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•AMDT. NO. 2786 
tive clinical effectiveness research, including the develop-
ment and use of clinical registries and health outcomes 
research data networks, in order to develop and maintain 
a comprehensive, interoperable data network to collect, 
link, and analyze data on outcomes and effectiveness from 
multiple sources, including electronic health records. 
‘‘(g) AUTHORITY TO CONTRACT WITH THE INSTI-
TUTE.—Agencies and instrumentalities of the Federal 
Government may enter into agreements with the Institute, 
and accept and retain funds, for the conduct and support 
of research described in this part, provided that the re-
search to be conducted or supported under such agree-
ments is authorized under the governing statutes of such 
agencies and instrumentalities.’’. 
(c) IN GENERAL.—Part D of title XI of the Social 
Security Act, as added by subsection (a), is amended by 
adding at the end the following new section: 
‘‘LIMITATIONS ON CERTAIN USES OF COMPARATIVE 
CLINICAL EFFECTIVENESS RESEARCH 
‘‘SEC. 1182. (a) The Secretary may only use evidence 
and findings from research conducted under section 1181 
to make a determination regarding coverage under title 
XVIII if such use is through an iterative and transparent 
process which includes public comment and considers the 
effect on subpopulations. 
‘‘(b) Nothing in section 1181 shall be construed as— 
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•AMDT. NO. 2786 
‘‘(1) superceding or modifying the coverage of 
items or services under title XVIII that the Sec-
retary determines are reasonable and necessary 
under section 1862(l)(1); or 
‘‘(2) authorizing the Secretary to deny coverage 
of items or services under such title solely on the 
basis of comparative clinical effectiveness research. 
‘‘(c)(1) The Secretary shall not use evidence or find-
ings from comparative clinical effectiveness research con-
ducted under section 1181 in determining coverage, reim-
bursement, or incentive programs under title XVIII in a 
manner that treats extending the life of an elderly, dis-
abled, or terminally ill individual as of lower value than 
extending the life of an individual who is younger, non-
disabled, or not terminally ill. 
‘‘(2) Paragraph (1) shall not be construed as pre-
venting the Secretary from using evidence or findings from 
such comparative clinical effectiveness research in deter-
mining coverage, reimbursement, or incentive programs 
under title XVIII based upon a comparison of the dif-
ference in the effectiveness of alternative treatments in ex-
tending an individual’s life due to the individual’s age, dis-
ability, or terminal illness. 
‘‘(d)(1) The Secretary shall not use evidence or find-
ings from comparative clinical effectiveness research con-
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•AMDT. NO. 2786 
ducted under section 1181 in determining coverage, reim-
bursement, or incentive programs under title XVIII in a 
manner that precludes, or with the intent to discourage, 
an individual from choosing a health care treatment based 
on how the individual values the tradeoff between extend-
ing the length of their life and the risk of disability. 
‘‘(2)(A) Paragraph (1) shall not be construed to— 
‘‘(i) limit the application of differential copay-
ments under title XVIII based on factors such as 
cost or type of service; or 
‘‘(ii) prevent the Secretary from using evidence 
or findings from such comparative clinical effective-
ness research in determining coverage, reimburse-
ment, or incentive programs under such title based 
upon a comparison of the difference in the effective-
ness of alternative health care treatments in extend-
ing an individual’s life due to that individual’s age, 
disability, or terminal illness. 
‘‘(3) Nothing in the provisions of, or amendments 
made by the Patient Protection and Affordable Care Act, 
shall be construed to limit comparative clinical effective-
ness research or any other research, evaluation, or dis-
semination of information concerning the likelihood that 
a health care treatment will result in disability. 
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•AMDT. NO. 2786 
‘‘(e) The Patient-Centered Outcomes Research Insti-
tute established under section 1181(b)(1) shall not develop 
or employ a dollars-per-quality adjusted life year (or simi-
lar measure that discounts the value of a life because of 
an individual’s disability) as a threshold to establish what 
type of health care is cost effective or recommended. The 
Secretary shall not utilize such an adjusted life year (or 
such a similar measure) as a threshold to determine cov-
erage, reimbursement, or incentive programs under title 
XVIII.’’. 
(d) IN GENERAL.—Part D of title XI of the Social 
Security Act, as added by subsection (a) and amended by 
subsection (c), is amended by adding at the end the fol-
lowing new section: 
‘‘TRUST FUND TRANSFERS TO PATIENT-CENTERED 
OUTCOMES RESEARCH TRUST FUND 
‘‘SEC. 1183. (a) IN GENERAL.—The Secretary shall 
provide for the transfer, from the Federal Hospital Insur-
ance Trust Fund under section 1817 and the Federal Sup-
plementary Medical Insurance Trust Fund under section 
1841, in proportion (as estimated by the Secretary) to the 
total expenditures during such fiscal year that are made 
under title XVIII from the respective trust fund, to the 
Patient-Centered Outcomes Research Trust Fund (re-
ferred to in this section as the ‘PCORTF’) under section 
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•AMDT. NO. 2786 
9511 of the Internal Revenue Code of 1986, of the fol-
lowing: 
‘‘(1) For fiscal year 2013, an amount equal to 
$1 multiplied by the average number of individuals 
entitled to benefits under part A, or enrolled under 
part B, of title XVIII during such fiscal year. 
‘‘(2) For each of fiscal years 2014, 2015, 2016, 
2017, 2018, and 2019, an amount equal to $2 mul-
tiplied by the average number of individuals entitled 
to benefits under part A, or enrolled under part B, 
of title XVIII during such fiscal year. 
‘‘(b) ADJUSTMENTS
FOR INCREASES
IN HEALTH 
CARE SPENDING.—In the case of any fiscal year begin-
ning after September 30, 2014, the dollar amount in effect 
under subsection (a)(2) for such fiscal year shall be equal 
to the sum of such dollar amount for the previous fiscal 
year (determined after the application of this subsection), 
plus an amount equal to the product of— 
‘‘(1) such dollar amount for the previous fiscal 
year, multiplied by 
‘‘(2) the percentage increase in the projected 
per capita amount of National Health Expenditures, 
as most recently published by the Secretary before 
the beginning of the fiscal year.’’. 
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•AMDT. NO. 2786 
(e) 
PATIENT-CENTERED
OUTCOMES
RESEARCH 
TRUST FUND; FINANCING FOR TRUST FUND.— 
(1) ESTABLISHMENT OF TRUST FUND.— 
(A) IN GENERAL.—Subchapter A of chap-
ter 98 of the Internal Revenue Code of 1986 
(relating to establishment of trust funds) is 
amended by adding at the end the following 
new section: 
‘‘SEC. 9511. PATIENT-CENTERED OUTCOMES RESEARCH 
TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a trust fund 
to be known as the ‘Patient-Centered Outcomes Research 
Trust Fund’ (hereafter in this section referred to as the 
‘PCORTF’), consisting of such amounts as may be appro-
priated or credited to such Trust Fund as provided in this 
section and section 9602(b). 
‘‘(b) TRANSFERS TO FUND.— 
‘‘(1) APPROPRIATION.—There are hereby ap-
propriated to the Trust Fund the following: 
‘‘(A) For fiscal year 2010, $10,000,000. 
‘‘(B) For fiscal year 2011, $50,000,000. 
‘‘(C) For fiscal year 2012, $150,000,000. 
‘‘(D) For fiscal year 2013— 
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•AMDT. NO. 2786 
transferred under section 1183 of the Social Secu-
rity Act. 
‘‘(3) LIMITATION ON TRANSFERS TO PCORTF.— 
No amount may be appropriated or transferred to 
the PCORTF on and after the date of any expendi-
ture from the PCORTF which is not an expenditure 
permitted under this section. The determination of 
whether an expenditure is so permitted shall be 
made without regard to— 
‘‘(A) any provision of law which is not con-
tained or referenced in this chapter or in a rev-
enue Act, and 
‘‘(B) whether such provision of law is a 
subsequently enacted provision or directly or in-
directly seeks to waive the application of this 
paragraph. 
‘‘(c) TRUSTEE.—The Secretary of the Treasury shall 
be a trustee of the PCORTF. 
‘‘(d) EXPENDITURES FROM FUND.— 
‘‘(1) AMOUNTS AVAILABLE TO THE PATIENT- 
CENTERED OUTCOMES RESEARCH INSTITUTE.—Sub-
ject to paragraph (2), amounts in the PCORTF are 
available, without further appropriation, to the Pa-
tient-Centered Outcomes Research Institute estab-
lished under section 1181(b) of the Social Security 
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•AMDT. NO. 2786 
Act for carrying out part D of title XI of the Social 
Security Act (as in effect on the date of enactment 
of such Act). 
‘‘(2) TRANSFER OF FUNDS.— 
‘‘(A) IN
GENERAL.—The trustee of the 
PCORTF shall provide for the transfer from 
the PCORTF of 20 percent of the amounts ap-
propriated or credited to the PCORTF for each 
of fiscal years 2011 through 2019 to the Sec-
retary of Health and Human Services to carry 
out section 937 of the Public Health Service 
Act. 
‘‘(B) AVAILABILITY.—Amounts transferred 
under subparagraph (A) shall remain available 
until expended. 
‘‘(C) REQUIREMENTS.—Of the amounts 
transferred under subparagraph (A) with re-
spect to a fiscal year, the Secretary of Health 
and Human Services shall distribute— 
‘‘(i) 80 percent to the Office of Com-
munication and Knowledge Transfer of the 
Agency for Healthcare Research and Qual-
ity (or any other relevant office designated 
by Agency for Healthcare Research and 
Quality) to carry out the activities de-
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•AMDT. NO. 2786 
scribed in section 937 of the Public Health 
Service Act; and 
‘‘(ii) 20 percent to the Secretary to 
carry out the activities described in such 
section 937. 
‘‘(e) NET REVENUES.—For purposes of this section, 
the term ‘net revenues’ means the amount estimated by 
the Secretary of the Treasury based on the excess of— 
‘‘(1) the fees received in the Treasury under 
subchapter B of chapter 34, over 
‘‘(2) the decrease in the tax imposed by chapter 
1 resulting from the fees imposed by such sub-
chapter. 
‘‘(f) TERMINATION.—No amounts shall be available 
for expenditure from the PCORTF after September 30, 
2019, and any amounts in such Trust Fund after such 
date shall be transferred to the general fund of the Treas-
ury.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for subchapter A of chapter 98 of such 
Code is amended by adding at the end the fol-
lowing new item: 
‘‘Sec. 9511. Patient-centered outcomes research trust fund.’’. 
(2) FINANCING FOR FUND FROM FEES ON IN-
SURED AND SELF-INSURED HEALTH PLANS.— 
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•AMDT. NO. 2786 
(A) GENERAL RULE.—Chapter 34 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new subchapter: 
‘‘Subchapter B—Insured and Self-Insured 
Health Plans 
‘‘Sec. 4375. Health insurance. 
‘‘Sec. 4376. Self-insured health plans. 
‘‘Sec. 4377. Definitions and special rules. 
‘‘SEC. 4375. HEALTH INSURANCE. 
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed 
on each specified health insurance policy for each policy 
year ending after September 30, 2012, a fee equal to the 
product of $2 ($1 in the case of policy years ending during 
fiscal year 2013) multiplied by the average number of lives 
covered under the policy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub-
section (a) shall be paid by the issuer of the policy. 
‘‘(c) SPECIFIED HEALTH INSURANCE POLICY.—For 
purposes of this section: 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, the term ‘specified health in-
surance policy’ means any accident or health insur-
ance policy (including a policy under a group health 
plan) issued with respect to individuals residing in 
the United States. 
‘‘(2) EXEMPTION FOR CERTAIN POLICIES.—The 
term ‘specified health insurance policy’ does not in-
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•AMDT. NO. 2786 
clude any insurance if substantially all of its cov-
erage is of excepted benefits described in section 
9832(c). 
‘‘(3) TREATMENT OF PREPAID HEALTH COV-
ERAGE ARRANGEMENTS.— 
‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B), such 
arrangement shall be treated as a specified 
health insurance policy, and the person referred 
to in such subparagraph shall be treated as the 
issuer. 
‘‘(B) DESCRIPTION OF ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed pay-
ments or premiums are received as consider-
ation for any person’s agreement to provide or 
arrange for the provision of accident or health 
coverage to residents of the United States, re-
gardless of how such coverage is provided or ar-
ranged to be provided. 
‘‘(d) ADJUSTMENTS
FOR INCREASES
IN HEALTH 
CARE SPENDING.—In the case of any policy year ending 
in any fiscal year beginning after September 30, 2014, the 
dollar amount in effect under subsection (a) for such pol-
icy year shall be equal to the sum of such dollar amount 
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•AMDT. NO. 2786 
for policy years ending in the previous fiscal year (deter-
mined after the application of this subsection), plus an 
amount equal to the product of— 
‘‘(1) such dollar amount for policy years ending 
in the previous fiscal year, multiplied by 
‘‘(2) the percentage increase in the projected 
per capita amount of National Health Expenditures, 
as most recently published by the Secretary before 
the beginning of the fiscal year. 
‘‘(e) TERMINATION.—This section shall not apply to 
policy years ending after September 30, 2019. 
‘‘SEC. 4376. SELF-INSURED HEALTH PLANS. 
‘‘(a) IMPOSITION OF FEE.—In the case of any appli-
cable self-insured health plan for each plan year ending 
after September 30, 2012, there is hereby imposed a fee 
equal to $2 ($1 in the case of plan years ending during 
fiscal year 2013) multiplied by the average number of lives 
covered under the plan. 
‘‘(b) LIABILITY FOR FEE.— 
‘‘(1) IN GENERAL.—The fee imposed by sub-
section (a) shall be paid by the plan sponsor. 
‘‘(2) PLAN SPONSOR.—For purposes of para-
graph (1) the term ‘plan sponsor’ means— 
‘‘(A) the employer in the case of a plan es-
tablished or maintained by a single employer, 
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•AMDT. NO. 2786 
‘‘(B) the employee organization in the case 
of a plan established or maintained by an em-
ployee organization, 
‘‘(C) in the case of— 
‘‘(i) a plan established or maintained 
by 2 or more employers or jointly by 1 or 
more employers and 1 or more employee 
organizations, 
‘‘(ii) a multiple employer welfare ar-
rangement, or 
‘‘(iii) a voluntary employees’ bene-
ficiary association described in section 
501(c)(9),the association, committee, joint 
board of trustees, or other similar group of 
representatives of the parties who establish 
or maintain the plan, or 
‘‘(D) the cooperative or association de-
scribed in subsection (c)(2)(F) in the case of a 
plan established or maintained by such a coop-
erative or association. 
‘‘(c) APPLICABLE SELF-INSURED HEALTH PLAN.— 
For purposes of this section, the term ‘applicable self-in-
sured health plan’ means any plan for providing accident 
or health coverage if— 
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•AMDT. NO. 2786 
‘‘(1) any portion of such coverage is provided 
other than through an insurance policy, and 
‘‘(2) such plan is established or maintained— 
‘‘(A) by 1 or more employers for the ben-
efit of their employees or former employees, 
‘‘(B) by 1 or more employee organizations 
for the benefit of their members or former 
members, 
‘‘(C) jointly by 1 or more employers and 1 
or more employee organizations for the benefit 
of employees or former employees, 
‘‘(D) by a voluntary employees’ beneficiary 
association described in section 501(c)(9), 
‘‘(E) by any organization described in sec-
tion 501(c)(6), or 
‘‘(F) in the case of a plan not described in 
the preceding subparagraphs, by a multiple em-
ployer welfare arrangement (as defined in sec-
tion 3(40) of Employee Retirement Income Se-
curity Act of 1974), a rural electric cooperative 
(as defined in section 3(40)(B)(iv) of such Act), 
or a rural telephone cooperative association (as 
defined in section 3(40)(B)(v) of such Act). 
‘‘(d) ADJUSTMENTS
FOR INCREASES
IN HEALTH 
CARE SPENDING.—In the case of any plan year ending 
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•AMDT. NO. 2786 
in any fiscal year beginning after September 30, 2014, the 
dollar amount in effect under subsection (a) for such plan 
year shall be equal to the sum of such dollar amount for 
plan years ending in the previous fiscal year (determined 
after the application of this subsection), plus an amount 
equal to the product of— 
‘‘(1) such dollar amount for plan years ending 
in the previous fiscal year, multiplied by 
‘‘(2) the percentage increase in the projected 
per capita amount of National Health Expenditures, 
as most recently published by the Secretary before 
the beginning of the fiscal year. 
‘‘(e) TERMINATION.—This section shall not apply to 
plan years ending after September 30, 2019. 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this sub-
chapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health in-
surance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument where-
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•AMDT. NO. 2786 
by a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED
STATES.—The term ‘United 
States’ includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any gov-
ernmental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be ex-
empt from the fees imposed by this subchapter 
except as provided in paragraph (2). 
‘‘(2) TREATMENT OF EXEMPT GOVERNMENTAL 
PROGRAMS.—In the case of an exempt governmental 
program, no fee shall be imposed under section 4375 
or section 4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM
DE-
FINED.—For purposes of this subchapter, the term 
‘exempt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
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•AMDT. NO. 2786 
‘‘(B) the medical assistance program es-
tablished by title XIX or XXI of the Social Se-
curity Act, 
‘‘(C) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to individuals (or 
the spouses and dependents thereof) by reason 
of such individuals being members of the 
Armed Forces of the United States or veterans, 
and 
‘‘(D) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to members of In-
dian tribes (as defined in section 4(d) of the In-
dian Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of subtitle 
F, the fees imposed by this subchapter shall be treated 
as if they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion of the United States.’’. 
(B) CLERICAL AMENDMENTS.— 
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•AMDT. NO. 2786 
(i) Chapter 34 of such Code is amend-
ed by striking the chapter heading and in-
serting the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS 
‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(ii) The table of chapters for subtitle 
D of such Code is amended by striking the 
item relating to chapter 34 and inserting 
the following new item: 
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’. 
(f) TAX-EXEMPT STATUS
OF
THE PATIENT-CEN-
TERED OUTCOMES RESEARCH INSTITUTE.—Subsection 
501(l) of the Internal Revenue Code of 1986 is amended 
by adding at the end the following new paragraph: 
‘‘(4) The Patient-Centered Outcomes Research 
Institute established under section 1181(b) of the 
Social Security Act.’’. 
SEC. 6302. FEDERAL COORDINATING COUNCIL FOR COM-
PARATIVE EFFECTIVENESS RESEARCH. 
Notwithstanding any other provision of law, the Fed-
eral Coordinating Council for Comparative Effectiveness 
Research established under section 804 of Division A of 
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•AMDT. NO. 2786 
the American Recovery and Reinvestment Act of 2009 (42 
U.S.C. 299b–8), including the requirement under sub-
section (e)(2) of such section, shall terminate on the date 
of enactment of this Act. 
Subtitle 
E—Medicare, 
Medicaid, 
and CHIP Program Integrity 
Provisions 
SEC. 6401. PROVIDER SCREENING AND OTHER ENROLL-
MENT REQUIREMENTS UNDER MEDICARE, 
MEDICAID, AND CHIP. 
(a) MEDICARE.—Section 1866(j) of the Social Secu-
rity Act (42 U.S.C. 1395cc(j)) is amended— 
(1) in paragraph (1)(A), by adding at the end 
the following: ‘‘Such process shall include screening 
of providers and suppliers in accordance with para-
graph (2), a provisional period of enhanced oversight 
in accordance with paragraph (3), disclosure require-
ments in accordance with paragraph (4), the imposi-
tion of temporary enrollment moratoria in accord-
ance with paragraph (5), and the establishment of 
compliance programs in accordance with paragraph 
(6).’’; 
(2) by redesignating paragraph (2) as para-
graph (7); and 
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•AMDT. NO. 2786 
(3) by inserting after paragraph (1) the fol-
lowing: 
‘‘(2) PROVIDER SCREENING.— 
‘‘(A) PROCEDURES.—Not later than 180 
days after the date of enactment of this para-
graph, the Secretary, in consultation with the 
Inspector General of the Department of Health 
and Human Services, shall establish procedures 
under which screening is conducted with respect 
to providers of medical or other items or serv-
ices and suppliers under the program under this 
title, the Medicaid program under title XIX, 
and the CHIP program under title XXI. 
‘‘(B) LEVEL
OF
SCREENING.—The Sec-
retary shall determine the level of screening 
conducted under this paragraph according to 
the risk of fraud, waste, and abuse, as deter-
mined by the Secretary, with respect to the cat-
egory of provider of medical or other items or 
services or supplier. Such screening— 
‘‘(i) shall include a licensure check, 
which may include such checks across 
States; and 
‘‘(ii) may, as the Secretary determines 
appropriate based on the risk of fraud, 
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•AMDT. NO. 2786 
waste, and abuse described in the pre-
ceding sentence, include— 
‘‘(I) 
a 
criminal 
background 
check; 
‘‘(II) fingerprinting; 
‘‘(III) unscheduled and unan-
nounced 
site 
visits, 
including 
preenrollment site visits; 
‘‘(IV) database checks (including 
such checks across States); and 
‘‘(V) such other screening as the 
Secretary determines appropriate. 
‘‘(C) APPLICATION FEES.— 
‘‘(i) INDIVIDUAL PROVIDERS.—Except 
as provided in clause (iii), the Secretary 
shall impose a fee on each individual pro-
vider of medical or other items or services 
or supplier (such as a physician, physician 
assistant, nurse practitioner, or clinical 
nurse specialist) with respect to which 
screening is conducted under this para-
graph in an amount equal to— 
‘‘(I) for 2010, $200; and 
‘‘(II) for 2011 and each subse-
quent year, the amount determined 
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•AMDT. NO. 2786 
under this clause for the preceding 
year, adjusted by the percentage 
change in the consumer price index 
for all urban consumers (all items; 
United States city average) for the 
12-month period ending with June of 
the previous year. 
‘‘(ii) INSTITUTIONAL
PROVIDERS.— 
Except as provided in clause (iii), the Sec-
retary shall impose a fee on each institu-
tional provider of medical or other items or 
services or supplier (such as a hospital or 
skilled nursing facility) with respect to 
which screening is conducted under this 
paragraph in an amount equal to— 
‘‘(I) for 2010, $500; and 
‘‘(II) for 2011 and each subse-
quent year, the amount determined 
under this clause for the preceding 
year, adjusted by the percentage 
change in the consumer price index 
for all urban consumers (all items; 
United States city average) for the 
12-month period ending with June of 
the previous year. 
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•AMDT. NO. 2786 
‘‘(iii) HARDSHIP EXCEPTION; WAIVER 
FOR CERTAIN MEDICAID PROVIDERS.—The 
Secretary may, on a case-by-case basis, ex-
empt a provider of medical or other items 
or services or supplier from the imposition 
of an application fee under this subpara-
graph if the Secretary determines that the 
imposition of the application fee would re-
sult in a hardship. The Secretary may 
waive the application fee under this sub-
paragraph for providers enrolled in a State 
Medicaid program for whom the State 
demonstrates that imposition of the fee 
would impede beneficiary access to care. 
‘‘(iv) USE OF FUNDS.—Amounts col-
lected as a result of the imposition of a fee 
under this subparagraph shall be used by 
the Secretary for program integrity efforts, 
including to cover the costs of conducting 
screening under this paragraph and to 
carry out this subsection and section 
1128J. 
‘‘(D) APPLICATION AND ENFORCEMENT.— 
‘‘(i) NEW
PROVIDERS
OF
SERVICES 
AND
SUPPLIERS.—The screening under 
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•AMDT. NO. 2786 
this paragraph shall apply, in the case of 
a provider of medical or other items or 
services or supplier who is not enrolled in 
the program under this title, title XIX , or 
title XXI as of the date of enactment of 
this paragraph, on or after the date that is 
1 year after such date of enactment. 
‘‘(ii) CURRENT PROVIDERS OF SERV-
ICES
AND
SUPPLIERS.—The 
screening 
under this paragraph shall apply, in the 
case of a provider of medical or other 
items or services or supplier who is en-
rolled in the program under this title, title 
XIX, or title XXI as of such date of enact-
ment, on or after the date that is 2 years 
after such date of enactment. 
‘‘(iii) REVALIDATION
OF
ENROLL-
MENT.—Effective beginning on the date 
that is 180 days after such date of enact-
ment, the screening under this paragraph 
shall apply with respect to the revalidation 
of enrollment of a provider of medical or 
other items or services or supplier in the 
program under this title, title XIX, or title 
XXI. 
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•AMDT. NO. 2786 
‘‘(iv) LIMITATION
ON
ENROLLMENT 
AND REVALIDATION OF ENROLLMENT.—In 
no case may a provider of medical or other 
items or services or supplier who has not 
been screened under this paragraph be ini-
tially enrolled or reenrolled in the program 
under this title, title XIX, or title XXI on 
or after the date that is 3 years after such 
date of enactment. 
‘‘(E) EXPEDITED RULEMAKING.—The Sec-
retary may promulgate an interim final rule to 
carry out this paragraph. 
‘‘(3) PROVISIONAL
PERIOD
OF
ENHANCED 
OVERSIGHT FOR NEW PROVIDERS OF SERVICES AND 
SUPPLIERS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures to provide for a provisional 
period of not less than 30 days and not more 
than 1 year during which new providers of med-
ical or other items or services and suppliers, as 
the Secretary determines appropriate, including 
categories of providers or suppliers, would be 
subject to enhanced oversight, such as prepay-
ment review and payment caps, under the pro-
gram under this title, the Medicaid program 
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•AMDT. NO. 2786 
under title XIX. and the CHIP program under 
title XXI. 
‘‘(B) IMPLEMENTATION.—The Secretary 
may establish by program instruction or other-
wise the procedures under this paragraph. 
‘‘(4) 
INCREASED
DISCLOSURE
REQUIRE-
MENTS.— 
‘‘(A) DISCLOSURE.—A provider of medical 
or other items or services or supplier who sub-
mits an application for enrollment or revalida-
tion of enrollment in the program under this 
title , title XIX, or title XXI on or after the 
date that is 1 year after the date of enactment 
of this paragraph shall disclose (in a form and 
manner and at such time as determined by the 
Secretary) any current or previous affiliation 
(directly or indirectly) with a provider of med-
ical or other items or services or supplier that 
has uncollected debt, has been or is subject to 
a payment suspension under a Federal health 
care program (as defined in section 1128B(f)), 
has been excluded from participation under the 
program under this title, the Medicaid program 
under title XIX, or the CHIP program under 
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•AMDT. NO. 2786 
title XXI, or has had its billing privileges de-
nied or revoked. 
‘‘(B) AUTHORITY
TO
DENY
ENROLL-
MENT.—If the Secretary determines that such 
previous affiliation poses an undue risk of 
fraud, waste, or abuse, the Secretary may deny 
such application. Such a denial shall be subject 
to appeal in accordance with paragraph (7). 
‘‘(5) AUTHORITY
TO
ADJUST
PAYMENTS
OF 
PROVIDERS OF SERVICES AND SUPPLIERS WITH THE 
SAME TAX IDENTIFICATION NUMBER FOR PAST-DUE 
OBLIGATIONS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this title, in the case of an 
applicable provider of services or supplier, the 
Secretary may make any necessary adjustments 
to payments to the applicable provider of serv-
ices or supplier under the program under this 
title in order to satisfy any past-due obligations 
described in subparagraph (B)(ii) of an obli-
gated provider of services or supplier. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) IN GENERAL.—The term ‘applica-
ble provider of services or supplier’ means 
a provider of services or supplier that has 
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•AMDT. NO. 2786 
the same taxpayer identification number 
assigned under section 6109 of the Inter-
nal Revenue Code of 1986 as is assigned 
to the obligated provider of services or sup-
plier under such section, regardless of 
whether the applicable provider of services 
or supplier is assigned a different billing 
number or national provider identification 
number under the program under this title 
than is assigned to the obligated provider 
of services or supplier. 
‘‘(ii) OBLIGATED PROVIDER OF SERV-
ICES OR SUPPLIER.—The term ‘obligated 
provider of services or supplier’ means a 
provider of services or supplier that owes a 
past-due obligation under the program 
under this title (as determined by the Sec-
retary). 
‘‘(6) TEMPORARY
MORATORIUM
ON
ENROLL-
MENT OF NEW PROVIDERS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
impose a temporary moratorium on the enroll-
ment of new providers of services and suppliers, 
including categories of providers of services and 
suppliers, in the program under this title, under 
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•AMDT. NO. 2786 
(2) by inserting after subparagraph (C), the fol-
lowing: 
‘‘(D) Subsections (a)(77) and (ii) of sec-
tion 1902 (relating to provider and supplier 
screening, oversight, and reporting require-
ments).’’. 
SEC. 6402. ENHANCED MEDICARE AND MEDICAID PRO-
GRAM INTEGRITY PROVISIONS. 
(a) IN GENERAL.—Part A of title XI of the Social 
Security Act (42 U.S.C. 1301 et seq.), as amended by sec-
tions 6002, 6004, and 6102, is amended by inserting after 
section 1128I the following new section: 
‘‘SEC. 1128J. MEDICARE AND MEDICAID PROGRAM INTEG-
RITY PROVISIONS. 
‘‘(a) DATA MATCHING.— 
‘‘(1) INTEGRATED DATA REPOSITORY.— 
‘‘(A) INCLUSION OF CERTAIN DATA.— 
‘‘(i) IN
GENERAL.—The Integrated 
Data Repository of the Centers for Medi-
care & Medicaid Services shall include, at 
a minimum, claims and payment data from 
the following: 
‘‘(I) The programs under titles 
XVIII and XIX (including parts A, B, 
C, and D of title XVIII). 
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