--H.R.3590-- H.R.3590 One Hundred Eleventh Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Tuesday, the fifth day of January, two thousand and ten An Act Entitled The Patient Protection and Affordable Care Act.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

Subtitle A--Immediate Improvements in Health Care Coverage for All Americans

`PART A--Individual and Group Market Reforms

`subpart ii--improving coverage

`Sec. 2711. No lifetime or annual limits.

`Sec. 2712. Prohibition on rescissions.

`Sec. 2713. Coverage of preventive health services.

`Sec. 2714. Extension of dependent coverage.

`Sec. 2715. Development and utilization of uniform explanation of coverage documents and standardized definitions.

`Sec. 2716. Prohibition of discrimination based on salary.

`Sec. 2717. Ensuring the quality of care.

`Sec. 2718. Bringing down the cost of health care coverage.

`Sec. 2719. Appeals process.

Subtitle B--Immediate Actions to Preserve and Expand Coverage

Subtitle C--Quality Health Insurance Coverage for All Americans

PART I--Health Insurance Market Reforms

`subpart i--general reform

`Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status.

`Sec. 2701. Fair health insurance premiums.

`Sec. 2702. Guaranteed availability of coverage.

`Sec. 2703. Guaranteed renewability of coverage.

`Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries based on health status.

`Sec. 2706. Non-discrimination in health care.

`Sec. 2707. Comprehensive health insurance coverage.

`Sec. 2708. Prohibition on excessive waiting periods.

PART II--Other Provisions

Subtitle D--Available Coverage Choices for All Americans

PART I--Establishment of Qualified Health Plans

PART II--Consumer Choices and Insurance Competition Through Health Benefit Exchanges

PART III--State Flexibility Relating to Exchanges

PART IV--State Flexibility to Establish Alternative Programs

PART V--Reinsurance and Risk Adjustment

Subtitle E--Affordable Coverage Choices for All Americans

PART I--Premium Tax Credits and Cost-sharing Reductions

subpart a--premium tax credits and cost-sharing reductions

subpart b--eligibility determinations

PART II--Small Business Tax Credit

Subtitle F--Shared Responsibility for Health Care

PART I--Individual Responsibility

PART II--Employer Responsibilities

Subtitle G--Miscellaneous Provisions

TITLE II--ROLE OF PUBLIC PROGRAMS

Subtitle A--Improved Access to Medicaid

Subtitle B--Enhanced Support for the Children's Health Insurance Program

Subtitle C--Medicaid and CHIP Enrollment Simplification

Subtitle D--Improvements to Medicaid Services

Subtitle E--New Options for States to Provide Long-Term Services and Supports

Subtitle F--Medicaid Prescription Drug Coverage

Subtitle G--Medicaid Disproportionate Share Hospital (DSH) Payments

Subtitle H--Improved Coordination for Dual Eligible Beneficiaries

Subtitle I--Improving the Quality of Medicaid for Patients and Providers

Subtitle J--Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)

Subtitle K--Protections for American Indians and Alaska Natives

Subtitle L--Maternal and Child Health Services

TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

Subtitle A--Transforming the Health Care Delivery System

PART I--Linking Payment to Quality Outcomes Under the Medicare Program

PART II--National Strategy to Improve Health Care Quality

PART III--Encouraging Development of New Patient Care Models

Subtitle B--Improving Medicare for Patients and Providers

PART I--Ensuring Beneficiary Access to Physician Care and Other Services

PART II--Rural Protections

PART III--Improving Payment Accuracy

Subtitle C--Provisions Relating to Part C

Subtitle D--Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans

Subtitle E--Ensuring Medicare Sustainability

Subtitle F--Health Care Quality Improvements

Subtitle G--Protecting and Improving Guaranteed Medicare Benefits

TITLE IV--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH

Subtitle A--Modernizing Disease Prevention and Public Health Systems

Subtitle B--Increasing Access to Clinical Preventive Services

Subtitle C--Creating Healthier Communities

Subtitle D--Support for Prevention and Public Health Innovation

Subtitle E--Miscellaneous Provisions

TITLE V--HEALTH CARE WORKFORCE

Subtitle A--Purpose and Definitions

Subtitle B--Innovations in the Health Care Workforce

Subtitle C--Increasing the Supply of the Health Care Workforce

Subtitle D--Enhancing Health Care Workforce Education and Training

Subtitle E--Supporting the Existing Health Care Workforce

Subtitle F--Strengthening Primary Care and Other Workforce Improvements

Subtitle G--Improving Access to Health Care Services

Subtitle H--General Provisions

TITLE VI--TRANSPARENCY AND PROGRAM INTEGRITY

Subtitle A--Physician Ownership and Other Transparency

Subtitle B--Nursing Home Transparency and Improvement

PART I--Improving Transparency of Information

PART II--Targeting Enforcement

PART III--Improving Staff Training

Subtitle C--Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-term Care Facilities and Providers

Subtitle D--Patient-Centered Outcomes Research

Subtitle E--Medicare, Medicaid, and CHIP Program Integrity Provisions

Subtitle F--Additional Medicaid Program Integrity Provisions

Subtitle G--Additional Program Integrity Provisions

Subtitle H--Elder Justice Act

Subtitle I--Sense of the Senate Regarding Medical Malpractice

TITLE VII--IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES

Subtitle A--Biologics Price Competition and Innovation

Subtitle B--More Affordable Medicines for Children and Underserved Communities

TITLE VIII--CLASS ACT

TITLE IX--REVENUE PROVISIONS

Subtitle A--Revenue Offset Provisions

Subtitle B--Other Provisions

TITLE X--STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

Subtitle A--Provisions Relating to Title I

Subtitle B--Provisions Relating to Title II

PART I--Medicaid and CHIP

PART II--Support for Pregnant and Parenting Teens and Women

PART III--Indian Health Care Improvement

Subtitle C--Provisions Relating to Title III

Subtitle D--Provisions Relating to Title IV

Subtitle E--Provisions Relating to Title V

Subtitle F--Provisions Relating to Title VI

Subtitle G--Provisions Relating to Title VIII

Subtitle H--Provisions Relating to Title IX

TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

Subtitle A--Immediate Improvements in Health Care Coverage for All Americans

SEC. 1001. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

`PART A--INDIVIDUAL AND GROUP MARKET REFORMS';

`Subpart II--Improving Coverage

`SEC. 2711. NO LIFETIME OR ANNUAL LIMITS.

`SEC. 2712. PROHIBITION ON RESCISSIONS.

`SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.

`SEC. 2714. EXTENSION OF DEPENDENT COVERAGE.

`SEC. 2715. DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS.

`SEC. 2716. PROHIBITION OF DISCRIMINATION BASED ON SALARY.

`SEC. 2717. ENSURING THE QUALITY OF CARE.

`SEC. 2718. BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.

`SEC. 2719. APPEALS PROCESS.

SEC. 1002. HEALTH INSURANCE CONSUMER INFORMATION.

`SEC. 2793. HEALTH INSURANCE CONSUMER INFORMATION.

SEC. 1003. ENSURING THAT CONSUMERS GET VALUE FOR THEIR DOLLARS.

`SEC. 2794. ENSURING THAT CONSUMERS GET VALUE FOR THEIR DOLLARS.

SEC. 1004. EFFECTIVE DATES.

Subtitle B--Immediate Actions to Preserve and Expand Coverage

SEC. 1101. IMMEDIATE ACCESS TO INSURANCE FOR UNINSURED INDIVIDUALS WITH A PREEXISTING CONDITION.

SEC. 1102. REINSURANCE FOR EARLY RETIREES.

SEC. 1103. IMMEDIATE INFORMATION THAT ALLOWS CONSUMERS TO IDENTIFY AFFORDABLE COVERAGE OPTIONS.

SEC. 1104. ADMINISTRATIVE SIMPLIFICATION.

SEC. 1105. EFFECTIVE DATE.

Subtitle C--Quality Health Insurance Coverage for All Americans

PART I--HEALTH INSURANCE MARKET REFORMS

SEC. 1201. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

`Subpart I--General Reform';

`SEC. 2704. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.

`SEC. 2701. FAIR HEALTH INSURANCE PREMIUMS.

`SEC. 2702. GUARANTEED AVAILABILITY OF COVERAGE.

`SEC. 2703. GUARANTEED RENEWABILITY OF COVERAGE.

`SEC. 2705. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.

`SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.

`SEC. 2707. COMPREHENSIVE HEALTH INSURANCE COVERAGE.

`SEC. 2708. PROHIBITION ON EXCESSIVE WAITING PERIODS.

PART II--OTHER PROVISIONS

SEC. 1251. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE.

SEC. 1252. RATING REFORMS MUST APPLY UNIFORMLY TO ALL HEALTH INSURANCE ISSUERS AND GROUP HEALTH PLANS.

SEC. 1253. EFFECTIVE DATES.

Subtitle D--Available Coverage Choices for All Americans

PART I--ESTABLISHMENT OF QUALIFIED HEALTH PLANS

SEC. 1301. QUALIFIED HEALTH PLAN DEFINED.

SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.

SEC. 1303. SPECIAL RULES.

SEC. 1304. RELATED DEFINITIONS.

PART II--CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH BENEFIT EXCHANGES

SEC. 1311. AFFORDABLE CHOICES OF HEALTH BENEFIT PLANS.

SEC. 1312. CONSUMER CHOICE.

SEC. 1313. FINANCIAL INTEGRITY.

PART III--STATE FLEXIBILITY RELATING TO EXCHANGES

SEC. 1321. STATE FLEXIBILITY IN OPERATION AND ENFORCEMENT OF EXCHANGES AND RELATED REQUIREMENTS.

SEC. 1322. FEDERAL PROGRAM TO ASSIST ESTABLISHMENT AND OPERATION OF NONPROFIT, MEMBER-RUN HEALTH INSURANCE ISSUERS.

SEC. 1323. COMMUNITY HEALTH INSURANCE OPTION.

SEC. 1324. LEVEL PLAYING FIELD.

PART IV--STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS

SEC. 1331. STATE FLEXIBILITY TO ESTABLISH BASIC HEALTH PROGRAMS FOR LOW-INCOME INDIVIDUALS NOT ELIGIBLE FOR MEDICAID.

SEC. 1332. WAIVER FOR STATE INNOVATION.

SEC. 1333. PROVISIONS RELATING TO OFFERING OF PLANS IN MORE THAN ONE STATE.

PART V--REINSURANCE AND RISK ADJUSTMENT

SEC. 1341. TRANSITIONAL REINSURANCE PROGRAM FOR INDIVIDUAL AND SMALL GROUP MARKETS IN EACH STATE.

SEC. 1342. ESTABLISHMENT OF RISK CORRIDORS FOR PLANS IN INDIVIDUAL AND SMALL GROUP MARKETS.

SEC. 1343. RISK ADJUSTMENT.

Subtitle E--Affordable Coverage Choices for All Americans

PART I--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS

Subpart A--Premium Tax Credits and Cost-sharing Reductions

SEC. 1401. REFUNDABLE TAX CREDIT PROVIDING PREMIUM ASSISTANCE FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.

`SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.

`(aa) whose tax for the taxable year is determined under section 1(c) (relating to unmarried individuals other than surviving spouses and heads of households) and who is not allowed a deduction under section 151 for the taxable year with respect to a dependent, or

`(bb) who is not described in item (aa) but who purchases only self-only coverage, and

`(aa) the numerator of which is the poverty line for the taxpayer's family size determined after application of subclause (I), and

`(bb) the denominator of which is the poverty line for the taxpayer's family size determined without regard to subclause (I).

SEC. 1402. REDUCED COST-SHARING FOR INDIVIDUALS ENROLLING IN QUALIFIED HEALTH PLANS.

(aa) the numerator of which is the poverty line for the taxpayer's family size determined after application of subclause (I), and

(bb) the denominator of which is the poverty line for the taxpayer's family size determined without regard to subclause (I).

Subpart B--Eligibility Determinations

SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY FOR EXCHANGE PARTICIPATION, PREMIUM TAX CREDITS AND REDUCED COST-SHARING, AND INDIVIDUAL RESPONSIBILITY EXEMPTIONS.

SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS.

SEC. 1413. STREAMLINING OF PROCEDURES FOR ENROLLMENT THROUGH AN EXCHANGE AND STATE MEDICAID, CHIP, AND HEALTH SUBSIDY PROGRAMS.

SEC. 1414. DISCLOSURES TO CARRY OUT ELIGIBILITY REQUIREMENTS FOR CERTAIN PROGRAMS.

SEC. 1415. PREMIUM TAX CREDIT AND COST-SHARING REDUCTION PAYMENTS DISREGARDED FOR FEDERAL AND FEDERALLY-ASSISTED PROGRAMS.

PART II--SMALL BUSINESS TAX CREDIT

SEC. 1421. CREDIT FOR EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL BUSINESSES.

`SEC. 45R. EMPLOYEE HEALTH INSURANCE EXPENSES OF SMALL EMPLOYERS.

Subtitle F--Shared Responsibility for Health Care

PART I--INDIVIDUAL RESPONSIBILITY

SEC. 1501. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

`CHAPTER 48--MAINTENANCE OF MINIMUM ESSENTIAL COVERAGE

`SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

`Chapter 48--Maintenance of Minimum Essential Coverage.'.

SEC. 1502. REPORTING OF HEALTH INSURANCE COVERAGE.

`Subpart D--Information Regarding Health Insurance Coverage

`SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.

`subpart d--information regarding health insurance coverage'.

PART II--EMPLOYER RESPONSIBILITIES

SEC. 1511. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS.

`SEC. 18A. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS.

SEC. 1512. EMPLOYER REQUIREMENT TO INFORM EMPLOYEES OF COVERAGE OPTIONS.

`SEC. 18B. NOTICE TO EMPLOYEES.

SEC. 1513. SHARED RESPONSIBILITY FOR EMPLOYERS.

`SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH COVERAGE.

SEC. 1514. REPORTING OF EMPLOYER HEALTH INSURANCE COVERAGE.

`SEC. 6056. LARGE EMPLOYERS REQUIRED TO REPORT ON HEALTH INSURANCE COVERAGE.

SEC. 1515. OFFERING OF EXCHANGE-PARTICIPATING QUALIFIED HEALTH PLANS THROUGH CAFETERIA PLANS.

Subtitle G--Miscellaneous Provisions

SEC. 1551. DEFINITIONS.

SEC. 1552. TRANSPARENCY IN GOVERNMENT.

SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE.

SEC. 1554. ACCESS TO THERAPIES.

SEC. 1555. FREEDOM NOT TO PARTICIPATE IN FEDERAL HEALTH INSURANCE PROGRAMS.

SEC. 1556. EQUITY FOR CERTAIN ELIGIBLE SURVIVORS.

SEC. 1557. NONDISCRIMINATION.

SEC. 1558. PROTECTIONS FOR EMPLOYEES.

`SEC. 18C. PROTECTIONS FOR EMPLOYEES.

SEC. 1559. OVERSIGHT.

SEC. 1560. RULES OF CONSTRUCTION.

SEC. 1561. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.

`Subtitle C--Other Provisions

`SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.

SEC. 1562. CONFORMING AMENDMENTS.

(aa) in the matter preceding clause (i), by inserting `and individuals' after `employers';

(bb) in clause (i), by inserting `or any additional individuals' after `additional groups'; and

(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'; and

(aa) by inserting `or individual, as applicable,' after `plan sponsor'; and

(bb) by inserting `or individual health insurance coverage'; and

(aa) by inserting `, or individual, as applicable,' after `employer'; and

(bb) by redesignating such subparagraph as subparagraph (B);

`SEC. 715. ADDITIONAL MARKET REFORMS.

`SEC. 9815. ADDITIONAL MARKET REFORMS.

SEC. 1563. SENSE OF THE SENATE PROMOTING FISCAL RESPONSIBILITY.

TITLE II--ROLE OF PUBLIC PROGRAMS

Subtitle A--Improved Access to Medicaid

SEC. 2001. MEDICAID COVERAGE FOR THE LOWEST INCOME POPULATIONS.

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`For any fiscal year quarter occurring in the calendar year: If the State is an expansion State, the applicable percentage point increase is: If the State is not an expansion State, the applicable percentage point increase is: 
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                                                        2017                                                                             30.3                                                                                 34.3 
                                                        2018                                                                             31.3                                                                                 33.3 
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SEC. 2002. INCOME ELIGIBILITY FOR NONELDERLY DETERMINED USING MODIFIED GROSS INCOME.

SEC. 2003. REQUIREMENT TO OFFER PREMIUM ASSISTANCE FOR EMPLOYER-SPONSORED INSURANCE.

SEC. 2004. MEDICAID COVERAGE FOR FORMER FOSTER CARE CHILDREN.

SEC. 2005. PAYMENTS TO TERRITORIES.

SEC. 2006. SPECIAL ADJUSTMENT TO FMAP DETERMINATION FOR CERTAIN STATES RECOVERING FROM A MAJOR DISASTER.

SEC. 2007. MEDICAID IMPROVEMENT FUND RESCISSION.

Subtitle B--Enhanced Support for the Children's Health Insurance Program

SEC. 2101. ADDITIONAL FEDERAL FINANCIAL PARTICIPATION FOR CHIP.

SEC. 2102. TECHNICAL CORRECTIONS.

Subtitle C--Medicaid and CHIP Enrollment Simplification

SEC. 2201. ENROLLMENT SIMPLIFICATION AND COORDINATION WITH STATE HEALTH INSURANCE EXCHANGES.

`SEC. 1943. ENROLLMENT SIMPLIFICATION AND COORDINATION WITH STATE HEALTH INSURANCE EXCHANGES.

SEC. 2202. PERMITTING HOSPITALS TO MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS FOR ALL MEDICAID ELIGIBLE POPULATIONS.

Subtitle D--Improvements to Medicaid Services

SEC. 2301. COVERAGE FOR FREESTANDING BIRTH CENTER SERVICES.

SEC. 2302. CONCURRENT CARE FOR CHILDREN.

SEC. 2303. STATE ELIGIBILITY OPTION FOR FAMILY PLANNING SERVICES.

`PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING SERVICES

SEC. 2304. CLARIFICATION OF DEFINITION OF MEDICAL ASSISTANCE.

Subtitle E--New Options for States to Provide Long-Term Services and Supports

SEC. 2401. COMMUNITY FIRST CHOICE OPTION.

SEC. 2402. REMOVAL OF BARRIERS TO PROVIDING HOME AND COMMUNITY-BASED SERVICES.

SEC. 2403. MONEY FOLLOWS THE PERSON REBALANCING DEMONSTRATION.

SEC. 2404. PROTECTION FOR RECIPIENTS OF HOME AND COMMUNITY-BASED SERVICES AGAINST SPOUSAL IMPOVERISHMENT.

SEC. 2405. FUNDING TO EXPAND STATE AGING AND DISABILITY RESOURCE CENTERS.

SEC. 2406. SENSE OF THE SENATE REGARDING LONG-TERM CARE.

Subtitle F--Medicaid Prescription Drug Coverage

SEC. 2501. PRESCRIPTION DRUG REBATES.

`(aa) A clotting factor for which a separate furnishing payment is made under section 1842(o)(5) and which is included on a list of such factors specified and updated regularly by the Secretary.

`(bb) A drug approved by the Food and Drug Administration exclusively for pediatric indications.'.

SEC. 2502. ELIMINATION OF EXCLUSION OF COVERAGE OF CERTAIN DRUGS.

SEC. 2503. PROVIDING ADEQUATE PHARMACY REIMBURSEMENT.

Subtitle G--Medicaid Disproportionate Share Hospital (DSH) Payments

SEC. 2551. DISPROPORTIONATE SHARE HOSPITAL PAYMENTS.

Subtitle H--Improved Coordination for Dual Eligible Beneficiaries

SEC. 2601. 5-YEAR PERIOD FOR DEMONSTRATION PROJECTS.

SEC. 2602. PROVIDING FEDERAL COVERAGE AND PAYMENT COORDINATION FOR DUAL ELIGIBLE BENEFICIARIES.

Subtitle I--Improving the Quality of Medicaid for Patients and Providers

SEC. 2701. ADULT HEALTH QUALITY MEASURES.

`SEC. 1139B. ADULT HEALTH QUALITY MEASURES.

SEC. 2702. PAYMENT ADJUSTMENT FOR HEALTH CARE-ACQUIRED CONDITIONS.

SEC. 2703. STATE OPTION TO PROVIDE HEALTH HOMES FOR ENROLLEES WITH CHRONIC CONDITIONS.

SEC. 2704. DEMONSTRATION PROJECT TO EVALUATE INTEGRATED CARE AROUND A HOSPITALIZATION.

SEC. 2705. MEDICAID GLOBAL PAYMENT SYSTEM DEMONSTRATION PROJECT.

SEC. 2706. PEDIATRIC ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION PROJECT.

SEC. 2707. MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT.

Subtitle J--Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)

SEC. 2801. MACPAC ASSESSMENT OF POLICIES AFFECTING ALL MEDICAID BENEFICIARIES.

(aa) by inserting `the efficient provision of' after `expenditures for'; and

(bb) by striking `hospital, skilled nursing facility, physician, Federally-qualified health center, rural health center, and other fees' and inserting `payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of other covered items and services'; and

Subtitle K--Protections for American Indians and Alaska Natives

SEC. 2901. SPECIAL RULES RELATING TO INDIANS.

SEC. 2902. ELIMINATION OF SUNSET FOR REIMBURSEMENT FOR ALL MEDICARE PART B SERVICES FURNISHED BY CERTAIN INDIAN HOSPITALS AND CLINICS.

Subtitle L--Maternal and Child Health Services

SEC. 2951. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS.

`SEC. 511. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS.

`(aa) randomized controlled research designs, and the evaluation results have been published in a peer-reviewed journal; or

`(bb) quasi-experimental research designs.

SEC. 2952. SUPPORT, EDUCATION, AND RESEARCH FOR POSTPARTUM DEPRESSION.

`SEC. 512. SERVICES TO INDIVIDUALS WITH A POSTPARTUM CONDITION AND THEIR FAMILIES.

SEC. 2953. PERSONAL RESPONSIBILITY EDUCATION.

`SEC. 513. PERSONAL RESPONSIBILITY EDUCATION.

SEC. 2954. RESTORATION OF FUNDING FOR ABSTINENCE EDUCATION.

SEC. 2955. INCLUSION OF INFORMATION ABOUT THE IMPORTANCE OF HAVING A HEALTH CARE POWER OF ATTORNEY IN TRANSITION PLANNING FOR CHILDREN AGING OUT OF FOSTER CARE AND INDEPENDENT LIVING PROGRAMS.

TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

Subtitle A--Transforming the Health Care Delivery System

PART I--LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM

SEC. 3001. HOSPITAL VALUE-BASED PURCHASING PROGRAM.

`(aa) Acute myocardial infarction (AMI).

`(bb) Heart failure.

`(cc) Pneumonia.

`(dd) Surgeries, as measured by the Surgical Care Improvement Project (formerly referred to as `Surgical Infection Prevention' for discharges occurring before July 2006).

`(ee) Healthcare-associated infections, as measured by the prevention metrics and targets established in the HHS Action Plan to Prevent Healthcare-Associated Infections (or any successor plan) of the Department of Health and Human Services.

`(aa) payments under paragraphs (5)(A), (5)(B), (5)(F), and (12) of subsection (d); and

`(bb) such other payments under subsection (d) determined appropriate by the Secretary.

SEC. 3002. IMPROVEMENTS TO THE PHYSICIAN QUALITY REPORTING SYSTEM.

SEC. 3003. IMPROVEMENTS TO THE PHYSICIAN FEEDBACK PROGRAM.

SEC. 3004. QUALITY REPORTING FOR LONG-TERM CARE HOSPITALS, INPATIENT REHABILITATION HOSPITALS, AND HOSPICE PROGRAMS.

SEC. 3005. QUALITY REPORTING FOR PPS-EXEMPT CANCER HOSPITALS.

SEC. 3006. PLANS FOR A VALUE-BASED PURCHASING PROGRAM FOR SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES.

SEC. 3007. VALUE-BASED PAYMENT MODIFIER UNDER THE PHYSICIAN FEE SCHEDULE.

SEC. 3008. PAYMENT ADJUSTMENT FOR CONDITIONS ACQUIRED IN HOSPITALS.

PART II--NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY

SEC. 3011. NATIONAL STRATEGY.

`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.

SEC. 3012. INTERAGENCY WORKING GROUP ON HEALTH CARE QUALITY.

SEC. 3013. QUALITY MEASURE DEVELOPMENT.

`PART D--HEALTH CARE QUALITY IMPROVEMENT

`Subpart I--Quality Measure Development

`SEC. 931. QUALITY MEASURE DEVELOPMENT.

SEC. 3014. QUALITY MEASUREMENT.

`QUALITY MEASUREMENT

SEC. 3015. DATA COLLECTION; PUBLIC REPORTING.

`SEC. 399II. COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE MEASURES.

`SEC. 399JJ. PUBLIC REPORTING OF PERFORMANCE INFORMATION.

PART III--ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS

SEC. 3021. ESTABLISHMENT OF CENTER FOR MEDICARE AND MEDICAID INNOVATION WITHIN CMS.

`CENTER FOR MEDICARE AND MEDICAID INNOVATION

SEC. 3022. MEDICARE SHARED SAVINGS PROGRAM.

`SHARED SAVINGS PROGRAM

SEC. 3023. NATIONAL PILOT PROGRAM ON PAYMENT BUNDLING.

`NATIONAL PILOT PROGRAM ON PAYMENT BUNDLING

SEC. 3024. INDEPENDENCE AT HOME DEMONSTRATION PROGRAM.

`INDEPENDENCE AT HOME MEDICAL PRACTICE DEMONSTRATION PROGRAM

SEC. 3025. HOSPITAL READMISSIONS REDUCTION PROGRAM.

`SEC. 399KK. QUALITY IMPROVEMENT PROGRAM FOR HOSPITALS WITH A HIGH SEVERITY ADJUSTED READMISSION RATE.

SEC. 3026. COMMUNITY-BASED CARE TRANSITIONS PROGRAM.

SEC. 3027. EXTENSION OF GAINSHARING DEMONSTRATION.

Subtitle B--Improving Medicare for Patients and Providers

PART I--ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES

SEC. 3101. INCREASE IN THE PHYSICIAN PAYMENT UPDATE.

SEC. 3102. EXTENSION OF THE WORK GEOGRAPHIC INDEX FLOOR AND REVISIONS TO THE PRACTICE EXPENSE GEOGRAPHIC ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

SEC. 3103. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY CAPS.

SEC. 3104. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.

SEC. 3105. EXTENSION OF AMBULANCE ADD-ONS.