# H.R. 3962/Division B
## DIVISION B — MEDICARE AND MEDICAID IMPROVEMENTS
### SEC. 1001. TABLE OF CONTENTS OF DIVISION.

The table of contents for this division is as follows:
Sec. 1001. Table of Contents of Division.

#### TITLE I—IMPROVING HEALTH CARE VALUE

    Subtitle A—Provisions Related to Medicare PART A
       Part 1—Market Basket Updates
          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 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.
    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 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. 1149. Timely Access to Post-Mastectomy Items.
          Sec. 1149A. Payment for Biosimilar Biological Products.
          Sec. 1149B. Study and Report on DME Competitive Bidding Process.
    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 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 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.
    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.

#### TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS

    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.

#### TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE

    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.

#### TITLE IV—QUALITY

    Subtitle A—Comparative Effectiveness Research
       Sec. 1401. Comparative Effectiveness Research.
    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 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.
    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.
    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.
    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.

#### TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION

    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.

#### 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.
    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.

#### TITLE VII—MEDICAID AND CHIP

    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 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.
    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 G—Payments to the Territories
       Sec. 1771. Payment to Territories.
    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.

#### 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.

#### 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.