H.R. 3962/Division B
DIVISION B — MEDICARE AND MEDICAID IMPROVEMENTS
[edit]SEC. 1001. TABLE OF CONTENTS OF DIVISION.
[edit]The table of contents for this division is as follows:
Sec. 1001. Table of Contents of Division.
- Part 2—Other Medicare PART A Provisions
- Sec. 1111. Payments to Skilled Nursing Facilities.
- Sec. 1112. Medicare DSH Report and Payment Adjustments in 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 as Attending Physicians to Serve Hospice Patients.
- Part 2—Other Medicare PART A Provisions
- Subtitle B—Provisions Related to PART B
- Part 1—Physicians' 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.
- Part 1—Physicians' Services
- 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. 1149. Timely Access to Post-Mastectomy Items.
- Sec. 1149A. Payment for Biosimilar Biological Products.
- Sec. 1149B. Study and Report on DME Competitive Bidding Process.
- Part 3—Other Provisions
- 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.
- 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 the 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.
- Sec. 1160. Implementation, and Congressional Review, of Proposal to Revise Medicare Payments to Promote High Value Health Care.
- 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.
- Part 1—Payment and Administration
- 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.
- Part 2—Beneficiary Protections and Anti-Fraud
- 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.
- Part 3—Treatment of Special Needs Plans
- 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.
- 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.
- Subtitle A—Improving and Simplifying Financial Assistance 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 in Calculation of Low Income Subsidy Benchmark.
- 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.
- 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.
- Sec. 1301. Accountable Care Organization Pilot Program.
- Sec. 1302. Medical Home Pilot Program.
- 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.
- 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 Educators as Certified Providers for Purposes of Medicare Diabetes Outpatient Self-Management Training Services.
- 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.
- Sec. 1413. Nursing Home Compare Medicare Website.
- Sec. 1414. Reporting of Expenditures.
- Sec. 1415. Standardized Complaint Form.
- Sec. 1416. Ensuring Staffing Accountability.
- Sec. 1417. Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers.
- Part 1—Improving Transparency of Information on Skilled Nursing Facilities, Nursing Facilities, and Other Long-Term Care Facilities
- 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.
- Sec. 1446. Quality Indicators for Care of People with Alzheimer’s Disease.
- Sec. 1501. Distribution of Unused Residency Positions.
- Sec. 1502. Increasing Training in Nonprovider 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.
- 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.
- 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.
- Sec. 1638. Requirement for Physicians to Provide Documentation on Referrals to Programs at High Risk of Waste and Abuse.
- Sec. 1639. Face to Face Encounter with Patient Required Before Physicians May Certify Eligibility for Home Health Services or Durable Medical Equipment Under Medicare.
- 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 Act 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.
- 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.
- Sec. 1654. Disclosure of Medicare Fraud and Abuse Hotline Number on Explanation of Benefits.
- Subtitle A—Medicaid and Health Reform
- 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.
- 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 optometrists.
- Sec. 1727. Therapeutic foster care.
- Sec. 1728. Assuring adequate payment levels for services.
- Sec. 1729. Preserving Medicaid coverage for youths upon release from public institutions.
- Sec. 1730. Quality measures for maternity and adult health services under Medicaid and CHIP.
- Sec. 1730A. Accountable care organization pilot program.
- Sec. 1730B. FQHC coverage.
- 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).
- Sec. 1739A. Sense of Congress regarding Community First Choice Option to provide medicaid coverage of community-based attendant services and supports.
- Subtitle E—Financing
- Sec. 1741. Payments to pharmacists.
- Sec. 1742. Prescription drug rebates.
- Sec. 1743. Extension of prescription drug discounts to enrollees of medicaid managed care organizations.
- 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 elimination.
- Sec. 1749. Extension of ARRA increase in FMAP.
- 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 relating 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.
- 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.
- 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.
- 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.