124 
(2) the program submits periodic reports to the 
Board showing the operation and effectiveness of the 
alternative methodology, in order for the Board to 
evaluate the appropriateness of applying the alter-
native methodology to other States. 
Subtitle C—Mandatory Assignment 
and Administrative Provisions 
SEC. 631. MANDATORY ASSIGNMENT. 
(a) NO BALANCE BILLING.—Payments for benefits 
under this Act shall constitute payment in full for such 
benefits and the entity furnishing an item or service for 
which payment is made under this Act shall accept such 
payment as payment in full for the item or service and 
may not accept any payment or impose any charge for 
any such item or service other than accepting payment 
from the State health security program in accordance with 
this Act. 
(b) ENFORCEMENT.—If an entity knowingly and will-
fully bills for an item or service or accepts payment in 
violation of subsection (a), the Board may apply sanctions 
against the entity in the same manner as sanctions could 
have been imposed under section 1842(j)(2) of the Social 
Security Act for a violation of section 1842(j)(1) of such 
Act. Such sanctions are in addition to any sanctions that 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00124
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS
125 
a State may impose under its State health security pro-
gram. 
SEC. 632. PROCEDURES FOR REIMBURSEMENT; APPEALS. 
(a) PROCEDURES FOR REIMBURSEMENT.—In accord-
ance with standards issued by the Board, a State health 
security program shall establish a timely and administra-
tively simple procedure to assure payment within 60 days 
of the date of submission of clean claims by providers 
under this Act. 
(b) APPEALS PROCESS.—Each State health security 
program shall establish an appeals process to handle all 
grievances pertaining to payment to providers under this 
title. 
TITLE VII—PROMOTION OF PRI-
MARY HEALTH CARE; DEVEL-
OPMENT OF HEALTH SERV-
ICE CAPACITY; PROGRAMS TO 
ASSIST THE MEDICALLY UN-
DERSERVED 
Subtitle A—Promotion and Expan-
sion of Primary Care Profes-
sional Training 
SEC. 701. ROLE OF BOARD; ESTABLISHMENT OF PRIMARY 
CARE PROFESSIONAL OUTPUT GOALS. 
(a) IN GENERAL.—The Board is responsible for— 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00125
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS
126 
(1) coordinating health professional education 
policies and goals, in consultation with the Secretary 
of Health and Human Services (in this title referred 
to as the ‘‘Secretary’’), to achieve the national goals 
specified in subsection (b); 
(2) overseeing the health professional education 
expenditures of the State health security programs 
from the account established under section 602(c); 
(3) developing and maintaining, in cooperation 
with the Secretary, a system to monitor the number 
and specialties of individuals through their health 
professional education, any postgraduate training, 
and professional practice; and 
(4) developing, coordinating, and promoting 
other policies that expand the number of primary 
care practitioners. 
(b) NATIONAL GOALS.—The national goals specified 
in this subsection are as follows: 
(1) GRADUATE MEDICAL EDUCATION.—By not 
later than 5 years after the date of the enactment 
of this Act, at least 50 percent of the residents in 
medical residency education programs (as defined in 
subsection (e)(1)) are primary care residents (as de-
fined in subsection (e)(3)). 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00126
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS
127 
(2) 
MIDLEVEL
PRIMARY
CARE
PRACTI-
TIONERS.—To assure an adequate supply of primary 
care practitioners, there shall be a number, specified 
by the Board, of midlevel primary care practitioners 
(as defined in subsection (e)(2)) employed in the 
health care system as of January 1, 2013. 
(c) METHOD FOR ATTAINMENT OF NATIONAL GOAL 
FOR
GRADUATE
MEDICAL
EDUCATION; 
PROGRAM 
GOALS.— 
(1) IN GENERAL.—The Board shall establish a 
method of applying the national goal in subsection 
(b)(1) to program goals for each medical residency 
education program or to medical residency education 
consortia. 
(2) 
CONSIDERATION.—The 
program 
goals 
under paragraph (1) shall be based on the distribu-
tion of medical schools and other teaching facilities 
within each State health security program, and the 
number of positions for graduate medical education. 
(3) MEDICAL RESIDENCY EDUCATION CONSOR-
TIUM.—In this subsection, the term ‘‘medical resi-
dency education consortium’’ means a consortium of 
medical residency education programs in a contig-
uous geographic area (which may be an interstate 
area) if the consortium— 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00127
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS
128 
(A) includes at least 1 medical school with 
a teaching hospital and related teaching set-
tings; and 
(B) has an affiliation with qualified com-
munity-based primary health service providers 
described in section 202(a) and with at least 1 
comprehensive health service organization es-
tablished under section 303. 
(4) ENFORCEMENT THROUGH STATE HEALTH 
SECURITY
BUDGETS.—The Board shall develop a 
formula for reducing payments to State health secu-
rity programs (that provide for payments to a med-
ical residency education program) that failed to meet 
the goal for the program established under this sub-
section. 
(d) METHOD FOR ATTAINMENT OF NATIONAL GOAL 
FOR MIDLEVEL PRIMARY CARE PRACTITIONERS.—To as-
sist in attaining the national goal identified in subsection 
(b)(2), the Board shall— 
(1) advise the Public Health Service on alloca-
tions of funding under titles VII and VIII of the 
Public Health Service Act, the National Health 
Service Corps, and other programs in order to in-
crease the supply of midlevel primary care practi-
tioners; and 
VerDate Nov 24 2008 
22:51 Feb 26, 2009
Jkt 079200
PO 00000
Frm 00128
Fmt 6652
Sfmt 6201
E:\BILLS\H1200.IH
H1200
mstockstill on PROD1PC66 with BILLS