose CommentsPermalink





(A) in the first sentence, by inserting ‘and in accordance with paragraph (3)’ before the period; andCommentsClose CommentsPermalink





(B) by adding at the end the following new sentence: ‘For purposes of this subsection and section 1173(c)(2), the term ‘modification’ includes a new version or a version upgrade’; andCommentsClose CommentsPermalink





(2) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(3) EXPEDITED PROCEDURES FOR ADOPTION OF ADDITIONS AND MODIFICATIONS TO STANDARDS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- For purposes of paragraph (1), the Secretary shall provide for an expedited upgrade program (in this paragraph referred to as the ‘upgrade program’), in accordance with this paragraph, to develop and approve additions and modifications to the standards adopted under section 1173(a) to improve the quality of such standards or to extend the functionality of such standards to meet evolving requirements in health care.CommentsClose CommentsPermalink





‘(B) PUBLICATION OF NOTICES- Under the upgrade program:CommentsClose CommentsPermalink





‘(i) VOLUNTARY NOTICE OF INITIATION OF PROCESS- Not later than 30 days after the date the Secretary receives a notice from a standard setting organization that the organization is initiating a process to develop an addition or modification to a standard adopted under section 1173(a), the Secretary shall publish a notice in the Federal Register that--CommentsClose CommentsPermalink





‘(I) identifies the subject matter of the addition or modification;CommentsClose CommentsPermalink





‘(II) provides a description of how persons may participate in the development process; andCommentsClose CommentsPermalink





‘(III) invites public participation in such process.CommentsClose CommentsPermalink





‘(ii) VOLUNTARY NOTICE OF PRELIMINARY DRAFT OF ADDITIONS OR MODIFICATIONS TO STANDARDS- Not later than 30 days after the date the Secretary receives a notice from a standard setting organization that the organization has prepared a preliminary draft of an addition or modification to a standard adopted by section 1173(a), the Secretary shall publish a notice in the Federal Register that--CommentsClose CommentsPermalink





‘(I) identifies the subject matter of (and summarizes) the addition or modification;CommentsClose CommentsPermalink





‘(II) specifies the procedure for obtaining the draft;CommentsClose CommentsPermalink





‘(III) provides a description of how persons may submit comments in writing and at any public hearing or meeting held by the organization on the addition or modification; andCommentsClose CommentsPermalink





‘(IV) invites submission of such comments and participation in such hearing or meeting without requiring the public to pay a fee to participate.CommentsClose CommentsPermalink





‘(iii) NOTICE OF PROPOSED ADDITION OR MODIFICATION TO STANDARDS- Not later than 30 days after the date the Secretary receives a notice from a standard setting organization that the organization has a proposed addition or modification to a standard adopted under section 1173(a) that the organization intends to submit under subparagraph (D)(iii), the Secretary shall publish a notice in the Federal Register that contains, with respect to the proposed addition or modification, the information required in the notice under clause (ii) with respect to the addition or modification.CommentsClose CommentsPermalink





‘(iv) CONSTRUCTION- Nothing in this paragraph shall be construed as requiring a standard setting organization to request the notices described in clauses (i) and (ii) with respect to an addition or modification to a standard in order to qualify for an expedited determination under subparagraph (C) with respect to a proposal submitted to the Secretary for adoption of such addition or modification.CommentsClose CommentsPermalink





‘(C) PROVISION OF EXPEDITED DETERMINATION- Under the upgrade program and with respect to a proposal by a standard setting organization for an addition or modification to a standard adopted under section 1173(a), if the Secretary determines that the standard setting organization developed such addition or modification in accordance with the requirements of subparagraph (D) and the National Committee on Vital and Health Statistics recommends approval of such addition or modification under subparagraph (E), the Secretary shall provide for expedited treatment of such proposal in accordance with subparagraph (F).CommentsClose CommentsPermalink





‘(D) REQUIREMENTS- The requirements under this subparagraph with respect to a proposed addition or modification to a standard by a standard setting organization are the following:CommentsClose CommentsPermalink





‘(i) REQUEST FOR PUBLICATION OF NOTICE- The standard setting organization submits to the Secretary a request for publication in the Federal Register of a notice described in subparagraph (B)(iii) for the proposed addition or modification.CommentsClose CommentsPermalink





‘(ii) PROCESS FOR RECEIPT AND CONSIDERATION OF PUBLIC COMMENT- The standard setting organization provides for a process through which, after the publication of the notice referred to under clause (i), the organization--CommentsClose CommentsPermalink





‘(I) receives and responds to public comments submitted on a timely basis on the proposed addition or modification before submitting such proposed addition or modification to the National Committee on Vital and Health Statistics under clause (iii);CommentsClose CommentsPermalink





‘(II) makes publicly available a written explanation for its response in the proposed addition or modification to comments submitted on a timely basis; andCommentsClose CommentsPermalink





‘(III) makes public comments received under clause (I) available, or provides access to such comments, to the Secretary.CommentsClose CommentsPermalink





‘(iii) SUBMITTAL OF FINAL PROPOSED ADDITION OR MODIFICATION TO NCVHS- After completion of the process under clause (ii), the standard setting organization submits the proposed addition or modification to the National Committee on Vital and Health Statistics for review and consideration under subparagraph (E). Such submission shall include information on the organization’s compliance with the notice and comment requirements (and responses to those comments) under clause (ii).CommentsClose CommentsPermalink





‘(E) HEARING AND RECOMMENDATIONS BY NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS- Under the upgrade program, upon receipt of a proposal submitted by a standard setting organization under subparagraph (D)(iii) for the adoption of an addition or modification to a standard, the National Committee on Vital and Health Statistics shall provide notice to the public and a reasonable opportunity for public testimony at a hearing on such addition or modification. The Secretary may participate in such hearing in such capacity (including presiding ex officio) as the Secretary shall determine appropriate. Not later than 90 days after the date of receipt of the proposal, the Committee shall submit to the Secretary its recommendation to adopt (or not adopt) the proposed addition or modification.CommentsClose CommentsPermalink





‘(F) DETERMINATION BY SECRETARY TO ACCEPT OR REJECT NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS RECOMMENDATION-CommentsClose CommentsPermalink





‘(i) TIMELY DETERMINATION- Under the upgrade program, if the National Committee on Vital and Health Statistics submits to the Secretary a recommendation under subparagraph (E) to adopt a proposed addition or modification, not later than 90 days after the date of receipt of such recommendation the Secretary shall make a determination to accept or reject the recommendation and shall publish notice of such determination in the Federal Register not later than 30 days after the date of the determination.CommentsClose CommentsPermalink





‘(ii) CONTENTS OF NOTICE- If the determination is to reject the recommendation, such notice shall include the reasons for the rejection. If the determination is to accept the recommendation, as part of such notice the Secretary shall promulgate the modified standard (including the accepted proposed addition or modification accepted).CommentsClose CommentsPermalink





‘(iii) LIMITATION ON CONSIDERATION- The Secretary shall not consider a proposal under this subparagraph unless the Secretary determines that the requirements of subparagraph (D) (including publication of notice and opportunity for public comment) have been met with respect to the proposal.CommentsClose CommentsPermalink





‘(G) EXEMPTION FROM PAPERWORK REDUCTION ACT- Chapter 35 of title 44, United States Code, shall not apply to a final rule promulgated under subparagraph (F).’.CommentsClose CommentsPermalink

SEC. 233. STUDY TO IMPROVE PRESERVATION AND PROTECTION OF SECURITY AND CONFIDENTIALITY OF HEALTH INFORMATION.

(a) In General- The Secretary of Health and Human Services shall conduct a study of the following:CommentsClose CommentsPermalink





(1) Current Federal security and confidentiality standards to determine the strengths and weaknesses of such standards for purposes of protecting the security and confidentiality of individually identifiable health information while taking into account the need for timely and efficient exchanges of health information to improve quality of care and ensure the availability of health information necessary to make medical decisions at the location in which the medical care involved is provided.CommentsClose CommentsPermalink





(2) The extent to which current security and confidentiality standards and State laws relating to security and confidentiality of individually identifiable health information should be reconciled to produce uniform standards, especially in the case of data that is shared by health care providers for patient care and other activities across State borders that would often result in more than one set of such standards that would apply.CommentsClose CommentsPermalink





(b) Report- Not later than 9 months after the date of the enactment of this subtitle, the Secretary of Health and Human Services shall submit to Congress a report on the study under subsection (a) and shall include in such report recommendations for improving the current Federal security and confidentiality standards, including recommendations for a mechanism to track breaches to the security or confidentiality of individually identifiable health information and for appropriate penalties to apply in the case of such a breach and including proposals to address issues examined in subsection (a)(2).CommentsClose CommentsPermalink





(c) Preservation of Current Security and Confidentiality Standards Before Submittal of Report- None of the provisions of this subtitle or amendments made by this subtitle may limit, or require issuance of a regulation that would limit, the effect of a current Federal security and confidentiality standard before the date of the submittal of the report under subsection (b).CommentsClose CommentsPermalink





(d) Current Federal Security and Confidentiality Standards Defined- For purposes of this section, the term ‘current Federal security and confidentiality standards’ means the Federal privacy standards established pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note) and security standards established under section 1173(d) of the Social Security Act.CommentsClose CommentsPermalink

SEC. 234. ASSISTING DOCTORS TO OBTAIN PROFICIENT AND TRANSMISSIBLE HEALTH INFORMATION TECHNOLOGY.

(a) In General- Section 179 of the Internal Revenue Code of 1986 (relating to election to expense certain depreciable assets) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(f) Health Care Information Technology-CommentsClose CommentsPermalink





‘(1) IN GENERAL- In the case of qualified health care information technology purchased by a medical care provider and placed in service during a taxable year--CommentsClose CommentsPermalink





‘(A) subsection (b)(1) shall be applied by substituting ‘$250,000’ for ‘$125,000’;CommentsClose CommentsPermalink





‘(B) subsection (b)(2) shall be applied by substituting ‘$600,000’ for ‘$500,000’; andCommentsClose CommentsPermalink





‘(C) subsection (b)(5)(A) shall be applied by substituting ‘$250,000 and $600,000’ for ‘$125,000 and $500,000’.CommentsClose CommentsPermalink





‘(2) DEFINITIONS- For purposes of this subsection--CommentsClose CommentsPermalink





‘(A) QUALIFIED HEALTH CARE INFORMATION TECHNOLOGY- The term ‘qualified health care information technology’ means section 179 property which--CommentsClose CommentsPermalink





‘(i) has been certified pursuant to section 3001(c)(3) of the Public Health Service Act; andCommentsClose CommentsPermalink





‘(ii) is used primarily for the electronic creation, maintenance, and exchange of medical care information to provide or improve the quality or efficiency of medical care.CommentsClose CommentsPermalink





‘(B) MEDICAL CARE PROVIDER- The term ‘medical care provider’ means any person engaged in the trade or business of providing medical care.CommentsClose CommentsPermalink





‘(C) MEDICAL CARE- The term ‘medical care’ has the meaning given such term by section 213(d).’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by this section shall apply to property placed in service after December 31, 2009.CommentsClose CommentsPermalink

SEC. 235. EXPANSION OF STARK AND ANTI-KICKBACK EXCEPTIONS FOR ELECTRONIC HEALTH RECORDS ARRANGEMENTS.

(a) Stark Exception- In applying section 1877(e) of the Social Security Act (42 U.S.C. 1395(e)), with respect to a regulation implementing such section by providing an exception to the prohibition against making certain physician referrals in the case of the offering or payment of nonmonetary remuneration (consisting of items and services in the form of software or information technology and training services) necessary and used predominantly to create, maintain, transmit, or receive electronic health records, the Secretary of Health and Human Services shall--CommentsClose CommentsPermalink





(1) not limit the period in which such an exception under such a regulation applies;CommentsClose CommentsPermalink





(2) not require the physician to pay any percentage of the cost of such nonmonetary remuneration; andCommentsClose CommentsPermalink





(3) apply the exception to such items and services in the form of hardware and maintenance services, in addition to such items and services in the form of software or information technology and training services.CommentsClose CommentsPermalink





(b) Anti-Kickback Exception- In applying section 1128B(b)(3)(E) of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(E)), with respect to a regulation implementing such section by providing an exception to the prohibition against offering, paying, soliciting, or receiving remuneration in order to induce or reward referrals making certain physician referrals in the case of the offering, payment, solicitation, or receipt of remuneration (consisting of certain arrangements involving interoperable electronic health records software or information technology and training services) necessary and used predominantly to create, maintain, transmit, or receive electronic health records, the Secretary of Health and Human Services shall--CommentsClose CommentsPermalink





(1) not limit the period in which such an exception under such a regulation applies;CommentsClose CommentsPermalink





(2) not require the recipient of such remuneration to pay any percentage of the cost of such remuneration; andCommentsClose CommentsPermalink





(3) apply the exception to such arrangements involving interoperable electronic health records hardware and maintenance services, in addition to software or information technology and training services.CommentsClose CommentsPermalink

SEC. 236. APPLICATION OF MEDICARE EHR INCENTIVES AND ADJUSTMENTS TO ADDITIONAL PROVIDERS.

(a) Application of EHR Medicare Incentive Payments and Adjustments to Nurse Practitioner, Physician Assistants, and Clinical Nurse Specialists-CommentsClose CommentsPermalink





(1) INCENTIVE PAYMENT- Section 1848(o)(5)(C) of the Social Security Act is amended by inserting ‘, and a practitioner described in section 1842(b)(18)(C)(i)’ after ‘1861(r)’.CommentsClose CommentsPermalink





(2) INCENTIVE ADJUSTMENT- Section 1848(a)(7)(E)(iii) of such Act is amended by inserting ‘, and a practitioner described in section 1842(b)(18)(C)(i)’ after ‘1861(r)’.CommentsClose CommentsPermalink





(b) Application of EHR Medicare Incentive Payments and Adjustments to SNFs, Home Health Agencies, IRFs, LTCHs, ASCs, and Long-Term Care Pharmacies-CommentsClose CommentsPermalink





(1) IN GENERAL- The Secretary of Health and Human Services shall establish a methodology to--CommentsClose CommentsPermalink





(A) determine eligible entities described in paragraph (2) that are to be considered meaningful EHR users in a manner similar to how eligible hospitals are determined to be meaningful EHR users for purposes of sections 1886(n) and 1886(b)(3)(B)(ix) of the Social Security Act; andCommentsClose CommentsPermalink





(B) apply the provisions of such sections to such eligible entities in a similar manner as they apply to hospitals under such section.CommentsClose CommentsPermalink





(2) ELIGIBLE ENTITIES DESCRIBED- Eligible entities described in this paragraph are the following:CommentsClose CommentsPermalink





(A) Skilled nursing facilities.CommentsClose CommentsPermalink





(B) Home health agencies.CommentsClose CommentsPermalink





(C) Inpatient rehabilitation facilities .CommentsClose CommentsPermalink





(D) Ambulatory surgical centers.CommentsClose CommentsPermalink





(E) Long-term care pharmacies.CommentsClose CommentsPermalink





(F) Long-term care hospitals.CommentsClose CommentsPermalink

PART 2--TELEHEALTH ENHANCEMENT

Subpart A--Medicare Program

SEC. 241. EXPANSION AND IMPROVEMENT OF TELEHEALTH SERVICES.

(a) Expanding Access to Telehealth Services to All Areas- Section 1834(m)(4)(C)(i) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(i)) is amended in paragraph (4)(C)(i) by striking ‘and only if such site is located’ and all that follows and inserting ‘without regard to the geographic area within the United States where the site is located.’.CommentsClose CommentsPermalink





(b) Expansion of Use of Store-and-Forward Technology- The second sentence of section 1834(m)(1) of such Act (42 U.S.C. 1395m(m)(1)) is amended by inserting ‘and any telehealth program that has been the recipient of any Federal support from the Centers for Medicare & Medicaid Services, the Indian Health Service, or the Health Services and Resources Administration’ after ‘Alaska or Hawaii’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1, 2010.CommentsClose CommentsPermalink

SEC. 242. INCREASE IN NUMBER OF TYPES OF ORIGINATING SITES; CLARIFICATION.

(a) Increase- Paragraph (4)(C)(ii) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the following new subclause:CommentsClose CommentsPermalink





‘(IX) A renal dialysis facility.’.CommentsClose CommentsPermalink





(b) Clarification of Intent of the Term Originating Site- Such section is further amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(5) CONSTRUCTION- In applying the term ‘originating site’ under this subsection, the Secretary shall apply the term only for the purpose of determining whether a site is eligible to receive a facility fee. Nothing in the application of such term under this subsection shall be construed as affecting the ability of an eligible practitioner to submit claims for telehealth services that are provided to other sites that have telehealth systems and capabilities.’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1, 2010.CommentsClose CommentsPermalink

SEC. 243. EXPANSION OF ELIGIBLE TELEHEALTH PROVIDERS AND CREDENTIALING OF TELEMEDICINE PRACTITIONERS.

(a) Expansion of Eligible Telehealth Providers- Section 1834(m)(1) of the Social Security Act (42 U.S.C. 1395m(m)(1)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)--CommentsClose CommentsPermalink





(A) by striking ‘or a practitioner’ and inserting ‘, a practitioner’;CommentsClose CommentsPermalink





(B) by inserting ‘, or other telehealth provider’ after ‘1842(b)(18)(C))’; andCommentsClose CommentsPermalink





(C) by striking ‘or practitioner’ and inserting ‘, practitioner, or provider’;CommentsClose CommentsPermalink





(2) in paragraphs (2), (3)(A), and (4), by striking ‘or practitioner’ and inserting ‘, practitioner, or other telehealth provider’ each place it appears; andCommentsClose CommentsPermalink





(3) in paragraph (4), by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(G) TELEHEALTH PROVIDER- The term ‘telehealth provider’ means any supplier or provider of services (other than a physician or practitioner) that is eligible to provide other health services under this title.’.CommentsClose CommentsPermalink





(b) Credentialing Telemedicine Practitioners- Section 1834(m) of such Act is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(5) HOSPITAL CREDENTIALING OF TELEMEDICINE PRACTITIONERS- A telemedicine practitioner that is credentialed by a hospital in compliance with the Joint Commission Standards for Telemedicine shall be considered in compliance with Medicare condition of participation and reimbursement credentialing requirements for telemedicine services.’.CommentsClose CommentsPermalink

SEC. 244. ACCESS TO TELEHEALTH SERVICES IN THE HOME.

(a) In General- Section 1895 of the Social Security Act (42 U.S.C. 1395fff(e)) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(f) Coverage of Telehealth Services-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall include telehealth services that are furnished via a telecommunication system by a home health agency to an individual receiving home health services under section 1814(a)(2)(C) or 1835(a)(2)(A) as a home health visit for purposes of eligibility and payment under this title if the telehealth services--CommentsClose CommentsPermalink





‘(A) are ordered as part of a plan of care certified by a physician pursuant to section 1814(a)(2)(C) or 1835(a)(2)(A);CommentsClose CommentsPermalink





‘(B) do not substitute for in-person home health services ordered as part of a plan of care certified by a physician pursuant to such respective section; andCommentsClose CommentsPermalink





‘(C) are considered the equivalent of a visit under criteria developed by the Secretary under paragraph (3).CommentsClose CommentsPermalink





‘(2) PHYSICIAN CERTIFICATION- Nothing in this section shall be construed as waiving the requirement for a physician certification under section 1814(a)(2)(C) or 1835(a)(2)(A) for the payment for home health services, whether or not furnished via a telecommunication system.CommentsClose CommentsPermalink





‘(3) CRITERIA FOR VISIT EQUIVALENCY-CommentsClose CommentsPermalink





‘(A) STANDARDS- The Secretary shall establish standards and qualifications for categorizing and coding under HCPCS codes telehealth services under this subsection as equivalent to an in-person visit for purposes of eligibility and payment for home health services under this title. In establishing the standards and qualifications, the Secretary may distinguish between varying modes and modalities of telehealth services and shall consider--CommentsClose CommentsPermalink





‘(i) the nature and amount of service time involved; andCommentsClose CommentsPermalink





‘(ii) the functions of the telecommunications.CommentsClose CommentsPermalink





‘(B) LIMITATION- A telecommunication that consists solely of a telephone audio conversation, facsimile, electronic text mail, or consultation between two health care practitioners is not considered a visit under this subsection.CommentsClose CommentsPermalink





‘(4) TELEHEALTH SERVICE-CommentsClose CommentsPermalink





‘(A) DEFINITION- For purposes of this subsection, the term ‘telehealth service’ means technology-based professional consultations, patient monitoring, patient training services, clinical observation, assessment, or treatment, and any additional services that utilize technologies specified by the Secretary as HCPCS codes developed under paragraph (3).CommentsClose CommentsPermalink





‘(B) UPDATE OF HCPCS CODES- The Secretary shall establish a process for the updating, not less frequently than annually, of HCPCS codes for telehealth services.CommentsClose CommentsPermalink





‘(5) CONDITIONS FOR PAYMENT AND COVERAGE- Nothing in this subsection shall be construed as waiving any condition of payment under sections 1814(a)(2)(C) or 1835(a)(2)(A) or exclusion of coverage under section 1862(a)(1).CommentsClose CommentsPermalink





‘(6) COST REPORTING- Notwithstanding any provision to the contrary, the Secretary shall provide that the costs of telehealth services under this subsection shall be reported as a reimbursable cost center on any cost report submitted by a home health agency to the Secretary.’.CommentsClose CommentsPermalink





(b) Effective Date-CommentsClose CommentsPermalink





(1) The amendment made by subsection (a) shall apply to telehealth services furnished on or after October 1, 2010. The Secretary of Health and Human Services shall develop and implement criteria and standards under section 1895(f)(3) of the Social Security Act, as amended by subsection (a), by no later than July 1, 2010.CommentsClose CommentsPermalink





(2) In the event that the Secretary has not complied with these deadlines, beginning October 1, 2010, a home health visit for purpose of eligibility and payment under title XVIII of the Social Security Act shall include telehealth services under section 1895(f) of such Act with the aggregate of telecommunication encounters in a 24-hour period considered the equivalent of one in-person visit.CommentsClose CommentsPermalink

SEC. 245. COVERAGE OF HOME HEALTH REMOTE PATIENT MANAGEMENT SERVICES FOR CHRONIC HEALTH CONDITIONS.

(a) Medicare Coverage-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--CommentsClose CommentsPermalink





(A) in subparagraph (DD), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(B) in subparagraph (EE), by adding ‘and’ at the end; andCommentsClose CommentsPermalink





(C) by inserting after subparagraph (EE) the following new subparagraph:CommentsClose CommentsPermalink





‘(FF) home health remote patient management services (as defined in subsection (hhh));’.CommentsClose CommentsPermalink





(2) SERVICES DESCRIBED- Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(hhh) Home Health Remote Patient Management Services for Chronic Health Conditions- (1) The term ‘remote patient management services’ means the remote monitoring, evaluation, and management of an individual with a covered chronic health condition (as defined in paragraph (2)) through the utilization of a system of technology that allows a remote interface to collect and transmit clinical data between the individual and a home health agency, in accordance with a plan of care established by a physician, for the purposes of clinical review or response by the home health agency. Such term, with respect to an individual, does not include any remote monitoring, evaluation, or management of the individual if such remote monitoring, evaluation, or management, respectively, is included as a home health visit under section 1895(f) for purposes of payment under this title.CommentsClose CommentsPermalink





‘(2) For purposes of paragraph (1), the term ‘covered chronic health condition’ means any chronic health condition specified by the Secretary.’.CommentsClose CommentsPermalink





(b) Payment-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1834 of such Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(n) Home Health Remote Patient Management Services-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall establish a fee schedule for home health remote patient management services (as defined in section 1861(hhh)) for which payment is made under this part. The fee schedule shall be designed in a manner so that, on an annual basis, the aggregate payment amounts under this title for such services approximates 50 percent of the savings amount described in paragraph (2) for such year.CommentsClose CommentsPermalink





‘(2) SAVINGS DESCRIBED-CommentsClose CommentsPermalink





‘(A) IN GENERAL- For purposes of paragraph (1), the savings amount described in this paragraph for a year is the amount (if any), as estimated by the Secretary before the beginning of the year, by which--CommentsClose CommentsPermalink





‘(i) the product described in subparagraph (B) for the year, exceedsCommentsClose CommentsPermalink





‘(ii) the total payments under this part and part A for items and services furnished to individuals receiving home health remote patient management services at any time during the year.CommentsClose CommentsPermalink





‘(B) PRODUCT DESCRIBED- The product described in this subparagraph for a year is the product of--CommentsClose CommentsPermalink





‘(i) the average per capita total payments under this part and part A for items and services furnished during the year to individuals not described in subparagraph (A)(ii), adjusted to remove case mix differences between such individuals not described in such subparagraph and the individuals described in such subparagraph; andCommentsClose CommentsPermalink





‘(ii) the number of individuals under subparagraph (A)(ii) for the year.CommentsClose CommentsPermalink





‘(3) LIMITATION- In no case may payments under this subsection result in the aggregate expenditures under this title (including payments under this subsection) exceeding the amount that the Secretary estimates would have been expended if coverage under this title for home health patient management services was not provided.CommentsClose CommentsPermalink





‘(4) CLARIFICATION- Payments under the fee schedule under this subsection, with respect to an individual, shall be in addition to any other payments that a home health agency would otherwise receive under this title for items and services furnished to such individual and shall have no effect on the amount of such other payments.CommentsClose CommentsPermalink





‘(5) PAYMENT TRANSFER- There shall be transferred from the Federal Hospital Insurance Trust Fund under section 1817 to the Federal Supplementary Medical Insurance Trust Fund under section 1841 each year an amount equivalent to the product of--CommentsClose CommentsPermalink





‘(A) expenditures under this subsection for the year, andCommentsClose CommentsPermalink





‘(B) the ratio of the portion of the savings described in paragraph (2) for the year that are attributable to part A, to the total savings described in such paragraph for the year.’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 1833(a)(1) of such Act (42 U.S.C. 1395l(1)) is amended--CommentsClose CommentsPermalink





(A) by striking ‘and (W)’ and inserting ‘(W)’; andCommentsClose CommentsPermalink





(B) by inserting before the semicolon at the end the following: ‘, (X) with respect to home health remote patient management services (as defined in section 1861(hhh)), the amounts paid shall be the amount determined under the fee schedule established under section 1834(n)’.CommentsClose CommentsPermalink





(c) Expansion of Home Health Remote Patient Management Services Coverage to Additional Chronic Health Conditions- The Secretary of Health and Human Services is authorized to carry out pilot projects for purposes of determining the extent to which the coverage under title XVIII of the Social Security Act of home health remote patient management services (as defined in paragraph (1) of section 1861(hhh) of such Act, as added by subsection (a)) should be extended to individuals with chronic health conditions other than those initially specified by the Secretary under paragraph (2) of such section.CommentsClose CommentsPermalink





(d) Effective Date- The amendments made by subsections (a), (b), and (c) shall apply to services furnished on or after January 1, 2010.CommentsClose CommentsPermalink

SEC. 246. SENSE OF CONGRESS ON THE USE OF REMOTE PATIENT MANAGEMENT SERVICES.

(a) Findings- Congress finds as follows:CommentsClose CommentsPermalink





(1) Remote patient management services can make chronic disease management more effective and efficient for patients and for the health care system.CommentsClose CommentsPermalink





(2) By collecting, analyzing, and transmitting clinical health information to a health care provider, remote patient management services allow patients and providers to manage the medical condition of patients in a consistent and real time fashion.CommentsClose CommentsPermalink





(3) Utilization of remote patient management services not only improves the quality of care given to patients, it also reduces the need for frequent office appointments, costly emergency room visits, and unnecessary hospitalizations.CommentsClose CommentsPermalink





(4) Management the medical condition or disease of a patient from the patient’s home reduces the need for face to face provider interactions. Use of remote patient management services minimizes unnecessary travel and missed work and provides particular value to patients residing in rural or underserved communities who would otherwise face potentially significant access barriers to receiving needed care.CommentsClose CommentsPermalink





(5) Among the areas in which remote patient management services are emerging in health care are the treatment of congestive heart failure, diabetes, cardiac arrhythmia, epilepsy, and sleep apnea. Prompt transmission of clinical data on each of these conditions, to the health care provider or the patient as appropriate, is essential to providing timely and appropriate therapeutic interventions which can then reduce expensive hospitalizations.CommentsClose CommentsPermalink





(6) Despite these benefits, remote patient management services have failed to diffuse rapidly. A significant barrier to wider adoption is the relative lack of payment mechanisms in fee for service Medicare to reimburse for remote, non face to face patient management.CommentsClose CommentsPermalink





(7) Elimination of this barrier to new remote patient management services should be encouraged by requiring reimbursement under the Medicare program for providers’ time spent analyzing and responding to patient data transmitted by remote technologies.CommentsClose CommentsPermalink





(8) Reimbursement under the Medicare program for health care providers’ time spent analyzing and responding to data transmitted to providers by remote technologies should be made on a separate basis and should not be combined with payments for others services (also referred to as ‘bundled payments’).CommentsClose CommentsPermalink





(9) Payment codes used for reporting and billing for payment for providers’ remote patient management services should be revised or adjusted, as appropriate, to encourage the application of such services for other medical conditions.CommentsClose CommentsPermalink





(b) Sense of Congress- It is the sense of the Congress that--CommentsClose CommentsPermalink





(1) remote patient management services are integral to improvement in the delivery, care, and efficiency of health care services furnished in the United States; andCommentsClose CommentsPermalink





(2) the Administrator of the Centers for Medicare & Medicaid Services should be encouraged to--CommentsClose CommentsPermalink





(A) expand the types of medical conditions for which the use of remote patient management services are reimbursed under the Medicare program;CommentsClose CommentsPermalink





(B) provide for separate, non-bundled payment under the Medicare program for remote patient management services; andCommentsClose CommentsPermalink





(C) create, revise and adjust, as appropriate, codes for the accurate reporting and billing for payment for remote patient management services.CommentsClose CommentsPermalink

SEC. 247. TELEHEALTH ADVISORY COMMITTEE.

(a) In General- Section 1834(m)(4)(F)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(F)(ii)) is amended by adding at the end the following sentences: ‘Such process shall require the Secretary to take into account the recommendations of the Telehealth Advisory Committee (as established under section 247(b) of the Medical Rights and Reform Act of 2009) when adding or deleting services (and HCPCS codes) and in establishing policies of the Centers for Medicare & Medicaid Services regarding the delivery of telehealth services. If the Secretary does not implement a recommendation of the Telehealth Advisory Committee, the Secretary shall publish in the Federal Register a statement regarding the reason such recommendation was not implemented.’.CommentsClose CommentsPermalink





(b) Telehealth Advisory Committee-CommentsClose CommentsPermalink





(1) ESTABLISHMENT- On and after the date that is 6 months after the date of enactment of this subtitle, the Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall have in place a Telehealth Advisory Committee (in this subsection referred to as the ‘Advisory Committee’) to make recommendations to the Secretary on--CommentsClose CommentsPermalink





(A) policies of the Centers for Medicare & Medicaid Services regarding the delivery of telehealth services; andCommentsClose CommentsPermalink





(B) the appropriate addition or deletion of services (and HCPCS codes) to those specified in paragraph (4)(F)(i) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) for authorized payment under paragraph (1) of such section.CommentsClose CommentsPermalink





(2) MEMBERSHIP; TERMS-CommentsClose CommentsPermalink





(A) MEMBERSHIP-CommentsClose CommentsPermalink





(i) IN GENERAL- The Advisory Committee shall be composed of 9 members, to be appointed by the Secretary, of whom--CommentsClose CommentsPermalink





(I) five shall be practicing physicians;CommentsClose CommentsPermalink





(II) two shall be practicing non-physician health care providers; andCommentsClose CommentsPermalink





(III) two shall be administrators of telehealth programs.CommentsClose CommentsPermalink





(ii) REQUIREMENTS FOR APPOINTING MEMBERS- In appointing members of the Advisory Committee, the Secretary shall--CommentsClose CommentsPermalink





(I) ensure that each member has prior experience with the practice of telemedicine or telehealth;CommentsClose CommentsPermalink





(II) give preference to individuals who are currently providing telemedicine or telehealth services or who are involved in telemedicine or telehealth programs;CommentsClose CommentsPermalink





(III) ensure that the membership of the Advisory Committee represents a balance of specialties and geographic regions; andCommentsClose CommentsPermalink





(IV) take into account the recommendations of stakeholders.CommentsClose CommentsPermalink





(B) TERMS- The members of the Advisory Committee shall serve for such term as the Secretary may specify.CommentsClose CommentsPermalink





(C) CONFLICTS OF INTEREST- An advisory committee member may not participate with respect to a particular matter considered in an advisory committee meeting if such member (or an immediate family member of such member) has a financial interest that could be affected by the advice given to the Secretary with respect to such matter.CommentsClose CommentsPermalink





(3) MEETINGS- The Advisory Committee shall meet twice per year and at such other times as the Advisory Committee may provide.CommentsClose CommentsPermalink





(4) PERMANENT COMMITTEE- Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Advisory Committee.CommentsClose CommentsPermalink





(5) WAIVER OF ADMINISTRATIVE LIMITATION- The Secretary shall establish the Advisory Committee notwithstanding any limitation that may apply to the number of advisory committees that may be established (within the Department of Health and Human Services or otherwise).CommentsClose CommentsPermalink

Subpart B--HRSA Grant Program

SEC. 250. GRANT PROGRAM FOR THE DEVELOPMENT OF TELEHEALTH NETWORKS.

(a) In General- The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’), acting through the Director of the Office for the Advancement of Telehealth (of the Health Resources and Services Administration), shall make grants to eligible entities (as described in subsection (b)(2)) for the purpose of expanding access to health care services for individuals in rural areas, frontier areas, and urban medically underserved areas through the use of telehealth.CommentsClose CommentsPermalink





(b) Eligible Entities-CommentsClose CommentsPermalink





(1) APPLICATION- To be eligible to receive a grant under this section, an eligible entity described in paragraph (2) shall, in consultation with the State office of rural health or other appropriate State entity, prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including the following:CommentsClose CommentsPermalink





(A) A description of the anticipated need for the grant.CommentsClose CommentsPermalink





(B) A description of the activities which the entity intends to carry out using amounts provided under the grant.CommentsClose CommentsPermalink





(C) A plan for continuing the project after Federal support under this section is ended.CommentsClose CommentsPermalink





(D) A description of the manner in which the activities funded under the grant will meet health care needs of underserved rural populations within the State.CommentsClose CommentsPermalink





(E) A description of how the local community or region to be served by the network or proposed network will be involved in the development and ongoing operations of the network.CommentsClose CommentsPermalink





(F) The source and amount of non-Federal funds the entity would pledge for the project.CommentsClose CommentsPermalink





(G) A showing of the long-term viability of the project and evidence of health care provider commitment to the network.CommentsClose CommentsPermalink





The application should demonstrate the manner in which the project will promote the integration of telehealth in the community so as to avoid redundancy of technology and achieve economies of scale.CommentsClose CommentsPermalink





(2) ELIGIBLE ENTITIES-CommentsClose CommentsPermalink





(A) IN GENERAL- An eligible entity described in this paragraph is a hospital or other health care provider in a health care network of community-based health care providers that includes at least--CommentsClose CommentsPermalink





(i) two of the organizations described in subparagraph (B); andCommentsClose CommentsPermalink





(ii) one of the institutions and entities described in subparagraph (C),CommentsClose CommentsPermalink





if the institution or entity is able to demonstrate use of the network for purposes of education or economic development (as required by the Secretary).CommentsClose CommentsPermalink





(B) ORGANIZATIONS DESCRIBED- The organizations described in this subparagraph are the following:CommentsClose CommentsPermalink





(i) Community or migrant health centers.CommentsClose CommentsPermalink





(ii) Local health departments.CommentsClose CommentsPermalink





(iii) Nonprofit hospitals.CommentsClose CommentsPermalink





(iv) Private practice health professionals, including community and rural health clinics.CommentsClose CommentsPermalink





(v) Other publicly funded health or social services agencies.CommentsClose CommentsPermalink





(vi) Skilled nursing facilities.CommentsClose CommentsPermalink





(vii) County mental health and other publicly funded mental health facilities.CommentsClose CommentsPermalink





(viii) Providers of home health services.CommentsClose CommentsPermalink





(ix) Renal dialysis facilities.CommentsClose CommentsPermalink





(C) INSTITUTIONS AND ENTITIES DESCRIBED- The institutions and entities described in this subparagraph are the following:CommentsClose CommentsPermalink





(i) A public school.CommentsClose CommentsPermalink





(ii) A public library.CommentsClose CommentsPermalink





(iii) A university or college.CommentsClose CommentsPermalink





(iv) A local government entity.CommentsClose CommentsPermalink





(v) A local health entity.CommentsClose CommentsPermalink





(vi) A health-related nonprofit foundation.CommentsClose CommentsPermalink





(vii) An academic health center.CommentsClose CommentsPermalink





An eligible entity may include for-profit entities so long as the recipient of the grant is a not-for-profit entity.CommentsClose CommentsPermalink





(c) Preference- The Secretary shall establish procedures to prioritize financial assistance under this section based upon the following considerations:CommentsClose CommentsPermalink





(1) The applicant is a health care provider in a health care network or a health care provider that proposes to form such a network that furnishes or proposes to furnish services in a medically underserved area, health professional shortage area, or mental health professional shortage area.CommentsClose CommentsPermalink





(2) The applicant is able to demonstrate broad geographic coverage in the rural or medically underserved areas of the State, or States in which the applicant is located.CommentsClose CommentsPermalink





(3) The applicant proposes to use Federal funds to develop plans for, or to establish, telehealth systems that will link rural hospitals and rural health care providers to other hospitals, health care providers, and patients.CommentsClose CommentsPermalink





(4) The applicant will use the amounts provided for a range of health care applications and to promote greater efficiency in the use of health care resources.CommentsClose CommentsPermalink





(5) The applicant is able to demonstrate the long-term viability of projects through cost participation (cash or in-kind).CommentsClose CommentsPermalink





(6) The applicant is able to demonstrate financial, institutional, and community support for the long-term viability of the network.CommentsClose CommentsPermalink





(7) The applicant is able to provide a detailed plan for coordinating system use by eligible entities so that health care services are given a priority over non-clinical uses.CommentsClose CommentsPermalink





(d) Maximum Amount of Assistance to Individual Recipients- The Secretary shall establish, by regulation, the terms and conditions of the grant and the maximum amount of a grant award to be made available to an individual recipient for each fiscal year under this section. The Secretary shall cause to have published in the Federal Register or the ‘HRSA Preview’ notice of the terms and conditions of a grant under this section and the maximum amount of such a grant for a fiscal year.CommentsClose CommentsPermalink





(e) Use of Amounts- The recipient of a grant under this section may use sums received under such grant for the acquisition of telehealth equipment and modifications or improvements of telecommunications facilities including the following:CommentsClose CommentsPermalink





(1) The development and acquisition through lease or purchase of computer hardware and software, audio and video equipment, computer network equipment, interactive equipment, data terminal equipment, and other facilities and equipment that would further the purposes of this section.CommentsClose CommentsPermalink





(2) The provision of technical assistance and instruction for the development and use of such programming equipment or facilities.CommentsClose CommentsPermalink





(3) The development and acquisition of instructional programming.CommentsClose CommentsPermalink





(4) Demonstration projects for teaching or training medical students, residents, and other health profession students in rural or medically underserved training sites about the application of telehealth.CommentsClose CommentsPermalink





(5) The provision of telenursing services designed to enhance care coordination and promote patient self-management skills.CommentsClose CommentsPermalink





(6) The provision of services designed to promote patient understanding and adherence to national guidelines for common chronic diseases, such as congestive heart failure or diabetes.CommentsClose CommentsPermalink





(7) Transmission costs, maintenance of equipment, and compensation of specialists and referring health care providers, when no other form of reimbursement is available.CommentsClose CommentsPermalink





(8) Development of projects to use telehealth to facilitate collaboration between health care providers.CommentsClose CommentsPermalink





(9) Electronic archival of patient records.CommentsClose CommentsPermalink





(10) Collection and analysis of usage statistics and data that can be used to document the cost-effectiveness of the telehealth services.CommentsClose CommentsPermalink





(11) Such other uses that are consistent with achieving the purposes of this section as approved by the Secretary.CommentsClose CommentsPermalink





(f) Prohibited Uses- Sums received under a grant under this section may not be used for any of the following:CommentsClose CommentsPermalink





(1) To acquire real property.CommentsClose CommentsPermalink





(2) Expenditures to purchase or lease equipment to the extent the expenditures would exceed more than 40 percent of the total grant funds.CommentsClose CommentsPermalink





(3) To purchase or install transmission equipment off the premises of the telehealth site and any transmission costs not directly related to the grant.CommentsClose CommentsPermalink





(4) For construction, except that such funds may be expended for minor renovations relating to the installation of equipment.CommentsClose CommentsPermalink





(5) Expenditures for indirect costs (as determined by the Secretary) to the extent the expenditures would exceed more than 15 percent of the total grant.CommentsClose CommentsPermalink





(g) Administration-CommentsClose CommentsPermalink





(1) NONDUPLICATION- The Secretary shall ensure that facilities constructed using grants provided under this section do not duplicate adequately established telehealth networks.CommentsClose CommentsPermalink





(2) COORDINATION WITH OTHER AGENCIES- The Secretary shall coordinate, to the extent practicable, with other Federal and State agencies and not-for-profit organizations, operating similar grant programs to pool resources for funding meritorious proposals.CommentsClose CommentsPermalink





(3) INFORMATIONAL EFFORTS- The Secretary shall establish and implement procedures to carry out outreach activities to advise potential end users located in rural and medically underserved areas of each State about the program authorized by this section.CommentsClose CommentsPermalink





(h) Prompt Implementation- The Secretary shall take such actions as are necessary to carry out the grant program as expeditiously as possible.CommentsClose CommentsPermalink





(i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 2010, and such sums as may be necessary for each of the fiscal years 2011 through 2014.CommentsClose CommentsPermalink

SEC. 251. REAUTHORIZATION OF TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT PROGRAMS.

Subsection (s) of section 330I of the Public Health Service Act (42 U.S.C. 254c-14) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)--CommentsClose CommentsPermalink





(A) by striking ‘and’ before ‘such sums’; andCommentsClose CommentsPermalink





(B) by inserting ‘$10,000,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2014’ before the semicolon; andCommentsClose CommentsPermalink





(2) in paragraph (2)--CommentsClose CommentsPermalink





(A) by striking ‘and’ before ‘such sums’; andCommentsClose CommentsPermalink





(B) by inserting ‘$10,000,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2014’ before the semicolon.CommentsClose CommentsPermalink

Subtitle D--Eliminating Waste, Fraud, and AbuseCommentsClose CommentsPermalink

SEC. 261. SITE INSPECTIONS; BACKGROUND CHECKS; DENIAL AND SUSPENSION OF BILLING PRIVILEGES.

(a) Site Inspections for DME Suppliers, Community Mental Health Centers, and Other Provider Groups- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SITE INSPECTIONS FOR DME SUPPLIERS, COMMUNITY MENTAL HEALTH CENTERS, AND OTHER PROVIDER GROUPS

‘Sec. 1898. (a) Site Inspections-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall conduct a site inspection for each applicable provider (as defined in paragraph (2)) that applies to enroll under this title in order to provide items or services under this title. Such site inspection shall be in addition to any other site inspection that the Secretary would otherwise conduct with regard to an applicable provider.CommentsClose CommentsPermalink





‘(2) APPLICABLE PROVIDER DEFINED-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Except as provided in subparagraph (B), in this section the term ‘applicable provider’ means--CommentsClose CommentsPermalink





‘(i) a supplier of durable medical equipment (including items described in section 1834(a)(13));CommentsClose CommentsPermalink





‘(ii) a supplier of prosthetics, orthotics, or supplies (including items described in paragraphs (8) and (9) of section 1861(s));CommentsClose CommentsPermalink





‘(iii) a community mental health center; orCommentsClose CommentsPermalink





‘(iv) any other provider group, as determined by the Secretary (including suppliers, both participating suppliers and non-participating suppliers, as such terms are defined for purposes of section 1842).CommentsClose CommentsPermalink





‘(B) EXCEPTION- In this section, the term ‘applicable provider’ does not include--CommentsClose CommentsPermalink





‘(i) a physician that provides durable medical equipment (as described in subparagraph (A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph (A)(ii)) to an individual as incident to an office visit by such individual; orCommentsClose CommentsPermalink





‘(ii) a hospital that provides durable medical equipment (as described in subparagraph (A)(i)) or prosthetics, orthotics, or supplies (as described in subparagraph (A)(ii)) to an individual as incident to an emergency room visit by such individual.CommentsClose CommentsPermalink





‘(b) Standards and Requirements- In conducting the site inspection pursuant to subsection (a), the Secretary shall ensure that the site being inspected is in full compliance with all the conditions and standards of participation and requirements for obtaining billing privileges under this title.CommentsClose CommentsPermalink





‘(c) Time- The Secretary shall conduct the site inspection for an applicable provider prior to the issuance of billing privileges under this title to such provider.CommentsClose CommentsPermalink





‘(d) Timely Review- The Secretary shall provide for procedures to ensure that the site inspection required under this section does not unreasonably delay the issuance of billing privileges under this title to an applicable provider.’.CommentsClose CommentsPermalink





(b) Background Checks- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (as amended by subsection (a)) is amended by adding at the end the following new section:CommentsClose CommentsPermalink

‘BACKGROUND CHECKS; DENIAL AND SUSPENSION OF BILLING PRIVILEGES

‘Sec. 1899. (a) Background Check Required- Except as provided in subsection (b), the Secretary shall conduct a background check on any individual or entity that enrolls under this title for the purpose of furnishing any item or service under this title, including any individual or entity that is a supplier, a person with an ownership or control interest, a managing employee (as defined in section 1126(b)), or an authorized or delegated official of the individual or entity. In performing the background check, the Secretary shall--CommentsClose CommentsPermalink





‘(1) conduct the background check before authorizing billing privileges under this title to the individual or entity, respectively;CommentsClose CommentsPermalink





‘(2) include a search of criminal records in the background check;CommentsClose CommentsPermalink





‘(3) provide for procedures that ensure the background check does not unreasonably delay the authorization of billing privileges under this title to an eligible individual or entity, respectively; andCommentsClose CommentsPermalink





‘(4) establish criteria for targeted reviews when the individual or entity renews participation under this title, with respect to the background check of the individual or entity, respectively, to detect changes in ownership, bankruptcies, or felonies by the individual or entity.CommentsClose CommentsPermalink





‘(b) Use of State Licensing Procedure- The Secretary may use the results of a State licensing procedure as a background check under subsection (a) if the State licensing procedure meets the requirements of such subsection.CommentsClose CommentsPermalink





‘(c) Attorney General Required To Provide Information-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Upon request of the Secretary, the Attorney General shall provide the criminal background check information referred to in subsection (a)(2) to the Secretary.CommentsClose CommentsPermalink





‘(2) RESTRICTION ON USE OF DISCLOSED INFORMATION- The Secretary may only use the information disclosed under subsection (a) for the purpose of carrying out the Secretary’s responsibilities under this title.CommentsClose CommentsPermalink





‘(d) Refusal To Authorize Billing Privileges-CommentsClose CommentsPermalink





‘(1) AUTHORITY- In addition to any other remedy available to the Secretary, the Secretary may refuse to authorize billing privileges under this title to an individual or entity if the Secretary determines, after a background check conducted under this section, that such individual or entity, respectively, has a history of acts that indicate authorization of billing privileges under this title to such individual or entity, respectively, would be detrimental to the best interests of the program or program beneficiaries. Such acts may include--CommentsClose CommentsPermalink





‘(A) any bankruptcy;CommentsClose CommentsPermalink





‘(B) any act resulting in a civil judgment against such individual or entity; orCommentsClose CommentsPermalink





‘(C) any felony conviction under Federal or State law.CommentsClose CommentsPermalink





‘(2) REPORTING OF REFUSAL TO AUTHORIZE BILLING PRIVILEGES TO THE HEALTHCARE INTEGRITY AND PROTECTION DATA BANK (HIPDB)-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (B), a determination under paragraph (1) to refuse to authorize billing privileges under this title to an individual or entity as a result of a background check conducted under this section shall be reported to the healthcare integrity and protection data bank established under section 1128E in accordance with the procedures for reporting final adverse actions taken against a health care provider, supplier, or practitioner under that section.CommentsClose CommentsPermalink





‘(B) EXCEPTION- Any determination described in subparagraph (A) that the Secretary specifies is not appropriate for inclusion in the healthcare integrity and protection data bank established under section 1128E shall not be reported to such data bank.’.CommentsClose CommentsPermalink





(c) Denial and Suspension of Billing Privileges- Section 1899 of the Social Security Act, as added by subsection (b), is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(e) Authority To Suspend Billing Privileges or Refuse To Authorize Additional Billing Privileges-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary may suspend any billing privilege under this title authorized for an individual or entity or refuse to authorize any additional billing privilege under this title to such individual or entity if--CommentsClose CommentsPermalink





‘(A) such individual or entity, respectively, has an outstanding overpayment due to the Secretary under this title;CommentsClose CommentsPermalink





‘(B) payments under this title to such individual or entity, respectively, have been suspended; orCommentsClose CommentsPermalink





‘(C) 100 percent of the payment claims under this title for such individual or entity, respectively, are reviewed on a pre-payment basis.CommentsClose CommentsPermalink





‘(2) APPLICATION TO RESTRUCTURED ENTITIES- In the case that an individual or entity is subject to a suspension or refusal of billing privileges under this section, if the Secretary determines that the ownership or management of a new entity is under the control or management of such an individual or entity subject to such a suspension or refusal, the new entity shall be subject to any such applicable suspension or refusal in the same manner and to the same extent as the initial individual or entity involved had been subject to such applicable suspension or refusal.CommentsClose CommentsPermalink





‘(3) DURATION OF SUSPENSION- A suspension of billing privileges under this subsection, with respect to an individual or entity, shall be in effect beginning on the date of the Secretary’s determination that the offense was committed and ending not earlier than such date on which all applicable overpayments and other applicable outstanding debts have been paid and all applicable payment suspensions have been lifted.’.CommentsClose CommentsPermalink





(d) Regulations; Effective Date-CommentsClose CommentsPermalink





(1) REGULATIONS- Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to implement the amendments made by subsections (a), (b), and (c).CommentsClose CommentsPermalink





(2) EFFECTIVE DATES-CommentsClose CommentsPermalink





(A) SITE INSPECTIONS AND BACKGROUND CHECKS- The amendments made by subsections (a) and (b) shall apply to applications to enroll under title XVIII of the Social Security Act received by the Secretary of Health and Human Services on or after the first day of the first year beginning after the date of the enactment of this Act.CommentsClose CommentsPermalink





(B) DENIALS AND SUSPENSIONS OF BILLING PRIVILEGES- The amendment made by subsection (c) shall apply to overpayments or debts in existence on or after the date of the enactment of this Act, regardless of whether the final determination, with respect to such overpayment or debt, was made before, on, or after such date.CommentsClose CommentsPermalink





(e) Use of Medicare Integrity Program Funds- The Secretary of Health and Human Services may use funds appropriated or transferred for purposes of carrying out the Medicare integrity program established under section 1893 of the Social Security Act (42 U.S.C. 1395ddd) to carry out the provisions of sections 1898 and 1899 of that Act (as added by subsections (a) and (b)).CommentsClose CommentsPermalink

SEC. 262. REGISTRATION AND BACKGROUND CHECKS OF BILLING AGENCIES AND INDIVIDUALS.

(a) In General- Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) (as amended by section 2(b)) is amended by adding at the end the following new section:CommentsClose CommentsPermalink

‘REGISTRATION AND BACKGROUND CHECKS OF BILLING AGENCIES AND INDIVIDUALS; IDENTIFICATION NUMBERS REQUIRED FOR PROVIDERS AND SUPPLIERS

‘Sec. 1899A. (a) Registration-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall establish procedures, including modifying the Provider Enrollment and Chain Ownership System (PECOS) administered by the Centers for Medicare & Medicaid Services, to provide for the registration of all applicable persons in accordance with this section.CommentsClose CommentsPermalink





‘(2) REQUIRED APPLICATION- Each applicable person shall submit a registration application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require.CommentsClose CommentsPermalink





‘(3) IDENTIFICATION NUMBER- If the Secretary approves an application submitted under subsection (b), the Secretary shall assign a unique identification number to the applicable person.CommentsClose CommentsPermalink





‘(4) REQUIREMENT- Every claim for reimbursement under this title that is compiled or submitted by an applicable person shall contain the identification number that is assigned to the applicable person pursuant to subsection (c).CommentsClose CommentsPermalink





‘(5) TIMELY REVIEW- The Secretary shall provide for procedures that ensure the timely consideration and determination regarding approval of applications under this subsection.CommentsClose CommentsPermalink





‘(6) DEFINITION OF APPLICABLE PERSON- In this section, the term ‘applicable person’ means any individual or entity that compiles or submits claims for reimbursement under this title to the Secretary on behalf of any individual or entity.CommentsClose CommentsPermalink





‘(b) Background Checks-CommentsClose CommentsPermalink





‘(1) In General- Except as provided in paragraph (2), the Secretary shall conduct a background check on any applicable person that registers under subsection (a). In performing the background check, the Secretary shall--CommentsClose CommentsPermalink





‘(A) conduct the background check before issuing a unique identification number to the applicable person;CommentsClose CommentsPermalink





‘(B) include a search of criminal records in the background check;CommentsClose CommentsPermalink





‘(C) provide for procedures that ensure the background check does not unreasonably delay the issuance of the unique identification number to an eligible applicable person; andCommentsClose CommentsPermalink





‘(D) establish criteria for periodic targeted reviews with respect to the background check of the applicable person.CommentsClose CommentsPermalink





‘(2) Use of State Licensing Procedure- The Secretary may use the results of a State licensing procedure as a background check under paragraph (1) if the State licensing procedure meets the requirements of such paragraph.CommentsClose CommentsPermalink





‘(3) Attorney General Required To Provide Information-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Upon request of the Secretary, the Attorney General shall provide the criminal background check information referred to in paragraph (1)(B) to the Secretary.CommentsClose CommentsPermalink





‘(B) RESTRICTION ON USE OF DISCLOSED INFORMATION- The Secretary may only use the information disclosed under paragraph (1) for the purpose of carrying out the Secretary’s responsibilities under this title.CommentsClose CommentsPermalink





‘(4) Refusal To Issue Unique Identification Number- In addition to any other remedy available to the Secretary, the Secretary may refuse to issue a unique identification number described in subsection (a)(3) to an applicable person if the Secretary determines, after a background check conducted under this subsection, that such person has a history of acts that indicate issuance of such number under this title to such person would be detrimental to the best interests of the program or program beneficiaries. Such acts may include--CommentsClose CommentsPermalink





‘(A) any bankruptcy;CommentsClose CommentsPermalink





‘(B) any act resulting in a civil judgment against such person; orCommentsClose CommentsPermalink





‘(C) any felony conviction under Federal or State law.CommentsClose CommentsPermalink





‘(c) Identification Numbers for Providers and Suppliers- The Secretary shall establish procedures to ensure that each provider of services and each supplier that submits claims for reimbursement under this title to the Secretary is assigned a unique identification number.’.CommentsClose CommentsPermalink





(b) Permissive Exclusion- Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(16) FRAUD BY APPLICABLE PERSON- An applicable person (as defined in section 1899A(a)(6)) that the Secretary determines knowingly submitted or caused to be submitted a claim for reimbursement under title XVIII that the applicable person knows or should know is false or fraudulent.’.CommentsClose CommentsPermalink





(c) Regulations; Effective Date-CommentsClose CommentsPermalink





(1) REGULATIONS- Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate such regulations as are necessary to implement the amendments made by subsections (a) and (b).CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall apply to applicable persons and other entities on and after the first day of the first year beginning after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 263. EXPANDED ACCESS TO THE HEALTHCARE INTEGRITY AND PROTECTION DATA BANK (HIPDB).

(a) In General- Section 1128E(d)(1) of the Social Security Act (42 U.S.C. 1320a-7e(d)(1)) is amended to read as follows:CommentsClose CommentsPermalink





‘(1) AVAILABILITY- The information in the data bank maintained under this section shall be available to--CommentsClose CommentsPermalink





‘(A) Federal and State government agencies and health plans, and any health care provider, supplier, or practitioner entering an employment or contractual relationship with an individual or entity who could potentially be the subject of a final adverse action, where the contract involves the furnishing of items or services reimbursed by one or more Federal health care programs (regardless of whether the individual or entity is paid by the programs directly, or whether the items or services are reimbursed directly or indirectly through the claims of a direct provider); andCommentsClose CommentsPermalink





‘(B) utilization and quality control peer review organizations and accreditation entities as defined by the Secretary, including but not limited to organizations described in part B of this title and in section 1154(a)(4)(C).’.CommentsClose CommentsPermalink





(b) No Fees for Use of HIPDB by Entities Contracting With Medicare- Section 1128E(d)(2) of the Social Security Act (42 U.S.C. 1320a-7e(d)(2)) is amended by striking ‘Federal agencies’ and inserting ‘Federal agencies or other entities, such as fiscal intermediaries and carriers, acting under contract on behalf of such agencies’.CommentsClose CommentsPermalink





(c) Criminal Penalty for Misuse of Information- Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(4) Whoever knowingly uses information maintained in the healthcare integrity and protection data bank maintained in accordance with section 1128E for a purpose other than a purpose authorized under that section shall be imprisoned for not more than three years or fined under title 18, United States Code, or both.’.CommentsClose CommentsPermalink





(d) Effective Date- The amendments made by this section shall take effect on the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 264. LIABILITY OF MEDICARE ADMINISTRATIVE CONTRACTORS FOR CLAIMS SUBMITTED BY EXCLUDED PROVIDERS.

(a) Reimbursement to the Secretary for Amounts Paid to Excluded Providers- Section 1874A(b) of the Social Security Act (42 U.S.C. 1395kk(b)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(6) REIMBURSEMENTS TO SECRETARY FOR AMOUNTS PAID TO EXCLUDED PROVIDERS- The Secretary shall not enter into a contract with a Medicare administrative contractor under this section unless the contractor agrees to reimburse the Secretary for any amounts paid by the contractor for a service under this title which is furnished by an individual or entity during any period for which the individual or entity is excluded, pursuant to section 1128, 1128A, or 1156, from participation in the health care program under this title if the amounts are paid after the 60-day period beginning on the date the Secretary provides notice of the exclusion to the contractor, unless the payment was made as a result of incorrect information provided by the Secretary or the individual or entity excluded from participation has concealed or altered their identity.’.CommentsClose CommentsPermalink





(b) Conforming Repeal of Mandatory Payment Rule- Section 1862(e) of the Social Security Act (42 U.S.C. 1395y(e)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)(B), by striking ‘and when the person’ and all that follows through ‘person)’; andCommentsClose CommentsPermalink





(2) by amending paragraph (2) to read as follows:CommentsClose CommentsPermalink





‘(2) No individual or entity may bill (or collect any amount from) any individual for any item or service for which payment is denied under paragraph (1). No individual is liable for payment of any amounts billed for such an item or service in violation of the preceding sentence.’.CommentsClose CommentsPermalink





(c) Effective Date-CommentsClose CommentsPermalink





(1) IN GENERAL- The amendments made by this section shall apply to claims for payment submitted on or after the date of the enactment of this Act.CommentsClose CommentsPermalink





(2) CONTRACT MODIFICATION- The Secretary of Health and Human Services shall take such steps as may be necessary to modify contracts entered into, renewed, or extended prior to the date of the enactment of this Act to conform such contracts to the provisions of this section.CommentsClose CommentsPermalink

SEC. 265. COMMUNITY MENTAL HEALTH CENTERS.

(a) In General- Section 1861(ff)(3)(B) of the Social Security Act (42 U.S.C. 1395x(ff)(3)(B)) is amended by striking ‘entity that--’ and all that follows and inserting the following: ‘entity that--CommentsClose CommentsPermalink





‘(i) provides the community mental health services specified in paragraph (1) of section 1913(c) of the Public Health Service Act;CommentsClose CommentsPermalink





‘(ii) meets applicable certification or licensing requirements for community mental health centers in the State in which it is located;CommentsClose CommentsPermalink





‘(iii) provides a significant share of its services to individuals who are not eligible for benefits under this title; andCommentsClose CommentsPermalink





‘(iv) meets such additional standards or requirements for obtaining billing privileges under this title as the Secretary may specify to ensure--CommentsClose CommentsPermalink





‘(I) the health and safety of beneficiaries receiving such services; orCommentsClose CommentsPermalink





‘(II) the furnishing of such services in an effective and efficient manner.’.CommentsClose CommentsPermalink





(b) Restriction- Section 1861(ff)(3)(A) of such Act (42 U.S.C. 1395x(ff)(3)(A)) is amended by inserting ‘other than in an individual’s home or in an inpatient or residential setting’ before the period.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after the first day of the sixth month that begins after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 266. LIMITING THE DISCHARGE OF DEBTS IN BANKRUPTCY PROCEEDINGS IN CASES WHERE A HEALTH CARE PROVIDER OR A SUPPLIER ENGAGES IN FRAUDULENT ACTIVITY.

(a) In General-CommentsClose CommentsPermalink





(1) CIVIL MONETARY PENALTIES- Section 1128A(a) of the Social Security Act (42 U.S.C. 1320a-7a(a)) is amended by adding at the end the following: ‘Notwithstanding any other provision of law, amounts made payable under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title.’.CommentsClose CommentsPermalink





(2) RECOVERY OF OVERPAYMENT TO PROVIDERS OF SERVICES UNDER PART A OF MEDICARE- Section 1815(d) of the Social Security Act (42 U.S.C. 1395g(d)) is amended--CommentsClose CommentsPermalink





(A) by inserting ‘(1)’ after ‘(d)’; andCommentsClose CommentsPermalink





(B) by adding at the end the following:CommentsClose CommentsPermalink





‘(2) Notwithstanding any other provision of law, amounts due to the Secretary under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title if the overpayment was the result of fraudulent activity, as may be defined by the Secretary.’.CommentsClose CommentsPermalink





(3) RECOVERY OF OVERPAYMENT OF BENEFITS UNDER PART b OF MEDICARE- Section 1833(j) of the Social Security Act (42 U.S.C. 1395l(j)) is amended--CommentsClose CommentsPermalink





(A) by inserting ‘(1)’ after ‘(j)’; andCommentsClose CommentsPermalink





(B) by adding at the end the following:CommentsClose CommentsPermalink





‘(2) Notwithstanding any other provision of law, amounts due to the Secretary under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title if the overpayment was the result of fraudulent activity, as may be defined by the Secretary.’.CommentsClose CommentsPermalink





(4) COLLECTION OF PAST-DUE OBLIGATIONS ARISING FROM BREACH OF SCHOLARSHIP AND LOAN CONTRACT- Section 1892(a) of the Social Security Act (42 U.S.C. 1395ccc(a)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(5) Notwithstanding any other provision of law, amounts due to the Secretary under this section are not dischargeable under section 727, 944, 1141, 1228, or 1328 of title 11, United States Code, or any other provision of such title.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply to bankruptcy petitions filed after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 267. ILLEGAL DISTRIBUTION OF A MEDICARE OR MEDICAID BENEFICIARY IDENTIFICATION OR BILLING PRIVILEGES.

Section 1128B(b) of the Social Security Act (42 U.S.C. 1320a-7b(b)), as amended by section 4(c), is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(5) Whoever knowingly, intentionally, and with the intent to defraud purchases, sells or distributes, or arranges for the purchase, sale, or distribution of two or more Medicare or Medicaid beneficiary identification numbers or billing privileges under title XVIII or title XIX shall be imprisoned for not more than three years or fined under title 18, United States Code (or, if greater, an amount equal to the monetary loss to the Federal and any State government as a result of such acts), or both.’.CommentsClose CommentsPermalink

SEC. 268. TREATMENT OF CERTAIN SOCIAL SECURITY ACT CRIMES AS FEDERAL HEALTH CARE OFFENSES.

(a) In General- Section 24(a) of title 18, United States Code, is amended--CommentsClose CommentsPermalink





(1) by striking the period at the end of paragraph (2) and inserting ‘; or’; andCommentsClose CommentsPermalink





(2) by adding at the end the following:CommentsClose CommentsPermalink





‘(3) section 1128B of the Social Security Act (42 U.S.C. 1320a-7b).’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and apply to acts committed on or after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 269. AUTHORITY OF OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.

(a) Authority- Notwithstanding any other provision of law, upon designation by the Inspector General of the Department of Health and Human Services, any criminal investigator of the Office of Inspector General of such department may, in accordance with guidelines issued by the Secretary of Health and Human Services and approved by the Attorney General, while engaged in activities within the lawful jurisdiction of such Inspector General--CommentsClose CommentsPermalink





(1) obtain and execute any warrant or other process issued under the authority of the United States;CommentsClose CommentsPermalink





(2) make an arrest without a warrant for--CommentsClose CommentsPermalink





(A) any offense against the United States committed in the presence of such investigator; orCommentsClose CommentsPermalink





(B) any felony offense against the United States, if such investigator has reasonable cause to believe that the person to be arrested has committed or is committing that felony offense; andCommentsClose CommentsPermalink





(3) exercise any other authority necessary to carry out the authority described in paragraphs (1) and (2).CommentsClose CommentsPermalink





(b) Funds- The Office of Inspector General of the Department of Health and Human Services may receive and expend funds that represent the equitable share from the forfeiture of property in investigations in which the Office of Inspector General participated, and that are transferred to the Office of Inspector General by the Department of Justice, the Department of the Treasury, or the United States Postal Service. Such equitable sharing funds shall be deposited in a separate account and shall remain available until expended.CommentsClose CommentsPermalink