S 2243 ISCommentsClose CommentsPermalink

112th CONGRESSCommentsClose CommentsPermalink

2d SessionCommentsClose CommentsPermalink

S. 2243CommentsClose CommentsPermalink

To establish a program to provide incentive payments to participating Medicare beneficiaries who voluntarily establish and maintain better health.CommentsClose CommentsPermalink

IN THE SENATE OF THE UNITED STATESCommentsClose CommentsPermalink

March 28, 2012CommentsClose CommentsPermalink

Mr. WYDEN (for himself and Mr. PORTMAN) introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

A BILLCommentsClose CommentsPermalink

To establish a program to provide incentive payments to participating Medicare beneficiaries who voluntarily establish and maintain better health.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Medicare Better Health Rewards Program Act of 2012’.CommentsClose CommentsPermalink

SEC. 2. MEDICARE BETTER HEALTH REWARDS PROGRAM.

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

‘MEDICARE BETTER HEALTH REWARDS PROGRAM

‘Sec. 1849. (a) In General- The Secretary shall establish a Better Health Rewards Program (in this section referred to as the ‘Program’) under which incentives are provided to Medicare beneficiaries who voluntarily agree to participate in the Program.CommentsClose CommentsPermalink





‘(b) Enrollment- A health professional participating in the Program shall provide their patients who are Medicare beneficiaries with a description of and an opportunity to enroll in the Program on a voluntary basis. If a Medicare beneficiary elects to enroll in the Program, the health professional shall inform the Secretary of the individual’s enrollment through a process established by the Secretary, which does not impose additional administrative requirements on the participating health professional.CommentsClose CommentsPermalink





‘(c) Establishment of Better Health Target Standards-CommentsClose CommentsPermalink





‘(1) IN GENERAL-CommentsClose CommentsPermalink





‘(A) ESTABLISHMENT- The Secretary shall establish standards for measuring better health targets and points for achieving such standards for participating Medicare beneficiaries, including such standards and points with respect to the following:CommentsClose CommentsPermalink





‘(i) Annual wellness visit.CommentsClose CommentsPermalink





‘(ii) Tobacco cessation.CommentsClose CommentsPermalink





‘(iii) Body Mass Index (BMI).CommentsClose CommentsPermalink





‘(iv) Diabetes screening test.CommentsClose CommentsPermalink





‘(v) Cardiovascular disease screening.CommentsClose CommentsPermalink





‘(vi) Cholesterol level screening.CommentsClose CommentsPermalink





‘(vii) Screening tests and specified vaccinations.CommentsClose CommentsPermalink





‘(B) CONSULTATION- In establishing standards and points for achieving such standards under this subsection, the Secretary--CommentsClose CommentsPermalink





‘(i) shall consult with 1 or more nationally recognized health care quality organizations, as determined appropriate by the Secretary; andCommentsClose CommentsPermalink





‘(ii) may consult with physicians and other professionals experienced with wellness programs.CommentsClose CommentsPermalink





‘(C) POINTS- The number of points awarded for a year for achieving standards with respect to each of the targets described in clauses (i) through (vii) of subparagraph (A) shall not exceed 5. Such points may be awarded on a sliding scale, based on standards established under this subsection, as determined appropriate by the Secretary.CommentsClose CommentsPermalink





‘(2) MODIFICATION OF BETTER HEALTH TARGET STANDARDS AND ASSIGNED POINTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Secretary may modify standards for measuring better health targets and, subject to paragraph (1)(C), points for achieving such standards for participating Medicare beneficiaries under this subsection.CommentsClose CommentsPermalink





‘(B) CONSULTATION- In modifying standards and points for achieving such standards under this paragraph, the Secretary--CommentsClose CommentsPermalink





‘(i) shall consult with 1 or more nationally recognized health care quality organizations, as determined appropriate by the Secretary; andCommentsClose CommentsPermalink





‘(ii) may consult with physicians and other professionals experienced with wellness programs.CommentsClose CommentsPermalink





‘(d) Conduct of Program-CommentsClose CommentsPermalink





‘(1) DURATION-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Subject to subparagraph (B), the Program shall be conducted for not less than a 3-year period.CommentsClose CommentsPermalink





‘(B) EXPANSION- The Secretary shall expand the duration and scope of the Program, to the extent determined appropriate by the Secretary, if--CommentsClose CommentsPermalink





‘(i) the Secretary determines that such expansion is expected to--CommentsClose CommentsPermalink





‘(I) reduce spending under this title without reducing the quality of care; orCommentsClose CommentsPermalink





‘(II) improve the quality of care and reduce spending;CommentsClose CommentsPermalink





‘(ii) the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce program spending under this title; andCommentsClose CommentsPermalink





‘(iii) the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits under this title for individuals.CommentsClose CommentsPermalink





‘(2) COLLECTION AND USE OF BASELINE DATA- During the first year of the Program, a health professional shall establish and report to the Secretary baseline information for each participating Medicare beneficiary who is a patient of the health professional as part of that beneficiary’s first year assessment under paragraph (3)(A). The health professional shall use such data to aid in the determination of whether and to what extent the participating Medicare beneficiary is meeting the target standards under subsection (c) in each of years 2 and 3 of the Program.CommentsClose CommentsPermalink





‘(3) REQUIRED ASSESSMENTS FOR PARTICIPATING MEDICARE BENEFICIARIES-CommentsClose CommentsPermalink





‘(A) FIRST YEAR- During year 1 of the Program, a health professional shall furnish to each participating Medicare beneficiary that is a patient of the health professional either an annual wellness visit or an initial preventive physical examination.CommentsClose CommentsPermalink





‘(B) SECOND AND THIRD YEARS- During each of years 2 and 3 of the Program, a health professional shall furnish to each participating Medicare beneficiary that is a patient of the health professional an annual wellness visit to determine whether and to what extent the participating Medicare beneficiary has met the target standards under subsection (c).CommentsClose CommentsPermalink





‘(e) Determination of Points and Payment of Incentives-CommentsClose CommentsPermalink





‘(1) DETERMINATION OF POINTS- During each of years 2 and 3 of the Program, a health professional shall--CommentsClose CommentsPermalink





‘(A) evaluate and report to the Secretary whether each participating Medicare beneficiary that is a patient of the health professional has achieved the target standards under subsection (c); andCommentsClose CommentsPermalink





‘(B) determine the total amount of points that each such participating Medicare beneficiary has achieved for the year based on the points assigned for achieving such standards under subsection (c).CommentsClose CommentsPermalink





‘(2) INCENTIVE PAYMENT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Secretary shall pay to each participating Medicare beneficiary who achieves at least 20 points under paragraph (1)(B) for the year an incentive payment as follows:CommentsClose CommentsPermalink

-------------------------------------------------------------------------------- CommentsClose CommentsPermalink

‘Points           Year 2 Payment Amount Year 3 or a Subsequent Year Payment Amount CommentsClose CommentsPermalink

-------------------------------------------------------------------------------- CommentsClose CommentsPermalink

20-24 points                       $100                                       $200 CommentsClose CommentsPermalink

25 or more points                  $200                                      $400. CommentsClose CommentsPermalink

-------------------------------------------------------------------------------- CommentsClose CommentsPermalink

‘(B) INFLATION ADJUSTMENT- The dollar amounts specified in this paragraph shall be increased, beginning with 2016, from year to year based on the percentage increase in the consumer price index for all urban consumers (all items; United States city average), rounded to the nearest $1.CommentsClose CommentsPermalink





‘(3) FINAL DETERMINATION OF STANDARDS ACHIEVEMENT MADE BY PARTICIPATING HEALTH PROFESSIONAL- Under the Program, a participating health professional shall make the final determination as to whether or not a participating Medicare beneficiary has met the target standards under subsection (c) and what screening tests and specified vaccinations, or other services, are necessary for purposes of making such determination.CommentsClose CommentsPermalink





‘(f) Spending Benchmarks-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall collect relevant data, including data on claims paid under this title for services furnished to participating Medicare beneficiaries during the Program, for purposes of determining the aggregate estimated savings achieved under this title for participating Medicare beneficiaries during each of years 2 and 3 of the Program in accordance with paragraph (2) (and for a subsequent year if the Program is expanded under subsection (d)(1)(B)).CommentsClose CommentsPermalink





‘(2) DETERMINATION OF AGGREGATE ESTIMATED SAVINGS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The amount of the aggregate estimated savings under this title for participating Medicare beneficiaries under paragraph (1), with respect to a year, shall be equal to--CommentsClose CommentsPermalink





‘(i) the estimated savings determined under subparagraph (B) for the year; minusCommentsClose CommentsPermalink





‘(ii) the aggregate incentive payments made under the Program during the year.CommentsClose CommentsPermalink





‘(B) DETERMINATION OF ESTIMATED SAVINGS- For purposes of subparagraph (A)(i), the estimated savings determined under this subparagraph for a year shall be equal to--CommentsClose CommentsPermalink





‘(i) the estimated aggregate expenditures under this title (as projected under subparagraph (C)) for the year; minusCommentsClose CommentsPermalink





‘(ii) the actual aggregate expenditures under this title (as determined by the Secretary and taking into account any reduction in specific health risks of the participating Medicare beneficiaries) for the year.CommentsClose CommentsPermalink





‘(C) PROJECTION OF ESTIMATED AGGREGATE CLAIMS COST-CommentsClose CommentsPermalink





‘(i) BENCHMARK BASE YEAR- The Secretary shall establish a benchmark base year amount of expenditures under this title for participating Medicare beneficiaries during year 1 of the Program.CommentsClose CommentsPermalink





‘(ii) PROJECTION- The Secretary shall use the benchmark base year amount established under clause (i) to project the estimated aggregate expenditures for all participating Medicare beneficiaries during each of years 2 and 3 of the Program as if the beneficiaries were not participating in the Program. In making such projection, the Secretary may include adjustments for health status or other specific risk factors and geographic variation for the participating Medicare beneficiaries.CommentsClose CommentsPermalink





‘(D) PUBLIC REPORT OF DETERMINATION AND OTHER PROGRAM INFORMATION- Not later than 90 days after determining the aggregate estimated savings (if any) under subparagraph (A) with respect to a year, the Secretary shall make available to the public a report containing a description of the amount of the savings determined, including the methodology and any other calculations or determinations involved in the determination of such amount. Such report shall include--CommentsClose CommentsPermalink





‘(i) a description of any reduction in specific health risks of participating Medicare beneficiaries identified by the Secretary;CommentsClose CommentsPermalink





‘(ii) a description of--CommentsClose CommentsPermalink





‘(I) standards for measuring better health targets under subsection (c); andCommentsClose CommentsPermalink





‘(II) the points available for achieving each such standard under that subsection; andCommentsClose CommentsPermalink





‘(iii) recommendations for such legislation and administrative action as the Secretary determines appropriateCommentsClose CommentsPermalink





‘(3) ADDITIONAL FUNDING IF AGGREGATE INCENTIVE PAYMENTS EXCEED ESTIMATED SAVINGS- If, for a year during the Program, the aggregate incentive payments made during the year exceed the estimated savings determined under paragraph (2)(B) for the year, the Secretary shall provide for the transfer, from the Prevention and Public Health Fund established under section 4002 of the Patient Protection and Affordable Care Act, of an amount equal to the amount of such excess, to the Federal Supplementary Medical Insurance Trust Fund under section 1841.CommentsClose CommentsPermalink





‘(g) Waiver Authority- The Secretary may waive such requirements of titles XI and XVIII as may be necessary to carry out the purposes of the Program established under this section.CommentsClose CommentsPermalink





‘(h) Definitions- In this section:CommentsClose CommentsPermalink





‘(1) ANNUAL WELLNESS VISIT- The term ‘annual wellness visit’ includes personalized prevention plan services (as defined in section 1861(hhh)(1)).CommentsClose CommentsPermalink





‘(2) HEALTH PROFESSIONAL- The term ‘health professional’ includes a physician (as defined in section 1861(r)(1)) and a practitioner described in clause (i) of section 1842(b)(18)(C).CommentsClose CommentsPermalink





‘(3) INITIAL PREVENTIVE PHYSICAL EXAMINATION- The term ‘initial preventive physical examination’ has the meaning given that term in section 1861(ww)(1).CommentsClose CommentsPermalink





‘(4) MEDICARE BENEFICIARY- The term ‘Medicare beneficiary’ means an individual enrolled in part B.CommentsClose CommentsPermalink





‘(5) PARTICIPATING MEDICARE BENEFICIARY- The term ‘participating Medicare beneficiary’ means a Medicare beneficiary who enrolls in the Program under subsection (b).CommentsClose CommentsPermalink





‘(6) SCREENING TESTS- The term ‘screening tests’ means any of the following that are determined by a health professional to be appropriate for a participating Medicare beneficiary:CommentsClose CommentsPermalink





‘(A) Colorectal cancer screening tests (as defined in section 1861(pp)).CommentsClose CommentsPermalink





‘(B) Screening mammography (as described in section 1861(jj)).CommentsClose CommentsPermalink





‘(C) Screening pap smear and screening pelvic exam (as defined in section 1861(nn)).CommentsClose CommentsPermalink





‘(D) Screening for glaucoma (as defined in section 1861(uu)).CommentsClose CommentsPermalink





‘(E) Bone mass measurement (as defined in section 1861(rr)) for qualified individuals described in paragraph (2)(A) of such section.CommentsClose CommentsPermalink





‘(F) HIV screening for high-risk groups (as identified by the Secretary).CommentsClose CommentsPermalink





‘(7) SPECIFIED VACCINATIONS- The term ‘specified vaccinations’ means the vaccinations described in section 1861(ww)(1) that are determined by a health professional to be appropriate for a participating Medicare beneficiary.’.CommentsClose CommentsPermalink





(b) Conforming Amendment- Section 4002(c) of the Patient Protection and Affordable Care Act (Public Law 111-148) is amended by inserting ‘and shall transfer amounts in the Fund to the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act in accordance with section 1849(f)(3) of such Act’ before the period at the end.CommentsClose CommentsPermalink

SEC. 3. PARTICIPATION BY MEDICARE ADVANTAGE PLANS.

Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(h) Providing Incentives for Voluntary Participation in a Better Health Rewards Program-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Effective for plan years beginning on or after the date of enactment of the Medicare Better Health Rewards Program Act of 2012, a Medicare Advantage organization may provide to individuals enrolled in an MA plan offered by the organization incentive payments, including cash, cash-equivalent, or other types of incentives, for voluntary participation in a Better Health Rewards Program (in this subsection referred to as the ‘Program’) that rewards individuals for meeting certain health targets established by the Secretary.CommentsClose CommentsPermalink





‘(2) LIMITATION- In no case shall the monthly bid amount submitted by a Medicare Advantage organization under section 1834(a)(6) (or the monthly premium charged by the organization under section 1854(b)) with respect to an MA plan offered by the organization take into account any incentive payments made to enrollees under the Program.CommentsClose CommentsPermalink





‘(3) IMPLEMENTATION- The Program under this subsection shall be conducted in a similar manner to the manner in which the program under section 1849 is conducted, in accordance with standards established by the Secretary.CommentsClose CommentsPermalink





‘(4) NOTIFICATION AND PROVISION OF INFORMATION- A Medicare Advantage organization seeking to participate in the Program shall--CommentsClose CommentsPermalink





‘(A) notify the Secretary of the organization’s intent to participate in the Program; andCommentsClose CommentsPermalink





‘(B) agree to provide to the Secretary--CommentsClose CommentsPermalink





‘(i) information regarding--CommentsClose CommentsPermalink





‘(I) which enrollees participate in the Program;CommentsClose CommentsPermalink





‘(II) the scores of those enrollees with respect to applicable health targets under the Program; andCommentsClose CommentsPermalink





‘(III) the incentives enrollees receive for meeting such health targets; andCommentsClose CommentsPermalink





‘(ii) any other information specified by the Secretary for purposes of this subsection.CommentsClose CommentsPermalink





‘(5) WAIVER AUTHORITY- The Secretary may waive such requirements of titles XI and XVIII as may be necessary to carry out the purposes of the Program established under this subsection.’.CommentsClose CommentsPermalink

SEC. 4. PARTICIPATION OF SECTION 1876 COST PLANS.

Section 1876 of the Social Security Act (42 U.S.C. 1395mm) is amended by inserting at the end the following:CommentsClose CommentsPermalink





‘(l) Providing Incentives for Voluntary Participation in a Better Health Rewards Program-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Effective for contract periods beginning on or after the date of enactment of the Medicare Better Health Rewards Program Act of 2012, an eligible organization may provide to members enrolled under this section with the organization incentive payments, including cash, cash-equivalent, or other types of incentives, for voluntary participation in a Better Health Rewards Program (in this subsection referred to as the ‘Program’) that rewards members for meeting certain health targets established by the Secretary.CommentsClose CommentsPermalink





‘(2) LIMITATION- In no case shall the payment to an eligible organization under this section (or the premium rate charged by the organization under this section) with respect to members enrolled with the organization take into account any incentive payments made to members under the Program.CommentsClose CommentsPermalink





‘(3) IMPLEMENTATION- The Program under this subsection shall be conducted in a similar manner to the manner in which the program under section 1849 is conducted, in accordance with standards established by the Secretary.CommentsClose CommentsPermalink





‘(4) NOTIFICATION AND PROVISION OF INFORMATION- An eligible organization seeking to participate in the Program shall--CommentsClose CommentsPermalink





‘(A) notify the Secretary of the organization’s intent to participate in the Program; andCommentsClose CommentsPermalink





‘(B) agree to provide to the Secretary--CommentsClose CommentsPermalink





‘(i) information regarding--CommentsClose CommentsPermalink





‘(I) which members participate in the Program;CommentsClose CommentsPermalink





‘(II) the scores of those members with respect to applicable health targets under the Program; andCommentsClose CommentsPermalink





‘(III) the incentives members receive for meeting such health targets; andCommentsClose CommentsPermalink





‘(ii) any other information specified by the Secretary for purposes of this subsection.CommentsClose CommentsPermalink





‘(5) WAIVER AUTHORITY- The Secretary may waive such requirements of titles XI and XVIII as may be necessary to carry out the purposes of the Program established under this subsection.’.CommentsClose CommentsPermalink

SEC. 5. PARTICIPATION OF PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE).

(a) Medicare- Section 1894 of the Social Security Act (42 U.S.C. 1395eee) is amended by inserting at the end the following:CommentsClose CommentsPermalink





‘(j) Providing Incentives for Voluntary Participation in a Better Health Rewards Program-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Effective for PACE program agreements entered into on or after the date of enactment of the Medicare Better Health Rewards Program Act of 2012, a PACE provider may provide to PACE program eligible individuals enrolled under this section with the PACE provider incentive payments, including cash, cash-equivalent, or other types of incentives, for voluntary participation in a Better Health Rewards Program (in this subsection referred to as the ‘Program’) that rewards enrollees for meeting certain health targets established by the Secretary.CommentsClose CommentsPermalink





‘(2) LIMITATION- In no case shall the payment to a PACE provider under this section (or any premium charged by the provider under this section) with respect to PACE program eligible individuals enrolled with the PACE provider take into account any incentive payments made to individuals under the Program.CommentsClose CommentsPermalink





‘(3) IMPLEMENTATION- The Program under this subsection shall be conducted in a similar manner to the manner in which the program under section 1849 is conducted, in accordance with standards established by the Secretary.CommentsClose CommentsPermalink





‘(4) NOTIFICATION AND PROVISION OF INFORMATION- A PACE provider seeking to participate in the Program shall--CommentsClose CommentsPermalink





‘(A) notify the Secretary of the PACE provider’s intent to participate in the Program; andCommentsClose CommentsPermalink





‘(B) agree to provide to the Secretary--CommentsClose CommentsPermalink





‘(i) information regarding--CommentsClose CommentsPermalink





‘(I) which PACE program eligible individuals enrolled with the PACE provider participate in the Program;CommentsClose CommentsPermalink





‘(II) the scores of those individuals with respect to applicable health targets under the Program; andCommentsClose CommentsPermalink





‘(III) the incentives individuals receive for meeting such health targets; andCommentsClose CommentsPermalink





‘(ii) any other information specified by the Secretary for purposes of this subsection.CommentsClose CommentsPermalink





‘(5) WAIVER AUTHORITY- The Secretary may waive such requirements of titles XI, XVIII, and XIX as may be necessary to carry out the purposes of the Program established under this subsection.’.CommentsClose CommentsPermalink





(b) Medicaid- Section 1934 of the Social Security Act (42 U.S.C. 1396u-4) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(k) Providing Incentives for Voluntary Participation in a Better Health Rewards Program-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Effective for PACE program agreements entered into on or after the date of enactment of the Medicare Better Health Rewards Program Act of 2012, a PACE provider may provide to PACE program eligible individuals enrolled under this section with the PACE provider incentive payments, including cash, cash-equivalent, or other types of incentives, for voluntary participation in a Better Health Rewards Program (in this subsection referred to as the ‘Program’) that rewards enrollees for meeting certain health targets established by the Secretary.CommentsClose CommentsPermalink





‘(2) LIMITATION- In no case shall the payment to a PACE provider under this section (or any premium charged by the provider under this section) with respect to PACE program eligible individuals enrolled with the PACE provider take into account any incentive payments made to individuals under the Program.CommentsClose CommentsPermalink





‘(3) IMPLEMENTATION- The Program under this subsection shall be conducted in a similar manner to the manner in which the program under section 1849 is conducted, in accordance with standards established by the Secretary.CommentsClose CommentsPermalink





‘(4) NOTIFICATION AND PROVISION OF INFORMATION- A PACE provider seeking to participate in the Program shall--CommentsClose CommentsPermalink





‘(A) notify the Secretary of the PACE provider’s intent to participate in the Program; andCommentsClose CommentsPermalink





‘(B) agree to provide to the Secretary--CommentsClose CommentsPermalink





‘(i) information regarding--CommentsClose CommentsPermalink





‘(I) which PACE program eligible individuals enrolled with the PACE provider participate in the Program;CommentsClose CommentsPermalink





‘(II) the scores of those individuals with respect to applicable health targets under the Program; andCommentsClose CommentsPermalink





‘(III) the incentives individuals receive for meeting such health targets; andCommentsClose CommentsPermalink





‘(ii) any other information specified by the Secretary for purposes of this subsection.CommentsClose CommentsPermalink





‘(5) WAIVER AUTHORITY- The Secretary may waive such requirements of titles XI, XVIII, and XIX as may be necessary to carry out the purposes of the Program established under this subsection.’.CommentsClose CommentsPermalink

SEC. 6. EXCLUSION OF INCENTIVE PAYMENTS.

(a) In General- Part III of subchapter B of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after section 139D the following new section:CommentsClose CommentsPermalink

‘SEC. 139E. MEDICARE BETTER HEALTH REWARDS PAYMENTS.

‘Gross income shall not include any payment made under the following programs:CommentsClose CommentsPermalink





‘(1) The Medicare Better Health Rewards Program established under section 1849 of the Social Security Act.CommentsClose CommentsPermalink





‘(2) A Better Health Rewards Program established pursuant to section 1859(h), 1876(l), 1894(j), or 1934(k) of the Social Security Act.’.CommentsClose CommentsPermalink





(b) Clerical Amendment- The table of sections for part III of subchapter B of chapter 1 of such Code is amended by inserting after the item relating to section 139D the following new item:CommentsClose CommentsPermalink





‘Sec. 139E. Medicare Better Health Rewards payments.’.CommentsClose CommentsPermalink