U.S. Congress - Text of S.1679 as Placed on Calendar Senate Affordable Health Choices Act
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An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce.
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S 1679 PCSCommentsClose CommentsPermalink
Calendar No. 161CommentsClose CommentsPermalink
111th CONGRESSCommentsClose CommentsPermalink
1st SessionCommentsClose CommentsPermalink
S. 1679CommentsClose CommentsPermalink
To make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce.CommentsClose CommentsPermalink
IN THE SENATE OF THE UNITED STATESCommentsClose CommentsPermalink
September 17, 2009CommentsClose CommentsPermalink
September 17, 2009CommentsClose CommentsPermalink
Mr. HARKIN, from the Committee on Health, Education, Labor, and Pensions reported the following original bill; which was read twice and placed on the calendarCommentsClose CommentsPermalink
A BILLCommentsClose CommentsPermalink
To make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce.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; TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as the ‘Affordable Health Choices Act’.CommentsClose CommentsPermalink
(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink
Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Subtitle A--Effective Coverage for All Americans
PART I--Provisions Applicable to the Individual and Group Markets
Sec. 101. Amendment to the Public Health Service Act.CommentsClose CommentsPermalink
‘PART A--Individual and Group Market Reforms
‘subpart 1--general reform
‘Sec. 2705. Prohibition of preexisting condition exclusions or other discrimination based on health status.CommentsClose CommentsPermalink
‘Sec. 2701. Fair insurance coverage.CommentsClose CommentsPermalink
‘Sec. 2702. Guaranteed availability of coverage.CommentsClose CommentsPermalink
‘Sec. 2703. Guaranteed renewability of coverage.CommentsClose CommentsPermalink
‘Sec. 2704. Increasing the Transparency of Health Care Costs and Regulatory Fees.CommentsClose CommentsPermalink
‘Sec. 2706. Prohibiting discrimination against individual participants and beneficiaries based on health status.CommentsClose CommentsPermalink
‘Sec. 2707. Ensuring the quality of care.CommentsClose CommentsPermalink
‘Sec. 2708. Coverage of preventive health services.CommentsClose CommentsPermalink
‘Sec. 2709. Coverage of Preventive Women’s Health Services.CommentsClose CommentsPermalink
‘Sec. 2710. Extension of dependent coverage.CommentsClose CommentsPermalink
‘Sec. 2711. No lifetime or annual limits.CommentsClose CommentsPermalink
‘Sec. 2712. Notification by plans not providing minimum qualifying coverage.CommentsClose CommentsPermalink
‘Sec. 2713. Non-discrimination in health care.CommentsClose CommentsPermalink
PART II--Provision Applicable to the Group Market
Sec. 121. Amendment to the Public Health Service Act.CommentsClose CommentsPermalink
‘Sec. 2720A. Prohibition of discrimination based on salary.CommentsClose CommentsPermalink
PART III--Other Provisions
Sec. 131. No changes to existing coverage.CommentsClose CommentsPermalink
Sec. 132. Applicability.CommentsClose CommentsPermalink
Sec. 133. Conforming amendments.CommentsClose CommentsPermalink
Sec. 134. Savings.CommentsClose CommentsPermalink
Sec. 135. Effective dates.CommentsClose CommentsPermalink
Subtitle B--Available Coverage for All Americans
Sec. 141. Building on the success of the Federal Employees Health Benefits Program and the health benefits program of most large employers so all Americans have affordable health benefit choices.CommentsClose CommentsPermalink
Sec. 142. Affordable health choices for all Americans.CommentsClose CommentsPermalink
‘TITLE XXXI--AFFORDABLE HEALTH CHOICES FOR ALL AMERICANS
‘Subtitle A--Affordable Choices
‘Sec. 3101. Affordable choices of health benefit plans.CommentsClose CommentsPermalink
‘Sec. 3102. Financial integrity.CommentsClose CommentsPermalink
‘Sec. 3103. Program design.CommentsClose CommentsPermalink
‘Sec. 3104. Allowing State flexibility.CommentsClose CommentsPermalink
‘Sec. 3105. Navigators.CommentsClose CommentsPermalink
‘Sec. 3106. Community health insurance option.CommentsClose CommentsPermalink
‘Sec. 3107. Application of same laws to private plans and the community health insurance option.CommentsClose CommentsPermalink
‘Sec. 3108. Participation of professionals on certain health-related commissions.CommentsClose CommentsPermalink
‘Sec. 3109. Health insurance consumer assistance grants.CommentsClose CommentsPermalink
Sec. 143. Freedom not to participate in Federal health insurance programs.CommentsClose CommentsPermalink
Subtitle C--Affordable Coverage for All Americans
Sec. 151. Support for affordable health coverage.CommentsClose CommentsPermalink
‘Subtitle B--Making Coverage Affordable
‘Sec. 3111. Support for affordable health coverage.CommentsClose CommentsPermalink
‘Sec. 3112. Small business health options program credit.CommentsClose CommentsPermalink
Sec. 152. Program integrity.CommentsClose CommentsPermalink
Subtitle D--Shared Responsibility for Health Care
Sec. 161. Individual responsibility.CommentsClose CommentsPermalink
Sec. 162. Notification on the availability of affordable health choices.CommentsClose CommentsPermalink
Sec. 163. Shared responsibility of employers.CommentsClose CommentsPermalink
‘Sec. 3115. Shared responsibility of employers.CommentsClose CommentsPermalink
‘Sec. 3116. Definitions.CommentsClose CommentsPermalink
Subtitle E--Improving Access to Health Care Services
Sec. 171. Spending for Federally Qualified Health Centers (FQHCs).CommentsClose CommentsPermalink
Sec. 172. Other provisions.CommentsClose CommentsPermalink
Sec. 173. Negotiated rulemaking for development of methodology and criteria for designating medically underserved populations and health professions shortage areas.CommentsClose CommentsPermalink
Sec. 174. Equity for certain eligible survivors.CommentsClose CommentsPermalink
Sec. 175. Reauthorization of the Wakefield Emergency Medical Services for Children Program.CommentsClose CommentsPermalink
Sec. 176. Co-locating primary and specialty care in community-based mental health settings.CommentsClose CommentsPermalink
Subtitle F--Making Health Care More Affordable for Retirees
Sec. 181. Reinsurance for retirees.CommentsClose CommentsPermalink
Subtitle G--Improving the Use of Health Information Technology for Enrollment; Miscellaneous Provisions
Sec. 185. Health information technology enrollment standards and protocols.CommentsClose CommentsPermalink
Sec. 186. Rule of construction regarding Hawaii’s Prepaid Health Care Act.CommentsClose CommentsPermalink
Sec. 187. Key National indicators.CommentsClose CommentsPermalink
Sec. 188. Study and report on rates of preventable diseases in new Medicare enrollees.CommentsClose CommentsPermalink
Sec. 189. Transparency in government.CommentsClose CommentsPermalink
Sec. 189A. Preserving the solvency of Medicare and Social Security.CommentsClose CommentsPermalink
Sec. 189B. Prohibition against discrimination on assisted suicide.CommentsClose CommentsPermalink
Sec. 189C. Access to therapies.CommentsClose CommentsPermalink
Sec. 189D. Freedom not to participate in Federal health insurance programs.CommentsClose CommentsPermalink
Subtitle H--CLASS Act
Sec. 190. Short title of subtitle.CommentsClose CommentsPermalink
Sec. 191. Establishment of national voluntary insurance program for purchasing community living assistance services and support.CommentsClose CommentsPermalink
‘TITLE XXXII--COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS
‘Sec. 3201. Purpose.CommentsClose CommentsPermalink
‘Sec. 3202. Definitions.CommentsClose CommentsPermalink
‘Sec. 3203. CLASS Independence Benefit Plan.CommentsClose CommentsPermalink
‘Sec. 3204. Enrollment and disenrollment requirements.CommentsClose CommentsPermalink
‘Sec. 3205. Benefits.CommentsClose CommentsPermalink
‘Sec. 3206. CLASS Independence Fund.CommentsClose CommentsPermalink
‘Sec. 3207. CLASS Independence Advisory Council.CommentsClose CommentsPermalink
‘Sec. 3208. Regulations; annual report.CommentsClose CommentsPermalink
‘Sec. 3209. Inspector General’s report.CommentsClose CommentsPermalink
‘Sec. 3210. Tax treatment of program.CommentsClose CommentsPermalink
TITLE II--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle A--National Strategy to Improve Health Care Quality
Sec. 201. National strategy.CommentsClose CommentsPermalink
Sec. 202. Interagency Working Group on Health Care Quality.CommentsClose CommentsPermalink
Sec. 203. Quality measure development.CommentsClose CommentsPermalink
Sec. 204. Quality measure endorsement; public reporting; data collection.CommentsClose CommentsPermalink
Sec. 205. Collection and analysis of data for quality and resource use measures.CommentsClose CommentsPermalink
Subtitle B--Health Care Quality Improvements
Sec. 211. Health care delivery system research; Quality improvement technical assistance.CommentsClose CommentsPermalink
Sec. 212. Grants to establish community health teams to support the patient-centered medical home.CommentsClose CommentsPermalink
Sec. 213. Grants to implement medication management services in treatment of chronic disease.CommentsClose CommentsPermalink
Sec. 214. Design and implementation of regionalized systems for emergency care.CommentsClose CommentsPermalink
Sec. 215. Trauma care centers and service availability.CommentsClose CommentsPermalink
Sec. 216. Reducing and reporting hospital readmissions.CommentsClose CommentsPermalink
Sec. 217. Program to facilitate shared decisionmaking.CommentsClose CommentsPermalink
Sec. 218. Presentation of prescription drug benefit and risk information.CommentsClose CommentsPermalink
Sec. 219. Center for health outcomes research and evaluation.CommentsClose CommentsPermalink
Sec. 220. Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals.CommentsClose CommentsPermalink
Sec. 221. Office of women’s health.CommentsClose CommentsPermalink
Sec. 222. Administrative simplification.CommentsClose CommentsPermalink
Sec. 223. Patient navigator program.CommentsClose CommentsPermalink
Sec. 224. Authorization of appropriations.CommentsClose CommentsPermalink
Subtitle C--Civil and Criminal Penalties for Acts Involving Federal Health Care Programs; Exception to Limitation on Certain Physician Referrals
Sec. 231. Safe harbors to antikickback civil penalties and criminal penalties for provision of health information technology and training services.CommentsClose CommentsPermalink
Sec. 232. Exception to limitation on certain physician referrals (under Stark) for provision of health information technology and training services to health care professionals.CommentsClose CommentsPermalink
Sec. 233. Rules of construction regarding use of consortia.CommentsClose CommentsPermalink
TITLE III--IMPROVING THE HEALTH OF THE AMERICAN PEOPLE
Subtitle A--Modernizing Disease Prevention and Public Health Systems
Sec. 301. National Prevention, Health Promotion and Public Health Council.CommentsClose CommentsPermalink
Sec. 302. Prevention and Public Health Fund.CommentsClose CommentsPermalink
Sec. 303. Clinical and Community Preventive Services.CommentsClose CommentsPermalink
Sec. 304. Education and outreach campaign regarding preventive benefits.CommentsClose CommentsPermalink
Subtitle B--Increasing Access to Clinical Preventive Services
Sec. 311. Right choices program.CommentsClose CommentsPermalink
Sec. 312. School-based health clinics.CommentsClose CommentsPermalink
Sec. 313. Oral healthcare prevention activities.CommentsClose CommentsPermalink
Sec. 314. Oral health improvement.CommentsClose CommentsPermalink
Subtitle C--Creating Healthier Communities
Sec. 321. Community transformation grants.CommentsClose CommentsPermalink
Sec. 322. Healthy aging, living well.CommentsClose CommentsPermalink
Sec. 323. Wellness for individuals with disabilities.CommentsClose CommentsPermalink
Sec. 324. Immunizations.CommentsClose CommentsPermalink
Sec. 325. Nutrition labeling of standard menu items at chain restaurants and of articles of food sold from vending machines.CommentsClose CommentsPermalink
Sec. 326. Encouraging employer-sponsored wellness programs.CommentsClose CommentsPermalink
Sec. 327. Demonstration project concerning individualized wellness plan.CommentsClose CommentsPermalink
Sec. 328. Reasonable break time for nursing mothers.CommentsClose CommentsPermalink
Subtitle D--Support for Prevention and Public Health Innovation
Sec. 331. Research on optimizing the delivery of public health services.CommentsClose CommentsPermalink
Sec. 332. Understanding health disparities: data collection and analysis.CommentsClose CommentsPermalink
Sec. 333. Health impact assessments.CommentsClose CommentsPermalink
Sec. 334. CDC and employer-based wellness programs.CommentsClose CommentsPermalink
Sec. 335. Epidemiology-Laboratory Capacity Grants.CommentsClose CommentsPermalink
Sec. 336. Federal messaging on health promotion and disease prevention.CommentsClose CommentsPermalink
Subtitle E--Advancing Research and Treatment for Pain Care Management
Sec. 341. Institute of Medicine Conference on Pain.CommentsClose CommentsPermalink
Sec. 342. Pain research at National Institutes of Health.CommentsClose CommentsPermalink
Sec. 343. Pain care education and training.CommentsClose CommentsPermalink
Sec. 344. Public awareness campaign on pain management.CommentsClose CommentsPermalink
Subtitle F--Coordinated Environmental Public Health Network
Sec. 351. Amendment to the Public Health Service Act.CommentsClose CommentsPermalink
Subtitle G--Miscellaneous Provisions
Sec. 361. Sense of the Senate concerning CBO scoring.CommentsClose CommentsPermalink
Sec. 362. Effectiveness of Federal health and wellness initiatives.CommentsClose CommentsPermalink
TITLE IV--HEALTH CARE WORKFORCE
Subtitle A--Purpose and Definitions
Sec. 401. Purpose.CommentsClose CommentsPermalink
Sec. 402. Definitions.CommentsClose CommentsPermalink
Subtitle B--Innovations in the Health Care Workforce
Sec. 411. National health care workforce commission.CommentsClose CommentsPermalink
Sec. 412. State health care workforce development grants.CommentsClose CommentsPermalink
Sec. 413. Health care workforce program assessment.CommentsClose CommentsPermalink
Subtitle C--Increasing the Supply of the Health Care Workforce
Sec. 421. Federally supported student loan funds.CommentsClose CommentsPermalink
Sec. 422. Nursing student loan program.CommentsClose CommentsPermalink
Sec. 423. Health care workforce loan repayment programs.CommentsClose CommentsPermalink
Sec. 424. Public health workforce recruitment and retention programs.CommentsClose CommentsPermalink
Sec. 425. Allied health workforce recruitment and retention programs.CommentsClose CommentsPermalink
Sec. 426. Grants for State and local programs.CommentsClose CommentsPermalink
Sec. 427. Funding for National Health Service Corps.CommentsClose CommentsPermalink
Sec. 428. Nurse-managed health clinics.CommentsClose CommentsPermalink
Sec. 429. Elimination of cap on commissioned corps.CommentsClose CommentsPermalink
Sec. 430. Establishing a Ready Reserve Corps.CommentsClose CommentsPermalink
Subtitle D--Enhancing Health Care Workforce Education and Training
Sec. 431. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship.CommentsClose CommentsPermalink
Sec. 432. Training opportunities for direct care workers.CommentsClose CommentsPermalink
Sec. 433. Training in general, pediatric, and public health dentistry.CommentsClose CommentsPermalink
Sec. 434. Alternative dental health care providers demonstration project.CommentsClose CommentsPermalink
Sec. 435. Geriatric education and training; career awards; comprehensive geriatric education.CommentsClose CommentsPermalink
Sec. 436. Mental and behavioral health education and training grants.CommentsClose CommentsPermalink
Sec. 437. Cultural competency, prevention and public health and individuals with disabilities training.CommentsClose CommentsPermalink
Sec. 438. Advanced nursing education grants.CommentsClose CommentsPermalink
Sec. 439. Nurse education, practice, and retention grants.CommentsClose CommentsPermalink
Sec. 440. Loan repayment and scholarship program.CommentsClose CommentsPermalink
Sec. 441. Nurse faculty loan program.CommentsClose CommentsPermalink
Sec. 442. Authorization of appropriations for parts B through D of title VIII.CommentsClose CommentsPermalink
Sec. 443. Grants to promote the community health workforce.CommentsClose CommentsPermalink
Sec. 444. Youth public health program.CommentsClose CommentsPermalink
Sec. 445. Fellowship training in public health.CommentsClose CommentsPermalink
Sec. 446. United States Public Health Sciences Track.CommentsClose CommentsPermalink
Subtitle E--Supporting the Existing Health Care Workforce
Sec. 451. Centers of excellence.CommentsClose CommentsPermalink
Sec. 452. Health care professionals training for diversity.CommentsClose CommentsPermalink
Sec. 453. Interdisciplinary, community-based linkages.CommentsClose CommentsPermalink
Sec. 454. Workforce diversity grants.CommentsClose CommentsPermalink
Sec. 455. Primary care extension program.CommentsClose CommentsPermalink
Sec. 456. Definition of economic hardship.CommentsClose CommentsPermalink
Subtitle F--General Provisions
Sec. 461. Reports.CommentsClose CommentsPermalink
TITLE V--PREVENTING FRAUD AND ABUSE
Subtitle A--Establishment of New Health and Human Services and Department of Justice Health Care Fraud Positions
Sec. 501. Health and Human Services Senior Advisor.CommentsClose CommentsPermalink
Sec. 502. Department of Justice Position.CommentsClose CommentsPermalink
Sec. 503. Reports to Congress.CommentsClose CommentsPermalink
Sec. 504. Fraud, waste, and abuse commission.CommentsClose CommentsPermalink
Subtitle B--Health Care Program Integrity Coordinating Council
Sec. 511. Establishment.CommentsClose CommentsPermalink
Subtitle C--False Statements and Representations
Sec. 521. Prohibition on false statements and representations.CommentsClose CommentsPermalink
Subtitle D--Federal Health Care Offense
Sec. 531. Clarifying definition.CommentsClose CommentsPermalink
Subtitle E--Uniformity in Fraud and Abuse Reporting
Sec. 541. Development of model uniform report form.CommentsClose CommentsPermalink
Subtitle F--Applicability of State Law to Combat Fraud and Abuse
Sec. 551. Applicability of State law to combat fraud and abuse.CommentsClose CommentsPermalink
Subtitle G--Enabling the Department of Labor to Issue Administrative Summary Cease and Desist Orders and Summary Seizures Orders Against Plans That Are in Financially Hazardous Condition
Sec. 561. Enabling the Department of Labor to issue administrative summary cease and desist orders and summary seizures orders against plans that are in financially hazardous condition.CommentsClose CommentsPermalink
Subtitle H--Requiring Multiple Employer Welfare Arrangement (MEWA) Plans to File a Registration Form With the Department of Labor Prior to Enrolling Anyone in the Plan
Sec. 571. MEWA plan registration with Department of Labor.CommentsClose CommentsPermalink
Subtitle I--Permitting Evidentiary Privilege and Confidential Communications
Sec. 581. Permitting evidentiary privilege and confidential communications.CommentsClose CommentsPermalink
TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES
Subtitle A--Biologics Price Competition and Innovation
Sec. 601. Short title.CommentsClose CommentsPermalink
Sec. 602. Approval pathway for biosimilar biological products.CommentsClose CommentsPermalink
Sec. 603. Savings.CommentsClose CommentsPermalink
Subtitle B--More Affordable Medicines for Children and Underserved Communities
Sec. 611. Expanded participation in 340B program.CommentsClose CommentsPermalink
Sec. 612. Improvements to 340B program integrity.CommentsClose CommentsPermalink
Sec. 613. GAO study to make recommendations on improving the 340B program.CommentsClose CommentsPermalink
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANSCommentsClose CommentsPermalink
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANSCommentsClose CommentsPermalink
Subtitle A--Effective Coverage for All AmericansCommentsClose CommentsPermalink
Subtitle A--Effective Coverage for All AmericansCommentsClose CommentsPermalink
PART I--PROVISIONS APPLICABLE TO THE INDIVIDUAL AND GROUP MARKETS
SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Part A of title XXVII of the Public Health Service Act (
(1) by striking the part heading and heading for subpart 1 and inserting the following:CommentsClose CommentsPermalink
‘PART A--INDIVIDUAL AND GROUP MARKET REFORMS
‘Subpart 1--General Reform’;
(2) in section 2701 (
(A) by striking the section heading and subsection (a) and inserting the following:CommentsClose CommentsPermalink
‘SEC. 2705. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.
‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.’; andCommentsClose CommentsPermalink
(B) by transferring the remainder of section so as to appear after the section 2704 as added by paragraph (5);CommentsClose CommentsPermalink
(3) in section 2702 (
42 U.S.C. 300gg-1 )--CommentsClose CommentsPermalink
(A) by striking the section heading and all that follows through subsection (a)--CommentsClose CommentsPermalink
(B) in subsection (b)--CommentsClose CommentsPermalink
(i) by striking ‘health insurance issuer offering health insurance coverage in connection with a group health plan’ each place that such appears and inserting ‘health insurance issuer offering group or individual health insurance coverage’; andCommentsClose CommentsPermalink
(ii) in paragraph (2)(A)--CommentsClose CommentsPermalink
(I) by inserting ‘or individual’ after ‘employer’; andCommentsClose CommentsPermalink
(II) by inserting ‘or individual health coverage, as the case may be’ before the semicolon;CommentsClose CommentsPermalink
(C) by redesignating subsections (b) through (f) as subsections (e) through (i), respectively; andCommentsClose CommentsPermalink
(D) by transferring the remainder of such section to appear at the end of section 2706 (as added by paragraph (5));CommentsClose CommentsPermalink
(4) by redesignating existing sections 2704 through 2707 and sections 2711 through 2713 as sections 2717 through 2720 and sections 2714 through 2716, respectively; andCommentsClose CommentsPermalink
(5) by inserting after the subpart heading (as added by paragraph (1)) the following:CommentsClose CommentsPermalink
‘SEC. 2701. FAIR INSURANCE COVERAGE.
‘(a) In General- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--CommentsClose CommentsPermalink
‘(1) such rate shall vary with respect to the particular plan or coverage involved only by--CommentsClose CommentsPermalink
‘(A) family structure;CommentsClose CommentsPermalink
‘(B) community rating area;CommentsClose CommentsPermalink
‘(C) the actuarial value of the benefit;CommentsClose CommentsPermalink
‘(D) age, except that such rate shall not vary by more than 2 to 1;CommentsClose CommentsPermalink
‘(E) tobacco use, except that such rate shall not vary by more than 1.5 to 1; andCommentsClose CommentsPermalink
‘(F) adherence to or participation in a reasonably designed program of health promotion and disease prevention, if such a program is offered by the employer that is the sponsor of the coverage involved; andCommentsClose CommentsPermalink
‘(2) such rate shall not vary with respect to the particular plan or coverage involved by health status-related factors, gender, class of business, claims experience, industry, or any other factor not described in paragraph (1), except that group health plans and health insurance issuers offering group health insurance coverage may establish premium discounts or rebates for modifying otherwise applicable copayments or deductibles in return for adherence to or participation in reasonably designed programs of health promotion or disease prevention.CommentsClose CommentsPermalink
‘(b) Community Rating Area- Taking into account the applicable recommendations of the National Association of Insurance Commissioners, the Secretary shall by regulation establish a minimum size for community rating areas for purposes of this section, which, for areas contained in a Metropolitan Statistical Area, shall not be smaller than such area.CommentsClose CommentsPermalink
‘SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE.
‘(a) Issuance of Coverage in the Individual and Group Market- Subject to subsections (b) through (e), each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage.CommentsClose CommentsPermalink
‘(b) Enrollment-CommentsClose CommentsPermalink
‘(1) RESTRICTION- A health insurance issuer described in subsection (a) may restrict enrollment in coverage described in such subsection to open or special enrollment periods.CommentsClose CommentsPermalink
‘(2) ESTABLISHMENT- A health insurance issuer described in subsection (a) shall, in accordance with the regulations promulgated under paragraph (3), establish special enrollment periods for qualifying events (under section 603 of the Employee Retirement Income Security Act of 1974).CommentsClose CommentsPermalink
‘(3) REGULATIONS- Not later than 1 year after the date of enactment of this section, the Secretary shall promulgate regulations with respect to enrollment periods under paragraphs (1) and (2).CommentsClose CommentsPermalink
‘SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.
‘(a) In General- Except as provided in this section, if a health insurance issuer offers health insurance coverage in the individual or group market, the issuer must renew or continue in force such coverage at the option of the plan sponsor or the individual, as applicable.CommentsClose CommentsPermalink
‘(b) Prohibition on Rescissions- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such coverage once the plan involved has been issued, except that this subsection shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the coverage. Coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).CommentsClose CommentsPermalink
‘SEC. 2704. INCREASING THE TRANSPARENCY OF HEALTH CARE COSTS AND REGULATORY FEES.
‘(a) Clear Accounting for Costs- A health insurance issuer offering group or individual health insurance coverage shall publicly report (in a manner to be established by the Secretary through regulation) the percentage of total premium revenue that such coverage expends--CommentsClose CommentsPermalink
‘(1) on reimbursement for clinical services provided to enrollees under such plan or coverage;CommentsClose CommentsPermalink
‘(2) for activities that improve health care quality;CommentsClose CommentsPermalink
‘(3) on taxes, license, or regulatory fee costs, and the cost of any surcharge imposed by the Gateway under title XXXI; andCommentsClose CommentsPermalink
‘(4) on all other non-claims costs, including an explanation of the nature of such costs and an itemized list of costs associated with compliance with the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(b) Definition- In this section, the term ‘activities to improve health care quality’ means activities described in section 2707.CommentsClose CommentsPermalink
‘(c) Processes and Methods- The Secretary shall develop a methodology for calculating the percentages described in subsection (a). Such methodology may provide for a requirement that a report described in subsection (a) include an actuarial certification of the information included in such report.CommentsClose CommentsPermalink
‘SEC. 2706. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:CommentsClose CommentsPermalink
‘(1) Health status.CommentsClose CommentsPermalink
‘(2) Medical condition (including both physical and mental illnesses).CommentsClose CommentsPermalink
‘(3) Claims experience.CommentsClose CommentsPermalink
‘(4) Receipt of health care.CommentsClose CommentsPermalink
‘(5) Medical history.CommentsClose CommentsPermalink
‘(6) Genetic information.CommentsClose CommentsPermalink
‘(7) Evidence of insurability (including conditions arising out of acts of domestic violence).CommentsClose CommentsPermalink
‘(8) Disability.CommentsClose CommentsPermalink
‘(9) Any other health status-related factor determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(b) Programs of Health Promotion or Disease Prevention-CommentsClose CommentsPermalink
‘(1) GENERAL PROVISIONS-CommentsClose CommentsPermalink
‘(A) GENERAL RULE- For purposes of paragraph (2)(B), a program of health promotion or disease prevention (referred to in this subsection as a ‘wellness program’) shall be a program offered by an employer that is designed to promote health or prevent disease that meets the applicable requirements of this subsection.CommentsClose CommentsPermalink
‘(B) NO CONDITIONS BASED ON HEALTH STATUS FACTOR- If none of the conditions for obtaining a premium discount or rebate or other reward for participation in a wellness program is based on an individual satisfying a standard that is related to a health status factor, such wellness program shall not violate this section if participation in the program is made available to all similarly situated individuals and the requirements of paragraph (2) are complied with.CommentsClose CommentsPermalink
‘(C) CONDITIONS BASED ON HEALTH STATUS FACTOR- If any of the conditions for obtaining a premium discount or rebate or other reward for participation in a wellness program is based on an individual satisfying a standard that is related to a health status factor, such wellness program shall not violate this section if the requirements of paragraph (3) are complied with.CommentsClose CommentsPermalink
‘(2) WELLNESS PROGRAMS NOT SUBJECT TO REQUIREMENTS- If none of the conditions for obtaining a premium discount or rebate or other reward under a wellness program as described in paragraph (1)(B) are based on an individual satisfying a standard that is related to a health status factor (or if such a wellness program does not provide such a reward), the wellness program shall not violate this section if participation in the program is made available to all similarly situated individuals. The following programs shall not have to comply with the requirements of paragraph (3) if participation in the program is made available to all similarly situated individuals:CommentsClose CommentsPermalink
‘(A) A program that reimburses all or part of the cost for memberships in a fitness center.CommentsClose CommentsPermalink
‘(B) A diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes.CommentsClose CommentsPermalink
‘(C) A program that encourages preventive care related to a health condition through the waiver of the copayment or deductible requirement under an individual or group health plan for the costs of certain items or services related to a health condition (such as prenatal care or well-baby visits).CommentsClose CommentsPermalink
‘(D) A program that reimburses individuals for the costs of smoking cessation programs without regard to whether the individual quits smoking.CommentsClose CommentsPermalink
‘(E) A program that provides a reward to individuals for attending a periodic health education seminar.CommentsClose CommentsPermalink
‘(3) WELLNESS PROGRAMS SUBJECT TO REQUIREMENTS- If any of the conditions for obtaining a premium discount, rebate, or reward under a wellness program as described in paragraph (1)(C) is based on an individual satisfying a standard that is related to a health status factor, the wellness program shall not violate this section if the following requirements are complied with:CommentsClose CommentsPermalink
‘(A) The reward for the wellness program, together with the reward for other wellness programs with respect to the plan that requires satisfaction of a standard related to a health status factor, shall not exceed 30 percent of the cost of employee-only coverage under the plan. If, in addition to employees or individuals, any class of dependents (such as spouses or spouses and dependent children) may participate fully in the wellness program, such reward shall not exceed 30 percent of the cost of the coverage in which an employee or individual and any dependents are enrolled. For purposes of this paragraph, the cost of coverage shall be determined based on the total amount of employer and employee contributions for the benefit package under which the employee is (or the employee and any dependents are) receiving coverage. A reward may be in the form of a discount or rebate of a premium or contribution, a waiver of all or part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or the value of a benefit that would otherwise not be provided under the plan. The Secretaries of Labor, Health and Human Services, and the Treasury may increase the reward available under this subparagraph to up to 50 percent of the cost of coverage if the Secretaries determine that such an increase is appropriate.CommentsClose CommentsPermalink
‘(B) The wellness program shall be reasonably designed to promote health or prevent disease. A program complies with the preceding sentence if the program has a reasonable chance of improving the health of, or preventing disease in, participating individuals and it is not overly burdensome, is not a subterfuge for discriminating based on a health status factor, and is not highly suspect in the method chosen to promote health or prevent disease. The plan or issuer shall evaluate the program’s reasonableness at least once per year.CommentsClose CommentsPermalink
‘(C) The plan shall give individuals eligible for the program the opportunity to qualify for the reward under the program at least once each year.CommentsClose CommentsPermalink
‘(D) The full reward under the wellness program shall be made available to all similarly situated individuals. For such purpose, among other things:CommentsClose CommentsPermalink
‘(i) The reward is not available to all similarly situated individuals for a period unless the wellness program allows--CommentsClose CommentsPermalink
‘(I) for a reasonable alternative standard (or waiver of the otherwise applicable standard) for obtaining the reward for any individual for whom, for that period, it is unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard; andCommentsClose CommentsPermalink
‘(II) for a reasonable alternative standard (or waiver of the otherwise applicable standard) for obtaining the reward for any individual for whom, for that period, it is medically inadvisable to attempt to satisfy the otherwise applicable standard.CommentsClose CommentsPermalink
‘(ii) If reasonable under the circumstances, the plan or issuer may seek verification, such as a statement from an individual’s physician, that a health status factor makes it unreasonably difficult or medically inadvisable for the individual to satisfy or attempt to satisfy the otherwise applicable standard.CommentsClose CommentsPermalink
‘(E) The plan or issuer involved shall disclose in all plan materials describing the terms of the wellness program the availability of a reasonable alternative standard (or the possibility of waiver of the otherwise applicable standard) required under subparagraph (D). If plan materials disclose that such a program is available, without describing its terms, the disclosure under this subparagraph shall not be required.CommentsClose CommentsPermalink
‘(c) Existing Programs- Nothing in this section shall prohibit a program of health promotion or disease prevention that was established prior to the date of enactment of this section and applied with all applicable regulations, and that is operating on such date, from continuing to be carried out for as long as such regulations remain in effect.CommentsClose CommentsPermalink
‘(d) Regulations- Nothing in this section shall be construed as prohibiting the Secretaries of Labor, Health and Human Services, or the Treasury from promulgating regulations in connection with this section.CommentsClose CommentsPermalink
‘SEC. 2707. ENSURING THE QUALITY OF CARE.
‘(a) In General- Except as provided in subsection (c), a group health plan and a health insurance issuer offering group or individual health insurance coverage shall develop and implement a reimbursement structure for making payments to health care providers that provides incentives for--CommentsClose CommentsPermalink
‘(1) the provision of high quality health care under the plan or coverage in a manner that includes--CommentsClose CommentsPermalink
‘(A) the implementation of case management, care coordination, chronic disease management, and medication and care compliance activities that includes the use of the medical home model as defined in section 212 of the Affordable Health Choices Act for treatment or services under the plan or coverage;CommentsClose CommentsPermalink
‘(B) the implementation of activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post-discharge reinforcement by an appropriate health care professional;CommentsClose CommentsPermalink
‘(C) the implementation of activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage;CommentsClose CommentsPermalink
‘(D) the implementation of wellness and health promotion activities;CommentsClose CommentsPermalink
‘(E) child health measures under section 1139A of the Social Security Act; andCommentsClose CommentsPermalink
‘(F) culturally and linguistically appropriate care, as defined by the Secretary; andCommentsClose CommentsPermalink
‘(2) payment policies that substantially reflects the payment policy of the Medicare program under title XVIII of the Social Security Act and the Children’s Health Insurance Program under title XXI of such Act with respect to any generally implemented incentive policy to promote high quality health care, except that in order that no plan or issuer be forced to deny patients medical care needed to prevent their deaths or preserve or restore their health, no plan or issuer shall be prohibited from providing payment for a treatment or diagnostic procedure it chooses to cover, unless such treatment or procedure has been determined to be unsafe or dangerous or capable of neither preventing the patient’s death nor preserving or restoring the patient’s health.CommentsClose CommentsPermalink
‘(b) Wellness and Prevention Programs- For purposes of subsection (a)(1)(D), wellness and health promotion activities may include personalized wellness and prevention services, which are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offer ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants, and which may include the following wellness and prevention efforts:CommentsClose CommentsPermalink
‘(1) Smoking cessation.CommentsClose CommentsPermalink
‘(2) Weight management.CommentsClose CommentsPermalink
‘(3) Stress management.CommentsClose CommentsPermalink
‘(4) Physical fitness.CommentsClose CommentsPermalink
‘(5) Nutrition.CommentsClose CommentsPermalink
‘(6) Heart disease prevention.CommentsClose CommentsPermalink
‘(7) Healthy lifestyle support.CommentsClose CommentsPermalink
‘(8) Diabetes prevention.CommentsClose CommentsPermalink
‘(c) Exceptions- In promulgating regulations under subsection (d), the Secretary may provide for exceptions to the requirements of subsection (a) for insurers that substantially meet the goals of this section.CommentsClose CommentsPermalink
‘(d) Regulations- Not later than 180 days after the date of enactment of the Affordable Health Choices Act, the Secretary shall promulgate regulations--CommentsClose CommentsPermalink
‘(1) that define the term ‘generally implemented’ for purposes of subsection (a)(2);CommentsClose CommentsPermalink
‘(2) that require the expiration of a minimum period of time between the date on which a policy is generally implemented for purposes of subsection (a)(2) and the date on which such policy shall apply with respect to health insurance coverage offered in the individual or group market; andCommentsClose CommentsPermalink
‘(3) that provide criteria for determining whether a payment policy is described in subsection (a).CommentsClose CommentsPermalink
‘(e) Study and Report- Not later than 180 days after the date of enactment of the Affordable Health Choices Act, the Government Accountability Office shall conduct a study and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report regarding the impact the activities under this section have had on the quality and cost of health care.CommentsClose CommentsPermalink
‘SEC. 2708. COVERAGE OF PREVENTIVE HEALTH SERVICES.
‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary) for--CommentsClose CommentsPermalink
‘(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;CommentsClose CommentsPermalink
‘(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; andCommentsClose CommentsPermalink
‘(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.CommentsClose CommentsPermalink
‘(b) Interval-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline.CommentsClose CommentsPermalink
‘(2) MINIMUM- The interval described in paragraph (1) shall not be less than 1 year.CommentsClose CommentsPermalink
‘SEC. 2709. COVERAGE OF PREVENTIVE WOMEN’S HEALTH SERVICES.
‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for, and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary) for, with respect to women (including pregnant women and individuals of child bearing age), such additional preventive care and screenings not covered under section 2708 as provided for in guidelines supported by the Health Resources and Services Administration.CommentsClose CommentsPermalink
‘SEC. 2710. EXTENSION OF DEPENDENT COVERAGE.
‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child until the child turns 26 years of age. Nothing in this section shall require a health plan or a health insurance issuer described in the preceding sentence to make coverage available for a child of a child receiving dependent coverage.CommentsClose CommentsPermalink
‘(b) Regulations- The Secretary shall promulgate regulations to define the dependents to which coverage shall be made available under subsection (a).CommentsClose CommentsPermalink
‘SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.
‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime or annual limits on the dollar value of benefits for any participant or beneficiary.CommentsClose CommentsPermalink
‘(b) Preventing Fraud and Abuse- This section shall not apply until the date on which the Secretary certifies that enacting this section will not result in undue proliferation of fraud and abuse, especially with regard to durable medical equipment.CommentsClose CommentsPermalink
‘SEC. 2712. NOTIFICATION BY PLANS NOT PROVIDING MINIMUM QUALIFYING COVERAGE.
‘(a) In General- Not later than 1 year after the date on which the Secretary establishes criteria with respect to minimum qualifying coverage under section 3103, a group health plan and a health insurance issuer offering group or individual health insurance coverage that fails to provide such minimum qualifying coverage shall notify, in such manner as may be required by the Secretary, enrollees and prospective enrollees in such plan or coverage of such failure prior to enrollment or re-enrollment.CommentsClose CommentsPermalink
‘(b) Modifications- If the Secretary modifies the criteria with respect to minimum qualifying coverage under section 3103, a group health plan or health insurance issuer that fails to provide such modified minimum qualifying coverage shall provide the notice required under subsection (a) within 60 days of the date of such modification.CommentsClose CommentsPermalink
‘SEC. 2713. NON-DISCRIMINATION IN HEALTH CARE.
‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.’.CommentsClose CommentsPermalink
PART II--PROVISION APPLICABLE TO THE GROUP MARKET
SEC. 121. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Subpart 2 of part A of title XXVII of the Public Health Service Act (
‘SEC. 2720A. PROHIBITION OF DISCRIMINATION BASED ON SALARY.
‘(a) In General- A group health plan and a health insurance issuer offering group health insurance coverage may not establish rules relating to the health insurance coverage eligibility (including continued eligibility) of any full-time employee under the terms of the plan that are based on the total hourly or annual salary of the employee.CommentsClose CommentsPermalink
‘(b) Limitation- Subsection (a) shall not be construed to prohibit a group health plan or health insurance issuer from establishing contribution requirements for enrollment in the plan or coverage that provide for the payment by employees with lower hourly or annual compensation of a lower dollar or percentage contribution than the payment required of a similarly situated employees with a higher hourly or annual compensation.’.CommentsClose CommentsPermalink
PART III--OTHER PROVISIONS
SEC. 131. NO CHANGES TO EXISTING COVERAGE.
(a) Option to Retain Current Insurance Coverage-CommentsClose CommentsPermalink
(1) IN GENERAL- Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled prior to the date of enactment of this title.CommentsClose CommentsPermalink
(2) CONTINUATION OF COVERAGE- With respect to a group health plan or health insurance coverage in which an individual was enrolled prior to the date of enactment of this title, this subtitle (and the amendments made by this subtitle) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after such date of enactment.CommentsClose CommentsPermalink
(b) Allowance for Family Members to Join Current Coverage- With respect to a group health plan or health insurance coverage in which an individual was enrolled prior to the date of enactment of this title and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of such date of enactment.CommentsClose CommentsPermalink
(c) Allowance for New Employees to Join Current Plan- A group health plan that provides coverage on the date of enactment of this Act may provide for the enrolling of new employees (and their families) in such plan, and this subtitle (and the amendments made by this subtitle) shall not apply with respect to such plan and such new employees (and their families).CommentsClose CommentsPermalink
(d) No Additional Benefit- Subsections (b) and (c) shall only apply to individuals described in such subsections and the family members of such individuals (as provided for in such subsections).CommentsClose CommentsPermalink
(e) Limitation- Subsections (a) through (d) shall not apply to any group health plan or health insurance coverage that has been modified to a significant extent with respect to covered benefits or cost sharing requirements after the date of enactment of this Act. The Secretary shall by regulation establish criteria to determine whether a plan or health insurance coverage has been modified to a significant extent under the preceding sentence, except that any coverage amendment made pursuant to an agreement between an employer or an individual and a health insurance issuer relating to the coverage which amends the coverage solely to conform to any requirement added by this Act (or amendments to this Act) shall not be treated as a significant modification.CommentsClose CommentsPermalink
(f) Effect on Collective Bargaining Agreements- In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before the date of enactment of this title, the provisions of this subtitle (and the amendments made by this subtitle) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to conform to any requirement added by this subtitle (or amendments) shall not be treated as a termination of such collective bargaining agreement.CommentsClose CommentsPermalink
(g) Risk Adjustment- The provisions of section 3101(c)(6) of the Public Health Service Act (as added by section 142) shall not apply to a group health plan or health insurance coverage to which this section applies.CommentsClose CommentsPermalink
SEC. 132. APPLICABILITY.
Section 2721 of the Public Health Service Act (
(1) by striking subsection (a);CommentsClose CommentsPermalink
(2) in subsection (b)--CommentsClose CommentsPermalink
(A) in paragraph (1), by striking ‘1 through 3’ and inserting ‘1 and 2’; andCommentsClose CommentsPermalink
(B) in paragraph (2)--CommentsClose CommentsPermalink
(i) in subparagraph (A), by striking ‘subparagraph (D)’ and inserting ‘subparagraph (D) or (E)’;CommentsClose CommentsPermalink
(ii) by striking ‘1 through 3’ and inserting ‘1 and 2’; andCommentsClose CommentsPermalink
(iii) by adding at the end the following:CommentsClose CommentsPermalink
‘(E) ELECTION NOT APPLICABLE- The election described in subparagraph (A) shall not be available with respect to the provisions of subpart 1.’;CommentsClose CommentsPermalink
(3) in subsection (c), by striking ‘1 through 3 shall not apply to any group’ and inserting ‘1 and 2 shall not apply to any individual coverage or any group’; andCommentsClose CommentsPermalink
(4) in subsection (d)--CommentsClose CommentsPermalink
(A) in paragraph (1), by striking ‘1 through 3 shall not apply to any group’ and inserting ‘1 and 2 shall not apply to any individual coverage or any group’;CommentsClose CommentsPermalink
(B) in paragraph (2)--CommentsClose CommentsPermalink
(i) in the matter preceding subparagraph (A), by striking ‘1 through 3 shall not apply to any group’ and inserting ‘1 and 2 shall not apply to any individual coverage or any group’; andCommentsClose CommentsPermalink
(ii) in subparagraph (C), by inserting ‘or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer’; andCommentsClose CommentsPermalink
(C) in paragraph (3), by striking ‘any group’ and inserting ‘any individual coverage or any group’.CommentsClose CommentsPermalink
SEC. 133. CONFORMING AMENDMENTS.
(a) Public Health Service Act- Title XXVII of the Public Health Service Act (
(1) in section 2705 (
(A) in subsection (c)--CommentsClose CommentsPermalink
(i) in paragraph (2), by striking ‘group health plan’ each place that such appears and inserting ‘group or individual health plan’; andCommentsClose CommentsPermalink
(ii) in paragraph (3)--CommentsClose CommentsPermalink
(I) by striking ‘group health insurance’ each place that such appears and inserting ‘group or individual health insurance’; andCommentsClose CommentsPermalink
(II) in subparagraph (D), by striking ‘small or large’ and inserting ‘individual or group’;CommentsClose CommentsPermalink
(B) in subsection (d), by striking ‘group health insurance’ each place that such appears and inserting ‘group or individual health insurance’; andCommentsClose CommentsPermalink
(C) in subsection (e)(1)(A), by striking ‘group health insurance’ and inserting ‘group or individual health insurance’;CommentsClose CommentsPermalink
(2) by striking the heading for subpart 2 of part A;CommentsClose CommentsPermalink
(3) in section 2717 (
(A) in subsection (a), by striking ‘health insurance issuer offering group health insurance coverage’ and inserting ‘health insurance issuer offering group or individual health insurance coverage’;CommentsClose CommentsPermalink
(B) in subsection (b)--CommentsClose CommentsPermalink
(i) by striking ‘health insurance issuer offering group health insurance coverage in connection with a group health plan’ in the matter preceding paragraph (1) and inserting ‘health insurance issuer offering group or individual health insurance coverage’; andCommentsClose CommentsPermalink
(ii) in paragraph (1), by striking ‘plan’ and inserting ‘plan or coverage’;CommentsClose CommentsPermalink
(C) in subsection (c)--CommentsClose CommentsPermalink
(i) in paragraph (2), by striking ‘group health insurance coverage offered by a health insurance issuer’ and inserting ‘health insurance issuer offering group or individual health insurance coverage’; andCommentsClose CommentsPermalink
(ii) in paragraph (3), by striking ‘issuer’ and inserting ‘health insurance issuer’; andCommentsClose CommentsPermalink
(D) in subsection (e), by striking ‘health insurance issuer offering group health insurance coverage’ and inserting ‘health insurance issuer offering group or individual health insurance coverage’;CommentsClose CommentsPermalink
(4) in section 2718 (
(A) in subsection (a), by striking ‘(or health insurance coverage offered in connection with such a plan)’ each place that such appears and inserting ‘or a health insurance issuer offering group or individual health insurance coverage’;CommentsClose CommentsPermalink
(B) in subsection (b), by striking ‘(or health insurance coverage offered in connection with such a plan)’ each place that such appears and inserting ‘or a health insurance issuer offering group or individual health insurance coverage’; andCommentsClose CommentsPermalink
(C) in subsection (c)--CommentsClose CommentsPermalink
(i) in paragraph (1), by striking ‘(and group health insurance coverage offered in connection with a group health plan)’ and inserting ‘and a health insurance issuer offering group or individual health insurance coverage’;CommentsClose CommentsPermalink
(ii) in paragraph (2), by striking ‘(or health insurance coverage offered in connection with such a plan)’ each place that such appears and inserting ‘or a health insurance issuer offering group or individual health insurance coverage’;CommentsClose CommentsPermalink
(5) in section 2719 (
(6) in section 2720 (
(A) in subsection (a), by striking ‘health insurance coverage offered in connection with such plan’ and inserting ‘individual health insurance coverage’;CommentsClose CommentsPermalink
(B) in subsection (b)--CommentsClose CommentsPermalink
(i) in paragraph (1), by striking ‘or a health insurance issuer that provides health insurance coverage in connection with a group health plan’ and inserting ‘or a health insurance issuer that offers group or individual health insurance coverage’;CommentsClose CommentsPermalink
(ii) in paragraph (2), by striking ‘health insurance coverage offered in connection with the plan’ and inserting ‘individual health insurance coverage’; andCommentsClose CommentsPermalink
(iii) in paragraph (3), by striking ‘health insurance coverage offered by an issuer in connection with such plan’ and inserting ‘individual health insurance coverage’;CommentsClose CommentsPermalink
(C) in subsection (c), by striking ‘health insurance issuer providing health insurance coverage in connection with a group health plan’ and inserting ‘health insurance issuer that offers group or individual health insurance coverage’; andCommentsClose CommentsPermalink
(D) in subsection (e)(1), by striking ‘health insurance coverage offered in connection with such a plan’ and inserting ‘individual health insurance coverage’;CommentsClose CommentsPermalink
(7) by striking the heading for subpart 3;CommentsClose CommentsPermalink
(8) in section 2714 (
(A) by striking the section heading and all that follows through subsection (b);CommentsClose CommentsPermalink
(B) in subsection (c)--CommentsClose CommentsPermalink
(i) in paragraph (1)--CommentsClose CommentsPermalink
(I) in the matter preceding subparagraph (A), by striking ‘small group’ and inserting ‘group and individual’; andCommentsClose CommentsPermalink
(II) in subparagraph (B)--CommentsClose CommentsPermalink
(aa) in the matter preceding clause (i), by inserting ‘and individuals’ after ‘employers’;CommentsClose CommentsPermalink
(bb) in clause (i), by inserting ‘or any additional individuals’ after ‘additional groups’; andCommentsClose CommentsPermalink
(cc) in clause (ii), by striking ‘without regard to the claims experience of those employers and their employees (and their dependents) or any health status-related factor relating to such’ and inserting ‘and individuals without regard to the claims experience of those individuals, employers and their employees (and their dependents) or any health status-related factor relating to such individuals’; andCommentsClose CommentsPermalink
(ii) in paragraph (2), by striking ‘small group’ and inserting ‘group or individual’;CommentsClose CommentsPermalink
(C) in subsection (d)--CommentsClose CommentsPermalink
(i) by striking ‘small group’ each place that such appears and inserting ‘group or individual’; andCommentsClose CommentsPermalink
(ii) in paragraph (1)(B)--CommentsClose CommentsPermalink
(I) by striking ‘all employers’ and inserting ‘all employers and individuals’;CommentsClose CommentsPermalink
(II) by striking ‘those employers’ and inserting ‘those individuals, employers’; andCommentsClose CommentsPermalink
(III) by striking ‘such employees’ and inserting ‘such individuals, employees’;CommentsClose CommentsPermalink
(D) by striking subsection (e);CommentsClose CommentsPermalink
(E) by striking subsection (f); andCommentsClose CommentsPermalink
(F) by transferring the remainder of such section to appear at the end of section 2702 (as added by section 101(5));CommentsClose CommentsPermalink
(9) in section 2715 (
(A) by striking the section heading and all that follows through subsection (a);CommentsClose CommentsPermalink
(B) in subsection (b)--CommentsClose CommentsPermalink
(i) in the matter preceding paragraph (1), by striking ‘group health plan in the small or large group market’ and inserting ‘health insurance coverage offered in the group or individual market’;CommentsClose CommentsPermalink
(ii) in paragraph (1), by inserting ‘, or individual, as applicable,’ after ‘plan sponsor’;CommentsClose CommentsPermalink
(iii) in paragraph (2), by inserting ‘, or individual, as applicable,’ after ‘plan sponsor’; andCommentsClose CommentsPermalink
(iv) by striking paragraph (3) and inserting the following:CommentsClose CommentsPermalink
‘(3) VIOLATION OF PARTICIPATION OR CONTRIBUTION RATES- In the case of a group health plan, the plan sponsor has failed to comply with a material plan provision relating to employer contribution or group participation rules, pursuant to applicable State law.’;CommentsClose CommentsPermalink
(C) in subsection (c)--CommentsClose CommentsPermalink
(i) in paragraph (1)--CommentsClose CommentsPermalink
(I) in the matter preceding subparagraph (A), by striking ‘group health insurance coverage offered in the small or large group market’ and inserting ‘group or individual health insurance coverage’;CommentsClose CommentsPermalink
(II) in subparagraph (A), by inserting ‘or individual, as applicable,’ after ‘plan sponsor’;CommentsClose CommentsPermalink
(III) in subparagraph (B)--CommentsClose CommentsPermalink
(aa) by inserting ‘or individual, as applicable,’ after ‘plan sponsor’; andCommentsClose CommentsPermalink
(bb) by inserting ‘or individual health insurance coverage’; andCommentsClose CommentsPermalink
(IV) in subparagraph (C), by inserting ‘or individuals, as applicable,’ after ‘those sponsors’; andCommentsClose CommentsPermalink
(ii) in paragraph (2)(A)--CommentsClose CommentsPermalink
(I) in the matter preceding clause (i), by striking ‘small group market or the large group market, or both markets,’ and inserting ‘individual or group market, or all markets,’; andCommentsClose CommentsPermalink
(II) in clause (i), by inserting ‘or individual, as applicable,’ after ‘plan sponsor’; andCommentsClose CommentsPermalink
(D) by transferring the remainder of such section to appear at the end of section 2703 (as added by section 101(5));CommentsClose CommentsPermalink
(10) in section 2716 (
(A) in subsection (a)--CommentsClose CommentsPermalink
(i) in the matter preceding paragraph (1), by striking ‘small employer’ and inserting ‘small employer or an individual’;CommentsClose CommentsPermalink
(ii) in paragraph (1), by inserting ‘, or individual, as applicable,’ after ‘employer’ each place that such appears; andCommentsClose CommentsPermalink
(iii) in paragraph (2), by striking ‘small employer’ and inserting ‘employer, or individual, as applicable,’;CommentsClose CommentsPermalink
(B) in subsection (b)--CommentsClose CommentsPermalink
(i) in paragraph (1)--CommentsClose CommentsPermalink
(I) in the matter preceding subparagraph (A), by striking ‘small employer’ and inserting ‘employer, or individual, as applicable,’;CommentsClose CommentsPermalink
(II) in subparagraph (A), by adding ‘and’ at the end;CommentsClose CommentsPermalink
(III) by striking subparagraphs (B) and (C); andCommentsClose CommentsPermalink
(IV) in subparagraph (D)--CommentsClose CommentsPermalink
(aa) by inserting ‘, or individual, as applicable,’ after ‘employer’; andCommentsClose CommentsPermalink
(bb) by redesignating such subparagraph as subparagraph (B);CommentsClose CommentsPermalink
(ii) in paragraph (2)--CommentsClose CommentsPermalink
(I) by striking ‘small employers’ each place that such appears and inserting ‘employers, or individuals, as applicable,’; andCommentsClose CommentsPermalink
(II) by striking ‘small employer’ and inserting ‘employer, or individual, as applicable,’; andCommentsClose CommentsPermalink
(C) by redesignating such section as section 2712 and transferring such section to appear after section 2711 (as added by section 101(5));CommentsClose CommentsPermalink
(11) by redesignating subpart 4 as subpart 2;CommentsClose CommentsPermalink
(12) in section 2721 (
(A) by striking subsection (a);CommentsClose CommentsPermalink
(B) by striking ‘subparts 1 through 3’ each place that such appears and inserting ‘subpart 1’; andCommentsClose CommentsPermalink
(C) by redesignating subsections (b) through (e) as subsections (a) through (d), respectively;CommentsClose CommentsPermalink
(13) in section 2722 (
(A) in subsection (a)--CommentsClose CommentsPermalink
(i) in paragraph (1), by striking ‘small or large group markets’ and inserting ‘individual or group market’; andCommentsClose CommentsPermalink
(ii) in paragraph (2), by inserting ‘or individual health insurance coverage’ after ‘group health plans’; andCommentsClose CommentsPermalink
(B) in subsection (b)(1)(B), by inserting ‘individual health insurance coverage or’ after ‘respect to’; andCommentsClose CommentsPermalink
(14) in section 2723(a)(1) (
(b) Applicability- Notwithstanding any other provision of the Affordable Health Choices Act, nothing in such Act (or an amendment made by such Act) shall be construed to--CommentsClose CommentsPermalink
(1) authorize the Secretary of Health and Human Services to promulgate regulations that prohibit a group health plan or health insurance issuer from carrying out utilization management techniques that are commonly used as of the date of enactment of this section; orCommentsClose CommentsPermalink
(2) restrict the application of the amendments made by this subtitle.CommentsClose CommentsPermalink
(c) Technical Amendment to the Employee Retirement Income Security Act of 1974- Subpart B of part 7 of subtitle A of title I of the Employee Retirement Income Security Act of 1974 (
‘SEC. 715. ADDITIONAL MARKET REFORMS.
‘(a) General Rule- Except as provided in subsection (b)--CommentsClose CommentsPermalink
‘(1) the provisions of subpart 1 of part A of title XXVII of the Public Health Service Act (as amended by the Affordable Health Choices Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subpart; andCommentsClose CommentsPermalink
‘(2) to the extent that any provision of this part conflicts with a provision of such subpart 1 with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such subpart 1 shall apply.CommentsClose CommentsPermalink
‘(b) Exception- Notwithstanding subsection (a), the provisions of sections 2701, 2702, and 2704 of title XXVII of the Public Health Service Act (as amended by the Affordable Health Choices Act) shall not apply with respect to self-insured group health plans, and the provisions of this part shall continue to apply to such plans as if such sections of the Public Health Service Act (as so amended) had not been enacted.’.CommentsClose CommentsPermalink
(d) Technical Amendment to the Internal Revenue Code of 1986- Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 9815. ADDITIONAL MARKET REFORMS.
‘(a) General Rule- Except as provided in subsection (b)--CommentsClose CommentsPermalink
‘(1) the provisions of subpart 1 of part A of title XXVII of the Public Health Service Act (as amended by the Affordable Health Choices Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subchapter; andCommentsClose CommentsPermalink
‘(2) to the extent that any provision of this subchapter conflicts with a provision of such subpart 1 with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such subpart 1 shall apply.CommentsClose CommentsPermalink
‘(b) Exception- Notwithstanding subsection (a), the provisions of sections 2701, 2702, and 2704 of title XXVII of the Public Health Service Act (as amended by the Affordable Health Choices Act) shall not apply with respect to self-insured group health plans, and the provisions of this subchapter shall continue to apply to such plans as if such sections of the Public Health Service Act (as so amended) had not been enacted.’.CommentsClose CommentsPermalink
SEC. 134. SAVINGS.
(a) Determination- The Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, shall for each fiscal year determine the amount of savings to the Federal Government as a result of the enactment of this subtitle.CommentsClose CommentsPermalink
(b) Use- Notwithstanding any other provision of this subtitle (or an amendment made by this subtitle), the savings to the Federal Government generated as a result of the enactment of this subtitle shall be used for deficit reduction.CommentsClose CommentsPermalink
SEC. 135. EFFECTIVE DATES.
(a) Applicability- Except as otherwise provided in subsection (b), this subtitle (and the amendments made by this subtitle) shall become effective for plan years beginning on or after the date that is 1 year after the date of enactment of this Act.CommentsClose CommentsPermalink
(b) Delayed Applicability- Sections 2701, 2702, 2705, and 2706 of the Public Health Service Act (as added by section 101) shall become effective with respect to group health plans or health insurance coverage offered in a State on the date on which such State becomes a participating or establishing State under section 3104 of the Public Health Service Act (as added by section 142).CommentsClose CommentsPermalink
Subtitle B--Available Coverage for All AmericansCommentsClose CommentsPermalink
Subtitle B--Available Coverage for All AmericansCommentsClose CommentsPermalink
SEC. 141. BUILDING ON THE SUCCESS OF THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM AND THE HEALTH BENEFITS PROGRAM OF MOST LARGE EMPLOYERS SO ALL AMERICANS HAVE AFFORDABLE HEALTH BENEFIT CHOICES.
(a) Findings- The Senate finds that--CommentsClose CommentsPermalink
(1) the Federal employees health benefits program under chapter 89 of title 5, United States Code, allows Members of Congress, and section 514 of the Employee Retirement Income Security Act of 1974 allows large employers, to have affordable choices among competing health benefit plans;CommentsClose CommentsPermalink
(2) the Federal employees health benefits program ensures that the health benefit plans available to Members of Congress meet minimum standards of quality and effectiveness;CommentsClose CommentsPermalink
(3) millions of Americans have no meaningful choice in health benefits, because health benefit plans are either unavailable or unaffordable; andCommentsClose CommentsPermalink
(4) all Americans should have the same kinds of meaningful choices of health benefit plans that Members of Congress, as Federal employees, enjoy through the Federal employees health benefits program.CommentsClose CommentsPermalink
(b) Sense of the Senate- It is the sense of the Senate that Congress should establish a means for all Americans to enjoy affordable choices in health benefit plans, in the same manner that Members of Congress have such choices through the Federal employees health benefits program.CommentsClose CommentsPermalink
SEC. 142. AFFORDABLE HEALTH CHOICES FOR ALL AMERICANS.
(a) Purpose- It is the purpose of this section to facilitate the establishment of Affordable Health Benefit Gateways in each State, with appropriate flexibility for States in establishing and administering the Gateways.CommentsClose CommentsPermalink
(b) American Health Benefit Gateways- The Public Health Service Act (
‘TITLE XXXI--AFFORDABLE HEALTH CHOICES FOR ALL AMERICANSCommentsClose CommentsPermalink
‘Subtitle A--Affordable ChoicesCommentsClose CommentsPermalink
‘SEC. 3101. AFFORDABLE CHOICES OF HEALTH BENEFIT PLANS.
‘(a) Assistance to States to Establish American Health Benefit Gateways-CommentsClose CommentsPermalink
‘(1) PLANNING AND ESTABLISHMENT GRANTS- Not later than 60 days after the date of enactment of this section (or as soon as practicable thereafter), the Secretary shall make awards, from amounts appropriated under paragraph (5), to States in the amount specified in paragraph (2) for the uses described in paragraph (3).CommentsClose CommentsPermalink
‘(2) AMOUNT SPECIFIED-CommentsClose CommentsPermalink
‘(A) TOTAL DETERMINED- For each fiscal year, the Secretary shall determine the total amount that the Secretary will make available for grants under this subsection.CommentsClose CommentsPermalink
‘(B) STATE AMOUNT- For each State that is awarded a grant under paragraph (1), the amount of such grants shall be based on a formula established by the Secretary under which each State shall receive an award in an amount that is based on the following two components:CommentsClose CommentsPermalink
‘(i) A minimum amount for each State.CommentsClose CommentsPermalink
‘(ii) An additional amount based on population.CommentsClose CommentsPermalink
The Secretary shall ensure that the aggregate amount awarded to all States under clause (i) is not less than 60 percent of the aggregate amount awarded to all States under this subparagraph.CommentsClose CommentsPermalink
‘(3) USE OF FUNDS- A State shall use amounts awarded under this subsection for activities (including planning activities) related to establishing an American Health Benefit Gateway, as described in subsection (b).CommentsClose CommentsPermalink
‘(4) RENEWABILITY OF GRANT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary may renew a grant awarded under paragraph (1) if the State recipient of such grant--CommentsClose CommentsPermalink
‘(i) is making progress, as determined by the Secretary, toward--CommentsClose CommentsPermalink
‘(I) establishing a Gateway; andCommentsClose CommentsPermalink
‘(II) implementing the reforms described in subtitle A of title I of the Affordable Health Choices Act; andCommentsClose CommentsPermalink
‘(ii) is meeting such other benchmarks as the Secretary may establish.CommentsClose CommentsPermalink
‘(B) LIMITATION- If a State is an establishing State or a participating State (as defined in section 3104), such State shall not be eligible for a grant renewal under subparagraph (A) as of the second fiscal year following the date on which such State was deemed to be an establishing State or a participating State.CommentsClose CommentsPermalink
‘(5) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary to carry out this subsection in each of fiscal years 2009 through 2014.CommentsClose CommentsPermalink
‘(b) American Health Benefit Gateways- An American Health Benefit Gateway (referred to in this title as a ‘Gateway’) means a mechanism that--CommentsClose CommentsPermalink
‘(1) facilitates the purchase of health insurance coverage and related insurance products through the Gateway at an affordable price by qualified individuals and qualified employers and reduces the cost of health care; andCommentsClose CommentsPermalink
‘(2) meets the requirements of subsection (c).CommentsClose CommentsPermalink
‘(c) Requirements-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT- A Gateway shall be a governmental agency or nonprofit entity that is established by--CommentsClose CommentsPermalink
‘(A) a State, in the case of an establishing State (as described in section 3104); orCommentsClose CommentsPermalink
‘(B) the Secretary, in the case of a participating State (as described in section 3104).CommentsClose CommentsPermalink
‘(2) OFFERING OF COVERAGE-CommentsClose CommentsPermalink
‘(A) IN GENERAL- A Gateway shall make available qualified health plans to qualified individuals and qualified employers.CommentsClose CommentsPermalink
‘(B) INCLUSION- In making available coverage pursuant to subparagraph (A), a Gateway shall include a community health insurance option (as described in section 3106).CommentsClose CommentsPermalink
‘(C) LIMITATION- A Gateway may not make available any health plan or other health insurance coverage that is not a qualified health plan.CommentsClose CommentsPermalink
‘(D) ALLOWANCE TO OFFER- A Gateway may make available a qualified health plan notwithstanding any provision of law that may require benefits other than the essential health benefits specified under section 3103(a).CommentsClose CommentsPermalink
‘(E) STATES MAY REQUIRE ADDITIONAL BENEFITS- Subject to the requirements of subparagraph (F), a State may require that a qualified health plan offered in such State offer benefits in addition to the essential health benefits described in section 3103(a).CommentsClose CommentsPermalink
‘(F) ADDITIONAL BENEFITS-CommentsClose CommentsPermalink
‘(i) NO ADDITIONAL FEDERAL COST- A requirement by a State under subparagraph (E) that a qualified health plan cover benefits in addition to the essential health benefits required shall not affect the amount of a credit provided under section 3111 with respect to such plan.CommentsClose CommentsPermalink
‘(ii) STATE MUST ASSUME COST- A State shall make payments to or on behalf of an eligible individual to defray the cost of any additional benefits described in subparagraph (E).CommentsClose CommentsPermalink
‘(3) FUNCTIONS- A Gateway shall, at a minimum--CommentsClose CommentsPermalink
‘(A) establish procedures for the certification, recertification, and decertification, consistent with guidelines developed by the Secretary under subsection (m), of health plans as qualified health plans;CommentsClose CommentsPermalink
‘(B) develop and make available tools to allow consumers to receive accurate and culturally and linguistically appropriate information on--CommentsClose CommentsPermalink
‘(i) expected premiums and out of pocket expenses (taking into account any credits for which such individual is eligible under section 3111);CommentsClose CommentsPermalink
‘(ii) the availability of in-network and out-of-network providers;CommentsClose CommentsPermalink
‘(iii) the costs of any surcharge assessed under paragraph (4);CommentsClose CommentsPermalink
‘(iv) data, by plan, that reflects the frequency with which preventive services rated ‘A’ or ‘B’ by the U.S. Preventive Services Task Force or recommended by the Advisory Committee on Immunization Practices are utilized by enrollees, a comparison of such data to the average frequency with which such preventive services are utilized by enrollees across all qualified health plans, and whether such preventive services are utilized by enrollees as frequently as recommended;CommentsClose CommentsPermalink
‘(v) medical loss ratios, as reported under section 2704(a);CommentsClose CommentsPermalink
‘(vi) any quality measures for health plan performance endorsed under section 399JJ; andCommentsClose CommentsPermalink
‘(vii) such other matters relating to consumer costs and expected experience under the plan as a Gateway may determine necessary;CommentsClose CommentsPermalink
‘(C) utilize the administrative simplification measures and standards developed under section 222 of the Affordable Health Choices Act;CommentsClose CommentsPermalink
‘(D) enter into agreements, to the extent determined appropriate by the Gateway, with navigators, as described in section 3105;CommentsClose CommentsPermalink
‘(E) facilitate the purchase of coverage for long-term services and supports;CommentsClose CommentsPermalink
‘(F) collect, analyze, and respond to complaints and concerns from enrollees regarding coverage provided through the Gateway;CommentsClose CommentsPermalink
‘(G) provide for the operation of a toll-free telephone hotline to respond to requests for assistance; andCommentsClose CommentsPermalink
‘(H) maintain an Internet website through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans.CommentsClose CommentsPermalink
‘(4) SURCHARGES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- A Gateway may assess a surcharge on all health insurance issuers offering qualified health plans through the Gateway to pay for the administrative and operational expenses of the Gateway.CommentsClose CommentsPermalink
‘(B) LIMITATION- A surcharge described in subparagraph (A) may not exceed 4 percent of the premiums collected by a qualified health plan.CommentsClose CommentsPermalink
‘(C) FURTHER LIMITATION- No funds collected through a Gateway surcharge for administrative and operational expenses may be used for staff retreats, promotional giveaways, excessive executive compensation, or promotion of Federal or State legislative and regulatory modifications.CommentsClose CommentsPermalink
‘(5) RISK ADJUSTMENT PAYMENT-CommentsClose CommentsPermalink
‘(A) ESTABLISHING AND PARTICIPATING STATES-CommentsClose CommentsPermalink
‘(i) LOW ACTUARIAL RISK PLANS- Using the criteria and methods developed under subparagraph (B), each establishing State or participating State (as defined in section 3104) shall assess a charge on health plans and health insurance issuers (with respect to health insurance coverage) described in subparagraph (C) if the actuarial risk of the enrollees of such plans or coverage for a year is less than the average actuarial risk of all enrollees in all plans or coverage in such State for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974).CommentsClose CommentsPermalink
‘(ii) HIGH ACTUARIAL RISK PLANS- Using the criteria and methods developed under subparagraph (B), each establishing State or participating State (as defined in section 3104) shall provide a payment to health plans and health insurance issuers (with respect to health insurance coverage) described in subparagraph (C) if the actuarial risk of the enrollees of such plans or coverage for a year is greater than the average actuarial risk of all enrollees in all plans and coverage in such State for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974).CommentsClose CommentsPermalink
‘(B) CRITERIA AND METHODS- The Secretary, in consultation with States, shall establish criteria and methods to be used in carrying out the risk adjustment activities under this paragraph. The Secretary may utilize criteria and methods similar to the criteria and methods utilized under part C or D of title XVIII of the Social Security Act.CommentsClose CommentsPermalink
‘(C) SCOPE- A health plan or a health insurance issuer is described in this subparagraph if such health plan or health insurance issuer provides coverage for an individual or for an employer group the size of which does not exceed--CommentsClose CommentsPermalink
‘(i) in the case of an employer with its primary place of business located in an establishing State, the criteria relating to the size of employers established by such State as described in section 3116(a)(2)(A)(ii)(I); orCommentsClose CommentsPermalink
‘(ii) in the case of an employer with its primary place of business located in a participating State, the criteria relating to the size of employers established by the Secretary as described in section 3116(a)(2)(A)(ii)(II).CommentsClose CommentsPermalink
‘(6) FACILITATING ENROLLMENT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- A Gateway shall (through, to the extent practicable, the use of information technology) implement policies and procedures to--CommentsClose CommentsPermalink
‘(i) facilitate the identification of individuals who lack qualifying coverage; andCommentsClose CommentsPermalink
‘(ii) assist such individuals in enrolling in--CommentsClose CommentsPermalink
‘(I) a qualified health plan that is affordable and available to such individual, if such individual is a qualified individual;CommentsClose CommentsPermalink
‘(II) the medicaid program under title XIX of the Social Security Act, if such individual is eligible for such program;CommentsClose CommentsPermalink
‘(III) the CHIP program under title XXI of the Social Security Act, if such individual is eligible for such program; orCommentsClose CommentsPermalink
‘(IV) other Federal programs in which such individual is eligible to participate.CommentsClose CommentsPermalink
‘(B) CHOICE FOR INDIVIDUALS ELIGIBLE FOR CHIP- A qualified individual who is eligible for the Children’s Health Insurance Program under title XXI of the Social Security Act may elect to enroll in such program or in a qualified health plan. Where such individual is a minor child, such election shall be made by the parent or guardian of such child.CommentsClose CommentsPermalink
‘(C) OVERSIGHT- The Secretary shall oversee the implementation of subparagraph (A)(ii) to ensure that individuals are assisted to enroll in the program most appropriate under such subparagraph for each such individual.CommentsClose CommentsPermalink
‘(D) ACCESSIBILITY OF MATERIALS- Any materials used by a Gateway to carry out this paragraph shall be provided in a form and manner calculated to be understood by individuals who may apply to be enrollees in a qualified health plan, taking into account potential language barriers and disabilities of individuals.CommentsClose CommentsPermalink
‘(7) CONSULTATION- A Gateway shall consult with stakeholders relevant to carrying out the activities under this subsection, including--CommentsClose CommentsPermalink
‘(A) educated health care consumers who are enrollees in qualified health plans;CommentsClose CommentsPermalink
‘(B) individuals and entities with experience in facilitating enrollment in qualified health plans;CommentsClose CommentsPermalink
‘(C) representatives of small businesses and self-employed individuals;CommentsClose CommentsPermalink
‘(D) State Medicaid offices; andCommentsClose CommentsPermalink
‘(E) advocates for enrolling hard to reach populations.CommentsClose CommentsPermalink
‘(8) STANDARDS AND PROTOCOLS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary, in consultation with the Office of the National Coordinator for Health Information Technology, shall develop interoperable, secure, scalable, and reusable standards and protocols that facilitate enrollment of individuals in Federal and State health and human services programs.CommentsClose CommentsPermalink
‘(B) COORDINATION- The Secretary shall facilitate enrollment of individuals in programs described in subparagraph (A) through methods which shall include--CommentsClose CommentsPermalink
‘(i) electronic matching against existing Federal and State data to serve as evidence of eligibility and digital documentation in lieu of paper-based documentation;CommentsClose CommentsPermalink
‘(ii) capability for individuals to apply, recertify, and manage eligibility information online, including conducting real-time queries against databases for existing eligibility prior to submitting applications; andCommentsClose CommentsPermalink
‘(iii) other functionalities necessary to provide eligible individuals with a streamlined enrollment process.CommentsClose CommentsPermalink
‘(C) ASSISTANCE- The Secretary shall award grants to enhance community-based enrollment to--CommentsClose CommentsPermalink
‘(i) States to assist such States in--CommentsClose CommentsPermalink
‘(I) contracting with qualified technology vendors to develop or acquire electronic enrollment software systems;CommentsClose CommentsPermalink
‘(II) contracting with community and consumer focused nonprofit organizations with experience working with consumers, including the uninsured and the underinsured, to establish Statewide helplines for enrollment assistance and referrals; andCommentsClose CommentsPermalink
‘(III) establishing public education campaigns through grants to qualifying organizations for the design and implementation of public education campaigns targeting uninsured and traditionally underserved communities; andCommentsClose CommentsPermalink
‘(ii) community-based organizations for infrastructure and training to establish electronic assistance programs.CommentsClose CommentsPermalink
‘(9) NOTIFICATION- With respect to the standards and protocols developed under paragraph (8), the Secretary--CommentsClose CommentsPermalink
‘(A) shall notify States of such standards and protocols; andCommentsClose CommentsPermalink
‘(B) may require, as a condition of receiving Federal funds, that States or other entities incorporate such standards and protocols into such investments.CommentsClose CommentsPermalink
‘(10) PUBLICATION OF COSTS- A Gateway shall publish the average costs of income or other taxes, licensing or regulatory fees, and any surcharges imposed by the Gateway, and the administrative costs of such Gateway, on an Internet website to educate consumers on such costs. Such information shall also include monies lost to waste, fraud, and abuse.CommentsClose CommentsPermalink
‘(d) Certification- A Gateway may certify a health plan as a qualified health plan if--CommentsClose CommentsPermalink
‘(1) such health plan meets the requirements of subsection (m);CommentsClose CommentsPermalink
‘(2) the Gateway determines that making available such health plan through such Gateway is in the interests of qualified individuals and qualified employers in the States or States in which such Gateway operates, except that the Gateway may not exclude a health plan--CommentsClose CommentsPermalink
‘(A) on the basis that such plan is a fee-for-service plan;CommentsClose CommentsPermalink
‘(B) through the imposition of premium price controls; orCommentsClose CommentsPermalink
‘(C) on the basis that the plan provides treatments necessary to prevent patients’ deaths in circumstances the Gateway determines are inappropriate or to costly; andCommentsClose CommentsPermalink
‘(3) the Gateway determines that the plan has not established a pattern or practice under which benefits covered by the plan are denied to covered individuals on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree of medical dependency, or quality of life.CommentsClose CommentsPermalink
‘(e) Guidance- The Secretary shall develop guidance that may be used by a Gateway to carry out the activities described in this section.CommentsClose CommentsPermalink
‘(f) Flexibility-CommentsClose CommentsPermalink
‘(1) REGIONAL OR OTHER INTERSTATE GATEWAYS- A Gateway may operate in more than one State, provided that each State in which such Gateway operates permits such operation.CommentsClose CommentsPermalink
‘(2) SUBSIDIARY GATEWAYS- A State may establish one or more subsidiary Gateway, provided that--CommentsClose CommentsPermalink
‘(A) each such Gateway serves a geographically distinct area; andCommentsClose CommentsPermalink
‘(B) the area served by each such Gateway is at least as large as a community rating area described in section 2701.CommentsClose CommentsPermalink
‘(g) No Limitation on Contracting Based on Abortion- No individual health care provider or health care facility may be excluded from contracting with a health insurance issuer participating in the Gateway on the basis that the provider or facility performs abortions or the provider or facility refuses to perform abortions, except in an emergency, if performing abortions is contrary to the religious or moral beliefs of the provider or facility.CommentsClose CommentsPermalink
‘(h) Portals to State Gateway- The Secretary shall establish a mechanism, including an Internet website, through which a resident of any State may identify any Gateway operating in such State.CommentsClose CommentsPermalink
‘(i) Choice-CommentsClose CommentsPermalink
‘(1) QUALIFIED INDIVIDUALS- A qualified individual may enroll in any qualified health plan available to such individual.CommentsClose CommentsPermalink
‘(2) QUALIFIED EMPLOYERS-CommentsClose CommentsPermalink
‘(A) EMPLOYER MAY SPECIFY TIER- A qualified employer may provide support for coverage of employees under a qualified health plan by selecting any tier of cost sharing described in section 3111(a)(1).CommentsClose CommentsPermalink
‘(B) EMPLOYEE MAY CHOOSE PLANS WITHIN A TIER- Each employee of a qualified employer may choose to enroll in a qualified health plan that offers coverage at the tier of cost sharing selected by an employer, as described in subparagraph (A).CommentsClose CommentsPermalink
‘(3) SELF-EMPLOYED INDIVIDUALS-CommentsClose CommentsPermalink
‘(A) DEEMING- An individual who is self-employed (as defined in section 401(c)(1) of the Internal Revenue Code of 1986) shall be deemed to be a qualified employer unless such individual notifies the applicable Gateway that such individual elects to be considered a qualified individual.CommentsClose CommentsPermalink
‘(B) ELIGIBILITY- In the case of a self-employed individual making the election described in subparagraph (A)--CommentsClose CommentsPermalink
‘(i) the income of such individual for purposes of section 3111 shall be deemed to be the total business income of such individual;CommentsClose CommentsPermalink
‘(ii) premium payments made by such individual to a qualified health plan shall not be treated as employer-provided coverage under section 106(a) of the Internal Revenue Code of 1986; andCommentsClose CommentsPermalink
‘(iii) the individual shall not be eligible for a credit under section 3112.CommentsClose CommentsPermalink
‘(j) Payment of Premiums by Qualified Individuals- A qualified individual enrolled in any qualified health plan may pay any applicable premium owed by such individual to the health insurance issuer issuing such qualified health plan.CommentsClose CommentsPermalink
‘(k) Single Risk Pool-CommentsClose CommentsPermalink
‘(1) INDIVIDUAL MARKET- A health insurance issuer shall consider all enrollees in an individual plan, including individuals who do not purchase such a plan through the Gateway, to be members of a single risk pool.CommentsClose CommentsPermalink
‘(2) GROUP HEALTH INSURANCE POLICIES- A health insurance issuer shall consider all enrollees in a small group health plan, other than a self-insured group health plan, including individuals who do not purchase such a plan through the Gateway, to be members of a single risk pool.CommentsClose CommentsPermalink
‘(l) Empowering Consumer Choice-CommentsClose CommentsPermalink
‘(1) CONTINUED OPERATION OF MARKET OUTSIDE GATEWAYS- Nothing in this title shall be construed to prohibit a health insurance issuer from offering a health insurance policy or providing coverage under such policy to a qualified individual where such policy is not a qualified health plan. Nothing in this title shall be construed to prohibit a qualified individual from enrolling in a health insurance plan where such plan is not a qualified health plan.CommentsClose CommentsPermalink
‘(2) CONTINUED OPERATION OF STATE BENEFIT REQUIREMENTS- Nothing in this title shall be construed to terminate, abridge, or limit the operation of any requirement under State law with respect to any policy or plan that is not a qualified health plan to offer benefits required under State law.CommentsClose CommentsPermalink
‘(3) VOLUNTARY NATURE OF A GATEWAY-CommentsClose CommentsPermalink
‘(A) CHOICE TO ENROLL OR NOT TO ENROLL- Nothing in this title shall be construed to restrict the choice of a qualified individual to enroll or not to enroll in a qualified health plan or to participate in a Gateway.CommentsClose CommentsPermalink
‘(B) PROHIBITION AGAINST COMPELLED ENROLLMENT- Nothing in this title shall be construed to compel an individual to enroll in a qualified health plan or to participate in a Gateway.CommentsClose CommentsPermalink
‘(m) Criteria for Certification-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall, by regulation, establish criteria for certification of health plans as qualified health plans. Such criteria shall require that, to be certified, a plan--CommentsClose CommentsPermalink
‘(A) not employ marketing practices that have the effect of discouraging the enrollment in such plan by individuals with significant health needs;CommentsClose CommentsPermalink
‘(B) employ methods to ensure that insurance products are simple, comparable, and structured for ease of consumer choice;CommentsClose CommentsPermalink
‘(C) ensure a wide choice of providers (in a manner consistent with applicable network adequacy provisions under section 2702(c));CommentsClose CommentsPermalink
‘(D) include within health insurance plan networks those essential community providers, where available, that serve predominately low-income, medically-underserved individuals, such as health care providers defined in section 340B(a)(4) of the Public Health Service Act and providers described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act as set forth by section 221 of
Public Law 111-8 ;CommentsClose CommentsPermalink‘(E) make available to individuals enrolled in, or seeking to enroll in, such plan a detailed description of--CommentsClose CommentsPermalink
‘(i) benefits offered, including maximums, limitations (including differential cost-sharing for out of network services), exclusions and other benefit limitations;CommentsClose CommentsPermalink
‘(ii) the service area;CommentsClose CommentsPermalink
‘(iii) required premiums;CommentsClose CommentsPermalink
‘(iv) cost-sharing requirements;CommentsClose CommentsPermalink
‘(v) the manner in which enrollees access providers; andCommentsClose CommentsPermalink
‘(vi) the grievance and appeals procedures;CommentsClose CommentsPermalink
‘(F) provide coverage for at least the essential health care benefits established under section 3103(a);CommentsClose CommentsPermalink
‘(G)(i) is accredited by the National Committee for Quality Assurance or by any other entity recognized by the Secretary for the accreditation of health insurance issuers or plans; orCommentsClose CommentsPermalink
‘(ii) receives such accreditation within a period established by a Gateway for such accreditation that is applicable to all qualified health plans;CommentsClose CommentsPermalink
‘(H) implement a quality improvement strategy described in subsection (n)(1);CommentsClose CommentsPermalink
‘(I) have adequate procedures in place for appeals of coverage determinations;CommentsClose CommentsPermalink
‘(J) may not establish a benefit design that is likely to substantially discourage enrollment by certain qualified individuals in such plan; andCommentsClose CommentsPermalink
‘(K) report to the applicable Gateway data on any quality measures for health plan performance endorsed under section 399JJ.CommentsClose CommentsPermalink
‘(2) REQUEST TO NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS- The Secretary shall request the National Association of Insurance Commissioners to develop and submit to the Secretary model criteria for the certification of qualified health plans, that address the elements described in subparagraphs (A) through (K) of paragraph (1). In developing such criteria, the National Association of Insurance Commissioners shall consult with appropriate Federal agencies, consumer representatives, insurance carriers, and other stakeholders.CommentsClose CommentsPermalink
‘(3) REQUIRED CONSIDERATION- If the model criteria described in paragraph (2) are submitted to the Secretary by the date that is 9 months after the date on which a request is made under such paragraph, the Secretary shall consider such model criteria in promulgating the regulations under paragraph (1).CommentsClose CommentsPermalink
‘(4) RULE OF CONSTRUCTION- Nothing in paragraph (1)(D) shall be construed to require a qualified health plan to contract with a provider described in such paragraph if such provider refuses to accept the generally applicable payment rates of such plan.CommentsClose CommentsPermalink
‘(n) Rewarding Quality Through Market-Based Incentives-CommentsClose CommentsPermalink
‘(1) STRATEGY DESCRIBED- A strategy described in this paragraph is a payment structure that provides increased reimbursement or other incentives for--CommentsClose CommentsPermalink
‘(A) improving health outcomes through the implementation of activities that shall include quality reporting, effective case management, care coordination, chronic disease management, medication and care compliance initiatives, including through the use of the medical home model as defined in section 212 of the Affordable Health Choices Act, for treatment or services under the plan or coverage;CommentsClose CommentsPermalink
‘(B) the implementation of activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional;CommentsClose CommentsPermalink
‘(C) the implementation of activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; andCommentsClose CommentsPermalink
‘(D) the implementation of wellness and health promotion activities.CommentsClose CommentsPermalink
‘(2) GUIDELINES- The Secretary, in consultation with experts in health care quality and stakeholders, shall develop guidelines concerning the matters described in paragraph (1).CommentsClose CommentsPermalink
‘(3) REQUIREMENTS- The guidelines developed under paragraph (2) shall require the periodic reporting to the applicable Gateway of the activities that a qualified health plan has conducted to implement a strategy described in paragraph (1).CommentsClose CommentsPermalink
‘(o) No Interference With State Regulatory Authority- Nothing in this title shall be construed to preempt any State law that does not prevent the application of the provisions of this title.CommentsClose CommentsPermalink
‘(p) Quality Improvement-CommentsClose CommentsPermalink
‘(1) ENHANCING PATIENT SAFETY- Beginning on January 1, 2012 a qualified health plan may contract with--CommentsClose CommentsPermalink
‘(A) a hospital with greater than 50 beds only if such hospital--CommentsClose CommentsPermalink
‘(i) utilizes a patient safety evaluation system as described in part C of title IX; andCommentsClose CommentsPermalink
‘(ii) implements a mechanism to ensure that each patient receives a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional; orCommentsClose CommentsPermalink
‘(B) a health care provider if such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.CommentsClose CommentsPermalink
‘(2) EXCEPTIONS- The Secretary may establish reasonable exceptions to the requirements described in paragraph (1).CommentsClose CommentsPermalink
‘(3) ADJUSTMENT- The Secretary may by regulation adjust the number of beds described in paragraph (1)(A).CommentsClose CommentsPermalink
‘(q) Continued Applicability of Mental Health Parity- Section 2716 shall apply to qualified health plans in the same manner and to the same extent as such section applies to health insurance issuers and group health plans.CommentsClose CommentsPermalink
‘(r) Promotion of Informed Choice of Health Insurance Coverage-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall develop standards for use by health insurance issuers offering health insurance coverage through the Gateway in the individual or group market in compiling and providing to enrollees a summary of benefits explanation that accurately represents the benefits and coverage provided by the issuer under each of its applicable health insurance products. In developing such standards, the Secretary shall consult with the National Association of Insurance Commissioners, a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance issuers, health care professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.CommentsClose CommentsPermalink
‘(2) REQUIREMENTS- The standards for the summary of benefits explanation developed under paragraph (1) shall provide for the following:CommentsClose CommentsPermalink
‘(A) APPEARANCE- The standards shall ensure that the summary is presented in a uniform format.CommentsClose CommentsPermalink
‘(B) LANGUAGE- The standards shall ensure that the language used in the summary is presented in a manner determined to be understandable by the average health plan enrollee.CommentsClose CommentsPermalink
‘(C) CONTENTS- The standards shall ensure that the summary includes the following:CommentsClose CommentsPermalink
‘(i) Information determined to be essential to a consumer’s understanding of the applicable health insurance plan benefits.CommentsClose CommentsPermalink
‘(ii) Uniform definitions of standard insurance terms including premium, deductible, co-insurance, co-payment, out-of-pocket limit, preferred provider, non-preferred provider, out-of-network co-payments, usual, customary and reasonable fees, excluded services, grievance and appeals, prior authorization, precertification, and such other terms as determined by the Secretary so that consumers may compare health insurance coverage and understand the terms of coverage.CommentsClose CommentsPermalink
‘(iii) Uniform definitions of medical terms including hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing care, rehabilitation services, hospice services, emergency medical transportation, and such other terms as determined by the Secretary so that consumers may compare the medical benefits and understand the extent of those medical benefits (or exceptions to those benefits).CommentsClose CommentsPermalink
‘(iv) A statement of whether the plan meets minimum qualifying coverage (when effective under section 3103.)CommentsClose CommentsPermalink
‘(v) Examples to illustrate common benefits scenarios, including scenarios that illustrate the health care needs of pregnancy and of at least several serious or chronic medical conditions.CommentsClose CommentsPermalink
‘(vi) Illustrations that enhance consumer understanding of the explanation.CommentsClose CommentsPermalink
‘(3) REQUIREMENT TO PROVIDE- Not later than 12 months after the Secretary develops standards under paragraph (1), each health insurance issuer offering health insurance coverage through the Gateway shall, prior to any enrollment restriction, provide annually to enrollees and potential enrollees a summary of benefits explanation pursuant to the standards developed by the Secretary under paragraph (1)CommentsClose CommentsPermalink
‘(4) PREEMPTION- The standards developed under paragraph (1) shall preempt any related State standards that require summary of benefits health plan explanations that provide less information to consumers, as determined by the Secretary.CommentsClose CommentsPermalink
‘(5) FAILURE TO PROVIDE- A health insurance issuer that willfully fails to provide the information required under this subsection shall be subject to a fine of not more than $1,000 for each such failure. Such failure with respect to each enrollee shall constitute a separate offense for purposes of this paragraph.CommentsClose CommentsPermalink
‘(6) APPLICATION- The provisions of this subsection shall apply to health insurance coverage offered through the Gateway. The Secretary shall evaluate the impact on consumers of expanding the application of the provisions of this subsection to additional health insurance issuers.CommentsClose CommentsPermalink
‘(s) Disclosure of Information-CommentsClose CommentsPermalink
‘(1) IN GENERAL- In connection with the offering of any health insurance coverage in the individual or group market through a Gateway, a health insurance issuer--CommentsClose CommentsPermalink
‘(A) shall disclose to such individual or employer as part of its solicitation and sales materials, the information described in paragraph (2);CommentsClose CommentsPermalink
‘(B) shall disclose to such individual or employer enrolled in such plan any change and an explanation of such change with respect to the information described in paragraph (2) with reasonable and timely advance notice with respect to such change;CommentsClose CommentsPermalink
‘(C) upon the request of such individual or employer, shall provide the information described in paragraph (2); andCommentsClose CommentsPermalink
‘(D) shall disclose such information as the Secretary may require in order to ensure compliance with consumer protection provisions under this title.CommentsClose CommentsPermalink
‘(2) INFORMATION DESCRIBED-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Subject to subparagraph (C), with respect to a health insurance issuer offering health insurance coverage in the individual or group market through a Gateway, information disclosed under this paragraph shall include--CommentsClose CommentsPermalink
‘(i) the provisions of such coverage concerning the issuer’s right to change premium rates, co-payments, in- and out-of-provider networks, or any other information as determined by the Secretary; andCommentsClose CommentsPermalink
‘(ii) the benefits and premiums available under all health insurance coverage for which an individual or employers is qualified.CommentsClose CommentsPermalink
‘(B) FORM OF INFORMATION- Information shall be provided under this paragraph in a manner determined to be understandable by the average employer or individual and shall be sufficient to reasonably inform such employer or individual of their rights and obligations under the health insurance coverage involved.CommentsClose CommentsPermalink
‘(C) EXCEPTION- Information described under this paragraph shall not include information that is proprietary or trade secret information.CommentsClose CommentsPermalink
‘SEC. 3102. FINANCIAL INTEGRITY.
‘(a) Accounting for Expenditures-CommentsClose CommentsPermalink
‘(1) IN GENERAL- A Gateway shall keep an accurate accounting of all activities, receipts, and expenditures and shall annually submit to the Secretary a report concerning such accountings.CommentsClose CommentsPermalink
‘(2) INVESTIGATIONS- The Secretary may investigate the affairs of a Gateway, may examine the properties and records of a Gateway, and may require periodical reports in relation to activities undertaken by a Gateway. A Gateway shall fully cooperate in any investigation conducted under this paragraph.CommentsClose CommentsPermalink
‘(3) AUDITS- A Gateway shall be subject to annual audits by the Secretary.CommentsClose CommentsPermalink
‘(4) PATTERN OF ABUSE- If the Secretary determines that a Gateway or a State has engaged in serious misconduct with respect to compliance with the requirements of, or carrying out activities required under, this title, the Secretary may rescind from payments otherwise due to such State involved under this or any other Act administered by the Secretary an amount not to exceed 1 percent of such payments per year until corrective actions are taken by the State that are determined to be adequate by the Secretary.CommentsClose CommentsPermalink
‘(5) PROTECTIONS AGAINST FRAUD AND ABUSE- With respect to activities carried out under this title, the Secretary shall provide for the efficient and non-discriminatory administration of Gateway activities and implement any measure or procedure that--CommentsClose CommentsPermalink
‘(A) the Secretary determines is appropriate to reduce fraud and abuse in the administration of this title; andCommentsClose CommentsPermalink
‘(B) the Secretary has authority to implement under this title or any other Act;CommentsClose CommentsPermalink
‘(6) APPLICATION OF THE FALSE CLAIMS ACT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Payments made by, through, or in connection with a Gateway are subject to the False Claims Act (
31 U.S.C. 3729 et seq.) if those payments include any Federal funds. Compliance with the requirements of this Act concerning eligibility for a health insurance issuer to participate in the Gateway shall be a material condition of an issuer’s entitlement to receive payments, including subsidy payments, through the Gateway.CommentsClose CommentsPermalink‘(B) DAMAGES- Notwithstanding paragraph (1) of
section 3729(a) of title 31, United States Code , and subject to paragraph (2) of such section, the civil penalty assessed under the False Claims Act on any person found liable under such Act as described in subparagraph (A) shall be increased by not less than 3 times and not more than 6 times the amount of damages which the Government sustains because of the act of that person.CommentsClose CommentsPermalink‘(b) GAO Oversight- Not later than 5 years after the date of enactment of this section, the Comptroller General shall conduct an ongoing study of Gateway activities and the enrollees in qualified health plans offered through Gateways. Such study shall review--CommentsClose CommentsPermalink
‘(1) the operations and administration of Gateways, including surveys and reports of qualified health plans offered through Gateways and on the experience of such plans (including data on enrollees in Gateways and individuals purchasing health insurance coverage outside of Gateways), the expenses of Gateways, claims statistics relating to qualified health plans, complaints data relating to such plans, and the manner in which Gateways meets their goals;CommentsClose CommentsPermalink
‘(2) any significant observations regarding the utilization and adoption of Gateways;CommentsClose CommentsPermalink
‘(3) where appropriate, recommendations for improvements in the operations or policies of Gateways; andCommentsClose CommentsPermalink
‘(4) how many physicians, by area and specialty, are not taking or accepting new patients enrolled in Federal Government health care programs, and the adequacy of provider networks of Federal Government health care programs.CommentsClose CommentsPermalink
‘SEC. 3103. PROGRAM DESIGN.
‘(a) Program Design-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall establish the following:CommentsClose CommentsPermalink
‘(A) Subject to paragraph (2), the essential health care benefits eligible for credits under section 3111, where such benefits shall include at least the following general categories:CommentsClose CommentsPermalink
‘(i) Ambulatory patient services.CommentsClose CommentsPermalink
‘(ii) Emergency services.CommentsClose CommentsPermalink
‘(iii) Hospitalization.CommentsClose CommentsPermalink
‘(iv) Maternity and newborn care.CommentsClose CommentsPermalink
‘(v) Mental health and substance abuse services.CommentsClose CommentsPermalink
‘(vi) Prescription drugs.CommentsClose CommentsPermalink
‘(vii) Rehabilitative and habilitative services and devices.CommentsClose CommentsPermalink
‘(viii) Laboratory services.CommentsClose CommentsPermalink
‘(ix) Preventive and wellness services.CommentsClose CommentsPermalink
‘(x) Pediatric services, including oral and vision care.CommentsClose CommentsPermalink
‘(B) The criteria that coverage must meet to be considered minimum qualifying coverage.CommentsClose CommentsPermalink
‘(C) The conditions under which coverage shall be considered affordable and available coverage for individuals and families at different income levels.CommentsClose CommentsPermalink
‘(D) The essential benefits provided for in subparagraph (A) shall include a requirement that there be non-discrimination in health care in a manner that, with respect to an individual who is eligible for medical or surgical care under a qualified health plan offered through a Gateway, prohibits the Administrator of the Gateway, or a qualified health plan offered through the Gateway, from denying such individual benefits for religious or spiritual health care, except that such religious or spiritual health care shall be an expense eligible for deduction as a medical care expense as determined by Internal Revenue Service Rulings interpreting section 213(d) of the Internal Revenue Code of 1986 as of January 1, 2009.CommentsClose CommentsPermalink
‘(2) LIMITATION- The Secretary shall ensure that the scope of the essential health benefits under paragraph (1)(A) is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary.CommentsClose CommentsPermalink
‘(3) CERTIFICATION- In establishing the essential health benefits described in paragraph (1)(A), the Secretary shall submit a report to the appropriate committees of Congress containing a certification from the Chief Actuary of the Centers for Medicare & Medicaid Services that such essential health benefits meet the limitation described in paragraph (2).CommentsClose CommentsPermalink
‘(b) National Independent Commission on Essential Health Care Benefits-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT- There is established a temporary advisory commission to be known as the National Independent Commission on Essential Health Care Benefits (in this section referred to as the ‘Commission’).CommentsClose CommentsPermalink
‘(2) DUTIES- The Commission shall:CommentsClose CommentsPermalink
‘(A) Review and analyze the benefits offered under typical employer-sponsored health plans, and State laws requiring coverage of specified items and services in the individual and group insurance markets.CommentsClose CommentsPermalink
‘(B) Hold public hearings, meetings, or other public listening sessions not less than 3 times to take testimony and receive such evidence as the Commission considers advisable to carry out activities under this section.CommentsClose CommentsPermalink
‘(C) Make recommendations to the Secretary regarding the specific items and services that should be included in the essential heath care benefits package eligible for credits under section 3111.CommentsClose CommentsPermalink
‘(3) CONSIDERATIONS- The Commission shall consider--CommentsClose CommentsPermalink
‘(A) the clinical appropriateness and effectiveness of the benefits covered;CommentsClose CommentsPermalink
‘(B) the affordability of the benefits covered;CommentsClose CommentsPermalink
‘(C) the financial protection of enrollees against high healthcare expenses;CommentsClose CommentsPermalink
‘(D) access to necessary healthcare services, including primary and preventive health services;CommentsClose CommentsPermalink
‘(E) existing State laws that require coverage of health care items or services in the individual and group markets; andCommentsClose CommentsPermalink
‘(F) the potential of additional or expanded benefits to increase costs and the interactions between the addition or expansion of benefits and reductions in existing benefits to meet the actuarial limitations described in subsection (a)(2).CommentsClose CommentsPermalink
‘(4) MEMBERSHIP-CommentsClose CommentsPermalink
‘(A) NUMBER AND APPOINTMENT- The Commission shall be composed of 17 members to be appointed by the Secretary.CommentsClose CommentsPermalink
‘(B) QUALIFICATIONS-CommentsClose CommentsPermalink
‘(i) IN GENERAL- The membership of the Commission shall include individuals with national recognition for their expertise in clinical medicine, primary and preventive health care, integrative medicine, and actuarial science and health plan benefit design.CommentsClose CommentsPermalink
‘(ii) INCLUSION- The membership of the Commission shall include an expert in actuarial science and health plan benefit design, a health care provider, a patient or consumer advocate, a representative of labor organizations representing workers, an employer, a third-party payer, a health services researcher, an individual skilled in the conduct and interpretation of the biomedical and health sciences, an individual with expertise in pediatric health care, and an individual with expertise in outcomes and effectiveness research and technology assessment.CommentsClose CommentsPermalink
‘(C) CHAIRMAN- The Secretary shall designate a member of the Commission who is an expert in actuarial science and health plan benefit design, at the time of appointment of such member, as Chairman.CommentsClose CommentsPermalink
‘(D) MEETINGS- The Commission shall meet at the call of the Chairman. Advance notice of such meetings shall be published in the Federal Register and the meetings shall be open to the public.CommentsClose CommentsPermalink
‘(E) ETHICAL DISCLOSURES- The Secretary shall establish a system for public disclosure by members of the Commission of financial and other potential conflicts of interest relating to such members.CommentsClose CommentsPermalink
‘(F) DEADLINE FOR APPOINTMENT- Members of the Commission shall be appointed by not later than 45 days after the date of enactment of this title.CommentsClose CommentsPermalink
‘(G) TERMS OF APPOINTMENT- The term of any appointment under subparagraph (A) to the Commission shall be for the life of the Commission.CommentsClose CommentsPermalink
‘(H) COMPENSATION- Members of the Commission shall receive no additional pay, allowances, or benefits by reason of their service on the Commission.CommentsClose CommentsPermalink
‘(I) EXPENSES- Each member of the Commission shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code.CommentsClose CommentsPermalink
‘(5) STAFF AND SUPPORT SERVICES-CommentsClose CommentsPermalink
‘(A) EXECUTIVE DIRECTOR-CommentsClose CommentsPermalink
‘(i) APPOINTMENT- The Secretary shall appoint an executive director of the Commission.CommentsClose CommentsPermalink
‘(ii) COMPENSATION- The executive director of the Commission shall be paid the rate of basic pay for level V of the Executive Schedule.CommentsClose CommentsPermalink
‘(iii) STAFF- With the approval of the Commission, the executive director may appoint such personnel as the executive director considers appropriate.CommentsClose CommentsPermalink
‘(iv) APPLICABILITY OF CIVIL SERVICE LAWS- The staff of the Commission shall be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and shall be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of such title (relating to classification and General Schedule pay rates).CommentsClose CommentsPermalink
‘(v) EXPERTS AND CONSULTANTS- With the approval of the Commission, the executive director may procure temporary and intermittent services under
section 3109(b) of title 5, United States Code .CommentsClose CommentsPermalink‘(6) POWERS-CommentsClose CommentsPermalink
‘(A) COST ESTIMATES BY OFFICE OF MANAGEMENT AND BUDGET AND OFFICE OF THE CHIEF ACTUARY OF THE CENTERS FOR MEDICARE & MEDICARE SERVICES- The Director of the Office of Management and Budget or the Chief Actuary of the Centers for Medicare & Medicaid Services, or both, shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties under this section.CommentsClose CommentsPermalink
‘(B) TECHNICAL ASSISTANCE- Upon the request of the Commission, the head of a Federal agency or its representatives, including representatives of the Office of Personnel Management, shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties under this section.CommentsClose CommentsPermalink
‘(C) OBTAINING INFORMATION- The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under
section 552 of title 5, United States Code .CommentsClose CommentsPermalink‘(D) PUBLIC INPUT- The Commission shall adopt procedures allowing any interested party to submit information for the Commission’s use in making reports and recommendations.CommentsClose CommentsPermalink
‘(7) REPORT- Not later than 6 months after the date of enactment of this title, the Commission shall submit a report to the Secretary and Congress which shall contain a detailed statement of only those recommendations, findings, and conclusions of the Commission that receive the approval of at least 12 members of the Commission. The Secretary shall provide for publication in the Federal Register and the posting on an appropriate Internet website of the report and recommendations of the Commission.CommentsClose CommentsPermalink
‘(8) TERMINATION- The Commission shall terminate on the date that is 30 days after the date on which the report is submitted under subsection (7).CommentsClose CommentsPermalink
‘(9) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to carry out this subsection, $1,500,000.CommentsClose CommentsPermalink
‘(c) Required Elements for Consideration-CommentsClose CommentsPermalink
‘(1) ESSENTIAL HEALTH CARE BENEFITS- In establishing the essential health benefits under subsection (a)(1)(A), the Secretary shall--CommentsClose CommentsPermalink
‘(A) consider the report and recommendations of the Commission established under subsection (b);CommentsClose CommentsPermalink
‘(B) ensure that such essential health benefits reflect an appropriate balance among the categories described in such subsection, so that benefits are not unduly weighted toward any category;CommentsClose CommentsPermalink
‘(C) not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life;CommentsClose CommentsPermalink
‘(D) take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups;CommentsClose CommentsPermalink
‘(E) ensure that health benefits established as essential not be subject to denial to individuals against their wishes on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree of medical dependency, or quality of life; andCommentsClose CommentsPermalink
‘(F) review the essential health benefits under subsection (a)(1)(A) not less than annually, and provide a report to Congress and the public that contains--CommentsClose CommentsPermalink
‘(i) an assessment of whether enrollees are facing any difficulty accessing needed services for reasons of coverage or cost;CommentsClose CommentsPermalink
‘(ii) an assessment of whether the essential benefits package needs to be modified or updated to account for changes in medical evidence or scientific advancement;CommentsClose CommentsPermalink
‘(iii) information on how the benefit package will be modified to address any such gaps in access or changes in the evidence base; andCommentsClose CommentsPermalink
‘(iv) an assessment of the potential of additional or expanded benefits to increase costs and the interactions between the addition or expansion of benefits and reductions in existing benefits to meet actuarial limitations described in subsection (a)(2).CommentsClose CommentsPermalink
‘(2) MINIMUM QUALIFYING COVERAGE- In establishing the criteria described in subsection (a)(1)(B), the Secretary--CommentsClose CommentsPermalink
‘(A) shall--CommentsClose CommentsPermalink
‘(i) exclude from meeting such criteria any coverage that--CommentsClose CommentsPermalink
‘(I) provides reimbursement for the treatment or mitigation of--CommentsClose CommentsPermalink
‘(aa) a single disease or condition; orCommentsClose CommentsPermalink
‘(bb) an unreasonably limited set of diseases or conditions; orCommentsClose CommentsPermalink
‘(II) has an out of pocket limit that exceeds the amount described in section 223(c)(2) of the Internal Revenue Code of 1986 for the year involved; andCommentsClose CommentsPermalink
‘(ii) establish such criteria (taking into account the requirements established under clause (i)) in a manner that results in the least practicable disruption of the health care marketplace, consistent with the goals and activities under this title; andCommentsClose CommentsPermalink
‘(B) may provide for the application of different criteria (except with respect to the limitation described in subparagraph (A)(i)(II)) with respect to young adults.CommentsClose CommentsPermalink
‘(3) AFFORDABLE COVERAGE- The Secretary shall establish a standard under which coverage is defined to be unaffordable only if the premium paid by the individual is greater than 12.5 percent of the adjusted gross income of the individual involved. Beginning with calendar years after 2013, the Secretary shall adjust the percentage described in this paragraph by an amount that is equal to the percentage increase or decrease in the medical care component of the Consumer Price Index for all urban consumers (U.S. city average) during the preceding calendar year.CommentsClose CommentsPermalink
‘SEC. 3104. ALLOWING STATE FLEXIBILITY.
‘(a) Optional State Establishment of Gateway- During the 4-year period following the date of enactment of this section, a State may--CommentsClose CommentsPermalink
‘(1)(A) establish a Gateway;CommentsClose CommentsPermalink
‘(B) adopt the insurance reform provisions as provided for in subtitle A of title I of the Affordable Health Choices Act (and the amendments made by such title); andCommentsClose CommentsPermalink
‘(C) agree to make employers that are State or local governments subject to sections 162 and 163 of the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(2)(A) request that the Secretary operate (for a minimum period of 5 years) a Gateway in such State;CommentsClose CommentsPermalink
‘(B) adopt the insurance reform provisions as provided for in subtitle A of title I of the Affordable Health Choices Act (and the amendments made by such subtitle); andCommentsClose CommentsPermalink
‘(C) agree to make employers that are State or local governments subject to sections 162 and 163 of the Affordable Health Choices Act; orCommentsClose CommentsPermalink
‘(3) elect not to take the actions described in paragraph (1) or (2).CommentsClose CommentsPermalink
‘(b) Establishing States-CommentsClose CommentsPermalink
‘(1) IN GENERAL- If the Secretary determines that a State has taken the actions described in subsection (a)(1), any resident of that State who is an eligible individual shall be eligible for credits under section 3111 beginning on the date that is 60 days after the date of such determination.CommentsClose CommentsPermalink
‘(2) CONTINUED REVIEW- The Secretary shall establish procedures to ensure continued review by the Secretary of the compliance of a State with the requirements of subsection (a). If the Secretary determines that a State has failed to maintain compliance with such requirements, the Secretary may revoke the determination under paragraph (1).CommentsClose CommentsPermalink
‘(3) DEEMING- A State that is the subject of a positive determination by the Secretary under paragraph (1) (unless such determination is revoked under paragraph (2)) shall be deemed to be an ‘establishing State’ beginning on the date that is 60 days after the date of such determination.CommentsClose CommentsPermalink
‘(c) Request for the Secretary to Establish a Gateway-CommentsClose CommentsPermalink
‘(1) IN GENERAL- In the case of a State that makes the request described in subsection (a)(2), the Secretary shall determine whether the State has enacted and has in effect the insurance reforms provided for in subtitle A of title I of the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(2) OPERATION OF GATEWAY-CommentsClose CommentsPermalink
‘(A) POSITIVE DETERMINATION- If the Secretary determines that the State has enacted and has in effect the insurance reforms described in paragraph (1), the Secretary shall establish a Gateway in such State as soon as practicable after making such determination.CommentsClose CommentsPermalink
‘(B) NEGATIVE DETERMINATION- If the Secretary determines that the State has not enacted or does not have in effect the insurance reforms described in paragraph (1), the Secretary shall establish a Gateway in such State as soon as practicable after the Secretary determines that such State has enacted and has in effect such reforms.CommentsClose CommentsPermalink
‘(3) PARTICIPATING STATE- The State shall be deemed to be a ‘participating State’ on the date on which the Gateway established by the Secretary is in effect in such State.CommentsClose CommentsPermalink
‘(4) ELIGIBILITY- Any resident of a State described in paragraph (3) who is an eligible individual shall be eligible for credits under section 3111 beginning on the date that is 60 days after the date on which such Gateway is established in such State.CommentsClose CommentsPermalink
‘(d) Federal Fallback in the Case of States That Refuse to Improve Health Care Coverage-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Upon the expiration of the 4-year period following the date of enactment of this section, in the case of a State that is not otherwise a participating State or an establishing State--CommentsClose CommentsPermalink
‘(A) the Secretary shall establish and operate a Gateway in such State;CommentsClose CommentsPermalink
‘(B) the insurance reform provisions provided for in subtitle A of title I of the Affordable Health Choices Act shall become effective in such State, notwithstanding any contrary provision of State law;CommentsClose CommentsPermalink
‘(C) the State shall be deemed to be a ‘participating State’; andCommentsClose CommentsPermalink
‘(D) the residents of that State who are eligible individuals shall be eligible for credits under section 3111 beginning on the date that is 60 days after the date on which such Gateway is established, if the State agrees to make employers that are State or local governments subject to sections 162 and 163 of the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(2) ELIGIBILITY OF INDIVIDUALS FOR CREDITS- With respect to a State that makes the election described in subsection (a)(3), the residents of such State shall not be eligible for credits under section 3111 until such State becomes a participating State under paragraph (1).CommentsClose CommentsPermalink
‘SEC. 3105. NAVIGATORS.
‘(a) In General- The Secretary shall award grants to establishing or participating States to enable such States (or the Gateways operating in such States) to enter into agreements with private and public entities under which such entities will serve as navigators in accordance with this section.CommentsClose CommentsPermalink
‘(b) Eligibility-CommentsClose CommentsPermalink
‘(1) IN GENERAL- To be eligible to enter into an agreement under subsection (a), an entity shall demonstrate that the entity has existing relationships with, or could readily establish relationships with, employers and employees, consumers (including the uninsured and the underinsured), or self-employed individuals, likely to be qualified to enroll in a qualified health plan.CommentsClose CommentsPermalink
‘(2) TYPES- Entities described in paragraph (1) may include trade, industry and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, small business development centers, other licensed insurance agents and brokers, and other entities that the Secretary determines to be capable of carrying out the duties described in subsection (c).CommentsClose CommentsPermalink
‘(c) Duties- An entity that serves as a navigator under an agreement under subsection (a) shall--CommentsClose CommentsPermalink
‘(1) conduct public education activities to raise awareness of the program under this title;CommentsClose CommentsPermalink
‘(2) distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of credits under section 3111;CommentsClose CommentsPermalink
‘(3) facilitate enrollment in a qualified health plan;CommentsClose CommentsPermalink
‘(4) provide referrals to the appropriate State agency or agencies for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; andCommentsClose CommentsPermalink
‘(5) provide information in a manner determined by the Secretary to be culturally and linguistically appropriate to the needs of the population served by the Gateway.CommentsClose CommentsPermalink
‘(d) Standards-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall establish standards for navigators under this section, including provisions to ensure that any private or public entity that is selected as a navigator is qualified, and licensed if appropriate, to engage in the navigator activities described in this section and to avoid conflicts of interest. Under such standards, a navigator shall not--CommentsClose CommentsPermalink
‘(A) be a health insurance issuer; orCommentsClose CommentsPermalink
‘(B) receive any consideration directly or indirectly from any health insurance issuer in connection with the participation of any employer in the program under this title or the enrollment of any qualified individual or qualified employer in a qualified health plan.CommentsClose CommentsPermalink
‘(2) FAIR AND IMPARTIAL INFORMATION AND SERVICES- The Secretary, in collaboration with States, shall develop guidelines regarding the duties described in subsection (c).CommentsClose CommentsPermalink
‘SEC. 3106. COMMUNITY HEALTH INSURANCE OPTION.
‘(a) Voluntary Nature-CommentsClose CommentsPermalink
‘(1) NO REQUIREMENT FOR HEALTH CARE PROVIDERS TO PARTICIPATE- Nothing in this section shall be construed to require a health care provider to participate in a community health insurance option, or to impose any penalty for non-participation.CommentsClose CommentsPermalink
‘(2) NO REQUIREMENT FOR INDIVIDUALS TO JOIN- Nothing in this section shall be construed to require an individual to participate in a community health insurance option, or to impose any penalty for non-participation.CommentsClose CommentsPermalink
‘(b) Establishment of Community Health Insurance Option-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT- The Secretary shall establish a community health insurance option to offer, through each Gateway established under this title, health care coverage that provides value, choice, competition, and stability of affordable, high quality coverage throughout the United States.CommentsClose CommentsPermalink
‘(2) COMMUNITY HEALTH INSURANCE OPTION- In this section, the term ‘community health insurance option’ means health insurance coverage that--CommentsClose CommentsPermalink
‘(A) except as specifically provided for in this section, complies with the requirements for being a qualified health plan;CommentsClose CommentsPermalink
‘(B) provides high value for the premium charged;CommentsClose CommentsPermalink
‘(C) reduces administrative costs and promotes administrative simplification for beneficiaries;CommentsClose CommentsPermalink
‘(D) promotes high quality clinical care;CommentsClose CommentsPermalink
‘(E) provides high quality customer service to beneficiaries;CommentsClose CommentsPermalink
‘(F) offers a wide choice of providers; andCommentsClose CommentsPermalink
‘(G) complies with State laws (if any), except as otherwise provided for in this title, relating to--CommentsClose CommentsPermalink
‘(i) guaranteed renewal;CommentsClose CommentsPermalink
‘(ii) rating;CommentsClose CommentsPermalink
‘(iii) preexisting conditions;CommentsClose CommentsPermalink
‘(iv) non-discrimination;CommentsClose CommentsPermalink
‘(v) quality improvement and reporting;CommentsClose CommentsPermalink
‘(vi) fraud and abuse;CommentsClose CommentsPermalink
‘(vii) solvency and financial requirements;CommentsClose CommentsPermalink
‘(viii) market conduct;CommentsClose CommentsPermalink
‘(ix) prompt payment;CommentsClose CommentsPermalink
‘(x) appeals and grievances;CommentsClose CommentsPermalink
‘(xi) privacy and confidentiality;CommentsClose CommentsPermalink
‘(xii) licensure; andCommentsClose CommentsPermalink
‘(xiii) benefit plan material or information.CommentsClose CommentsPermalink
‘(3) ESSENTIAL HEALTH BENEFITS-CommentsClose CommentsPermalink
‘(A) GENERAL RULE- Except as provided in subparagraph (B), a community health insurance option offered under this section shall provide coverage only for the essential health benefits described in section 3103.CommentsClose CommentsPermalink
‘(B) STATES MAY OFFER ADDITIONAL BENEFITS- A State may require that a community health insurance option offered in such State offer benefits in addition to the essential health benefits required under subparagraph (A).CommentsClose CommentsPermalink
‘(C) CREDITS-CommentsClose CommentsPermalink
‘(i) IN GENERAL- An individual enrolled in a community health insurance option under this section shall be eligible for credits under section 3111 in the same manner as an individual who is enrolled in a qualified health plan.CommentsClose CommentsPermalink
‘(ii) NO ADDITIONAL FEDERAL COST- A requirement by a State under subparagraph (B) that a community health insurance option cover benefits in addition to the essential health benefits required under subparagraph (A) shall not affect the amount of a credit provided under section 3111 with respect to such plan.CommentsClose CommentsPermalink
‘(D) STATE MUST ASSUME COST- A State shall make payments to or on behalf of an eligible individual to defray the cost of any additional benefits described in subparagraph (B).CommentsClose CommentsPermalink
‘(E) ENSURING ACCESS TO ALL SERVICES- Nothing in this Act shall prohibit an individual enrolled in a community health insurance option from paying out-of-pocket the full cost of any item or service not included as an essential health benefit or otherwise covered as a benefit by a health plan. Nothing in this Act shall prohibit any type of medical provider from accepting an out-of-pocket payment from an individual enrolled in a community health insurance option for a service otherwise not included as an essential health benefit.CommentsClose CommentsPermalink
‘(F) PROTECTING ACCESS TO END OF LIFE CARE- A community health insurance option offered under this section shall be prohibited from limiting access to end of life care.CommentsClose CommentsPermalink
‘(4) COST SHARING- A community health insurance option shall offer coverage at each of the cost sharing tiers described in section 3111(a).CommentsClose CommentsPermalink
‘(5) PREMIUMS-CommentsClose CommentsPermalink
‘(A) PREMIUMS SUFFICIENT TO COVER COSTS- The Secretary shall set premium rates in an amount sufficient to cover expected costs (including claims and administrative costs) using methods in general use by qualified health plans.CommentsClose CommentsPermalink
‘(B) APPLICABLE RULES- The provisions of title XXVII relating to premiums shall apply to community health insurance options under this section, including modified community rating provisions under section 2701.CommentsClose CommentsPermalink
‘(C) COLLECTION OF DATA- The Secretary shall collect data as necessary to set premium rates under subparagraph (A).CommentsClose CommentsPermalink
‘(D) CONTINGENCY MARGIN- In establishing premium rates under subparagraph (A), the Secretary shall include an appropriate amount for a contingency margin.CommentsClose CommentsPermalink
‘(6) REIMBURSEMENT RATES-CommentsClose CommentsPermalink
‘(A) NEGOTIATED RATES- The Secretary shall negotiate rates for the reimbursement of health care providers for benefits covered under a community health insurance option.CommentsClose CommentsPermalink
‘(B) LIMITATION- The rates described in subparagraph (A) shall not be higher, in aggregate, than the average reimbursement rates paid by health insurance issuers offering qualified health plans through the Gateway.CommentsClose CommentsPermalink
‘(C) INNOVATION- Subject to the limits contained in subparagraph (A), a State Advisory Council established or designated under subsection (d) may develop or encourage the use of innovative payment policies that promote quality, efficiency and savings to consumers.CommentsClose CommentsPermalink
‘(D) PHYSICIAN NEGOTIATED RATES- Nothing in this paragraph shall prohibit the application of a State law that permits physicians to jointly negotiate with health plans. In such State, physicians may jointly negotiate with a community health insurance option concerning rates paid by the option.CommentsClose CommentsPermalink
‘(7) SOLVENCY AND CONSUMER PROTECTION-CommentsClose CommentsPermalink
‘(A) SOLVENCY- The Secretary shall establish a Federal solvency standard to be applied with respect to a community health insurance option. A community health insurance option shall also be subject to the solvency standard of each State in which such community health insurance option is offered.CommentsClose CommentsPermalink
‘(B) MINIMUM REQUIRED- In establishing the standard described under subparagraph (A), the Secretary shall require a reserve fund that shall be equal to at least the dollar value of the incurred but not reported claims of a community health insurance option.CommentsClose CommentsPermalink
‘(C) CONSUMER PROTECTIONS- The consumer protection laws of a State shall apply to a community health insurance option.CommentsClose CommentsPermalink
‘(8) REQUIREMENTS ESTABLISHED IN PARTNERSHIP WITH INSURANCE COMMISSIONERS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary, in collaboration with the National Association of Insurance Commissioners (in this paragraph referred to as the ‘NAIC’), may promulgate regulations to establish additional requirements for a community health insurance option.CommentsClose CommentsPermalink
‘(B) APPLICABILITY- Any requirement promulgated under subparagraph (A) shall be applicable to such option beginning 90 days after the date on which the regulation involved becomes final.CommentsClose CommentsPermalink
‘(9) OMBUDSMAN- In establishing community health insurance options, the Secretary shall establish an ombudsman or similar mechanism to provide assistance to consumers with respect to disputes, grievances, or appeals.CommentsClose CommentsPermalink
‘(c) Start-up Fund-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT OF FUND-CommentsClose CommentsPermalink
‘(A) IN GENERAL- There is established in the Treasury of the United States a trust fund to be known as the ‘Health Benefit Plan Start-Up Fund’ (referred to in this section as the ‘Start-Up Fund’), that shall consist of such amounts as may be appropriated or credited to the Start-Up Fund as provided for in this subsection to provide loans for the initial operations of a community health insurance option. Such amounts shall remain available until expended.CommentsClose CommentsPermalink
‘(B) FUNDING- There is hereby appropriated to the Start-Up Fund, out of any moneys in the Treasury not otherwise appropriated an amount requested by the Secretary of Health and Human Services as necessary to--CommentsClose CommentsPermalink
‘(i) pay the start-up costs associated with the initial operations of a community health insurance option;CommentsClose CommentsPermalink
‘(ii) pay the costs of making payments on claims submitted during the period that is not more than 90 days from the date on which such option is offered; andCommentsClose CommentsPermalink
‘(iii) make payments under paragraph (3).CommentsClose CommentsPermalink
‘(2) USE OF START-UP FUND- The Secretary shall use amounts contained in the Start-Up Fund to make payments (subject to the repayment requirements in paragraph (5)) for the purposes described in paragraph (1)(B).CommentsClose CommentsPermalink
‘(3) RISK CORRIDOR PAYMENTS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- In any case in which the Secretary has entered into a contract with a contracting administrator, the Secretary shall use amounts contained in the Start-Up Fund to make risk corridor payments to such administrator during the 2-year period beginning on the date on which such administrator enters into a contract under subsection (e). Such payments shall be based on the risk corridors in effect during fiscal years 2006 and 2007 for making payments under section 1860D-15(e) of the Social Security Act.CommentsClose CommentsPermalink
‘(B) SUBSEQUENT YEAR- In years after the expiration of the period referred to in subparagraph (A), the Secretary may extend or increase the risk corridors and payments provided for under subparagraph (A).CommentsClose CommentsPermalink
‘(C) AMOUNT USED TO REDUCE COSTS- The Secretary shall deposit any payments received from a contracting administrator under subparagraph (A) into the Start-Up Fund.CommentsClose CommentsPermalink
‘(4) PASS THROUGH OF REBATES- The Secretary may establish procedures for reducing the amount of payments to a contracting administrator to take into account any rebates or price concessions.CommentsClose CommentsPermalink
‘(5) REPAYMENT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- A community health insurance option shall be required to repay the Secretary of the Treasury (on such terms as the Secretary may require) for any payments made under paragraph (1)(B) by the date that is not later than 10 years after the date on which the payment is made. The Secretary may require the payment of interest with respect to such repayments at rates that do not exceed the market interest rate (as determined by the Secretary).CommentsClose CommentsPermalink
‘(B) SANCTIONS IN CASE OF FOR-PROFIT CONVERSION- In any case in which the Secretary enters into a contract with a qualified entity for the offering of a community health insurance option and such entity is determined to be a for-profit entity by the Secretary, such entity shall be--CommentsClose CommentsPermalink
‘(i) immediately liable to the Secretary for any payments received by such entity from the Start-Up Fund; andCommentsClose CommentsPermalink
‘(ii) permanently ineligible to offer a qualified health plan.CommentsClose CommentsPermalink
‘(d) State Advisory Council-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT- A State shall establish or designate a public or non-profit private entity to serve as the State Advisory Council to provide recommendations to the Secretary on the operations and policies of a community health insurance option in the State. Such Council shall provide recommendations on at least the following:CommentsClose CommentsPermalink
‘(A) policies and procedures to integrate quality improvement and cost containment mechanisms into the health care delivery system;CommentsClose CommentsPermalink
‘(B) mechanisms to facilitate public awareness of the availability of a community health insurance option; andCommentsClose CommentsPermalink
‘(C) alternative payment structures under a community health insurance option for health care providers that encourage quality improvement and cost control.CommentsClose CommentsPermalink
‘(2) MEMBERS- The members of the State Advisory Council shall be representatives of the public and shall include educated health care consumers and providers.CommentsClose CommentsPermalink
‘(3) APPLICABILITY OF RECOMMENDATIONS- The Secretary may apply the recommendations of a State Advisory Council to a community health insurance option that State, in any other State, or in all States.CommentsClose CommentsPermalink
‘(e) Authority to Contract; Terms of Contract-CommentsClose CommentsPermalink
‘(1) AUTHORITY-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary may enter into a contract or contracts with one or more qualified entities for the purpose of performing administrative functions (including functions described in subsection (a)(4) of section 1874A of the Social Security Act) with respect to a community health insurance option in the same manner as the Secretary may enter into contracts under subsection (a)(1) of such section. The Secretary shall have the same authority with respect to a community health insurance option under this section as the Secretary has under subsections (a)(1) and (b) of section 1874A of the Social Security Act with respect to title XVIII of such Act.CommentsClose CommentsPermalink
‘(B) REQUIREMENTS APPLY- If the Secretary enters into a contract with a qualified entity to offer a community health insurance option, under such contract such entity--CommentsClose CommentsPermalink
‘(i) shall meet the criteria established under paragraph (2); andCommentsClose CommentsPermalink
‘(ii) shall receive an administrative fee under paragraph (7).CommentsClose CommentsPermalink
‘(C) LIMITATION- Contracts under this subsection shall not involve the transfer of insurance risk to the contracting administrator.CommentsClose CommentsPermalink
‘(D) REFERENCE- An entity with which the Secretary has entered into a contract under this paragraph shall be referred to as a ‘contracting administrator’.CommentsClose CommentsPermalink
‘(2) QUALIFIED ENTITY- To be qualified to be selected by the Secretary to offer a community health insurance option, an entity shall--CommentsClose CommentsPermalink
‘(A) meet the criteria established under section 1874A(a)(2) of the Social Security Act;CommentsClose CommentsPermalink
‘(B) be a nonprofit entity for purposes of offering such option;CommentsClose CommentsPermalink
‘(C) meet the solvency standards applicable under subsection (b)(7);CommentsClose CommentsPermalink
‘(D) be eligible to offer health insurance or health benefits coverage;CommentsClose CommentsPermalink
‘(E) meet quality standards specified by the Secretary;CommentsClose CommentsPermalink
‘(F) have in place effective procedures to control fraud, abuse, and waste; andCommentsClose CommentsPermalink
‘(G) meet such other requirements as the Secretary may impose.CommentsClose CommentsPermalink
‘Procedures described under subparagraph (F) shall include the implementation of procedures to use beneficiary identifiers to identify individuals entitled to benefits so that such an individual’s social security account number is not used, and shall also include procedures for the use of technology (including front-end, prepayment intelligent data-matching technology similar to that used by hedge funds, investment funds, and banks) to provide real-time data analysis of claims for payment under this title to identify and investigate unusual billing or order practices under this title that could indicate fraud or abuse.CommentsClose CommentsPermalink
‘(3) TERM- A contract provided for under paragraph (1) shall be for a term of at least 5 years but not more than 10 years, as determined by the Secretary. At the end of each such term, the Secretary shall conduct a competitive bidding process for the purposes of renewing existing contracts or selecting new qualified entities with which to enter into contracts under such paragraph.CommentsClose CommentsPermalink
‘(4) LIMITATION- A contract may not be renewed under this subsection unless the Secretary determines that the contracting administrator has met performance requirements established by the Secretary in the areas described in paragraph (7)(B).CommentsClose CommentsPermalink
‘(5) AUDITS- The Inspector General shall conduct periodic audits with respect to contracting administrators under this subsection to ensure that the administrator involved is in compliance with this section.CommentsClose CommentsPermalink
‘(6) REVOCATION- A contract awarded under this subsection shall be revoked by the Secretary or the Inspector General only after notice to the contracting administrator involved and an opportunity for a hearing. The Secretary may revoke such contract if the Secretary determines that such administrator has engaged in fraud, deception, waste, abuse of power, negligence, mismanagement of taxpayer dollars, or gross mismanagement. An entity that has had a contract revoked under this paragraph shall not be qualified to enter into a subsequent contract under this subsection.CommentsClose CommentsPermalink
‘(7) FEE FOR ADMINISTRATION-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall pay the contracting administrator a fee for the management, administration, and delivery of the benefits under this section.CommentsClose CommentsPermalink
‘(B) REQUIREMENT FOR HIGH QUALITY ADMINISTRATION- The Secretary may increase the fee described in subparagraph (A) by not more than 10 percent, or reduce the fee described in subparagraph (A) by not more than 50 percent, based on the extent to which the contracting administrator, in the determination of the Secretary, meets performance requirements established by the Secretary, in at least the following areas:CommentsClose CommentsPermalink
‘(i) Maintaining low premium costs and low cost sharing requirements, provided that such requirements are consistent with section 3111(a).CommentsClose CommentsPermalink
‘(ii) Reducing administrative costs and promoting administrative simplification for beneficiaries.CommentsClose CommentsPermalink
‘(iii) Promoting high quality clinical care.CommentsClose CommentsPermalink
‘(iv) Providing high quality customer service to beneficiaries.CommentsClose CommentsPermalink
‘(C) NON-RENEWAL- The Secretary may not renew a contract to offer a community health insurance option under this section with any contracting entity that has been assessed more than one reduction under subparagraph (B) during the contract period.CommentsClose CommentsPermalink
‘(8) LIMITATION- Notwithstanding the terms of a contract under this subsection, the Secretary shall negotiate the reimbursement rates for purposes of subsection (b)(6).CommentsClose CommentsPermalink
‘(f) Report by HHS and Insolvency Warnings-CommentsClose CommentsPermalink
‘(1) IN GENERAL- On an annual basis, the Secretary shall conduct a study on the solvency of a community health insurance option and submit to Congress a report describing the results of such study.CommentsClose CommentsPermalink
‘(2) RESULT- If, in any year, the result of the study under paragraph (1) is that a community health insurance option is insolvent, such result shall be treated as a community health insurance option solvency warning.CommentsClose CommentsPermalink
‘(3) SUBMISSION OF PLAN AND PROCEDURE-CommentsClose CommentsPermalink
‘(A) IN GENERAL- If there is a community health insurance option solvency warning under paragraph (2) made in a year, the President shall submit to Congress, within the 15-day period beginning on the date of the budget submission to Congress under
section 1105(a) of title 31, United States Code , for the succeeding year, proposed legislation to respond to such warning.CommentsClose CommentsPermalink‘(B) PROCEDURE- In the case of a legislative proposal submitted by the President pursuant to subparagraph (A), such proposal shall be considered by Congress using the same procedures described under sections 803 and 804 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 that shall be used for a medicare funding warning.CommentsClose CommentsPermalink
‘(g) Marketing Parity- In a facility controlled by the Federal Government, or by a State, where marketing or promotional materials related to a community health insurance option are made available to the public, making available marketing or promotional materials relating to private health insurance plans shall not be prohibited. Such materials include informational pamphlets, guidebooks, enrollment forms, or other materials determined reasonable for display.CommentsClose CommentsPermalink
‘(h) Authorization of Appropriations- There is authorized to be appropriated, such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink
‘SEC. 3107. APPLICATION OF SAME LAWS TO PRIVATE PLANS AND THE COMMUNITY HEALTH INSURANCE OPTION.
‘(a) In General- Notwithstanding any other provision of law, any health insurance coverage offered by a private health insurance issuer shall not be subject to any Federal or State law described in subsection (b) if a community health insurance option under section 3106 is not subject to such law.CommentsClose CommentsPermalink
‘(b) Laws Described- The Federal and State laws described in this subsection are those Federal and State laws relating to--CommentsClose CommentsPermalink
‘(1) guaranteed renewal;CommentsClose CommentsPermalink
‘(2) rating;CommentsClose CommentsPermalink
‘(3) preexisting conditions;CommentsClose CommentsPermalink
‘(4) non-discrimination;CommentsClose CommentsPermalink
‘(5) quality improvement and reporting;CommentsClose CommentsPermalink
‘(6) fraud and abuse;CommentsClose CommentsPermalink
‘(7) solvency and financial requirements;CommentsClose CommentsPermalink
‘(8) market conduct;CommentsClose CommentsPermalink
‘(9) prompt payment;CommentsClose CommentsPermalink
‘(10) appeals and grievances;CommentsClose CommentsPermalink
‘(11) privacy and confidentiality;CommentsClose CommentsPermalink
‘(12) licensure; andCommentsClose CommentsPermalink
‘(13) benefit plan material or information.CommentsClose CommentsPermalink
‘SEC. 3108. PARTICIPATION OF PROFESSIONALS ON CERTAIN HEALTH-RELATED COMMISSIONS.
‘The membership of any council, committee, or other advisory body which the Secretary uses to inform official decision-making related to coverage of, or payment for, medical procedures, conditions, or care, shall have as its participants professionals who hold medical degrees from accredited American universities or colleges and have active clinical practice. Such advisory entities shall be composed of not less than one-third of such professionals.CommentsClose CommentsPermalink
‘SEC. 3109. HEALTH INSURANCE CONSUMER ASSISTANCE GRANTS.
‘(a) In General- The Secretary shall award grants to establishing or participating States to enable such States (or the Gateways operating in such States) to establish, expand, or provide support for offices of health insurance consumer assistance.CommentsClose CommentsPermalink
‘(b) Eligibility-CommentsClose CommentsPermalink
‘(1) IN GENERAL- To be eligible to receive a grant, a State shall designate an office of health insurance consumer assistance that, directly or in coordination with State health insurance regulators and consumer assistance organizations, receives and responds to inquiries and complaints concerning health insurance coverage with respect to Federal health insurance requirements and under State law.CommentsClose CommentsPermalink
‘(2) CRITERIA- A State that receives a grant under this section shall comply with criteria established by the Secretary for carrying out activities under such grant.CommentsClose CommentsPermalink
‘(c) Duties- The State-designated office of health insurance consumer assistance shall--CommentsClose CommentsPermalink
‘(1) assist with the filing of complaints and appeals, including filing appeals with a qualified health plan’s internal appeal or grievance process and providing information about the external appeal process;CommentsClose CommentsPermalink
‘(2) track consumer complaints, quantify such complaints, and regularly report such complaints to the State Gateway or the Secretary, as necessary;CommentsClose CommentsPermalink
‘(3) educate consumers on their rights and responsibilities with respect to qualified health plans; andCommentsClose CommentsPermalink
‘(4) assist consumers with enrollment in a qualified health plan by providing information, referral, and assistance, in collaboration with navigators under section 3105.CommentsClose CommentsPermalink
‘(d) Authorization of Appropriations- There is authorized to be appropriated to carry out this section, $20,000,000 for fiscal year 2010, and such sums as may be necessary for each fiscal year thereafter.’.CommentsClose CommentsPermalink
SEC. 143. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS.
(a) Requirement- Notwithstanding any other provision of law, on the date of enactment of this Act, all Members of Congress and congressional staff shall enroll in a Federal health insurance program--CommentsClose CommentsPermalink
(1) created under this Act (or an amendment made by this Act); orCommentsClose CommentsPermalink
(2) offered through a Gateway established under this Act (or an amendment made by this Act).CommentsClose CommentsPermalink
(b) Definitions- In this section:CommentsClose CommentsPermalink
(1) MEMBER OF CONGRESS- The term ‘Member of Congress’ means any member of the House of Representatives or the Senate.CommentsClose CommentsPermalink
(2) CONGRESSIONAL STAFF- The term ‘congressional staff’ means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.CommentsClose CommentsPermalink
Subtitle C--Affordable Coverage for All AmericansCommentsClose CommentsPermalink
Subtitle C--Affordable Coverage for All AmericansCommentsClose CommentsPermalink
SEC. 151. SUPPORT FOR AFFORDABLE HEALTH COVERAGE.
(a) In General- Title XXXI of the Public Health Service Act, as added by section 142(a), is amended by inserting after subtitle A the following:CommentsClose CommentsPermalink
‘Subtitle B--Making Coverage AffordableCommentsClose CommentsPermalink
‘SEC. 3111. SUPPORT FOR AFFORDABLE HEALTH COVERAGE.
‘(a) Cost Sharing for a Basic Plan-CommentsClose CommentsPermalink
‘(1) BASIC PLAN- The Secretary shall establish at least the following tiers of cost sharing for eligible individuals:CommentsClose CommentsPermalink
‘(A) A tier for a basic plan in which--CommentsClose CommentsPermalink
‘(i) a qualified health plan shall, on average, provide reimbursement for 76 percent of the total allowed costs of the benefit provided; andCommentsClose CommentsPermalink
‘(ii) the out of pocket limitation for the plan shall not be greater than the out of pocket limitation applicable under section 223(c)(2) of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink
‘(B) A tier in which--CommentsClose CommentsPermalink
‘(i) the average reimbursement percentage is equal to the reimbursement percentage of the basic plan increased by 8 percentage points; andCommentsClose CommentsPermalink
‘(ii) the dollar value of the out of pocket limitation shall not be greater than 50 percent of the dollar value of the out of pocket limitation of the basic plan.CommentsClose CommentsPermalink
‘(C) A tier in which--CommentsClose CommentsPermalink
‘(i) the average reimbursement percentage is equal to the reimbursement percentage of the basic plan increased by 17 percentage points; andCommentsClose CommentsPermalink
‘(ii) the dollar value of the out of pocket limitation shall not be greater than 20 percent of the dollar value of the out of pocket limitation of the basic plan.CommentsClose CommentsPermalink
‘(2) OUT OF POCKET- For purposes of this section, the term ‘out of pocket’ shall include all expenditures for covered qualified medical expenses (as provided for with respect to high deductible health plans under section 223(d)(2) of the Internal Revenue Code of 1986).CommentsClose CommentsPermalink
‘(b) Payment of Credits-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall, with respect to an eligible individual (as defined in section 3116(a)(1)) and on behalf of such individual, pay a premium credit to the Gateway through which the individual is enrolled in the qualified health plan involved. Such Gateway shall remit an amount equal to such credit to the qualified health plan in which such individual is enrolled.CommentsClose CommentsPermalink
‘(2) AMOUNT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Subject to the indexing provision described in paragraph (6), and the limitation described in paragraph (4), the amount of an annual credit with respect to an eligible individual under paragraph (1) shall be an amount determined by the Secretary so that the eligible individual involved is not required to pay in the case of an individual with an adjusted gross income equal to 400 percent of the poverty line for a family of the size involved, an amount that exceeds 12.5 percent of such individual’s income for the year involved.CommentsClose CommentsPermalink
‘(B) REDUCTIONS BASED ON INCOME- The amount that an eligible individual is required to pay under subparagraph (A) shall be ratably reduced to 1 percent of income in the case of an eligible individual with an adjusted gross income equal to 150 percent of the poverty line for a family of the size involved for the year.CommentsClose CommentsPermalink
‘(3) SIMPLIFIED SCHEDULE- The Secretary may establish a schedule of premium credits under this subsection in dollar amounts to simplify the administration of this section so long as any such schedule does not significantly change the value of the premium credits described in paragraph (2).CommentsClose CommentsPermalink
‘(4) LIMITATION OF CREDITS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- A credit under paragraph (1) may not exceed the lesser of the amount of the reference premium for the individual involved or the premium of the qualified health plan in which such individual is enrolled.CommentsClose CommentsPermalink
‘(B) REFERENCE PREMIUM- In this section, the term ‘reference premium’ means--CommentsClose CommentsPermalink
‘(i) with respect to an individual enrolling in coverage whose adjusted gross income does not exceed 200 percent of the poverty line for a family of the size involved for the year, the weighted average annual premium of the 3 lowest cost qualified health plans that--CommentsClose CommentsPermalink
‘(I) meet the criteria for cost sharing and out of pocket limits described in subsection (a)(1)(C); andCommentsClose CommentsPermalink
‘(II) are offered in the community rating area in which the individual resides;CommentsClose CommentsPermalink
‘(ii) with respect to an individual enrolling in coverage whose adjusted gross income exceeds 200, but does not exceed 300, percent of the poverty line for a family of the size involved for the year, the weighted average annual premium of the 3 lowest cost qualified health plans that--CommentsClose CommentsPermalink
‘(I) meet the criteria for cost sharing and out of pocket limits described in subsection (a)(1)(B); andCommentsClose CommentsPermalink
‘(II) are offered in the community rating area in which the individual resides; andCommentsClose CommentsPermalink
‘(iii) with respect to an individual enrolling in coverage whose adjusted gross income exceeds 300, but does not exceed 400, percent of the poverty line for a family of the size involved for the year, the weighted average annual premium of the 3 lowest cost qualified health plans that--CommentsClose CommentsPermalink
‘(I) meet the criteria for cost sharing and out of pocket limits described in subsection (a)(1)(A); andCommentsClose CommentsPermalink
‘(II) are offered in the community rating area in which the individual resides.CommentsClose CommentsPermalink
‘(C) INDIVIDUALS ALLOWED TO ENROLL IN ANY PLAN- Nothing in this section shall be construed to prohibit a qualified individual from enrolling in any qualified health plan.CommentsClose CommentsPermalink
‘(D) LIMITATION- In determining the 3 lowest cost health plans for purposes of this paragraph, the community health insurance option shall not be considered.CommentsClose CommentsPermalink
‘(5) METHOD OF CALCULATION-CommentsClose CommentsPermalink
‘(A) CALCULATION OF CREDIT BASED ON ESSENTIAL HEALTH CARE BENEFITS- In the case of a qualified health plan that provides reimbursement for benefits that are not included in the essential health benefits established by the Secretary under section 3103(a)(1)(A), the reference premium shall be determined for purposes of paragraph (2) without regard to such reimbursement.CommentsClose CommentsPermalink
‘(B) RISK ADJUSTMENT- The reference premium shall be adjusted to account for premium differences based on age, family size, and geographic variation.CommentsClose CommentsPermalink
‘(C) RULE IN CASE OF FEWER PLANS- In any case in which there are less than 3 qualified health plans offered in the community rating area in which the individual resides, the determinations made under paragraph (2) shall be based on the number of such qualified plans that are actually offered in the area.CommentsClose CommentsPermalink
‘(6) INDEXING- Beginning with calendar years after 2013, the percentages described in paragraph (2) that specify the portion of the reference premium that an individual or family is responsible for paying shall be annually adjusted by a percentage that is equal to the percentage increase or decrease in the medical care component of the Consumer Price Index for all urban consumers (U.S. city average) during the preceding calendar year.CommentsClose CommentsPermalink
‘(c) State Flexibility- A State may make payments to or on behalf of an eligible individual that are greater than the amounts required under this section.CommentsClose CommentsPermalink
‘(d) Eligibility Determinations-CommentsClose CommentsPermalink
‘(1) RULE FOR ELIGIBILITY DETERMINATIONS- The Secretary shall, by regulation, establish rules and procedures for--CommentsClose CommentsPermalink
‘(A) the submission of applications during the fourth quarter of the calendar year involved for payments under this section, including the electronic submission of documents necessary for application and enrollment;CommentsClose CommentsPermalink
‘(B) making determinations with respect to the eligibility of individuals submitting applications under subparagraph (A) for payments under this section and informing individuals of such determinations, including verifying income through the use of data contained in the tax returns of applicants for such credits;CommentsClose CommentsPermalink
‘(C) making determinations of adjusted gross income in cases where the individual applicant was not required to file a tax return for the taxable year involved;CommentsClose CommentsPermalink
‘(D) resolving appeals of such determinations;CommentsClose CommentsPermalink
‘(E) redetermining eligibility on a periodic basis; andCommentsClose CommentsPermalink
‘(F) making payments under this section.CommentsClose CommentsPermalink
‘(2) DETERMINATION OF ELIGIBILITY- For purposes of paragraph (1), the Secretary shall establish rules that permit eligibility to be determined based on--CommentsClose CommentsPermalink
‘(A) the applicant’s adjusted gross income for the second preceding taxable year; orCommentsClose CommentsPermalink
‘(B) in the case of an individual who is seeking payment under this section based on claiming a significant decrease in adjusted gross income--CommentsClose CommentsPermalink
‘(i) the applicant’s adjusted gross income for the most recent period otherwise practicable; orCommentsClose CommentsPermalink
‘(ii) the applicant’s declaration of estimated annual adjusted gross income for the year involved.CommentsClose CommentsPermalink
‘(3) DETERMINING ELIGIBILITY-CommentsClose CommentsPermalink
‘(A) AUTHORITY OF THE SECRETARY-CommentsClose CommentsPermalink
‘(i) IN GENERAL- The Secretary shall have the authority to make determinations (including redeterminations) with respect to the eligibility of individuals submitting applications for credits under this section. The Secretary shall verify, through the Internal Revenue Service or using the income and eligibility verification system utilized for purposes of the Medicaid program under section 1137 of the Social Security Act, the income data received from individuals submitting applications for credits under this section.CommentsClose CommentsPermalink
‘(ii) AUTHORITY TO USE TAX RETURNS- To be eligible to receive a credit under this section, an individual shall--CommentsClose CommentsPermalink
‘(I) authorize the disclosure of the tax return information of the individual as provided for in section 6103(l)(21) of the Internal Revenue Code; orCommentsClose CommentsPermalink
‘(II) with respect to individuals who do not file a tax return for the year involved--CommentsClose CommentsPermalink
‘(aa) provide satisfactory documentation of adjusted gross income, as determined by the Secretary, which may include a prior year Federal income tax return; andCommentsClose CommentsPermalink
‘(bb) authorize the disclosure to the Secretary of such information as may be required from the Internal Revenue Service to verify that such individual has not filed a tax return for the year involved.CommentsClose CommentsPermalink
‘(iii) STRINGENCY- The verification requirements with respect to individuals described in clause (ii)(II) shall be at least as stringent as those required under section 1137 of the Social Security Act.CommentsClose CommentsPermalink
‘(B) DELEGATION OF AUTHORITY- Except under the conditions described in subparagraph (D), the Secretary shall delegate to a Gateway (and, upon request from such State or States, to the State or States in which such Gateway operates) the authority to carry out the activities described in subparagraph (A). The Gateway may consult with the Internal Revenue Service to verify income data received from individuals submitting applications for credits under this section.CommentsClose CommentsPermalink
‘(C) REQUIREMENT FOR CONSISTENCY- A Gateway (and, as applicable, the State or States in which such Gateway operates) shall carry out the activities described in subparagraph (B) in a manner that is consistent with the regulations promulgated under paragraph (1).CommentsClose CommentsPermalink
‘(D) REVOCATION OF AUTHORITY- If the Secretary determines that a Gateway (or the State or States in which such Gateway operates) is carrying out the activities described in subparagraph (A) in a manner that is substantially inconsistent with the regulations promulgated under paragraph (1), the Secretary may, after notice and opportunity for a hearing, revoke the delegation of authority under subparagraph (A). If the Secretary revokes the delegation of authority, the references to a Gateway in subparagraph (E) and (F) shall be deemed to be references to the Secretary.CommentsClose CommentsPermalink
‘(E) REQUIREMENT TO REPORT CHANGE IN STATUS-CommentsClose CommentsPermalink
‘(i) IN GENERAL- An individual who has been determined to be eligible for credits under this section shall notify the Gateway of any changes that may affect such eligibility in a manner specified by the Secretary.CommentsClose CommentsPermalink
‘(ii) REDETERMINATION- If the Gateway receives a notice from an individual under clause (i), the Gateway shall promptly redetermine the individual’s eligibility for payments.CommentsClose CommentsPermalink
‘(F) TERMINATION OF PAYMENTS- The Gateway shall terminate payments on behalf of an individual (after providing notice to the individual) if--CommentsClose CommentsPermalink
‘(i) the individual fails to provide information for purposes of subparagraph (E)(i) on a timely basis; orCommentsClose CommentsPermalink
‘(ii) the Gateway determines that the individual is no longer eligible for such payments.CommentsClose CommentsPermalink
‘(G) TERRITORIAL TAX AUTHORITIES- With respect to determinations of eligibility for, or payment of, credits under this section that require the use of information maintained by a tax authority of a United States territory, the Secretary shall make such determination in coordination with such authority under rules and procedures that are similar to the rules and procedures applied to determinations made where such information is obtained from the Internal Revenue Service.CommentsClose CommentsPermalink
‘(4) APPLICATION-CommentsClose CommentsPermalink
‘(A) METHODS- The process established under paragraph (1)(A) shall permit applications in person, by mail, telephone, or the Internet.CommentsClose CommentsPermalink
‘(B) FORM AND CONTENTS- An application under paragraph (1)(A) shall be in such form and manner as specified by the Secretary, and may require documentation.CommentsClose CommentsPermalink
‘(C) SUBMISSION- An application under paragraph (1)(A) may be submitted to the Gateway, or to a State agency for a determination under this section.CommentsClose CommentsPermalink
‘(D) ASSISTANCE- A Gateway, or a State agency under this section, shall assist individuals in the filing of applications under paragraph (1)(A).CommentsClose CommentsPermalink
‘(5) RECONCILIATION-CommentsClose CommentsPermalink
‘(A) FILING OF STATEMENT- In the case of an individual who has received payments under this section for a year and who is claiming a significant decrease (as determined by the Secretary) in adjusted gross income from such year, such individual shall file with the Secretary an income reconciliation statement, at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(B) RECONCILIATION-CommentsClose CommentsPermalink
‘(i) IN GENERAL- Based on and using the adjusted gross income reported in the statement filed by an individual under subparagraph (A), the Secretary shall compute the amount of payments that should have been provided on behalf of the individual for the year involved.CommentsClose CommentsPermalink
‘(ii) OVERPAYMENT OF PAYMENTS-CommentsClose CommentsPermalink
‘(I) IN GENERAL- Subject to the limitation in subclause (II), if the amount of payments provided on behalf of an individual for a year under this section was significantly greater (as determined by the Secretary) than the amount computed under clause (i), the individual shall be liable to the Secretary for such excess amount. The Secretary may establish methods under which such liability may be assessed through a reduction in the amount of any credit otherwise applicable under this section with respect to such individual.CommentsClose CommentsPermalink
‘(II) LIMITATION- With respect to any individual described in subclause (I) who had a verified adjusted gross income that did not exceed 400 percent of the poverty line for a family of the size involved for such year, the amount of any repayment under such subclause (I) shall not exceed--CommentsClose CommentsPermalink
‘(aa) $250 for an individual who filed an individual tax return for such year; orCommentsClose CommentsPermalink
‘(bb) $400 for an individual who filed a joint tax return for such year.CommentsClose CommentsPermalink
Any such individual with a adjusted gross income that exceeds 400 percent of the poverty line for a family of the size involved for such year shall repay the entire amount so received.CommentsClose CommentsPermalink
‘(iii) UNDERPAYMENT OF PAYMENTS- If the amount of payments provided to an individual for a year under this section was less than the amount computed under clause (i), the Secretary shall pay to the individual the amount of such deficit. The Secretary may establish methods under which such payments may be provided through an increase in the amount of any credit otherwise applicable under this section with respect to such individual.CommentsClose CommentsPermalink
‘(iv) COORDINATION WITH IRS- The Secretary shall coordinate with the Secretary of the Treasury to develop procedures to enable the Internal Revenue Service to administer this subparagraph with respect to the collection of overpayments.CommentsClose CommentsPermalink
‘(C) FAILURE TO FILE- In the case of an individual who fails to file a statement for a year as required under subparagraph (A), the individual shall not be eligible for further payments until such statement is filed. The Secretary shall waive the application of this subparagraph if the individual establishes, to the satisfaction of the Secretary, good cause for the failure to file the statement on a timely basis.CommentsClose CommentsPermalink
‘(D) DETERMINATIONS- The Secretary shall make determinations with respect to statements submitted under this paragraph based on income data from the most recent tax return filed by the individual.CommentsClose CommentsPermalink
‘(6) DETERMINATIONS MADE WITH RESPECT TO SAME TAXABLE YEARS- In making determinations under this section with respect to adjusted gross income as compared to the poverty line, the Secretary shall ensure that the poverty line data used relates to the same taxable year for which the adjusted gross income is determined.CommentsClose CommentsPermalink
‘(7) OUTREACH- The Gateway shall conduct culturally and linguistically appropriate outreach activities to provide information to individuals that may potentially be eligible for payments under this section. Such activities shall include information on the application process with respect to such payments.CommentsClose CommentsPermalink
‘(e) Exclusion From Income- Amounts received by an individual under this section shall not be considered as income, and shall not be taken into account in determining assets or resources for purposes of determining the eligibility of such individual, or any other individual, for benefits or assistance, or the amount or extent of benefits or assistance, under any Federal program or under any State or local program financed in whole or in part with Federal funds.CommentsClose CommentsPermalink
‘(f) Conflict- A Gateway may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary under this title.CommentsClose CommentsPermalink
‘(g) No Federal Funding- Nothing in this title shall allow Federal payments for individuals who are not lawfully present in the United States.CommentsClose CommentsPermalink
‘(h) Appropriation- Out of any funds in the Treasury of the United States not otherwise appropriated, there are appropriated such sums as may be necessary to carry out this section for each fiscal year.CommentsClose CommentsPermalink
‘SEC. 3112. SMALL BUSINESS HEALTH OPTIONS PROGRAM CREDIT.
‘(a) Calculation of Credit- For each calendar year beginning in calendar year 2010, in the case of an employer that is a qualified small employer, out of any funds in the Treasury of the United States not otherwise appropriated, the Secretary shall make a payment to such qualified small employer in the amount described in subsection (b).CommentsClose CommentsPermalink
‘(b) General Credit Amount- For purposes of this section:CommentsClose CommentsPermalink
‘(1) IN GENERAL- The credit amount described in this subsection shall be the product of--CommentsClose CommentsPermalink
‘(A) the applicable amount specified in paragraph (2);CommentsClose CommentsPermalink
‘(B) the employer size factor specified in paragraph (3); andCommentsClose CommentsPermalink
‘(C) the percentage of year factor specified in paragraph (4).CommentsClose CommentsPermalink
‘(2) APPLICABLE AMOUNT- For purposes of paragraph (1):CommentsClose CommentsPermalink
‘(A) IN GENERAL- The applicable amount shall be equal to--CommentsClose CommentsPermalink
‘(i) $1,000 for each employee of the employer who receives self-only health insurance coverage through the employer;CommentsClose CommentsPermalink
‘(ii) $2,000 for each employee of the employer who receives family health insurance coverage through the employer; andCommentsClose CommentsPermalink
‘(iii) $1,500 for each employee of the employer who receives health insurance coverage for two adults or one adult and one or more children through the employer.CommentsClose CommentsPermalink
‘(B) BONUS FOR PAYMENT OF GREATER PERCENTAGE OF PREMIUMS- The applicable amount specified in subparagraph (A) shall be increased by $200 in the case of subparagraph (A)(i), $400 in the case of subparagraph (A)(ii), and $300 in the case of subparagraph (A)(iii), for each additional 10 percent of the qualified employee health insurance expenses exceeding 60 percent which are paid by the qualified small employer.CommentsClose CommentsPermalink
‘(3) EMPLOYER SIZE FACTOR- For purposes of paragraph (1), the employer size factor shall be the percentage determined in accordance with the following:CommentsClose CommentsPermalink
‘(A) With respect to an employer with 10 or fewer employees, the percentage shall be 100 percent.CommentsClose CommentsPermalink
‘(B) With respect to an employer with more than 10, but not more than 20, full-time employees, the percentage shall be 80 percent.CommentsClose CommentsPermalink
‘(C) With respect to an employer with more than 20, but not more than 30, full-time employees, the percentage shall be 50 percent.CommentsClose CommentsPermalink
‘(D) With respect to an employer with more than 30, but not more than 40, full-time employees, the percentage shall be 40 percent.CommentsClose CommentsPermalink
‘(E) With respect to an employer with more than 40, but not more than 50, full-time employees, the percentage shall be 20 percent.CommentsClose CommentsPermalink
‘(F) With respect to an employer with more than 50 full-time employees, the percentage shall be 0 percent.CommentsClose CommentsPermalink
‘(4) PERCENTAGE OF YEAR FACTOR- For purposes of paragraph (1), the percentage of year factor shall be equal to the ratio of--CommentsClose CommentsPermalink
‘(A) the number of months during the year for which the employer paid or incurred at least 60 percent of the qualified employee health insurance expenses of such employer; andCommentsClose CommentsPermalink
‘(B) 12.CommentsClose CommentsPermalink
‘(c) Definitions and Special Rules- For purposes of this section:CommentsClose CommentsPermalink
‘(1) QUALIFIED SMALL EMPLOYER-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘qualified small employer’ means an employer (as defined in section 3(d) of the Fair Labor Standards Act of 1938 and including self-employed individuals) that--CommentsClose CommentsPermalink
‘(i) pays or incurs at least 60 percent of the qualified employee health insurance expenses of such employer, or who is self-employed; andCommentsClose CommentsPermalink
‘(ii) was--CommentsClose CommentsPermalink
‘(I) an employer that--CommentsClose CommentsPermalink
‘(aa) employed an average of 50 or fewer full-time employees during the preceding taxable year; andCommentsClose CommentsPermalink
‘(bb) had an average wage of less than $50,000 for full time employees in the preceding taxable year; orCommentsClose CommentsPermalink
‘(II) a self-employed individual that--CommentsClose CommentsPermalink
‘(aa) had not less than $5,000 in net earnings;CommentsClose CommentsPermalink
‘(bb) had not greater than $50,000 in net earnings; andCommentsClose CommentsPermalink
‘(cc) has elected not to receive a credit under section 3111.CommentsClose CommentsPermalink
‘(B) LIMITATION- An employer may not receive a credit under this section for more than 1 period of not more than 3 consecutive years.CommentsClose CommentsPermalink
‘(2) QUALIFIED EMPLOYEE HEALTH INSURANCE EXPENSES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘qualified employee health insurance expenses’ means any amount paid by an employer or an employee of such employer for health insurance coverage to the extent such amount is for coverage--CommentsClose CommentsPermalink
‘(i) provided to any employee (as defined in section 3(e) of the Fair Labor Standards Act of 1938), orCommentsClose CommentsPermalink
‘(ii) for a self-employed individual.CommentsClose CommentsPermalink
‘(B) EXCEPTION FOR AMOUNTS PAID UNDER SALARY REDUCTION ARRANGEMENTS- No amount paid or incurred for health insurance coverage pursuant to a salary reduction arrangement shall be taken into account for purposes of subparagraph (A).CommentsClose CommentsPermalink
‘(3) FULL-TIME EMPLOYEE- The term ‘full time employee’ means, with respect to any period, an employee (as defined in section 3(e) of the Fair Labor Standards Act of 1938) of an employer if the average number of hours worked by such employee in the preceding taxable year for such employer was at least 40 hours per week.CommentsClose CommentsPermalink
‘(d) Inflation Adjustment-CommentsClose CommentsPermalink
‘(1) IN GENERAL- For each calendar year after 2010, the dollar amounts specified in subsections (b)(2)(A), (b)(2)(B), and (c)(1)(A)(ii) (after the application of this paragraph) shall be the amounts in effect in the preceding calendar year or, if greater, the product of--CommentsClose CommentsPermalink
‘(A) the corresponding dollar amount specified in such subsection; andCommentsClose CommentsPermalink
‘(B) the ratio of the index of wage inflation (as determined by the Bureau of Labor Statistics) for August of the preceding calendar year to such index of wage inflation for August of 2008.CommentsClose CommentsPermalink
‘(2) ROUNDING- If any amount determined under paragraph (1) is not a multiple of $100, such amount shall be rounded to the next lowest multiple of $100.CommentsClose CommentsPermalink
‘(e) Application of Certain Rules in Determination of Employer Size- For purposes of this section:CommentsClose CommentsPermalink
‘(1) APPLICATION OF AGGREGATION RULE FOR EMPLOYERS- All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 employer.CommentsClose CommentsPermalink
‘(2) EMPLOYERS NOT IN EXISTENCE IN PRECEDING YEAR- In the case of an employer which was not in existence for the full preceding taxable year, the determination of whether such employer meets the requirements of this section shall be based on the average number of full-time employees that it is reasonably expected such employer will employ on business days in the employer’s first full taxable year.CommentsClose CommentsPermalink
‘(3) PREDECESSORS- Any reference in this subsection to an employer shall include a reference to any predecessor of such employer.’.CommentsClose CommentsPermalink
SEC. 152. PROGRAM INTEGRITY.
(a) In General- Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink
‘(21) VOLUNTARY AUTHORIZATION FOR INCOME VERIFICATION-CommentsClose CommentsPermalink
‘(A) VOLUNTARY AUTHORIZATION- The Secretary shall provide a mechanism for each taxpayer to indicate whether such taxpayer authorizes the Secretary to disclose to the Secretary of Health and Human Services (or, pursuant to a delegation described in subsection (d)(4)(B), to a State or a Gateway (as defined in section 3101 of the Public Health Service Act) return information of a taxpayer who may be eligible for credits under section 3111 of the Public Health Service Act.CommentsClose CommentsPermalink
‘(B) PROVISION OF INFORMATION- If a taxpayer authorizes the disclosure described in subparagraph (A), the Secretary shall disclose to the Secretary of Health and Human Services (or, pursuant to a delegation described in subsection (d)(4)(B), to a State or a Gateway) the minimum necessary amount of information necessary to establish whether such individual is eligible for credits under section 3111 of the Public Health Service Act.CommentsClose CommentsPermalink
‘(C) RESTRICTION ON USE OF DISCLOSED INFORMATION- Return information disclosed under subparagraph (A) may be used by the Secretary (or, pursuant to a delegation described in subsection (d)(4)(B), a State or a Gateway) only for the purposes of, and to the extent necessary in, establishing the appropriate amount of any payments under section 3111 of the Public Health Service Act.’.CommentsClose CommentsPermalink
(b) Collection of Amounts- Section 6305(a) of the Internal Revenue Code of 1986 is amended by inserting ‘or under section 3111 of the Public Health Service Act’ after ‘Social Security Act’.CommentsClose CommentsPermalink
(c) Conforming Amendments-CommentsClose CommentsPermalink
(1) Paragraph (3) of section 6103(a) of such Code is amended by striking ‘or (20)’ and inserting ‘(20), or (21)’.CommentsClose CommentsPermalink
(2) Paragraph (4) of section 6103(p) of such Code is amended by striking ‘(l)(10), (16), (18), (19), or (20)’ each place it appears and inserting ‘(l)(10), (16), (18), (19), (20), or (21)’.CommentsClose CommentsPermalink
(3) Paragraph (2) of section 7213(a) of such Code is amended by striking ‘or (20)’ and inserting ‘(20), or (21)’.CommentsClose CommentsPermalink
Subtitle D--Shared Responsibility for Health CareCommentsClose CommentsPermalink
Subtitle D--Shared Responsibility for Health CareCommentsClose CommentsPermalink
SEC. 161. INDIVIDUAL RESPONSIBILITY.
(a) Payments-CommentsClose CommentsPermalink
(1) IN GENERAL- Subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to determination of tax liability) is amended by adding at the end the following new part:CommentsClose CommentsPermalink
‘PART VIII--SHARED RESPONSIBILITY PAYMENTS
‘Sec. 59B. Shared responsibility payments.CommentsClose CommentsPermalink
‘SEC. 59B. SHARED RESPONSIBILITY PAYMENTS.
‘(a) Requirement- Every individual shall ensure that such individual, and each dependent of such individual, is covered under qualifying coverage at all times during the taxable year.CommentsClose CommentsPermalink
‘(b) Payment-CommentsClose CommentsPermalink
‘(1) IN GENERAL-CommentsClose CommentsPermalink
‘(A) IN GENERAL- In the case of any individual who did not have in effect qualifying coverage (as defined in section 3116 of the Public Health Service Act) for any month during the taxable year, there is hereby imposed for the taxable year, in addition to any other amount imposed by this subtitle, an amount equal to the amount established under paragraph (2).CommentsClose CommentsPermalink
‘(B) RULE FOR DEPENDENTS- Any amount to be imposed under this subsection with respect to an individual described in subparagraph (A) that is a dependent (as defined in section 152) of another taxpayer shall be imposed--CommentsClose CommentsPermalink
‘(i) except in any case described in clause (ii), upon the taxpayer on whom such individual is a dependent; orCommentsClose CommentsPermalink
‘(ii) in any case in which the taxpayer with respect to whom such individual is a dependent files a joint return, jointly upon the taxpayer and the spouse of the taxpayer.CommentsClose CommentsPermalink
‘(C) LIMITATION- The maximum amount imposed under this paragraph with respect to any taxpayer shall not exceed 4 times the amount determined under paragraph (2)(D).CommentsClose CommentsPermalink
‘(2) AMOUNT ESTABLISHED-CommentsClose CommentsPermalink
‘(A) REQUIREMENT TO ESTABLISH- Not later than June 30 of each calendar year, the Secretary, in consultation with the Secretary of Health and Human Services and with the States, shall establish an amount for purposes of paragraph (1).CommentsClose CommentsPermalink
‘(B) EFFECTIVE DATE- The amount established under subparagraph (A) shall be effective with respect to the taxable year following the date on which the amount under subparagraph (A) is established.CommentsClose CommentsPermalink
‘(C) REQUIRED CONSIDERATION- Subject to the limitation described in subparagraph (D), in establishing the amount under subparagraph (A), the Secretary shall seek to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).CommentsClose CommentsPermalink
‘(D) LIMITATION-CommentsClose CommentsPermalink
‘(i) IN GENERAL- Subject to an adjustment under clause (ii), the amount established under this subparagraph is $750.CommentsClose CommentsPermalink
‘(ii) INFLATION ADJUSTMENT- Beginning with taxable years after 2011, the amount described in clause (i) shall be adjusted by the Secretary by notice, published in the Federal Register, for each fiscal year to reflect the total percentage change that occurred in the medical care component of the Consumer Price Index for all urban consumers (all items; U.S. city average) during the preceding calendar year.CommentsClose CommentsPermalink
‘(c) Exemptions- Subsection (b) shall not apply to any individual--CommentsClose CommentsPermalink
‘(1) with respect to any month if such month occurs during any period in which such individual did not have qualifying coverage (as so defined) for a period of less than 90 days,CommentsClose CommentsPermalink
‘(2) who is a resident of a State that is not a participating State or an establishing State (as such terms are defined in section 3104 of the Public Health Service Act),CommentsClose CommentsPermalink
‘(3) who is an Indian as defined in section 4 of the Indian Health Care Improvement Act,CommentsClose CommentsPermalink
‘(4) for whom affordable health care coverage is not available (as such terms are defined by the Secretary of Health and Human Services under section 3103 of the Public Health Service Act), orCommentsClose CommentsPermalink
‘(5) described in section 3116(a)(4)(C) of the Public Health Service Act.CommentsClose CommentsPermalink
‘(d) Coordination With Other Provisions-CommentsClose CommentsPermalink
‘(1) NOT TREATED AS TAX FOR CERTAIN PURPOSES- The amount imposed by this section shall not be treated as a tax imposed by this chapter for purposes of determining--CommentsClose CommentsPermalink
‘(A) the amount of any credit allowable under this chapter, orCommentsClose CommentsPermalink
‘(B) the amount of the minimum tax imposed by section 55.CommentsClose CommentsPermalink
‘(2) TREATMENT UNDER SUBTITLE F- For purposes of subtitle F, the amount imposed by this section shall be treated as if it were a tax imposed by section 1.CommentsClose CommentsPermalink
‘(3) SECTION 15 NOT TO APPLY- Section 15 shall not apply to the amount imposed by this section.CommentsClose CommentsPermalink
‘(4) SECTION NOT TO AFFECT LIABILITY OF POSSESSIONS, ETC- This section shall not apply for purposes of determining liability to any possession of the United States. For purposes of section 932 and 7654, the amount imposed under this section shall not be treated as a tax imposed by this chapter.CommentsClose CommentsPermalink
‘(e) Uses- Amounts collected under this section shall be dedicated to premium credits established under section 3111 of the Public Health Service Act.CommentsClose CommentsPermalink
‘(f) Regulations- The Secretary may prescribe such regulations as may be appropriate to carry out the purposes of this section.’.CommentsClose CommentsPermalink
(2) CLERICAL AMENDMENT- The table of parts for subchapter A of chapter 1 of such Code is amended by adding at the end the following new item:CommentsClose CommentsPermalink
‘PART VIII--Shared Responsibility Payments’.
(3) EFFECTIVE DATE- The amendments made by this section shall apply to taxable years beginning after December 31, 2011.CommentsClose CommentsPermalink
(b) Reporting of Health Insurance Coverage-CommentsClose CommentsPermalink
(1) IN GENERAL- Part III of subchapter A of chapter 61 of the Internal Revenue Code of 1986 is amended by inserting after subpart B the following new subpart:CommentsClose CommentsPermalink
‘Subpart D--Information Regarding Health Insurance Coverage
‘Sec. 6055. Reporting of health insurance coverage.CommentsClose CommentsPermalink
‘SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.
‘(a) In General- Every person who provides health insurance that is qualifying coverage shall make a return described in subsection (b).CommentsClose CommentsPermalink
‘(b) Form and Manner of Return- A return is described in this subsection if such return--CommentsClose CommentsPermalink
‘(1) is in such form as the Secretary prescribes,CommentsClose CommentsPermalink
‘(2) contains--CommentsClose CommentsPermalink
‘(A) the name, address, and taxpayer identification number of each individual who is covered under health insurance that is qualifying coverage provided by such person, andCommentsClose CommentsPermalink
‘(B) the number of months during the calendar year during which each such individual was covered under such health insurance, andCommentsClose CommentsPermalink
‘(3) such other information as the Secretary may prescribe.CommentsClose CommentsPermalink
‘(c) Statements to Be Furnished to Individuals With Respect to Whom Information Is Reported-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Every person required to make a return under subsection (a) shall furnish to each individual whose name is required to be set forth in such return a written statement showing--CommentsClose CommentsPermalink
‘(A) the name, address, and phone number of the information contact of the person required to make such return, andCommentsClose CommentsPermalink
‘(B) the number of months during the calendar year during which such individual was covered under health insurance that is qualifying coverage provided by such person.CommentsClose CommentsPermalink
‘(2) TIME FOR FURNISHING STATEMENTS- The written statement required under paragraph (1) shall be furnished on or before January 31 of the year following the calendar year for which the return under subsection (a) was required to be made.CommentsClose CommentsPermalink
‘(d) Qualifying Coverage- For purposes of this section, the term ‘qualifying coverage’ has the meaning given such term under section 3116 of the Public Health Service Act.’.CommentsClose CommentsPermalink
(2) CONFORMING AMENDMENTS- The table of subparts for part III of subchapter A of chapter 61 of such Code is amended by inserting after the item relating to subpart C the following new item:CommentsClose CommentsPermalink
‘subpart d--health insurance coverage’.
(3) EFFECTIVE DATE- The amendments made by this section shall apply to taxable years beginning after December 31, 2011.CommentsClose CommentsPermalink
(c) Notification of Nonenrollment- Not later than June 30 of each year, the Secretary of the Treasury, acting through the Internal Revenue Service and in consultation with the Secretary of Health and Human Services, shall send a notification each individual who files an individual income tax return and who is not enrolled in qualifying coverage (as defined in section 3116 of the Public Health Service Act). Such notification shall contain information on the services available through the Gateway (if any) operating in the State in which such individual resides.CommentsClose CommentsPermalink
SEC. 162. NOTIFICATION ON THE AVAILABILITY OF AFFORDABLE HEALTH CHOICES.
The Fair Labor Standards Act of 1938 is amended by inserting after section 18 (
‘SEC. 18A. NOTICE TO EMPLOYEES.
‘(a) In General- In accordance with regulations promulgated by the Secretary, an employer to which this Act applies, shall provide to each employee at the time of hiring (or with respect to current employees, within 90 days of the date on which a State becomes an establishing or participating State under section 3104 of the Public Health Service Act), written notice informing the employee of the existence of the American Health Benefits Gateway, including a description of the services provided by such Gateway and the manner in which the employee may contact the Gateway to request assistance.CommentsClose CommentsPermalink
‘(b) Effective Date- Subsection (a) shall take effect with respect to employers in a State beginning 90 days after the date on which the State becomes an establishing or participating State under section 3104 of the Public Health Service. Act.’.CommentsClose CommentsPermalink
SEC. 163. SHARED RESPONSIBILITY OF EMPLOYERS.
Subtitle B of title XXXI of the Public Health Service Act, as amended by section 151, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 3115. SHARED RESPONSIBILITY OF EMPLOYERS.
‘(a) Employees Not Offered Coverage- An employer shall make a payment to the Secretary in the amount described in subsection (b) with respect to each employee--CommentsClose CommentsPermalink
‘(1) who is not offered qualifying coverage by such employer during each month where such employee is not offered qualifying coverage; orCommentsClose CommentsPermalink
‘(2) on behalf of whom such employer is not contributing at least 60 percent of the monthly premiums for such coverage for each such month.CommentsClose CommentsPermalink
‘(b) Amount-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The annual amount described in this subsection shall be equal to $750 for each full-time employee described in subsection (a). Such amount shall be pro-rated with respect to each month in which subsection (a) applies with respect to an employee.CommentsClose CommentsPermalink
‘(2) PRO RATA APPLICATION FOR PART-TIME EMPLOYEES- The provisions of paragraph (1) shall apply with respect to part-time employees employed by the employer, except that the annual payment amount described in such paragraph shall be reduced to $375 for each part-time employee.CommentsClose CommentsPermalink
‘(3) APPLICATION- The provisions of this subsection shall only apply with respect to the number of employees employed by the employer in excess of 25 employees.CommentsClose CommentsPermalink
‘(c) Procedures- The Secretary shall develop procedures for making determinations with respect to qualifying coverage and for making the payments required under subsection (a). Such procedures shall provide for the making of payments on a quarterly basis.CommentsClose CommentsPermalink
‘(d) Use of Funds- Amounts shall be collected under subsection (a) and be available for obligation only to the extent and in the amount provided in advance in appropriations Acts. Such amounts are authorized to remain available until expended.CommentsClose CommentsPermalink
‘(e) Inflation Adjustment- Beginning with calendar years after 2013, the amounts described in subsection (b) shall be adjusted by the Secretary by notice, published in the Federal Register, for each fiscal year to reflect the total percentage change that occurred in the medical care component of the Consumer Price Index for all urban consumers (all items; U.S. city average) during the preceding calendar year.CommentsClose CommentsPermalink
‘(f) Exemption for Small Employers-CommentsClose CommentsPermalink
‘(1) IN GENERAL- For purposes of this section, the term ‘employer’ means an employer that employs more than 25 employees on business days during the preceding calendar year. An employer shall not be considered to employ more than 25 employees if--CommentsClose CommentsPermalink
‘(A) the employer’s workforce exceeds 25 employees for 120 days or fewer during the calendar year; andCommentsClose CommentsPermalink
‘(B) the employees employed during such 120-day period were seasonal workers.CommentsClose CommentsPermalink
‘(2) DEFINITION OF SEASONAL WORKERS- In this subsection, the term ‘seasonal worker’ means an individual who performs labor or services on a seasonal basis where, ordinarily, the employment pertains to or is of the kind exclusively performed at certain seasons or periods of the year and which, from its nature, may not be continuous or carried on throughout the year.CommentsClose CommentsPermalink
‘(3) APPLICATION OF AGGREGATION RULE FOR EMPLOYERS- All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 employer.CommentsClose CommentsPermalink
‘(4) EMPLOYERS NOT IN EXISTENCE IN PRECEDING YEAR- In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.CommentsClose CommentsPermalink
‘(5) PREDECESSORS- Any reference in this subsection to an employer shall include a reference to any predecessor of such employer.CommentsClose CommentsPermalink
‘(g) Authority to Certify- The Secretary, in collaboration with the Secretary of the Treasury and the Secretary of Labor, shall establish procedures for determining the number of employees of employers who are not offered qualifying coverage.CommentsClose CommentsPermalink
‘(h) Independent Contractors- For purposes of determining whether an employer is subject to this section, any individual who qualifies as an independent contractor under Federal law and who is retained by such employer shall not be counted when determining the number of employees employed by the employer.CommentsClose CommentsPermalink
‘(i) Regulations- The Secretary, in consultation with the Secretary of Labor, shall promulgate such regulations as may be appropriate to carry out activities under this section.CommentsClose CommentsPermalink
‘(j) Effective Date- This section shall apply with respect to an employer beginning in the calendar year in which the State in which the employer is located becomes an establishing State or a participating State.CommentsClose CommentsPermalink
‘SEC. 3116. DEFINITIONS.
‘(a) In General- In this title:CommentsClose CommentsPermalink
‘(1) ELIGIBLE INDIVIDUAL- The term ‘eligible individual’ means an individual who is--CommentsClose CommentsPermalink
‘(A) a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States;CommentsClose CommentsPermalink
‘(B) a qualified individual;CommentsClose CommentsPermalink
‘(C) enrolled in a qualified health plan; andCommentsClose CommentsPermalink
‘(D) not receiving full benefits coverage under a State child health plan under title XXI of the Social Security Act (
42 U.S.C. 1397aa et seq.) (or full benefits coverage under a demonstration project funded through such title XXI).CommentsClose CommentsPermalink‘(2) QUALIFIED EMPLOYER-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘qualified employer’ means an employer that--CommentsClose CommentsPermalink
‘(i) elects to make all full-time employees of such employer eligible for a qualified health plan; andCommentsClose CommentsPermalink
‘(ii)(I) in the case of an employer that elects to make its employees eligible for qualified health plans in an establishing State--CommentsClose CommentsPermalink
‘(aa) employs fewer than the number of employees specified in subparagraph (B); andCommentsClose CommentsPermalink
‘(bb) meets criteria established by the State; orCommentsClose CommentsPermalink
‘(II) in the case of an employer that elects to make its employees eligible for qualified health plans in a participating State--CommentsClose CommentsPermalink
‘(aa) employs fewer than the number of employees specified in subparagraph (B); andCommentsClose CommentsPermalink
‘(bb) meets criteria established by the Secretary.CommentsClose CommentsPermalink
‘(B) NUMBER OF EMPLOYEES-CommentsClose CommentsPermalink
‘(i) ESTABLISHMENT-CommentsClose CommentsPermalink
‘(I) BY STATE- In the case of an establishing State, such State may by regulation establish the number of employees described in subparagraph (A)(ii)(I)(aa) but such number may not be less than 50.CommentsClose CommentsPermalink
‘(II) BY THE SECRETARY- In the case of a participating State, the Secretary may by regulation establish the number of employees described in subparagraph (A)(ii)(II)(aa) but such number may not be less than 50.CommentsClose CommentsPermalink
‘(ii) DEFAULT- If a State or the Secretary does not establish the number described in subclause (I) or (II), respectively, of clause (i), such number shall be 50.CommentsClose CommentsPermalink
‘(C) CONTINUATION OF PARTICIPATION- A qualified employer that is enrolled in a qualified health plan and that experiences an increase in the number of employees of such employer such that the number of employees of such employer exceeds the number specified in subparagraph (B)(i) or subparagraph (B)(ii), as applicable, shall, notwithstanding such increase, continue to be considered a qualified employer for purposes of this title, provided that such employer remains enrolled in a qualified health plan.CommentsClose CommentsPermalink
‘(3) QUALIFIED HEALTH PLAN-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘qualified health plan’ means health plan that--CommentsClose CommentsPermalink
‘(i) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in section 3101(m) issued or recognized by each Gateway through which such plan is offered; andCommentsClose CommentsPermalink
‘(ii) is offered by a health insurance issuer that--CommentsClose CommentsPermalink
‘(I) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title;CommentsClose CommentsPermalink
‘(II) agrees to offer at least one qualified health plan in the tier described in section 3111(a)(1)(A) and at least one plan in the tier described in section 3111(a)(1)(B);CommentsClose CommentsPermalink
‘(III) complies with the regulations developed by the Secretary under section 3101(m) and such other requirements as an applicable Gateway may establish; andCommentsClose CommentsPermalink
‘(IV) agrees to pay any surcharge assessed under section 3101(c)(4).CommentsClose CommentsPermalink
‘(B) INCLUSION OF COMMUNITY HEALTH INSURANCE OPTION- Any reference in this title to a qualified health plan shall be deemed to include a community health insurance option, unless specifically provided for otherwise.CommentsClose CommentsPermalink
‘(4) QUALIFIED INDIVIDUAL-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘qualified individual’ means an individual who is--CommentsClose CommentsPermalink
‘(i) residing in a participating State or an establishing State (as defined in section 3104);CommentsClose CommentsPermalink
‘(ii) not incarcerated, except an individual in custody pending the disposition of charges;CommentsClose CommentsPermalink
‘(iii) not entitled to coverage under the Medicare program under part A of title XVIII of the Social Security Act;CommentsClose CommentsPermalink
‘(iv) not enrolled in coverage under the Medicare program under part B of title XVIII of the Social Security Act or under part C of such title; andCommentsClose CommentsPermalink
‘(v) not eligible for coverage under--CommentsClose CommentsPermalink
‘(I) the Medicaid program under a State plan under title XIX of the Social Security Act (
42 U.S.C. 1396 et seq.), or under a waiver under section 1115 of such Act;CommentsClose CommentsPermalink‘(II) the TRICARE program under chapter 55 of title 10, United States Code (as defined in section 1072(7) of such title);CommentsClose CommentsPermalink
‘(III) the Federal employees health benefits program under chapter 89 of title 5, United States Code; orCommentsClose CommentsPermalink
‘(IV) employer-sponsored coverage (except as provided under subparagraph (B)).CommentsClose CommentsPermalink
‘(B) EMPLOYEES WITHOUT AFFORDABLE COVERAGE- An individual who is eligible for employer-sponsored coverage shall be deemed to be a qualified individual under subparagraph (A) only if such coverage--CommentsClose CommentsPermalink
‘(i) does not meet the criteria established under section 3103 for minimum qualifying coverage; orCommentsClose CommentsPermalink
‘(ii) is not affordable (as such term is defined by the Secretary under section 3103) for such employee.CommentsClose CommentsPermalink
‘(C) INDIVIDUALS AT LESS THAN 150 PERCENT OF POVERTY- An individual with an adjusted gross income that does not exceed 150 percent of the poverty line for a family of the size involved shall not be considered a qualified individual for purposes of this title.CommentsClose CommentsPermalink
‘(5) QUALIFYING COVERAGE- The term ‘qualifying coverage’ means--CommentsClose CommentsPermalink
‘(A) a group health plan or health insurance coverage--CommentsClose CommentsPermalink
‘(i) that an individual is enrolled in on the date of enactment of this title; orCommentsClose CommentsPermalink
‘(ii) that is described in clause (i) and that is renewed by an enrollee as provided for in section 131 of the Affordable Health Choices Act;CommentsClose CommentsPermalink
‘(B) a group health plan or health insurance coverage that--CommentsClose CommentsPermalink
‘(i) is not described in subparagraph (A); andCommentsClose CommentsPermalink
‘(ii) meets or exceeds the criteria for minimum qualifying coverage (as defined in section 3103);CommentsClose CommentsPermalink
‘(C) Medicare coverage under parts A and B of title XVIII of the Social Security Act or under part C of such title;CommentsClose CommentsPermalink
‘(D) Medicaid coverage under a State plan under title XIX of the Social Security Act (or under a waiver under section 1115 of such Act), other than coverage consisting solely of benefits under section 1928 of such Act;CommentsClose CommentsPermalink
‘(E) coverage under title XXI of the Social Security Act;CommentsClose CommentsPermalink
‘(F) coverage under the TRICARE program under chapter 55 of title 10, United States Code;CommentsClose CommentsPermalink
‘(G) coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary to be not less than the coverage provided under a qualified health plan, based on the individual’s priority for services as provided under section 1705(a) of such title;CommentsClose CommentsPermalink
‘(H) coverage under the Federal employees health benefits program under chapter 89 of title 5, United States Code;CommentsClose CommentsPermalink
‘(I) a State health benefits high risk pool;CommentsClose CommentsPermalink
‘(J) a health benefit plan under
section 2504(e) of title 22, United States Code ; orCommentsClose CommentsPermalink‘(K) coverage under a qualified health plan.CommentsClose CommentsPermalink
For purposes of this paragraph, an individual shall be deemed to have qualifying coverage if such individual is an individual described in section 1402(e) or (g) of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink
‘(6) ADJUSTED GROSS INCOME- The term ‘adjusted gross income’ with respect to an individual has the meaning given such term for purposes of section 62(a) of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink
‘(7) EDUCATED HEALTH CARE CONSUMER- The term ‘educated health care consumer’ means an individual who is knowledgeable about the health care system, and has background or experience in making informed decisions regarding health, medical, and scientific matters.CommentsClose CommentsPermalink
‘(b) Incorporation of Additional Definitions- Unless specifically provided for otherwise, the definitions contained in section 2791 shall apply with respect to this title.’.CommentsClose CommentsPermalink
Subtitle E--Improving Access to Health Care ServicesCommentsClose CommentsPermalink
Subtitle E--Improving Access to Health Care ServicesCommentsClose CommentsPermalink
SEC. 171. SPENDING FOR FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS).
(a) In General- Section 330(r) of the Public Health Service Act (
‘(1) GENERAL AMOUNTS FOR GRANTS- For the purpose of carrying out this section, in addition to the amounts authorized to be appropriated under subsection (d), there is authorized to be appropriated the following:CommentsClose CommentsPermalink
‘(A) For fiscal year 2010, $2,988,821,592.CommentsClose CommentsPermalink
‘(B) For fiscal year 2011, $3,862,107,440.CommentsClose CommentsPermalink
‘(C) For fiscal year 2012, $4,990,553,440.CommentsClose CommentsPermalink
‘(D) For fiscal year 2013, $6,448,713,307.CommentsClose CommentsPermalink
‘(E) For fiscal year 2014, $7,332,924,155.CommentsClose CommentsPermalink
‘(F) For fiscal year 2015, $8,332,924,155.CommentsClose CommentsPermalink
‘(G) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of--CommentsClose CommentsPermalink
‘(i) one plus the average percentage increase in costs incurred per patient served; andCommentsClose CommentsPermalink
‘(ii) one plus the average percentage increase in the total number of patients served.’.CommentsClose CommentsPermalink
(b) Rule of Construction- Section 330(r) of the Public Health Service Act (
‘(4) RULE OF CONSTRUCTION WITH RESPECT TO RURAL HEALTH CLINICS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Nothing in this section shall be construed to prevent a community health center from contracting with a Federally certified rural health clinic (as defined in section 1861(aa)(2) of the Social Security Act), a low-volume hospital (as defined for purposes of section 1886 of such Act), a critical access hospital, a sole community hospital (as defined for purposes of section 1886(d)(5)(D)(iii) of such Act), or a medicare-dependent share hospital (as defined for purposes of section 1886(d)(5)(G)(iv) of such Act) for the delivery of primary health care services that are available at the clinic or hospital to individuals who would otherwise be eligible for free or reduced cost care if that individual were able to obtain that care at the community health center. Such services may be limited in scope to those primary health care services available in that clinic or hospitals.CommentsClose CommentsPermalink
‘(B) ASSURANCES- In order for a clinic or hospital to receive funds under this section through a contract with a community health center under subparagraph (A), such clinic or hospital shall establish policies to ensure--CommentsClose CommentsPermalink
‘(i) nondiscrimination based on the ability of a patient to pay; andCommentsClose CommentsPermalink
‘(ii) the establishment of a sliding fee scale for low-income patients.’.CommentsClose CommentsPermalink
SEC. 172. OTHER PROVISIONS.
(a) Settings for Service Delivery- Section 330(a)(1) of the Public Health Service Act (
(b) Location of Service Delivery Sites- Section 330(a) of the Public Health Service Act (
‘(3) CONSIDERATIONS-CommentsClose CommentsPermalink
‘(A) LOCATION OF SITES- Subject to subparagraph (B), a center shall not be required to locate its service facility or facilities within a designated medically underserved area in order to serve either the residents of its catchment area or a special medically underserved population comprised of migratory and seasonal agricultural workers, the homeless, or residents of public housing, if that location is determined by the center to be reasonably accessible to and appropriate to meet the needs of the medically underserved residents of the center’s catchment area or the special medically underserved population, in accordance with subparagraphs (A) and (J) of subsection (k)(3).CommentsClose CommentsPermalink
‘(B) LOCATION WITHIN ANOTHER CENTER’S AREA- The Secretary may permit applicants for grants under this section to propose the location of a service delivery site within another center’s catchment area if the applicant demonstrates sufficient unmet need in such area and can otherwise justify the need for additional Federal resources in the catchment area. In determining whether to approve such a proposal, the Secretary shall take into consideration whether collaboration between the two centers exists, or whether the applicant has made reasonable attempts to establish such collaboration, and shall consider any comments timely submitted by the affected center concerning the potential impact of the proposal on the availability or accessibility of services the affected center currently provides or the financial viability of the affected center.’.CommentsClose CommentsPermalink
(c) Affiliation Agreements- Section 330(k)(3)(B) of the Public Health Service Act (
(d) Governance Requirements- Section 330(k)(3) of the Public Health Service Act (
(1) in subparagraph (H)--CommentsClose CommentsPermalink
(A) in clause (ii), strike ‘; and’ and inserting ‘, except that in the case of a public center (as defined in the second sentence of this paragraph), the public entity may retain authority to establish financial and personnel policies for the center; and’;CommentsClose CommentsPermalink
(B) in clause (iii), by adding ‘and’ at the end; andCommentsClose CommentsPermalink
(C) by inserting after clause (iii) the following:CommentsClose CommentsPermalink
‘(iv) in the case of a co-applicant with a public entity, meets the requirements of clauses (i) and (ii);’; andCommentsClose CommentsPermalink
(2) in the second sentence, by inserting before the period the following: ‘that is governed by a board that satisfies the requirements of subparagraph (H) or that jointly applies (or has applied) for funding with a co-applicant board that meets such requirements’.CommentsClose CommentsPermalink
(e) Adjustment in Center’s Operating Plan and Budget- Section 330(k)(3)(I)(i) of the Public Health Service Act (
(f) Joint Purchasing Arrangements for Reduced Cost- Section 330(l) of the Public Health Service Act (
(1) by striking ‘The Secretary’ and inserting the following:CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary’; andCommentsClose CommentsPermalink
(2) by adding at the end the following:CommentsClose CommentsPermalink
‘(2) ASSISTANCE WITH SUPPLIES AND SERVICES COSTS- The Secretary, directly or through grants or contracts, may carry out projects to establish and administer arrangements under which the costs of providing the supplies and services needed for the operation of federally qualified health centers are reduced through collaborative efforts of the centers, through making purchases that apply to multiple centers, or through such other methods as the Secretary determines to be appropriate.’.CommentsClose CommentsPermalink
(g) Opportunity To Correct Material Failure Regarding Grant Conditions- Section 330(e) of the Public Health Service Act (
‘(6) OPPORTUNITY TO CORRECT MATERIAL FAILURE REGARDING GRANT CONDITIONS- If the Secretary finds that a center materially fails to meet any requirement (except for any requirements waived by the Secretary) necessary to qualify for its grant under this subsection, the Secretary shall provide the center with an opportunity to achieve compliance (over a period of up to 1 year from making such finding) before terminating the center’s grant. A center may appeal and obtain an impartial review of any Secretarial determination made with respect to a grant under this subsection, or may appeal and receive a fair hearing on any Secretarial determination involving termination of the center’s grant entitlement, modification of the center’s service area, termination of a medically underserved population designation within the center’s service area, disallowance of any grant expenditures, or a significant reduction in a center’s grant amount.’.CommentsClose CommentsPermalink
SEC. 173. NEGOTIATED RULEMAKING FOR DEVELOPMENT OF METHODOLOGY AND CRITERIA FOR DESIGNATING MEDICALLY UNDERSERVED POPULATIONS AND HEALTH PROFESSIONS SHORTAGE AREAS.
(a) Establishment-CommentsClose CommentsPermalink
(1) IN GENERAL- The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall establish, through a negotiated rulemaking process under subchapter 3 of chapter 5 of title 5, United States Code, a comprehensive methodology and criteria for designation of--CommentsClose CommentsPermalink
(A) medically underserved populations in accordance with section 330(b)(3) of the Public Health Service Act (
(B) health professions shortage areas under section 332 of the Public Health Service Act (
(2) FACTORS TO CONSIDER- In establishing the methodology and criteria under paragraph (1), the Secretary--CommentsClose CommentsPermalink
(A) shall consult with relevant stakeholders who will be significantly affected by a rule (such as national, State and regional organizations representing affected entities), State health offices, community organizations, health centers and other affected entities, and other interested parties; andCommentsClose CommentsPermalink
(B) shall take into account--CommentsClose CommentsPermalink
(i) the timely availability and appropriateness of data used to determine a designation to potential applicants for such designations;CommentsClose CommentsPermalink
(ii) the impact of the methodology and criteria on communities of various types and on health centers and other safety net providers;CommentsClose CommentsPermalink
(iii) the degree of ease or difficulty that will face potential applicants for such designations in securing the necessary data; andCommentsClose CommentsPermalink
(iv) the extent to which the methodology accurately measures various barriers that confront individuals and population groups in seeking health care services.CommentsClose CommentsPermalink
(b) Publication of Notice- In carrying out the rulemaking process under this subsection, the Secretary shall publish the notice provided for under
(c) Target Date for Publication of Rule- As part of the notice under subsection (b), and for purposes of this subsection, the ‘target date for publication’, as referred to in section 564(a)(5) of title 5, United Sates Code, shall be July 1, 2010.CommentsClose CommentsPermalink
(d) Appointment of Negotiated Rulemaking Committee and Facilitator- The Secretary shall provide for--CommentsClose CommentsPermalink
(1) the appointment of a negotiated rulemaking committee under
(2) the nomination of a facilitator under section 566(c) of such title 5 by not later than 10 days after the date of appointment of the committee.CommentsClose CommentsPermalink
(e) Preliminary Committee Report- The negotiated rulemaking committee appointed under subsection (d) shall report to the Secretary, by not later than April 1, 2010, regarding the committee’s progress on achieving a consensus with regard to the rulemaking proceeding and whether such consensus is likely to occur before one month before the target date for publication of the rule. If the committee reports that the committee has failed to make significant progress toward such consensus or is unlikely to reach such consensus by the target date, the Secretary may terminate such process and provide for the publication of a rule under this section through such other methods as the Secretary may provide.CommentsClose CommentsPermalink
(f) Final Committee Report- If the committee is not terminated under subsection (e), the rulemaking committee shall submit a report containing a proposed rule by not later than one month before the target publication date.CommentsClose CommentsPermalink
(g) Interim Final Effect- The Secretary shall publish a rule under this section in the Federal Register by not later than the target publication date. Such rule shall be effective and final immediately on an interim basis, but is subject to change and revision after public notice and opportunity for a period (of not less than 90 days) for public comment. In connection with such rule, the Secretary shall specify the process for the timely review and approval of applications for such designations pursuant to such rules and consistent with this section.CommentsClose CommentsPermalink
(h) Publication of Rule After Public Comment- The Secretary shall provide for consideration of such comments and republication of such rule by not later than 1 year after the target publication date.CommentsClose CommentsPermalink
SEC. 174. EQUITY FOR CERTAIN ELIGIBLE SURVIVORS.
(a) Rebuttable Presumption- Section 411(c)(4) of the Black Lung Benefits Act (
(b) Continuation of Benefits- Section 422(l) of the Black Lung Benefits Act (
(c) Effective Date- The amendments made by this section shall apply with respect to claims filed under part B or part C of the Black Lung Benefits Act (
SEC. 175. REAUTHORIZATION OF THE WAKEFIELD EMERGENCY MEDICAL SERVICES FOR CHILDREN PROGRAM.
Section 1910 of the Public Health Service Act (
(1) in subsection (a), by striking ‘3-year period (with an optional 4th year’ and inserting ‘4-year period (with an optional 5th year’; andCommentsClose CommentsPermalink
(2) in subsection (d)--CommentsClose CommentsPermalink
(A) by striking ‘and such sums’ and inserting ‘such sums’; andCommentsClose CommentsPermalink
(B) by inserting before the period the following: ‘, $25,000,000 for fiscal year 2010, $26,250,000 for fiscal year 2011, $27,562,500 for fiscal year 2012, $28,940,625 for fiscal year 2013, and $30,387,656 for fiscal year 2014’.CommentsClose CommentsPermalink
SEC. 176. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.
Subpart 3 of part B of title V of the Public Health Service Act (
‘SEC. 520K. GRANTS FOR CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.
‘(a) Definitions- In this section:CommentsClose CommentsPermalink
‘(1) ELIGIBLE ENTITY- The term ‘eligible entity’ means a qualified community mental health program defined under section 1913(b)(1).CommentsClose CommentsPermalink
‘(2) SPECIAL POPULATIONS- The term ‘special populations’ refers to the following 3 groups:CommentsClose CommentsPermalink
‘(A) Children and adolescents with mental and emotional disturbances who have co-occurring primary care conditions and chronic diseases.CommentsClose CommentsPermalink
‘(B) Adults with mental illnesses who have co-occurring primary care conditions and chronic diseases.CommentsClose CommentsPermalink
‘(C) Older adults with mental illnesses who have co-occurring primary care conditions and chronic diseases.CommentsClose CommentsPermalink
‘(b) Program Authorized- The Secretary, acting through the Administrator of the Substance Abuse and Mental Health Services Administration and in coordination with the Director of the Health Resources and Services Administration, shall award grants to eligible entities to establish demonstration projects for the provision of coordinated and integrated services to special populations through the co-location of primary and specialty care services in community-based mental and behavioral health settings.CommentsClose CommentsPermalink
‘(c) Application- To be eligible to receive a grant under this section, an eligible entity shall submit an application to the Administrator at such time, in such manner, and accompanied by such information as the Administrator may require. Each such application shall include--CommentsClose CommentsPermalink
‘(1) an assessment of the primary care needs of the patients served by the eligible entity and a description of how the eligible entity will address such needs; andCommentsClose CommentsPermalink
‘(2) a description of partnerships, cooperative agreements, or other arrangements with local primary care providers, including community health centers, to provide services to special populations.CommentsClose CommentsPermalink
‘(d) Use of Funds-CommentsClose CommentsPermalink
‘(1) IN GENERAL- For the benefit of special populations, an eligible entity shall use funds awarded under this section for--CommentsClose CommentsPermalink
‘(A) the provision, by qualified primary care professionals on a reasonable cost basis, of--CommentsClose CommentsPermalink
‘(i) primary care services on site at the eligible entity;CommentsClose CommentsPermalink
‘(ii) diagnostic and laboratory services; orCommentsClose CommentsPermalink
‘(iii) adult and pediatric eye, ear, and dental screenings;CommentsClose CommentsPermalink
‘(B) reasonable costs associated with medically necessary referrals to qualified specialty care professionals as well as to other coordinators of care or, if permitted by the terms of the grant, for the provision, by qualified specialty care professionals on a reasonable cost basis on site at the eligible entity;CommentsClose CommentsPermalink
‘(C) information technology required to accommodate the clinical needs of primary and specialty care professionals; orCommentsClose CommentsPermalink
‘(D) facility improvements or modifications needed to bring primary and specialty care professionals on site at the eligible entity.CommentsClose CommentsPermalink
‘(2) LIMITATION- Not to exceed 15 percent of grant funds may be used for activities described in subparagraphs (C) and (D) of paragraph (1).CommentsClose CommentsPermalink
‘(e) Geographic Distribution- The Secretary shall ensure that grants awarded under this section are equitably distributed among the geographical regions of the United States and between urban and rural populations.CommentsClose CommentsPermalink
‘(f) Evaluation- Not later than 3 months after a grant or cooperative agreement awarded under this section expires, an eligible entity shall submit to the Secretary the results of an evaluation to be conducted by the entity concerning the effectiveness of the activities carried out under the grant or agreement.CommentsClose CommentsPermalink
‘(g) Report- Not later than 5 years after the date of enactment of this section, the Secretary shall prepare and submit to the appropriate committees of Congress a report that shall evaluate the activities funded under this section. The report shall include an evaluation of the impact of co-locating primary and specialty care in community mental and behavioral health settings on overall patient health status and recommendations on whether or not the demonstration program under this section should be made permanent.CommentsClose CommentsPermalink
‘(h) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, $50,000,0000 for fiscal year 2010 and such sums as may be necessary for each of fiscal years 2011 through 2014.’.CommentsClose CommentsPermalink
Subtitle F--Making Health Care More Affordable for RetireesCommentsClose CommentsPermalink
Subtitle F--Making Health Care More Affordable for RetireesCommentsClose CommentsPermalink
SEC. 181. REINSURANCE FOR RETIREES.
(a) Administration-CommentsClose CommentsPermalink
(1) IN GENERAL- Not later than 90 days after the date of enactment of this section, the Secretary shall establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for a portion of the cost of providing health benefits to retirees whose primary residence is located in any State that is not a participating State or an establishing State (as described in section 3104) for a portion of the cost of providing health insurance coverage to retirees (and to the eligible spouses, surviving spouses, and dependents of such retirees) during the period beginning on the date on which such program is established and ending on the date on which such State becomes a participating State or an establishing State.CommentsClose CommentsPermalink
(2) REFERENCE- In this section:CommentsClose CommentsPermalink
(A) HEALTH BENEFITS- The term ‘health benefits’ means medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded, or delivered through the purchase of insurance or otherwise.CommentsClose CommentsPermalink
(B) EMPLOYMENT-BASED PLAN- The term ‘employment-based plan’ means a group health benefits plan that--CommentsClose CommentsPermalink
(i) is--CommentsClose CommentsPermalink
(I) maintained by one or more current or former employers (including without limitation any State or local government or political subdivision thereof), employee organization, a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan; orCommentsClose CommentsPermalink
(II) a multiemployer plan (as defined in section 3(37) of the Employee Retirement Income Security Act of 1974); andCommentsClose CommentsPermalink
(ii) provides health benefits to retirees.CommentsClose CommentsPermalink
(C) RETIREES- The term ‘retirees’ means individuals who are age 55 and older but are not eligible for coverage under title XVIII of the Social Security Act, and who are not active employees of an employer maintaining , or currently contributing to, the employment-based plan or of any employer that has made substantial contributions to fund such plan.CommentsClose CommentsPermalink
(b) Participation-CommentsClose CommentsPermalink
(1) EMPLOYMENT-BASED PLAN ELIGIBILITY- To be eligible to participate in the program established under this section, an employment-based plan (as defined in subsection (a)(2) and referred to in this section as a ‘participating employment-based plan’ shall--CommentsClose CommentsPermalink
(A) provide employment-based health plan benefits; andCommentsClose CommentsPermalink
(B) submit to the Secretary an application for participation in the program, at such time, in such manner, and containing such information as the Secretary shall require.CommentsClose CommentsPermalink
(2) APPROPRIATE EMPLOYMENT-BASED HEALTH BENEFITS- Appropriate employment-based health benefits described in this paragraph shall--CommentsClose CommentsPermalink
(A) meet the requirements established under section 3103(a)(1)(B);CommentsClose CommentsPermalink
(B) implement programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions;CommentsClose CommentsPermalink
(C) provide documentation of the actual cost of medical claims involved; andCommentsClose CommentsPermalink
(D) be certified as appropriate by the Secretary.CommentsClose CommentsPermalink
(c) Payments-CommentsClose CommentsPermalink
(1) SUBMISSION OF CLAIMS-CommentsClose CommentsPermalink
(A) IN GENERAL- A participating employment-based plan shall submit claims for reimbursement to the Secretary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted.CommentsClose CommentsPermalink
(B) BASIS FOR CLAIMS- Claims submitted under paragraph (1) shall be based on the actual amount expended by the participating employment-based plan involved within the plan year for the appropriate employment-based health benefits provided to a retiree or the spouse, surviving spouse, or dependent of such retiree. In determining the amount of a claim for purposes of this subsection, the participating employment-based plan shall take into account any negotiated price concessions (such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations) obtained by such plan with respect to such health benefit. For purposes of determining the amount of any such claim, the costs paid by the retiree or the retiree’s spouse, surviving spouse, or dependent in the form of deductibles, co-payments, or co-insurance shall be included in the amounts paid by the participating employment-based plan.CommentsClose CommentsPermalink
(2) PROGRAM PAYMENTS- If the Secretary determines that a participating employment-based plan has submitted a valid claim under paragraph (1), the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceed $15,000, subject to the limits contained in paragraph (3).CommentsClose CommentsPermalink
(3) LIMIT- To be eligible for reimbursement under the program, a claim submitted by a participating employment-based plan shall not be less than $15,000 nor greater than $90,000. Such amounts shall be adjusted each fiscal year based on the percentage increase in the Medical Care Component of the Consumer Price Index for all urban consumers (rounded to the nearest multiple of $1,000) for the year involved.CommentsClose CommentsPermalink
(4) USE OF PAYMENTS- Amounts paid to a participating employment-based plan under this subsection shall be used to lower costs for the plan. Such payments may be used to reduce premium costs for an entity described in subsection (a)(2)(B)(i) or to reduce premium contributions, co-payments, deductibles, co-insurance, or other out-of-pocket costs for plan participants. Such payments shall not be used as general revenues for an entity described in subsection (a)(2)(B)(i). The Secretary shall develop a mechanism to monitor the appropriate use of such payments by such entities.CommentsClose CommentsPermalink
(5) PAYMENTS NOT TREATED AS INCOME- Payments received under this subsection shall not be included in determining the gross income of an entity described in subsection (a)(2)(B)(i) that is maintaining or currently contributing to a participating employment-based plan.CommentsClose CommentsPermalink
(6) APPEALS- The Secretary shall establish--CommentsClose CommentsPermalink
(A) an appeals process to permit participating employment-based plans to appeal a determination of the Secretary with respect to claims submitted under this section; andCommentsClose CommentsPermalink
(B) procedures to protect against fraud, waste, and abuse under the program.CommentsClose CommentsPermalink
(d) Audits- The Secretary shall conduct annual audits of claims data submitted by participating employment-based plans under this section to ensure that such plans are in compliance with the requirements of this section.CommentsClose CommentsPermalink
(e) Retiree Reserve Trust Fund-CommentsClose CommentsPermalink
(1) ESTABLISHMENT OF TRUST FUND-CommentsClose CommentsPermalink
(A) IN GENERAL- There is established in the Treasury of the United States a trust fund to be known as the ‘Retiree Reserve Trust Fund’ (referred to in this section as the ‘Trust Fund’), that shall consist of such amounts as may be appropriated or credited to the Trust Fund as provided for in this subsection to enable the Secretary to carry out the program under this section. Such amounts shall remain available until expended.CommentsClose CommentsPermalink
(B) FUNDING- There are hereby appropriated to the Trust Fund, out of any moneys in the Treasury not otherwise appropriated an amount requested by the Secretary of Health and Human Services as necessary to carry out this section, except that the total of all such amounts requested shall not exceed $10,000,000,000.CommentsClose CommentsPermalink
(C) APPROPRIATIONS FROM THE TRUST FUND- Amounts in the Trust Fund may be appropriated to provide funding to carry out this program under this sectionCommentsClose CommentsPermalink
(2) USE OF TRUST FUND- The Secretary shall use amounts contained in the Trust Fund to carry out the program under this section.CommentsClose CommentsPermalink
(3) LIMITATIONS- The Secretary has the authority to stop taking applications for participation in the program to comply with the funding limit provided for in paragraph (1)(B).CommentsClose CommentsPermalink
Subtitle G--Improving the Use of Health Information Technology for Enrollment; Miscellaneous ProvisionsCommentsClose CommentsPermalink
Subtitle G--Improving the Use of Health Information Technology for Enrollment; Miscellaneous ProvisionsCommentsClose CommentsPermalink
SEC. 185. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.
Title XXX of the Public Health Service Act (
‘Subtitle C--Other ProvisionsCommentsClose CommentsPermalink
‘SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.
‘(a) In General-CommentsClose CommentsPermalink
‘(1) STANDARDS AND PROTOCOLS- Not later than 180 days after the date of enactment of this title, the Secretary, in consultation with the HIT Policy Committee and the HIT Standards Committee, shall develop interoperable and secure standards and protocols that facilitate enrollment of individuals in Federal and State health and human services programs, as determined by the Secretary.CommentsClose CommentsPermalink
‘(2) METHODS- The Secretary shall facilitate enrollment in such programs through methods determined appropriate by the Secretary, which shall include providing individuals and third parties authorized by such individuals and their designees notification of eligibility and verification of eligibility required under such programs.CommentsClose CommentsPermalink
‘(b) Content- The standards and protocols for electronic enrollment in the Federal and State programs described in subsection (a) shall allow for the following:CommentsClose CommentsPermalink
‘(1) Electronic matching against existing Federal and State data, including vital records, employment history, enrollment systems, tax records, and other data determined appropriate by the Secretary to serve as evidence of eligibility and in lieu of paper-based documentation.CommentsClose CommentsPermalink
‘(2) Simplification and submission of electronic documentation, digitization of documents, and systems verification of eligibility.CommentsClose CommentsPermalink
‘(3) Reuse of stored eligibility information (including documentation) to assist with retention of eligible individuals.CommentsClose CommentsPermalink
‘(4) Capability for individuals to apply, recertify and manage their eligibility information online, including at home, at points of service, and other community-based locations.CommentsClose CommentsPermalink
‘(5) Ability to expand the enrollment system to integrate new programs, rules, and functionalities, to operate at increased volume, and to apply streamlined verification and eligibility processes to other Federal and State programs, as appropriate.CommentsClose CommentsPermalink
‘(6) Notification of eligibility, recertification, and other needed communication regarding eligibility, which may include communication via email and cellular phones.CommentsClose CommentsPermalink
‘(7) Other functionalities necessary to provide eligibles with streamlined enrollment process.CommentsClose CommentsPermalink
‘(c) Approval and Notification- With respect to any standard or protocol developed under subsection (a) that has been approved by the HIT Policy Committee and the HIT Standards Committee, the Secretary--CommentsClose CommentsPermalink
‘(1) shall notify States of such standards or protocols; andCommentsClose CommentsPermalink
‘(2) may require, as a condition of receiving Federal funds for the health information technology investments, that States or other entities incorporate such standards and protocols into such investments.CommentsClose CommentsPermalink
‘(d) Grants for Implementation of Appropriate Enrollment HIT-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall award grant to eligible entities to develop new, and adapt existing, technology systems to implement the HIT enrollment standards and protocols developed under subsection (a) (referred to in this subsection as ‘appropriate HIT technology’).CommentsClose CommentsPermalink
‘(2) ELIGIBLE ENTITIES- To be eligible for a grant under this subsection, an entity shall--CommentsClose CommentsPermalink
‘(A) be a State, political subdivision of a State, or a local governmental entity; andCommentsClose CommentsPermalink
‘(B) submit to the Secretary an application at such time, in such manner, and containing--CommentsClose CommentsPermalink
‘(i) a plan to adopt and implement appropriate enrollment technology that includes--CommentsClose CommentsPermalink
‘(I) proposed reduction in maintenance costs of technology systems;CommentsClose CommentsPermalink
‘(II) elimination or updating of legacy systems; andCommentsClose CommentsPermalink
‘(III) demonstrated collaboration with other entities that may receive a grant under this section that are located in the same State, political subdivision, or locality;CommentsClose CommentsPermalink
‘(ii) an assurance that the entity will share such appropriate enrollment technology in accordance with paragraph (4); andCommentsClose CommentsPermalink
‘(iii) such other information as the Secretary may require.CommentsClose CommentsPermalink
‘(3) SHARING-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall ensure that appropriate enrollment HIT adopted under grants under this subsection is made available to other qualified State, qualified political subdivisions of a State, or other appropriate qualified entities (as described in subparagraph (B)) at no cost.CommentsClose CommentsPermalink
‘(B) QUALIFIED ENTITIES- The Secretary shall determine what entities are qualified to receive enrollment HIT under subparagraph (A), taking into consideration the recommendations of the HIT Policy Committee and the HIT Standards Committee.’.CommentsClose CommentsPermalink
SEC. 186. RULE OF CONSTRUCTION REGARDING HAWAII’S PREPAID HEALTH CARE ACT.
Nothing in this title (or an amendment made by this title) shall be construed to modify or limit the application of the exemption for Hawaii’s Prepaid Health Care Act (Haw. Rev. Stat. 393-1 et seq.) as provided for under section 514(b)(5) of the Employee Retirement Income Security Act of 1974 (
SEC. 187. KEY NATIONAL INDICATORS.
(a) Definitions- In this section:CommentsClose CommentsPermalink
(1) ACADEMY- The term ‘Academy’ means the National Academy of Sciences.CommentsClose CommentsPermalink
(2) COMMISSION- The term ‘Commission’ means the Commission on Key National Indicators established under subsection (b).CommentsClose CommentsPermalink
(3) INSTITUTE- The term ‘Institute’ means a Key National Indicators Institute as designated under subsection (c)(3).CommentsClose CommentsPermalink
(b) Commission on Key National Indicators-CommentsClose CommentsPermalink
(1) ESTABLISHMENT- There is established a ‘Commission on Key National Indicators’.CommentsClose CommentsPermalink
(2) MEMBERSHIP-CommentsClose CommentsPermalink
(A) NUMBER AND APPOINTMENT- The Commission shall be composed of 8 members, to be appointed equally by the majority and minority leaders of the Senate and the Speaker and minority leader of the House of Representatives.CommentsClose CommentsPermalink
(B) PROHIBITED APPOINTMENTS- Members of the Commission shall not include Members of Congress or other elected Federal, State, or local government officials.CommentsClose CommentsPermalink
(C) QUALIFICATIONS- In making appointments under subparagraph (A), the majority and minority leaders of the Senate and the Speaker and minority leader of the House of Representatives shall appoint individuals who have shown a dedication to improving civic dialogue and decision-making through the wide use of scientific evidence and factual information.CommentsClose CommentsPermalink
(D) PERIOD OF APPOINTMENT- Each member of the Commission shall be appointed for a 2-year term, except that 1 initial appointment shall be for 3 years. Any vacancies shall not affect the power and duties of the Commission but shall be filled in the same manner as the original appointment and shall last only for the remainder of that term.CommentsClose CommentsPermalink
(E) DATE- Members of the Commission shall be appointed by not later than 30 days after the date of enactment of this Act.CommentsClose CommentsPermalink
(F) INITIAL ORGANIZING PERIOD- -Not later than 60 days after the date of enactment of this Act, the Commission shall develop and implement a schedule for completion of the review and reports required under subsection (d).CommentsClose CommentsPermalink
(G) CO-CHAIRPERSONS- The Commission shall select 2 Co-Chairpersons from among its members.CommentsClose CommentsPermalink
(c) Duties of the Commission-CommentsClose CommentsPermalink
(1) IN GENERAL- The Commission shall--CommentsClose CommentsPermalink
(A) conduct comprehensive oversight of a newly established key national indicators system consistent with the purpose described in this subsection;CommentsClose CommentsPermalink
(B) make recommendations on how to improve the key national indicators system;CommentsClose CommentsPermalink
(C) coordinate with Federal Government users and information providers to assure access to relevant and quality data; andCommentsClose CommentsPermalink
(D) enter into contracts with the Academy.CommentsClose CommentsPermalink
(2) REPORTS-CommentsClose CommentsPermalink
(A) ANNUAL REPORT TO CONGRESS- Not later than 1 year after the selection of the 2 Co-Chairpersons of the Commission, and each subsequent year thereafter, the Commission shall prepare and submit to the appropriate Committees of Congress and the President a report that contains a detailed statement of the recommendations, findings, and conclusions of the Commission on the activities of the Academy and a designated Institute related to the establishment of a Key National Indicator System.CommentsClose CommentsPermalink
(B) ANNUAL REPORT TO THE ACADEMY-CommentsClose CommentsPermalink
(i) IN GENERAL- Not later than 6 months after the selection of the 2 Co-Chairpersons of the Commission, and each subsequent year thereafter, the Commission shall prepare and submit to the Academy and a designated Institute a report making recommendations concerning potential issue areas and key indicators to be included in the Key National Indicators.CommentsClose CommentsPermalink
(ii) LIMITATION- The Commission shall not have the authority to direct the Academy or, if established, the Institute, to adopt, modify, or delete any key indicators.CommentsClose CommentsPermalink
(3) CONTRACT WITH THE NATIONAL ACADEMY OF SCIENCES- -CommentsClose CommentsPermalink
(A) IN GENERAL- -As soon as practicable after the selection of the 2 Co-Chairpersons of the Commission, the Co-Chairpersons shall enter into an arrangement with the National Academy of Sciences under which the Academy shall--CommentsClose CommentsPermalink
(i) review available public and private sector research on the selection of a set of key national indicators;CommentsClose CommentsPermalink
(ii) determine how best to establish a key national indicator system for the United States, by either creating its own institutional capability or designating an independent private nonprofit organization as an Institute to implement a key national indicator system;CommentsClose CommentsPermalink
(iii) if the Academy designates an independent Institute under clause (ii), provide scientific and technical advice to the Institute and create an appropriate governance mechanism that balances Academy involvement and the independence of the Institute; andCommentsClose CommentsPermalink
(iv) provide an annual report to the Commission addressing scientific and technical issues related to the key national indicator system and, if established, the Institute, and governance of the Institute’s budget and operations.CommentsClose CommentsPermalink
(B) PARTICIPATION- In executing the arrangement under subparagraph (A), the National Academy of Sciences shall convene a multi-sector, multi-disciplinary process to define major scientific and technical issues associated with developing, maintaining, and evolving a Key National Indicator System and, if an Institute is established, to provide it with scientific and technical advice.CommentsClose CommentsPermalink
(C) ESTABLISHMENT OF A KEY NATIONAL INDICATOR SYSTEM-CommentsClose CommentsPermalink
(i) IN GENERAL- In executing the arrangement under subparagraph (A), the National Academy of Sciences shall enable the establishment of a key national indicator system by--CommentsClose CommentsPermalink
(I) creating its own institutional capability; orCommentsClose CommentsPermalink
(II) partnering with an independent private nonprofit organization as an Institute to implement a key national indicator system.CommentsClose CommentsPermalink
(ii) INSTITUTE- If the Academy designates an Institute under clause (i)(II), such Institute shall be a non-profit entity (as defined for purposes of section 501(c)(3) of the Internal Revenue Code of 1986) with an educational mission, a governance structure that emphasizes independence, and characteristics that make such entity appropriate for establishing a key national indicator system.CommentsClose CommentsPermalink
(iii) RESPONSIBILITIES- Either the Academy or the Institute designated under clause (i)(II) shall be responsible for the following:CommentsClose CommentsPermalink
(I) Identifying and selecting issue areas to be represented by the key national indicators.CommentsClose CommentsPermalink
(II) Identifying and selecting the measures used for key national indicators within the issue areas under subclause (I).CommentsClose CommentsPermalink
(III) Identifying and selecting data to populate the key national indicators described under subclause (II).CommentsClose CommentsPermalink
(IV) Designing, publishing, and maintaining a public website that contains a freely accessible database allowing public access to the key national indicators.CommentsClose CommentsPermalink
(V) Developing a quality assurance framework to ensure rigorous and independent processes and the selection of quality data.CommentsClose CommentsPermalink
(VI) Developing a budget for the construction and management of a sustainable, adaptable, and evolving key national indicator system that reflects all Commission funding of Academy and, if an Institute is established, Institute activities.CommentsClose CommentsPermalink
(VII) Reporting annually to the Commission regarding its selection of issue areas, key indicators, data, and progress toward establishing a web-accessible database.CommentsClose CommentsPermalink
(VIII) Responding directly to the Commission in response to any Commission recommendations and to the Academy regarding any inquiries by the Academy.CommentsClose CommentsPermalink
(iv) GOVERNANCE- Upon the establishment of a key national indicator system, the Academy shall create an appropriate governance mechanism that incorporates advisory and control functions. If an Institute is designated under clause (i)(II), the governance mechanism shall balance appropriate Academy involvement and the independence of the Institute.CommentsClose CommentsPermalink
(v) MODIFICATION AND CHANGES- The Academy shall retain the sole discretion, at any time, to alter its approach to the establishment of a key national indicator system or, if an Institute is designated under clause (i)(II), to alter any aspect of its relationship with the Institute or to designate a different non-profit entity to serve as the Institute.CommentsClose CommentsPermalink
(vi) CONSTRUCTION- Nothing in this section shall be construed to limit the ability of the Academy or the Institute designated under clause (i)(II) to receive private funding for activities related to the establishment of a key national indicator system.CommentsClose CommentsPermalink
(D) ANNUAL REPORT- As part of the arrangement under subparagraph (A), the National Academy of Sciences shall, not later than 270 days after the date of enactment of this Act, and annually thereafter, submit to the Co-Chairpersons of the Commission a report that contains the findings and recommendations of the Academy.CommentsClose CommentsPermalink
(d) Government Accountability Office Study and Report-CommentsClose CommentsPermalink
(1) GAO STUDY- The Comptroller General of the United States shall conduct a study of previous work conducted by all public agencies, private organizations, or foreign countries with respect to best practices for a key national indicator system. The study shall be submitted to the appropriate authorizing committees of Congress.CommentsClose CommentsPermalink
(2) GAO FINANCIAL AUDIT- If an Institute is established under this section, the Comptroller General shall conduct an annual audit of the financial statements of the Institute, in accordance with generally accepted government auditing standards and submit a report on such audit to the Commission and the appropriate authorizing committees of Congress.CommentsClose CommentsPermalink
(3) GAO PROGRAMMATIC REVIEW- The Comptroller General of the United States shall conduct programmatic assessments of the Institute established under this section as determined necessary by the Comptroller General and report the findings to the Commission and to the appropriate authorizing committees of Congress.CommentsClose CommentsPermalink
(e) Authorization of Appropriations-CommentsClose CommentsPermalink
(1) IN GENERAL- -There are authorized to be appropriated to carry out the purposes of this section, $10,000,000 for fiscal year 2010, and $7,500,000 for each of fiscal year 2011 through 2018.CommentsClose CommentsPermalink
(2) AVAILABILITY- -Amounts appropriated under paragraph (1) shall remain available until expended.CommentsClose CommentsPermalink
SEC. 188. STUDY AND REPORT ON RATES OF PREVENTABLE DISEASES IN NEW MEDICARE ENROLLEES.
(a) Study-CommentsClose CommentsPermalink
(1) IN GENERAL- The Comptroller General of the United States (in this section referred to as the ‘Comptroller General’) shall conduct a study on--CommentsClose CommentsPermalink
(A) whether applicable new Medicare enrollees exhibit higher than expected rates of preventable disease when compared to the entire population of new Medicare enrollees or another appropriate statistical baseline; andCommentsClose CommentsPermalink
(B) if applicable new Medicare enrollees exhibit such a higher than expected rate of preventable disease, whether such rate is related to the failure of the enrollee’s previous private health insurance issuer to promote, cover, or adequately pay for preventive health benefits.CommentsClose CommentsPermalink
(2) APPLICABLE NEW MEDICARE ENROLLEE- In this section, the term ‘applicable new Medicare enrollee’ means an individual--CommentsClose CommentsPermalink
(A) who is entitled to, or enrolled for, benefits under part A of title XVII of the Social Security Act (
(B) who was covered by private health insurance or Medicaid or other Federal Government health programs (as of the day before the date of such entitlement or enrollment).CommentsClose CommentsPermalink
(b) Report- Not later than 3 years after the date on which at least 5 Gateways under title XXXI of the Public Health Service Act, as added by section 142, are operating in the United States, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.CommentsClose CommentsPermalink
SEC. 189. TRANSPARENCY IN GOVERNMENT.
Not later than 30 days after the date of enactment of this Act, the Secretary of Health and Human Services shall publish on the Internet website of the Department of Health and Human Services, a list of all of the authorities provided to the Secretary under this Act (and the amendments made by this Act).CommentsClose CommentsPermalink
SEC. 189A. PRESERVING THE SOLVENCY OF MEDICARE AND SOCIAL SECURITY.
Nothing in this Act (or an amendment made by this Act) shall be carried out in a manner that threatens the solvency of Medicare or Social Security programs.CommentsClose CommentsPermalink
SEC. 189B. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE.
(a) In General- The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.CommentsClose CommentsPermalink
(b) Definition- In this section, the term ‘health care entity’ includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.CommentsClose CommentsPermalink
(c) Construction and Treatment of Certain Services- Nothing in subsection (a) shall be construed to apply to or to affect any limitation relating to--CommentsClose CommentsPermalink
(1) the withholding or withdrawing of medical treatment or medical care;CommentsClose CommentsPermalink
(2) the withholding or withdrawing of nutrition or hydration;CommentsClose CommentsPermalink
(3) abortion; orCommentsClose CommentsPermalink
(4) the use of an item, good, benefit, or service furnished for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as such item, good, benefit, or service is not also furnished for the purpose of causing, or the purpose of assisting in causing, death, for any reason.CommentsClose CommentsPermalink
(d) Administration- The Office for Civil Rights of the Department of Health and Human Services is designated to receive complaints of discrimination based on this section.CommentsClose CommentsPermalink
SEC. 189C. ACCESS TO THERAPIES.
Notwithstanding any other provision of the Affordable Health Choices Act, the Secretary of Health and Human Services shall not promulgate any regulation that--CommentsClose CommentsPermalink
(1) creates any unreasonable barriers to the ability of individuals to obtain appropriate medical care;CommentsClose CommentsPermalink
(2) impedes timely access to health care services;CommentsClose CommentsPermalink
(3) interferes with communications regarding a full range of treatment options between the patient and the provider;CommentsClose CommentsPermalink
(4) restricts the ability of health care providers to provide full disclosure of all relevant information to patients making health care decisions;CommentsClose CommentsPermalink
(5) violates the principles of informed consent and the ethical standards of health care professionals; orCommentsClose CommentsPermalink
(6) limits the availability of health care treatment for the full duration of a patient’s medical needs.CommentsClose CommentsPermalink
SEC. 189D. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS.
No individual, company, business, nonprofit entity, or health insurer offering group or individual health insurance shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendments), and there shall be no penalty or fine imposed upon any such insurer for choosing not to participate in such programs.CommentsClose CommentsPermalink
Subtitle H--CLASS ActCommentsClose CommentsPermalink
Subtitle H--CLASS ActCommentsClose CommentsPermalink
SEC. 190. SHORT TITLE OF SUBTITLE.
This subtitle may be cited as the ‘Community Living Assistance Services and Supports Act’ or the ‘CLASS Act’.CommentsClose CommentsPermalink
SEC. 191. ESTABLISHMENT OF NATIONAL VOLUNTARY INSURANCE PROGRAM FOR PURCHASING COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORT.
(a) Establishment of CLASS Program-CommentsClose CommentsPermalink
(1) IN GENERAL- The Public Health Service Act (
‘TITLE XXXII--COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTSCommentsClose CommentsPermalink
‘SEC. 3201. PURPOSE.
‘The purpose of this title is to establish a national voluntary insurance program for purchasing community living assistance services and supports in order to--CommentsClose CommentsPermalink
‘(1) provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence and live in the community through a new financing strategy for community living assistance services and supports;CommentsClose CommentsPermalink
‘(2) establish an infrastructure that will help address the Nation’s community living assistance services and supports needs;CommentsClose CommentsPermalink
‘(3) alleviate burdens on family caregivers; andCommentsClose CommentsPermalink
‘(4) address institutional bias by providing a financing mechanism that supports personal choice and independence to live in the community.CommentsClose CommentsPermalink
‘SEC. 3202. DEFINITIONS.
‘In this title:CommentsClose CommentsPermalink
‘(1) ACTIVE ENROLLEE- The term ‘active enrollee’ means an individual who is enrolled in the CLASS program in accordance with section 3204 and who has paid any premiums due to maintain such enrollment.CommentsClose CommentsPermalink
‘(2) ACTIVELY EMPLOYED- The term ‘actively employed’ means an individual who--CommentsClose CommentsPermalink
‘(A) is reporting for work at the individual’s usual place of employment or at another location to which the individual is required to travel because of the individual’s employment (or in the case of an individual who is a member of the uniformed services, is on active duty and is physically able to perform the duties of the individual’s position); andCommentsClose CommentsPermalink
‘(B) is able to perform all the usual and customary duties of the individual’s employment on the individual’s regular work schedule.CommentsClose CommentsPermalink
‘(3) ACTIVITIES OF DAILY LIVING- The term ‘activities of daily living’ means each of the following activities specified in section 7702B(c)(2)(B) of the Internal Revenue Code of 1986:CommentsClose CommentsPermalink
‘(A) Eating.CommentsClose CommentsPermalink
‘(B) Toileting.CommentsClose CommentsPermalink
‘(C) Transferring.CommentsClose CommentsPermalink
‘(D) Bathing.CommentsClose CommentsPermalink
‘(E) Dressing.CommentsClose CommentsPermalink
‘(F) Continence.CommentsClose CommentsPermalink
‘(4) CLASS PROGRAM- The term ‘CLASS program’ means the program established under this title.CommentsClose CommentsPermalink
‘(5) DISABILITY DETERMINATION SERVICE- The term ‘Disability Determination Service’ means, with respect to each State, the entity that has an agreement with the Commissioner of Social Security to make disability determinations for purposes of title II or XVI of the Social Security Act (
42 U.S.C. 401 et seq., 1381 et seq.).CommentsClose CommentsPermalink‘(6) ELIGIBLE BENEFICIARY-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘eligible beneficiary’ means any individual who is an active enrollee in the CLASS program and, as of the date described in subparagraph (B)--CommentsClose CommentsPermalink
‘(i) has paid premiums for enrollment in such program for at least 60 months;CommentsClose CommentsPermalink
‘(ii) has earned, for each calendar year that occurs during the first 60 months for which the individual has paid premiums for enrollment in the program, at least an amount equal to the amount of wages and self-employment income which an individual must have in order to be credited with a quarter of coverage under section 213(d) of the Social Security Act for that year; andCommentsClose CommentsPermalink
‘(iii) has paid premiums for enrollment in such program for at least 24 consecutive months, if a lapse in premium payments of more than 3 months has occurred during the period that begins on the date of the individual’s enrollment and ends on the date of such determination.CommentsClose CommentsPermalink
‘(B) DATE DESCRIBED- For purposes of subparagraph (A), the date described in this subparagraph is the date on which the individual is determined to have a functional limitation described in section 3203(a)(1)(C) that is expected to last for a continuous period of more than 90 days.CommentsClose CommentsPermalink
‘(C) REGULATIONS- The Secretary shall promulgate regulations specifying exceptions to the minimum earnings requirements under subparagraph (A)(ii) for purposes of being considered an eligible beneficiary for certain populations.CommentsClose CommentsPermalink
‘(7) HOSPITAL; NURSING FACILITY; INTERMEDIATE CARE FACILITY FOR THE MENTALLY RETARDED; INSTITUTION FOR MENTAL DISEASES- The terms ‘hospital’, ‘nursing facility’, ‘intermediate care facility for the mentally retarded’, and ‘institution for mental diseases’ have the meanings given such terms for purposes of Medicaid.CommentsClose CommentsPermalink
‘(8) CLASS INDEPENDENCE ADVISORY COUNCIL- The term ‘CLASS Independence Advisory Council’ or ‘Council’ means the Advisory Council established under section 3207 to advise the Secretary.CommentsClose CommentsPermalink
‘(9) CLASS INDEPENDENCE BENEFIT PLAN- The term ‘CLASS Independence Benefit Plan’ means the benefit plan developed and designated by the Secretary in accordance with section 3203.CommentsClose CommentsPermalink
‘(10) CLASS INDEPENDENCE FUND- The term ‘CLASS Independence Fund’ or ‘Fund’ means the fund established under section 3206.CommentsClose CommentsPermalink
‘(11) MEDICAID- The term ‘Medicaid’ means the program established under title XIX of the Social Security Act (
42 U.S.C. 1396 et seq.).CommentsClose CommentsPermalink‘(12) PROTECTION AND ADVOCACY SYSTEM- The term ‘Protection and Advocacy System’ means the system for each State established under section 143 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (
42 U.S.C. 15043 ).CommentsClose CommentsPermalink
‘SEC. 3203. CLASS INDEPENDENCE BENEFIT PLAN.
‘(a) Process for Development-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary, in consultation with appropriate actuaries and other experts, shall develop at least 3 actuarially sound benefit plans as alternatives for consideration for designation by the Secretary as the CLASS Independence Benefit Plan under which eligible beneficiaries shall receive benefits under this title. Each of the plan alternatives developed shall be designed to provide eligible beneficiaries with the benefits described in section 3205 consistent with the following requirements:CommentsClose CommentsPermalink
‘(A) PREMIUMS- Beginning with the first year of the CLASS program, and for each year thereafter, the Secretary shall establish all premiums to be paid by enrollees for the year based on an actuarial analysis of the 75-year costs of the program that ensures solvency throughout such 75-year period.CommentsClose CommentsPermalink
‘(B) VESTING PERIOD- A 5-year vesting period for eligibility for benefits.CommentsClose CommentsPermalink
‘(C) BENEFIT TRIGGERS- A benefit trigger for provision of benefits that requires a determination that an individual has a functional limitation, as certified by a licensed health care practitioner, described in any of the following clauses that is expected to last for a continuous period of more than 90 days:CommentsClose CommentsPermalink
‘(i) The individual is determined to be unable to perform at least the minimum number (which may be 2 or 3) of activities of daily living as are required under the plan for the provision of benefits without substantial assistance (as defined by the Secretary) from another individual.CommentsClose CommentsPermalink
‘(ii) The individual requires substantial supervision to protect the individual from threats to health and safety due to substantial cognitive impairment.CommentsClose CommentsPermalink
‘(iii) The individual has a level of functional limitation similar (as determined under regulations prescribed by the Secretary) to the level of functional limitation described in clause (i) or (ii).CommentsClose CommentsPermalink
‘(D) CASH BENEFIT- Payment of a cash benefit that satisfies the following requirements:CommentsClose CommentsPermalink
‘(i) MINIMUM REQUIRED AMOUNT- The benefit amount provides an eligible beneficiary with not less than an average of $50 per day (as determined based on the reasonably expected distribution of beneficiaries receiving benefits at various benefit levels).CommentsClose CommentsPermalink
‘(ii) AMOUNT SCALED TO FUNCTIONAL ABILITY- The benefit amount is varied based on a scale of functional ability, with not less than 2, and not more than 6, benefit level amounts.CommentsClose CommentsPermalink
‘(iii) DAILY OR WEEKLY- The benefit is paid on a daily or weekly basis.CommentsClose CommentsPermalink
‘(iv) NO LIFETIME OR AGGREGATE LIMIT- The benefit is not subject to any lifetime or aggregate limit.CommentsClose CommentsPermalink
‘(E) COORDINATION WITH SUPPLEMENTAL COVERAGE OBTAINED THROUGH THE EXCHANGE- The benefits allow for coordination with any supplemental coverage purchased through a Gateway established under section 3101.CommentsClose CommentsPermalink
‘(2) REVIEW AND RECOMMENDATION BY THE CLASS INDEPENDENCE ADVISORY COUNCIL- The CLASS Independence Advisory Council shall--CommentsClose CommentsPermalink
‘(A) evaluate the alternative benefit plans developed under paragraph (1); andCommentsClose CommentsPermalink
‘(B) recommend for designation as the CLASS Independence Benefit Plan for offering to the public the plan that the Council determines best balances price and benefits to meet enrollees’ needs in an actuarially sound manner, while optimizing the probability of the long-term sustainability of the CLASS program.CommentsClose CommentsPermalink
‘(3) DESIGNATION BY THE SECRETARY- Not later than October 1, 2012, the Secretary, taking into consideration the recommendation of the CLASS Independence Advisory Council under paragraph (2)(B), shall designate a benefit plan as the CLASS Independence Benefit Plan. The Secretary shall publish such designation, along with details of the plan and the reasons for the selection by the Secretary, in a final rule that allows for a period of public comment.CommentsClose CommentsPermalink
‘(b) Additional Premium Requirements-CommentsClose CommentsPermalink
‘(1) ADJUSTMENT OF PREMIUMS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Except as provided in subparagraphs (B), (C), (D), and (E), the amount of the monthly premium determined for an individual upon such individual’s enrollment in the CLASS program shall remain the same for as long as the individual is an active enrollee in the program.CommentsClose CommentsPermalink
‘(B) RECALCULATED PREMIUM IF REQUIRED FOR PROGRAM SOLVENCY-CommentsClose CommentsPermalink
‘(i) IN GENERAL- Subject to clause (ii), if the Secretary determines, based on the most recent report of the Board of Trustees of the CLASS Independence Fund, the advice of the CLASS Independence Advisory Council, and the annual report of the Inspector General of the Department of Health and Human Services, and waste, fraud, and abuse, or such other information as the Secretary determines appropriate, that the monthly premiums and income to the CLASS Independence Fund for a year are projected to be insufficient with respect to the 20-year period that begins with that year, the Secretary shall adjust the monthly premiums for individuals enrolled in the CLASS program as necessary.CommentsClose CommentsPermalink
‘(ii) EXEMPTION FROM INCREASE- Any increase in a monthly premium imposed as result of a determination described in clause (i) shall not apply with respect to the monthly premium of any active enrollee who--CommentsClose CommentsPermalink
‘(I) has attained age 65;CommentsClose CommentsPermalink
‘(II) has paid premiums for enrollment in the program for at least 20 years; andCommentsClose CommentsPermalink
‘(III) is not actively employed.CommentsClose CommentsPermalink
‘(C) RECALCULATED PREMIUM IF REENROLLMENT AFTER MORE THAN A 3-MONTH LAPSE-CommentsClose CommentsPermalink
‘(i) IN GENERAL- The reenrollment of an individual after a 90-day period during which the individual failed to pay the monthly premium required to maintain the individual’s enrollment in the CLASS program shall be treated as an initial enrollment for purposes of age-adjusting the premium for enrollment in the program.CommentsClose CommentsPermalink
‘(ii) CREDIT FOR PRIOR MONTHS IF REENROLLED WITHIN 5 YEARS- An individual who reenrolls in the CLASS program after such a 90-day period and before the end of the 5-year period that begins with the first month for which the individual failed to pay the monthly premium required to maintain the individual’s enrollment in the program shall be--CommentsClose CommentsPermalink
‘(I) credited with any months of paid premiums that accrued prior to the individual’s lapse in enrollment; andCommentsClose CommentsPermalink
‘(II) notwithstanding the total amount of any such credited months, required to satisfy section 3202(6)(A)(ii) before being eligible to receive benefits.CommentsClose CommentsPermalink
‘(D) PENALTY FOR REENOLLMENT AFTER 5-YEAR LAPSE- In the case of an individual who reenrolls in the CLASS program after the end of the 5-year period described in subparagraph (C)(ii), the monthly premium required for the individual shall be the age-adjusted premium that would be applicable to an initially enrolling individual who is the same age as the reenrolling individual, increased by the greater of--CommentsClose CommentsPermalink
‘(i) an amount that the Secretary determines is actuarially sound for each month that occurs during the period that begins with the first month for which the individual failed to pay the monthly premium required to maintain the individual’s enrollment in the CLASS program and ends with the month preceding the month in which the reenollment is effective; orCommentsClose CommentsPermalink
‘(ii) 1 percent of the applicable age-adjusted premium for each such month occurring in such period.CommentsClose CommentsPermalink
‘(2) ADMINISTRATIVE EXPENSES- In determining the monthly premiums for the CLASS program the Secretary, in coordination with the Commissioner of Social Security, may factor in costs for administering the program, not to exceed--CommentsClose CommentsPermalink
‘(A) in the case of the first 5 years in which the program is in effect under this title, an amount equal to 3 percent of all premiums paid during each such year; andCommentsClose CommentsPermalink
‘(B) in the case of subsequent years, an amount equal to 5 percent of the total amount of all expenditures (including benefits paid) under this title with respect to that year.CommentsClose CommentsPermalink
‘(3) NO UNDERWRITING REQUIREMENTS- No underwriting (other than on the basis of age in accordance with paragraph (2)) shall be used to--CommentsClose CommentsPermalink
‘(A) determine the monthly premium for enrollment in the CLASS program; orCommentsClose CommentsPermalink
‘(B) prevent an individual from enrolling in the program.CommentsClose CommentsPermalink
‘SEC. 3204. ENROLLMENT AND DISENROLLMENT REQUIREMENTS.
‘(a) Automatic Enrollment-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Subject to paragraph (2), the Secretary, in coordination with the Secretary of the Treasury, shall establish procedures under which each individual described in subsection (c) shall be automatically enrolled in the CLASS program by an employer of such individual in the same manner as an employer may elect to automatically enroll employees in a plan under section 401(k), 403(b), or 457 of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink
‘(2) ALTERNATIVE ENROLLMENT PROCEDURES- The procedures established under paragraph (1) shall provide for an alternative enrollment process for an individual described in subsection (c) in the case of such an individual--CommentsClose CommentsPermalink
‘(A) who is self-employed;CommentsClose CommentsPermalink
‘(B) who has more than 1 employer;CommentsClose CommentsPermalink
‘(C) whose employer does not elect to participate in the automatic enrollment process established by the Secretary; orCommentsClose CommentsPermalink
‘(D) who is a spouse described in subsection (c)(2) of who is not subject to automatic enrollment.CommentsClose CommentsPermalink
‘(3) ADMINISTRATION-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary and the Secretary of the Treasury shall, by regulation, establish procedures to--CommentsClose CommentsPermalink
‘(i) ensure that an individual is not automatically enrolled in the CLASS program by more than 1 employer; andCommentsClose CommentsPermalink
‘(ii) allow for an individual’s employer to deduct a premium for a spouse described in subsection (c)(1)(B) who is not subject to automatic enrollment.CommentsClose CommentsPermalink
‘(B) FORM- Enrollment in the CLASS program shall be made in such manner as the Secretary may prescribe in order to ensure ease of administration.CommentsClose CommentsPermalink
‘(b) Election to Opt-out- An individual described in subsection (c) may elect to waive enrollment in the CLASS program at any time in such form and manner as the Secretary and the Secretary of the Treasury shall prescribe.CommentsClose CommentsPermalink
‘(c) Individual Described- For purposes of enrolling in the CLASS program, an individual described in this paragraph is--CommentsClose CommentsPermalink
‘(1) an individual--CommentsClose CommentsPermalink
‘(A) who has attained age 18;CommentsClose CommentsPermalink
‘(B) who--CommentsClose CommentsPermalink
‘(i) receives wages on which there is imposed a tax under section 3201(a) of the Internal Revenue Code of 1986; orCommentsClose CommentsPermalink
‘(ii) derives self-employment income on which there is imposed a tax under section 1401(a) of the Internal Revenue Code of 1986;CommentsClose CommentsPermalink
‘(C) who is actively employed; andCommentsClose CommentsPermalink
‘(D) who is not--CommentsClose CommentsPermalink
‘(i) a patient in a hospital or nursing facility, an intermediate care facility for the mentally retarded, or an institution for mental diseases and receiving medical assistance under Medicaid; orCommentsClose CommentsPermalink
‘(ii) confined in a jail, prison, other penal institution or correctional facility, or by court order pursuant to conviction of a criminal offense or in connection with a verdict or finding described in section 202(x)(1)(A)(ii) of the Social Security Act (
42 U.S.C. 402(x)(1)(A)(ii) ); orCommentsClose CommentsPermalink‘(2) the spouse of an individual described in paragraph (1) and who would be an individual so described but for subparagraph (B) or (C) of that paragraph.CommentsClose CommentsPermalink
‘(d) Rule of Construction- Nothing in this title shall be construed as requiring an active enrollee to continue to satisfy subparagraph (B) or (C) of subsection (c)(1) in order to maintain enrollment in the CLASS program.CommentsClose CommentsPermalink
‘(e) Payment-CommentsClose CommentsPermalink
‘(1) PAYROLL DEDUCTION- An amount equal to the monthly premium for the enrollment in the CLASS program of an individual shall be deducted from the wages or self-employment income of such individual in accordance with such procedures as the Secretary, in coordination with the Secretary of the Treasury, shall establish for employers who elect to deduct and withhold such premiums on behalf of enrolled employees.CommentsClose CommentsPermalink
‘(2) ALTERNATIVE PAYMENT MECHANISM- The Secretary, in coordination with the Secretary of the Treasury, shall establish alternative procedures for the payment of monthly premiums by an individual enrolled in the CLASS program--CommentsClose CommentsPermalink
‘(A) who does not have an employer who elects to deduct and withhold premiums in accordance with subparagraph (A); orCommentsClose CommentsPermalink
‘(B) who does not earn wages or derive self-employment income.CommentsClose CommentsPermalink
‘(f) Transfer of Premiums Collected-CommentsClose CommentsPermalink
‘(1) IN GENERAL- During each calendar year the Secretary of the Treasury shall deposit into the CLASS Independence Fund a total amount equal, in the aggregate, to 100 percent of the premiums collected during that year.CommentsClose CommentsPermalink
‘(2) TRANSFERS BASED ON ESTIMATES- The amount deposited pursuant to paragraph (1) shall be transferred in at least monthly payments to the CLASS Independence Fund on the basis of estimates by the Secretary and certified to the Secretary of the Treasury of the amounts collected in accordance with subparagraphs (A) and (B) of paragraph (5). Proper adjustments shall be made in amounts subsequently transferred to the Fund to the extent prior estimates were in excess of, or were less than, actual amounts collected.CommentsClose CommentsPermalink
‘(g) Other Enrollment and Disenrollment Opportunities- The Secretary, in coordination with the Secretary of the Treasury, shall establish procedures under which--CommentsClose CommentsPermalink
‘(1) an individual who, in the year of the individual’s initial eligibility to enroll in the CLASS program, has elected to waive enrollment in the program, is eligible to elect to enroll in the program, in such form and manner as the Secretaries shall establish, only during an open enrollment period established by the Secretaries that is specific to the individual and that may not occur more frequently than biennially after the date on which the individual first elected to waive enrollment in the program; andCommentsClose CommentsPermalink
‘(2) an individual shall only be permitted to disenroll from the program during an annual disenrollment period established by the Secretaries and in such form and manner as the Secretaries shall establish.CommentsClose CommentsPermalink
‘SEC. 3205. BENEFITS.
‘(a) Determination of Eligibility-CommentsClose CommentsPermalink
‘(1) APPLICATION FOR RECEIPT OF BENEFITS- The Secretary, in coordination with the Commissioner of Social Security, shall establish procedures under which an active enrollee shall apply for receipt of benefits under the CLASS Independence Benefit Plan.CommentsClose CommentsPermalink
‘(2) ELIGIBILITY ASSESSMENTS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Not later than January 1, 2012, the Secretary shall enter into agreements with--CommentsClose CommentsPermalink
‘(i) the Disability Determination Service for each State to provide for eligibility assessments of active enrollees who apply for receipt of benefits;CommentsClose CommentsPermalink
‘(ii) the Protection and Advocacy System for each State to provide advocacy services in accordance with subsection (d); andCommentsClose CommentsPermalink
‘(iii) public and private entities to provide advice and assistance counseling in accordance with subsection (e).CommentsClose CommentsPermalink
‘(B) REGULATIONS- The Secretary, in coordination with the Commissioner of Social Security, shall promulgate regulations to develop an expedited eligibility determination process, as certified by a licensed health care practitioner, an appeals process, and a redetermination process, as certified by a licensed health care practitioner, including whether an applicant is eligible for a cash benefit under the program and if so, the amount of the cash benefit (in accordance the sliding scale established under the plan).CommentsClose CommentsPermalink
‘(C) PRESUMPTIVE ELIGIBILITY FOR CERTAIN INSTITUTIONALIZED ENROLLEES PLANNING TO DISCHARGE- An active enrollee shall be deemed presumptively eligible if the enrollee--CommentsClose CommentsPermalink
‘(i) has applied for, and attests is eligible for, the maximum cash benefit available under the sliding scale established under the CLASS Independence Benefit Plan;CommentsClose CommentsPermalink
‘(ii) is a patient in a hospital (but only if the hospitalization is for long-term care), nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases; andCommentsClose CommentsPermalink
‘(iii) is in the process of, or about to being the process of, planning to discharge from the hospital, facility, or institution, or within 60 days from the date of discharge from the hospital, facility, or institution.CommentsClose CommentsPermalink
‘(D) APPEALS- The Secretary shall establish procedures under which an applicant for benefits under the CLASS Independence Benefit Plan shall be guaranteed the right to appeal an adverse determination.CommentsClose CommentsPermalink
‘(b) Benefits- An eligible beneficiary shall receive the following benefits under the CLASS Independence Benefit Plan:CommentsClose CommentsPermalink
‘(1) CASH BENEFIT- A cash benefit established by the Secretary in accordance with the requirements of section 3203(a)(1)(D) that--CommentsClose CommentsPermalink
‘(A) the first year in which beneficiaries receive the benefits under the plan, is not less than the average dollar amount specified in clause (i) of such section; andCommentsClose CommentsPermalink
‘(B) for any subsequent year, is not less than the average per day dollar limit applicable under this subparagraph for the preceding year, increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) over the previous year.CommentsClose CommentsPermalink
‘(2) ADVOCACY SERVICES- Advocacy services in accordance with subsection (d).CommentsClose CommentsPermalink
‘(3) ADVICE AND ASSISTANCE COUNSELING- Advice and assistance counseling in accordance with subsection (e).CommentsClose CommentsPermalink
‘(4) ADMINISTRATIVE EXPENSES- Advocacy services and advise and assistance counseling services under paragraphs (2) and (3) of this subsection shall be included as administrative expenses under section 3203(b)(3).CommentsClose CommentsPermalink
‘(c) Payment of Benefits-CommentsClose CommentsPermalink
‘(1) LIFE INDEPENDENCE ACCOUNT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall establish procedures for administering the provision of benefits to eligible beneficiaries under the CLASS Independence Benefit Plan, including the payment of the cash benefit for the beneficiary into a Life Independence Account established by the Secretary on behalf of each eligible beneficiary.CommentsClose CommentsPermalink
‘(B) USE OF CASH BENEFITS- Cash benefits paid into a Life Independence Account of an eligible beneficiary shall be used to purchase nonmedical services and supports that the beneficiary needs to maintain his or her independence at home or in another residential setting of their choice in the community, including (but not limited to) home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, and nursing support. Nothing in the preceding sentence shall prevent an eligible beneficiary from using cash benefits paid into a Life Independence Account for obtaining assistance with decision making concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives or other written instructions recognized under State law, such as a living will or durable power of attorney for health care, in the case that an injury or illness causes the individual to be unable to make health care decisions.CommentsClose CommentsPermalink
‘(C) ELECTRONIC MANAGEMENT OF FUNDS- The Secretary shall establish procedures for--CommentsClose CommentsPermalink
‘(i) crediting an account established on behalf of a beneficiary with the beneficiary’s cash daily benefit;CommentsClose CommentsPermalink
‘(ii) allowing the beneficiary to access such account through debit cards; andCommentsClose CommentsPermalink
‘(iii) accounting for withdrawals by the beneficiary from such account.CommentsClose CommentsPermalink
‘(D) PRIMARY PAYOR RULES FOR BENEFICIARIES WHO ARE ENROLLED IN MEDICAID- In the case of an eligible beneficiary who is enrolled in Medicaid, the following payment rules shall apply:CommentsClose CommentsPermalink
‘(i) INSTITUTIONALIZED BENEFICIARY- If the beneficiary is a patient in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases, the beneficiary shall retain an amount equal to 5 percent of the beneficiary’s daily or weekly cash benefit (as applicable) (which shall be in addition to the amount of the beneficiary’s personal needs allowance provided under Medicaid), and the remainder of such benefit shall be applied toward the facility’s cost of providing the beneficiary’s care, and Medicaid shall provide secondary coverage for such care.CommentsClose CommentsPermalink
‘(ii) BENEFICIARIES RECEIVING HOME AND COMMUNITY-BASED SERVICES-CommentsClose CommentsPermalink
‘(I) 50 PERCENT OF BENEFIT RETAINED BY BENEFICIARY- Subject to subclause (II), if a beneficiary is receiving medical assistance under Medicaid for home and community based services, the beneficiary shall retain an amount equal to 50 percent of the beneficiary’s daily or weekly cash benefit (as applicable), and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the State of providing such assistance (and shall not be used to claim Federal matching funds under Medicaid), and Medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance.CommentsClose CommentsPermalink
‘(II) REQUIREMENT FOR STATE OFFSET- A State shall be paid the remainder of a beneficiary’s daily or weekly cash benefit under subclause (I) only if the State home and community-based waiver under section 1115 of the Social Security Act (
42 U.S.C. 1315 ) or subsection (c) or (d) of section 1915 of such Act (42 U.S.C. 1396n ), or the State plan amendment under subsection (i) of such section does not include a waiver of the requirements of section 1902(a)(1) of the Social Security Act (relating to statewideness) or of section 1902(a)(10)(B) of such Act (relating to comparability) and the State offers at a minimum case management services, personal care services, habilitation services, and respite care under such a waiver or State plan amendment.CommentsClose CommentsPermalink‘(III) DEFINITION OF HOME AND COMMUNITY-BASED SERVICES- In this clause, the term ‘home and community-based services’ means any services which may be offered under a home and community-based waiver authorized for a State under section 1115 of the Social Security Act (
42 U.S.C. 1315 ) or subsection (c) or (d) of section 1915 of such Act (42 U.S.C. 1396n ) or under a State plan amendment under subsection (i) of such section.CommentsClose CommentsPermalink‘(iii) BENEFICIARIES ENROLLED IN PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)-CommentsClose CommentsPermalink
‘(I) IN GENERAL- Subject to subclause (II), if a beneficiary is receiving medical assistance under Medicaid for PACE program services under section 1934 of the Social Security Act (
42 U.S.C. 1396u-4 ), the beneficiary shall retain an amount equal to 50 percent of the beneficiary’s daily or weekly cash benefit (as applicable), and the remainder of the daily or weekly cash benefit shall be applied toward the cost to the State of providing such assistance (and shall not be used to claim Federal matching funds under Medicaid), and Medicaid shall provide secondary coverage for the remainder of any costs incurred in providing such assistance.CommentsClose CommentsPermalink‘(II) INSTITUTIONALIZED RECIPIENTS OF PACE PROGRAM SERVICES- If a beneficiary receiving assistance under Medicaid for PACE program services is a patient in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases, the beneficiary shall be treated as in institutionalized beneficiary under clause (i).CommentsClose CommentsPermalink
‘(2) AUTHORIZED REPRESENTATIVES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall establish procedures to allow access to a beneficiary’s cash benefits by an authorized representative of the eligible beneficiary on whose behalf such benefits are paid.CommentsClose CommentsPermalink
‘(B) QUALITY ASSURANCE AND PROTECTION AGAINST FRAUD AND ABUSE- The procedures established under subparagraph (A) shall ensure that authorized representatives of eligible beneficiaries comply with standards of conduct established by the Secretary, including standards requiring that such representatives provide quality services on behalf of such beneficiaries, do not have conflicts of interest, and do not misuse benefits paid on behalf of such beneficiaries or otherwise engage in fraud or abuse.CommentsClose CommentsPermalink
‘(3) COMMENCEMENT OF BENEFITS- Benefits shall be paid to, or on behalf of, an eligible beneficiary beginning with the first month in which an application for such benefits is approved.CommentsClose CommentsPermalink
‘(4) ROLLOVER OPTION FOR LUMP-SUM PAYMENT- An eligible beneficiary may elect to--CommentsClose CommentsPermalink
‘(A) defer payment of their daily or weekly benefit and to rollover any such deferred benefits from month-to-month, but not from year-to-year; andCommentsClose CommentsPermalink
‘(B) receive a lump-sum payment of such deferred benefits in an amount that may not exceed the lesser of--CommentsClose CommentsPermalink
‘(i) the total amount of the accrued deferred benefits; orCommentsClose CommentsPermalink
‘(ii) the applicable annual benefit.CommentsClose CommentsPermalink
‘(5) PERIOD FOR DETERMINATION OF ANNUAL BENEFITS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The applicable period for determining with respect to an eligible beneficiary the applicable annual benefit and the amount of any accrued deferred benefits is the 12-month period that commences with the first month in which the beneficiary began to receive such benefits, and each 12-month period thereafter.CommentsClose CommentsPermalink
‘(B) INCLUSION OF INCREASED BENEFITS- The Secretary shall establish procedures under which cash benefits paid to an eligible beneficiary that increase or decrease as a result of a change in the functional status of the beneficiary before the end of a 12-month benefit period shall be included in the determination of the applicable annual benefit paid to the eligible beneficiary.CommentsClose CommentsPermalink
‘(C) RECOUPMENT OF UNPAID, ACCRUED BENEFITS-CommentsClose CommentsPermalink
‘(i) IN GENERAL- The Secretary, in coordination with the Secretary of the Treasury, shall recoup any accrued benefits in the event of--CommentsClose CommentsPermalink
‘(I) the death of a beneficiary; orCommentsClose CommentsPermalink
‘(II) the failure of a beneficiary to elect under paragraph (4)(B) to receive such benefits as a lump-sum payment before the end of the 12-month period in which such benefits accrued.CommentsClose CommentsPermalink
‘(ii) PAYMENT INTO CLASS INDEPENDENCE FUND- Any benefits recouped in accordance with clause (i) shall be paid into the CLASS Independence Fund and used in accordance with section 3206.CommentsClose CommentsPermalink
‘(6) REQUIREMENT TO RECERTIFY ELIGIBILITY FOR RECEIPT OF BENEFITS- An eligible beneficiary shall periodically, as determined by the Secretary, in coordination with the Commissioner of Social Security--CommentsClose CommentsPermalink
‘(A) recertify by submission of medical evidence the beneficiary’s continued eligibility for receipt of benefits; andCommentsClose CommentsPermalink
‘(B) submit records of expenditures attributable to the aggregate cash benefit received by the beneficiary during the preceding year.CommentsClose CommentsPermalink
‘(7) SUPPLEMENT, NOT SUPPLANT OTHER HEALTH CARE BENEFITS- Subject to the Medicaid payment rules under paragraph (1)(D), benefits received by an eligible beneficiary shall supplement, but not supplant, other health care benefits for which the beneficiary is eligible under Medicaid or any other Federally funded program that provides health care benefits or assistance.CommentsClose CommentsPermalink
‘(d) Advocacy Services- An agreement entered into under subsection (a)(2)(A)(ii) shall require the Protection and Advocacy System for the State to--CommentsClose CommentsPermalink
‘(1) assign, as needed, an advocacy counselor to each eligible beneficiary that is covered by such agreement and who shall provide an eligible beneficiary with--CommentsClose CommentsPermalink
‘(A) information regarding how to access the appeals process established for the program;CommentsClose CommentsPermalink
‘(B) assistance with respect to the annual recertification and notification required under subsection (c)(6); andCommentsClose CommentsPermalink
‘(C) such other assistance with obtaining services as the Secretary, by regulation, shall require; andCommentsClose CommentsPermalink
‘(2) ensure that the System and such counselors comply with the requirements of subsection (h).CommentsClose CommentsPermalink
‘(e) Advice and Assistance Counseling- An agreement entered into under subsection (a)(2)(A)(iii) shall require the entity to assign, as requested by an eligible beneficiary that is covered by such agreement, an advice and assistance counselor who shall provide an eligible beneficiary with information regarding--CommentsClose CommentsPermalink
‘(1) accessing and coordinating long-term services and supports in the most integrated setting;CommentsClose CommentsPermalink
‘(2) possible eligibility for other benefits and services;CommentsClose CommentsPermalink
‘(3) development of a service and support plan;CommentsClose CommentsPermalink
‘(4) information about programs established under the Assistive Technology Act of 1998 and the services offered under such programs;CommentsClose CommentsPermalink
‘(5) available assistance with decision making concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives or other written instructions recognized under State law, such as a living will or durable power of attorney for health care, in the case that an injury or illness causes the individual to be unable to make health care decisions; andCommentsClose CommentsPermalink
‘(6) such other services as the Secretary, by regulation, may require.CommentsClose CommentsPermalink
‘(f) No Effect on Eligibility for Other Benefits- Benefits paid to an eligible beneficiary under the CLASS program shall be disregarded for purposes of determining or continuing the beneficiary’s eligibility for receipt of benefits under any other Federal, State, or locally funded assistance program, including benefits paid under titles II, XVI, XVIII, XIX, or XXI of the Social Security Act (
42 U.S.C. 401 et seq., 1381 et seq., 1395 et seq., 1396 et seq., 1397aa et seq.), under the laws administered by the Secretary of Veterans Affairs, under low-income housing assistance programs, or under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.).CommentsClose CommentsPermalink‘(g) Rule of Construction- Nothing in this title shall be construed as prohibiting benefits paid under the CLASS Independence Benefit Plan from being used to compensate a family caregiver for providing community living assistance services and supports to an eligible beneficiary.CommentsClose CommentsPermalink
‘(h) Protection Against Conflict of Interests- The Secretary shall establish procedures to ensure that the Disability Determination Service and Protection and Advocacy System for a State, advocacy counselors for eligible beneficiaries, and any other entities that provide services to active enrollees and eligible beneficiaries under the CLASS program comply with the following:CommentsClose CommentsPermalink
‘(1) If the entity provides counseling or planning services, such services are provided in a manner that fosters the best interests of the active enrollee or beneficiary.CommentsClose CommentsPermalink
‘(2) The entity has established operating procedures that are designed to avoid or minimize conflicts of interest between the entity and an active enrollee or beneficiary.CommentsClose CommentsPermalink
‘(3) The entity provides information about all services and options available to the active enrollee or beneficiary, to the best of its knowledge, including services available through other entities or providers.CommentsClose CommentsPermalink
‘(4) The entity assists the active enrollee or beneficiary to access desired services, regardless of the provider.CommentsClose CommentsPermalink
‘(5) The entity reports the number of active enrollees and beneficiaries provided with assistance by age, disability, and whether such enrollees and beneficiaries received services from the entity or another entity.CommentsClose CommentsPermalink
‘(6) If the entity provides counseling or planning services, the entity ensures that an active enrollee or beneficiary is informed of any financial interest that the entity has in a service provider.CommentsClose CommentsPermalink
‘(7) The entity provides an active enrollee or beneficiary with a list of available service providers that can meet the needs of the active enrollee or beneficiary.CommentsClose CommentsPermalink
The Secretary shall establish the procedures under this subsection that apply to the Disability Determination Service in coordination with the Commissioner of Social Security.CommentsClose CommentsPermalink
‘SEC. 3206. CLASS INDEPENDENCE FUND.
‘(a) Establishment of CLASS Independence Fund- There is established in the Treasury of the United States a trust fund to be known as the ‘CLASS Independence Fund’. The Secretary of the Treasury shall serve as Managing Trustee of such Fund. The Fund shall consist of all amounts derived from payments into the Fund under sections 3204(f) and 3205(c)(5)(C)(ii), and remaining after investment of such amounts under subsection (b), including additional amounts derived as income from such investments. The amounts held in the Fund are appropriated and shall remain available without fiscal year limitation--CommentsClose CommentsPermalink
‘(1) to be held for investment on behalf of individuals enrolled in the CLASS program;CommentsClose CommentsPermalink
‘(2) to pay the administrative expenses related to the Fund and to investment under subsection (b); andCommentsClose CommentsPermalink
‘(3) to pay cash benefits to eligible beneficiaries under the CLASS Independence Benefit Plan.CommentsClose CommentsPermalink
‘(b) Investment of Fund Balance- The Secretary of the Treasury shall invest and manage the CLASS Independence Fund in the same manner, and to the same extent, as the Federal Supplementary Medical Insurance Trust Fund may be invested and managed under subsections (c), (d), and (e) of section 1841(d) of the Social Security Act (
42 U.S.C. 1395t ).CommentsClose CommentsPermalink‘(c) Lock-Box Protection-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Notwithstanding any other provision of law, it shall not be in order in the Senate or the House of Representatives to consider any measure that would authorize the payment or use of amounts in the Fund for any purpose other than a purpose authorized under this title.CommentsClose CommentsPermalink
‘(2) 60-vote WAIVER REQUIRED IN THE SENATE-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Paragraph (1) may be waived or suspended in the Senate only by the affirmative vote of 3/5 of the Members, duly chosen and sworn.CommentsClose CommentsPermalink
‘(B) APPEALS-CommentsClose CommentsPermalink
‘(i) PROCEDURE- Appeals in the Senate from the decisions of the Chair relating to subparagraph (A) shall be limited to 1 hour, to be equally divided between, and controlled by, the mover and the manager of the measure that would authorize the payment or use of amounts in the Fund for a purpose other than a purpose authorized under this title.CommentsClose CommentsPermalink
‘(ii) 60-votes REQUIRED- An affirmative vote of 3/5 of the Members, duly chosen and sworn, shall be required in the Senate to sustain an appeal of the ruling of the Chair on a point of order raised in relation to subparagraph (A).CommentsClose CommentsPermalink
‘(3) RULES OF THE SENATE AND HOUSE OF REPRESENTATIVES- This subsection is enacted by Congress--CommentsClose CommentsPermalink
‘(A) as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and is deemed to be part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a measure described in paragraph (1), and it supersedes other rules only to the extent that it is inconsistent with such rules; andCommentsClose CommentsPermalink
‘(B) with full recognition of the constitutional right of either House to change the rules (so far as they relate to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.CommentsClose CommentsPermalink
‘(d) Board of Trustees-CommentsClose CommentsPermalink
‘(1) IN GENERAL- With respect to the CLASS Independence Fund, there is hereby created a body to be known as the Board of Trustees of the CLASS Independence Fund (hereinafter in this section referred to as the ‘Board of Trustees’) composed of the Commissioner of Social Security, the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services, all ex officio, and of two members of the public (both of whom may not be from the same political party), who shall be nominated by the President for a term of 4 years and subject to confirmation by the Senate. A member of the Board of Trustees serving as a member of the public and nominated and confirmed to fill a vacancy occurring during a term shall be nominated and confirmed only for the remainder of such term. An individual nominated and confirmed as a member of the public may serve in such position after the expiration of such member’s term until the earlier of the time at which the member’s successor takes office or the time at which a report of the Board is first issued under paragraph (2) after the expiration of the member’s term. The Secretary of the Treasury shall be the Managing Trustee of the Board of Trustees. The Board of Trustees shall meet not less frequently than once each calendar year. A person serving on the Board of Trustees shall not be considered to be a fiduciary and shall not be personally liable for actions taken in such capacity with respect to the Trust Fund.CommentsClose CommentsPermalink
‘(2) DUTIES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- It shall be the duty of the Board of Trustees to do the following:CommentsClose CommentsPermalink
‘(i) Hold the CLASS Independence Fund.CommentsClose CommentsPermalink
‘(ii) Report to the Congress not later than the first day of April of each year on the operation and status of the CLASS Independence Fund during the preceding fiscal year and on its expected operation and status during the current fiscal year and the next 2 fiscal years.CommentsClose CommentsPermalink
‘(iii) Report immediately to the Congress whenever the Board is of the opinion that the amount of the CLASS Independence Fund is not actuarially sound in regards to the projections under section 3203(b)(2)(B)(i).CommentsClose CommentsPermalink
‘(iv) Review the general policies followed in managing the CLASS Independence Fund, and recommend changes in such policies, including necessary changes in the provisions of law which govern the way in which the CLASS Independence Fund is to be managed.CommentsClose CommentsPermalink
‘(B) REPORT- The report provided for in subparagraph (A)(ii) shall--CommentsClose CommentsPermalink
‘(i) include--CommentsClose CommentsPermalink
‘(I) a statement of the assets of, and the disbursements made from, the CLASS Independence Fund during the preceding fiscal year;CommentsClose CommentsPermalink
‘(II) an estimate of the expected income to, and disbursements to be made from, the CLASS Independence Fund during the current fiscal year and each of the next 2 fiscal years;CommentsClose CommentsPermalink
‘(III) a statement of the actuarial status of the CLASS Independence Fund for the current fiscal year, each of the next 2 fiscal years, and as projected over the 75-year period beginning with the current fiscal year;CommentsClose CommentsPermalink
‘(IV) an actuarial opinion by the Chief Actuary of the Social Security Administration certifying that the techniques and methodologies used are generally accepted within the actuarial profession and that the assumptions and cost estimates used are reasonable; andCommentsClose CommentsPermalink
‘(V) an opinion by the Commissioner of Social Security that the Disability Determination Service personnel are not over burdened by the additional requirements of the CLASS program; andCommentsClose CommentsPermalink
‘(ii) be printed as a House document of the session of the Congress to which the report is made.CommentsClose CommentsPermalink
‘(C) RECOMMENDATIONS- If the Board of Trustees determines that enrollment trends and expected future benefit claims on the CLASS Independence Fund are not actuarially sound in regards to the projections under section 3203(b)(2)(B)(i) and are unlikely to be resolved with reasonable premium increases or through other means, the Board of Trustees shall include in the report provided for in subparagraph (A)(ii) recommendations for such legislative action as the Board of Trustees determine to be appropriate, including whether to adjust monthly premiums or impose a temporary moratorium on new enrollments.CommentsClose CommentsPermalink
‘SEC. 3207. CLASS INDEPENDENCE ADVISORY COUNCIL.
‘(a) Establishment- There is hereby created an Advisory Committee to be known as the ‘CLASS Independence Advisory Council’.CommentsClose CommentsPermalink
‘(b) Membership-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The CLASS Independence Advisory Council shall be composed of not more than 15 individuals, not otherwise in the employ of the United States--CommentsClose CommentsPermalink
‘(A) who shall be appointed by the President without regard to the civil service laws and regulations; andCommentsClose CommentsPermalink
‘(B) a majority of whom shall be representatives of individuals who participate or are likely to participate in the CLASS program, and shall include representatives of older and younger workers, individuals with disabilities, family caregivers of individuals who require services and supports to maintain their independence at home or in another residential setting of their choice in the community, individuals with expertise in long-term care or disability insurance, actuarial science, economics, and other relevant disciplines, as determined by the Secretary.CommentsClose CommentsPermalink
‘(2) TERMS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The members of the CLASS Independence Advisory Council shall serve overlapping terms of 3 years (unless appointed to fill a vacancy occurring prior to the expiration of a term, in which case the individual shall serve for the remainder of the term).CommentsClose CommentsPermalink
‘(B) LIMITATION- A member shall not be eligible to serve for more than 2 consecutive terms.CommentsClose CommentsPermalink
‘(3) CHAIR- The President shall, from time to time, appoint one of the members of the CLASS Independence Advisory Council to serve as the Chair.CommentsClose CommentsPermalink
‘(c) Duties- The CLASS Independence Advisory Council shall advise the Secretary on matters of general policy in the administration of the CLASS program established under this title and in the formulation of regulations under this title including with respect to--CommentsClose CommentsPermalink
‘(1) the development of the CLASS Independence Benefit Plan under section 3203; andCommentsClose CommentsPermalink
‘(2) the determination of monthly premiums under such plan.CommentsClose CommentsPermalink
‘(d) Application of FACA- The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14 of that Act, shall apply to the CLASS Independence Advisory Council.CommentsClose CommentsPermalink
‘(e) Authorization of Appropriations-CommentsClose CommentsPermalink
‘(1) IN GENERAL- There are authorized to be appropriated to the CLASS Independence Advisory Council to carry out its duties under this section, such sums as may be necessary for fiscal year 2011 and for each fiscal year thereafter.CommentsClose CommentsPermalink
‘(2) AVAILABILITY- Any sums appropriated under the authorization contained in this section shall remain available, without fiscal year limitation, until expended.CommentsClose CommentsPermalink
‘SEC. 3208. REGULATIONS; ANNUAL REPORT.
‘(a) Regulations- The Secretary shall promulgate such regulations as are necessary to carry out the CLASS program in accordance with this title. Such regulations shall include provisions to prevent fraud and abuse under the program.CommentsClose CommentsPermalink
‘(b) Annual Report- Beginning January 1, 2014, the Secretary shall submit an annual report to Congress on the CLASS program. Each report shall include the following:CommentsClose CommentsPermalink
‘(1) The total number of enrollees in the program.CommentsClose CommentsPermalink
‘(2) The total number of eligible beneficiaries during the fiscal year.CommentsClose CommentsPermalink
‘(3) The total amount of cash benefits provided during the fiscal year.CommentsClose CommentsPermalink
‘(4) A description of instances of fraud or abuse identified during the fiscal year.CommentsClose CommentsPermalink
‘(5) Recommendations for such administrative or legislative action as the Secretary determines is necessary to improve the program or to prevent the occurrence of fraud or abuse.CommentsClose CommentsPermalink
‘SEC. 3209. INSPECTOR GENERAL’S REPORT.
‘The Inspector General of the Department of Health and Human Services shall submit an annual report to the Secretary and Congress relating to the overall progress of the CLASS program and of the existence of waste, fraud, and abuse in the CLASS program. Each such report shall include findings in the following areas:CommentsClose CommentsPermalink
‘(1) The eligibility determination process.CommentsClose CommentsPermalink
‘(2) The provision of cash benefits.CommentsClose CommentsPermalink
‘(3) Quality assurance and protection against waste, fraud, and abuse.CommentsClose CommentsPermalink
‘(4) Recouping of unpaid and accrued benefits.CommentsClose CommentsPermalink
‘SEC. 3210. TAX TREATMENT OF PROGRAM.
‘The CLASS program shall be treated for purposes of the Internal Revenue Code of 1986 in the same manner as a qualified long-term care insurance contract for qualified long-term care services.’.CommentsClose CommentsPermalink
(2) CONFORMING AMENDMENTS TO MEDICAID- Section 1902(a) of the Social Security Act (
42 U.S.C. 1396a(a) ), as amended by section 5006(e)(2)(A) of division B ofPublic Law 111-5 , is amended--CommentsClose CommentsPermalink
(A) in paragraph (72), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(B) in paragraph (73)(B), by striking the period and inserting ‘; and’; andCommentsClose CommentsPermalink
(C) by inserting after paragraph (73) the following:CommentsClose CommentsPermalink
‘(74) provide that the State will comply with such regulations regarding the application of primary and secondary payor rules with respect to individuals who are eligible for medical assistance under this title and are eligible beneficiaries under the CLASS program established under title XXXII of the Public Health Service Act as the Secretary shall establish.’.CommentsClose CommentsPermalink
(b) Assurance of Adequate Infrastructure for the Provision of Personal Care Attendant Workers- Section 1902(a) of the Social Security Act (
42 U.S.C. 1396a(a) ), as amended by subsection (a)(2), is amended--CommentsClose CommentsPermalink
(1) in paragraph (73)(B), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(2) in paragraph (74), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink
(3) by inserting after paragraph (74), the following:CommentsClose CommentsPermalink
‘(75) provide that, not later than 2 years after the date of enactment of the Community Living Assistance Services and Supports Act, each State shall--CommentsClose CommentsPermalink
‘(A) assess the extent to which entities such as providers of home care, home health services, home and community service providers, public authorities created to provide personal care services to individuals eligible for medical assistance under the State plan, and nonprofit organizations, are serving or have the capacity to serve as fiscal agents for, employers of, and providers of employment-related benefits for, personal care attendant workers who provide personal care services to individuals receiving benefits under the CLASS program established under title XXXII of the Public Health Service Act, including in rural and underserved areas;CommentsClose CommentsPermalink
‘(B) designate or create such entities to serve as fiscal agents for, employers of, and providers of employment-related benefits for, such workers to ensure an adequate supply of the workers for individuals receiving benefits under the CLASS program, including in rural and underserved areas; andCommentsClose CommentsPermalink
‘(C) ensure that the designation or creation of such entities will not negatively alter or impede existing programs, models, methods, or administration of service delivery that provide for consumer controlled or self-directed home and community services and further ensure that such entities will not impede the ability of individuals to direct and control their home and community services, including the ability to select, manage, dismiss, co-employ, or employ such workers or inhibit such individuals from relying on family members for the provision of personal care services.’.CommentsClose CommentsPermalink
(c) Personal Care Attendants Workforce Advisory Panel-CommentsClose CommentsPermalink
(1) ESTABLISHMENT- Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services shall establish a Personal Care Attendants Workforce Advisory Panel for the purpose of examining and advising the Secretary and Congress on workforce issues related to personal care attendant workers, including with respect to the adequacy of the number of such workers, the salaries, wages, and benefits of such workers, and access to the services provided by such workers.CommentsClose CommentsPermalink
(2) MEMBERSHIP- In appointing members to the Personal Care Attendants Workforce Advisory Panel, the Secretary shall ensure that such members include the following:CommentsClose CommentsPermalink
(A) Individuals with disabilities of all ages.CommentsClose CommentsPermalink
(B) Senior individuals.CommentsClose CommentsPermalink
(C) Representatives of individuals with disabilities.CommentsClose CommentsPermalink
(D) Representatives of senior individuals.CommentsClose CommentsPermalink
(E) Representatives of workforce and labor organizations.CommentsClose CommentsPermalink
(F) Representatives of home and community-based service providers.CommentsClose CommentsPermalink
(G) Representatives of assisted living providers.CommentsClose CommentsPermalink
(d) Inclusion of Information on Supplemental Coverage in the National Clearinghouse for Long-term Care Information; Extension of Funding- Section 6021(d) of the Deficit Reduction Act of 2005 (
42 U.S.C. 1396p note) is amended--CommentsClose CommentsPermalink
(1) in paragraph (2)(A)--CommentsClose CommentsPermalink
(A) in clause (ii), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(B) in clause (iii), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink
(C) by adding at the end the following:CommentsClose CommentsPermalink
‘(iv) include information regarding the CLASS program established under title XXXII of the Public Health Service Act and coverage available for purchase through a Gateway established under section 3101 of such Act that is supplemental coverage to the benefits provided under a CLASS Independence Benefit Plan under that program.’; andCommentsClose CommentsPermalink
(2) in paragraph (3), by striking ‘2010’ and inserting ‘2015’.CommentsClose CommentsPermalink
(e) Effective Date- The amendments made by subsections (a), (b), and (d) take effect on January 1, 2011.CommentsClose CommentsPermalink
TITLE II--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARECommentsClose CommentsPermalink
TITLE II--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARECommentsClose CommentsPermalink
Subtitle A--National Strategy to Improve Health Care QualityCommentsClose CommentsPermalink
Subtitle A--National Strategy to Improve Health Care QualityCommentsClose CommentsPermalink
SEC. 201. NATIONAL STRATEGY.
(a) In General- Title III of the Public Health Service Act (
‘PART S--HEALTH CARE QUALITY PROGRAMS
‘Subpart I--National Strategy for Quality Improvement in Health Care
‘SEC. 399HH. NATIONAL STRATEGY FOR QUALITY IMPROVEMENT IN HEALTH CARE.
‘(a) Establishment of National Strategy and Priorities-CommentsClose CommentsPermalink
‘(1) NATIONAL STRATEGY- The Secretary, through a transparent collaborative process, shall establish a national strategy to improve the delivery of health care services, patient health outcomes, and population health.CommentsClose CommentsPermalink
‘(2) IDENTIFICATION OF PRIORITIES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall identify national priorities for improvement in developing the strategy under paragraph (1).CommentsClose CommentsPermalink
‘(B) REQUIREMENTS- The Secretary shall ensure that priorities identified under subparagraph (A) will--CommentsClose CommentsPermalink
‘(i) address the health care provided to patients with high-cost chronic diseases;CommentsClose CommentsPermalink
‘(ii) improve the design, development, demonstration, dissemination, and adoption of infrastructure and innovative methodologies and strategies for quality improvement in the delivery of health care services that represent best practices to improve patient safety and reduce medical errors, preventable admissions and readmissions, and health care-associated infections;CommentsClose CommentsPermalink
‘(iii) have the greatest potential for improving the health outcomes, efficiency, and patient-centeredness of health care;CommentsClose CommentsPermalink
‘(iv) reduce health disparities across health disparity populations (as defined by section 485E) and geographic areas;CommentsClose CommentsPermalink
‘(v) address gaps in quality and health outcomes measures, comparative effectiveness information, and data aggregation techniques, including the use of data registries;CommentsClose CommentsPermalink
‘(vi) identify areas in the delivery of health care services that have the potential for rapid improvement in the quality of patient care;CommentsClose CommentsPermalink
‘(vii) improve Federal payment policy to emphasize quality;CommentsClose CommentsPermalink
‘(viii) enhance the use of health care data to improve quality, transparency, and outcomes; andCommentsClose CommentsPermalink
‘(ix) address other areas as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(C) CONSIDERATIONS- In identifying priorities under subparagraph (A), the Secretary shall take into consideration--CommentsClose CommentsPermalink
‘(i) the recommendations submitted by qualified consensus-based entities as required under section 399JJ; andCommentsClose CommentsPermalink
‘(ii) the recommendations of the Interagency Working Group on Health Care Quality established under section 202 of the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(b) Strategic Plan-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The national strategy shall include a comprehensive strategic plan to achieve the priorities described in subsection (a).CommentsClose CommentsPermalink
‘(2) REQUIREMENTS- The strategic plan shall include provisions for addressing, at a minimum, the following:CommentsClose CommentsPermalink
‘(A) Coordination among agencies within the Department, which shall include steps to minimize duplication of efforts and utilization of common quality measures, where available. Such common quality measures shall be measures endorsed under section 399JJ.CommentsClose CommentsPermalink
‘(B) Agency-specific strategic plans to achieve national priorities.CommentsClose CommentsPermalink
‘(C) Establishment of annual benchmarks for each relevant agency to achieve national priorities.CommentsClose CommentsPermalink
‘(D) A process for regular reporting by the agencies to the Secretary on the implementation of the strategic plan.CommentsClose CommentsPermalink
‘(E) Use of common incentives among public and private payers with regard to quality and patient safety efforts.CommentsClose CommentsPermalink
‘(F) Incorporating quality improvement and measurement in the strategic plan for health information technology required by the American Recovery and Reinvestment Act of 2009 (
Public Law 111-5 ).CommentsClose CommentsPermalink‘(c) Periodic Update of National Strategy- The Secretary shall update the national strategy not less than triennially. Any such update shall include a review of short- and long-term goals.CommentsClose CommentsPermalink
‘(d) Submission and Availability of National Strategy- The Secretary shall transmit to the relevant Committees of Congress the national strategy and updates to such strategy.CommentsClose CommentsPermalink
‘(e) Public Reporting-CommentsClose CommentsPermalink
‘(1) ANNUAL NATIONAL HEALTH CARE QUALITY REPORT CARD- Not later than January 31, 2011, and annually thereafter, the Secretary shall publish a national health care quality report card, which shall include--CommentsClose CommentsPermalink
‘(A) the considerations for national priorities described in subsection (a)(2);CommentsClose CommentsPermalink
‘(B) an analysis of the progress of the strategic plans under subsection (b)(2)(B) in achieving the national priorities under subsection (a)(2), and any gaps in such strategic plans;CommentsClose CommentsPermalink
‘(C) the extent to which private sector strategies have informed Federal quality improvement efforts; andCommentsClose CommentsPermalink
‘(D) a summary of consumer and provider feedback regarding quality improvement practices.CommentsClose CommentsPermalink
‘(2) WEBSITE- Not later than July 1, 2010, the Director shall create an Internet website to make public information regarding--CommentsClose CommentsPermalink
‘(A) the national priorities for health care quality improvement established under subsection (a)(2);CommentsClose CommentsPermalink
‘(B) the agency-specific strategic plans for health care quality described in subsection (b)(2)(B);CommentsClose CommentsPermalink
‘(C) the annual national health care quality report card described in paragraph (1); andCommentsClose CommentsPermalink
‘(D) other information, as the Secretary determines to be appropriate.’.CommentsClose CommentsPermalink
(b) Agency Quality Review-CommentsClose CommentsPermalink
(1) IN GENERAL- Each relevant agency within the Department of Health and Human Services shall review the statutory authority, regulations, policies, and procedures of such agency, as in effect on the date of enactment of this title, for purposes of determining whether there are any deficiencies or inconsistencies that prohibit full compliance with the intent, purposes, and provisions of this title (and the amendments made by this title).CommentsClose CommentsPermalink
(2) PROPOSALS- Each agency described in paragraph (1) shall, not later than July 1, 2010, submit to the Secretary of Health and Human Services a proposal of the measures as may be necessary to bring the authority, regulations, policies, and procedures of such agency into conformity with the intent, purposes, and provisions of the this title (and the amendments made by this title).CommentsClose CommentsPermalink
SEC. 202. INTERAGENCY WORKING GROUP ON HEALTH CARE QUALITY.
(a) In General- The President shall convene a working group to be known as the Interagency Working Group on Health Care Quality (referred to in this section as the ‘Working Group’).CommentsClose CommentsPermalink
(b) Goals- The goals of the Working Group shall be to achieve the following:CommentsClose CommentsPermalink
(1) Collaboration, cooperation, and consultation between Federal departments and agencies with respect to developing and disseminating strategies, goals, models, and timetables that are consistent with the national priorities identified under section 399HH(a)(2) of the Public Health Service Act (as added by section 201).CommentsClose CommentsPermalink
(2) Avoidance of inefficient duplication of quality improvement efforts and resources, where practicable, and a streamlined process for quality reporting and compliance requirements.CommentsClose CommentsPermalink
(c) Composition-CommentsClose CommentsPermalink
(1) IN GENERAL- The Working Group shall be composed of senior level representatives of--CommentsClose CommentsPermalink
(A) the Department of Health and Human Services;CommentsClose CommentsPermalink
(B) the Department of Labor;CommentsClose CommentsPermalink
(C) the United States Office of Personnel Management;CommentsClose CommentsPermalink
(D) the Department of Defense;CommentsClose CommentsPermalink
(E) the Department of Education;CommentsClose CommentsPermalink
(F) the Department of Veterans Affairs; andCommentsClose CommentsPermalink
(G) any other Federal agencies and departments with activities relating to improving health care quality and safety, as determined by the President.CommentsClose CommentsPermalink
(2) CHAIR AND VICE-CHAIR-CommentsClose CommentsPermalink
(A) CHAIR- The Working Group shall be chaired by the Secretary of Health and Human Services.CommentsClose CommentsPermalink
(B) VICE-CHAIR- Members of the Working Group, other than the Secretary of Health and Human Services, shall serve as Vice Chair of the Group on a rotating basis, as determined by the Group.CommentsClose CommentsPermalink
(d) Report to Congress- Not later than December 31, 2010, and annually thereafter, the Working Group shall submit to the relevant Committees of Congress, and make public on an Internet website, a report describing the progress and recommendations of the Working Group in meeting the goals described in subsection (b).CommentsClose CommentsPermalink
SEC. 203. QUALITY MEASURE DEVELOPMENT.
Title IX of the Public Health Service Act (
(1) by redesignating part D as part E;CommentsClose CommentsPermalink
(2) by redesignating sections 931 through 938 as sections 941 through 948, respectively;CommentsClose CommentsPermalink
(3) in section 948(1), as so redesignated, by striking ‘931’ and inserting ‘941’; andCommentsClose CommentsPermalink
(4) by inserting after section 926 the following:CommentsClose CommentsPermalink
‘PART D--HEALTH CARE QUALITY IMPROVEMENT
‘Subpart I--Quality Measure Development
‘SEC. 931. QUALITY MEASURE DEVELOPMENT.
‘(a) Quality Measure- In this subpart, the term ‘quality measure’ means a standard for measuring the performance and improvement of population health or of health plans, providers of services, and other clinicians in the delivery of health care services.CommentsClose CommentsPermalink
‘(b) Identification of Quality Measures-CommentsClose CommentsPermalink
‘(1) IDENTIFICATION- The Director shall identify, not less often than biennially, gaps where no quality measures exist, or where existing quality measures need improvement, updating, or expansion, consistent with the national strategy under section 399HH, for use in programs authorized under this Act. In identifying such gaps, the Director shall take into consideration the gaps identified by a qualified consensus-based entity under section 399JJ.CommentsClose CommentsPermalink
‘(2) PUBLICATION- The Director shall make available to the public on an Internet website a report on any gaps identified under paragraph (1) and the process used to make such identification.CommentsClose CommentsPermalink
‘(c) Grants or Contracts for Quality Measure Development-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Director shall award grants, contracts, or intergovernmental agreements to eligible entities for purposes of developing, improving, updating, or expanding quality measures identified under subsection (b).CommentsClose CommentsPermalink
‘(2) PRIORITIZATION IN THE DEVELOPMENT OF QUALITY MEASURES- In awarding grants, contracts, or agreements under this subsection, the Director shall give priority to the development of quality measures that allow the assessment of--CommentsClose CommentsPermalink
‘(A) health outcomes and functional status of patients;CommentsClose CommentsPermalink
‘(B) the continuity, management, and coordination of health care and care transitions, including episodes of care, for patients across the continuum of providers, health care settings, and health plans;CommentsClose CommentsPermalink
‘(C) patient, caregiver, and authorized representative experience, quality and relevance of information provided to patients, caregivers, and authorized representatives, and use of information by patients, caregivers, and authorized representatives to inform decisionmaking about treatment options and, where appropriate, palliative care;CommentsClose CommentsPermalink
‘(D) the safety, effectiveness, and timeliness of care;CommentsClose CommentsPermalink
‘(E) health disparities across health disparity populations (as defined in section 485E) and geographic areas;CommentsClose CommentsPermalink
‘(F) the appropriate use of health care resources and services; orCommentsClose CommentsPermalink
‘(G) use of innovative strategies and methodologies identified under section 933.CommentsClose CommentsPermalink
‘(3) ELIGIBLE ENTITIES- To be eligible for a grant or contract under this subsection, an entity shall--CommentsClose CommentsPermalink
‘(A) have demonstrated expertise and capacity in the development and evaluation of quality measures;CommentsClose CommentsPermalink
‘(B) have adopted procedures to include in the quality measure development process--CommentsClose CommentsPermalink
‘(i) the views of those providers or payers whose performance will be assessed by the measure; andCommentsClose CommentsPermalink
‘(ii) the views of other parties who also will use the quality measures (such as patients, consumers, and health care purchasers);CommentsClose CommentsPermalink
‘(C) collaborate with a qualified consensus-based entity (as defined in section 399JJ), as practicable, and the Secretary so that quality measures developed by the eligible entity will meet the requirements to be considered for endorsement by such qualified consensus-based entity;CommentsClose CommentsPermalink
‘(D) have transparent policies regarding conflicts of interest; andCommentsClose CommentsPermalink
‘(E) submit an application to the Director at such time and in such manner, as the Director may require.CommentsClose CommentsPermalink
‘(4) USE OF FUNDS- An entity that receives a grant, contract, or agreement under this subsection shall use such award to develop quality measures that meet the following requirements:CommentsClose CommentsPermalink
‘(A) Such measures build upon measures developed under section 1139A of Social Security Act, where applicable.CommentsClose CommentsPermalink
‘(B) To the extent practicable, data on such quality measures is able to be collected using health information technologies.CommentsClose CommentsPermalink
‘(C) Each quality measure is free of charge to users of such measure.CommentsClose CommentsPermalink
‘(D) Each quality measure is publicly available on an Internet website.CommentsClose CommentsPermalink
‘(d) Other Activities by the Director- The Director may use amounts available under this section to update and test, where applicable, quality measures endorsed by a qualified consensus-based entity (as defined in section 399JJ) or adopted by the Secretary.CommentsClose CommentsPermalink
‘(e) Funding- There are authorized to be appropriated to carry out this section, $75,000,000 for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
SEC. 204. QUALITY MEASURE ENDORSEMENT; PUBLIC REPORTING; DATA COLLECTION.
Title III of the Public Health Service Act (
‘Subpart II--Health Care Quality Programs
‘SEC. 399JJ. QUALITY MEASURE ENDORSEMENT.
‘(a) Definitions- In this subpart:CommentsClose CommentsPermalink
‘(1) QUALIFIED CONSENSUS-BASED ENTITY- The term ‘qualified consensus-based entity’ means an entity with a contract with the Secretary under section 1890 of the Social Security Act.CommentsClose CommentsPermalink
‘(2) QUALITY MEASURE- The term ‘quality measure’ means a standard for measuring the performance and improvement of population health or of health plans, providers of services, and other clinicians in the delivery of health care services.CommentsClose CommentsPermalink
‘(3) MULTI-STAKEHOLDER GROUP- The term ‘multi-stakeholder group’ means, with respect to a quality measure, a voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of such quality measure.CommentsClose CommentsPermalink
‘(b) Grants and Contracts- A qualified consensus-based entity may receive a grant or contract under this subsection to--CommentsClose CommentsPermalink
‘(1) make recommendations to the Secretary for national priorities for performance improvement in population health and in the delivery of health care services;CommentsClose CommentsPermalink
‘(2) identify gaps in endorsed quality measures, which shall include measures that--CommentsClose CommentsPermalink
‘(A) are within priority areas identified by the Secretary under the national strategy established under section 399HH;CommentsClose CommentsPermalink
‘(B) assess common care episodes, patient health outcomes, processes, efficiency, cost, and appropriate use of health care services and resources and address health disparities across health disparity populations (as defined in section 485E) and geographic areas; orCommentsClose CommentsPermalink
‘(C) assess use of innovative methodologies and strategies for quality improvement practices in the delivery of health care services that represent best practices for such quality improvement identified in section 933;CommentsClose CommentsPermalink
‘(3) identify and endorse quality measures, including measures that address gaps identified in paragraph (2);CommentsClose CommentsPermalink
‘(4) update endorsed quality measures at least every 3 years;CommentsClose CommentsPermalink
‘(5) make endorsed quality measures publicly available and have a plan for broad-based dissemination of endorsed measures; andCommentsClose CommentsPermalink
‘(6) transmit endorsed quality measures to the Secretary.CommentsClose CommentsPermalink
‘(c) Annual Reports-CommentsClose CommentsPermalink
‘(1) IN GENERAL- A qualified consensus-based entity that receives a grant or contract under this section shall provide a report to the Secretary not less than annually--CommentsClose CommentsPermalink
‘(A) of where gaps (as described in subsection (b)(2)) exist and where quality measures are unavailable or inadequate to identify or address such gaps; andCommentsClose CommentsPermalink
‘(B) regarding areas in which evidence is insufficient to support endorsement of quality measures in priority areas identified by the Secretary under the national strategy established under section 399HH and where targeted research may address such gaps.CommentsClose CommentsPermalink
‘(2) IMPACT OF QUALITY MEASURES- A qualified consensus-based entity that receives a grant or contract under this section shall provide a report to the Secretary not less than annually regarding the economic and quality impact of the use of endorsed measures.CommentsClose CommentsPermalink
‘(d) Priorities for Performance Improvement-CommentsClose CommentsPermalink
‘(1) RECOMMENDATION FOR NATIONAL PRIORITIES- A qualified consensus-based entity that receives a grant or contract under this section shall evaluate evidence and convene multi-stakeholder groups to make recommendations to the Secretary for national priorities for performance improvement in population health and in the delivery of health care services for consideration under the national strategy established under section 399HH. The qualified consensus-based entity shall make such recommendations not less frequently than triennially.CommentsClose CommentsPermalink
‘(2) REQUIREMENTS FOR TRANSPARENCY IN PROCESS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- In convening multi-stakeholder groups under paragraph (1) with respect to recommendations for national priorities, the qualified consensus-based entity shall provide for an open and transparent process for the activities conducted pursuant to such convening.CommentsClose CommentsPermalink
‘(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS- The process under subparagraph (A) shall ensure that the selection of representatives comprising such groups provides for public nominations for, and the opportunity for public comment on, such selection.CommentsClose CommentsPermalink
‘(3) CONSIDERATIONS IN RECOMMENDING PRIORITIES- In making recommendations under paragraph (1), the qualified consensus-based entity shall ensure that priority is given to areas in the delivery of health care services for all populations including children, and other vulnerable populations that--CommentsClose CommentsPermalink
‘(A) address the health care provided to patients with prevalent, high-cost chronic diseases;CommentsClose CommentsPermalink
‘(B) improve the design, development, demonstration, and adoption of infrastructure and innovative methodologies and strategies for quality improvement practices in the delivery of health care services, including those that improve patient safety and reduce medical errors, readmissions, and health care-associated infections;CommentsClose CommentsPermalink
‘(C) have the greatest potential for improving the health outcomes, efficiency, and patient-centeredness of health care;CommentsClose CommentsPermalink
‘(D) reduce health disparities across populations (as defined in section 485E) and geographic areas;CommentsClose CommentsPermalink
‘(E) address gaps in quality and health outcomes measures, comparative effectiveness information, and data aggregation techniques, including the use of data registries;CommentsClose CommentsPermalink
‘(F) identify areas in the delivery of health care services that have the potential for rapid improvement in the quality of patient care; andCommentsClose CommentsPermalink
‘(G) address the appropriate use of health care technology, resources and services.CommentsClose CommentsPermalink
‘(e) Process for Consultation of Stakeholder Groups-CommentsClose CommentsPermalink
‘(1) CONSULTATION OF SELECTION OF ENDORSED QUALITY MEASURES- A qualified consensus-based entity that receives a grant or contract under this section shall convene multi-stakeholder groups to provide guidance on the selection of individual or composite quality measures, for use in reporting performance information to the public or for use in Federal health programs, from among--CommentsClose CommentsPermalink
‘(A) such measures that have been endorsed by the qualified consensus-based entity (under section 1890(b) of the Social Security Act or otherwise); andCommentsClose CommentsPermalink
‘(B) such measures that have not been considered for endorsement by the qualified consensus-based entity but are used or proposed to be used by the Secretary under subsection (f)(2) under laws under the jurisdiction of the Secretary that require the collection or reporting of quality measures.CommentsClose CommentsPermalink
‘(2) TRANSMISSION OF MULTI-STAKEHOLDER GUIDANCE- The qualified consensus-based entity shall transmit to the Secretary the guidance of multi-stakeholder groups provided under paragraph (1).CommentsClose CommentsPermalink
‘(3) REQUIREMENT FOR TRANSPARENCY IN PROCESS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- In convening multi-stakeholder groups under paragraph (1) with respect to the selection of quality measures, the qualified consensus-based entity shall provide for an open and transparent process for the activities conducted pursuant to such convening.CommentsClose CommentsPermalink
‘(B) SELECTION OF ORGANIZATIONS PARTICIPATING IN MULTI-STAKEHOLDER GROUPS- The process under subparagraph (A) shall ensure that the selection of representatives comprising such groups provides for public nominations for, and the opportunity for public comment on, such selection.CommentsClose CommentsPermalink
‘(f) Coordination of Use of Quality Measures-CommentsClose CommentsPermalink
‘(1) ENDORSED QUALITY MEASURES- The Secretary may make a determination under regulation or otherwise to use a quality measure described in subsection (e)(1)(A) only after taking into account the guidance of multi-stakeholder groups under subsection (e)(2).CommentsClose CommentsPermalink
‘(2) USE OF INTERIM MEASURES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary may make a determination, by regulation or otherwise, to use a quality measure that has not been endorsed as described in subsection (e)(1)(A), provided that the Secretary--CommentsClose CommentsPermalink
‘(i) in a timely manner, transmits the measure to the qualified consensus-based entity for consideration for endorsement and for the multi-stakeholder consultation process under subsection (e)(1);CommentsClose CommentsPermalink
‘(ii) publishes in the Federal Register the rationale for the use of the measure; andCommentsClose CommentsPermalink
‘(iii) phases out use of the measure upon a decision of the qualified consensus-based entity not to endorse the measure, contingent on availability of an adequate alternative endorsed measure (as determined by the Secretary), taking into account guidance from multi-stakeholder consultation process under subsection (e)(1).CommentsClose CommentsPermalink
‘(B) NO ADEQUATE ALTERNATIVE- If an adequate alternative endorsed measure is not available, the Secretary shall support the development of such an alternative endorsed measure, as described in section 931.CommentsClose CommentsPermalink
‘(3) REQUIREMENT OF COORDINATION WITH ENTITY-CommentsClose CommentsPermalink
‘(A) REQUIREMENT FOR NOTIFICATION OF ENTITY OF DEADLINE FOR RECOMMENDATIONS FOR QUALITY MEASURES IN PROPOSED REGULATIONS- For each notice of proposed rulemaking to implement the collection or reporting of data on quality measures as described in section 399LL, the Secretary shall establish a process for the regular provision of advance notice to the qualified consensus-based entity of the date certain by which recommendations of the entity with respect to quality measures must be submitted to the Secretary for consideration in the development of such specified regulation.CommentsClose CommentsPermalink
‘(B) TIMELY NOTICE- Under the process established under subparagraph (A), notice shall be given to the qualified consensus-based entity not less than 120 days before the date certain referred to in subparagraph (A).CommentsClose CommentsPermalink
‘(C) PUBLICATION OF DESCRIPTION OF ENTITY RECOMMENDATIONS AND RESPONSES- In publishing a specified regulation, the Secretary shall include a description of each recommendation of the qualified consensus-based entity with respect to quality measures and shall include responses of the Secretary to each such recommendation.CommentsClose CommentsPermalink
‘(D) DEFINITION- In this paragraph, the term ‘specified regulation’ means a notice of proposed rulemaking to implement the collection or reporting of data on quality measures as described in section 399LL.CommentsClose CommentsPermalink
‘(4) EFFECTIVE DATE- This subsection shall apply with respect to determinations or requirements by the Secretary for the use of quality measures made on or after the date of enactment of the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(g) Review of Quality Measures Used by the Secretary-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Not less than once every 3 years, the Secretary shall review quality measures used by the Secretary and, with respect to each such measure, shall determine whether to--CommentsClose CommentsPermalink
‘(A) maintain the use of such measure; orCommentsClose CommentsPermalink
‘(B) phase out such measure.CommentsClose CommentsPermalink
‘(2) CONSIDERATIONS- In conducting the review under paragraph (1), the Secretary shall--CommentsClose CommentsPermalink
‘(A) seek to avoid duplication of measures used; andCommentsClose CommentsPermalink
‘(B) take into consideration current innovative methodologies and strategies for quality improvement practices in the delivery of health care services that represent best practices for such quality improvement and measures endorsed by a qualified consensus-based entity since the previous review by the Secretary.CommentsClose CommentsPermalink
‘(h) Process for Dissemination of Measures Used by the Secretary- The Secretary shall establish a process for disseminating quality measures used by the Secretary. Such process shall include the incorporation of such measures, where applicable, in workforce programs, training curricula, payment programs, and any other means of dissemination determined by the Secretary. The Secretary shall establish a process to disseminate such quality measures through the Interagency Working Group established under section 202 of the Affordable Health Choices Act.CommentsClose CommentsPermalink
‘(i) Funding- To carry out this section there are authorized to be appropriated $50,000,000 for each of fiscal years for 2010 through 2014.CommentsClose CommentsPermalink
‘SEC. 399KK. PUBLIC REPORTING OF PERFORMANCE INFORMATION.
‘(a) Reporting of Quality Measures-CommentsClose CommentsPermalink
‘(1) IN GENERAL-CommentsClose CommentsPermalink
‘(A) REPORTING SYSTEM- Not later than 5 years after the date of enactment of the Affordable Health Choices Act, and after notice and opportunity for public comment, the Secretary shall implement a system for the reporting on quality measures that protect patient privacy and, where appropriate--CommentsClose CommentsPermalink
‘(i) assess health outcomes and functional status of patients;CommentsClose CommentsPermalink
‘(ii) assess the continuity and coordination of care and care transitions, including episodes of care, for patients across the continuum of providers and health care settings;CommentsClose CommentsPermalink
‘(iii) assess patient experience and patient, caregiver, and family engagement;CommentsClose CommentsPermalink
‘(iv) assess the safety, effectiveness, and timeliness of care; andCommentsClose CommentsPermalink
‘(v) assess health disparities (as defined by section 485E) across populations and geographic areas.CommentsClose CommentsPermalink
‘(2) FORM AND MANNER- The data submitted under the system implemented under paragraph (1) shall be in a form and manner specified by the Secretary.CommentsClose CommentsPermalink
‘(3) MEASURES DESCRIBED- The quality measures described in paragraph (1) shall--CommentsClose CommentsPermalink
‘(A) be risk adjusted, taking into account differences in patient health status, patient characteristics, and geographic location, as appropriate;CommentsClose CommentsPermalink
‘(B) be valid, reliable, evidence-based, feasible to collect, and actionable by providers, payers and consumers, as appropriate;CommentsClose CommentsPermalink
‘(C) minimize the burden of collection and reporting such measures; andCommentsClose CommentsPermalink
‘(D) be consistent with the national strategy established by the Secretary under section 399HH.CommentsClose CommentsPermalink
‘(b) Development of Performance Websites- The Secretary shall make available to the public performance information summarizing data on quality measures collected in subsection (a) through a series of standardized Internet websites tailored to respond to the differing needs of hospitals and other institutional providers and services, physicians and other clinicians, patients, consumers, researchers, policymakers, States, and such other stakeholders as the Secretary may specify.CommentsClose CommentsPermalink
‘(c) Design- Each standardized Internet website made available under subsection (b) shall be designed to make the use and navigation of that website readily available to individuals accessing it. The Secretary shall develop a flexible format to meet the differing needs of the various stakeholders and shall modify the website to permit a user to easily customize queries.CommentsClose CommentsPermalink
‘(d) Information on Conditions- Performance information made publicly available on a standardized Internet website under subsection (b) shall be presented by, but not limited to, clinical condition to the extent such information is available, and the information presented shall, where appropriate, be provider-specific and sufficiently disaggregated and specific to meet the needs of patients with different clinical conditions.CommentsClose CommentsPermalink
‘(e) Consultation- The Secretary shall carry out this section in collaboration with a qualified consensus-based entity under section 399JJ to determine the type of information that is useful to stakeholders and the format that best facilitates use of the reports and of performance reporting Internet websites. The qualified consensus-based entity shall convene multi-stakeholder groups as provided in section 399JJ to review the design and format of each Internet website made available under subsection (b) and shall transmit to the Secretary the views of such multi-stakeholder groups with respect to each such design and format.CommentsClose CommentsPermalink
‘SEC. 399LL. EVALUATION OF DATA COLLECTION PROCESS FOR QUALITY MEASUREMENT.
‘(a) GAO Evaluations- The Comptroller General of the United States shall conduct periodic evaluations of the implementation of the data collection processes for quality measures used by the Secretary.CommentsClose CommentsPermalink
‘(b) Considerations- In carrying out the evaluation under subsection (a), the Comptroller General shall determine--CommentsClose CommentsPermalink
‘(1) whether the system for the collection of data for quality measures provides for validation of data as relevant, fair, and scientifically credible;CommentsClose CommentsPermalink
‘(2) whether data collection efforts under the system use the most efficient and cost-effective means in a manner that minimizes administrative burden on persons required to collect data and that adequately protects the privacy of patients’ personal health information and provides data security;CommentsClose CommentsPermalink
‘(3) whether standards under the system provide for an opportunity for physicians and other clinicians and institutional providers of services to review and correct findings; andCommentsClose CommentsPermalink
‘(4) the extent to which quality measures--CommentsClose CommentsPermalink
‘(A) assess health outcomes and functional status of patients;CommentsClose CommentsPermalink
‘(B) assess the continuity and coordination of care and care transitions, including episodes of care, for patients across the continuum of providers, age, and health care settings;CommentsClose CommentsPermalink
‘(C) assess patient experience and patient, caregiver, and family engagement;CommentsClose CommentsPermalink
‘(D) assess the safety, effectiveness, and timeliness of care;CommentsClose CommentsPermalink
‘(E) assess health disparities across health disparity populations (as defined by section 485E) and geographic areas;CommentsClose CommentsPermalink
‘(F) address the appropriate use of health care resources and services;CommentsClose CommentsPermalink
‘(G) are designed to be collected as part of health information technologies supporting better delivery of health care services;CommentsClose CommentsPermalink
‘(H) result in direct or indirect costs to users of such measures; andCommentsClose CommentsPermalink
‘(I) provide utility to both the care of individuals and the management of population health.CommentsClose CommentsPermalink
‘(c) Report- The Comptroller General shall submit reports to Congress and to the Secretary containing a description of the findings and conclusions of the results of each such evaluation.’.CommentsClose CommentsPermalink
SEC. 205. COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE MEASURES.
(a) In General- Part S of title III of the Public Health Service Act, as amended by section 204, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 399MM. COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE MEASURES.
‘(a) Purpose- The purpose of this section is to provide for the development of reports based on Federal health care data and private data that is publicly available or is provided by the entity making the request for the report in order to--CommentsClose CommentsPermalink
‘(1) improve the quality and efficiency of health care and advance health care research;CommentsClose CommentsPermalink
‘(2) enhance the education and awareness of consumers for evaluating health care services; andCommentsClose CommentsPermalink
‘(3) provide the public with reports on national, regional, and provider- and supplier-specific performance, which may be in a provider- or supplier-identifiable format.CommentsClose CommentsPermalink
‘(b) Establishment of Process- The Secretary shall establish a process to collect, and validate, aggregate data on quality measures described in section 399JJ to facilitate public reporting described in section 399KK. Such process shall--CommentsClose CommentsPermalink
‘(1) be developed based on guidance of a broad-based, public-private collaboration;CommentsClose CommentsPermalink
‘(2) employ methods that are scientifically sound and feasible to implement nationwide through the use of consistent methods for the collection, analysis, and reporting of quality and resource use measures;CommentsClose CommentsPermalink
‘(3) over time, where feasible, build on expanding availability of health information technology and other data systems that are directly used to improve and coordinate patient care;CommentsClose CommentsPermalink
‘(4) allow for the integration of data on quality of care and resource use from a range of data sources used by providers and patients to coordinate and improve care, including public sources, private sources, and public-private collaborations;CommentsClose CommentsPermalink
‘(5) be implemented in accordance with an aggressive timeline to be established by the Secretary based on the technical and practical feasibility of measures and related data systems; andCommentsClose CommentsPermalink
‘(6) utilize clinical and claims data to evaluate the quality and efficiency of health care.CommentsClose CommentsPermalink
‘(c) Data Collection, Aggregation, and Analysis- The Secretary shall ensure the collection and aggregation of consistent data on quality and resource use measures from information systems used to support health care delivery to implement the public reporting of performance information as described in section 399KK. The Secretary shall ensure that such collection, aggregation, and analysis systems span an increasingly broad range of patient populations, providers, and geographic areas over time.CommentsClose CommentsPermalink
‘(d) Grants and Contracts for Data Collection-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall award grants or contracts to eligible entities to support the collection and aggregation of quality and resource use measures described under subsection (c).CommentsClose CommentsPermalink
‘(2) ELIGIBLE ENTITIES- To be eligible for a grant or contract under this subsection, an entity shall--CommentsClose CommentsPermalink
‘(A)(i) be a multi-stakeholder entity that coordinates the development of methods and implementation plans for the consistent reporting of summary quality and cost information;CommentsClose CommentsPermalink
‘(ii) be an entity capable of submitting such summary data for a particular population and providers, such as a disease registry, regional collaboration, health plan collaboration, or other population-wide source; orCommentsClose CommentsPermalink
‘(iii) be a Federal Indian Health Service program or a health program operated by an Indian Tribe (as defined in section 4 of the Indian Health Care Improvement Act);CommentsClose CommentsPermalink
‘(B) promote the use of the systems that provide data to improve and coordinate patient care;CommentsClose CommentsPermalink
‘(C) support the provision of timely, consistent quality and resource use information to health care providers, and other groups and organizations as appropriate, with an opportunity for providers to correct inaccurate measures; andCommentsClose CommentsPermalink
‘(D) support the provision of consistent measures on quality and resource use to the public in accordance with the process established by the Secretary under subsection (b).CommentsClose CommentsPermalink
‘(3) CONSISTENT DATA AGGREGATION- The Secretary shall award funding under this subsection only to entities enabling summary data that can be integrated and compared across multiple sources. The Secretary shall also provide standards for the protection of the security and privacy of patient data.CommentsClose CommentsPermalink
‘(e) Pilot Programs to Develop, Validate, and Improve Methods Used to Support the Nationwide Quality Measurement and Reporting Strategy-CommentsClose CommentsPermalink
‘(1) IN GENERAL-CommentsClose CommentsPermalink
‘(A) DEVELOPMENT, VALIDATION, AND IMPROVEMENT METHODS- The Secretary shall support the development, validation, implementation, and refinement of nationally consistent methods used to support quality measurement and reporting under section 399KK.CommentsClose CommentsPermalink
‘(B) GRANTS AND CONTRACTS- The Secretary may award grants or contracts to eligible quality data entities to carry out subparagraph (A).CommentsClose CommentsPermalink
‘(2) ELIGIBLE QUALITY DATA ENTITIES- To be eligible for a grant or contract under this subsection, a quality data entity shall--CommentsClose CommentsPermalink
‘(A) be a public or private organization with expertise and experience in large-scale health care data aggregation, integration, analysis, or reporting; andCommentsClose CommentsPermalink
‘(B) support the implementation of quality measurement and reporting under section 399KK, including the production of data that can be combined and compared with equivalent information from other entities involved in supporting the delivery of care.CommentsClose CommentsPermalink
‘(f) Grants and Contracts for Data Analysis-CommentsClose CommentsPermalink
‘(1) FEDERAL HEALTH CARE DATA- In this subsection:CommentsClose CommentsPermalink
‘(A) IN GENERAL- Subject to subparagraph (B), the term ‘Federal health care data’ means--CommentsClose CommentsPermalink
‘(i) deidentified enrollment data and deidentified claims data maintained by the Secretary or entities under programs, contracts, grants, or memoranda of understanding administered by the Secretary; andCommentsClose CommentsPermalink
‘(ii) where feasible, other deidentified enrollment data and deidentified claims data maintained by the Federal Government or entities under contract with the Federal Government.CommentsClose CommentsPermalink
‘(B) EXCEPTION- The term ‘Federal health care data’ includes data relating to programs administered by the Secretary under the Social Security Act only to the extent that the disclosure of such data is authorized or required under such Act.CommentsClose CommentsPermalink
‘(2) AWARDS- The Secretary shall award contracts to eligible entities to support the analysis of quality and resource use measures described under subsection (c).CommentsClose CommentsPermalink
‘(3) ELIGIBLE ENTITIES-CommentsClose CommentsPermalink
‘(A) QUALIFICATIONS- The Secretary shall enter into a contract with an entity under paragraph (2) only if the Secretary determines that the entity--CommentsClose CommentsPermalink
‘(i) has the research capability to conduct and complete reports under this subsection;CommentsClose CommentsPermalink
‘(ii) has in place--CommentsClose CommentsPermalink
‘(I) an information technology infrastructure to support the database of Federal health care data that is to be disclosed to the entity; andCommentsClose CommentsPermalink
‘(II) operational standards to provide security for such database;CommentsClose CommentsPermalink
‘(iii) has experience with, and expertise on, the development of reports on health care quality and efficiency; andCommentsClose CommentsPermalink
‘(iv) has a significant business presence in the United States.CommentsClose CommentsPermalink
‘(B) CONTRACT REQUIREMENTS- Each contract with an entity under paragraph (2) shall contain the following requirements:CommentsClose CommentsPermalink
‘(i) ENSURING BENEFICIARY PRIVACY-CommentsClose CommentsPermalink
‘(I) HIPAA- The entity shall meet the requirements imposed on a covered entity for purposes of applying part C of title XI and all regulatory provisions promulgated thereunder, including regulations (relating to privacy) adopted pursuant to the authority of the Secretary under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (
42 U.S.C. 1320d-2 note).CommentsClose CommentsPermalink‘(II) OTHER STATUTORY PROTECTIONS- The entity shall be required to refrain from disclosing data that could be withheld by the Secretary under
section 552 of title 5, United States Code , or whose disclosure by the Secretary would violate section 552a of such title.CommentsClose CommentsPermalink‘(ii) PROPRIETARY INFORMATION- The entity shall provide assurances that the entity will not disclose any negotiated price concessions, such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations, obtained by health care providers or suppliers or health care plans, or any other proprietary cost information.CommentsClose CommentsPermalink
‘(iii) DISCLOSURE- The entity shall disclose--CommentsClose CommentsPermalink
‘(I) any financial, reporting, or contractual relationship between the entity and any health care provider or supplier or health care plan; andCommentsClose CommentsPermalink
‘(II) if applicable, the fact that the entity is managed, controlled, or operated by any health care provider or supplier or health care plan.CommentsClose CommentsPermalink
‘(iv) COMPONENT OF ANOTHER ORGANIZATION- If the entity is a component of another organization--CommentsClose CommentsPermalink
‘(I) the entity shall maintain Federal health care data and reports separately from the rest of the organization and establish appropriate security measures to maintain the confidentiality and privacy of the Federal health care data and reports; andCommentsClose CommentsPermalink
‘(II) the entity shall not make an unauthorized disclosure to the rest of the organization of Federal health care data or reports in breach of such confidentiality and privacy requirement.CommentsClose CommentsPermalink
‘(v) TERMINATION OR NONRENEWAL- If a contract under this subsection is terminated or not renewed, the following requirements shall apply:CommentsClose CommentsPermalink
‘(I) CONFIDENTIALITY AND PRIVACY PROTECTIONS- The entity shall continue to comply with the confidentiality and privacy requirements under this subsection with respect to all Federal health care data disclosed to the entity and each report developed by the entity.CommentsClose CommentsPermalink
‘(II) DISPOSITION OF DATA AND REPORTS- The entity shall--CommentsClose CommentsPermalink
‘(aa) return to the Secretary all Federal health care data disclosed to the entity and each report developed by the entity; orCommentsClose CommentsPermalink
‘(bb) if returning the Federal health care data and reports is not practicable, destroy the reports and Federal health care data.CommentsClose CommentsPermalink
‘(vi) RISK ADJUSTMENT- The entity shall ensure that the methodology used to develop a report under paragraph (4) shall include acceptable risk adjustment and case-mix adjustment developed in consultation with providers.CommentsClose CommentsPermalink
‘(C) COMPETITIVE PROCEDURES- Competitive procedures (as defined in section 4(5) of the Federal Procurement Policy Act) shall be used to enter into contracts under paragraph (2).CommentsClose CommentsPermalink
‘(D) REVIEW OF CONTRACT IN EVENT OF A MERGER OR ACQUISITION- The Secretary shall review the contract with an entity receiving a contract under this subsection in the event of a merger or acquisition of the entity in order to ensure that the requirements under this subsection will continue to be met.CommentsClose CommentsPermalink
‘(4) PROCEDURES FOR THE DEVELOPMENT OF REPORTS- Notwithstanding section 552(b)(6) or 552a(b) of title 5, United States Code, subject to paragraph (1)(B), not later than 12 months after the date of enactment of this section, the Secretary, in accordance with the purpose described in subsection (a), shall establish and implement procedures under which an entity may submit a request to an entity with a contract under this subsection to develop a report based on--CommentsClose CommentsPermalink
‘(A) Federal health care data disclosed to the entity under paragraph (5); andCommentsClose CommentsPermalink
‘(B) private data that is publicly available or is provided to the entity by the entity making the request for the report.CommentsClose CommentsPermalink
‘(5) ACCESS TO FEDERAL HEALTH CARE DATA-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The procedures established under paragraph (4) shall provide for the secure disclosure of Federal health care data to each entity with a contract under paragraph (2).CommentsClose CommentsPermalink
‘(B) UPDATE INFORMATION- Not less than every 6 months, the Secretary shall update the information disclosed under subparagraph (A) to each such entity.CommentsClose CommentsPermalink
‘(g) Public Reporting of Quality Resource Use Measures at the Provider, Group, System, Regional, and Other Levels- The Secretary shall make aggregated data, and reports developed under subsection (f), on quality and resource use measures collected under this section available to health care providers and the public through the process described in 399KK.CommentsClose CommentsPermalink
‘(h) Research Access to Health Care Data and Reporting on Performance- The Secretary shall permit researchers that meet criteria used to evaluate the appropriateness of the release data for research purposes (as established by the Secretary) to--CommentsClose CommentsPermalink
‘(1) have access to Federal health care data (as defined in subsection (f)); andCommentsClose CommentsPermalink
‘(2) report on the performance of health care providers and suppliers, including reporting in a provider- or supplier-identifiable format.CommentsClose CommentsPermalink
‘(i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $90,000,000 for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(b) HIT Policy Committee- Section 3002(b)(2)(B) of the Public Health Service Act (
42 U.S.C. 300jj-12(b)(2)(B) ) is amended by adding at the end the following:CommentsClose CommentsPermalink
‘(ix) The use of certified electronic health records to collect and report quality measures accepted by the Secretary.’.CommentsClose CommentsPermalink
Subtitle B--Health Care Quality ImprovementsCommentsClose CommentsPermalink
Subtitle B--Health Care Quality ImprovementsCommentsClose CommentsPermalink
SEC. 211. HEALTH CARE DELIVERY SYSTEM RESEARCH; QUALITY IMPROVEMENT TECHNICAL ASSISTANCE.
Part D of title IX of the Public Health Service Act, as amended by section 203, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘Subpart II--Health Care Quality Improvement Programs
‘SEC. 933. HEALTH CARE DELIVERY SYSTEM RESEARCH.
‘(a) Purpose- The purposes of this section are to--CommentsClose CommentsPermalink
‘(1) enable the Director to identify, develop, evaluate, disseminate, and provide training in innovative methodologies and strategies for quality improvement practices in the delivery of health care services that represent best practices (referred to as ‘best practices’) in health care quality, safety, and value; andCommentsClose CommentsPermalink
‘(2) ensure that the Director is accountable for implementing a model to pursue such research in a collaborative manner with other related Federal agencies.CommentsClose CommentsPermalink
‘(b) Establishment of Center- There is established within the Agency the Patient Safety Research Center (referred to in this section as the ‘Center’).CommentsClose CommentsPermalink
‘(c) General Functions of Center- The Center shall--CommentsClose CommentsPermalink
‘(1) carry out its functions using research from a variety of disciplines, which may include epidemiology, health services, sociology, psychology, human factors engineering, biostatistics, health economics, clinical research, and health informatics;CommentsClose CommentsPermalink
‘(2) conduct or support activities for activities identified in subsection (a), and for--CommentsClose CommentsPermalink
‘(A) best practices for quality improvement practices in the delivery of health care services; andCommentsClose CommentsPermalink
‘(B) that include changes in processes of care and the redesign of systems used by providers that will reliably result in intended health outcomes, improve patient safety, and reduce medical errors (such as skill development for health care providers in team-based health care delivery and rapid cycle process improvement) and facilitate adoption of improved workflow;CommentsClose CommentsPermalink
‘(3) identify health care providers, including health care systems, single institutions, and individual providers, that--CommentsClose CommentsPermalink
‘(A) deliver consistently high-quality, efficient health care services (as determined by the Secretary); andCommentsClose CommentsPermalink
‘(B) employ best practices that are adaptable and scalable to diverse health care settings or effective in improving care across diverse settings;CommentsClose CommentsPermalink
‘(4) assess research, evidence, and knowledge about what strategies and methodologies are most effective in improving health care delivery;CommentsClose CommentsPermalink
‘(5) find ways to translate such information rapidly and effectively into practice, and document the sustainability of those improvements;CommentsClose CommentsPermalink
‘(6) create strategies for quality improvement through the development of tools, methodologies, and interventions that can successfully reduce variations in the delivery of health care;CommentsClose CommentsPermalink
‘(7) identify, measure, and improve organizational, human, or other causative factors, including those related to the culture and system design of a health care organization, that contribute to the success and sustainability of specific quality improvement and patient safety strategies;CommentsClose CommentsPermalink
‘(8) provide for the development of best practices in the delivery of health care services that--CommentsClose CommentsPermalink
‘(A) have a high likelihood of success, based on structured review of empirical evidence;CommentsClose CommentsPermalink
‘(B) are specified with sufficient detail of the individual processes, steps, training, skills, and knowledge required for implementation and incorporation into workflow of health care practitioners in a variety of settings;CommentsClose CommentsPermalink
‘(C) are designed to be readily adapted by health care providers in a variety of settings; andCommentsClose CommentsPermalink
‘(D) where applicable, assist health care providers in working with other health care providers across the continuum of care and in engaging patients and their families in improving the care and patient health outcomes;CommentsClose CommentsPermalink
‘(9) provide for the funding of the activities of organizations with recognized expertise and excellence in improving the delivery of health care services, including children’s health care, by involving multiple disciplines, managers of health care entities, broad development and training, patients, caregivers and families, and frontline health care workers, including activities for the examination of strategies to share best quality improvement practices and to promote excellence in the delivery of health care services; andCommentsClose CommentsPermalink
‘(10) build capacity at the State and community level to lead quality and safety efforts through education, training, and mentoring programs to carry out the activities under paragraphs (1) through (9).CommentsClose CommentsPermalink
‘(d) Research Functions of Center-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Center shall support, such as through a contract or other mechanism, research on health care delivery system improvement and the development of tools to facilitate adoption of best practices that improve the quality, safety, and efficiency of health care delivery services. Such support may include establishing a Quality Improvement Network Research Program for the purpose of testing, scaling, and disseminating of interventions to improve quality and efficiency in health care. Recipients of funding under the Program may include national, State, multi-State, or multi-site quality improvement networks.CommentsClose CommentsPermalink
‘(2) RESEARCH REQUIREMENTS- The research conducted pursuant to paragraph (1) shall--CommentsClose CommentsPermalink
‘(A) address the priorities identified by the Secretary in the national strategic plan established under section 399HH;CommentsClose CommentsPermalink
‘(B) identify areas in which evidence is insufficient to identify strategies and methodologies, taking into consideration areas of insufficient evidence identified by a qualified consensus-based entity in the report required under section 399JJ;CommentsClose CommentsPermalink
‘(C) address concerns identified by health care institutions and providers and communicated through the Center pursuant to subsection (e);CommentsClose CommentsPermalink
‘(D) reduce preventable morbidity, mortality, and associated costs of morbidity and mortality by building capacity for patient safety research;CommentsClose CommentsPermalink
‘(E) support the discovery of processes for the reliable, safe, efficient, and responsive delivery of health care, taking into account discoveries from clinical research and comparative effectiveness research;CommentsClose CommentsPermalink
‘(F) be designed to help improve health care quality and is tested in practice-based settings;CommentsClose CommentsPermalink
‘(G) allow communication of research findings and translate evidence into practice recommendations that are adaptable to a variety of settings, and which, as soon as practicable after the establishment of the Center, shall include--CommentsClose CommentsPermalink
‘(i) the implementation of a national application of Intensive Care Unit improvement projects relating to the adult (including geriatric), pediatric, and neonatal patient populations;CommentsClose CommentsPermalink
‘(ii) practical methods for addressing health care associated infections, including Methicillin-Resistant Staphylococcus Aureus and Vancomycin-Resistant Entercoccus infections and other emerging infections; andCommentsClose CommentsPermalink
‘(iii) practical methods for reducing preventable hospital admissions and readmissions;CommentsClose CommentsPermalink
‘(H) expand demonstration projects for improving the quality of children’s health care and the use of health information technology, such as through Pediatric Quality Improvement Collaboratives and Learning Networks, consistent with provisions of section 1139A of the Social Security Act for assessing and improving quality, where applicable;CommentsClose CommentsPermalink
‘(I) identify and mitigate hazards by--CommentsClose CommentsPermalink
‘(i) analyzing events reported to patient safety reporting systems and patient safety organizations; andCommentsClose CommentsPermalink
‘(ii) using the results of such analyses to develop scientific methods of response to such events;CommentsClose CommentsPermalink
‘(J) include the conduct of systematic reviews of existing practices that improve the quality, safety, and efficiency of health care delivery, as well as new research on improving such practices; andCommentsClose CommentsPermalink
‘(K) include the examination of how to measure and evaluate the progress of quality and patient safety activities.CommentsClose CommentsPermalink
‘(e) Dissemination of Research Findings-CommentsClose CommentsPermalink
‘(1) PUBLIC AVAILABILITY- The Director shall make the research findings of the Center available to the public through multiple media and appropriate formats to reflect the varying needs of health care providers and consumers and diverse levels of health literacy.CommentsClose CommentsPermalink
‘(2) LINKAGE TO HEALTH INFORMATION TECHNOLOGY- The Secretary shall ensure that research findings and results generated by the Center are shared with the Office of the National Coordinator of Health Information Technology and used to inform the activities of the health information technology extension program under section 3012, as well as any relevant standards, certification criteria, or implementation specifications.CommentsClose CommentsPermalink
‘(f) Prioritization- The Director shall identify and regularly update a list of processes or systems on which to focus research and dissemination activities of the Center, taking into account--CommentsClose CommentsPermalink
‘(1) cost to Federal health programs;CommentsClose CommentsPermalink
‘(2) consumer assessment of health care experience;CommentsClose CommentsPermalink
‘(3) provider assessment of such processes or systems and opportunities to minimize distress and injury to the health care workforce;CommentsClose CommentsPermalink
‘(4) potential impact of such processes or systems on health status and function of patients, including vulnerable populations including children;CommentsClose CommentsPermalink
‘(5) areas of insufficient evidence identified under subsection (d)(2)(B); andCommentsClose CommentsPermalink
‘(6) the evolution of meaningful use of health information technology, as defined in section 3000.CommentsClose CommentsPermalink
‘(g) Funding- There is authorized to be appropriated to carry out this section $20,000,000 for fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘SEC. 934. QUALITY IMPROVEMENT TECHNICAL ASSISTANCE AND IMPLEMENTATION.
‘(a) In General- The Director, through the Patient Safety Research Center established in section 933 (referred to in this section as the ‘Center’), shall award--CommentsClose CommentsPermalink
‘(1) technical assistance grants or contracts to eligible entities to provide technical support to institutions that deliver health care and health care providers so that such institutions and providers understand, adapt, and implement the models and practices identified in the research conducted by the Center, including the Quality Improvement Networks Research Program; andCommentsClose CommentsPermalink
‘(2) implementation grants or contracts to eligible entities to implement the models and practices described under paragraph (1).CommentsClose CommentsPermalink
‘(b) Eligible Entities-CommentsClose CommentsPermalink
‘(1) TECHNICAL ASSISTANCE AWARD- To be eligible to receive a technical assistance grant or contract under subsection (a)(1), an entity--CommentsClose CommentsPermalink
‘(A) may be a health care provider, health care provider association, professional society, health care worker organization, Indian health organization, quality improvement organization, patient safety organization, local quality improvement collaborative, the Joint Commission, academic health center, university, physician-based research network, primary care extension program established under section 399V, a Federal Indian Health Service program or a health program operated by an Indian Tribe (as defined in section 4 of the Indian Health Care Improvement Act), or any other entity identified by the Secretary; andCommentsClose CommentsPermalink
‘(B) shall have demonstrated expertise in providing information and technical support and assistance to health care providers regarding quality improvement.CommentsClose CommentsPermalink
‘(2) IMPLEMENTATION AWARD- To be eligible to receive an implementation grant or contract under subsection (a)(2), an entity--CommentsClose CommentsPermalink
‘(A) may be a hospital or other health care provider or consortium or providers, as determined by the Secretary; andCommentsClose CommentsPermalink
‘(B) shall have demonstrated expertise in providing information and technical support and assistance to health care providers regarding quality improvement.CommentsClose CommentsPermalink
‘(c) Application-CommentsClose CommentsPermalink
‘(1) TECHNICAL ASSISTANCE AWARD- To receive a technical assistance grant or contract under subsection (a)(1), an eligible entity shall submit an application to the Secretary at such time, in such manner, and containing--CommentsClose CommentsPermalink
‘(A) a plan for a sustainable business model that may include a system of--CommentsClose CommentsPermalink
‘(i) charging fees to institutions and providers that receive technical support from the entity; andCommentsClose CommentsPermalink
‘(ii) reducing or eliminating such fees for such institutions and providers that serve low-income populations; andCommentsClose CommentsPermalink
‘(B) such other information as the Director may require.CommentsClose CommentsPermalink
‘(2) IMPLEMENTATION AWARD- To receive a grant or contract under subsection (a)(2), an eligible entity shall submit an application to the Secretary at such time, in such manner, and containing--CommentsClose CommentsPermalink
‘(A) a plan for implementation of a model or practice identified in the research conducted by the Center including--CommentsClose CommentsPermalink
‘(i) financial cost, staffing requirements, and timeline for implementation; andCommentsClose CommentsPermalink
‘(ii) pre- and projected post-implementation quality measure performance data in targeted improvement areas identified by the Secretary; andCommentsClose CommentsPermalink
‘(B) such other information as the Director may require.CommentsClose CommentsPermalink
‘(d) Matching Funds- The Director may not award a grant or contract under this section to an entity unless the entity agrees that it will make available (directly or through contributions from other public or private entities) non-Federal contributions toward the activities to be carried out under the grant or contract in an amount equal to $1 for each $5 of Federal funds provided under the grant or contract. Such non-Federal matching funds may be provided directly or through donations from public or private entities and may be in cash or in-kind, fairly evaluated, including plant, equipment, or services.CommentsClose CommentsPermalink
‘(e) Evaluation-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Director shall evaluate the performance of each entity that receives a grant or contract under this section. The evaluation of an entity shall include a study of--CommentsClose CommentsPermalink
‘(A) the success of such entity in achieving the implementation, by the health care institutions and providers assisted by such entity, of the models and practices identified in the research conducted by the Center under section 933;CommentsClose CommentsPermalink
‘(B) the perception of the health care institutions and providers assisted by such entity regarding the value of the entity; andCommentsClose CommentsPermalink
‘(C) where practicable, better patient health outcomes and lower cost resulting from the assistance provided by such entity.CommentsClose CommentsPermalink
‘(2) EFFECT OF EVALUATION- Based on the outcome of the evaluation of the entity under paragraph (1), the Director shall determine whether to renew a grant or contract with such entity under this section.CommentsClose CommentsPermalink
‘(f) Coordination- The entities that receive a grant or contract under this section shall coordinate with health information technology regional extension centers under section 3012(c) and the primary care extension program established under section 399V regarding the dissemination of quality improvement, system delivery reform, and best practices information.’.CommentsClose CommentsPermalink
SEC. 212. GRANTS TO ESTABLISH COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME.
(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’) shall establish a program to provide grants to eligible entities to establish community-based interdisciplinary, interprofessional teams (referred to in this section as ‘health teams’) to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. Grants shall be used to--CommentsClose CommentsPermalink
(1) establish health teams to provide support services to primary care providers; andCommentsClose CommentsPermalink
(2) provide capitated payments to primary care providers as determined by the Secretary.CommentsClose CommentsPermalink
(b) Eligible Entities- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink
(1)(A) be a State or State-designated entity; orCommentsClose CommentsPermalink
[Struck out->][ (B) be an Indian Tribe or tribal organization, as defined in section 4 of the Indian Health Care Improvement Act; ][<-Struck out]CommentsClose CommentsPermalink
(2) submit a plan for achieving long-term financial sustainability within 3 years;CommentsClose CommentsPermalink
(3) submit a plan for incorporating prevention initiatives and patient education and care management resources into the delivery of health care that is integrated with community-based prevention and treatment resources, where available;CommentsClose CommentsPermalink
(4) ensure that the health team established by the entity includes an interdisciplinary, interprofessional team of health care providers, as determined by the Secretary; such team may include medical specialists, nurses, nutritionists, dieticians, social workers, behavioral and mental health providers (including substance use disorder prevention and treatment providers), doctors of chiropractic, licensed complementary and alternative medicine practitioners, and physicians’ assistants; andCommentsClose CommentsPermalink
(5) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
(c) Requirements for Health Teams- A health team established pursuant to a grant under subsection (a) shall--CommentsClose CommentsPermalink
(1) establish contractual agreements with primary care providers to provide support services;CommentsClose CommentsPermalink
(2) support patient-centered medical homes, defined as mode of care that includes--CommentsClose CommentsPermalink
(A) personal physicians;CommentsClose CommentsPermalink
(B) whole person orientation;CommentsClose CommentsPermalink
(C) coordinated and integrated care;CommentsClose CommentsPermalink
(D) safe and high quality care though evidence-informed medicine, appropriate use of health information technology, and continuous quality improvements;CommentsClose CommentsPermalink
(E) expanded access to care; andCommentsClose CommentsPermalink
(F) payment that recognizes added value from additional components of patient-centered care;CommentsClose CommentsPermalink
(3) collaborate with local primary care providers and existing State and community based resources to coordinate disease prevention, chronic disease management, transitioning between health care providers and settings and case management for patients, including children, with priority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary;CommentsClose CommentsPermalink
(4) in collaboration with local health care providers, develop and implement interdisciplinary, interprofessional care plans that integrate clinical and community preventive and health promotion services for patients, including children, with a priority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary;CommentsClose CommentsPermalink
(5) incorporate health care providers, patients, caregivers, and authorized representatives in program design and oversight;CommentsClose CommentsPermalink
(6) provide support necessary for local primary care providers to--CommentsClose CommentsPermalink
(A) coordinate and provide access to high-quality health care services;CommentsClose CommentsPermalink
(B) coordinate and provide access to preventive and health promotion services;CommentsClose CommentsPermalink
(C) provide access to appropriate specialty care and inpatient services;CommentsClose CommentsPermalink
(D) provide quality-driven, cost-effective, culturally appropriate, and patient- and family-centered health care;CommentsClose CommentsPermalink
(E) provide access to pharmacist-delivered medication management services, including medication reconciliation;CommentsClose CommentsPermalink
(F) provide coordination of the appropriate use of complementary and alternative (CAM) services to those who request such services;CommentsClose CommentsPermalink
(G) promote effective strategies for treatment planning, monitoring health outcomes and resource use, sharing information, treatment decision support, and organizing care to avoid duplication of service and other medical management approaches intended to improve quality and value of health care services;CommentsClose CommentsPermalink
(H) provide local access to the continuum of health care services in the most appropriate setting, including access to individuals that implement the care plans of patients and coordinate care, such as integrative health care practitioners;CommentsClose CommentsPermalink
(I) collect and report data that permits evaluation of the success of the collaborative effort on patient outcomes, including collection of data on patient experience of care, and identification of areas for improvement; andCommentsClose CommentsPermalink
(J) establish a coordinated system of early identification and referral for children at risk for developmental or behavioral problems such as through the use of infolines, health information technology, or other means as determined by the Secretary;CommentsClose CommentsPermalink
(7) provide 24-hour care management and support during transitions in care settings including--CommentsClose CommentsPermalink
(A) a transitional care program that provides onsite visits from the care coordinator, assists with the development of discharge plans and medication reconciliation upon admission to and discharge from the hospitals, nursing home, or other institution setting;CommentsClose CommentsPermalink
(B) discharge planning and counseling support to providers, patients, caregivers, and authorized representatives;CommentsClose CommentsPermalink
(C) assuring that post-discharge care plans include medication management, as appropriate;CommentsClose CommentsPermalink
(D) referrals for mental and behavioral health services, which may include the use of infolines; andCommentsClose CommentsPermalink
(E) transitional health care needs from adolescence to adulthood;CommentsClose CommentsPermalink
(8) serve as a liaison to community prevention and treatment programs;CommentsClose CommentsPermalink
(9) demonstrate a capacity to implement and maintain health information technology that meets the requirements of certified EHR technology (as defined in section 3000 of the Public Health Service Act (
(10) where applicable, report to the Secretary information on quality measures used under section 399JJ of the Public Health Service Act.CommentsClose CommentsPermalink
(d) Requirement for Primary Care Providers- A provider who contracts with a care team shall--CommentsClose CommentsPermalink
(1) provide a care plan to the care team for each patient participant;CommentsClose CommentsPermalink
(2) provide access to participant health records; andCommentsClose CommentsPermalink
(3) meet regularly with the care team to ensure integration of care.CommentsClose CommentsPermalink
(e) Reporting to Secretary- An entity that receives a grant under subsection (a) shall submit to the Secretary a report that describes and evaluates, as requested by the Secretary, the activities carried out by the entity under subsection (c).CommentsClose CommentsPermalink
(f) Definition of Primary Care- In this section, the term ‘primary care’ means the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.CommentsClose CommentsPermalink
SEC. 213. GRANTS TO IMPLEMENT MEDICATION MANAGEMENT SERVICES IN TREATMENT OF CHRONIC DISEASE.
Title IX of the Public Health Service Act (
‘SEC. 935. GRANTS TO IMPLEMENT MEDICATION MANAGEMENT SERVICES IN TREATMENT OF CHRONIC DISEASES.
‘(a) In General- The Secretary, acting through the Patient Safety Research Center established in section 933 (referred to in this section as the ‘Center’), shall establish a program to provide grants to eligible entities to implement medication management (referred to in this section as ‘MTM’) services provided by licensed pharmacists, as a collaborative, multidisciplinary, inter-professional approach to the treatment of chronic diseases for targeted individuals, to improve the quality of care and reduce overall cost in the treatment of such diseases. The Secretary shall commence the grant program not later than May 1, 2010.CommentsClose CommentsPermalink
‘(b) Eligible Entities- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink
‘(1) provide a setting appropriate for MTM services, as recommended by the experts described in subsection (e);CommentsClose CommentsPermalink
‘(2) submit to the Secretary a plan for achieving long-term financial sustainability;CommentsClose CommentsPermalink
‘(3) where applicable, submit a plan for coordinating MTM services through local community health teams established in section 212 of the Affordable Health Choices Act or in collaboration with primary care extension programs established in section 399V;CommentsClose CommentsPermalink
‘(4) submit a plan for meeting the requirements under subsection (c); andCommentsClose CommentsPermalink
‘(5) submit to the Secretary such other information as the Secretary may require.CommentsClose CommentsPermalink
‘(c) MTM Services to Targeted Individuals- The MTM services provided with the assistance of a grant awarded under subsection (a) shall, as allowed by State law including applicable collaborative pharmacy practice agreements, include--CommentsClose CommentsPermalink
‘(1) performing or obtaining necessary assessments of the health and functional status of each patient receiving such MTM services;CommentsClose CommentsPermalink
‘(2) formulating a medication treatment plan according to therapeutic goals agreed upon by the prescriber and the patient or caregiver or authorized representative of the patient;CommentsClose CommentsPermalink
‘(3) selecting, initiating, modifying, recommending changes to, or administering medication therapy;CommentsClose CommentsPermalink
‘(4) monitoring, which may include access to, ordering, or performing laboratory assessments, and evaluating the response of the patient to therapy, including safety and effectiveness;CommentsClose CommentsPermalink
‘(5) performing an initial comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events, quarterly targeted medication reviews for ongoing monitoring, and additional followup interventions on a schedule developed collaboratively with the prescriber;CommentsClose CommentsPermalink
‘(6) documenting the care delivered and communicating essential information about such care, including a summary of the medication review, and the recommendations of the pharmacist to other appropriate health care providers of the patient in a timely fashion;CommentsClose CommentsPermalink
‘(7) providing education and training designed to enhance the understanding and appropriate use of the medications by the patient, caregiver, and other authorized representative;CommentsClose CommentsPermalink
‘(8) providing information, support services, and resources and strategies designed to enhance patient adherence with therapeutic regimens;CommentsClose CommentsPermalink
‘(9) coordinating and integrating MTM services within the broader health care management services provided to the patient; andCommentsClose CommentsPermalink
‘(10) such other patient care services allowed under pharmacist scopes of practice in use in other Federal programs that have implemented MTM services.CommentsClose CommentsPermalink
‘(d) Targeted Individuals- MTM services provided by licensed pharmacists under a grant awarded under subsection (a) shall be offered to targeted individuals who--CommentsClose CommentsPermalink
‘(1) take 4 or more prescribed medications (including over-the-counter medications and dietary supplements);CommentsClose CommentsPermalink
‘(2) take any ‘high risk’ medications;CommentsClose CommentsPermalink
‘(3) have 2 or more chronic diseases, as identified by the Secretary; orCommentsClose CommentsPermalink
‘(4) have undergone a transition of care, or other factors, as determined by the Secretary, that are likely to create a high risk of medication-related problems.CommentsClose CommentsPermalink
‘(e) Consultation With Experts- In designing and implementing MTM services provided under grants awarded under subsection (a), the Secretary shall consult with Federal, State, private, public-private, and academic entities, pharmacy and pharmacist organizations, health care organizations, consumer advocates, chronic disease groups, and other stakeholders involved with the research, dissemination, and implementation of pharmacist-delivered MTM services, as the Secretary determines appropriate. The Secretary, in collaboration with this group, shall determine whether it is possible to incorporate rapid cycle process improvement concepts in use in other Federal programs that have implemented MTM services.CommentsClose CommentsPermalink
‘(f) Reporting to the Secretary- An entity that receives a grant under subsection (a) shall submit to the Secretary a report that describes and evaluates, as requested by the Secretary, the activities carried out under subsection (c), including quality measures endorsed under 399JJ, as determined by the Secretary.CommentsClose CommentsPermalink
‘(g) Evaluation and Report- The Secretary shall submit to the relevant committees of Congress a report which shall--CommentsClose CommentsPermalink
‘(1) assess the clinical effectiveness of pharmacist-provided services under the MTM services program, as compared to usual care, including an evaluation of whether enrollees maintained better health with fewer hospitalizations and emergency room visits than similar patients not enrolled in the program;CommentsClose CommentsPermalink
‘(2) assess changes in overall health care resource use by targeted individuals;CommentsClose CommentsPermalink
‘(3) assess patient and prescriber satisfaction with MTM services;CommentsClose CommentsPermalink
‘(4) assess the impact of patient-cost sharing requirements on medication adherence and recommendations for modifications;CommentsClose CommentsPermalink
‘(5) identify and evaluate other factors that may impact clinical and economic outcomes, including demographic characteristics, clinical characteristics, and health services use of the patient, as well as characteristics of the regimen, pharmacy benefit, and MTM services provided; andCommentsClose CommentsPermalink
‘(6) evaluate the extent to which participating pharmacists who maintain a dispensing role have a conflict of interest in the provision of MTM services, and if such conflict is found, provide recommendations on how such a conflict might be appropriately addressed.CommentsClose CommentsPermalink
‘(h) Grant to Fund Development of Performance Measures- Secretary may, through the quality measure development program under section 931 of the Public Health Service Act, award grants or contracts to eligible entities for the purpose of funding the development of performance measures that assess the use and effectiveness of medication therapy management services.’.CommentsClose CommentsPermalink
SEC. 214. DESIGN AND IMPLEMENTATION OF REGIONALIZED SYSTEMS FOR EMERGENCY CARE.
(a) In General- Title XII of the Public Health Service Act (
(1) in section 1203--CommentsClose CommentsPermalink
(A) in the section heading, by inserting ‘for trauma systems’ after ‘grants’; andCommentsClose CommentsPermalink
(B) in subsection (a), by striking ‘Administrator of the Health Resources and Services Administration’ and inserting ‘Assistant Secretary for Preparedness and Response’;CommentsClose CommentsPermalink
(2) by inserting after section 1203 the following:CommentsClose CommentsPermalink
‘SEC. 1204. COMPETITIVE GRANTS FOR REGIONALIZED SYSTEMS FOR EMERGENCY CARE RESPONSE.
‘(a) In General- The Secretary, acting through the Assistant Secretary for Preparedness and Response, shall award not fewer than 4 multiyear contracts or competitive grants to eligible entities to support pilot projects that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems.CommentsClose CommentsPermalink
‘(b) Eligible Entity; Region- In this section:CommentsClose CommentsPermalink
‘(1) ELIGIBLE ENTITY- The term ‘eligible entity’ means--CommentsClose CommentsPermalink
‘(A) a State or a partnership of 1 or more States and 1 or more local governments; orCommentsClose CommentsPermalink
‘(B) an Indian Tribe (as defined in section 4 of the Indian Health Care Improvement Act) or a partnership of 1 or more Indian Tribes.CommentsClose CommentsPermalink
‘(2) REGION- The term ‘region’ means an area within a State, an area that lies within multiple States, or a similar area (such as a multicounty area), as determined by the Secretary.CommentsClose CommentsPermalink
‘(3) EMERGENCY SERVICES- The term ‘emergency services’ includes acute, prehospital, and trauma care.CommentsClose CommentsPermalink
‘(c) Pilot Projects- The Secretary shall award a contract or grant under subsection (a) to an eligible entity that proposes a pilot project to design, implement, and evaluate an emergency medical and trauma system that--CommentsClose CommentsPermalink
‘(1) coordinates with public health and safety services, emergency medical services, medical facilities, trauma centers, and other entities in a region to develop an approach to emergency medical and trauma system access throughout the region, including 9-1-1 Public Safety Answering Points and emergency medical dispatch;CommentsClose CommentsPermalink
‘(2) includes a mechanism, such as a regional medical direction or transport communications system, that operates throughout the region to ensure that the patient is taken to the medically appropriate facility (whether an initial facility or a higher-level facility) in a timely fashion;CommentsClose CommentsPermalink
‘(3) allows for the tracking of prehospital and hospital resources, including inpatient bed capacity, emergency department capacity, trauma center capacity, on-call specialist coverage, ambulance diversion status, and the coordination of such tracking with regional communications and hospital destination decisions; andCommentsClose CommentsPermalink
‘(4) includes a consistent region-wide prehospital, hospital, and interfacility data management system that--CommentsClose CommentsPermalink
‘(A) submits data to the National EMS Information System, the National Trauma Data Bank, and others;CommentsClose CommentsPermalink
‘(B) reports data to appropriate Federal and State databanks and registries; andCommentsClose CommentsPermalink
‘(C) contains information sufficient to evaluate key elements of prehospital care, hospital destination decisions, including initial hospital and interfacility decisions, and relevant health outcomes of hospital care.CommentsClose CommentsPermalink
‘(d) Application-CommentsClose CommentsPermalink
‘(1) IN GENERAL- An eligible entity that seeks a contract or grant described in subsection (a) shall submit to the Secretary an application at such time and in such manner as the Secretary may require.CommentsClose CommentsPermalink
‘(2) APPLICATION INFORMATION- Each application shall include--CommentsClose CommentsPermalink
‘(A) an assurance from the eligible entity that the proposed system--CommentsClose CommentsPermalink
‘(i) has been coordinated with the applicable State Office of Emergency Medical Services (or equivalent State office);CommentsClose CommentsPermalink
‘(ii) includes consistent indirect and direct medical oversight of prehospital, hospital, and interfacility transport throughout the region;CommentsClose CommentsPermalink
‘(iii) coordinates prehospital treatment and triage, hospital destination, and interfacility transport throughout the region;CommentsClose CommentsPermalink
‘(iv) includes a categorization or designation system for special medical facilities throughout the region that is integrated with transport and destination protocols;CommentsClose CommentsPermalink
‘(v) includes a regional medical direction, patient tracking, and resource allocation system that supports day-to-day emergency care and surge capacity and is integrated with other components of the national and State emergency preparedness system; andCommentsClose CommentsPermalink
‘(vi) addresses pediatric concerns related to integration, planning, preparedness, and coordination of emergency medical services for infants, children and adolescents; andCommentsClose CommentsPermalink
‘(B) such other information as the Secretary may require.CommentsClose CommentsPermalink
‘(e) Requirement of Matching Funds-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary may not make a grant under this section unless the State (or consortia of States) involved agrees, with respect to the costs to be incurred by the State (or consortia) in carrying out the purpose for which such grant was made, to make available non-Federal contributions (in cash or in kind under paragraph (2)) toward such costs in an amount equal to not less than $1 for each $3 of Federal funds provided in the grant. Such contributions may be made directly or through donations from public or private entities.CommentsClose CommentsPermalink
‘(2) NON-FEDERAL CONTRIBUTIONS- Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including equipment or services (and excluding indirect or overhead costs). Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.CommentsClose CommentsPermalink
‘(f) Priority- The Secretary shall give priority for the award of the contracts or grants described in subsection (a) to any eligible entity that serves a population in a medically underserved area (as defined in section 330(b)(3)).CommentsClose CommentsPermalink
‘(g) Report- Not later than 90 days after the completion of a pilot project under subsection (a), the recipient of such contract or grant described in shall submit to the Secretary a report containing the results of an evaluation of the program, including an identification of--CommentsClose CommentsPermalink
‘(1) the impact of the regional, accountable emergency care and trauma system on patient health outcomes for various critical care categories, such as trauma, stroke, cardiac emergencies, neurological emergencies, and pediatric emergencies;CommentsClose CommentsPermalink
‘(2) the system characteristics that contribute to the effectiveness and efficiency of the program (or lack thereof);CommentsClose CommentsPermalink
‘(3) methods of assuring the long-term financial sustainability of the emergency care and trauma system;CommentsClose CommentsPermalink
‘(4) the State and local legislation necessary to implement and to maintain the system;CommentsClose CommentsPermalink
‘(5) the barriers to developing regionalized, accountable emergency care and trauma systems, as well as the methods to overcome such barriers; andCommentsClose CommentsPermalink
‘(6) recommendations on the utilization of available funding for future regionalization efforts.CommentsClose CommentsPermalink
‘(h) Dissemination of Findings- The Secretary shall, as appropriate, disseminate to the public and to the appropriate Committees of the Congress, the information contained in a report made under subsection (g).’; andCommentsClose CommentsPermalink
(3) in section 1232--CommentsClose CommentsPermalink
(A) in subsection (a), by striking ‘appropriated’ and all that follows through the period at the end and inserting ‘appropriated $24,000,000 for each of fiscal years 2010 through 2014.’; andCommentsClose CommentsPermalink
(B) by inserting after subsection (c) the following:CommentsClose CommentsPermalink
‘(d) Authority- For the purpose of carrying out parts A through C, beginning on the date of enactment of the Affordable Health Choices Act, the Secretary shall transfer authority in administering grants and related authorities under such parts from the Administrator of the Health Resources and Services Administration to the Assistant Secretary for Preparedness and Response.’.CommentsClose CommentsPermalink
(b) Support for Emergency Medicine Research- Part H of title IV of the Public Health Service Act (
42 U.S.C. 289 et seq.) is amended by inserting after the section 498C the following:CommentsClose CommentsPermalink
‘SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RESEARCH.
‘(a) Emergency Medical Research- The Secretary shall support Federal programs administered by the National Institutes of Health, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and other agencies involved in improving the emergency care system to expand and accelerate research in emergency medical care systems and emergency medicine, including--CommentsClose CommentsPermalink
‘(1) the basic science of emergency medicine;CommentsClose CommentsPermalink
‘(2) the model of service delivery and the components of such models that contribute to enhanced patient health outcomes;CommentsClose CommentsPermalink
‘(3) the translation of basic scientific research into improved practice; andCommentsClose CommentsPermalink
‘(4) the development of timely and efficient delivery of health services.CommentsClose CommentsPermalink
‘(b) Pediatric Emergency Medical Research- The Secretary shall support Federal programs administered by the National Institutes of Health, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and other agencies to coordinate and expand research in pediatric emergency medical care systems and pediatric emergency medicine, including--CommentsClose CommentsPermalink
‘(1) an examination of the gaps and opportunities in pediatric emergency care research and a strategy for the optimal organization and funding of such research;CommentsClose CommentsPermalink
‘(2) the role of pediatric emergency services as an integrated component of the overall health system;CommentsClose CommentsPermalink
‘(3) system-wide pediatric emergency care planning, preparedness, coordination, and funding;CommentsClose CommentsPermalink
‘(4) pediatric training in professional education; andCommentsClose CommentsPermalink
‘(5) research in pediatric emergency care, specifically on the efficacy, safety, and health outcomes of medications used for infants, children, and adolescents in emergency care settings in order to improve patient safety.CommentsClose CommentsPermalink
‘(c) Impact Research- The Secretary shall support research to determine the estimated economic impact of, and savings that result from, the implementation of coordinated emergency care systems.CommentsClose CommentsPermalink
‘(d) Authorization of Appropriations- There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
SEC. 215. TRAUMA CARE CENTERS AND SERVICE AVAILABILITY.
(a) Trauma Care Centers-CommentsClose CommentsPermalink
(1) GRANTS FOR TRAUMA CARE CENTERS- Section 1241 of the Public Health Service Act (
‘(a) In General- The Secretary shall establish 3 programs to award grants to qualified public, nonprofit, Indian Health Service, Indian tribal, and urban Indian trauma centers--CommentsClose CommentsPermalink
‘(1) to assist in defraying substantial uncompensated care costs;CommentsClose CommentsPermalink
‘(2) to further the core missions of such trauma centers, including by addressing costs associated with patient stabilization and transfer, trauma education and outreach, coordination with local and regional trauma systems, essential personnel and other fixed costs, and expenses associated with employee and non-employee physician services; andCommentsClose CommentsPermalink
‘(3) to provide emergency relief to ensure the continued and future availability of trauma services.CommentsClose CommentsPermalink
‘(b) Minimum Qualifications of Trauma Centers-CommentsClose CommentsPermalink
‘(1) PARTICIPATION IN TRAUMA CARE SYSTEM OPERATING UNDER CERTAIN PROFESSIONAL GUIDELINES- Except as provided in paragraph (2), the Secretary may not award a grant to a trauma center under subsection (a) unless the trauma center is a participant in a trauma system that substantially complies with section 1213.CommentsClose CommentsPermalink
‘(2) EXEMPTION- Paragraph (1) shall not apply to trauma centers that are located in States with no existing trauma care system.CommentsClose CommentsPermalink
‘(3) QUALIFICATION FOR SUBSTANTIAL UNCOMPENSATED CARE COSTS- The Secretary shall award substantial uncompensated care grants under subsection (a)(1) only to trauma centers meeting at least 1 of the criteria in 1 of the following 3 categories:CommentsClose CommentsPermalink
‘(A) CATEGORY A- The criteria for category A are as follows:CommentsClose CommentsPermalink
‘(i) At least 40 percent of the visits in the emergency department of the hospital in which the trauma center is located were charity or self-pay patients.CommentsClose CommentsPermalink
‘(ii) At least 50 percent of the visits in such emergency department were Medicaid (under title XIX of the Social Security Act (
42 U.S.C. 1396 et seq.)) and charity and self-pay patients combined.CommentsClose CommentsPermalink‘(B) CATEGORY B- The criteria for category B are as follows:CommentsClose CommentsPermalink
‘(i) At least 35 percent of the visits in the emergency department were charity or self-pay patients.CommentsClose CommentsPermalink
‘(ii) At least 50 percent of the visits in the emergency department were Medicaid and charity and self-pay patients combined.CommentsClose CommentsPermalink
‘(C) CATEGORY C- The criteria for category C are as follows:CommentsClose CommentsPermalink
‘(i) At least 20 percent of the visits in the emergency department were charity or self-pay patients.CommentsClose CommentsPermalink
‘(ii) At least 30 percent of the visits in the emergency department were Medicaid and charity and self-pay patients combined.CommentsClose CommentsPermalink
‘(4) TRAUMA CENTERS IN 1115 WAIVER STATES- Notwithstanding paragraph (3), the Secretary may award a substantial uncompensated care grant to a trauma center under subsection (a)(1) if the trauma center qualifies for funds under a Low Income Pool or Safety Net Care Pool established through a waiver approved under section 1115 of the Social Security Act (
42 U.S.C. 1315 ).CommentsClose CommentsPermalink‘(5) DESIGNATION- The Secretary may not award a grant to a trauma center unless such trauma center is verified by the American College of Surgeons or designated by an equivalent State or local agency.CommentsClose CommentsPermalink
‘(c) Additional Requirements- The Secretary may not award a grant to a trauma center under subsection (a)(1) unless such trauma center--CommentsClose CommentsPermalink
‘(1) submits to the Secretary a plan satisfactory to the Secretary that demonstrates a continued commitment to serving trauma patients regardless of their ability to pay; andCommentsClose CommentsPermalink
‘(2) has policies in place to assist patients who cannot pay for part or all of the care they receive, including a sliding fee scale, and to ensure fair billing and collection practices.’.CommentsClose CommentsPermalink
(2) CONSIDERATIONS IN MAKING GRANTS- Section 1242 of the Public Health Service Act (
42 U.S.C. 300d-42 ) is amended by striking subsections (a) and (b) and inserting the following:CommentsClose CommentsPermalink‘(a) Substantial Uncompensated Care Awards-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall establish an award basis for each eligible trauma center for grants under section 1241(a)(1) according to the percentage described in paragraph (2), subject to the requirements of section 1241(b)(3).CommentsClose CommentsPermalink
‘(2) PERCENTAGES- The applicable percentages are as follows:CommentsClose CommentsPermalink
‘(A) With respect to a category A trauma center, 100 percent of the uncompensated care costs.CommentsClose CommentsPermalink
‘(B) With respect to a category B trauma center, not more than 75 percent of the uncompensated care costs.CommentsClose CommentsPermalink
‘(C) With respect to a category C trauma center, not more than 50 percent of the uncompensated care costs.CommentsClose CommentsPermalink
‘(b) Core Mission Awards-CommentsClose CommentsPermalink
‘(1) IN GENERAL- In awarding grants under section 1241(a)(2), the Secretary shall--CommentsClose CommentsPermalink
‘(A) reserve 25 percent of the amount allocated for core mission awards for Level III and Level IV trauma centers; andCommentsClose CommentsPermalink
‘(B) reserve 25 percent of the amount allocated for core mission awards for large urban Level I and II trauma centers--CommentsClose CommentsPermalink
‘(i) that have at least 1 graduate medical education fellowship in trauma or trauma related specialties for which demand is exceeding supply;CommentsClose CommentsPermalink
‘(ii) for which--CommentsClose CommentsPermalink
‘(I) annual uncompensated care costs exceed $10,000,000; orCommentsClose CommentsPermalink
‘(II) at least 20 percent of emergency department visits are charity or self-pay or Medicaid patients; andCommentsClose CommentsPermalink
‘(iii) that are not eligible for substantial uncompensated care awards under section 1241(a)(1).CommentsClose CommentsPermalink
‘(c) Emergency Awards- In awarding grants under section 1241(a)(3), the Secretary shall--CommentsClose CommentsPermalink
‘(1) give preference to any application submitted by a trauma center that provides trauma care in a geographic area in which the availability of trauma care has significantly decreased or will significantly decrease if the center is forced to close or downgrade service or growth in demand for trauma services exceeds capacity; andCommentsClose CommentsPermalink
‘(2) reallocate any emergency awards funds not obligated due to insufficient, or a lack of qualified, applications to the significant uncompensated care award program.’.CommentsClose CommentsPermalink
(3) CERTAIN AGREEMENTS- Section 1243 of the Public Health Service Act (
42 U.S.C. 300d-43 ) is amended by striking subsections (a), (b), and (c) and inserting the following:CommentsClose CommentsPermalink‘(a) Maintenance of Financial Support- The Secretary may require a trauma center receiving a grant under section 1241(a) to maintain access to trauma services at comparable levels to the prior year during the grant period .CommentsClose CommentsPermalink
‘(b) Trauma Care Registry- The Secretary may require the trauma center receiving a grant under section 1241(a) to provide data to a national and centralized registry of trauma cases, in accordance with guidelines developed by the American College of Surgeons, and as the Secretary may otherwise require.’.CommentsClose CommentsPermalink
(4) GENERAL PROVISIONS- Section 1244 of the Public Health Service Act (
‘(a) Application- The Secretary may not award a grant to a trauma center under section 1241(a) unless such center submits an application for the grant to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.CommentsClose CommentsPermalink
‘(b) Limitation on Duration of Support- The period during which a trauma center receives payments under a grant under section 1241(a)(3) shall be for 3 fiscal years, except that the Secretary may waive such requirement for a center and authorize such center to receive such payments for 1 additional fiscal year.CommentsClose CommentsPermalink
‘(c) Limitation on Amount of Grant- Notwithstanding section 1242(a), a grant under section 1241 may not be made in an amount exceeding $2,000,000 for each fiscal year.CommentsClose CommentsPermalink
‘(d) Eligibility- Except as provided in section 1242(b)(1)(B)(iii), acquisition of, or eligibility for, a grant under section 1241(a) shall not preclude a trauma center from being eligible for other grants described in such section.CommentsClose CommentsPermalink
‘(e) Funding Distribution- Of the total amount appropriated for a fiscal year under section 1245, 70 percent shall be used for substantial uncompensated care awards under section 1241(a)(1), 20 percent shall be used for core mission awards under section 1241(a)(2), and 10 percent shall be used for emergency awards under section 1241(a)(3).CommentsClose CommentsPermalink
‘(f) Minimum Allowance- Notwithstanding subsection (e), if the amount appropriated for a fiscal year under section 1245 is less than $25,000,000, all available funding for such fiscal year shall be used for substantial uncompensated care awards under section 1241(a)(1).CommentsClose CommentsPermalink
‘(g) Substantial Uncompensated Care Award Distribution and Proportional Share- Notwithstanding section 1242(a), of the amount appropriated for substantial uncompensated care grants for a fiscal year, the Secretary shall--CommentsClose CommentsPermalink
‘(1) make available--CommentsClose CommentsPermalink
‘(A) 50 percent of such funds for category A trauma center grantees;CommentsClose CommentsPermalink
‘(B) 35 percent of such funds for category B trauma center grantees; andCommentsClose CommentsPermalink
‘(C) 15 percent of such funds for category C trauma center grantees; andCommentsClose CommentsPermalink
‘(2) provide available funds within each category in a manner proportional to the award basis specified in section 1242(a)(2) to each eligible trauma center.CommentsClose CommentsPermalink
‘(h) Report- Beginning 2 years after the date of enactment of the Affordable Health Choices Act, and every 2 years thereafter, the Secretary shall biennially report to Congress regarding the status of the grants made under section 1241 and on the overall financial stability of trauma centers.’.CommentsClose CommentsPermalink
(5) AUTHORIZATION OF APPROPRIATIONS- Section 1245 of the Public Health Service Act (
‘SEC. 1245. AUTHORIZATION OF APPROPRIATIONS.
‘For the purpose of carrying out this part, there are authorized to be appropriated $100,000,000 for fiscal year 2009, and such sums as may be necessary for each of fiscal years 2010 through 2015. Such authorization of appropriations is in addition to any other authorization of appropriations or amounts that are available for such purpose.’.CommentsClose CommentsPermalink
(6) DEFINITION- Part D of title XII of the Public Health Service Act (
42 U.S.C. 300d-41 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 1246. DEFINITION.
‘In this part, the term ‘uncompensated care costs’ means unreimbursed costs from serving self-pay, charity, or Medicaid patients, without regard to payment under section 1923 of the Social Security Act, all of which are attributable to emergency care and trauma care, including costs related to subsequent inpatient admissions to the hospital.’.CommentsClose CommentsPermalink
(b) Trauma Service Availability- Title XII of the Public Health Service Act (
42 U.S.C. 300d et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink
‘PART H--TRAUMA SERVICE AVAILABILITY
‘SEC. 1281. GRANTS TO STATES.
‘(a) Establishment- To promote universal access to trauma care services provided by trauma centers and trauma-related physician specialties, the Secretary shall provide funding to States to enable such States to award grants to eligible entities for the purposes described in this section.CommentsClose CommentsPermalink
‘(b) Awarding of Grants by States- Each State may award grants to eligible entities within the State for the purposes described in subparagraph (d).CommentsClose CommentsPermalink
‘(c) Eligibility-CommentsClose CommentsPermalink
‘(1) IN GENERAL- To be eligible to receive a grant under subsection (b) an entity shall--CommentsClose CommentsPermalink
‘(A) be--CommentsClose CommentsPermalink
‘(i) a public or nonprofit trauma center or consortium thereof that meets that requirements of paragraphs (1), (2), and (5) of section 1241(b);CommentsClose CommentsPermalink
‘(ii) a safety net public or nonprofit trauma center that meets the requirements of paragraphs (1) through (5) of section 1241(b); orCommentsClose CommentsPermalink
‘(iii) a hospital in an underserved area (as defined by the State) that seeks to establish new trauma services; andCommentsClose CommentsPermalink
‘(B) submit to the State an application at such time, in such manner, and containing such information as the State may require.CommentsClose CommentsPermalink
‘(2) LIMITATION- A State shall use at least 40 percent of the amount available to the State under this part for a fiscal year to award grants to safety net trauma centers described in paragraph (1)(A)(ii).CommentsClose CommentsPermalink
‘(d) Use of Funds- The recipient of a grant under subsection (b) shall carry out 1 or more of the following activities consistent with subsection (b):CommentsClose CommentsPermalink
‘(1) Providing trauma centers with funding to support physician compensation in trauma-related physician specialties where shortages exist in the region involved, with priority provided to safety net trauma centers described in subsection (c)(1)(A)(ii).CommentsClose CommentsPermalink
‘(2) Providing for individual safety net trauma center fiscal stability and costs related to having service that is available 24 hours a day, 7 days a week, with priority provided to safety net trauma centers described in subsection (c)(1)(A)(ii) located in urban, border, and rural areas.CommentsClose CommentsPermalink
‘(3) Reducing trauma center overcrowding at specific trauma centers related to throughput of trauma patients.CommentsClose CommentsPermalink
‘(4) Establishing new trauma services in underserved areas as defined by the State.CommentsClose CommentsPermalink
‘(5) Enhancing collaboration between trauma centers and other hospitals and emergency medical services personnel related to trauma service availability.CommentsClose CommentsPermalink
‘(6) Making capital improvements to enhance access and expedite trauma care, including providing helipads and associated safety infrastructure.CommentsClose CommentsPermalink
‘(7) Enhancing trauma surge capacity at specific trauma centers.CommentsClose CommentsPermalink
‘(8) Ensuring expedient receipt of trauma patients transported by ground or air to the appropriate trauma center.CommentsClose CommentsPermalink
‘(9) Enhancing interstate trauma center collaboration.CommentsClose CommentsPermalink
‘(e) Limitation-CommentsClose CommentsPermalink
‘(1) IN GENERAL- A State may use not more than 20 percent of the amount available to the State under this part for a fiscal year for administrative costs associated with awarding grants and related costs.CommentsClose CommentsPermalink
‘(2) MAINTENANCE OF EFFORT- The Secretary may not provide funding to a State under this part unless the State agrees that such funds will be used to supplement and not supplant State funding otherwise available for the activities and costs described in this part.CommentsClose CommentsPermalink
‘(f) Distribution of Funds- The following shall apply with respect to grants provided in this part:CommentsClose CommentsPermalink
‘(1) LESS THAN $10,000,000- If the amount of appropriations for this part in a fiscal year is less than $10,000,000, the Secretary shall divide such funding evenly among only those States that have 1 or more trauma centers eligible for funding under section 1241(b)(3)(A).CommentsClose CommentsPermalink
‘(2) LESS THAN $20,000,000- If the amount of appropriations in a fiscal year is less than $20,000,000, the Secretary shall divide such funding evenly among only those States that have 1 or more trauma centers eligible for funding under subparagraphs (A) and (B) of section 1241(b)(3).CommentsClose CommentsPermalink
‘(3) LESS THAN $30,000,000- If the amount of appropriations for this part in a fiscal year is less than $30,000,000, the Secretary shall divide such funding evenly among only those States that have 1 or more trauma centers eligible for funding under section 1241(b)(3).CommentsClose CommentsPermalink
‘(4) $30,000,000 OR MORE- If the amount of appropriations for this part in a fiscal year is $30,000,000 or more, the Secretary shall divide such funding evenly among all States.CommentsClose CommentsPermalink
‘SEC. 1282. AUTHORIZATION OF APPROPRIATIONS.
‘For the purpose of carrying out this part, there is authorized to be appropriated $100,000,000 for each of fiscal years 2010 through 2015.’.CommentsClose CommentsPermalink
SEC. 216. REDUCING AND REPORTING HOSPITAL READMISSIONS.
(a) In General- Part S of title III of the Public Health Service Act, as amended by section 205, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 399NN. READMISSIONS.
‘(a) Purpose- The purpose of this section is to improve the quality and value of inpatient hospital services in order to--CommentsClose CommentsPermalink
‘(1) improve the coordination of care; andCommentsClose CommentsPermalink
‘(2) appropriately reduce inefficiency and waste, such as unnecessary hospital readmissions, in the care furnished.CommentsClose CommentsPermalink
‘(b) Information Gathering and Analysis- Beginning 2010, the Secretary shall analyze and calculate hospital-specific and national applicable readmissions rates based on subsection (e). In developing criteria and carrying out this section, the Secretary shall consider the unique characters of rural and low-volume hospitals (including critical access hospitals).CommentsClose CommentsPermalink
‘(c) Disclosure-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Beginning in 2011, the Secretary shall establish procedures to provide for the confidential disclosure to hospitals receiving funds under this Act of information on hospital-specific and national applicable readmission rates described in subsection (b).CommentsClose CommentsPermalink
‘(2) PUBLIC DISCLOSURE OF INFORMATION- Not later than 2 years after the date of enactment of this section, the Secretary shall make the information on the rates of applicable readmission rates and other statistical information of hospital receiving funds under this Act disclosed under paragraph (1) publicly available in a form and manner determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(3) REPORT- Not later than 180 days after the date of enactment of this section, the Secretary shall submit to Congress a report that contains--CommentsClose CommentsPermalink
‘(A) a summary of the implementation of the procedures under paragraph (1);CommentsClose CommentsPermalink
‘(B) a plan for the public disclosure of information under paragraph (2); andCommentsClose CommentsPermalink
‘(C) recommendations for such legislation or administrative action as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(d) Applicable Readmission Defined-CommentsClose CommentsPermalink
‘(1) IN GENERAL- In this section, the term ‘applicable readmission’ means a readmission--CommentsClose CommentsPermalink
‘(A) selected by the Secretary under subsection (e));CommentsClose CommentsPermalink
‘(B) that occurs within a time interval (as specified under subsection (f)) following a discharge from a hospital; andCommentsClose CommentsPermalink
‘(C) which is for a condition or procedure selected under subsection (g).CommentsClose CommentsPermalink
‘(2) DETERMINATION OF APPLICABILITY TO READMISSIONS TO CERTAIN HOSPITALS- The Secretary shall determine whether the term ‘applicable readmission’ includes readmissions to the same hospital as the prior discharge or readmissions to any hospital.CommentsClose CommentsPermalink
‘(e) Selection of Readmissions- Not later 6 months after the date of enactment of this section, the Secretary, in consultation with appropriate representatives of the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality, shall, for each of the conditions or procedures selected under subsection (g), select readmissions that meet each of the following requirements:CommentsClose CommentsPermalink
‘(1) The readmission could reasonably have been prevented by the provision of care consistent with evidence-based guidelines during the prior admission or the post discharge follow-up period.CommentsClose CommentsPermalink
‘(2) The readmission is for a condition or procedure related to the care provided during the prior admission or post discharge follow-up period, which includes a readmission for the following:CommentsClose CommentsPermalink
‘(A) The same condition or procedure as the prior discharge.CommentsClose CommentsPermalink
‘(B) An infection or other complication of care.CommentsClose CommentsPermalink
‘(C) A condition or procedure indicative of a failed surgical intervention.CommentsClose CommentsPermalink
‘(D) Other conditions or procedures as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(f) Specification of Time Interval- The Secretary shall specify a time interval, of not less than 7 days and not more than 30 days, between the prior discharge and applicable readmission for purposes of this section.CommentsClose CommentsPermalink
‘(g) Selection of Conditions or Procedures-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Not later than 6 months after the date of enactment of this section, the Secretary shall select at least 2 conditions or procedures which meet each of the following requirements:CommentsClose CommentsPermalink
‘(A) Such conditions or procedures have a high volume.CommentsClose CommentsPermalink
‘(B) For the time interval specified under subsection (f), such conditions or procedures have a relatively high rate of occurrence of subsequent readmissions described in subsection (f), as compared to all other conditions or procedures.CommentsClose CommentsPermalink
‘(2) EXPANSION OF CONDITIONS OR PROCEDURES SELECTED- The Secretary shall expand the list of readmission conditions analyzed under this section to include at least 8 conditions with the highest volume and highest rate of readmissions. At least one of the conditions selected shall be a condition prevalent in geriatric patients.CommentsClose CommentsPermalink
‘(h) Quality Improvement Program for Hospitals With a High Severity Adjusted Readmission Rate-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Not later than 2 years after the date of enactment of this section, the Secretary shall establish a program for eligible hospitals to improve their readmission rates through the use of patient safety organizations (as defined in section 921(4)).CommentsClose CommentsPermalink
‘(B) ELIGIBLE HOSPITAL DEFINED- In this subsection, the term ‘eligible hospital’ means a hospital which the Secretary determines (based on the most recent available historical data) has a severity adjusted readmission rate for the conditions described in subsection (g) among the highest 25 percent of all hospitals nationally.CommentsClose CommentsPermalink
‘(C) RISK ADJUSTMENT- The Secretary shall utilize appropriate risk adjustment measures to determine eligible hospitals.CommentsClose CommentsPermalink
‘(2) REPORT TO THE SECRETARY- Eligible hospitals and patient safety organizations working with those hospitals shall report to the Secretary on the processes employed by the hospital to improve readmission rates and the impact of such processes on readmission rates.’.CommentsClose CommentsPermalink
(b) GAO Study and Report-CommentsClose CommentsPermalink
(1) STUDY- The Comptroller General of the United States shall conduct a study on the impact of section 399NN of the Public Health Service Act, as added by subsection (a), on--CommentsClose CommentsPermalink
(A) care furnished to consumers;CommentsClose CommentsPermalink
(B) expenditures under Federal health programs; andCommentsClose CommentsPermalink
(C) the cost and quality of care furnished by hospitals.CommentsClose CommentsPermalink
(2) REPORT- Not later than January 1, 2013, the Comptroller General of the United States shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.CommentsClose CommentsPermalink
(c) Study by IOM-CommentsClose CommentsPermalink
(1) IN GENERAL- The Secretary of Health and Human Services shall seek to enter into an agreement with the Institute of Medicine to submit to Congress, not later than 1 year after the date of enactment of this Act, a report on recommendations on how to reduce unnecessary hospital readmissions. Such report shall also include recommendations on how to develop a coordinated care plan for patients being discharged from the hospital.CommentsClose CommentsPermalink
(2) AUTHORIZATION- For the purpose of carrying out this subsection, there is authorized to be appropriated such sums as may be necessary for fiscal year 2010.CommentsClose CommentsPermalink
SEC. 217. PROGRAM TO FACILITATE SHARED DECISIONMAKING.
Part D of title IX of the Public Health Service Act, as amended by section 213, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 936. PROGRAM TO FACILITATE SHARED DECISIONMAKING.
‘(a) Purpose- The purpose of this section is to facilitate collaborative processes between patients, caregivers or authorized representatives, and clinicians that engages the patient, caregiver or authorized representative in decisionmaking, provides patients, caregivers or authorized representatives with information about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.CommentsClose CommentsPermalink
‘(b) Definitions- In this section:CommentsClose CommentsPermalink
‘(1) PATIENT DECISION AID- The term ‘patient decision aid’ means an educational tool that helps patients, caregivers or authorized representatives understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.CommentsClose CommentsPermalink
‘(2) PREFERENCE SENSITIVE CARE- The term ‘preference sensitive care’ means medical care for which the clinical evidence does not clearly support one treatment option such that the appropriate course of treatment depends on the values of the patient or the preferences of the patient, caregivers or authorized representatives regarding the benefits, harms and scientific evidence for each treatment option, the use of such care should depend on the informed patient choice among clinically appropriate treatment options.CommentsClose CommentsPermalink
‘(c) Establishment of Independent Standards for Patient Decision Aids for Preference Sensitive Care-CommentsClose CommentsPermalink
‘(1) CONTRACT WITH ENTITY TO ESTABLISH STANDARDS AND CERTIFY PATIENT DECISION AIDS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- For purposes of supporting consensus-based standards for patient decision aids for preference sensitive care and a certification process for patient decision aids for use in the Federal health programs and by other interested parties, the Secretary shall have in effect a contract with the qualified consensus-based entity identified in section 399JJ. Such contract shall provide that the entity perform the duties described in paragraph (2).CommentsClose CommentsPermalink
‘(B) TIMING FOR FIRST CONTRACT- As soon as practicable after the date of the enactment of this section, the Secretary shall enter into the first contract under subparagraph (A).CommentsClose CommentsPermalink
‘(C) PERIOD OF CONTRACT- A contract under subparagraph (A) shall be for a period of 18 months (except such contract may be renewed after a subsequent bidding process).CommentsClose CommentsPermalink
‘(2) DUTIES- The following duties are described in this paragraph:CommentsClose CommentsPermalink
‘(A) DEVELOP AND IDENTIFY STANDARDS FOR PATIENT DECISION AIDS- The entity shall synthesize evidence and convene a broad range of experts and key stakeholders to develop and identify consensus-based standards to evaluate patient decision aids for preference sensitive care.CommentsClose CommentsPermalink
‘(B) ENDORSE PATIENT DECISION AIDS- The entity shall review patient decision aids and develop a certification process whether patient decision aids meet the standards developed and identified under subparagraph (A). The entity shall give priority to the review and certification of patient decision aids for preference sensitive care.CommentsClose CommentsPermalink
‘(d) Program to Develop, Update and Patient Decision Aids to Assist Health Care Providers and Patients-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary, acting through the Director, and in coordination with heads of other relevant agencies, such as the Director of the Centers for Disease Control and Prevention and the Director of the National Institutes of Health, shall establish a program to award grants or contracts--CommentsClose CommentsPermalink
‘(A) to develop, update, and produce patient decision aids for preference sensitive care to assist health care providers in educating patients, caregivers, and authorized representatives concerning the relative safety, relative effectiveness (including possible health outcomes and impact on functional status), and relative cost of treatment or, where appropriate, palliative care options;CommentsClose CommentsPermalink
‘(B) to test such materials to ensure such materials are balanced and evidence based in aiding health care providers and patients, caregivers, and authorized representatives to make informed decisions about patient care and can be easily incorporated into a broad array of practice settings; andCommentsClose CommentsPermalink
‘(C) to educate providers on the use of such materials, including through academic curricula.CommentsClose CommentsPermalink
‘(2) REQUIREMENTS FOR PATIENT DECISION AIDS- Patient decision aids developed and produced pursuant to a grant or contract under paragraph (1)--CommentsClose CommentsPermalink
‘(A) shall be designed to engage patients, caregivers, and authorized representatives in informed decisionmaking with health care providers;CommentsClose CommentsPermalink
‘(B) shall present up-to-date clinical evidence about the risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized representatives from a variety of cultural and educational backgrounds to reflect the varying needs of consumers and diverse levels of health literacy;CommentsClose CommentsPermalink
‘(C) shall, where appropriate, explain why there is a lack of evidence to support one treatment option over another; andCommentsClose CommentsPermalink
‘(D) shall address health care decisions across the age span, including those affecting vulnerable populations including children.CommentsClose CommentsPermalink
‘(3) DISTRIBUTION- The Director shall ensure that patient decision aids produced with grants or contracts under this section are available to the public.CommentsClose CommentsPermalink
‘(4) NONDUPLICATION OF EFFORTS- The Director shall ensure that the activities under this section of the Agency and other agencies, including the Centers for Disease Control and Prevention and the National Institutes of Health, are free of unnecessary duplication of effort.CommentsClose CommentsPermalink
‘(e) Grants to Support Shared Decision Making Implementation-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall establish a program to provide for the phased-in development, implementation, and evaluation of shared decisionmaking using patient decision aids to meet the objective of improving the understanding of patients of their medical treatment options.CommentsClose CommentsPermalink
‘(2) SHARED DECISIONMAKING RESOURCE CENTERS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall provide grants for the establishment and support of Shared Decision Making Resource Centers (referred to in this subsection as ‘Centers’) to provide technical assistance to providers and to develop and disseminate best practices and other information to support and accelerate adoption, implementation, and effective use of patient decision aids and shared decision making by providers.CommentsClose CommentsPermalink
‘(B) OBJECTIVES- The objective of a Center is to enhance and promote the adoption of patient decision aids and shared decisionmaking through--CommentsClose CommentsPermalink
‘(i) providing assistance to eligible providers with the implementation and effective use of, and training on, patient decision aids; andCommentsClose CommentsPermalink
‘(ii) the dissemination of best practices and research on the implementation and effective use of patient decision aids.CommentsClose CommentsPermalink
‘(3) SHARED DECISIONMAKING PARTICIPATION GRANTS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall provide grants to health care providers for the development and implementation of shared decisionmaking techniques.CommentsClose CommentsPermalink
‘(B) PREFERENCE- In order to facilitate the use of best practices, the Secretary shall provide a preference in making grants under this subsection to health care providers who participate in training by Shared Decision Making Resource Centers or comparable training.CommentsClose CommentsPermalink
‘(C) LIMITATION- Funds under this paragraph shall not be used to purchase or implement use of patient decision aids other than those certified under the process identified in subsection (c).CommentsClose CommentsPermalink
‘(4) GUIDANCE- The Secretary may issue guidance to eligible grantees under this subsection on the use of patient decision aids.CommentsClose CommentsPermalink
‘(5) QUALITY MEASURES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary shall measure the quality of shared decisionmaking. For purposes of making such measurements, the Secretary shall select quality measures as described in section 399JJ.CommentsClose CommentsPermalink
‘(B) REPORTING DATA ON MEASURES- A provider receiving a grant under this subsection shall report to the Secretary data on quality measures selected under subparagraph (A) in accordance with procedures established by the Secretary.CommentsClose CommentsPermalink
‘(C) FEEDBACK ON MEASURES- The Secretary shall provide confidential reports to eligible providers receiving a grant under this section on the performance of the eligible provider on quality measures selected by the Secretary under subparagraph (A), the aggregate performance of all eligible providers participating in the program, and any improvements in such performance. Such reports shall be made publicly available not less than 3 years after the date of enactment of this section.CommentsClose CommentsPermalink
‘(D) GRANT TO FUND DEVELOPMENT OF PERFORMANCE MEASURES- The Director may, through the quality measure development program under section 931, award grants or contracts to eligible entities to fund development of performance measures which assess the use by health care providers of shared decisionmaking processes or patient decision aids.CommentsClose CommentsPermalink
‘(E) CONTENTS OF REPORT- Each report submitted under this paragraph shall--CommentsClose CommentsPermalink
‘(i) include an assessment of--CommentsClose CommentsPermalink
‘(I) quality measures selected under subparagraph (A);CommentsClose CommentsPermalink
‘(II) patient and health care provider satisfaction with regard to activities carried out under this paragraph;CommentsClose CommentsPermalink
‘(III) utilization of medical services for patients of providers receiving a grant under this paragraph and other patients as determined appropriate by the Secretary;CommentsClose CommentsPermalink
‘(IV) appropriate utilization of shared decisionmaking by providers receiving a grant under this paragraph; andCommentsClose CommentsPermalink
‘(V) the costs to providers participating of selecting, purchasing, and incorporating approved patient decision aids and meeting reporting requirements under this paragraph; andCommentsClose CommentsPermalink
‘(ii) identify the characteristics of individual eligible providers that are most effective in implementing shared decisionmaking under the applicable phase of the program.CommentsClose CommentsPermalink
‘(f) Funding- For purposes of carrying out this section there are authorized to be appropriated such sums as may be necessary for fiscal year 2010 and each subsequent fiscal year.’.CommentsClose CommentsPermalink
SEC. 218. PRESENTATION OF PRESCRIPTION DRUG BENEFIT AND RISK INFORMATION.
(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Commissioner of Food and Drugs, shall determine whether the addition of quantitative summaries of the benefits and risks of prescription drugs in a standardized format (such as a table or drug facts box) to the promotional labeling or print advertising of such drugs would improve health care decisionmaking by clinicians and patients and consumers.CommentsClose CommentsPermalink
(b) Review and Consultation- In making the determination under subsection (a), the Secretary shall review all available scientific evidence and research on decisionmaking and social and cognitive psychology and consult with drug manufacturers, clinicians, patients and consumers, experts in health literacy, representatives of racial and ethnic minorities, and experts in women’s and pediatric health.CommentsClose CommentsPermalink
(c) Report- Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress a report that provides--CommentsClose CommentsPermalink
(1) the determination by the Secretary under subsection (a); andCommentsClose CommentsPermalink
(2) the reasoning and analysis underlying that determination.CommentsClose CommentsPermalink
(d) Authority- If the Secretary determines under subsection (a) that the addition of quantitative summaries of the benefits and risks of prescription drugs in a standardized format (such as a table or drug facts box) to the promotional labeling or print advertising of such drugs would improve health care decision-making by clinicians and patients and consumers, then the Secretary, not later than 3 years after the date of submission of the report under subsection (c), shall promulgate proposed regulations as necessary to implement such format.CommentsClose CommentsPermalink
(e) Clarification- Nothing in this section shall be construed to restrict the existing authorities of the Secretary with respect to benefit and risk information.CommentsClose CommentsPermalink
SEC. 219. CENTER FOR HEALTH OUTCOMES RESEARCH AND EVALUATION.
Part D of title IX of the Public Health Service Act, as amended by section 217, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 937. CENTER FOR HEALTH OUTCOMES RESEARCH AND EVALUATION.
‘(a) Establishment- The Secretary shall establish within the Agency the Center for Health Outcomes Research and Evaluation (referred to in this section as the ‘Center’) to collect, conduct, support, and synthesize research with respect to comparing health outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.CommentsClose CommentsPermalink
‘(b) Duties- The Center shall--CommentsClose CommentsPermalink
‘(1) coordinate, conduct, support, and synthesize research relevant to the comparative health outcomes and effectiveness of the full spectrum of health care treatments, including pharmaceuticals, medical devices, medical and surgical procedures, screening and diagnostics, behavioral health care, oral health, and other health interventions;CommentsClose CommentsPermalink
‘(2) coordinate, conduct, and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;CommentsClose CommentsPermalink
‘(3) coordinate, conduct, support, and synthesize research that--CommentsClose CommentsPermalink
‘(A) identifies which treatment is most effective and least toxic for each individual given each individual’s genetic makeup and coexisting conditions; andCommentsClose CommentsPermalink
‘(B) reduces treatment disparities, among ethnic and racial minorities, children, and vulnerable populations;CommentsClose CommentsPermalink
‘(4) use a broad range of methodologies, including randomized controlled clinical trials, observational studies and other approaches;CommentsClose CommentsPermalink
‘(5) create informational tools that organize, synthesize, and disseminate research findings to providers, patients, and public and private payers;CommentsClose CommentsPermalink
‘(6) develop a publicly available resource database that collects and contains high-quality, independent evidence to inform healthcare decisionmaking, which shall include reliable evidence from government and non-government sources;CommentsClose CommentsPermalink
‘(7) submit to the Secretary, and Congress appropriate relevant reports described in subsection (h);CommentsClose CommentsPermalink
‘(8) encourage, as appropriate, the development and use of clinical registries and the development of health outcomes research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data; andCommentsClose CommentsPermalink
‘(9) not later than one year after the date of the enactment of this section, develop minimum methodological standards to be used when conducting studies of comparative health outcomes and value (and procedures for use of such standards) in order to help ensure accurate and effective comparisons and assessments of treatment options, and update such standards at least biennially.CommentsClose CommentsPermalink
‘(c) Powers-CommentsClose CommentsPermalink
‘(1) OBTAINING OFFICIAL DATA- The Center may secure directly from any department or agency of the United States information necessary to enable the Center to carry out this section. Upon request of the Center, the head of that department or agency shall furnish that information to the Center on an agreed upon schedule.CommentsClose CommentsPermalink
‘(2) DATA COLLECTION- In order to carry out its functions, the Center shall--CommentsClose CommentsPermalink
‘(A) utilize existing information, both published and unpublished, where possible, collected and assessed either by the staff of the Center or under other arrangements made in accordance with this section;CommentsClose CommentsPermalink
‘(B) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate;CommentsClose CommentsPermalink
‘(C) adopt procedures allowing any interested party to submit information for use by the Center or the Advisory Counsel under subsection (d) in making reports and recommendations; andCommentsClose CommentsPermalink
‘(D) comply with any existing data privacy standards applicable to the Center.CommentsClose CommentsPermalink
‘(3) PERIODIC AUDIT- -The Center shall be subject to periodic audit by the Comptroller General.CommentsClose CommentsPermalink
‘(d) Advisory Council-CommentsClose CommentsPermalink
‘(1) IN GENERAL- To ensure transparency, the Secretary shall establish through the Agency’s National Advisory Council, an advisory council (referred to in this section as the ‘Council’) that includes representatives from the scientific research, patient, provider, and health industry communities.CommentsClose CommentsPermalink
‘(2) COMPOSITION OF COUNCIL-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The members of the Council shall consist of--CommentsClose CommentsPermalink
‘(i) 2 ex officio members who shall be--CommentsClose CommentsPermalink
‘(I) the Director; andCommentsClose CommentsPermalink
‘(II) the Chief Medical Officer of the Centers for Medicare & Medicaid Services; andCommentsClose CommentsPermalink
‘(ii) 19 additional members who shall represent broad constituencies of stakeholders.CommentsClose CommentsPermalink
‘(B) QUALIFICATIONS-CommentsClose CommentsPermalink
‘(i) DIVERSE REPRESENTATION OF PERSPECTIVES- The members of the Council shall represent a broad range of perspectives and shall collectively have experience in the following areas:CommentsClose CommentsPermalink
‘(I) Epidemiology.CommentsClose CommentsPermalink
‘(II) Health services research.CommentsClose CommentsPermalink
‘(III) Bioethics.CommentsClose CommentsPermalink
‘(IV) Communication and decision sciences.CommentsClose CommentsPermalink
‘(V) Health economics.CommentsClose CommentsPermalink
‘(VI) Safe use of medical products.CommentsClose CommentsPermalink
‘(VII) The practice of medicine.CommentsClose CommentsPermalink
‘(ii) DIVERSE REPRESENTATION OF HEALTH CARE COMMUNITY- At least one member shall represent each of the following health care communities:CommentsClose CommentsPermalink
‘(I) Consumers.CommentsClose CommentsPermalink
‘(II) Practicing physicians, including surgeons.CommentsClose CommentsPermalink
‘(III) Nurses.CommentsClose CommentsPermalink
‘(IV) State licensed practitioners and other health care professionals.CommentsClose CommentsPermalink
‘(V) Employers.CommentsClose CommentsPermalink
‘(VI) Public payers.CommentsClose CommentsPermalink
‘(VII) Insurance plans.CommentsClose CommentsPermalink
‘(VIII) Clinical researchers who conduct research on behalf of pharmaceutical or device manufacturers.CommentsClose CommentsPermalink
‘(IX) Clinical researchers who conduct research related to personalized medicine.CommentsClose CommentsPermalink
‘(X) Clinical researchers who conduct research related to reducing health disparities.CommentsClose CommentsPermalink
‘(3) APPOINTMENT- The Secretary or the Secretary’s designee shall appoint the members of the Council.CommentsClose CommentsPermalink
‘(4) TERMS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- -Except as provided in subparagraph (B), each member of the Council shall be appointed for a term of 4 years.CommentsClose CommentsPermalink
‘(B) TERMS OF INITIAL APPOINTEES- -Of the members first appointed--CommentsClose CommentsPermalink
‘(i) 10 shall be appointed for a term of 4 years; andCommentsClose CommentsPermalink
‘(ii) 9 shall be appointed for a term of 2 years.CommentsClose CommentsPermalink
‘(5) CONFLICTS OF INTEREST- -In appointing the members of the Council, the Secretary shall take into consideration any financial conflicts of interest.CommentsClose CommentsPermalink
‘(e) Rare Disease Research- In the case of a research study of a rare disease, the Secretary shall appoint a clinical expert advisory panel for purposes of assisting in the design of such research study and determining the feasibility of recruiting for and conducting such research study.CommentsClose CommentsPermalink
‘(f) Expert Advisory Panels- The Center may appoint expert advisory panels to advise the Center and the agency, instrumentality, or entity conducting the research regarding the research question involved and the research design or protocol, including important patient subgroups and other parameters of the research. Such expert advisory panels may include individuals with experience in the relevant topic, project, or category for which the panel is established, including practicing and research clinicians and relevant specialists and subspecialists.CommentsClose CommentsPermalink
‘(g) Research Requirements- Any research conducted, supported, or synthesized under this section shall meet the following requirements:CommentsClose CommentsPermalink
‘(1) ENSURING TRANSPARENCY, CREDIBILITY, AND ACCESS- The establishment of the agenda and conduct of the research shall be insulated from undue political or stakeholder influence, in accordance with the following:CommentsClose CommentsPermalink
‘(A) Methods of conducting such research shall be scientifically based and take into account scientific advances in personalized medicine and reduces treatment disparities that include ethnic and racial minorities and children.CommentsClose CommentsPermalink
‘(B) All aspects of the prioritization of research, conduct of the research, and development of conclusions based on the research shall be transparent to all stakeholders.CommentsClose CommentsPermalink
‘(C) The process and methods for conducting such research shall be publicly documented and available to all stakeholders.CommentsClose CommentsPermalink
‘(D) The Center shall establish a process for stakeholders involved to review and provide comment on the methods and findings of such research.CommentsClose CommentsPermalink
‘(2) STAKEHOLDER INPUT- The priorities of the research, the research, and the dissemination of the research shall involve the consultation of patients, health care providers, experts in wellness and health promotion, and health care consumer representatives through transparent mechanisms recommended by the Council.CommentsClose CommentsPermalink
‘(h) Public Access to Health Outcomes Information-CommentsClose CommentsPermalink
‘(1) IN GENERAL- To the extent practicable, not later than 180 days after receipt by the Center of a relevant report described in paragraph (2), appropriate information contained in such report shall be posted on the official public Internet site of the Center, as applicable.CommentsClose CommentsPermalink
‘(2) RELEVANT REPORTS DESCRIBED- For purposes of this section, a relevant report is each of the following submitted by a grantee or contractor of the Center:CommentsClose CommentsPermalink
‘(A) An interim progress report.CommentsClose CommentsPermalink
‘(B) A draft final report that is available to stakeholders for review.CommentsClose CommentsPermalink
‘(C) Stakeholder comments and response to same.CommentsClose CommentsPermalink
‘(D) A final progress report on new research submitted for publication by a peer review journal.CommentsClose CommentsPermalink
‘(E) A final report.CommentsClose CommentsPermalink
‘(3) BENEFIT TO SUBPOPULATIONS- All reports described in paragraph (2) shall assess whether the research demonstrates a benefit of the therapy with respect to a specific subpopulation of individuals, even if the outcome of the research demonstrates that, on average, with respect to the general population, the clinical benefits of the treatment do not exceed the harm.CommentsClose CommentsPermalink
‘(i) Access by Congress and the Counsel to Center Information- The Secretary shall establish a process for the Center to share with Congress reports and non-proprietary data of the Center.CommentsClose CommentsPermalink
‘(j) Dissemination, Incorporation, and Feedback of Information-CommentsClose CommentsPermalink
‘(1) DISSEMINATION- The Center shall provide for the dissemination of findings produced by research supported, conducted, or synthesized under this section to health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans. Center reports and recommendations shall not be construed as mandates for payment, coverage, or treatment.CommentsClose CommentsPermalink
‘(2) INCORPORATION- The Center shall assist users of health information technology focused on clinical decision support to promote the timely incorporation of the findings described in paragraph (1) into clinical practices and to promote the ease of use of such incorporation.CommentsClose CommentsPermalink
‘(3) FEEDBACK- The Center shall establish a process to receive feedback from providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans about the value of the information disseminated under this section.CommentsClose CommentsPermalink
‘(k) Reports to Congress-CommentsClose CommentsPermalink
‘(1) ANNUAL REPORTS- Beginning not later than one year after the date of enactment of this section, the Director shall submit to Congress an annual report on the activities of the Center and the Council, and the research conducted, under this section.CommentsClose CommentsPermalink
‘(2) ANALYSIS AND REVIEW- Not later than December 31, 2011, the Secretary, shall submit to Congress a report on all activities conducted or supported under this section as of such date. Such report shall--CommentsClose CommentsPermalink
‘(A) include an evaluation of the impact from such activities, the overall costs of such activities, and an analysis of the backlog of any research proposals approved but not funded; andCommentsClose CommentsPermalink
‘(B) address whether Congress should expand the responsibilities of the Center to include studies of the effectiveness of various aspects of the health care delivery system, including health plans and delivery models, such as health plan features, benefit designs and performance, and the ways in which health services are organized, managed, and delivered.’.CommentsClose CommentsPermalink
SEC. 220. DEMONSTRATION PROGRAM TO INTEGRATE QUALITY IMPROVEMENT AND PATIENT SAFETY TRAINING INTO CLINICAL EDUCATION OF HEALTH PROFESSIONALS.
(a) In General- The Secretary may award grants to eligible entities or consortia under this section to carry out demonstration projects to develop and implement academic curricula that integrates quality improvement and patient safety in the clinical education of health professionals. Such awards shall be made on a competitive basis and pursuant to peer review.CommentsClose CommentsPermalink
(b) Eligibility- To be eligible to receive a grant under subsection (a), an entity or consortium shall--CommentsClose CommentsPermalink
(1) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require;CommentsClose CommentsPermalink
(2) be or include--CommentsClose CommentsPermalink
(A) a health professions school;CommentsClose CommentsPermalink
(B) a school of public health;CommentsClose CommentsPermalink
(C) a school of social work;CommentsClose CommentsPermalink
(D) a school of nursing;CommentsClose CommentsPermalink
(E) a school of pharmacy;CommentsClose CommentsPermalink
(F) an institution with a graduate medical education program; orCommentsClose CommentsPermalink
(G) a school of health care administration;CommentsClose CommentsPermalink
(3) collaborate in the development of curricula described in subsection (a) with an organization that accredits such school or institution;CommentsClose CommentsPermalink
(4) provide for the collection of data regarding the effectiveness of the demonstration project; andCommentsClose CommentsPermalink
(5) provide matching funds in accordance with subsection (c).CommentsClose CommentsPermalink
(c) Matching Funds-CommentsClose CommentsPermalink
(1) IN GENERAL- The Secretary may award a grant to an entity or consortium under this section only if the entity or consortium agrees to make available non-Federal contributions toward the costs of the program to be funded under the grant in an amount that is not less than $1 for each $5 of Federal funds provided under the grant.CommentsClose CommentsPermalink
(2) DETERMINATION OF AMOUNT CONTRIBUTED- Non-Federal contributions under paragraph (1) may be in cash or in kind, fairly evaluated, including equipment or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such contributions.CommentsClose CommentsPermalink
(d) Evaluation- The Secretary shall take such action as may be necessary to evaluate the projects funded under this section and publish, make publicly available, and disseminate the results of such evaluations on as wide a basis as is practicable.CommentsClose CommentsPermalink
(e) Reports- Not later than 2 years after the date of enactment of this section, and annually thereafter, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate and the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives a report that--CommentsClose CommentsPermalink
(1) describes the specific projects supported under this section; andCommentsClose CommentsPermalink
(2) contains recommendations for Congress based on the evaluation conducted under subsection (d).CommentsClose CommentsPermalink
SEC. 221. OFFICE OF WOMEN’S HEALTH.
(a) Health and Human Services Office on Women’s Health-CommentsClose CommentsPermalink
(1) ESTABLISHMENT- Part A of title II of the Public Health Service Act (
‘SEC. 229. HEALTH AND HUMAN SERVICES OFFICE ON WOMEN’S HEALTH.
‘(a) Establishment of Office- There is established within the Office of the Secretary, an Office on Women’s Health (referred to in this section as the ‘Office’). The Office shall be headed by a Deputy Assistant Secretary for Women’s Health who may report to the Secretary.CommentsClose CommentsPermalink
‘(b) Duties- The Secretary, acting through the Office, with respect to the health concerns of women, shall--CommentsClose CommentsPermalink
‘(1) establish short-range and long-range goals and objectives within the Department of Health and Human Services and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Department that relate to disease prevention, health promotion, service delivery, research, and public and health care professional education, for issues of particular concern to women throughout their lifespan;CommentsClose CommentsPermalink
‘(2) provide expert advice and consultation to the Secretary concerning scientific, legal, ethical, and policy issues relating to women’s health;CommentsClose CommentsPermalink
‘(3) monitor the Department of Health and Human Services’ offices, agencies, and regional activities regarding women’s health and identify needs regarding the coordination of activities, including intramural and extramural multidisciplinary activities;CommentsClose CommentsPermalink
‘(4) establish a Department of Health and Human Services Coordinating Committee on Women’s Health, which shall be chaired by the Deputy Assistant Secretary for Women’s Health and composed of senior level representatives from each of the agencies and offices of the Department of Health and Human Services;CommentsClose CommentsPermalink
‘(5) establish a National Women’s Health Information Center to--CommentsClose CommentsPermalink
‘(A) facilitate the exchange of information regarding matters relating to health information, health promotion, preventive health services, research advances, and education in the appropriate use of health care;CommentsClose CommentsPermalink
‘(B) facilitate access to such information;CommentsClose CommentsPermalink
‘(C) assist in the analysis of issues and problems relating to the matters described in this paragraph; andCommentsClose CommentsPermalink
‘(D) provide technical assistance with respect to the exchange of information (including facilitating the development of materials for such technical assistance);CommentsClose CommentsPermalink
‘(6) coordinate efforts to promote women’s health programs and policies with the private sector; andCommentsClose CommentsPermalink
‘(7) through publications and any other means appropriate, provide for the exchange of information between the Office and recipients of grants, contracts, and agreements under subsection (c), and between the Office and health professionals and the general public.CommentsClose CommentsPermalink
‘(c) Grants and Contracts Regarding Duties-CommentsClose CommentsPermalink
‘(1) AUTHORITY- In carrying out subsection (b), the Secretary may make grants to, and enter into cooperative agreements, contracts, and interagency agreements with, public and private entities, agencies, and organizations.CommentsClose CommentsPermalink
‘(2) EVALUATION AND DISSEMINATION- The Secretary shall directly or through contracts with public and private entities, agencies, and organizations, provide for evaluations of projects carried out with financial assistance provided under paragraph (1) and for the dissemination of information developed as a result of such projects.CommentsClose CommentsPermalink
‘(d) Reports- Not later than 1 year after the date of enactment of this section, and every second year thereafter, the Secretary shall prepare and submit to the appropriate committees of Congress a report describing the activities carried out under this section during the period for which the report is being prepared.CommentsClose CommentsPermalink
‘(e) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(2) TRANSFER OF FUNCTIONS- There are transferred to the Office on Women’s Health (established under section 229 of the Public Health Service Act, as added by this section), all functions exercised by the Office on Women’s Health of the Public Health Service prior to the date of enactment of this section, including all personnel and compensation authority, all delegation and assignment authority, and all remaining appropriations. All orders, determinations, rules, regulations, permits, agreements, grants, contracts, certificates, licenses, registrations, privileges, and other administrative actions that--CommentsClose CommentsPermalink
(A) have been issued, made, granted, or allowed to become effective by the President, any Federal agency or official thereof, or by a court of competent jurisdiction, in the performance of functions transferred under this paragraph; andCommentsClose CommentsPermalink
(B) are in effect at the time this section takes effect, or were final before the date of enactment of this section and are to become effective on or after such date,CommentsClose CommentsPermalink
shall continue in effect according to their terms until modified, terminated, superseded, set aside, or revoked in accordance with law by the President, the Secretary, or other authorized official, a court of competent jurisdiction, or by operation of law.CommentsClose CommentsPermalink
(b) Centers for Disease Control and Prevention Office of Women’s Health- Part A of title III of the Public Health Service Act (
42 U.S.C. 241 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 310A. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF WOMEN’S HEALTH.
‘(a) Establishment- There is established within the Office of the Director of the Centers for Disease Control and Prevention, an office to be known as the Office of Women’s Health (referred to in this section as the ‘Office’). The Office shall be headed by a director who shall be appointed by the Director of such Centers.CommentsClose CommentsPermalink
‘(b) Purpose- The Director of the Office shall--CommentsClose CommentsPermalink
‘(1) report to the Director of the Centers for Disease Control and Prevention on the current level of the Centers’ activity regarding women’s health conditions across, where appropriate, age, biological, and sociocultural contexts, in all aspects of the Centers’ work, including prevention programs, public and professional education, services, and treatment;CommentsClose CommentsPermalink
‘(2) establish short-range and long-range goals and objectives within the Centers for women’s health and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Centers that relate to prevention, research, education and training, service delivery, and policy development, for issues of particular concern to women;CommentsClose CommentsPermalink
‘(3) identify projects in women’s health that should be conducted or supported by the Centers;CommentsClose CommentsPermalink
‘(4) consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on the policy of the Centers with regard to women; andCommentsClose CommentsPermalink
‘(5) serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4)).CommentsClose CommentsPermalink
‘(c) Definition- As used in this section, the term ‘women’s health conditions’, with respect to women of all age, ethnic, and racial groups, means diseases, disorders, and conditions--CommentsClose CommentsPermalink
‘(1) unique to, significantly more serious for, or significantly more prevalent in women; andCommentsClose CommentsPermalink
‘(2) for which the factors of medical risk or type of medical intervention are different for women, or for which there is reasonable evidence that indicates that such factors or types may be different for women.CommentsClose CommentsPermalink
‘(d) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(c) Office of Women’s Health Research- Section 486(a) of the Public Health Service Act (
42 U.S.C. 287d(a) ) is amended by inserting ‘and who shall report directly to the Director’ before the period at the end thereof .CommentsClose CommentsPermalink(d) Substance Abuse and Mental Health Services Administration- Section 501(f) of the Public Health Service Act (
42 U.S.C. 290aa(f) ) is amended--CommentsClose CommentsPermalink
(1) in paragraph (1), by inserting ‘who shall report directly to the Administrator’ before the period;CommentsClose CommentsPermalink
(2) by redesignating paragraph (4) as paragraph (5); andCommentsClose CommentsPermalink
(3) by inserting after paragraph (3), the following:CommentsClose CommentsPermalink
‘(4) OFFICE- Nothing in this subsection shall be construed to preclude the Secretary from establishing within the Substance Abuse and Mental Health Administration an Office of Women’s Health.’.CommentsClose CommentsPermalink
(e) Agency for Healthcare Research and Quality Activities Regarding Women’s Health.- Part C of title IX of the Public Health Service Act (
42 U.S.C. 299c et seq.) is amended--CommentsClose CommentsPermalink
(1) by redesignating sections 925 and 926 as sections 926 and 927, respectively; andCommentsClose CommentsPermalink
(2) by inserting after section 924 the following:CommentsClose CommentsPermalink
‘SEC. 925. ACTIVITIES REGARDING WOMEN’S HEALTH.
‘(a) Establishment- There is established within the Office of the Director, an Office of Women’s Health and Gender-Based Research (referred to in this section as the ‘Office’). The Office shall be headed by a director who shall be appointed by the Director of Healthcare and Research Quality.CommentsClose CommentsPermalink
‘(b) Purpose- The official designated under subsection (a) shall--CommentsClose CommentsPermalink
‘(1) report to the Director on the current Agency level of activity regarding women’s health, across, where appropriate, age, biological, and sociocultural contexts, in all aspects of Agency work, including the development of evidence reports and clinical practice protocols and the conduct of research into patient outcomes, delivery of health care services, quality of care, and access to health care;CommentsClose CommentsPermalink
‘(2) establish short-range and long-range goals and objectives within the Agency for research important to women’s health and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Agency that relate to health services and medical effectiveness research, for issues of particular concern to women;CommentsClose CommentsPermalink
‘(3) identify projects in women’s health that should be conducted or supported by the Agency;CommentsClose CommentsPermalink
‘(4) consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on Agency policy with regard to women; andCommentsClose CommentsPermalink
‘(5) serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4)).’.CommentsClose CommentsPermalink
‘(c) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(f) Health Resources and Services Administration Office of Women’s Health- Title VII of the Social Security Act (
42 U.S.C. 901 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 713. OFFICE OF WOMEN’S HEALTH.
‘(a) Establishment- The Secretary shall establish within the Office of the Administrator of the Health Resources and Services Administration, an office to be known as the Office of Women’s Health. The Office shall be headed by a director who shall be appointed by the Administrator.CommentsClose CommentsPermalink
‘(b) Purpose- The Director of the Office shall--CommentsClose CommentsPermalink
‘(1) report to the Administrator on the current Administration level of activity regarding women’s health across, where appropriate, age, biological, and sociocultural contexts;CommentsClose CommentsPermalink
‘(2) establish short-range and long-range goals and objectives within the Health Resources and Services Administration for women’s health and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Administration that relate to health care provider training, health service delivery, research, and demonstration projects, for issues of particular concern to women;CommentsClose CommentsPermalink
‘(3) identify projects in women’s health that should be conducted or supported by the bureaus of the Administration;CommentsClose CommentsPermalink
‘(4) consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on Administration policy with regard to women; andCommentsClose CommentsPermalink
‘(5) serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4) of the Public Health Service Act).CommentsClose CommentsPermalink
‘(c) Continued Administration of Existing Programs- The Director of the Office shall assume the authority for the development, implementation, administration, and evaluation any projects carried out through the Health Resources and Services Administration relating to women’s health on the date of enactment of this section.CommentsClose CommentsPermalink
‘(d) Definitions- For purposes of this section:CommentsClose CommentsPermalink
‘(1) ADMINISTRATION- The term ‘Administration’ means the Health Resources and Services Administration.CommentsClose CommentsPermalink
‘(2) ADMINISTRATOR- The term ‘Administrator’ means the Administrator of the Health Resources and Services Administration.CommentsClose CommentsPermalink
‘(3) OFFICE- The term ‘Office’ means the Office of Women’s Health established under this section in the Administration.CommentsClose CommentsPermalink
‘(e) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(g) Food and Drug Administration Office of Women’s Health- Chapter X of the Federal Food, Drug, and Cosmetic Act (
21 U.S.C. 391 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 1011. OFFICE OF WOMEN’S HEALTH.
‘(a) Establishment- There is established within the Office of the Commissioner, an office to be known as the Office of Women’s Health (referred to in this section as the ‘Office’). The Office shall be headed by a director who shall be appointed by the Commissioner of Food and Drugs.CommentsClose CommentsPermalink
‘(b) Purpose- The Director of the Office shall--CommentsClose CommentsPermalink
‘(1) report to the Commissioner of Food and Drugs on current Food and Drug Administration (referred to in this section as the ‘Administration’) levels of activity regarding women’s participation in clinical trials and the analysis of data by sex in the testing of drugs, medical devices, and biological products across, where appropriate, age, biological, and sociocultural contexts;CommentsClose CommentsPermalink
‘(2) establish short-range and long-range goals and objectives within the Administration for issues of particular concern to women’s health within the jurisdiction of the Administration, including, where relevant and appropriate, adequate inclusion of women and analysis of data by sex in Administration protocols and policies;CommentsClose CommentsPermalink
‘(3) provide information to women and health care providers on those areas in which differences between men and women exist;CommentsClose CommentsPermalink
‘(4) consult with pharmaceutical, biologics, and device manufacturers, health professionals with expertise in women’s issues, consumer organizations, and women’s health professionals on Administration policy with regard to women;CommentsClose CommentsPermalink
‘(5) make annual estimates of funds needed to monitor clinical trials and analysis of data by sex in accordance with needs that are identified; andCommentsClose CommentsPermalink
‘(6) serve as a member of the Department of Health and Human Services Coordinating Committee on Women’s Health (established under section 229(b)(4) of the Public Health Service Act).CommentsClose CommentsPermalink
‘(c) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(h) No New Regulatory Authority- Nothing in this section and the amendments made by this section may be construed as establishing regulatory authority or modifying any existing regulatory authority.CommentsClose CommentsPermalink
(i) Limitation on Termination- Notwithstanding any other provision of law, a Federal office of women’s health (including the Office of Research on Women’s Health of the National Institutes of Health) or Federal appointive position with primary responsibility over women’s health issues (including the Associate Administrator for Women’s Services under the Substance Abuse and Mental Health Services Administration) that is in existence on the date of enactment of this section shall not be terminated, reorganized, or have any of it’s powers or duties transferred unless such termination, reorganization, or transfer is approved by Congress through the adoption of a concurrent resolution of approval.CommentsClose CommentsPermalink
(j) Rule of Construction- Nothing in this section (or the amendments made by this section) shall be construed to limit the authority of the Secretary of Health and Human Services with respect to women’s health, or with respect to activities carried out through the Department of Health and Human Services on the date of enactment of this section.CommentsClose CommentsPermalink
SEC. 222. ADMINISTRATIVE SIMPLIFICATION.
(a) Standards for Financial and Administrative Transactions-CommentsClose CommentsPermalink
(1) IN GENERAL- The Secretary shall adopt and regularly update standards, implementation specifications, and operating rules for the electronic exchange and use of health information for purposes of financial and administrative transactions (as provided for in paragraph (2)).CommentsClose CommentsPermalink
(2) ADDITIONAL REQUIREMENTS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS- The standards, implementation specifications, and operating rules provided for in paragraph (1) shall--CommentsClose CommentsPermalink
(A) be unique with no conflicting or redundant standards;CommentsClose CommentsPermalink
(B) be authoritative, requiring no additional standards or companion guides;CommentsClose CommentsPermalink
(C) be comprehensive and robust, requiring minimal augmentation by paper transactions or clarification by phone calls;CommentsClose CommentsPermalink
(D) enable the real time determination of a patient’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether a patient is eligible for a specific service with a specific physician at a specific facility, which may include a machine-readable health plan identification card;CommentsClose CommentsPermalink
(E) provide for timely acknowledgment; andCommentsClose CommentsPermalink
(F) require that all data elements within a standard or specification (such as reason and remark codes) be described in unambiguous terms (with no optional fields permitted and a requirement that data elements be either required or conditioned upon set values in other fields) with additional conditions being prohibited.CommentsClose CommentsPermalink
(3) TIME FOR ADOPTION- Not later than 2 years after the date of enactment of this section, the Secretary shall adopt standards, implementation specifications, and operating rules under this section.CommentsClose CommentsPermalink
(4) REQUIREMENTS FOR INITIAL STANDARDS- The initial set of standards, implementation specifications, and operating rules under paragraph (1) shall include--CommentsClose CommentsPermalink
(A) requirements to clarify, refine, and expand, as needed, standards required under section 1173 of the Social Security Act;CommentsClose CommentsPermalink
(B) requirements for acknowledgments, such as those for receipt of a claim;CommentsClose CommentsPermalink
(C) requirements to permit electronic funds transfers (to allow automated reconciliation with the related health care payment and remittance advice);CommentsClose CommentsPermalink
(D) the requirements of timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing (for all participants, including health insurance issuers, health care providers, and patients); andCommentsClose CommentsPermalink
(E) other requirements relating to administrative simplification as identified by the Secretary, in consultation with stakeholders.CommentsClose CommentsPermalink
(5) BUILDING ON EXISTING STANDARDS- In developing the standards, implementation specifications, and operating rules under paragraph (1), the Secretary shall build upon existing and planned standards, implementation specifications, and operating rules.CommentsClose CommentsPermalink
(6) EXPEDITED PROCEDURES FOR ADOPTION OF ADDITIONS AND MODIFICATIONS TO STANDARDS- Notwithstanding any other provision of law, the Secretary may use the following expedited procedures for purposes of paragraph (1):CommentsClose CommentsPermalink
(A) EXPEDITED UPGRADE PROGRAM- 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 described in paragraph (4) 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 described in paragraph (4), 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 described in paragraph (4), 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 described in paragraph (4) 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 described in paragraph (4), 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) HEARINGS 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 120 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 90 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) as a final rule under this subsection without any further notice or public comment period.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
(H) TREATMENT AS SATISFYING REQUIREMENTS FOR NOTICE AND COMMENT- Any requirements under
(I) MODIFICATION DEFINED- For purposes of this section, the term ‘modification’ includes a new version or a version upgrade.CommentsClose CommentsPermalink
(7) IMPLEMENTATION AND ENFORCEMENT- Not later than 2 years after the date of enactment of this section, the Secretary shall submit to the appropriate committees of Congress a plan for the implementation and enforcement, by not later than 5 years after such date of enactment, of the standards, implementation specifications, and operating rules provided for under paragraph (1).CommentsClose CommentsPermalink
(b) Health Plan Identifier- Not later than 1 year after the date of enactment of this section, the Secretary shall promulgate a final rule to establish a National Health Plan Identifier system.CommentsClose CommentsPermalink
SEC. 223. PATIENT NAVIGATOR PROGRAM.
Section 340A of the Public Health Service Act (
(1) in subsection (e), by adding at the end the following:CommentsClose CommentsPermalink
‘(3) MINIMUM CORE PROFICIENCIES- The Secretary shall not award a grant to an entity under this section unless such entity provides assurances that patient navigators recruited, assigned, trained, or employed using grant funds meet minimum core proficiencies, as defined by the entity that submits the application, that are tailored for the main focus or intervention of the navigator involved.’; andCommentsClose CommentsPermalink
(2) in subsection (m)--CommentsClose CommentsPermalink
(A) in paragraph (1), by striking ‘and $3,500,000 for fiscal year 2010.’ and inserting ‘$3,500,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2015.’; andCommentsClose CommentsPermalink
(B) in paragraph (2), by striking ‘2010’ and inserting ‘2015’.CommentsClose CommentsPermalink
SEC. 224. AUTHORIZATION OF APPROPRIATIONS.
Except where otherwise provided in this subtitle (or an amendment made by this subtitle), there is authorized to be appropriated such sums as may be necessary to carry out this subtitle (and such amendments made by this subtitle).CommentsClose CommentsPermalink
Subtitle C--Civil and Criminal Penalties for Acts Involving Federal Health Care Programs; Exception to Limitation on Certain Physician ReferralsCommentsClose CommentsPermalink
Subtitle C--Civil and Criminal Penalties for Acts Involving Federal Health Care Programs; Exception to Limitation on Certain Physician ReferralsCommentsClose CommentsPermalink
SEC. 231. SAFE HARBORS TO ANTIKICKBACK CIVIL PENALTIES AND CRIMINAL PENALTIES FOR PROVISION OF HEALTH INFORMATION TECHNOLOGY AND TRAINING SERVICES.
(a) For Civil Penalties- Section 1128A of the Social Security Act (
(1) in subsection (b), by adding at the end the following new paragraph:CommentsClose CommentsPermalink
‘(4) For purposes of this subsection, inducements to reduce or limit services described in paragraph (1) shall not include the practical or other advantages resulting from health information technology or related installation, maintenance, support, or training services.’; andCommentsClose CommentsPermalink
(2) in subsection (i), by adding at the end the following new paragraph:CommentsClose CommentsPermalink
‘(8) The term ‘health information technology’ means hardware, software, license, right, intellectual property, equipment, or other information technology (including new versions, upgrades, and connectivity) designed or provided primarily for the electronic creation, maintenance, or exchange of health information to better coordinate care or improve health care quality, efficiency, or research.’.CommentsClose CommentsPermalink
(b) For Criminal Penalties- Section 1128B of such Act (
(1) in subsection (b)(3)--CommentsClose CommentsPermalink
(A) in subparagraph (G), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(B) in the subparagraph (H) added by section 237(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (
(i) by moving such subparagraph 2 ems to the left; andCommentsClose CommentsPermalink
(ii) by striking the period at the end and inserting a semicolon;CommentsClose CommentsPermalink
(C) in the subparagraph (H) added by section 431(a) of such Act (117 Stat. 2287)--CommentsClose CommentsPermalink
(i) by redesignating such subparagraph as subparagraph (I);CommentsClose CommentsPermalink
(ii) by moving such subparagraph 2 ems to the left; andCommentsClose CommentsPermalink
(iii) by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink
(D) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink
‘(J) any nonmonetary remuneration (in the form of health information technology, as defined in section 1128A(i)(8), or related installation, maintenance, support or training services) made to a person by a specified entity (as defined in subsection (g)) if--CommentsClose CommentsPermalink
‘(i) the provision of such remuneration is without an agreement between the parties or legal condition that--CommentsClose CommentsPermalink
‘(I) limits or restricts the use of the health information technology to services provided by the physician to individuals receiving services at the specified entity;CommentsClose CommentsPermalink
‘(II) limits or restricts the use of the health information technology in conjunction with other health information technology; orCommentsClose CommentsPermalink
‘(III) conditions the provision of such remuneration on the referral of patients or business to the specified entity;CommentsClose CommentsPermalink
‘(ii) such remuneration is arranged for in a written agreement that is signed by the parties involved (or their representatives) and that specifies the remuneration solicited or received (or offered or paid) and states that the provision of such remuneration is made for the primary purpose of better coordination of care or improvement of health quality, efficiency, or research; andCommentsClose CommentsPermalink
‘(iii) the specified entity providing the remuneration (or a representative of such entity) has not taken any action to disable any basic feature of any hardware or software component of such remuneration that would permit interoperability.’; andCommentsClose CommentsPermalink
(2) by adding at the end the following new subsection:CommentsClose CommentsPermalink
‘(g) Specified Entity Defined- For purposes of subsection (b)(3)(J), the term ‘specified entity’ means an entity that is a hospital, group practice, prescription drug plan sponsor, a Medicare Advantage organization, or any other such entity specified by the Secretary, considering the goals and objectives of this section, as well as the goals to better coordinate the delivery of health care and to promote the adoption and use of health information technology.’.CommentsClose CommentsPermalink
(c) Effective Date and Effect on State Laws-CommentsClose CommentsPermalink
(1) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall take effect on the date that is 120 days after the date of the enactment of this Act.CommentsClose CommentsPermalink
(2) PREEMPTION OF STATE LAWS- No State (as defined in section 1101(a) of the Social Security Act (
(d) Study and Report To Assess Effect of Safe Harbors on Health System-CommentsClose CommentsPermalink
(1) IN GENERAL- The Secretary of Health and Human Services shall conduct a study to determine the impact of each of the safe harbors described in paragraph (3). In particular, the study shall examine the following:CommentsClose CommentsPermalink
(A) The effectiveness of each safe harbor in increasing the adoption of health information technology.CommentsClose CommentsPermalink
(B) The types of health information technology provided under each safe harbor.CommentsClose CommentsPermalink
(C) The extent to which the financial or other business relationships between providers under each safe harbor have changed as a result of the safe harbor in a way that adversely affects or benefits the health care system or choices available to consumers.CommentsClose CommentsPermalink
(D) The impact of the adoption of health information technology on health care quality, cost, and access under each safe harbor.CommentsClose CommentsPermalink
(2) REPORT- Not later than 3 years after the effective date described in subsection (c)(1), the Secretary of Health and Human Services shall submit to Congress a report on the study under paragraph (1).CommentsClose CommentsPermalink
(3) SAFE HARBORS DESCRIBED- For purposes of paragraphs (1) and (2), the safe harbors described in this paragraph are--CommentsClose CommentsPermalink
(A) the safe harbor under section 1128A(b)(4) of such Act (
(B) the safe harbor under section 1128B(b)(3)(J) of such Act (
SEC. 232. EXCEPTION TO LIMITATION ON CERTAIN PHYSICIAN REFERRALS (UNDER STARK) FOR PROVISION OF HEALTH INFORMATION TECHNOLOGY AND TRAINING SERVICES TO HEALTH CARE PROFESSIONALS.
(a) In General- Section 1877(b) of the Social Security Act (
‘(6) INFORMATION TECHNOLOGY AND TRAINING SERVICES-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Any nonmonetary remuneration (in the form of health information technology or related installation, maintenance, support or training services) made by a specified entity to a physician if--CommentsClose CommentsPermalink
‘(i) the provision of such remuneration is without an agreement between the parties or legal condition that--CommentsClose CommentsPermalink
‘(I) limits or restricts the use of the health information technology to services provided by the physician to individuals receiving services at the specified entity;CommentsClose CommentsPermalink
‘(II) limits or restricts the use of the health information technology in conjunction with other health information technology; orCommentsClose CommentsPermalink
‘(III) conditions the provision of such remuneration on the referral of patients or business to the specified entity;CommentsClose CommentsPermalink
‘(ii) such remuneration is arranged for in a written agreement that is signed by the parties involved (or their representatives) and that specifies the remuneration made and states that the provision of such remuneration is made for the primary purpose of better coordination of care or improvement of health quality, efficiency, or research; andCommentsClose CommentsPermalink
‘(iii) the specified entity (or a representative of such entity) has not taken any action to disable any basic feature of any hardware or software component of such remuneration that would permit interoperability.CommentsClose CommentsPermalink
‘(B) HEALTH INFORMATION TECHNOLOGY DEFINED- For purposes of this paragraph, the term ‘health information technology’ means hardware, software, license, right, intellectual property, equipment, or other information technology (including new versions, upgrades, and connectivity) designed or provided primarily for the electronic creation, maintenance, or exchange of health information to better coordinate care or improve health care quality, efficiency, or research.CommentsClose CommentsPermalink
‘(C) SPECIFIED ENTITY DEFINED- For purposes of this paragraph, the term ‘specified entity’ means an entity that is a hospital, group practice, prescription drug plan sponsor, a Medicare Advantage organization, or any other such entity specified by the Secretary, considering the goals and objectives of this section, as well as the goals to better coordinate the delivery of health care and to promote the adoption and use of health information technology.’.CommentsClose CommentsPermalink
(b) Effective Date; Effect on State Laws-CommentsClose CommentsPermalink
(1) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect on the date that is 120 days after the date of the enactment of this Act.CommentsClose CommentsPermalink
(2) PREEMPTION OF STATE LAWS- No State (as defined in section 1101(a) of the Social Security Act (
(c) Study and Report To Assess Effect of Exception on Health System-CommentsClose CommentsPermalink
(1) IN GENERAL- The Secretary of Health and Human Services shall conduct a study to determine the impact of the exception under section 1877(b)(6) of such Act (
(A) The effectiveness of the exception in increasing the adoption of health information technology.CommentsClose CommentsPermalink
(B) The types of health information technology provided under the exception.CommentsClose CommentsPermalink
(C) The extent to which the financial or other business relationships between providers under the exception have changed as a result of the exception in a way that adversely affects or benefits the health care system or choices available to consumers.CommentsClose CommentsPermalink
(D) The impact of the adoption of health information technology on health care quality, cost, and access under the exception.CommentsClose CommentsPermalink
(2) REPORT- Not later than 3 years after the effective date described in subsection (b)(1), the Secretary of Health and Human Services shall submit to Congress a report on the study under paragraph (1).CommentsClose CommentsPermalink
SEC. 233. RULES OF CONSTRUCTION REGARDING USE OF CONSORTIA.
(a) Application to Safe Harbor From Criminal Penalties- Section 1128B(b)(3) of the Social Security Act (
(b) Application to Stark Exception- Paragraph (6) of section 1877(b) of the Social Security Act (
‘(D) RULE OF CONSTRUCTION- For purposes of subparagraph (A), nothing in such subparagraph shall be construed as preventing a specified entity, consistent with the specific requirements of such subparagraph, from--CommentsClose CommentsPermalink
‘(i) forming a consortium composed of health care providers, payers, employers, and other interested entities to collectively purchase and donate health information technology; orCommentsClose CommentsPermalink
‘(ii) offering health care providers a choice of health information technology products in order to take into account the varying needs of such providers receiving such products.’.CommentsClose CommentsPermalink
TITLE III--IMPROVING THE HEALTH OF THE AMERICAN PEOPLECommentsClose CommentsPermalink
TITLE III--IMPROVING THE HEALTH OF THE AMERICAN PEOPLECommentsClose CommentsPermalink
Subtitle A--Modernizing Disease Prevention and Public Health SystemsCommentsClose CommentsPermalink
Subtitle A--Modernizing Disease Prevention and Public Health SystemsCommentsClose CommentsPermalink
SEC. 301. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCIL.
(a) Establishment- The President shall establish a council to be known as the ‘National Prevention, Health Promotion and Public Health Council’ (referred to in this section as the ‘Council’).CommentsClose CommentsPermalink
(b) Chairperson- The President shall appoint an individual to serve as the chairperson of the Council.CommentsClose CommentsPermalink
(c) Composition- The Council shall be composed of--CommentsClose CommentsPermalink
(1) the Secretary of Health and Human Services;CommentsClose CommentsPermalink
(2) the Secretary of Agriculture;CommentsClose CommentsPermalink
(3) the Secretary of Education;CommentsClose CommentsPermalink
(4) the Chairman of the Federal Trade Commission;CommentsClose CommentsPermalink
(5) the Chairman of the Federal Communications Commission;CommentsClose CommentsPermalink
(6) the Secretary of Transportation;CommentsClose CommentsPermalink
(7) the Secretary of Defense;CommentsClose CommentsPermalink
(8) the Secretary of Veterans Affairs;CommentsClose CommentsPermalink
(9) the Secretary of the Interior;CommentsClose CommentsPermalink
(10) the Secretary of Labor;CommentsClose CommentsPermalink
(11) the Secretary of Homeland Security;CommentsClose CommentsPermalink
(12) the Secretary of Housing and Urban Development;CommentsClose CommentsPermalink
(13) the Director of the United States Patent and Trademark Office;CommentsClose CommentsPermalink
(14) the Administrator of the Environmental Protection Agency;CommentsClose CommentsPermalink
(15) the Director of the Domestic Policy Council;CommentsClose CommentsPermalink
(16) the Director of the Office of Personnel Management;CommentsClose CommentsPermalink
(17) the Director of the Office of National Drug Control Policy;CommentsClose CommentsPermalink
(18) the Chairman of the Corporation for National and Community Service; andCommentsClose CommentsPermalink
(19) the head of any other Federal agency that the chairperson determines is appropriate.CommentsClose CommentsPermalink
(d) Purposes and Duties- The Council shall--CommentsClose CommentsPermalink
(1) provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States;CommentsClose CommentsPermalink
(2) after obtaining input from relevant stakeholders, develop a national prevention, health promotion, public health, and integrative health care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States;CommentsClose CommentsPermalink
(3) provide recommendations to the President and Congress concerning the most pressing health issues confronting the United States and changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition;CommentsClose CommentsPermalink
(4) consider and propose evidence-based models, policies, and innovative approaches for the promotion of transformative models of prevention, integrative health, and public health on individual and community levels across the United States;CommentsClose CommentsPermalink
(5) establish processes for continual public input, including input from State, regional, and local leadership communities and other relevant stakeholders, including Indian tribes and tribal organizations;CommentsClose CommentsPermalink
(6) submit the reports required under subsection (g); andCommentsClose CommentsPermalink
(7) carry out other activities determined appropriate by the President.CommentsClose CommentsPermalink
(e) Meetings- The Council shall meet at the call of the Chairperson.CommentsClose CommentsPermalink
(f) National Prevention and Health Promotion Strategy- Not later than 1 year after the date of enactment of this Act, the Chairperson, in consultation with the Council, shall develop and make public a national prevention, health promotion and public health strategy, and shall review and revise such strategy periodically. Such strategy shall--CommentsClose CommentsPermalink
(1) set specific goals and objectives for improving the health of the United States through federally-supported prevention, health promotion, and public health programs, consistent with ongoing goal setting efforts conducted by specific agencies;CommentsClose CommentsPermalink
(2) establish specific and measurable actions and timelines to carry out the strategy, and determine accountability for meeting those timelines, within and across Federal departments and agencies; andCommentsClose CommentsPermalink
(3) make recommendations to improve Federal efforts relating to prevention, health promotion, public health, and integrative health care practices to ensure Federal efforts are consistent with available standards and evidence.CommentsClose CommentsPermalink
(g) Report- Not later than July 1, 2010, and annually thereafter through January 1, 2015, the Council shall submit to the President and the relevant committees of Congress, a report that--CommentsClose CommentsPermalink
(1) describes the activities and efforts on prevention, health promotion, and public health and activities to develop a national strategy conducted by the Council during the period for which the report is prepared;CommentsClose CommentsPermalink
(2) describes the national progress in meeting specific prevention, health promotion, and public health goals defined in the strategy and further describes corrective actions recommended by the Council and taken by relevant agencies and organizations to meet these goals;CommentsClose CommentsPermalink
(3) contains a list of national priorities on health promotion and disease prevention to address lifestyle behavior modification (smoking cessation, proper nutrition, and appropriate exercise) and the prevention measures for the 5 leading disease killers in the United States;CommentsClose CommentsPermalink
(4) contains specific science-based initiatives to achieve the measurable goals of Healthy People 2010 regarding nutrition, exercise, and smoking cessation, and targeting the 5 leading disease killers in the United States;CommentsClose CommentsPermalink
(5) contains specific plans for consolidating Federal health programs and Centers that exist to promote healthy behavior and reduce disease risk (including eliminating programs and offices determined to be ineffective in meeting the priority goals of Healthy People 2010);CommentsClose CommentsPermalink
(6) contains specific plans to ensure that all Federal health care programs are fully coordinated with science-based prevention recommendations by the Director of the Centers for Disease Control and Prevention;CommentsClose CommentsPermalink
(7) contains specific plans to ensure that all non-Department of Health and Human Services prevention programs are based on the science-based guidelines developed by the Centers for Disease Control and Prevention under paragraph (4); andCommentsClose CommentsPermalink
(8) contains a list of new non-Federal and non-government partners identified by the council to build Federal capacity in health promotion and disease prevention efforts.CommentsClose CommentsPermalink
(h) Periodic Reviews- The Secretary and the Comptroller General of the United States shall jointly conduct periodic reviews, not less than every 5 years, and evaluations of every Federal disease prevention and health promotion initiative, program, and agency. Such reviews shall be evaluated based on effectiveness in meeting metrics-based goals with an analysis posted on such agencies’ public Internet websites.CommentsClose CommentsPermalink
(i) Annual Request to Give Testimony- The Chairperson shall annually request an opportunity to testify before Congress concerning--CommentsClose CommentsPermalink
(1) the progress made by the United States in meeting the prevention, health promotion, and public health goals defined in the strategy and the effectiveness of Federal programs related to these goals; andCommentsClose CommentsPermalink
(2) the amount and sources of Federal funds that are targeted to prevention, health promotion, and public health initiatives and results of program evaluations.CommentsClose CommentsPermalink
SEC. 302. PREVENTION AND PUBLIC HEALTH FUND.
(a) Purpose- It is the purpose of this section to establish a Prevention and Public Health Fund (referred to in this section as the ‘Fund’), to be administered through the Department of Health and Human Services, Office of the Secretary, to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.CommentsClose CommentsPermalink
(b) Funding- There are hereby authorized to be appropriated, and appropriated, to the Fund, out of any monies in the Treasury not otherwise appropriated--CommentsClose CommentsPermalink
(1) for fiscal year 2010, $2,000,000,000;CommentsClose CommentsPermalink
(2) for fiscal year 2011, $4,000,000,000;CommentsClose CommentsPermalink
(3) for fiscal year 2012, $6,000,000,000;CommentsClose CommentsPermalink
(4) for fiscal year 2013, $8,000,000,000;CommentsClose CommentsPermalink
(5) for fiscal year 2014, $10,000,000,000;CommentsClose CommentsPermalink
(6) for fiscal year 2015, $ 10,000,000,000;CommentsClose CommentsPermalink
(7) for fiscal year 2016, $10,000,000,000;CommentsClose CommentsPermalink
(8) for fiscal year 2017, $10,000,000,000;CommentsClose CommentsPermalink
(9) for fiscal year 2018, $10,000,000,000; andCommentsClose CommentsPermalink
(10) for fiscal year 2019, and each fiscal year thereafter, $10,000,000,000.CommentsClose CommentsPermalink
(c) Use of Fund- The Secretary shall transfer amounts in the Fund to accounts within the Department of Health and Human Services to increase funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act, for prevention, wellness and public health activities including prevention research and health screenings. Such transfers shall be subject to the transfer authority provided for in the annual appropriations Act for the fiscal year in which the funds become available.CommentsClose CommentsPermalink
(d) Transfer Authority - The Committee on Appropriations of the Senate and the Committee on Appropriations of the House of Representatives may provide for the transfer of funds in the Fund to eligible activities under this section, subject to subsection (c).CommentsClose CommentsPermalink
SEC. 303. CLINICAL AND COMMUNITY PREVENTIVE SERVICES.
(a) Preventive Services Task Force- Section 915 of the Public Health Service Act (
‘(a) Preventive Services Task Force-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT AND PURPOSE- The Director shall convene an independent Preventive Services Task Force (referred to in this subsection as the ‘Task Force’) to be composed of individuals with appropriate expertise. Such Task Force shall review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations, to be published in the Guide to Clinical Preventive Services (referred to in this section as the ‘Guide’), for individuals and organizations delivering clinical services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, Congress and other policy-makers, governmental public health agencies, health care quality organizations, and organizations developing national health objectives. Such recommendations shall consider clinical preventive best practice recommendations from the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Disease Control and Prevention, the Institute of Medicine, specialty medical associations, patient groups, and scientific societies.CommentsClose CommentsPermalink
‘(2) DUTIES- The duties of the Task Force shall include--CommentsClose CommentsPermalink
‘(A) the development of additional topic areas for new recommendations and interventions related to those topic areas, including those related to specific sub-populations and age groups;CommentsClose CommentsPermalink
‘(B) at least once during every 5-year period, review interventions and update recommendations related to existing topic areas, including new or improved techniques to assess the health effects of interventions;CommentsClose CommentsPermalink
‘(C) improved integration with Federal Government health objectives and related target setting for health improvement;CommentsClose CommentsPermalink
‘(D) the enhanced dissemination of recommendations;CommentsClose CommentsPermalink
‘(E) the provision of technical assistance to those health care professionals, agencies and organizations that request help in implementing the Guide recommendations; andCommentsClose CommentsPermalink
‘(F) the submission of yearly reports to Congress and related agencies identifying gaps in research, such as preventive services that receive an insufficient evidence statement, and recommending priority areas that deserve further examination, including areas related to populations and age groups not adequately addressed by current recommendations.CommentsClose CommentsPermalink
‘(3) ROLE OF AGENCY- The Agency shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force, ensuring adequate staff resources, and assistance to those organizations requesting it for implementation of the Guide’s recommendations.CommentsClose CommentsPermalink
‘(4) COORDINATION WITH COMMUNITY PREVENTIVE SERVICES TASK FORCE- The Task Force shall take appropriate steps to coordinate its work with the Community Preventive Services Task Force and the Advisory Committee on Immunization Practices, including the examination of how each task force’s recommendations interact at the nexus of clinic and community.CommentsClose CommentsPermalink
‘(5) OPERATION- Operation. In carrying out the duties under paragraph (2), the Task Force is not subject to the provisions of Appendix 2 of title 5, United States Code.CommentsClose CommentsPermalink
‘(6) INDEPENDENCE- All members of the Task Force convened under this subsection, and any recommendations made by such members, shall be independent and, to the extent practicable, not subject to political pressure.CommentsClose CommentsPermalink
‘(7) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary for each fiscal year to carry out the activities of the Task Force.’.CommentsClose CommentsPermalink
(b) Community Preventive Services Task Force- Part P of title III of the Public Health Service Act is amended by adding at the end the following:CommentsClose CommentsPermalink
‘SEC. 399S. COMMUNITY PREVENTIVE SERVICES TASK FORCE.
‘(a) Establishment and Purpose- The Director of the Centers for Disease Control and Prevention shall convene an independent Community Preventive Services Task Force (referred to in this subsection as the ‘Task Force’) to be composed of individuals with appropriate expertise. Such Task Force shall review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations, to be published in the Guide to Community Preventive Services (referred to in this section as the ‘Guide’), for individuals and organizations delivering population-based services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, schools, governmental public health agencies, Indian tribes, tribal organizations and urban Indian organizations, medical groups, Congress and other policy-makers. Community preventive services include any policies, programs, processes or activities designed to affect or otherwise affecting health at the population level.CommentsClose CommentsPermalink
‘(b) Duties- The duties of the Task Force shall include--CommentsClose CommentsPermalink
‘(1) the development of additional topic areas for new recommendations and interventions related to those topic areas, including those related to specific populations and age groups, as well as the social, economic and physical environments that can have broad effects on the health and disease of populations and health disparities among sub-populations and age groups;CommentsClose CommentsPermalink
‘(2) at least once during every 5-year period, review interventions and update recommendations related to existing topic areas, including new or improved techniques to assess the health effects of interventions, including health impact assessment and population health modeling;CommentsClose CommentsPermalink
‘(3) improved integration with Federal Government health objectives and related target setting for health improvement;CommentsClose CommentsPermalink
‘(4) the enhanced dissemination of recommendations;CommentsClose CommentsPermalink
‘(5) the provision of technical assistance to those health care professionals, agencies, and organizations that request help in implementing the Guide recommendations; andCommentsClose CommentsPermalink
‘(6) providing yearly reports to Congress and related agencies identifying gaps in research and recommending priority areas that deserve further examination, including areas related to populations and age groups not adequately addressed by current recommendations.CommentsClose CommentsPermalink
‘(c) Role of Agency- The Director shall provide ongoing administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force, ensuring adequate staff resources, and assistance to those organizations requesting it for implementation of Guide recommendations.CommentsClose CommentsPermalink
‘(d) Coordination With Preventive Services Task Force- The Task Force shall take appropriate steps to coordinate its work with the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices, including the examination of how each task force’s recommendations interact at the nexus of clinic and community.CommentsClose CommentsPermalink
‘(e) Operation- In carrying out the duties under subsection (b), the Task Force shall not be subject to the provisions of Appendix 2 of title 5, United States Code.CommentsClose CommentsPermalink
‘(f) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary for each fiscal year to carry out the activities of the Task Force.’.CommentsClose CommentsPermalink
SEC. 304. EDUCATION AND OUTREACH CAMPAIGN REGARDING PREVENTIVE BENEFITS.
(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’) shall provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Such campaign shall include the dissemination of information that--CommentsClose CommentsPermalink
(1) describes the importance of utilizing preventive services to promote wellness, reduce health disparities, and mitigate chronic disease;CommentsClose CommentsPermalink
(2) promotes the use of preventive services recommended by the United States Preventive Services Task Force and the Community Preventive Services Task Force;CommentsClose CommentsPermalink
(3) encourages healthy behaviors linked to the prevention of chronic diseases;CommentsClose CommentsPermalink
(4) explains the preventive services covered under health plans offered through a Gateway;CommentsClose CommentsPermalink
(5) describes additional preventive care supported by the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Advisory Committee on Immunization Practices, and other appropriate agencies; andCommentsClose CommentsPermalink
(6) includes general health promotion information.CommentsClose CommentsPermalink
(b) Consultation- In coordinating the campaign under subsection (a), the Secretary shall consult with the Institute of Medicine to provide ongoing advice on evidence-based scientific information for policy, program development, and evaluation.CommentsClose CommentsPermalink
(c) Authorization of Appropriations- There are authorized to be appropriated such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink
Subtitle B--Increasing Access to Clinical Preventive ServicesCommentsClose CommentsPermalink
Subtitle B--Increasing Access to Clinical Preventive ServicesCommentsClose CommentsPermalink
SEC. 311. RIGHT CHOICES PROGRAM.
(a) In General- Beginning on the date of enactment of this Act, the Secretary shall award an annual grant to each State for the establishment of ‘Right Choices Programs’.CommentsClose CommentsPermalink
(b) Administration- A State shall use amounts received under a grant under subsection (a) to establish and implement a Right Choices Program. A State may administer the program through the State Medicaid program or through a comparable program. Under such program the State shall--CommentsClose CommentsPermalink
(1) conduct outreach activities through State health and human services programs, through safety net facilities, or through other mechanisms determined appropriate by the State and the Secretary, to identify uninsured individuals; andCommentsClose CommentsPermalink
(2) provide individuals identified under paragraph (1), who are eligible individuals, with a Right Choices Card to be used to access the services described in subsection (d).CommentsClose CommentsPermalink
(c) Eligible Individuals- To be eligible to participate in a Right Choices program under this section, an individual shall--CommentsClose CommentsPermalink
(1) be a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or otherwise residing in the United States under color of law;CommentsClose CommentsPermalink
(2) not be covered under any health insurance coverage during the 6-month period immediately preceding the date of the determination of eligibility;CommentsClose CommentsPermalink
(3) have a family income that does not exceed 350 percent of the Federal poverty level for a family of the size involved; andCommentsClose CommentsPermalink
(4) not be eligible for health care benefits provided through Medicare, Medicaid, the State Children’s Health Insurance Program, the armed services, or the Department of Veterans Affairs.CommentsClose CommentsPermalink
(d) Services- Services described in this subsection include the following:CommentsClose CommentsPermalink
(1) RISK-STRATIFIED CARE PLAN-CommentsClose CommentsPermalink
(A) IN GENERAL- An eligible individual participating in the Right Choices Program shall receive--CommentsClose CommentsPermalink
(i) a one-time health risk appraisal; andCommentsClose CommentsPermalink
(ii) a risk-stratified care plan provided by a primary care professional who may be affiliated with the Medicare or Medicaid programs under title XVIII or XIX of the Social Security Act, or with a Federal or State safety net provider (such as a community care team, community health center, or rural health clinic, as identified by the State).CommentsClose CommentsPermalink
(B) REFERRALS- A care plan under subparagraph (A)--CommentsClose CommentsPermalink
(i) shall include recommendations for behavioral changes, referrals to community-based resources, and referrals for age and gender appropriate immunizations and screenings to prevent chronic diseases (as identified by the Secretary, in consultation with the Director of the Centers for Disease Control and Prevention, the Administrator of the Agency for Healthcare Research and Quality, the Administrator of the Health Resources and Services Administration, the Administrator of the Substance Abuse and Mental Health Services Administration, and other appropriate sources); andCommentsClose CommentsPermalink
(ii) to the extent feasible, shall include referrals by the State of individuals to State and Federal programs for which they may be eligible.CommentsClose CommentsPermalink
(2) TREATMENT- An eligible individual participating in the Right Choices Program who has been diagnosed with an illnesses shall be referred for treatment to existing Federal or State safety net providers or facilities, as appropriate (such as public hospitals, community health centers, and rural health clinics).CommentsClose CommentsPermalink
(e) Payment of Providers-CommentsClose CommentsPermalink
(1) IN GENERAL- The State shall be required to reimburse health care providers that provide services to individuals under the Right Choices Program. Such reimbursement shall be approved by the Secretary and determined based on the amount paid by the State for similar services under the Medicaid program in the State. Such reimbursement shall not exceed the reimbursement provided for similar services under the Medicare program.CommentsClose CommentsPermalink
(2) COST SHARING- A State shall require that an eligible individual with a family income that exceeds 200 percent of the Federal poverty level for a family of the size involved that is participating in the State’s Right Choices Program, contribute a portion of the cost of care under such Program on a sliding scale as determined by the Secretary.CommentsClose CommentsPermalink
(f) Amount of Grant- The amount of a grant to a State under this section for a year shall be determined by the Secretary based on the rates of uninsured per capita of adults and children in the State (as compared to all States) and the prevalence of the most common costly chronic diseases in the State (as compared to all States). The Secretary shall determine what amount of the grant can be used for State administration of the program. The Secretary may also set aside not more than 20 percent of the funds appropriated to carry out this section to allocate to programs that fund the treatment of individuals participating in a Right Choices Program.CommentsClose CommentsPermalink
(g) Payments- The Secretary shall determine the manner in which payments shall be made to States under this section on a prospective basis to enable the State to provide individuals with access to items and services until the Federal or State Gateways are available.CommentsClose CommentsPermalink
(h) Limitation on Funds- The Secretary shall not obligate in excess of $5,000,000,000 for any fiscal year under this section.CommentsClose CommentsPermalink
(i) Definition- In this section, the term ‘State’ means each of the several States, the District of Columbia, and each of the territories of the United States, and shall include Indian tribes and tribal organizations (as such terms are defined in section 4(b) and section 4(c) of the Indian Self-Determination and Education Assistance Act).CommentsClose CommentsPermalink
(j) Evaluation- The Secretary shall conduct an annual evaluation of the effectiveness of the pilot program under this section.CommentsClose CommentsPermalink
(k) Limitation- Nothing in this title (or an amendment made by this title) shall require that a State use State revenue to fund programs under this section.CommentsClose CommentsPermalink
(l) Sunset- The program under this section shall terminate with respect to a State, on the date on which the Federal or State Gateways are available.CommentsClose CommentsPermalink
SEC. 312. SCHOOL-BASED HEALTH CLINICS.
Part Q of title III of the Public Health Service Act (
‘SEC. 399Z-1. SCHOOL-BASED HEALTH CLINICS.
‘(a) Definitions; Establishment of Criteria- In this section:CommentsClose CommentsPermalink
‘(1) COMPREHENSIVE PRIMARY HEALTH SERVICES- The term ‘comprehensive primary health services’ means the core services offered by school-based health clinics, which shall include the following:CommentsClose CommentsPermalink
‘(A) PHYSICAL- Comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions, and referrals to, and follow-up for, specialty care and oral health services.CommentsClose CommentsPermalink
‘(B) MENTAL HEALTH- Mental health and substance use disorder assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs.CommentsClose CommentsPermalink
‘(2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The term ‘medically underserved children and adolescents’ means a population of children and adolescents who are residents of an area designated as a medically underserved area or a health professional shortage area by the Secretary.CommentsClose CommentsPermalink
‘(B) CRITERIA- The Secretary shall prescribe criteria for determining the specific shortages of personal health services for medically underserved children and adolescents under subparagraph (A) that shall--CommentsClose CommentsPermalink
‘(i) take into account any comments received by the Secretary from the chief executive officer of a State and local officials in a State; andCommentsClose CommentsPermalink
‘(ii) include factors indicative of the health status of such children and adolescents of an area, including the ability of the residents of such area to pay for health services, the accessibility of such services, the availability of health professionals to such children and adolescents, and other factors as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(3) SCHOOL-BASED HEALTH CLINIC- The term ‘school-based health clinic’ means a health clinic that--CommentsClose CommentsPermalink
‘(A) is located in or near a school facility of a school district or board;CommentsClose CommentsPermalink
‘(B) is organized through school, community, and health provider relationships;CommentsClose CommentsPermalink
‘(C) is administered by a sponsoring facility; andCommentsClose CommentsPermalink
‘(D) provides, at a minimum, comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with established standards, community practice, reporting laws, and other State laws, including parental consent and notification laws that are not inconsistent with Federal law.CommentsClose CommentsPermalink
‘(4) SPONSORING FACILITY- The term ‘sponsoring facility’ is a community-based organization, which may include--CommentsClose CommentsPermalink
‘(A) a hospital;CommentsClose CommentsPermalink
‘(B) a public health department;CommentsClose CommentsPermalink
‘(C) a community health center;CommentsClose CommentsPermalink
‘(D) a nonprofit health care agency;CommentsClose CommentsPermalink
‘(E) a local education agency;CommentsClose CommentsPermalink
‘(F) a faith-based organization; orCommentsClose CommentsPermalink
‘(G) any other entity determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(b) Authority to Award Grants- The Secretary shall award grants for the costs of the operation of school-based health clinics (referred to in this section as ‘SBHCs’) that meet the requirements of this section.CommentsClose CommentsPermalink
‘(c) Applications- To be eligible to receive a grant under this section, an entity shall--CommentsClose CommentsPermalink
‘(1) be an SBHC (as defined in subsection (a)(4)); andCommentsClose CommentsPermalink
‘(2) submit to the Secretary an application at such time, in such manner, and containing--CommentsClose CommentsPermalink
‘(A) evidence that the applicant meets all criteria necessary to be designated an SBHC;CommentsClose CommentsPermalink
‘(B) evidence of local need for the services to be provided by the SBHC;CommentsClose CommentsPermalink
‘(C) an assurance that--CommentsClose CommentsPermalink
‘(i) SBHC services will be provided to those children and adolescents for whom parental or guardian consent has been obtained in cooperation with Federal, State, and local laws governing health care service provision to children and adolescents;CommentsClose CommentsPermalink
‘(ii) the SBHC has made and will continue to make every reasonable effort to establish and maintain collaborative relationships with other health care providers in the catchment area of the SBHC;CommentsClose CommentsPermalink
‘(iii) the SBHC will provide on-site access during the academic day when school is in session and 24-hour coverage through an on-call system and through its backup health providers to ensure access to services on a year-round basis when the school or the SBHC is closed;CommentsClose CommentsPermalink
‘(iv) the SBHC will be integrated into the school environment and will coordinate health services with school personnel, such as administrators, teachers, nurses, counselors, and support personnel, as well as with other community providers co-located at the school;CommentsClose CommentsPermalink
‘(v) the SBHC sponsoring facility assumes all responsibility for the SBHC administration, operations, and oversight; andCommentsClose CommentsPermalink
‘(vi) the SBHC will comply with Federal, State, and local laws concerning patient privacy and student records, including regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 and section 444 of the General Education Provisions Act; andCommentsClose CommentsPermalink
‘(D) such other information as the Secretary may require.CommentsClose CommentsPermalink
‘(d) Preferences- In reviewing applications, the Secretary may give preference to applicants who demonstrate an ability to serve the following:CommentsClose CommentsPermalink
‘(1) Communities that have evidenced barriers to primary health care and mental health and substance use disorder prevention services for children and adolescents.CommentsClose CommentsPermalink
‘(2) Communities with high per capita numbers of children and adolescents who are uninsured, underinsured, or enrolled in public health insurance programs.CommentsClose CommentsPermalink
‘(3) Populations of children and adolescents that have historically demonstrated difficulty in accessing health and mental health and substance use disorder prevention services.CommentsClose CommentsPermalink
‘(e) Waiver of Requirements- The Secretary may--CommentsClose CommentsPermalink
‘(1) under appropriate circumstances, waive the application of all or part of the requirements of this subsection with respect to an SBHC for not to exceed 2 years; andCommentsClose CommentsPermalink
‘(2) upon a showing of good cause, waive the requirement that the SBHC provide all required comprehensive primary health services for a designated period of time to be determined by the Secretary.CommentsClose CommentsPermalink
‘(f) Use of Funds-CommentsClose CommentsPermalink
‘(1) FUNDS- Funds awarded under a grant under this section may be used forCommentsClose CommentsPermalink
‘(A) acquiring and leasing equipment (including the costs of amortizing the principle of, and paying interest on, loans for such equipment);CommentsClose CommentsPermalink
‘(B) providing training related to the provision of required comprehensive primary health services and additional health services;CommentsClose CommentsPermalink
‘(C) the management and operation of health center programs; andCommentsClose CommentsPermalink
‘(D) the payment of salaries for physicians, nurses, and other personnel of the SBHC.CommentsClose CommentsPermalink
‘(2) CONSTRUCTION- The Secretary may award grants which may be used to pay the costs associated with expanding and modernizing existing buildings for use as an SBHC, including the purchase of trailers or manufactured buildings to install on the school property.CommentsClose CommentsPermalink
‘(3) AMOUNT- The amount of any grant made in any fiscal year to an SBHC shall be determined by the Secretary, taking into account--CommentsClose CommentsPermalink
‘(A) the financial need of the SBHC;CommentsClose CommentsPermalink
‘(B) State, local, or other operation funding provided to the SBHC; andCommentsClose CommentsPermalink
‘(C) other factors as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(4) LIMITATION- Any provider of services that is determined by a State to be in violation of a State law described in subsection (a)(4)(D) with respect to activities carried out at a SBHC shall not be eligible to receive additional funding under this section.CommentsClose CommentsPermalink
‘(g) Matching Requirement-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Each eligible entity that receives a grant under this section shall provide, from non-Federal sources, an amount equal to 20 percent of the amount of the grant (which may be provided in cash or in-kind) to carry out the activities supported by the grant.CommentsClose CommentsPermalink
‘(2) WAIVER- The Secretary may waive all or part of the matching requirement described in paragraph (1) for any fiscal year for the SBHC if the Secretary determines that applying the matching requirement to the SBHC would result in serious hardship or an inability to carry out the purposes of this section.CommentsClose CommentsPermalink
‘(h) Supplement, Not Supplant- Grant funds provided under this section shall be used to supplement, not supplant, other Federal or State funds.CommentsClose CommentsPermalink
‘(i) Technical Assistance- The Secretary shall establish a program through which the Secretary shall provide (either through the Department of Health and Human Services or by grant or contract) technical and other assistance to SBHCs to assist such SBHCs to meet the requirements of subsection (c)(2)(C). Services provided through the program may include necessary technical and nonfinancial assistance, including fiscal and program management assistance, training in fiscal and program management, operational and administrative support, and the provision of information to the entities of the variety of resources available under this title and how those resources can be best used to meet the health needs of the communities served by the entities.CommentsClose CommentsPermalink
‘(j) Evaluation- The Secretary shall develop and implement a plan for evaluating SBHCs and monitoring quality performance under the awards made under this section.CommentsClose CommentsPermalink
‘(k) Age Appropriate Services- An eligible entity receiving funds under this section shall only provide age appropriate services through a SBHC funded under this section to an individual.CommentsClose CommentsPermalink
‘(l) Authorization of Appropriations- For purposes of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
SEC. 313. ORAL HEALTHCARE PREVENTION ACTIVITIES.
(a) In General- Title III of the Public Health Service Act (
‘PART S--ORAL HEALTHCARE PREVENTION ACTIVITIES
‘SEC. 399GG. ORAL HEALTHCARE PREVENTION EDUCATION CAMPAIGN.
‘(a) Establishment- The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in consultation with professional oral health organizations, shall, subject to the availability of appropriations, establish a 5-year national, public education campaign (referred to in this section as the ‘campaign’) that is focused on oral healthcare prevention and education, including prevention of oral disease such as early childhood and other caries, periodontal disease, and oral cancer.CommentsClose CommentsPermalink
‘(b) Requirements- In establishing the campaign, the Secretary shall--CommentsClose CommentsPermalink
‘(1) ensure that activities are targeted towards specific populations such as children, pregnant women, parents, the elderly, individuals with disabilities, and ethnic and racial minority populations, including Indians, Alaska Natives and Native Hawaiians (as defined in section 4(c) of the Indian Health Care Improvement Act) in a culturally and linguistically appropriate manner; andCommentsClose CommentsPermalink
‘(2) utilize science-based strategies to convey oral health prevention messages that include, but are not limited to, community water fluoridation and dental sealants.CommentsClose CommentsPermalink
‘(c) Planning and Implementation- Not later than 2 years after the date of enactment of this section, the Secretary shall begin implementing the 5-year campaign. During the 2-year period referred to in the previous sentence, the Secretary shall conduct planning activities with respect to the campaign.CommentsClose CommentsPermalink
‘SEC. 399GG-1. RESEARCH-BASED DENTAL CARIES DISEASE MANAGEMENT.
‘(a) In General- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall award demonstration grants to eligible entities to demonstrate the effectiveness of research-based dental caries disease management activities.CommentsClose CommentsPermalink
‘(b) Eligibility- To be eligible for a grant under this section, an entity shall--CommentsClose CommentsPermalink
‘(1) be a community-based provider of dental services (as defined by the Secretary), including a Federally-qualified health center, a clinic of a hospital owned or operated by a State (or by an instrumentality or a unit of government within a State), a State or local department of health, a dental program of the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act), a health system provider, a private provider of dental services, medical, dental, public health, nursing, nutrition educational institutions, or national organizations involved in improving children’s oral health; andCommentsClose CommentsPermalink
‘(2) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(c) Use of Funds- A grantee shall use amounts received under a grant under this section to demonstrate the effectiveness of research-based dental caries disease management activities.CommentsClose CommentsPermalink
‘(d) Use of Information- The Secretary shall utilize information generated from grantees under this section in planning and implementing the public education campaign under section 399GG.CommentsClose CommentsPermalink
‘SEC. 399GG-2. AUTHORIZATION OF APPROPRIATIONS.
‘There is authorized to be appropriated to carry out this part, such sums as may be necessary.’.CommentsClose CommentsPermalink
SEC. 314. ORAL HEALTH IMPROVEMENT.
(a) School-based Sealant Programs- Section 317M(c)(1) of the Public Health Service Act (
(b) Oral Health Infrastructure- Section 317M of the Public Health Service Act (
(1) by redesignating subsections (d) and (e) as subsections (e) and (f), respectively; andCommentsClose CommentsPermalink
(2) by inserting after subsection (c), the following:CommentsClose CommentsPermalink
‘(d) Oral Health Infrastructure-CommentsClose CommentsPermalink
‘(1) COOPERATIVE AGREEMENTS- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall enter into cooperative agreements with State, territorial, and Indian tribes or tribal organizations (as those terms are defined in section 4 of the Indian Health Care Improvement Act) to establish oral health leadership and program guidance, oral health data collection and interpretation, (including determinants of poor oral health among vulnerable populations), a multi-dimensional delivery system for oral health, and to implement science-based programs (including dental sealants and community water fluoridation) to improve oral health.CommentsClose CommentsPermalink
‘(2) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated such sums as necessary to carry out this subsection for fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(c) Updating National Oral Healthcare Surveillance Activities-CommentsClose CommentsPermalink
(1) PRAMS-CommentsClose CommentsPermalink
(A) IN GENERAL- The Secretary of Health and Human Services (referred to in this subsection as the ‘Secretary’) shall carry out activities to update and improve the Pregnancy Risk Assessment Monitoring System (referred to in this section as ‘PRAMS’) as it relates to oral healthcare.CommentsClose CommentsPermalink
(B) STATE REPORTS AND MANDATORY MEASUREMENTS-CommentsClose CommentsPermalink
(i) IN GENERAL- Not later than 5 years after the date of enactment of this Act, and every 5 years thereafter, a State shall submit to the Secretary a report concerning activities conducted within the State under PRAMS.CommentsClose CommentsPermalink
(ii) MEASUREMENTS- The oral healthcare measurements developed by the Secretary for use under PRAMS shall be mandatory with respect to States for purposes of the State reports under clause (i).CommentsClose CommentsPermalink
(C) FUNDING- There is authorized to be appropriated to carry out this paragraph, such sums as may be necessary.CommentsClose CommentsPermalink
(2) NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY- The Secretary shall develop oral healthcare components that shall include tooth-level surveillance for inclusion in the National Health and Nutrition Examination Survey. Such components shall be updated by the Secretary at least every 6 years. For purposes of this paragraph, the term ‘tooth-level surveillance’ means a clinical examination where an examiner looks at each dental surface, on each tooth in the mouth and as expanded by the Division of Oral Health of the Centers for Disease Control and Prevention.CommentsClose CommentsPermalink
(3) MEDICAL EXPENDITURES PANEL SURVEY- The Secretary shall ensure that the Medical Expenditures Panel Survey by the Agency for Healthcare Research and Quality includes the verification of dental utilization, expenditure, and coverage findings through conduct of a look-back analysis.CommentsClose CommentsPermalink
(4) NATIONAL ORAL HEALTH SURVEILLANCE SYSTEM-CommentsClose CommentsPermalink
(A) APPROPRIATIONS- There is authorized to be appropriated, such sums as may be necessary for each of fiscal years 2010 through 2014 to increase the participation of States in the National Oral Health Surveillance System from 16 States to all 50 States, territories, and District of Columbia.CommentsClose CommentsPermalink
(B) REQUIREMENTS- The Secretary shall ensure that the National Oral Health Surveillance System include the measurement of early childhood caries.CommentsClose CommentsPermalink
Subtitle C--Creating Healthier CommunitiesCommentsClose CommentsPermalink
Subtitle C--Creating Healthier CommunitiesCommentsClose CommentsPermalink
SEC. 321. COMMUNITY TRANSFORMATION GRANTS.
(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Director of the Centers for Disease Control and Prevention (referred to in this section as the ‘Director’), shall award competitive grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, address health disparities, and develop a stronger evidence-base of effective prevention programming.CommentsClose CommentsPermalink
(b) Eligibility- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink
(1) be a--CommentsClose CommentsPermalink
(A) State governmental agency;CommentsClose CommentsPermalink
(B) local governmental agency;CommentsClose CommentsPermalink
(C) national network of community-based organizations; orCommentsClose CommentsPermalink
(D) Indian tribe; andCommentsClose CommentsPermalink
(2) submit to the Director an application at such time, in such a manner, and containing such information as the Director may require, including a description of the program to be carried out under the grant; andCommentsClose CommentsPermalink
(3) demonstrate a history or capacity, if funded, to develop relationships necessary to engage key stakeholders from multiple sectors across a community, such as healthy futures corps.CommentsClose CommentsPermalink
(c) Use of Funds-CommentsClose CommentsPermalink
(1) IN GENERAL- An eligible entity shall use amounts received under a grant under this section to carry out programs described in this subsection.CommentsClose CommentsPermalink
(2) COMMUNITY TRANSFORMATION PLAN-CommentsClose CommentsPermalink
(A) IN GENERAL- An eligible entity that receives a grant under this section shall submit to the Director (for approval) a detailed plan that includes the policy, environmental, programmatic, and as appropriate infrastructure changes needed to promote healthy living and reduce disparities.CommentsClose CommentsPermalink
(B) ACTIVITIES- Activities within the plan may focus on (but not be limited to)--CommentsClose CommentsPermalink
(i) creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of healthy lifestyle and prevention curricula, and activities to prevent chronic diseases;CommentsClose CommentsPermalink
(ii) creating the infrastructure to support active living and access to nutritious foods in a safe environment;CommentsClose CommentsPermalink
(iii) developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity and smoking cessation, enhance safety in a community, or address any other chronic disease priority area identified by the grantee;CommentsClose CommentsPermalink
(iv) assessing and implementing worksite wellness programming and incentives;CommentsClose CommentsPermalink
(v) working to highlight healthy options at restaurants and other food venues;CommentsClose CommentsPermalink
(vi) prioritizing strategies to reduce racial and ethnic disparities, including social determinants of health; andCommentsClose CommentsPermalink
(vii) addressing the needs of special populations, including all age groups and individuals with disabilities.CommentsClose CommentsPermalink
(3) COMMUNITY-BASED PREVENTION HEALTH ACTIVITIES-CommentsClose CommentsPermalink
(A) IN GENERAL- An eligible entity shall use amounts received under a grant under this section to implement a variety of programs, policies, and infrastructure improvements to promote healthier lifestyles.CommentsClose CommentsPermalink
(B) ACTIVITIES- An eligible entity shall implement activities detailed in the community transformation plan under paragraph (2).CommentsClose CommentsPermalink
(C) IN-KIND SUPPORT- An eligible entity shall provide in-kind resources such as staff, equipment, or office space in carrying out activities under this section.CommentsClose CommentsPermalink
(4) EVALUATION-CommentsClose CommentsPermalink
(A) IN GENERAL- An eligible entity shall use amounts provided under a grant under this section to conduct activities to measure changes in the prevalence of chronic disease risk factors among community members participating in preventive health activitiesCommentsClose CommentsPermalink
(B) TYPES OF MEASURES- In carrying out subparagraph (A), the eligible entity shall, with respect to residents in the community, measure--CommentsClose CommentsPermalink
(i) changes in weight;CommentsClose CommentsPermalink
(ii) changes in proper nutrition;CommentsClose CommentsPermalink
(iii) changes in physical activity;CommentsClose CommentsPermalink
(iv) changes in tobacco use prevalence;CommentsClose CommentsPermalink
(v) other factors using community-specific data from the Behavioral Risk Factor Surveillance Survey; andCommentsClose CommentsPermalink
(vi) other factors as determined by the Secretary.CommentsClose CommentsPermalink
(C) REPORTING- An eligible entity shall annually submit to the Director a report containing an evaluation of activities carried out under the grant.CommentsClose CommentsPermalink
(5) DISSEMINATION- A grantee under this section shall--CommentsClose CommentsPermalink
(A) meet at least annually in regional or national meetings to discuss challenges, best practices, and lessons learned with respect to activities carried out under the grant; andCommentsClose CommentsPermalink
(B) develop models for the replication of successful programs and activities and the mentoring of other eligible entities.CommentsClose CommentsPermalink
(d) Training-CommentsClose CommentsPermalink
(1) IN GENERAL- The Director shall develop a program to provide training for eligible entities on effective strategies for the prevention and control of chronic diseaseCommentsClose CommentsPermalink
(2) COMMUNITY TRANSFORMATION PLAN- The Director shall provide appropriate feedback and technical assistance to grantees to establish community transformation plansCommentsClose CommentsPermalink
(3) EVALUATION- The Director shall provide a literature review and framework for the evaluation of programs conducted as part of the grant program under this section, in addition to working with academic institutions or other entities with expertise in outcome evaluation.CommentsClose CommentsPermalink
(e) Prohibition- A grantee shall not use funds provided under a grant under this section to create video games or to carry out any other activities that may lead to higher rates of obesity or inactivity.CommentsClose CommentsPermalink
(f) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, such sums as may be necessary for each fiscal years 2010 through 2014.CommentsClose CommentsPermalink
SEC. 322. HEALTHY AGING, LIVING WELL.
(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Director of the Centers for Disease Control and Prevention, shall award grants to State or local health departments and Indian tribes to carry out 5-year pilot programs to provide public health community interventions, screenings, and where necessary, clinical referrals for individuals who are between 55 and 64 years of age.CommentsClose CommentsPermalink
(b) Eligibility- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink
(1) be--CommentsClose CommentsPermalink
(A) a State health department;CommentsClose CommentsPermalink
(B) a local health department; orCommentsClose CommentsPermalink
(C) an Indian tribe;CommentsClose CommentsPermalink
(2) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require including a description of the program to be carried out under the grant;CommentsClose CommentsPermalink
(3) design a strategy for improving the health of the 55-to-64 year-old population through community-based public health interventions; andCommentsClose CommentsPermalink
(4) demonstrate the capacity, if funded, to develop the relationships necessary with relevant health agencies, health care providers, community-based organizations, and insurers to carry out the activities described in subsection (c), such relationships to include the identification of a community-based clinical partner, such as a community health center or rural health clinic.CommentsClose CommentsPermalink
(c) Use of Funds-CommentsClose CommentsPermalink
(1) IN GENERAL- A State or local health department shall use amounts received under a grant under this section to carry out a program to provide the services described in this subsection to individuals who are between 55 and 64 years of age.CommentsClose CommentsPermalink
(2) PUBLIC HEALTH INTERVENTIONS-CommentsClose CommentsPermalink
(A) IN GENERAL- In developing and implementing such activities, a grantee shall collaborate with the Centers for Disease Control and Prevention and the Administration on Aging, and relevant local agencies and organizations.CommentsClose CommentsPermalink
(B) TYPES OF INTERVENTION ACTIVITIES- Intervention activities conducted under this paragraph may include efforts to improve nutrition, increase physical activity, reduce tobacco use and substance abuse, improve mental health, and promote healthy lifestyles among the target population.CommentsClose CommentsPermalink
(3) COMMUNITY PREVENTIVE SCREENINGS-CommentsClose CommentsPermalink
(A) IN GENERAL- In addition to community-wide public health interventions, a State or local health department shall use amounts received under a grant under this section to conduct ongoing health screening to identify risk factors for cardiovascular disease, stroke, and diabetes among individuals who are between 55 and 64 years of age.CommentsClose CommentsPermalink
(B) TYPES OF SCREENING ACTIVITIES- Screening activities conducted under this paragraph may include--CommentsClose CommentsPermalink
(i) mental health/behavioral health and substance use disorders;CommentsClose CommentsPermalink
(ii) physical activity, smoking, and nutrition; andCommentsClose CommentsPermalink
(iii) any other measures deemed appropriate by the Secretary.CommentsClose CommentsPermalink
(C) MONITORING- Grantees under this section shall maintain records of screening results under this paragraph to establish the baseline data for monitoring the targeted populationCommentsClose CommentsPermalink
(4) CLINICAL REFERRAL/TREATMENT FOR CHRONIC DISEASES-CommentsClose CommentsPermalink
(A) IN GENERAL- A State or local health department shall use amounts received under a grant under this section to ensure that individuals between 55 and 64 years of age who are found to have chronic disease risk factors through the screening activities described in paragraph (3)(B), receive clinical referral/treatment for follow-up services to reduce such risk.CommentsClose CommentsPermalink
(B) MECHANISM-CommentsClose CommentsPermalink
(i) IDENTIFICATION AND DETERMINATION OF STATUS- With respect to each individual with risk factors for or having heart disease, stroke, diabetes, or any other condition for which such individual was screened under paragraph (3), a grantee under this section shall determine whether or not such individual is covered under any public or private health insurance program.CommentsClose CommentsPermalink
(ii) INSURED INDIVIDUALS- An individual determined to be covered under a health insurance program under clause (i) shall be referred by the grantee to the existing providers under such program or, if such individual does not have a current provider, to a provider who is in-network with respect to the program involved.CommentsClose CommentsPermalink
(iii) UNINSURED INDIVIDUALS- With respect to an individual determined to be uninsured under clause (i), the grantee’s community-based clinical partner described in subsection (b)(4) shall assist the individual in determining eligibility for available public coverage options and identify other appropriate community health care resources and assistance programs.CommentsClose CommentsPermalink
(C) PUBLIC HEALTH INTERVENTION PROGRAM- A State or local health department shall use amounts received under a grant under this section to enter into contracts with community health centers or rural health clinics and mental health and substance use disorder service providers to assist in the referral/treatment of at risk patients to community resources for clinical follow-up and help determine eligibility for other public programs.CommentsClose CommentsPermalink
(5) GRANTEE EVALUATION- An eligible entity shall use amounts provided under a grant under this section to conduct activities to measure changes in the prevalence of chronic disease risk factors among participants.CommentsClose CommentsPermalink
(d) Pilot Program Evaluation- The Secretary shall conduct an annual evaluation of the effectiveness of the pilot program under this section. In determining such effectiveness, the Secretary shall consider changes in the prevalence of uncontrolled chronic disease risk factors among new Medicare enrollees (or individuals nearing enrollment, including those who are 63 and 64 years of age) who reside in States or localities receiving grants under this section as compared with national and historical data for those States and localities for the same population.CommentsClose CommentsPermalink
(e) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2010 through 2014.CommentsClose CommentsPermalink
SEC. 323. WELLNESS FOR INDIVIDUALS WITH DISABILITIES.
Title V of the Rehabilitation Act of 1973 (
‘SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MEDICAL DIAGNOSTIC EQUIPMENT.
‘(a) Standards- Not later than 24 months after the date of enactment of the Affordable Health Choices Act, the Architectural and Transportation Barriers Compliance Board shall, in consultation with the Commissioner of the Food and Drug Administration, promulgate regulatory standards in accordance with the Administrative Procedure Act (
2 U.S.C. 551 et seq.) setting forth the minimum technical criteria for medical diagnostic equipment used in (or in conjunction with) physician’s offices, clinics, emergency rooms, hospitals, and other medical settings. The standards shall ensure that such equipment is accessible to, and usable by, individuals with accessibility needs, and shall allow independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible.CommentsClose CommentsPermalink‘(b) Medical Diagnostic Equipment Covered- The standards issued under subsection (a) for medical diagnostic equipment shall apply to equipment that includes examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals.CommentsClose CommentsPermalink
‘(c) Review and Amendment- The Architectural and Transportation Barriers Compliance Board, in consultation with the Commissioner of the Food and Drug Administration, shall periodically review and, as appropriate, amend the standards in accordance with the Administrative Procedure Act (
2 U.S.C. 551 et seq.).’.CommentsClose CommentsPermalink
SEC. 324. IMMUNIZATIONS.
(a) State Authority to Purchase Recommended Vaccines for Adults- Section 317 of the Public Health Service Act (
‘(l) Authority to Purchase Recommended Vaccines for Adults-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary may negotiate and enter into contracts with manufacturers of vaccines for the purchase and delivery of vaccines for adults as provided for under subsection (e).CommentsClose CommentsPermalink
‘(2) STATE PURCHASE- A State may obtain additional quantities of such adult vaccines (subject to amounts specified to the Secretary by the State in advance of negotiations) through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary under this subsection.’.CommentsClose CommentsPermalink
(b) Demonstration Program to Improve Immunization Coverage- Section 317 of the Public Health Service Act (
‘(m) Demonstration Program to Improve Immunization Coverage-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a demonstration program to award grants to States to improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based, population-based interventions for high-risk populations.CommentsClose CommentsPermalink
‘(2) STATE PLAN- To be eligible for a grant under paragraph (1), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a State plan that describes the interventions to be implemented under the grant and how such interventions match with local needs and capabilities, as determined through consultation with local authorities.CommentsClose CommentsPermalink
‘(3) USE OF FUNDS- Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including--CommentsClose CommentsPermalink
‘(A) providing immunization reminders or recalls for target populations of clients, patients, and consumers;CommentsClose CommentsPermalink
‘(B) educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions;CommentsClose CommentsPermalink
‘(C) reducing out-of-pocket costs for families for vaccines and their administration;CommentsClose CommentsPermalink
‘(D) carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization;CommentsClose CommentsPermalink
‘(E) providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services;CommentsClose CommentsPermalink
‘(F) providing reminders or recalls for immunization providers;CommentsClose CommentsPermalink
‘(G) conducting assessments of, and providing feedback to, immunization providers;CommentsClose CommentsPermalink
‘(H) any combination of one or more interventions described in this paragraph; orCommentsClose CommentsPermalink
‘(I) immunization information systems to allow all States to have electronic databases for immunization records.CommentsClose CommentsPermalink
‘(4) CONSIDERATION- In awarding grants under this subsection, the Secretary shall consider any reviews or recommendations of the Task Force on Community Preventive Services.CommentsClose CommentsPermalink
‘(5) EVALUATION- Not later than 3 years after the date on which a State receives a grant under this subsection, the State shall submit to the Secretary an evaluation of progress made toward improving immunization coverage rates among high-risk populations within the State.CommentsClose CommentsPermalink
‘(6) REPORT TO CONGRESS- Not later than 4 years after the date of enactment of the Affordable Health Choices Act, the Secretary shall submit to Congress a report concerning the effectiveness of the demonstration program established under this subsection together with recommendations on whether to continue and expand such program.CommentsClose CommentsPermalink
‘(7) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, such sums as may be necessary for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
(c) Reauthorization of Immunization Program- Section 317(j) of the Public Health Service Act (
(1) in paragraph (1), by striking ‘for each of the fiscal years 1998 through 2005’; andCommentsClose CommentsPermalink
(2) in paragraph (2), by striking ‘after October 1, 1997,’.CommentsClose CommentsPermalink
(d) Rule of Construction Regarding Access to Immunizations- Nothing in this section (including the amendments made by this section), or any other provision of this Act (including any amendments made by this Act) shall be construed to decrease children’s access to immunizations.CommentsClose CommentsPermalink
SEC. 325. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN RESTAURANTS AND OF ARTICLES OF FOOD SOLD FROM VENDING MACHINES.
(a) Technical Amendments- Section 403(q)(5)(A) of the Federal Food, Drug, and Cosmetic Act (
(1) in subitem (i), by inserting at the beginning ‘except as provided in clause (H)(ii)(III),’; andCommentsClose CommentsPermalink
(2) in subitem (ii), by inserting at the beginning ‘except as provided in clause (H)(ii)(III),’.CommentsClose CommentsPermalink
(b) Labeling Requirements- Section 403(q)(5) of the Federal Food, Drug, and Cosmetic Act (
‘(H) Restaurants, Retail Food Establishments, and Vending Machines-CommentsClose CommentsPermalink
‘(i) GENERAL REQUIREMENTS FOR RESTAURANTS AND SIMILAR RETAIL FOOD ESTABLISHMENTS- Except for food described in subclause (vii), in the case of food that is a standard menu item that is offered for sale in a restaurant or similar retail food establishment that is part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items, the restaurant or similar retail food establishment shall disclose the information described in subclauses (ii) and (iii).CommentsClose CommentsPermalink
‘(ii) INFORMATION REQUIRED TO BE DISCLOSED BY RESTAURANTS AND RETAIL FOOD ESTABLISHMENTS- Except as provided in subclause (vii), the restaurant or similar retail food establishment shall disclose in a clear and conspicuous manner--CommentsClose CommentsPermalink
‘(I)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu listing the item for sale, the number of calories contained in the standard menu item, as usually prepared and offered for sale; andCommentsClose CommentsPermalink
‘(bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu and designed to enable the public to understand, in the context of a total daily diet, the significance of the caloric information that is provided on the menu;CommentsClose CommentsPermalink
‘(II)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu board, including a drive-through menu board, the number of calories contained in the standard menu item, as usually prepared and offered for sale; andCommentsClose CommentsPermalink
‘(bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu board, designed to enable the public to understand, in the context of a total daily diet, the significance of the nutrition information that is provided on the menu board;CommentsClose CommentsPermalink
‘(III) in a written form, available on the premises of the restaurant or similar retail establishment and to the consumer upon request, the nutrition information required under clauses (C) and (D) of subparagraph (1); andCommentsClose CommentsPermalink
‘(IV) on the menu or menu board, a prominent, clear, and conspicuous statement regarding the availability of the information described in item (III).CommentsClose CommentsPermalink
‘(iii) SELF-SERVICE FOOD AND FOOD ON DISPLAY- Except as provided in subclause (vii), in the case of food sold at a salad bar, buffet line, cafeteria line, or similar self-service facility, and for self-service beverages or food that is on display and that is visible to customers, a restaurant or similar retail food establishment shall place adjacent to each food offered a sign that lists calories per displayed food item or per serving.CommentsClose CommentsPermalink
‘(iv) REASONABLE BASIS- For the purposes of this clause, a restaurant or similar retail food establishment shall have a reasonable basis for its nutrient content disclosures, including nutrient databases, cookbooks, laboratory analyses, and other reasonable means, as described in section 101.10 of title 21, Code of Federal Regulations (or any successor regulation) or in a related guidance of the Food and Drug Administration.CommentsClose CommentsPermalink
‘(v) MENU VARIABILITY AND COMBINATION MEALS- The Secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children’s combination meals, through means determined by the Secretary, including ranges, averages, or other methods.CommentsClose CommentsPermalink
‘(vi) ADDITIONAL INFORMATION- If the Secretary determines that a nutrient, other than a nutrient required under subclause (ii)(III), should be disclosed for the purpose of providing information to assist consumers in maintaining healthy dietary practices, the Secretary may require, by regulation, disclosure of such nutrient in the written form required under subclause (ii)(III).CommentsClose CommentsPermalink
‘(vii) NONAPPLICABILITY TO CERTAIN FOOD-CommentsClose CommentsPermalink
‘(I) IN GENERAL- Subclauses (i) through (vi) do not apply to--CommentsClose CommentsPermalink
‘(aa) items that are not listed on a menu or menu board (such as condiments and other items placed on the table or counter for general use);CommentsClose CommentsPermalink
‘(bb) daily specials, temporary menu items appearing on the menu for less than 60 days per calendar year, or custom orders; orCommentsClose CommentsPermalink
‘(cc) such other food that is part of a customary market test appearing on the menu for less than 90 days, under terms and conditions established by the Secretary.CommentsClose CommentsPermalink
‘(II) WRITTEN FORMS- Subparagraph (5)(C) shall apply to any regulations promulgated under subclauses (ii)(III) and (vi).CommentsClose CommentsPermalink
‘(viii) VENDING MACHINES-CommentsClose CommentsPermalink
‘(I) IN GENERAL- In the case of an article of food sold from a vending machine that--CommentsClose CommentsPermalink
‘(aa) does not permit a prospective purchaser to examine the Nutrition Facts Panel before purchasing the article or does not otherwise provide visible nutrition information at the point of purchase; andCommentsClose CommentsPermalink
‘(bb) is operated by a person who is engaged in the business of owning or operating 20 or more vending machines,CommentsClose CommentsPermalink
the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories contained in the article.CommentsClose CommentsPermalink
‘(ix) VOLUNTARY PROVISION OF NUTRITION INFORMATION-CommentsClose CommentsPermalink
‘(I) IN GENERAL- An authorized official of any restaurant or similar retail food establishment or vending machine operator not subject to the requirements of this clause may elect to be subject to the requirements of such clause, by registering biannually the name and address of such restaurant or similar retail food establishment or vending machine operator with the Secretary, as specified by the Secretary by regulation.CommentsClose CommentsPermalink
‘(II) REGISTRATION- Within 120 days of enactment of this clause, the Secretary shall publish a notice in the Federal Register specifying the terms and conditions for implementation of item (I), pending promulgation of regulations.CommentsClose CommentsPermalink
‘(III) RULE OF CONSTRUCTION- Nothing in this subclause shall be construed to authorize the Secretary to require an application, review, or licensing process for any entity to register with the Secretary, as described in such item.CommentsClose CommentsPermalink
‘(x) REGULATIONS-CommentsClose CommentsPermalink
‘(I) PROPOSED REGULATION- Not later than 1 year after the date of enactment of this clause, the Secretary shall promulgate proposed regulations to carry out this clause.CommentsClose CommentsPermalink
‘(II) CONTENTS- In promulgating regulations, the Secretary shall--CommentsClose CommentsPermalink
‘(aa) consider standardization of recipes and methods of preparation, reasonable variation in serving size and formulation of menu items, space on menus and menu boards, inadvertent human error, training of food service workers, variations in ingredients, and other factors, as the Secretary determines; andCommentsClose CommentsPermalink
‘(bb) specify the format and manner of the nutrient content disclosure requirements under this subclause.CommentsClose CommentsPermalink
‘(III) REPORTING- The Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a quarterly report that describes the Secretary’s progress toward promulgating final regulations under this subparagraph.CommentsClose CommentsPermalink
‘(xi) DEFINITION- In this clause, the term ‘menu’ or ‘menu board’ means the primary writing of the restaurant or other similar retail food establishment from which a consumer makes an order selection.’CommentsClose CommentsPermalink
(c) National Uniformity- Section 403A(a)(4) of the Federal Food, Drug, and Cosmetic Act (
(d) Rule of Construction- Nothing in the amendments made by this section shall be construed--CommentsClose CommentsPermalink
(1) to preempt any provision of State or local law, unless such provision establishes or continues into effect nutrient content disclosures of the type required under section 403(q)(5)(H) of the Federal Food, Drug, and Cosmetic Act (as added by subsection (b)) and is expressly preempted under subsection (a)(4) of such section;CommentsClose CommentsPermalink
(2) to apply to any State or local requirement respecting a statement in the labeling of food that provides for a warning concerning the safety of the food or component of the food; orCommentsClose CommentsPermalink
(3) except as provided in section 403(q)(5)(H)(ix) of the Federal Food, Drug, and Cosmetic Act (as added by subsection (b)), to apply to any restaurant or similar retail food establishment other than a restaurant or similar retail food establishment described in section 403(q)(5)(H)(i) of such Act.CommentsClose CommentsPermalink
SEC. 326. ENCOURAGING EMPLOYER-SPONSORED WELLNESS PROGRAMS.
A group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan may offer incentives to an individual who voluntarily participates in a wellness program that is reasonably-designed to promote health or prevent disease. Nothing in this Act (or an amendment made by this Act) shall be construed to limit the ability of a group health plan or health insurance issuer, under regulations in effect on the date of enactment of this Act, to offer participants variations in employee contributions towards the cost of coverage for participation in wellness programs.CommentsClose CommentsPermalink
SEC. 327. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS PLAN.
Section 330 of the Public Health Service Act (
‘(s) Pilot Program for Individualized Wellness Plans-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan that is designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment.CommentsClose CommentsPermalink
‘(2) AGREEMENTS- The Secretary shall enter into agreements with not more than 10 community health centers funded under this section to conduct activities under the pilot program under paragraph (1).CommentsClose CommentsPermalink
‘(3) WELLNESS PLANS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- An individualized wellness plan prepared under the pilot program under this subsection may include one or more of the following as appropriate to the individual’s identified risk factors:CommentsClose CommentsPermalink
‘(i) Nutritional counseling.CommentsClose CommentsPermalink
‘(ii) A physical activity plan.CommentsClose CommentsPermalink
‘(iii) Alcohol and smoking cessation counseling and services.CommentsClose CommentsPermalink
‘(iv) Stress management.CommentsClose CommentsPermalink
‘(v) Dietary supplements that have health claims approved by the Secretary.CommentsClose CommentsPermalink
‘(vi) Compliance assistance provided by a community health center employee.CommentsClose CommentsPermalink
‘(B) RISK FACTORS- Wellness plan risk factors shall include--CommentsClose CommentsPermalink
‘(i) weight;CommentsClose CommentsPermalink
‘(ii) tobacco and alcohol use;CommentsClose CommentsPermalink
‘(iii) exercise rates;CommentsClose CommentsPermalink
‘(iv) nutritional status; andCommentsClose CommentsPermalink
‘(v) blood pressure.CommentsClose CommentsPermalink
‘(C) COMPARISONS- Individualized wellness plans shall make comparisons between the individual involved and a control group of individuals with respect to the risk factors described in subparagraph (B).CommentsClose CommentsPermalink
‘(4) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, such sums as may be necessary.’.CommentsClose CommentsPermalink
SEC. 328. REASONABLE BREAK TIME FOR NURSING MOTHERS.
Section 7 of the Fair Labor Standards Act of 1938 (
‘(r)(1) An employer shall provide--CommentsClose CommentsPermalink
‘(A) a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk; andCommentsClose CommentsPermalink
‘(B) a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.CommentsClose CommentsPermalink
‘(2) An employer shall not be required to compensate an employee receiving reasonable break time under paragraph (1) for any work time spent for such purpose.CommentsClose CommentsPermalink
‘(3) An employer that employs less than 50 employees shall not be subject to the requirements of this subsection, if such requirements would impose an undue hardship by causing the employer significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer’s business.’.CommentsClose CommentsPermalink
Subtitle D--Support for Prevention and Public Health InnovationCommentsClose CommentsPermalink
Subtitle D--Support for Prevention and Public Health InnovationCommentsClose CommentsPermalink
SEC. 331. RESEARCH ON OPTIMIZING THE DELIVERY OF PUBLIC HEALTH SERVICES.
(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Director of the Centers for Disease Control and Prevention, shall provide funding for research in the area of public health services and systems.CommentsClose CommentsPermalink
(b) Requirements of Research- Research supported under this section shall include--CommentsClose CommentsPermalink
(1) examining evidence-based practices relating to prevention, with a particular focus on high priority areas as identified by the Secretary in the National Prevention Strategy or Healthy People 2020, and including comparing community-based public health interventions in terms of effectiveness and cost;CommentsClose CommentsPermalink
(2) analyzing the translation of interventions from academic settings to real world settings; andCommentsClose CommentsPermalink
(3) identifying effective strategies for organizing, financing, or delivering public health services in real world community settings, including comparing State and local health department structures and systems in terms of effectiveness and cost.CommentsClose CommentsPermalink
(c) Existing Partnerships- Research supported under this section shall be coordinated with the Community Preventive Services Task Force and carried out by building on existing partnerships within the Federal Government while also considering initiatives at the State and local levels and in the private sector.CommentsClose CommentsPermalink
(d) Annual Report- The Secretary shall, on an annual basis, submit to Congress a report concerning the activities and findings with respect to research supported under this section.CommentsClose CommentsPermalink
SEC. 332. UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION AND ANALYSIS.
The Public Health Service Act (
‘TITLE XXXIII--DATA COLLECTION, ANALYSIS, AND QUALITYCommentsClose CommentsPermalink
‘SEC. 3301. DATA COLLECTION, ANALYSIS, AND QUALITY.
‘(a) Data Collection-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall ensure that, by not later than 1 year after the date of enactment of this title, any ongoing or federally conducted or supported health care or public health program, activity or survey collects and reports--CommentsClose CommentsPermalink
‘(A) data on race and ethnicity for applicants, recipients, or beneficiaries;CommentsClose CommentsPermalink
‘(B) data on gender, geographic location, socioeconomic status (including education, employment or income), primary language, and, disability status data for applicants, recipients, or beneficiaries;CommentsClose CommentsPermalink
‘(C) data at the smallest geographic level such as State, local, or institutional levels if such data can be aggregated;CommentsClose CommentsPermalink
‘(D) if practicable, data by racial and ethnic subgroups for applicants, recipients or beneficiaries using, if needed, statistical oversamples of these subpopulations; andCommentsClose CommentsPermalink
‘(E) any other demographic data as deemed appropriate by the Secretary regarding health disparities.CommentsClose CommentsPermalink
‘(2) COLLECTION STANDARDS- In collecting data described in paragraph (1), the Secretary or designee shall--CommentsClose CommentsPermalink
‘(A) use Office of Management and Budget standards, at a minimum, for race and ethnicity measures;CommentsClose CommentsPermalink
‘(B) develop standards for the measurement of gender, geographic location, socioeconomic status, primary language and disability measures; andCommentsClose CommentsPermalink
‘(C) develop standards for the collection of data described in paragraph (1) that, at a minimum--CommentsClose CommentsPermalink
‘(i) collects self-reported data by the applicant, recipient, or beneficiary; andCommentsClose CommentsPermalink
‘(ii) collects data from a parent or legal guardian if the applicant, recipient, or beneficiary is a minor or legally incapacitated.CommentsClose CommentsPermalink
‘(3) DATA MANAGEMENT- In collecting data described in paragraph (1), the Secretary, acting through the National Coordinator for Health Information Technology shall--CommentsClose CommentsPermalink
‘(A) develop national standards for the management of data collected; andCommentsClose CommentsPermalink
‘(B) develop interoperability and security systems for data management.CommentsClose CommentsPermalink
‘(b) Data Analysis-CommentsClose CommentsPermalink
‘(1) IN GENERAL- For each federally conducted or supported health care or public health program or activity, the Secretary shall analyze data collected under paragraph (a) to detect and monitor trends in health disparities (as defined in section 485E) at the Federal and State levels.CommentsClose CommentsPermalink
‘(c) Data Reporting and Dissemination-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall make the analyses described in (b) available to--CommentsClose CommentsPermalink
‘(A) the Office of Minority Health;CommentsClose CommentsPermalink
‘(B) the National Center on Minority Health and Health Disparities;CommentsClose CommentsPermalink
‘(C) the Agency for Healthcare Research and Quality;CommentsClose CommentsPermalink
‘(D) the Centers for Disease Control and Prevention;CommentsClose CommentsPermalink
‘(E) the Centers for Medicare & Medicaid Services;CommentsClose CommentsPermalink
‘(F) the Indian Health Service and epidemiology centers funded under the Indian Health Care Improvement Act;CommentsClose CommentsPermalink
‘(G) other agencies within the Department of Health and Human Services; andCommentsClose CommentsPermalink
‘(H) other entities as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(2) REPORTING OF DATA- The Secretary shall report data and analyses described in (a) and (b) through--CommentsClose CommentsPermalink
‘(A) public postings on the Internet websites of the Department of Health and Human Services; andCommentsClose CommentsPermalink
‘(B) any other reporting or dissemination mechanisms determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(3) AVAILABILITY OF DATA- The Secretary may make data described in (a) and (b) available for additional research, analyses, and dissemination to other Federal agencies, non-governmental entities, and the public.CommentsClose CommentsPermalink
‘(d) Limitations on Use of Data- Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.CommentsClose CommentsPermalink
‘(e) Protection of Data- The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) is protected--CommentsClose CommentsPermalink
‘(1) under the same privacy protections that are at least as broad as those that the Secretary applies to other health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (
Public Law 104-191 ; 110 Stat. 2033); andCommentsClose CommentsPermalink‘(2) from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.CommentsClose CommentsPermalink
‘(f) Data on Rural Underserved Populations- The Secretary shall ensure that any data collected in accordance with this section regarding racial and ethnic minority groups is also collected regarding underserved rural and frontier populations.CommentsClose CommentsPermalink
‘(g) Authorization of Appropriations- For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘(h) Requirement for Implementation- Notwithstanding any other provision of this section, data may not be collected under this section unless funds are directly appropriated for such purpose in an appropriations Act.’.CommentsClose CommentsPermalink
SEC. 333. HEALTH IMPACT ASSESSMENTS.
(a) Purpose- It is the purpose of this section to determine if the built environment has an impact on health.CommentsClose CommentsPermalink
(b) Definition- In this section:CommentsClose CommentsPermalink
(1) ADMINISTRATOR- The term ‘Administrator’ means the Administrator of the Environmental Protection Agency.CommentsClose CommentsPermalink
(2) BUILT ENVIRONMENT- The term ‘built environment’ means an environment consisting of building, spaces, and products that are created or modified by individuals and entities, including homes, schools, workplaces, greenways, business areas, transportation systems, and parks and recreation areas, electrical transmission lines, waste disposal sites, and land-use planning and policies that impact urban, rural and suburban communities.CommentsClose CommentsPermalink
(3) DIRECTOR- The term ‘Director’ means the Director of the Centers for Disease Control and Prevention.CommentsClose CommentsPermalink
(4) ENVIRONMENTAL HEALTH- The term ‘environmental health’ means the health and wellbeing of a population as affected by the direct pathological effects of chemicals, radiation or biological agents, and the effects, including the indirect effects, of the broad physical, psychological, social and aesthetic environment.CommentsClose CommentsPermalink
(5) HEALTH IMPACT ASSESSMENT- The term ‘health impact assessment’ means a combination of procedures, methods, and tools by which a regulation, program, or other project is assessed as to its potential effects on the health of a population, and the distribution of those effects within the population.CommentsClose CommentsPermalink
(6) SECRETARY- The term ‘Secretary’ means the Secretary of Health and Human Services.CommentsClose CommentsPermalink
(c) Fostering Health Impact Assessment-CommentsClose CommentsPermalink
(1) ESTABLISHMENT- The Secretary, acting through the Director and in coordination with the Administrator, shall establish a program at the National Center of Environmental Health at the Centers for Disease Control and Prevention to foster advances and provide technical support in the field of health impact assessments.CommentsClose CommentsPermalink
(2) ACTIVITIES- Through the program under paragraph (1), the Secretary shall--CommentsClose CommentsPermalink
(A) collect and disseminate evidence-based practices relating to health impact assessments;CommentsClose CommentsPermalink
(B) manage capacity building grants, technical assistance, and training on the use of health impact assessments; andCommentsClose CommentsPermalink
(C) provide guidance on health impact assessments including similar international efforts, known associations between the built environment and health outcomes, forecasting of potential health effects of the built environment, and best practices relating to the inclusion of the public in planning processes.CommentsClose CommentsPermalink
SEC. 334. CDC AND EMPLOYER-BASED WELLNESS PROGRAMS.
Title III of the Public Health Service Act (
‘PART T--EMPLOYER-BASED WELLNESS PROGRAM
‘SEC. 399HH. WORKPLACE WELLNESS MARKETING CAMPAIGN.
‘Subject to appropriations Acts, the Director of the Centers for Disease Control and Prevention (referred to in this section as the ‘Director’), in coordination with relevant worksite health promotion organizations, State and local health departments, the Indian Health Service, Indian tribes and tribal organizations, and academic institutions, shall conduct targeted educational campaigns to--CommentsClose CommentsPermalink
‘(1) make employers, employer groups, and other interested parties aware of the benefits of employer-based wellness programs;CommentsClose CommentsPermalink
‘(2) establish a culture of health by emphasizing health promotion and disease prevention;CommentsClose CommentsPermalink
‘(3) emphasize an integrated and coordinated approach to workplace wellness; andCommentsClose CommentsPermalink
‘(4) ensure informed decisions through high quality information to organizational leaders.CommentsClose CommentsPermalink
‘SEC. 399HH-1. TECHNICAL ASSISTANCE FOR EMPLOYER-BASED WELLNESS PROGRAMS.
‘In order to expand the utilization of evidence-based prevention and health promotion approaches in the workplace, the Director shall--CommentsClose CommentsPermalink
‘(1) provide employers (including small, medium, and large employers, as determined by the Director) with technical assistance, consultation, tools, and other resources in evaluating such employers’ employer-based wellness programs, including--CommentsClose CommentsPermalink
‘(A) measuring the participation and methods to increase participation of employees in such programs;CommentsClose CommentsPermalink
‘(B) developing standardized measures that assess policy, environmental and systems changes necessary to have a positive health impact on employees’ health behaviors, health outcomes, and health care expenditures; andCommentsClose CommentsPermalink
‘(C) evaluating such programs as they relate to changes in the health status of employees, the absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees; andCommentsClose CommentsPermalink
‘(2) build evaluation capacity among workplace staff by training employers on how to evaluate employer-based wellness programs by ensuring evaluation resources, technical assistance, and consultation are available to workplace staff as needed through such mechanisms as web portals, call centers, or other means.CommentsClose CommentsPermalink
‘SEC. 399HH-2. NATIONAL WORKSITE HEALTH POLICIES AND PROGRAMS STUDY.
‘(a) In General- In order to assess, analyze, and monitor over time data about workplace policies and programs, and to develop instruments to assess and evaluate comprehensive workplace chronic disease prevention and health promotion programs, policies and practices, not later than 2 years after the date of enactment of this part, and at regular intervals (to be determined by the Director) thereafter, the Director shall conduct a national worksite health policies and programs survey to assess employer-based health policies and programs.CommentsClose CommentsPermalink
‘(b) Report- Upon the completion of each study under subsection (a), the Director shall submit to Congress a report that includes the recommendations of the Director for the implementation of effective employer-based health policies and programs.CommentsClose CommentsPermalink
‘SEC. 399HH-3. RESEARCH IN WORKPLACE WELLNESS.
‘(a) Workplace Demonstration Studies- To expand the science base for effective prevention and health promotion approaches in the workplace, the Director, in collaboration with academic institutions and employers, shall institute workplace demonstration projects across small, medium, and large employers. Such demonstration projects shall be designed to determine how best to transform the work environment for health, safety, and wellness, how to create a strong, sustainable, coordinated, and integrated workplace health promotion and wellness program, and how to create innovative and sustainable policy and environmental strategies to improve employee health and wellness.CommentsClose CommentsPermalink
‘(b) Report- Upon the completion of the study under subsection (b), the Director shall submit to Congress a report that includes the recommendations of the Director for the implementation of effective employer-based health policies and programs.CommentsClose CommentsPermalink
‘SEC. 399HH-4. PRIORITIZATION OF EVALUATION BY SECRETARY.
‘The Secretary shall evaluate, in accordance with this part, all programs funded through the Centers for Disease Control and Prevention before conducting such an evaluation of privately funded programs unless an entity with a privately funded wellness program requests such an evaluation.CommentsClose CommentsPermalink
‘SEC. 399HH-5. PROHIBITION OF FEDERAL WORKPLACE WELLNESS REQUIREMENTS.
‘Notwithstanding any other provision of this part, any recommendations, data, or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.’.CommentsClose CommentsPermalink
SEC. 335. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.
Title XXVIII of the Public Health Service Act (
‘Subtitle C--Strengthening Public Health Surveillance SystemsCommentsClose CommentsPermalink
‘SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.
‘(a) In General- Subject to the availability of appropriations, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish an Epidemiology and Laboratory Capacity Grant Program to award grants to eligible entities to assist public health agencies in improving surveillance for, and response to, infectious diseases and other conditions of public health importance by--CommentsClose CommentsPermalink
‘(1) strengthening epidemiologic capacity;CommentsClose CommentsPermalink
‘(2) enhancing laboratory practice;CommentsClose CommentsPermalink
‘(3) improving information systems; andCommentsClose CommentsPermalink
‘(4) developing and implementing prevention and control strategies.CommentsClose CommentsPermalink
‘(b) Eligible Entities- In this section, the term ‘eligible entity’ means an entity that--CommentsClose CommentsPermalink
‘(1) is--CommentsClose CommentsPermalink
‘(A) a State health department;CommentsClose CommentsPermalink
‘(B) a local health department that meets such criteria as the Director of the Centers for Diseases Control and Prevention determines for purposes of this section;CommentsClose CommentsPermalink
‘(C) a tribal jurisdiction that meets such criteria as the Director of the Centers for Disease Control and Prevention determines for purposes of this section; orCommentsClose CommentsPermalink
‘(D) a partnership established for purposes of this section between one or more eligible entities described in subparagraph (A), (B), or (C) and an academic center; andCommentsClose CommentsPermalink
‘(2) submits to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(c) Use of Funds-CommentsClose CommentsPermalink
‘(1) IN GENERAL- An eligible entity shall use amounts received under a grant under this section for core functions described in this subsection including--CommentsClose CommentsPermalink
‘(A) building public health capacity to identify and monitor the occurrence of infectious diseases and other conditions of public health importance;CommentsClose CommentsPermalink
‘(B) detecting new and emerging infectious disease threats, including laboratory capacity to detect antimicrobial resistant infections;CommentsClose CommentsPermalink
‘(C) identifying and responding to disease outbreaks;CommentsClose CommentsPermalink
‘(D) hiring necessary staff;CommentsClose CommentsPermalink
‘(E) conducting needed staff training and educational development; andCommentsClose CommentsPermalink
‘(F) other activities that improve surveillance as determined by the Director of the Centers for Disease Control and Prevention.CommentsClose CommentsPermalink
‘(2) DEVELOPMENT AND MAINTENANCE OF INFORMATION EXCHANGE-CommentsClose CommentsPermalink
‘(A) NATIONAL STANDARDS- Not later than 180 days after the date of the enactment of this subtitle, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, and in consultation with the National Coordinator for Health Information Technology, shall issue guidelines for public health entities that--CommentsClose CommentsPermalink
‘(i) are designed to ensure that all State and local health departments and public health laboratories have access to information systems to receive, monitor, and report infectious diseases and other urgent conditions of public health importance; andCommentsClose CommentsPermalink
‘(ii) are consistent with standards and recommendations for health information technology by the National Coordinator for Health Information Technology, and by the American Health Information Community (AHIC) and its successors.CommentsClose CommentsPermalink
‘(B) SECURE INFORMATION SYSTEMS- An eligible entity shall use amounts received through a grant under this section to ensure that the entity has access to a web-based, secure information system that complies with the guidelines developed under subparagraph (A). Such a system shall be designed--CommentsClose CommentsPermalink
‘(i) to receive automated case reports of State and national reportable conditions from clinical systems and health care offices that use electronic health records and from clinical and public health laboratories, and to submit reports of nationally reportable conditions to the Director of the Centers for Disease Control and Prevention;CommentsClose CommentsPermalink
‘(ii) to receive and analyze, within 24 hours, de-identified electronic clinical data for situational awareness and to forward such reports immediately to the Centers for Disease Control and Prevention at the time of receipt;CommentsClose CommentsPermalink
‘(iii) to manage, link, and process different types of data, including information on newly reported cases, exposed contacts, laboratory results, number of people vaccinated or given prophylactic medications, adverse events monitoring and follow-up, in an integrated outbreak management system;CommentsClose CommentsPermalink
‘(iv) to geocode analyze, display, report, and map, using Geographic Information System technology, accumulated data and to share data with other local health departments, State health departments, and the Centers for Disease Control and Prevention;CommentsClose CommentsPermalink
‘(v) to receive, manage, and disseminate alerts, protocols, and other information, including Health Alert Network and Epi-X information, as appropriate, for public health workers, health care providers, and public health partners in emergency response within each health department’s jurisdiction and to automate the exchange and cascading of such information with external partners using national standards;CommentsClose CommentsPermalink
‘(vi) to have information technology security and critical infrastructure protection as appropriate to protect public health information;CommentsClose CommentsPermalink
‘(vii) to have the technical infrastructure needed to ensure availability, backup, and disaster recovery of data, application services, and communications systems during natural disasters such as floods, tornados, hurricanes, and power outages; andCommentsClose CommentsPermalink
‘(viii) to provide for other capabilities as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(C) LABORATORY SYSTEMS- An eligible entity shall use amounts received under a grant under this section to ensure that State or local public health laboratories are utilizing web-based, secure systems that are in compliance with the guidelines developed by the Secretary under subparagraph (A) and that--CommentsClose CommentsPermalink
‘(i) are fully integrated laboratory information systems;CommentsClose CommentsPermalink
‘(ii) provide for the reporting of electronic test results to the appropriate local and State health departments using currently existing national format and coding standards;CommentsClose CommentsPermalink
‘(iii) have information technology security and critical infrastructure protection to protect public health information (as determined by the Secretary);CommentsClose CommentsPermalink
‘(iv) have the technical infrastructure needed to ensure availability, backup, and disaster recovery of data, application services, and communications systems during natural disasters including floods, tornadoes, hurricanes, and power outages; andCommentsClose CommentsPermalink
‘(v) address other capabilities as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(D) OTHER USES- In addition to the activities described in subparagraphs (B) and (C), an eligible entity (including the entity’s public health laboratory) may use amounts received under a grant under this section for systems development and maintenance, hiring necessary staff, and staff technical training. Grantees under this section may elect to develop their own systems or use federally developed systems in carrying out activities under this paragraph.CommentsClose CommentsPermalink
‘(d) Priority- In allocating funds under subsection (f)(2) for activities under subsection (c)(2)(B) (relating to secure information systems), the Secretary shall give priority to eligible entities that demonstrate need.CommentsClose CommentsPermalink
‘(e) Reports- Not later than September 30, 2011, and each September 30 thereafter, the Secretary shall submit to Congress an annual report on the activities carried out under this section by recipients of assistance under this section.CommentsClose CommentsPermalink
‘(f) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $190,000,000 for each of fiscal years 2010 through 2013, of which--CommentsClose CommentsPermalink
‘(1) not less than $95,000,000 shall be made available each such fiscal year for activities under subsection (c)(1);CommentsClose CommentsPermalink
‘(2) not less than $60,000,000 shall be made available each such fiscal year for activities under subsection (c)(2)(B); andCommentsClose CommentsPermalink
‘(3) not less than $32,000,000 shall be made available each such fiscal year for activities under subsection (c)(2)(C).’.CommentsClose CommentsPermalink
SEC. 336. FEDERAL MESSAGING ON HEALTH PROMOTION AND DISEASE PREVENTION.
(a) Media Campaign-CommentsClose CommentsPermalink
(1) IN GENERAL- Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Director of the Centers for Disease Control and Prevention, shall establish and implement a national science-based media campaign on health promotion and disease prevention.CommentsClose CommentsPermalink
(2) REQUIREMENTS OF CAMPAIGN- The campaign implemented under paragraph (1)--CommentsClose CommentsPermalink
(A) shall be designed to address proper nutrition, regular exercise, smoking cessation, obesity reduction, the 5 leading disease killers in the United States, and secondary prevention through disease screening promotion;CommentsClose CommentsPermalink
(B) shall be carried out through competitively bid contracts awarded to entities providing for the professional production and design of such campaign;CommentsClose CommentsPermalink
(C) may include the use of television, radio, Internet, and other commercial marketing venues and may be targeted to specific age groups based on peer-reviewed social research;CommentsClose CommentsPermalink
(D) shall not be duplicative of any other Federal efforts relating to health promotion and disease prevention; andCommentsClose CommentsPermalink
(E) may include the use of humor and nationally recognized positive role models.CommentsClose CommentsPermalink
(3) EVALUATION- The Secretary shall ensure that the campaign implemented under paragraph (1) is subject to an independent evaluation every 2 years and shall report every 2 years to Congress on the effectiveness of such campaigns towards meeting science-based metrics.CommentsClose CommentsPermalink
(b) Website- The Secretary, in consultation with private-sector experts, shall maintain or enter into a contract to maintain an Internet website to provide science-based information on guidelines for nutrition, regular exercise, obesity reduction, smoking cessation, and specific chronic disease prevention. Such website shall be designed to provide information to health care providers and consumers.CommentsClose CommentsPermalink
(c) Dissemination of Information Through Providers- The Secretary, acting through the Centers for Disease Control and Prevention, shall develop and implement a plan for the dissemination of health promotion and disease prevention information consistent with national priorities, to health care providers who participate in Federal programs, including programs administered by the Indian Health Service, the Department of Veterans Affairs, the Department of Defense, and the Health Resources and Services Administration, and the Medicare and Medicaid Programs.CommentsClose CommentsPermalink
(d) Personalized Prevention Plans-CommentsClose CommentsPermalink
(1) CONTRACT- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall enter into a contract with a qualified entity for the development and operation of a Federal Internet website personalized prevention plan tool.CommentsClose CommentsPermalink
(2) USE- The website developed under paragraph (1) shall be designed to be used as a source of the most up-to-date scientific evidence relating to disease prevention for use by individuals. Such website shall contain a component that enables an individual to determine their disease risk (based on personal health and family history, BMI, and other relevant information) relating to the 5 leading diseases in the United States, and obtain personalized suggestions for preventing such diseases.CommentsClose CommentsPermalink
(e) Internet Portal- The Secretary shall establish an Internet portal for accessing risk-assessment tools developed and maintained by private and academic entities.CommentsClose CommentsPermalink
(f) Priority Funding- Funding for the activities authorized under this section shall take priority over funding provided through the Centers for Disease Control and Prevention for grants to States and other entities for similar purposes and goals as provided for in this section. Not to exceed $500,000,000 shall be expended on the campaigns and activities required under this section.CommentsClose CommentsPermalink
Subtitle E--Advancing Research and Treatment for Pain Care ManagementCommentsClose CommentsPermalink
Subtitle E--Advancing Research and Treatment for Pain Care ManagementCommentsClose CommentsPermalink
SEC. 341. INSTITUTE OF MEDICINE CONFERENCE ON PAIN.
(a) Convening- Not later than June 30, 2010, the Secretary of Health and Human Services shall seek to enter into an agreement with the Institute of Medicine of the National Academies to convene a Conference on Pain (in this section referred to as ‘the Conference’).CommentsClose CommentsPermalink
(b) Purposes- The purposes of the Conference shall be to--CommentsClose CommentsPermalink
(1) increase the recognition of pain as a significant public health problem in the United States;CommentsClose CommentsPermalink
(2) evaluate the adequacy of assessment, diagnosis, treatment, and management of acute and chronic pain in the general population, and in identified racial, ethnic, gender, age, and other demographic groups that may be disproportionately affected by inadequacies in the assessment, diagnosis, treatment, and management of pain;CommentsClose CommentsPermalink
(3) identify barriers to appropriate pain care, including--CommentsClose CommentsPermalink
(A) lack of understanding and education among employers, patients, health care providers, regulators, and third-party payors;CommentsClose CommentsPermalink
(B) barriers to access to care at the primary, specialty, and tertiary care levels, including barriers--CommentsClose CommentsPermalink
(i) specific to those populations that are disproportionately undertreated for pain;CommentsClose CommentsPermalink
(ii) related to physician concerns over regulatory and law enforcement policies applicable to some pain therapies; andCommentsClose CommentsPermalink
(iii) attributable to benefit, coverage, and payment policies in both the public and private sectors; andCommentsClose CommentsPermalink
(C) gaps in basic and clinical research on the symptoms and causes of pain, and potential assessment methods and new treatments to improve pain care; andCommentsClose CommentsPermalink
(4) establish an agenda for action in both the public and private sectors that will reduce such barriers and significantly improve the state of pain care research, education, and clinical care in the United States.CommentsClose CommentsPermalink
(c) Other Appropriate Entity- If the Institute of Medicine declines to enter into an agreement under subsection (a), the Secretary of Health and Human Services may enter into such agreement with another appropriate entity.CommentsClose CommentsPermalink
(d) Report- A report summarizing the Conference’s findings and recommendations shall be submitted to the Congress not later than June 30, 2011.CommentsClose CommentsPermalink
(e) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated $500,000 for each of fiscal years 2010 and 2011.CommentsClose CommentsPermalink
SEC. 342. PAIN RESEARCH AT NATIONAL INSTITUTES OF HEALTH.
Part B of title IV of the Public Health Service Act (
‘SEC. 409J. PAIN RESEARCH.
‘(a) Research Initiatives-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Director of NIH is encouraged to continue and expand, through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and potential treatments for pain.CommentsClose CommentsPermalink
‘(2) ANNUAL RECOMMENDATIONS- Not less than annually, the Pain Consortium, in consultation with the Division of Program Coordination, Planning, and Strategic Initiatives, shall develop and submit to the Director of NIH recommendations on appropriate pain research initiatives that could be undertaken with funds reserved under section 402A(c)(1) for the Common Fund or otherwise available for such initiatives.CommentsClose CommentsPermalink
‘(3) DEFINITION- In this subsection, the term ‘Pain Consortium’ means the Pain Consortium of the National Institutes of Health or a similar trans-National Institutes of Health coordinating entity designated by the Secretary for purposes of this subsection.CommentsClose CommentsPermalink
‘(b) Interagency Pain Research Coordinating Committee-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT- The Secretary shall establish not later than 1 year after the date of the enactment of this section and as necessary maintain a committee, to be known as the Interagency Pain Research Coordinating Committee (in this section referred to as the ‘Committee’), to coordinate all efforts within the Department of Health and Human Services and other Federal agencies that relate to pain research.CommentsClose CommentsPermalink
‘(2) MEMBERSHIP-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Committee shall be composed of the following voting members:CommentsClose CommentsPermalink
‘(i) Not more than 7 voting Federal representatives as follows:CommentsClose CommentsPermalink
‘(I) The Director of the Centers for Disease Control and Prevention.CommentsClose CommentsPermalink
‘(II) The Director of the National Institutes of Health and the directors of such national research institutes and national centers as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(III) The heads of such other agencies of the Department of Health and Human Services as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(IV) Representatives of other Federal agencies that conduct or support pain care research and treatment, including the Department of Defense and the Department of Veterans Affairs.CommentsClose CommentsPermalink
‘(ii) 12 additional voting members appointed under subparagraph (B).CommentsClose CommentsPermalink
‘(B) ADDITIONAL MEMBERS- The Committee shall include additional voting members appointed by the Secretary as follows:CommentsClose CommentsPermalink
‘(i) 6 members shall be appointed from among scientists, physicians, and other health professionals, who--CommentsClose CommentsPermalink
‘(I) are not officers or employees of the United States;CommentsClose CommentsPermalink
‘(II) represent multiple disciplines, including clinical, basic, and public health sciences;CommentsClose CommentsPermalink
‘(III) represent different geographical regions of the United States; andCommentsClose CommentsPermalink
‘(IV) are from practice settings, academia, manufacturers or other research settings; andCommentsClose CommentsPermalink
‘(ii) 6 members shall be appointed from members of the general public, who are representatives of leading research, advocacy, and service organizations for individuals with pain-related conditions.CommentsClose CommentsPermalink
‘(C) NONVOTING MEMBERS- The Committee shall include such nonvoting members as the Secretary determines to be appropriate.CommentsClose CommentsPermalink
‘(3) CHAIRPERSON- The voting members of the Committee shall select a chairperson from among such members. The selection of a chairperson shall be subject to the approval of the Director of NIH.CommentsClose CommentsPermalink
‘(4) MEETINGS- The Committee shall meet at the call of the chairperson of the Committee or upon the request of the Director of NIH, but in no case less often than once each year.CommentsClose CommentsPermalink
‘(5) DUTIES- The Committee shall--CommentsClose CommentsPermalink
‘(A) develop a summary of advances in pain care research supported or conducted by the Federal agencies relevant to the diagnosis, prevention, and treatment of pain and diseases and disorders associated with pain;CommentsClose CommentsPermalink
‘(B) identify critical gaps in basic and clinical research on the symptoms and causes of pain;CommentsClose CommentsPermalink
‘(C) make recommendations to ensure that the activities of the National Institutes of Health and other Federal agencies, including the Department of Defense and the Department of Veteran Affairs, are free of unnecessary duplication of effort;CommentsClose CommentsPermalink
‘(D) make recommendations on how best to disseminate information on pain care; andCommentsClose CommentsPermalink
‘(E) make recommendations on how to expand partnerships between public entities, including Federal agencies, and private entities to expand collaborative, cross-cutting research.CommentsClose CommentsPermalink
‘(6) REVIEW- The Secretary shall review the necessity of the Committee at least once every 2 years.’.CommentsClose CommentsPermalink
SEC. 343. PAIN CARE EDUCATION AND TRAINING.
Part D of title VII of the Public Health Service Act (
‘SEC. 759. PROGRAM FOR EDUCATION AND TRAINING IN PAIN CARE.
‘(a) In General- The Secretary may make awards of grants, cooperative agreements, and contracts to health professions schools, hospices, and other public and private entities for the development and implementation of programs to provide education and training to health care professionals in pain care.CommentsClose CommentsPermalink
‘(b) Priorities- In making awards under subsection (a), the Secretary shall give priority to awards for the implementation of programs under such subsection.CommentsClose CommentsPermalink
‘(c) Certain Topics- An award may be made under subsection (a) only if the applicant for the award agrees that the program carried out with the award will include information and education on--CommentsClose CommentsPermalink
‘(1) recognized means for assessing, diagnosing, treating, and managing pain and related signs and symptoms, including the medically appropriate use of controlled substances;CommentsClose CommentsPermalink
‘(2) applicable laws, regulations, rules, and policies on controlled substances, including the degree to which misconceptions and concerns regarding such laws, regulations, rules, and policies, or the enforcement thereof, may create barriers to patient access to appropriate and effective pain care;CommentsClose CommentsPermalink
‘(3) interdisciplinary approaches to the delivery of pain care, including delivery through specialized centers providing comprehensive pain care treatment expertise;CommentsClose CommentsPermalink
‘(4) cultural, linguistic, literacy, geographic, and other barriers to care in underserved populations; andCommentsClose CommentsPermalink
‘(5) recent findings, developments, and improvements in the provision of pain care.CommentsClose CommentsPermalink
‘(d) Program Sites- Education and training under subsection (a) may be provided at or through health professions schools, residency training programs, and other graduate programs in the health professions; entities that provide continuing education in medicine, pain management, dentistry, psychology, social work, nursing, and pharmacy; hospices; and such other programs or sites as the Secretary determines to be appropriate.CommentsClose CommentsPermalink
‘(e) Evaluation of Programs- The Secretary shall (directly or through grants or contracts) provide for the evaluation of programs implemented under subsection (a) in order to determine the effect of such programs on knowledge and practice of pain care.CommentsClose CommentsPermalink
‘(f) Peer Review Groups- In carrying out section 799(f) with respect to this section, the Secretary shall ensure that the membership of each peer review group involved includes individuals with expertise and experience in pain care.CommentsClose CommentsPermalink
‘(g) Pain Care Defined- For purposes of this section the term ‘pain care’ means the assessment, diagnosis, treatment, or management of acute or chronic pain regardless of causation or body location.CommentsClose CommentsPermalink
‘(h) Authorization of Appropriations- There is authorized to be appropriated to carry out this section, $5,000,000 for each of the fiscal years 2010 through 2012. Amounts appropriated under this subsection shall remain available until expended.’.CommentsClose CommentsPermalink
SEC. 344. PUBLIC AWARENESS CAMPAIGN ON PAIN MANAGEMENT.
Part B of title II of the Public Health Service Act (
‘SEC. 249. NATIONAL EDUCATION OUTREACH AND AWARENESS CAMPAIGN ON PAIN MANAGEMENT.
‘(a) Establishment- Not later than June 30, 2010, the Secretary shall establish and implement a national pain care education outreach and awareness campaign described in subsection (b).CommentsClose CommentsPermalink
‘(b) Requirements- The Secretary shall design the public awareness campaign under this section to educate consumers, patients, their families, and other caregivers with respect to--CommentsClose CommentsPermalink
‘(1) the incidence and importance of pain as a national public health problem;CommentsClose CommentsPermalink
‘(2) the adverse physical, psychological, emotional, societal, and financial consequences that can result if pain is not appropriately assessed, diagnosed, treated, or managed;CommentsClose CommentsPermalink
‘(3) the availability, benefits, and risks of all pain treatment and management options;CommentsClose CommentsPermalink
‘(4) having pain promptly assessed, appropriately diagnosed, treated, and managed, and regularly reassessed with treatment adjusted as needed;CommentsClose CommentsPermalink
‘(5) the role of credentialed pain management specialists and subspecialists, and of comprehensive interdisciplinary centers of treatment expertise;CommentsClose CommentsPermalink
‘(6) the availability in the public, nonprofit, and private sectors of pain management-related information, services, and resources for consumers, employers, third-party payors, patients, their families, and caregivers, including information on--CommentsClose CommentsPermalink
‘(A) appropriate assessment, diagnosis, treatment, and management options for all types of pain and pain-related symptoms; andCommentsClose CommentsPermalink
‘(B) conditions for which no treatment options are yet recognized; andCommentsClose CommentsPermalink
‘(7) other issues the Secretary deems appropriate.CommentsClose CommentsPermalink
‘(c) Consultation- In designing and implementing the public awareness campaign required by this section, the Secretary shall consult with organizations representing patients in pain and other consumers, employers, physicians including physicians specializing in pain care, other pain management professionals, medical device manufacturers, and pharmaceutical companies.CommentsClose CommentsPermalink
‘(d) Coordination-CommentsClose CommentsPermalink
‘(1) LEAD OFFICIAL- The Secretary shall designate one official in the Department of Health and Human Services to oversee the campaign established under this section.CommentsClose CommentsPermalink
‘(2) AGENCY COORDINATION- The Secretary shall ensure the involvement in the public awareness campaign under this section of the Surgeon General of the Public Health Service, the Director of the Centers for Disease Control and Prevention, and such other representatives of offices and agencies of the Department of Health and Human Services as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(e) Underserved Areas and Populations- In designing the public awareness campaign under this section, the Secretary shall--CommentsClose CommentsPermalink
‘(1) take into account the special needs of geographic areas and racial, ethnic, gender, age, and other demographic groups that are currently underserved; andCommentsClose CommentsPermalink
‘(2) provide resources that will reduce disparities in access to appropriate diagnosis, assessment, and treatment.CommentsClose CommentsPermalink
‘(f) Grants and Contracts- The Secretary may make awards of grants, cooperative agreements, and contracts to public agencies and private nonprofit organizations to assist with the development and implementation of the public awareness campaign under this section.CommentsClose CommentsPermalink
‘(g) Evaluation and Report- Not later than the end of fiscal year 2012, the Secretary shall prepare and submit to the Congress a report evaluating the effectiveness of the public awareness campaign under this section in educating the general public with respect to the matters described in subsection (b).CommentsClose CommentsPermalink
‘(h) Authorization of Appropriations- For purposes of carrying out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2010 and $4,000,000 for each of fiscal years 2011 through 2012.’.CommentsClose CommentsPermalink
Subtitle F--Coordinated Environmental Public Health NetworkCommentsClose CommentsPermalink
Subtitle F--Coordinated Environmental Public Health NetworkCommentsClose CommentsPermalink
SEC. 351. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (
‘TITLE XXXIV--COORDINATED ENVIRONMENTAL PUBLIC HEALTH NETWORKCommentsClose CommentsPermalink
‘SEC. 3400. DEFINITIONS.
‘In this title:CommentsClose CommentsPermalink
‘(1) ADMINISTRATOR- The term ‘Administrator’ means the Administrator of the Environmental Protection Agency.CommentsClose CommentsPermalink
‘(2) COORDINATED NETWORK- The term ‘Coordinated Network’ means the Coordinated Environmental Public Health Network established under section 3401(a).CommentsClose CommentsPermalink
‘(3) DIRECTOR- The term ‘Director’ means the Director of the Centers for Disease Control and Prevention.CommentsClose CommentsPermalink
‘(4) DIRECTOR OF CENTER- The term ‘Director of Center’ means the Director of the National Center for Environmental Health at the Centers for Disease Control and Prevention.CommentsClose CommentsPermalink
‘(5) MEDICAL PRIVACY REGULATIONS- The term ‘medical privacy regulations’ means the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.CommentsClose CommentsPermalink
‘(6) PRIORITY CHRONIC CONDITIONS AND HEALTH EFFECTS- The term ‘priority chronic conditions and health effects’ means the conditions, as specified by the Secretary, to be tracked in the Coordinated Network and the State Networks.CommentsClose CommentsPermalink
‘(7) STATE NETWORK- The term ‘State Network’ means a State Environmental Public Health Network established under section 3401(b).CommentsClose CommentsPermalink
‘(8) STATE- The term ‘State’ means a State, local government, territory, or Indian tribe that is eligible to receive a health tracking grant under section 3401(b).CommentsClose CommentsPermalink
‘SEC. 3401. ESTABLISHMENT OF COORDINATED AND STATE ENVIRONMENTAL PUBLIC HEALTH NETWORKS.
‘(a) Coordinated Environmental Public Health Network- Not later than 36 months after the date of the enactment of this title, the Secretary, acting through the Director, in consultation with the Administrator and the Director of Center, and with the involvement of other Federal agencies, and State and local health departments, shall establish and operate a Coordinated Environmental Public Health Network. In establishing and operating the Coordinated Network, the Secretary shall, as practicable--CommentsClose CommentsPermalink
‘(1) identify, build upon, expand, and coordinate among existing data and surveillance systems, surveys, registries, and other Federal public health and environmental infrastructure as practicable;CommentsClose CommentsPermalink
‘(2) provide for public access to an electronic national database that accepts data from the State Networks on the incidence and prevalence of priority chronic conditions and health effects and relevant environmental and other factors, in a manner which protects personal privacy consistent with the medical privacy regulations;CommentsClose CommentsPermalink
‘(3) prepare, publish, and submit to Congress--CommentsClose CommentsPermalink
‘(A) not later than 12 months after the date of enactment of this title, and annually thereafter, a Coordinated Network Status Report, including a statement of the activities carried out under this title, the identification of gaps in the data of the coordinated Network, including diseases of concern and environmental exposures not tracked, and identification of key milestones achieved in the preceding year, with such report to be made available to the public on the websites of the Centers for Disease Control and Prevention and the Environmental Protection Agency; andCommentsClose CommentsPermalink
‘(B) not later than 2 years after the date of enactment of this title, and biennially thereafter, a Coordinated Network Health and Environment Report, including a statement of the activities carried out under this title, an analysis of the most currently available incidence, prevalence, and trends of priority chronic conditions and health effects, and potentially relevant environmental and other factors, by State and, as practicable by local areas, and recommendations regarding high risk populations, public health concerns, response and prevention strategies, and additional tracking needs, in order to allow the public to access and understand information about environmental health at the Federal, State, and, where practicable, local level;CommentsClose CommentsPermalink
‘(4) provide for the establishment of State Networks, and coordinate the State Networks as provided for under subsection (b);CommentsClose CommentsPermalink
‘(5) provide technical assistance to support the State Networks;CommentsClose CommentsPermalink
‘(6) not later than 12 months after the date of the enactment of this title, develop minimum standards and procedures for data collection and reporting for the State Networks, to be updated not less than annually thereafter; andCommentsClose CommentsPermalink
‘(7) in developing the minimum standards and procedures under subparagraph (F), include mechanisms for allowing the States to set priorities, and allocate resources accordingly.CommentsClose CommentsPermalink
‘(b) State Environmental Public Health Networks-CommentsClose CommentsPermalink
‘(1) GRANTS- Not later than 12 months after the date of the enactment of this title, the Secretary, acting through the Director, in consultation with the Administrator and the Director of Center shall award grants to States for the establishment, maintenance, and operation of State Networks in accordance with the minimum standards and procedures established by the Secretary under subsection (a)(3).CommentsClose CommentsPermalink
‘(2) SPECIALIZED ASSISTANCE- The Coordinated Network shall provide specialized assistance to grantees in the establishment, maintenance, and operation of State Networks.CommentsClose CommentsPermalink
‘(3) REQUIREMENTS- A State receiving a grant under this subsection shall use the grant--CommentsClose CommentsPermalink
‘(A) to establish an environmental public health network that will provide--CommentsClose CommentsPermalink
‘(i) for the tracking of the incidence, prevalence, and trends of priority chronic conditions and health effects, as well as any additional priority chronic conditions and health effects and potentially related environmental exposures of concern to that State;CommentsClose CommentsPermalink
‘(ii) for identification of priority chronic conditions and health effects and potentially relevant environmental and other factors that disproportionately impact low income and minority communities;CommentsClose CommentsPermalink
‘(iii) for the protection of the confidentiality of all personal data reported, in accordance with the medical privacy regulations;CommentsClose CommentsPermalink
‘(iv) a means by which confidential data may, in accordance with Federal and State law, be disclosed to researchers for the purposes of public health research;CommentsClose CommentsPermalink
‘(v) the fullest possible public access to data collected by the State Network or through the Coordinated Network, while ensuring that individual privacy is protected in accordance with subsection (a)(1)(B); andCommentsClose CommentsPermalink
‘(vi) for the collection of exposure data through biomonitoring and other methods, which may include the entering into of cooperative agreements as described in section 3404;CommentsClose CommentsPermalink
‘(B) to develop a publicly available plan for establishing the State Network in order to meet minimum standards and procedures as developed by the Secretary under subsection (a)(1)(F);CommentsClose CommentsPermalink
‘(C) to appoint a lead public health department or agency that will be responsible for the development, operation, and maintenance of the State Network, and ensure the appropriate coordination among State and local agencies, including environmental agencies, regarding the development, operation, and maintenance of the State Network; andCommentsClose CommentsPermalink
‘(D) to recruit and train public health officials to continue to expand the State Network.CommentsClose CommentsPermalink
‘(4) LIMITATION- A State that receives a grant under this section may not use more than 10 percent of the funds made available through the grant for administrative costs.CommentsClose CommentsPermalink
‘(5) APPLICATION- To seek a grant under this section, a State shall submit to the Secretary an application at such time, in such form and manner, and accompanied by such information as the Secretary may specify.CommentsClose CommentsPermalink
‘(c) Pilot Projects-CommentsClose CommentsPermalink
‘(1) IN GENERAL- A State may apply for a grant under this subsection to implement a pilot project that is approved by the Secretary, acting through the Director and in consultation with the Administrator, and the Director of Center.CommentsClose CommentsPermalink
‘(2) ACTIVITIES- A State shall use amounts received under a grant under this subsection to carry out a pilot project designed to develop State Network enhancements and to develop programs to address specific local and regional concerns.CommentsClose CommentsPermalink
‘(3) RESULTS- The Secretary may consider the results of the pilot projects under this subsection for inclusion into the Coordinated Network.CommentsClose CommentsPermalink
‘(d) Privacy- In establishing and operating the Coordinated Network under subsection (a), and in making grants under subsections (b) and (c), the Secretary shall ensure the protection of privacy of individually identifiable health information, including ensuring protection consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (
42 U.S.C. 1320d-2 note).CommentsClose CommentsPermalink‘(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘SEC. 3402. INCREASING PUBLIC HEALTH PERSONNEL CAPACITY.
‘(a) In General- Beginning in fiscal year 2010, the Secretary, acting through the Director, shall enter into a cooperative agreement with the Council of State and Territorial Epidemiologists to train and place, in State and local health departments, applied epidemiology fellows to enhance State and local public health capacity in the areas of environmental health, chronic and other noninfectious diseases and conditions, and public health surveillance.CommentsClose CommentsPermalink
‘(b) Authorization of Appropriations- There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘SEC. 3403. GENERAL PROVISION.
‘The Secretary shall integrate the enactment of this title with all environmental health tracking programs funded prior to the date of enactment of this title, including by integrating the programs, in existence on the date of enactment of this title, to develop State Network enhancements and to develop programs to address specific local and regional concerns.CommentsClose CommentsPermalink
‘SEC. 3404. EXPANSION OF BIOMONITORING CAPABILITIES AND DATA COLLECTION.
‘(a) Purpose- It is the purpose of this section to expand the scope and amount of biomonitoring data collected and analyzed by the Centers for Disease Control and Prevention, State laboratories, and consortia of State laboratories, in order to obtain robust information, including information by geographically defined areas and subpopulations, about a range of environmental exposures.CommentsClose CommentsPermalink
‘(b) In General- In meeting the purpose of this section, the Secretary shall ensure that biomonitoring data are collected intramurally through appropriate sources, including the National Health and Nutrition Examination Survey, and extramurally shall enter into collaboration or partnerships with other entities to obtain additional information regarding vulnerable subpopulations or other subpopulations.CommentsClose CommentsPermalink
‘(c) Cooperative Agreements-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary, acting through the Director, shall enter into cooperative agreements with States or consortia of States to support the purposes of this title.CommentsClose CommentsPermalink
‘(2) APPLICATIONS- Applications for such cooperative agreements by consortia of States shall address the manner in which such States will coordinate activities with other States in the region, and shall designate a lead State for administrative purposes.CommentsClose CommentsPermalink
‘(3) TRAINING AND QUALITY ASSURANCE- The Secretary, acting through the Director, shall through the cooperative agreements with States or a consortia of States provide laboratory training and quality assurance.CommentsClose CommentsPermalink
‘(d) Privacy- In carrying out this section, the Secretary shall ensure the protection of privacy of individually identifiable health information, including ensuring protection consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (
42 U.S.C. 1320d-2 note).CommentsClose CommentsPermalink‘(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
Subtitle G--Miscellaneous ProvisionsCommentsClose CommentsPermalink
Subtitle G--Miscellaneous ProvisionsCommentsClose CommentsPermalink
SEC. 361. SENSE OF THE SENATE CONCERNING CBO SCORING.
(a) Finding- The Senate finds that the costs of prevention programs are difficult to estimate due in part because prevention initiatives are hard to measure and results may occur outside the 5 and 10 year budget windows.CommentsClose CommentsPermalink
(b) Sense of Congress- It is the sense of the Senate that Congress should work with the Congressional Budget Office to develop better methodologies for scoring progress to be made in prevention and wellness programs.CommentsClose CommentsPermalink
SEC. 362. EFFECTIVENESS OF FEDERAL HEALTH AND WELLNESS INITIATIVES.
To determine whether existing Federal health and wellness initiatives are effective in achieving their stated goals, the Secretary of Health and Human Services shall--CommentsClose CommentsPermalink
(1) conduct an evaluation of such programs as they relate to changes in health status of the American public and specifically on the health status of the Federal workforce, including absenteeism of employees, the productivity of employees, the rate of workplace injury, and the medical costs incurred by employees, and health conditions, including workplace fitness, healthy food and beverages, and incentives in the Federal Employee Health Benefits Program; andCommentsClose CommentsPermalink
(2) submit to Congress a report concerning such evaluation, which shall include conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.CommentsClose CommentsPermalink
TITLE IV--HEALTH CARE WORKFORCECommentsClose CommentsPermalink
TITLE IV--HEALTH CARE WORKFORCECommentsClose CommentsPermalink
Subtitle A--Purpose and DefinitionsCommentsClose CommentsPermalink
Subtitle A--Purpose and DefinitionsCommentsClose CommentsPermalink
SEC. 401. PURPOSE.
The purpose of this title is to improve access to and the delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity, and rural populations by--CommentsClose CommentsPermalink
(1) gathering and assessing comprehensive data in order for the health care workforce to meet the health care needs of individuals, including research on the supply, demand, distribution, diversity, and skills needs of the health care workforce;CommentsClose CommentsPermalink
(2) increasing the supply of a qualified health care workforce to improve access to and the delivery of health care services for all individuals;CommentsClose CommentsPermalink
(3) enhancing health care workforce education and training to improve access to and the delivery of health care services for all individuals; andCommentsClose CommentsPermalink
(4) providing support to the existing health care workforce to improve access to and the delivery of health care services for all individuals.CommentsClose CommentsPermalink
SEC. 402. DEFINITIONS.
(a) This Title- In this title:CommentsClose CommentsPermalink
(1) HEALTH CARE CAREER PATHWAY- The term ‘healthcare career pathway’ means a rigorous, engaging, and high quality set of courses and services that--CommentsClose CommentsPermalink
(A) includes an articulated sequence of academic and career courses, including 21st century skills;CommentsClose CommentsPermalink
(B) is aligned with the needs of healthcare industries in a region or State;CommentsClose CommentsPermalink
(C) prepares students for entry into the full range of postsecondary education options, including registered apprenticeships, and careers;CommentsClose CommentsPermalink
(D) provides academic and career counseling in student-to-counselor ratios that allow students to make informed decisions about academic and career options;CommentsClose CommentsPermalink
(E) meets State academic standards, State requirements for secondary school graduation and is aligned with requirements for entry into postsecondary education, and applicable industry standards; andCommentsClose CommentsPermalink
(F) leads to 2 or more credentials, including--CommentsClose CommentsPermalink
(i) a secondary school diploma; andCommentsClose CommentsPermalink
(ii) a postsecondary degree, an apprenticeship or other occupational certification, a certificate, or a license.CommentsClose CommentsPermalink
(2) INSTITUTION OF HIGHER EDUCATION- The term ‘institution of higher education’ has the meaning given the term in sections 101 and 102 of the Higher Education Act of 1965 (
(3) LOW INCOME INDIVIDUAL, STATE WORKFORCE INVESTMENT BOARD, AND LOCAL WORKFORCE INVESTMENT BOARD- The terms ‘low-income individual’, ‘State workforce investment board’, and ‘local workforce investment board’, have the meanings given the terms in section 101 of the Workforce investment Act of 1998 (
(4) POSTSECONDARY EDUCATION- The term ‘postsecondary education’ means--CommentsClose CommentsPermalink
(A) a 4-year program of instruction, or not less than a 1-year program of instruction that is acceptable for credit toward an associate or a baccalaureate degree, offered by an institution of higher education; orCommentsClose CommentsPermalink
(B) a certificate or registered apprenticeship program at the postsecondary level offered by an institution of higher education or a non-profit educational institution.CommentsClose CommentsPermalink
(5) REGISTERED APPRENTICESHIP PROGRAM- The term ‘registered apprenticeship program’ means an industry skills training program at the postsecondary level that combines technical and theoretical training through structure on the job learning with related instruction (in a classroom or through distance learning) while an individual is employed, working under the direction of qualified personnel or a mentor, and earning incremental wage increases aligned to enhance job proficiency, resulting in the acquisition of a nationally recognized and portable certificate, under a plan approved by the Office of Apprenticeship or a State agency recognized by the Department of Labor.CommentsClose CommentsPermalink
(b) Title VII of the Public Health Service Act- Section 799B of the Public Health Service Act (
(1) by striking paragraph (3) and inserting the following:CommentsClose CommentsPermalink
‘(3) PHYSICIAN ASSISTANT EDUCATION PROGRAM- The term ‘physician assistant education program’ means an educational program in a public or private institution in a State that--CommentsClose CommentsPermalink
‘(A) has as its objective the education of individuals who, upon completion of their studies in the program, be qualified to provide primary care medical services with the supervision of a physician; andCommentsClose CommentsPermalink
‘(B) is accredited by the Accreditation Review Commission on Education for the Physician Assistant.’; andCommentsClose CommentsPermalink
(2) by adding at the end the following:CommentsClose CommentsPermalink
‘(12) AREA HEALTH EDUCATION CENTER- The term ‘area health education center’ means a public or nonprofit private organization that has a cooperative agreement or contract in effect with an entity that has received an award under subsection (b) or (c) of section 751, satisfies the requirements in section 751(d)(1), and has as one of its principal functions the operation of an area health education center. Appropriate organizations may include hospitals, health organizations with accredited primary care training programs, accredited physician assistant educational programs associated with a college or university, and universities or colleges not operating a school of medicine or osteopathic medicine.CommentsClose CommentsPermalink
‘(13) AREA HEALTH EDUCATION CENTER PROGRAM- The term ‘area health education center program’ means cooperative program consisting of an entity that has received an award under subsection (b) or (c) of section 751 for the purpose of planning, developing, operating, and evaluating an area health education center program and one or more area health education centers, which carries out the required activities described in subsection (b)(4) or (c)(4) of section 751, satisfies the program requirements in such section, has as one of its principal functions identifying and implementing strategies and activities that address health care workforce needs in its service area, in coordination with the local workforce investment boards.CommentsClose CommentsPermalink
‘(14) CLINICAL SOCIAL WORKER- The term ‘clinical social worker’ has the meaning given the term in section 1861(hh)(1) of the Social Security Act (
42 U.S.C. 1395x(hh)(1) ).CommentsClose CommentsPermalink‘(15) CULTURAL COMPETENCY- The term ‘cultural competency’ shall be defined by the Secretary in a manner consistent with section 1707(d)(3).CommentsClose CommentsPermalink
‘(16) DIRECT CARE WORKER- The term ‘direct care worker’ has the meaning given that term in the 2010 Standard Occupational Classifications of the Department of Labor for Home Health Aides [31-1011], Psychiatric Aides [31-1013], Nursing Assistants [31-1014], and Personal Care Aides [39-9021].CommentsClose CommentsPermalink
‘(17) FEDERALLY QUALIFIED HEALTH CENTER- The term ‘Federally qualified health center’ has the meaning given that term in section 1861(aa) of the Social Security Act (
42 U.S.C. 1395x(aa) ).CommentsClose CommentsPermalink‘(18) FRONTIER HEALTH PROFESSIONAL SHORTAGE AREA- The term ‘frontier health professional shortage area’ means an area--CommentsClose CommentsPermalink
‘(A) with a population density less than 6 persons per square mile within the service area; andCommentsClose CommentsPermalink
‘(B) with respect to which the distance or time for the population to access care is excessive.CommentsClose CommentsPermalink
‘(19) GRADUATE PSYCHOLOGY- The term ‘graduate psychology’ means an accredited program in professional psychology.CommentsClose CommentsPermalink
‘(20) HEALTH DISPARITY POPULATION- The term ‘health disparity population’ has the meaning given such term in section 903(d)(1).CommentsClose CommentsPermalink
‘(21) HEALTH LITERACY- The term ‘health literacy’ means the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.CommentsClose CommentsPermalink
‘(22) MENTAL HEALTH SERVICE PROFESSIONAL- The term ‘mental health service professional’ means an individual with a graduate or postgraduate degree from an accredited institution of higher education in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance abuse disorder prevention and treatment, marriage and family counseling, school counseling, or professional counseling.CommentsClose CommentsPermalink
‘(23) ONE-STOP DELIVERY SYSTEM CENTER- The term ‘one-stop delivery system’ means a one-stop delivery system described in section 134(c) of the Workforce Investment Act of 1998 (
29 U.S.C. 2864(c) ).CommentsClose CommentsPermalink‘(24) PARAPROFESSIONAL CHILD AND ADOLESCENT MENTAL HEALTH WORKER- The term ‘paraprofessional child and adolescent mental health worker’ means an individual who is not a mental or behavioral health service professional, but who works at the first stage of contact with children and families who are seeking mental or behavioral health services, including substance abuse prevention and treatment services.CommentsClose CommentsPermalink
‘(25) RACIAL AND ETHNIC MINORITY GROUP; RACIAL AND ETHNIC MINORITY POPULATION- The terms ‘racial and ethnic minority group’ and ‘racial and ethnic minority population’ have the meaning given the term ‘racial and ethnic minority group’ in section 1707.CommentsClose CommentsPermalink
‘(26) RURAL HEALTH CLINIC- The term ‘rural health clinic’ has the meaning given that term in section 1861(aa) of the Social Security Act (
42 U.S.C. 1395x(aa) ).’.CommentsClose CommentsPermalink
(c) Title VIII of the Public Health Service Act- Section 801 of the Public Health Service Act (
(1) in paragraph (2)--CommentsClose CommentsPermalink
(A) by striking ‘means a’ and inserting ‘means an accredited (as defined in paragraph 6)’; andCommentsClose CommentsPermalink
(B) by striking the period as inserting the following: ‘where graduates are--CommentsClose CommentsPermalink
‘(A) authorized to sit for the National Council Licensure EXamination-Registered Nurse (NCLEX-RN); orCommentsClose CommentsPermalink
‘(B) licensed registered nurses who will receive a graduate or equivalent degree or training to become an advanced education nurse as defined by section 811(b).’; andCommentsClose CommentsPermalink
(2) by adding at the end the following:CommentsClose CommentsPermalink
‘(16) ACCELERATED NURSING DEGREE PROGRAM- The term ‘accelerated nursing degree program’ means a program of education in professional nursing offered by an accredited school of nursing in which an individual holding a bachelors degree in another discipline receives a BSN or MSN degree in an accelerated time frame as determined by the accredited school of nursing.CommentsClose CommentsPermalink
‘(17) BRIDGE OR DEGREE COMPLETION PROGRAM- The term ‘bridge or degree completion program’ means a program of education in professional nursing offered by an accredited school of nursing, as defined in paragraph (2), that leads to a baccalaureate degree in nursing. Such programs may include, Registered Nurse (RN) to Bachelor’s of Science of Nursing (BSN) programs, RN to MSN (Master of Science of Nursing) programs, or BSN to Doctoral programs.’.CommentsClose CommentsPermalink
Subtitle B--Innovations in the Health Care WorkforceCommentsClose CommentsPermalink
Subtitle B--Innovations in the Health Care WorkforceCommentsClose CommentsPermalink
SEC. 411. NATIONAL HEALTH CARE WORKFORCE COMMISSION.
(a) Purpose- It is the purpose of this section to establish a National Health Care Workforce Commission that--CommentsClose CommentsPermalink
(1) serves as a national resource for Congress, the President, States, and localities by--CommentsClose CommentsPermalink
(A) disseminating information on current and projected health care workforce supply and demand;CommentsClose CommentsPermalink
(B) disseminating information on health care workforce education and training capacity and instruction or delivery models and best practices;CommentsClose CommentsPermalink
(C) recognizing efforts of Federal, State, and local partnerships to develop and offer health care career pathways of proven effectiveness;CommentsClose CommentsPermalink
(D) disseminating information on promising retention practices for health care professionals;CommentsClose CommentsPermalink
(E) communicating information on important policies and practices that affect the recruitment, education and training, and retention of the health care workforce; andCommentsClose CommentsPermalink
(F) disseminating recommendations on the development of a fiscally sustainable integrated workforce that supports a high-quality health care delivery system that meets the needs of patients and populations;CommentsClose CommentsPermalink
(2) communicates and coordinates with the Departments of Health and Human Services, Labor, Veterans Affairs, Homeland Security, and Education on related activities administered by one or more of such Departments;CommentsClose CommentsPermalink
(3) develops and commissions evaluations of education and training activities to determine whether the demand for health care workers is being met;CommentsClose CommentsPermalink
(4) identifies barriers to improved coordination at the Federal, State, and local levels and recommend ways to address such barriers; andCommentsClose CommentsPermalink
(5) encourages innovations to address population needs, constant changes in technology, and other environmental factors.CommentsClose CommentsPermalink
(b) Establishment- There is hereby established the National Health Care Workforce Commission (in this section referred to as the ‘Commission’).CommentsClose CommentsPermalink
(c) Membership-CommentsClose CommentsPermalink
(1) NUMBER AND APPOINTMENT- The Commission shall be composed of 15 members to be appointed by the Comptroller General, without regard to section 5 of the Federal Advisory Committee Act (5 U.S.C. App.).CommentsClose CommentsPermalink
(2) QUALIFICATIONS-CommentsClose CommentsPermalink
(A) IN GENERAL- The membership of the Commission shall include individuals--CommentsClose CommentsPermalink
(i) with national recognition for their expertise in health care labor market analysis, including health care workforce analysis; health care finance and economics; health care facility management; health care plans and integrated delivery systems; health care workforce education and training; health care philanthropy; providers of health care services; and other related fields; andCommentsClose CommentsPermalink
(ii) who will provide a combination of professional perspectives, broad geographic representation, and a balance between urban, suburban, rural, and frontier representatives.CommentsClose CommentsPermalink
(B) INCLUSION-CommentsClose CommentsPermalink
(i) IN GENERAL- The membership of the Commission shall include no less than one representative of--CommentsClose CommentsPermalink
(I) the health care workforce and health professionals;CommentsClose CommentsPermalink
(II) employers;CommentsClose CommentsPermalink
(III) third-party payers;CommentsClose CommentsPermalink
(IV) individuals skilled in the conduct and interpretation of health care services and health economics research;CommentsClose CommentsPermalink
(V) representatives of consumers;CommentsClose CommentsPermalink
(VI) labor unions;CommentsClose CommentsPermalink
(VII) State or local workforce investment boards; andCommentsClose CommentsPermalink
(VIII) educational institutions (which may include elementary and secondary institutions, institutions of higher education, including 2 and 4 year institutions, or registered apprenticeship programs).CommentsClose CommentsPermalink
(ii) ADDITIONAL MEMBERS- The remaining membership may include additional representatives from clause (i) and other individuals as determined appropriate by the Comptroller General of the United States.CommentsClose CommentsPermalink
(C) MAJORITY NON-PROVIDERS- Individuals who are directly involved in health professions education or practice shall not constitute a majority of the membership of the Commission.CommentsClose CommentsPermalink
(D) ETHICAL DISCLOSURE- The Comptroller General shall establish a system for public disclosure by members of the Commission of financial and other potential conflicts of interest relating to such members. Members of the Commission shall be treated as employees of Congress for purposes of applying title I of the Ethics in Government Act of 1978. Members of the Commission shall not be treated as special government employees under title 18, United States Code.CommentsClose CommentsPermalink
(3) TERMS-CommentsClose CommentsPermalink
(A) IN GENERAL- The terms of members of the Commission shall be for 3 years except that the Comptroller General shall designate staggered terms for the members first appointed.CommentsClose CommentsPermalink
(B) VACANCIES- Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that members term until a successor has taken office. A vacancy in the Commission shall be filled in the manner in which the original appointment was made.CommentsClose CommentsPermalink
(C) INITIAL APPOINTMENTS- The Comptroller General shall make initial appointments of members to the Commission not later than September 30, 2010.CommentsClose CommentsPermalink
(4) COMPENSATION- While serving on the business of the Commission (including travel time), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of tile 5, United States Code, and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Commission. Physicians serving as personnel of the Commission may be provided a physician comparability allowance by the Commission in the same manner as Government physicians may be provided such an allowance by an agency under
(5) CHAIRMAN, VICE CHAIRMAN- The Comptroller General shall designate a member of the Commission, at the time of appointment of the member, as Chairman and a member as Vice Chairman for that term of appointment, except that in the case of vacancy of the chairmanship or vice chairmanship, the Comptroller General may designate another member for the remainder of that member’s term.CommentsClose CommentsPermalink
(6) MEETINGS- The Commission shall meet at the call of the chairman, but no less frequently than on a quarterly basis.CommentsClose CommentsPermalink
(d) Duties-CommentsClose CommentsPermalink
(1) REVIEW OF HEALTH CARE WORKFORCE AND ANNUAL REPORTS- In order to develop a fiscally sustainable integrated workforce that supports a high-quality, readily accessible health care delivery system that meets the needs of patients and populations, the Commission, in consultation with relevant Federal, State, and local agencies, shall--CommentsClose CommentsPermalink
(A) review current and projected health care workforce supply and demand, including the topics described in paragraph (2);CommentsClose CommentsPermalink
(B) make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies;CommentsClose CommentsPermalink
(C) by not later than October 1 of each year (beginning with 2011), submit a report to Congress and the Administration containing the results of such reviews and recommendations concerning related policies; andCommentsClose CommentsPermalink
(D) by not later than April 1 of each year (beginning with 2011), submit a report to Congress and the Administration containing a review of, and recommendations on, at a minimum one high priority area as described in paragraph (3).CommentsClose CommentsPermalink
(2) SPECIFIC TOPICS TO BE REVIEWED- The topics described in this paragraph include--CommentsClose CommentsPermalink
(A) current health care workforce supply and distribution, including demographics, skill sets, and demands, with projected demands during the subsequent 10 and 25 year periods;CommentsClose CommentsPermalink
(B) health care workforce education and training capacity, including the number of students who have completed education and training, including registered apprenticeships; the number of qualified faculty; the education and training infrastructure; and the education and training demands, with projected demands during the subsequent 10 and 25 year periods, and including identified models of education and training delivery and best practices;CommentsClose CommentsPermalink
(C) the education loan and grant programs in titles VII and VIII of the Public Health Service Act (
(D) the implications of new and existing Federal policies which affect the health care workforce, including Medicare and Medicaid graduate medical education policies, titles VII and VIII of the Public Health Service Act (
(E) the health care workforce needs of special populations, such as minorities, rural populations, medically underserved populations, gender specific needs, individuals with disabilities, and geriatric and pediatric populations with recommendations for new and existing Federal policies to meet the needs of these special populations; andCommentsClose CommentsPermalink
(F) recommendations creating or revising national loan repayment programs and scholarship programs to require low-income, minority medical students to serve in their home communities, if designated as medical underserved community.CommentsClose CommentsPermalink
(3) HIGH PRIORITY AREAS-CommentsClose CommentsPermalink
(A) IN GENERAL- The initial high priority topics described in this paragraph include--CommentsClose CommentsPermalink
(i) integrated health care workforce planning that identifies health care professional skills needed and maximizes the skill sets of health care professionals across disciplines;CommentsClose CommentsPermalink
(ii) an analysis of the nature, scopes of practice, and demands for health care workers in the enhanced information technology and management workplace;CommentsClose CommentsPermalink
(iii) Medicare and Medicaid graduate medical education policies and recommendations, including increasing direct payments to community based training sites and medical training programs, for aligning with national workforce goals;CommentsClose CommentsPermalink
(iv) nursing workforce capacity at all levels, including education and training capacity, projected demands, and integration within the health care delivery system;CommentsClose CommentsPermalink
(v) oral health care workforce capacity, including education and training capacity, projected demands, and integration within the health care delivery system;CommentsClose CommentsPermalink
(vi) mental and behavioral health care workforce capacity, including education and training capacity, projected demands, and integration within the health care delivery system;CommentsClose CommentsPermalink
(vii) allied health and public health care workforce capacity, including education and training capacity, projected demands, and integration within the health care delivery system;CommentsClose CommentsPermalink
(viii) the geographic distribution of health care providers as compared to the identified health care workforce needs of States and regions; andCommentsClose CommentsPermalink
(ix) emergency medical service workforce capacity, including training and the retention and recruitment of the volunteer workforce.CommentsClose CommentsPermalink
(B) FUTURE DETERMINATIONS- The Commission may require that additional topics be included under subparagraph (A). The appropriate committees of Congress may recommend to the Commission the inclusion of other topics for health care workforce development areas that require special attention.CommentsClose CommentsPermalink
(4) GRANT PROGRAM- The Commission shall review implementation progress reports on, and report to Congress about, the State Health Care Workforce Development Grants program established in section 412.CommentsClose CommentsPermalink
(5) STUDY- The Commission shall study effective mechanisms for financing education and training for careers in health care, including public health and allied health.CommentsClose CommentsPermalink
(6) RECOMMENDATIONS- The Commission shall submit recommendations to Congress, the Department of Labor, and the Department of Health and Human Services about improving safety, health, and worker protections in the workplace for the health care workforce.CommentsClose CommentsPermalink
(7) ASSESSMENT- The Commission shall assess and receive reports from the National Center for Health Care Workforce Analysis established under title VII of the Public Service Health Act.CommentsClose CommentsPermalink
(e) Consultation With Federal, State, and Local Agencies, Congress, and Other Organizations-CommentsClose CommentsPermalink
(1) IN GENERAL- The Commission shall consult with Federal agencies (including the Departments of Health and Human Services, Labor, Education, Commerce, Agriculture, Defense, and Veterans Affairs and the Environmental Protection Agency), Congress, the Medicare Payment Advisory Commission, the Medicaid and CHIP Payment and Access Commission, and, to the extent practicable, with State and local agencies, Indian tribes, voluntary health care organizations, professional societies, and other relevant public-private health care partnerships.CommentsClose CommentsPermalink
(2) OBTAINING OFFICIAL DATA- The Commission, consistent with established privacy rules, may secure directly from any department or agency of the Executive Branch information necessary to enable the Commission to carry out this section.CommentsClose CommentsPermalink
(3) DETAIL OF FEDERAL GOVERNMENT EMPLOYEES- An employee of the Federal Government may be detailed to the Commission without reimbursement. The detail of such an employee shall be without interruption or loss of civil service status.CommentsClose CommentsPermalink
(f) Director and Staff; Experts and Consultants- Subject to such review as the Comptroller General of the United States determines to be necessary to ensure the efficient administration of the Commission, the Commission may--CommentsClose CommentsPermalink
(1) employ and fix the compensation of an executive director that shall not exceed the rate of basic pay payable for level V of the Executive Schedule and such other personnel as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service);CommentsClose CommentsPermalink
(2) seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies;CommentsClose CommentsPermalink
(3) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 3709 of the Revised Statutes (
(4) make advance, progress, and other payments which relate to the work of the Commission;CommentsClose CommentsPermalink
(5) provide transportation and subsistence for persons serving without compensation; andCommentsClose CommentsPermalink
(6) prescribe such rules and regulations as the Commission determines to be necessary with respect to the internal organization and operation of the Commission.CommentsClose CommentsPermalink
(g) Powers-CommentsClose CommentsPermalink
(1) DATA COLLECTION- In order to carry out its functions under this section, the Commission shall--CommentsClose CommentsPermalink
(A) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section, including coordination with the Bureau of Labor Statistics;CommentsClose CommentsPermalink
(B) carry out, or award grants or contracts for the carrying out of, original research and development, where existing information is inadequate, andCommentsClose CommentsPermalink
(C) adopt procedures allowing interested parties to submit information for the Commission’s use in making reports and recommendations.CommentsClose CommentsPermalink
(2) ACCESS OF THE GOVERNMENT ACCOUNTABILITY OFFICE TO INFORMATION- The Comptroller General of the United States shall have unrestricted access to all deliberations, records, and data of the Commission, immediately upon request.CommentsClose CommentsPermalink
(3) PERIODIC AUDIT- The Commission shall be subject to periodic audit by an independent public accountant under contract to the Commission.CommentsClose CommentsPermalink
(h) Authorization of Appropriations-CommentsClose CommentsPermalink
(1) REQUEST FOR APPROPRIATIONS- The Commission shall submit requests for appropriations in the same manner as the Comptroller General of the United States submits requests for appropriations. Amounts so appropriated for the Commission shall be separate from amounts appropriated for the Comptroller General.CommentsClose CommentsPermalink
(2) AUTHORIZATION- There are authorized to be appropriated such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink
(3) GIFTS- The Commission is authorized to accept and gifts for purposing of carrying out this section.CommentsClose CommentsPermalink
(i) Definitions- In this section:CommentsClose CommentsPermalink
(1) HEALTH CARE WORKFORCE- The term ‘health care workforce’ includes all health care providers with direct patient care and support responsibilities, such as physicians, nurses, nurse practitioners, primary care providers, preventive medicine physicians, optometrists, ophthalmologists, physician assistants, pharmacists, dentists, dental hygienists, and other oral healthcare professionals, allied health professionals, doctors of chiropractic, community health workers, health care paraprofessionals, direct care workers, psychologists and other behavioral and mental health professionals (including substance abuse prevention and treatment providers), social workers, physical and occupational therapists, certified nurse midwives, podiatrists, the EMS workforce (including professional and volunteer ambulance personnel and firefighters who perform emergency medical services), licensed complementary and alternative medicine providers, integrative health practitioners, public health professionals, and any other health professional that the Comptroller General of the United States determines appropriate.CommentsClose CommentsPermalink
(2) HEALTH PROFESSIONALS- The term ‘health professionals’ includes--CommentsClose CommentsPermalink
(A) dentists, dental hygienists, primary care providers, specialty physicians, nurses, nurse practitioners, physician assistants, psychologists and other behavioral and mental health professionals (including substance abuse prevention and treatment providers), social workers, physical therapists, public health professionals, clinical pharmacists, allied health professionals, doctors of chiropractic, community health workers, school nurses, certified nurse midwives, podiatrists, licensed complementary and alternative medicine providers, the EMS workforce (including professional and volunteer ambulance personnel and firefighters who perform emergency medical services), and integrative health practitioners;CommentsClose CommentsPermalink
(B) national representatives of health professionals;CommentsClose CommentsPermalink
(C) representatives of schools of medicine, osteopathy, nursing, dentistry, optometry, pharmacy, chiropractic, allied health, educational programs for public health professionals, behavioral and mental health professionals (as so defined), social workers, pharmacists, physical therapists, oral health care industry dentistry and dental hygiene, and physician assistants;CommentsClose CommentsPermalink
(D) representatives of public and private teaching hospitals, and ambulatory health facilities, including Federal medical facilities; andCommentsClose CommentsPermalink
(E) any other health professional the Comptroller General of the United States determines appropriate.CommentsClose CommentsPermalink
(j) Reimbursement of Costs- The Commission shall reimburse the Government Accountability Office for the full cost of carrying out its activities under this section as billed therefore by the Comptroller General of the United States. Such reimbursements shall be credited to the appropriation account ‘Salaries and Expenses, Government Accountability Office’ current when the payment is received and remain available until expended.CommentsClose CommentsPermalink
SEC. 412. STATE HEALTH CARE WORKFORCE DEVELOPMENT GRANTS.
(a) Establishment- There is established a competitive health care workforce development grant program (referred to in this section as the ‘program’) for the purpose of enabling State partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels.CommentsClose CommentsPermalink
(b) Assessment and Reporting-CommentsClose CommentsPermalink
(1) DUTIES OF COMMISSION- The National Health Care Workforce Commission established in section 411 (referred to in this section as the ‘Commission’) shall--CommentsClose CommentsPermalink
(A) in collaboration with the Department of Labor and in coordination with the Department of Education and other relevant Federal agencies, make recommendations to the fiscal and administrative agent under paragraph (2) for grant recipients;CommentsClose CommentsPermalink
(B) assess the implementation of the grants; andCommentsClose CommentsPermalink
(C) collect performance and report information, including identified models and best practices, on grants from the fiscal and administrative agent and distribute this information to Congress, relevant Federal agencies, and to the public.CommentsClose CommentsPermalink
(2) FISCAL AND ADMINISTRATIVE AGENT- The Health Resources and Services Administration of the Department of Health and Human Services (referred to in this section as the ‘Administration’) shall be the fiscal and administrative agent for the grants awarded under this section. The Administration is authorized to carry out the program, in consultation with the Commission, which shall review reports on the development, implementation, and evaluation activities of the grant program, including--CommentsClose CommentsPermalink
(A) administering the grants;CommentsClose CommentsPermalink
(B) providing technical assistance to grantees; andCommentsClose CommentsPermalink
(C) reporting performance information to the Commission.CommentsClose CommentsPermalink
(c) Planning Grants-CommentsClose CommentsPermalink
(1) AMOUNT AND DURATION- A planning grant shall be awarded under this subsection for a period of not more than one year and the maximum award may not be more than $150,000.CommentsClose CommentsPermalink
(2) ELIGIBILITY- To be eligible to receive a planning grant, an entity shall be an eligible partnership. An eligible partnership shall be a State workforce investment board, if it includes or modifies the members to include at least one representative from each of the following: health care employer, labor organization, a public 2-year institution of higher education, a public 4-year institution of higher education, the recognized State federation of labor, the State public secondary education agency, the State P-16 or P-20 Council if such a council exists, and a philanthropic organization that is actively engaged in providing learning, mentoring, and work opportunities to recruit, educate, and train individuals for, and retain individuals in, careers in health care and related industries.CommentsClose CommentsPermalink
(3) FISCAL AND ADMINISTRATIVE AGENT- The Governor of the State receiving a planning grant has the authority to appoint a fiscal and an administrative agency for the partnership.CommentsClose CommentsPermalink
(4) APPLICATION- Each State partnership desiring a planning grant shall submit an application to the Administrator of the Administration at such time and in such manner, and accompanied by such information as the Administrator may reasonable require. Each application submitted for a planning grant shall describe the members of the State partnership, the activities for which assistance is sought, the proposed performance benchmarks to be used to measure progress under the planning grant, a budget for use of the funds to complete the required activities described in paragraph (5), and such additional assurance and information as the Administrator determines to be essential to ensure compliance with the grant program requirements.CommentsClose CommentsPermalink
(5) REQUIRED ACTIVITIES- A State partnership receiving a planning grant shall carry out the following:CommentsClose CommentsPermalink
(A) Analyze State labor market information in order to create health care career pathways for students and adults.CommentsClose CommentsPermalink
(B) Identify current and projected high demand State or regional health care sectors for purposes of planning career pathways.CommentsClose CommentsPermalink
(C) Identify existing Federal, State, and private resources to recruit, educate or train, and retain a skilled health care workforce and strengthen partnerships.CommentsClose CommentsPermalink
(D) Describe the academic and health care industry skill standards for high school graduation, for entry into postsecondary education, and for various credentials and licensure.CommentsClose CommentsPermalink
(E) Describe State secondary and postsecondary education and training policies, models, or practices for the health care sector, including career information and guidance counseling.CommentsClose CommentsPermalink
(F) Identify Federal or State policies or rules to developing a coherent and comprehensive health care workforce development strategy and barriers and a plan to resolve these barriers.CommentsClose CommentsPermalink
(G) Participate in the Administration’s evaluation and reporting activities.CommentsClose CommentsPermalink
(6) PERFORMANCE AND EVALUATION- Before the State partnership receives a planning grant, such partnership and the Administrator of the Administration shall jointly determine the performance benchmarks that will be established for the purposes of the planning grant.CommentsClose CommentsPermalink
(7) MATCH- Each State partnership receiving a planning grant shall provide an amount, in cash or in kind, that is not less that 15 percent of the amount of the grant, to carry out the activities supported by the grant. The matching requirement may be provided from funds available under other Federal, State, local or private sources to carry out the activities.CommentsClose CommentsPermalink
(8) REPORT-CommentsClose CommentsPermalink
(A) REPORT TO ADMINISTRATION- Not later than 1 year after a State partnership receives a planning grant, the partnership shall submit a report to the Administration on the State’s performance of the activities under the grant, including the use of funds, including matching funds, to carry out required activities, and a description of the progress of the State workforce investment board in meeting the performance benchmarks.CommentsClose CommentsPermalink
(B) REPORT TO CONGRESS- The Administration shall submit a report to Congress analyzing the planning activities, performance, and fund utilization of each State grant recipient, including an identification of promising practices and a profile of the activities of each State grant recipient.CommentsClose CommentsPermalink
(d) Implementation Grants-CommentsClose CommentsPermalink
(1) IN GENERAL- The Administration shall--CommentsClose CommentsPermalink
(A) competitively award implementation grants to State partnerships to enable such partnerships to implement activities that will result in a coherent and comprehensive plan for health workforce development that will address current and projected workforce demands within the State; andCommentsClose CommentsPermalink
(B) inform the Commission and Congress about the awards made.CommentsClose CommentsPermalink
(2) DURATION- An implementation grant shall be awarded for a period of no more than 2 years, except in those cases where the Administration determines that the grantee is high performing and the activities supported by the grant warrant up to 1 additional year of funding.CommentsClose CommentsPermalink
(3) ELIGIBILITY- To be eligible for an implementation grant, a State partnership shall have--CommentsClose CommentsPermalink
(A) received a planning grant under subsection (c) and completed all requirements of such grant; orCommentsClose CommentsPermalink
(B) completed a satisfactory application, including a plan to coordinate with required partners and complete the required activities during the 2 year period of the implementation grant.CommentsClose CommentsPermalink
(4) FISCAL AND ADMINISTRATIVE AGENT- A State partnership receiving an implementation grant shall appoint a fiscal and an administration agent for the implementation of such grant.CommentsClose CommentsPermalink
(5) APPLICATION- Each eligible State partnership desiring an implementation grant shall submit an application to the Administration at such time, in such manner, and accompanied by such information as the Administration may reasonably require. Each application submitted shall include--CommentsClose CommentsPermalink
(A) a description of the members of the State partnership;CommentsClose CommentsPermalink
(B) a description of how the State partnership completed the required activities under the planning grant, if applicable;CommentsClose CommentsPermalink
(C) a description of the activities for which implementation grant funds are sought, including grants to regions by the State partnership to advance coherent and comprehensive regional health care workforce planning activities;CommentsClose CommentsPermalink
(D) a description of how the State partnership will coordinate with required partners and complete the required partnership activities during the duration of an implementation grant.CommentsClose CommentsPermalink
(E) a budget proposal of the cost of the activities supported by the implementation grant and a timeline for the provision of matching funds required;CommentsClose CommentsPermalink
(F) proposed performance benchmarks to be used to assess and evaluate the progress of the partnership activities;CommentsClose CommentsPermalink
(G) a description of how the State partnership will collect data to report progress in grant activities; andCommentsClose CommentsPermalink
(H) such additional assurances as the Administration determines to be essential to ensure compliance with grant requirements.CommentsClose CommentsPermalink
(6) REQUIRED ACTIVITIES-CommentsClose CommentsPermalink
(A) IN GENERAL- A State partnership that receives an implementation grant may reserve not less than 60 percent of the grant funds to make grants to be competitively awarded by the State partnership, consistent with State procurement rules, to encourage regional partnerships to address health care workforce development needs and to promote innovative health care workforce career pathway activities, including career counseling, learning, and employment.CommentsClose CommentsPermalink
(B) ELIGIBLE PARTNERSHIP DUTIES- An eligible State partnership receiving an implementation grant shall--CommentsClose CommentsPermalink
(i) identify and convene regional leadership to discuss opportunities to engage in statewide health care workforce development planning, including potential use of grants to be competitively awarded by the State partnership to encourage innovative approaches to improving the supply, diversity, distribution, and development of regional health care workforces, including the alignment of curricula (and prerequisites) for health care careers, the expansion of and access to quality and timely career information and guidance, and education and training programs;CommentsClose CommentsPermalink
(ii) in consultation with key stakeholders and regional leaders, take appropriate steps to reduce Federal, State, or local barriers to a comprehensive and coherent strategy, including changes in State or local policies to foster coherent and comprehensive health care workforce development activities, including health care career pathways at the State and regional levels and career planning information, and as appropriate, requests for Federal program or administrative waivers;CommentsClose CommentsPermalink
(iii) develop and disseminate a preliminary statewide strategy that addresses short- and long-term health care workforce development supply versus demand, including the solicitation of comments or feedback from key stakeholders and the general public, and refine accordingly;CommentsClose CommentsPermalink
(iv) convene State partnership members on a regular basis, and at least on a semiannual basis;CommentsClose CommentsPermalink
(v) assist leaders at the regional level to form partnerships, including the provision of technical assistance and capacity building activities such as the dissemination of best practices and tools within the State;CommentsClose CommentsPermalink
(vi) collect and assess data on and report on the performance benchmarks selected by the State partnership and the Administration for implementation activities carried out by regional and State partnerships; andCommentsClose CommentsPermalink
(vii) participate in the Administration’s evaluation and reporting activities.CommentsClose CommentsPermalink
(7) PERFORMANCE AND EVALUATION- Before the State partnership receives an implementation grant, it and the Administrator shall jointly determine the performance benchmarks that shall be established for the purposes of the implementation grant.CommentsClose CommentsPermalink
(8) MATCH- Each State partnership receiving an implementation grant shall provide an amount, in cash or in kind that is not less than 25 percent of the amount of the grant, to carry out the activities supported by the grant. The matching funds may be provided from funds available from other Federal, State, local, or private sources to carry out such activities.CommentsClose CommentsPermalink
(9) REPORTS-CommentsClose CommentsPermalink
(A) REPORT TO ADMINISTRATION- For each year of the implementation grant, the State partnership receiving the implementation grant shall submit a report to the Administration on the performance of the State of the grant activities, including a description of the use of the funds, including matched funds, to complete activities, and a description of the performance of the State partnership in meeting the performance benchmarks.CommentsClose CommentsPermalink
(B) REPORT TO CONGRESS- The Administration shall submit a report to Congress analyzing implementation activities, performance, and fund utilization of the State grantees, including an identification of promising practices and a profile of the activities of each State grantee.CommentsClose CommentsPermalink
(e) Authorization for Appropriations-CommentsClose CommentsPermalink
(1) PLANNING GRANTS- There are authorized to be appropriated to award planning grants under subsection (c) $8,000,000 for fiscal year 2010, and such sums as may be necessary for each subsequent fiscal year.CommentsClose CommentsPermalink
(2) IMPLEMENTATION GRANTS- There are authorized to be appropriated to award implementation grants under subsection (d), $150,000,000 for fiscal year 2010, and such sums as may be necessary for each subsequent fiscal year.CommentsClose CommentsPermalink
SEC. 413. HEALTH CARE WORKFORCE PROGRAM ASSESSMENT.
(a) In General- Section 761 of the Public Health Service Act (
(1) by redesignating subsection (c) as subsection (e);CommentsClose CommentsPermalink
(2) by striking subsection (b) and inserting the following:CommentsClose CommentsPermalink
‘(b) National Center for Health Care Workforce Analysis-CommentsClose CommentsPermalink
‘(1) ESTABLISHMENT- The Secretary shall establish the National Center for Health Workforce Analysis (referred to in this section as the ‘National Center’).CommentsClose CommentsPermalink
‘(2) PURPOSES- The purposes of the National Center are to--CommentsClose CommentsPermalink
‘(A) provide for the development of information describing the health care workforce and the analysis of health care workforce related issues;CommentsClose CommentsPermalink
‘(B) carry out the activities under section 792(a); andCommentsClose CommentsPermalink
‘(C) collect, analyze, and report data related to programs under this title in coordination with the State and Regional Centers for Health Workforce Analysis described in subsection (c) (referred to in this section as the ‘State and Regional Centers’) and with the State agency responsible for the statewide employment statistics system under section 15(e) of the Wagner-Peyser Act (
29 U.S.C. 49l-2 ).CommentsClose CommentsPermalink‘(3) FUNCTIONS- The National Center shall, in coordination with the Commission established in section 411 of the Affordable Health Choices Act--CommentsClose CommentsPermalink
‘(A) annually evaluate the effectiveness of programs under this title;CommentsClose CommentsPermalink
‘(B) develop and publish benchmarks for performance for programs under this title;CommentsClose CommentsPermalink
‘(C) establish, maintain, and make publicly available through the Internet a national health workforce database to collect data from--CommentsClose CommentsPermalink
‘(i) longitudinal evaluations (as described in subsection (d)(2) on performance measures (as developed under sections 749(d)(3), 757(d)(3), and 762(a)(3)); andCommentsClose CommentsPermalink
‘(ii) the State and Regional Centers described in subsection (c); andCommentsClose CommentsPermalink
‘(D) and establish and maintain a registry of each grant awarded under this title.CommentsClose CommentsPermalink
‘(4) COLLABORATION AND DATA SHARING-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The National Center shall collaborate with Federal agencies, health professions education organizations, health professions organizations, and professional medical societies for the purpose of linking data regarding grants awarded under this title with 1 or more of the following:CommentsClose CommentsPermalink
‘(i) Data maintained by the Department of Health and Human Services and its various agencies.CommentsClose CommentsPermalink
‘(ii) Data maintained by the Bureau of Labor Statistics.CommentsClose CommentsPermalink
‘(iii) Data maintained by the Census Bureau.CommentsClose CommentsPermalink
‘(iv) Data maintained by the Departments of Defense and Veterans Affairs.CommentsClose CommentsPermalink
‘(v) Data sets maintained by health professions education organizations, health professions organizations, or professional medical societies.CommentsClose CommentsPermalink
‘(vi) Other data sets, as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(B) CONTRACTS FOR HEALTH WORKFORCE ANALYSIS- For the purpose of carrying out the activities described in subparagraph (A), the National Center may enter into contracts with health professions education organizations, health professions organizations, or professional medical societies.CommentsClose CommentsPermalink
‘(c) State and Regional Centers for Health Workforce Analysis-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall award grants to, or enter into contracts with, eligible entities for purposes of--CommentsClose CommentsPermalink
‘(A) collecting, analyzing, and reporting to the National Center data regarding programs under this title;CommentsClose CommentsPermalink
‘(B) conducting and broadly disseminating research and reports on State, regional, and national health workforce issues;CommentsClose CommentsPermalink
‘(C) evaluating the effectiveness of programs under this title; andCommentsClose CommentsPermalink
‘(D) providing technical assistance to local and regional entities on the collection, analysis, and reporting of data related to health workforce issues.CommentsClose CommentsPermalink
‘(2) ELIGIBLE ENTITIES- To be eligible for a grant or contract under this subsection, an entity shall--CommentsClose CommentsPermalink
‘(A) be a State (including a State Office of Rural Health), a State workforce investment board, a public health or health professions school, an academic health center (including an area health education center program), or an appropriate public or private nonprofit entity or a partnership of such entities, such as a community college system; andCommentsClose CommentsPermalink
‘(B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(d) Increase in Grants for Longitudinal Evaluations-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall increase the amount of a grant or contract awarded to an eligible entity under this title for the establishment and maintenance of a longitudinal evaluation of students, residents, fellows, interns, or faculty who have received education, training, or financial assistance from programs under this title.CommentsClose CommentsPermalink
‘(2) CAPABILITY- A longitudinal evaluation shall be capable of--CommentsClose CommentsPermalink
‘(A) studying participation in the National Health Service Corps, practice in federally qualified health centers, practice in health professional shortage areas and medically underserved areas, and practice in primary care; andCommentsClose CommentsPermalink
‘(B) collecting and reporting data on performance measures developed under sections 749(d)(3), 757(d)(3), and 762(a)(3).CommentsClose CommentsPermalink
‘(3) GUIDELINES- A longitudinal evaluation shall comply with guidelines issued under sections 749(d)(4), 757(d)(4), and 762(a)(4).CommentsClose CommentsPermalink
‘(4) ELIGIBLE ENTITIES- To be eligible to obtain an increase under this section, an entity shall be a recipient of a grant or contract under this title and have not previously received an increase under this section.’; andCommentsClose CommentsPermalink
(3) in subsection (e), as so redesignated--CommentsClose CommentsPermalink
(A) by striking paragraph (1) and inserting the following:CommentsClose CommentsPermalink
‘(1) IN GENERAL-CommentsClose CommentsPermalink
‘(A) NATIONAL CENTER FOR HEALTH WORKFORCE ANALYSIS- To carry out subsection (b), there are authorized to be appropriated $5,000,000 for each of fiscal years 2010 and 2011, $10,000,000 for each of fiscal years 2012 through 2014, and such sums as may be necessary for each subsequent fiscal year.CommentsClose CommentsPermalink
‘(B) STATE AND REGIONAL CENTERS- To carry out subsection (c), there are authorized to be appropriated $4,500,000 for each of fiscal years 2010 through 2014, and such sums as may be necessary for each subsequent fiscal year.CommentsClose CommentsPermalink
‘(C) GRANTS FOR LONGITUDINAL EVALUATIONS- To carry out subsection (d), there are authorized to be appropriated such sums as may be necessary for fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘(D) CARRYOVER FUNDS- An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years.’; andCommentsClose CommentsPermalink
(4) in paragraph (2), by striking ‘subsection (a)’ and inserting ‘paragraph (1)’.CommentsClose CommentsPermalink
(b) Transfer of Functions- Not later than 180 days after the date of enactment of this Act, all of the functions, authorities, and resources of the National Center for Health Workforce Analysis of the Health Resources and Services Administration, as in effect on the date before the date of enactment of this Act, shall be transferred to the National Center for Health Workforce Analysis established under section 761 of the Public Health Service Act, as amended by subsection (a).CommentsClose CommentsPermalink
(c) Priority for Use of Longitudinal Evaluations- Section 791(a)(1) of the Public Health Service Act (
(1) in subparagraph (A), by striking ‘or’ at the end;CommentsClose CommentsPermalink
(2) in subparagraph (B), by striking the period and inserting ‘; or’; andCommentsClose CommentsPermalink
(3) by adding at the end the following:CommentsClose CommentsPermalink
‘(C) utilizes a longitudinal evaluation (as described in section 761(d)(2)) and reports data from such system to the national workforce database (as established under section 761(b)(3)(D)).’.CommentsClose CommentsPermalink
(d) Performance Measures; Guidelines for Longitudinal Evaluations-CommentsClose CommentsPermalink
(1) ADVISORY COMMITTEE ON TRAINING IN PRIMARY CARE MEDICINE AND DENTISTRY- Section 748(d) of the Public Health Service Act is amended--CommentsClose CommentsPermalink
(A) in paragraph (1), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(B) in paragraph (2), by striking the period and inserting a semicolon; andCommentsClose CommentsPermalink
(C) by adding at the end the following:CommentsClose CommentsPermalink
‘(3) not later than 3 years after the date of enactment of the Affordable Health Choices Act, develop, publish, and implement performance measures, which shall be quantitative to the extent possible, for programs under this part;CommentsClose CommentsPermalink
‘(4) develop and publish guidelines for longitudinal evaluations (as described in section 761(d)(2)) for programs under this part; andCommentsClose CommentsPermalink
‘(5) recommend appropriation levels for programs under this part.’.CommentsClose CommentsPermalink
(2) ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES- Section 756(d) of the Public Health Service Act is amended--CommentsClose CommentsPermalink
(A) in paragraph (1), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(B) in paragraph (2), by striking the period and inserting a semicolon; andCommentsClose CommentsPermalink
(C) by adding at the end the following:CommentsClose CommentsPermalink
‘(3) not later than 3 years after the date of enactment of the Affordable Health Choices Act, develop, publish, and implement performance measures, which shall be quantitative to the extent possible, for programs under this part;CommentsClose CommentsPermalink
‘(4) develop and publish guidelines for longitudinal evaluations (as described in section 761(d)(2)) for programs under this part; andCommentsClose CommentsPermalink
‘(5) recommend appropriation levels for programs under this part.’.CommentsClose CommentsPermalink
(3) ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION- Section 762(a) of the Public Health Service Act (
(A) in paragraph (1), by striking ‘and’ at the end;CommentsClose CommentsPermalink
(B) in paragraph (2), by striking the period and inserting a semicolon; andCommentsClose CommentsPermalink
(C) by adding at the end the following:CommentsClose CommentsPermalink
‘(3) not later than 3 years after the date of enactment of the Affordable Health Choices Act develop, publish, and implement performance measures, which shall be quantitative to the extent possible, for programs under this title, except for programs under part C or D;CommentsClose CommentsPermalink
‘(4) develop and publish guidelines for longitudinal evaluations (as described in section 761(d)(2)) for programs under this title, except for programs under part C or D; andCommentsClose CommentsPermalink
‘(5) recommend appropriation levels for programs under this title, except for programs under part C or D.’.CommentsClose CommentsPermalink
Subtitle C--Increasing the Supply of the Health Care WorkforceCommentsClose CommentsPermalink
Subtitle C--Increasing the Supply of the Health Care WorkforceCommentsClose CommentsPermalink
SEC. 421. FEDERALLY SUPPORTED STUDENT LOAN FUNDS.
(a) Medical Schools and Primary Health Care- Section 723 of the Public Health Service Act (
(1) in subsection (a)--CommentsClose CommentsPermalink
(A) in paragraph (1), by striking subparagraph (B) and inserting the following:CommentsClose CommentsPermalink
‘(B) to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.’; andCommentsClose CommentsPermalink
(B) by striking paragraph (3) and inserting the following:CommentsClose CommentsPermalink
‘(3) NONCOMPLIANCE BY STUDENT- Each agreement entered into with a student pursuant to paragraph (1) shall provide that, if the student fails to comply with such agreement, the loan involved will begin to accrue interest at a rate of 2 percent per year greater than the rate at which the student would pay if compliant in such year.’; andCommentsClose CommentsPermalink
(2) by adding at the end the following:CommentsClose CommentsPermalink
‘(d) Sense of Congress- It is the sense of Congress that funds repaid under the loan program under this section should not be transferred to the Treasury of the United States or otherwise used for any other purpose other than to carry out this section.’.CommentsClose CommentsPermalink
(b) Student Loan Guidelines- The Secretary of Health and Human Services shall not require parental financial information for an independent student to determine financial need under section 723 of the Public Health Service Act (
SEC. 422. NURSING STUDENT LOAN PROGRAM.
(a) Loan Agreements- Section 836(a) of the Public Health Service Act (
(1) by striking ‘$2,500’ and inserting ‘$3,300’;CommentsClose CommentsPermalink
(2) by striking ‘$4,000’ and inserting ‘$5,200’; andCommentsClose CommentsPermalink
(3) by striking ‘$13,000’ and all that follows through the period and inserting ‘$17,000 in the case of any student during fiscal years 2010 and 2011. After fiscal year 2011, such amounts shall be adjusted to provide for a cost-of-attendance increase for the yearly loan rate and the aggregate of the loans.’.CommentsClose CommentsPermalink
(b) Loan Provisions- Section 836(b) of the Public Health Service Act (
(1) in paragraph (1)(C), by striking ‘1986’ and inserting ‘2000’; andCommentsClose CommentsPermalink
(2) in paragraph (3), by striking ‘the date of enactment of the Nurse Training Amendments of 1979’ and inserting ‘September 29, 1995’.CommentsClose CommentsPermalink
SEC. 423. HEALTH CARE WORKFORCE LOAN REPAYMENT PROGRAMS.
Part E of title VII of the Public Health Service Act (
‘Subpart 3--Recruitment and Retention Programs
‘SEC. 775. INVESTMENT IN TOMORROW’S PEDIATRIC HEALTH CARE WORKFORCE.
‘(a) Establishment- The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.CommentsClose CommentsPermalink
‘(b) Program Administration- Through the program established under this section, the Secretary shall enter into contracts with qualified health professionals under which--CommentsClose CommentsPermalink
‘(1) such qualified health professionals will agree to provide pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care in an area with a shortage of the specified pediatric subspecialty that has a sufficient pediatric population to support such pediatric subspecialty, as determined by the Secretary; andCommentsClose CommentsPermalink
‘(2) the Secretary agrees to make payments on the principal and interest of undergraduate, graduate, or graduate medical education loans of professionals described in paragraph (1) of not more than $35,000 a year for each year of agreed upon service under such paragraph for a period of not more than 3 years during the qualified health professional’s--CommentsClose CommentsPermalink
‘(A) participation in an accredited pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental health subspecialty residency or fellowship; orCommentsClose CommentsPermalink
‘(B) employment as a pediatric medical subspecialist, pediatric surgical specialist, or child and adolescent mental health professional serving an area or population described in such paragraph.CommentsClose CommentsPermalink
‘(c) In General-CommentsClose CommentsPermalink
‘(1) ELIGIBLE INDIVIDUALS-CommentsClose CommentsPermalink
‘(A) PEDIATRIC MEDICAL SPECIALISTS AND PEDIATRIC SURGICAL SPECIALISTS- For purposes of contracts with respect to pediatric medical specialists and pediatric surgical specialists, the term ‘qualified health professional’ means a licensed physician who--CommentsClose CommentsPermalink
‘(i) is entering or receiving training in an accredited pediatric medical subspecialty or pediatric surgical specialty residency or fellowship; orCommentsClose CommentsPermalink
‘(ii) has completed (but not prior to the end of the calendar year in which this section is enacted) the training described in subparagraph (B).CommentsClose CommentsPermalink
‘(B) CHILD AND ADOLESCENT MENTAL AND BEHAVIORAL HEALTH- For purposes of contracts with respect to child and adolescent mental and behavioral health care, the term ‘qualified health professional’ means a health care professional who--CommentsClose CommentsPermalink
‘(i) has received specialized training or clinical experience in child and adolescent mental health in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance abuse disorder prevention and treatment, marriage and family therapy, school counseling, or professional counseling;CommentsClose CommentsPermalink
‘(ii) has a license or certification in a State to practice allopathic medicine, osteopathic medicine, psychology, school psychology, psychiatric nursing, social work, school social work, marriage and family therapy, school counseling, or professional counseling; orCommentsClose CommentsPermalink
‘(iii) is a mental health service professional who completed (but not before the end of the calendar year in which this section is enacted) specialized training or clinical experience in child and adolescent mental health described in clause (i).CommentsClose CommentsPermalink
‘(2) ADDITIONAL ELIGIBILITY REQUIREMENTS- The Secretary may not enter into a contract under this subsection with an eligible individual unless--CommentsClose CommentsPermalink
‘(A) the individual agrees to work in, or for a provider serving, a health professional shortage area or medically underserved area, or to serve a medically underserved population;CommentsClose CommentsPermalink
‘(B) the individual is a United States citizen or a permanent legal United States resident; andCommentsClose CommentsPermalink
‘(C) if the individual is enrolled in a graduate program, the program is accredited, and the individual has an acceptable level of academic standing (as determined by the Secretary).CommentsClose CommentsPermalink
‘(d) Priority- In entering into contracts under this subsection, the Secretary shall give priority to applicants who--CommentsClose CommentsPermalink
‘(1) are or will be working in a school or other pre-kindergarten, elementary, or secondary education setting;CommentsClose CommentsPermalink
‘(2) have familiarity with evidence-based methods and cultural and linguistic competence health care services; andCommentsClose CommentsPermalink
‘(3) demonstrate financial need.CommentsClose CommentsPermalink
‘(e) Authorization of Appropriations- There is authorized to be appropriated $30,000,000 for each of fiscal years 2010 through 2014 to carry out subsection (c)(1)(A) and $20,000,000 for each of fiscal years 2010 through 2013 to carry out subsection (c)(1)(B).’.CommentsClose CommentsPermalink
SEC. 424. PUBLIC HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.
Part E of title VII of the Public Health Service Act (
‘SEC. 776. PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM.
‘(a) Establishment- The Secretary shall establish the Public Health Workforce Loan Repayment Program (referred to in this section as the ‘Program’) to assure an adequate supply of public health professionals to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies.CommentsClose CommentsPermalink
‘(b) Eligibility- To be eligible to participate in the Program, an individual shall--CommentsClose CommentsPermalink
‘(1)(A) be accepted for enrollment, or be enrolled, as a student in an accredited academic educational institution in a State or territory in the final year of a course of study or program leading to a public health or health professions degree or certificate; and have accepted employment with a Federal, State, local, or tribal public health agency, or a related training fellowship, as recognized by the Secretary, to commence upon graduation;CommentsClose CommentsPermalink
‘(B)(i) have graduated, during the preceding 10-year period, from an accredited educational institution in a State or territory and received a public health or health professions degree or certificate; andCommentsClose CommentsPermalink
‘(ii) be employed by, or have accepted employment with, a Federal, State, local, or tribal public health agency or a related training fellowship, as recognized by the Secretary;CommentsClose CommentsPermalink
‘(2) be a United States citizen; andCommentsClose CommentsPermalink
‘(3)(A) submit an application to the Secretary to participate in the Program;CommentsClose CommentsPermalink
‘(B) execute a written contract as required in subsection (c); andCommentsClose CommentsPermalink
‘(4) not have received, for the same service, a reduction of loan obligations under section 455(m), 428J, 428K, 428L, or 460 of the Higher Education Act of 1965.CommentsClose CommentsPermalink
‘(c) Contract- The written contract (referred to in this section as the ‘written contract’) between the Secretary and an individual shall contain--CommentsClose CommentsPermalink
‘(1) an agreement on the part of the Secretary that the Secretary will repay on behalf of the individual loans incurred by the individual in the pursuit of the relevant degree or certificate in accordance with the terms of the contract;CommentsClose CommentsPermalink
‘(2) an agreement on the part of the individual that the individual will serve in the full-time employment of a Federal, State, local, or tribal public health agency or a related fellowship program in a position related to the course of study or program for which the contract was awarded for a period of time (referred to in this section as the ‘period of obligated service’) equal to the greater of--CommentsClose CommentsPermalink
‘(A) 3 years; orCommentsClose CommentsPermalink
‘(B) such longer period of time as determined appropriate by the Secretary and the individual;CommentsClose CommentsPermalink
‘(3) an agreement, as appropriate, on the part of the individual to relocate to a priority service area (as determined by the Secretary) in exchange for an additional loan repayment incentive amount to be determined by the Secretary;CommentsClose CommentsPermalink
‘(4) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual that is conditioned thereon, is contingent on funds being appropriated for loan repayments under this section;CommentsClose CommentsPermalink
‘(5) a statement of the damages to which the United States is entitled, under this section for the individual’s breach of the contract; andCommentsClose CommentsPermalink
‘(6) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section.CommentsClose CommentsPermalink
‘(d) Payments-CommentsClose CommentsPermalink
‘(1) IN GENERAL- A loan repayment provided for an individual under a written contract under the Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for tuition expenses incurred by the individual.CommentsClose CommentsPermalink
‘(2) PAYMENTS FOR YEARS SERVED- For each year of obligated service that an individual contracts to serve under subsection (c) the Secretary may pay up to $35,000 on behalf of the individual for loans described in paragraph (1). With respect to participants under the Program whose total eligible loans are less than $105,000, the Secretary shall pay an amount that does not exceed 1/3 of the eligible loan balance for each year of obligated service of the individual.CommentsClose CommentsPermalink
‘(3) TAX LIABILITY- For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual, the Secretary shall, in addition to such payments, make payments to the individual in an amount not to exceed 39 percent of the total amount of loan repayments made for the taxable year involved.CommentsClose CommentsPermalink
‘(e) Postponing Obligated Service- With respect to an individual receiving a degree or certificate from a health professions or other related school, the date of the initiation of the period of obligated service may be postponed as approved by the Secretary.CommentsClose CommentsPermalink
‘(f) Breach of Contract- An individual who fails to comply with the contract entered into under subsection (c) shall be subject to the same financial penalties as provided for under section 338E for breaches of loan repayment contracts under section 338B.CommentsClose CommentsPermalink
‘(g) Authorization of Appropriations- There is authorized to be appropriated to carry out this section $195,000,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2015.’.CommentsClose CommentsPermalink
SEC. 425. ALLIED HEALTH WORKFORCE RECRUITMENT AND RETENTION PROGRAMS.
(a) Purpose- The purpose of this section is to assure an adequate supply of allied health professionals to eliminate critical allied health workforce shortages in Federal, State, local, and tribal public health agencies or in settings where patients might require health care services, including acute care facilities, ambulatory care facilities, personal residences and other settings, as recognized by the Secretary of Health and Human Services by authorizing an Allied Health Loan Forgiveness Program.CommentsClose CommentsPermalink
(b) Allied Health Workforce Recruitment and Retention Program- Section 428K of the Higher Education Act of 1965 (
(1) in subsection (b), by adding at the end the following:CommentsClose CommentsPermalink
‘(18) ALLIED HEALTH PROFESSIONALS- The individual is employed full-time as an allied health professional--CommentsClose CommentsPermalink
‘(A) in a Federal, State, local, or tribal public health agency; orCommentsClose CommentsPermalink
‘(B) in a setting where patients might require health care services, including acute care facilities, ambulatory care facilities, personal residences and other settings located in health professional shortage areas, medically underserved areas, or medically underserved populations, as recognized by the Secretary of Health and Human Services.’; andCommentsClose CommentsPermalink
(2) in subsection (g)--CommentsClose CommentsPermalink
(A) by redesignating paragraphs (1) through (9) as paragraphs (2) through (10), respectively; andCommentsClose CommentsPermalink
(B) by inserting before paragraph (2) (as redesignated by subparagraph (A)) the following:CommentsClose CommentsPermalink
‘(1) ALLIED HEALTH PROFESSIONAL- The term ‘allied health professional’ means an allied health professional as defined in section 799B(5) of the Public Heath Service Act (
42 U.S.C. 295p(5) ) who--CommentsClose CommentsPermalink
‘(A) has graduated and received an allied health professions degree or certificate from an institution of higher education; andCommentsClose CommentsPermalink
‘(B) is employed with a Federal, State, local or tribal public health agency, or in a setting where patients might require health care services, including acute care facilities, ambulatory care facilities, personal residences and other settings located in health professional shortage areas, medically underserved areas, or medically underserved populations, as recognized by the Secretary of Health and Human Services.’.CommentsClose CommentsPermalink
SEC. 426. GRANTS FOR STATE AND LOCAL PROGRAMS.
(a) In General- Section 765(d) of the Public Health Service Act (
(1) in paragraph (7), by striking ‘; or’ and inserting a semicolon;CommentsClose CommentsPermalink
(2) by redesignating paragraph (8) as paragraph (9); andCommentsClose CommentsPermalink
(3) by inserting after paragraph (7) the following:CommentsClose CommentsPermalink
‘(8) public health workforce loan repayment programs; or’.CommentsClose CommentsPermalink
(b) Training for Mid-career Public Health Professionals- Part E of title VII of the Public Health Service Act (
‘SEC. 777. TRAINING FOR MID-CAREER PUBLIC AND ALLIED HEALTH PROFESSIONALS.
‘(a) In General- The Secretary may make grants to, or enter into contracts with, any eligible entity to award scholarships to eligible individuals to enroll in degree or professional training programs for the purpose of enabling mid-career professionals in the public health and allied health workforce to receive additional training in the field of public health and allied health.CommentsClose CommentsPermalink
‘(b) Eligibility-CommentsClose CommentsPermalink
‘(1) ELIGIBLE ENTITY- The term ‘eligible entity’ indicates an accredited educational institution that offers a course of study, certificate program, or professional training program in public or allied health or a related discipline, as determined by the SecretaryCommentsClose CommentsPermalink
‘(2) ELIGIBLE INDIVIDUALS- The term ‘eligible individuals’ includes those individuals employed in public and allied health positions at the Federal, State, tribal, or local level who are interested in retaining or upgrading their education.CommentsClose CommentsPermalink
‘(c) Authorization of Appropriations- There is authorized to be appropriated to carry out this section, $60,000,000 for fiscal year 2010 and such sums as may be necessary for each of fiscal years 2011 through 2015. Fifty percent of appropriated funds shall be allotted to public health mid-career professionals and 50 percent shall be allotted to allied health mid-career professionals.’.CommentsClose CommentsPermalink
SEC. 427. FUNDING FOR NATIONAL HEALTH SERVICE CORPS.
Section 338H(a) of the Public Health Service Act (
‘(a) Authorization of Appropriations- For the purpose of carrying out this section, there is authorized to be appropriated, out of any funds in the Treasury not otherwise appropriated, the following:CommentsClose CommentsPermalink
‘(1) For fiscal year 2010, $320,461,632.CommentsClose CommentsPermalink
‘(2) For fiscal year 2011, $414,095,394.CommentsClose CommentsPermalink
‘(3) For fiscal year 2012, $535,087,442.CommentsClose CommentsPermalink
‘(4) For fiscal year 2013, $691,431,432.CommentsClose CommentsPermalink
‘(5) For fiscal year 2014, $893,456,433.CommentsClose CommentsPermalink
‘(6) For fiscal year 2015, $1,154,510,336.CommentsClose CommentsPermalink
‘(7) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of--CommentsClose CommentsPermalink
‘(A) one plus the average percentage increase in the costs of health professions education during the prior fiscal year; andCommentsClose CommentsPermalink
‘(B) one plus the average percentage change in the number of individuals residing in health professions shortage areas designated under section 333 during the prior fiscal year, relative to the number of individuals residing in such areas during the previous fiscal year.’. [Struck out->]
[ NOTE: this section is the same as section 173 of title I. ][<-Struck out]CommentsClose CommentsPermalink
SEC. 428. NURSE-MANAGED HEALTH CLINICS.
(a) Purpose- The purpose of this section is to fund the development and operation of nurse-managed health clinics in order to provide comprehensive primary health care and wellness services to vulnerable populations living in the Nation’s medically underserved communities, and to reduce the level of health disparities experienced by vulnerable populations.CommentsClose CommentsPermalink
(b) Grants- Subpart 1 of part D of title III of the Public Health Service Act (
‘SEC. 330A-1. GRANTS TO NURSE-MANAGED HEALTH CLINICS.
‘(a) Definitions-CommentsClose CommentsPermalink
‘(1) COMPREHENSIVE PRIMARY HEALTH CARE SERVICES- In this section, the term ‘comprehensive primary health care services’ means the primary health services described in section 330(b)(1).CommentsClose CommentsPermalink
‘(2) NURSE-MANAGED HEALTH CLINIC- The term ‘nurse-managed health clinic’ means a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school, college, university or department of nursing, federally qualified health center, or independent nonprofit health or social services agency.CommentsClose CommentsPermalink
‘(b) Authority to Award Grants- The Secretary shall award grants for the cost of the operation of nurse-managed health clinics that meet the requirements of this section.CommentsClose CommentsPermalink
‘(c) Applications- To be eligible to receive a grant under this section, an entity shall--CommentsClose CommentsPermalink
‘(1) be an NMHC; andCommentsClose CommentsPermalink
‘(2) submit to the Secretary an application at such time, in such manner, and containing--CommentsClose CommentsPermalink
‘(A) assurances that nurses are the major providers of services at the NMHC and that at least 1 advanced practice nurse holds an executive management position within the organizational structure of the NMHC;CommentsClose CommentsPermalink
‘(B) an assurance that the NMHC will continue providing comprehensive primary health care services or wellness services without regard to income or insurance status of the patient for the duration of the grant period; andCommentsClose CommentsPermalink
‘(C) an assurance that, not later than 90 days of receiving a grant under this section, the NMHC will establish a community advisory committee, for which a majority of the members shall be individuals who are served by the NMHC.CommentsClose CommentsPermalink
‘(d) Grant Amount- The amount of any grant made under this section for any fiscal year shall be determined by the Secretary, taking into account--CommentsClose CommentsPermalink
‘(1) the financial need of the NMHC, considering State, local, and other operational funding provided to the NMHC; andCommentsClose CommentsPermalink
‘(2) other factors, as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(e) Authorization of Appropriations- For the purposes of carrying out this section, there are authorized to be appropriated $50,000,000 for the fiscal year 2010 and such sums as may be necessary for each of the fiscal years 2011 through 2014.’.CommentsClose CommentsPermalink
SEC. 429. ELIMINATION OF CAP ON COMMISSIONED CORPS.
Section 202 of the Department of Health and Human Services Appropriations Act, 1993 (
SEC. 430. ESTABLISHING A READY RESERVE CORPS.
Section 203 of the Public Health Service Act (
‘SEC. 203. COMMISSIONED CORPS AND READY RESERVE CORPS.
‘(a) Establishment-CommentsClose CommentsPermalink
‘(1) IN GENERAL- There shall be in the Service a commissioned Regular Corps and a Ready Reserve Corps for service in time of national emergency.CommentsClose CommentsPermalink
‘(2) REQUIREMENT- All commissioned officers shall be citizens of the United States and shall be appointed without regard to the civil-service laws and compensated without regard to the Classification Act of 1923, as amended.CommentsClose CommentsPermalink
‘(3) APPOINTMENT- Commissioned officers of the Ready Reserve Corps shall be appointed by the President and commissioned officers of the Regular Corps shall be appointed by the President with the advice and consent of the Senate.CommentsClose CommentsPermalink
‘(4) ACTIVE DUTY- Commissioned officers of the Ready Reserve Corps shall at all times be subject to call to active duty by the Surgeon General, including active duty for the purpose of training.CommentsClose CommentsPermalink
‘(5) WARRANT OFFICERS- Warrant officers may be appointed to the Service for the purpose of providing support to the health and delivery systems maintained by the Service and any warrant officer appointed to the Service shall be considered for purposes of this Act and title 37, United States Code, to be a commissioned officer within the Commissioned Corps of the Service.CommentsClose CommentsPermalink
‘(b) Assimilating Reserve Corp Officers Into the Regular Corps- Effective on the date of enactment of the Affordable Health Choices Act, all individuals classified as officers in the Reserve Corps under this section (as such section existed on the day before the date of enactment of such Act) and serving on active duty shall be deemed to be commissioned officers of the Regular Corps.CommentsClose CommentsPermalink
‘(c) Purpose and Use of Ready Research-CommentsClose CommentsPermalink
‘(1) PURPOSE- The purpose of the Ready Reserve Corps is to fulfill the need to have additional Commissioned Corps personnel available on short notice (similar to the uniformed service’s reserve program) to assist regular Commissioned Corps personnel to meet both routine public health and emergency response missions.CommentsClose CommentsPermalink
‘(2) USES- The Ready Reserve Corps shall--CommentsClose CommentsPermalink
‘(A) participate in routine training to meet the general and specific needs of the Commissioned Corps;CommentsClose CommentsPermalink
‘(B) be available and ready for involuntary calls to active duty during national emergencies and public health crises, similar to the uniformed service reserve personnel;CommentsClose CommentsPermalink
‘(C) be available for backfilling critical positions left vacant during deployment of active duty Commissioned Corps members, as well as for deployment to respond to public health emergencies, both foreign and domestic; andCommentsClose CommentsPermalink
‘(D) be available for service assignment in isolated, hardship, and medically underserved communities (as defined in section 799B) to improve access to health services.CommentsClose CommentsPermalink
‘(d) Funding- For the purpose of carrying out the duties and responsibilities of the Commissioned Corps under this section, there are authorized to be appropriated $5,000,000 for each of fiscal years 2010 through 2014 for recruitment and training and $12,500,000 for each of fiscal years 2010 through 2014 for the Ready Reserve Corps.’.CommentsClose CommentsPermalink
Subtitle D--Enhancing Health Care Workforce Education and TrainingCommentsClose CommentsPermalink
Subtitle D--Enhancing Health Care Workforce Education and TrainingCommentsClose CommentsPermalink
SEC. 431. TRAINING IN FAMILY MEDICINE, GENERAL INTERNAL MEDICINE, GENERAL PEDIATRICS, AND PHYSICIAN ASSISTANTSHIP.
Part C of title VII (
‘SEC. 747. PRIMARY CARE TRAINING AND ENHANCEMENT.
‘(a) Support and Development of Primary Care Training Programs-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary may make grants to, or enter into contracts with, an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, academically affiliated physician assistant training program, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract--CommentsClose CommentsPermalink
‘(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program in the field of family medicine, general internal medicine, or general pediatrics for medical students, interns, residents, or practicing physicians as defined by the Secretary;CommentsClose CommentsPermalink
‘(B) to provide need-based financial assistance in the form of traineeships and fellowships to medical students, interns, residents, practicing physicians, or other medical personnel, who are participants in any such program, and who plan to specialize or work in the practice of the fields defined in subparagraph (A);CommentsClose CommentsPermalink
‘(C) to plan, develop, and operate a program for the training of physicians who plan to teach in family medicine, general internal medicine, or general pediatrics training programs;CommentsClose CommentsPermalink
‘(D) to plan, develop, and operate a program for the training of physicians teaching in community-based settings;CommentsClose CommentsPermalink
‘(E) to provide financial assistance in the form of traineeships and fellowships to physicians who are participants in any such programs and who plan to teach or conduct research in a family medicine, general internal medicine, or general pediatrics training program;CommentsClose CommentsPermalink
‘(F) to plan, develop, and operate a physician assistant education program, and for the training of individuals who will teach in programs to provide such training;CommentsClose CommentsPermalink
‘(G) to plan, develop, and operate a demonstration program that provides training in new competencies, as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in section 411 of the Affordable Health Choices Act, which may include--CommentsClose CommentsPermalink
‘(i) providing training to primary care physicians relevant to providing care through patient-centered medical homes (as defined by the Secretary for purposes of this section);CommentsClose CommentsPermalink
‘(ii) developing tools and curricula relevant to patient-centered medical homes; andCommentsClose CommentsPermalink
‘(iii) providing continuing education to primary care physicians relevant to patient-centered medical homes; andCommentsClose CommentsPermalink
‘(H) to plan, develop, and operate joint degree programs to provide interdisciplinary and interprofessional graduate training in public health and other health professions to provide training in environmental health, infectious disease control, disease prevention and health promotion, epidemiological studies and injury control.CommentsClose CommentsPermalink
‘(2) DURATION OF AWARDS- The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.CommentsClose CommentsPermalink
‘(b) Capacity Building in Primary Care-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary may make grants to or enter into contracts with accredited schools of medicine or osteopathic medicine to establish, maintain, or improve--CommentsClose CommentsPermalink
‘(A) academic units (which may be departments, divisions, or other units) or programs that improve clinical teaching and research in fields defined in subsection (a)(1)(A); orCommentsClose CommentsPermalink
‘(B) programs that integrate academic administrative units in fields defined in subsection (a)(1)(A) to enhance interdisciplinary recruitment, training, and faculty development.CommentsClose CommentsPermalink
‘(2) PREFERENCE IN MAKING AWARDS UNDER THIS SUBSECTION- In making awards of grants and contracts under paragraph (1), the Secretary shall give preference to any qualified applicant for such an award that agrees to expend the award for the purpose of--CommentsClose CommentsPermalink
‘(A) establishing academic units or programs in fields defined in subsection (a)(1)(A); orCommentsClose CommentsPermalink
‘(B) substantially expanding such units or programs.CommentsClose CommentsPermalink
‘(3) PRIORITIES IN MAKING AWARDS- In awarding grants or contracts under paragraph (1), the Secretary shall give priority to qualified applicants that--CommentsClose CommentsPermalink
‘(A) proposes a collaborative project between academic administrative units of primary care;CommentsClose CommentsPermalink
‘(B) proposes innovative approaches to clinical teaching using models of primary care, such as the patient centered medical home, team management of chronic disease, and interprofessional integrated models of health care that incorporate transitions in health care settings and integration physical and mental health provision;CommentsClose CommentsPermalink
‘(C) have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers trained, who enter and remain in primary care practice;CommentsClose CommentsPermalink
‘(D) have a record of training individuals who are from underrepresented minority groups or from a rural or disadvantaged background;CommentsClose CommentsPermalink
‘(E) provide training in the care of vulnerable populations such as children, older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance-related disorders, individuals with HIV/AIDS, and individuals with disabilities;CommentsClose CommentsPermalink
‘(F) establish formal relationships and submit joint applications with federally qualified health centers, rural health clinics, area health education centers, or clinics located in underserved areas or that serve underserved populations;CommentsClose CommentsPermalink
‘(G) teach trainees the skills to provide interprofessional, integrated care through collaboration among health professionals;CommentsClose CommentsPermalink
‘(H) provide training in enhanced communication with patients, evidence-based practice, chronic disease management, preventive care, health information technology, or other competencies as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in section 411 of the Affordable Health Choices Act; orCommentsClose CommentsPermalink
‘(I) provide training in cultural competency and health literacy.CommentsClose CommentsPermalink
‘(4) DURATION OF AWARDS- The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.CommentsClose CommentsPermalink
‘(c) Authorization of Appropriations-CommentsClose CommentsPermalink
‘(1) IN GENERAL- For purposes of carrying out this section (other than subsection (b)(1)(B)), there are authorized to be appropriated $125,000,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2014.CommentsClose CommentsPermalink
‘(2) TRAINING PROGRAMS- Fifteen percent of the amount appropriated pursuant to paragraph (1) in each such fiscal year shall be allocated to the physician assistant training programs described in subsection (a)(1)(F), which prepare students for practice in primary care.CommentsClose CommentsPermalink
‘(3) INTEGRATING ACADEMIC ADMINISTRATIVE UNITS- For purposes of carrying out subsection (b)(1)(B), there are authorized to be appropriated $750,000 for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
SEC. 432. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.
Part C of title VII of the Public Health Service Act (
‘SEC. 747A. TRAINING OPPORTUNITIES FOR DIRECT CARE WORKERS.
‘(a) In General- The Secretary shall award grants to eligible entities to enable such entities to provide new training opportunities for direct care workers who are employed in long-term care settings such as nursing homes (as defined in section 1908(e)(1) of the Social Security Act (
42 U.S.C. 1396g(e)(1) ), assisted living facilities and skilled nursing facilities, intermediate care facilities for individuals with mental retardation, home and community based settings, and any other setting the Secretary determines to be appropriate.CommentsClose CommentsPermalink‘(b) Eligibility- To be eligible to receive a grant under this section, an entity shall--CommentsClose CommentsPermalink
‘(1) be an institution of higher education (as defined in section 102 of the Higher Education Act of 1965 (
20 U.S.C. 1002 )) that--CommentsClose CommentsPermalink
‘(A) is accredited by a nationally recognized accrediting agency or association listed under section 101(c) of the Higher Education Act of 1965 (
20 U.S.C. 1001(c) ); andCommentsClose CommentsPermalink‘(B) has established a public-private educational partnership with a nursing home or skilled nursing facility, agency or entity providing home and community based services to individuals with disabilities, or other long-term care provider; andCommentsClose CommentsPermalink
‘(2) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(c) Use of Funds- An eligible entity shall use amounts awarded under a grant under this section to provide assistance to eligible individuals to offset the cost of tuition and required fees for enrollment in academic programs provided by such entity.CommentsClose CommentsPermalink
‘(d) Eligible Individual-CommentsClose CommentsPermalink
‘(1) ELIGIBILITY- To be eligible for assistance under this section, an individual shall be enrolled in courses provided by a grantee under this subsection and maintain satisfactory academic progress in such courses.CommentsClose CommentsPermalink
‘(2) CONDITION OF ASSISTANCE- As a condition of receiving assistance under this section, an individual shall agree that, following completion of the assistance period, the individual will work in the field of geriatrics, disability services, long term services and supports, or chronic care management for a minimum of 2 years under guidelines set by the Secretary.CommentsClose CommentsPermalink
‘(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section, $10,000,000 for the period of fiscal years 2011 through 2013.’.CommentsClose CommentsPermalink
SEC. 433. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTRY.
Part C of Title VII of the Public Health Service Act (
(1) redesignating section 748, as amended by section 413 of this Act, as section 749; andCommentsClose CommentsPermalink
(2) inserting after section 747A, as added by section 432, the following:CommentsClose CommentsPermalink
‘SEC. 748. TRAINING IN GENERAL, PEDIATRIC, AND PUBLIC HEALTH DENTISTRY.
‘(a) Support and Development of Dental Training Programs-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary may make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital, or a public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract--CommentsClose CommentsPermalink
‘(A) to plan, develop, and operate, or participate in, an approved professional training program in the field of general dentistry, pediatric dentistry, or public health dentistry for dental students, residents, practicing dentists, dental hygienists, or other approved primary care dental trainees, that emphasizes training for general, pediatric, or public health dentistry;CommentsClose CommentsPermalink
‘(B) to provide financial assistance to dental students, residents, practicing dentists, and dental hygiene students who are in need thereof, who are participants in any such program, and who plan to work in the practice of general, pediatric, public heath dentistry, or dental hygiene;CommentsClose CommentsPermalink
‘(C) to plan, develop, and operate a program for the training of oral health care providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene;CommentsClose CommentsPermalink
‘(D) to provide financial assistance in the form of traineeships and fellowships to dentists who plan to teach or are teaching in general, pediatric, or public health dentistry;CommentsClose CommentsPermalink
‘(E) to meet the costs of projects to establish, maintain, or improve dental faculty development programs in primary care (which may be departments, divisions or other units);CommentsClose CommentsPermalink
‘(F) to meet the costs of projects to establish, maintain, or improve predoctoral and postdoctoral training in primary care programs;CommentsClose CommentsPermalink
‘(G) to create a loan repayment program for faculty in dental programs; andCommentsClose CommentsPermalink
‘(H) to provide technical assistance to pediatric training programs in developing and implementing instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all pediatric populations with an emphasis on underserved children.CommentsClose CommentsPermalink
‘(2) FACULTY LOAN REPAYMENT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- A grant or contract under subsection (a)(1)(G) may be awarded to a program of general, pediatric, or public health dentistry described in such subsection to plan, develop, and operate a loan repayment program under which--CommentsClose CommentsPermalink
‘(i) individuals agree to serve full-time as faculty members; andCommentsClose CommentsPermalink
‘(ii) the program of general, pediatric or public health dentistry agrees to pay the principal and interest on the outstanding student loans of the individuals.CommentsClose CommentsPermalink
‘(B) MANNER OF PAYMENTS- With respect to the payments described in subparagraph (A)(ii), upon completion by an individual of each of the first, second, third, fourth, and fifth years of service, the program shall pay an amount equal to 10, 15, 20, 25, and 30 percent, respectively, of the individual’s student loan balance as calculated based on principal and interest owed at the initiation of the agreement.CommentsClose CommentsPermalink
‘(b) Eligible Entity- For purposes of this subsection, entities eligible for such grants or contracts in general, pediatric, or public health dentistry shall include entities that have programs in dental or dental hygiene schools, or approved residency or advanced education programs in the practice of general, pediatric, or public health dentistry. Eligible entities may partner with schools of public health to permit the education of dental students, residents, and dental hygiene students for a master’s year in public health at a school of public health.CommentsClose CommentsPermalink
‘(c) Priorities in Making Awards- With respect to training provided for under this section, the Secretary shall give priority in awarding grants or contracts to the following:CommentsClose CommentsPermalink
‘(1) Qualified applicants that propose collaborative projects between departments of primary care medicine and departments of general, pediatric, or public health dentistry.CommentsClose CommentsPermalink
‘(2) Qualified applicants that have a record of training the greatest percentage of providers, or that have demonstrated significant improvements in the percentage of providers, who enter and remain in general, pediatric, or public health dentistry.CommentsClose CommentsPermalink
‘(3) Qualified applicants that have a record of training individuals who are from a rural or disadvantaged background, or from underrepresented minorities.CommentsClose CommentsPermalink
‘(4) Qualified applicants that establish formal relationships with Federally qualified health centers, rural health centers, or accredited teaching facilities and that conduct training of students, residents, fellows, or faculty at the center or facility.CommentsClose CommentsPermalink
‘(5) Qualified applicants that conduct teaching programs targeting vulnerable populations such as older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance-related disorders, individuals with disabilities, and individuals with HIV/AIDS.CommentsClose CommentsPermalink
‘(6) Qualified applicants that include educational activities in cultural competency and health literacy.CommentsClose CommentsPermalink
‘(7) Qualified applicants that provide instruction regarding the oral health status, dental care needs, and risk-based clinical disease management of all populations, with an emphasis on underserved children.CommentsClose CommentsPermalink
‘(8) Qualified applicants that intend to establish a special populations oral health care education center or training program for the didactic and clinical education of dentists, dental health professionals, and dental hygienists who plan to teach oral health care for people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and vulnerable elderly.CommentsClose CommentsPermalink
‘(d) Preference in Making Awards- In making awards of grants or contracts under this section, the Secretary shall give preference to any qualified applicant that--CommentsClose CommentsPermalink
‘(1) has a high rate for placing graduates in practice settings having the principal focus of serving in underserved areas or health disparity populations (including serving patients eligible for Medicaid or the Children’s Health Insurance Program, or those with special health care needs); orCommentsClose CommentsPermalink
‘(2) during the 2-year period before the fiscal year for which such an award is sought, has achieved a significant increase in the rate of placing graduates in such settings or graduating practitioners who serve health disparity populations in their practices.CommentsClose CommentsPermalink
‘(e) Application- An eligible entity desiring a grant under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(f) Duration of Award- The period during which payments are made to an entity from an award of a grant or contract under subsection (a) shall be 5 years. The provision of such payments shall be subject to annual approval by the Secretary and subject to the availability of appropriations for the fiscal year involved to make the payments.CommentsClose CommentsPermalink
‘(g) Authorizations of Appropriations- For the purpose of carrying out subsections (a) and (b), there is authorized to be appropriated $30,000,000 for fiscal year 2010 and such sums as may be necessary for each of fiscal years 2011 through 2015.CommentsClose CommentsPermalink
‘(h) Carryover Funds- An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years.’.CommentsClose CommentsPermalink
SEC. 434. ALTERNATIVE DENTAL HEALTH CARE PROVIDERS DEMONSTRATION PROJECT.
Subpart X of part D of title III of the Public Health Service Act (
‘SEC. 340H. DEMONSTRATION PROGRAM.
‘(a) In General-CommentsClose CommentsPermalink
‘(1) AUTHORIZATION- The Secretary is authorized to award grants to 15 eligible entities to enable such entities to establish a demonstration program to establish training programs to train, or to employ, alternative dental health care providers in order to increase access to dental health care services in rural and other underserved communities.CommentsClose CommentsPermalink
‘(2) DEFINITION- The term ‘alternative dental health care providers’ includes community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, dental health aides, and any other health professional that the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(b) Timeframe- The demonstration projects funded under this section shall begin not later than 2 years after the date of enactment of this section, and shall conclude not later than 7 years after such date of enactment.CommentsClose CommentsPermalink
‘(c) Eligible Entities- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink
‘(1) be--CommentsClose CommentsPermalink
‘(A) an institution of higher education, including a community college;CommentsClose CommentsPermalink
‘(B) a public-private partnership;CommentsClose CommentsPermalink
‘(C) a federally qualified health center;CommentsClose CommentsPermalink
‘(D) an Indian Health Service facility or a tribe or tribal organization (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act);CommentsClose CommentsPermalink
‘(E) a State or county public health clinic, a health facility operated by an Indian tribe or tribal organization, or urban Indian organization providing dental services; orCommentsClose CommentsPermalink
‘(F) a public hospital or health system;CommentsClose CommentsPermalink
‘(2) be within a program accredited by the Commission on Dental Accreditation or within a dental education program in an accredited institution; andCommentsClose CommentsPermalink
‘(3) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(d) Administrative Provisions-CommentsClose CommentsPermalink
‘(1) AMOUNT OF GRANT- Each grant under this section shall be in an amount that is not less than $4,000,000 for the 5-year period during which the demonstration project being conducted.CommentsClose CommentsPermalink
‘(2) DISBURSEMENT OF FUNDS-CommentsClose CommentsPermalink
‘(A) PRELIMINARY DISBURSEMENTS- Beginning 1 year after the enactment of this section, the Secretary may disperse to any entity receiving a grant under this section not more than 20 percent of the total funding awarded to such entity under such grant, for the purpose of enabling the entity to plan the demonstration project to be conducted under such grant.CommentsClose CommentsPermalink
‘(B) SUBSEQUENT DISBURSEMENTS- The remaining amount of grant funds not dispersed under subparagraph (A) shall be dispersed such that not less than 15 percent of such remaining amount is dispersed each subsequent year.CommentsClose CommentsPermalink
‘(e) Compliance With State Requirements- Each entity receiving a grant under this section shall certify that it is in compliance with all applicable State licensing requirements.CommentsClose CommentsPermalink
‘(f) Evaluation-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall contract with the Director of the Institute of Medicine (referred to in this subsection as the ‘Director’) to conduct a study of the demonstration programs conducted under this section that shall provide analysis, based upon quantitative and qualitative data, regarding access to dental health care in the United States.CommentsClose CommentsPermalink
‘(2) DATA COLLECTION-CommentsClose CommentsPermalink
‘(A) BASELINE DATA- The Director shall gather data from each demonstration project not later than 24 months after the commencement of the project, which shall serve as baseline data for the study.CommentsClose CommentsPermalink
‘(B) COMPARISON DATA- The Director shall begin collecting data from each demonstration project 1 year after such project concludes, and shall conclude such data collection not later than 18 months after the conclusion of the project.CommentsClose CommentsPermalink
‘(g) Clarification Regarding Dental Health Aide Program- Nothing in this section shall prohibit a dental health aide training program approved by the Indian Health Service from being eligible for a grant under this section.CommentsClose CommentsPermalink
‘(h) Authorization of Appropriations- There is authorized to be appropriated such sums as may be necessary to carry out this section.’.CommentsClose CommentsPermalink
SEC. 435. GERIATRIC EDUCATION AND TRAINING; CAREER AWARDS; COMPREHENSIVE GERIATRIC EDUCATION.
(a) Workforce Development; Career Awards- Section 753 of the Public Health Service Act (
‘(d) Geriatric Workforce Development-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall award grants or contracts under this subsection to entities that operate a geriatric education center pursuant to subsection (a)(1).CommentsClose CommentsPermalink
‘(2) APPLICATION- To be eligible for an award under paragraph (1), an entity described in such paragraph shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(3) USE OF FUNDS- Amounts awarded under a grant or contract under paragraph (1) shall be used to--CommentsClose CommentsPermalink
‘(A) carry out the fellowship program described in paragraph (4); andCommentsClose CommentsPermalink
‘(B) carry out 1 of the 2 activities described in paragraph (5).CommentsClose CommentsPermalink
‘(4) FELLOWSHIP PROGRAM-CommentsClose CommentsPermalink
‘(A) IN GENERAL- Pursuant to paragraph (3), a geriatric education center that receives an award under this subsection shall use such funds to offer short-term intensive courses (referred to in this subsection as a ‘fellowship’) that focus on geriatrics, chronic care management, and long-term care that provide supplemental training for faculty members in medical schools and other health professions schools with programs in psychology, pharmacy, nursing, social work, dentistry, public health, allied health, or other health disciplines, as approved by the Secretary. Such a fellowship shall be open to current faculty, and appropriately credentialed volunteer faculty and practitioners, who do not have formal training in geriatrics, to upgrade their knowledge and clinical skills for the care of older adults and adults with functional limitations and to enhance their interdisciplinary teaching skills.CommentsClose CommentsPermalink
‘(B) LOCATION- A fellowship shall be offered either at the geriatric education center that is sponsoring the course, in collaboration with other geriatric education centers, or at medical schools, schools of dentistry, schools of nursing, schools of pharmacy, schools of social work, graduate programs in psychology, or allied health and other health professions schools approved by the Secretary with which the geriatric education centers are affiliated.CommentsClose CommentsPermalink
‘(C) CME CREDIT- Participation in a fellowship under this paragraph shall be accepted with respect to complying with continuing health profession education requirements. As a condition of such acceptance, the recipient shall agree to subsequently provide a minimum of 18 hours of voluntary instructional support through a geriatric education center that is providing clinical training to students or trainees in long-term care settings.CommentsClose CommentsPermalink
‘(5) ADDITIONAL REQUIRED ACTIVITIES DESCRIBED- Pursuant to paragraph (3), a geriatric education center that receives an award under this subsection shall use such funds to carry out 1 of the following 2 activities.CommentsClose CommentsPermalink
‘(A) FAMILY CAREGIVER AND DIRECT CARE PROVIDER TRAINING- A geriatric education center that receives an award under this subsection shall offer at least 2 courses each year, at no charge or nominal cost, to family caregivers and direct care providers that are designed to provide practical training for supporting frail elders and individuals with disabilities. The Secretary shall require such Centers to work with appropriate community partners to develop training program content and to publicize the availability of training courses in their service areas. All family caregiver and direct care provider training programs shall include instruction on the management of psychological and behavioral aspects of dementia, communication techniques for working with individuals who have dementia, and the appropriate, safe, and effective use of medications for older adults.CommentsClose CommentsPermalink
‘(B) INCORPORATION OF BEST PRACTICES- A geriatric education center that receives an award under this subsection shall develop and include material on depression and other mental disorders common among older adults, medication safety issues for older adults, and management of the psychological and behavioral aspects of dementia and communication techniques with individuals who have dementia in all training courses, where appropriate.CommentsClose CommentsPermalink
‘(6) TARGETS- A geriatric education center that receives an award under this subsection shall meet targets approved by the Secretary for providing geriatric training to a certain number of faculty or practitioners during the term of the award, as well as other parameters established by the Secretary, including guidelines for the content of the fellowships.CommentsClose CommentsPermalink
‘(7) AMOUNT OF AWARD- An award under this subsection shall be in an amount of $150,000. Not more than 24 geriatric education centers may receive an award under this subsection.CommentsClose CommentsPermalink
‘(8) MAINTENANCE OF EFFORT- A geriatric education center that receives an award under this subsection shall provide assurances to the Secretary that funds provided to the geriatric education center under this subsection will be used only to supplement, not to supplant, the amount of Federal, State, and local funds otherwise expended by the geriatric education center.CommentsClose CommentsPermalink
‘(9) AUTHORIZATION OF APPROPRIATIONS- In addition to any other funding available to carry out this section, there is authorized to be appropriated to carry out this subsection, $10,800,000 for the period of fiscal year 2011 through 2014.CommentsClose CommentsPermalink
‘(e) Geriatric Career Incentive Awards-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall award grants or contracts under this section to individuals described in paragraph (2) to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and chronic care management.CommentsClose CommentsPermalink
‘(2) ELIGIBLE INDIVIDUALS- To be eligible to received an award under paragraph (1), an individual shall--CommentsClose CommentsPermalink
‘(A) be an advanced practice nurse, a clinical social worker, a pharmacist, or student of psychology who is pursuing a doctorate or other advanced degree in geriatrics or related fields in an accredited health professions school; andCommentsClose CommentsPermalink
‘(B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(3) CONDITION OF AWARD- As a condition of receiving an award under this subsection, an individual shall agree that, following completion of the award period, the individual will teach or practice in the field of geriatrics, long-term care, or chronic care management for a minimum of 5 years under guidelines set by the Secretary.CommentsClose CommentsPermalink
‘(4) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, $10,000,000 for the period of fiscal years 2011 through 2013.’.CommentsClose CommentsPermalink
(b) Expansion of Eligibility for Geriatric Academic Career Awards; Payment to Institution- Section 753(c) of the Public Health Service Act 294(c)) is amended--CommentsClose CommentsPermalink
(1) by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively;CommentsClose CommentsPermalink
(2) by striking paragraph (2) through paragraph (3) and inserting the following:CommentsClose CommentsPermalink
‘(2) ELIGIBLE INDIVIDUALS- To be eligible to receive an Award under paragraph (1), an individual shall--CommentsClose CommentsPermalink
‘(A) be board certified or board eligible in internal medicine, family practice, psychiatry, or licensed dentistry, or have completed any required training in a discipline and employed in an accredited health professions school that is approved by the Secretary;CommentsClose CommentsPermalink
‘(B) have completed an approved fellowship program in geriatrics; andCommentsClose CommentsPermalink
‘(C) have a junior (non-tenured) faculty appointment at an accredited (as determined by the Secretary) school of medicine, osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy, or other allied health disciplines in an accredited health professions school that is approved by the Secretary.CommentsClose CommentsPermalink
‘(3) LIMITATIONS- No Award under paragraph (1) may be made to an eligible individual unless the individual--CommentsClose CommentsPermalink
‘(A) has submitted to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, and the Secretary has approved such application;CommentsClose CommentsPermalink
‘(B) provides, in such form and manner as the Secretary may require, assurances that the individual will meet the service requirement described in paragraph (6); andCommentsClose CommentsPermalink
‘(C) provides, in such form and manner as the Secretary may require, assurances that the individual has a full-time faculty appointment in a health professions institution and documented commitment from such institution to spend 75 percent of the total time of such individual on teaching and developing skills in interdisciplinary education in geriatrics.CommentsClose CommentsPermalink
‘(4) MAINTENANCE OF EFFORT- An eligible individual that receives an Award under paragraph (1) shall provide assurances to the Secretary that funds provided to the eligible individual under this subsection will be used only to supplement, not to supplant, the amount of Federal, State, and local funds otherwise expended by the eligible individual.’; andCommentsClose CommentsPermalink
(3) in paragraph (5), as so designated--CommentsClose CommentsPermalink
(A) in subparagraph (A)--CommentsClose CommentsPermalink
(i) by inserting ‘for individuals who are physicians’ after ‘this section’; andCommentsClose CommentsPermalink
(ii) by inserting after the period at the end the following: ‘The Secretary shall determine the amount of an Award under this section for individuals who are not physicians.’; andCommentsClose CommentsPermalink
(B) by adding at the end the following:CommentsClose CommentsPermalink
‘(C) PAYMENT TO INSTITUTION- The Secretary shall transfer funds awarded to an individual under this section to the institution where such individual will carry out the award, in order to facilitate financial management of the reward pursuant to guidelines of the Health Resources and Services Administration.’.CommentsClose CommentsPermalink
(c) Comprehensive Geriatric Education- Section 855 of the Public Health Service Act (
(1) in subsection (b)--CommentsClose CommentsPermalink
(A) in paragraph (3), by striking ‘or’ at the end;CommentsClose CommentsPermalink
(B) in paragraph (4), by striking the period and inserting ‘; or’; andCommentsClose CommentsPermalink
(C) by adding at the end the following:CommentsClose CommentsPermalink
‘(5) establish traineeships for individuals who are preparing for advanced education nursing degrees in geriatric nursing, long-term care, gero-psychiatric nursing or other nursing areas that specialize in the care of the elderly population.’; andCommentsClose CommentsPermalink
(2) in subsection (e), by striking ‘2003 through 2007’ and inserting ‘2010 through 2014’.CommentsClose CommentsPermalink
SEC. 436. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.
(a) In General- Part D of title VII (
(1) striking section 757;CommentsClose CommentsPermalink
(2) redesignating section 756 (as amended by section 413) as section 757; andCommentsClose CommentsPermalink
(3) inserting after section 755 the following:CommentsClose CommentsPermalink
‘SEC. 756. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.
‘(a) Grants Authorized- The Secretary may award grants to eligible institutions of higher education to support the recruitment of students for, and education and clinical experience of the students in--CommentsClose CommentsPermalink
‘(1) baccalaureate, master’s, and doctoral degree programs of social work, as well as the development of faculty in social work;CommentsClose CommentsPermalink
‘(2) accredited master’s, doctoral, internship, and post-doctoral residency programs of psychology for the development and implementation of interdisciplinary training of psychology graduate students for providing behavioral and mental health services, including substance abuse prevention and treatment services;CommentsClose CommentsPermalink
‘(3) accredited institutions of higher education or accredited professional training programs that are establishing or expanding internships or other field placement programs in child and adolescent mental health in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance abuse prevention and treatment, marriage and family therapy, school counseling, or professional counseling; andCommentsClose CommentsPermalink
‘(4) State-licensed mental health nonprofit and for-profit organizations to enable such organizations to pay for programs for preservice or in-service training of paraprofessional child and adolescent mental health workers.CommentsClose CommentsPermalink
‘(b) Eligibility Requirements- To be eligible for a grant under this section, an institution shall demonstrate--CommentsClose CommentsPermalink
‘(1) participation in the institutions’ programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual orientations;CommentsClose CommentsPermalink
‘(2) knowledge and understanding of the concerns of the individuals and groups described in subsection (a);CommentsClose CommentsPermalink
‘(3) any internship or other field placement program assisted under the grant will prioritize cultural and linguistic competency;CommentsClose CommentsPermalink
‘(4) the institution will provide to the Secretary such data, assurances, and information as the Secretary may require; andCommentsClose CommentsPermalink
‘(5) with respect to any violation of the agreement between the Secretary and the institution, the institution will pay such liquidated damages as prescribed by the Secretary by regulation.CommentsClose CommentsPermalink
‘(c) Institutional Requirement- For grants authorized under subsection (a)(1), at least 4 of the grant recipients shall be historically black colleges or universities or other minority-serving institutions.CommentsClose CommentsPermalink
‘(d) Priority-CommentsClose CommentsPermalink
‘(1) In selecting the grant recipients in social work under subsection (a)(1), the Secretary shall give priority to applicants that--CommentsClose CommentsPermalink
‘(A) are accredited by the Council on Social Work Education;CommentsClose CommentsPermalink
‘(B) have a graduation rate of not less than 80 percent for social work students; andCommentsClose CommentsPermalink
‘(C) exhibit an ability to recruit social workers from and place social workers in areas with a high need and high demand population.CommentsClose CommentsPermalink
‘(2) In selecting the grant recipients in graduate psychology under subsection (a)(2), the Secretary shall give priority to institutions in which training focuses on the needs of vulnerable groups such as older adults and children, individuals with mental health or substance-related disorders, victims of abuse or trauma and of combat stress disorders such as posttraumatic stress disorder and traumatic brain injuries, homeless individuals, chronically ill persons, and their families.CommentsClose CommentsPermalink
‘(3) In selecting the grant recipients in professional training programs in child and adolescent mental health under subsection (a)(3), the Secretary shall give priority to applicants that--CommentsClose CommentsPermalink
‘(A) have demonstrated the ability to collect data on the number of students trained in child and adolescent mental health and the populations served by such students after graduation;CommentsClose CommentsPermalink
‘(B) have demonstrated familiarity with evidence-based methods in child and adolescent mental health services, including substance abuse prevention and treatment services;CommentsClose CommentsPermalink
‘(C) have programs designed to increase the number of paraprofessionals serving high-priority populations and to applicants who come from high-priority communities and plan to serve in Health Professional Shortage Areas, Medically Underserved Areas, or Medically Underserved Populations; andCommentsClose CommentsPermalink
‘(D) offer curriculum taught collaboratively with a family on the consumer and family lived experience or the importance of family-professional partnership.CommentsClose CommentsPermalink
‘(4) In selecting the grant recipients to offer preservice or in-service training of paraprofessional child and adolescent mental health workers under subsection (a)(4), the Secretary shall give priority to applicants that--CommentsClose CommentsPermalink
‘(A) have demonstrated the ability to collect data on the number of paraprofessional child and adolescent mental health workers trained by the applicant and the populations served by these workers after the completion of the training;CommentsClose CommentsPermalink
‘(B) have demonstrated familiarity with evidence-based methods in child and adolescent mental health services;CommentsClose CommentsPermalink
‘(C) have programs designed to increase the number of professionals serving high-priority populations, or who come from high-priority communities and plan to serve medically underserved populations or in health professional shortage areas or medically underserved areas;CommentsClose CommentsPermalink
‘(D) offer curriculum taught collaboratively with a family on the consumer and family lived experience or the importance of family-paraprofessional partnership; andCommentsClose CommentsPermalink
‘(E) provide services through a community mental health program described in section 1913(b)(1).CommentsClose CommentsPermalink
‘(e) Authorization of Appropriation- For the fiscal years 2010 through 2013, there is authorized to be appropriated to carry out this section--CommentsClose CommentsPermalink
‘(1) $8,000,000 for training in social work in subsection (a)(1);CommentsClose CommentsPermalink
‘(2) $12,000,000 for training in graduate psychology in subsection (a)(2), of which not less than $10,000,000 shall be allocated for doctoral, postdoctoral, and internship level training;CommentsClose CommentsPermalink
‘(3) $10,000,000 for training in professional child and adolescent mental health in subsection (a)(3); andCommentsClose CommentsPermalink
‘(4) $5,000,000 for training in paraprofessional child and adolescent work in subsection (a)(4).’.CommentsClose CommentsPermalink
(b) Conforming Amendments- Section 757(b)(2) of the Public Health Service Act, as redesignated by subsection (a), is amended by striking ‘sections 751(a)(1)(A), 751(a)(1)(B), 753(b), 754(3)(A), and 755(b)’ and inserting ‘sections 751(b), 753(b), and 755(b)’.CommentsClose CommentsPermalink
SEC. 437. CULTURAL COMPETENCY, PREVENTION AND PUBLIC HEALTH AND INDIVIDUALS WITH DISABILITIES TRAINING.
Part B of title VII of the Public Health Service Act (
‘SEC. 742. CULTURAL COMPETENCY, PREVENTION AND PUBLIC HEALTH AND INDIVIDUALS WITH DISABILITIES TRAINING.
‘(a) In General- The Secretary shall support the development, evaluation, and dissemination of model curricula for cultural competency, prevention, and public health proficiency and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs, and for other purposes determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(b) Curricula-CommentsClose CommentsPermalink
‘(1) COLLABORATION- In carrying out subsection (a), the Secretary shall collaborate with health professional societies, licensing and accreditation entities, health professions schools, and experts in minority health and cultural competency, prevention and public health and disability groups, community-based organizations, and other organizations as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(2) FOCUS- Curricula developed under this section shall include a focus on cultural competency measures, prevention and public health competency measures, and working with individuals with disabilities competency measures. In addition, cultural competency, prevention and public health proficiency, and working with individuals with disabilities aptitude self-assessment methodology for health providers, systems, and institutions.CommentsClose CommentsPermalink
‘(c) Dissemination-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Model curricula developed under this section shall be disseminated through the Internet Clearinghouse under section 270 and such other means as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(2) EVALUATION- The Secretary shall evaluate the adoption and the implementation of cultural competency, prevention and public health, and working with individuals with a disability training curricula, and the facilitate inclusion of these competency measures in quality measurement systems as appropriate.CommentsClose CommentsPermalink
‘(d) Authorization of Appropriations- There is authorized to be appropriated to carry out this section such sums as necessary for each of the fiscal years 2010 through 2015.’.CommentsClose CommentsPermalink
SEC. 438. ADVANCED NURSING EDUCATION GRANTS.
Section 811 of the Public Health Service Act (
(1) in subsection (c)--CommentsClose CommentsPermalink
(A) in the subsection heading, by striking ‘and Nurse Midwifery Programs’; andCommentsClose CommentsPermalink
(B) by striking ‘and nurse midwifery’;CommentsClose CommentsPermalink
(2) in subsection (f)--CommentsClose CommentsPermalink
(A) by striking paragraph (2); andCommentsClose CommentsPermalink
(B) by redesignating paragraph (3) as paragraph (2); andCommentsClose CommentsPermalink
(3) by redesignating subsections (d), (e), and (f) as subsections (e), (f), and (g), respectively; andCommentsClose CommentsPermalink
(4) by inserting after subsection (c), the following:CommentsClose CommentsPermalink
‘(d) Authorized Nurse-midwifery Programs- Midwifery programs that are eligible for support under this section are educational programs that--CommentsClose CommentsPermalink
‘(1) have as their objective the education of midwives, who will upon completion of their studies in such programs, be qualified to effectively provide primary health care services to women at locations where women might require health care services, including acute care facilities, ambulatory care facilities, birth centers, personal residences, and other settings as authorized by State or Federal law; andCommentsClose CommentsPermalink
‘(2) are accredited by the American College of Nurse-Midwives Accreditation Commission for Midwifery Education.’.CommentsClose CommentsPermalink
SEC. 439. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.
(a) In General- Section 831 of the Public Health Service Act (
(1) in the section heading, by striking ‘retention’ and inserting ‘quality’;CommentsClose CommentsPermalink
(2) in subsection (a)--CommentsClose CommentsPermalink
(A) in paragraph (1), by adding ‘or’ after the semicolon;CommentsClose CommentsPermalink
(B) by striking paragraph (2); andCommentsClose CommentsPermalink
(C) by redesignating paragraph (3) as paragraph (2);CommentsClose CommentsPermalink
(3) in subsection (b)(3), by striking ‘managed care, quality improvement’ and inserting ‘coordinated care’;CommentsClose CommentsPermalink
(4) in subsection (g), by inserting ‘, as defined in section 801(2),’ after ‘school of nursing’; andCommentsClose CommentsPermalink
(5) in subsection (h), by striking ‘2003 through 2007’ and inserting ‘2010 through 2014’.CommentsClose CommentsPermalink
(b) Nurse Retention Grants- Title VIII of the Public Health Service Act is amended by inserting after section 831 (
‘SEC. 831A. NURSE RETENTION GRANTS.
‘(a) Retention Priority Areas- The Secretary may award grants to, and enter into contracts with, eligible entities to enhance the nursing workforce by initiating and maintaining nurse retention programs pursuant to subsection (b) or (c).CommentsClose CommentsPermalink
‘(b) Grants for Career Ladder Program- The Secretary may award grants to, and enter into contracts with, eligible entities for programs--CommentsClose CommentsPermalink
‘(1) to promote career advancement for individuals including licensed practical nurses, licensed vocational nurses, certified nurse assistants, home health aides, diploma degree or associate degree nurses, to become baccalaureate prepared registered nurses or advanced education nurses in order to meet the needs of the registered nurse workforce;CommentsClose CommentsPermalink
‘(2) developing and implementing internships and residency programs in collaboration with an accredited school of nursing, as defined by section 801(2), to encourage mentoring and the development of specialties; orCommentsClose CommentsPermalink
‘(3) to assist individuals in obtaining education and training required to enter the nursing profession and advance within such profession, such as by providing career counseling and mentoring.CommentsClose CommentsPermalink
‘(c) Enhancing Patient Care Delivery Systems-CommentsClose CommentsPermalink
‘(1) GRANTS- The Secretary may award grants to eligible entities to improve the retention of nurses and enhance patient care that is directly related to nursing activities by enhancing collaboration and communication among nurses and other health care professionals, and by promoting nurse involvement in the organizational and clinical decision-making processes of a health care facility.CommentsClose CommentsPermalink
‘(2) PRIORITY- In making awards of grants under this subsection, the Secretary shall give preference to applicants that have not previously received an award under this subsection (or section 831(c) as such section existed on the day before the date of enactment of this section).CommentsClose CommentsPermalink
‘(3) CONTINUATION OF AN AWARD- The Secretary shall make continuation of any award under this subsection beyond the second year of such award contingent on the recipient of such award having demonstrated to the Secretary measurable and substantive improvement in nurse retention or patient care.CommentsClose CommentsPermalink
‘(d) Other Priority Areas- The Secretary may award grants to, or enter into contracts with, eligible entities to address other areas that are of high priority to nurse retention, as determined by the Secretary.CommentsClose CommentsPermalink
‘(e) Report- The Secretary shall submit to the Congress before the end of each fiscal year a report on the grants awarded and the contracts entered into under this section. Each such report shall identify the overall number of such grants and contracts and provide an explanation of why each such grant or contract will meet the priority need of the nursing workforce.CommentsClose CommentsPermalink
‘(f) Eligible Entity- For purposes of this section, the term ‘eligible entity’ includes an accredited school of nursing, as defined by section 801(2), a health care facility, or a partnership of such a school and facility.CommentsClose CommentsPermalink
‘(g) Authorization of Appropriations- There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2012.’.CommentsClose CommentsPermalink
SEC. 440. LOAN REPAYMENT AND SCHOLARSHIP PROGRAM.
(a) Loan Repayments and Scholarships- Section 846(a)(3) of the Public Health Service Act (
(b) Technical and Conforming Amendments- Title VIII (
(1) by redesignating section 810 (relating to prohibition against discrimination by schools on the basis of sex) as section 809 and moving such section so that it follows section 808;CommentsClose CommentsPermalink
(2) in sections 835, 836, 838, 840, and 842, by striking the term ‘this subpart’ each place it appears and inserting ‘this part’;CommentsClose CommentsPermalink
(3) in section 836(h), by striking the last sentence;CommentsClose CommentsPermalink
(4) in section 836, by redesignating subsection (l) as subsection (k);CommentsClose CommentsPermalink
(5) in section 839, by striking ‘839’ and all that follows through ‘(a)’ and inserting ‘839. (a)’;CommentsClose CommentsPermalink
(6) in section 835(b), by striking ‘841’ each place it appears and inserting ‘871’;CommentsClose CommentsPermalink
(7) by redesignating section 841 as section 871, moving part F to the end of the title, and redesignating such part as part I;CommentsClose CommentsPermalink
(8) in part G--CommentsClose CommentsPermalink
(A) by redesignating section 845 as section 851; andCommentsClose CommentsPermalink
(B) by redesignating part G as part F;CommentsClose CommentsPermalink
(9) in part H--CommentsClose CommentsPermalink
(A) by redesignating sections 851 and 852 as sections 861 and 862, respectively; andCommentsClose CommentsPermalink
(B) by redesignating part H as part G; andCommentsClose CommentsPermalink
(10) in part I--CommentsClose CommentsPermalink
(A) by redesignating section 855, as amended by section 435, as section 865; andCommentsClose CommentsPermalink
(B) by redesignating part I as part H.CommentsClose CommentsPermalink
SEC. 441. NURSE FACULTY LOAN PROGRAM.
(a) In General- Section 846A of the Public Health Service Act (
(1) in subsection (a)--CommentsClose CommentsPermalink
(A) in the subsection heading, by striking ‘Establishment’ and inserting ‘School of Nursing Student Loan Fund’; andCommentsClose CommentsPermalink
(B) by inserting ‘accredited’ after ‘agreement with any’;CommentsClose CommentsPermalink
(2) in subsection (c)--CommentsClose CommentsPermalink
(A) in paragraph (2), by striking ‘$30,000’ and all that follows through the semicolon and inserting ‘$35,500, during fiscal years 2010 and 2011 fiscal years (after fiscal year 2011, such amounts shall be adjusted to provide for a cost-of-attendance increase for the yearly loan rate and the aggregate loan;’; andCommentsClose CommentsPermalink
(B) in paragraph (3)(A), by inserting ‘an accredited’ after ‘faculty member in’;CommentsClose CommentsPermalink
(3) in subsection (e), by striking ‘a school’ and inserting ‘an accredited school’; andCommentsClose CommentsPermalink
(4) in subsection (f), by striking ‘2003 through 2007’ and inserting ‘2010 through 2014’.CommentsClose CommentsPermalink
(b) Eligible Individual Student Loan Repayment- Title VIII of the Public Health Service Act is amended by inserting after section 846A (
‘SEC. 847. ELIGIBLE INDIVIDUAL STUDENT LOAN REPAYMENT.
‘(a) In General- The Secretary, acting through the Administrator of the Health Resources and Services Administration, may enter into an agreement with eligible individuals for the repayment of education loans, in accordance with this section, to increase the number of qualified nursing faculty.CommentsClose CommentsPermalink
‘(b) Agreements- Each agreement entered into under this subsection shall require that the eligible individual shall serve as a full-time member of the faculty of an accredited school of nursing, for a total period, in the aggregate, of at least 4 years during the 6-year period beginning on the later of--CommentsClose CommentsPermalink
‘(1) the date on which the individual receives a master’s or doctorate nursing degree from an accredited school of nursing; orCommentsClose CommentsPermalink
‘(2) the date on which the individual enters into an agreement under this subsection.CommentsClose CommentsPermalink
‘(c) Agreement Provisions- Agreements entered into pursuant to subsection (b) shall be entered into on such terms and conditions as the Secretary may determine, except that--CommentsClose CommentsPermalink
‘(1) not more than 10 months after the date on which the 6-year period described under subsection (b) begins, but in no case before the individual starts as a full-time member of the faculty of an accredited school of nursing the Secretary shall begin making payments, for and on behalf of that individual, on the outstanding principal of, and interest on, any loan of that individual obtained to pay for such degree;CommentsClose CommentsPermalink
‘(2) for an individual who has completed a master’s in nursing or equivalent degree in nursing--CommentsClose CommentsPermalink
‘(A) payments may not exceed $10,000 per calendar year; andCommentsClose CommentsPermalink
‘(B) total payments may not exceed $40,000 during the 2010 and 2011 fiscal years (after fiscal year 2011, such amounts shall be adjusted to provide for a cost-of-attendance increase for the yearly loan rate and the aggregate loan); andCommentsClose CommentsPermalink
‘(3) for an individual who has completed a doctorate or equivalent degree in nursing--CommentsClose CommentsPermalink
‘(A) payments may not exceed $20,000 per calendar year; andCommentsClose CommentsPermalink
‘(B) total payments may not exceed $80,000 during the 2010 and 2011 fiscal years (adjusted for subsequent fiscal years as provided for in the same manner as in paragraph (2)(B)).CommentsClose CommentsPermalink
‘(d) Breach of Agreement-CommentsClose CommentsPermalink
‘(1) IN GENERAL- In the case of any agreement made under subsection (b), the individual is liable to the Federal Government for the total amount paid by the Secretary under such agreement, and for interest on such amount at the maximum legal prevailing rate, if the individual fails to meet the agreement terms required under such subsection.CommentsClose CommentsPermalink
‘(2) WAIVER OR SUSPENSION OF LIABILITY- In the case of an individual making an agreement for purposes of paragraph (1), the Secretary shall provide for the waiver or suspension of liability under such paragraph if compliance by the individual with the agreement involved is impossible or would involve extreme hardship to the individual or if enforcement of the agreement with respect to the individual would be unconscionable.CommentsClose CommentsPermalink
‘(3) DATE CERTAIN FOR RECOVERY- Subject to paragraph (2), any amount that the Federal Government is entitled to recover under paragraph (1) shall be paid to the United States not later than the expiration of the 3-year period beginning on the date the United States becomes so entitled.CommentsClose CommentsPermalink
‘(4) AVAILABILITY- Amounts recovered under paragraph (1) shall be available to the Secretary for making loan repayments under this section and shall remain available for such purpose until expended.CommentsClose CommentsPermalink
‘(e) Eligible Individual Defined- For purposes of this section, the term ‘eligible individual’ means an individual who--CommentsClose CommentsPermalink
‘(1) is a United States citizen, national, or lawful permanent resident;CommentsClose CommentsPermalink
‘(2) holds an unencumbered license as a registered nurse; andCommentsClose CommentsPermalink
‘(3) has either already completed a master’s or doctorate nursing program at an accredited school of nursing or is currently enrolled on a full-time or part-time basis in such a program.CommentsClose CommentsPermalink
‘(f) Priority- For the purposes of this section and section 846A, funding priority will be awarded to School of Nursing Student Loans that support doctoral nursing students or Individual Student Loan Repayment that support doctoral nursing students.CommentsClose CommentsPermalink
‘(g) Authorization of Appropriations- There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.’.CommentsClose CommentsPermalink
SEC. 442. AUTHORIZATION OF APPROPRIATIONS FOR PARTS B THROUGH D OF TITLE VIII.
Section 871 of the Public Health Service Act, as redesignated and moved by section 440, is amended to read as follows:CommentsClose CommentsPermalink
‘SEC. 871. AUTHORIZATION OF APPROPRIATIONS.
‘For the purpose of carrying out parts B, C, and D (subject to section 851(g)), there are authorized to be appropriated $338,000,000 for fiscal year 2010, and such sums as may be necessary for each of the fiscal years 2011 through 2016.’.CommentsClose CommentsPermalink
SEC. 443. GRANTS TO PROMOTE THE COMMUNITY HEALTH WORKFORCE.
(a) In General- Part P of title III of the Public Health Service Act (
‘SEC. 399U. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS AND OUTCOMES.
‘(a) Grants Authorized- The Director of the Centers for Disease Control and Prevention, in collaboration with the Secretary, shall award grants to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.CommentsClose CommentsPermalink
‘(b) Use of Funds- Grants awarded under subsection (a) shall be used to support community health workers--CommentsClose CommentsPermalink
‘(1) to educate, guide, and provide outreach in a community setting regarding health problems prevalent in medically underserved communities, particularly racial and ethnic minority populations;CommentsClose CommentsPermalink
‘(2) to educate, guide, and provide experiential learning opportunities that target behavioral risk factors;CommentsClose CommentsPermalink
‘(3) to educate and provide guidance regarding effective strategies to promote positive health behaviors within the family;CommentsClose CommentsPermalink
‘(4) to educate and provide outreach regarding enrollment in health insurance including the State Children’s Health Insurance Program under title XXI of the Social Security Act, Medicare under title XVIII of such Act and Medicaid under title XIX of such Act;CommentsClose CommentsPermalink
‘(5) to educate and refer underserved populations to appropriate healthcare agencies and community-based programs and organizations in order to increase access to quality healthcare services and to eliminate duplicative care; orCommentsClose CommentsPermalink
‘(6) to educate, guide, and provide home visitation services regarding maternal health and prenatal care.CommentsClose CommentsPermalink
‘(c) Application- Each eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary, at such time, in such manner, and accompanied by such information as the Secretary may require.CommentsClose CommentsPermalink
‘(d) Priority- In awarding grants under subsection (a), the Secretary shall give priority to applicants that--CommentsClose CommentsPermalink
‘(1) propose to target geographic areas--CommentsClose CommentsPermalink
‘(A) with a high percentage of residents who are eligible for health insurance but are uninsured or underinsured;CommentsClose CommentsPermalink
‘(B) with a high percentage of residents who suffer from chronic diseases; orCommentsClose CommentsPermalink
‘(C) with a high infant mortality rate;CommentsClose CommentsPermalink
‘(2) have experience in providing health or health-related social services to individuals who are underserved with respect to such services; andCommentsClose CommentsPermalink
‘(3) have documented community activity and experience with community health workers.CommentsClose CommentsPermalink
‘(e) Collaboration With Academic Institutions and the One-stop Delivery System- The Secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions and one-stop delivery systems under section 134(c) of the Workforce Investment Act of 1998. Nothing in this section shall be construed to require such collaboration.CommentsClose CommentsPermalink
‘(f) Evidence-based Interventions- The Secretary shall encourage community health worker programs receiving funding under this section to implement a process or an outcome-based payment system that rewards community health workers for connecting underserved populations with the most appropriate services at the most appropriate time. Nothing in this section shall be construed to require such a payment.CommentsClose CommentsPermalink
‘(g) Quality Assurance and Cost Effectiveness- The Secretary shall establish guidelines for assuring the quality of the training and supervision of community health workers under the programs funded under this section and for assuring the cost-effectiveness of such programs.CommentsClose CommentsPermalink
‘(h) Monitoring- The Secretary shall monitor community health worker programs identified in approved applications under this section and shall determine whether such programs are in compliance with the guidelines established under subsection (g).CommentsClose CommentsPermalink
‘(i) Technical Assistance- The Secretary may provide technical assistance to community health worker programs identified in approved applications under this section with respect to planning, developing, and operating programs under the grant.CommentsClose CommentsPermalink
‘(j) Authorization of Appropriations- There are authorized to be appropriated, such sums as may be necessary to carry out this section for each of fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘(k) Definitions- In this section:CommentsClose CommentsPermalink
‘(1) COMMUNITY HEALTH WORKER- The term ‘community health worker’, as defined by the Department of Labor as Standard Occupational Classification [21-1094] means an individual who promotes health or nutrition within the community in which the individual resides--CommentsClose CommentsPermalink
‘(A) by serving as a liaison between communities and healthcare agencies;CommentsClose CommentsPermalink
‘(B) by providing guidance and social assistance to community residents;CommentsClose CommentsPermalink
‘(C) by enhancing community residents’ ability to effectively communicate with healthcare providers;CommentsClose CommentsPermalink
‘(D) by providing culturally and linguistically appropriate health or nutrition education;CommentsClose CommentsPermalink
‘(E) by advocating for individual and community health; andCommentsClose CommentsPermalink
‘(F) by providing referral and follow-up services or otherwise coordinating care.CommentsClose CommentsPermalink
‘(2) COMMUNITY SETTING- The term ‘community setting’ means a home or a community organization located in the neighborhood in which a participant in the program under this section resides.CommentsClose CommentsPermalink
‘(3) ELIGIBLE ENTITY- The term ‘eligible entity’ means a public or nonprofit private entity (including a State or public subdivision of a State, a public health department, a free health clinic, a hospital, or a Federally-qualified health center (as defined in section 1861(aa) of the Social Security Act)), or a consortium of any such entities.CommentsClose CommentsPermalink
‘(4) MEDICALLY UNDERSERVED COMMUNITY- The term ‘medically underserved community’ means a community identified by a State--CommentsClose CommentsPermalink
‘(A) that has a substantial number of individuals who are members of a medically underserved population, as defined by section 330(b)(3); andCommentsClose CommentsPermalink
‘(B) a significant portion of which is a health professional shortage area as designated under section 332.’.CommentsClose CommentsPermalink
(b) Technical Amendments-CommentsClose CommentsPermalink
(1) Section 399R of the Public Health Service Act (as added by section 2 of the ALS Registry Act (
Public Law 110-373 ; 122 Stat. 4047)) is redesignated as section 399S.CommentsClose CommentsPermalink(2) Section 399R of such Act (as added by section 3 of the Prenatally and Postnatally Diagnosed Conditions Awareness Act (
Public Law 110-374 ; 122 Stat. 4051)) is redesignated as section 399T.CommentsClose CommentsPermalink
SEC. 444. YOUTH PUBLIC HEALTH PROGRAM.
Section 751(b)(4)(A) of the Public Health Service Act, as amended by section 453, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘(vii) Establish a youth public health program to expose and recruit high school students into health careers, with a focus on careers in public health.’.CommentsClose CommentsPermalink
SEC. 445. FELLOWSHIP TRAINING IN PUBLIC HEALTH.
Part E of title VII of the Public Health Service Act (
‘SEC. 778. FELLOWSHIP TRAINING IN APPLIED PUBLIC HEALTH EPIDEMIOLOGY, PUBLIC HEALTH LABORATORY SCIENCE, PUBLIC HEALTH INFORMATICS, AND EXPANSION OF THE EPIDEMIC INTELLIGENCE SERVICE.
‘(a) In General- The Secretary may carry out activities to address documented workforce shortages in State and local health departments in the critical areas of applied public health epidemiology and public health laboratory science and informatics and may expand the Epidemic Intelligence Service.CommentsClose CommentsPermalink
‘(b) Specific Uses- In carrying out subsection (a), the Secretary shall provide for the expansion of existing fellowship programs operated through the Centers for Disease Control and Prevention in a manner that is designed to alleviate shortages of the type described in subsection (a).CommentsClose CommentsPermalink
‘(c) Other Programs- The Secretary may provide for the expansion of other applied epidemiology training programs that meet objectives similar to the objectives of the programs described in subsection (b).CommentsClose CommentsPermalink
‘(d) Work Obligation- Participation in fellowship training programs under this section shall be deemed to be service for purposes of satisfying work obligations stipulated in contracts under section 338I(j).CommentsClose CommentsPermalink
‘(e) General Support- Amounts may be used from grants awarded under this section to expand the Public Health Informatics Fellowship Program at the Centers for Disease Control and Prevention to better support all public health systems at all levels of government.CommentsClose CommentsPermalink
‘(f) Authorization of Appropriations- There are authorized to be appropriated to carry out this section $39,500,000 for each of fiscal years 2010 through 2013, of which--CommentsClose CommentsPermalink
‘(1) $5,000,000 shall be made available in each such fiscal year for epidemiology fellowship training program activities under subsections (b) and (c);CommentsClose CommentsPermalink
‘(2) $5,000,000 shall be made available in each such fiscal year for laboratory fellowship training programs under subsection (b);CommentsClose CommentsPermalink
‘(3) $5,000,000 shall be made available in each such fiscal year for the Public Health Informatics Fellowship Program under subsection (e); andCommentsClose CommentsPermalink
‘(4) $24,500,000 shall be made available for expanding the Epidemic Intelligence Service under subsection (a).’.CommentsClose CommentsPermalink
SEC. 446. UNITED STATES PUBLIC HEALTH SCIENCES TRACK.
Title II of the Public Health Service Act (
‘PART D--UNITED STATES PUBLIC HEALTH SCIENCES TRACK
‘SEC. 271. ESTABLISHMENT.
‘(a) United States Public Health Services Track-CommentsClose CommentsPermalink
‘(1) IN GENERAL- There is hereby authorized to be established a United States Public Health Sciences Track (referred to in this part as the ‘Track’), at sites to be selected by the Secretary, with authority to grant appropriate advanced degrees in a manner that uniquely emphasizes team-based service, public health, epidemiology, and emergency preparedness and response. It shall be so organized as to graduate not less than--CommentsClose CommentsPermalink
‘(A) 150 medical students annually, 10 of whom shall be awarded studentships to the Uniformed Services University of Health Sciences;CommentsClose CommentsPermalink
‘(B) 100 dental students annually;CommentsClose CommentsPermalink
‘(C) 250 nursing students annually;CommentsClose CommentsPermalink
‘(D) 100 public health students annually;CommentsClose CommentsPermalink
‘(E) 100 behavioral and mental health professional students annually;CommentsClose CommentsPermalink
‘(F) 100 physician assistant or nurse practitioner students annually; andCommentsClose CommentsPermalink
‘(G) 50 pharmacy students annually.CommentsClose CommentsPermalink
‘(2) LOCATIONS- The Track shall be located at existing and accredited, affiliated health professions education training programs at academic health centers located in regions of the United States determined appropriate by the Surgeon General, in consultation with the National Health Care Workforce Commission.CommentsClose CommentsPermalink
‘(b) Number of Graduates- Except as provided in subsection (a), the number of persons to be graduated from the Track shall be prescribed by the Secretary. In so prescribing the number of persons to be graduated from the Track, the Secretary shall institute actions necessary to ensure the maximum number of first-year enrollments in the Track consistent with the academic capacity of the affiliated sites and the needs of the United States for medical, dental, and nursing personnel.CommentsClose CommentsPermalink
‘(c) Development- The development of the Track may be by such phases as the Secretary may prescribe subject to the requirements of subsection (a).CommentsClose CommentsPermalink
‘(d) Integrated Longitudinal Plan- The Surgeon General shall develop an integrated longitudinal plan for health professions continuing education throughout the continuum of health-related education, training, and practice. Training under such plan shall emphasize patient-centered, interdisciplinary, and care coordination skills. Experience with deployment of emergency response teams shall be included during the clinical experiences.CommentsClose CommentsPermalink
‘(e) Faculty Development- The Surgeon General shall develop faculty development programs and curricula in decentralized venues of health care, to balance urban, tertiary, and inpatient venues.CommentsClose CommentsPermalink
‘SEC. 272. ADMINISTRATION.
‘(a) In General- The business of the Track shall be conducted by the Surgeon General with funds appropriated for and provided by the Department of Health and Human Services. The National Health Workforce Commission shall assist the Surgeon General in an advisory capacity.CommentsClose CommentsPermalink
‘(b) Faculty-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Surgeon General, after considering the recommendations of the National Health Workforce Commission, shall obtain the services of such professors, instructors, and administrative and other employees as may be necessary to operate the Track, but utilize when possible, existing affiliated health professions training institutions. Members of the faculty and staff shall be employed under salary schedules and granted retirement and other related benefits prescribed by the Secretary so as to place the employees of the Track faculty on a comparable basis with the employees of fully accredited schools of the health professions within the United States.CommentsClose CommentsPermalink
‘(2) TITLES- The Surgeon General may confer academic titles, as appropriate, upon the members of the faculty.CommentsClose CommentsPermalink
‘(3) NONAPPLICATION OF PROVISIONS- The limitations in
section 5373 of title 5, United States Code , shall not apply to the authority of the Surgeon General under paragraph (1) to prescribe salary schedules and other related benefits.CommentsClose CommentsPermalink‘(c) Agreements- The Surgeon General may negotiate agreements with agencies of the Federal Government to utilize on a reimbursable basis appropriate existing Federal medical resources located in the United States (or locations selected in accordance with section 271(a)(2)). Under such agreements the facilities concerned will retain their identities and basic missions. The Surgeon General may negotiate affiliation agreements with accredited universities and health professions training institutions in the United States. Such agreements may include provisions for payments for educational services provided students participating in Department of Health and Human Services educational programs.CommentsClose CommentsPermalink
‘(d) Programs- The Surgeon General may establish the following educational programs for Track students:CommentsClose CommentsPermalink
‘(1) Postdoctoral, postgraduate, and technological programs.CommentsClose CommentsPermalink
‘(2) A cooperative program for medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students.CommentsClose CommentsPermalink
‘(3) Other programs that the Surgeon General determines necessary in order to operate the Track in a cost-effective manner.CommentsClose CommentsPermalink
‘(e) Continuing Medical Education- The Surgeon General shall establish programs in continuing medical education for members of the health professions to the end that high standards of health care may be maintained within the United States.CommentsClose CommentsPermalink
‘(f) Authority of the Surgeon General-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Surgeon General is authorized--CommentsClose CommentsPermalink
‘(A) to enter into contracts with, accept grants from, and make grants to any nonprofit entity for the purpose of carrying out cooperative enterprises in medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing research, consultation, and education;CommentsClose CommentsPermalink
‘(B) to enter into contracts with entities under which the Surgeon General may furnish the services of such professional, technical, or clerical personnel as may be necessary to fulfill cooperative enterprises undertaken by the Track;CommentsClose CommentsPermalink
‘(C) to accept, hold, administer, invest, and spend any gift, devise, or bequest of personal property made to the Track, including any gift, devise, or bequest for the support of an academic chair, teaching, research, or demonstration project;CommentsClose CommentsPermalink
‘(D) to enter into agreements with entities that may be utilized by the Track for the purpose of enhancing the activities of the Track in education, research, and technological applications of knowledge; andCommentsClose CommentsPermalink
‘(E) to accept the voluntary services of guest scholars and other persons.CommentsClose CommentsPermalink
‘(2) LIMITATION- The Surgeon General may not enter into any contract with an entity if the contract would obligate the Track to make outlays in advance of the enactment of budget authority for such outlays.CommentsClose CommentsPermalink
‘(3) SCIENTISTS- Scientists or other medical, dental, or nursing personnel utilized by the Track under an agreement described in paragraph (1) may be appointed to any position within the Track and may be permitted to perform such duties within the Track as the Surgeon General may approve.CommentsClose CommentsPermalink
‘(4) VOLUNTEER SERVICES- A person who provides voluntary services under the authority of subparagraph (E) of paragraph (1) shall be considered to be an employee of the Federal Government for the purposes of chapter 81 of title 5, relating to compensation for work-related injuries, and to be an employee of the Federal Government for the purposes of chapter 171 of title 28, relating to tort claims. Such a person who is not otherwise employed by the Federal Government shall not be considered to be a Federal employee for any other purpose by reason of the provision of such services.CommentsClose CommentsPermalink
‘SEC. 273. STUDENTS; SELECTION; OBLIGATION.
‘(a) Student Selection-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students at the Track shall be selected under procedures prescribed by the Surgeon General. In so prescribing, the Surgeon General shall consider the recommendations of the National Health Workforce Commission.CommentsClose CommentsPermalink
‘(2) PRIORITY- In developing admissions procedures under paragraph (1), the Surgeon General shall ensure that such procedures give priority to applicant medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students from rural communities and underrepresented minorities.CommentsClose CommentsPermalink
‘(b) Contract and Service Obligation-CommentsClose CommentsPermalink
‘(1) CONTRACT- Upon being admitted to the Track, a medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, or nursing student shall enter into a written contract with the Surgeon General that shall contain--CommentsClose CommentsPermalink
‘(A) an agreement under which--CommentsClose CommentsPermalink
‘(i) subject to subparagraph (B), the Surgeon General agrees to provide the student with tuition (or tuition remission) and a student stipend (described in paragraph (2)) in each school year for a period of years (not to exceed 4 school years) determined by the student, during which period the student is enrolled in the Track at an affiliated or other participating health professions institution pursuant to an agreement between the Track and such institution; andCommentsClose CommentsPermalink
‘(ii) subject to subparagraph (B), the student agrees--CommentsClose CommentsPermalink
‘(I) to accept the provision of such tuition and student stipend to the student;CommentsClose CommentsPermalink
‘(II) to maintain enrollment at the Track until the student completes the course of study involved;CommentsClose CommentsPermalink
‘(III) while enrolled in such course of study, to maintain an acceptable level of academic standing (as determined by the Surgeon General);CommentsClose CommentsPermalink
‘(IV) if pursuing a degree from a school of medicine or osteopathic medicine, dental, public health, or nursing school or a physician assistant, pharmacy, or behavioral and mental health professional program, to complete a residency or internship in a specialty that the Surgeon General determines is appropriate; andCommentsClose CommentsPermalink
‘(V) to serve for a period of time (referred to in this part as the ‘period of obligated service’) within the Commissioned Corps of the Public Health Service equal to 2 years for each school year during which such individual was enrolled at the College, reduced as provided for in paragraph (3);CommentsClose CommentsPermalink
‘(B) a provision that any financial obligation of the United States arising out of a contract entered into under this part and any obligation of the student which is conditioned thereon, is contingent upon funds being appropriated to carry out this part;CommentsClose CommentsPermalink
‘(C) a statement of the damages to which the United States is entitled for the student’s breach of the contract; andCommentsClose CommentsPermalink
‘(D) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with the provisions of this part.CommentsClose CommentsPermalink
‘(2) TUITION AND STUDENT STIPEND-CommentsClose CommentsPermalink
‘(A) TUITION REMISSION RATES- The Surgeon General, based on the recommendations of the National Health Workforce Commission established under section 411 of the Affordable Health Choices Act, shall establish Federal tuition remission rates to be used by the Track to provide reimbursement to affiliated and other participating health professions institutions for the cost of educational services provided by such institutions to Track students. The agreement entered into by such participating institutions under paragraph (1)(A)(i) shall contain an agreement to accept as payment in full the established remission rate under this subparagraph.CommentsClose CommentsPermalink
‘(B) STIPEND- The Surgeon General, based on the recommendations of the National Health Workforce Commission, shall establish and update Federal stipend rates for payment to students under this part.CommentsClose CommentsPermalink
‘(3) REDUCTIONS IN THE PERIOD OF OBLIGATED SERVICE- The period of obligated service under paragraph (1)(A)(ii)(V) shall be reduced--CommentsClose CommentsPermalink
‘(A) in the case of a student who elects to participate in a high-needs speciality residency (as determined by the National Health Workforce Commission), by 3 months for each year of such participation (not to exceed a total of 12 months); andCommentsClose CommentsPermalink
‘(B) in the case of a student who, upon completion of their residency, elects to practice in a Federal medical facility (as defined in section 781(e)) that is located in a health professional shortage area (as defined in section 332), by 3 months for year of full-time practice in such a facility (not to exceed a total of 12 months).CommentsClose CommentsPermalink
‘(c) Second 2 Years of Service- During the third and fourth years in which a medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, or nursing student is enrolled in the Track, training should be designed to prioritize clinical rotations in Federal medical facilities in health professional shortage areas, and emphasize a balance of hospital and community-based experiences, and training within interdisciplinary teams.CommentsClose CommentsPermalink
‘(d) Dentist, Physician Assistant, Pharmacist, Behavioral and Mental Health Professional, Public Health Professional, and Nurse Training- The Surgeon General shall establish provisions applicable with respect to dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students that are comparable to those for medical students under this section, including service obligations, tuition support, and stipend support. The Surgeon General shall give priority to health professions training institutions that train medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students for some significant period of time together, but at a minimum have a discrete and shared core curriculum.CommentsClose CommentsPermalink
‘(e) Elite Federal Disaster Teams- The Surgeon General, in consultation with the Secretary, the Director of the Centers for Disease Control and Prevention, and other appropriate military and Federal government agencies, shall develop criteria for the appointment of highly qualified Track faculty, medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, and nursing students, and graduates to elite Federal disaster preparedness teams to train and to respond to public health emergencies, natural disasters, bioterrorism events, and other emergencies.CommentsClose CommentsPermalink
‘(f) Student Dropped From Track in Affiliate School- A medical, dental, physician assistant, pharmacy, behavioral and mental health, public health, or nursing student who, under regulations prescribed by the Surgeon General, is dropped from the Track in an affiliated school for deficiency in conduct or studies, or for other reasons, shall be liable to the United States for all tuition and stipend support provided to the student.CommentsClose CommentsPermalink
‘SEC. 274. FUNDING.
‘Beginning with fiscal year 2010, the Secretary shall transfer from the Public Health and Social Services Emergency Fund such sums as may be necessary to carry out this part.’.CommentsClose CommentsPermalink
Subtitle E--Supporting the Existing Health Care WorkforceCommentsClose CommentsPermalink
Subtitle E--Supporting the Existing Health Care WorkforceCommentsClose CommentsPermalink
SEC. 451. CENTERS OF EXCELLENCE.
Section 736 of the Public Health Service Act (
‘(h) Formula for Allocations-CommentsClose CommentsPermalink
‘(1) ALLOCATIONS- Based on the amount appropriated under subsection (i) for a fiscal year, the following subparagraphs shall apply as appropriate:CommentsClose CommentsPermalink
‘(A) IN GENERAL- If the amounts appropriated under subsection (i) for a fiscal year are $24,000,000 or less--CommentsClose CommentsPermalink
‘(i) the Secretary shall make available $12,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(2)(A); andCommentsClose CommentsPermalink
‘(ii) and available after grants are made with funds under clause (i), the Secretary shall make available--CommentsClose CommentsPermalink
‘(I) 60 percent of such amount for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (3) or (4) of subsection (c) (including meeting the conditions under subsection (e)); andCommentsClose CommentsPermalink
‘(II) 40 percent of such amount for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5).CommentsClose CommentsPermalink
‘(B) FUNDING IN EXCESS OF $24,000,000- If amounts appropriated under subsection (i) for a fiscal year exceed $24,000,000 but are less than $30,000,000--CommentsClose CommentsPermalink
‘(i) 80 percent of such excess amounts shall be made available for grants under subsection (a) to health professions schools that meet the requirements described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e)); andCommentsClose CommentsPermalink
‘(ii) 20 percent of such excess amount shall be made available for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5).CommentsClose CommentsPermalink
‘(C) FUNDING IN EXCESS OF $30,000,000- If amounts appropriated under subsection (i) for a fiscal year exceed $30,000,000 but are less than $40,000,000, the Secretary shall make available--CommentsClose CommentsPermalink
‘(i) not less than $12,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(2)(A);CommentsClose CommentsPermalink
‘(ii) not less than $12,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e));CommentsClose CommentsPermalink
‘(iii) not less than $6,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5); andCommentsClose CommentsPermalink
‘(iv) after grants are made with funds under clauses (i) through (iii), any remaining excess amount for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (2)(A), (3), (4), or (5) of subsection (c).CommentsClose CommentsPermalink
‘(D) FUNDING IN EXCESS OF $40,000,000- If amounts appropriated under subsection (i) for a fiscal year are $40,000,000 or more, the Secretary shall make available--CommentsClose CommentsPermalink
‘(i) not less than $16,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(2)(A);CommentsClose CommentsPermalink
‘(ii) not less than $16,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e));CommentsClose CommentsPermalink
‘(iii) not less than $8,000,000 for grants under subsection (a) to health professions schools that meet the conditions described in subsection (c)(5); andCommentsClose CommentsPermalink
‘(iv) after grants are made with funds under clauses (i) through (iii), any remaining funds for grants under subsection (a) to health professions schools that meet the conditions described in paragraph (2)(A), (3), (4), or (5) of subsection (c).CommentsClose CommentsPermalink
‘(2) NO LIMITATION- Nothing in this subsection shall be construed as limiting the centers of excellence referred to in this section to the designated amount, or to preclude such entities from competing for grants under this section.CommentsClose CommentsPermalink
‘(3) MAINTENANCE OF EFFORT-CommentsClose CommentsPermalink
‘(A) IN GENERAL- With respect to activities for which a grant made under this part are authorized to be expended, the Secretary may not make such a grant to a center of excellence for any fiscal year unless the center agrees to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained by the center for the fiscal year preceding the fiscal year for which the school receives such a grant.CommentsClose CommentsPermalink
‘(B) USE OF FEDERAL FUNDS- With respect to any Federal amounts received by a center of excellence and available for carrying out activities for which a grant under this part is authorized to be expended, the center shall, before expending the grant, expend the Federal amounts obtained from sources other than the grant, unless given prior approval from the Secretary.CommentsClose CommentsPermalink
‘(i) Authorization of Appropriations- There are authorized to be appropriated to carry out this section--CommentsClose CommentsPermalink
‘(1) $50,000,000 for each of the fiscal years 2010 through 2015; andCommentsClose CommentsPermalink
‘(2) and such sums as are necessary for each subsequent fiscal year.’.CommentsClose CommentsPermalink
SEC. 452. HEALTH CARE PROFESSIONALS TRAINING FOR DIVERSITY.
(a) Loan Repayments and Fellowships Regarding Faculty Positions- Section 738(a)(1) of the Public Health Service Act (
(b) Scholarships for Disadvantaged Students- Section 740(a) of such Act (
(c) Reauthorization for Loan Repayments and Fellowships Regarding Faculty Positions- Section 740(b) of such Act (
(d) Reauthorization for Educational Assistance in the Health Professions Regarding Individuals From a Disadvantaged Background- Section 740(c) of such Act (
SEC. 453. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.
(a) Area Health Education Centers- Section 751 of the Public Health Service Act (
‘SEC. 751. AREA HEALTH EDUCATION CENTERS.
‘(a) Establishment of Awards- The Secretary shall make awards in accordance with this section.CommentsClose CommentsPermalink
‘(b) Infrastructure Development Award-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall make awards to eligible entities to enable such entities to initiate health care workforce educational programs or to continue to carry out comparable programs that are operating at the time the award is made by planning, developing, operating, and evaluating of an area health education center program.CommentsClose CommentsPermalink
‘(2) ELIGIBLE ENTITY- For purposes of this subsection, an ‘eligible entity’ means a school of medicine or osteopathic medicine, an incorporated consortium of such schools, or the parent institutions of such a school. With respect to a State in which no area health education center program is in operation, the Secretary may award a grant or contract under paragraph (1) to a school of nursing.CommentsClose CommentsPermalink
‘(3) APPLICATION- An eligible entity desiring to receive an award under this subsection shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(4) USE OF FUNDS-CommentsClose CommentsPermalink
‘(A) REQUIRED ACTIVITIES- An eligible entity shall use amounts awarded under a grant under paragraph (1) to carry out the following activities:CommentsClose CommentsPermalink
‘(i) Develop and implement strategies, in coordination with the applicable one-stop delivery system under section 134(c) of the Workforce Investment Act of 1998, to recruit individuals from underrepresented minority populations or from disadvantaged or rural backgrounds into health professions, and support such individuals in attaining such careers.CommentsClose CommentsPermalink
‘(ii) Develop and implement strategies to foster and provide community-based training and education to individuals seeking careers in health professions within underserved areas for the purpose of developing and maintaining a diverse health care workforce that is prepared to deliver high-quality care, with an emphasis on primary care, in underserved areas or for health disparity populations, in collaboration with other Federal and State health care workforce development programs, the State workforce agency, and local workforce investment boards, and in health care safety net sites.CommentsClose CommentsPermalink
‘(iii) Prepare individuals to more effectively provide health services to underserved areas and health disparity populations through field placements or preceptorships in conjunction with community-based organizations, accredited primary care residency training programs, Federally qualified health centers, rural health clinics, public health departments, or other appropriate facilities.CommentsClose CommentsPermalink
‘(iv) Conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse practitioners, nurse midwives, dentists, psychologists, pharmacists, optometrists, community health workers, public and allied health professionals, or other health professionals, as practicable.CommentsClose CommentsPermalink
‘(v) Deliver or facilitate continuing education and information dissemination programs for health care professionals, with an emphasis on individuals providing care in underserved areas and for health disparity populations.CommentsClose CommentsPermalink
‘(vi) Propose and implement effective program and outcomes measurement and evaluation strategies.CommentsClose CommentsPermalink
‘(B) INNOVATIVE OPPORTUNITIES- An eligible entity may use amounts awarded under a grant under paragraph (1) to carry out any of the following activities:CommentsClose CommentsPermalink
‘(i) Develop and implement innovative curricula in collaboration with community-based accredited primary care residency training programs, Federally qualified health centers, rural health clinics, behavioral and mental health facilities, public health departments, or other appropriate facilities, with the goal of increasing the number of primary care physicians and other primary care providers prepared to serve in underserved areas and health disparity populations.CommentsClose CommentsPermalink
‘(ii) Coordinate community-based participatory research with academic health centers, and facilitate rapid flow and dissemination of evidence-based health care information, research results, and best practices to improve quality, efficiency, and effectiveness of health care and health care systems within community settings.CommentsClose CommentsPermalink
‘(iii) Develop and implement other strategies to address identified workforce needs and increase and enhance the health care workforce in the area served by the area health education center program.CommentsClose CommentsPermalink
‘(c) Point of Service Maintenance and Enhancement Award-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary shall make awards to eligible entities to maintain and improve the effectiveness and capabilities of an existing area health education center program, and make other modifications to the program that are appropriate due to changes in demographics, needs of the populations served, or other similar issues affecting the program.CommentsClose CommentsPermalink
‘(2) ELIGIBLE ENTITY- For purposes of this subsection, the term ‘eligible entity’ means an entity that has received funds under this section (as this section was in effect on the day before the date of enactment of the Affordable Health Choices Act), is operating an area health education center program, including area health education centers, and has a center or centers that are no longer eligible to receive financial assistance under subsection (b).CommentsClose CommentsPermalink
‘(3) APPLICATION- An eligible entity desiring to receive an award under this subsection shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(4) USE OF FUNDS-CommentsClose CommentsPermalink
‘(A) REQUIRED ACTIVITIES- An eligible entity shall use amounts awarded under a grant under paragraph (1) to carry out the following activities:CommentsClose CommentsPermalink
‘(i) Develop and implement strategies in coordination with the applicable one-stop delivery system under section 134(c) of the Workforce Investment Act of 1998 to recruit individuals from underrepresented minority groups, underserved areas, or with rural backgrounds into health care careers, and support such individuals in attaining such careers.CommentsClose CommentsPermalink
‘(ii) Develop and implement strategies to foster and provide community-based training and education to individuals seeking careers in health professions within underserved areas for the purpose of developing and maintaining a diverse health care workforce that is prepared to deliver high-quality care, with an emphasis on primary care, in underserved areas and to health disparity populations, in collaboration with other Federal and State health care workforce development programs, and in health care safety net sites.CommentsClose CommentsPermalink
‘(iii) Prepare individuals to more effectively provide health services to underserved areas or health disparity populations through field placements or preceptorships in conjunction with community-based organizations, accredited primary care residency training programs, Federally qualified health centers, rural health clinics, behavioral and mental health facilities, public health departments, or other appropriate facilities.CommentsClose CommentsPermalink
‘(iv) Conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse practitioners, nurse midwives, dentists, psychologists, pharmacists, optometrists, community health workers, public and allied health professionals, or other health professionals, as practicable.CommentsClose CommentsPermalink
‘(v) Deliver or facilitate continuing education and information dissemination programs for health care professionals, with an emphasis on individuals providing care in underserved areas and for health disparity populations.CommentsClose CommentsPermalink
‘(vi) Propose and implement effective program and outcomes measurement and evaluation strategies.CommentsClose CommentsPermalink
‘(B) INNOVATIVE OPPORTUNITIES- An eligible entity shall use amounts awarded under a grant under paragraph (1) to carry out at least 1 of the following activities:CommentsClose CommentsPermalink
‘(i) Develop innovative curricula in collaboration with community-based accredited primary care residency training programs, Federally qualified health centers, rural health clinics, behavioral and mental health facilities, public health departments, or other appropriate facilities, with the goal of increasing the number of primary care physicians and other primary care providers prepared to serve in underserved areas and health disparity populations.CommentsClose CommentsPermalink
‘(ii) Coordinate community-based participatory research with academic health centers, and facilitate rapid flow and dissemination of evidence-based health care information, research results, and best practices to improve quality, efficiency, and effectiveness of health care and health care systems within community settings.CommentsClose CommentsPermalink
‘(iii) Develop and implement other strategies to address identified workforce needs and increase and enhance the health care workforce in the area served by the area health education center program.CommentsClose CommentsPermalink
‘(d) Requirements-CommentsClose CommentsPermalink
‘(1) AREA HEALTH EDUCATION CENTER PROGRAM- In carrying out this section, the Secretary shall ensure the following:CommentsClose CommentsPermalink
‘(A) An entity that receives an award under this section shall conduct at least 10 percent of clinical education required for medical students in community settings that are removed from the primary teaching facility of the contracting institution for grantees that operate a school of medicine or osteopathic medicine. In States in which an entity that receives an award under this section is a nursing school or its parent institution, the Secretary shall alternatively ensure that--CommentsClose CommentsPermalink
‘(i) the nursing school places at least 10 percent of its students in training sites affiliated with an area health education center that is remote from the primary teaching facility of the school; andCommentsClose CommentsPermalink
‘(ii) the entity receiving the award maintains a written agreement with a school of medicine or osteopathic medicine to place at least 10 percent of students from that school in training sites in the area health education center program area.CommentsClose CommentsPermalink
‘(B) An entity receiving funds under subsection (c) does not distribute such funding to a center that is eligible to receive funding under subsection (b).CommentsClose CommentsPermalink
‘(2) AREA HEALTH EDUCATION CENTER- The Secretary shall ensure that each area health education center program includes at least 1 area health education center, and that each such center--CommentsClose CommentsPermalink
‘(A) is a public or private organization whose structure, governance, and operation is independent from the awardee and the parent institution of the awardee;CommentsClose CommentsPermalink
‘(B) is not a school of medicine or osteopathic medicine, the parent institution of such a school, or a branch campus or other subunit of a school of medicine or osteopathic medicine or its parent institution, or a consortium of such entities;CommentsClose CommentsPermalink
‘(C) designates an underserved area or population to be served by the center which is in a location removed from the main location of the teaching facilities of the schools participating in the program with such center and does not duplicate, in whole or in part, the geographic area or population served by any other center;CommentsClose CommentsPermalink
‘(D) fosters networking and collaboration among communities and between academic health centers and community-based centers;CommentsClose CommentsPermalink
‘(E) serves communities with a demonstrated need of health professionals in partnership with academic medical centers;CommentsClose CommentsPermalink
‘(F) addresses the health care workforce needs of the communities served in coordination with the public workforce investment system; andCommentsClose CommentsPermalink
‘(G) has a community-based governing or advisory board that reflects the diversity of the communities involved.CommentsClose CommentsPermalink
‘(e) Matching Funds- With respect to the costs of operating a program through a grant under this section, to be eligible for financial assistance under this section, an entity shall make available (directly or through contributions from State, county or municipal governments, or the private sector) recurring non-Federal contributions in cash or in kind, toward such costs in an amount that is equal to not less than 50 percent of such costs. At least 25 percent of the total required non-Federal contributions shall be in cash. An entity may apply to the Secretary for a waiver of not more than 75 percent of the matching fund amount required by the entity for each of the first 3 years the entity is funded through a grant under subsection (b).CommentsClose CommentsPermalink
‘(f) Limitation- Not less than 75 percent of the total amount provided to an area health education center program under subsection (b) or (c) shall be allocated to the area health education centers participating in the program under this section. To provide needed flexibility to newly funded area health education center programs, the Secretary may waive the requirement in the sentence for the first 2 years of a new area health education center program funded under subsection (b).CommentsClose CommentsPermalink
‘(g) Award- An award to an entity under this section shall be not less than $250,000 annually per area health education center included in the program involved. If amounts appropriated to carry out this section are not sufficient to comply with the preceding sentence, the Secretary may reduce the per center amount provided for in such sentence as necessary, provided the distribution established in subsection (k)(2) is maintained.CommentsClose CommentsPermalink
‘(h) Project Terms-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Except as provided in paragraph (2), the period during which payments may be made under an award under subsection (b) may not exceed--CommentsClose CommentsPermalink
‘(A) in the case of a program, 12 years; orCommentsClose CommentsPermalink
‘(B) in the case of a center within a program, 6 years.CommentsClose CommentsPermalink
‘(2) EXCEPTION- The periods described in paragraph (1) shall not apply to programs receiving point of service maintenance and enhancement awards under subsection (c) to maintain existing centers and activities.CommentsClose CommentsPermalink
‘(i) Inapplicability of Provision- Notwithstanding any other provision of this title, section 791(a) shall not apply to an area health education center funded under this section.CommentsClose CommentsPermalink
‘(j) Authorization of Appropriations-CommentsClose CommentsPermalink
‘(1) IN GENERAL- There is authorized to be appropriated to carry out this section $125,000,000 for each of the fiscal years 2010 through 2014.CommentsClose CommentsPermalink
‘(2) REQUIREMENTS- Of the amounts appropriated for a fiscal year under paragraph (1)--CommentsClose CommentsPermalink
‘(A) not more than 35 percent shall be used for awards under subsection (b);CommentsClose CommentsPermalink
‘(B) not less than 60 percent shall be used for awards under subsection (c);CommentsClose CommentsPermalink
‘(C) not more than 1 percent shall be used for grants and contracts to implement outcomes evaluation for the area health education centers; andCommentsClose CommentsPermalink
‘(D) not more than 4 percent shall be used for grants and contracts to provide technical assistance to entities receiving awards under this section.CommentsClose CommentsPermalink
‘(3) CARRYOVER FUNDS- An entity that receives an award under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case may any funds be carried over pursuant to the preceding sentence for more than 3 years.CommentsClose CommentsPermalink
‘(k) Sense of Congress- It is the sense of the Congress that every State have an area health education center program in effect under this section.’.CommentsClose CommentsPermalink
(b) Continuing Educational Support for Health Professionals Serving in Underserved Communities- Part D of title VII of the Public Health Service Act (
42 U.S.C. 294 et seq.) is amended by striking section 752 and inserting the following:CommentsClose CommentsPermalink
‘SEC. 752. CONTINUING EDUCATIONAL SUPPORT FOR HEALTH PROFESSIONALS SERVING IN UNDERSERVED COMMUNITIES.
‘(a) In General- The Secretary shall make grants to, and enter into contracts with, eligible entities to improve health care, increase retention, increase representation of minority faculty members, enhance the practice environment, and provide information dissemination and educational support to reduce professional isolation through the timely dissemination of research findings using relevant resources.CommentsClose CommentsPermalink
‘(b) Eligible Entities- For purposes of this section, the term ‘eligible entity’ means an entity described in section 799(b).CommentsClose CommentsPermalink
‘(c) Application- An eligible entity desiring to receive an award under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(d) Use of Funds- An eligible entity shall use amounts awarded under a grant or contract under this section to provide innovative supportive activities to enhance education through distance learning, continuing educational activities, collaborative conferences, and electronic and telelearning activities, with priority for primary care.CommentsClose CommentsPermalink
‘(e) Authorization- There is authorized to be appropriated to carry out this section $5,000,000 for each of the fiscal years 2010 through 2014, and such sums as may be necessary for each subsequent fiscal year.’.CommentsClose CommentsPermalink
SEC. 454. WORKFORCE DIVERSITY GRANTS.
Section 821 of the Public Health Service Act (
(1) in subsection (a)--CommentsClose CommentsPermalink
(A) by striking ‘The Secretary may’ and inserting the following:CommentsClose CommentsPermalink
‘(1) AUTHORITY- The Secretary may’;CommentsClose CommentsPermalink
(B) by striking ‘pre-entry preparation, and retention activities’ and inserting the following: ‘stipends for diploma or associate degree nurses to enter a bridge or degree completion program, student scholarships or stipends for accelerated nursing degree programs, pre-entry preparation, advanced education preparation, and retention activities’; andCommentsClose CommentsPermalink
(2) in subsection (b)--CommentsClose CommentsPermalink
(A) by striking ‘First’ and all that follows through ‘including the’ and inserting ‘National Advisory Council on Nurse Education and Practice and consult with nursing associations including the National Coalition of Ethnic Minority Nurse Associations,’; andCommentsClose CommentsPermalink
(B) by inserting before the period the following: ‘, and other organizations determined appropriate by the Secretary’.CommentsClose CommentsPermalink
SEC. 455. PRIMARY CARE EXTENSION PROGRAM.
Part P of title III of the Public Health Service Act (
‘SEC. 399V. PRIMARY CARE EXTENSION PROGRAM.
‘(a) Establishment, Purpose and Definition-CommentsClose CommentsPermalink
‘(1) IN GENERAL- The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall establish a Primary Care Extension Program.CommentsClose CommentsPermalink
‘(2) PURPOSE- The Primary Care Extension Program shall provide support and assistance to primary care providers to educate providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services (including substance abuse prevention and treatment services), and evidence-based and evidence-informed therapies and techniques, in order to enable providers to incorporate such matters into their practice and to improve community health by working with community-based health connectors (referred to in this section as ‘Health Extension Agents’).CommentsClose CommentsPermalink
‘(3) DEFINITIONS- In this section:CommentsClose CommentsPermalink
‘(A) HEALTH EXTENSION AGENT- The term ‘Health Extension Agent’ means any local, community-based health worker who facilitates and provides assistance to primary care practices by implementing quality improvement or system redesign, incorporating the principles of the patient-centered medical home to provide high-quality, effective, efficient, and safe primary care and to provide guidance to patients in culturally and linguistically appropriate ways, and linking practices to diverse health system resources.CommentsClose CommentsPermalink
‘(B) PRIMARY CARE PROVIDER- The term ‘primary care provider’ means a clinician who provides integrated, accessible health care services and who is accountable for addressing a large majority of personal health care needs, including providing preventive and health promotion services for men, women, and children of all ages, developing a sustained partnership with patients, and practicing in the context of family and community, as recognized by a State licensing or regulatory authority, unless otherwise specified in this section.CommentsClose CommentsPermalink
‘(b) Grants to Establish State Hubs and Local Primary Care Extension Agencies-CommentsClose CommentsPermalink
‘(1) GRANTS- The Secretary shall award competitive grants to States for the establishment of State- or multistate-level primary care Primary Care Extension Program State Hubs (referred to in this section as ‘Hubs’).CommentsClose CommentsPermalink
‘(2) COMPOSITION OF HUBS- A Hub established by a State pursuant to paragraph (1)--CommentsClose CommentsPermalink
‘(A) shall consist of, at a minimum, the State health department, the entity responsible for administering the State Medicaid program (if other than the State health department), the State-level entity administering the Medicare program, and the departments of 1 or more health professions schools in the State that train providers in primary care; andCommentsClose CommentsPermalink
‘(B) may include entities such as hospital associations, primary care practice-based research networks, health professional societies, State primary care associations, State licensing boards, organizations with a contract with the Secretary under section 1153 of the Social Security Act, consumer groups, and other appropriate entities.CommentsClose CommentsPermalink
‘(c) State and Local Activities-CommentsClose CommentsPermalink
‘(1) HUB ACTIVITIES- Hubs established under a grant under subsection (b) shall--CommentsClose CommentsPermalink
‘(A) submit to the Secretary a plan to coordinate functions with quality improvement organizations and area health education centers if such entities are members of the Hub not described in subsection (b)(2)(A);CommentsClose CommentsPermalink
‘(B) contract with a county- or local-level entity that shall serve as the Primary Care Extension Agency to administer the services described in paragraph (2);CommentsClose CommentsPermalink
‘(C) organize and administer grant funds to county- or local-level Primary Care Extension Agencies that serve a catchment area, as determined by the State; andCommentsClose CommentsPermalink
‘(D) organize State-wide or multistate networks of local-level Primary Care Extension Agencies to share and disseminate information and practices.CommentsClose CommentsPermalink
‘(2) LOCAL PRIMARY CARE EXTENSION AGENCY ACTIVITIES-CommentsClose CommentsPermalink
‘(A) REQUIRED ACTIVITIES- Primary Care Extension Agencies established by a Hub under paragraph (1) shall--CommentsClose CommentsPermalink
‘(i) assist primary care providers to implement a patient-centered medical home to improve the accessibility, quality, and efficiency of primary care services;CommentsClose CommentsPermalink
‘(ii) develop and support primary care learning communities to enhance the dissemination of research findings for evidence-based practice, assess implementation of practice improvement, share best practices, and involve community clinicians in the generation of new knowledge and identification of important questions for research;CommentsClose CommentsPermalink
‘(iii) participate in a national network of Primary Care Extension Hubs and propose how the Primary Care Extension Agency will share and disseminate lessons learned and best practices; andCommentsClose CommentsPermalink
‘(iv) develop a plan for financial sustainability involving State, local, and private contributions, to provide for the reduction in Federal funds that is expected after an initial 6-year period of program establishment, infrastructure development, and planning.CommentsClose CommentsPermalink
‘(B) DISCRETIONARY ACTIVITIES- Primary Care Extension Agencies established by a Hub under paragraph (1) may--CommentsClose CommentsPermalink
‘(i) provide technical assistance, training, and organizational support for community health teams established under section 212 of the Affordable Health Choices Act;CommentsClose CommentsPermalink
‘(ii) collect data and provision of primary care provider feedback from standardized measurements of processes and outcomes to aid in continuous performance improvement;CommentsClose CommentsPermalink
‘(iii) collaborate with local health departments, community health centers, tribes and tribal entities, and other community agencies to identify community health priorities and local health workforce needs, and participate in community-based efforts to address the social and primary determinants of health, strengthen the local primary care workforce, and eliminate health disparities;CommentsClose CommentsPermalink
‘(iv) develop measures to monitor the impact of the proposed program on the health of practice enrollees and of the wider community served; andCommentsClose CommentsPermalink
‘(v) participate in other activities, as determined appropriate by the Secretary.CommentsClose CommentsPermalink
‘(d) Federal Program Administration-CommentsClose CommentsPermalink
‘(1) GRANTS; TYPES- Grants awarded under subsection (b) shall be--CommentsClose CommentsPermalink
‘(A) program grants, that are awarded to State or multistate entities that submit fully-developed plans for the implementation of a Hub, for a period of 6 years; orCommentsClose CommentsPermalink
‘(B) planning grants, that are awarded to State or multistate entities with the goal of developing a plan for a Hub, for a period of 2 years.CommentsClose CommentsPermalink
‘(2) APPLICATIONS- To be eligible for a grant under subsection (b), a State or multistate entity shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require.CommentsClose CommentsPermalink
‘(3) EVALUATION- A State that receives a grant under subsection (b) shall be evaluated at the end of the grant period by an evaluation panel appointed by the Secretary.CommentsClose CommentsPermalink
‘(4) CONTINUING SUPPORT- After the sixth year in which assistance is provided to a State under a grant awarded under subsection (b), the State may receive additional support under this section if the State program has received satisfactory evaluations with respect to program performance and the merits of the State sustainability plan, as determined by the Secretary.CommentsClose CommentsPermalink
‘(5) LIMITATION- A State shall not use in excess of 10 percent of the amount received under a grant to carry out administrative activities under this section. Funds awarded pursuant to this section shall not be used for funding direct patient care.CommentsClose CommentsPermalink
‘(e) Requirements on the Secretary- In carrying out this section, the Secretary shall consult with the heads of other Federal agencies with demonstrated experience and expertise in health care and preventive medicine, such as the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Administration, the Health Resources and Services Administration, the National Institutes of Health, the Office of the National Coordinator for Health Information Technology, the Indian Health Service, the Agricultural Cooperative Extension Service of the Department of Agriculture, and other entities, as the Secretary determines appropriate.CommentsClose CommentsPermalink
‘(f) Authorization of Appropriations- To awards grants as provided in subsection (d), there are authorized to be appropriated $120,000,000 for each of fiscal years 2011 and 2012, and such sums as may be necessary to carry out this section for each of fiscal years 2013 through 2014.’.CommentsClose CommentsPermalink
SEC. 456. DEFINITION OF ECONOMIC HARDSHIP.
Section 435(o) of the Higher Education Act of 1965 (
(1) in paragraph (1)--CommentsClose CommentsPermalink
(A) in subparagraph (A)(ii), by striking ‘or’ after the semicolon;CommentsClose CommentsPermalink
(B) by redesignating subparagraph (B) as subparagraph (C); andCommentsClose CommentsPermalink
(C) by inserting after subparagraph (A) the following:CommentsClose CommentsPermalink
‘(B) such borrower is working full-time and has a Federal educational debt burden that equals or exceeds 20 percent of such borrower’s adjusted gross income, and the difference between such borrower’s adjusted gross income minus such burden is less than 220 percent of the greater of--CommentsClose CommentsPermalink
‘(i) the annual earnings of an individual earning the minimum wage under section 6 of the Fair Labor Standards Act of 1938; orCommentsClose CommentsPermalink
‘(ii) 150 percent of the poverty line, as defined under section 673(2) of the Community Services Block Grant Act, applicable to such borrower’s family size; or’; andCommentsClose CommentsPermalink
(2) in paragraph (2), by striking ‘(1)(B)’ and inserting ‘(1)(C)’.CommentsClose CommentsPermalink
Subtitle F--General ProvisionsCommentsClose CommentsPermalink
Subtitle F--General ProvisionsCommentsClose CommentsPermalink
SEC. 461. REPORTS.
(a) Reports by Secretary of Health and Human Services- On an annual basis, the Secretary of Health and Human Services shall submit to the appropriate Committees of Congress a report on the activities carried out under the amendments made by this title, and the effectiveness of such activities.CommentsClose CommentsPermalink
(b) Reports by Recipients of Funds- The Secretary of Health and Human Services may require, as a condition of receiving funds under the amendments made by this title, that the entity receiving such award submit to such Secretary such reports as the such Secretary may require on activities carried out with such award, and the effectiveness of such activities.CommentsClose CommentsPermalink
TITLE V--PREVENTING FRAUD AND ABUSECommentsClose CommentsPermalink
TITLE V--PREVENTING FRAUD AND ABUSECommentsClose CommentsPermalink
Subtitle A--Establishment of New Health and Human Services and Department of Justice Health Care Fraud PositionsCommentsClose CommentsPermalink
Subtitle A--Establishment of New Health and Human Services and Department of Justice Health Care Fraud PositionsCommentsClose CommentsPermalink
SEC. 501. HEALTH AND HUMAN SERVICES SENIOR ADVISOR.
Part C of title XXVII of the Public Health Service Act (
(1) by redesignating section 2792 as section 2796; andCommentsClose CommentsPermalink
(2) by inserting after section 2791, the following:CommentsClose CommentsPermalink
‘SEC. 2792. SENIOR ADVISOR FOR HEALTH CARE FRAUD.
‘(a) Establishment- The Secretary shall appoint an individual to serve as the Senior Advisor for Health Care Fraud (referred to in this section as the ‘Senior Advisor’) within the Office of the Deputy Secretary. The Senior Advisory shall be the principal advisor on policy and program development and oversight with respect to--CommentsClose CommentsPermalink
‘(1) the detection and prevention of health care fraud, waste, and abuse involving public health insurance coverage and private health insurance coverage; andCommentsClose CommentsPermalink
‘(2) the coordination of anti-fraud efforts within the Department of Health and Human Services and with the Inspector General, the Department of Justice, other Federal agencies as appropriate, State and local law enforcement, State regulatory agencies, and private health insurance coverage.CommentsClose CommentsPermalink
‘(b) Requirements- The Senior Advisor shall--CommentsClose CommentsPermalink
‘(1) be an officer or employee of the Department of Health and Human Services designated by the Secretary for purposes of this section from among the career officers and employees of the Department who have the experience and expertise necessary to carry out the duties specified in subsection (a); orCommentsClose CommentsPermalink
‘(2) be an individual hired by the Secretary from the private sector from among individuals in the private sector who have the experience and expertise necessary to carry out the duties specified in subsection (a).CommentsClose CommentsPermalink
‘(c) Definition- In this section, the term ‘public health insurance coverage’ means coverage--CommentsClose CommentsPermalink
‘(1) provided under title XVIII, XIX, or XXI of the Social Security Act;CommentsClose CommentsPermalink
‘(2) provided under the veteran’s health care program under chapter 17 of title 38, United States Code;CommentsClose CommentsPermalink
‘(3) provided through the Indian Health Service;CommentsClose CommentsPermalink
‘(4) under the TRICARE program under chapter 55 of title 10, United States Code; andCommentsClose CommentsPermalink
‘(5) under the Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code.’.CommentsClose CommentsPermalink
SEC. 502. DEPARTMENT OF JUSTICE POSITION.
Chapter 41 of title 28, United States Code, is amended by adding at the end the following:CommentsClose CommentsPermalink
‘Sec. 614. Senior Counsel for Health Care Fraud Enforcement
‘The Attorney General shall appoint an individual to serve as the Senior Counsel for Health Care Fraud Enforcement (referred to in this section as the ‘Senior Counsel’) within the Office of the Deputy Attorney General to serve as the principal advisor to the Attorney General on policy and program development and oversight with respect to--CommentsClose CommentsPermalink
‘(1) the investigation and prosecution of health care fraud and abuse involving public and private health insurance coverage (as defined in section 2791 of the Public Health Service Act); andCommentsClose CommentsPermalink
‘(2) the coordination of such efforts within the Department of Justice and with the Inspector General, the Department of Health and Human Services, other Federal agencies as appropriate, State and local law enforcement, State regulatory agencies, and private health insurance coverage.’.CommentsClose CommentsPermalink
SEC. 503. REPORTS TO CONGRESS.
(a) Reports- The Senior Advisor for Health Care Fraud appointed under section 2792 of the Public Health Service Act and the Senior Counsel for Health Care Fraud Enforcement appointed under
(b) Definition- In this section, the term ‘public health insurance coverage’ means coverage--CommentsClose CommentsPermalink
(1) provided under title XVIII, XIX, or XXI of the Social Security Act;CommentsClose CommentsPermalink
(2) provided under the veteran’s health care program under chapter 17 of title 38, United States Code;CommentsClose CommentsPermalink
(3) provided through the Indian Health Service;CommentsClose CommentsPermalink
(4) under the TRICARE program under chapter 55 of title 10, United States Code; andCommentsClose CommentsPermalink
(5) under the Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code.CommentsClose CommentsPermalink
SEC. 504. FRAUD, WASTE, AND ABUSE COMMISSION.
(a) Establishment- Not later than 180 days after the date of enactment of this Act, the President shall establish a commission to be composed of representatives appointed by the President from insurers, employers, health care providers, anti-fraud organizations, consumers and patient groups, and Federal officials to review Federal health care programs and private health insurance with respect to policies and procedures to eliminate fraud, waste, and abuse under such programs and to more effectively align public and private sector efforts to combat fraud, waste, and abuse.CommentsClose CommentsPermalink
(b) Period of Review- The commission under subsection (a) shall review the programs involved for a period of 2 years following the date on which such commission is established.CommentsClose CommentsPermalink
(c) Report- Not later than 3 years after the date on which the commission under subsection (a) is established, the commission shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report concerning the review conducted under such subsection. Such report shall include recommendations for modify such programs and other recommendations to better coordinate public and private efforts to combat fraud and abuse.CommentsClose CommentsPermalink
(d) Cooperation- The President shall direct Federal officials to cooperate in the activities of the commission under this section. Commissioners shall have experience in fighting waste, fraud or abuse in the public and private sectors.CommentsClose CommentsPermalink
(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section, $5,000,000.CommentsClose CommentsPermalink
Subtitle B--Health Care Program Integrity Coordinating CouncilCommentsClose CommentsPermalink
Subtitle B--Health Care Program Integrity Coordinating CouncilCommentsClose CommentsPermalink
SEC. 511. ESTABLISHMENT.
Part C of title XXVII of the Public Health Service Act (
‘SEC. 2794. HEALTH CARE PROGRAM INTEGRITY COORDINATING COUNCIL.
‘(a) Establishment- There is established a council to be known as the ‘Health Care Program Integrity Coordinating Council’ (referred to in this section as the ‘Council’).CommentsClose CommentsPermalink
‘(b) Membership- The Council shall be composed of--CommentsClose CommentsPermalink
‘(1) the Secretary of Health and Human Services;CommentsClose CommentsPermalink
‘(2) the Attorney General;CommentsClose CommentsPermalink
‘(3) the Inspector General for the Department of Health and Human Services;CommentsClose CommentsPermalink
‘(4) the Secretary of Labor;CommentsClose CommentsPermalink
‘(5) the Secretary of Defense;CommentsClose CommentsPermalink
‘(6) the Director of the Office of Personnel Management;CommentsClose CommentsPermalink
‘(7) the Under Secretary for Health for the Veterans Health Administration of the Department of Veterans Affairs;CommentsClose CommentsPermalink
‘(8) the Commissioner of the Social Security Administration;CommentsClose CommentsPermalink
‘(9) the President of the National Association of Insurance Commissioners;CommentsClose CommentsPermalink
‘(10) the President of the National Association of Medicaid Fraud Control Units;CommentsClose CommentsPermalink
‘(11) the Comptroller General of the United States;CommentsClose CommentsPermalink
‘(12) the Inspector General of the Department of Labor;CommentsClose CommentsPermalink
‘(13) the Inspector General of the Department of Defense;CommentsClose CommentsPermalink
‘(14) the Inspector General of the Department of Veterans Affairs;CommentsClose CommentsPermalink
‘(15) the Inspector General of the Department of Justice;CommentsClose CommentsPermalink
‘(16) the chairperson and ranking member of relevant committees of jurisdiction of the Senate and the House of Representatives; andCommentsClose CommentsPermalink
‘(17) any other member, the appointment of whom a majority of the members of the Council determines is necessary to carry out this title, except that an individual who is a representative of an entity subject to regulation under such Act shall not be appointed under this subparagraph.CommentsClose CommentsPermalink
‘(c) Duties- The Council shall--CommentsClose CommentsPermalink
‘(1) not later than 6 months after the date of enactment of this section, develop a strategic plan for improving the coordination and information sharing among Federal agencies, State agencies, and private health insurance coverage with respect to the prevention, detection, and control of fraud, waste, and abuse, including fraud and abuse of consumers of the health care program or private health insurance issuers;CommentsClose CommentsPermalink
‘(2) annually submit to Congress a report on actions taken to implement the strategic plan required under paragraph (1);CommentsClose CommentsPermalink
‘(3) in carrying out the responsibilities identified under paragraph (1), evaluate ways to ensure that private health insurance coverage is included in investigative and data sharing programs, to the maximum extent feasible, with adequate protection provided for law enforcement-related data that is sensitive because of concerns for the identities of criminal subjects or targets, and that recognizes that private coverage may be responsible for fraud, waste, and abuse of public and policyholder funds;CommentsClose CommentsPermalink
‘(4) not later than 12 months after the date of enactment of this section, develop and issue guidelines for purposes of carrying out the strategic plan under paragraph (1), recognizing that fraudulent activity in the health care system can affect both public and private sector health insurance coverage, and that the prevention, detection, investigation, and prosecution of fraud against private health insurance coverage is integral to the overall effort to combat health care fraud;CommentsClose CommentsPermalink
‘(5) at least once during every 5-year period, update the strategic plan issued pursuant to paragraph (1) and the guidelines issued pursuant to paragraph (4);CommentsClose CommentsPermalink
‘(6) develop recommendations, in consultation with the Office of Management and Budget, for measures to estimate the amount of fraud, waste, and abuse in connection with public and private health insurance coverage, and the annual savings resulting from specific program integrity measures;CommentsClose CommentsPermalink
‘(7) identify improvements needed for purposes of information-sharing systems and activities used in implementing the strategic plan under paragraph (1); andCommentsClose CommentsPermalink
‘(8) establish a consultative panel composed of representatives of the private sector health insurance industry and consult with this panel in the formulation of Council recommendations.CommentsClose CommentsPermalink
‘(d) Exemptions- The Council shall be exempt from--CommentsClose CommentsPermalink
‘(1) sections 553, 556, and 557 of title 5, United States Code, in the issuance of guidelines pursuant to subsection (c)(4); andCommentsClose CommentsPermalink
‘(2) the Federal Advisory Committee Act (5 U.S.C. app.) in order to protect against the release of information which might undermine Federal, State, or local health care fraud control efforts.CommentsClose CommentsPermalink
‘(e) Public Participation- The Council shall provide for reasonable public participation in matters before the Council to the extent that such participation would not compromise the Council’s, or any other Federal, State, or local government entity’s, efforts to control health care fraud and abuse.’.CommentsClose CommentsPermalink
Subtitle C--False Statements and RepresentationsCommentsClose CommentsPermalink
Subtitle C--False Statements and RepresentationsCommentsClose CommentsPermalink
SEC. 521. PROHIBITION ON FALSE STATEMENTS AND REPRESENTATIONS.
(a) Prohibition- Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (
‘SEC. 519. PROHIBITION ON FALSE STATEMENTS AND REPRESENTATIONS.
‘No person, in connection with a plan or other arrangement that is multiple employer welfare arrangement described in section 3(40), shall make a false statement or false representation of fact, knowing it to be false, in connection with the marketing or sale of such plan or arrangement, to any employee, any member of an employee organization, any beneficiary, any employer, any employee organization, the Secretary, or any State, or the representative or agent of any such person, State, or the Secretary, concerning--CommentsClose CommentsPermalink
‘(1) the financial condition or solvency of such plan or arrangement;CommentsClose CommentsPermalink
‘(2) the benefits provided by such plan or arrangement;CommentsClose CommentsPermalink
‘(3) the regulatory status of such plan or other arrangement under any Federal or State law governing collective bargaining, labor management relations, or intern union affairs; orCommentsClose CommentsPermalink
‘(4) the regulatory status of such plan or other arrangement regarding exemption from state regulatory authority under this Act.CommentsClose CommentsPermalink
This section shall not apply to any plan or arrangement that does not fall within the meaning of the term ‘multiple employer welfare arrangement’ under section 3(40(A).’.CommentsClose CommentsPermalink
(b) Criminal Penalties- Section 501 of the Employee Retirement Income Security Act of 1974 (
29 U.S.C. 1131 ) is amended--CommentsClose CommentsPermalink
(1) by inserting ‘(a)’ before ‘Any person’; andCommentsClose CommentsPermalink
(2) by adding at the end the following:CommentsClose CommentsPermalink
‘(b) Any person that violates section 519 shall upon conviction be imprisoned not more than 10 years or fined under title 18, United States Code, or both.’.CommentsClose CommentsPermalink
(c) Conforming Amendment- The table of sections for part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following:CommentsClose CommentsPermalink
‘Sec. 519. Prohibition on false statement and representations.’.CommentsClose CommentsPermalink
Subtitle D--Federal Health Care OffenseCommentsClose CommentsPermalink
Subtitle D--Federal Health Care OffenseCommentsClose CommentsPermalink
SEC. 531. CLARIFYING DEFINITION.
Subtitle E--Uniformity in Fraud and Abuse ReportingCommentsClose CommentsPermalink
Subtitle E--Uniformity in Fraud and Abuse ReportingCommentsClose CommentsPermalink
SEC. 541. DEVELOPMENT OF MODEL UNIFORM REPORT FORM.
Part C of title XXVII of the Public Health Service Act (
‘SEC. 2795. UNIFORM FRAUD AND ABUSE REFERRAL FORMAT.
‘The Secretary shall request the National Association of Insurance Commissioners to develop a model uniform report form for private health insurance issuer seeking to refer suspected fraud and abuse to State insurance departments or other responsible State agencies for investigation. The Secretary shall request that the National Association of Insurance Commissioners develop recommendations for uniform reporting standards for such referrals.’.CommentsClose CommentsPermalink
Subtitle F--Applicability of State Law to Combat Fraud and AbuseCommentsClose CommentsPermalink
Subtitle F--Applicability of State Law to Combat Fraud and AbuseCommentsClose CommentsPermalink
SEC. 551. APPLICABILITY OF STATE LAW TO COMBAT FRAUD AND ABUSE.
(a) In General- Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (
‘SEC. 520. APPLICABILITY OF STATE LAW TO COMBAT FRAUD AND ABUSE.
‘The Secretary may, for the purpose of identifying, preventing, or prosecuting fraud and abuse, adopt regulatory standards establishing, or issue an order relating to a specific person establishing, that a person engaged in the business of providing insurance through a multiple employer welfare arrangement described in section 3(40) is subject to the laws of the States in which such person operates which regulate insurance in such State, notwithstanding section 514(b)(6) of this Act or the Liability Risk Retention Act of 1986, and regardless of whether the law of the State is otherwise preempted under any of such provisions. This section shall not apply to any plan or arrangement that does not fall within the meaning of the term ‘multiple employer welfare arrangement’ under section 3(40(A).’.CommentsClose CommentsPermalink
(b) Conforming Amendment- The table of sections for part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, as amended by section 521, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘Sec. 520. Applicability of State law to combat fraud and abuse.’.CommentsClose CommentsPermalink
Subtitle G--Enabling the Department of Labor to Issue Administrative Summary Cease and Desist Orders and Summary Seizures Orders Against Plans That Are in Financially Hazardous ConditionCommentsClose CommentsPermalink
Subtitle G--Enabling the Department of Labor to Issue Administrative Summary Cease and Desist Orders and Summary Seizures Orders Against Plans That Are in Financially Hazardous ConditionCommentsClose CommentsPermalink
SEC. 561. ENABLING THE DEPARTMENT OF LABOR TO ISSUE ADMINISTRATIVE SUMMARY CEASE AND DESIST ORDERS AND SUMMARY SEIZURES ORDERS AGAINST PLANS THAT ARE IN FINANCIALLY HAZARDOUS CONDITION.
(a) In General- Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (
‘SEC. 521. ADMINISTRATIVE SUMMARY CEASE AND DESIST ORDERS AND SUMMARY SEIZURE ORDERS AGAINST MULTIPLE EMPLOYER WELFARE ARRANGEMENTS IN FINANCIALLY HAZARDOUS CONDITION.
‘(a) In General- The Secretary may issue a cease and desist (ex parte) order under this title if it appears to the Secretary that the alleged conduct of a multiple employer welfare arrangement described in section 3(40), other than a plan or arrangement described in subsection (g), is fraudulent, or creates an immediate danger to the public safety or welfare, or is causing or can be reasonably expected to cause significant, imminent, and irreparable public injury.CommentsClose CommentsPermalink
‘(b) Hearing- A person that is adversely affected by the issuance of a cease and desist order under subsection (a) may request a hearing by the Secretary regarding such order. The Secretary may require that a proceeding under this section, including all related information and evidence, be conducted in a confidential manner.CommentsClose CommentsPermalink
‘(c) Burden of Proof- The burden of proof in any hearing conducted under subsection (b) shall be on the party requesting the hearing to show cause why the cease and desist order should be set aside.CommentsClose CommentsPermalink
‘(d) Determination- Based upon the evidence presented at a hearing under subsection (b), the cease and desist order involved may be affirmed, modified, or set aside by the Secretary in whole or in part.CommentsClose CommentsPermalink
‘(e) Seizure- The Secretary may issue a summary seizure order under this title if it appears that a multiple employer welfare arrangement is in a financially hazardous condition.CommentsClose CommentsPermalink
‘(f) Regulations- The Secretary may promulgate such regulations or other guidance as may be necessary or appropriate to carry out this section.CommentsClose CommentsPermalink
‘(g) Exception- This section shall not apply to any plan or arrangement that does not fall within the meaning of the term ‘multiple employer welfare arrangement’ under section 3(40(A).’.CommentsClose CommentsPermalink
(b) Conforming Amendment- The table of sections for part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, as amended by section 551, is further amended by adding at the end the following:CommentsClose CommentsPermalink
‘Sec. 521. Administrative summary cease and desist orders and summary seizure orders against health plans in financially hazardous condition.’.CommentsClose CommentsPermalink
Subtitle H--Requiring Multiple Employer Welfare Arrangement (MEWA) Plans to File a Registration Form With the Department of Labor Prior to Enrolling Anyone in the PlanCommentsClose CommentsPermalink
Subtitle H--Requiring Multiple Employer Welfare Arrangement (MEWA) Plans to File a Registration Form With the Department of Labor Prior to Enrolling Anyone in the PlanCommentsClose CommentsPermalink
SEC. 571. MEWA PLAN REGISTRATION WITH DEPARTMENT OF LABOR.
Section 101(g) of the Employee Retirement Income Security Act of 1974 (
(1) by striking ‘Secretary may’ and inserting ‘Secretary shall’; andCommentsClose CommentsPermalink
(2) by inserting ‘to register with the Secretary prior to operating in a State and may, by regulation, require such multiple employer welfare arrangements’ after ‘not group health plans’.CommentsClose CommentsPermalink
Subtitle I--Permitting Evidentiary Privilege and Confidential CommunicationsCommentsClose CommentsPermalink
Subtitle I--Permitting Evidentiary Privilege and Confidential CommunicationsCommentsClose CommentsPermalink
SEC. 581. PERMITTING EVIDENTIARY PRIVILEGE AND CONFIDENTIAL COMMUNICATIONS.
Section 504 of the Employee Retirement Income Security Act of 1974 (
‘(d) The Secretary may promulgate a regulation that provides an evidentiary privilege for, and provides for the confidentiality of communications between or among, any of the following entities or their agents, consultants, or employees:CommentsClose CommentsPermalink
‘(1) A State insurance department.CommentsClose CommentsPermalink
‘(2) A State attorney general.CommentsClose CommentsPermalink
‘(3) The National Association of Insurance Commissioners.CommentsClose CommentsPermalink
‘(4) The Department of Labor.CommentsClose CommentsPermalink
‘(5) The Department of the Treasury.CommentsClose CommentsPermalink
‘(6) The Department of Justice.CommentsClose CommentsPermalink
‘(7) The Department of Health and Human Services.CommentsClose CommentsPermalink
‘(8) Any other Federal or State authority that the Secretary determines is appropriate for the purposes of enforcing the provisions of this title.CommentsClose CommentsPermalink
‘(e) The privilege established under subsection (d) shall apply to communications related to any investigation, audit, examination, or inquiry conducted or coordinated by any of the agencies. A communication that is privileged under subsection (d) shall not waive any privilege otherwise available to the communicating agency or to any person who provided the information that is communicated.’.CommentsClose CommentsPermalink
TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIESCommentsClose CommentsPermalink
TITLE VI--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIESCommentsClose CommentsPermalink
Subtitle A--Biologics Price Competition and InnovationCommentsClose CommentsPermalink
Subtitle A--Biologics Price Competition and InnovationCommentsClose CommentsPermalink
SEC. 601. SHORT TITLE.
(a) In General- This subtitle may be cited as the ‘Biologics Price Competition and Innovation Act of 2009’.CommentsClose CommentsPermalink
(b) Sense of the Senate- It is the sense of the Senate that a biosimilars pathway balancing innovation and consumer interests should be established.CommentsClose CommentsPermalink
SEC. 602. APPROVAL PATHWAY FOR BIOSIMILAR BIOLOGICAL PRODUCTS.
(a) Licensure of Biological Products as Biosimilar or Interchangeable- Section 351 of the Public Health Service Act (
(1) in subsection (a)(1)(A), by inserting ‘under this subsection or subsection (k)’ after ‘biologics license’; andCommentsClose CommentsPermalink
(2) by adding at the end the following:CommentsClose CommentsPermalink
‘(k) Licensure of Biological Products as Biosimilar or Interchangeable-CommentsClose CommentsPermalink
‘(1) IN GENERAL- Any person may submit an application for licensure of a biological product under this subsection.CommentsClose CommentsPermalink
‘(2) CONTENT-CommentsClose CommentsPermalink
‘(A) IN GENERAL-CommentsClose CommentsPermalink
‘(i) REQUIRED INFORMATION- An application submitted under this subsection shall include information demonstrating that--CommentsClose CommentsPermalink
‘(I) the biological product is biosimilar to a reference product based upon data derived from--CommentsClose CommentsPermalink
‘(aa) analytical studies that demonstrate that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components;CommentsClose CommentsPermalink
‘(bb) animal studies (including the assessment of toxicity); andCommentsClose CommentsPermalink
‘(cc) a clinical study or studies (including the assessment of immunogenicity and pharmacokinetics or pharmacodynamics) that are sufficient to demonstrate safety, purity, and potency in 1 or more appropriate conditions of use for which the reference product is licensed and intended to be used and for which licensure is sought for the biological product;CommentsClose CommentsPermalink
‘(II) the biological product and reference product utilize the same mechanism or mechanisms of action for the condition or conditions of use prescribed, recommended, or suggested in the proposed labeling, but only to the extent the mechanism or mechanisms of action are known for the reference product;CommentsClose CommentsPermalink
‘(III) the condition or conditions of use prescribed, recommended, or suggested in the labeling proposed for the biological product have been previously approved for the reference product;CommentsClose CommentsPermalink
‘(IV) the route of administration, the dosage form, and the strength of the biological product are the same as those of the reference product; andCommentsClose CommentsPermalink
‘(V) the facility in which the biological product is manufactured, processed, packed, or held meets standards designed to assure that the biological product continues to be safe, pure, and potent.CommentsClose CommentsPermalink
‘(ii) DETERMINATION BY SECRETARY- The Secretary may determine, in the Secretary’s discretion, that an element described in clause (i)(I) is unnecessary in an application submitted under this subsection.CommentsClose CommentsPermalink
‘(iii) ADDITIONAL INFORMATION- An application submitted under this subsection--CommentsClose CommentsPermalink
‘(I) shall include publicly-available information regarding the Secretary’s previous determination that the reference product is safe, pure, and potent; andCommentsClose CommentsPermalink
‘(II) may include any additional information in support of the application, including publicly-available information with respect to the reference product or another biological product.CommentsClose CommentsPermalink
‘(B) INTERCHANGEABILITY- An application (or a supplement to an application) submitted under this subsection may include information demonstrating that the biological product meets the standards described in paragraph (4).CommentsClose CommentsPermalink
‘(3) EVALUATION BY SECRETARY- Upon review of an application (or a supplement to an application) submitted under this subsection, the Secretary shall license the biological product under this subsection if--CommentsClose CommentsPermalink
‘(A) the Secretary determines that the information submitted in the application (or the supplement) is sufficient to show that the biological product--CommentsClose CommentsPermalink
‘(i) is biosimilar to the reference product; orCommentsClose CommentsPermalink
‘(ii) meets the standards described in paragraph (4), and therefore is interchangeable with the reference product; andCommentsClose CommentsPermalink
‘(B) the applicant (or other appropriate person) consents to the inspection of the facility that is the subject of the application, in accordance with subsection (c).CommentsClose CommentsPermalink
‘(4) SAFETY STANDARDS FOR DETERMINING INTERCHANGEABILITY- Upon review of an application submitted under this subsection or any supplement to such application, the Secretary shall determine the biological product to be interchangeable with the reference product if the Secretary determines that the information submitted in the application (or a supplement to such application) is sufficient to show that--CommentsClose CommentsPermalink
‘(A) the biological product--CommentsClose CommentsPermalink
‘(i) is biosimilar to the reference product; andCommentsClose CommentsPermalink
‘(ii) can be expected to produce the same clinical result as the reference product in any given patient; andCommentsClose CommentsPermalink
‘(B) for a biological product that is administered more than once to an individual, the risk in terms of safety or diminished efficacy of alternating or switching between use of the biological product and the reference product is not greater than the risk of using the reference product without such alternation or switch.CommentsClose CommentsPermalink
‘(5) GENERAL RULES-CommentsClose CommentsPermalink
‘(A) ONE REFERENCE PRODUCT PER APPLICATION- A biological product, in an application submitted under this subsection, may not be evaluated against more than 1 reference product.CommentsClose CommentsPermalink
‘(B) REVIEW- An application submitted under this subsection shall be reviewed by the division within the Food and Drug Administration that is responsible for the review and approval of the application under which the reference product is licensed.CommentsClose CommentsPermalink
‘(C) RISK EVALUATION AND MITIGATION STRATEGIES- The authority of the Secretary with respect to risk evaluation and mitigation strategies under the Federal Food, Drug, and Cosmetic Act shall apply to biological products licensed under this subsection in the same manner as such authority applies to biological products licensed under subsection (a).CommentsClose CommentsPermalink
‘(6) EXCLUSIVITY FOR FIRST INTERCHANGEABLE BIOLOGICAL PRODUCT- Upon review of an application submitted under this subsection relying on the same reference product for which a prior biological product has received a determination of interchangeability for any condition of use, the Secretary shall not make a determination under paragraph (4) that the second or subsequent biological product is interchangeable for any condition of use until the earlier of--CommentsClose CommentsPermalink
‘(A) 1 year after the first commercial marketing of the first interchangeable biosimilar biological product to be approved as interchangeable for that reference product;CommentsClose CommentsPermalink
‘(B) 18 months after--CommentsClose CommentsPermalink
‘(i) a final court decision on all patents in suit in an action instituted under subsection (l)(6) against the applicant that submitted the application for the first approved interchangeable biosimilar biological product; orCommentsClose CommentsPermalink
‘(ii) the dismissal with or without prejudice of an action instituted under subsection (l)(6) against the applicant that submitted the application for the first approved interchangeable biosimilar biological product; orCommentsClose CommentsPermalink
‘(C)(i) 42 months after approval of the first interchangeable biosimilar biological product if the applicant that submitted such application has been sued under subsection (l)(6) and such litigation is still ongoing within such 42-month period; orCommentsClose CommentsPermalink
‘(ii) 18 months after approval of the first interchangeable biosimilar biological product if the applicant that submitted such application has not been sued under subsection (l)(6).CommentsClose CommentsPermalink
For purposes of this paragraph, the term ‘final court decision’ means a final decision of a court from which no appeal (other than a petition to the United States Supreme Court for a writ of certiorari) has been or can be taken.CommentsClose CommentsPermalink
‘(7) EXCLUSIVITY FOR REFERENCE PRODUCT-CommentsClose CommentsPermalink
‘(A) EFFECTIVE DATE OF BIOSIMILAR APPLICATION APPROVAL- Approval of an application under this subsection may not be made effective by the Secretary until the date that is 12 years after the date on which the reference product was first licensed under subsection (a).CommentsClose CommentsPermalink
‘(B) FILING PERIOD- An application under this subsection may not be submitted to the Secretary until the date that is 4 years after the date on which the reference product was first licensed under subsection (a).CommentsClose CommentsPermalink
‘(C) FIRST LICENSURE- Subparagraphs (A) and (B) shall not apply to a license for or approval of--CommentsClose CommentsPermalink
‘(i) a supplement for the biological product that is the reference product; orCommentsClose CommentsPermalink
‘(ii) a subsequent application filed by the same sponsor or manufacturer of the biological product that is the reference product (or a licensor, predecessor in interest, or other related entity) for--CommentsClose CommentsPermalink
‘(I) a change (not including a modification to the structure of the biological product) that results in a new indication, route of administration, dosing schedule, dosage form, delivery system, delivery device, or strength; orCommentsClose CommentsPermalink
‘(II) a modification to the structure of the biological product that does not result in a change in safety, purity, or potency.CommentsClose CommentsPermalink
‘(8) GUIDANCE DOCUMENTS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- The Secretary may, after opportunity for public comment, issue guidance in accordance, except as provided in subparagraph (B)(i), with section 701(h) of the Federal Food, Drug, and Cosmetic Act with respect to the licensure of a biological product under this subsection. Any such guidance may be general or specific.CommentsClose CommentsPermalink
‘(B) PUBLIC COMMENT-CommentsClose CommentsPermalink
‘(i) IN GENERAL- The Secretary shall provide the public an opportunity to comment on any proposed guidance issued under subparagraph (A) before issuing final guidance.CommentsClose CommentsPermalink
‘(ii) INPUT REGARDING MOST VALUABLE GUIDANCE- The Secretary shall establish a process through which the public may provide the Secretary with input regarding priorities for issuing guidance.CommentsClose CommentsPermalink
‘(C) NO REQUIREMENT FOR APPLICATION CONSIDERATION- The issuance (or non-issuance) of guidance under subparagraph (A) shall not preclude the review of, or action on, an application submitted under this subsection.CommentsClose CommentsPermalink
‘(D) REQUIREMENT FOR PRODUCT CLASS-SPECIFIC GUIDANCE- If the Secretary issues product class-specific guidance under subparagraph (A), such guidance shall include a description of--CommentsClose CommentsPermalink
‘(i) the criteria that the Secretary will use to determine whether a biological product is highly similar to a reference product in such product class; andCommentsClose CommentsPermalink
‘(ii) the criteria, if available, that the Secretary will use to determine whether a biological product meets the standards described in paragraph (4).CommentsClose CommentsPermalink
‘(E) CERTAIN PRODUCT CLASSES-CommentsClose CommentsPermalink
‘(i) GUIDANCE- The Secretary may indicate in a guidance document that the science and experience, as of the date of such guidance, with respect to a product or product class (not including any recombinant protein) does not allow approval of an application for a license as provided under this subsection for such product or product class.CommentsClose CommentsPermalink
‘(ii) MODIFICATION OR REVERSAL- The Secretary may issue a subsequent guidance document under subparagraph (A) to modify or reverse a guidance document under clause (i).CommentsClose CommentsPermalink
‘(iii) NO EFFECT ON ABILITY TO DENY LICENSE- Clause (i) shall not be construed to require the Secretary to approve a product with respect to which the Secretary has not indicated in a guidance document that the science and experience, as described in clause (i), does not allow approval of such an application.CommentsClose CommentsPermalink
‘(l) Patents-CommentsClose CommentsPermalink
‘(1) CONFIDENTIAL ACCESS TO SUBSECTION (k) APPLICATION-CommentsClose CommentsPermalink
‘(A) APPLICATION OF PARAGRAPH- Unless otherwise agreed to by a person that submits an application under subsection (k) (referred to in this subsection as the ‘subsection (k) applicant’) and the sponsor of the application for the reference product (referred to in this subsection as the ‘reference product sponsor’), the provisions of this paragraph shall apply to the exchange of information described in this subsection.CommentsClose CommentsPermalink
‘(B) IN GENERAL-CommentsClose CommentsPermalink
‘(i) PROVISION OF CONFIDENTIAL INFORMATION- When a subsection (k) applicant submits an application under subsection (k), such applicant shall provide to the persons described in clause (ii), subject to the terms of this paragraph, confidential access to the information required to be produced pursuant to paragraph (2) and any other information that the subsection (k) applicant determines, in its sole discretion, to be appropriate (referred to in this subsection as the ‘confidential information’).CommentsClose CommentsPermalink
‘(ii) RECIPIENTS OF INFORMATION- The persons described in this clause are the following:CommentsClose CommentsPermalink
‘(I) OUTSIDE COUNSEL- One or more attorneys designated by the reference product sponsor who are employees of an entity other than the reference product sponsor (referred to in this paragraph as the ‘outside counsel’), provided that such attorneys do not engage, formally or informally, in patent prosecution relevant or related to the reference product.CommentsClose CommentsPermalink
‘(II) IN-HOUSE COUNSEL- One attorney that represents the reference product sponsor who is an employee of the reference product sponsor, provided that such attorney does not engage, formally or informally, in patent prosecution relevant or related to the reference product.CommentsClose CommentsPermalink
‘(iii) PATENT OWNER ACCESS- A representative of the owner of a patent exclusively licensed to a reference product sponsor with respect to the reference product and who has retained a right to assert the patent or participate in litigation concerning the patent may be provided the confidential information, provided that the representative informs the reference product sponsor and the subsection (k) applicant of his or her agreement to be subject to the confidentiality provisions set forth in this paragraph, including those under clause (ii).CommentsClose CommentsPermalink
‘(C) LIMITATION ON DISCLOSURE- No person that receives confidential information pursuant to subparagraph (B) shall disclose any confidential information to any other person or entity, including the reference product sponsor employees, outside scientific consultants, or other outside counsel retained by the reference product sponsor, without the prior written consent of the subsection (k) applicant, which shall not be unreasonably withheld.CommentsClose CommentsPermalink
‘(D) USE OF CONFIDENTIAL INFORMATION- Confidential information shall be used for the sole and exclusive purpose of determining, with respect to each patent assigned to or exclusively licensed by the reference product sponsor, whether a claim of patent infringement could reasonably be asserted if the subsection (k) applicant engaged in the manufacture, use, offering for sale, sale, or importation into the United States of the biological product that is the subject of the application under subsection (k).CommentsClose CommentsPermalink
‘(E) OWNERSHIP OF CONFIDENTIAL INFORMATION- The confidential information disclosed under this paragraph is, and shall remain, the property of the subsection (k) applicant. By providing the confidential information pursuant to this paragraph, the subsection (k) applicant does not provide the reference product sponsor or the outside counsel any interest in or license to use the confidential information, for purposes other than those specified in subparagraph (D).CommentsClose CommentsPermalink
‘(F) EFFECT OF INFRINGEMENT ACTION- In the event that the reference product sponsor files a patent infringement suit, the use of confidential information shall continue to be governed by the terms of this paragraph until such time as a court enters a protective order regarding the information. Upon entry of such order, the subsection (k) applicant may redesignate confidential information in accordance with the terms of that order. No confidential information shall be included in any publicly-available complaint or other pleading. In the event that the reference product sponsor does not file an infringement action by the date specified in paragraph (6), the reference product sponsor shall return or destroy all confidential information received under this paragraph, provided that if the reference product sponsor opts to destroy such information, it will confirm destruction in writing to the subsection (k) applicant.CommentsClose CommentsPermalink
‘(G) RULE OF CONSTRUCTION- Nothing in this paragraph shall be construed--CommentsClose CommentsPermalink
‘(i) as an admission by the subsection (k) applicant regarding the validity, enforceability, or infringement of any patent; orCommentsClose CommentsPermalink
‘(ii) as an agreement or admission by the subsection (k) applicant with respect to the competency, relevance, or materiality of any confidential information.CommentsClose CommentsPermalink
‘(H) EFFECT OF VIOLATION- The disclosure of any confidential information in violation of this paragraph shall be deemed to cause the subsection (k) applicant to suffer irreparable harm for which there is no adequate legal remedy and the court shall consider immediate injunctive relief to be an appropriate and necessary remedy for any violation or threatened violation of this paragraph.CommentsClose CommentsPermalink
‘(2) SUBSECTION (k) APPLICATION INFORMATION- Not later than 20 days after the Secretary notifies the subsection (k) applicant that the application has been accepted for review, the subsection (k) applicant--CommentsClose CommentsPermalink
‘(A) shall provide to the reference product sponsor a copy of the application submitted to the Secretary under subsection (k), and such other information that describes the process or processes used to manufacture the biological product that is the subject of such application; andCommentsClose CommentsPermalink
‘(B) may provide to the reference product sponsor additional information requested by or on behalf of the reference product sponsor.CommentsClose CommentsPermalink
‘(3) LIST AND DESCRIPTION OF PATENTS-CommentsClose CommentsPermalink
‘(A) LIST BY REFERENCE PRODUCT SPONSOR- Not later than 60 days after the receipt of the application and information under paragraph (2), the reference product sponsor shall provide to the subsection (k) applicant--CommentsClose CommentsPermalink
‘(i) a list of patents for which the reference product sponsor believes a claim of patent infringement could reasonably be asserted by the reference product sponsor, or by a patent owner that has granted an exclusive license to the reference product sponsor with respect to the reference product, if a person not licensed by the reference product sponsor engaged in the making, using, offering to sell, selling, or importing into the United States of the biological product that is the subject of the subsection (k) application; andCommentsClose CommentsPermalink
‘(ii) an identification of the patents on such list that the reference product sponsor would be prepared to license to the subsection (k) applicant.CommentsClose CommentsPermalink
‘(B) LIST AND DESCRIPTION BY SUBSECTION (k) APPLICANT- Not later than 60 days after receipt of the list under subparagraph (A), the subsection (k) applicant--CommentsClose CommentsPermalink
‘(i) may provide to the reference product sponsor a list of patents to which the subsection (k) applicant believes a claim of patent infringement could reasonably be asserted by the reference product sponsor if a person not licensed by the reference product sponsor engaged in the making, using, offering to sell, selling, or importing into the United States of the biological product that is the subject of the subsection (k) application;CommentsClose CommentsPermalink
‘(ii) shall provide to the reference product sponsor, with respect to each patent listed by the reference product sponsor under subparagraph (A) or listed by the subsection (k) applicant under clause (i)--CommentsClose CommentsPermalink
‘(I) a detailed statement that describes, on a claim by claim basis, the factual and legal basis of the opinion of the subsection (k) applicant that such patent is invalid, unenforceable, or will not be infringed by the commercial marketing of the biological product that is the subject of the subsection (k) application; orCommentsClose CommentsPermalink
‘(II) a statement that the subsection (k) applicant does not intend to begin commercial marketing of the biological product before the date that such patent expires; andCommentsClose CommentsPermalink
‘(iii) shall provide to the reference product sponsor a response regarding each patent identified by the reference product sponsor under subparagraph (A)(ii).CommentsClose CommentsPermalink
‘(C) DESCRIPTION BY REFERENCE PRODUCT SPONSOR- Not later than 60 days after receipt of the list and statement under subparagraph (B), the reference product sponsor shall provide to the subsection (k) applicant a detailed statement that describes, with respect to each patent described in subparagraph (B)(ii)(I), on a claim by claim basis, the factual and legal basis of the opinion of the reference product sponsor that such patent will be infringed by the commercial marketing of the biological product that is the subject of the subsection (k) application and a response to the statement concerning validity and enforceability provided under subparagraph (B)(ii)(I).CommentsClose CommentsPermalink
‘(4) PATENT RESOLUTION NEGOTIATIONS-CommentsClose CommentsPermalink
‘(A) IN GENERAL- After receipt by the subsection (k) applicant of the statement under paragraph (3)(C), the reference product sponsor and the subsection (k) applicant shall engage in good faith negotiations to agree on which, if any, patents listed under paragraph (3) by the subsection (k) applicant or the reference product sponsor shall be the subject of an action for patent infringement under paragraph (6).CommentsClose CommentsPermalink
‘(B) FAILURE TO REACH AGREEMENT- If, within 15 days of beginning negotiations under subparagraph (A), the subsection (k) applicant and the reference product sponsor fail to agree on a final and complete list of which, if any, patents listed under paragraph (3) by the subsection (k) applicant or the reference product sponsor shall be the subject of an action for patent infringement under paragraph (6), the provisions of paragraph (5) shall apply to the parties.CommentsClose CommentsPermalink
‘(5) PATENT RESOLUTION IF NO AGREEMENT-CommentsClose CommentsPermalink
‘(A) NUMBER OF PATENTS- The subsection (k) applicant shall notify the reference product sponsor of the number of patents that such applicant will provide to the reference product sponsor under subparagraph (B)(i)(I).CommentsClose CommentsPermalink
‘(B) EXCHANGE OF PATENT LISTS-CommentsClose CommentsPermalink
‘(i) IN GENERAL- On a date agreed to by the subsection (k) applicant and the reference product sponsor, but in no case later than 5 days after the subsection (k) applicant notifies the reference product sponsor under subparagraph (A), the subsection (k) applicant and the reference product sponsor shall simultaneously exchange--CommentsClose CommentsPermalink
‘(I) the list of patents that the subsection (k) applicant believes should be the subject of an action for patent infringement under paragraph (6); andCommentsClose CommentsPermalink
‘(II) the list of patents, in accordance with clause (ii), that the reference product sponsor believes should be the subject of an action for patent infringement under paragraph (6).CommentsClose CommentsPermalink
‘(ii) NUMBER OF PATENTS LISTED BY REFERENCE PRODUCT SPONSOR-CommentsClose CommentsPermalink
‘(I) IN GENERAL- Subject to subclause (II), the number of patents listed by the reference product sponsor under clause (i)(II) may not exceed the number of patents listed by the subsection (k) applicant under clause (i)(I).CommentsClose CommentsPermalink
‘(II) EXCEPTION- If a subsection (k) applicant does not list any patent under clause (i)(I), the reference product sponsor may list 1 patent under clause (i)(II).CommentsClose CommentsPermalink
‘(6) IMMEDIATE PATENT INFRINGEMENT ACTION-CommentsClose CommentsPermalink
‘(A) ACTION IF AGREEMENT ON PATENT LIST- If the subsection (k) applicant and the reference product sponsor agree on patents as described in paragraph (4), not later than 30 days after such agreement, the reference product sponsor shall bring an action for patent infringement with respect to each such patent.CommentsClose CommentsPermalink
‘(B) ACTION IF NO AGREEMENT ON PATENT LIST- If the provisions of paragraph (5) apply to the parties as described in paragraph (4)(B), not later than 30 days after the exchange of lists under paragraph (5)(B), the reference product sponsor shall bring an action for patent infringement with respect to each patent that is included on such lists.CommentsClose CommentsPermalink
‘(C) NOTIFICATION AND PUBLICATION OF COMPLAINT-CommentsClose CommentsPermalink
‘(i) NOTIFICATION TO SECRETARY- Not later than 30 days after a complaint is served to a subsection (k) applicant in an action for patent infringement described under this paragraph, the subsection (k) applicant shall provide the Secretary with notice and a copy of such complaint.CommentsClose CommentsPermalink
‘(ii) PUBLICATION BY SECRETARY- The Secretary shall publish in the Federal Register notice of a complaint received under clause (i).CommentsClose CommentsPermalink
‘(7) NEWLY ISSUED OR LICENSED PATENTS- In the case of a patent that--CommentsClose CommentsPermalink
‘(A) is issued to, or exclusively licensed by, the reference product sponsor after the date that the reference product sponsor provided the list to the subsection (k) applicant under paragraph (3)(A); andCommentsClose CommentsPermalink
‘(B) the reference product sponsor reasonably believes that, due to the issuance of such patent, a claim of patent infringement could reasonably be asserted by the reference product sponsor if a person not licensed by the reference product sponsor engaged in the making, using, offering to sell, selling, or importing into the United States of the biological product that is the subject of the subsection (k) application,CommentsClose CommentsPermalink
not later than 30 days after such issuance or licensing, the reference product sponsor shall provide to the subsection (k) applicant a supplement to the list provided by the reference product sponsor under paragraph (3)(A) that includes such patent, not later than 30 days after such supplement is provided, the subsection (k) applicant shall provide a statement to the reference product sponsor in accordance with paragraph (3)(B), and such patent shall be subject to paragraph (8).CommentsClose CommentsPermalink
‘(8) NOTICE OF COMMERCIAL MARKETING AND PRELIMINARY INJUNCTION-CommentsClose CommentsPermalink
‘(A) NOTICE OF COMMERCIAL MARKETING- The subsection (k) applicant shall provide notice to the reference product sponsor not later than 180 days before the date of the first commercial marketing of the biological product licensed under subsection (k).CommentsClose CommentsPermalink
‘(B) PRELIMINARY INJUNCTION- After receiving the notice under subparagraph (A) and before such date of the first commercial marketing of such biological product, the reference product sponsor may seek a preliminary injunction prohibiting the subsection (k) applicant from engaging in the commercial manufacture or sale of such biological product until the court decides the issue of patent validity, enforcement, and infringement with respect to any patent that is--CommentsClose CommentsPermalink
‘(i) included in the list provided by the reference product sponsor under paragraph (3)(A) or in the list provided by the subsection (k) applicant under paragraph (3)(B); andCommentsClose CommentsPermalink
‘(ii) not included, as applicable, on--CommentsClose CommentsPermalink
‘(I) the list of patents described in paragraph (4); orCommentsClose CommentsPermalink
‘(II) the lists of patents described in paragraph (5)(B).CommentsClose CommentsPermalink
‘(C) REASONABLE COOPERATION- If the reference product sponsor has sought a preliminary injunction under subparagraph (B), the reference product sponsor and the subsection (k) applicant shall reasonably cooperate to expedite such further discovery as is needed in connection with the preliminary injunction motion.CommentsClose CommentsPermalink
‘(9) LIMITATION ON DECLARATORY JUDGMENT ACTION-CommentsClose CommentsPermalink
‘(A) SUBSECTION (k) APPLICATION PROVIDED- If a subsection (k) applicant provides the application and information required under paragraph (2)(A), neither the reference product sponsor nor the subsection (k) applicant may, prior to the date notice is received under paragraph (8)(A), bring any action under
section 2201 of title 28, United States Code , for a declaration of infringement, validity, or enforceability of any patent that is described in clauses (i) and (ii) of paragraph (8)(B).CommentsClose CommentsPermalink‘(B) SUBSEQUENT FAILURE TO ACT BY SUBSECTION (k) APPLICANT- If a subsection (k) applicant fails to complete an action required of the subsection (k) applicant under paragraph (3)(B)(ii), paragraph (5), paragraph (6)(C)(i), paragraph (7), or paragraph (8)(A), the reference product sponsor, but not the subsection (k) applicant, may bring an action under
section 2201 of title 28, United States Code , for a declaration of infringement, validity, or enforceability of any patent included in the list described in paragraph (3)(A), including as provided under paragraph (7).CommentsClose CommentsPermalink‘(C) SUBSECTION (k) APPLICATION NOT PROVIDED- If a subsection (k) applicant fails to provide the application and information required under paragraph (2)(A), the reference product sponsor, but not the subsection (k) applicant, may bring an action under
section 2201 of title 28, United States Code , for a declaration of infringement, validity, or enforceability of any patent that claims the biological product or a use of the biological product.’.CommentsClose CommentsPermalink(b) Definitions- Section 351(i) of the Public Health Service Act (
42 U.S.C. 262(i) ) is amended--CommentsClose CommentsPermalink
(1) by striking ‘In this section, the term ‘biological product’ means’ and inserting the following: ‘In this section:CommentsClose CommentsPermalink
‘(1) The term ‘biological product’ means’;CommentsClose CommentsPermalink
(2) in paragraph (1), as so designated, by inserting ‘protein (except any chemically synthesized polypeptide),’ after ‘allergenic product,’; andCommentsClose CommentsPermalink
(3) by adding at the end the following:CommentsClose CommentsPermalink
‘(2) The term ‘biosimilar’ or ‘biosimilarity’, in reference to a biological product that is the subject of an application under subsection (k), means--CommentsClose CommentsPermalink
‘(A) that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components; andCommentsClose CommentsPermalink
‘(B) there are no clinically meaningful differences between the biological product and the reference product in terms of the safety, purity, and potency of the product.CommentsClose CommentsPermalink
‘(3) The term ‘interchangeable’ or ‘interchangeability’, in reference to a biological product that is shown to meet the standards described in subsection (k)(4), means that the biological product may be substituted for the reference product without the intervention of the health care provider who prescribed the reference product.CommentsClose CommentsPermalink
‘(4) The term ‘reference product’ means the single biological product licensed under subsection (a) against which a biological product is evaluated in an application submitted under subsection (k).’.CommentsClose CommentsPermalink
(c) Conforming Amendments Relating to Patents-CommentsClose CommentsPermalink
(1) PATENTS-
Section 271(e) of title 35, United States Code , is amended--CommentsClose CommentsPermalink
(A) in paragraph (2)--CommentsClose CommentsPermalink
(i) in subparagraph (A), by striking ‘or’ at the end;CommentsClose CommentsPermalink
(ii) in subparagraph (B), by adding ‘or’ at the end; andCommentsClose CommentsPermalink
(iii) by inserting after subparagraph (B) the following:CommentsClose CommentsPermalink
‘(C)(i) with respect to a patent that is identified in the list of patents described in section 351(l)(3) of the Public Health Service Act (including as provided under section 351(l)(7) of such Act), an application seeking approval of a biological product, orCommentsClose CommentsPermalink
‘(ii) if the applicant for the application fails to provide the application and information required under section 351(l)(2)(A) of such Act, an application seeking approval of a biological product for a patent that could be identified pursuant to section 351(l)(3)(A)(i) of such Act,’; andCommentsClose CommentsPermalink
(iv) in the matter following subparagraph (C) (as added by clause (iii)), by striking ‘or veterinary biological product’ and inserting ‘, veterinary biological product, or biological product’;CommentsClose CommentsPermalink
(B) in paragraph (4)--CommentsClose CommentsPermalink
(i) in subparagraph (B), by--CommentsClose CommentsPermalink
(I) striking ‘or veterinary biological product’ and inserting ‘, veterinary biological product, or biological product’; andCommentsClose CommentsPermalink
(II) striking ‘and’ at the end;CommentsClose CommentsPermalink
(ii) in subparagraph (C), by--CommentsClose CommentsPermalink
(I) striking ‘or veterinary biological product’ and inserting ‘, veterinary biological product, or biological product’; andCommentsClose CommentsPermalink
(II) striking the period and inserting ‘, and’;CommentsClose CommentsPermalink
(iii) by inserting after subparagraph (C) the following:CommentsClose CommentsPermalink
‘(D) the court shall order a permanent injunction prohibiting any infringement of the patent by the biological product involved in the infringement until