Division B
MEDICARE AND MEDICAID IMPROVEMENTS
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Sec. 1001 - Table of Contents of division
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Title I - IMPROVING HEALTH CARE VALUE
Subtitle A - Provisions related to Medicare part A
Part 1 - Market Basket Update
Sec. 1101 - Skilled nursing facility payment update
Sec. 1102 - Inpatient rehabilitation facility payment update
Sec. 1103 - Incorporating productivity improvements into market basket updates that do not already incorporate such improvements
Part 2 - Other Medicare Part A Provisions
Sec. 1111 - Payments to skilled nursing facilities
Sec. 1112 - Medicare DSH report and payment adjustments to response to coverage expansion
Sec. 1113 - Extension of hospice regulation moratorium
Sec. 1114 - Permitting physician assistants to order post-hospital extended care services
and to provide for recognition of attending physician assistants to
serve hospice patients
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Subtitle B - Provisions Related to Part B
Part 1 - Physician's Services
Sec. 1121 - Resource-based feedback program for physicians in Medicare
Sec. 1122 - Misvalued codes under the physician fee schedule
Sec. 1123 - Payments for efficient areas
Sec. 1124 - Modifications to the Physician Quality Reporting Initiative (PQRI)
Sec. 1125 - Adjustment to Medicare payment localities
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Part 2 - Market Basket Updates
Sec. 1131 - Incorporating productivity improvements into market basket updates that do not already incorporate such improvements
Part 3 - Other Provisions
Sec. 1141 - Rental and purchase of power-driven wheelchairs
Sec. 1141A - Election to take ownership, or to decline ownership, of a certain item of complex durable medical equipment after the 13-month capped rental period ends
Sec. 1142 - Extension of payment rule for brachytherapy
Sec. 1143 - Home infusion therapy report to Congress
Sec. 1144 - Require ambulatory surgical centers (ASCs) to submit cost data and other data
Sec. 1145 - Treatment of certain cancer hospitals
Sec. 1146 - Payment for imaging services
Sec. 1147 - Durable medical equipment program improvements
Sec. 1148 - MedPAC study and report on bone mass measurement
Sec. 1149A - Payment for biosimilar biological products
Sec. 1149B - Study and report on DME competitive bidding process
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Subtitle C - Provisions Related to Medicare Parts A and B
Sec. 1151 - Reducing potentially preventable hospital readmissions
Sec. 1152 - Post acute care services payment reform plan and bundling pilot program
Sec. 1153 - Home health payment update for 2010
Sec. 1154 - Payment adjustments for home health care
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Sec. 1155 - Incorporating productivity improvements into market basket update for home health services
Sec. 1155A - MedPAC study on variation in home health margins
Sec. 1155B - Permitting home health agencies to assign most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation cases
Sec. 1156 - Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals
Sec. 1157 - Institute of Medicine study of geographic adjustment factors under Medicare
Sec. 1158 - Revision of Medicare payment systems to address geographic inequities
Sec. 1159 - Institute of Medicine study of geographic variation in health care spending and promoting high-value health care
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Sec. 1160 - Implementation, and Congressional review, of proposal to revise Medicare payments to promote high value health care
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Subtitle D - Medicare Advantage Reforms
Part 1 - Payment and Administration
Sec. 1161 - Phase-in of payment based on fee-for-service costs; quality bonus payments
Sec. 1162 - Authority for Secretarial coding intensity adjustment authority
Sec. 1163 - Simplification of annual beneficiary election periods
Sec. 1164 - Extension of reasonable cost contracts
Sec. 1165 - Limitation of waiver authority for employer group plans
Sec. 1166 - Improving risk adjustment for payments
Sec. 1167 - Elimination of MA Regional Plan Stabilization Fund
Sec. 1168 - Study regarding the effects of calculating Medicare Advantage payment rates on a regional average of Medicare fee for service rates
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Part 2 - Beneficiary Protections and Anti-Fraud
Sec. 1171 - Limitation on cost-sharing for individual health services
Sec. 1172 - Continuous open enrollment for enrollees in plans with enrollment suspension
Sec. 1173 - Information for beneficiaries on MA plan administrative costs
Sec. 1174 - Strengthening audit authority
Sec. 1175 - Authority to deny plan bids
Sec. 1175A -State authority to enforce standardized marketing requirements
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Part 3 - Treatment of Special Needs Plans
Sec. 1176 - Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs individuals
Sec. 1177 - Extension of authority of special needs plans to restrict enrollment; service area moratorium for certain SNPs
Sec. 1178 - Extension of Medicare senior housing plans
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Subtitle E - Improvements to Medicare Part D
Sec. 1181 - Elimination of coverage gap
Sec. 1182 - Discounts for certain part D drugs in original coverage gap
Sec. 1183 - Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities
Sec. 1184 - Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D
Sec. 1185 - No mid-year formulary changes permitted
Sec. 1186 - Negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries
Sec. 1187 - Accurate dispensing in long-term care facilities
Sec. 1188 - Free generic fill
Sec. 1189 - State certification prior to waiver of licensure requirements under Medicare prescription drug program
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Subtitle F - Medicare Rural Access Protections
Sec. 1191 - Telehealth expansion and enhancements
Sec. 1192 - Extension of outpatient hold harmless provision
Sec. 1193 - Extension of section 508 hospital reclassifications
Sec. 1194 - Extension of geographic floor for work
Sec. 1195 - Extension of payment for technical component of certain physician pathology services
Sec. 1196 - Extension of ambulance add-ons
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Title II - MEDICARE BENEFICIARY IMPROVEMENTS
Subtitle A - Improving and Simplifying Financial Assitance for Low Income Medicare Beneficiaries
Sec. 1201 - Improving assets tests for Medicare Savings Program and low-income subsidy program
Sec. 1202 - Elimination of Part D cost-sharing for certain non-institutionalized full-benefit dual eligible individuals
Sec. 1203 - Eliminating barriers to enrollment
Sec. 1204 - Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment
Sec. 1205 - Intelligent assignment in enrollment
Sec. 1206 - Special enrollment period and automatic enrollment process for certain subsidy eligible individuals
Sec. 1207 - Application of MA premiums prior to rebate and quality bonus payments in calculation for low income subsidy benchmark
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Subtitle B - Reducing Health Disparities
Sec. 1221 - Ensuring effective communication in Medicare
Sec. 1222 - Demonstration to promote access for Medicare beneficiaries with limited English proficiency by providing reimbursement for culturally and linguistically appropriate services
Sec. 1223 - IOM report on impact of language access services
Sec. 1224 - Definitions
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Subtitle C - Miscellaneous Improvements
Sec. 1231 - Extension of therapy caps exceptions process
Sec. 1232 - Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions
Sec. 1233 - Voluntary advance care planning consultation
Sec. 1234 - Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries
Sec. 1235 - Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium
Sec. 1236 - Demonstration program on use of patient decisions aids
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Title III - PROMOTING PRIMARY CARE MENTAL HEALTH SERVICES AND COORDINATED CARE
Sec. 1301 - Accountable Care Organization pilot program
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Sec 1302 - Medical home pilot program
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Sec. 1303 - Payment incentive for selected primary care services
Sec. 1304 - Increased reimbursement rate for certified nurse-midwives
Sec. 1305 - Coverage and waiver of cost-sharing for preventive services
Sec. 1306 - Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal
Sec. 1307 - Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment
Sec. 1308 - Coverage of marriage and family therapist services and mental health counselor services
Sec. 1309 - Extension of physician fee schedule mental health add-on
Sec. 1310 - Expanding access to vaccines
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Sec. 1311 - Expansion of Medicare-Covered Preventive Services at Federally Qualified Health Centers
Sec. 1312 - Independence at home demonstration program
Sec. 1313 - Recognition of certified diabetes outpatient self-management training services
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Title IV - QUALITY
Subtitle A - Comparative Effectiveness Research
Sec. 1401 - Comparative effectiveness research
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Subtitle B - Nursing Home Transparency
Part 1 - Improving Transparency of Information on Skilled Nursing Facilities, Nursing Facilities, and Other Long-Term Care Facilities
Sec. 1411 - Required disclosure of ownership and additional disclosable parties information
Sec. 1412 - Accountability requirements
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Sec. 1413 - Nursing home compare Medicare website
Sec. 1414 - Reporting of expenditures
Sec. 1415 - Standardized complaint form
Sec. 1416 - Ensuring staffing accountability
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Sec. 1417 - Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers
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Part 2 - Targeting Enforcement
Sec. 1421 - Civil money penalties
Sec. 1422 - National independent monitor pilot program
Sec. 1423 - Notification of facility closure
Part 3 - Improving Staff Training
Sec. 1431 - Dementia and abuse prevention training
Sec. 1432 - Study and report on training required for certified nurse aides and supervisory staff
Sec. 1433 - Qualification of director of food services of a skilled nursing facility or nursing facility
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Subtitle C - Quality Measurements
Sec. 1441 - Establishment of national priorities for quality improvement
Sec. 1442 - Development of new quality measures; GAO evaluation of data collection process for quality measurement
Sec. 1443 - Multi-stakeholder pre-rulemaking input into selection of quality measures
Sec. 1444 - Application of quality measures
Sec. 1445 - Consensus-based entity funding
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Subtitle D - Physician Payments Sunshine Provision
Sec. 1451 - Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and other health care entities and between physicians and other health care entities
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Subtitle E - Public Reporting on Health Care- Associated Infections
Sec. 1461 - Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections
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Title V - MEDICARE GRADUATE MEDICAL EDUCATION
Sec. 1501 - Distribution of unused residency positions
Sec. 1502 - Increasing training in non-provider settings
Sec. 1503 - Rules for counting resident time for didactic and scholarly activities and other activities
Sec. 1504 - Preservation of resident cap positions from closed hospitals
Sec. 1505 - Improving accountability for approved medical residency training
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Title VI - PROGRAM INTEGRITY
Subtitle A - Increased Funding to fight waste, fraud, and abuse
Sec. 1601 - Increased funding and flexibility to fight fraud and abuse
Subtitle B - Enhanced penalties for fraud and abuse
Sec. 1611 - Enhanced penalties for false statements on provider or supplier enrollment applications
Sec. 1612 - Enhanced penalties for submission of false statements material to a false claim
Sec. 1613 - Enhanced penalties for delaying inspections
Sec. 1614 - Enhanced hospice program safeguards
Sec. 1615 - Enhanced penalties for individuals excluded from program participation
Sec. 1616 - Enhanced penalties for provision of false information by Medicare Advantage and part D plans
Sec. 1617 - Enhanced penalties for Medicare Advantage and part D marketing violations
Sec. 1618 - Enhanced penalties for obstruction of program audits
Sec. 1619 - Exclusion of certain individuals and entities from participation in Medicare and State health care programs
Sec. 1620 - OIG authority to exclude from Federal health care programs officers and owners of entities convicted of fraud
Sec. 1621 - Self-referral disclosure protocol
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Subtitle C - Enhanced Program and Provider Protections
Sec. 1631 - Enhanced CMS program protection authority
Sec. 1632 - Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations
Sec. 1633 - Required inclusion of payment modifier for certain evaluation and management services
Sec. 1634 - Evaluations and reports required under Medicare Integrity Program
Sec. 1635 - Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse
Sec. 1636 - Maximum period for submission of Medicare claims reduced to not more than 12 months
Sec. 1637 - Physicians who order durable medical equipment or home health services required to be Medicare enrolled physicians or eligible professionals
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Sec. 1638 - Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse
Sec. 1639 - Face-to-face ecounter with patient required before eligibility certifications for home health services or durable medical equipment
Sec. 1640 - Extension of testimonial subpoena authority to program exclusion investigations
Sec. 1641 - Required repayments of Medicare and Medicaid overpayments
Sec. 1642 - Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program
Sec. 1643 - Access to certain information on renal dialysis facilities
Sec. 1644 - Billing agents, clearinghouses, or other alternate payees required to register under Medicare
Sec. 1645 - Conforming civil monetary penalties to False Claims ct amendments
Sec. 1646 - Requiring provider and supplier payments under Medicare to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions
Sec. 1647 - Inspector General for the Health Choices Administration
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Subtitle D - Access to Information Needed to Prevent Fraud, Waste, and Abuse
Sec. 1651 - Access to Information Necessary to Identify Fraud, Waste, and Abuse
Sec. 1652 - Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank
Sec. 1653 - Compliance with HIPAA privacy and security standards
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Title VII - MEDICAID AND CHIP
Subtitle A - Medicaid and Health Reform
Sec. 1. Table of contents [Temporary]
Sec. 1701 - Eligibility for individuals with income below 150 percent of the Federal poverty level
Sec. 1702 - Requirements and special rules for certain Medicaid eligible individuals
Sec. 1703 - CHIP and Medicaid maintenance of eligibility
Sec. 1704 - Reduction in Medicaid DSH
Sec. 1705 - Expanded outstationing
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Subtitle B - Prevention
Sec. 1711 - Required coverage of preventive services
Sec. 1712 - Tobacco cessation
Sec. 1713 - Optional coverage of nurse home visitation services
Sec. 1714 - State eligibility option for family planning services
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Subtitle C - Access
Sec. 1721 - Payments to primary care practitioners
Sec. 1722 - Medical home pilot program
Sec. 1723 - Translation or interpretation services
Sec. 1724 - Optional coverage for freestanding birth center services
Sec. 1725 - Inclusion of public health clinics under the vaccines for children program
Sec. 1726 - Requiring coverage of services of podiatrists
Sec. 1726A- Requiring coverage of services of optomotrists
Sec. 1727 - Therapeutic foster care
Sec. 1728 - Assuring adequate payment levels for services
Sec. 1729 - Preserving Medicaid coverage for maternity and adult health services under medicaid and CHIP
Recorded By: Michael Murphy
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Sec. 1730
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Subtitle D - Coverage
Sec. 1731 - Optional Medicaid coverage of low-income HIV-infected individuals
Sec. 1732 - Extending transitional Medicaid Assistance (TMA)
Sec. 1733 - Requirement of 12-month continuous coverage under certain CHIP programs
Sec. 1734 - Preventing the application under CHIP of coverage waiting periods for certain children
Sec. 1735 - Adult day health care services
Sec. 1736 - Medicaid coverage for citizens of Freely Associated States
Sec. 1737 - Continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary services
Sec. 1738 - State option to disregard certain income in providing continued Medicaid coverage for certain individuals with extremely high prescription costs
Sec. 1739 - Provisions relating to community living assistance services and supports (CLASS)
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Subtitle E - Financing
Sec. 1741 - Payments to pharmacists
Sec. 1742 - Prescription drug rebates
Sec. 1743 - Extension of prescription drug discounts to enrolle
Sec. 1744 - Payments for graduate medical education
Sec. 1745 - Nursing Facility Supplemental Payment Program
Sec. 1746 - Report on Medicaid payments
Sec. 1747 - Reviews of Medicaid
Sec. 1748 - Extension of delay in managed care organization provider tax climination
Sec. 1749 - Extension of ARRA increase in FMAP
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Subtitle F - Waste, Fraud, and Abuse
Sec. 1751 - Health care acquired conditions
Sec. 1752 - Evaluations and reports required under Medicaid Integrity Program
Sec. 1753 - Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse
Sec. 1754 - Overpayments
Sec. 1755 - Managed care organizations
Sec. 1756 - Termination of provider participation under Medicaid and CHIP if terminated under Medicare or other State plan or child health plan
Sec. 1757 - Medicaid and CHIP exclusion from participation realting to certain ownership, control and management affiliations
Sec. 1758 - Requirement to report expanded set of data elements under MMIS to detect fraud and abuse
Sec. 1759 - Billing agents, clearinghouses, or other alternate payees required to register under Medicaid
Sec. 1760 - Denial of payments for litigation-related misconduct
Sec. 1761 - Mandatory State use of national correct coding initiative
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Subtitle G - Puerto Rico and the Territories
Sec. 1771 - Payment to territories
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Subtitle H - Miscellaneous
Sec. 1781 - Technical corrections
Sec. 1782 - Extension of QI program
Sec. 1783 - Assuring transparency of information
Sec. 1784 - Medicaid and CHIP Payment and Access Commission
Sec. 1785 - Outreach and enrollment of Medicaid and CHIP eligible individuals
Sec. 1786 - Prohibitions on Federal Medicaid and CHIP payment for undocumented aliens
Sec. 1787 - Demonstration project for stabilization of emergency medical conditions by institutions for mental diseases
Sec. 1788 - Application of Medicaid Improvement Fund
Sec. 1789 - Treatment of certain Medicaid brokers
Sec. 1790 - Rule for changes requiring State legislation
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Title VIII - REVENUE RELATED PROVISIONS
Sec. 1801 - Disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the medicare prescription drug program to assist Social Security Administration's outreach to eligible individuals
Sec. 1802 - Comparative Effectiveness Research Trust Fund; financing for Trust Fund
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Title IX - MISCELLANEOUS PROVISIONS
Sec. 1901 - Repeal of trigger provision
Sec. 1902 - Repeal of comparative cost adjustment (CCA) program
Sec. 1903 - Extension of gainsharing demonstration
Sec. 1904 - Grants to States for quality home visitation programs for families with young children and families expecting children
Sec. 1905 - Improved coordination and protection for dual eligibles
Sec. 1906 - Assessment of medicare cost-intensive diseases and conditions
Sec. 1907 - Establishment of Center for Medicare and Medicaid Innovation within CMS
Sec. 1908 - Application of emergency services laws
Sec. 1909 - Disregard under the Supplemental Security Income program of compensation for participation in clinical trials for rare diseases or conditions
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