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Consumers (all items: U.S. City Average) for 
such preceding fiscal year. 
‘‘(C) HARDSHIP EXCEPTION.—For purposes 
of subparagraph (A)(ii), this subparagraph ap-
plies to a child if the State determines, on a 
case-by-case basis, that the annual aggregate 
amount of premiums and cost-sharing imposed 
for coverage of the family of the child would ex-
ceed 5 percent of such family’s income for the 
year involved.’’. 
(E) Section 2113 of such Act (42 U.S.C. 1397mm) is 
amended— 
(i) in subsection (a)(1), by striking ‘‘2013’’ and 
inserting ‘‘2015’’; and 
(ii) in subsection (g), by striking ‘‘$100,000,000 
for the period of fiscal years 2009 through 2013’’ and 
inserting ‘‘$140,000,000 for the period of fiscal years 
2009 through 2015’’. 
(F) Section 108 of Public Law 111–3 is amended by 
striking ‘‘$11,706,000,000’’ and all that follows through the 
second sentence and inserting ‘‘$15,361,000,000 to accom-
pany the allotment made for the period beginning on Octo-
ber 1, 2014, and ending on March 31, 2015, under section 
2104(a)(18)(A) of the Social Security Act (42 U.S.C. 
1397dd(a)(18)(A)), to remain available until expended. 
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Such amount shall be used to provide allotments to States 
under paragraph (3) of section 2104(m) of the Social Secu-
rity Act (42 U.S.C. 1397dd(m)) for the first 6 months of 
fiscal year 2015 in the same manner as allotments are pro-
vided under subsection (a)(18)(A) of such section 2104 and 
subject to the same terms and conditions as apply to the 
allotments provided from such subsection (a)(18)(A).’’. 
PART II—SUPPORT FOR PREGNANT AND 
PARENTING TEENS AND WOMEN 
SEC. 10211. DEFINITIONS. 
In this part: 
(1) ACCOMPANIMENT.—The term ‘‘accompani-
ment’’ means assisting, representing, and accom-
panying a woman in seeking judicial relief for child 
support, child custody, restraining orders, and res-
titution for harm to persons and property, and in fil-
ing criminal charges, and may include the payment 
of court costs and reasonable attorney and witness 
fees associated therewith. 
(2) ELIGIBLE
INSTITUTION
OF
HIGHER
EDU-
CATION.—The term ‘‘eligible institution of higher edu-
cation’’ means an institution of higher education (as 
such term is defined in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001)) that has es-
tablished and operates, or agrees to establish and op-
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erate upon the receipt of a grant under this part, a 
pregnant and parenting student services office. 
(3) COMMUNITY
SERVICE
CENTER.—The term 
‘‘community service center’’ means a non-profit orga-
nization that provides social services to residents of a 
specific geographical area via direct service or by con-
tract with a local governmental agency. 
(4) HIGH
SCHOOL.—The term ‘‘high school’’ 
means any public or private school that operates 
grades 10 through 12, inclusive, grades 9 through 12, 
inclusive or grades 7 through 12, inclusive. 
(5) INTERVENTION SERVICES.—The term ‘‘inter-
vention services’’ means, with respect to domestic vio-
lence, sexual violence, sexual assault, or stalking, 24- 
hour telephone hotline services for police protection 
and referral to shelters. 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(7) STATE.—The term ‘‘State’’ includes the Dis-
trict of Columbia, any commonwealth, possession, or 
other territory of the United States, and any Indian 
tribe or reservation. 
(8) SUPPORTIVE
SOCIAL
SERVICES.—The term 
‘‘supportive social services’’ means transitional and 
permanent housing, vocational counseling, and indi-
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vidual and group counseling aimed at preventing do-
mestic violence, sexual violence, sexual assault, or 
stalking. 
(9) VIOLENCE.—The term ‘‘violence’’ means ac-
tual violence and the risk or threat of violence. 
SEC. 10212. ESTABLISHMENT OF PREGNANCY ASSISTANCE 
FUND. 
(a) IN GENERAL.—The Secretary, in collaboration and 
coordination with the Secretary of Education (as appro-
priate), shall establish a Pregnancy Assistance Fund to be 
administered by the Secretary, for the purpose of awarding 
competitive grants to States to assist pregnant and par-
enting teens and women. 
(b) USE OF FUND.—A State may apply for a grant 
under subsection (a) to carry out any activities provided 
for in section 10213. 
(c) APPLICATIONS.—To be eligible to receive a grant 
under subsection (a), a State shall submit to the Secretary 
an application at such time, in such manner, and con-
taining such information as the Secretary may require, in-
cluding a description of the purposes for which the grant 
is being requested and the designation of a State agency 
for receipt and administration of funding received under 
this part. 
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SEC. 10213. PERMISSIBLE USES OF FUND. 
(a) IN GENERAL.—A State shall use amounts received 
under a grant under section 10212 for the purposes de-
scribed in this section to assist pregnant and parenting 
teens and women. 
(b) INSTITUTIONS OF HIGHER EDUCATION.— 
(1) IN GENERAL.—A State may use amounts re-
ceived under a grant under section 10212 to make 
funding available to eligible institutions of higher 
education to enable the eligible institutions to estab-
lish, maintain, or operate pregnant and parenting 
student services. Such funding shall be used to supple-
ment, not supplant, existing funding for such services. 
(2) APPLICATION.—An eligible institution of 
higher education that desires to receive funding under 
this subsection shall submit an application to the des-
ignated State agency at such time, in such manner, 
and containing such information as the State agency 
may require. 
(3) MATCHING REQUIREMENT.—An eligible insti-
tution of higher education that receives funding under 
this subsection shall contribute to the conduct of the 
pregnant and parenting student services office sup-
ported by the funding an amount from non-Federal 
funds equal to 25 percent of the amount of the fund-
ing provided. The non-Federal share may be in cash 
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or in-kind, fairly evaluated, including services, facili-
ties, supplies, or equipment. 
(4) USE OF FUNDS FOR ASSISTING PREGNANT 
AND PARENTING COLLEGE STUDENTS.—An eligible in-
stitution of higher education that receives funding 
under this subsection shall use such funds to establish, 
maintain or operate pregnant and parenting student 
services and may use such funding for the following 
programs and activities: 
(A) Conduct a needs assessment on campus 
and within the local community— 
(i) to assess pregnancy and parenting 
resources, located on the campus or within 
the local community, that are available to 
meet the needs described in subparagraph 
(B); and 
(ii) to set goals for— 
(I) improving such resources for 
pregnant, parenting, and prospective 
parenting students; and 
(II) improving access to such re-
sources. 
(B) Annually assess the performance of the 
eligible institution in meeting the following needs 
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of students enrolled in the eligible institution 
who are pregnant or are parents: 
(i) The inclusion of maternity coverage 
and the availability of riders for additional 
family members in student health care. 
(ii) Family housing. 
(iii) Child care. 
(iv) Flexible or alternative academic 
scheduling, such as telecommuting pro-
grams, to enable pregnant or parenting stu-
dents to continue their education or stay in 
school. 
(v) Education to improve parenting 
skills for mothers and fathers and to 
strengthen marriages. 
(vi) Maternity and baby clothing, baby 
food (including formula), baby furniture, 
and similar items to assist parents and pro-
spective parents in meeting the material 
needs of their children. 
(vii) Post-partum counseling. 
(C) Identify public and private service pro-
viders, located on the campus of the eligible in-
stitution or within the local community, that are 
qualified to meet the needs described in subpara-
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graph (B), and establishes programs with quali-
fied providers to meet such needs. 
(D) Assist pregnant and parenting students, 
fathers or spouses in locating and obtaining serv-
ices that meet the needs described in subpara-
graph (B). 
(E) If appropriate, provide referrals for 
prenatal care and delivery, infant or foster care, 
or adoption, to a student who requests such in-
formation. An office shall make such referrals 
only to service providers that serve the following 
types of individuals: 
(i) Parents. 
(ii) 
Prospective 
parents 
awaiting 
adoption. 
(iii) Women who are pregnant and 
plan on parenting or placing the child for 
adoption. 
(iv) Parenting or prospective par-
enting couples. 
(5) REPORTING.— 
(A) ANNUAL REPORT BY INSTITUTIONS.— 
(i) IN GENERAL.—For each fiscal year 
that an eligible institution of higher edu-
cation receives funds under this subsection, 
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the eligible institution shall prepare and 
submit to the State, by the date determined 
by the State, a report that— 
(I) itemizes the pregnant and par-
enting student services office’s expendi-
tures for the fiscal year; 
(II) contains a review and evalua-
tion of the performance of the office in 
fulfilling the requirements of this sec-
tion, using the specific performance 
criteria or standards established under 
subparagraph (B)(i); and 
(III) describes the achievement of 
the office in meeting the needs listed in 
paragraph (4)(B) of the students served 
by the eligible institution, and the fre-
quency of use of the office by such stu-
dents. 
(ii) 
PERFORMANCE
CRITERIA.—Not 
later than 180 days before the date the an-
nual report described in clause (i) is sub-
mitted, the State— 
(I) shall identify the specific per-
formance criteria or standards that 
shall be used to prepare the report; and 
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(II) may establish the form or for-
mat of the report. 
(B) REPORT
BY
STATE.—The State shall 
annually prepare and submit a report on the 
findings under this subsection, including the 
number of eligible institutions of higher edu-
cation that were awarded funds and the number 
of students served by each pregnant and par-
enting student services office receiving funds 
under this section, to the Secretary. 
(c) SUPPORT
FOR
PREGNANT
AND
PARENTING 
TEENS.—A State may use amounts received under a grant 
under section 10212 to make funding available to eligible 
high schools and community service centers to establish, 
maintain or operate pregnant and parenting services in the 
same general manner and in accordance with all conditions 
and requirements described in subsection (b), except that 
paragraph (3) of such subsection shall not apply for pur-
poses of this subsection. 
(d) IMPROVING SERVICES
FOR PREGNANT WOMEN 
WHO ARE VICTIMS OF DOMESTIC VIOLENCE, SEXUAL VIO-
LENCE, SEXUAL ASSAULT, AND STALKING.— 
(1) IN GENERAL.—A State may use amounts re-
ceived under a grant under section 10212 to make 
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funding available tp its State Attorney General to as-
sist Statewide offices in providing— 
(A) intervention services, accompaniment, 
and supportive social services for eligible preg-
nant women who are victims of domestic vio-
lence, sexual violence, sexual assault, or stalking. 
(B) technical assistance and training (as 
described in subsection (c)) relating to violence 
against eligible pregnant women to be made 
available to the following: 
(i) Federal, State, tribal, territorial, 
and local governments, law enforcement 
agencies, and courts. 
(ii) Professionals working in legal, so-
cial service, and health care settings. 
(iii) Nonprofit organizations. 
(iv) Faith-based organizations. 
(2) ELIGIBILITY.—To be eligible for a grant 
under paragraph (1), a State Attorney General shall 
submit an application to the designated State agency 
at such time, in such manner, and containing such 
information, as specified by the State. 
(3) TECHNICAL ASSISTANCE AND TRAINING DE-
SCRIBED.—For purposes of paragraph (1)(B), tech-
nical assistance and training is— 
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(A) the identification of eligible pregnant 
women experiencing domestic violence, sexual vi-
olence, sexual assault, or stalking; 
(B) the assessment of the immediate and 
short-term safety of such a pregnant woman, the 
evaluation of the impact of the violence or stalk-
ing on the pregnant woman’s health, and the as-
sistance of the pregnant woman in developing a 
plan aimed at preventing further domestic vio-
lence, sexual violence, sexual assault, or stalking, 
as appropriate; 
(C) the maintenance of complete medical or 
forensic records that include the documentation 
of any examination, treatment given, and refer-
rals made, recording the location and nature of 
the pregnant woman’s injuries, and the establish-
ment of mechanisms to ensure the privacy and 
confidentiality of those medical records; and 
(D) the identification and referral of the 
pregnant woman to appropriate public and pri-
vate nonprofit entities that provide intervention 
services, accompaniment, and supportive social 
services. 
(4) ELIGIBLE PREGNANT WOMAN.—In this sub-
section, the term ‘‘eligible pregnant woman’’ means 
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any woman who is pregnant on the date on which 
such woman becomes a victim of domestic violence, 
sexual violence, sexual assault, or stalking or who was 
pregnant during the one-year period before such date. 
(e) PUBLIC AWARENESS AND EDUCATION.—A State 
may use amounts received under a grant under section 
10212 to make funding available to increase public aware-
ness and education concerning any services available to 
pregnant and parenting teens and women under this part, 
or any other resources available to pregnant and parenting 
women in keeping with the intent and purposes of this part. 
The State shall be responsible for setting guidelines or limits 
as to how much of funding may be utilized for public 
awareness and education in any funding award. 
SEC. 10214. APPROPRIATIONS. 
There is authorized to be appropriated, and there are 
appropriated, $25,000,000 for each of fiscal years 2010 
through 2019, to carry out this part. 
PART III—INDIAN HEALTH CARE IMPROVEMENT 
SEC. 10221. INDIAN HEALTH CARE IMPROVEMENT. 
(a) IN GENERAL.—Except as provided in subsection 
(b), S. 1790 entitled ‘‘A bill to amend the Indian Health 
Care Improvement Act to revise and extend that Act, and 
for other purposes.’’, as reported by the Committee on In-
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dian Affairs of the Senate in December 2009, is enacted 
into law. 
(b) AMENDMENTS.— 
(1) Section 119 of the Indian Health Care Im-
provement Act (as amended by section 111 of the bill 
referred to in subsection (a)) is amended— 
(A) in subsection (d)— 
(i) in paragraph (2), by striking ‘‘In 
establishing’’ and inserting ‘‘Subject to 
paragraphs (3) and (4), in establishing’’; 
and 
(ii) by adding at the end the following: 
‘‘(3) ELECTION OF INDIAN TRIBE OR TRIBAL OR-
GANIZATION.— 
‘‘(A) IN GENERAL.—Subparagraph (B) of 
paragraph (2) shall not apply in the case of an 
election made by an Indian tribe or tribal orga-
nization located in a State (other than Alaska) 
in which the use of dental health aide therapist 
services or midlevel dental health provider serv-
ices is authorized under State law to supply such 
services in accordance with State law. 
‘‘(B) ACTION BY SECRETARY.—On an elec-
tion by an Indian tribe or tribal organization 
under subparagraph (A), the Secretary, acting 
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through the Service, shall facilitate implementa-
tion of the services elected. 
‘‘(4) VACANCIES.—The Secretary shall not fill 
any vacancy for a certified dentist in a program op-
erated by the Service with a dental health aide thera-
pist.’’; and 
(B) by adding at the end the following: 
‘‘(e) EFFECT OF SECTION.—Nothing in this section 
shall restrict the ability of the Service, an Indian tribe, or 
a tribal organization to participate in any program or to 
provide any service authorized by any other Federal law.’’. 
(2) The Indian Health Care Improvement Act 
(as amended by section 134(b) of the bill referred to 
in subsection (a)) is amended by striking section 125 
(relating to treatment of scholarships for certain pur-
poses). 
(3) Section 806 of the Indian Health Care Im-
provement Act (25 U.S.C. 1676) is amended— 
(A) by striking ‘‘Any limitation’’ and in-
serting the following: 
‘‘(a) HHS APPROPRIATIONS.—Any limitation’’; and 
(B) by adding at the end the following: 
‘‘(b) LIMITATIONS PURSUANT TO OTHER FEDERAL 
LAW.—Any limitation pursuant to other Federal laws on 
the use of Federal funds appropriated to the Service shall 
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apply with respect to the performance or coverage of abor-
tions.’’. 
(4) The bill referred to in subsection (a) is 
amended by striking section 201. 
Subtitle C—Provisions Relating to 
Title III 
SEC. 10301. PLANS FOR A VALUE-BASED PURCHASING PRO-
GRAM FOR AMBULATORY SURGICAL CEN-
TERS. 
(a) IN GENERAL.—Section 3006 is amended by adding 
at the end the following new subsection: 
‘‘(f) AMBULATORY SURGICAL CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary shall develop 
a plan to implement a value-based purchasing pro-
gram for payments under the Medicare program 
under title XVIII of the Social Security Act for am-
bulatory surgical centers (as described in section 
1833(i) of the Social Security Act (42 U.S.C. 
1395l(i))). 
‘‘(2) DETAILS.—In developing the plan under 
paragraph (1), the Secretary shall consider the fol-
lowing issues: 
‘‘(A) The ongoing development, selection, 
and modification process for measures (including 
under section 1890 of the Social Security Act (42 
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U.S.C. 1395aaa) and section 1890A of such Act, 
as added by section 3014), to the extent feasible 
and practicable, of all dimensions of quality and 
efficiency in ambulatory surgical centers. 
‘‘(B) The reporting, collection, and valida-
tion of quality data. 
‘‘(C) The structure of value-based payment 
adjustments, including the determination of 
thresholds or improvements in quality that 
would substantiate a payment adjustment, the 
size of such payments, and the sources of funding 
for the value-based bonus payments. 
‘‘(D) Methods for the public disclosure of in-
formation on the performance of ambulatory sur-
gical centers. 
‘‘(E) Any other issues determined appro-
priate by the Secretary. 
‘‘(3) CONSULTATION.—In developing the plan 
under paragraph (1), the Secretary shall— 
‘‘(A) consult with relevant affected parties; 
and 
‘‘(B) consider experience with such dem-
onstrations that the Secretary determines are rel-
evant to the value-based purchasing program de-
scribed in paragraph (1). 
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‘‘(4) REPORT
TO
CONGRESS.—Not later than 
January 1, 2011, the Secretary shall submit to Con-
gress a report containing the plan developed under 
paragraph (1).’’. 
(b) TECHNICAL.—Section 3006(a)(2)(A) is amended 
by striking clauses (i) and (ii). 
SEC. 10302. REVISION TO NATIONAL STRATEGY FOR QUAL-
ITY IMPROVEMENT IN HEALTH CARE. 
Section 399HH(a)(2)(B)(iii) of the Public Health 
Service Act, as added by section 3011, is amended by insert-
ing ‘‘(taking into consideration the limitations set forth in 
subsections (c) and (d) of section 1182 of the Social Security 
Act)’’ after ‘‘information’’. 
SEC. 10303. DEVELOPMENT OF OUTCOME MEASURES. 
(a) DEVELOPMENT.—Section 931 of the Public Health 
Service Act, as added by section 3013(a), is amended by 
adding at the end the following new subsection: 
‘‘(f) DEVELOPMENT OF OUTCOME MEASURES.— 
‘‘(1) IN GENERAL.—The Secretary shall develop, 
and periodically update (not less than every 3 years), 
provider-level outcome measures for hospitals and 
physicians, as well as other providers as determined 
appropriate by the Secretary. 
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‘‘(2) CATEGORIES OF MEASURES.—The measures 
developed under this subsection shall include, to the 
extent determined appropriate by the Secretary— 
‘‘(A) outcome measurement for acute and 
chronic diseases, including, to the extent feasible, 
the 5 most prevalent and resource-intensive acute 
and chronic medical conditions; and 
‘‘(B) outcome measurement for primary and 
preventative care, including, to the extent fea-
sible, measurements that cover provision of such 
care for distinct patient populations (such as 
healthy children, chronically ill adults, or infirm 
elderly individuals). 
‘‘(3) GOALS.—In developing such measures, the 
Secretary shall seek to— 
‘‘(A) address issues regarding risk adjust-
ment, accountability, and sample size; 
‘‘(B) include the full scope of services that 
comprise a cycle of care; and 
‘‘(C) include multiple dimensions. 
‘‘(4) TIMEFRAME.— 
‘‘(A) ACUTE AND CHRONIC DISEASES.—Not 
later than 24 months after the date of enactment 
of this Act, the Secretary shall develop not less 
than 10 measures described in paragraph (2)(A). 
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‘‘(B) PRIMARY
AND
PREVENTIVE
CARE.— 
Not later than 36 months after the date of enact-
ment of this Act, the Secretary shall develop not 
less than 10 measures described in paragraph 
(2)(B).’’. 
(b) 
HOSPITAL-ACQUIRED
CONDITIONS.—Section 
1890A of the Social Security Act, as amended by section 
3013(b), is amended by adding at the end the following new 
subsection: 
‘‘(f) HOSPITAL ACQUIRED CONDITIONS.—The Sec-
retary shall, to the extent practicable, publicly report on 
measures for hospital-acquired conditions that are currently 
utilized by the Centers for Medicare & Medicaid Services 
for the adjustment of the amount of payment to hospitals 
based on rates of hospital-acquired infections.’’. 
(c) CLINICAL PRACTICE GUIDELINES.—Section 304(b) 
of the Medicare Improvements for Patients and Providers 
Act of 2008 (Public Law 110–275) is amended by adding 
at the end the following new paragraph: 
‘‘(4) IDENTIFICATION.— 
‘‘(A) IN GENERAL.—Following receipt of the 
report submitted under paragraph (2), and not 
less than every 3 years thereafter, the Secretary 
shall contract with the Institute to employ the 
results of the study performed under paragraph 
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(1) and the best methods identified by the Insti-
tute for the purpose of identifying existing and 
new clinical practice guidelines that were devel-
oped using such best methods, including guide-
lines listed in the National Guideline Clearing-
house. 
‘‘(B) CONSULTATION.—In carrying out the 
identification process under subparagraph (A), 
the Secretary shall allow for consultation with 
professional societies, voluntary health care orga-
nizations, and expert panels.’’. 
SEC. 10304. SELECTION OF EFFICIENCY MEASURES. 
Sections 1890(b)(7) and 1890A of the Social Security 
Act, as added by section 3014, are amended by striking 
‘‘quality’’ each place it appears and inserting ‘‘quality and 
efficiency’’. 
SEC. 10305. DATA COLLECTION; PUBLIC REPORTING. 
Section 399II(a) of the Public Health Service Act, as 
added by section 3015, is amended to read as follows: 
‘‘(a) IN GENERAL.— 
‘‘(1) ESTABLISHMENT
OF
STRATEGIC
FRAME-
WORK.—The Secretary shall establish and implement 
an overall strategic framework to carry out the public 
reporting of performance information, as described in 
section 399JJ. Such strategic framework may include 
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methods and related timelines for implementing na-
tionally consistent data collection, data aggregation, 
and analysis methods. 
‘‘(2) COLLECTION AND AGGREGATION OF DATA.— 
The Secretary shall collect and aggregate consistent 
data on quality and resource use measures from in-
formation systems used to support health care deliv-
ery, and may award grants or contracts for this pur-
pose. The Secretary shall align such collection and ag-
gregation efforts with the requirements and assistance 
regarding the expansion of health information tech-
nology systems, the interoperability of such technology 
systems, and related standards that are in effect on 
the date of enactment of the Patient Protection and 
Affordable Care Act. 
‘‘(3) SCOPE.—The Secretary shall ensure that 
the data collection, data aggregation, and analysis 
systems described in paragraph (1) involve an in-
creasingly broad range of patient populations, pro-
viders, and geographic areas over time.’’. 
SEC. 10306. IMPROVEMENTS UNDER THE CENTER FOR 
MEDICARE AND MEDICAID INNOVATION. 
Section 1115A of the Social Security Act, as added by 
section 3021, is amended— 
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(1) in subsection (a), by inserting at the end the 
following new paragraph: 
‘‘(5) TESTING
WITHIN
CERTAIN
GEOGRAPHIC 
AREAS.—For purposes of testing payment and service 
delivery models under this section, the Secretary may 
elect to limit testing of a model to certain geographic 
areas.’’; 
(2) in subsection (b)(2)— 
(A) in subparagraph (A)— 
(i) in the second sentence, by striking 
‘‘the preceding sentence may include’’ and 
inserting ‘‘this subparagraph may include, 
but are not limited to,’’; and 
(ii) by inserting after the first sentence 
the following new sentence: ‘‘The Secretary 
shall focus on models expected to reduce pro-
gram costs under the applicable title while 
preserving or enhancing the quality of care 
received by individuals receiving benefits 
under such title.’’; 
(B) in subparagraph (B), by adding at the 
end the following new clauses: 
‘‘(xix) Utilizing, in particular in enti-
ties located in medically underserved areas 
and facilities of the Indian Health Service 
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(whether operated by such Service or by an 
Indian tribe or tribal organization (as those 
terms are defined in section 4 of the Indian 
Health Care Improvement Act)), telehealth 
services— 
‘‘(I) in treating behavioral health 
issues (such as post-traumatic stress 
disorder) and stroke; and 
‘‘(II) to improve the capacity of 
non-medical providers and non-special-
ized medical providers to provide 
health services for patients with chron-
ic complex conditions. 
‘‘(xx) Utilizing a diverse network of 
providers of services and suppliers to im-
prove care coordination for applicable indi-
viduals described in subsection (a)(4)(A)(i) 
with 2 or more chronic conditions and a 
history 
of 
prior-year 
hospitalization 
through interventions developed under the 
Medicare Coordinated Care Demonstration 
Project under section 4016 of the Balanced 
Budget Act of 1997 (42 U.S.C. 1395b–1 
note).’’; and 
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(C) in subparagraph (C), by adding at the 
end the following new clause: 
‘‘(viii) Whether the model demonstrates 
effective linkage with other public sector or 
private sector payers.’’; 
(3) in subsection (b)(4), by adding at the end the 
following new subparagraph: 
‘‘(C) MEASURE SELECTION.—To the extent 
feasible, the Secretary shall select measures under 
this paragraph that reflect national priorities for 
quality improvement and patient-centered care 
consistent with the measures described in 
1890(b)(7)(B).’’; and 
(4) in subsection (c)— 
(A) in paragraph (1)(B), by striking ‘‘care 
and reduce spending; and’’ and inserting ‘‘pa-
tient care without increasing spending;’’; 
(B) in paragraph (2), by striking ‘‘reduce 
program spending under applicable titles.’’ and 
inserting ‘‘reduce (or would not result in any in-
crease in) net program spending under applica-
ble titles; and’’; and 
(C) by adding at the end the following: 
‘‘(3) the Secretary determines that such expan-
sion would not deny or limit the coverage or provi-
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sion of benefits under the applicable title for applica-
ble individuals. 
In determining which models or demonstration projects to 
expand under the preceding sentence, the Secretary shall 
focus on models and demonstration projects that improve 
the quality of patient care and reduce spending.’’. 
SEC. 10307. IMPROVEMENTS TO THE MEDICARE SHARED 
SAVINGS PROGRAM. 
Section 1899 of the Social Security Act, as added by 
section 3022, is amended by adding at the end the following 
new subsections: 
‘‘(i) OPTION TO USE OTHER PAYMENT MODELS.— 
‘‘(1) IN GENERAL.—If the Secretary determines 
appropriate, the Secretary may use any of the pay-
ment models described in paragraph (2) or (3) for 
making payments under the program rather than the 
payment model described in subsection (d). 
‘‘(2) PARTIAL CAPITATION MODEL.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), a model described in this paragraph 
is a partial capitation model in which an ACO 
is at financial risk for some, but not all, of the 
items and services covered under parts A and B, 
such as at risk for some or all physicians’ serv-
ices or all items and services under part B. The 
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Secretary may limit a partial capitation model 
to ACOs that are highly integrated systems of 
care and to ACOs capable of bearing risk, as de-
termined to be appropriate by the Secretary. 
‘‘(B) NO ADDITIONAL PROGRAM EXPENDI-
TURES.—Payments to an ACO for items and 
services under this title for beneficiaries for a 
year under the partial capitation model shall be 
established in a manner that does not result in 
spending more for such ACO for such bene-
ficiaries than would otherwise be expended for 
such ACO for such beneficiaries for such year if 
the model were not implemented, as estimated by 
the Secretary. 
‘‘(3) OTHER PAYMENT MODELS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), a model described in this paragraph 
is any payment model that the Secretary deter-
mines will improve the quality and efficiency of 
items and services furnished under this title. 
‘‘(B) NO ADDITIONAL PROGRAM EXPENDI-
TURES.—Subparagraph (B) of paragraph (2) 
shall apply to a payment model under subpara-
graph (A) in a similar manner as such subpara-
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graph (B) applies to the payment model under 
paragraph (2). 
‘‘(j) INVOLVEMENT IN PRIVATE PAYER AND OTHER 
THIRD PARTY ARRANGEMENTS.—The Secretary may give 
preference to ACOs who are participating in similar ar-
rangements with other payers. 
‘‘(k) TREATMENT
OF PHYSICIAN GROUP PRACTICE 
DEMONSTRATION.—During the period beginning on the 
date of the enactment of this section and ending on the date 
the program is established, the Secretary may enter into 
an agreement with an ACO under the demonstration under 
section 1866A, subject to rebasing and other modifications 
deemed appropriate by the Secretary.’’. 
SEC. 10308. REVISIONS TO NATIONAL PILOT PROGRAM ON 
PAYMENT BUNDLING. 
(a) IN GENERAL.—Section 1866D of the Social Secu-
rity Act, as added by section 3023, is amended— 
(1) in paragraph (a)(2)(B), in the matter pre-
ceding clause (i), by striking ‘‘8 conditions’’ and in-
serting ‘‘10 conditions’’; 
(2) by striking subsection (c)(1)(B) and inserting 
the following: 
‘‘(B) EXPANSION.—The Secretary may, at 
any point after January 1, 2016, expand the du-
ration and scope of the pilot program, to the ex-
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tent determined appropriate by the Secretary, 
if— 
‘‘(i) the Secretary determines that such 
expansion is expected to— 
‘‘(I) reduce spending under title 
XVIII of the Social Security Act with-
out reducing the quality of care; or 
‘‘(II) improve the quality of care 
and reduce spending; 
‘‘(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that such expansion would reduce program 
spending under such title XVIII; and 
‘‘(iii) the Secretary determines that 
such expansion would not deny or limit the 
coverage or provision of benefits under this 
title for individuals.’’; and 
(3) by striking subsection (g) and inserting the 
following new subsection: 
‘‘(g) APPLICATION
OF PILOT PROGRAM
TO CON-
TINUING CARE HOSPITALS.— 
‘‘(1) IN GENERAL.—In conducting the pilot pro-
gram, the Secretary shall apply the provisions of the 
program so as to separately pilot test the continuing 
care hospital model. 
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‘‘(2) SPECIAL RULES.—In pilot testing the con-
tinuing care hospital model under paragraph (1), the 
following rules shall apply: 
‘‘(A) Such model shall be tested without the 
limitation to the conditions selected under sub-
section (a)(2)(B). 
‘‘(B) Notwithstanding subsection (a)(2)(D), 
an episode of care shall be defined as the full pe-
riod that a patient stays in the continuing care 
hospital plus the first 30 days following dis-
charge from such hospital. 
‘‘(3) CONTINUING CARE HOSPITAL DEFINED.—In 
this subsection, the term ‘continuing care hospital’ 
means an entity that has demonstrated the ability to 
meet patient care and patient safety standards and 
that provides under common management the medical 
and rehabilitation services provided in inpatient re-
habilitation hospitals and units (as defined in section 
1886(d)(1)(B)(ii)), long term care hospitals (as de-
fined in section 1886(d)(1)(B)(iv)(I)), and skilled 
nursing facilities (as defined in section 1819(a)) that 
are located in a hospital described in section 
1886(d).’’. 
(b) TECHNICAL AMENDMENTS.— 
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(1) Section 3023 is amended by striking 
‘‘1886C’’ and inserting ‘‘1866C’’. 
(2) Title XVIII of the Social Security Act is 
amended by redesignating section 1866D, as added by 
section 3024, as section 1866E. 
SEC. 10309. REVISIONS TO HOSPITAL READMISSIONS RE-
DUCTION PROGRAM. 
Section 1886(q)(1) of the Social Security Act, as added 
by section 3025, in the matter preceding subparagraph (A), 
is amended by striking ‘‘the Secretary shall reduce the pay-
ments’’ and all that follows through ‘‘the product of’’ and 
inserting ‘‘the Secretary shall make payments (in addition 
to the payments described in paragraph (2)(A)(ii)) for such 
a discharge to such hospital under subsection (d) (or section 
1814(b)(3), as the case may be) in an amount equal to the 
product of’’. 
SEC. 10310. REPEAL OF PHYSICIAN PAYMENT UPDATE. 
The provisions of, and the amendment made by, sec-
tion 3101 are repealed. 
SEC. 10311. REVISIONS TO EXTENSION OF AMBULANCE 
ADD-ONS. 
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) of 
the Social Security Act (42 U.S.C. 1395m(l)(13)(A)), as 
amended by section 3105(a), is further amended— 
(1) in the matter preceding clause (i)— 
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(A) by striking ‘‘2007, for’’ and inserting 
‘‘2007, and for’’; and 
(B) by striking ‘‘2010, and for such services 
furnished on or after April 1, 2010, and before 
January 1, 2011’’ and inserting ‘‘2011’’; and 
(2) in each of clauses (i) and (ii)— 
(A) by striking ‘‘, and on or after April 1, 
2010, and before January 1, 2011’’ each place it 
appears; and 
(B) by striking ‘‘January 1, 2010’’ and in-
serting ‘‘January 1, 2011’’ each place it appears. 
(b) AIR AMBULANCE.—Section 146(b)(1) of the Medi-
care Improvements for Patients and Providers Act of 2008 
(Public Law 110–275), as amended by section 3105(b), is 
further amended by striking ‘‘December 31, 2009, and dur-
ing the period beginning on April 1, 2010, and ending on 
January 1, 2011’’ and inserting ‘‘December 31, 2010’’. 
(c) 
SUPER
RURAL
AMBULANCE.—Section 
1834(l)(12)(A) of the Social Security Act (42 U.S.C. 
1395m(l)(12)(A)), as amended by section 3105(c), is further 
amended by striking ‘‘2010, and on or after April 1, 2010, 
and before January 1, 2011’’ and inserting ‘‘2011’’. 
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SEC. 10312. CERTAIN PAYMENT RULES FOR LONG-TERM 
CARE HOSPITAL SERVICES AND MORATORIUM 
ON THE ESTABLISHMENT OF CERTAIN HOS-
PITALS AND FACILITIES. 
(a) CERTAIN PAYMENT RULES.—Section 114(c) of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 
U.S.C. 1395ww note), as amended by section 4302(a) of the 
American Recovery and Reinvestment Act (Public Law 
111–5) and section 3106(a) of this Act, is further amended 
by striking ‘‘4-year period’’ each place it appears and in-
serting ‘‘5-year period’’. 
(b) MORATORIUM.—Section 114(d) of such Act (42 
U.S.C. 1395ww note), as amended by section 3106(b) of this 
Act, in the matter preceding subparagraph (A), is amended 
by striking ‘‘4-year period’’ and inserting ‘‘5-year period’’. 
SEC. 10313. REVISIONS TO THE EXTENSION FOR THE RURAL 
COMMUNITY 
HOSPITAL 
DEMONSTRATION 
PROGRAM. 
(a) IN GENERAL.—Subsection (g) of section 410A of 
the Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2272), as added by section 3123(a) of this Act, is amended 
to read as follows: 
‘‘(g) FIVE-YEAR EXTENSION OF DEMONSTRATION PRO-
GRAM.— 
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‘‘(1) IN
GENERAL.—Subject to the succeeding 
provisions of this subsection, the Secretary shall con-
duct the demonstration program under this section for 
an additional 5-year period (in this section referred 
to as the ‘5-year extension period’) that begins on the 
date immediately following the last day of the initial 
5-year period under subsection (a)(5). 
‘‘(2) EXPANSION OF DEMONSTRATION STATES.— 
Notwithstanding subsection (a)(2), during the 5-year 
extension period, the Secretary shall expand the num-
ber of States with low population densities deter-
mined by the Secretary under such subsection to 20. 
In determining which States to include in such ex-
pansion, the Secretary shall use the same criteria and 
data that the Secretary used to determine the States 
under such subsection for purposes of the initial 5- 
year period. 
‘‘(3) INCREASE IN MAXIMUM NUMBER OF HOS-
PITALS PARTICIPATING IN THE DEMONSTRATION PRO-
GRAM.—Notwithstanding subsection (a)(4), during the 
5-year extension period, not more than 30 rural com-
munity hospitals may participate in the demonstra-
tion program under this section. 
‘‘(4) HOSPITALS IN DEMONSTRATION PROGRAM 
ON DATE OF ENACTMENT.—In the case of a rural 
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community hospital that is participating in the dem-
onstration program under this section as of the last 
day of the initial 5-year period, the Secretary— 
‘‘(A) shall provide for the continued partici-
pation of such rural community hospital in the 
demonstration program during the 5-year exten-
sion period unless the rural community hospital 
makes an election, in such form and manner as 
the Secretary may specify, to discontinue such 
participation; and 
‘‘(B) in calculating the amount of payment 
under subsection (b) to the rural community hos-
pital for covered inpatient hospital services fur-
nished by the hospital during such 5-year exten-
sion period, shall substitute, under paragraph 
(1)(A) of such subsection— 
‘‘(i) the reasonable costs of providing 
such services for discharges occurring in the 
first cost reporting period beginning on or 
after the first day of the 5-year extension 
period, for 
‘‘(ii) the reasonable costs of providing 
such services for discharges occurring in the 
first cost reporting period beginning on or 
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after the implementation of the demonstra-
tion program.’’. 
(b) CONFORMING AMENDMENTS.—Subsection (a)(5) of 
section 410A of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 108– 
173; 117 Stat. 2272), as amended by section 3123(b) of this 
Act, is amended by striking ‘‘1-year extension’’ and insert-
ing ‘‘5-year extension’’. 
SEC. 10314. ADJUSTMENT TO LOW-VOLUME HOSPITAL PRO-
VISION. 
Section 1886(d)(12) of the Social Security Act (42 
U.S.C. 1395ww(d)(12), as amended by section 3125, is 
amended— 
(1) in subparagraph (C)(i), by striking ‘‘1,500 
discharges’’ and inserting ‘‘1,600 discharges’’; and 
(2) in subparagraph (D), by striking ‘‘1,500 dis-
charges’’ and inserting ‘‘1,600 discharges’’. 
SEC. 10315. REVISIONS TO HOME HEALTH CARE PROVI-
SIONS. 
(a) REBASING.—Section 1895(b)(3)(A)(iii) of the So-
cial Security Act, as added by section 3131, is amended— 
(1) in the clause heading, by striking ‘‘2013’’ and 
inserting ‘‘2014’’; 
(2) in subclause (I), by striking ‘‘2013’’ and in-
serting ‘‘2014’’; and 
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(3) in subclause (II), by striking ‘‘2016’’ and in-
serting ‘‘2017’’. 
(b) REVISION OF HOME HEALTH STUDY AND RE-
PORT.—Section 3131(d) is amended to read as follows: 
‘‘(d) STUDY AND REPORT ON THE DEVELOPMENT OF 
HOME HEALTH PAYMENT REVISIONS IN ORDER TO EN-
SURE ACCESS TO CARE AND PAYMENT FOR SEVERITY OF 
ILLNESS.— 
‘‘(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘Secretary’) shall conduct a study on home health 
agency costs involved with providing ongoing access 
to care to low-income Medicare beneficiaries or bene-
ficiaries in medically underserved areas, and in treat-
ing beneficiaries with varying levels of severity of ill-
ness. In conducting the study, the Secretary may ana-
lyze items such as the following: 
‘‘(A) Methods to potentially revise the home 
health prospective payment system under section 
1895 of the Social Security Act (42 U.S.C. 
1395fff) to account for costs related to patient se-
verity of illness or to improving beneficiary ac-
cess to care, such as— 
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‘‘(i) payment adjustments for services 
that may involve additional or fewer re-
sources; 
‘‘(ii) changes to reflect resources in-
volved with providing home health services 
to low-income Medicare beneficiaries or 
Medicare beneficiaries residing in medically 
underserved areas; 
‘‘(iii) ways outlier payments might be 
revised to reflect costs of treating Medicare 
beneficiaries with high levels of severity of 
illness; and 
‘‘(iv) other issues determined appro-
priate by the Secretary. 
‘‘(B) Operational issues involved with po-
tential implementation of potential revisions to 
the home health payment system, including im-
pacts for both home health agencies and adminis-
trative and systems issues for the Centers for 
Medicare & Medicaid Services, and any possible 
payment vulnerabilities associated with imple-
menting potential revisions. 
‘‘(C) Whether additional research might be 
needed. 
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‘‘(D) Other items determined appropriate 
by the Secretary. 
‘‘(2) CONSIDERATIONS.—In conducting the study 
under paragraph (1), the Secretary may consider 
whether patient severity of illness and access to care 
could be measured by factors, such as— 
‘‘(A) population density and relative pa-
tient access to care; 
‘‘(B) variations in service costs for pro-
viding care to individuals who are dually eligi-
ble under the Medicare and Medicaid programs; 
‘‘(C) the presence of severe or chronic dis-
eases, which might be measured by multiple, dis-
continuous home health episodes; 
‘‘(D) poverty status, such as evidenced by 
the receipt of Supplemental Security Income 
under title XVI of the Social Security Act; and 
‘‘(E) other factors determined appropriate 
by the Secretary. 
‘‘(3) REPORT.—Not later than March 1, 2014, 
the Secretary shall submit to Congress a report on the 
study conducted under paragraph (1), together with 
recommendations for such legislation and administra-
tive action as the Secretary determines appropriate. 
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‘‘(4) CONSULTATIONS.—In conducting the study 
under paragraph (1), the Secretary shall consult with 
appropriate stakeholders, such as groups representing 
home health agencies and groups representing Medi-
care beneficiaries. 
‘‘(5) 
MEDICARE
DEMONSTRATION
PROJECT 
BASED ON THE RESULTS OF THE STUDY.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (D), taking into account the results of the 
study conducted under paragraph (1), the Sec-
retary may, as determined appropriate, provide 
for a demonstration project to test whether mak-
ing payment adjustments for home health serv-
ices under the Medicare program would substan-
tially improve access to care for patients with 
high severity levels of illness or for low-income or 
underserved Medicare beneficiaries. 
‘‘(B) WAIVING BUDGET NEUTRALITY.—The 
Secretary shall not reduce the standard prospec-
tive payment amount (or amounts) under section 
1895 of the Social Security Act (42 U.S.C. 
1395fff) applicable to home health services fur-
nished during a period to offset any increase in 
payments during such period resulting from the 
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application of the payment adjustments under 
subparagraph (A). 
‘‘(C) NO
EFFECT
ON
SUBSEQUENT
PERI-
ODS.—A payment adjustment resulting from the 
application of subparagraph (A) for a period— 
‘‘(i) shall not apply to payments for 
home health services under title XVIII after 
such period; and 
‘‘(ii) shall not be taken into account in 
calculating the payment amounts applicable 
for such services after such period. 
‘‘(D) DURATION.—If the Secretary deter-
mines it appropriate to conduct the demonstra-
tion project under this subsection, the Secretary 
shall conduct the project for a four year period 
beginning not later than January 1, 2015. 
‘‘(E) FUNDING.—The Secretary shall pro-
vide for the transfer from the Federal Hospital 
Insurance Trust Fund under section 1817 of the 
Social Security Act (42 U.S.C. 1395i) and the 
Federal Supplementary Medical Insurance Trust 
Fund established under section 1841 of such Act 
(42 U.S.C. 1395t), in such proportion as the Sec-
retary determines appropriate, of $500,000,000 
for the period of fiscal years 2015 through 2018. 
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Such funds shall be made available for the study 
described in paragraph (1) and the design, im-
plementation and evaluation of the demonstra-
tion described in this paragraph. Amounts avail-
able under this subparagraph shall be available 
until expended. 
‘‘(F) EVALUATION
AND
REPORT.—If the 
Secretary determines it appropriate to conduct 
the demonstration project under this subsection, 
the Secretary shall— 
‘‘(i) provide for an evaluation of the 
project; and 
‘‘(ii) submit to Congress, by a date 
specified by the Secretary, a report on the 
project. 
‘‘(G) ADMINISTRATION.—Chapter 35 of title 
44, United States Code, shall not apply with re-
spect to this subsection.’’. 
SEC. 10316. MEDICARE DSH. 
Section 1886(r)(2)(B) of the Social Security Act, as 
added by section 3133, is amended— 
(1) in clause (i)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘(divided by 100)’’; 
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(B) in subclause (I), by striking ‘‘2012’’ 
and inserting ‘‘2013’’; 
(C) in subclause (II), by striking the period 
at the end and inserting a comma; and 
(D) by adding at the end the following flush 
matter: 
‘‘minus 1.5 percentage points.’’. 
(2) in clause (ii)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘(divided by 100)’’; 
(B) in subclause (I), by striking ‘‘2012’’ 
and inserting ‘‘2013’’; 
(C) in subclause (II), by striking the period 
at the end and inserting a comma; and 
(D) by adding at the end the following flush 
matter: 
‘‘and, for each of 2018 and 2019, minus 1.5 
percentage points.’’. 
SEC. 10317. REVISIONS TO EXTENSION OF SECTION 508 
HOSPITAL PROVISIONS. 
Section 3137(a) is amended to read as follows: 
‘‘(a) EXTENSION.— 
‘‘(1) IN GENERAL.—Subsection (a) of section 106 
of division B of the Tax Relief and Health Care Act 
of 2006 (42 U.S.C. 1395 note), as amended by section 
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117 of the Medicare, Medicaid, and SCHIP Extension 
Act of 2007 (Public Law 110–173) and section 124 
of the Medicare Improvements for Patients and Pro-
viders Act of 2008 (Public Law 110–275), is amended 
by striking ‘September 30, 2009’ and inserting ‘Sep-
tember 30, 2010’. 
‘‘(2) SPECIAL RULE FOR FISCAL YEAR 2010.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), for purposes of implementation of the 
amendment made by paragraph (1), including 
(notwithstanding 
paragraph 
(3) 
of 
section 
117(a) of the Medicare, Medicaid and SCHIP 
Extension Act of 2007 (Public Law 110–173), as 
amended by section 124(b) of the Medicare Im-
provements for Patients and Providers Act of 
2008 (Public Law 110–275)) for purposes of the 
implementation of paragraph (2) of such section 
117(a), during fiscal year 2010, the Secretary of 
Health and Human Services (in this subsection 
referred to as the ‘Secretary’) shall use the hos-
pital wage index that was promulgated by the 
Secretary in the Federal Register on August 27, 
2009 (74 Fed. Reg. 43754), and any subsequent 
corrections. 
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‘‘(B) EXCEPTION.—Beginning on April 1, 
2010, in determining the wage index applicable 
to hospitals that qualify for wage index reclassi-
fication, the Secretary shall include the average 
hourly wage data of hospitals whose reclassifica-
tion was extended pursuant to the amendment 
made by paragraph (1) only if including such 
data results in a higher applicable reclassified 
wage index. 
‘‘(3) ADJUSTMENT FOR CERTAIN HOSPITALS IN 
FISCAL YEAR 2010.— 
‘‘(A) IN GENERAL.—In the case of a sub-
section (d) hospital (as defined in subsection 
(d)(1)(B) of section 1886 of the Social Security 
Act (42 U.S.C. 1395ww)) with respect to 
which— 
‘‘(i) a reclassification of its wage index 
for purposes of such section was extended 
pursuant to the amendment made by para-
graph (1); and 
‘‘(ii) the wage index applicable for 
such hospital for the period beginning on 
October 1, 2009, and ending on March 31, 
2010, was lower than for the period begin-
ning on April 1, 2010, and ending on Sep-
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tember 30, 2010, by reason of the applica-
tion of paragraph (2)(B); 
the Secretary shall pay such hospital an addi-
tional payment that reflects the difference be-
tween the wage index for such periods. 
‘‘(B) TIMEFRAME
FOR
PAYMENTS.—The 
Secretary shall make payments required under 
subparagraph by not later than December 31, 
2010.’’. 
SEC. 10318. REVISIONS TO TRANSITIONAL EXTRA BENEFITS 
UNDER MEDICARE ADVANTAGE. 
Section 1853(p)(3)(A) of the Social Security Act, as 
added by section 3201(h), is amended by inserting ‘‘in 
2009’’ before the period at the end. 
SEC. 10319. REVISIONS TO MARKET BASKET ADJUSTMENTS. 
(a) 
INPATIENT
ACUTE
HOSPITALS.—Section 
1886(b)(3)(B)(xii) of the Social Security Act, as added by 
section 3401(a), is amended— 
(1) in subclause (I), by striking ‘‘and’’ at the 
end; 
(2) by redesignating subclause (II) as subclause 
(III); 
(3) by inserting after subclause (II) the following 
new subclause: 
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‘‘(II) for each of fiscal years 2012 and 2013, by 
0.1 percentage point; and’’; and 
(4) in subclause (III), as redesignated by para-
graph (2), by striking ‘‘2012’’ and inserting ‘‘2014’’. 
(b) 
LONG-TERM
CARE
HOSPITALS.—Section 
1886(m)(4) of the Social Security Act, as added by section 
3401(c), is amended— 
(1) in subparagraph (A)— 
(A) in clause (i)— 
(i) by striking ‘‘each of rate years 2010 
and 2011’’ and inserting ‘‘rate year 2010’’; 
and 
(ii) by striking ‘‘and’’ at the end; 
(B) by redesignating clause (ii) as clause 
(iv); 
(C) by inserting after clause (i) the fol-
lowing new clauses: 
‘‘(ii) for rate year 2011, 0.50 percent-
age point; 
‘‘(iii) for each of the rate years begin-
ning in 2012 and 2013, 0.1 percentage 
point; and’’; and 
(D) in clause (iv), as redesignated by sub-
paragraph (B), by striking ‘‘2012’’ and inserting 
‘‘2014’’; and 
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(2) in subparagraph (B), by striking ‘‘(A)(ii)’’ 
and inserting ‘‘(A)(iv)’’. 
(c) INPATIENT REHABILITATION FACILITIES.—Section 
1886(j)(3)(D)(i) of the Social Security Act, as added by sec-
tion 3401(d), is amended— 
(1) in subclause (I), by striking ‘‘and’’ at the 
end; 
(2) by redesignating subclause (II) as subclause 
(III); 
(3) by inserting after subclause (II) the following 
new subclause: 
‘‘(II) for each of fiscal years 2012 
and 2013, 0.1 percentage point; and’’; 
and 
(4) in subclause (III), as redesignated by para-
graph (2), by striking ‘‘2012’’ and inserting ‘‘2014’’. 
(d) 
HOME
HEALTH
AGENCIES.—Section 
1895(b)(3)(B)(vi)(II) of such Act, as added by section 
3401(e), is amended by striking ‘‘and 2012’’ and inserting 
‘‘, 2012, and 2013’’. 
(e) PSYCHIATRIC HOSPITALS.—Section 1886(s)(3)(A) 
of the Social Security Act, as added by section 3401(f), is 
amended— 
(1) in clause (i), by striking ‘‘and’’ at the end; 
(2) by redesignating clause (ii) as clause (iii); 
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(3) by inserting after clause (ii) the following 
new clause: 
‘‘(ii) for each of the rate years begin-
ning in 2012 and 2013, 0.1 percentage 
point; and’’; and 
(4) in clause (iii), as redesignated by paragraph 
(2), by striking ‘‘2012’’ and inserting ‘‘2014’’. 
(f) HOSPICE CARE.—Section 1814(i)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395f(i)(1)(C)), as amended 
by section 3401(g), is amended— 
(1) in clause (iv)(II), by striking ‘‘0.5’’ and in-
serting ‘‘0.3’’; and 
(2) in clause (v), in the matter preceding sub-
clause (I), by striking ‘‘0.5’’ and inserting ‘‘0.3’’. 
(g) 
OUTPATIENT
HOSPITALS.—Section 
1833(t)(3)(G)(i) of the Social Security Act, as added by sec-
tion 3401(i), is amended— 
(1) in subclause (I), by striking ‘‘and’’ at the 
end; 
(2) by redesignating subclause (II) as subclause 
(III); 
(3) by inserting after subclause (II) the following 
new subclause: 
‘‘(II) for each of 2012 and 2013, 
0.1 percentage point; and’’; and 
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(4) in subclause (III), as redesignated by para-
graph (2), by striking ‘‘2012’’ and inserting ‘‘2014’’. 
SEC. 10320. EXPANSION OF THE SCOPE OF, AND ADDI-
TIONAL 
IMPROVEMENTS 
TO, 
THE 
INDE-
PENDENT MEDICARE ADVISORY BOARD. 
(a) IN GENERAL.—Section 1899A of the Social Secu-
rity Act, as added by section 3403, is amended— 
(1) in subsection (c)— 
(A) in paragraph (1)(B), by adding at the 
end the following new sentence: ‘‘In any year 
(beginning with 2014) that the Board is not re-
quired to submit a proposal under this section, 
the Board shall submit to Congress an advisory 
report on matters related to the Medicare pro-
gram.’’; 
(B) in paragraph (2)(A)— 
(i) in clause (iv), by inserting ‘‘or the 
full premium subsidy under section 1860D– 
14(a)’’ before the period at the end of the 
last sentence; and 
(ii) by adding at the end the following 
new clause: 
‘‘(vii) If the Chief Actuary of the Cen-
ters for Medicare & Medicaid Services has 
made a determination described in sub-
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section (e)(3)(B)(i)(II) in the determination 
year, the proposal shall be designed to help 
reduce the growth rate described in para-
graph (8) while maintaining or enhancing 
beneficiary access to quality care under this 
title.’’; 
(C) in paragraph (2)(B)— 
(i) in clause (v), by striking ‘‘and’’ at 
the end; 
(ii) in clause (vi), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the following 
new clause: 
‘‘(vii) take into account the data and 
findings contained in the annual reports 
under subsection (n) in order to develop 
proposals that can most effectively promote 
the delivery of efficient, high quality care to 
Medicare beneficiaries.’’; 
(D) in paragraph (3)— 
(i) in the heading, by striking ‘‘TRANS-
MISSION
OF
BOARD
PROPOSAL
TO
PRESI-
DENT’’ and inserting ‘‘SUBMISSION
OF 
BOARD PROPOSAL TO CONGRESS AND THE 
PRESIDENT’’; 
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(ii) in subparagraph (A)(i), by strik-
ing ‘‘transmit a proposal under this section 
to the President’’ and insert ‘‘submit a pro-
posal under this section to Congress and the 
President’’; and 
(iii) in subparagraph (A)(ii)— 
(I) in subclause (I), by inserting 
‘‘or’’ at the end; 
(II) in subclause (II), by striking 
‘‘; or’’ and inserting a period; and 
(III) by striking subclause (III); 
(E) in paragraph (4)— 
(i) by striking ‘‘the Board under para-
graph (3)(A)(i) or’’; and 
(ii) by striking ‘‘immediately’’ and in-
serting ‘‘within 2 days’’; 
(F) in paragraph (5)— 
(i) by striking ‘‘to but’’ and inserting 
‘‘but’’; and 
(ii) by inserting ‘‘Congress and’’ after 
‘‘submit a proposal to’’; and 
(G) in paragraph (6)(B)(i), by striking 
‘‘per unduplicated enrollee’’ and inserting ‘‘(cal-
culated as the sum of per capita spending under 
each of parts A, B, and D)’’; 
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(2) in subsection (d)— 
(A) in paragraph (1)(A)— 
(i) by inserting ‘‘the Board or’’ after 
‘‘a proposal is submitted by’’; and 
(ii) 
by 
inserting 
‘‘subsection 
(c)(3)(A)(i) or’’ after ‘‘the Senate under’’; 
and 
(B) in paragraph (2)(A), by inserting ‘‘the 
Board or’’ after ‘‘a proposal is submitted by’’; 
(3) in subsection (e)— 
(A) in paragraph (1), by inserting ‘‘the 
Board or’’ after ‘‘a proposal submitted by’’; and 
(B) in paragraph (3)— 
(i) by striking ‘‘EXCEPTION.—The Sec-
retary shall not be required to implement 
the recommendations contained in a pro-
posal submitted in a proposal year by’’ and 
inserting ‘‘EXCEPTIONS.— 
‘‘(A) IN GENERAL.—The Secretary shall not 
implement the recommendations contained in a 
proposal submitted in a proposal year by the 
Board or’’; 
(ii) by redesignating subparagraphs 
(A) and (B) as clauses (i) and (ii), respec-
tively, and indenting appropriately; and 
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(iii) by adding at the end the following 
new subparagraph: 
‘‘(B) LIMITED ADDITIONAL EXCEPTION.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), the Secretary shall not implement the 
recommendations contained in a proposal 
submitted by the Board or the President to 
Congress pursuant to this section in a pro-
posal year (beginning with proposal year 
2019) if— 
‘‘(I) the Board was required to 
submit a proposal to Congress under 
this section in the year preceding the 
proposal year; and 
‘‘(II) the Chief Actuary of the 
Centers for Medicare & Medicaid Serv-
ices makes a determination in the de-
termination year that the growth rate 
described in subsection (c)(8) exceeds 
the growth rate described in subsection 
(c)(6)(A)(i). 
‘‘(ii) LIMITED ADDITIONAL EXCEPTION 
MAY NOT BE APPLIED IN TWO CONSECUTIVE 
YEARS.—This subparagraph shall not apply 
if the recommendations contained in a pro-
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posal submitted by the Board or the Presi-
dent to Congress pursuant to this section in 
the year preceding the proposal year were 
not required to be implemented by reason of 
this subparagraph. 
‘‘(iii) NO AFFECT ON REQUIREMENT TO 
SUBMIT
PROPOSALS
OR
FOR
CONGRES-
SIONAL
CONSIDERATION
OF
PROPOSALS.— 
Clause (i) and (ii) shall not affect— 
‘‘(I) the requirement of the Board 
or the President to submit a proposal 
to Congress in a proposal year in ac-
cordance with the provisions of this 
section; or 
‘‘(II) Congressional consideration 
of a legislative proposal (described in 
subsection 
(c)(3)(B)(iv)) 
contained 
such a proposal in accordance with 
subsection (d).’’; 
(4) in subsection (f)(3)(B)— 
(A) by striking ‘‘or advisory reports to Con-
gress’’ and inserting ‘‘, advisory reports, or advi-
sory recommendations’’; and 
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(B) by inserting ‘‘or produce the public re-
port under subsection (n)’’ after ‘‘this section’’; 
and 
(5) by adding at the end the following new sub-
sections: 
‘‘(n) ANNUAL PUBLIC REPORT.— 
‘‘(1) IN GENERAL.—Not later than July 1, 2014, 
and annually thereafter, the Board shall produce a 
public report containing standardized information on 
system-wide health care costs, patient access to care, 
utilization, and quality-of-care that allows for com-
parison by region, types of services, types of pro-
viders, and both private payers and the program 
under this title. 
‘‘(2) REQUIREMENTS.—Each report produced 
pursuant to paragraph (1) shall include information 
with respect to the following areas: 
‘‘(A) The quality and costs of care for the 
population at the most local level determined 
practical by the Board (with quality and costs 
compared to national benchmarks and reflecting 
rates of change, taking into account quality 
measures described in section 1890(b)(7)(B)). 
‘‘(B) Beneficiary and consumer access to 
care, patient and caregiver experience of care, 
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and the cost-sharing or out-of-pocket burden on 
patients. 
‘‘(C) Epidemiological shifts and demo-
graphic changes. 
‘‘(D) The proliferation, effectiveness, and 
utilization of health care technologies, including 
variation in provider practice patterns and 
costs. 
‘‘(E) Any other areas that the Board deter-
mines affect overall spending and quality of care 
in the private sector. 
‘‘(o) ADVISORY RECOMMENDATIONS
FOR NON-FED-
ERAL HEALTH CARE PROGRAMS.— 
‘‘(1) IN GENERAL.—Not later than January 15, 
2015, and at least once every two years thereafter, the 
Board shall submit to Congress and the President rec-
ommendations to slow the growth in national health 
expenditures (excluding expenditures under this title 
and in other Federal health care programs) while pre-
serving or enhancing quality of care, such as rec-
ommendations— 
‘‘(A) that the Secretary or other Federal 
agencies can implement administratively; 
‘‘(B) that may require legislation to be en-
acted by Congress in order to be implemented; 
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‘‘(C) that may require legislation to be en-
acted by State or local governments in order to 
be implemented; 
‘‘(D) that private sector entities can volun-
tarily implement; and 
‘‘(E) with respect to other areas determined 
appropriate by the Board. 
‘‘(2) COORDINATION.—In making recommenda-
tions under paragraph (1), the Board shall coordinate 
such recommendations with recommendations con-
tained in proposals and advisory reports produced by 
the Board under subsection (c). 
‘‘(3) AVAILABLE TO PUBLIC.—The Board shall 
make recommendations submitted to Congress and the 
President under this subsection available to the pub-
lic.’’. 
(b) NAME CHANGE.—Any reference in the provisions 
of, or amendments made by, section 3403 to the ‘‘Inde-
pendent Medicare Advisory Board’’ shall be deemed to be 
a reference to the ‘‘Independent Payment Advisory Board’’. 
(c) RULE OF CONSTRUCTION.—Nothing in the amend-
ments made by this section shall preclude the Independent 
Medicare Advisory Board, as established under section 
1899A of the Social Security Act (as added by section 
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3403), from solely using data from public or private sources 
to carry out the amendments made by subsection (a)(4). 
SEC. 10321. REVISION TO COMMUNITY HEALTH TEAMS. 
Section 3502(c)(2)(A) is amended by inserting ‘‘or 
other primary care providers’’ after ‘‘physicians’’. 
SEC. 10322. QUALITY REPORTING FOR PSYCHIATRIC HOS-
PITALS. 
(a) IN GENERAL.—Section 1886(s) of the Social Secu-
rity Act, as added by section 3401(f), is amended by adding 
at the end the following new paragraph: 
‘‘(4) 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 psychiatric hospital or psychiatric 
unit that does not submit data to the Sec-
retary in accordance with subparagraph (C) 
with respect to such a rate year, any an-
nual update to a standard Federal rate for 
discharges for the hospital during the rate 
year, and after application of paragraph 
(2), 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 psychiatric hospital and psychiatric unit 
shall submit to the Secretary 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 Sec-
retary 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 psychiatric hospital 
and a psychiatric unit has the opportunity to re-
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view the data that is to be made public with re-
spect to the hospital or unit prior to such data 
being made public. The Secretary shall report 
quality measures that relate to services furnished 
in inpatient settings in psychiatric hospitals and 
psychiatric units on the Internet website of the 
Centers for Medicare & Medicaid Services.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1890(b)(7)(B)(i)(I) of the Social Security Act, as added by 
section 3014, is amended by inserting ‘‘1886(s)(4)(D),’’ 
after ‘‘1886(o)(2),’’. 
SEC. 10323. MEDICARE COVERAGE FOR INDIVIDUALS EX-
POSED TO ENVIRONMENTAL HEALTH HAZ-
ARDS. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) is amended by inserting after 
section 1881 the following new section: 
‘‘SEC. 1881A. MEDICARE COVERAGE FOR INDIVIDUALS EX-
POSED TO ENVIRONMENTAL HEALTH HAZ-
ARDS. 
‘‘(a) DEEMING
OF INDIVIDUALS
AS ELIGIBLE
FOR 
MEDICARE BENEFITS.— 
‘‘(1) IN GENERAL.—For purposes of eligibility 
for benefits under this title, an individual determined 
under subsection (c) to be an environmental exposure 
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affected individual described in subsection (e)(2) shall 
be deemed to meet the conditions specified in section 
226(a). 
‘‘(2) DISCRETIONARY DEEMING.—For purposes of 
eligibility for benefits under this title, the Secretary 
may deem an individual determined under subsection 
(c) to be an environmental exposure affected indi-
vidual described in subsection (e)(3) to meet the con-
ditions specified in section 226(a). 
‘‘(3) EFFECTIVE DATE OF COVERAGE.—An Indi-
vidual who is deemed eligible for benefits under this 
title under paragraph (1) or (2) shall be— 
‘‘(A) entitled to benefits under the program 
under Part A as of the date of such deeming; and 
‘‘(B) eligible to enroll in the program under 
Part B beginning with the month in which such 
deeming occurs. 
‘‘(b) PILOT PROGRAM FOR CARE OF CERTAIN INDIVID-
UALS RESIDING IN EMERGENCY DECLARATION AREAS.— 
‘‘(1) PROGRAM; PURPOSE.— 
‘‘(A) PRIMARY PILOT PROGRAM.—The Sec-
retary shall establish a pilot program in accord-
ance with this subsection to provide innovative 
approaches to furnishing comprehensive, coordi-
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nated, and cost-effective care under this title to 
individuals described in paragraph (2)(A). 
‘‘(B) OPTIONAL
PILOT
PROGRAMS.—The 
Secretary may establish a separate pilot pro-
gram, in accordance with this subsection, with 
respect to each geographic area subject to an 
emergency declaration (other than the declara-
tion of June 17, 2009), in order to furnish such 
comprehensive, coordinated and cost-effective 
care to individuals described in subparagraph 
(2)(B) who reside in each such area. 
‘‘(2) INDIVIDUAL DESCRIBED.—For purposes of 
paragraph (1), an individual described in this para-
graph is an individual who enrolls in part B, sub-
mits to the Secretary an application to participate in 
the applicable pilot program under this subsection, 
and— 
‘‘(A) is an environmental exposure affected 
individual described in subsection (e)(2) who re-
sides in or around the geographic area subject to 
an emergency declaration made as of June 17, 
2009; or 
‘‘(B) is an environmental exposure affected 
individual described in subsection (e)(3) who— 
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‘‘(i) is deemed under subsection (a)(2); 
and 
‘‘(ii) meets such other criteria or con-
ditions for participation in a pilot program 
under paragraph (1)(B) as the Secretary 
specifies. 
‘‘(3) FLEXIBLE
BENEFITS
AND
SERVICES.—A 
pilot program under this subsection may provide for 
the furnishing of benefits, items, or services not other-
wise covered or authorized under this title, if the Sec-
retary determines that furnishing such benefits, items, 
or services will further the purposes of such pilot pro-
gram (as described in paragraph (1)). 
‘‘(4) INNOVATIVE REIMBURSEMENT METHODOLO-
GIES.—For purposes of the pilot program under this 
subsection, the Secretary— 
‘‘(A) shall develop and implement appro-
priate methodologies to reimburse providers for 
furnishing benefits, items, or services for which 
payment is not otherwise covered or authorized 
under this title, if such benefits, items, or serv-
ices are furnished pursuant to paragraph (3); 
and 
‘‘(B) may develop and implement innova-
tive approaches to reimbursing providers for any 
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benefits, items, or services furnished under this 
subsection. 
‘‘(5) 
LIMITATION.—Consistent 
with 
section 
1862(b), no payment shall be made under the pilot 
program under this subsection with respect to bene-
fits, items, or services furnished to an environmental 
exposure affected individual (as defined in subsection 
(e)) to the extent that such individual is eligible to re-
ceive such benefits, items, or services through any 
other public or private benefits plan or legal agree-
ment. 
‘‘(6) WAIVER AUTHORITY.—The Secretary may 
waive such provisions of this title and title XI as are 
necessary to carry out pilot programs under this sub-
section. 
‘‘(7) FUNDING.—For purposes of carrying out 
pilot programs under this subsection, the Secretary 
shall provide for the transfer, from the Federal Hos-
pital Insurance Trust Fund under section 1817 and 
the Federal Supplementary Medical Insurance Trust 
Fund under section 1841, in such proportion as the 
Secretary determines appropriate, of such sums as the 
Secretary determines necessary, to the Centers for 
Medicare & Medicaid Services Program Management 
Account. 
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‘‘(8) WAIVER
OF
BUDGET
NEUTRALITY.—The 
Secretary shall not require that pilot programs under 
this subsection be budget neutral with respect to ex-
penditures under this title. 
‘‘(c) DETERMINATIONS.— 
‘‘(1) BY THE COMMISSIONER OF SOCIAL SECU-
RITY.—For purposes of this section, the Commissioner 
of Social Security, in consultation with the Secretary, 
and using the cost allocation method prescribed in 
section 201(g), shall determine whether individuals 
are environmental exposure affected individuals. 
‘‘(2) BY THE SECRETARY.—The Secretary shall 
determine eligibility for pilot programs under sub-
section (b). 
‘‘(d) EMERGENCY DECLARATION DEFINED.—For pur-
poses of this section, the term ‘emergency declaration’ means 
a declaration of a public health emergency under section 
104(a) of the Comprehensive Environmental Response, 
Compensation, and Liability Act of 1980. 
‘‘(e) ENVIRONMENTAL EXPOSURE AFFECTED INDI-
VIDUAL DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this section, 
the term ‘environmental exposure affected individual’ 
means— 
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‘‘(A) an individual described in paragraph 
(2); and 
‘‘(B) an individual described in paragraph 
(3). 
‘‘(2) INDIVIDUAL DESCRIBED.— 
‘‘(A) IN
GENERAL.—An individual de-
scribed in this paragraph is any individual 
who— 
‘‘(i) is diagnosed with 1 or more condi-
tions described in subparagraph (B); 
‘‘(ii) as demonstrated in such manner 
as the Secretary determines appropriate, 
has been present for an aggregate total of 6 
months in the geographic area subject to an 
emergency declaration specified in sub-
section (b)(2)(A), during a period ending— 
‘‘(I) not less than 10 years prior 
to such diagnosis; and 
‘‘(II) prior to the implementation 
of all the remedial and removal actions 
specified in the Record of Decision for 
Operating Unit 4 and the Record of 
Decision for Operating Unit 7; 
‘‘(iii) files an application for benefits 
under this title (or has an application filed 
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on behalf of the individual), including pur-
suant to this section; and 
‘‘(iv) is determined under this section 
to meet the criteria in this subparagraph. 
‘‘(B) CONDITIONS
DESCRIBED.—For pur-
poses of subparagraph (A), the following condi-
tions are described in this subparagraph: 
‘‘(i) Asbestosis, pleural thickening, or 
pleural plaques as established by— 
‘‘(I) interpretation by a ‘B Read-
er’ qualified physician of a plain chest 
x-ray or interpretation of a computed 
tomographic radiograph of the chest by 
a qualified physician, as determined 
by the Secretary; or 
‘‘(II) such other diagnostic stand-
ards as the Secretary specifies, 
except that this clause shall not apply to 
pleural thickening or pleural plaques unless 
there are symptoms or conditions requiring 
medical treatment as a result of these diag-
noses. 
‘‘(ii) Mesothelioma, or malignancies of 
the lung, colon, rectum, larynx, stomach, 
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esophagus, pharynx, or ovary, as established 
by— 
‘‘(I) pathologic examination of bi-
opsy tissue; 
‘‘(II) 
cytology 
from 
bronchioalveolar lavage; or 
‘‘(III) 
such 
other 
diagnostic 
standards as the Secretary specifies. 
‘‘(iii) Any other diagnosis which the 
Secretary, in consultation with the Commis-
sioner of Social Security, determines is an 
asbestos-related medical condition, as estab-
lished by such diagnostic standards as the 
Secretary specifies. 
‘‘(3) OTHER INDIVIDUAL DESCRIBED.—An indi-
vidual described in this paragraph is any individual 
who— 
‘‘(A) is not an individual described in 
paragraph (2); 
‘‘(B) is diagnosed with a medical condition 
caused by the exposure of the individual to a 
public health hazard to which an emergency dec-
laration applies, based on such medical condi-
tions, diagnostic standards, and other criteria as 
the Secretary specifies; 
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‘‘(C) as demonstrated in such manner as the 
Secretary determines appropriate, has been 
present for an aggregate total of 6 months in the 
geographic area subject to the emergency declara-
tion involved, during a period determined appro-
priate by the Secretary; 
‘‘(D) files an application for benefits under 
this title (or has an application filed on behalf 
of the individual), including pursuant to this 
section; and 
‘‘(E) is determined under this section to 
meet the criteria in this paragraph.’’. 
(b) PROGRAM FOR EARLY DETECTION OF CERTAIN 
MEDICAL
CONDITIONS
RELATED
TO
ENVIRONMENTAL 
HEALTH HAZARDS.—Title XX of the Social Security Act 
(42 U.S.C. 1397 et seq.), as amended by section 5507, is 
amended by adding at the end the following: 
‘‘SEC. 2009. PROGRAM FOR EARLY DETECTION OF CERTAIN 
MEDICAL CONDITIONS RELATED TO ENVI-
RONMENTAL HEALTH HAZARDS. 
‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary shall 
establish a program in accordance with this section to make 
competitive grants to eligible entities specified in subsection 
(b) for the purpose of— 
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‘‘(1) screening at-risk individuals (as defined in 
subsection (c)(1)) for environmental health conditions 
(as defined in subsection (c)(3)); and 
‘‘(2) developing and disseminating public infor-
mation and education concerning— 
‘‘(A) the availability of screening under the 
program under this section; 
‘‘(B) the detection, prevention, and treat-
ment of environmental health conditions; and 
‘‘(C) the availability of Medicare benefits 
for certain individuals diagnosed with environ-
mental health conditions under section 1881A. 
‘‘(b) ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—For purposes of this section, 
an eligible entity is an entity described in paragraph 
(2) which submits an application to the Secretary in 
such form and manner, and containing such informa-
tion and assurances, as the Secretary determines ap-
propriate. 
‘‘(2) TYPES OF ELIGIBLE ENTITIES.—The enti-
ties described in this paragraph are the following: 
‘‘(A) A hospital or community health center. 
‘‘(B) A Federally qualified health center. 
‘‘(C) A facility of the Indian Health Serv-
ice. 
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‘‘(D) A National Cancer Institute-des-
ignated cancer center. 
‘‘(E) An agency of any State or local gov-
ernment. 
‘‘(F) A nonprofit organization. 
‘‘(G) Any other entity the Secretary deter-
mines appropriate. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) AT-RISK INDIVIDUAL.—The term ‘at-risk in-
dividual’ means an individual who— 
‘‘(A)(i) as demonstrated in such manner as 
the Secretary determines appropriate, has been 
present for an aggregate total of 6 months in the 
geographic area subject to an emergency declara-
tion specified under paragraph (2), during a pe-
riod ending— 
‘‘(I) not less than 10 years prior to the 
date of such individual’s application under 
subparagraph (B); and 
‘‘(II) prior to the implementation of 
all the remedial and removal actions speci-
fied in the Record of Decision for Operating 
Unit 4 and the Record of Decision for Oper-
ating Unit 7; or 
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‘‘(ii) meets such other criteria as the Sec-
retary determines appropriate considering the 
type of environmental health condition at issue; 
and 
‘‘(B) has submitted an application (or has 
an application submitted on the individual’s be-
half), to an eligible entity receiving a grant 
under this section, for screening under the pro-
gram under this section. 
‘‘(2) 
EMERGENCY
DECLARATION.—The 
term 
‘emergency declaration’ means a declaration of a pub-
lic health emergency under section 104(a) of the Com-
prehensive Environmental Response, Compensation, 
and Liability Act of 1980. 
‘‘(3) ENVIRONMENTAL HEALTH CONDITION.—The 
term ‘environmental health condition’ means— 
‘‘(A) asbestosis, pleural thickening, or pleu-
ral plaques, as established by— 
‘‘(i) interpretation by a ‘B Reader’ 
qualified physician of a plain chest x-ray or 
interpretation of a computed tomographic 
radiograph of the chest by a qualified physi-
cian, as determined by the Secretary; or 
‘‘(ii) such other diagnostic standards 
as the Secretary specifies; 
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‘‘(B) mesothelioma, or malignancies of the 
lung, colon, rectum, larynx, stomach, esophagus, 
pharynx, or ovary, as established by— 
‘‘(i) pathologic examination of biopsy 
tissue; 
‘‘(ii) cytology from bronchioalveolar la-
vage; or 
‘‘(iii) such other diagnostic standards 
as the Secretary specifies; and 
‘‘(C) any other medical condition which the 
Secretary determines is caused by exposure to a 
hazardous substance or pollutant or contaminant 
at a Superfund site to which an emergency dec-
laration applies, based on such criteria and as 
established by such diagnostic standards as the 
Secretary specifies. 
‘‘(4) HAZARDOUS SUBSTANCE; POLLUTANT; CON-
TAMINANT.—The terms ‘hazardous substance’, ‘pollut-
ant’, and ‘contaminant’ have the meanings given 
those terms in section 101 of the Comprehensive Envi-
ronmental Response, Compensation, and Liability 
Act of 1980 (42 U.S.C. 9601). 
‘‘(5) SUPERFUND
SITE.—The term ‘Superfund 
site’ means a site included on the National Priorities 
List developed by the President in accordance with 
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section 105(a)(8)(B) of the Comprehensive Environ-
mental Response, Compensation, and Liability Act of 
1980 (42 U.S.C. 9605(a)(8)(B)). 
‘‘(d) HEALTH COVERAGE UNAFFECTED.—Nothing in 
this section shall be construed to affect any coverage obliga-
tion of a governmental or private health plan or program 
relating to an at-risk individual. 
‘‘(e) FUNDING.— 
‘‘(1) IN
GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there are ap-
propriated to the Secretary, to carry out the program 
under this section— 
‘‘(A) $23,000,000 for the period of fiscal 
years 2010 through 2014; and 
‘‘(B) $20,000,000 for each 5-fiscal year pe-
riod thereafter. 
‘‘(2) AVAILABILITY.—Funds appropriated under 
paragraph (1) shall remain available until expended. 
‘‘(f) NONAPPLICATION.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the preceding sections of this title shall not 
apply to grants awarded under this section. 
‘‘(2) LIMITATIONS ON USE OF GRANTS.—Section 
2005(a) shall apply to a grant awarded under this 
section to the same extent and in the same manner 
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as such section applies to payments to States under 
this title, except that paragraph (4) of such section 
shall not be construed to prohibit grantees from con-
ducting screening for environmental health conditions 
as authorized under this section.’’. 
SEC. 10324. PROTECTIONS FOR FRONTIER STATES. 
(a) FLOOR ON AREA WAGE INDEX FOR HOSPITALS IN 
FRONTIER STATES.— 
(1) IN GENERAL.—Section 1886(d)(3)(E) of the 
Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) is 
amended— 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘clause (ii) or (iii)’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(iii) FLOOR
ON
AREA
WAGE
INDEX 
FOR HOSPITALS IN FRONTIER STATES.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (IV), for discharges occurring 
on or after October 1, 2010, the area 
wage index applicable under this sub-
paragraph to any hospital which is lo-
cated in a frontier State (as defined in 
subclause (II)) may not be less than 
1.00. 
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‘‘(II) 
FRONTIER
STATE
DE-
FINED.—In this clause, the term ‘fron-
tier State’ means a State in which at 
least 50 percent of the counties in the 
State are frontier counties. 
‘‘(III) FRONTIER
COUNTY
DE-
FINED.—In this clause, the term ‘fron-
tier county’ means a county in which 
the population per square mile is less 
than 6. 
‘‘(IV) LIMITATION.—This clause 
shall not apply to any hospital located 
in a State that receives a non-labor re-
lated share adjustment under para-
graph (5)(H).’’. 
(2) WAIVING
BUDGET
NEUTRALITY.—Section 
1886(d)(3)(E) of the Social Security Act (42 U.S.C. 
1395ww(d)(3)(E)), as amended by subsection (a), is 
amended in the third sentence by inserting ‘‘and the 
amendments made by section 10324(a)(1) of the Pa-
tient Protection and Affordable Care Act’’ after 
‘‘2003’’. 
(b) FLOOR ON AREA WAGE ADJUSTMENT FACTOR FOR 
HOSPITAL OUTPATIENT DEPARTMENT SERVICES IN FRON-
TIER STATES.—Section 1833(t) of the Social Security Act 
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(42 U.S.C. 1395l(t)), as amended by section 3138, is 
amended— 
(1) in paragraph (2)(D), by striking ‘‘the Sec-
retary’’ and inserting ‘‘subject to paragraph (19), the 
Secretary’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(19) FLOOR ON AREA WAGE ADJUSTMENT FAC-
TOR FOR HOSPITAL OUTPATIENT DEPARTMENT SERV-
ICES IN FRONTIER STATES.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), with respect to covered OPD services 
furnished on or after January 1, 2011, the area 
wage adjustment factor applicable under the 
payment system established under this subsection 
to any hospital outpatient department which is 
located in a frontier State (as defined in section 
1886(d)(3)(E)(iii)(II)) may not be less than 
1.00. The preceding sentence shall not be applied 
in a budget neutral manner. 
‘‘(B) LIMITATION.—This paragraph shall 
not apply to any hospital outpatient department 
located in a State that receives a non-labor re-
lated 
share 
adjustment 
under 
section 
1886(d)(5)(H).’’. 
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(c) FLOOR FOR PRACTICE EXPENSE INDEX FOR PHY-
SICIANS’ SERVICES FURNISHED IN FRONTIER STATES.— 
Section 1848(e)(1) of the Social Security Act (42 U.S.C. 
1395w–4(e)(1)), as amended by section 3102, is amended— 
(1) in subparagraph (A), by striking ‘‘and (H)’’ 
and inserting ‘‘(H), and (I)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(I) FLOOR FOR PRACTICE EXPENSE INDEX 
FOR
SERVICES
FURNISHED
IN
FRONTIER 
STATES.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), for purposes of payment for services 
furnished in a frontier State (as defined in 
section 1886(d)(3)(E)(iii)(II)) on or after 
January 1, 2011, after calculating the prac-
tice expense index in subparagraph (A)(i), 
the Secretary shall increase any such index 
to 1.00 if such index would otherwise be less 
that 1.00. The preceding sentence shall not 
be applied in a budget neutral manner. 
‘‘(ii) LIMITATION.—This subparagraph 
shall not apply to services furnished in a 
State that receives a non-labor related share 
adjustment under section 1886(d)(5)(H).’’. 
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SEC. 10325. REVISION TO SKILLED NURSING FACILITY PRO-
SPECTIVE PAYMENT SYSTEM. 
(a) TEMPORARY
DELAY
OF
RUG–IV.—Notwith-
standing any other provision of law, the Secretary of 
Health and Human Services shall not, prior to October 1, 
2011, implement Version 4 of the Resource Utilization 
Groups (in this subsection refereed to as ‘‘RUG–IV’’) pub-
lished in the Federal Register on August 11, 2009, entitled 
‘‘Prospective Payment System and Consolidated Billing for 
Skilled Nursing Facilities for FY 2010; Minimum Data 
Set, Version 3.0 for Skilled Nursing Facilities and Medicaid 
Nursing Facilities’’ (74 Fed. Reg. 40288). Beginning on Oc-
tober 1, 2010, the Secretary of Health and Human Services 
shall implement the change specific to therapy furnished on 
a concurrent basis that is a component of RUG–IV and 
changes to the lookback period to ensure that only those 
services furnished after admission to a skilled nursing facil-
ity are used as factors in determining a case mix classifica-
tion under the skilled nursing facility prospective payment 
system under section 1888(e) of the Social Security Act (42 
U.S.C. 1395yy(e)). 
(b) CONSTRUCTION.—Nothing in this section shall be 
interpreted as delaying the implementation of Version 3.0 
of the Minimum Data Sets (MDS 3.0) beyond the planned 
implementation date of October 1, 2010. 
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SEC. 10326. PILOT TESTING PAY-FOR-PERFORMANCE PRO-
GRAMS FOR CERTAIN MEDICARE PROVIDERS. 
(a) IN GENERAL.—Not later than January 1, 2016, 
the Secretary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall, for each provider 
described in subsection (b), conduct a separate pilot pro-
gram under title XVIII of the Social Security Act to test 
the implementation of a value-based purchasing program 
for payments under such title for the provider. 
(b) PROVIDERS DESCRIBED.—The providers described 
in this paragraph are the following: 
(1) Psychiatric hospitals (as described in clause 
(i) of section 1886(d)(1)(B) of such Act (42 U.S.C. 
1395ww(d)(1)(B))) and psychiatric units (as de-
scribed in the matter following clause (v) of such sec-
tion). 
(2) Long-term care hospitals (as described in 
clause (iv) of such section). 
(3) Rehabilitation hospitals (as described in 
clause (ii) of such section). 
(4) PPS-exempt cancer hospitals (as described in 
clause (v) of such section). 
(5) Hospice programs (as defined in section 
1861(dd)(2) of such Act (42 U.S.C. 1395x(dd)(2))). 
(c) WAIVER AUTHORITY.—The Secretary may waive 
such requirements of titles XI and XVIII of the Social Secu-
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rity Act as may be necessary solely for purposes of carrying 
out the pilot programs under this section. 
(d) NO ADDITIONAL PROGRAM EXPENDITURES.—Pay-
ments under this section under the separate pilot program 
for value based purchasing (as described in subsection (a)) 
for each provider type described in paragraphs (1) through 
(5) of subsection (b) for applicable items and services under 
title XVIII of the Social Security Act for a year shall be 
established in a manner that does not result in spending 
more under each such value based purchasing program for 
such year than would otherwise be expended for such pro-
vider type for such year if the pilot program were not im-
plemented, as estimated by the Secretary. 
(e) EXPANSION OF PILOT PROGRAM.—The Secretary 
may, at any point after January 1, 2018, expand the dura-
tion and scope of a pilot program conducted under this sub-
section, to the extent determined appropriate by the Sec-
retary, if— 
(1) the Secretary determines that such expansion 
is expected to— 
(A) reduce spending under title XVIII of the 
Social Security Act without reducing the quality 
of care; or 
(B) improve the quality of care and reduce 
spending; 
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(2) the Chief Actuary of the Centers for Medicare 
& Medicaid Services certifies that such expansion 
would reduce program spending under such title 
XVIII; and 
(3) the Secretary determines that such expansion 
would not deny or limit the coverage or provision of 
benefits under such title XIII for Medicare bene-
ficiaries. 
SEC. 10327. IMPROVEMENTS TO THE PHYSICIAN QUALITY 
REPORTING SYSTEM. 
(a) IN GENERAL.—Section 1848(m) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(m)) is amended by adding 
at the end the following new paragraph: 
‘‘(7) ADDITIONAL INCENTIVE PAYMENT.— 
‘‘(A) IN GENERAL.—For 2011 through 2014, 
if an eligible professional meets the requirements 
described in subparagraph (B), the applicable 
quality percent for such year, as described in 
clauses (iii) and (iv) of paragraph (1)(B), shall 
be increased by 0.5 percentage points. 
‘‘(B) 
REQUIREMENTS
DESCRIBED.—In 
order to qualify for the additional incentive pay-
ment described in subparagraph (A), an eligible 
professional shall meet the following require-
ments: 
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‘‘(i) The eligible professional shall— 
‘‘(I) satisfactorily submit data on 
quality measures for purposes of para-
graph (1) for a year; and 
‘‘(II) have such data submitted on 
their behalf through a Maintenance of 
Certification Program (as defined in 
subparagraph (C)(i)) that meets— 
‘‘(aa) the criteria for a reg-
istry (as described in subsection 
(k)(4)); or 
‘‘(bb) an alternative form 
and manner determined appro-
priate by the Secretary. 
‘‘(ii) The eligible professional, more 
frequently than is required to qualify for or 
maintain board certification status— 
‘‘(I) participates in such a Main-
tenance of Certification program for a 
year; and 
‘‘(II) 
successfully 
completes 
a 
qualified Maintenance of Certification 
Program practice assessment (as de-
fined in subparagraph (C)(ii)) for such 
year. 
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‘‘(iii) A Maintenance of Certification 
program submits to the Secretary, on behalf 
of the eligible professional, information— 
‘‘(I) in a form and manner speci-
fied by the Secretary, that the eligible 
professional has successfully met the re-
quirements of clause (ii) (which may 
be in the form of a structural meas-
ure); 
‘‘(II) if requested by the Sec-
retary, on the survey of patient experi-
ence with care (as described in sub-
paragraph (C)(ii)(II)); and 
‘‘(III) as the Secretary may re-
quire, on the methods, measures, and 
data used under the Maintenance of 
Certification Program and the quali-
fied Maintenance of Certification Pro-
gram practice assessment. 
‘‘(C) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) The term ‘Maintenance of Certifi-
cation Program’ means a continuous assess-
ment program, such as qualified American 
Board of Medical Specialties Maintenance 
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of Certification program or an equivalent 
program (as determined by the Secretary), 
that advances quality and the lifelong 
learning and self-assessment of board cer-
tified specialty physicians by focusing on 
the competencies of patient care, medical 
knowledge, practice-based learning, inter-
personal and communication skills and pro-
fessionalism. Such a program shall include 
the following: 
‘‘(I) The program requires the 
physician to maintain a valid, unre-
stricted medical license in the United 
States. 
‘‘(II) The program requires a 
physician to participate in educational 
and self-assessment programs that re-
quire an assessment of what was 
learned. 
‘‘(III) The program requires a 
physician to demonstrate, through a 
formalized, secure examination, that 
the physician has the fundamental di-
agnostic skills, medical knowledge, and 
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clinical judgment to provide quality 
care in their respective specialty. 
‘‘(IV) The program requires suc-
cessful completion of a qualified Main-
tenance of Certification Program prac-
tice assessment as described in clause 
(ii). 
‘‘(ii) The term ‘qualified Maintenance 
of Certification Program practice assess-
ment’ means an assessment of a physician’s 
practice that— 
‘‘(I) includes an initial assess-
ment of an eligible professional’s prac-
tice that is designed to demonstrate the 
physician’s use of evidence-based medi-
cine; 
‘‘(II) includes a survey of patient 
experience with care; and 
‘‘(III) requires a physician to im-
plement a quality improvement inter-
vention to address a practice weakness 
identified in the initial assessment 
under subclause (I) and then to re-
measure to assess performance im-
provement after such intervention.’’. 
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(b) AUTHORITY.—Section 3002(c) of this Act is 
amended by adding at the end the following new paragraph: 
‘‘(3) AUTHORITY.—For years after 2014, if the 
Secretary of Health and Human Services determines 
it to be appropriate, the Secretary may incorporate 
participation in a Maintenance of Certification Pro-
gram and successful completion of a qualified Mainte-
nance of Certification Program practice assessment 
into the composite of measures of quality of care fur-
nished pursuant to the physician fee schedule pay-
ment modifier, as described in section 1848(p)(2) of 
the Social Security Act (42 U.S.C. 1395w–4(p)(2)).’’. 
(c) ELIMINATION OF MA REGIONAL PLAN STABILIZA-
TION FUND.— 
(1) IN GENERAL.—Section 1858 of the Social Se-
curity Act (42 U.S.C. 1395w–27a) is amended by 
striking subsection (e). 
(2) TRANSITION.—Any amount contained in the 
MA Regional Plan Stabilization Fund as of the date 
of the enactment of this Act shall be transferred to the 
Federal Supplementary Medical Insurance Trust 
Fund. 
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SEC. 10328. IMPROVEMENT IN PART D MEDICATION THER-
APY MANAGEMENT (MTM) PROGRAMS. 
(a) IN GENERAL.—Section 1860D–4(c)(2) of the So-
cial Security Act (42 U.S.C. 1395w–104(c)(2)) is amend-
ed— 
(1) by redesignating subparagraphs (C), (D), 
and (E) as subparagraphs (E), (F), and (G), respec-
tively; and 
(2) by inserting after subparagraph (B) the fol-
lowing new subparagraphs: 
‘‘(C) REQUIRED INTERVENTIONS.—For plan 
years beginning on or after the date that is 2 
years after the date of the enactment of the Pa-
tient Protection and Affordable Care Act, pre-
scription drug plan sponsors shall offer medica-
tion therapy management services to targeted 
beneficiaries described in subparagraph (A)(ii) 
that include, at a minimum, the following to in-
crease adherence to prescription medications or 
other goals deemed necessary by the Secretary: 
‘‘(i) An annual comprehensive medica-
tion review furnished person-to-person or 
using telehealth technologies (as defined by 
the Secretary) by a licensed pharmacist or 
other qualified provider. The comprehensive 
medication review— 
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‘‘(I) shall include a review of the 
individual’s medications and may re-
sult in the creation of a recommended 
medication action plan or other ac-
tions in consultation with the indi-
vidual and with input from the pre-
scriber to the extent necessary and 
practicable; and 
‘‘(II) shall include providing the 
individual with a written or printed 
summary of the results of the review. 
The Secretary, in consultation with relevant 
stakeholders, shall develop a standardized 
format for the action plan under subclause 
(I) and the summary under subclause (II). 
‘‘(ii) Follow-up interventions as war-
ranted based on the findings of the annual 
medication review or the targeted medica-
tion enrollment and which may be provided 
person-to-person or using telehealth tech-
nologies (as defined by the Secretary). 
‘‘(D) ASSESSMENT.—The prescription drug 
plan sponsor shall have in place a process to as-
sess, at least on a quarterly basis, the medication 
use of individuals who are at risk but not en-
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rolled in the medication therapy management 
program, including individuals who have experi-
enced a transition in care, if the prescription 
drug plan sponsor has access to that informa-
tion. 
‘‘(E) AUTOMATIC ENROLLMENT WITH ABIL-
ITY TO OPT-OUT.—The prescription drug plan 
sponsor shall have in place a process to— 
‘‘(i) subject to clause (ii), automati-
cally enroll targeted beneficiaries described 
in subparagraph (A)(ii), including bene-
ficiaries identified under subparagraph (D), 
in the medication therapy management pro-
gram required under this subsection; and 
‘‘(ii) permit such beneficiaries to opt- 
out of enrollment in such program.’’. 
(b) RULE OF CONSTRUCTION.—Nothing in this section 
shall limit the authority of the Secretary of Health and 
Human Services to modify or broaden requirements for a 
medication therapy management program under part D of 
title XVIII of the Social Security Act or to study new mod-
els for medication therapy management through the Center 
for Medicare and Medicaid Innovation under section 1115A 
of such Act, as added by section 3021. 
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SEC. 
10329. 
DEVELOPING 
METHODOLOGY 
TO 
ASSESS 
HEALTH PLAN VALUE. 
(a) DEVELOPMENT.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), in consultation with relevant stakeholders includ-
ing health insurance issuers, health care consumers, em-
ployers, health care providers, and other entities determined 
appropriate by the Secretary, shall develop a methodology 
to measure health plan value. Such methodology shall take 
into consideration, where applicable— 
(1) the overall cost to enrollees under the plan; 
(2) the quality of the care provided for under the 
plan; 
(3) the efficiency of the plan in providing care; 
(4) the relative risk of the plan’s enrollees as 
compared to other plans; 
(5) the actuarial value or other comparative 
measure of the benefits covered under the plan; and 
(6) other factors determined relevant by the Sec-
retary. 
(b) REPORT.—Not later than 18 months after the date 
of enactment of this Act, the Secretary shall submit to Con-
gress a report concerning the methodology developed under 
subsection (a). 
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SEC. 10330. MODERNIZING COMPUTER AND DATA SYSTEMS 
OF THE CENTERS FOR MEDICARE & MED-
ICAID 
SERVICES 
TO 
SUPPORT 
IMPROVE-
MENTS IN CARE DELIVERY. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall develop a plan (and detailed budget for the 
resources needed to implement such plan) to modernize the 
computer and data systems of the Centers for Medicare & 
Medicaid Services (in this section referred to as ‘‘CMS’’). 
(b) CONSIDERATIONS.—In developing the plan, the 
Secretary shall consider how such modernized computer sys-
tem could— 
(1) in accordance with the regulations promul-
gated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996, make 
available data in a reliable and timely manner to 
providers of services and suppliers to support their ef-
forts to better manage and coordinate care furnished 
to beneficiaries of CMS programs; and 
(2) support consistent evaluations of payment 
and delivery system reforms under CMS programs. 
(c) POSTING OF PLAN.—By not later than 9 months 
after the date of the enactment of this Act, the Secretary 
shall post on the website of the Centers for Medicare & Med-
icaid Services the plan described in subsection (a). 
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SEC. 10331. PUBLIC REPORTING OF PERFORMANCE INFOR-
MATION. 
(a) IN GENERAL.— 
(1) DEVELOPMENT.—Not later than January 1, 
2011, the Secretary shall develop a Physician Com-
pare Internet website with information on physicians 
enrolled in the Medicare program under section 
1866(j) of the Social Security Act (42 U.S.C. 
1395cc(j)) and other eligible professionals who par-
ticipate in the Physician Quality Reporting Initia-
tive under section 1848 of such Act (42 U.S.C. 
1395w–4). 
(2) PLAN.—Not later than January 1, 2013, and 
with respect to reporting periods that begin no earlier 
than January 1, 2012, the Secretary shall also imple-
ment a plan for making publicly available through 
Physician Compare, consistent with subsection (c), 
information on physician performance that provides 
comparable information for the public on quality and 
patient experience measures with respect to physi-
cians enrolled in the Medicare program under such 
section 1866(j). To the extent scientifically sound 
measures that are developed consistent with the re-
quirements of this section are available, such informa-
tion, to the extent practicable, shall include— 
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(A) measures collected under the Physician 
Quality Reporting Initiative; 
(B) an assessment of patient health out-
comes and the functional status of patients; 
(C) an assessment of the continuity and co-
ordination of care and care transitions, includ-
ing episodes of care and risk-adjusted resource 
use; 
(D) an assessment of efficiency; 
(E) an assessment of patient experience and 
patient, caregiver, and family engagement; 
(F) an assessment of the safety, effectiveness, 
and timeliness of care; and 
(G) other information as determined appro-
priate by the Secretary. 
(b) OTHER REQUIRED CONSIDERATIONS.—In devel-
oping and implementing the plan described in subsection 
(a)(2), the Secretary shall, to the extent practicable, in-
clude— 
(1) processes to assure that data made public, ei-
ther by the Centers for Medicare & Medicaid Services 
or by other entities, is statistically valid and reliable, 
including risk adjustment mechanisms used by the 
Secretary; 
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(2) processes by which a physician or other eligi-
ble professional whose performance on measures is 
being publicly reported has a reasonable opportunity, 
as determined by the Secretary, to review his or her 
individual results before they are made public; 
(3) processes by the Secretary to assure that the 
implementation of the plan and the data made avail-
able on Physician Compare provide a robust and ac-
curate portrayal of a physician’s performance; 
(4) data that reflects the care provided to all pa-
tients seen by physicians, under both the Medicare 
program and, to the extent practicable, other payers, 
to the extent such information would provide a more 
accurate portrayal of physician performance; 
(5) processes to ensure appropriate attribution of 
care when multiple physicians and other providers 
are involved in the care of a patient; 
(6) processes to ensure timely statistical perform-
ance feedback is provided to physicians concerning 
the data reported under any program subject to pub-
lic reporting under this section; and 
(7) implementation of computer and data sys-
tems of the Centers for Medicare & Medicaid Services 
that support valid, reliable, and accurate public re-
porting activities authorized under this section. 
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(c) ENSURING PATIENT PRIVACY.—The Secretary shall 
ensure that information on physician performance and pa-
tient experience is not disclosed under this section in a 
manner that violates sections 552 or 552a of title 5, United 
States Code, with regard to the privacy of individually 
identifiable health information. 
(d) 
FEEDBACK
FROM
MULTI-STAKEHOLDER 
GROUPS.—The Secretary shall take into consideration 
input provided by multi-stakeholder groups, consistent with 
sections 1890(b)(7) and 1890A of the Social Security Act, 
as added by section 3014 of this Act, in selecting quality 
measures for use under this section. 
(e) CONSIDERATION OF TRANSITION TO VALUE-BASED 
PURCHASING.—In developing the plan under this sub-
section (a)(2), the Secretary shall, as the Secretary deter-
mines appropriate, consider the plan to transition to a 
value-based purchasing program for physicians and other 
practitioners developed under section 131 of the Medicare 
Improvements for Patients and Providers Act of 2008 (Pub-
lic Law 110–275). 
(f) REPORT TO CONGRESS.—Not later than January 
1, 2015, the Secretary shall submit to Congress a report 
on the Physician Compare Internet website developed under 
subsection (a)(1). Such report shall include information on 
the efforts of and plans made by the Secretary to collect 
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and publish data on physician quality and efficiency and 
on patient experience of care in support of value-based pur-
chasing and consumer choice, together with recommenda-
tions for such legislation and administrative action as the 
Secretary determines appropriate. 
(g) EXPANSION.—At any time before the date on which 
the report is submitted under subsection (f), the Secretary 
may expand (including expansion to other providers of 
services and suppliers under title XVIII of the Social Secu-
rity Act) the information made available on such website. 
(h) FINANCIAL INCENTIVES TO ENCOURAGE CON-
SUMERS TO CHOOSE HIGH QUALITY PROVIDERS.—The 
Secretary may establish a demonstration program, not later 
than January 1, 2019, to provide financial incentives to 
Medicare beneficiaries who are furnished services by high 
quality physicians, as determined by the Secretary based 
on factors in subparagraphs (A) through (G) of subsection 
(a)(2). In no case may Medicare beneficiaries be required 
to pay increased premiums or cost sharing or be subject 
to a reduction in benefits under title XVIII of the Social 
Security Act as a result of such demonstration program. 
The Secretary shall ensure that any such demonstration 
program does not disadvantage those beneficiaries without 
reasonable access to high performing physicians or create 
financial inequities under such title. 
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(i) DEFINITIONS.—In this section: 
(1) ELIGIBLE PROFESSIONAL.—The term ‘‘eligi-
ble professional’’ has the meaning given that term for 
purposes of the Physician Quality Reporting Initia-
tive under section 1848 of the Social Security Act (42 
U.S.C. 1395w–4). 
(2) PHYSICIAN.—The term ‘‘physician’’ has the 
meaning given that term in section 1861(r) of such 
Act (42 U.S.C. 1395x(r)). 
(3) PHYSICIAN COMPARE.—The term ‘‘Physician 
Compare’’ means the Internet website developed under 
subsection (a)(1). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
SEC. 10332. AVAILABILITY OF MEDICARE DATA FOR PER-
FORMANCE MEASUREMENT. 
(a) IN GENERAL.—Section 1874 of the Social Security 
Act (42 U.S.C. 1395kk) is amended by adding at the end 
the following new subsection: 
‘‘(e) AVAILABILITY OF MEDICARE DATA.— 
‘‘(1) IN GENERAL.—Subject to paragraph (4), the 
Secretary shall make available to qualified entities 
(as defined in paragraph (2)) data described in para-
graph (3) for the evaluation of the performance of 
providers of services and suppliers. 
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‘‘(2) QUALIFIED ENTITIES.—For purposes of this 
subsection, the term ‘qualified entity’ means a public 
or private entity that— 
‘‘(A) is qualified (as determined by the Sec-
retary) to use claims data to evaluate the per-
formance of providers of services and suppliers 
on measures of quality, efficiency, effectiveness, 
and resource use; and 
‘‘(B) agrees to meet the requirements de-
scribed in paragraph (4) and meets such other 
requirements as the Secretary may specify, such 
as ensuring security of data. 
‘‘(3) DATA DESCRIBED.—The data described in 
this paragraph are standardized extracts (as deter-
mined by the Secretary) of claims data under parts 
A, B, and D for items and services furnished under 
such parts for one or more specified geographic areas 
and time periods requested by a qualified entity. The 
Secretary shall take such actions as the Secretary 
deems necessary to protect the identity of individuals 
entitled to or enrolled for benefits under such parts. 
‘‘(4) REQUIREMENTS.— 
‘‘(A) FEE.—Data described in paragraph 
(3) shall be made available to a qualified entity 
under this subsection at a fee equal to the cost 
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of making such data available. Any fee collected 
pursuant to the preceding sentence shall be de-
posited into the Federal Supplementary Medical 
Insurance Trust Fund under section 1841. 
‘‘(B) SPECIFICATION OF USES AND METH-
ODOLOGIES.—A qualified entity requesting data 
under this subsection shall— 
‘‘(i) submit to the Secretary a descrip-
tion of the methodologies that such qualified 
entity will use to evaluate the performance 
of providers of services and suppliers using 
such data; 
‘‘(ii)(I) except as provided in subclause 
(II), if available, use standard measures, 
such as measures endorsed by the entity 
with a contract under section 1890(a) and 
measures developed pursuant to section 931 
of the Public Health Service Act; or 
‘‘(II) use alternative measures if the 
Secretary, in consultation with appropriate 
stakeholders, determines that use of such al-
ternative measures would be more valid, re-
liable, responsive to consumer preferences, 
cost-effective, or relevant to dimensions of 
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quality and resource use not addressed by 
such standard measures; 
‘‘(iii) include data made available 
under this subsection with claims data from 
sources other than claims data under this 
title in the evaluation of performance of 
providers of services and suppliers; 
‘‘(iv) only include information on the 
evaluation of performance of providers and 
suppliers in reports described in subpara-
graph (C); 
‘‘(v) make available to providers of 
services and suppliers, upon their request, 
data made available under this subsection; 
and 
‘‘(vi) prior to their release, submit to 
the Secretary the format of reports under 
subparagraph (C). 
‘‘(C) REPORTS.—Any report by a qualified 
entity evaluating the performance of providers of 
services and suppliers using data made available 
under this subsection shall— 
‘‘(i) include an understandable descrip-
tion of the measures, which shall include 
quality measures and the rationale for use 
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of other measures described in subparagraph 
(B)(ii)(II), risk adjustment methods, physi-
cian attribution methods, other applicable 
methods, data specifications and limita-
tions, and the sponsors, so that consumers, 
providers of services and suppliers, health 
plans, researchers, and other stakeholders 
can assess such reports; 
‘‘(ii) be made available confidentially, 
to any provider of services or supplier to be 
identified in such report, prior to the public 
release of such report, and provide an op-
portunity to appeal and correct errors; 
‘‘(iii) only include information on a 
provider of services or supplier in an aggre-
gate form as determined appropriate by the 
Secretary; and 
‘‘(iv) except as described in clause (ii), 
be made available to the public. 
‘‘(D) 
APPROVAL
AND
LIMITATION
OF 
USES.—The Secretary shall not make data de-
scribed in paragraph (3) available to a qualified 
entity unless the qualified entity agrees to release 
the information on the evaluation of performance 
of providers of services and suppliers. Such enti-
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ty shall only use such data, and information de-
rived from such evaluation, for the reports under 
subparagraph (C). Data released to a qualified 
entity under this subsection shall not be subject 
to discovery or admission as evidence in judicial 
or administrative proceedings without consent of 
the applicable provider of services or supplier.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect on January 1, 2012. 
SEC. 10333. COMMUNITY-BASED COLLABORATIVE CARE 
NETWORKS. 
Part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end 
the following new subpart: 
‘‘Subpart XI—Community-Based Collaborative Care 
Network Program 
‘‘SEC. 340H. COMMUNITY-BASED COLLABORATIVE CARE 
NETWORK PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
to eligible entities to support community-based collaborative 
care networks that meet the requirements of subsection (b). 
‘‘(b) COMMUNITY-BASED COLLABORATIVE CARE NET-
WORKS.— 
‘‘(1) DESCRIPTION.—A community-based collabo-
rative care network (referred to in this section as a 
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‘network’) shall be a consortium of health care pro-
viders with a joint governance structure (including 
providers within a single entity) that provides com-
prehensive coordinated and integrated health care 
services (as defined by the Secretary) for low-income 
populations. 
‘‘(2) REQUIRED INCLUSION.—A network shall in-
clude the following providers (unless such provider 
does not exist within the community, declines or re-
fuses to participate, or places unreasonable conditions 
on their participation): 
‘‘(A) A hospital that meets the criteria in 
section 1923(b)(1) of the Social Security Act; 
and 
‘‘(B) All Federally qualified health centers 
(as defined in section 1861(aa) of the Social Se-
curity Act located in the community. 
‘‘(3) PRIORITY.—In awarding grants, the Sec-
retary shall give priority to networks that include— 
‘‘(A) the capability to provide the broadest 
range of services to low-income individuals; 
‘‘(B) the broadest range of providers that 
currently serve a high volume of low-income in-
dividuals; and 
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‘‘(C) a county or municipal department of 
health. 
‘‘(c) APPLICATION.— 
‘‘(1) APPLICATION.—A network described in sub-
section (b) shall submit an application to the Sec-
retary. 
‘‘(2) RENEWAL.—In subsequent years, based on 
the performance of grantees, the Secretary may pro-
vide renewal grants to prior year grant recipients. 
‘‘(d) USE OF FUNDS.— 
‘‘(1) USE BY GRANTEES.—Grant funds may be 
used for the following activities: 
‘‘(A) Assist low-income individuals to— 
‘‘(i) access and appropriately use 
health services; 
‘‘(ii) enroll in health coverage pro-
grams; and 
‘‘(iii) obtain a regular primary care 
provider or a medical home. 
‘‘(B) Provide case management and care 
management. 
‘‘(C) Perform health outreach using neigh-
borhood health workers or through other means. 
‘‘(D) Provide transportation. 
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‘‘(E) Expand capacity, including through 
telehealth, after-hours services or urgent care. 
‘‘(F) Provide direct patient care services. 
‘‘(2) GRANT FUNDS TO HRSA GRANTEES.—The 
Secretary may limit the percent of grant funding that 
may be spent on direct care services provided by 
grantees of programs administered by the Health Re-
sources and Services Administration or impose other 
requirements on such grantees deemed necessary. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated to carry out this section such 
sums as may be necessary for each of fiscal years 2011 
through 2015.’’. 
SEC. 10334. MINORITY HEALTH. 
(a) OFFICE OF MINORITY HEALTH.— 
(1) IN GENERAL.—Section 1707 of the Public 
Health Service Act (42 U.S.C. 300u–6) is amended— 
(A) in subsection (a), by striking ‘‘within 
the Office of Public Health and Science’’ and all 
that follows through the end and inserting ‘‘. The 
Office of Minority Health as existing on the date 
of enactment of the Patient Protection and Af-
fordable Care Act shall be transferred to the Of-
fice of the Secretary in such manner that there 
is established in the Office of the Secretary, the 
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Office of Minority Health, which shall be headed 
by the Deputy Assistant Secretary for Minority 
Health who shall report directly to the Secretary, 
and shall retain and strengthen authorities (as 
in existence on such date of enactment) for the 
purpose of improving minority health and the 
quality of health care minorities receive, and 
eliminating racial and ethnic disparities. In 
carrying out this subsection, the Secretary, act-
ing through the Deputy Assistant Secretary, 
shall award grants, contracts, enter into memo-
randa of understanding, cooperative, inter-
agency, intra-agency and other agreements with 
public and nonprofit private entities, agencies, 
as well as Departmental and Cabinet agencies 
and organizations, and with organizations that 
are indigenous human resource providers in 
communities of color to assure improved health 
status of racial and ethnic minorities, and shall 
develop measures to evaluate the effectiveness of 
activities aimed at reducing health disparities 
and supporting the local community. Such meas-
ures shall evaluate community outreach activi-
ties, language services, workforce cultural com-
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petence, and other areas as determined by the 
Secretary.’’; and 
(B) by striking subsection (h) and inserting 
the following: 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for each 
of fiscal years 2011 through 2016.’’. 
(2) TRANSFER OF FUNCTIONS.—There are trans-
ferred to the Office of Minority Health in the office 
of the Secretary of Health and Human Services, all 
duties, responsibilities, authorities, accountabilities, 
functions, staff, funds, award mechanisms, and other 
entities under the authority of the Office of Minority 
Health of the Public Health Service as in effect on the 
date before the date of enactment of this Act, which 
shall continue in effect according to the terms in effect 
on the date before such date of enactment, until modi-
fied, terminated, superseded, set aside, or revoked in 
accordance with law by the President, the Secretary, 
a court of competent jurisdiction, or by operation of 
law. 
(3) REPORTS.—Not later than 1 year after the 
date of enactment of this section, and biennially 
thereafter, the Secretary of Health and Human Serv-
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ices shall prepare and submit to the appropriate com-
mittees of Congress a report describing the activities 
carried out under section 1707 of the Public Health 
Service Act (as amended by this subsection) during 
the period for which the report is being prepared. Not 
later than 1 year after the date of enactment of this 
section, and biennially thereafter, the heads of each of 
the agencies of the Department of Health and Human 
Services shall submit to the Deputy Assistant Sec-
retary for Minority Health a report summarizing the 
minority health activities of each of the respective 
agencies. 
(b) ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI-
NORITY HEALTH WITHIN THE DEPARTMENT OF HEALTH 
AND HUMAN SERVICES.— 
(1) IN
GENERAL.—Title XVII of the Public 
Health Service Act (42 U.S.C. 300u et seq.) is amend-
ed by inserting after section 1707 the following sec-
tion: 
‘‘SEC. 1707A. INDIVIDUAL OFFICES OF MINORITY HEALTH 
WITHIN THE DEPARTMENT. 
‘‘(a) IN GENERAL.—The head of each agency specified 
in subsection (b)(1) shall establish within the agency an of-
fice to be known as the Office of Minority Health. The head 
of each such Office shall be appointed by the head of the 
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agency within which the Office is established, and shall re-
port directly to the head of the agency. The head of such 
agency shall carry out this section (as this section relates 
to the agency) acting through such Director. 
‘‘(b) SPECIFIED AGENCIES.—The agencies referred to 
in subsection (a) are the Centers for Disease Control and 
Prevention, the Health Resources and Services Administra-
tion, the Substance Abuse and Mental Health Services Ad-
ministration, the Agency for Healthcare Research and 
Quality, the Food and Drug Administration, and the Cen-
ters for Medicare & Medicaid Services. 
‘‘(c) DIRECTOR; APPOINTMENT.—Each Office of Mi-
nority Health established in an agency listed in subsection 
(a) shall be headed by a director, with documented experi-
ence and expertise in minority health services research and 
health disparities elimination. 
‘‘(d) REFERENCES.—Except as otherwise specified, 
any reference in Federal law to an Office of Minority 
Health (in the Department of Health and Human Services) 
is deemed to be a reference to the Office of Minority Health 
in the Office of the Secretary. 
‘‘(e) FUNDING.— 
‘‘(1) ALLOCATIONS.—Of the amounts appro-
priated for a specified agency for a fiscal year, the 
Secretary must designate an appropriate amount of 
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funds for the purpose of carrying out activities under 
this section through the minority health office of the 
agency. In reserving an amount under the preceding 
sentence for a minority health office for a fiscal year, 
the Secretary shall reduce, by substantially the same 
percentage, the amount that otherwise would be avail-
able for each of the programs of the designated agency 
involved. 
‘‘(2) AVAILABILITY OF FUNDS FOR STAFFING.— 
The purposes for which amounts made available 
under paragraph may be expended by a minority 
health office include the costs of employing staff for 
such office.’’. 
(2) NO NEW REGULATORY AUTHORITY.—Nothing 
in this subsection and the amendments made by this 
subsection may be construed as establishing regu-
latory authority or modifying any existing regulatory 
authority. 
(3) LIMITATION
ON
TERMINATION.—Notwith-
standing any other provision of law, a Federal office 
of minority health or Federal appointive position 
with primary responsibility over minority health 
issues that is in existence in an office of agency of the 
Department of Health and Human Services on the 
date of enactment of this section shall not be termi-
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nated, reorganized, or have any of its power or duties 
transferred unless such termination, reorganization, 
or transfer is approved by an Act of Congress. 
(c) REDESIGNATION OF NATIONAL CENTER ON MINOR-
ITY HEALTH AND HEALTH DISPARITIES.— 
(1) REDESIGNATION.—Title IV of the Public 
Health Service Act (42 U.S.C. 281 et seq.) is amend-
ed— 
(A) by redesignating subpart 6 of part E as 
subpart 20; 
(B) by transferring subpart 20, as so redes-
ignated, to part C of such title IV; 
(C) by inserting subpart 20, as so redesig-
nated, after subpart 19 of such part C; and 
(D) in subpart 20, as so redesignated— 
(i) by redesignating sections 485E 
through 485H as sections 464z–3 through 
464z–6, respectively; 
(ii) by striking ‘‘National Center on 
Minority Health and Health Disparities’’ 
each place such term appears and inserting 
‘‘National Institute on Minority Health and 
Health Disparities’’; and 
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(iii) by striking ‘‘Center’’ each place 
such term appears and inserting ‘‘Insti-
tute’’. 
(2) PURPOSE OF INSTITUTE; DUTIES.—Section 
464z–3 of the Public Health Service Act, as so redes-
ignated, is amended— 
(A) in subsection (h)(1), by striking ‘‘re-
search endowments at centers of excellence under 
section 736.’’ and inserting the following: ‘‘re-
search endowments— 
‘‘(1) at centers of excellence under section 736; 
and 
‘‘(2) at centers of excellence under section 464z– 
4.’’; 
(B) in subsection (h)(2)(A), by striking ‘‘av-
erage’’ and inserting ‘‘median’’; and 
(C) by adding at the end the following: 
‘‘(h) INTERAGENCY COORDINATION.—The Director of 
the Institute, as the primary Federal officials with responsi-
bility for coordinating all research and activities conducted 
or supported by the National Institutes of Health on minor-
ity health and health disparities, shall plan, coordinate, re-
view and evaluate research and other activities conducted 
or supported by the Institutes and Centers of the National 
Institutes of Health.’’. 
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(3) 
TECHNICAL
AND
CONFORMING
AMEND-
MENTS.— 
(A) Section 401(b)(24) of the Public Health 
Service Act (42 U.S.C. 281(b)(24)) is amended 
by striking ‘‘Center’’ and inserting ‘‘Institute’’. 
(B) Subsection (d)(1) of section 903 of the 
Public Health Service Act (42 U.S.C. 299a– 
1(d)(1)) is amended by striking ‘‘section 485E’’ 
and inserting ‘‘section 464z–3’’. 
SEC. 10335. TECHNICAL CORRECTION TO THE HOSPITAL 
VALUE-BASED PURCHASING PROGRAM. 
Section 1886(o)(2)A) of the Social Security Act, as 
added by section 3001, is amended, in the first sentence, 
by inserting ‘‘, other than measures of readmissions,’’ after 
‘‘shall select measures’’. 
SEC. 10336. GAO STUDY AND REPORT ON MEDICARE BENE-
FICIARY ACCESS TO HIGH-QUALITY DIALYSIS 
SERVICES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study on the impact 
on Medicare beneficiary access to high-quality dialy-
sis services of including specified oral drugs that are 
furnished to such beneficiaries for the treatment of 
end stage renal disease in the bundled prospective 
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payment system under section 1881(b)(14) of the So-
cial Security Act (42 U.S.C. 1395rr(b)(14)) (pursu-
ant to the proposed rule published by the Secretary of 
Health and Human Services in the Federal Register 
on September 29, 2009 (74 Fed. Reg. 49922 et seq.)). 
Such study shall include an analysis of— 
(A) the ability of providers of services and 
renal dialysis facilities to furnish specified oral 
drugs or arrange for the provision of such drugs; 
(B) the ability of providers of services and 
renal dialysis facilities to comply, if necessary, 
with applicable State laws (such as State phar-
macy licensure requirements) in order to furnish 
specified oral drugs; 
(C) whether appropriate quality measures 
exist to safeguard care for Medicare beneficiaries 
being furnished specified oral drugs by providers 
of services and renal dialysis facilities; and 
(D) other areas determined appropriate by 
the Comptroller General. 
(2) SPECIFIED ORAL DRUG DEFINED.—For pur-
poses of paragraph (1), the term ‘‘specified oral drug’’ 
means a drug or biological for which there is no 
injectable equivalent (or other non-oral form of ad-
ministration). 
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(b) REPORT.—Not later than 1 year after the date of 
the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report containing 
the results of the study conducted under subsection (a), to-
gether with recommendations for such legislation and ad-
ministrative action as the Comptroller General determines 
appropriate. 
Subtitle D—Provisions Relating to 
Title IV 
SEC. 10401. AMENDMENTS TO SUBTITLE A. 
(a) Section 4001(h)(4) and (5) of this Act is amended 
by striking ‘‘2010’’ each place such appears and inserting 
‘‘2020’’. 
(b) Section 4002(c) of this Act is amended— 
(1) by striking ‘‘research and health screenings’’ 
and inserting ‘‘research, health screenings, and initia-
tives’’; and 
(2) by striking ‘‘for Preventive’’ and inserting 
‘‘Regarding Preventive’’. 
(c) Section 4004(a)(4) of this Act is amended by strik-
ing ‘‘a Gateway’’ and inserting ‘‘an Exchange’’. 
SEC. 10402. AMENDMENTS TO SUBTITLE B. 
(a) Section 399Z–1(a)(1(A) of the Public Health Serv-
ice Act, as added by section 4101(b) of this Act, is amended 
by inserting ‘‘and vision’’ after ‘‘oral’’. 
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(b) Section 1861(hhh)(4)(G) of the Social Security Act, 
as added by section 4103(b), is amended to read as follows: 
‘‘(G) A beneficiary shall be eligible to re-
ceive only an initial preventive physical exam-
ination (as defined under subsection (ww)(1)) 
during the 12-month period after the date that 
the beneficiary’s coverage begins under part B 
and shall be eligible to receive personalized pre-
vention plan services under this subsection each 
year thereafter provided that the beneficiary has 
not received either an initial preventive physical 
examination or personalized prevention plan 
services within the preceding 12-month period.’’. 
SEC. 10403. AMENDMENTS TO SUBTITLE C. 
Section 4201 of this Act is amended— 
(1) in subsection (a), by adding before the period 
the following: ‘‘, with not less than 20 percent of such 
grants being awarded to rural and frontier areas’’; 
(2) in subsection (c)(2)(B)(vii), by striking ‘‘both 
urban and rural areas’’ and inserting ‘‘urban, rural, 
and frontier areas’’; and 
(3) in subsection (f), by striking ‘‘each fiscal 
years’’ and inserting ‘‘each of fiscal year’’. 
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SEC. 10404. AMENDMENTS TO SUBTITLE D. 
Section 399MM(2) of the Public Health Service Act, 
as added by section 4303 of this Act, is amended by striking 
‘‘by ensuring’’ and inserting ‘‘and ensuring’’. 
SEC. 10405. AMENDMENTS TO SUBTITLE E. 
Subtitle E of title IV of this Act is amended by striking 
section 4401. 
SEC. 10406. AMENDMENT RELATING TO WAIVING COINSUR-
ANCE FOR PREVENTIVE SERVICES. 
Section 4104(b) of this Act is amended to read as fol-
lows: 
‘‘(b) PAYMENT AND ELIMINATION OF COINSURANCE IN 
ALL SETTINGS.—Section 1833(a)(1) of the Social Security 
Act (42 U.S.C. 1395l(a)(1)), as amended by section 
4103(c)(1), is amended— 
‘‘(1) in subparagraph (T), by inserting ‘(or 100 
percent if such services are recommended with a grade 
of A or B by the United States Preventive Services 
Task Force for any indication or population and are 
appropriate for the individual)’ after ‘80 percent’; 
‘‘(2) in subparagraph (W)— 
‘‘(A) in clause (i), by inserting ‘(if such 
subparagraph were applied, by substituting ‘‘100 
percent’’ for ‘‘80 percent’’)’ after ‘subparagraph 
(D)’; and 
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‘‘(B) in clause (ii), by striking ‘80 percent’ 
and inserting ‘100 percent’; 
‘‘(3) by striking ‘and’ before ‘(X)’; and 
‘‘(4) by inserting before the semicolon at the end 
the following: ‘, and (Y) with respect to preventive 
services described in subparagraphs (A) and (B) of 
section 1861(ddd)(3) that are appropriate for the in-
dividual and, in the case of such services described in 
subparagraph (A), are recommended with a grade of 
A or B by the United States Preventive Services Task 
Force for any indication or population, the amount 
paid shall be 100 percent of (i) except as provided in 
clause (ii), the lesser of the actual charge for the serv-
ices or the amount determined under the fee schedule 
that applies to such services under this part, and (ii) 
in the case of such services that are covered OPD serv-
ices (as defined in subsection (t)(1)(B)), the amount 
determined under subsection (t)’.’’. 
SEC. 10407. BETTER DIABETES CARE. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Catalyst to Better Diabetes Care Act of 2009’’. 
(b) NATIONAL DIABETES REPORT CARD.— 
(1) IN GENERAL.—The Secretary, in collabora-
tion with the Director of the Centers for Disease Con-
trol and Prevention (referred to in this section as the 
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‘‘Director’’), shall prepare on a biennial basis a na-
tional diabetes report card (referred to in this section 
as a ‘‘Report Card’’) and, to the extent possible, for 
each State. 
(2) CONTENTS.— 
(A) IN GENERAL.—Each Report Card shall 
include aggregate health outcomes related to in-
dividuals 
diagnosed 
with 
diabetes 
and 
prediabetes including— 
(i) preventative care practices and 
quality of care; 
(ii) risk factors; and 
(iii) outcomes. 
(B) UPDATED
REPORTS.—Each Report 
Card that is prepared after the initial Report 
Card shall include trend analysis for the Nation 
and, to the extent possible, for each State, for the 
purpose of— 
(i) tracking progress in meeting estab-
lished national goals and objectives for im-
proving diabetes care, costs, and prevalence 
(including Healthy People 2010); and 
(ii) informing policy and program de-
velopment. 
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(3) AVAILABILITY.—The Secretary, in collabora-
tion with the Director, shall make each Report Card 
publicly available, including by posting the Report 
Card on the Internet. 
(c) IMPROVEMENT
OF VITAL STATISTICS COLLEC-
TION.— 
(1) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and 
Prevention and in collaboration with appropriate 
agencies and States, shall— 
(A) promote the education and training of 
physicians on the importance of birth and death 
certificate data and how to properly complete 
these documents, including the collection of such 
data for diabetes and other chronic diseases; 
(B) encourage State adoption of the latest 
standard revisions of birth and death certificates; 
and 
(C) work with States to re-engineer their 
vital statistics systems in order to provide cost- 
effective, timely, and accurate vital systems data. 
(2) DEATH
CERTIFICATE
ADDITIONAL
LAN-
GUAGE.—In carrying out this subsection, the Sec-
retary may promote improvements to the collection of 
diabetes mortality data, including the addition of a 
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question for the individual certifying the cause of 
death regarding whether the deceased had diabetes. 
(d) STUDY ON APPROPRIATE LEVEL OF DIABETES 
MEDICAL EDUCATION.— 
(1) IN GENERAL.—The Secretary shall, in col-
laboration with the Institute of Medicine and appro-
priate associations and councils, conduct a study of 
the impact of diabetes on the practice of medicine in 
the United States and the appropriateness of the level 
of diabetes medical education that should be required 
prior to licensure, board certification, and board re-
certification. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary shall 
submit a report on the study under paragraph (1) to 
the Committees on Ways and Means and Energy and 
Commerce of the House of Representatives and the 
Committees on Finance and Health, Education, 
Labor, and Pensions of the Senate. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated to carry out this section such 
sums as may be necessary. 
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SEC. 10408. GRANTS FOR SMALL BUSINESSES TO PROVIDE 
COMPREHENSIVE 
WORKPLACE 
WELLNESS 
PROGRAMS. 
(a) ESTABLISHMENT.—The Secretary shall award 
grants to eligible employers to provide their employees with 
access to comprehensive workplace wellness programs (as 
described under subsection (c)). 
(b) SCOPE.— 
(1) DURATION.—The grant program established 
under this section shall be conducted for a 5-year pe-
riod. 
(2) ELIGIBLE
EMPLOYER.—The term ‘‘eligible 
employer’’ means an employer (including a non-prof-
it employer) that— 
(A) employs less than 100 employees who 
work 25 hours or greater per week; and 
(B) does not provide a workplace wellness 
program as of the date of enactment of this Act. 
(c) COMPREHENSIVE WORKPLACE WELLNESS PRO-
GRAMS.— 
(1) CRITERIA.—The Secretary shall develop pro-
gram criteria for comprehensive workplace wellness 
programs under this section that are based on and 
consistent with evidence-based research and best prac-
tices, including research and practices as provided in 
the Guide to Community Preventive Services, the 
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Guide to Clinical Preventive Services, and the Na-
tional Registry for Effective Programs. 
(2) REQUIREMENTS.—A comprehensive work-
place wellness program shall be made available by an 
eligible employer to all employees and include the fol-
lowing components: 
(A) Health awareness initiatives (including 
health education, preventive screenings, and 
health risk assessments). 
(B) Efforts to maximize employee engage-
ment (including mechanisms to encourage em-
ployee participation). 
(C) Initiatives to change unhealthy behav-
iors and lifestyle choices (including counseling, 
seminars, online programs, and self-help mate-
rials). 
(D) Supportive environment efforts (includ-
ing workplace policies to encourage healthy life-
styles, healthy eating, increased physical activ-
ity, and improved mental health). 
(d) APPLICATION.—An eligible employer desiring to 
participate in the grant program under this section shall 
submit an application to the Secretary, in such manner 
and containing such information as the Secretary may re-
quire, which shall include a proposal for a comprehensive 
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workplace wellness program that meet the criteria and re-
quirements described under subsection (c). 
(e) AUTHORIZATION OF APPROPRIATION.—For pur-
poses of carrying out the grant program under this section, 
there is authorized to be appropriated $200,000,000 for the 
period of fiscal years 2011 through 2015. Amounts appro-
priated pursuant to this subsection shall remain available 
until expended. 
SEC. 10409. CURES ACCELERATION NETWORK. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Cures Acceleration Network Act of 2009’’. 
(b) REQUIREMENT FOR THE DIRECTOR OF NIH TO 
ESTABLISH A CURES ACCELERATION NETWORK.—Section 
402(b) of the Public Health Service Act (42 U.S.C. 282(b)) 
is amended— 
(1) in paragraph (22), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (23), by striking the period 
and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (23), the fol-
lowing: 
‘‘(24) implement the Cures Acceleration Network 
described in section 402C.’’. 
(c) ACCEPTING GIFTS TO SUPPORT THE CURES AC-
CELERATION NETWORK.—Section 499(c)(1) of the Public 
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Health Service Act (42 U.S.C. 290b(c)(1)) is amended by 
adding at the end the following: 
‘‘(E) The Cures Acceleration Network de-
scribed in section 402C.’’. 
(d) ESTABLISHMENT OF THE CURES ACCELERATION 
NETWORK.—Part A of title IV of the Public Health Service 
Act is amended by inserting after section 402B (42 U.S.C. 
282b) the following: 
‘‘SEC. 402C. CURES ACCELERATION NETWORK. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) BIOLOGICAL PRODUCT.—The term ‘biologi-
cal product’ has the meaning given such term in sec-
tion 351 of the Public Health Service Act. 
‘‘(2) DRUG; DEVICE.—The terms ‘drug’ and ‘de-
vice’ have the meanings given such terms in section 
201 of the Federal Food, Drug, and Cosmetic Act. 
‘‘(3) HIGH NEED CURE.—The term ‘high need 
cure’ means a drug (as that term is defined by section 
201(g)(1) of the Federal Food, Drug, and Cosmetic 
Act, biological product (as that term is defined by sec-
tion 262(i)), or device (as that term is defined by sec-
tion 201(h) of the Federal Food, Drug, and Cosmetic 
Act) that, in the determination of the Director of 
NIH— 
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‘‘(A) is a priority to diagnose, mitigate, 
prevent, or treat harm from any disease or con-
dition; and 
‘‘(B) for which the incentives of the commer-
cial market are unlikely to result in its adequate 
or timely development. 
‘‘(4) MEDICAL
PRODUCT.—The term ‘medical 
product’ means a drug, device, biological product, or 
product that is a combination of drugs, devices, and 
biological products. 
‘‘(b) ESTABLISHMENT OF THE CURES ACCELERATION 
NETWORK.—Subject to the appropriation of funds as de-
scribed in subsection (g), there is established within the Of-
fice of the Director of NIH a program to be known as the 
Cures Acceleration Network (referred to in this section as 
‘CAN’), which shall— 
‘‘(1) be under the direction of the Director of 
NIH, taking into account the recommendations of a 
CAN Review Board (referred to in this section as the 
‘Board’), described in subsection (d); and 
‘‘(2) award grants and contracts to eligible enti-
ties, as described in subsection (e), to accelerate the 
development of high need cures, including through the 
development of medical products and behavioral 
therapies. 
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‘‘(c) FUNCTIONS.—The functions of the CAN are to— 
‘‘(1) conduct and support revolutionary advances 
in basic research, translating scientific discoveries 
from bench to bedside; 
‘‘(2) award grants and contracts to eligible enti-
ties to accelerate the development of high need cures; 
‘‘(3) provide the resources necessary for govern-
ment agencies, independent investigators, research or-
ganizations, biotechnology companies, academic re-
search institutions, and other entities to develop high 
need cures; 
‘‘(4) reduce the barriers between laboratory dis-
coveries and clinical trials for new therapies; and 
‘‘(5) facilitate review in the Food and Drug Ad-
ministration for the high need cures funded by the 
CAN, through activities that may include— 
‘‘(A) the facilitation of regular and ongoing 
communication with the Food and Drug Admin-
istration regarding the status of activities con-
ducted under this section; 
‘‘(B) ensuring that such activities are co-
ordinated with the approval requirements of the 
Food and Drug Administration, with the goal of 
expediting the development and approval of 
countermeasures and products; and 
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‘‘(C) connecting interested persons with ad-
ditional technical assistance made available 
under section 565 of the Federal Food, Drug, 
and Cosmetic Act. 
‘‘(d) CAN BOARD.— 
‘‘(1) ESTABLISHMENT.—There is established a 
Cures Acceleration Network Review Board (referred to 
in this section as the ‘Board’), which shall advise the 
Director of NIH on the conduct of the activities of the 
Cures Acceleration Network. 
‘‘(2) MEMBERSHIP.— 
‘‘(A) IN GENERAL.— 
‘‘(i) APPOINTMENT.—The Board shall 
be comprised of 24 members who are ap-
pointed by the Secretary and who serve at 
the pleasure of the Secretary. 
‘‘(ii) CHAIRPERSON AND VICE CHAIR-
PERSON.—The Secretary shall designate, 
from among the 24 members appointed 
under clause (i), one Chairperson of the 
Board (referred to in this section as the 
‘Chairperson’) and one Vice Chairperson. 
‘‘(B) TERMS.— 
‘‘(i) IN GENERAL.—Each member shall 
be appointed to serve a 4-year term, except 
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that any member appointed to fill a va-
cancy occurring prior to the expiration of 
the term for which the member’s predecessor 
was appointed shall be appointed for the re-
mainder of such term. 
‘‘(ii) 
CONSECUTIVE
APPOINTMENTS; 
MAXIMUM TERMS.—A member may be ap-
pointed to serve not more than 3 terms on 
the Board, and may not serve more than 2 
such terms consecutively. 
‘‘(C) QUALIFICATIONS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
appoint individuals to the Board based sole-
ly upon the individual’s established record 
of distinguished service in one of the areas 
of expertise described in clause (ii). Each 
individual appointed to the Board shall be 
of distinguished achievement and have a 
broad range of disciplinary interests. 
‘‘(ii) EXPERTISE.—The Secretary shall 
select individuals based upon the following 
requirements: 
‘‘(I) For each of the fields of— 
‘‘(aa) basic research; 
‘‘(bb) medicine; 
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‘‘(cc) biopharmaceuticals; 
‘‘(dd) discovery and delivery 
of medical products; 
‘‘(ee) bioinformatics and gene 
therapy; 
‘‘(ff) medical instrumenta-
tion; and 
‘‘(gg) regulatory review and 
approval of medical products, 
the Secretary shall select at least 1 in-
dividual who is eminent in such fields. 
‘‘(II) At least 4 individuals shall 
be recognized leaders in professional 
venture capital or private equity orga-
nizations and have demonstrated expe-
rience in private equity investing. 
‘‘(III) At least 8 individuals shall 
represent disease advocacy organiza-
tions. 
‘‘(3) EX-OFFICIO MEMBERS.— 
‘‘(A) APPOINTMENT.—In addition to the 24 
Board members described in paragraph (2), the 
Secretary shall appoint as ex-officio members of 
the Board— 
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‘‘(i) a representative of the National 
Institutes of Health, recommended by the 
Secretary of the Department of Health and 
Human Services; 
‘‘(ii) a representative of the Office of 
the Assistant Secretary of Defense for 
Health Affairs, recommended by the Sec-
retary of Defense; 
‘‘(iii) a representative of the Office of 
the Under Secretary for Health for the Vet-
erans Health Administration, recommended 
by the Secretary of Veterans Affairs; 
‘‘(iv) a representative of the National 
Science Foundation, recommended by the 
Chair of the National Science Board; and 
‘‘(v) a representative of the Food and 
Drug Administration, recommended by the 
Commissioner of Food and Drugs. 
‘‘(B) TERMS.—Each ex-officio member shall 
serve a 3-year term on the Board, except that the 
Chairperson may adjust the terms of the initial 
ex-officio members in order to provide for a stag-
gered term of appointment for all such members. 
‘‘(4) RESPONSIBILITIES OF THE BOARD AND THE 
DIRECTOR OF NIH.— 
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‘‘(A) RESPONSIBILITIES OF THE BOARD.— 
‘‘(i) IN
GENERAL.—The Board shall 
advise, and provide recommendations to, the 
Director of NIH with respect to— 
‘‘(I) policies, programs, and pro-
cedures for carrying out the duties of 
the Director of NIH under this section; 
and 
‘‘(II) significant barriers to suc-
cessful translation of basic science into 
clinical application (including issues 
under the purview of other agencies 
and departments). 
‘‘(ii) REPORT.—In the case that the 
Board identifies a significant barrier, as 
described in clause (i)(II), the Board shall 
submit to the Secretary a report regarding 
such barrier. 
‘‘(B) RESPONSIBILITIES OF THE DIRECTOR 
OF NIH.—With respect to each recommendation 
provided by the Board under subparagraph 
(A)(i), the Director of NIH shall respond in 
writing to the Board, indicating whether such 
Director will implement such recommendation. 
In the case that the Director of NIH indicates a 
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recommendation of the Board will not be imple-
mented, such Director shall provide an expla-
nation of the reasons for not implementing such 
recommendation. 
‘‘(5) MEETINGS.— 
‘‘(A) IN GENERAL.—The Board shall meet 4 
times per calendar year, at the call of the Chair-
person. 
‘‘(B) QUORUM; 
REQUIREMENTS; 
LIMITA-
TIONS.— 
‘‘(i) QUORUM.—A quorum shall consist 
of a total of 13 members of the Board, ex-
cluding ex-officio members, with diverse 
representation as described in clause (iii). 
‘‘(ii) CHAIRPERSON
OR
VICE
CHAIR-
PERSON.—Each meeting of the Board shall 
be attended by either the Chairperson or the 
Vice Chairperson. 
‘‘(iii) DIVERSE REPRESENTATION.—At 
each meeting of the Board, there shall be not 
less than one scientist, one representative of 
a disease advocacy organization, and one 
representative of a professional venture cap-
ital or private equity organization. 
‘‘(6) COMPENSATION AND TRAVEL EXPENSES.— 
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‘‘(A) COMPENSATION.—Members shall re-
ceive compensation at a rate to be fixed by the 
Chairperson but not to exceed a rate equal to the 
daily equivalent of the annual rate of basic pay 
prescribed for level IV of the Executive Schedule 
under section 5315 of title 5, United States Code, 
for each day (including travel time) during 
which the member is engaged in the performance 
of the duties of the Board. All members of the 
Board who are officers or employees of the 
United States shall serve without compensation 
in addition to that received for their services as 
officers or employees of the United States. 
‘‘(B) TRAVEL EXPENSES.—Members of the 
Board shall be allowed travel expenses, including 
per diem in lieu of subsistence, at rates author-
ized for persons employed intermittently by the 
Federal Government under section 5703(b) of 
title 5, United States Code, while away from 
their homes or regular places of business in the 
performance of services for the Board. 
‘‘(e) GRANT PROGRAM.— 
‘‘(1) SUPPORTING
INNOVATION.—To carry out 
the purposes described in this section, the Director of 
NIH shall award contracts, grants, or cooperative 
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agreements to the entities described in paragraph (2), 
to— 
‘‘(A) promote innovation in technologies 
supporting the advanced research and develop-
ment and production of high need cures, includ-
ing through the development of medical products 
and behavioral therapies. 
‘‘(B) accelerate the development of high need 
cures, including through the development of med-
ical products, behavioral therapies, and biomark-
ers that demonstrate the safety or effectiveness of 
medical products; or 
‘‘(C) help the award recipient establish pro-
tocols that comply with Food and Drug Admin-
istration standards and otherwise permit the re-
cipient to meet regulatory requirements at all 
stages of development, manufacturing, review, 
approval, and safety surveillance of a medical 
product. 
‘‘(2) ELIGIBLE ENTITIES.—To receive assistance 
under paragraph (1), an entity shall— 
‘‘(A) be a public or private entity, which 
may include a private or public research institu-
tion, an institution of higher education, a med-
ical center, a biotechnology company, a pharma-
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ceutical company, a disease advocacy organiza-
tion, a patient advocacy organization, or an 
academic research institution; 
‘‘(B) submit an application containing— 
‘‘(i) a detailed description of the 
project for which the entity seeks such grant 
or contract; 
‘‘(ii) a timetable for such project; 
‘‘(iii) an assurance that the entity will 
submit— 
‘‘(I) interim reports describing the 
entity’s— 
‘‘(aa) progress in carrying 
out the project; and 
‘‘(bb) compliance with all 
provisions of this section and con-
ditions of receipt of such grant or 
contract; and 
‘‘(II) a final report at the conclu-
sion of the grant period, describing the 
outcomes of the project; and 
‘‘(iv) a description of the protocols the 
entity will follow to comply with Food and 
Drug Administration standards and regu-
latory requirements at all stages of develop-
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ment, manufacturing, review, approval, and 
safety surveillance of a medical product; 
and 
‘‘(C) provide such additional information as 
the Director of NIH may require. 
‘‘(3) AWARDS.— 
‘‘(A) THE CURES ACCELERATION PARTNER-
SHIP AWARDS.— 
‘‘(i) INITIAL
AWARD
AMOUNT.—Each 
award under this subparagraph shall be not 
more than $15,000,000 per project for the 
first fiscal year for which the project is 
funded, which shall be payable in one pay-
ment. 
‘‘(ii) FUNDING IN SUBSEQUENT FISCAL 
YEARS.—An eligible entity receiving an 
award under clause (i) may apply for addi-
tional funding for such project by submit-
ting to the Director of NIH the information 
required under subparagraphs (B) and (C) 
of paragraph (2). The Director may fund a 
project of such eligible entity in an amount 
not to exceed $15,000,000 for a fiscal year 
subsequent to the initial award under clause 
(i). 
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‘‘(iii) MATCHING FUNDS.—As a condi-
tion for receiving an award under this sub-
section, an eligible entity shall contribute to 
the project non-Federal funds in the amount 
of $1 for every $3 awarded under clauses (i) 
and (ii), except that the Director of NIH 
may waive or modify such matching re-
quirement in any case where the Director 
determines that the goals and objectives of 
this section cannot adequately be carried 
out unless such requirement is waived. 
‘‘(B) THE
CURES
ACCELERATION
GRANT 
AWARDS.— 
‘‘(i) INITIAL
AWARD
AMOUNT.—Each 
award under this subparagraph shall be not 
more than $15,000,000 per project for the 
first fiscal year for which the project is 
funded, which shall be payable in one pay-
ment. 
‘‘(ii) FUNDING IN SUBSEQUENT FISCAL 
YEARS.—An eligible entity receiving an 
award under clause (i) may apply for addi-
tional funding for such project by submit-
ting to the Board the information required 
under subparagraphs (B) and (C) of para-
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graph (2). The Director of NIH may fund 
a project of such eligible entity in an 
amount not to exceed $15,000,000 for a fis-
cal year subsequent to the initial award 
under clause (i). 
‘‘(C) THE CURES ACCELERATION FLEXIBLE 
RESEARCH AWARDS.—If the Director of NIH de-
termines that the goals and objectives of this sec-
tion cannot adequately be carried out through a 
contract, grant, or cooperative agreement, the 
Director of NIH shall have flexible research au-
thority to use other transactions to fund projects 
in accordance with the terms and conditions of 
this section. Awards made under such flexible re-
search authority for a fiscal year shall not exceed 
20 percent of the total funds appropriated under 
subsection (g)(1) for such fiscal year. 
‘‘(4) SUSPENSION OF AWARDS FOR DEFAULTS, 
NONCOMPLIANCE WITH PROVISIONS AND PLANS, AND 
DIVERSION OF FUNDS; REPAYMENT OF FUNDS.—The 
Director of NIH may suspend the award to any enti-
ty upon noncompliance by such entity with provi-
sions and plans under this section or diversion of 
funds. 
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‘‘(5) AUDITS.—The Director of NIH may enter 
into agreements with other entities to conduct peri-
odic audits of the projects funded by grants or con-
tracts awarded under this subsection. 
‘‘(6) CLOSEOUT PROCEDURES.—At the end of a 
grant or contract period, a recipient shall follow the 
closeout procedures under section 74.71 of title 45, 
Code of Federal Regulations (or any successor regula-
tion). 
‘‘(7) REVIEW.—A determination by the Director 
of NIH as to whether a drug, device, or biological 
product is a high need cure (for purposes of subsection 
(a)(3)) shall not be subject to judicial review. 
‘‘(f) COMPETITIVE BASIS OF AWARDS.—Any grant, co-
operative agreement, or contract awarded under this section 
shall be awarded on a competitive basis. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—For purposes of carrying out 
this section, there are authorized to be appropriated 
$500,000,000 for fiscal year 2010, and such sums as 
may be necessary for subsequent fiscal years. Funds 
appropriated under this section shall be available 
until expended. 
‘‘(2) LIMITATION ON USE OF FUNDS OTHERWISE 
APPROPRIATED.—No funds appropriated under this 
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Act, other than funds appropriated under paragraph 
(1), may be allocated to the Cures Acceleration Net-
work.’’. 
SEC. 10410. CENTERS OF EXCELLENCE FOR DEPRESSION. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Establishing a Network of Health-Advancing National 
Centers of Excellence for Depression Act of 2009’’ or the 
‘‘ENHANCED Act of 2009’’. 
(b) CENTERS OF EXCELLENCE FOR DEPRESSION.— 
Subpart 3 of part B of title V of the Public Health Service 
Act (42 U.S.C. 290bb et seq.) is amended by inserting after 
section 520A the following: 
‘‘SEC. 520B. NATIONAL CENTERS OF EXCELLENCE FOR DE-
PRESSION. 
‘‘(a) DEPRESSIVE DISORDER DEFINED.—In this sec-
tion, the term ‘depressive disorder’ means a mental or brain 
disorder relating to depression, including major depression, 
bipolar disorder, and related mood disorders. 
‘‘(b) GRANT PROGRAM.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Administrator, shall award grants on a 
competitive basis to eligible entities to establish na-
tional centers of excellence for depression (referred to 
in this section as ‘Centers’), which shall engage in ac-
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tivities related to the treatment of depressive dis-
orders. 
‘‘(2) ALLOCATION OF AWARDS.—If the funds au-
thorized under subsection (f) are appropriated in the 
amounts provided for under such subsection, the Sec-
retary shall allocate such amounts so that— 
‘‘(A) not later than 1 year after the date of 
enactment of the ENHANCED Act of 2009, not 
more than 20 Centers may be established; and 
‘‘(B) not later than September 30, 2016, not 
more than 30 Centers may be established. 
‘‘(3) GRANT PERIOD.— 
‘‘(A) IN GENERAL.—A grant awarded under 
this section shall be for a period of 5 years. 
‘‘(B) RENEWAL.—A grant awarded under 
subparagraph (A) may be renewed, on a com-
petitive basis, for 1 additional 5-year period, at 
the discretion of the Secretary. In determining 
whether to renew a grant, the Secretary shall 
consider the report cards issued under subsection 
(e)(2). 
‘‘(4) USE
OF
FUNDS.—Grant funds awarded 
under this subsection shall be used for the establish-
ment and ongoing activities of the recipient of such 
funds. 
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‘‘(5) ELIGIBLE ENTITIES.— 
‘‘(A) REQUIREMENTS.—To be eligible to re-
ceive a grant under this section, an entity 
shall— 
‘‘(i) be an institution of higher edu-
cation or a public or private nonprofit re-
search institution; and 
‘‘(ii) submit an application to the Sec-
retary at such time and in such manner as 
the Secretary may require, as described in 
subparagraph (B). 
‘‘(B) APPLICATION.—An application de-
scribed in subparagraph (A)(ii) shall include— 
‘‘(i) evidence that such entity— 
‘‘(I) provides, or is capable of co-
ordinating with other entities to pro-
vide, comprehensive health services 
with a focus on mental health services 
and subspecialty expertise for depres-
sive disorders; 
‘‘(II) collaborates with other men-
tal health providers, as necessary, to 
address co-occurring mental illnesses; 
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‘‘(III) is capable of training 
health 
professionals 
about 
mental 
health; and 
‘‘(ii) such other information, as the 
Secretary may require. 
‘‘(C) PRIORITIES.—In awarding grants 
under this section, the Secretary shall give pri-
ority to eligible entities that meet 1 or more of 
the following criteria: 
‘‘(i) Demonstrated capacity and exper-
tise to serve the targeted population. 
‘‘(ii) Existing infrastructure or exper-
tise to provide appropriate, evidence-based 
and culturally and linguistically competent 
services. 
‘‘(iii) A location in a geographic area 
with disproportionate numbers of under-
served and at-risk populations in medically 
underserved areas and health professional 
shortage areas. 
‘‘(iv) Proposed innovative approaches 
for outreach to initiate or expand services. 
‘‘(v) Use of the most up-to-date science, 
practices, and interventions available. 
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‘‘(vi) Demonstrated capacity to estab-
lish cooperative and collaborative agree-
ments with community mental health cen-
ters and other community entities to pro-
vide mental health, social, and human serv-
ices to individuals with depressive dis-
orders. 
‘‘(6) NATIONAL COORDINATING CENTER.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator, shall designate 1 re-
cipient of a grant under this section to be the co-
ordinating center of excellence for depression (re-
ferred to in this section as the ‘coordinating cen-
ter’). The Secretary shall select such coordinating 
center on a competitive basis, based upon the 
demonstrated capacity of such center to perform 
the duties described in subparagraph (C). 
‘‘(B) APPLICATION.—A Center that has been 
awarded a grant under paragraph (1) may 
apply for designation as the coordinating center 
by submitting an application to the Secretary at 
such time, in such manner, and containing such 
information as the Secretary may require. 
‘‘(C) DUTIES.—The coordinating center 
shall— 
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‘‘(i) develop, administer, and coordi-
nate the network of Centers under this sec-
tion; 
‘‘(ii) oversee and coordinate the na-
tional database described in subsection (d); 
‘‘(iii) lead a strategy to disseminate 
the findings and activities of the Centers 
through such database; and 
‘‘(iv) serve as a liaison with the Ad-
ministration, the National Registry of Evi-
dence-based Programs and Practices of the 
Administration, and any Federal inter-
agency or interagency forum on mental 
health. 
‘‘(7) MATCHING FUNDS.—The Secretary may not 
award a grant or contract under this section to an 
entity unless the entity agrees that it will make avail-
able (directly or through contributions from other 
public or private entities) non-Federal contributions 
toward the activities to be carried out under the grant 
or contract in an amount equal to $1 for each $5 of 
Federal funds provided under the grant or contract. 
Such non-Federal matching funds may be provided 
directly or through donations from public or private 
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entities and may be in cash or in-kind, fairly evalu-
ated, including plant, equipment, or services. 
‘‘(c) ACTIVITIES OF THE CENTERS.—Each Center shall 
carry out the following activities: 
‘‘(1) GENERAL ACTIVITIES.—Each Center shall— 
‘‘(A) integrate basic, clinical, or health serv-
ices interdisciplinary research and practice in 
the development, implementation, and dissemi-
nation of evidence-based interventions; 
‘‘(B) involve a broad cross-section of stake-
holders, such as researchers, clinicians, con-
sumers, families of consumers, and voluntary 
health organizations, to develop a research agen-
da and disseminate findings, and to provide 
support in the implementation of evidence-based 
practices; 
‘‘(C) provide training and technical assist-
ance to mental health professionals, and engage 
in and disseminate translational research with a 
focus on meeting the needs of individuals with 
depressive disorders; and 
‘‘(D) educate policy makers, employers, 
community leaders, and the public about depres-
sive disorders to reduce stigma and raise aware-
ness of treatments. 
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‘‘(2) IMPROVED TREATMENT STANDARDS, CLIN-
ICAL GUIDELINES, DIAGNOSTIC PROTOCOLS, AND CARE 
COORDINATION PRACTICE.—Each Center shall collabo-
rate with other Centers in the network to— 
‘‘(A) develop and implement treatment 
standards, clinical guidelines, and protocols that 
emphasize primary prevention, early interven-
tion, treatment for, and recovery from, depressive 
disorders; 
‘‘(B) foster communication with other pro-
viders attending to co-occurring physical health 
conditions such as cardiovascular, diabetes, can-
cer, and substance abuse disorders; 
‘‘(C) leverage available community re-
sources, develop and implement improved self- 
management programs, and, when appropriate, 
involve family and other providers of social sup-
port in the development and implementation of 
care plans; and 
‘‘(D) use electronic health records and tele-
health technology to better coordinate and man-
age, and improve access to, care, as determined 
by the coordinating center. 
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‘‘(3) TRANSLATIONAL RESEARCH THROUGH COL-
LABORATION OF CENTERS AND COMMUNITY-BASED OR-
GANIZATIONS.—Each Center shall— 
‘‘(A) demonstrate effective use of a public- 
private partnership to foster collaborations 
among members of the network and community- 
based organizations such as community mental 
health centers and other social and human serv-
ices providers; 
‘‘(B) 
expand 
interdisciplinary, 
translational, and patient-oriented research and 
treatment; and 
‘‘(C) coordinate with accredited academic 
programs to provide ongoing opportunities for 
the professional and continuing education of 
mental health providers. 
‘‘(d) NATIONAL DATABASE.— 
‘‘(1) IN GENERAL.—The coordinating center shall 
establish and maintain a national, publicly available 
database to improve prevention programs, evidence- 
based interventions, and disease management pro-
grams for depressive disorders, using data collected 
from the Centers, as described in paragraph (2). 
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‘‘(2) DATA COLLECTION.—Each Center shall sub-
mit data gathered at such center, as appropriate, to 
the coordinating center regarding— 
‘‘(A) the prevalence and incidence of depres-
sive disorders; 
‘‘(B) the health and social outcomes of indi-
viduals with depressive disorders; 
‘‘(C) the effectiveness of interventions de-
signed, tested, and evaluated; 
‘‘(D) other information, as the Secretary 
may require. 
‘‘(3) SUBMISSION
OF
DATA
TO
THE
ADMINIS-
TRATOR.—The coordinating center shall submit to the 
Administrator the data and financial information 
gathered under paragraph (2). 
‘‘(4) PUBLICATION USING DATA FROM THE DATA-
BASE.—A Center, or an individual affiliated with a 
Center, may publish findings using the data described 
in paragraph (2) only if such center submits such 
data to the coordinating center, as required under 
such paragraph. 
‘‘(e) ESTABLISHMENT OF STANDARDS; REPORT CARDS 
AND RECOMMENDATIONS; THIRD PARTY REVIEW.— 
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‘‘(1) ESTABLISHMENT OF STANDARDS.—The Sec-
retary, acting through the Administrator, shall estab-
lish performance standards for— 
‘‘(A) each Center; and 
‘‘(B) the network of Centers as a whole. 
‘‘(2) REPORT
CARDS.—The Secretary, acting 
through the Administrator, shall— 
‘‘(A) for each Center, not later than 3 years 
after the date on which such center of excellence 
is established and annually thereafter, issue a re-
port card to the coordinating center to rate the 
performance of such Center; and 
‘‘(B) not later than 3 years after the date 
on which the first grant is awarded under sub-
section (b)(1) and annually thereafter, issue a re-
port card to Congress to rate the performance of 
the network of centers of excellence as a whole. 
‘‘(3) RECOMMENDATIONS.—Based upon the re-
port cards described in paragraph (2), the Secretary 
shall, not later than September 30, 2015— 
‘‘(A) make recommendations to the Centers 
regarding improvements such centers shall make; 
and 
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‘‘(B) make recommendations to Congress for 
expanding the Centers to serve individuals with 
other types of mental disorders. 
‘‘(4) THIRD PARTY REVIEW.—Not later than 3 
years after the date on which the first grant is award-
ed under subsection (b)(1) and annually thereafter, 
the Secretary shall arrange for an independent third 
party to conduct an evaluation of the network of Cen-
ters to ensure that such centers are meeting the goals 
of this section. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—To carry out this section, 
there are authorized to be appropriated— 
‘‘(A) $100,000,000 for each of the fiscal 
years 2011 through 2015; and 
‘‘(B) $150,000,000 for each of the fiscal 
years 2016 through 2020. 
‘‘(2) ALLOCATION OF FUNDS AUTHORIZED.—Of 
the amount appropriated under paragraph (1) for a 
fiscal year, the Secretary shall determine the alloca-
tion of each Center receiving a grant under this sec-
tion, but in no case may the allocation be more than 
$5,000,000, except that the Secretary may allocate not 
more than $10,000,000 to the coordinating center.’’. 
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SEC. 10411. PROGRAMS RELATING TO CONGENITAL HEART 
DISEASE. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘Congenital Heart Futures Act’’. 
(b) PROGRAMS RELATING
TO CONGENITAL HEART 
DISEASE.— 
(1) NATIONAL CONGENITAL HEART DISEASE SUR-
VEILLANCE SYSTEM.—Part P of title III of the Public 
Health Service Act (42 U.S.C. 280g et seq.), as 
amended by section 5405, is further amended by add-
ing at the end the following: 
‘‘SEC. 399V–2. NATIONAL CONGENITAL HEART DISEASE SUR-
VEILLANCE SYSTEM. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, 
may— 
‘‘(1) enhance and expand infrastructure to track 
the epidemiology of congenital heart disease and to 
organize such information into a nationally-rep-
resentative, population-based surveillance system that 
compiles data concerning actual occurrences of con-
genital heart disease, to be known as the ‘National 
Congenital Heart Disease Surveillance System’; or 
‘‘(2) award a grant to one eligible entity to un-
dertake the activities described in paragraph (1). 
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‘‘(b) PURPOSE.—The purpose of the Congenital Heart 
Disease Surveillance System shall be to facilitate further 
research into the types of health services patients use and 
to identify possible areas for educational outreach and pre-
vention in accordance with standard practices of the Cen-
ters for Disease Control and Prevention. 
‘‘(c) CONTENT.—The Congenital Heart Disease Sur-
veillance System— 
‘‘(1) may include information concerning the in-
cidence and prevalence of congenital heart disease in 
the United States; 
‘‘(2) may be used to collect and store data on 
congenital heart disease, including data concerning— 
‘‘(A) demographic factors associated with 
congenital heart disease, such as age, race, eth-
nicity, sex, and family history of individuals 
who are diagnosed with the disease; 
‘‘(B) risk factors associated with the disease; 
‘‘(C) causation of the disease; 
‘‘(D) treatment approaches; and 
‘‘(E) outcome measures, such that analysis 
of the outcome measures will allow derivation of 
evidence-based best practices and guidelines for 
congenital heart disease patients; and 
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‘‘(3) may ensure the collection and analysis of 
longitudinal data related to individuals of all ages 
with congenital heart disease, including infants, 
young children, adolescents, and adults of all ages. 
‘‘(d) PUBLIC ACCESS.—The Congenital Heart Disease 
Surveillance System shall be made available to the public, 
as appropriate, including congenital heart disease research-
ers. 
‘‘(e) PATIENT PRIVACY.—The Secretary shall ensure 
that the Congenital Heart Disease Surveillance System is 
maintained in a manner that complies with the regulations 
promulgated under section 264 of the Health Insurance 
Portability and Accountability Act of 1996. 
‘‘(f) ELIGIBILITY FOR GRANT.—To be eligible to receive 
a grant under subsection (a)(2), an entity shall— 
‘‘(1) be a public or private nonprofit entity with 
specialized experience in congenital heart disease; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require.’’. 
(2) CONGENITAL HEART DISEASE RESEARCH.— 
Subpart 2 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285b et seq.) is amended by 
adding at the end the following: 
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‘‘SEC. 425. CONGENITAL HEART DISEASE. 
‘‘(a) IN GENERAL.—The Director of the Institute may 
expand, intensify, and coordinate research and related ac-
tivities of the Institute with respect to congenital heart dis-
ease, which may include congenital heart disease research 
with respect to— 
‘‘(1) causation of congenital heart disease, in-
cluding genetic causes; 
‘‘(2) long-term outcomes in individuals with con-
genital heart disease, including infants, children, 
teenagers, adults, and elderly individuals; 
‘‘(3) diagnosis, treatment, and prevention; 
‘‘(4) studies using longitudinal data and retro-
spective analysis to identify effective treatments and 
outcomes for individuals with congenital heart dis-
ease; and 
‘‘(5) identifying barriers to life-long care for in-
dividuals with congenital heart disease. 
‘‘(b) COORDINATION OF RESEARCH ACTIVITIES.—The 
Director of the Institute may coordinate research efforts re-
lated to congenital heart disease among multiple research 
institutions and may develop research networks. 
‘‘(c) MINORITY AND MEDICALLY UNDERSERVED COM-
MUNITIES.—In carrying out the activities described in this 
section, the Director of the Institute shall consider the appli-
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cation of such research and other activities to minority and 
medically underserved communities.’’. 
(c) AUTHORIZATION OF APPROPRIATIONS.—There are 
authorized to be appropriated to carry out the amendments 
made by this section such sums as may be necessary for 
each of fiscal years 2011 through 2015. 
SEC. 10412. AUTOMATED DEFIBRILLATION IN ADAM’S MEM-
ORY ACT. 
Section 312 of the Public Health Service Act (42 
U.S.C. 244) is amended— 
(1) in subsection (c)(6), after ‘‘clearinghouse’’ in-
sert ‘‘, that shall be administered by an organization 
that has substantial expertise in pediatric education, 
pediatric medicine, and electrophysiology and sudden 
death,’’; and 
(2) in the first sentence of subsection (e), by 
striking ‘‘fiscal year 2003’’ and all that follows 
through ‘‘2006’’ and inserting ‘‘for each of fiscal years 
2003 through 2014’’. 
SEC. 10413. YOUNG WOMEN’S BREAST HEALTH AWARENESS 
AND SUPPORT OF YOUNG WOMEN DIAG-
NOSED WITH BREAST CANCER. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Young Women’s Breast Health Education and Awareness 
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Requires Learning Young Act of 2009’’ or the ‘‘EARLY 
Act’’. 
(b) AMENDMENT.—Title III of the Public Health Serv-
ice Act (42 U.S.C. 241 et seq.), as amended by this Act, 
is further amended by adding at the end the following: 
‘‘PART V—PROGRAMS RELATING TO BREAST 
HEALTH AND CANCER 
‘‘SEC. 399NN. YOUNG WOMEN’S BREAST HEALTH AWARE-
NESS AND SUPPORT OF YOUNG WOMEN DIAG-
NOSED WITH BREAST CANCER. 
‘‘(a) PUBLIC EDUCATION CAMPAIGN.— 
‘‘(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Centers for Disease Con-
trol and Prevention, shall conduct a national evi-
dence-based education campaign to increase aware-
ness of young women’s knowledge regarding— 
‘‘(A) breast health in young women of all 
racial, ethnic, and cultural backgrounds; 
‘‘(B) breast awareness and good breast 
health habits; 
‘‘(C) the occurrence of breast cancer and the 
general and specific risk factors in women who 
may be at high risk for breast cancer based on 
familial, racial, ethnic, and cultural back-
grounds such as Ashkenazi Jewish populations; 
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‘‘(D) evidence-based information that would 
encourage young women and their health care 
professional to increase early detection of breast 
cancers; and 
‘‘(E) the availability of health information 
and other resources for young women diagnosed 
with breast cancer. 
‘‘(2) EVIDENCE-BASED, AGE APPROPRIATE MES-
SAGES.—The campaign shall provide evidence-based, 
age-appropriate messages and materials as developed 
by the Centers for Disease Control and Prevention 
and the Advisory Committee established under para-
graph (4). 
‘‘(3) MEDIA CAMPAIGN.—In conducting the edu-
cation campaign under paragraph (1), the Secretary 
shall award grants to entities to establish national 
multimedia campaigns oriented to young women that 
may include advertising through television, radio, 
print media, billboards, posters, all forms of existing 
and especially emerging social networking media, 
other Internet media, and any other medium deter-
mined appropriate by the Secretary. 
‘‘(4) ADVISORY COMMITTEE.— 
‘‘(A) ESTABLISHMENT.—Not later than 60 
days after the date of the enactment of this sec-
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tion, the Secretary, acting through the Director 
of the Centers for Disease Control and Preven-
tion, shall establish an advisory committee to as-
sist in creating and conducting the education 
campaigns under paragraph (1) and subsection 
(b)(1). 
‘‘(B) MEMBERSHIP.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall appoint to the ad-
visory committee under subparagraph (A) such 
members as deemed necessary to properly advise 
the Secretary, and shall include organizations 
and individuals with expertise in breast cancer, 
disease prevention, early detection, diagnosis, 
public health, social marketing, genetic screening 
and counseling, treatment, rehabilitation, pallia-
tive care, and survivorship in young women. 
‘‘(b) HEALTH CARE PROFESSIONAL EDUCATION CAM-
PAIGN.—The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, and in con-
sultation with the Administrator of the Health Resources 
and Services Administration, shall conduct an education 
campaign among physicians and other health care profes-
sionals to increase awareness— 
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