Hear The Bill
We Read...You Listen...We ALL Decide
 HR3962 - Division B - Medicare and Medicaid Improvements
Frequently Asked Questions
Download PDF Version
  
 Division B
MEDICARE AND MEDICAID IMPROVEMENTS

 Sec. 1001 -  Table of Contents of division
Recorded By:  Lynne Darlington

Click for Download and Artist Information
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
Recorded By:  Ken Maxon

Click for Download and Artist Information
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

Recorded By:  Amy Taylor

Click for Download and Artist Information
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

Recorded By:  Cameron Thomas

Click for Download and Artist Information
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


Recorded By:  Roger Baker

Click for Download and Artist Information
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

Recorded By:  Larry Appel

Click for Download and Artist Information
Sec. 1160  -  Implementation, and Congressional review, of proposal to revise Medicare payments to promote high value health care
Recorded By:  Dave Courvoisier

Click for Download and Artist Information
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


Recorded By:  Chris Mezzolesta

Click for Download and Artist Information
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

Recorded By:  Sergei Burbank

Click for Download and Artist Information

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

Recorded By:  Drew Hadwal

Click for Download and Artist Information
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

Recorded By:  Karen Commins

Click for Download and Artist Information
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

Recorded By:  Rajiv Hasan

Click for Download and Artist Information
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
Recorded By:  Nicole Sandler

Click for Download and Artist Information
 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

Recorded By:  Lee Plaud

Click for Download and Artist Information
 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
Recorded By:  Joe Rodriguez

Click for Download and Artist Information
Title III -  PROMOTING PRIMARY CARE MENTAL HEALTH SERVICES AND COORDINATED CARE
Sec. 1301  -  Accountable Care Organization pilot program
Recorded By:  Al Remington

Click for Download and Artist Information
Sec 1302  -  Medical home pilot program
Recorded By:  Mike Vendetti

Click for Download and Artist Information
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
Recorded By:  Lori Furth

Click for Download and Artist Information
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

Recorded By:  Karen Commins

Click for Download and Artist Information
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
Recorded By:  Lisa Junco

Click for Download and Artist Information
Title IV  -  QUALITY
Subtitle A  -  Comparative Effectiveness Research
Sec. 1401  -  Comparative effectiveness research
Recorded By:  Jenn Thayer

Click for Download and Artist Information
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

Recorded By:  Laura Wiese

Click for Download and Artist Information
Sec. 1413  -  Nursing home compare Medicare website

Sec. 1414  -  Reporting of expenditures

Sec. 1415  -  Standardized complaint form

Sec. 1416  -  Ensuring staffing accountability

Recorded By:  Curt Palmer

Click for Download and Artist Information
Sec. 1417  -  Nationwide program for national and State background checks on direct patient access employees of long-term care facilities and providers
Recorded By:  Dave Frizell

Click for Download and Artist Information
Part 2 - Targeting Enforcement

Sec. 1421  -  Civil money penalties
Recorded By:  Bill Fike

Click for Download and Artist Information
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

Recorded By:  Chris Mezzolesta

Click for Download and Artist Information
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
Recorded By:  Liz De Nesnera

Click for Download and Artist Information
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
Recorded By:  John Florian

Click for Download and Artist Information
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
Recorded By:  Robert Jadah

Click for Download and Artist Information
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

Recorded By:  Mary-Catherine Jones

Click for Download and Artist Information
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
Recorded By:  Beverly Ann Astley

Click for Download and Artist Information
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

Recorded By:  Beverly Ann Astley

Click for Download and Artist Information
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
Recorded By:  Kathleen "Kat" Keesling

Click for Download and Artist Information
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

Recorded By:  Roger Baker

Click for Download and Artist Information
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
Recorded By:  Matt Cowlrick

Click for Download and Artist Information
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

Recorded By:  Linda Ristig

Click for Download and Artist Information
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
Recorded By:  Veronica Shea

Click for Download and Artist Information
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

Click for Download and Artist Information
Sec. 1730
Recorded By:  Steve Clarke

Click for Download and Artist Information
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)
Recorded By:  Mike Vendetti

Click for Download and Artist Information
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

Recorded By:  Chris Mezzolesta

Click for Download and Artist Information
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
Recorded By:  Scott Purvis

Click for Download and Artist Information
Subtitle G  -  Puerto Rico and the Territories
Sec. 1771  -  Payment to territories
Recorded By:  Pablo Hernandez

Click for Download and Artist Information
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
Recorded By:  Janet Benson

Click for Download and Artist Information
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
Recorded By:  Jody Silvers

Click for Download and Artist Information
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
Recorded By:  Mike Vendetti

Click for Download and Artist Information