1826 
section, unless the pilot program under 
this section has been implemented on a 
permanent basis under subsection (e)(3). 
‘‘(d) 
COMMUNITY-BASED
MEDICAL
HOME 
MODEL.— 
‘‘(1) IN GENERAL.— 
‘‘(A) AUTHORITY
FOR
PAYMENTS.— 
Under the community-based medical 
home model under this subsection (in 
this section referred to as the ‘CBMH 
model’), the Secretary shall make pay-
ments for the furnishing of medical 
home services by a community-based 
medical home (as defined in subpara-
graph (B)) pursuant to paragraph 
(5)(B) for high need beneficiaries. 
‘‘(B) 
COMMUNITY-BASED
MEDICAL 
HOME
DEFINED.—In this section, the 
term 
‘community-based 
medical 
home’ means a nonprofit community- 
based or State-based organization 
that is certified under paragraph (2) 
as meeting the following require-
ments: 
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‘‘(i) The organization provides 
beneficiaries with medical home 
services. 
‘‘(ii) The organization pro-
vides 
medical 
home 
services 
under the supervision of and in 
close collaboration with the pri-
mary care or principal care physi-
cian, nurse practitioner, or physi-
cian assistant designated by the 
beneficiary as his or her commu-
nity-based 
medical 
home 
pro-
vider. 
‘‘(iii) The organization em-
ploys community health workers, 
including nurses or other non- 
physician 
practitioners, 
lay 
health workers, or other persons 
as determined appropriate by the 
Secretary, that assist the primary 
or principal care physician, nurse 
practitioner, or physician assist-
ant in chronic care management 
activities such as teaching self- 
care skills for managing chronic 
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illnesses, transitional care serv-
ices, care plan setting, medication 
therapy management services for 
patients with multiple chronic 
diseases, or help beneficiaries ac-
cess the health care and commu-
nity-based resources in their local 
geographic area. 
‘‘(iv) The organization meets 
such other requirements as the 
Secretary may specify. 
‘‘(C) HIGH
NEED
BENEFICIARY.—In 
this section, the term ‘high need ben-
eficiary’ means an individual who re-
quires regular medical monitoring, 
advising, or treatment. 
‘‘(2) QUALIFICATION PROCESS FOR COM-
MUNITY-BASED
MEDICAL
HOMES.—The Sec-
retary shall establish a process— 
‘‘(A) for the initial qualification of 
community-based or State-based or-
ganizations as community-based med-
ical homes; and 
‘‘(B) to provide for the review and 
qualification 
of 
such 
community- 
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based and State-based organizations 
pursuant to criteria established by 
the Secretary. 
‘‘(3) DURATION.—The pilot program for 
community-based medical homes under 
this subsection shall start no later than 2 
years after the date of the enactment of 
this section. Each demonstration site 
under the pilot program shall operate for 
a period of up to 5 years after the initial 
implementation phase, without regard to 
the receipt of a initial implementation 
funding under subsection (i). 
‘‘(4) PREFERENCE.—In selecting sites 
for the CBMH model, the Secretary may 
give preference to— 
‘‘(A) applications from geographic 
areas that propose to coordinate 
health care services for chronically ill 
beneficiaries 
across 
a 
variety 
of 
health care settings, such as primary 
care physician practices with fewer 
than 10 physicians, specialty physi-
cians, nurse practitioner practices, 
Federally qualified health centers, 
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rural health clinics, and other set-
tings; 
‘‘(B) 
applications 
that 
include 
other payors that furnish medical 
home services for chronically ill pa-
tients covered by such payors; and 
‘‘(C) applications from States that 
propose to use the medical home 
model to coordinate health care serv-
ices for individuals enrolled under 
this title, individuals enrolled under 
title XIX, and full-benefit dual eligible 
individuals (as defined in section 
1935(c)(6)) 
with 
chronic 
diseases 
across a variety of health care set-
tings. 
‘‘(5) PAYMENTS.— 
‘‘(A) ESTABLISHMENT
OF
METHOD-
OLOGY.—The Secretary shall establish 
a methodology for the payment for 
medical 
home 
services 
furnished 
under the CBMH model. 
‘‘(B) PER BENEFICIARY PER MONTH 
PAYMENTS.—Under 
such 
payment 
methodology, 
the 
Secretary 
shall 
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make two separate monthly payments 
for each high need beneficiary who 
consents to receive medical home 
services through such medical home, 
as follows: 
‘‘(i) PAYMENT
TO
COMMUNITY- 
BASED ORGANIZATION.—One month-
ly payment to a community-based 
or State-based organization. 
‘‘(ii) PAYMENT
TO
PRIMARY
OR 
PRINCIPAL
CARE
PRACTICE.—One 
monthly payment to the primary 
or principal care practice for 
such beneficiary. 
‘‘(C) PROSPECTIVE
PAYMENT.—The 
payments under subparagraph (B) 
shall be paid on a prospective basis. 
‘‘(D) AMOUNT OF PAYMENT.—In de-
termining the amount of such pay-
ment, the Secretary shall consider the 
following: 
‘‘(i) The clinical work and 
practice expenses involved in pro-
viding the medical home services 
provided by the community-based 
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medical home (such as providing 
increased access, care coordina-
tion, care plan setting, population 
disease management, and teach-
ing self-care skills for managing 
chronic illnesses) for which pay-
ment is not made under this title 
as of the date of the enactment of 
this section. 
‘‘(ii) Use appropriate risk-ad-
justment 
in 
determining 
the 
amount of the per beneficiary per 
month payment under this para-
graph. 
‘‘(6) INITIAL
IMPLEMENTATION
FUND-
ING.—The Secretary may make available 
initial implementation funding to a com-
munity based or State-based organization 
or a State that is participating in the 
pilot program under this subsection. 
Such organization shall provide the Sec-
retary with a detailed implementation 
plan that includes how such funds will be 
used. 
‘‘(e) EXPANSION OF PROGRAM.— 
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‘‘(1) EVALUATION
OF
COST
AND
QUAL-
ITY.—The Secretary shall evaluate the 
pilot program to determine— 
‘‘(A) the extent to which medical 
homes result in— 
‘‘(i) improvement in the qual-
ity and coordination of health 
care services, particularly with 
regard to the care of complex pa-
tients; 
‘‘(ii) improvement in reducing 
health disparities; 
‘‘(iii) reductions in prevent-
able hospitalizations; 
‘‘(iv) prevention of readmis-
sions; 
‘‘(v) reductions in emergency 
room visits; 
‘‘(vi) improvement in health 
outcomes, including patient func-
tional status where applicable; 
‘‘(vii) improvement in patient 
satisfaction; 
‘‘(viii) improved efficiency of 
care such as reducing duplicative 
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diagnostic tests and laboratory 
tests; and 
‘‘(ix) reductions in health care 
expenditures; and 
‘‘(B) the feasability and advis-
ability of reimbursing medical homes 
for medical home services under this 
title on a permanent basis. 
‘‘(2) REPORT.—Not later than 60 days 
after the date of completion of the eval-
uation under paragraph (1), the Sec-
retary shall submit to Congress and make 
available to the public a report on the 
findings of the evaluation under para-
graph (1). 
‘‘(3) EXPANSION OF PROGRAM.— 
‘‘(A) IN
GENERAL.—Subject to the 
results of the evaluation under para-
graph (1) and subparagraph (B), the 
Secretary may issue regulations to 
implement, on a permanent basis, one 
or more models, if, and to the extent 
that such model or models, are bene-
ficial to the program under this title, 
including that such implementation 
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will improve quality of care, as deter-
mined by the Secretary. 
‘‘(B) 
CERTIFICATION
REQUIRE-
MENT.—The Secretary may not issue 
such regulations unless the Chief Ac-
tuary of the Centers for Medicare & 
Medicaid Services certifies that the 
expansion of the components of the 
pilot program described in subpara-
graph (A) would result in estimated 
spending under this title that would 
be no more than the level of spending 
that the Secretary estimates would 
otherwise be spent under this title in 
the absence of such expansion. 
‘‘(f) ADMINISTRATIVE PROVISIONS.— 
‘‘(1) NO
DUPLICATION
IN
PAYMENTS.— 
During any month, the Secretary may not 
make payments under this section under 
more than one model or through more 
than one medical home under any model 
for the furnishing of medical home serv-
ices to an individual. 
‘‘(2) NO EFFECT ON PAYMENT FOR EVAL-
UATION AND MANAGEMENT SERVICES.—Pay-
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ments made under this section are in ad-
dition to, and have no effect on the 
amount of, payment for evaluation and 
management services made under this 
title 
‘‘(3) ADMINISTRATION.—Chapter 35 of 
title 44, United States Code shall not 
apply to this section. 
‘‘(g) FUNDING.— 
‘‘(1) OPERATIONAL
COSTS.—For pur-
poses of administering and carrying out 
the pilot program (including the design, 
implementation, technical assistance for 
and evaluation of such program), in addi-
tion to funds otherwise available, there 
shall be transferred from the Federal 
Supplementary Medical Insurance Trust 
Fund under section 1841 to the Secretary 
for the Centers for Medicare & Medicaid 
Services Program Management Account 
$6,000,000 for each of fiscal years 2010 
through 
2014. 
Amounts 
appropriated 
under this paragraph for a fiscal year 
shall be available until expended. 
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‘‘(2) PATIENT-CENTERED MEDICAL HOME 
SERVICES.—In addition to funds otherwise 
available, there shall be available to the 
Secretary for the Centers for Medicare & 
Medicaid Services, from the Federal Sup-
plementary 
Medical 
Insurance 
Trust 
Fund under section 1841— 
‘‘(A) $200,000,000 for each of fiscal 
years 2010 through 2014 for payments 
for medical home services under sub-
section (c)(3); and 
‘‘(B) $125,000,000 for each of fiscal 
years 2012 through 2016, for pay-
ments under subsection (d)(5). 
Amounts available under this paragraph 
for a fiscal year shall be available until 
expended. 
‘‘(3) INITIAL IMPLEMENTATION.—In addi-
tion to funds otherwise available, there 
shall be available to the Secretary for the 
Centers for Medicare & Medicaid Serv-
ices, from the Federal Supplementary 
Medical Insurance Trust Fund under sec-
tion 1841, $2,500,000 for each of fiscal 
years 2010 through 2012, under sub-
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section (d)(6). Amounts available under 
this paragraph for a fiscal year shall be 
available until expended. 
‘‘(h) TREATMENT OF TRHCA MEDICARE MED-
ICAL HOME DEMONSTRATION FUNDING.— 
‘‘(1) In addition to funds otherwise 
available for payment of medical home 
services under subsection (c)(3), there 
shall also be available the amount pro-
vided in subsection (g) of section 204 of 
division B of the Tax Relief and Health 
Care Act of 2006 (42 U.S.C. 1395b–1 note). 
‘‘(2) Notwithstanding section 1302(c) 
of 
the 
America’s 
Affordable 
Health 
Choices Act of 2009, in addition to funds 
provided in paragraph (1) and subsection 
(g)(2)(A), the funding for medical home 
services that would otherwise have been 
available if such section 204 medical 
home demonstration had been imple-
mented (without regard to subsection (g) 
of such section) shall be available to the 
independent 
patient-centered 
medical 
home model described in subsection (c).’’. 
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(b) EFFECTIVE
DATE.—The amendment 
made by this section shall apply to services 
furnished on or after the date of the enact-
ment of this Act. 
(c) CONFORMING REPEAL.—Section 204 of 
division B of the Tax Relief and Health Care 
Act of 2006 (42 U.S.C. 1395b–1 note), as amend-
ed by section 133(a)(2) of the Medicare Im-
provements for Patients and Providers Act of 
2008 (Public Law 110–275), is repealed. 
SEC. 1303. PAYMENT INCENTIVE FOR SELECTED PRIMARY 
CARE SERVICES. 
(a) IN GENERAL.—Section 1833 of the So-
cial Security Act is amended by inserting 
after subsection (o) the following new sub-
section: 
‘‘(p) PRIMARY CARE PAYMENT INCENTIVES.— 
‘‘(1) IN GENERAL.—In the case of pri-
mary care services (as defined in para-
graph (2)) furnished on or after January 
1, 2011, by a primary care practitioner (as 
defined in paragraph (3)) for which 
amounts are payable under section 1848, 
in addition to the amount otherwise paid 
under this part there shall also be paid to 
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the practitioner (or to an employer or fa-
cility in the cases described in clause (A) 
of section 1842(b)(6)) (on a monthly or 
quarterly basis) from the Federal Supple-
mentary Medical Insurance Trust Fund 
an amount equal 5 percent (or 10 percent 
if the practitioner predominately fur-
nishes such services in an area that is 
designated (under section 332(a)(1)(A) of 
the Public Health Service Act) as a pri-
mary care health professional shortage 
area. 
‘‘(2) PRIMARY CARE SERVICES DEFINED.— 
In this subsection, the term ‘primary care 
services’— 
‘‘(A) means services which are 
evaluation and management services 
as defined in section 1848(j)(5)(A); 
and 
‘‘(B) includes services furnished 
by another health care professional 
that would be described in subpara-
graph (A) if furnished by a physician. 
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1841 
‘‘(3) PRIMARY
CARE
PRACTITIONER
DE-
FINED.—In this subsection, the term ‘pri-
mary care practitioner’— 
‘‘(A) means a physician or other 
health care practitioner (including a 
nurse practitioner) who— 
‘‘(i) specializes in family medi-
cine, general internal medicine, 
general pediatrics, geriatrics, or 
obstetrics and gynecology; and 
‘‘(ii) has allowed charges for 
primary care services that ac-
count for at least 50 percent of 
the physician’s or practitioner’s 
total allowed charges under sec-
tion 1848, as determined by the 
Secretary for the most recent pe-
riod for which data are available; 
and 
‘‘(B) includes a physician assist-
ant who is under the supervision of a 
physician described in subparagraph 
(A). 
‘‘(4) LIMITATION
ON
REVIEW.—There 
shall be no administrative or judicial re-
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view under section 1869, section 1878, or 
otherwise, respecting— 
‘‘(A) any determination or des-
ignation under this subsection; 
‘‘(B) the identification of services 
as primary care services under this 
subsection; and 
‘‘(C) the identification of a practi-
tioner as a primary care practitioner 
under this subsection. 
‘‘(5) COORDINATION
WITH
OTHER
PAY-
MENTS.— 
‘‘(A) WITH OTHER PRIMARY CARE IN-
CENTIVES.—The provisions of this sub-
section shall not be taken into ac-
count in applying subsections (m) and 
(u) and any payment under such sub-
sections shall not be taken into ac-
count in computing payments under 
this subsection. 
‘‘(B) WITH
QUALITY
INCENTIVES.— 
Payments under this subsection shall 
not be taken into account in deter-
mining the amounts that would other-
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1843 
wise be paid under this part for pur-
poses of section 1834(g)(2)(B).’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1833(m) of such Act (42 
U.S.C. 1395l(m)) is amended by redesig-
nating paragraph (4) as paragraph (5) 
and by inserting after paragraph (3) the 
following new paragraph: 
‘‘(4) The provisions of this subsection shall 
not be taken into account in applying sub-
sections (m) or (u) and any payment under 
such subsections shall not be taken into ac-
count in computing payments under this sub-
section.’’. 
(2) Section 1848(m)(5)(B) of such Act 
(42 U.S.C. 1395w–4(m)(5)(B)) is amended 
by inserting ‘‘, (p),’’ after ‘‘(m)’’. 
(3) Section 1848(o)(1)(B)(iv) of such 
Act (42 U.S.C. 1395w–4(o)(1)(B)(iv)) is 
amended by inserting ‘‘primary care’’ be-
fore ‘‘health professional shortage area’’. 
SEC. 1304. INCREASED REIMBURSEMENT RATE FOR CER-
TIFIED NURSE-MIDWIVES. 
(a) IN GENERAL.—Section 1833(a)(1)(K) of 
the 
Social 
Security 
Act 
(42 
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1844 
U.S.C.1395l(a)(1)(K)) is amended by striking 
‘‘(but in no event’’ and all that follows through 
‘‘performed by a physician)’’. 
(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall apply to services 
furnished on or after January 1, 2011. 
SEC. 1305. COVERAGE AND WAIVER OF COST-SHARING FOR 
PREVENTIVE SERVICES. 
(a) MEDICARE COVERED PREVENTIVE SERV-
ICES DEFINED.—Section 1861 of the Social Se-
curity Act (42 U.S.C. 1395x), as amended by 
section 1233(a)(1)(B), is amended by adding at 
the end the following new subsection: 
‘‘Medicare Covered Preventive Services 
‘‘(iii)(1) Subject to the succeeding provi-
sions of this subsection, the term ‘Medicare 
covered preventive services’ means the fol-
lowing: 
‘‘(A) Prostate cancer screening tests 
(as defined in subsection (oo)). 
‘‘(B) Colorectal cancer screening tests 
(as defined in subsection (pp). 
‘‘(C) Diabetes outpatient self-manage-
ment training services (as defined in sub-
section (qq)). 
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‘‘(D) Screening for glaucoma for cer-
tain individuals (as described in sub-
section (s)(2)(U)). 
‘‘(E) Medical nutrition therapy serv-
ices for certain individuals (as described 
in subsection (s)(2)(V)). 
‘‘(F) An initial preventive physical ex-
amination 
(as 
defined 
in 
subsection 
(ww)). 
‘‘(G) Cardiovascular screening blood 
tests (as defined in subsection (xx)(1)). 
‘‘(H) Diabetes screening tests (as de-
fined in subsection (yy)). 
‘‘(I) Ultrasound screening for abdom-
inal aortic aneurysm for certain individ-
uals 
(as 
described 
in 
subsection 
(s)(2)(AA)). 
‘‘(J) Pneumococcal and influenza vac-
cines and their administration (as de-
scribed in subsection (s)(10)(A)) and hep-
atitis B vaccine and its administration 
for certain individuals (as described in 
subsection (s)(10)(B)). 
‘‘(K) Screening mammography (as de-
fined in subsection (jj)). 
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‘‘(L) Screening pap smear and screen-
ing pelvic exam (as defined in subsection 
(nn)). 
‘‘(M) Bone mass measurement (as de-
fined in subsection (rr)). 
‘‘(N) Kidney disease education serv-
ices (as defined in subsection (ggg)). 
‘‘(O) Additional preventive services 
(as defined in subsection (ddd)). 
‘‘(2) With respect to specific Medicare cov-
ered preventive services, the limitations and 
conditions described in the provisions ref-
erenced in paragraph (1) with respect to such 
services shall apply.’’. 
(b) PAYMENT
AND ELIMINATION
OF COST- 
SHARING.— 
(1) IN GENERAL.— 
(A) IN
GENERAL.—Section 1833(a) 
of the Social Security Act (42 U.S.C. 
1395l(a)) is amended by adding after 
and below paragraph (9) the fol-
lowing: 
‘‘With respect to Medicare covered preventive 
services, in any case in which the payment 
rate otherwise provided under this part is 
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1847 
computed as a percent of less than 100 per-
cent of an actual charge, fee schedule rate, or 
other rate, such percentage shall be increased 
to 100 percent.’’. 
(B) 
APPLICATION
TO 
SIGMOIDOSCOPIES
AND 
COLONOSCOPIES.—Section 
1834(d) 
of 
such Act (42 U.S.C. 1395m(d)) is 
amended— 
(i) in paragraph (2)(C), by 
amending clause (ii) to read as 
follows: 
‘‘(ii) NO COINSURANCE.—In the 
case of a beneficiary who receives 
services described in clause (i), 
there shall be no coinsurance ap-
plied.’’; and 
(ii) in paragraph (3)(C), by 
amending clause (ii) to read as 
follows: 
‘‘(ii) NO COINSURANCE.—In the 
case of a beneficiary who receives 
services described in clause (i), 
there shall be no coinsurance ap-
plied.’’. 
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(2) ELIMINATION
OF
COINSURANCE
IN 
OUTPATIENT HOSPITAL SETTINGS.— 
(A) 
EXCLUSION
FROM
OPD
FEE 
SCHEDULE.—Section 1833(t)(1)(B)(iv) of 
the Social Security Act (42 U.S.C. 
1395l(t)(1)(B)(iv)) is amended by strik-
ing ‘‘screening mammography (as de-
fined in section 1861(jj)) and diag-
nostic mammography’’ and inserting 
‘‘diagnostic mammograms and Medi-
care covered preventive services (as 
defined in section 1861(iii)(1))’’. 
(B) 
CONFORMING
AMENDMENTS.— 
Section 1833(a)(2) of the Social Secu-
rity Act (42 U.S.C. 1395l(a)(2)) is 
amended— 
(i) in subparagraph (F), by 
striking ‘‘and’’ after the semicolon 
at the end; 
(ii) in subparagraph (G), by 
adding ‘‘and’’ at the end; and 
(iii) by adding at the end the 
following new subparagraph: 
‘‘(H) with respect to additional 
preventive services (as defined in sec-
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tion 1861(ddd)) furnished by an out-
patient department of a hospital, the 
amount determined under paragraph 
(1)(W);’’. 
(3) WAIVER OF APPLICATION OF DEDUCT-
IBLE FOR ALL PREVENTIVE SERVICES.—The 
first sentence of section 1833(b) of the So-
cial Security Act (42 U.S.C. 1395l(b)) is 
amended— 
(A) in clause (1), by striking 
‘‘items and services described in sec-
tion 
1861(s)(10)(A)’’ 
and 
inserting 
‘‘Medicare covered preventive serv-
ices (as defined in section 1861(iii))’’; 
(B) by inserting ‘‘and’’ before 
‘‘(4)’’; and 
(C) by striking clauses (5) through 
(8). 
(4) APPLICATION TO PROVIDERS OF SERV-
ICES.—Section 1866(a)(2)(A)(ii) of such Act 
(42 U.S.C. 1395cc(a)(2)(A)(ii)) is amended 
by inserting ‘‘other than for Medicare 
covered preventive services and’’ after 
‘‘for such items and services (’’. 
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(c) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to services 
furnished on or after January 1, 2011. 
SEC. 1306. WAIVER OF DEDUCTIBLE FOR COLORECTAL 
CANCER SCREENING TESTS REGARDLESS OF 
CODING, SUBSEQUENT DIAGNOSIS, OR ANCIL-
LARY TISSUE REMOVAL. 
(a) IN GENERAL.—Section 1833 of the So-
cial Security Act (42 U.S.C. 1395l(b)), as 
amended by section 1305(b), is further amend-
ed— 
(1) in subsection (a), in the sentence 
added by section 1305(b)(1)(A), by insert-
ing ‘‘(including services described in the 
last sentence of section 1833(b))’’ after 
‘‘preventive services’’; and 
(2) in subsection (b), by adding at the 
end the following new sentence: ‘‘Clause 
(1) of the first sentence of this subsection 
shall apply with respect to a colorectal 
cancer screening test regardless of the 
code that is billed for the establishment 
of a diagnosis as a result of the test, or 
for the removal of tissue or other matter 
or other procedure that is furnished in 
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connection with, as a result of, and in the 
same clinical encounter as, the screening 
test.’’. 
(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall apply to items 
and services furnished on or after January 1, 
2011. 
SEC. 1307. EXCLUDING CLINICAL SOCIAL WORKER SERV-
ICES FROM COVERAGE UNDER THE MEDI-
CARE SKILLED NURSING FACILITY PROSPEC-
TIVE PAYMENT SYSTEM AND CONSOLIDATED 
PAYMENT. 
(a) IN GENERAL.—Section 1888(e)(2)(A)(ii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting 
‘‘clinical social worker services,’’ after ‘‘quali-
fied psychologist services,’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1861(hh)(2) of the Social Security Act (42 
U.S.C. 1395x(hh)(2)) is amended by striking 
‘‘and other than services furnished to an inpa-
tient of a skilled nursing facility which the fa-
cility is required to provide as a requirement 
for participation’’. 
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(c) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to items and 
services furnished on or after July 1, 2010. 
SEC. 1308. COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES. 
(a) COVERAGE
OF MARRIAGE
AND FAMILY 
THERAPIST SERVICES.— 
(1) COVERAGE
OF
SERVICES.—Section 
1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 
1235, is amended— 
(A) in subparagraph (EE), by 
striking ‘‘and’’ at the end; 
(B) in subparagraph (FF), by add-
ing ‘‘and’’ at the end; and 
(C) by adding at the end the fol-
lowing new subparagraph: 
‘‘(GG) marriage and family thera-
pist services (as defined in subsection 
(jjj));’’. 
(2) DEFINITION.—Section 1861 of the 
Social Security Act (42 U.S.C. 1395x), as 
amended by sections 1233 and 1305, is 
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amended by adding at the end the fol-
lowing new subsection: 
‘‘Marriage and Family Therapist Services 
‘‘(jjj)(1) The term ‘marriage and family 
therapist services’ means services performed 
by a marriage and family therapist (as de-
fined in paragraph (2)) for the diagnosis and 
treatment of mental illnesses, which the mar-
riage and family therapist is legally author-
ized to perform under State law (or the State 
regulatory mechanism provided by State law) 
of the State in which such services are per-
formed, as would otherwise be covered if fur-
nished by a physician or as incident to a phy-
sician’s professional service, but only if no fa-
cility or other provider charges or is paid any 
amounts with respect to the furnishing of 
such services. 
‘‘(2) The term ‘marriage and family thera-
pist’ means an individual who— 
‘‘(A) possesses a master’s or doctoral 
degree which qualifies for licensure or 
certification as a marriage and family 
therapist pursuant to State law; 
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‘‘(B) after obtaining such degree has 
performed at least 2 years of clinical su-
pervised experience in marriage and fam-
ily therapy; and 
‘‘(C) is licensed or certified as a mar-
riage and family therapist in the State in 
which marriage and family therapist 
services are performed.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER 
PART B.—Section 1832(a)(2)(B) of the So-
cial Security Act (42 U.S.C. 1395k(a)(2)(B)) 
is amended by adding at the end the fol-
lowing new clause: 
‘‘(v) marriage and family ther-
apist services;’’. 
(4) AMOUNT OF PAYMENT.— 
(A) 
IN
GENERAL.—Section 
1833(a)(1) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)) is amended— 
(i) by striking ‘‘and’’ before 
‘‘(W)’’; and 
(ii) by inserting before the 
semicolon at the end the fol-
lowing: ‘‘, and (X) with respect to 
marriage and family therapist 
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services 
under 
section 
1861(s)(2)(GG), the amounts paid 
shall be 80 percent of the lesser of 
the actual charge for the services 
or 75 percent of the amount de-
termined for payment of a psy-
chologist under clause (L)’’. 
(B) 
DEVELOPMENT
OF
CRITERIA 
WITH RESPECT TO CONSULTATION WITH A 
HEALTH CARE PROFESSIONAL.—The Sec-
retary of Health and Human Services 
shall, taking into consideration con-
cerns for patient confidentiality, de-
velop criteria with respect to pay-
ment for marriage and family thera-
pist services for which payment may 
be made directly to the marriage and 
family therapist under part B of title 
XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) under which such 
a therapist must agree to consult 
with a patient’s attending or primary 
care physician or nurse practitioner 
in accordance with such criteria. 
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‘‘Mental Health Counselor Services 
‘‘(kkk)(1) The term ‘mental health coun-
selor services’ means services performed by a 
mental health counselor (as defined in para-
graph (2)) for the diagnosis and treatment of 
mental illnesses which the mental health 
counselor is legally authorized to perform 
under State law (or the State regulatory 
mechanism provided by the State law) of the 
State in which such services are performed, 
as would otherwise be covered if furnished by 
a physician or as incident to a physician’s 
professional service, but only if no facility or 
other provider charges or is paid any 
amounts with respect to the furnishing of 
such services. 
‘‘(2) The term ‘mental health counselor’ 
means an individual who— 
‘‘(A) possesses a master’s or doctor’s 
degree which qualifies the individual for 
licensure or certification for the practice 
of mental health counseling in the State 
in which the services are performed; 
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‘‘(B) after obtaining such a degree has 
performed at least 2 years of supervised 
mental health counselor practice; and 
‘‘(C) is licensed or certified as a men-
tal health counselor or professional coun-
selor by the State in which the services 
are performed.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER 
PART B.—Section 1832(a)(2)(B) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395k(a)(2)(B)), as amended by subsection 
(a)(3), is further amended— 
(A) by striking ‘‘and’’ at the end of 
clause (iv); 
(B) by adding ‘‘and’’ at the end of 
clause (v); and 
(C) by adding at the end the fol-
lowing new clause: 
‘‘(vi) mental health counselor 
services;’’. 
(4) AMOUNT OF PAYMENT.— 
(A) 
IN
GENERAL.—Section 
1833(a)(1) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)), as amended by 
subsection (a), is further amended— 
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(i) by striking ‘‘and’’ before 
‘‘(X)’’; and 
(ii) by inserting before the 
semicolon at the end the fol-
lowing: ‘‘, and (Y), with respect to 
mental health counselor services 
under section 1861(s)(2)(HH), the 
amounts paid shall be 80 percent 
of the lesser of the actual charge 
for the services or 75 percent of 
the amount determined for pay-
ment of a psychologist under 
clause (L)’’. 
(B) 
DEVELOPMENT
OF
CRITERIA 
WITH RESPECT TO CONSULTATION WITH A 
PHYSICIAN.—The Secretary of Health 
and Human Services shall, taking 
into consideration concerns for pa-
tient confidentiality, develop criteria 
with respect to payment for mental 
health counselor services for which 
payment may be made directly to the 
mental health counselor under part B 
of title XVIII of the Social Security 
Act (42 U.S.C. 1395j et seq.) under 
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which such a counselor must agree to 
consult with a patient’s attending or 
primary care physician in accordance 
with such criteria. 
(5) 
EXCLUSION
OF
MENTAL
HEALTH 
COUNSELOR SERVICES FROM SKILLED NURS-
ING
FACILITY
PROSPECTIVE
PAYMENT
SYS-
TEM.—Section 1888(e)(2)(A)(ii) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395yy(e)(2)(A)(ii)), as amended by sec-
tion 1307(a) and subsection (a), is amend-
ed by inserting ‘‘mental health counselor 
services 
(as 
defined 
in 
section 
1861(kkk)(1)),’’ after ‘‘marriage and family 
therapist services (as defined in sub-
section (jjj)(1)),’’. 
(6) COVERAGE OF MENTAL HEALTH COUN-
SELOR SERVICES PROVIDED IN RURAL HEALTH 
CLINICS AND FEDERALLY QUALIFIED HEALTH 
CENTERS.—Section 1861(aa)(1)(B) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(aa)(1)(B)), as amended by sub-
section (a), is amended by striking ‘‘or by 
a marriage and family therapist (as de-
fined in subsection (jjj)(2)),’’ and inserting 
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‘‘by a marriage and family therapist (as 
defined in subsection (jjj)(2)), or a mental 
health counselor (as defined in sub-
section (kkk)(2)),’’. 
(7) INCLUSION OF MENTAL HEALTH COUN-
SELORS AS PRACTITIONERS FOR ASSIGNMENT 
OF CLAIMS.—Section 1842(b)(18)(C) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395u(b)(18)(C)), as amended by sub-
section (a)(7), is amended by adding at 
the end the following new clause: 
‘‘(viii) A mental health counselor (as 
defined in section 1861(kkk)(2)).’’. 
(c) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to items and 
services furnished on or after January 1, 2011. 
SEC. 1309. EXTENSION OF PHYSICIAN FEE SCHEDULE MEN-
TAL HEALTH ADD-ON. 
Section 138(a)(1) of the Medicare Improve-
ments for Patients and Providers Act of 2008 
(Public Law 110–275) is amended by striking 
‘‘December 31, 2009’’ and inserting ‘‘December 
31, 2011’’. 
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SEC. 1310. EXPANDING ACCESS TO VACCINES. 
(a) IN GENERAL.—Paragraph (10) of section 
1861(s) of the Social Security Act (42 U.S.C. 
1395w(s)) is amended to read as follows: 
‘‘(10) federally recommended vaccines 
(as defined in subsection (lll)) and their 
respective administration;’’. 
(b) FEDERALLY
RECOMMENDED
VACCINES 
DEFINED.—Section 1861 of such Act is further 
amended by adding at the end the following 
new subsection: 
‘‘Federally Recommended Vaccines 
‘‘(lll) The term ‘federally recommended 
vaccine’ means an approved vaccine rec-
ommended by the Advisory Committee on Im-
munization Practices (an advisory committee 
established by the Secretary, acting through 
the Director of the Centers for Disease Con-
trol and Prevention).’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1833 of such Act (42 U.S.C. 
1395l) is amended, in each of subsections 
(a)(1)(B), (a)(2)(G), and (a)(3)(A), by strik-
ing 
‘‘1861(s)(10)(A)’’ 
and 
inserting 
‘‘1861(s)(10)’’ each place it appears. 
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(2) Section 1842(o)(1)(A)(iv) of such 
Act 
(42 
U.S.C. 
1395u(o)(1)(A)(iv)) 
is 
amended— 
(A) by striking ‘‘subparagraph (A) 
or (B) of’’; and 
(B) by inserting before the period 
the following: ‘‘and before January 1, 
2011, and influenza vaccines fur-
nished on or after January 1, 2011’’. 
(3) Section 1847A(c)(6) of such Act (42 
U.S.C. 1395w–3a(c)(6)) is amended by 
striking subparagraph (G) and inserting 
the following: 
‘‘(G) IMPLEMENTATION.—Chapter 35 
of title 44, United States Code shall 
not apply to manufacturer provision 
of information pursuant to section 
1927(b)(3)(A)(iii) for purposes of im-
plementation of this section.’’. 
(4) Section 1860D–2(e)(1) of such Act 
(42 U.S.C. 1395w–102(e)(1)) is amended by 
striking ‘‘such term includes a vaccine’’ 
and all that follows through ‘‘its adminis-
tration) and’’. 
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(5) Section 1861(ww)(2)(A) of such Act 
(42 U.S.C. 1395x(ww)(2)(A))) is amended 
by striking ‘‘Pneumococcal, influenza, 
and hepatitis B vaccine and administra-
tion’’ 
and 
inserting 
‘‘Federally 
rec-
ommended vaccines (as defined in sub-
section (lll)) and their respective adminis-
tration’’. 
(6) Section 1861(iii)(1) of such Act, as 
added by section 1305(a), is amended by 
amending subparagraph (J) to read as 
follows: 
‘‘(J) Federally recommended vaccines 
(as defined in subsection (lll)) and their 
respective administration.’’. 
(7) Section 1927(b)(3)(A)(iii) of such 
Act (42 U.S.C. 1396r–8(b)(3)(A)(iii)) is 
amended, in the matter following sub-
clause (III), by inserting ‘‘(A)(iv) (includ-
ing influenza vaccines furnished on or 
after January 1, 2011),’’ after ‘‘described 
in subparagraph’’ 
(d) EFFECTIVE DATES.—The amendments 
made by— 
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(1) this section (other than by sub-
section (c)(7)) shall apply to vaccines ad-
ministered on or after January 1, 2011; 
and 
(2) by subsection (c)(7) shall apply to 
calendar quarters beginning on or after 
January 1, 2010. 
SEC. 1311. EXPANSION OF MEDICARE-COVERED PREVEN-
TIVE SERVICES AT FEDERALLY QUALIFIED 
HEALTH CENTERS. 
Section 1861(aa)(3)(A) of the Social Secu-
rity Act (42 U.S.C. 1395w (aa)(3)(A)) is amend-
ed to read as follows:
‘‘(A) services of the type described 
subparagraphs (A) through (C) of 
paragraph (1) and services described 
in section 1861(iii); and’’. 
TITLE IV—QUALITY 
Subtitle A—Comparative 
Effectiveness Research 
SEC. 1401. COMPARATIVE EFFECTIVENESS RESEARCH. 
(a) IN GENERAL.—Title XI of the Social Se-
curity Act is amended by adding at the end 
the following new part: 
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‘‘PART D—COMPARATIVE EFFECTIVENESS 
RESEARCH 
‘‘COMPARATIVE EFFECTIVENESS RESEARCH 
‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE 
EFFECTIVENESS RESEARCH ESTABLISHED.— 
‘‘(1) IN GENERAL.—The Secretary shall 
establish 
within 
the 
Agency 
for 
Healthcare Research and Quality a Cen-
ter for Comparative Effectiveness Re-
search (in this section referred to as the 
‘Center’) to conduct, support, and syn-
thesize research (including research con-
ducted or supported under section 1013 
of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 
2003) with respect to the outcomes, effec-
tiveness, and appropriateness of health 
care services and procedures in order to 
identify the manner in which diseases, 
disorders, and other health conditions 
can most effectively and appropriately be 
prevented, diagnosed, treated, and man-
aged clinically. 
‘‘(2) DUTIES.—The Center shall— 
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‘‘(A) conduct, support, and syn-
thesize research relevant to the com-
parative effectiveness of the full spec-
trum of health care items, services 
and 
systems, 
including 
pharma-
ceuticals, medical devices, medical 
and surgical procedures, and other 
medical interventions; 
‘‘(B) conduct and support system-
atic reviews of clinical research, in-
cluding original research conducted 
subsequent to the date of the enact-
ment of this section; 
‘‘(C) 
continuously 
develop 
rig-
orous scientific methodologies for 
conducting comparative effectiveness 
studies, and use such methodologies 
appropriately; 
‘‘(D) submit to the Comparative 
Effectiveness Research Commission, 
the Secretary, and Congress appro-
priate relevant reports described in 
subsection (d)(2); and 
‘‘(E) encourage, as appropriate, 
the development and use of clinical 
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registries and the development of 
clinical effectiveness research data 
networks 
from 
electronic 
health 
records, post marketing drug and 
medical device surveillance efforts, 
and other forms of electronic health 
data. 
‘‘(3) POWERS.— 
‘‘(A) OBTAINING
OFFICIAL
DATA.— 
The Center may secure directly from 
any department or agency of the 
United States information necessary 
to enable it to carry out this section. 
Upon request of the Center, the head 
of that department or agency shall 
furnish that information to the Cen-
ter on an agreed upon schedule. 
‘‘(B) DATA
COLLECTION.—In order 
to carry out its functions, the Center 
shall— 
‘‘(i) utilize existing informa-
tion, both published and unpub-
lished, where possible, collected 
and assessed either by its own 
staff or under other arrangements 
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made in accordance with this sec-
tion, 
‘‘(ii) 
carry 
out, 
or 
award 
grants or contracts for, original 
research 
and 
experimentation, 
where existing information is in-
adequate, and 
‘‘(iii) adopt procedures allow-
ing any interested party to submit 
information for the use by the 
Center and Commission under 
subsection (b) in making reports 
and recommendations. 
‘‘(C) ACCESS
OF
GAO
TO
INFORMA-
TION.—The Comptroller General shall 
have unrestricted access to all delib-
erations, records, and nonproprietary 
data of the Center and Commission 
under subsection (b), immediately 
upon request. 
‘‘(D) PERIODIC AUDIT.—The Center 
and Commission under subsection (b) 
shall be subject to periodic audit by 
the Comptroller General. 
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‘‘(b) OVERSIGHT
BY COMPARATIVE EFFEC-
TIVENESS RESEARCH COMMISSION.— 
‘‘(1) IN GENERAL.—The Secretary shall 
establish an independent Comparative 
Effectiveness Research Commission (in 
this section referred to as the ‘Commis-
sion’) to oversee and evaluate the activi-
ties carried out by the Center under sub-
section (a), subject to the authority of the 
Secretary, to ensure such activities result 
in highly credible research and informa-
tion resulting from such research. 
‘‘(2) DUTIES.—The Commission shall— 
‘‘(A) determine national priorities 
for research described in subsection 
(a) and in making such determina-
tions consult with a broad array of 
public and private stakeholders, in-
cluding patients and health care pro-
viders and payers; 
‘‘(B) monitor the appropriateness 
of use of the CERTF described in sub-
section (g) with respect to the timely 
production of comparative effective-
ness research determined to be a na-
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tional priority under subparagraph 
(A); 
‘‘(C) identify highly credible re-
search methods and standards of evi-
dence for such research to be consid-
ered by the Center; 
‘‘(D) review the methodologies de-
veloped by the center under sub-
section (a)(2)(C); 
‘‘(E) not later than one year after 
the date of the enactment of this sec-
tion, 
enter 
into 
an 
arrangement 
under which the Institute of Medicine 
of the National Academy of Sciences 
shall conduct an evaluation and re-
port on standards of evidence for 
such research; 
‘‘(F) support forums to increase 
stakeholder awareness and permit 
stakeholder feedback on the efforts of 
the Center to advance methods and 
standards that promote highly cred-
ible research; 
‘‘(G) make recommendations for 
policies that would allow for public 
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access of data produced under this 
section, in accordance with appro-
priate privacy and proprietary prac-
tices, while ensuring that the infor-
mation produced through such data 
is timely and credible; 
‘‘(H) appoint a clinical perspective 
advisory panel for each research pri-
ority 
determined 
under 
subpara-
graph (A), which shall consult with 
patients and advise the Center on re-
search questions, methods, and evi-
dence gaps in terms of clinical out-
comes for the specific research in-
quiry to be examined with respect to 
such priority to ensure that the infor-
mation produced from such research 
is clinically relevant to decisions 
made by clinicians and patients at 
the point of care; 
‘‘(I) make recommendations for 
the priority for periodic reviews of 
previous 
comparative 
effectiveness 
research and studies conducted by 
the Center under subsection (a); 
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‘‘(J) routinely review processes of 
the Center with respect to such re-
search to confirm that the informa-
tion produced by such research is ob-
jective, 
credible, 
consistent 
with 
standards 
of 
evidence 
established 
under this section, and developed 
through a transparent process that 
includes consultations with appro-
priate stakeholders; and 
‘‘(K) make recommendations to 
the center for the broad dissemina-
tion of the findings of research con-
ducted and supported under this sec-
tion that enables clinicians, patients, 
consumers, and payers to make more 
informed health care decisions that 
improve quality and value. 
‘‘(3) COMPOSITION OF COMMISSION.— 
‘‘(A) IN GENERAL.—The members of 
the Commission shall consist of— 
‘‘(i) the Director of the Agency 
for 
Healthcare 
Research 
and 
Quality; 
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‘‘(ii) the Chief Medical Officer 
of the Centers for Medicare & 
Medicaid Services; and 
‘‘(iii) 15 additional members 
who shall represent broad con-
stituencies of stakeholders includ-
ing clinicians, patients, research-
ers, 
third-party 
payers, 
con-
sumers of Federal and State bene-
ficiary programs. 
Of such members, at least 9 shall be 
practicing physicians, health care 
practitioners, consumers, or patients. 
‘‘(B) QUALIFICATIONS.— 
‘‘(i) DIVERSE
REPRESENTATION 
OF
PERSPECTIVES.—The members 
of the Commission shall represent 
a broad range of perspectives and 
shall collectively have experience 
in the following areas: 
‘‘(I) Epidemiology. 
‘‘(II) Health services re-
search. 
‘‘(III) Bioethics. 
‘‘(IV) Decision sciences. 
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‘‘(V) Health disparities. 
‘‘(VI) Economics. 
‘‘(ii) DIVERSE
REPRESENTATION 
OF
HEALTH
CARE
COMMUNITY.—At 
least one member shall represent 
each of the following health care 
communities: 
‘‘(I) Patients. 
‘‘(II) 
Health 
care 
con-
sumers. 
‘‘(III) 
Practicing 
Physi-
cians, including surgeons. 
‘‘(IV) Other health care 
practitioners engaged in clin-
ical care. 
‘‘(V) Employers. 
‘‘(VI) Public payers. 
‘‘(VII) Insurance plans. 
‘‘(VIII) Clinical research-
ers who conduct research on 
behalf of pharmaceutical or 
device manufacturers. 
‘‘(C) LIMITATION.—No more than 3 
of the Members of the Commission 
may be representatives of pharma-
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ceutical or device manufacturers and 
such representatives shall be clinical 
researchers described under subpara-
graph (B)(ii)(VIII). 
‘‘(4) APPOINTMENT.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall appoint the members of the 
Commission. 
‘‘(B) 
CONSULTATION.—In 
consid-
ering candidates for appointment to 
the Commission, the Secretary may 
consult with the Government Ac-
countability Office and the Institute 
of Medicine of the National Academy 
of Sciences. 
‘‘(5) CHAIRMAN; VICE
CHAIRMAN.—The 
Secretary shall designate a member of 
the Commission, at the time of appoint-
ment of the member, as Chairman and a 
member as Vice Chairman for that term 
of appointment, except that in the case of 
vacancy of the Chairmanship or Vice 
Chairmanship, the Secretary may des-
ignate another member for the remainder 
of that member’s term. The Chairman 
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shall serve as an ex officio member of the 
National Advisory Council of the Agency 
for Health Care Research and Quality 
under section 931(c)(3)(B) of the Public 
Health Service Act. 
‘‘(6) TERMS.— 
‘‘(A) IN GENERAL.—Except as pro-
vided 
in 
subparagraph 
(B), 
each 
member of the Commission shall be 
appointed for a term of 4 years. 
‘‘(B) 
TERMS
OF
INITIAL
AP-
POINTEES.—Of the members first ap-
pointed— 
‘‘(i) 8 shall be appointed for a 
term of 4 years; and 
‘‘(ii) 7 shall be appointed for a 
term of 3 years. 
‘‘(7) COORDINATION.—To enhance effec-
tiveness and coordination, the Secretary 
is encouraged, to the greatest extent pos-
sible, to seek coordination between the 
Commission and the National Advisory 
Council of the Agency for Healthcare Re-
search and Quality. 
‘‘(8) CONFLICTS OF INTEREST.— 
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‘‘(A) IN
GENERAL.—In appointing 
the members of the Commission or a 
clinical perspective advisory panel 
described in paragraph (2)(H), the 
Secretary or the Commission, respec-
tively, shall take into consideration 
any financial interest (as defined in 
subparagraph (D)), consistent with 
this paragraph, and develop a plan 
for managing any identified conflicts. 
‘‘(B) EVALUATION
AND
CRITERIA.— 
When considering an appointment to 
the Commission or a clinical perspec-
tive advisory panel described para-
graph (2)(H) the Secretary or the 
Commission shall review the exper-
tise of the individual and the finan-
cial disclosure report filed by the in-
dividual pursuant to the Ethics in 
Government Act of 1978 for each indi-
vidual under consideration for the 
appointment, so as to reduce the like-
lihood that an appointed individual 
will later require a written deter-
mination as referred to in section 
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208(b)(1) of title 18, United States 
Code, a written certification as re-
ferred to in section 208(b)(3) of title 
18, United States Code, or a waiver as 
referred to in subparagraph (D)(iii) 
for service on the Commission at a 
meeting of the Commission. 
‘‘(C) DISCLOSURES; PROHIBITIONS ON 
PARTICIPATION; WAIVERS.— 
‘‘(i) DISCLOSURE
OF
FINANCIAL 
INTEREST.—Prior to a meeting of 
the Commission or a clinical per-
spective advisory panel described 
in paragraph (2)(H) regarding a 
‘particular matter’ (as that term is 
used in section 208 of title 18, 
United States Code), each mem-
ber of the Commission or the clin-
ical perspective advisory panel 
who is a full-time Government 
employee or special Government 
employee shall disclose to the 
Secretary financial interests in 
accordance with subsection (b) of 
such section 208. 
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‘‘(ii) PROHIBITIONS ON PARTICI-
PATION.—Except 
as 
provided 
under clause (iii), a member of 
the Commission or a clinical per-
spective advisory panel described 
in paragraph (2)(H) may not par-
ticipate with respect to a par-
ticular 
matter 
considered 
in 
meeting of the Commission or the 
clinical 
perspective 
advisory 
panel if such member (or an im-
mediate family member of such 
member) has a financial interest 
that could be affected by the ad-
vice given to the Secretary with 
respect to such matter, excluding 
interests exempted in regulations 
issued by the Director of the Of-
fice of Government Ethics as too 
remote or inconsequential to af-
fect the integrity of the services 
of the Government officers or em-
ployees to which such regulations 
apply. 
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‘‘(iii) 
WAIVER.—If 
the 
Sec-
retary determines it necessary to 
afford the Commission or a clin-
ical perspective advisory panel 
described in paragraph 2(H) es-
sential expertise, the Secretary 
may grant a waiver of the prohi-
bition in clause (ii) to permit a 
member described in such sub-
paragraph to— 
‘‘(I) participate as a non- 
voting member with respect 
to a particular matter consid-
ered in a Commission or a 
clinical perspective advisory 
panel meeting; or 
‘‘(II) participate as a vot-
ing member with respect to a 
particular matter considered 
in a Commission or a clinical 
perspective 
advisory 
panel 
meeting. 
‘‘(iv) LIMITATION
ON
WAIVERS 
AND OTHER EXCEPTIONS.— 
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‘‘(I) DETERMINATION OF AL-
LOWABLE
EXCEPTIONS
FOR
THE 
COMMISSION.—The number of 
waivers granted to members 
of the Commission cannot ex-
ceed one-half of the total 
number of members for the 
Commission. 
‘‘(II) PROHIBITION
ON
VOT-
ING
STATUS
ON
CLINICAL
PER-
SPECTIVE
ADVISORY
PANELS.— 
No voting member of any clin-
ical 
perspective 
advisory 
panel shall be in receipt of a 
waiver. No more than two 
nonvoting members of any 
clinical perspective advisory 
panel shall receive a waiver. 
‘‘(D) 
FINANCIAL
INTEREST
DE-
FINED.—For purposes of this para-
graph, the term ‘financial interest’ 
means a financial interest under sec-
tion 208(a) of title 18, United States 
Code. 
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‘‘(9) COMPENSATION.—While serving on 
the business of the Commission (includ-
ing travel time), a member of the Com-
mission shall be entitled to compensation 
at the per diem equivalent of the rate 
provided for level IV of the Executive 
Schedule under section 5315 of title 5, 
United States Code; and while so serving 
away from home and the member’s reg-
ular place of business, a member may be 
allowed travel expenses, as authorized by 
the Director of the Commission. 
‘‘(10) AVAILABILITY
OF
REPORTS.—The 
Commission shall transmit to the Sec-
retary a copy of each report submitted 
under this subsection and shall make 
such reports available to the public. 
‘‘(11) DIRECTOR
AND
STAFF; EXPERTS 
AND
CONSULTANTS.—Subject to such re-
view as the Secretary deems necessary to 
assure the efficient administration of the 
Commission, the Commission may— 
‘‘(A) appoint an Executive Direc-
tor (subject to the approval of the 
Secretary) and such other personnel 
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as Federal employees under section 
2105 of title 5, United States Code, as 
may be necessary to carry out its du-
ties (without regard to the provisions 
of title 5, United States Code, gov-
erning appointments in the competi-
tive service); 
‘‘(B) seek such assistance and sup-
port as may be required in the per-
formance of its duties from appro-
priate Federal departments and agen-
cies; 
‘‘(C) enter into contracts or make 
other arrangements, as may be nec-
essary for the conduct of the work of 
the Commission (without regard to 
section 3709 of the Revised Statutes 
(41 U.S.C. 5)); 
‘‘(D) make advance, progress, and 
other payments which relate to the 
work of the Commission; 
‘‘(E) provide transportation and 
subsistence for persons serving with-
out compensation; and 
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‘‘(F) prescribe such rules and reg-
ulations as it deems necessary with 
respect to the internal organization 
and operation of the Commission. 
‘‘(c) RESEARCH
REQUIREMENTS.—Any re-
search conducted, supported, or synthesized 
under this section shall meet the following re-
quirements: 
‘‘(1) ENSURING
TRANSPARENCY, CREDI-
BILITY, AND ACCESS.— 
‘‘(A) The establishment of the 
agenda and conduct of the research 
shall be insulated from inappropriate 
political or stakeholder influence. 
‘‘(B) Methods of conducting such 
research shall be scientifically based. 
‘‘(C) 
All 
aspects 
of 
the 
prioritization of research, conduct of 
the research, and development of con-
clusions based on the research shall 
be transparent to all stakeholders. 
‘‘(D) The process and methods for 
conducting such research shall be 
publicly documented and available to 
all stakeholders. 
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‘‘(E) Throughout the process of 
such research, the Center shall pro-
vide 
opportunities 
for 
all 
stake-
holders involved to review and pro-
vide public comment on the methods 
and findings of such research. 
‘‘(2) USE OF CLINICAL PERSPECTIVE AD-
VISORY PANELS.—The research shall meet 
a national research priority determined 
under subsection (b)(2)(A) and shall con-
sider advice given to the Center by the 
clinical perspective advisory panel for 
the national research priority. 
‘‘(3) STAKEHOLDER INPUT.— 
‘‘(A) IN
GENERAL.—The Commis-
sion 
shall 
consult 
with 
patients, 
health care providers, health care 
consumer representatives, and other 
appropriate stakeholders with an in-
terest in the research through a 
transparent process recommended by 
the Commission. 
‘‘(B) SPECIFIC AREAS OF CONSULTA-
TION.—Consultation 
shall 
include 
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where deemed appropriate by the 
Commission— 
‘‘(i) recommending research 
priorities and questions; 
‘‘(ii) recommending research 
methodologies; and 
‘‘(iii) advising on and assisting 
with efforts to disseminate re-
search findings. 
‘‘(C) OMBUDSMAN.—The Secretary 
shall designate a patient ombudsman. 
The ombudsman shall— 
‘‘(i) serve as an available point 
of contact for any patients with 
an interest in proposed compara-
tive effectiveness studies by the 
Center; and 
‘‘(ii) ensure that any com-
ments from patients regarding 
proposed comparative effective-
ness studies are reviewed by the 
Commission. 
‘‘(4) TAKING
INTO
ACCOUNT
POTENTIAL 
DIFFERENCES.—Research shall— 
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‘‘(A) be designed, as appropriate, 
to take into account the potential for 
differences in the effectiveness of 
health care items and services used 
with various subpopulations such as 
racial and ethnic minorities, women, 
different age groups (including chil-
dren, adolescents, adults, and sen-
iors), and individuals with different 
comorbidities; and— 
‘‘(B) seek, as feasible and appro-
priate, to include members of such 
subpopulations as subjects in the re-
search. 
‘‘(d) PUBLIC ACCESS TO COMPARATIVE EF-
FECTIVENESS INFORMATION.— 
‘‘(1) IN
GENERAL.—Not later than 90 
days after receipt by the Center or Com-
mission, as applicable, of a relevant re-
port described in paragraph (2) made by 
the Center, Commission, or clinical per-
spective advisory panel under this sec-
tion, appropriate information contained 
in such report shall be posted on the offi-
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cial public Internet site of the Center and 
of the Commission, as applicable. 
‘‘(2) RELEVANT
REPORTS
DESCRIBED.— 
For purposes of this section, a relevant 
report is each of the following submitted 
by the Center or a grantee or contractor 
of the Center: 
‘‘(A) Any interim or progress re-
ports as deemed appropriate by the 
Secretary. 
‘‘(B) Stakeholder comments. 
‘‘(C) A final report. 
‘‘(e) DISSEMINATION AND INCORPORATION OF 
COMPARATIVE EFFECTIVENESS INFORMATION.— 
‘‘(1) DISSEMINATION.—The Center shall 
provide for the dissemination of appro-
priate findings produced by research 
supported, 
conducted, 
or 
synthesized 
under this section to health care pro-
viders, patients, vendors of health infor-
mation technology focused on clinical de-
cision support, appropriate professional 
associations, and Federal and private 
health plans, and other relevant stake-
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holders. In disseminating such findings 
the Center shall— 
‘‘(A) convey findings of research 
so that they are comprehensible and 
useful to patients and providers in 
making health care decisions; 
‘‘(B) discuss findings and other 
considerations specific to certain sub- 
populations, 
risk 
factors, 
and 
comorbidities as appropriate; 
‘‘(C) include considerations such 
as limitations of research and what 
further research may be needed, as 
appropriate; 
‘‘(D) not include any data that the 
dissemination of which would violate 
the privacy of research participants 
or violate any confidentiality agree-
ments made with respect to the use of 
data under this section; and 
‘‘(E) assist the users of health in-
formation technology focused on clin-
ical decision support to promote the 
timely incorporation of such findings 
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into clinical practices and promote 
the ease of use of such incorporation. 
‘‘(2) DISSEMINATION
PROTOCOLS
AND 
STRATEGIES.—The Center shall develop 
protocols and strategies for the appro-
priate dissemination of research findings 
in order to ensure effective communica-
tion of findings and the use and incorpo-
ration of such findings into relevant ac-
tivities for the purpose of informing high-
er quality and more effective and effi-
cient decisions regarding medical items 
and services. In developing and adopting 
such protocols and strategies, the Center 
shall 
consult 
with 
stakeholders 
con-
cerning the types of dissemination that 
will be most useful to the end users of in-
formation and may provide for the utili-
zation of multiple formats for conveying 
findings to different audiences, including 
dissemination to individuals with limited 
English proficiency. 
‘‘(f) REPORTS TO CONGRESS.— 
‘‘(1) ANNUAL REPORTS.—Beginning not 
later than one year after the date of the 
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enactment of this section, the Director of 
the Agency of Healthcare Research and 
Quality and the Commission shall submit 
to Congress an annual report on the ac-
tivities of the Center and the Commis-
sion, as well as the research, conducted 
under this section. Each such report shall 
include a discussion of the Center’s com-
pliance with subsection (c)(4)(B), includ-
ing any reasons for lack of compliance 
with such subsection. 
‘‘(2) RECOMMENDATION FOR FAIR SHARE 
PER CAPITA AMOUNT FOR ALL-PAYER FINANC-
ING.—Beginning not later than December 
31, 2011, the Secretary shall submit to 
Congress an annual recommendation for 
a fair share per capita amount described 
in subsection (c)(1) of section 9511 of the 
Internal Revenue Code of 1986 for pur-
poses of funding the CERTF under such 
section. 
‘‘(3) ANALYSIS AND REVIEW.—Not later 
than December 31, 2013, the Secretary, in 
consultation with the Commission, shall 
submit to Congress a report on all activi-
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ties conducted or supported under this 
section as of such date. Such report shall 
include an evaluation of the overall costs 
of such activities and an analysis of the 
backlog of any research proposals ap-
proved by the Commission but not fund-
ed. 
‘‘(g) FUNDING OF COMPARATIVE EFFECTIVE-
NESS
RESEARCH.—For fiscal year 2010 and 
each subsequent fiscal year, amounts in the 
Comparative Effectiveness Research Trust 
Fund (referred to in this section as the 
‘CERTF’) under section 9511 of the Internal 
Revenue Code of 1986 shall be available, with-
out the need for further appropriations and 
without fiscal year limitation, to the Sec-
retary to carry out this section. 
‘‘(h) CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit the Commis-
sion or the Center to mandate coverage, reim-
bursement, or other policies for any public or 
private payer.’’. 
(b) COMPARATIVE EFFECTIVENESS RESEARCH 
TRUST
FUND; 
FINANCING
FOR
THE
TRUST 
FUND.—For provision establishing a Compara-
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tive Effectiveness Research Trust Fund and 
financing such Trust Fund, see section 1802. 
Subtitle B—Nursing Home 
Transparency 
PART 1—IMPROVING TRANSPARENCY OF INFOR-
MATION ON SKILLED NURSING FACILITIES 
AND NURSING FACILITIES 
SEC. 1411. REQUIRED DISCLOSURE OF OWNERSHIP AND 
ADDITIONAL DISCLOSABLE PARTIES INFOR-
MATION. 
(a) IN GENERAL.—Section 1124 of the So-
cial Security Act (42 U.S.C. 1320a–3) is amend-
ed by adding at the end the following new 
subsection: 
‘‘(c) REQUIRED DISCLOSURE OF OWNERSHIP 
AND ADDITIONAL DISCLOSABLE PARTIES INFOR-
MATION.— 
‘‘(1) DISCLOSURE.—A facility (as de-
fined in paragraph (7)(B)) shall have the 
information described in paragraph (3) 
available— 
‘‘(A) during the period beginning 
on the date of the enactment of this 
subsection and ending on the date 
such information is made available to 
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the public under section 1411(b) of 
the 
America’s 
Affordable 
Health 
Choices Act of 2009, for submission to 
the Secretary, the Inspector General 
of the Department of Health and 
Human Services, the State in which 
the facility is located, and the State 
long-term care ombudsman in the 
case where the Secretary, the Inspec-
tor General, the State, or the State 
long-term care ombudsman requests 
such information; and 
‘‘(B) beginning on the effective 
date of the final regulations promul-
gated under paragraph (4)(A), for re-
porting such information in accord-
ance with such final regulations. 
Nothing in subparagraph (A) shall be 
construed as authorizing a facility to dis-
pose of or delete information described in 
such subparagraph after the effective 
date of the final regulations promulgated 
under paragraph (4)(A). 
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‘‘(2) PUBLIC AVAILABILITY OF INFORMA-
TION.—During the period described in 
paragraph (1)(A), a facility shall— 
‘‘(A) make the information de-
scribed in paragraph (3) available to 
the public upon request and update 
such information as may be necessary 
to reflect changes in such informa-
tion; and 
‘‘(B) post a notice of the avail-
ability of such information in the 
lobby of the facility in a prominent 
manner. 
‘‘(3) INFORMATION DESCRIBED.— 
‘‘(A) IN
GENERAL.—The following 
information is described in this para-
graph: 
‘‘(i) The information described 
in subsections (a) and (b), subject 
to subparagraph (C). 
‘‘(ii) The identity of and infor-
mation on— 
‘‘(I) each member of the 
governing body of the facility, 
including the name, title, and 
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period of service of each such 
member; 
‘‘(II) each person or entity 
who is an officer, director, 
member, partner, trustee, or 
managing employee of the fa-
cility, 
including 
the 
name, 
title, and date of start of serv-
ice of each such person or en-
tity; and 
‘‘(III) each person or enti-
ty 
who 
is 
an 
additional 
disclosable party of the facil-
ity. 
‘‘(iii) The organizational struc-
ture of each person and entity de-
scribed in subclauses (II) and (III) 
of clause (ii) and a description of 
the relationship of each such per-
son or entity to the facility and to 
one another. 
‘‘(B) SPECIAL RULE WHERE INFORMA-
TION
IS
ALREADY
REPORTED
OR
SUB-
MITTED.—To the extent that informa-
tion reported by a facility to the In-
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ternal Revenue Service on Form 990, 
information submitted by a facility to 
the Securities and Exchange Commis-
sion, or information otherwise sub-
mitted to the Secretary or any other 
Federal agency contains the informa-
tion described in clauses (i), (ii), or 
(iii) of subparagraph (A), the Sec-
retary may allow, to the extent prac-
ticable, such Form or such informa-
tion to meet the requirements of 
paragraph (1) and to be submitted in 
a manner specified by the Secretary. 
‘‘(C) SPECIAL
RULE.—In applying 
subparagraph (A)(i)— 
‘‘(i) 
with 
respect 
to 
sub-
sections (a) and (b), ‘ownership or 
control interest’ shall include di-
rect or indirect interests, includ-
ing such interests in intermediate 
entities; and 
‘‘(ii) 
subsection 
(a)(3)(A)(ii) 
shall include the owner of a 
whole or part interest in any 
mortgage, deed of trust, note, or 
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other obligation secured, in whole 
or in part, by the entity or any of 
the property or assets thereof, if 
the interest is equal to or exceeds 
5 percent of the total property or 
assets of the entirety. 
‘‘(4) REPORTING.— 
‘‘(A) IN GENERAL.—Not later than 
the date that is 2 years after the date 
of the enactment of this subsection, 
the Secretary shall promulgate regu-
lations requiring, effective on the 
date that is 90 days after the date on 
which such final regulations are pub-
lished in the Federal Register, a facil-
ity to report the information de-
scribed in paragraph (3) to the Sec-
retary in a standardized format, and 
such other regulations as are nec-
essary to carry out this subsection. 
Such final regulations shall ensure 
that the facility certifies, as a condi-
tion of participation and payment 
under the program under title XVIII 
or XIX, that the information reported 
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1901 
by the facility in accordance with 
such final regulations is accurate and 
current. 
‘‘(B) 
GUIDANCE.—The 
Secretary 
shall provide guidance and technical 
assistance to States on how to adopt 
the standardized format under sub-
paragraph (A). 
‘‘(5) NO EFFECT ON EXISTING REPORTING 
REQUIREMENTS.—Nothing 
in 
this 
sub-
section shall reduce, diminish, or alter 
any reporting requirement for a facility 
that is in effect as of the date of the en-
actment of this subsection. 
‘‘(6) DEFINITIONS.—In this subsection: 
‘‘(A) 
ADDITIONAL
DISCLOSABLE 
PARTY.—The 
term 
‘additional 
disclosable party’ means, with respect 
to a facility, any person or entity 
who— 
‘‘(i) exercises operational, fi-
nancial, or managerial control 
over the facility or a part thereof, 
or provides policies or procedures 
for any of the operations of the 
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1902 
facility, or provides financial or 
cash management services to the 
facility; 
‘‘(ii) leases or subleases real 
property to the facility, or owns a 
whole or part interest equal to or 
exceeding 5 percent of the total 
value of such real property; 
‘‘(iii) lends funds or provides a 
financial guarantee to the facility 
in an amount which is equal to or 
exceeds $50,000; or 
‘‘(iv) provides management or 
administrative services, clinical 
consulting services, or accounting 
or financial services to the facil-
ity. 
‘‘(B) FACILITY.—The term ‘facility’ 
means a disclosing entity which is— 
‘‘(i) a skilled nursing facility 
(as defined in section 1819(a)); or 
‘‘(ii) a nursing facility (as de-
fined in section 1919(a)). 
‘‘(C) 
MANAGING
EMPLOYEE.—The 
term 
‘managing 
employee’ 
means, 
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1903 
with respect to a facility, an indi-
vidual (including a general manager, 
business manager, administrator, di-
rector, or consultant) who directly or 
indirectly manages, advises, or super-
vises any element of the practices, fi-
nances, or operations of the facility. 
‘‘(D) ORGANIZATIONAL STRUCTURE.— 
The term ‘organizational structure’ 
means, in the case of— 
‘‘(i) a corporation, the officers, 
directors, and shareholders of the 
corporation who have an owner-
ship interest in the corporation 
which is equal to or exceeds 5 
percent; 
‘‘(ii) a limited liability com-
pany, the members and managers 
of the limited liability company 
(including, as applicable, what 
percentage 
each 
member 
and 
manager has of the ownership in-
terest in the limited liability com-
pany); 
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1904 
‘‘(iii) a general partnership, 
the partners of the general part-
nership; 
‘‘(iv) a limited partnership, 
the general partners and any lim-
ited partners of the limited part-
nership who have an ownership 
interest in the limited partner-
ship which is equal to or exceeds 
10 percent; 
‘‘(v) a trust, the trustees of the 
trust; 
‘‘(vi) an individual, contact in-
formation for the individual; and 
‘‘(vii) any other person or en-
tity, such information as the Sec-
retary determines appropriate.’’. 
(b) PUBLIC AVAILABILITY OF INFORMATION.— 
(1) IN
GENERAL.—Not later than the 
date that is 1 year after the date on 
which the final regulations promulgated 
under section 1124(c)(4)(A) of the Social 
Security Act, as added by subsection (a), 
are published in the Federal Register, the 
information reported in accordance with 
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1905 
such final regulations shall be made 
available to the public in accordance 
with procedures established by the Sec-
retary. 
(2) DEFINITIONS.—In this subsection: 
(A) NURSING
FACILITY.—The term 
‘‘nursing facility’’ has the meaning 
given such term in section 1919(a) of 
the Social Security Act (42 U.S.C. 
1396r(a)). 
(B) SECRETARY.—The term ‘‘Sec-
retary’’ means the Secretary of Health 
and Human Services. 
(C) SKILLED
NURSING
FACILITY.— 
The term ‘‘skilled nursing facility’’ 
has the meaning given such term in 
section 1819(a) of the Social Security 
Act (42 U.S.C. 1395i–3(a)). 
(c) CONFORMING AMENDMENTS.— 
(1) SKILLED NURSING FACILITIES.—Sec-
tion 1819(d)(1) of the Social Security Act 
(42 U.S.C. 1395i–3(d)(1)) is amended by 
striking subparagraph (B) and redesig-
nating subparagraph (C) as subpara-
graph (B). 
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1906 
(2) 
NURSING
FACILITIES.—Section 
1919(d)(1) of the Social Security Act (42 
U.S.C. 1396r(d)(1)) is amended by striking 
subparagraph (B) and redesignating sub-
paragraph (C) as subparagraph (B). 
SEC. 1412. ACCOUNTABILITY REQUIREMENTS. 
(a) EFFECTIVE
COMPLIANCE
AND
ETHICS 
PROGRAMS.— 
(1) SKILLED NURSING FACILITIES.—Sec-
tion 1819(d)(1) of the Social Security Act 
(42 U.S.C. 1395i–3(d)(1)), as amended by 
section 1411(c)(1), is amended by adding 
at the end the following new subpara-
graph: 
‘‘(C) COMPLIANCE AND ETHICS PRO-
GRAMS.— 
‘‘(i) 
REQUIREMENT.—On 
or 
after the date that is 36 months 
after the date of the enactment of 
this subparagraph, a skilled nurs-
ing facility shall, with respect to 
the entity that operates the facil-
ity (in this subparagraph referred 
to as the ‘operating organization’ 
or ‘organization’), have in oper-
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bajohnson on DSK2BSOYB1PROD with BILLS
1907 
ation a compliance and ethics 
program that is effective in pre-
venting and detecting criminal, 
civil, and administrative viola-
tions under this Act and in pro-
moting quality of care consistent 
with regulations developed under 
clause (ii). 
‘‘(ii) DEVELOPMENT OF REGULA-
TIONS.— 
‘‘(I) IN GENERAL.—Not later 
than the date that is 2 years 
after such date of the enact-
ment, the Secretary, in con-
sultation with the Inspector 
General of the Department of 
Health and Human Services, 
shall promulgate regulations 
for an effective compliance 
and ethics program for oper-
ating 
organizations, 
which 
may include a model compli-
ance program. 
‘‘(II) DESIGN
OF
REGULA-
TIONS.—Such regulations with 
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1908 
respect to specific elements or 
formality of a program may 
vary with the size of the orga-
nization, such that larger or-
ganizations 
should 
have 
a 
more formal and rigorous pro-
gram and include established 
written policies defining the 
standards and procedures to 
be followed by its employees. 
Such requirements shall spe-
cifically apply to the cor-
porate level management of 
multi-unit 
nursing 
home 
chains. 
‘‘(III) 
EVALUATION.—Not 
later than 3 years after the 
date of promulgation of regu-
lations under this clause, the 
Secretary shall complete an 
evaluation of the compliance 
and ethics programs required 
to be established under this 
subparagraph. Such evalua-
tion shall determine if such 
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1909 
programs led to changes in 
deficiency citations, changes 
in quality performance, or 
changes in other metrics of 
resident quality of care. The 
Secretary shall submit to Con-
gress a report on such evalua-
tion and shall include in such 
report such recommendations 
regarding changes in the re-
quirements for such programs 
as the Secretary determines 
appropriate. 
‘‘(iii) REQUIREMENTS FOR COM-
PLIANCE AND ETHICS PROGRAMS.—In 
this subparagraph, the term ‘com-
pliance 
and 
ethics 
program’ 
means, with respect to a skilled 
nursing facility, a program of the 
operating organization that— 
‘‘(I) has been reasonably 
designed, implemented, and 
enforced so that it generally 
will be effective in preventing 
and detecting criminal, civil, 
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1910 
and administrative violations 
under this Act and in pro-
moting quality of care; and 
‘‘(II) includes at least the 
required components speci-
fied in clause (iv). 
‘‘(iv) REQUIRED COMPONENTS OF 
PROGRAM.—The required compo-
nents of a compliance and ethics 
program of an organization are 
the following: 
‘‘(I) The organization must 
have established compliance 
standards and procedures to 
be followed by its employees, 
contractors, and other agents 
that are reasonably capable of 
reducing 
the 
prospect 
of 
criminal, civil, and adminis-
trative violations under this 
Act. 
‘‘(II) Specific individuals 
within high-level personnel of 
the organization must have 
been assigned overall respon-
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1913 
sible for the failure to detect 
an offense. 
‘‘(VII) After an offense has 
been detected, the organiza-
tion must have taken all rea-
sonable steps to respond ap-
propriately to the offense and 
to prevent further similar of-
fenses, including repayment 
of any funds to which it was 
not entitled and any nec-
essary modification to its pro-
gram to prevent and detect 
criminal, civil, and adminis-
trative violations under this 
Act. 
‘‘(VIII) The organization 
must periodically undertake 
reassessment of its compli-
ance 
program 
to 
identify 
changes necessary to reflect 
changes within the organiza-
tion and its facilities. 
‘‘(v) COORDINATION.—The pro-
visions of this subparagraph shall 
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bajohnson on DSK2BSOYB1PROD with BILLS
1914 
apply with respect to a skilled 
nursing facility in lieu of section 
1874(d).’’. 
(2) 
NURSING
FACILITIES.—Section 
1919(d)(1) of the Social Security Act (42 
U.S.C. 1396r(d)(1)), as amended by section 
1411(c)(2), is amended by adding at the 
end the following new subparagraph: 
‘‘(C) COMPLIANCE AND ETHICS PRO-
GRAM.— 
‘‘(i) 
REQUIREMENT.—On 
or 
after the date that is 36 months 
after the date of the enactment of 
this subparagraph, a nursing fa-
cility shall, with respect to the en-
tity that operates the facility (in 
this subparagraph referred to as 
the ‘operating organization’ or 
‘organization’), have in operation 
a compliance and ethics program 
that is effective in preventing and 
detecting criminal, civil, and ad-
ministrative violations under this 
Act and in promoting quality of 
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1915 
care consistent with regulations 
developed under clause (ii). 
‘‘(ii) DEVELOPMENT OF REGULA-
TIONS.— 
‘‘(I) IN GENERAL.—Not later 
than the date that is 2 years 
after such date of the enact-
ment, the Secretary, in con-
sultation with the Inspector 
General of the Department of 
Health and Human Services, 
shall develop regulations for 
an effective compliance and 
ethics program for operating 
organizations, which may in-
clude 
a 
model 
compliance 
program. 
‘‘(II) DESIGN
OF
REGULA-
TIONS.—Such regulations with 
respect to specific elements or 
formality of a program may 
vary with the size of the orga-
nization, such that larger or-
ganizations 
should 
have 
a 
more formal and rigorous pro-
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1916 
gram and include established 
written policies defining the 
standards and procedures to 
be followed by its employees. 
Such requirements may spe-
cifically apply to the cor-
porate level management of 
multi-unit 
nursing 
home 
chains. 
‘‘(III) 
EVALUATION.—Not 
later than 3 years after the 
date of promulgation of regu-
lations under this clause the 
Secretary shall complete an 
evaluation of the compliance 
and ethics programs required 
to be established under this 
subparagraph. Such evalua-
tion shall determine if such 
programs led to changes in 
deficiency citations, changes 
in quality performance, or 
changes in other metrics of 
resident quality of care. The 
Secretary shall submit to Con-
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1917 
gress a report on such evalua-
tion and shall include in such 
report such recommendations 
regarding changes in the re-
quirements for such programs 
as the Secretary determines 
appropriate. 
‘‘(iii) REQUIREMENTS FOR COM-
PLIANCE AND ETHICS PROGRAMS.—In 
this subparagraph, the term ‘com-
pliance 
and 
ethics 
program’ 
means, with respect to a nursing 
facility, a program of the oper-
ating organization that— 
‘‘(I) has been reasonably 
designed, implemented, and 
enforced so that it generally 
will be effective in preventing 
and detecting criminal, civil, 
and administrative violations 
under this Act and in pro-
moting quality of care; and 
‘‘(II) includes at least the 
required components speci-
fied in clause (iv). 
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1918 
‘‘(iv) REQUIRED COMPONENTS OF 
PROGRAM.—The required compo-
nents of a compliance and ethics 
program of an organization are 
the following: 
‘‘(I) The organization must 
have established compliance 
standards and procedures to 
be followed by its employees 
and other agents that are rea-
sonably capable of reducing 
the prospect of criminal, civil, 
and administrative violations 
under this Act. 
‘‘(II) Specific individuals 
within high-level personnel of 
the organization must have 
been assigned overall respon-
sibility to oversee compliance 
with such standards and pro-
cedures and has sufficient re-
sources and authority to as-
sure such compliance. 
‘‘(III) 
The 
organization 
must have used due care not 
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1919 
to delegate substantial discre-
tionary authority to individ-
uals whom the organization 
knew, or should have known 
through the exercise of due 
diligence, had a propensity to 
engage in criminal, civil, and 
administrative 
violations 
under this Act. 
‘‘(IV) 
The 
organization 
must have taken steps to com-
municate effectively its stand-
ards and procedures to all em-
ployees 
and 
other 
agents, 
such as by requiring partici-
pation in training programs 
or by disseminating publica-
tions that explain in a prac-
tical manner what is required. 
‘‘(V) 
The 
organization 
must have taken reasonable 
steps to achieve compliance 
with its standards, such as by 
utilizing monitoring and au-
diting systems reasonably de-
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1920 
signed 
to 
detect 
criminal, 
civil, and administrative vio-
lations under this Act by its 
employees and other agents 
and by having in place and 
publicizing a reporting sys-
tem whereby employees and 
other agents could report vio-
lations by others within the 
organization without fear of 
retribution. 
‘‘(VI) The standards must 
have been consistently en-
forced 
through 
appropriate 
disciplinary mechanisms, in-
cluding, as appropriate, dis-
cipline of individuals respon-
sible for the failure to detect 
an offense. 
‘‘(VII) After an offense has 
been detected, the organiza-
tion must have taken all rea-
sonable steps to respond ap-
propriately to the offense and 
to prevent further similar of-
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1921 
fenses, including repayment 
of any funds to which it was 
not entitled and any nec-
essary modification to its pro-
gram to prevent and detect 
criminal, civil, and adminis-
trative violations under this 
Act. 
‘‘(VIII) The organization 
must periodically undertake 
reassessment of its compli-
ance 
program 
to 
identify 
changes necessary to reflect 
changes within the organiza-
tion and its facilities. 
‘‘(v) COORDINATION.—The pro-
visions of this subparagraph shall 
apply with respect to a nursing 
facility 
in 
lieu 
of 
section 
1902(a)(77).’’. 
(b) QUALITY ASSURANCE AND PERFORMANCE 
IMPROVEMENT PROGRAM.— 
(1) SKILLED NURSING FACILITIES.—Sec-
tion 1819(b)(1)(B) of the Social Security 
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bajohnson on DSK2BSOYB1PROD with BILLS
1922 
Act (42 U.S.C. 1396r(b)(1)(B)) is amend-
ed— 
(A) by striking ‘‘ASSURANCE’’ and 
inserting ‘‘ASSURANCE AND QUALITY AS-
SURANCE
AND
PERFORMANCE
IMPROVE-
MENT PROGRAM’’; 
(B) by designating the matter be-
ginning with ‘‘A skilled nursing facil-
ity’’ as a clause (i) with the heading 
‘‘IN GENERAL.—’’ and the appropriate 
indentation; 
(C) in clause (i) (as so designated 
by subparagraph (B)), by redesig-
nating clauses (i) and (ii) as sub-
clauses (I) and (II), respectively; and 
(D) by adding at the end the fol-
lowing new clause: 
‘‘(ii) QUALITY
ASSURANCE
AND 
PERFORMANCE
IMPROVEMENT
PRO-
GRAM.— 
‘‘(I) IN GENERAL.—Not later 
than December 31, 2011, the 
Secretary shall establish and 
implement a quality assur-
ance 
and 
performance 
im-
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1923 
provement program (in this 
clause 
referred 
to 
as 
the 
‘QAPI program’) for skilled 
nursing facilities, including 
multi-unit chains of such fa-
cilities. Under the QAPI pro-
gram, the Secretary shall es-
tablish standards relating to 
such facilities and provide 
technical assistance to such 
facilities on the development 
of best practices in order to 
meet 
such 
standards. 
Not 
later than 1 year after the 
date on which the regulations 
are promulgated under sub-
clause (II), a skilled nursing 
facility must submit to the 
Secretary a plan for the facil-
ity to meet such standards 
and 
implement 
such 
best 
practices, including how to 
coordinate the implementa-
tion of such plan with quality 
assessment and assurance ac-
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1924 
tivities 
conducted 
under 
clause (i). 
‘‘(II) 
REGULATIONS.—The 
Secretary 
shall 
promulgate 
regulations to carry out this 
clause.’’. 
(2) 
NURSING
FACILITIES.—Section 
1919(b)(1)(B) of the Social Security Act 
(42 U.S.C. 1396r(b)(1)(B)) is amended— 
(A) by striking ‘‘ASSURANCE’’ and 
inserting ‘‘ASSURANCE AND QUALITY AS-
SURANCE
AND
PERFORMANCE
IMPROVE-
MENT PROGRAM’’; 
(B) by designating the matter be-
ginning with ‘‘A nursing facility’’ as a 
clause (i) with the heading ‘‘IN GEN-
ERAL.—’’ and the appropriate indenta-
tion; and 
(C) by adding at the end the fol-
lowing new clause: 
‘‘(ii) QUALITY
ASSURANCE
AND 
PERFORMANCE
IMPROVEMENT
PRO-
GRAM.— 
‘‘(I) IN GENERAL.—Not later 
than December 31, 2011, the 
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1925 
Secretary shall establish and 
implement a quality assur-
ance 
and 
performance 
im-
provement program (in this 
clause 
referred 
to 
as 
the 
‘QAPI program’) for nursing 
facilities, including multi-unit 
chains 
of 
such 
facilities. 
Under the QAPI program, the 
Secretary 
shall 
establish 
standards relating to such fa-
cilities and provide technical 
assistance to such facilities on 
the development of best prac-
tices in order to meet such 
standards. Not later than 1 
year after the date on which 
the regulations are promul-
gated under subclause (II), a 
nursing facility must submit 
to the Secretary a plan for the 
facility to meet such stand-
ards and implement such best 
practices, including how to 
coordinate the implementa-
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1926 
tion of such plan with quality 
assessment and assurance ac-
tivities 
conducted 
under 
clause (i). 
‘‘(II) 
REGULATIONS.—The 
Secretary 
shall 
promulgate 
regulations to carry out this 
clause.’’. 
(3) PROPOSAL
TO
REVISE
QUALITY
AS-
SURANCE AND PERFORMANCE IMPROVEMENT 
PROGRAMS.—The Secretary shall include 
in the proposed rule published under sec-
tion 1888(e) of the Social Security Act (42 
U.S.C. 1395yy(e)(5)(A)) for the subsequent 
fiscal year to the extent otherwise au-
thorized under section 1819(b)(1)(B) or 
1819(d)(1)(C) of the Social Security Act or 
other statutory or regulatory authority, 
one or more proposals for skilled nursing 
facilities to modify and strengthen qual-
ity assurance and performance improve-
ment programs in such facilities. At the 
time of publication of such proposed rule 
and to the extent otherwise authorized 
under 
section 
1919(b)(1)(B) 
or 
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1927 
1919(d)(1)(C) of such Act or other regu-
latory authority. 
(4) FACILITY
PLAN.—Not later than 1 
year after the date on which the regula-
tions are promulgated under subclause 
(II) of clause (ii) of sections 1819(b)(1)(B) 
and 1919(b)(1)(B) of the Social Security 
Act, as added by paragraphs (1) and (2), a 
skilled nursing facility and a nursing fa-
cility must submit to the Secretary a plan 
for the facility to meet the standards 
under such regulations and implement 
such best practices, including how to co-
ordinate the implementation of such plan 
with quality assessment and assurance 
activities conducted under clause (i) of 
such sections. 
(c) GAO STUDY
ON
NURSING
FACILITY 
UNDERCAPITALIZATION.— 
(1) 
IN
GENERAL.—The 
Comptroller 
General of the United States shall con-
duct a study that examines the following: 
(A) The extent to which corpora-
tions that own or operate large num-
bers of nursing facilities, taking into 
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1928 
account ownership type (including 
private equity and control interests), 
are undercapitalizing such facilities. 
(B) The effects of such under-
capitalization on quality of care, in-
cluding staffing and food costs, at 
such facilities. 
(C) 
Options 
to 
address 
such 
undercapitalization, such as require-
ments relating to surety bonds, liabil-
ity insurance, or minimum capitaliza-
tion. 
(2) REPORT.—Not later than 18 months 
after the date of the enactment of this 
Act, the Comptroller General shall submit 
to Congress a report on the study con-
ducted under paragraph (1). 
(3) NURSING
FACILITY.—In this sub-
section, the term ‘‘nursing facility’’ in-
cludes a skilled nursing facility. 
SEC. 1413. NURSING HOME COMPARE MEDICARE WEBSITE. 
(a) SKILLED NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1819 of the 
Social Security Act (42 U.S.C. 1395i–3) is 
amended— 
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bajohnson on DSK2BSOYB1PROD with BILLS
1929 
(A) by redesignating subsection 
(i) as subsection (j); and 
(B) by inserting after subsection 
(h) the following new subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION OF ADDITIONAL INFORMA-
TION.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall ensure that the Department of 
Health and Human Services includes, 
as part of the information provided 
for comparison of nursing homes on 
the official Internet website of the 
Federal Government for Medicare 
beneficiaries (commonly referred to 
as the ‘Nursing Home Compare’ Medi-
care 
website) 
(or 
a 
successor 
website), the following information in 
a manner that is prominent, easily ac-
cessible, readily understandable to 
consumers of long-term care services, 
and searchable: 
‘‘(i) Information that is re-
ported to the Secretary under sec-
tion 1124(c)(4). 
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1930 
‘‘(ii) Information on the ‘Spe-
cial Focus Facility program’ (or a 
successor 
program) 
established 
by the Centers for Medicare and 
Medicaid Services, according to 
procedures 
established 
by 
the 
Secretary. Such procedures shall 
provide for the inclusion of infor-
mation with respect to, and the 
names and locations of, those fa-
cilities that, since the previous 
quarter— 
‘‘(I) were newly enrolled 
in the program; 
‘‘(II) are enrolled in the 
program and have failed to 
significantly improve; 
‘‘(III) are enrolled in the 
program 
and 
have 
signifi-
cantly improved; 
‘‘(IV) have graduated from 
the program; and 
‘‘(V) have closed volun-
tarily or no longer participate 
under this title. 
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1931 
‘‘(iii) Staffing data for each fa-
cility (including resident census 
data and data on the hours of 
care provided per resident per 
day) based on data submitted 
under subsection (b)(8)(C), includ-
ing information on staffing turn-
over and tenure, in a format that 
is clearly understandable to con-
sumers of long-term care services 
and allows such consumers to 
compare differences in staffing 
between facilities and State and 
national averages for the facili-
ties. Such format shall include— 
‘‘(I) concise explanations 
of how to interpret the data 
(such as a plain English expla-
nation 
of 
data 
reflecting 
‘nursing home staff hours per 
resident day’); 
‘‘(II) differences in types 
of staff (such as training asso-
ciated 
with 
different 
cat-
egories of staff); 
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1932 
‘‘(III) the relationship be-
tween nurse staffing levels 
and quality of care; and 
‘‘(IV) an explanation that 
appropriate 
staffing 
levels 
vary based on patient case 
mix. 
‘‘(iv) Links to State Internet 
websites with information regard-
ing State survey and certification 
programs, links to Form 2567 
State inspection reports (or a suc-
cessor form) on such websites, in-
formation to guide consumers in 
how to interpret and understand 
such reports, and the facility plan 
of correction or other response to 
such report. 
‘‘(v) The standardized com-
plaint form developed under sub-
section (f)(8), including explana-
tory material on what complaint 
forms are, how they are used, and 
how to file a complaint with the 
State 
survey 
and 
certification 
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1933 
program and the State long-term 
care ombudsman program. 
‘‘(vi) Summary information on 
the number, type, severity, and 
outcome of substantiated com-
plaints. 
‘‘(vii) The number of adju-
dicated instances of criminal vio-
lations by employees of a nursing 
facility— 
‘‘(I) that were committed 
inside the facility; 
‘‘(II) with respect to such 
instances 
of 
violations 
or 
crimes committed inside of 
the facility that were the vio-
lations or crimes of abuse, ne-
glect, and exploitation, crimi-
nal sexual abuse, or other vio-
lations or crimes that resulted 
in serious bodily injury; and 
‘‘(III) the number of civil 
monetary 
penalties 
levied 
against the facility, employ-
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1934 
ees, contractors, and other 
agents. 
‘‘(B) DEADLINE
FOR
PROVISION
OF 
INFORMATION.— 
‘‘(i) IN
GENERAL.—Except as 
provided in clause (ii), the Sec-
retary shall ensure that the infor-
mation 
described 
in 
subpara-
graph (A) is included on such 
website (or a successor website) 
not later than 1 year after the 
date of the enactment of this sub-
section. 
‘‘(ii) 
EXCEPTION.—The 
Sec-
retary shall ensure that the infor-
mation 
described 
in 
subpara-
graph (A)(i) and (A)(iii) is in-
cluded on such website (or a suc-
cessor website) not later than the 
date on which the requirements 
under section 1124(c)(4) and sub-
section 
(b)(8)(C)(ii) 
are 
imple-
mented. 
‘‘(2) REVIEW
AND
MODIFICATION
OF 
WEBSITE.— 
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1935 
‘‘(A) IN
GENERAL.—The Secretary 
shall establish a process— 
‘‘(i) to review the accuracy, 
clarity of presentation, timeliness, 
and comprehensiveness of infor-
mation reported on such website 
as of the day before the date of 
the enactment of this subsection; 
and 
‘‘(ii) not later than 1 year after 
the date of the enactment of this 
subsection, to modify or revamp 
such website in accordance with 
the 
review 
conducted 
under 
clause (i). 
‘‘(B) 
CONSULTATION.—In 
con-
ducting the review under subpara-
graph (A)(i), the Secretary shall con-
sult with— 
‘‘(i) State long-term care om-
budsman programs; 
‘‘(ii) 
consumer 
advocacy 
groups; 
‘‘(iii) 
provider 
stakeholder 
groups; and 
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1936 
‘‘(iv) any other representa-
tives of programs or groups the 
Secretary 
determines 
appro-
priate.’’. 
(2) TIMELINESS OF SUBMISSION OF SUR-
VEY AND CERTIFICATION INFORMATION.— 
(A) 
IN
GENERAL.—Section 
1819(g)(5) of the Social Security Act 
(42 U.S.C. 1395i–3(g)(5)) is amended 
by adding at the end the following 
new subparagraph: 
‘‘(E) SUBMISSION
OF
SURVEY
AND 
CERTIFICATION
INFORMATION
TO
THE 
SECRETARY.—In order to improve the 
timeliness of information made avail-
able to the public under subpara-
graph (A) and provided on the Nurs-
ing Home Compare Medicare website 
under subsection (i), each State shall 
submit information respecting any 
survey or certification made respect-
ing a skilled nursing facility (includ-
ing any enforcement actions taken by 
the State) to the Secretary not later 
than the date on which the State 
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1937 
sends such information to the facility. 
The Secretary shall use the informa-
tion submitted under the preceding 
sentence to update the information 
provided on the Nursing Home Com-
pare Medicare website as expedi-
tiously as practicable but not less fre-
quently than quarterly.’’. 
(B) EFFECTIVE DATE.—The amend-
ment made by this paragraph shall 
take effect 1 year after the date of the 
enactment of this Act. 
(3) SPECIAL FOCUS FACILITY PROGRAM.— 
Section 1819(f) of such Act is amended by 
adding at the end the following new 
paragraph: 
‘‘(8) 
SPECIAL
FOCUS
FACILITY
PRO-
GRAM.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall conduct a special focus facility 
program for enforcement of require-
ments for skilled nursing facilities 
that the Secretary has identified as 
having substantially failed to meet 
applicable requirement of this Act. 
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1938 
‘‘(B) 
PERIODIC
SURVEYS.—Under 
such program the Secretary shall 
conduct surveys of each facility in 
the program not less than once every 
6 months.’’. 
(b) NURSING FACILITIES.— 
(1) IN GENERAL.—Section 1919 of the 
Social Security Act (42 U.S.C. 1396r) is 
amended— 
(A) by redesignating subsection 
(i) as subsection (j); and 
(B) by inserting after subsection 
(h) the following new subsection: 
‘‘(i) NURSING HOME COMPARE WEBSITE.— 
‘‘(1) INCLUSION OF ADDITIONAL INFORMA-
TION.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall ensure that the Department of 
Health and Human Services includes, 
as part of the information provided 
for comparison of nursing homes on 
the official Internet website of the 
Federal Government for Medicare 
beneficiaries (commonly referred to 
as the ‘Nursing Home Compare’ Medi-
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1939 
care 
website) 
(or 
a 
successor 
website), the following information in 
a manner that is prominent, easily ac-
cessible, readily understandable to 
consumers of long-term care services, 
and searchable: 
‘‘(i) Staffing data for each fa-
cility (including resident census 
data and data on the hours of 
care provided per resident per 
day) based on data submitted 
under subsection (b)(8)(C)(ii), in-
cluding information on staffing 
turnover and tenure, in a format 
that is clearly understandable to 
consumers of long-term care serv-
ices and allows such consumers to 
compare differences in staffing 
between facilities and State and 
national averages for the facili-
ties. Such format shall include— 
‘‘(I) concise explanations 
of how to interpret the data 
(such as plain English expla-
nation 
of 
data 
reflecting 
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1940 
‘nursing home staff hours per 
resident day’); 
‘‘(II) differences in types 
of staff (such as training asso-
ciated 
with 
different 
cat-
egories of staff); 
‘‘(III) the relationship be-
tween nurse staffing levels 
and quality of care; and 
‘‘(IV) an explanation that 
appropriate 
staffing 
levels 
vary based on patient case 
mix. 
‘‘(ii) Links to State Internet 
websites with information regard-
ing State survey and certification 
programs, links to Form 2567 
State inspection reports (or a suc-
cessor form) on such websites, in-
formation to guide consumers in 
how to interpret and understand 
such reports, and the facility plan 
of correction or other response to 
such report. 
VerDate Nov 24 2008 
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1941 
‘‘(iii) The standardized com-
plaint form developed under sub-
section (f)(10), including explana-
tory material on what complaint 
forms are, how they are used, and 
how to file a complaint with the 
State 
survey 
and 
certification 
program and the State long-term 
care ombudsman program. 
‘‘(iv) Summary information on 
the number, type, severity, and 
outcome of substantiated com-
plaints. 
‘‘(v) 
The 
number 
of 
adju-
dicated instances of criminal vio-
lations by employees of a nursing 
facility— 
‘‘(I) that were committed 
inside of the facility; and 
‘‘(II) with respect to such 
instances 
of 
violations 
or 
crimes committed outside of 
the facility, that were the vio-
lations or crimes that resulted 
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1942 
in the serious bodily injury of 
an elder. 
‘‘(B) DEADLINE
FOR
PROVISION
OF 
INFORMATION.— 
‘‘(i) IN
GENERAL.—Except as 
provided in clause (ii), the Sec-
retary shall ensure that the infor-
mation 
described 
in 
subpara-
graph (A) is included on such 
website (or a successor website) 
not later than 1 year after the 
date of the enactment of this sub-
section. 
‘‘(ii) 
EXCEPTION.—The 
Sec-
retary shall ensure that the infor-
mation 
described 
in 
subpara-
graph (A)(i) and (A)(iii) is in-
cluded on such website (or a suc-
cessor website) not later than the 
date on which the requirements 
under section 1124(c)(4) and sub-
section 
(b)(8)(C)(ii) 
are 
imple-
mented. 
‘‘(2) REVIEW
AND
MODIFICATION
OF 
WEBSITE.— 
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1943 
‘‘(A) IN
GENERAL.—The Secretary 
shall establish a process— 
‘‘(i) to review the accuracy, 
clarity of presentation, timeliness, 
and comprehensiveness of infor-
mation reported on such website 
as of the day before the date of 
the enactment of this subsection; 
and 
‘‘(ii) not later than 1 year after 
the date of the enactment of this 
subsection, to modify or revamp 
such website in accordance with 
the 
review 
conducted 
under 
clause (i). 
‘‘(B) 
CONSULTATION.—In 
con-
ducting the review under subpara-
graph (A)(i), the Secretary shall con-
sult with— 
‘‘(i) State long-term care om-
budsman programs; 
‘‘(ii) 
consumer 
advocacy 
groups; 
‘‘(iii) 
provider 
stakeholder 
groups; 
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1944 
‘‘(iv) skilled nursing facility 
employees and their representa-
tives; and 
‘‘(v) any other representatives 
of programs or groups the Sec-
retary determines appropriate.’’. 
(2) TIMELINESS OF SUBMISSION OF SUR-
VEY AND CERTIFICATION INFORMATION.— 
(A) 
IN
GENERAL.—Section 
1919(g)(5) of the Social Security Act 
(42 U.S.C. 1396r(g)(5)) is amended by 
adding at the end the following new 
subparagraph: 
‘‘(E) SUBMISSION
OF
SURVEY
AND 
CERTIFICATION
INFORMATION
TO
THE 
SECRETARY.—In order to improve the 
timeliness of information made avail-
able to the public under subpara-
graph (A) and provided on the Nurs-
ing Home Compare Medicare website 
under subsection (i), each State shall 
submit information respecting any 
survey or certification made respect-
ing a nursing facility (including any 
enforcement actions taken by the 
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1945 
State) to the Secretary not later than 
the date on which the State sends 
such information to the facility. The 
Secretary shall use the information 
submitted under the preceding sen-
tence to update the information pro-
vided on the Nursing Home Compare 
Medicare website as expeditiously as 
practicable but not less frequently 
than quarterly.’’. 
(B) EFFECTIVE DATE.—The amend-
ment made by this paragraph shall 
take effect 1 year after the date of the 
enactment of this Act. 
(3) SPECIAL FOCUS FACILITY PROGRAM.— 
Section 1919(f) of such Act is amended by 
adding at the end of the following new 
paragraph: 
‘‘(10) SPECIAL
FOCUS
FACILITY
PRO-
GRAM.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall conduct a special focus facility 
program for enforcement of require-
ments for nursing facilities that the 
Secretary has identified as having 
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bajohnson on DSK2BSOYB1PROD with BILLS
1946 
substantially failed to meet applica-
ble requirements of this Act. 
‘‘(B) 
PERIODIC
SURVEYS.—Under 
such program the Secretary shall 
conduct surveys of each facility in 
the program not less often than once 
every 6 months.’’. 
(c) AVAILABILITY OF REPORTS ON SURVEYS, 
CERTIFICATIONS, 
AND
COMPLAINT
INVESTIGA-
TIONS.— 
(1) SKILLED NURSING FACILITIES.—Sec-
tion 1819(d)(1) of the Social Security Act 
(42 U.S.C. 1395i–3(d)(1)), as amended by 
sections 1411 and 1412, is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(D) AVAILABILITY OF SURVEY, CER-
TIFICATION, AND COMPLAINT INVESTIGA-
TION
REPORTS.—A skilled nursing fa-
cility must— 
‘‘(i) have reports with respect 
to any surveys, certifications, and 
complaint investigations made re-
specting the facility during the 3 
preceding years available for any 
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1947 
individual to review upon re-
quest; and 
‘‘(ii) post notice of the avail-
ability of such reports in areas of 
the facility that are prominent 
and accessible to the public. 
The facility shall not make available 
under clause (i) identifying informa-
tion 
about 
complainants 
or 
resi-
dents.’’. 
(2) 
NURSING
FACILITIES.—Section 
1919(d)(1) of the Social Security Act (42 
U.S.C. 1396r(d)(1)), as amended by sec-
tions 1411 and 1412, is amended by add-
ing at the end the following new subpara-
graph: 
‘‘(D) AVAILABILITY OF SURVEY, CER-
TIFICATION, AND COMPLAINT INVESTIGA-
TION
REPORTS.—A 
nursing 
facility 
must— 
‘‘(i) have reports with respect 
to any surveys, certifications, and 
complaint investigations made re-
specting the facility during the 3 
preceding years available for any 
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bajohnson on DSK2BSOYB1PROD with BILLS
1948 
individual to review upon re-
quest; and 
‘‘(ii) post notice of the avail-
ability of such reports in areas of 
the facility that are prominent 
and accessible to the public. 
The facility shall not make available 
under clause (i) identifying informa-
tion 
about 
complainants 
or 
resi-
dents.’’. 
(3) EFFECTIVE DATE.—The amendments 
made by this subsection shall take effect 
1 year after the date of the enactment of 
this Act. 
(d) GUIDANCE
TO STATES
ON FORM 2567 
STATE INSPECTION REPORTS AND COMPLAINT IN-
VESTIGATION REPORTS.— 
(1) 
GUIDANCE.—The 
Secretary 
of 
Health and Human Services (in this sub-
title referred to as the ‘‘Secretary’’) shall 
provide guidance to States on how States 
can establish electronic links to Form 
2567 State inspection reports (or a suc-
cessor form), complaint investigation re-
ports, and a facility’s plan of correction 
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bajohnson on DSK2BSOYB1PROD with BILLS
1949 
or other response to such Form 2567 
State inspection reports (or a successor 
form) on the Internet website of the State 
that provides information on skilled 
nursing facilities and nursing facilities 
and the Secretary shall, if possible, in-
clude such information on Nursing Home 
Compare. 
(2) REQUIREMENT.—Section 1902(a)(9) 
of the Social Security Act (42 U.S.C. 
1396a(a)(9)) is amended— 
(A) by striking ‘‘and’’ at the end of 
subparagraph (B); 
(B) by striking the semicolon at 
the end of subparagraph (C) and in-
serting ‘‘, and’’; and 
(C) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) that the State maintain a 
consumer-oriented website providing 
useful information to consumers re-
garding all skilled nursing facilities 
and all nursing facilities in the State, 
including for each facility, Form 2567 
State inspection reports (or a suc-
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1976 
case where a facility self-re-
ports and promptly corrects a 
deficiency for which a penalty 
was 
imposed 
under 
this 
clause not later than 10 cal-
endar days after the date of 
such 
imposition, 
the 
Sec-
retary 
may 
reduce 
the 
amount of the penalty im-
posed by not more than 50 
percent. 
‘‘(V) PROHIBITION
ON
RE-
DUCTION
FOR
CERTAIN
DEFI-
CIENCIES.— 
‘‘(aa) 
REPEAT
DEFI-
CIENCIES.—The 
Secretary 
may 
not 
reduce 
under 
subclause (IV) the amount 
of a penalty if the defi-
ciency is a repeat defi-
ciency. 
‘‘(bb) CERTAIN
OTHER 
DEFICIENCIES.—The 
Sec-
retary 
may 
not 
reduce 
under subclause (IV) the 
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