Most commented sections:

• Paragraph 24 (2 comments)
• Paragraph 13 (1 comments)
• Paragraph 25 (1 comments)

HR 4872 EASIn the Senate .R.4872CommentsClose CommentsPermalink

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The initial premium percentage is-- The final premium percentage is--CommentsClose CommentsPermalink

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Up to 133%                                2.0%                              2.0%CommentsClose CommentsPermalink

133% up to 150%                                3.0%                              4.0% CommentsClose CommentsPermalink

150% up to 200%                                4.0%                              6.3% CommentsClose CommentsPermalink

200% up to 250%                                6.3%                             8.05% CommentsClose CommentsPermalink

250% up to 300%                               8.05%                              9.5% CommentsClose CommentsPermalink

300% up to 400%                                9.5%                        9.5%’; and CommentsClose CommentsPermalink

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(a) Modified Adjusted Gross Income-CommentsClose CommentsPermalink





(1) IN GENERAL- The following provisions of the Internal Revenue Code of 1986 are each amended by striking ‘modified gross’ each place it appears and inserting ‘modified adjusted gross’:CommentsClose CommentsPermalink





(A) Clauses (i) and (ii) of section 36B(d)(2)(A), as added by section 1401 of the Patient Protection and Affordable Care Act.CommentsClose CommentsPermalink





(B) Section 6103(l)(21)(A)(iv), as added by section 1414 of such Act.CommentsClose CommentsPermalink





(C) Clauses (i) and (ii) of section 5000A(c)(4), as added by section 1501(b) of such Act.CommentsClose CommentsPermalink





(2) DEFINITION-CommentsClose CommentsPermalink





(A) Section 36B(d)(2)(B) of such Code, as so added, is amended to read as follows:CommentsClose CommentsPermalink





‘(B) MODIFIED ADJUSTED GROSS INCOME- The term ‘modified adjusted gross income’ means adjusted gross income increased by--CommentsClose CommentsPermalink





‘(i) any amount excluded from gross income under section 911, andCommentsClose CommentsPermalink





‘(ii) any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.’.CommentsClose CommentsPermalink





(B) Section 5000A(c)(4)(C) of such Code, as so added, is amended to read as follows:CommentsClose CommentsPermalink





‘(C) MODIFIED ADJUSTED GROSS INCOME- The term ‘modified adjusted gross income’ means adjusted gross income increased by--CommentsClose CommentsPermalink





‘(i) any amount excluded from gross income under section 911, andCommentsClose CommentsPermalink





‘(ii) any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.’.CommentsClose CommentsPermalink





(b) Modified Adjusted Gross Income Definition-CommentsClose CommentsPermalink





(1) MEDICAID- Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended by striking ‘modified gross income’ each place it appears in the text and headings of the following provisions and inserting ‘modified adjusted gross income’:CommentsClose CommentsPermalink





(A) Paragraph (14) of subsection (e), as added by section 2002(a) of the Patient Protection and Affordable Care Act.CommentsClose CommentsPermalink





(B) Subsection (gg)(4)(A), as added by section 2001(b) of such Act.CommentsClose CommentsPermalink





(2) CHIP-CommentsClose CommentsPermalink





(A) STATE PLAN REQUIREMENTS- Section 2102(b)(1)(B)(v) of the Social Security Act (42 U.S.C. 1397bb(b)(1)(B)(v)), as added by section 2101(d)(1) of the Patient Protection and Affordable Care Act, is amended by striking ‘modified gross income’ and inserting ‘modified adjusted gross income’.CommentsClose CommentsPermalink





(B) PLAN ADMINISTRATION- Section 2107(e)(1)(E) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(E)), as added by section 2101(d)(2) of the Patient Protection and Affordable Care Act, is amended by striking ‘modified gross income’ and inserting ‘modified adjusted gross income’.CommentsClose CommentsPermalink





(c) No Excess Payments- Section 36B(f) of the Internal Revenue Code of 1986, as added by section 1401(a) of the Patient Protection and Affordable Care Act, is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(3) INFORMATION REQUIREMENT- Each Exchange (or any person carrying out 1 or more responsibilities of an Exchange under section 1311(f)(3) or 1321(c) of the Patient Protection and Affordable Care Act) shall provide the following information to the Secretary and to the taxpayer with respect to any health plan provided through the Exchange:CommentsClose CommentsPermalink





‘(A) The level of coverage described in section 1302(d) of the Patient Protection and Affordable Care Act and the period such coverage was in effect.CommentsClose CommentsPermalink





‘(B) The total premium for the coverage without regard to the credit under this section or cost-sharing reductions under section 1402 of such Act.CommentsClose CommentsPermalink





‘(C) The aggregate amount of any advance payment of such credit or reductions under section 1412 of such Act.CommentsClose CommentsPermalink





‘(D) The name, address, and TIN of the primary insured and the name and TIN of each other individual obtaining coverage under the policy.CommentsClose CommentsPermalink





‘(E) Any information provided to the Exchange, including any change of circumstances, necessary to determine eligibility for, and the amount of, such credit.CommentsClose CommentsPermalink





‘(F) Information necessary to determine whether a taxpayer has received excess advance payments.’.CommentsClose CommentsPermalink





(d) Adult Dependents-CommentsClose CommentsPermalink





(1) EXCLUSION OF AMOUNTS EXPENDED FOR MEDICAL CARE- The first sentence of section 105(b) of the Internal Revenue Code of 1986 (relating to amounts expended for medical care) is amended--CommentsClose CommentsPermalink





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





(B) by inserting before the period the following: ‘, and any child (as defined in section 152(f)(1)) of the United States,

March 25, 2010.

Resolved, That the bill from the House taxpayer who as of the end of the taxable year has not attained age 27’.CommentsClose CommentsPermalink




(2) SELF-EMPLOYED HEALTH INSURANCE DEDUCTION- Section 162(l)(1) of such Code is amended to read as follows:CommentsClose CommentsPermalink





‘(1) ALLOWANCE OF DEDUCTION- In the case of a taxpayer who is an employee within the meaning of section 401(c)(1), there shall be allowed as a deduction under this section an amount equal to the amount paid during the taxable year for insurance which constitutes medical care for--CommentsClose CommentsPermalink





‘(A) the taxpayer,CommentsClose CommentsPermalink





‘(B) the taxpayer’s spouse,CommentsClose CommentsPermalink





‘(C) the taxpayer’s dependents, andCommentsClose CommentsPermalink





‘(D) any child (as defined in section 152(f)(1)) of the taxpayer who as of the end of the taxable year has not attained age 27.’.CommentsClose CommentsPermalink





(3) COVERAGE UNDER SELF-EMPLOYED DEDUCTION- Section 162(l)(2)(B) of such Code is amended by inserting ‘, or any dependent, or individual described in subparagraph (D) of paragraph (1) with respect to,’ after ‘spouse of’.CommentsClose CommentsPermalink





(4) SICK AND ACCIDENT BENEFITS PROVIDED TO MEMBERS OF A VOLUNTARY EMPLOYEES’ BENEFICIARY ASSOCIATION AND THEIR DEPENDENTS- Section 501(c)(9) of such Code is amended by adding at the end the following new sentence: ‘For purposes of providing for the payment of Representatives (H.R. 4872) entitled ‘An Act tosick and accident benefits to members of such an association and their dependents, the term ‘dependent’ shall include any individual who is a child (as defined in section 152(f)(1)) of a member who as of the end of the calendar year has not attained age 27.’.CommentsClose CommentsPermalink





(5) MEDICAL AND OTHER BENEFITS FOR RETIRED EMPLOYEES- Section 401(h) of such Code is amended by adding at the end the following: ‘For purposes of this subsection, the term ‘dependent’ shall include any individual who is a child (as defined in section 152(f)(1)) of a retired employee who as of the end of the calendar year has not attained age 27.’.CommentsClose CommentsPermalink





(e) Five Percent Income Disregard for Certain Individuals- Section 1902(e)(14) of the Social Security Act (42 U.S.C. 1396a(e)(14)), as amended by subsection (b)(1), is further amended--CommentsClose CommentsPermalink





(1) in subparagraph (B), by striking ‘No type’ and inserting ‘Subject to subparagraph (I), no type’; andCommentsClose CommentsPermalink





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





‘(I) TREATMENT OF PORTION OF MODIFIED ADJUSTED GROSS INCOME- For purposes of determining the income eligibility of an individual for medical assistance whose eligibility is determined based on the application of modified adjusted gross income under subparagraph (A), the State shall--CommentsClose CommentsPermalink





‘(i) determine the dollar equivalent of the difference between the upper income limit on eligibility for such an individual (expressed as a percentage of the poverty line) and such upper income limit increased by 5 percentage points; andCommentsClose CommentsPermalink





‘(ii) notwithstanding the requirement in subparagraph (A) with respect to use of modified adjusted gross income, utilize as the applicable income of such individual, in determining such income eligibility, an amount equal to the modified adjusted gross income applicable to such individual reduced by such dollar equivalent amount.’.CommentsClose CommentsPermalink

(a) Coverage Gap Rebate for 2010-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1860D-42 of the Social Security Act (42 U.S.C. 1395w-152) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(c) Coverage Gap Rebate for 2010-CommentsClose CommentsPermalink





‘(1) IN GENERAL- In the case of an individual described in subparagraphs (A) through (D) of section 1860D-14A(g)(1) who as of the last day of a calendar quarter in 2010 has incurred costs for covered part D drugs so that the individual has exceeded the initial coverage limit under section 1860D-2(b)(3) for 2010, the Secretary shall provide for payment from the Medicare Prescription Drug Account of $250 to the individual by not later than the 15th day of the third month following the end of such quarter.CommentsClose CommentsPermalink





‘(2) LIMITATION- The Secretary shall provide only 1 payment under this subsection with respect to any individual.’.CommentsClose CommentsPermalink





(2) REPEAL OF PROVISION- Section 3315 of the Patient Protection and Affordable Care Act (including the amendments made by such section) is repealed, and any provision of law amended or repealed by such sections is hereby restored or revived as if such section had not been enacted into law.CommentsClose CommentsPermalink





(b) Closing the Donut Hole- Part D of title XVIII of the Social Security Act (42 U.S.C. 1395w-101 et seq.), as amended by section 3301 of the Patient Protection and Affordable Care Act, is further amended--CommentsClose CommentsPermalink





(1) in section 1860D-43--CommentsClose CommentsPermalink





(A) in subsection (b), by striking ‘July 1, 2010’ and inserting ‘January 1, 2011’; andCommentsClose CommentsPermalink





(B) in subsection (c)(2), by striking ‘July 1, 2010, and ending on December 31, 2010,’ and inserting ‘January 1, 2011, and December 31, 2011,’;CommentsClose CommentsPermalink





(2) in section 1860D-14A--CommentsClose CommentsPermalink





(A) in subsection (a)--CommentsClose CommentsPermalink





(i) by striking ‘July 1, 2010’ and inserting ‘January 1, 2011’; andCommentsClose CommentsPermalink





(ii) by striking ‘April 1, 2010’ and inserting ‘180 days after the date of the enactment of this section’;CommentsClose CommentsPermalink





(B) in subsection (b)(1)(C)--CommentsClose CommentsPermalink





(i) in the heading, by striking ‘2010 AND’;CommentsClose CommentsPermalink





(ii) by striking ‘July 1, 2010’ and inserting ‘January 1, 2011’; andCommentsClose CommentsPermalink





(iii) by striking ‘May 1, 2010’ and inserting ‘not later than 30 days after the date of the establishment of a model agreement under subsection (a)’;CommentsClose CommentsPermalink





(C) in subsection (c)--CommentsClose CommentsPermalink





(i) in paragraph (1)(A)(iii), by striking ‘July 1, 2010, and ending on December 31, 2011’ and inserting ‘January 1, 2011, and ending on December 31, 2011’; andCommentsClose CommentsPermalink





(ii) in paragraph (2), by striking ‘2010’ and inserting ‘2011’;CommentsClose CommentsPermalink





(D) in subsection (d)(2)(B), by striking ‘July 1, 2010, and ending on December 31, 2010’ and inserting ‘January 1, 2011, and ending on December 31, 2011’; andCommentsClose CommentsPermalink





(E) in subsection (g)(1)--CommentsClose CommentsPermalink





(i) in the matter before subparagraph (A), by striking ‘an applicable drug’ and inserting ‘a covered part D drug’;CommentsClose CommentsPermalink





(ii) by adding ‘and’ at the end of subparagraph (C);CommentsClose CommentsPermalink





(iii) by striking subparagraph (D); andCommentsClose CommentsPermalink





(iv) by redesignating subparagraph (E) as subparagraph (D); andCommentsClose CommentsPermalink





(3) in section 1860D-2(b)--CommentsClose CommentsPermalink





(A) in paragraph (2)(A), by striking ‘The coverage’ and inserting ‘Subject to subparagraphs (C) and (D), the coverage’;CommentsClose CommentsPermalink





(B) in paragraph (2)(B), by striking ‘subparagraph (A)(ii)’ and inserting ‘subparagraphs (A)(ii), (C), and (D)’;CommentsClose CommentsPermalink





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





‘(C) COVERAGE FOR GENERIC DRUGS IN COVERAGE GAP-CommentsClose CommentsPermalink





‘(i) IN GENERAL- Except as provided in paragraph (4), the coverage for an applicable beneficiary (as defined in section 1860D-14A(g)(1)) has coinsurance (for costs above the initial coverage limit under paragraph (3) and below the out-of-pocket threshold) for covered part D drugs that are not applicable drugs under section 1860D-14A(g)(2) that is--CommentsClose CommentsPermalink





‘(I) equal to the generic-gap coinsurance percentage (specified in clause (ii)) for the year; orCommentsClose CommentsPermalink





‘(II) actuarially equivalent (using processes and methods established under section 1860D-11(c)) to an average expected payment of such percentage of such costs for covered part D drugs that are not applicable drugs under section 1860D-14A(g)(2).CommentsClose CommentsPermalink





‘(ii) GENERIC-GAP COINSURANCE PERCENTAGE- The generic-gap coinsurance percentage specified in this clause for--CommentsClose CommentsPermalink





‘(I) 2011 is 93 percent;CommentsClose CommentsPermalink





‘(II) 2012 and each succeeding year before 2020 is the generic-gap coinsurance percentage under this clause for the previous year decreased by 7 percentage points; andCommentsClose CommentsPermalink





‘(III) 2020 and each subsequent year is 25 percent.CommentsClose CommentsPermalink





‘(D) COVERAGE FOR APPLICABLE DRUGS IN COVERAGE GAP-CommentsClose CommentsPermalink





‘(i) IN GENERAL- Except as provided in paragraph (4), the coverage for an applicable beneficiary (as defined in section 1860D-14A(g)(1)) has coinsurance (for costs above the initial coverage limit under paragraph (3) and below the out-of-pocket threshold) for the negotiated price (as defined in section 1860D-14A(g)(6)) of covered part D drugs that are applicable drugs under section 1860D-14A(g)(2) that is--CommentsClose CommentsPermalink





‘(I) equal to the difference between the applicable gap percentage (specified in clause (ii) for the year) and the discount percentage specified in section 1860D-14A(g)(4)(A) for such applicable drugs; orCommentsClose CommentsPermalink





‘(II) actuarially equivalent (using processes and methods established under section 1860D-11(c)) to an average expected payment of such percentage of such costs, for covered part D drugs that are applicable drugs under section 1860D-14A(g)(2).CommentsClose CommentsPermalink





‘(ii) APPLICABLE GAP PERCENTAGE- The applicable gap percentage specified in this clause for--CommentsClose CommentsPermalink





‘(I) 2013 and 2014 is 97.5 percent;CommentsClose CommentsPermalink





‘(II) 2015 and 2016 is 95 percent;CommentsClose CommentsPermalink





‘(III) 2017 is 90 percent;CommentsClose CommentsPermalink





‘(IV) 2018 is 85 percent;CommentsClose CommentsPermalink





‘(V) 2019 is 80 percent; andCommentsClose CommentsPermalink





‘(VI) 2020 and each subsequent year is 75 percent.’;CommentsClose CommentsPermalink





(D) in paragraph (3)(A), as restored under subsection (a)(2), by striking ‘paragraph (4)’ and inserting ‘paragraphs (2)(C), (2)(D), and (4)’; andCommentsClose CommentsPermalink





(E) in paragraph (4)(E), by inserting before the period at the end the following: ‘, except that incurred costs shall not include the portion of the negotiated price that represents the reduction in coinsurance resulting from the application of paragraph (2)(D)’; andCommentsClose CommentsPermalink





(4) in section 1860D-22(a)(2)(A), by inserting before the period at the end the following: ‘, not taking into account the value of any discount or coverage provided during the gap in prescription drug coverage that occurs between the initial coverage limit under section 1860D-2(b)(3) during the year and the out-of-pocket threshold specified in section 1860D-2(b)(4)(B)’.CommentsClose CommentsPermalink





(c) Conforming Amendment to AMP Under Medicaid- Section 1927(k)(1)(B)(i) of the Social Security Act (42 U.S.C. 1396r-8(k)(1)(B)(i)), as amended by section 2503(a)(2)(B) of the Patient Protection and Affordable Care Act, is amended--CommentsClose CommentsPermalink





(1) by striking ‘and’ at the end of subclause (III);CommentsClose CommentsPermalink





(2) by striking the period at the end of subclause (IV); andCommentsClose CommentsPermalink





(3) by adding at the end the following new subclause:CommentsClose CommentsPermalink





‘(V) discounts provided by manufacturers under section 1860D-14A.’.CommentsClose CommentsPermalink





(d) Reducing Growth Rate of Out-of-pocket Cost Threshold- Section 1860D-2(b) of the Social Security Act (42 U.S.C. 1395w-102(b)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (4)(B)(i)--CommentsClose CommentsPermalink





(A) in subclause (I), by striking ‘or’ at the end;CommentsClose CommentsPermalink





(B) by redesignating subclause (II) as subclause (VI); andCommentsClose CommentsPermalink





(C) by inserting after subclause (I) the following new subclauses:CommentsClose CommentsPermalink





‘(II) for each of years 2007 through 2013, is equal to the amount specified in this subparagraph for the previous year, increased by the annual percentage increase described in paragraph (6) for the year involved;CommentsClose CommentsPermalink





‘(III) for 2014 and 2015, is equal to the amount specified in this subparagraph for the previous year, increased by the annual percentage increase described in paragraph (6) for the year involved, minus 0.25 percentage point;CommentsClose CommentsPermalink





‘(IV) for each of years 2016 through 2019, is equal to the amount specified in this subparagraph for the previous year, increased by the lesser of--CommentsClose CommentsPermalink

‘(aa) the annual percentage increase described in paragraph (7) for the year involved, plus 2 percentage points; orCommentsClose CommentsPermalink

‘(bb) the annual percentage increase described in paragraph (6) for the year;CommentsClose CommentsPermalink

‘(V) for 2020, is equal to the amount that would have been applied under this subparagraph for reconciliation pursuant 2020 if the amendments made by section 1101(d)(1) of the Health Care and Education Reconciliation Act of 2010 had not been enacted; or’; andCommentsClose CommentsPermalink





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





‘(7) ADDITIONAL ANNUAL PERCENTAGE INCREASE- The annual percentage increase specified in this paragraph for a year is equal to the annual percentage increase in the consumer price index for all urban consumers (United States city average) for the 12-month period ending in July of the previous year.’.CommentsClose CommentsPermalink

(a) Repeal- Effective as if included in the enactment of the Patient Protection and Affordable Care Act, sections 3201 and 3203 of such Act (and the amendments made by such sections) are repealed.CommentsClose CommentsPermalink





(b) Phase-in of Modified Benchmarks- Section 1853 of the Social Security Act (42 U.S.C. 1395w-23) is amended--CommentsClose CommentsPermalink





(1) in subsection (j)(1)(A), by striking ‘(or, beginning with 2007, 1/12 of the applicable amount determined under subsection (k)(1)) for the area for the year’ and inserting ‘for the area for the year (or, for 2007, 2008, 2009, and 2010, 1/12 of the applicable amount determined under subsection (k)(1) for the area for the year; for 2011, 1/12 of the applicable amount determined under subsection (k)(1) for the area for 2010; and, beginning with 2012, 1/12 of the blended benchmark amount determined under subsection (n)(1) for the area for the year)’; andCommentsClose CommentsPermalink





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





‘(n) Determination of Blended Benchmark Amount-CommentsClose CommentsPermalink





‘(1) IN GENERAL- For purposes of subsection (j), subject to paragraphs (3), (4), and (5), the term ‘blended benchmark amount’ means for an area--CommentsClose CommentsPermalink





‘(A) for 2012 the sum of--CommentsClose CommentsPermalink





‘(i) 1/2 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(ii) 1/2 of the amount specified in paragraph (2)(A) for the area and year; andCommentsClose CommentsPermalink





‘(B) for a subsequent year the amount specified in paragraph (2)(A) for the area and year.CommentsClose CommentsPermalink





‘(2) SPECIFIED AMOUNT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The amount specified in this subparagraph for an area and year is the product of--CommentsClose CommentsPermalink





‘(i) the base payment amount specified in subparagraph (E) for the area and year adjusted to take into account the phase-out in the indirect costs of medical education from capitation rates described in subsection (k)(4); andCommentsClose CommentsPermalink





‘(ii) the applicable percentage for the area for the year specified under subparagraph (B).CommentsClose CommentsPermalink





‘(B) APPLICABLE PERCENTAGE- Subject to subparagraph (D), the applicable percentage specified in this subparagraph for an area for a year in the case of an area that is ranked--CommentsClose CommentsPermalink





‘(i) in the highest quartile under subparagraph (C) for the previous year is 95 percent;CommentsClose CommentsPermalink





‘(ii) in the second highest quartile under such subparagraph for the previous year is 100 percent;CommentsClose CommentsPermalink





‘(iii) in the third highest quartile under such subparagraph for the previous year is 107.5 percent; orCommentsClose CommentsPermalink





‘(iv) in the lowest quartile under such subparagraph for the previous year is 115 percent.CommentsClose CommentsPermalink





‘(C) PERIODIC RANKING- For purposes of this paragraph in the case of an area located--CommentsClose CommentsPermalink





‘(i) in 1 of the 50 States or the District of Columbia, the Secretary shall rank such area in each year specified under subsection (c)(1)(D)(ii) based upon the level of the amount specified in subparagraph (A)(i) for such areas; orCommentsClose CommentsPermalink





‘(ii) in a territory, the Secretary shall rank such areas in each such year based upon the level of the amount specified in subparagraph (A)(i) for such area relative to quartile rankings computed under clause (i).CommentsClose CommentsPermalink





‘(D) 1-year TRANSITION FOR CHANGES IN APPLICABLE PERCENTAGE- If, for a year after 2012, there is a change in the quartile in which an area is ranked compared to the previous year, the applicable percentage for the area in the year shall be the average of--CommentsClose CommentsPermalink





‘(i) the applicable percentage for the area for the previous year; andCommentsClose CommentsPermalink





‘(ii) the applicable percentage that would otherwise apply for the area for the year.CommentsClose CommentsPermalink





‘(E) BASE PAYMENT AMOUNT- Subject to subparagraph (F), the base payment amount specified in this subparagraph--CommentsClose CommentsPermalink





‘(i) for 2012 is the amount specified in subsection (c)(1)(D) for the area for the year; orCommentsClose CommentsPermalink





‘(ii) for a subsequent year that--CommentsClose CommentsPermalink





‘(I) is not specified under subsection (c)(1)(D)(ii), is the base amount specified in this subparagraph for the area for the previous year, increased by the national per capita MA growth percentage, described in subsection (c)(6) for that succeeding year, but not taking into account any adjustment under subparagraph (C) of such subsection for a year before 2004; andCommentsClose CommentsPermalink





‘(II) is specified under subsection (c)(1)(D)(ii), is the amount specified in subsection (c)(1)(D) for the area for the year.CommentsClose CommentsPermalink





‘(F) APPLICATION OF INDIRECT MEDICAL EDUCATION PHASE-OUT- The base payment amount specified in subparagraph (E) for a year shall be adjusted in the same manner under paragraph (4) of subsection (k) as the applicable amount is adjusted under such subsection.CommentsClose CommentsPermalink





‘(3) ALTERNATIVE PHASE-INS-CommentsClose CommentsPermalink





‘(A) 4-year PHASE-IN FOR CERTAIN AREAS- If the difference between the applicable amount (as defined in subsection (k)) for an area for 2010 and the projected 2010 benchmark amount (as defined in subparagraph (C)) for the area is at least $30 but less than $50, the blended benchmark amount for the area is--CommentsClose CommentsPermalink





‘(i) for 2012 the sum of--CommentsClose CommentsPermalink





‘(I) 3/4 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 1/4 of the amount specified in paragraph (2)(A) for the area and year;CommentsClose CommentsPermalink





‘(ii) for 2013 the sum of--CommentsClose CommentsPermalink





‘(I) 1/2 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 1/2 of the amount specified in paragraph (2)(A) for the area and year;CommentsClose CommentsPermalink





‘(iii) for 2014 the sum of--CommentsClose CommentsPermalink





‘(I) 1/4 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 3/4 of the amount specified in paragraph (2)(A) for the area and year; andCommentsClose CommentsPermalink





‘(iv) for a subsequent year the amount specified in paragraph (2)(A) for the area and year.CommentsClose CommentsPermalink





‘(B) 6-year PHASE-IN FOR CERTAIN AREAS- If the difference between the applicable amount (as defined in subsection (k)) for an area for 2010 and the projected 2010 benchmark amount (as defined in subparagraph (C)) for the area is at least $50, the blended benchmark amount for the area is--CommentsClose CommentsPermalink





‘(i) for 2012 the sum of--CommentsClose CommentsPermalink





‘(I) 5/6 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 1/6 of the amount specified in paragraph (2)(A) for the area and year;CommentsClose CommentsPermalink





‘(ii) for 2013 the sum of--CommentsClose CommentsPermalink





‘(I) 2/3 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 1/3 of the amount specified in paragraph (2)(A) for the area and year;CommentsClose CommentsPermalink





‘(iii) for 2014 the sum of--CommentsClose CommentsPermalink





‘(I) 1/2 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 1/2 of the amount specified in paragraph (2)(A) for the area and year;CommentsClose CommentsPermalink





‘(iv) for 2015 the sum of--CommentsClose CommentsPermalink





‘(I) 1/3 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 2/3 of the amount specified in paragraph (2)(A) for the area and year; andCommentsClose CommentsPermalink





‘(v) for 2016 the sum of--CommentsClose CommentsPermalink





‘(I) 1/6 of the applicable amount for the area and year; andCommentsClose CommentsPermalink





‘(II) 5/6 of the amount specified in paragraph (2)(A) for the area and year; andCommentsClose CommentsPermalink





‘(vi) for a subsequent year the amount specified in paragraph (2)(A) for the area and year.CommentsClose CommentsPermalink





‘(C) PROJECTED 2010 BENCHMARK AMOUNT- The projected 2010 benchmark amount described in this subparagraph for an area is equal to the sum of--CommentsClose CommentsPermalink





‘(i) 1/2 of the applicable amount (as defined in subsection (k)) for the area for 2010; andCommentsClose CommentsPermalink





‘(ii) 1/2 of the amount specified in paragraph (2)(A) for the area for 2010 but determined as if there were substituted for the applicable percentage specified in clause (ii) of such paragraph the sum of--CommentsClose CommentsPermalink





‘(I) the applicable percent that would be specified under subparagraph (B) of paragraph (2) (determined without regard to subparagraph (D) of such paragraph) for the area for 2010 if any reference in such paragraph to Title II of the concurrent resolution on the budget ‘the previous year’ were deemed a reference to 2010; andCommentsClose CommentsPermalink





‘(II) the applicable percentage increase that would apply to a qualifying plan in the area under subsection (o) as if any reference in such subsection to 2012 were deemed a reference to 2010 and as if the determination of a qualifying county under paragraph (3)(B) of such subsection were made for 2010.CommentsClose CommentsPermalink





‘(4) CAP ON BENCHMARK AMOUNT- In no case shall the blended benchmark amount for an area for a year (determined taking into account subsection (o)) be greater than the applicable amount that would (but for the application of this subsection) be determined under subsection (k)(1) for the area for the year.CommentsClose CommentsPermalink





‘(5) NON-APPLICATION TO PACE PLANS- This subsection shall not apply to payments to a PACE program under section 1894.’.CommentsClose CommentsPermalink





(c) Applicable Percentage Quality Increases- Section 1853 of such Act (42 U.S.C. 1395w-23), as amended by subsection (b), is amended--CommentsClose CommentsPermalink





(1) in subsection (j), by inserting ‘subject to subsection (o),’ after ‘For purposes of this part,’;CommentsClose CommentsPermalink





(2) in subsection (n)(2)(B), as added by subsection (b), by inserting ‘, subject to subsection (o)’ after ‘as follows’; andCommentsClose CommentsPermalink





(3) by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(o) Applicable Percentage Quality Increases-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Subject to the succeeding paragraphs, in the case of a qualifying plan with respect to a year beginning with 2012, the applicable percentage under subsection (n)(2)(B) shall be increased on a plan or contract level, as determined by the Secretary--CommentsClose CommentsPermalink





‘(A) for 2012, by 1.5 percentage points;CommentsClose CommentsPermalink





‘(B) for 2013, by 3.0 percentage points; andCommentsClose CommentsPermalink





‘(C) for 2014 or a subsequent year, by 5.0 percentage points.CommentsClose CommentsPermalink





‘(2) INCREASE FOR QUALIFYING PLANS IN QUALIFYING COUNTIES- The increase applied under paragraph (1) for a qualifying plan located in a qualifying county for a year shall be doubled.CommentsClose CommentsPermalink





‘(3) QUALIFYING PLANS AND QUALIFYING COUNTY DEFINED; APPLICATION OF INCREASES TO LOW ENROLLMENT AND NEW PLANS- For purposes of this subsection:CommentsClose CommentsPermalink





‘(A) QUALIFYING PLAN-CommentsClose CommentsPermalink





‘(i) IN GENERAL- The term ‘qualifying plan’ means, for a year and subject to paragraph (4), a plan that had a quality rating under paragraph (4) of 4 stars or higher based on the most recent data available for such year.CommentsClose CommentsPermalink





‘(ii) APPLICATION OF INCREASES TO LOW ENROLLMENT PLANS-CommentsClose CommentsPermalink





‘(I) 2012- For 2012, the term ‘qualifying plan’ includes an MA plan that the Secretary determines is not able to have a quality rating under paragraph (4) because of low enrollment.CommentsClose CommentsPermalink





‘(II) 2013 AND SUBSEQUENT YEARS- For 2013 and subsequent years, for purposes of determining whether an MA plan with low enrollment (as defined by the Secretary) is included as a qualifying plan, the Secretary shall establish a method to apply to MA plans with low enrollment (as defined by the Secretary) the computation of quality rating and the rating system under paragraph (4).CommentsClose CommentsPermalink





‘(iii) APPLICATION OF INCREASES TO NEW PLANS-CommentsClose CommentsPermalink





‘(I) IN GENERAL- A new MA plan that meets criteria specified by the Secretary shall be treated as a qualifying plan, except that in applying paragraph (1), the applicable percentage under subsection (n)(2)(B) shall be increased--CommentsClose CommentsPermalink

‘(aa) for fiscal 2012, by 1.5 percentage points;CommentsClose CommentsPermalink

‘(bb) for 2013, by 2.5 percentage points; andCommentsClose CommentsPermalink

‘(cc) for 2014 or a subsequent year, by 3.5 percentage points.CommentsClose CommentsPermalink

‘(II) NEW MA PLAN DEFINED- The term ‘new MA plan’ means, with respect to a year, a plan offered by an organization or sponsor that has not had a contract as a Medicare Advantage organization in the preceding 3-year period.CommentsClose CommentsPermalink





‘(B) QUALIFYING COUNTY- The term ‘qualifying county’ means, for a year, a county--CommentsClose CommentsPermalink





‘(i) that has an MA capitation rate that, in 2004, was based on the amount specified in subsection (c)(1)(B) for a Metropolitan Statistical Area with a population of more than 250,000;CommentsClose CommentsPermalink





‘(ii) for which, as of December 2009, of the Medicare Advantage eligible individuals residing in the county at least 25 percent of such individuals were enrolled in Medicare Advantage plans; andCommentsClose CommentsPermalink





‘(iii) that has per capita fee-for-service spending that is lower than the national monthly per capita cost for expenditures for individuals enrolled under the original medicare fee-for-service program for the year.CommentsClose CommentsPermalink





‘(4) QUALITY DETERMINATIONS FOR APPLICATION OF INCREASE-CommentsClose CommentsPermalink





‘(A) QUALITY DETERMINATION- The quality rating for a plan shall be determined according to a 5-star rating system (based on the data collected under section 1852(e)).CommentsClose CommentsPermalink





‘(B) PLANS THAT FAILED TO REPORT- An MA plan which does not report data that enables the Secretary to rate the plan for purposes of this paragraph shall be counted as having a rating of fewer than 3.5 stars.CommentsClose CommentsPermalink





‘(5) EXCEPTION FOR PACE PLANS- This subsection shall not apply to payments to a PACE program under section 1894.’.CommentsClose CommentsPermalink





(4) DETERMINATION OF MEDICARE PART D LOW-INCOME BENCHMARK PREMIUM- Section 1860D-14(b)(2)(B)(iii) of the Social Security Act (42 U.S.C. 1395w-114(b)(2)(B)(iii)) as amended by section 3302 of the Patient Protection and Affordable Care Act, is amended by striking ‘, determined without regard to any reduction in such premium as a result of any beneficiary rebate under section 1854(b)(1)(C) or bonus payment under section 1853(n)’ and inserting the following: ‘and determined before the application of the monthly rebate computed under section 1854(b)(1)(C)(i) for that plan and year involved and, in the case of a qualifying plan, before the application of the increase under section 1853(o) for that plan and year 2010 (S. Coninvolved’.CommentsClose CommentsPermalink





(d) Beneficiary Rebates- Section 1854(b)(1)(C) of such Act (42 U.S.C. 1395w-24(b)(1)(C)), as amended by section 3202(b) of the Patient Protection and Affordable Care Act, is further amended--CommentsClose CommentsPermalink





(1) in clause (i), by inserting ‘(or the applicable rebate percentage specified in clause (iii) in the case of plan years beginning on or after January 1, 2012)’ after ‘75 percent’; andCommentsClose CommentsPermalink





(2) by striking clause (iii), by redesignating clauses (iv) and (v) as clauses (vii) and (viii), respectively, and by inserting after clause (ii) the following new clauses:CommentsClose CommentsPermalink





‘(iii) APPLICABLE REBATE PERCENTAGE- The applicable rebate percentage specified in this clause for a plan for a year, based on the system under section 1853(o)(4)(A), is the sum of--CommentsClose CommentsPermalink





‘(I) the product of the old phase-in proportion for the year under clause (iv) and 75 percent; andCommentsClose CommentsPermalink





‘(II) the product of the new phase-in proportion for the year under clause (iv) and the final applicable rebate percentage under clause (v).CommentsClose CommentsPermalink





‘(iv) OLD AND NEW PHASE-IN PROPORTIONS- For purposes of clause (iv)--CommentsClose CommentsPermalink





‘(I) for 2012, the old phase-in proportion is 2/3 and the new phase-in proportion is 1/3 ;CommentsClose CommentsPermalink





‘(II) for 2013, the old phase-in proportion is 1/3 and the new phase-in proportion is 2/3 ; andCommentsClose CommentsPermalink





‘(III) for 2014 and any subsequent year, the old phase-in proportion is 0 and the new phase-in proportion is 1.CommentsClose CommentsPermalink





‘(v) FINAL APPLICABLE REBATE PERCENTAGE- Subject to clause (vi), the final applicable rebate percentage under this clause is--CommentsClose CommentsPermalink





‘(I) in the case of a plan with a quality rating under such system of at least 4.5 stars, 70 percent;CommentsClose CommentsPermalink





‘(II) in the case of a plan with a quality rating under such system of at least 3.5 stars and less than 4.5 stars, 65 percent; andCommentsClose CommentsPermalink





‘(III) in the case of a plan with a quality rating under such system of less than 3.5 stars, 50 percent.CommentsClose CommentsPermalink





‘(vi) TREATMENT OF LOW ENROLLMENT AND NEW PLANS- For purposes of clause (v)--CommentsClose CommentsPermalink





‘(I) for 2012, in the case of a plan described in subclause (I) of subsection (o)(3)(A)(ii), the plan shall be treated as having a rating of 4.5 stars; andCommentsClose CommentsPermalink





‘(II) for 2012 or a subsequent year, in the case of a new MA plan (as defined under subclause (III) of subsection (o)(3)(A)(iii)) that is treated as a qualifying plan pursuant to subclause (I) of such subsection, the plan shall be treated as having a rating of 3.5 stars.’.CommentsClose CommentsPermalink





(e) Coding Intensity Adjustment- Section 1853(a)(1)(C)(ii) of such Act (42 U.S.C. 1395w-23(a)(1)(C)(ii)) is amended--CommentsClose CommentsPermalink





(1) in the heading, by striking ‘DURING PHASEOUT OF BUDGET NEUTRALITY FACTOR’ and inserting ‘OF CODING ADJUSTMENT’;CommentsClose CommentsPermalink





(2) in the matter before subclause (I), by striking ‘through 2010’ and inserting ‘and each subsequent year’; andCommentsClose CommentsPermalink





(3) in subclause (II)--CommentsClose CommentsPermalink





(A) in the first sentence, by inserting ‘annually’ before ‘conduct an analysis’;CommentsClose CommentsPermalink





(B) in the second sentence--CommentsClose CommentsPermalink





(i) by inserting ‘on a timely basis’ after ‘are incorporated’; andCommentsClose CommentsPermalink





(ii) by striking ‘only for 2008, 2009, and 2010’ and inserting ‘for 2008 and subsequent years’;CommentsClose CommentsPermalink





(C) in the third sentence, by inserting ‘and updated as appropriate’ before the period at the end; andCommentsClose CommentsPermalink





(D) by adding at the end the following new subclauses:CommentsClose CommentsPermalink





‘(III) In calculating each year’s adjustment, the adjustment factor shall be for 2014, not less than the adjustment factor applied for 2010, plus 1.3 percentage points; for each of years 2015 through 2018, not less than the adjustment factor applied for the previous year, plus 0.25 percentage point; and for 2019 and each subsequent year, not less than 5.7 percent.CommentsClose CommentsPermalink





‘(IV) Such adjustment shall be applied to risk scores until the Secretary implements risk adjustment using Medicare Advantage diagnostic, cost, and use data.’.CommentsClose CommentsPermalink





(f) Repeal of Comparative Cost Adjustment Program- Section 1860C-1 of the Social Security Act (42 U.S.C. 1395w-29), as added by section 241(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173), is repealed.CommentsClose CommentsPermalink

Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(4) REQUIREMENT FOR MINIMUM MEDICAL LOSS RATIO- If the Secretary determines for a contract year (beginning with 2014) that an MA plan has failed to have a medical loss ratio of at least .Res85--CommentsClose CommentsPermalink





‘(A) the MA plan shall remit to the Secretary an amount equal to the product of--CommentsClose CommentsPermalink





‘(i) the total revenue of the MA plan under this part for the contract year; andCommentsClose CommentsPermalink





‘(ii) the difference between .13).’, do pass with the following

AMENDMENTS:

( 1 ) On page 118, strike lines 15 85 and the medical loss ratio;CommentsClose CommentsPermalink




‘(B) for 3 consecutive contract years, the Secretary shall not permit the enrollment of new enrollees under the plan for coverage during the second succeeding contract year; andCommentsClose CommentsPermalink





‘(C) the Secretary shall terminate the plan contract if the plan fails to have such a medical loss ratio for 5 consecutive contract years.’.CommentsClose CommentsPermalink

(a) IPPS- Section 1886(b)(3)(B) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)), as amended by sections 3401(a)(4) and 10319(a) of the Patient Protection and Affordable Care Act, is amended--CommentsClose CommentsPermalink





(1) in clause (xii)--CommentsClose CommentsPermalink





(A) by placing the subclause (II) (inserted by section 10319(a)(3) of the Patient Protection and Affordable Care Act) immediately after subclause (I) and, in such subclause (II), by striking ‘and’ at the end; andCommentsClose CommentsPermalink





(B) by striking subclause (III) and inserting the following:CommentsClose CommentsPermalink





‘(III) for fiscal year 2014, by 0.3 percentage point;CommentsClose CommentsPermalink





‘(IV) for each of fiscal years 2015 and 2016, by 0.2 percentage point; andCommentsClose CommentsPermalink





‘(V) for each of fiscal years 2017, 2018, and 2019, by 0.75 percentage point.’; andCommentsClose CommentsPermalink





(2) by striking clause (xiii).CommentsClose CommentsPermalink





(b) Long-term Care Hospitals- Section 1886(m)(4) of the Social Security Act (42 U.S.C. 1395ww(m)(4)), as added by section 3401(c) of the Patient Protection and Affordable Care Act and amended by section 10319(b) of such Act, is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A)--CommentsClose CommentsPermalink





(A) in clause (iii), by striking ‘and’ at the end; andCommentsClose CommentsPermalink





(B) by striking clause (iv) and inserting the following:CommentsClose CommentsPermalink





‘(iv) for rate year 2014, 0.3 percentage point;CommentsClose CommentsPermalink





‘(v) for each of rate years 2015 and 2016, 0.2 percentage point; andCommentsClose CommentsPermalink





‘(vi) for each of rate years 2017, 2018, and 2019, 0.75 percentage point.’;CommentsClose CommentsPermalink





(2) by striking subparagraph (B); andCommentsClose CommentsPermalink





(3) by striking ‘(4) OTHER ADJUSTMENT- ’ and all that follows through ‘For purposes’ and inserting ‘(4) OTHER ADJUSTMENT- For purposes’ (and redesignating clauses (i) through 25 (and redesignate(vi) as subparagraphs (A) through (F), respectively, with appropriate indentation).CommentsClose CommentsPermalink





(c) Inpatient Rehabilitation Facilities- Section 1886(j)(3)(D) of the Social Security Act (42 U.S.C. 1395ww(j)(3)(D)), as added by section 3401(d)(2) of the Patient Protection and Affordable Care Act and amended by section 10319(c) of such Act, is amended--CommentsClose CommentsPermalink





(1) in clause (i)--CommentsClose CommentsPermalink





(A) by placing the subclause (II) (inserted by section 10319(c)(3) of the Patient Protection and Affordable Care Act) immediately after subclause (I) and, in such subclause (II), by striking ‘and’ at the end; andCommentsClose CommentsPermalink





(B) by striking subclause (III) and inserting the following:CommentsClose CommentsPermalink





‘(III) for fiscal year 2014, 0.3 percentage point;CommentsClose CommentsPermalink





‘(IV) for each of fiscal years 2015 and 2016, 0.2 percentage point; andCommentsClose CommentsPermalink





‘(V) for each of fiscal years 2017, 2018, and 2019, 0.75 percentage point.’;CommentsClose CommentsPermalink





(2) by striking clause (ii); andCommentsClose CommentsPermalink





(3) by striking ‘(D) OTHER ADJUSTMENT- ’ and all that follows through ‘For purposes’ and inserting ‘(D) OTHER ADJUSTMENT- For purposes’ (and redesignating subclauses (I) through (V) as clauses (i) through (v), respectively, with appropriate indentation).CommentsClose CommentsPermalink





(d) Psychiatric Hospitals- Section 1886(s)(3) of the Social Security Act, as added by section 3401(f) of the Patient Protection and Affordable Care Act and amended by section 10319(e) of such Act, is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A)--CommentsClose CommentsPermalink





(A) by placing the clause (ii) (inserted by section 10319(e)(3) of the Patient Protection and Affordable Care Act) immediately after clause (i) and, in such clause (ii), by striking ‘and’ at the end; andCommentsClose CommentsPermalink





(B) by striking clause (iii) and inserting the following:CommentsClose CommentsPermalink





‘(iii) for the rate year beginning in 2014, 0.3 percentage point;CommentsClose CommentsPermalink





‘(iv) for each of the rate years beginning in 2015 and 2016, 0.2 percentage point; andCommentsClose CommentsPermalink





‘(v) for each of the rate years beginning in 2017, 2018, and 2019, 0.75 percentage point.’;CommentsClose CommentsPermalink





(2) by striking subparagraph (B); andCommentsClose CommentsPermalink





(3) by striking ‘(3) OTHER ADJUSTMENT- ’ and all that follows through ‘For purposes’ and inserting ‘(3) OTHER ADJUSTMENT- For purposes’ (and redesignating clauses (i) through (v) as subparagraphs (A) through (E), respectively, with appropriate indentation).CommentsClose CommentsPermalink





(e) Outpatient Hospitals- Section 1833(t)(3)(G) of the Social Security Act (42 U.S.C. 1395l(t)(3)(G)), as added by section 3401(i)(2) of the Patient Protection and Affordable Care Act and amended by section 10319(g) of such Act, is amended--CommentsClose CommentsPermalink





(1) in clause (i)--CommentsClose CommentsPermalink





(A) by placing the subclause (II) (inserted by section 10319(g)(3) of the Patient Protection and Affordable Care Act) immediately after subclause (I) and, in such subclause (II), by striking ‘and’ at the end; andCommentsClose CommentsPermalink





(B) by striking subclause (III) and inserting the following:CommentsClose CommentsPermalink





‘(III) for 2014, 0.3 percentage point;CommentsClose CommentsPermalink





‘(IV) for each of 2015 and 2016, 0.2 percentage point; andCommentsClose CommentsPermalink





‘(V) for each of 2017, 2018, and 2019, 0.75 percentage point.’;CommentsClose CommentsPermalink





(2) by striking clause (ii); andCommentsClose CommentsPermalink





(3) by striking ‘(G) OTHER ADJUSTMENT- ’ and all that follows through ‘For purposes’ and inserting ‘(G) OTHER ADJUSTMENT- For purposes’ (and redesignating subclauses (I) through (V) as clauses (i) through (v), respectively, with appropriate indentation).CommentsClose CommentsPermalink

Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), as amended by section 3135(a) of the Patient Protection and Affordable Care Act, is amended--CommentsClose CommentsPermalink





(1) in subsection (b)(4)--CommentsClose CommentsPermalink





(A) in subparagraph (B), by striking ‘this paragraph’ and inserting ‘subparagraph (A)’; andCommentsClose CommentsPermalink





(B) by amending subparagraph (C) to read as follows:CommentsClose CommentsPermalink





‘(C) ADJUSTMENT IN IMAGING UTILIZATION RATE- With respect to fee schedules established for 2011 and subsequent years, in the methodology for determining practice expense relative value units for expensive diagnostic imaging equipment under the final rule published by the Secretary in the Federal Register on November 25, 2009 (42 CFR 410 et al.), the Secretary shall use a 75 percent assumption instead of the utilization rates otherwise established in such final rule.’; andCommentsClose CommentsPermalink





(2) in subsection (c)(2)(B)(v), by striking subclauses (III), (IV), and (V) and inserting the following new subclause:CommentsClose CommentsPermalink





‘(III) CHANGE IN UTILIZATION RATE FOR CERTAIN IMAGING SERVICES- Effective for fee schedules established beginning with 2011, reduced expenditures attributable to the change in the utilization rate applicable to 2011, as described in subsection (b)(4)(C).’.CommentsClose CommentsPermalink

(a) In General- Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)), as amended by sections 2551(a)(4) and 10201(e)(1) of the Patient Protection and Affordable Care Act, is amended--CommentsClose CommentsPermalink





(1) in paragraph (6)(B)(iii), in the matter preceding subclause (I), by striking ‘or paragraph (7)’; andCommentsClose CommentsPermalink





(2) by striking paragraph (7) and inserting the following:CommentsClose CommentsPermalink





‘(7) MEDICAID DSH REDUCTIONS-CommentsClose CommentsPermalink





‘(A) REDUCTIONS-CommentsClose CommentsPermalink





‘(i) IN GENERAL- For each of fiscal years 2014 through 2020 the Secretary shall effect the following reductions:CommentsClose CommentsPermalink





‘(I) REDUCTION IN DSH ALLOTMENTS- The Secretary shall reduce DSH allotments to States in the amount specified under the DSH health reform methodology under subparagraph (B) for the State for the fiscal year.CommentsClose CommentsPermalink





‘(II) REDUCTIONS IN PAYMENTS- The Secretary shall reduce payments to States under section 1903(a) for each calendar quarter in the fiscal year, in the manner specified in clause (iii), in an amount equal to 1/4 of the DSH allotment reduction under subclause (I) for the State for the fiscal year.CommentsClose CommentsPermalink





‘(ii) AGGREGATE REDUCTIONS- The aggregate reductions in DSH allotments for all States under clause (i)(I) shall be equal to--CommentsClose CommentsPermalink





‘(I) $500,000,000 for fiscal year 2014;CommentsClose CommentsPermalink





‘(II) $600,000,000 for fiscal year 2015;CommentsClose CommentsPermalink





‘(III) $600,000,000 for fiscal year 2016;CommentsClose CommentsPermalink





‘(IV) $1,800,000,000 for fiscal year 2017;CommentsClose CommentsPermalink





‘(V) $5,000,000,000 for fiscal year 2018;CommentsClose CommentsPermalink





‘(VI) $5,600,000,000 for fiscal year 2019; andCommentsClose CommentsPermalink





‘(VII) $4,000,000,000 for fiscal year 2020.CommentsClose CommentsPermalink





The Secretary shall distribute such aggregate reductions among States in accordance with subparagraph (B).CommentsClose CommentsPermalink





‘(iii) MANNER OF PAYMENT REDUCTION- The amount of the payment reduction under clause (i)(II) for a State for a quarter shall be deemed an overpayment to the State under this title to be disallowed against the State’s regular quarterly draw for all spending under section 1903(d)(2). Such a disallowance is not subject to a reconsideration under subsections accordingly).( 2 ) On page 120, strike lines 3 (d) and (e) of section 1116.CommentsClose CommentsPermalink





‘(iv) DEFINITION- In this paragraph, the term ‘State’ means the 50 States and the District of Columbia.CommentsClose CommentsPermalink





‘(B) DSH HEALTH REFORM METHODOLOGY- The Secretary shall carry out subparagraph (A) through 5.

Attest:

Secretary.

111th CONGRESS

2d Session

H.R. 4872

AMENDMENTS

use of a DSH Health Reform methodology that meets the following requirements:CommentsClose CommentsPermalink




‘(i) The methodology imposes the largest percentage reductions on the States that--CommentsClose CommentsPermalink





‘(I) have the lowest percentages of uninsured individuals (determined on the basis of data from the Bureau of the Census, audited hospital cost reports, and other information likely to yield accurate data) during the most recent year for which such data are available; orCommentsClose CommentsPermalink





‘(II) do not target their DSH payments on--CommentsClose CommentsPermalink