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tion 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)). 
(5) STABILIZED.—The term ‘‘stabilized’’ means, 
with respect to an individual, that the emergency 
medical condition no longer exists with respect to the 
individual and the individual is no longer dangerous 
to self or others. 
(6) STATE.—The term ‘‘State’’ has the meaning 
given that term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
Subtitle J—Improvements to the 
Medicaid and CHIP Payment 
and 
Access 
Commission 
(MACPAC) 
SEC. 2801. MACPAC ASSESSMENT OF POLICIES AFFECTING 
ALL MEDICAID BENEFICIARIES. 
(a) IN GENERAL.—Section 1900 of the Social Security 
Act (42 U.S.C. 1396) is amended— 
(1) in subsection (b)— 
(A) in paragraph (1)— 
(i) in the paragraph heading, by in-
serting ‘‘FOR ALL STATES’’ before ‘‘AND AN-
NUAL’’; and 
(ii) in subparagraph (A), by striking 
‘‘children’s’’; 
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(iii) in subparagraph (B), by inserting 
‘‘, the Secretary, and States’’ after ‘‘Con-
gress’’; 
(iv) in subparagraph (C), by striking 
‘‘March 1’’ and inserting ‘‘March 15’’; and 
(v) in subparagraph (D), by striking 
‘‘June 1’’ and inserting ‘‘June 15’’; 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) in clause (i)— 
(aa) by inserting ‘‘the effi-
cient provision of’’ after ‘‘expendi-
tures 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 profes-
sionals, hospitals, residential and 
long-term care providers, pro-
viders of home and community 
based services, Federally-qualified 
health centers and rural health 
clinics, managed care entities, 
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and providers of other covered 
items and services’’; and 
(II) in clause (iii), by inserting 
‘‘(including how such factors and 
methodologies enable such beneficiaries 
to obtain the services for which they 
are eligible, affect provider supply, and 
affect providers that serve a dispropor-
tionate share of low-income and other 
vulnerable populations)’’ after ‘‘bene-
ficiaries’’; 
(ii) by redesignating subparagraphs 
(B) and (C) as subparagraphs (F) and (H), 
respectively; 
(iii) by inserting after subparagraph 
(A), the following: 
‘‘(B) ELIGIBILITY POLICIES.—Medicaid and 
CHIP eligibility policies, including a determina-
tion of the degree to which Federal and State 
policies provide health care coverage to needy 
populations. 
‘‘(C) ENROLLMENT AND RETENTION PROC-
ESSES.—Medicaid and CHIP enrollment and re-
tention processes, including a determination of 
the degree to which Federal and State policies 
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encourage the enrollment of individuals who are 
eligible for such programs and screen out indi-
viduals who are ineligible, while minimizing the 
share of program expenses devoted to such proc-
esses. 
‘‘(D) COVERAGE POLICIES.—Medicaid and 
CHIP benefit and coverage policies, including a 
determination of the degree to which Federal and 
State policies provide access to the services en-
rollees require to improve and maintain their 
health and functional status. 
‘‘(E) QUALITY
OF
CARE.—Medicaid and 
CHIP policies as they relate to the quality of 
care provided under those programs, including a 
determination of the degree to which Federal and 
State policies achieve their stated goals and 
interact with similar goals established by other 
purchasers of health care services.’’; 
(iv) by inserting after subparagraph 
(F) (as redesignated by clause (ii) of this 
subparagraph), the following: 
‘‘(G) INTERACTIONS WITH MEDICARE AND 
MEDICAID.—Consistent with paragraph (11), the 
interaction of policies under Medicaid and the 
Medicare program under title XVIII, including 
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with respect to how such interactions affect ac-
cess to services, payments, and dual eligible indi-
viduals.’’ and 
(v) in subparagraph (H) (as so redes-
ignated), by inserting ‘‘and preventive, 
acute, and long-term services and supports’’ 
after ‘‘barriers’’; 
(C) 
by 
redesignating 
paragraphs 
(3) 
through (9) as paragraphs (4) through (10), re-
spectively; 
(D) by inserting after paragraph (2), the 
following new paragraph: 
‘‘(3) RECOMMENDATIONS
AND
REPORTS
OF 
STATE-SPECIFIC DATA.—MACPAC shall— 
‘‘(A) review national and State-specific 
Medicaid and CHIP data; and 
‘‘(B) submit reports and recommendations 
to Congress, the Secretary, and States based on 
such reviews.’’; 
(E) in paragraph (4), as redesignated by 
subparagraph (C), by striking ‘‘or any other 
problems’’ and all that follows through the period 
and inserting ‘‘, as well as other factors that ad-
versely affect, or have the potential to adversely 
affect, access to care by, or the health care status 
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of, Medicaid and CHIP beneficiaries. MACPAC 
shall include in the annual report required 
under paragraph (1)(D) a description of all such 
areas or problems identified with respect to the 
period addressed in the report.’’; 
(F) in paragraph (5), as so redesignated,— 
(i) in the paragraph heading, by in-
serting ‘‘AND
REGULATIONS’’ after ‘‘RE-
PORTS’’; and 
(ii) by striking ‘‘If’’ and inserting the 
following: 
‘‘(A) CERTAIN
SECRETARIAL
REPORTS.— 
If’’; and 
(iii) in the second sentence, by insert-
ing ‘‘and the Secretary’’ after ‘‘appropriate 
committees of Congress’’; and 
(iv) by adding at the end the following: 
‘‘(B) REGULATIONS.—MACPAC shall re-
view Medicaid and CHIP regulations and may 
comment through submission of a report to the 
appropriate committees of Congress and the Sec-
retary, on any such regulations that affect access, 
quality, or efficiency of health care.’’; 
(G) in paragraph (10), as so redesignated, 
by inserting ‘‘, and shall submit with any rec-
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ommendations, a report on the Federal and 
State-specific budget consequences of the rec-
ommendations’’ before the period; and 
(H) by adding at the end the following: 
‘‘(11) CONSULTATION AND COORDINATION WITH 
MEDPAC.— 
‘‘(A) IN GENERAL.—MACPAC shall consult 
with the Medicare Payment Advisory Commis-
sion (in this paragraph referred to as ‘MedPAC’) 
established under section 1805 in carrying out 
its duties under this section, as appropriate and 
particularly with respect to the issues specified 
in paragraph (2) as they relate to those Med-
icaid beneficiaries who are dually eligible for 
Medicaid and the Medicare program under title 
XVIII, adult Medicaid beneficiaries (who are not 
dually eligible for Medicare), and beneficiaries 
under Medicare. Responsibility for analysis of 
and recommendations to change Medicare policy 
regarding 
Medicare 
beneficiaries, 
including 
Medicare beneficiaries who are dually eligible for 
Medicare and Medicaid, shall rest with MedPAC. 
‘‘(B) INFORMATION
SHARING.—MACPAC 
and MedPAC shall have access to deliberations 
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and records of the other such entity, respectively, 
upon the request of the other such entity. 
‘‘(12) CONSULTATION WITH STATES.—MACPAC 
shall regularly consult with States in carrying out its 
duties under this section, including with respect to 
developing processes for carrying out such duties, and 
shall ensure that input from States is taken into ac-
count and represented in MACPAC’s recommenda-
tions and reports. 
‘‘(13) COORDINATE
AND
CONSULT
WITH
THE 
FEDERAL
COORDINATED
HEALTH
CARE
OFFICE.— 
MACPAC shall coordinate and consult with the Fed-
eral Coordinated Health Care Office established under 
section 2081 of the Patient Protection and Affordable 
Care Act before making any recommendations regard-
ing dual eligible individuals. 
‘‘(14) PROGRAMMATIC
OVERSIGHT
VESTED
IN 
THE SECRETARY.—MACPAC’s authority to make rec-
ommendations in accordance with this section shall 
not affect, or be considered to duplicate, the Sec-
retary’s authority to carry out Federal responsibil-
ities with respect to Medicaid and CHIP.’’; 
(2) in subsection (c)(2)— 
(A) by striking subparagraphs (A) and (B) 
and inserting the following: 
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‘‘(A) IN
GENERAL.—The membership of 
MACPAC shall include individuals who have 
had direct experience as enrollees or parents or 
caregivers of enrollees in Medicaid or CHIP and 
individuals with national recognition for their 
expertise in Federal safety net health programs, 
health finance and economics, actuarial science, 
health plans and integrated delivery systems, re-
imbursement for health care, health information 
technology, and other providers of health services, 
public health, and other related fields, who pro-
vide a mix of different professions, broad geo-
graphic representation, and a balance between 
urban and rural representation. 
‘‘(B) 
INCLUSION.—The 
membership 
of 
MACPAC shall include (but not be limited to) 
physicians, dentists, and other health profes-
sionals, employers, third-party payers, and indi-
viduals with expertise in the delivery of health 
services. Such membership shall also include rep-
resentatives of children, pregnant women, the el-
derly, individuals with disabilities, caregivers, 
and dual eligible individuals, current or former 
representatives of State agencies responsible for 
administering Medicaid, and current or former 
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representatives of State agencies responsible for 
administering CHIP.’’. 
(3) in subsection (d)(2), by inserting ‘‘and 
State’’ after ‘‘Federal’’; 
(4) in subsection (e)(1), in the first sentence, by 
inserting ‘‘and, as a condition for receiving payments 
under sections 1903(a) and 2105(a), from any State 
agency responsible for administering Medicaid or 
CHIP,’’ after ‘‘United States’’; and 
(5) in subsection (f)— 
(A) in the subsection heading, by striking 
‘‘AUTHORIZATION OF APPROPRIATIONS’’ and in-
serting ‘‘FUNDING’’; 
(B) in paragraph (1), by inserting ‘‘(other 
than for fiscal year 2010)’’ before ‘‘in the same 
manner’’; and 
(C) by adding at the end the following: 
‘‘(3) FUNDING FOR FISCAL YEAR 2010.— 
‘‘(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated to MACPAC to carry out the pro-
visions of this section for fiscal year 2010, 
$9,000,000. 
‘‘(B) 
TRANSFER
OF
FUNDS.—Notwith-
standing section 2104(a)(13), from the amounts 
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appropriated in such section for fiscal year 
2010, $2,000,000 is hereby transferred and made 
available in such fiscal year to MACPAC to 
carry out the provisions of this section. 
‘‘(4) AVAILABILITY.—Amounts made available 
under paragraphs (2) and (3) to MACPAC to carry 
out the provisions of this section shall remain avail-
able until expended.’’. 
(b) CONFORMING MEDPAC AMENDMENTS.—Section 
1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)), 
is amended— 
(1) in paragraph (1)(C), by striking ‘‘March 1 
of each year (beginning with 1998)’’ and inserting 
‘‘March 15’’; 
(2) in paragraph (1)(D), by inserting ‘‘, and (be-
ginning with 2012) containing an examination of the 
topics described in paragraph (9), to the extent fea-
sible’’ before the period; and 
(3) by adding at the end the following: 
‘‘(9) REVIEW AND ANNUAL REPORT ON MEDICAID 
AND
COMMERCIAL
TRENDS.—The Commission shall 
review and report on aggregate trends in spending, 
utilization, and financial performance under the 
Medicaid program under title XIX and the private 
market for health care services with respect to pro-
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viders for which, on an aggregate national basis, a 
significant portion of revenue or services is associated 
with the Medicaid program. Where appropriate, the 
Commission shall conduct such review in consultation 
with the Medicaid and CHIP Payment and Access 
Commission established under section 1900 (in this 
section referred to as ‘MACPAC’). 
‘‘(10) COORDINATE
AND
CONSULT
WITH
THE 
FEDERAL COORDINATED HEALTH CARE OFFICE.—The 
Commission shall coordinate and consult with the 
Federal Coordinated Health Care Office established 
under section 2081 of the Patient Protection and Af-
fordable Care Act before making any recommenda-
tions regarding dual eligible individuals. 
‘‘(11) INTERACTION
OF
MEDICAID
AND
MEDI-
CARE.—The Commission shall consult with MACPAC 
in carrying out its duties under this section, as ap-
propriate. Responsibility for analysis of and rec-
ommendations to change Medicare policy regarding 
Medicare beneficiaries, including Medicare bene-
ficiaries who are dually eligible for Medicare and 
Medicaid, shall rest with the Commission. Responsi-
bility for analysis of and recommendations to change 
Medicaid policy regarding Medicaid beneficiaries, in-
cluding Medicaid beneficiaries who are dually eligible 
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for 
Medicare 
and 
Medicaid, 
shall 
rest 
with 
MACPAC.’’. 
Subtitle K—Protections for Amer-
ican Indians and Alaska Natives 
SEC. 2901. SPECIAL RULES RELATING TO INDIANS. 
(a) NO COST-SHARING FOR INDIANS WITH INCOME AT 
OR BELOW 300 PERCENT OF POVERTY ENROLLED IN COV-
ERAGE THROUGH A STATE EXCHANGE.—For provisions 
prohibiting cost sharing for Indians enrolled in any quali-
fied health plan in the individual market through an Ex-
change, see section 1402(d) of the Patient Protection and 
Affordable Care Act. 
(b) PAYER OF LAST RESORT.—Health programs oper-
ated by the Indian Health Service, Indian tribes, tribal or-
ganizations, and Urban Indian organizations (as those 
terms are defined in section 4 of the Indian Health Care 
Improvement Act (25 U.S.C. 1603)) shall be the payer of 
last resort for services provided by such Service, tribes, or 
organizations to individuals eligible for services through 
such programs, notwithstanding any Federal, State, or 
local law to the contrary. 
(c) FACILITATING ENROLLMENT OF INDIANS UNDER 
THE EXPRESS LANE OPTION.—Section 1902(e)(13)(F)(ii) 
of the Social Security Act (42 U.S.C. 1396a(e)(13)(F)(ii)) 
is amended— 
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(1) in the clause heading, by inserting ‘‘AND IN-
DIAN
TRIBES
AND
TRIBAL
ORGANIZATIONS’’ after 
‘‘AGENCIES’’; and 
(2) by adding at the end the following: 
‘‘(IV) The Indian Health Service, 
an Indian Tribe, Tribal Organization, 
or Urban Indian Organization (as de-
fined in section 1139(c)).’’. 
(d) TECHNICAL CORRECTIONS.—Section 1139(c) of the 
Social Security Act (42 U.S.C. 1320b–9(c)) is amended by 
striking ‘‘In this section’’ and inserting ‘‘For purposes of 
this section, title XIX, and title XXI’’. 
SEC. 2902. ELIMINATION OF SUNSET FOR REIMBURSEMENT 
FOR ALL MEDICARE PART B SERVICES FUR-
NISHED BY CERTAIN INDIAN HOSPITALS AND 
CLINICS. 
(a) REIMBURSEMENT FOR ALL MEDICARE PART B 
SERVICES FURNISHED
BY CERTAIN INDIAN HOSPITALS 
AND CLINICS.—Section 1880(e)(1)(A) of the Social Security 
Act (42 U.S.C. 1395qq(e)(1)(A)) is amended by striking 
‘‘during the 5-year period beginning on’’ and inserting ‘‘on 
or after’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to items or services furnished on or after 
January 1, 2010. 
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Subtitle L—Maternal and Child 
Health Services 
SEC. 2951. MATERNAL, INFANT, AND EARLY CHILDHOOD 
HOME VISITING PROGRAMS. 
Title V of the Social Security Act (42 U.S.C. 701 et 
seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 511. MATERNAL, INFANT, AND EARLY CHILDHOOD 
HOME VISITING PROGRAMS. 
‘‘(a) PURPOSES.—The purposes of this section are— 
‘‘(1) to strengthen and improve the programs 
and activities carried out under this title; 
‘‘(2) to improve coordination of services for at 
risk communities; and 
‘‘(3) to identify and provide comprehensive serv-
ices to improve outcomes for families who reside in at 
risk communities. 
‘‘(b) REQUIREMENT
FOR ALL STATES TO ASSESS 
STATEWIDE NEEDS
AND IDENTIFY
AT RISK COMMU-
NITIES.— 
‘‘(1) IN
GENERAL.—Not later than 6 months 
after the date of enactment of this section, each State 
shall, as a condition of receiving payments from an 
allotment for the State under section 502 for fiscal 
year 2011, conduct a statewide needs assessment 
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(which shall be separate from the statewide needs as-
sessment required under section 505(a)) that identi-
fies— 
‘‘(A) communities with concentrations of— 
‘‘(i) premature birth, low-birth weight 
infants, and infant mortality, including in-
fant death due to neglect, or other indica-
tors of at-risk prenatal, maternal, newborn, 
or child health; 
‘‘(ii) poverty; 
‘‘(iii) crime; 
‘‘(iv) domestic violence; 
‘‘(v) high rates of high-school drop- 
outs; 
‘‘(vi) substance abuse; 
‘‘(vii) unemployment; or 
‘‘(viii) child maltreatment; 
‘‘(B) the quality and capacity of existing 
programs or initiatives for early childhood home 
visitation in the State including— 
‘‘(i) the number and types of individ-
uals and families who are receiving services 
under such programs or initiatives; 
‘‘(ii) the gaps in early childhood home 
visitation in the State; and 
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‘‘(iii) the extent to which such pro-
grams or initiatives are meeting the needs 
of eligible families described in subsection 
(k)(2); and 
‘‘(C) the State’s capacity for providing sub-
stance abuse treatment and counseling services to 
individuals and families in need of such treat-
ment or services. 
‘‘(2) 
COORDINATION
WITH
OTHER
ASSESS-
MENTS.—In conducting the statewide needs assess-
ment required under paragraph (1), the State shall 
coordinate with, and take into account, other appro-
priate needs assessments conducted by the State, as 
determined by the Secretary, including the needs as-
sessment required under section 505(a) (both the most 
recently completed assessment and any such assess-
ment in progress), the communitywide strategic plan-
ning and needs assessments conducted in accordance 
with section 640(g)(1)(C) of the Head Start Act, and 
the inventory of current unmet needs and current 
community-based and prevention-focused programs 
and activities to prevent child abuse and neglect, and 
other family resource services operating in the State 
required under section 205(3) of the Child Abuse Pre-
vention and Treatment Act. 
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‘‘(3) SUBMISSION
TO
THE
SECRETARY.—Each 
State shall submit to the Secretary, in such form and 
manner as the Secretary shall require— 
‘‘(A) the results of the statewide needs as-
sessment required under paragraph (1); and 
‘‘(B) a description of how the State intends 
to address needs identified by the assessment, 
particularly with respect to communities identi-
fied under paragraph (1)(A), which may include 
applying for a grant to conduct an early child-
hood home visitation program in accordance 
with the requirements of this section. 
‘‘(c) GRANTS FOR EARLY CHILDHOOD HOME VISITA-
TION PROGRAMS.— 
‘‘(1) AUTHORITY TO MAKE GRANTS.—In addition 
to any other payments made under this title to a 
State, the Secretary shall make grants to eligible enti-
ties to enable the entities to deliver services under 
early childhood home visitation programs that satisfy 
the requirements of subsection (d) to eligible families 
in order to promote improvements in maternal and 
prenatal health, infant health, child health and devel-
opment, parenting related to child development out-
comes, school readiness, and the socioeconomic status 
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of such families, and reductions in child abuse, ne-
glect, and injuries. 
‘‘(2) AUTHORITY TO USE INITIAL GRANT FUNDS 
FOR PLANNING OR IMPLEMENTATION.—An eligible en-
tity that receives a grant under paragraph (1) may 
use a portion of the funds made available to the enti-
ty during the first 6 months of the period for which 
the grant is made for planning or implementation ac-
tivities to assist with the establishment of early child-
hood home visitation programs that satisfy the re-
quirements of subsection (d). 
‘‘(3) GRANT DURATION.—The Secretary shall de-
termine the period of years for which a grant is made 
to an eligible entity under paragraph (1). 
‘‘(4) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide an eligible entity that receives a grant 
under paragraph (1) with technical assistance in ad-
ministering programs or activities conducted in whole 
or in part with grant funds. 
‘‘(d) REQUIREMENTS.—The requirements of this sub-
section for an early childhood home visitation program con-
ducted with a grant made under this section are as follows: 
‘‘(1) QUANTIFIABLE, MEASURABLE IMPROVEMENT 
IN BENCHMARK AREAS.— 
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‘‘(A) IN GENERAL.—The eligible entity es-
tablishes, subject to the approval of the Secretary, 
quantifiable, measurable 3- and 5-year bench-
marks for demonstrating that the program re-
sults in improvements for the eligible families 
participating in the program in each of the fol-
lowing areas: 
‘‘(i) Improved maternal and newborn 
health. 
‘‘(ii) Prevention of child injuries, child 
abuse, neglect, or maltreatment, and reduc-
tion of emergency department visits. 
‘‘(iii) Improvement in school readiness 
and achievement. 
‘‘(iv) Reduction in crime or domestic 
violence. 
‘‘(v) Improvements in family economic 
self-sufficiency. 
‘‘(vi) Improvements in the coordina-
tion and referrals for other community re-
sources and supports. 
‘‘(B) DEMONSTRATION
OF
IMPROVEMENTS 
AFTER 3 YEARS.— 
‘‘(i) REPORT
TO
THE
SECRETARY.— 
Not later than 30 days after the end of the 
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3rd year in which the eligible entity con-
ducts the program, the entity submits to the 
Secretary a report demonstrating improve-
ment in at least 4 of the areas specified in 
subparagraph (A). 
‘‘(ii) CORRECTIVE
ACTION
PLAN.—If 
the report submitted by the eligible entity 
under clause (i) fails to demonstrate im-
provement in at least 4 of the areas speci-
fied in subparagraph (A), the entity shall 
develop and implement a plan to improve 
outcomes in each of the areas specified in 
subparagraph (A), subject to approval by 
the Secretary. The plan shall include provi-
sions for the Secretary to monitor imple-
mentation of the plan and conduct contin-
ued oversight of the program, including 
through submission by the entity of regular 
reports to the Secretary. 
‘‘(iii) TECHNICAL ASSISTANCE.— 
‘‘(I) IN GENERAL.—The Secretary 
shall provide an eligible entity re-
quired to develop and implement an 
improvement plan under clause (ii) 
with technical assistance to develop 
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and implement the plan. The Secretary 
may provide the technical assistance 
directly or through grants, contracts, 
or cooperative agreements. 
‘‘(II) ADVISORY PANEL.—The Sec-
retary shall establish an advisory 
panel for purposes of obtaining rec-
ommendations regarding the technical 
assistance provided to entities in ac-
cordance with subclause (I). 
‘‘(iv) NO
IMPROVEMENT
OR
FAILURE 
TO SUBMIT REPORT.—If the Secretary de-
termines after a period of time specified by 
the Secretary that an eligible entity imple-
menting an improvement plan under clause 
(ii) has failed to demonstrate any improve-
ment in the areas specified in subparagraph 
(A), or if the Secretary determines that an 
eligible entity has failed to submit the re-
port required under clause (i), the Secretary 
shall terminate the entity’s grant and may 
include any unexpended grant funds in 
grants made to nonprofit organizations 
under subsection (h)(2)(B). 
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‘‘(C) FINAL REPORT.—Not later than De-
cember 31, 2015, the eligible entity shall submit 
a report to the Secretary demonstrating improve-
ments (if any) in each of the areas specified in 
subparagraph (A). 
‘‘(2) IMPROVEMENTS
IN
OUTCOMES
FOR
INDI-
VIDUAL FAMILIES.— 
‘‘(A) IN
GENERAL.—The program is de-
signed, with respect to an eligible family partici-
pating in the program, to result in the partici-
pant outcomes described in subparagraph (B) 
that the eligible entity identifies on the basis of 
an individualized assessment of the family, are 
relevant for that family. 
‘‘(B) PARTICIPANT OUTCOMES.—The partic-
ipant outcomes described in this subparagraph 
are the following: 
‘‘(i) Improvements in prenatal, mater-
nal, and newborn health, including im-
proved pregnancy outcomes 
‘‘(ii) Improvements in child health and 
development, including the prevention of 
child injuries and maltreatment and im-
provements in cognitive, language, social- 
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emotional, and physical developmental indi-
cators. 
‘‘(iii) 
Improvements 
in 
parenting 
skills. 
‘‘(iv) Improvements in school readiness 
and child academic achievement. 
‘‘(v) Reductions in crime or domestic 
violence. 
‘‘(vi) Improvements in family eco-
nomic self-sufficiency. 
‘‘(vii) Improvements in the coordina-
tion of referrals for, and the provision of, 
other community resources and supports for 
eligible families, consistent with State child 
welfare agency training. 
‘‘(3) CORE COMPONENTS.—The program includes 
the following core components: 
‘‘(A) SERVICE DELIVERY MODEL OR MOD-
ELS.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), the program is conducted using 1 or 
more of the service delivery models described 
in item (aa) or (bb) of subclause (I) or in 
subclause (II) selected by the eligible entity: 
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‘‘(I) The model conforms to a 
clear consistent home visitation model 
that has been in existence for at least 
3 years and is research-based, ground-
ed in relevant empirically-based knowl-
edge, linked to program determined 
outcomes, associated with a national 
organization or institution of higher 
education that has comprehensive home 
visitation program standards that en-
sure high quality service delivery and 
continuous program quality improve-
ment, and has demonstrated signifi-
cant, (and in the case of the service de-
livery model described in item (aa), 
sustained) positive outcomes, as de-
scribed in the benchmark areas speci-
fied in paragraph (1)(A) and the par-
ticipant outcomes described in para-
graph (2)(B), when evaluated using 
well-designed and rigorous— 
‘‘(aa) randomized controlled 
research designs, and the evalua-
tion results have been published in 
a peer-reviewed journal; or 
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‘‘(bb) quasi-experimental re-
search designs. 
‘‘(II) The model conforms to a 
promising 
and 
new 
approach 
to 
achieving the benchmark areas speci-
fied in paragraph (1)(A) and the par-
ticipant outcomes described in para-
graph (2)(B), has been developed or 
identified by a national organization 
or institution of higher education, and 
will be evaluated through well-designed 
and rigorous process. 
‘‘(ii) MAJORITY
OF
GRANT
FUNDS 
USED FOR EVIDENCE-BASED MODELS.—An 
eligible entity shall use not more than 25 
percent of the amount of the grant paid to 
the entity for a fiscal year for purposes of 
conducting a program using the service de-
livery model described in clause (i)(II). 
‘‘(iii) CRITERIA FOR EVIDENCE OF EF-
FECTIVENESS OF MODELS.—The Secretary 
shall establish criteria for evidence of effec-
tiveness of the service delivery models and 
shall ensure that the process for establishing 
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the criteria is transparent and provides the 
opportunity for public comment. 
‘‘(B) ADDITIONAL REQUIREMENTS.— 
‘‘(i) The program adheres to a clear, 
consistent model that satisfies the require-
ments of being grounded in empirically- 
based knowledge related to home visiting 
and linked to the benchmark areas specified 
in paragraph (1)(A) and the participant 
outcomes described in paragraph (2)(B) re-
lated to the purposes of the program. 
‘‘(ii) 
The 
program 
employs 
well- 
trained and competent staff, as dem-
onstrated by education or training, such as 
nurses, social workers, educators, child de-
velopment specialists, or other well-trained 
and competent staff, and provides ongoing 
and specific training on the model being de-
livered. 
‘‘(iii) The program maintains high 
quality supervision to establish home visitor 
competencies. 
‘‘(iv) The program demonstrates strong 
organizational capacity to implement the 
activities involved. 
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‘‘(v) The program establishes appro-
priate linkages and referral networks to 
other community resources and supports for 
eligible families. 
‘‘(vi) The program monitors the fidel-
ity of program implementation to ensure 
that services are delivered pursuant to the 
specified model. 
‘‘(4) PRIORITY FOR SERVING HIGH-RISK POPU-
LATIONS.—The eligible entity gives priority to pro-
viding services under the program to the following: 
‘‘(A) Eligible families who reside in commu-
nities in need of such services, as identified in 
the statewide needs assessment required under 
subsection (b)(1)(A). 
‘‘(B) Low-income eligible families. 
‘‘(C) Eligible families who are pregnant 
women who have not attained age 21. 
‘‘(D) Eligible families that have a history of 
child abuse or neglect or have had interactions 
with child welfare services. 
‘‘(E) Eligible families that have a history of 
substance abuse or need substance abuse treat-
ment. 
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‘‘(F) Eligible families that have users of to-
bacco products in the home. 
‘‘(G) Eligible families that are or have chil-
dren with low student achievement. 
‘‘(H) Eligible families with children with 
developmental delays or disabilities. 
‘‘(I) Eligible families who, or that include 
individuals who, are serving or formerly served 
in the Armed Forces, including such families 
that have members of the Armed Forces who have 
had multiple deployments outside of the United 
States. 
‘‘(e) APPLICATION REQUIREMENTS.—An eligible entity 
desiring a grant under this section shall submit an applica-
tion to the Secretary for approval, in such manner as the 
Secretary may require, that includes the following: 
‘‘(1) A description of the populations to be served 
by the entity, including specific information regard-
ing how the entity will serve high risk populations de-
scribed in subsection (d)(4). 
‘‘(2) An assurance that the entity will give pri-
ority to serving low-income eligible families and eligi-
ble families who reside in at risk communities identi-
fied in the statewide needs assessment required under 
subsection (b)(1)(A). 
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‘‘(B) services are provided to an eligible 
family in accordance with the individual assess-
ment for that family. 
‘‘(8) Assurances that the entity will— 
‘‘(A) submit annual reports to the Secretary 
regarding the program and activities carried out 
under the program that include such information 
and data as the Secretary shall require; and 
‘‘(B) participate in, and cooperate with, 
data and information collection necessary for the 
evaluation required under subsection (g)(2) and 
other research and evaluation activities carried 
out under subsection (h)(3). 
‘‘(9) A description of other State programs that 
include home visitation services, including, if appli-
cable to the State, other programs carried out under 
this title with funds made available from allotments 
under section 502(c), programs funded under title IV, 
title II of the Child Abuse Prevention and Treatment 
Act (relating to community-based grants for the pre-
vention of child abuse and neglect), and section 645A 
of the Head Start Act (relating to Early Head Start 
programs). 
‘‘(10) Other information as required by the Sec-
retary. 
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‘‘(f) MAINTENANCE OF EFFORT.—Funds provided to 
an eligible entity receiving a grant under this section shall 
supplement, and not supplant, funds from other sources for 
early childhood home visitation programs or initiatives. 
‘‘(g) EVALUATION.— 
‘‘(1) INDEPENDENT, EXPERT ADVISORY PANEL.— 
The 
Secretary, 
in 
accordance 
with 
subsection 
(h)(1)(A), shall appoint an independent advisory 
panel consisting of experts in program evaluation 
and research, education, and early childhood develop-
ment— 
‘‘(A) to review, and make recommendations 
on, the design and plan for the evaluation re-
quired under paragraph (2) within 1 year after 
the date of enactment of this section; 
‘‘(B) to maintain and advise the Secretary 
regarding the progress of the evaluation; and 
‘‘(C) to comment, if the panel so desires, on 
the report submitted under paragraph (3). 
‘‘(2) AUTHORITY TO CONDUCT EVALUATION.—On 
the basis of the recommendations of the advisory 
panel under paragraph (1), the Secretary shall, by 
grant, contract, or interagency agreement, conduct an 
evaluation of the statewide needs assessments sub-
mitted under subsection (b) and the grants made 
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under subsections (c) and (h)(3)(B). The evaluation 
shall include— 
‘‘(A) an analysis, on a State-by-State basis, 
of the results of such assessments, including indi-
cators of maternal and prenatal health and in-
fant health and mortality, and State actions in 
response to the assessments; and 
‘‘(B) an assessment of— 
‘‘(i) the effect of early childhood home 
visitation programs on child and parent 
outcomes, including with respect to each of 
the benchmark areas specified in subsection 
(d)(1)(A) and the participant outcomes de-
scribed in subsection (d)(2)(B); 
‘‘(ii) the effectiveness of such programs 
on different populations, including the ex-
tent to which the ability of programs to im-
prove participant outcomes varies across 
programs and populations; and 
‘‘(iii) the potential for the activities 
conducted under such programs, if scaled 
broadly, to improve health care practices, 
eliminate health disparities, and improve 
health care system quality, efficiencies, and 
reduce costs. 
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‘‘(3) REPORT.—Not later than March 31, 2015, 
the Secretary shall submit a report to Congress on the 
results of the evaluation conducted under paragraph 
(2) and shall make the report publicly available. 
‘‘(h) OTHER PROVISIONS.— 
‘‘(1) INTRA-AGENCY COLLABORATION.—The Sec-
retary shall ensure that the Maternal and Child 
Health Bureau and the Administration for Children 
and Families collaborate with respect to carrying out 
this section, including with respect to— 
‘‘(A) reviewing and analyzing the statewide 
needs assessments required under subsection (b), 
the awarding and oversight of grants awarded 
under this section, the establishment of the advi-
sory 
panels 
required 
under 
subsections 
(d)(1)(B)(iii)(II) and (g)(1), and the evaluation 
and report required under subsection (g); and 
‘‘(B) consulting with other Federal agencies 
with responsibility for administering or evalu-
ating programs that serve eligible families to co-
ordinate and collaborate with respect to research 
related to such programs and families, including 
the Office of the Assistant Secretary for Planning 
and Evaluation of the Department of Health and 
Human Services, the Centers for Disease Control 
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and Prevention, the National Institute of Child 
Health and Human Development of the National 
Institutes of Health, the Office of Juvenile Jus-
tice and Delinquency Prevention of the Depart-
ment of Justice, and the Institute of Education 
Sciences of the Department of Education. 
‘‘(2) GRANTS TO ELIGIBLE ENTITIES THAT ARE 
NOT STATES.— 
‘‘(A) INDIAN
TRIBES, TRIBAL
ORGANIZA-
TIONS, OR URBAN INDIAN ORGANIZATIONS.—The 
Secretary shall specify requirements for eligible 
entities that are Indian Tribes (or a consortium 
of Indian Tribes), Tribal Organizations, or 
Urban Indian Organizations to apply for and 
conduct an early childhood home visitation pro-
gram with a grant under this section. Such re-
quirements shall, to the greatest extent prac-
ticable, be consistent with the requirements ap-
plicable to eligible entities that are States and 
shall require an Indian Tribe (or consortium), 
Tribal Organization, or Urban Indian Organi-
zation to— 
‘‘(i) conduct a needs assessment simi-
lar to the assessment required for all States 
under subsection (b); and 
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‘‘(ii) establish quantifiable, measurable 
3- and 5-year benchmarks consistent with 
subsection (d)(1)(A). 
‘‘(B) NONPROFIT ORGANIZATIONS.—If, as of 
the beginning of fiscal year 2012, a State has not 
applied or been approved for a grant under this 
section, the Secretary may use amounts appro-
priated under paragraph (1) of subsection (j) 
that are available for expenditure under para-
graph (3) of that subsection to make a grant to 
an eligible entity that is a nonprofit organiza-
tion described in subsection (k)(1)(B) to conduct 
an early childhood home visitation program in 
the State. The Secretary shall specify the require-
ments for such an organization to apply for and 
conduct the program which shall, to the greatest 
extent practicable, be consistent with the require-
ments applicable to eligible entities that are 
States and shall require the organization to— 
‘‘(i) carry out the program based on 
the needs assessment conducted by the State 
under subsection (b); and 
‘‘(ii) establish quantifiable, measurable 
3- and 5-year benchmarks consistent with 
subsection (d)(1)(A). 
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‘‘(3) RESEARCH AND OTHER EVALUATION ACTIVI-
TIES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
carry out a continuous program of research and 
evaluation activities in order to increase knowl-
edge about the implementation and effectiveness 
of home visiting programs, using random assign-
ment designs to the maximum extent feasible. 
The Secretary may carry out such activities di-
rectly, or through grants, cooperative agreements, 
or contracts. 
‘‘(B) REQUIREMENTS.—The Secretary shall 
ensure that— 
‘‘(i) evaluation of a specific program 
or project is conducted by persons or indi-
viduals not directly involved in the oper-
ation of such program or project; and 
‘‘(ii) the conduct of research and eval-
uation activities includes consultation with 
independent researchers, State officials, and 
developers and providers of home visiting 
programs on topics including research de-
sign and administrative data matching. 
‘‘(4) REPORT AND RECOMMENDATION.—Not later 
than December 31, 2015, the Secretary shall submit 
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a report to Congress regarding the programs con-
ducted with grants under this section. The report re-
quired under this paragraph shall include— 
‘‘(A) information regarding the extent to 
which eligible entities receiving grants under this 
section demonstrated improvements in each of 
the areas specified in subsection (d)(1)(A); 
‘‘(B) information regarding any technical 
assistance 
provided 
under 
subsection 
(d)(1)(B)(iii)(I), including the type of any such 
assistance provided; and 
‘‘(C) recommendations for such legislative 
or administrative action as the Secretary deter-
mines appropriate. 
‘‘(i) APPLICATION OF OTHER PROVISIONS OF TITLE.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not 
apply to a grant made under this section. 
‘‘(2) EXCEPTIONS.—The following provisions of 
this title shall apply to a grant made under this sec-
tion to the same extent and in the same manner as 
such provisions apply to allotments made under sec-
tion 502(c): 
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‘‘(A) Section 504(b)(6) (relating to prohibi-
tion on payments to excluded individuals and 
entities). 
‘‘(B) Section 504(c) (relating to the use of 
funds for the purchase of technical assistance). 
‘‘(C) Section 504(d) (relating to a limita-
tion on administrative expenditures). 
‘‘(D) Section 506 (relating to reports and 
audits), but only to the extent determined by the 
Secretary to be appropriate for grants made 
under this section. 
‘‘(E) Section 507 (relating to penalties for 
false statements). 
‘‘(F) 
Section 
508 
(relating 
to 
non-
discrimination). 
‘‘(G) Section 509(a) (relating to the admin-
istration of the grant program). 
‘‘(j) APPROPRIATIONS.— 
‘‘(1) IN
GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there are ap-
propriated to the Secretary to carry out this section— 
‘‘(A) $100,000,000 for fiscal year 2010; 
‘‘(B) $250,000,000 for fiscal year 2011; 
‘‘(C) $350,000,000 for fiscal year 2012; 
‘‘(D) $400,000,000 for fiscal year 2013; and 
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‘‘(E) $400,000,000 for fiscal year 2014. 
‘‘(2) RESERVATIONS.—Of the amount appro-
priated under this subsection for a fiscal year, the 
Secretary shall reserve— 
‘‘(A) 3 percent of such amount for purposes 
of making grants to eligible entities that are In-
dian Tribes (or a consortium of Indian Tribes), 
Tribal Organizations, or Urban Indian Organi-
zations; and 
‘‘(B) 3 percent of such amount for purposes 
of carrying out subsections (d)(1)(B)(iii), (g), 
and (h)(3). 
‘‘(3) AVAILABILITY.—Funds made available to 
an eligible entity under this section for a fiscal year 
shall remain available for expenditure by the eligible 
entity through the end of the second succeeding fiscal 
year after award. Any funds that are not expended by 
the eligible entity during the period in which the 
funds are available under the preceding sentence may 
be used for grants to nonprofit organizations under 
subsection (h)(2)(B). 
‘‘(k) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.— 
‘‘(A) IN GENERAL.—The term ‘eligible enti-
ty’ means a State, an Indian Tribe, Tribal Or-
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ganization, or Urban Indian Organization, 
Puerto Rico, Guam, the Virgin Islands, the 
Northern 
Mariana 
Islands, 
and 
American 
Samoa. 
‘‘(B) NONPROFIT
ORGANIZATIONS.—Only 
for purposes of awarding grants under subsection 
(h)(2)(B), such term shall include a nonprofit 
organization with an established record of pro-
viding early childhood home visitation programs 
or initiatives in a State or several States. 
‘‘(2) ELIGIBLE FAMILY.—The term ‘eligible fam-
ily’ means— 
‘‘(A) a woman who is pregnant, and the fa-
ther of the child if the father is available; or 
‘‘(B) a parent or primary caregiver of a 
child, including grandparents or other relatives 
of the child, and foster parents, who are serving 
as the child’s primary caregiver from birth to 
kindergarten entry, and including a noncusto-
dial parent who has an ongoing relationship 
with, and at times provides physical care for, the 
child. 
‘‘(3) INDIAN TRIBE; TRIBAL ORGANIZATION.—The 
terms ‘Indian Tribe’ and ‘Tribal Organization’, and 
‘Urban Indian Organization’ have the meanings 
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given such terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
SEC. 2952. SUPPORT, EDUCATION, AND RESEARCH FOR 
POSTPARTUM DEPRESSION. 
(a) RESEARCH ON POSTPARTUM CONDITIONS.— 
(1) EXPANSION AND INTENSIFICATION OF ACTIVI-
TIES.—The Secretary of Health and Human Services 
(in this subsection and subsection (c) referred to as 
the ‘‘Secretary’’) is encouraged to continue activities 
on postpartum depression or postpartum psychosis 
(in this subsection and subsection (c) referred to as 
‘‘postpartum conditions’’), including research to ex-
pand the understanding of the causes of, and treat-
ments for, postpartum conditions. Activities under 
this paragraph shall include conducting and sup-
porting the following: 
(A) Basic research concerning the etiology 
and causes of the conditions. 
(B) Epidemiological studies to address the 
frequency and natural history of the conditions 
and the differences among racial and ethnic 
groups with respect to the conditions. 
(C) The development of improved screening 
and diagnostic techniques. 
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(D) Clinical research for the development 
and evaluation of new treatments. 
(E) Information and education programs 
for health care professionals and the public, 
which may include a coordinated national cam-
paign to increase the awareness and knowledge 
of postpartum conditions. Activities under such 
a national campaign may— 
(i) include public service announce-
ments through television, radio, and other 
means; and 
(ii) focus on— 
(I) 
raising 
awareness 
about 
screening; 
(II) educating new mothers and 
their families about postpartum condi-
tions to promote earlier diagnosis and 
treatment; and 
(III) ensuring that such education 
includes complete information con-
cerning postpartum conditions, includ-
ing its symptoms, methods of coping 
with the illness, and treatment re-
sources. 
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(2) SENSE OF CONGRESS REGARDING LONGITU-
DINAL STUDY OF RELATIVE MENTAL HEALTH CON-
SEQUENCES
FOR
WOMEN
OF
RESOLVING
A
PREG-
NANCY.— 
(A) SENSE OF CONGRESS.—It is the sense of 
Congress that the Director of the National Insti-
tute of Mental Health may conduct a nationally 
representative longitudinal study (during the pe-
riod of fiscal years 2010 through 2019) of the rel-
ative mental health consequences for women of 
resolving a pregnancy (intended and unin-
tended) in various ways, including carrying the 
pregnancy to term and parenting the child, car-
rying the pregnancy to term and placing the 
child for adoption, miscarriage, and having an 
abortion. This study may assess the incidence, 
timing, magnitude, and duration of the imme-
diate and long-term mental health consequences 
(positive or negative) of these pregnancy out-
comes. 
(B) REPORT.—Subject to the completion of 
the study under subsection (a), beginning not 
later than 5 years after the date of the enactment 
of this Act, and periodically thereafter for the 
duration of the study, such Director may pre-
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pare and submit to the Congress reports on the 
findings of the study. 
(b) GRANTS TO PROVIDE SERVICES TO INDIVIDUALS 
WITH A POSTPARTUM CONDITION AND THEIR FAMILIES.— 
Title V of the Social Security Act (42 U.S.C. 701 et seq.), 
as amended by section 2951, is amended by adding at the 
end the following new section: 
‘‘SEC. 512. SERVICES TO INDIVIDUALS WITH A POSTPARTUM 
CONDITION AND THEIR FAMILIES. 
‘‘(a) IN GENERAL.—In addition to any other pay-
ments made under this title to a State, the Secretary may 
make grants to eligible entities for projects for the establish-
ment, operation, and coordination of effective and cost-effi-
cient systems for the delivery of essential services to individ-
uals with or at risk for postpartum conditions and their 
families. 
‘‘(b) CERTAIN ACTIVITIES.—To the extent practicable 
and appropriate, the Secretary shall ensure that projects 
funded under subsection (a) provide education and services 
with respect to the diagnosis and management of 
postpartum conditions for individuals with or at risk for 
postpartum conditions and their families. The Secretary 
may allow such projects to include the following: 
‘‘(1) Delivering or enhancing outpatient and 
home-based health and support services, including 
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case management and comprehensive treatment serv-
ices. 
‘‘(2) Delivering or enhancing inpatient care 
management services that ensure the well-being of the 
mother and family and the future development of the 
infant. 
‘‘(3) Improving the quality, availability, and or-
ganization of health care and support services (in-
cluding transportation services, attendant care, home-
maker services, day or respite care, and providing 
counseling on financial assistance and insurance). 
‘‘(4) Providing education about postpartum con-
ditions to promote earlier diagnosis and treatment. 
Such education may include— 
‘‘(A) providing complete information on 
postpartum conditions, symptoms, methods of 
coping with the illness, and treatment resources; 
and 
‘‘(B) in the case of a grantee that is a State, 
hospital, or birthing facility— 
‘‘(i) providing education to new moth-
ers and fathers, and other family members 
as appropriate, concerning postpartum con-
ditions before new mothers leave the health 
facility; and 
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‘‘(ii) ensuring that training programs 
regarding such education are carried out at 
the health facility. 
‘‘(c) INTEGRATION WITH OTHER PROGRAMS.—To the 
extent practicable and appropriate, the Secretary may inte-
grate the grant program under this section with other grant 
programs carried out by the Secretary, including the pro-
gram under section 330 of the Public Health Service Act. 
‘‘(d) REQUIREMENTS.—The Secretary shall establish 
requirements for grants made under this section that in-
clude a limit on the amount of grants funds that may be 
used for administration, accounting, reporting, or program 
oversight functions and a requirement for each eligible enti-
ty that receives a grant to submit, for each grant period, 
a report to the Secretary that describes how grant funds 
were used during such period. 
‘‘(e) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to entities seeking a grant 
under this section in order to assist such entities in com-
plying with the requirements of this section. 
‘‘(f) APPLICATION OF OTHER PROVISIONS OF TITLE.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not 
apply to a grant made under this section. 
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‘‘(2) EXCEPTIONS.—The following provisions of 
this title shall apply to a grant made under this sec-
tion to the same extent and in the same manner as 
such provisions apply to allotments made under sec-
tion 502(c): 
‘‘(A) Section 504(b)(6) (relating to prohibi-
tion on payments to excluded individuals and 
entities). 
‘‘(B) Section 504(c) (relating to the use of 
funds for the purchase of technical assistance). 
‘‘(C) Section 504(d) (relating to a limita-
tion on administrative expenditures). 
‘‘(D) Section 506 (relating to reports and 
audits), but only to the extent determined by the 
Secretary to be appropriate for grants made 
under this section. 
‘‘(E) Section 507 (relating to penalties for 
false statements). 
‘‘(F) 
Section 
508 
(relating 
to 
non-
discrimination). 
‘‘(G) Section 509(a) (relating to the admin-
istration of the grant program). 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) The term ‘eligible entity’— 
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‘‘(A) means a public or nonprofit private 
entity; and 
‘‘(B) includes a State or local government, 
public-private partnership, recipient of a grant 
under section 330H of the Public Health Service 
Act (relating to the Healthy Start Initiative), 
public or nonprofit private hospital, community- 
based organization, hospice, ambulatory care fa-
cility, community health center, migrant health 
center, public housing primary care center, or 
homeless health center. 
‘‘(2) The term ‘postpartum condition’ means 
postpartum depression or postpartum psychosis.’’. 
(c) GENERAL PROVISIONS.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section and the amendment made by 
subsection (b), there are authorized to be appro-
priated, in addition to such other sums as may be 
available for such purpose— 
(A) $3,000,000 for fiscal year 2010; and 
(B) such sums as may be necessary for fis-
cal years 2011 and 2012. 
(2) REPORT BY THE SECRETARY.— 
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(A) STUDY.—The Secretary shall conduct a 
study on the benefits of screening for postpartum 
conditions. 
(B) REPORT.—Not later than 2 years after 
the date of the enactment of this Act, the Sec-
retary shall complete the study required by sub-
paragraph (A) and submit a report to the Con-
gress on the results of such study. 
SEC. 2953. PERSONAL RESPONSIBILITY EDUCATION. 
Title V of the Social Security Act (42 U.S.C. 701 et 
seq.), as amended by sections 2951 and 2952(c), is amended 
by adding at the end the following: 
‘‘SEC. 513. PERSONAL RESPONSIBILITY EDUCATION. 
‘‘(a) ALLOTMENTS TO STATES.— 
‘‘(1) AMOUNT.— 
‘‘(A) IN
GENERAL.—For the purpose de-
scribed in subsection (b), subject to the suc-
ceeding provisions of this section, for each of fis-
cal years 2010 through 2014, the Secretary shall 
allot to each State an amount equal to the prod-
uct of— 
‘‘(i) the amount appropriated under 
subsection (f) for the fiscal year and avail-
able for allotments to States after the appli-
cation of subsection (c); and 
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‘‘(ii) the State youth population per-
centage determined under paragraph (2). 
‘‘(B) MINIMUM ALLOTMENT.— 
‘‘(i) IN GENERAL.—Each State allot-
ment under this paragraph for a fiscal year 
shall be at least $250,000. 
‘‘(ii) PRO
RATA
ADJUSTMENTS.—The 
Secretary shall adjust on a pro rata basis 
the amount of the State allotments deter-
mined under this paragraph for a fiscal 
year to the extent necessary to comply with 
clause (i). 
‘‘(C) APPLICATION
REQUIRED
TO
ACCESS 
ALLOTMENTS.— 
‘‘(i) IN GENERAL.—A State shall not 
be paid from its allotment for a fiscal year 
unless the State submits an application to 
the Secretary for the fiscal year and the 
Secretary approves the application (or re-
quires changes to the application that the 
State satisfies) and meets such additional 
requirements as the Secretary may specify. 
‘‘(ii) REQUIREMENTS.—The State ap-
plication shall contain an assurance that 
the State has complied with the require-
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ments of this section in preparing and sub-
mitting the application and shall include 
the following as well as such additional in-
formation as the Secretary may require: 
‘‘(I) Based on data from the Cen-
ters for Disease Control and Prevention 
National Center for Health Statistics, 
the most recent pregnancy rates for the 
State for youth ages 10 to 14 and 
youth ages 15 to 19 for which data are 
available, the most recent birth rates 
for such youth populations in the State 
for which data are available, and 
trends in those rates for the most re-
cently preceding 5-year period for 
which such data are available. 
‘‘(II) State-established goals for 
reducing the pregnancy rates and birth 
rates for such youth populations. 
‘‘(III) A description of the State’s 
plan for using the State allotments 
provided under this section to achieve 
such goals, especially among youth 
populations that are the most high-risk 
or vulnerable for pregnancies or other-
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wise have special circumstances, in-
cluding youth in foster care, homeless 
youth, youth with HIV/AIDS, preg-
nant youth who are under 21 years of 
age, mothers who are under 21 years of 
age, and youth residing in areas with 
high birth rates for youth. 
‘‘(2) STATE YOUTH POPULATION PERCENTAGE.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(A)(ii), the State youth population per-
centage is, with respect to a State, the proportion 
(expressed as a percentage) of— 
‘‘(i) the number of individuals who 
have attained age 10 but not attained age 
20 in the State; to 
‘‘(ii) the number of such individuals in 
all States. 
‘‘(B) DETERMINATION
OF
NUMBER
OF 
YOUTH.—The number of individuals described in 
clauses (i) and (ii) of subparagraph (A) in a 
State shall be determined on the basis of the most 
recent Bureau of the Census data. 
‘‘(3) AVAILABILITY
OF
STATE
ALLOTMENTS.— 
Subject to paragraph (4)(A), amounts allotted to a 
State pursuant to this subsection for a fiscal year 
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shall remain available for expenditure by the State 
through the end of the second succeeding fiscal year. 
‘‘(4) AUTHORITY TO AWARD GRANTS FROM STATE 
ALLOTMENTS TO LOCAL ORGANIZATIONS AND ENTI-
TIES IN NONPARTICIPATING STATES.— 
‘‘(A) GRANTS FROM UNEXPENDED ALLOT-
MENTS.—If a State does not submit an applica-
tion under this section for fiscal year 2010 or 
2011, the State shall no longer be eligible to sub-
mit an application to receive funds from the 
amounts allotted for the State for each of fiscal 
years 2010 through 2014 and such amounts shall 
be used by the Secretary to award grants under 
this paragraph for each of fiscal years 2012 
through 2014. The Secretary also shall use any 
amounts from the allotments of States that sub-
mit applications under this section for a fiscal 
year that remain unexpended as of the end of the 
period in which the allotments are available for 
expenditure under paragraph (3) for awarding 
grants under this paragraph. 
‘‘(B) 3-YEAR GRANTS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
solicit applications to award 3-year grants 
in each of fiscal years 2012, 2013, and 2014 
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to local organizations and entities to con-
duct, consistent with subsection (b), pro-
grams and activities in States that do not 
submit an application for an allotment 
under this section for fiscal year 2010 or 
2011. 
‘‘(ii) FAITH-BASED ORGANIZATIONS OR 
CONSORTIA.—The Secretary may solicit and 
award grants under this paragraph to 
faith-based organizations or consortia. 
‘‘(C) EVALUATION.—An organization or en-
tity awarded a grant under this paragraph shall 
agree to participate in a rigorous Federal eval-
uation. 
‘‘(5) MAINTENANCE
OF
EFFORT.—No payment 
shall be made to a State from the allotment deter-
mined for the State under this subsection or to a local 
organization or entity awarded a grant under para-
graph (4), if the expenditure of non-federal funds by 
the State, organization, or entity for activities, pro-
grams, or initiatives for which amounts from allot-
ments and grants under this subsection may be ex-
pended is less than the amount expended by the State, 
organization, or entity for such programs or initia-
tives for fiscal year 2009. 
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‘‘(6) DATA
COLLECTION
AND
REPORTING.—A 
State or local organization or entity receiving funds 
under this section shall cooperate with such require-
ments relating to the collection of data and informa-
tion and reporting on outcomes regarding the pro-
grams and activities carried out with such funds, as 
the Secretary shall specify. 
‘‘(b) PURPOSE.— 
‘‘(1) IN GENERAL.—The purpose of an allotment 
under subsection (a)(1) to a State is to enable the 
State (or, in the case of grants made under subsection 
(a)(4)(B), to enable a local organization or entity) to 
carry out personal responsibility education programs 
consistent with this subsection. 
‘‘(2) PERSONAL
RESPONSIBILITY
EDUCATION 
PROGRAMS.— 
‘‘(A) IN
GENERAL.—In this section, the 
term ‘personal responsibility education program’ 
means a program that is designed to educate 
adolescents on— 
‘‘(i) both abstinence and contraception 
for the prevention of pregnancy and sexu-
ally transmitted infections, including HIV/ 
AIDS, consistent with the requirements of 
subparagraph (B); and 
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‘‘(ii) at least 3 of the adulthood prepa-
ration subjects described in subparagraph 
(C). 
‘‘(B) REQUIREMENTS.—The requirements of 
this subparagraph are the following: 
‘‘(i) The program replicates evidence- 
based effective programs or substantially in-
corporates elements of effective programs 
that have been proven on the basis of rig-
orous scientific research to change behavior, 
which means delaying sexual activity, in-
creasing condom or contraceptive use for 
sexually active youth, or reducing preg-
nancy among youth. 
‘‘(ii) The program is medically-accu-
rate and complete. 
‘‘(iii) The program includes activities 
to educate youth who are sexually active re-
garding responsible sexual behavior with re-
spect to both abstinence and the use of con-
traception. 
‘‘(iv) The program places substantial 
emphasis on both abstinence and contracep-
tion for the prevention of pregnancy among 
youth and sexually transmitted infections. 
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‘‘(v) The program provides age-appro-
priate information and activities. 
‘‘(vi) The information and activities 
carried out under the program are provided 
in the cultural context that is most appro-
priate for individuals in the particular 
population group to which they are di-
rected. 
‘‘(C) 
ADULTHOOD
PREPARATION
SUB-
JECTS.—The adulthood preparation subjects de-
scribed in this subparagraph are the following: 
‘‘(i) Healthy relationships, such as 
positive self-esteem and relationship dynam-
ics, friendships, dating, romantic involve-
ment, marriage, and family interactions. 
‘‘(ii) Adolescent development, such as 
the development of healthy attitudes and 
values about adolescent growth and develop-
ment, body image, racial and ethnic diver-
sity, and other related subjects. 
‘‘(iii) Financial literacy. 
‘‘(iv) Parent-child communication. 
‘‘(v) Educational and career success, 
such as developing skills for employment 
preparation, job seeking, independent liv-
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ing, financial self-sufficiency, and work-
place productivity. 
‘‘(vi) Healthy life skills, such as goal- 
setting, decision making, negotiation, com-
munication and interpersonal skills, and 
stress management. 
‘‘(c) RESERVATIONS OF FUNDS.— 
‘‘(1) GRANTS TO IMPLEMENT INNOVATIVE STRAT-
EGIES.—From the amount appropriated under sub-
section (f) for the fiscal year, the Secretary shall re-
serve $10,000,000 of such amount for purposes of 
awarding grants to entities to implement innovative 
youth pregnancy prevention strategies and target 
services to high-risk, vulnerable, and culturally under- 
represented youth populations, including youth in fos-
ter care, homeless youth, youth with HIV/AIDS, preg-
nant women who are under 21 years of age and their 
partners, mothers who are under 21 years of age and 
their partners, and youth residing in areas with high 
birth rates for youth. An entity awarded a grant 
under this paragraph shall agree to participate in a 
rigorous Federal evaluation of the activities carried 
out with grant funds. 
‘‘(2) OTHER RESERVATIONS.—From the amount 
appropriated under subsection (f) for the fiscal year 
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that remains after the application of paragraph (1), 
the Secretary shall reserve the following amounts: 
‘‘(A) GRANTS FOR INDIAN TRIBES OR TRIB-
AL ORGANIZATIONS.—The Secretary shall reserve 
5 percent of such remainder for purposes of 
awarding grants to Indian tribes and tribal or-
ganizations in such manner, and subject to such 
requirements, as the Secretary, in consultation 
with Indian tribes and tribal organizations, de-
termines appropriate. 
‘‘(B) SECRETARIAL RESPONSIBILITIES.— 
‘‘(i) RESERVATION
OF
FUNDS.—The 
Secretary shall reserve 10 percent of such 
remainder for expenditures by the Secretary 
for the activities described in clauses (ii) 
and (iii). 
‘‘(ii) PROGRAM
SUPPORT.—The Sec-
retary shall provide, directly or through a 
competitive grant process, research, training 
and technical assistance, including dissemi-
nation of research and information regard-
ing effective and promising practices, pro-
viding consultation and resources on a 
broad array of teen pregnancy prevention 
strategies, including abstinence and contra-
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ception, and developing resources and mate-
rials to support the activities of recipients 
of grants and other State, tribal, and com-
munity organizations working to reduce 
teen pregnancy. In carrying out such func-
tions, the Secretary shall collaborate with a 
variety of entities that have expertise in the 
prevention of teen pregnancy, HIV and sex-
ually transmitted infections, healthy rela-
tionships, financial literacy, and other top-
ics addressed through the personal responsi-
bility education programs. 
‘‘(iii) 
EVALUATION.—The 
Secretary 
shall evaluate the programs and activities 
carried out with funds made available 
through allotments or grants under this sec-
tion. 
‘‘(d) ADMINISTRATION.— 
‘‘(1) IN GENERAL.—The Secretary shall admin-
ister this section through the Assistant Secretary for 
the Administration for Children and Families within 
the Department of Health and Human Services. 
‘‘(2) APPLICATION
OF
OTHER
PROVISIONS
OF 
TITLE.— 
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‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the other provisions of this 
title shall not apply to allotments or grants 
made under this section. 
‘‘(B) EXCEPTIONS.—The following provi-
sions of this title shall apply to allotments and 
grants made under this section to the same ex-
tent and in the same manner as such provisions 
apply to allotments made under section 502(c): 
‘‘(i) Section 504(b)(6) (relating to pro-
hibition on payments to excluded individ-
uals and entities). 
‘‘(ii) Section 504(c) (relating to the use 
of funds for the purchase of technical assist-
ance). 
‘‘(iii) Section 504(d) (relating to a 
limitation on administrative expenditures). 
‘‘(iv) Section 506 (relating to reports 
and audits), but only to the extent deter-
mined by the Secretary to be appropriate 
for grants made under this section. 
‘‘(v) Section 507 (relating to penalties 
for false statements). 
‘‘(vi) Section 508 (relating to non-
discrimination). 
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‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) AGE-APPROPRIATE.—The term ‘age-appro-
priate’, with respect to the information in pregnancy 
prevention, means topics, messages, and teaching 
methods suitable to particular ages or age groups of 
children and adolescents, based on developing cog-
nitive, emotional, and behavioral capacity typical for 
the age or age group. 
‘‘(2) MEDICALLY ACCURATE AND COMPLETE.— 
The term ‘medically accurate and complete’ means 
verified or supported by the weight of research con-
ducted in compliance with accepted scientific methods 
and— 
‘‘(A) published in peer-reviewed journals, 
where applicable; or 
‘‘(B) comprising information that leading 
professional organizations and agencies with rel-
evant expertise in the field recognize as accurate, 
objective, and complete. 
‘‘(3) INDIAN TRIBES; TRIBAL ORGANIZATIONS.— 
The terms ‘Indian tribe’ and ‘Tribal organization’ 
have the meanings given such terms in section 4 of 
the Indian Health Care Improvement Act (25 U.S.C. 
1603)). 
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‘‘(4) YOUTH.—The term ‘youth’ means an indi-
vidual who has attained age 10 but has not attained 
age 20. 
‘‘(f) APPROPRIATION.—For the purpose of carrying out 
this section, there is appropriated, out of any money in the 
Treasury not otherwise appropriated, $75,000,000 for each 
of fiscal years 2010 through 2014. Amounts appropriated 
under this subsection shall remain available until ex-
pended.’’. 
SEC. 2954. RESTORATION OF FUNDING FOR ABSTINENCE 
EDUCATION. 
Section 510 of the Social Security Act (42 U.S.C. 710) 
is amended— 
(1) in subsection (a), by striking ‘‘fiscal year 
1998 and each subsequent fiscal year’’ and inserting 
‘‘each of fiscal years 2010 through 2014’’; and 
(2) in subsection (d)— 
(A) in the first sentence, by striking ‘‘1998 
through 2003’’ and inserting ‘‘2010 through 
2014’’; and 
(B) in the second sentence, by inserting 
‘‘(except that such appropriation shall be made 
on the date of enactment of the Patient Protec-
tion and Affordable Care Act in the case of fiscal 
year 2010)’’ before the period. 
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SEC. 2955. INCLUSION OF INFORMATION ABOUT THE IM-
PORTANCE OF HAVING A HEALTH CARE 
POWER OF ATTORNEY IN TRANSITION PLAN-
NING FOR CHILDREN AGING OUT OF FOSTER 
CARE AND INDEPENDENT LIVING PROGRAMS. 
(a) TRANSITION PLANNING.—Section 475(5)(H) of the 
Social Security Act (42 U.S.C. 675(5)(H)) is amended by 
inserting ‘‘includes information about the importance of 
designating another individual to make health care treat-
ment decisions on behalf of the child if the child becomes 
unable to participate in such decisions and the child does 
not have, or does not want, a relative who would otherwise 
be authorized under State law to make such decisions, and 
provides the child with the option to execute a health care 
power of attorney, health care proxy, or other similar docu-
ment recognized under State law,’’ after ‘‘employment serv-
ices,’’. 
(b) 
INDEPENDENT
LIVING
EDUCATION.—Section 
477(b)(3) of such Act (42 U.S.C. 677(b)(3)) is amended by 
adding at the end the following: 
‘‘(K) A certification by the chief executive 
officer of the State that the State will ensure that 
an adolescent participating in the program 
under this section are provided with education 
about the importance of designating another in-
dividual to make health care treatment decisions 
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on behalf of the adolescent if the adolescent be-
comes unable to participate in such decisions 
and the adolescent does not have, or does not 
want, a relative who would otherwise be author-
ized under State law to make such decisions, 
whether a health care power of attorney, health 
care proxy, or other similar document is recog-
nized under State law, and how to execute such 
a document if the adolescent wants to do so.’’. 
(c) HEALTH OVERSIGHT AND COORDINATION PLAN.— 
Section 
422(b)(15)(A) 
of 
such 
Act 
(42 
U.S.C. 
622(b)(15)(A)) is amended— 
(1) in clause (v), by striking ‘‘and’’ at the end; 
and 
(2) by adding at the end the following: 
‘‘(vii) steps to ensure that the compo-
nents of the transition plan development 
process required under section 475(5)(H) 
that relate to the health care needs of chil-
dren aging out of foster care, including the 
requirements to include options for health 
insurance, information about a health care 
power of attorney, health care proxy, or 
other similar document recognized under 
State law, and to provide the child with the 
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option to execute such a document, are met; 
and’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section take effect on October 1, 2010. 
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 PRO-
GRAM. 
(a) PROGRAM.— 
(1) IN GENERAL.—Section 1886 of the Social Se-
curity Act (42 U.S.C. 1395ww), as amended by sec-
tion 4102(a) of the HITECH Act (Public Law 111– 
5), is amended by adding at the end the following 
new subsection: 
‘‘(o) HOSPITAL
VALUE-BASED
PURCHASING
PRO-
GRAM.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this subsection, the Sec-
retary shall establish a hospital value-based pur-
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chasing program (in this subsection referred to 
as the ‘Program’) under which value-based in-
centive payments are made in a fiscal year to 
hospitals that meet the performance standards 
under paragraph (3) for the performance period 
for such fiscal year (as established under para-
graph (4)). 
‘‘(B) PROGRAM TO BEGIN IN FISCAL YEAR 
2013.—The Program shall apply to payments for 
discharges occurring on or after October 1, 2012. 
‘‘(C) APPLICABILITY OF PROGRAM TO HOS-
PITALS.— 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, subject to clause (ii), the 
term ‘hospital’ means a subsection (d) hos-
pital (as defined in subsection (d)(1)(B)). 
‘‘(ii) EXCLUSIONS.—The term ‘hos-
pital’ shall not include, with respect to a 
fiscal year, a hospital— 
‘‘(I) that is subject to the payment 
reduction 
under 
subsection 
(b)(3)(B)(viii)(I) for such fiscal year; 
‘‘(II) for which, during the per-
formance period for such fiscal year, 
the Secretary has cited deficiencies that 
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pose immediate jeopardy to the health 
or safety of patients; 
‘‘(III) for which there are not a 
minimum number (as determined by 
the Secretary) of measures that apply 
to the hospital for the performance pe-
riod for such fiscal year; or 
‘‘(IV) for which there are not a 
minimum number (as determined by 
the Secretary) of cases for the measures 
that apply to the hospital for the per-
formance period for such fiscal year. 
‘‘(iii) INDEPENDENT
ANALYSIS.—For 
purposes of determining the minimum 
numbers under subclauses (III) and (IV) of 
clause (ii), the Secretary shall have con-
ducted an independent analysis of what 
numbers are appropriate. 
‘‘(iv) EXEMPTION.—In the case of a 
hospital 
that 
is 
paid 
under 
section 
1814(b)(3), the Secretary may exempt such 
hospital from the application of this sub-
section if the State which is paid under 
such section submits an annual report to 
the Secretary describing how a similar pro-
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gram in the State for a participating hos-
pital or hospitals achieves or surpasses the 
measured results in terms of patient health 
outcomes and cost savings established under 
this subsection. 
‘‘(2) MEASURES.— 
‘‘(A) IN GENERAL.—The Secretary shall se-
lect measures for purposes of the Program. Such 
measures shall be selected from the measures 
specified under subsection (b)(3)(B)(viii). 
‘‘(B) REQUIREMENTS.— 
‘‘(i) FOR
FISCAL
YEAR
2013.—For 
value-based incentive payments made with 
respect to discharges occurring during fiscal 
year 2013, the Secretary shall ensure the 
following: 
‘‘(I) 
CONDITIONS
OR
PROCE-
DURES.—Measures are selected under 
subparagraph (A) that cover at least 
the following 5 specific conditions or 
procedures: 
‘‘(aa) Acute myocardial in-
farction (AMI). 
‘‘(bb) Heart failure. 
‘‘(cc) Pneumonia. 
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‘‘(dd) Surgeries, as measured 
by the Surgical Care Improve-
ment 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 es-
tablished in the HHS Action Plan 
to Prevent Healthcare-Associated 
Infections (or any successor plan) 
of the Department of Health and 
Human Services. 
‘‘(II) 
HCAHPS.—Measures 
se-
lected under subparagraph (A) shall be 
related to the Hospital Consumer As-
sessment of Healthcare Providers and 
Systems survey (HCAHPS). 
‘‘(ii) INCLUSION OF EFFICIENCY MEAS-
URES.—For value-based incentive payments 
made with respect to discharges occurring 
during fiscal year 2014 or a subsequent fis-
cal year, the Secretary shall ensure that 
measures selected under subparagraph (A) 
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include efficiency measures, including meas-
ures of ‘Medicare spending per beneficiary’. 
Such measures shall be adjusted for factors 
such as age, sex, race, severity of illness, 
and other factors that the Secretary deter-
mines appropriate. 
‘‘(C) LIMITATIONS.— 
‘‘(i) TIME
REQUIREMENT
FOR
PRIOR 
REPORTING
AND
NOTICE.—The Secretary 
may not select a measure under subpara-
graph (A) for use under the Program with 
respect to a performance period for a fiscal 
year (as established under paragraph (4)) 
unless such measure has been specified 
under subsection (b)(3)(B)(viii) and in-
cluded on the Hospital Compare Internet 
website for at least 1 year prior to the be-
ginning of such performance period. 
‘‘(ii) MEASURE NOT APPLICABLE UN-
LESS HOSPITAL FURNISHES SERVICES AP-
PROPRIATE TO THE MEASURE.—A measure 
selected under subparagraph (A) shall not 
apply to a hospital if such hospital does not 
furnish services appropriate to such meas-
ure. 
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‘‘(D) REPLACING
MEASURES.—Subclause 
(VI) of subsection (b)(3)(B)(viii) shall apply to 
measures selected under subparagraph (A) in the 
same manner as such subclause applies to meas-
ures selected under such subsection. 
‘‘(3) PERFORMANCE STANDARDS.— 
‘‘(A) ESTABLISHMENT.—The Secretary shall 
establish performance standards with respect to 
measures selected under paragraph (2) for a per-
formance period for a fiscal year (as established 
under paragraph (4)). 
‘‘(B) ACHIEVEMENT AND IMPROVEMENT.— 
The performance standards established under 
subparagraph (A) shall include levels of achieve-
ment and improvement. 
‘‘(C) TIMING.—The Secretary shall establish 
and announce the performance standards under 
subparagraph (A) not later than 60 days prior 
to the beginning of the performance period for 
the fiscal year involved. 
‘‘(D) CONSIDERATIONS
IN
ESTABLISHING 
STANDARDS.—In establishing performance stand-
ards with respect to measures under this para-
graph, the Secretary shall take into account ap-
propriate factors, such as— 
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‘‘(i) practical experience with the 
measures involved, including whether a sig-
nificant proportion of hospitals failed to 
meet the performance standard during pre-
vious performance periods; 
‘‘(ii) historical performance standards; 
‘‘(iii) improvement rates; and 
‘‘(iv) the opportunity for continued im-
provement. 
‘‘(4) PERFORMANCE PERIOD.—For purposes of 
the Program, the Secretary shall establish the per-
formance period for a fiscal year. Such performance 
period shall begin and end prior to the beginning of 
such fiscal year. 
‘‘(5) HOSPITAL PERFORMANCE SCORE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary shall develop a method-
ology for assessing the total performance of each 
hospital based on performance standards with 
respect to the measures selected under paragraph 
(2) for a performance period (as established 
under paragraph (4)). Using such methodology, 
the Secretary shall provide for an assessment (in 
this subsection referred to as the ‘hospital per-
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formance score’) for each hospital for each per-
formance period. 
‘‘(B) APPLICATION.— 
‘‘(i) APPROPRIATE
DISTRIBUTION.— 
The Secretary shall ensure that the applica-
tion of the methodology developed under 
subparagraph (A) results in an appropriate 
distribution of value-based incentive pay-
ments under paragraph (6) among hospitals 
achieving different levels of hospital per-
formance scores, with hospitals achieving 
the highest hospital performance scores re-
ceiving the largest value-based incentive 
payments. 
‘‘(ii) HIGHER OF ACHIEVEMENT OR IM-
PROVEMENT.—The methodology developed 
under subparagraph (A) shall provide that 
the hospital performance score is determined 
using the higher of its achievement or im-
provement score for each measure. 
‘‘(iii) WEIGHTS.—The methodology de-
veloped under subparagraph (A) shall pro-
vide for the assignment of weights for cat-
egories of measures as the Secretary deter-
mines appropriate. 
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‘‘(iv) 
NO
MINIMUM
PERFORMANCE 
STANDARD.—The Secretary shall not set a 
minimum performance standard in deter-
mining the hospital performance score for 
any hospital. 
‘‘(v) REFLECTION
OF
MEASURES
AP-
PLICABLE TO THE HOSPITAL.—The hospital 
performance score for a hospital shall reflect 
the measures that apply to the hospital. 
‘‘(6) CALCULATION OF VALUE-BASED INCENTIVE 
PAYMENTS.— 
‘‘(A) IN GENERAL.—In the case of a hos-
pital that the Secretary determines meets (or ex-
ceeds) the performance standards under para-
graph (3) for the performance period for a fiscal 
year (as established under paragraph (4)), the 
Secretary shall increase the base operating DRG 
payment amount (as defined in paragraph 
(7)(D)), as determined after application of para-
graph (7)(B)(i), for a hospital for each discharge 
occurring in such fiscal year by the value-based 
incentive payment amount. 
‘‘(B) VALUE-BASED
INCENTIVE
PAYMENT 
AMOUNT.—The value-based incentive payment 
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amount for each discharge of a hospital in a fis-
cal year shall be equal to the product of— 
‘‘(i) the base operating DRG payment 
amount (as defined in paragraph (7)(D)) 
for the discharge for the hospital for such 
fiscal year; and 
‘‘(ii) the value-based incentive payment 
percentage specified under subparagraph 
(C) for the hospital for such fiscal year. 
‘‘(C) VALUE-BASED
INCENTIVE
PAYMENT 
PERCENTAGE.— 
‘‘(i) IN GENERAL.—The Secretary shall 
specify a value-based incentive payment 
percentage for a hospital for a fiscal year. 
‘‘(ii) REQUIREMENTS.—In specifying 
the value-based incentive payment percent-
age for each hospital for a fiscal year under 
clause (i), the Secretary shall ensure that— 
‘‘(I) such percentage is based on 
the hospital performance score of the 
hospital under paragraph (5); and 
‘‘(II) the total amount of value- 
based incentive payments under this 
paragraph to all hospitals in such fis-
cal year is equal to the total amount 
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available 
for 
value-based 
incentive 
payments for such fiscal year under 
paragraph (7)(A), as estimated by the 
Secretary. 
‘‘(7) FUNDING
FOR
VALUE-BASED
INCENTIVE 
PAYMENTS.— 
‘‘(A) AMOUNT.—The total amount available 
for value-based incentive payments under para-
graph (6) for all hospitals for a fiscal year shall 
be equal to the total amount of reduced payments 
for all hospitals under subparagraph (B) for 
such fiscal year, as estimated by the Secretary. 
‘‘(B) ADJUSTMENT TO PAYMENTS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
reduce the base operating DRG payment 
amount (as defined in subparagraph (D)) 
for a hospital for each discharge in a fiscal 
year (beginning with fiscal year 2013) by 
an amount equal to the applicable percent 
(as defined in subparagraph (C)) of the base 
operating DRG payment amount for the 
discharge for the hospital for such fiscal 
year. The Secretary shall make such reduc-
tions for all hospitals in the fiscal year in-
volved, regardless of whether or not the hos-
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pital has been determined by the Secretary 
to have earned a value-based incentive pay-
ment under paragraph (6) for such fiscal 
year. 
‘‘(ii) NO
EFFECT
ON
OTHER
PAY-
MENTS.—Payments described in items (aa) 
and (bb) of subparagraph (D)(i)(II) for a 
hospital shall be determined as if this sub-
section had not been enacted. 
‘‘(C) APPLICABLE PERCENT DEFINED.—For 
purposes of subparagraph (B), the term ‘applica-
ble percent’ means— 
‘‘(i) with respect to fiscal year 2013, 
1.0 percent; 
‘‘(ii) with respect to fiscal year 2014, 
1.25 percent; 
‘‘(iii) with respect to fiscal year 2015, 
1.5 percent; 
‘‘(iv) with respect to fiscal year 2016, 
1.75 percent; and 
‘‘(v) with respect to fiscal year 2017 
and succeeding fiscal years, 2 percent. 
‘‘(D) BASE
OPERATING
DRG
PAYMENT 
AMOUNT DEFINED.— 
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‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), in this subsection, the term 
‘base operating DRG payment amount’ 
means, with respect to a hospital for a fis-
cal year— 
‘‘(I) the payment amount that 
would otherwise be made under sub-
section (d) (determined without regard 
to subsection (q)) for a discharge if this 
subsection did not apply; reduced by 
‘‘(II) any portion of such pay-
ment amount that is attributable to— 
‘‘(aa) payments under para-
graphs (5)(A), (5)(B), (5)(F), and 
(12) of subsection (d); and 
‘‘(bb) such other payments 
under subsection (d) determined 
appropriate by the Secretary. 
‘‘(ii) SPECIAL
RULES
FOR
CERTAIN 
HOSPITALS.— 
‘‘(I) SOLE COMMUNITY HOSPITALS 
AND
MEDICARE-DEPENDENT, 
SMALL 
RURAL HOSPITALS.—In the case of a 
medicare-dependent, small rural hos-
pital (with respect to discharges occur-
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ring during fiscal year 2012 and 2013) 
or a sole community hospital, in ap-
plying subparagraph (A)(i), the pay-
ment amount that would otherwise be 
made under subsection (d) shall be de-
termined without regard to subpara-
graphs (I) and (L) of subsection (b)(3) 
and subparagraphs (D) and (G) of 
subsection (d)(5). 
‘‘(II) HOSPITALS
PAID
UNDER 
SECTION 1814.—In the case of a hos-
pital that is paid under section 
1814(b)(3), the term ‘base operating 
DRG payment amount’ means the 
payment amount under such section. 
‘‘(8) ANNOUNCEMENT OF NET RESULT OF AD-
JUSTMENTS.—Under the Program, the Secretary 
shall, not later than 60 days prior to the fiscal year 
involved, inform each hospital of the adjustments to 
payments to the hospital for discharges occurring in 
such fiscal year under paragraphs (6) and (7)(B)(i). 
‘‘(9) NO
EFFECT
IN
SUBSEQUENT
FISCAL 
YEARS.—The value-based incentive payment under 
paragraph (6) and the payment reduction under 
paragraph (7)(B)(i) shall each apply only with re-
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spect to the fiscal year involved, and the Secretary 
shall not take into account such value-based incentive 
payment or payment reduction in making payments 
to a hospital under this section in a subsequent fiscal 
year. 
‘‘(10) PUBLIC REPORTING.— 
‘‘(A) HOSPITAL SPECIFIC INFORMATION.— 
‘‘(i) IN GENERAL.—The Secretary shall 
make information available to the public re-
garding the performance of individual hos-
pitals under the Program, including— 
‘‘(I) the performance of the hos-
pital with respect to each measure that 
applies to the hospital; 
‘‘(II) the performance of the hos-
pital with respect to each condition or 
procedure; and 
‘‘(III) the hospital performance 
score assessing the total performance of 
the hospital. 
‘‘(ii) OPPORTUNITY
TO
REVIEW
AND 
SUBMIT CORRECTIONS.—The Secretary shall 
ensure that a hospital has the opportunity 
to review, and submit corrections for, the 
information to be made public with respect 
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to the hospital under clause (i) prior to 
such information being made public. 
‘‘(iii) 
WEBSITE.—Such 
information 
shall be posted on the Hospital Compare 
Internet website in an easily understand-
able format. 
‘‘(B) AGGREGATE INFORMATION.—The Sec-
retary shall periodically post on the Hospital 
Compare Internet website aggregate information 
on the Program, including— 
‘‘(i) the number of hospitals receiving 
value-based incentive payments under para-
graph (6) and the range and total amount 
of such value-based incentive payments; and 
‘‘(ii) the number of hospitals receiving 
less than the maximum value-based incen-
tive payment available to the hospital for 
the fiscal year involved and the range and 
amount of such payments. 
‘‘(11) IMPLEMENTATION.— 
‘‘(A) APPEALS.—The Secretary shall estab-
lish a process by which hospitals may appeal the 
calculation of a hospital’s performance assess-
ment with respect to the performance standards 
established under paragraph (3)(A) and the hos-
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pital performance score under paragraph (5). 
The Secretary shall ensure that such process pro-
vides for resolution of such appeals in a timely 
manner. 
‘‘(B) LIMITATION ON REVIEW.—Except as 
provided in subparagraph (A), there shall be no 
administrative or judicial review under section 
1869, section 1878, or otherwise of the following: 
‘‘(i) The methodology used to determine 
the amount of the value-based incentive 
payment under paragraph (6) and the de-
termination of such amount. 
‘‘(ii) The determination of the amount 
of funding available for such value-based in-
centive payments under paragraph (7)(A) 
and the payment reduction under para-
graph (7)(B)(i). 
‘‘(iii) The establishment of the perform-
ance standards under paragraph (3) and 
the performance period under paragraph 
(4). 
‘‘(iv) The measures specified under 
subsection (b)(3)(B)(viii) and the measures 
selected under paragraph (2). 
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‘‘(v) The methodology developed under 
paragraph (5) that is used to calculate hos-
pital performance scores and the calculation 
of such scores. 
‘‘(vi) The validation methodology spec-
ified in subsection (b)(3)(B)(viii)(XI). 
‘‘(C) CONSULTATION
WITH
SMALL
HOS-
PITALS.—The Secretary shall consult with small 
rural and urban hospitals on the application of 
the Program to such hospitals. 
‘‘(12) PROMULGATION
OF
REGULATIONS.—The 
Secretary shall promulgate regulations to carry out 
the Program, including the selection of measures 
under paragraph (2), the methodology developed 
under paragraph (5) that is used to calculate hospital 
performance scores, and the methodology used to de-
termine the amount of value-based incentive pay-
ments under paragraph (6).’’. 
(2) AMENDMENTS FOR REPORTING OF HOSPITAL 
QUALITY
INFORMATION.—Section 1886(b)(3)(B)(viii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(B)(viii)) is amended— 
(A) in subclause (II), by adding at the end 
the following sentence: ‘‘The Secretary may re-
quire hospitals to submit data on measures that 
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are not used for the determination of value-based 
incentive payments under subsection (o).’’; 
(B) in subclause (V), by striking ‘‘beginning 
with fiscal year 2008’’ and inserting ‘‘for fiscal 
years 2008 through 2012’’; 
(C) in subclause (VII), in the first sentence, 
by striking ‘‘data submitted’’ and inserting ‘‘in-
formation regarding measures submitted’’; and 
(D) by adding at the end the following new 
subclauses: 
‘‘(VIII) Effective for payments beginning with fiscal 
year 2013, with respect to quality measures for outcomes 
of care, the Secretary shall provide for such risk adjustment 
as the Secretary determines to be appropriate to maintain 
incentives for hospitals to treat patients with severe illnesses 
or conditions. 
‘‘(IX)(aa) Subject to item (bb), effective for payments 
beginning with fiscal year 2013, each measure specified by 
the Secretary under this clause shall be endorsed by the enti-
ty with a contract under section 1890(a). 
‘‘(bb) In the case of a specified area or medical topic 
determined appropriate by the Secretary for which a fea-
sible and practical measure has not been endorsed by the 
entity with a contract under section 1890(a), the Secretary 
may specify a measure that is not so endorsed as long as 
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due consideration is given to measures that have been en-
dorsed or adopted by a consensus organization identified 
by the Secretary. 
‘‘(X) To the extent practicable, the Secretary shall, 
with input from consensus organizations and other stake-
holders, take steps to ensure that the measures specified by 
the Secretary under this clause are coordinated and aligned 
with quality measures applicable to— 
‘‘(aa) physicians under section 1848(k); and 
‘‘(bb) other providers of services and suppliers 
under this title. 
‘‘(XI) The Secretary shall establish a process to vali-
date measures specified under this clause as appropriate. 
Such process shall include the auditing of a number of ran-
domly selected hospitals sufficient to ensure validity of the 
reporting program under this clause as a whole and shall 
provide a hospital with an opportunity to appeal the vali-
dation of measures reported by such hospital.’’. 
(3) 
WEBSITE
IMPROVEMENTS.—Section 
1886(b)(3)(B) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)), as amended by section 4102(b) of 
the HITECH Act (Public Law 111–5), is amended by 
adding at the end the following new clause: 
‘‘(x)(I) The Secretary shall develop standard Internet 
website reports tailored to meet the needs of various stake-
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holders such as hospitals, patients, researchers, and policy-
makers. The Secretary shall seek input from such stake-
holders in determining the type of information that is useful 
and the formats that best facilitate the use of the informa-
tion. 
‘‘(II) The Secretary shall modify the Hospital Com-
pare Internet website to make the use and navigation of 
that website readily available to individuals accessing it.’’. 
(4) GAO STUDY AND REPORT.— 
(A) STUDY.—The Comptroller General of 
the United States shall conduct a study on the 
performance of the hospital value-based pur-
chasing 
program 
established 
under 
section 
1886(o) of the Social Security Act, as added by 
paragraph (1). Such study shall include an 
analysis of the impact of such program on— 
(i) the quality of care furnished to 
Medicare beneficiaries, including diverse 
Medicare beneficiary populations (such as 
diverse in terms of race, ethnicity, and so-
cioeconomic status); 
(ii) expenditures under the Medicare 
program, including any reduced expendi-
tures under Part A of title XVIII of such 
Act that are attributable to the improve-
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ment in the delivery of inpatient hospital 
services by reason of such hospital value- 
based purchasing program; 
(iii) the quality performance among 
safety net hospitals and any barriers such 
hospitals face in meeting the performance 
standards applicable under such hospital 
value-based purchasing program; and 
(iv) the quality performance among 
small rural and small urban hospitals and 
any barriers such hospitals face in meeting 
the performance standards applicable under 
such hospital value-based purchasing pro-
gram. 
(B) REPORTS.— 
(i) INTERIM REPORT.—Not later than 
October 1, 2015, the Comptroller General of 
the United States shall submit to Congress 
an interim report containing the results of 
the study conducted under subparagraph 
(A), together with recommendations for such 
legislation and administrative action as the 
Comptroller 
General 
determines 
appro-
priate. 
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(ii) FINAL
REPORT.—Not later than 
July 1, 2017, the Comptroller General of the 
United States shall submit to Congress a re-
port containing the results of the study con-
ducted under subparagraph (A), together 
with recommendations for such legislation 
and administrative action as the Comp-
troller General determines appropriate. 
(5) HHS STUDY AND REPORT.— 
(A) STUDY.—The Secretary of Health and 
Human Services shall conduct a study on the 
performance of the hospital value-based pur-
chasing 
program 
established 
under 
section 
1886(o) of the Social Security Act, as added by 
paragraph (1). Such study shall include an 
analysis— 
(i) of ways to improve the hospital 
value-based purchasing program and ways 
to address any unintended consequences 
that may occur as a result of such program; 
(ii) of whether the hospital value-based 
purchasing program resulted in lower 
spending under the Medicare program 
under title XVIII of such Act or other fi-
nancial savings to hospitals; 
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(iii) the appropriateness of the Medi-
care program sharing in any savings gen-
erated through the hospital value-based pur-
chasing program; and 
(iv) any other area determined appro-
priate by the Secretary. 
(B) REPORT.—Not later than January 1, 
2016, the Secretary of Health and Human Serv-
ices shall submit to Congress a report containing 
the results of the study conducted under subpara-
graph (A), together with recommendations for 
such legislation and administrative action as the 
Secretary determines appropriate. 
(b) VALUE-BASED
PURCHASING
DEMONSTRATION 
PROGRAMS.— 
(1) VALUE-BASED PURCHASING DEMONSTRATION 
PROGRAM
FOR
INPATIENT
CRITICAL
ACCESS
HOS-
PITALS.— 
(A) ESTABLISHMENT.— 
(i) IN
GENERAL.—Not later than 2 
years after the date of enactment of this Act, 
the Secretary of Health and Human Serv-
ices (in this subsection referred to as the 
‘‘Secretary’’) shall establish a demonstration 
program under which the Secretary estab-
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lishes a value-based purchasing program 
under the Medicare program under title 
XVIII of the Social Security Act for critical 
access hospitals (as defined in paragraph 
(1) of section 1861(mm) of such Act (42 
U.S.C. 1395x(mm))) with respect to inpa-
tient critical access hospital services (as de-
fined in paragraph (2) of such section) in 
order to test innovative methods of meas-
uring and rewarding quality and efficient 
health care furnished by such hospitals. 
(ii) DURATION.—The demonstration 
program under this paragraph shall be con-
ducted for a 3-year period. 
(iii) SITES.—The Secretary shall con-
duct the demonstration program under this 
paragraph at an appropriate number (as 
determined by the Secretary) of critical ac-
cess hospitals. The Secretary shall ensure 
that such hospitals are representative of the 
spectrum of such hospitals that participate 
in the Medicare program. 
(B) WAIVER
AUTHORITY.—The Secretary 
may waive such requirements of titles XI and 
XVIII of the Social Security Act as may be nec-
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essary to carry out the demonstration program 
under this paragraph. 
(C) BUDGET NEUTRALITY REQUIREMENT.— 
In conducting the demonstration program under 
this section, the Secretary shall ensure that the 
aggregate payments made by the Secretary do 
not exceed the amount which the Secretary would 
have paid if the demonstration program under 
this section was not implemented. 
(D) REPORT.—Not later than 18 months 
after the completion of the demonstration pro-
gram under this paragraph, the Secretary shall 
submit to Congress a report on the demonstra-
tion program together with— 
(i) recommendations on the establish-
ment of a permanent value-based pur-
chasing program under the Medicare pro-
gram for critical access hospitals with re-
spect to inpatient critical access hospital 
services; and 
(ii) recommendations for such other 
legislation and administrative action as the 
Secretary determines appropriate. 
(2) VALUE-BASED PURCHASING DEMONSTRATION 
PROGRAM FOR HOSPITALS EXCLUDED FROM HOSPITAL 
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HR 3590 EAS/PP 
VALUE-BASED PURCHASING PROGRAM AS A RESULT 
OF
INSUFFICIENT
NUMBERS
OF
MEASURES
AND 
CASES.— 
(A) ESTABLISHMENT.— 
(i) IN
GENERAL.—Not later than 2 
years after the date of enactment of this Act, 
the Secretary shall establish a demonstra-
tion program under which the Secretary es-
tablishes a value-based purchasing program 
under the Medicare program under title 
XVIII of the Social Security Act for appli-
cable hospitals (as defined in clause (ii)) 
with respect to inpatient hospital services 
(as defined in section 1861(b) of the Social 
Security Act (42 U.S.C. 1395x(b))) in order 
to test innovative methods of measuring and 
rewarding quality and efficient health care 
furnished by such hospitals. 
(ii) 
APPLICABLE
HOSPITAL
DE-
FINED.—For purposes of this paragraph, 
the term ‘‘applicable hospital’’ means a hos-
pital described in subclause (III) or (IV) of 
section 1886(o)(1)(C)(ii) of the Social Secu-
rity Act, as added by subsection (a)(1). 
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(iii) DURATION.—The demonstration 
program under this paragraph shall be con-
ducted for a 3-year period. 
(iv) SITES.—The Secretary shall con-
duct the demonstration program under this 
paragraph at an appropriate number (as 
determined by the Secretary) of applicable 
hospitals. The Secretary shall ensure that 
such hospitals are representative of the spec-
trum of such hospitals that participate in 
the Medicare program. 
(B) WAIVER
AUTHORITY.—The Secretary 
may waive such requirements of titles XI and 
XVIII of the Social Security Act as may be nec-
essary to carry out the demonstration program 
under this paragraph. 
(C) BUDGET NEUTRALITY REQUIREMENT.— 
In conducting the demonstration program under 
this section, the Secretary shall ensure that the 
aggregate payments made by the Secretary do 
not exceed the amount which the Secretary would 
have paid if the demonstration program under 
this section was not implemented. 
(D) REPORT.—Not later than 18 months 
after the completion of the demonstration pro-
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gram under this paragraph, the Secretary shall 
submit to Congress a report on the demonstra-
tion program together with— 
(i) recommendations on the establish-
ment of a permanent value-based pur-
chasing program under the Medicare pro-
gram for applicable hospitals with respect 
to inpatient hospital services; and 
(ii) recommendations for such other 
legislation and administrative action as the 
Secretary determines appropriate. 
SEC. 3002. IMPROVEMENTS TO THE PHYSICIAN QUALITY RE-
PORTING SYSTEM. 
(a) EXTENSION.—Section 1848(m) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(m)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘2010’’ and insert-
ing ‘‘2014’’; and 
(B) in subparagraph (B)— 
(i) in clause (i), by striking ‘‘and’’ at 
the end; 
(ii) in clause (ii), by striking the pe-
riod at the end and inserting a semicolon; 
and 
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(iii) by adding at the end the following 
new clauses: 
‘‘(iii) for 2011, 1.0 percent; and 
‘‘(iv) for 2012, 2013, and 2014, 0.5 
percent.’’; 
(2) in paragraph (3)— 
(A) in subparagraph (A), in the matter pre-
ceding clause (i), by inserting ‘‘(or, for purposes 
of subsection (a)(8), for the quality reporting pe-
riod for the year)’’ after ‘‘reporting period’’; and 
(B) in subparagraph (C)(i), by inserting ‘‘, 
or, for purposes of subsection (a)(8), for a qual-
ity reporting period for the year’’ after ‘‘(a)(5), 
for a reporting period for a year’’; 
(3) in paragraph (5)(E)(iv), by striking ‘‘sub-
section (a)(5)(A)’’ and inserting ‘‘paragraphs (5)(A) 
and (8)(A) of subsection (a)’’; and 
(4) in paragraph (6)(C)— 
(A) in clause (i)(II), by striking ‘‘, 2009, 
2010, and 2011’’ and inserting ‘‘and subsequent 
years’’; and 
(B) in clause (iii)— 
(i) by inserting ‘‘(a)(8)’’ after ‘‘(a)(5)’’; 
and 
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(ii) by striking ‘‘under subparagraph 
(D)(iii) of such subsection’’ and inserting 
‘‘under subsection (a)(5)(D)(iii) or the qual-
ity 
reporting 
period 
under 
subsection 
(a)(8)(D)(iii), respectively’’. 
(b) INCENTIVE PAYMENT ADJUSTMENT FOR QUALITY 
REPORTING.—Section 1848(a) of the Social Security Act 
(42 U.S.C. 1395w–4(a)) is amended by adding at the end 
the following new paragraph: 
‘‘(8) INCENTIVES FOR QUALITY REPORTING.— 
‘‘(A) ADJUSTMENT.— 
‘‘(i) IN GENERAL.—With respect to cov-
ered professional services furnished by an 
eligible professional during 2015 or any 
subsequent year, if the eligible professional 
does not satisfactorily submit data on qual-
ity measures for covered professional serv-
ices for the quality reporting period for the 
year 
(as 
determined 
under 
subsection 
(m)(3)(A)), the fee schedule amount for such 
services furnished by such professional dur-
ing the year (including the fee schedule 
amount for purposes of determining a pay-
ment based on such amount) shall be equal 
to the applicable percent of the fee schedule 
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amount that would otherwise apply to such 
services under this subsection (determined 
after application of paragraphs (3), (5), 
and (7), but without regard to this para-
graph). 
‘‘(ii) APPLICABLE PERCENT.—For pur-
poses of clause (i), the term ‘applicable per-
cent’ means— 
‘‘(I) for 2015, 98.5 percent; and 
‘‘(II) for 2016 and each subse-
quent year, 98 percent. 
‘‘(B) APPLICATION.— 
‘‘(i) PHYSICIAN
REPORTING
SYSTEM 
RULES.—Paragraphs (5), (6), and (8) of 
subsection (k) shall apply for purposes of 
this paragraph in the same manner as they 
apply for purposes of such subsection. 
‘‘(ii) INCENTIVE PAYMENT VALIDATION 
RULES.—Clauses (ii) and (iii) of subsection 
(m)(5)(D) shall apply for purposes of this 
paragraph in a similar manner as they 
apply for purposes of such subsection. 
‘‘(C) DEFINITIONS.—For purposes of this 
paragraph: 
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‘‘(i) ELIGIBLE
PROFESSIONAL; COV-
ERED PROFESSIONAL SERVICES.—The terms 
‘eligible professional’ and ‘covered profes-
sional services’ have the meanings given 
such terms in subsection (k)(3). 
‘‘(ii) 
PHYSICIAN
REPORTING
SYS-
TEM.—The term ‘physician reporting sys-
tem’ means the system established under 
subsection (k). 
‘‘(iii) QUALITY REPORTING PERIOD.— 
The term ‘quality reporting period’ means, 
with respect to a year, a period specified by 
the Secretary.’’. 
(c) MAINTENANCE OF CERTIFICATION PROGRAMS.— 
(1) IN GENERAL.—Section 1848(k)(4) of the So-
cial Security Act (42 U.S.C. 1395w–4(k)(4)) is 
amended by inserting ‘‘or through a Maintenance of 
Certification program operated by a specialty body of 
the American Board of Medical Specialties that meets 
the criteria for such a registry’’ after ‘‘Database)’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply for years after 2010. 
(d) INTEGRATION OF PHYSICIAN QUALITY REPORTING 
AND EHR REPORTING.—Section 1848(m) of the Social Se-
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HR 3590 EAS/PP 
curity Act (42 U.S.C. 1395w–4(m)) is amended by adding 
at the end the following new paragraph: 
‘‘(7) INTEGRATION OF PHYSICIAN QUALITY RE-
PORTING AND EHR REPORTING.—Not later than Jan-
uary 1, 2012, the Secretary shall develop a plan to 
integrate reporting on quality measures under this 
subsection with reporting requirements under sub-
section (o) relating to the meaningful use of electronic 
health records. Such integration shall consist of the 
following: 
‘‘(A) The selection of measures, the report-
ing of which would both demonstrate— 
‘‘(i) meaningful use of an electronic 
health record for purposes of subsection (o); 
and 
‘‘(ii) quality of care furnished to an 
individual. 
‘‘(B) Such other activities as specified by 
the Secretary.’’. 
(e) FEEDBACK.—Section 1848(m)(5) of the Social Se-
curity Act (42 U.S.C. 1395w–4(m)(5)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(H) FEEDBACK.—The Secretary shall pro-
vide timely feedback to eligible professionals on 
the performance of the eligible professional with 
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respect to satisfactorily submitting data on qual-
ity measures under this subsection.’’. 
(f) APPEALS.—Such section is further amended— 
(1) in subparagraph (E), by striking ‘‘There 
shall’’ and inserting ‘‘Except as provided in subpara-
graph (I), there shall’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(I) INFORMAL
APPEALS
PROCESS.—The 
Secretary shall, by not later than January 1, 
2011, establish and have in place an informal 
process for eligible professionals to seek a review 
of the determination that an eligible professional 
did not satisfactorily submit data on quality 
measures under this subsection.’’. 
SEC. 3003. IMPROVEMENTS TO THE PHYSICIAN FEEDBACK 
PROGRAM. 
(a) IN GENERAL.—Section 1848(n) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(n)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘GENERAL.—The Sec-
retary’’ and inserting ‘‘GENERAL.— 
‘‘(i) 
ESTABLISHMENT.—The 
Sec-
retary’’; 
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(ii) in clause (i), as added by clause 
(i), by striking ‘‘the ‘Program’)’’ and all 
that follows through the period at the end of 
the second sentence and inserting ‘‘the ‘Pro-
gram’).’’; and 
(iii) by adding at the end the following 
new clauses: 
‘‘(ii) REPORTS
ON
RESOURCES.—The 
Secretary shall use claims data under this 
title (and may use other data) to provide 
confidential reports to physicians (and, as 
determined appropriate by the Secretary, to 
groups of physicians) that measure the re-
sources involved in furnishing care to indi-
viduals under this title. 
‘‘(iii) INCLUSION OF CERTAIN INFOR-
MATION.—If determined appropriate by the 
Secretary, the Secretary may include infor-
mation on the quality of care furnished to 
individuals under this title by the physician 
(or group of physicians) in such reports.’’; 
and 
(B) in subparagraph (B), by striking ‘‘sub-
paragraph (A)’’ and inserting ‘‘subparagraph 
(A)(ii)’’; 
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(2) in paragraph (4)— 
(A) in the heading, by inserting ‘‘INITIAL’’ 
after ‘‘FOCUS’’; and 
(B) in the matter preceding subparagraph 
(A), by inserting ‘‘initial’’ after ‘‘focus the’’; 
(3) in paragraph (6), by adding at the end the 
following new sentence: ‘‘For adjustments for reports 
on utilization under paragraph (9), see subparagraph 
(D) of such paragraph.’’; and 
(4) by adding at the end the following new para-
graphs: 
‘‘(9) REPORTS ON UTILIZATION.— 
‘‘(A) DEVELOPMENT
OF
EPISODE
GROUP-
ER.— 
‘‘(i) IN GENERAL.—The Secretary shall 
develop an episode grouper that combines 
separate but clinically related items and 
services into an episode of care for an indi-
vidual, as appropriate. 
‘‘(ii) TIMELINE FOR DEVELOPMENT.— 
The episode grouper described in subpara-
graph (A) shall be developed by not later 
than January 1, 2012. 
‘‘(iii) PUBLIC AVAILABILITY.—The Sec-
retary shall make the details of the episode 
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grouper described in subparagraph (A) 
available to the public. 
‘‘(iv) ENDORSEMENT.—The Secretary 
shall seek endorsement of the episode group-
er described in subparagraph (A) by the en-
tity with a contract under section 1890(a). 
‘‘(B) REPORTS ON UTILIZATION.—Effective 
beginning with 2012, the Secretary shall provide 
reports to physicians that compare, as deter-
mined appropriate by the Secretary, patterns of 
resource use of the individual physician to such 
patterns of other physicians. 
‘‘(C) ANALYSIS
OF
DATA.—The Secretary 
shall, for purposes of preparing reports under 
this paragraph, establish methodologies as appro-
priate, such as to— 
‘‘(i) attribute episodes of care, in whole 
or in part, to physicians; 
‘‘(ii) identify appropriate physicians 
for purposes of comparison under subpara-
graph (B); and 
‘‘(iii) aggregate episodes of care attrib-
uted to a physician under clause (i) into a 
composite measure per individual. 
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‘‘(D) DATA ADJUSTMENT.—In preparing re-
ports under this paragraph, the Secretary shall 
make appropriate adjustments, including adjust-
ments— 
‘‘(i) to account for differences in socio-
economic and demographic characteristics, 
ethnicity, and health status of individuals 
(such as to recognize that less healthy indi-
viduals may require more intensive inter-
ventions); and 
‘‘(ii) to eliminate the effect of geo-
graphic adjustments in payment rates (as 
described in subsection (e)). 
‘‘(E) PUBLIC
AVAILABILITY
OF
METHOD-
OLOGY.—The Secretary shall make available to 
the public— 
‘‘(i) 
the 
methodologies 
established 
under subparagraph (C); 
‘‘(ii) information regarding any ad-
justments made to data under subpara-
graph (D); and 
‘‘(iii) aggregate reports with respect to 
physicians. 
‘‘(F) DEFINITION OF PHYSICIAN.—In this 
paragraph: 
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‘‘(i) IN
GENERAL.—The term ‘physi-
cian’ has the meaning given that term in 
section 1861(r)(1). 
‘‘(ii) TREATMENT OF GROUPS.—Such 
term includes, as the Secretary determines 
appropriate, a group of physicians. 
‘‘(G) LIMITATIONS ON REVIEW.—There shall 
be no administrative or judicial review under 
section 1869, section 1878, or otherwise of the es-
tablishment of the methodology under subpara-
graph (C), including the determination of an 
episode of care under such methodology. 
‘‘(10) COORDINATION WITH OTHER VALUE-BASED 
PURCHASING REFORMS.—The Secretary shall coordi-
nate the Program with the value-based payment 
modifier established under subsection (p) and, as the 
Secretary determines appropriate, other similar pro-
visions of this title.’’. 
(b) CONFORMING AMENDMENT.—Section 1890(b) of 
the Social Security Act (42 U.S.C. 1395aaa(b)) is amended 
by adding at the end the following new paragraph: 
‘‘(6) REVIEW AND ENDORSEMENT OF EPISODE 
GROUPER
UNDER
THE
PHYSICIAN
FEEDBACK
PRO-
GRAM.—The entity shall provide for the review and, 
as appropriate, the endorsement of the episode group-
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er 
developed 
by 
the 
Secretary 
under 
section 
1848(n)(9)(A). Such review shall be conducted on an 
expedited basis.’’. 
SEC. 3004. QUALITY REPORTING FOR LONG-TERM CARE 
HOSPITALS, 
INPATIENT 
REHABILITATION 
HOSPITALS, AND HOSPICE PROGRAMS. 
(a) LONG-TERM CARE HOSPITALS.—Section 1886(m) 
of the Social Security Act (42 U.S.C. 1395ww(m)), as 
amended by section 3401(c), is amended by adding at the 
end the following new paragraph: 
‘‘(5) QUALITY REPORTING.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE 
TO REPORT.— 
‘‘(i) IN GENERAL.—Under the system 
described in paragraph (1), for rate year 
2014 and each subsequent rate year, in the 
case of a long-term care hospital that does 
not submit data to the Secretary in accord-
ance with subparagraph (C) with respect to 
such a rate year, any annual update to a 
standard Federal rate for discharges for the 
hospital during the rate year, and after ap-
plication of paragraph (3), shall be reduced 
by 2 percentage points. 
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‘‘(ii) SPECIAL RULE.—The application 
of this subparagraph may result in such an-
nual update being less than 0.0 for a rate 
year, and may result in payment rates 
under the system described in paragraph 
(1) for a rate year being less than such pay-
ment rates for the preceding rate year. 
‘‘(B) NONCUMULATIVE APPLICATION.—Any 
reduction under subparagraph (A) shall apply 
only with respect to the rate year involved and 
the Secretary shall not take into account such re-
duction in computing the payment amount 
under the system described in paragraph (1) for 
a subsequent rate year. 
‘‘(C) SUBMISSION OF QUALITY DATA.—For 
rate year 2014 and each subsequent rate year, 
each long-term care hospital shall submit to the 
Secretary data on quality measures specified 
under subparagraph (D). Such data shall be sub-
mitted in a form and manner, and at a time, 
specified by the Secretary for purposes of this 
subparagraph. 
‘‘(D) QUALITY MEASURES.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), any measure specified by the Secretary 
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under this subparagraph must have been 
endorsed by the entity with a contract 
under section 1890(a). 
‘‘(ii) EXCEPTION.—In the case of a 
specified area or medical topic determined 
appropriate by the Secretary for which a 
feasible and practical measure has not been 
endorsed by the entity with a contract 
under section 1890(a), the Secretary may 
specify a measure that is not so endorsed as 
long as due consideration is given to meas-
ures that have been endorsed or adopted by 
a consensus organization identified by the 
Secretary. 
‘‘(iii) TIME
FRAME.—Not later than 
October 1, 2012, the Secretary shall publish 
the measures selected under this subpara-
graph that will be applicable with respect to 
rate year 2014. 
‘‘(E) PUBLIC AVAILABILITY OF DATA SUB-
MITTED.—The Secretary shall establish proce-
dures for making data submitted under subpara-
graph (C) available to the public. Such proce-
dures shall ensure that a long-term care hospital 
has the opportunity to review the data that is to 
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be made public with respect to the hospital prior 
to such data being made public. The Secretary 
shall report quality measures that relate to serv-
ices furnished in inpatient settings in long-term 
care hospitals on the Internet website of the Cen-
ters for Medicare & Medicaid Services.’’. 
(b) INPATIENT REHABILITATION HOSPITALS.—Section 
1886(j) of the Social Security Act (42 U.S.C. 1395ww(j)) 
is amended— 
(1) by redesignating paragraph (7) as para-
graph (8); and 
(2) by inserting after paragraph (6) the fol-
lowing new paragraph: 
‘‘(7) QUALITY REPORTING.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE 
TO REPORT.— 
‘‘(i) IN GENERAL.—For purposes of fis-
cal year 2014 and each subsequent fiscal 
year, in the case of a rehabilitation facility 
that does not submit data to the Secretary 
in accordance with subparagraph (C) with 
respect to such a fiscal year, after deter-
mining the increase factor described in 
paragraph (3)(C), and after application of 
paragraph (3)(D), the Secretary shall re-
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duce such increase factor for payments for 
discharges occurring during such fiscal year 
by 2 percentage points. 
‘‘(ii) SPECIAL RULE.—The application 
of this subparagraph may result in the in-
crease factor described in paragraph (3)(C) 
being less than 0.0 for a fiscal year, and 
may result in payment rates under this 
subsection for a fiscal year being less than 
such payment rates for the preceding fiscal 
year. 
‘‘(B) NONCUMULATIVE APPLICATION.—Any 
reduction under subparagraph (A) shall apply 
only with respect to the fiscal year involved and 
the Secretary shall not take into account such re-
duction in computing the payment amount 
under this subsection for a subsequent fiscal 
year. 
‘‘(C) SUBMISSION OF QUALITY DATA.—For 
fiscal year 2014 and each subsequent rate year, 
each rehabilitation facility shall submit to the 
Secretary data on quality measures specified 
under subparagraph (D). Such data shall be sub-
mitted in a form and manner, and at a time, 
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specified by the Secretary for purposes of this 
subparagraph. 
‘‘(D) QUALITY MEASURES.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), any measure specified by the Secretary 
under this subparagraph must have been 
endorsed by the entity with a contract 
under section 1890(a). 
‘‘(ii) EXCEPTION.—In the case of a 
specified area or medical topic determined 
appropriate by the Secretary for which a 
feasible and practical measure has not been 
endorsed by the entity with a contract 
under section 1890(a), the Secretary may 
specify a measure that is not so endorsed as 
long as due consideration is given to meas-
ures that have been endorsed or adopted by 
a consensus organization identified by the 
Secretary. 
‘‘(iii) TIME
FRAME.—Not later than 
October 1, 2012, the Secretary shall publish 
the measures selected under this subpara-
graph that will be applicable with respect to 
fiscal year 2014. 
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‘‘(E) PUBLIC AVAILABILITY OF DATA SUB-
MITTED.—The Secretary shall establish proce-
dures for making data submitted under subpara-
graph (C) available to the public. Such proce-
dures shall ensure that a rehabilitation facility 
has the opportunity to review the data that is to 
be made public with respect to the facility prior 
to such data being made public. The Secretary 
shall report quality measures that relate to serv-
ices furnished in inpatient settings in rehabilita-
tion facilities on the Internet website of the Cen-
ters for Medicare & Medicaid Services.’’. 
(c) HOSPICE PROGRAMS.—Section 1814(i) of the So-
cial Security Act (42 U.S.C. 1395f(i)) is amended— 
(1) by redesignating paragraph (5) as para-
graph (6); and 
(2) by inserting after paragraph (4) the fol-
lowing new paragraph: 
‘‘(5) QUALITY REPORTING.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE 
TO REPORT.— 
‘‘(i) IN GENERAL.—For purposes of fis-
cal year 2014 and each subsequent fiscal 
year, in the case of a hospice program that 
does not submit data to the Secretary in ac-
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cordance with subparagraph (C) with re-
spect to such a fiscal year, after deter-
mining the market basket percentage in-
crease under paragraph (1)(C)(ii)(VII) or 
paragraph (1)(C)(iii), as applicable, and 
after application of paragraph (1)(C)(iv), 
with respect to the fiscal year, the Secretary 
shall reduce such market basket percentage 
increase by 2 percentage points. 
‘‘(ii) SPECIAL RULE.—The application 
of this subparagraph may result in the 
market basket percentage increase under 
paragraph (1)(C)(ii)(VII) or paragraph 
(1)(C)(iii), as applicable, being less than 
0.0 for a fiscal year, and may result in 
payment rates under this subsection for a 
fiscal year being less than such payment 
rates for the preceding fiscal year. 
‘‘(B) NONCUMULATIVE APPLICATION.—Any 
reduction under subparagraph (A) shall apply 
only with respect to the fiscal year involved and 
the Secretary shall not take into account such re-
duction in computing the payment amount 
under this subsection for a subsequent fiscal 
year. 
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‘‘(C) SUBMISSION OF QUALITY DATA.—For 
fiscal year 2014 and each subsequent fiscal year, 
each hospice program shall submit to the Sec-
retary data on quality measures specified under 
subparagraph (D). Such data shall be submitted 
in a form and manner, and at a time, specified 
by the Secretary for purposes of this subpara-
graph. 
‘‘(D) QUALITY MEASURES.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), any measure specified by the Secretary 
under this subparagraph must have been 
endorsed by the entity with a contract 
under section 1890(a). 
‘‘(ii) EXCEPTION.—In the case of a 
specified area or medical topic determined 
appropriate by the Secretary for which a 
feasible and practical measure has not been 
endorsed by the entity with a contract 
under section 1890(a), the Secretary may 
specify a measure that is not so endorsed as 
long as due consideration is given to meas-
ures that have been endorsed or adopted by 
a consensus organization identified by the 
Secretary. 
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‘‘(iii) TIME
FRAME.—Not later than 
October 1, 2012, the Secretary shall publish 
the measures selected under this subpara-
graph that will be applicable with respect to 
fiscal year 2014. 
‘‘(E) PUBLIC AVAILABILITY OF DATA SUB-
MITTED.—The Secretary shall establish proce-
dures for making data submitted under subpara-
graph (C) available to the public. Such proce-
dures shall ensure that a hospice program has 
the opportunity to review the data that is to be 
made public with respect to the hospice program 
prior to such data being made public. The Sec-
retary shall report quality measures that relate 
to hospice care provided by hospice programs on 
the Internet website of the Centers for Medicare 
& Medicaid Services.’’. 
SEC. 3005. QUALITY REPORTING FOR PPS-EXEMPT CANCER 
HOSPITALS. 
Section 1866 of the Social Security Act (42 U.S.C. 
1395cc) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (U), by striking ‘‘and’’ 
at the end; 
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(B) in subparagraph (V), by striking the 
period at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(W) in the case of a hospital described in 
section 1886(d)(1)(B)(v), to report quality data 
to the Secretary in accordance with subsection 
(k).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(k) QUALITY REPORTING BY CANCER HOSPITALS.— 
‘‘(1) IN GENERAL.—For purposes of fiscal year 
2014 and each subsequent fiscal year, a hospital de-
scribed in section 1886(d)(1)(B)(v) shall submit data 
to the Secretary in accordance with paragraph (2) 
with respect to such a fiscal year. 
‘‘(2) SUBMISSION OF QUALITY DATA.—For fiscal 
year 2014 and each subsequent fiscal year, each hos-
pital described in such section shall submit to the Sec-
retary data on quality measures specified under 
paragraph (3). Such data shall be submitted in a 
form and manner, and at a time, specified by the 
Secretary for purposes of this subparagraph. 
‘‘(3) QUALITY MEASURES.— 
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‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), any measure specified by the Sec-
retary under this paragraph must have been en-
dorsed by the entity with a contract under sec-
tion 1890(a). 
‘‘(B) EXCEPTION.—In the case of a specified 
area or medical topic determined appropriate by 
the Secretary for which a feasible and practical 
measure has not been endorsed by the entity with 
a contract under section 1890(a), the Secretary 
may specify a measure that is not so endorsed as 
long as due consideration is given to measures 
that have been endorsed or adopted by a con-
sensus organization identified by the Secretary. 
‘‘(C) TIME FRAME.—Not later than October 
1, 2012, the Secretary shall publish the measures 
selected under this paragraph that will be appli-
cable with respect to fiscal year 2014. 
‘‘(4) PUBLIC
AVAILABILITY
OF
DATA
SUB-
MITTED.—The Secretary shall establish procedures for 
making data submitted under paragraph (4) avail-
able to the public. Such procedures shall ensure that 
a hospital described in section 1886(d)(1)(B)(v) has 
the opportunity to review the data that is to be made 
public with respect to the hospital prior to such data 
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(I) the Substance Abuse and Mental Health 
Services Administration; 
(J) the Administration for Children and 
Families; 
(K) the Department of Commerce; 
(L) the Office of Management and Budget; 
(M) the United States Coast Guard; 
(N) the Federal Bureau of Prisons; 
(O) the National Highway Traffic Safety 
Administration; 
(P) the Federal Trade Commission; 
(Q) the Social Security Administration; 
(R) the Department of Labor; 
(S) the United States Office of Personnel 
Management; 
(T) the Department of Defense; 
(U) the Department of Education; 
(V) the Department of Veterans Affairs; 
(W) the Veterans Health Administration; 
and 
(X) any other Federal agencies and depart-
ments with activities relating to improving 
health care quality and safety, as determined by 
the President. 
(2) CHAIR AND VICE-CHAIR.— 
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