501 
riage and family therapist is legally authorized to perform 
under State law (or the State regulatory mechanism pro-
vided by 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 ‘marriage and family therapist’ 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; 
‘‘(B) after obtaining such degree has performed 
at least 2 years of clinical supervised experience in 
marriage and family therapy; and 
‘‘(C) is licensed or certified as a marriage 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 Social Security 
Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add-
ing at the end the following new clause: 
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‘‘(v) marriage and family therapist 
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 following: ‘‘, and (X) with 
respect to marriage and family therapist 
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 determined 
for payment of a psychologist under clause 
(L)’’. 
(B) DEVELOPMENT OF CRITERIA WITH RE-
SPECT
TO
CONSULTATION
WITH
A
HEALTH 
CARE PROFESSIONAL.—The Secretary of Health 
and Human Services shall, taking into consider-
ation concerns for patient confidentiality, de-
velop criteria with respect to payment for mar-
riage and family therapist services for which 
payment may be made directly to the marriage 
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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. 
(5) EXCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES FROM SKILLED NURSING FA-
CILITY
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 
1307(a), is amended by inserting ‘‘marriage and 
family therapist services (as defined in subsection 
(jjj)(1)),’’ after ‘‘clinical social worker services,’’. 
(6) COVERAGE
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES PROVIDED IN RURAL HEALTH 
CLINICS AND FEDERALLY QUALIFIED HEALTH CEN-
TERS.—Section 1861(aa)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by 
striking ‘‘or by a clinical social worker (as defined 
in subsection (hh)(1)),’’ and inserting ‘‘, by a clinical 
social worker (as defined in subsection (hh)(1)), or 
by a marriage and family therapist (as defined in 
subsection (jjj)(2)),’’. 
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(7) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS
AS
PRACTITIONERS
FOR
ASSIGNMENT 
OF CLAIMS.—Section 1842(b)(18)(C) of the Social 
Security Act (42 U.S.C. 1395u(b)(18)(C)) is amend-
ed by adding at the end the following new clause: 
‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(jjj)(2)).’’. 
(b) COVERAGE OF MENTAL HEALTH COUNSELOR 
SERVICES.— 
(1) 
COVERAGE
OF
SERVICES.—Section 
1861(s)(2) of the Social Security Act (42 U.S.C. 
1395x(s)(2)), as previously amended, is further 
amended— 
(A) in subparagraph (FF), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (GG), by inserting 
‘‘and’’ at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(HH) mental health counselor services (as de-
fined in subsection (kkk)(1));’’. 
(2) DEFINITION.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x), as previously 
amended, is amended by adding at the end the fol-
lowing new subsection: 
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‘‘Mental Health Counselor Services 
‘‘(kkk)(1) The term ‘mental health counselor services’ 
means services performed by a mental health counselor (as 
defined in paragraph (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 inci-
dent 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 certifi-
cation for the practice of mental health counseling in 
the State in which the services are performed; 
‘‘(B) after obtaining such a degree has per-
formed at least 2 years of supervised mental health 
counselor practice; and 
‘‘(C) is licensed or certified as a mental health 
counselor or professional counselor by the State in 
which the services are performed.’’. 
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(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of the Social 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 following new 
clause: 
‘‘(vi) mental health counselor serv-
ices;’’. 
(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— 
(i) by striking ‘‘and’’ before ‘‘(X)’’; 
and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, 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 
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or 75 percent of the amount determined 
for payment of a psychologist under clause 
(L)’’. 
(B) DEVELOPMENT OF CRITERIA WITH RE-
SPECT TO CONSULTATION WITH A PHYSICIAN.— 
The Secretary of Health and Human Services 
shall, taking into consideration concerns for pa-
tient confidentiality, develop criteria with re-
spect to payment for mental health counselor 
services for which payment may be made di-
rectly to the mental health counselor under part 
B of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) under which such a coun-
selor must agree to consult with a patient’s at-
tending or primary care physician in accordance 
with such criteria. 
(5) EXCLUSION
OF
MENTAL
HEALTH
COUN-
SELOR SERVICES FROM SKILLED NURSING FACILITY 
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(ii)), as amended by section 
1307(a) and subsection (a), is amended by inserting 
‘‘mental health counselor services (as defined in sec-
tion 1861(kkk)(1)),’’ after ‘‘marriage and family 
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therapist 
services 
(as 
defined 
in 
subsection 
(jjj)(1)),’’. 
(6) COVERAGE
OF
MENTAL
HEALTH
COUN-
SELOR
SERVICES
PROVIDED
IN
RURAL
HEALTH 
CLINICS AND FEDERALLY QUALIFIED HEALTH CEN-
TERS.—Section 1861(aa)(1)(B) of the Social Secu-
rity Act (42 U.S.C. 1395x(aa)(1)(B)), as amended 
by subsection (a), is amended by striking ‘‘or by a 
marriage and family therapist (as defined in sub-
section (jjj)(2)),’’ and inserting ‘‘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 Se-
curity Act (42 U.S.C. 1395u(b)(18)(C)), as amended 
by subsection (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. 
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509 
SEC. 1309. EXTENSION OF PHYSICIAN FEE SCHEDULE MEN-
TAL HEALTH ADD-ON. 
Section 138(a)(1) of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110–275) 
is amended by striking ‘‘December 31, 2009’’ and insert-
ing ‘‘December 31, 2011’’. 
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 de-
fined in subsection (lll)) and their respective admin-
istration;’’. 
(b) FEDERALLY
RECOMMENDED
VACCINES
DE-
FINED.—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 recommended by the Advisory 
Committee on Immunization Practices (an advisory com-
mittee established by the Secretary, acting through the Di-
rector of the Centers for Disease Control and Preven-
tion).’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1833 of such Act (42 U.S.C. 1395l) 
is amended, in each of subsections (a)(1)(B), 
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(a)(2)(G), 
and 
(a)(3)(A), 
by 
striking 
‘‘1861(s)(10)(A)’’ and inserting ‘‘1861(s)(10)’’ each 
place it appears. 
(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 fol-
lowing: ‘‘and before January 1, 2011, and influ-
enza vaccines furnished 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 subpara-
graph (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 administration) and’’. 
(5) Section 1861(ww)(2)(A) of such Act (42 
U.S.C. 1395x(ww)(2)(A))) is amended by striking 
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‘‘Pneumococcal, influenza, and hepatitis B vaccine 
and administration’’ and inserting ‘‘Federally rec-
ommended vaccines (as defined in subsection (lll)) 
and their respective administration’’. 
(6) Section 1861(iii)(1) of such Act, as added 
by section 1305(a), is amended by amending sub-
paragraph (J) to read as follows: 
‘‘(J) Federally recommended vaccines (as de-
fined in subsection (lll)) and their respective admin-
istration.’’. 
(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 subclause (III), by inserting 
‘‘(A)(iv) (including influenza vaccines furnished on 
or after January 1, 2011),’’ after ‘‘described in sub-
paragraph’’ 
(d) EFFECTIVE DATES.—The amendments made 
by— 
(1) this section (other than by subsection 
(c)(7)) shall apply to vaccines administered on or 
after January 1, 2011; and 
(2) by subsection (c)(7) shall apply to calendar 
quarters beginning on or after January 1, 2010. 
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512 
SEC. 1311. EXPANSION OF MEDICARE-COVERED PREVEN-
TIVE SERVICES AT FEDERALLY QUALIFIED 
HEALTH CENTERS. 
Section 1861(aa)(3)(A) of the Social Security Act (42 
U.S.C. 1395w (aa)(3)(A)) is amended to read as follows:
‘‘(A) services of the type described sub-
paragraphs (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 Security Act 
is amended by adding at the end the following new part: 
‘‘PART D—COMPARATIVE EFFECTIVENESS RESEARCH 
‘‘COMPARATIVE EFFECTIVENESS RESEARCH 
‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE EFFEC-
TIVENESS RESEARCH ESTABLISHED.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish within the Agency for Healthcare Research and 
Quality a Center for Comparative Effectiveness Re-
search (in this section referred to as the ‘Center’) to 
conduct, support, and synthesize research (including 
research conducted or supported under section 1013 
of the Medicare Prescription Drug, Improvement, 
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and Modernization Act of 2003) with respect to the 
outcomes, effectiveness, and appropriateness of 
health care services and procedures in order to iden-
tify the manner in which diseases, disorders, and 
other health conditions can most effectively and ap-
propriately be prevented, diagnosed, treated, and 
managed clinically. 
‘‘(2) DUTIES.—The Center shall— 
‘‘(A) conduct, support, and synthesize re-
search relevant to the comparative effectiveness 
of the full spectrum of health care items, serv-
ices and systems, including pharmaceuticals, 
medical devices, medical and surgical proce-
dures, and other medical interventions; 
‘‘(B) conduct and support systematic re-
views of clinical research, including original re-
search conducted subsequent to the date of the 
enactment of this section; 
‘‘(C) continuously develop rigorous sci-
entific methodologies for conducting compara-
tive effectiveness studies, and use such meth-
odologies appropriately; 
‘‘(D) submit to the Comparative Effective-
ness Research Commission, the Secretary, and 
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Congress appropriate relevant reports described 
in subsection (d)(2); and 
‘‘(E) encourage, as appropriate, the devel-
opment and use of clinical registries and the de-
velopment 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 depart-
ment or agency of the United States informa-
tion necessary to enable it to carry out this sec-
tion. Upon request of the Center, the head of 
that department or agency shall furnish that in-
formation to the Center on an agreed upon 
schedule. 
‘‘(B) DATA
COLLECTION.—In order to 
carry out its functions, the Center shall— 
‘‘(i) utilize existing information, both 
published and unpublished, where possible, 
collected and assessed either by its own 
staff or under other arrangements made in 
accordance with this section, 
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‘‘(ii) carry out, or award grants or 
contracts for, original research and experi-
mentation, where existing information is 
inadequate, and 
‘‘(iii) adopt procedures allowing 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 INFORMATION.— 
The Comptroller General shall have unrestricted 
access to all deliberations, records, and non-
proprietary data of the Center and Commission 
under subsection (b), immediately upon request. 
‘‘(D) PERIODIC AUDIT.—The Center and 
Commission under subsection (b) shall be sub-
ject to periodic audit by the Comptroller Gen-
eral. 
‘‘(b) OVERSIGHT BY COMPARATIVE EFFECTIVENESS 
RESEARCH COMMISSION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an independent Comparative Effectiveness Re-
search Commission (in this section referred to as the 
‘Commission’) to oversee and evaluate the activities 
carried out by the Center under subsection (a), sub-
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ject to the authority of the Secretary, to ensure such 
activities result in highly credible research and infor-
mation resulting from such research. 
‘‘(2) DUTIES.—The Commission shall— 
‘‘(A) determine national priorities for re-
search described in subsection (a) and in mak-
ing such determinations consult with a broad 
array of public and private stakeholders, includ-
ing patients and health care providers and pay-
ers; 
‘‘(B) monitor the appropriateness of use of 
the CERTF described in subsection (g) with re-
spect to the timely production of comparative 
effectiveness research determined to be a na-
tional priority under subparagraph (A); 
‘‘(C) identify highly credible research 
methods and standards of evidence for such re-
search to be considered by the Center; 
‘‘(D) review the methodologies developed 
by the center under subsection (a)(2)(C); 
‘‘(E) not later than one year after the date 
of the enactment of this section, enter into an 
arrangement under which the Institute of Medi-
cine of the National Academy of Sciences shall 
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conduct an evaluation and report on standards 
of evidence for such research; 
‘‘(F) support forums to increase stake-
holder awareness and permit stakeholder feed-
back on the efforts of the Center to advance 
methods and standards that promote highly 
credible research; 
‘‘(G) make recommendations for policies 
that would allow for public access of data pro-
duced under this section, in accordance with ap-
propriate privacy and proprietary practices, 
while ensuring that the information produced 
through such data is timely and credible; 
‘‘(H) appoint a clinical perspective advisory 
panel for each research priority determined 
under subparagraph (A), which shall consult 
with patients and advise the Center on research 
questions, methods, and evidence gaps in terms 
of clinical outcomes for the specific research in-
quiry to be examined with respect to such pri-
ority to ensure that the information produced 
from such research is clinically relevant to deci-
sions made by clinicians and patients at the 
point of care; 
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member shall represent each of the fol-
lowing health care communities: 
‘‘(I) Patients. 
‘‘(II) Health care consumers. 
‘‘(III) Practicing Physicians, in-
cluding surgeons. 
‘‘(IV) Other health care practi-
tioners engaged in clinical care. 
‘‘(V) Employers. 
‘‘(VI) Public payers. 
‘‘(VII) Insurance plans. 
‘‘(VIII) Clinical researchers who 
conduct research on behalf of pharma-
ceutical or device manufacturers. 
‘‘(C) LIMITATION.—No more than 3 of the 
Members of the Commission may be representa-
tives of pharmaceutical or device manufacturers 
and such representatives shall be clinical re-
searchers 
described 
under 
subparagraph 
(B)(ii)(VIII). 
‘‘(4) APPOINTMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
appoint the members of the Commission. 
‘‘(B) CONSULTATION.—In considering can-
didates for appointment to the Commission, the 
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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 Sec-
retary shall designate a member of the Commission, 
at the time of appointment of the member, as Chair-
man 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 Sec-
retary may designate another member for the re-
mainder of that member’s term. The Chairman shall 
serve as an ex officio member of the National Advi-
sory Council of the Agency for Health Care Re-
search and Quality under section 931(c)(3)(B) of 
the Public Health Service Act. 
‘‘(6) TERMS.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), each member of the Com-
mission shall be appointed for a term of 4 
years. 
‘‘(B) TERMS OF INITIAL APPOINTEES.—Of 
the members first appointed— 
‘‘(i) 8 shall be appointed for a term of 
4 years; and 
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522 
‘‘(ii) 7 shall be appointed for a term 
of 3 years. 
‘‘(7) COORDINATION.—To enhance effectiveness 
and coordination, the Secretary is encouraged, to the 
greatest extent possible, to seek coordination be-
tween the Commission and the National Advisory 
Council of the Agency for Healthcare Research and 
Quality. 
‘‘(8) CONFLICTS OF INTEREST.— 
‘‘(A) IN
GENERAL.—In appointing the 
members of the Commission or a clinical per-
spective advisory panel described in paragraph 
(2)(H), the Secretary or the Commission, re-
spectively, shall take into consideration any fi-
nancial interest (as defined in subparagraph 
(D)), consistent with this paragraph, and de-
velop a plan for managing any identified con-
flicts. 
‘‘(B) EVALUATION AND CRITERIA.—When 
considering an appointment to the Commission 
or a clinical perspective advisory panel de-
scribed paragraph (2)(H) the Secretary or the 
Commission shall review the expertise of the in-
dividual and the financial disclosure report filed 
by the individual pursuant to the Ethics in Gov-
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523 
ernment Act of 1978 for each individual under 
consideration for the appointment, so as to re-
duce the likelihood that an appointed individual 
will later require a written determination as re-
ferred to in section 208(b)(1) of title 18, United 
States Code, a written certification as referred 
to in section 208(b)(3) of title 18, United 
States Code, or a waiver as referred to in sub-
paragraph (D)(iii) for service on the Commis-
sion at a meeting of the Commission. 
‘‘(C) DISCLOSURES; 
PROHIBITIONS
ON 
PARTICIPATION; WAIVERS.— 
‘‘(i) DISCLOSURE OF FINANCIAL IN-
TEREST.—Prior to a meeting of the Com-
mission or a clinical perspective advisory 
panel described in paragraph (2)(H) re-
garding a ‘particular matter’ (as that term 
is used in section 208 of title 18, United 
States Code), each member of the Commis-
sion or the clinical perspective advisory 
panel who is a full-time Government em-
ployee or special Government employee 
shall disclose to the Secretary financial in-
terests in accordance with subsection (b) of 
such section 208. 
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‘‘(ii) PROHIBITIONS
ON
PARTICIPA-
TION.—Except as provided under clause 
(iii), a member of the Commission or a 
clinical perspective advisory panel de-
scribed in paragraph (2)(H) may not par-
ticipate with respect to a particular matter 
considered in meeting of the Commission 
or the clinical perspective advisory panel if 
such member (or an immediate 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 
Office of Government Ethics as too remote 
or inconsequential to affect the integrity of 
the services of the Government officers or 
employees to which such regulations apply. 
‘‘(iii) WAIVER.—If the Secretary de-
termines it necessary to afford the Com-
mission or a clinical perspective advisory 
panel described in paragraph 2(H) essen-
tial expertise, the Secretary may grant a 
waiver of the prohibition in clause (ii) to 
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permit a member described in such sub-
paragraph to— 
‘‘(I) participate as a non-voting 
member with respect to a particular 
matter considered in a Commission or 
a clinical perspective advisory panel 
meeting; or 
‘‘(II) participate as a voting 
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.— 
‘‘(I) DETERMINATION OF ALLOW-
ABLE EXCEPTIONS FOR THE COMMIS-
SION.—The number of waivers grant-
ed to members of the Commission 
cannot exceed one-half of the total 
number of members for the Commis-
sion. 
‘‘(II) PROHIBITION
ON
VOTING 
STATUS
ON
CLINICAL
PERSPECTIVE 
ADVISORY PANELS.—No voting mem-
ber of any clinical perspective advisory 
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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
DEFINED.— 
For purposes of this paragraph, the term ‘fi-
nancial interest’ means a financial interest 
under section 208(a) of title 18, United States 
Code. 
‘‘(9) COMPENSATION.—While serving on the 
business of the Commission (including travel time), 
a member of the Commission 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 mem-
ber’s regular place of business, a member may be al-
lowed travel expenses, as authorized by the Director 
of the Commission. 
‘‘(10) AVAILABILITY OF REPORTS.—The Com-
mission shall transmit to the Secretary 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 review as the Sec-
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‘‘(E) provide transportation and subsist-
ence for persons serving without compensation; 
and 
‘‘(F) prescribe such rules and regulations 
as it deems necessary with respect to the inter-
nal organization and operation of the Commis-
sion. 
‘‘(c) RESEARCH REQUIREMENTS.—Any research con-
ducted, supported, or synthesized under this section shall 
meet the following requirements: 
‘‘(1) ENSURING TRANSPARENCY, CREDIBILITY, 
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 re-
search, conduct of the research, and develop-
ment of conclusions based on the research shall 
be transparent to all stakeholders. 
‘‘(D) The process and methods for con-
ducting such research shall be publicly docu-
mented and available to all stakeholders. 
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529 
‘‘(E) Throughout the process of such re-
search, the Center shall provide opportunities 
for all stakeholders involved to review and pro-
vide public comment on the methods and find-
ings of such research. 
‘‘(2) USE OF CLINICAL PERSPECTIVE ADVISORY 
PANELS.—The research shall meet a national re-
search 
priority 
determined 
under 
subsection 
(b)(2)(A) and shall consider advice given to the Cen-
ter by the clinical perspective advisory panel for the 
national research priority. 
‘‘(3) STAKEHOLDER INPUT.— 
‘‘(A) IN GENERAL.—The Commission shall 
consult with patients, health care providers, 
health care consumer representatives, and other 
appropriate stakeholders with an interest in the 
research through a transparent process rec-
ommended by the Commission. 
‘‘(B) SPECIFIC
AREAS
OF
CONSULTA-
TION.—Consultation 
shall 
include 
where 
deemed appropriate by the Commission— 
‘‘(i) recommending research priorities 
and questions; 
‘‘(ii) recommending research meth-
odologies; and 
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‘‘(iii) advising on and assisting with 
efforts to disseminate research findings. 
‘‘(C) OMBUDSMAN.—The Secretary shall 
designate a patient ombudsman. The ombuds-
man shall— 
‘‘(i) serve as an available point of con-
tact for any patients with an interest in 
proposed comparative effectiveness studies 
by the Center; and 
‘‘(ii) ensure that any comments from 
patients regarding proposed comparative 
effectiveness studies are reviewed by the 
Commission. 
‘‘(4) TAKING INTO ACCOUNT POTENTIAL DIF-
FERENCES.—Research shall— 
‘‘(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 children, adolescents, adults, 
and seniors), and individuals with different 
comorbidities; and— 
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‘‘(B) seek, as feasible and appropriate, to 
include members of such subpopulations as sub-
jects in the research. 
‘‘(d) PUBLIC ACCESS TO COMPARATIVE EFFECTIVE-
NESS INFORMATION.— 
‘‘(1) IN
GENERAL.—Not later than 90 days 
after receipt by the Center or Commission, as appli-
cable, of a relevant report described in paragraph 
(2) made by the Center, Commission, or clinical per-
spective advisory panel under this section, appro-
priate information contained in such report shall be 
posted on the official public Internet site of the Cen-
ter 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 reports as 
deemed appropriate by the Secretary. 
‘‘(B) Stakeholder comments. 
‘‘(C) A final report. 
‘‘(e) DISSEMINATION AND INCORPORATION OF COM-
PARATIVE EFFECTIVENESS INFORMATION.— 
‘‘(1) DISSEMINATION.—The Center shall pro-
vide for the dissemination of appropriate findings 
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produced by research supported, conducted, or syn-
thesized under this section to health care providers, 
patients, vendors of health information technology 
focused on clinical decision support, appropriate pro-
fessional associations, and Federal and private 
health plans, and other relevant stakeholders. In dis-
seminating 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 consider-
ations specific to certain sub-populations, risk 
factors, and comorbidities as appropriate; 
‘‘(C) include considerations such as limita-
tions of research and what further research 
may be needed, as appropriate; 
‘‘(D) not include any data that the dis-
semination of which would violate the privacy of 
research participants or violate any confiden-
tiality agreements made with respect to the use 
of data under this section; and 
‘‘(E) assist the users of health information 
technology focused on clinical decision support 
to promote the timely incorporation of such 
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findings into clinical practices and promote the 
ease of use of such incorporation. 
‘‘(2) DISSEMINATION PROTOCOLS AND STRATE-
GIES.—The Center shall develop protocols and strat-
egies for the appropriate dissemination of research 
findings in order to ensure effective communication 
of findings and the use and incorporation of such 
findings into relevant activities for the purpose of in-
forming higher quality and more effective and effi-
cient decisions regarding medical items and services. 
In developing and adopting such protocols and strat-
egies, the Center shall consult with stakeholders con-
cerning the types of dissemination that will be most 
useful to the end users of information and may pro-
vide for the utilization of multiple formats for con-
veying findings to different audiences, including dis-
semination to individuals with limited English pro-
ficiency. 
‘‘(f) REPORTS TO CONGRESS.— 
‘‘(1) ANNUAL REPORTS.—Beginning not later 
than one year after the date of the enactment of this 
section, the Director of the Agency of Healthcare 
Research and Quality and the Commission shall sub-
mit to Congress an annual report on the activities 
of the Center and the Commission, as well as the re-
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534 
search, conducted under this section. Each such re-
port shall include a discussion of the Center’s com-
pliance with subsection (c)(4)(B), including any rea-
sons for lack of compliance with such subsection. 
‘‘(2) RECOMMENDATION FOR FAIR SHARE PER 
CAPITA AMOUNT FOR ALL-PAYER FINANCING.—Be-
ginning not later than December 31, 2011, the Sec-
retary shall submit to Congress an annual rec-
ommendation for a fair share per capita amount de-
scribed in subsection (c)(1) of section 9511 of the 
Internal Revenue Code of 1986 for purposes 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 re-
port on all activities conducted or supported under 
this section as of such date. Such report shall in-
clude an evaluation of the overall costs of such ac-
tivities and an analysis of the backlog of any re-
search proposals approved by the Commission but 
not funded. 
‘‘(g) FUNDING
OF COMPARATIVE EFFECTIVENESS 
RESEARCH.—For fiscal year 2010 and each subsequent 
fiscal year, amounts in the Comparative Effectiveness Re-
search Trust Fund (referred to in this section as the 
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535 
‘CERTF’) under section 9511 of the Internal Revenue 
Code of 1986 shall be available, without the need for fur-
ther appropriations and without fiscal year limitation, to 
the Secretary to carry out this section. 
‘‘(h) CONSTRUCTION.—Nothing in this section shall 
be construed to permit the Commission or the Center to 
mandate coverage, reimbursement, or other policies for 
any public or private payer.’’. 
(b) 
COMPARATIVE
EFFECTIVENESS
RESEARCH 
TRUST FUND; FINANCING FOR THE TRUST FUND.—For 
provision establishing a Comparative Effectiveness Re-
search 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 Social Secu-
rity Act (42 U.S.C. 1320a–3) is amended by adding at 
the end the following new subsection: 
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536 
‘‘(c) REQUIRED DISCLOSURE OF OWNERSHIP AND 
ADDITIONAL DISCLOSABLE PARTIES INFORMATION.— 
‘‘(1) DISCLOSURE.—A facility (as defined in 
paragraph (7)(B)) shall have the information de-
scribed 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 the public under section 1411(b) of 
the America’s Affordable Health Choices Act of 
2009, for submission to the Secretary, the In-
spector General of the Department of Health 
and Human Services, the State in which the fa-
cility is located, and the State long-term care 
ombudsman in the case where the Secretary, 
the Inspector General, the State, or the State 
long-term care ombudsman requests such infor-
mation; and 
‘‘(B) beginning on the effective date of the 
final regulations promulgated under paragraph 
(4)(A), for reporting such information in ac-
cordance with such final regulations. 
Nothing in subparagraph (A) shall be construed as 
authorizing a facility to dispose of or delete informa-
tion described in such subparagraph after the effec-
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tive date of the final regulations promulgated under 
paragraph (4)(A). 
‘‘(2) PUBLIC AVAILABILITY OF INFORMATION.— 
During the period described in paragraph (1)(A), a 
facility shall— 
‘‘(A) make the information described in 
paragraph (3) available to the public upon re-
quest and update such information as may be 
necessary to reflect changes in such informa-
tion; and 
‘‘(B) post a notice of the availability of 
such information in the lobby of the facility in 
a prominent manner. 
‘‘(3) INFORMATION DESCRIBED.— 
‘‘(A) IN GENERAL.—The following infor-
mation is described in this paragraph: 
‘‘(i) The information described in sub-
sections (a) and (b), subject to subpara-
graph (C). 
‘‘(ii) The identity of and information 
on— 
‘‘(I) each member of the gov-
erning body of the facility, including 
the name, title, and period of service 
of each such member; 
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‘‘(II) each person or entity who is 
an officer, director, member, partner, 
trustee, or managing employee of the 
facility, including the name, title, and 
date of start of service of each such 
person or entity; and 
‘‘(III) each person or entity who 
is an additional disclosable party of 
the facility. 
‘‘(iii) The organizational structure of 
each person and entity described in sub-
clauses (II) and (III) of clause (ii) and a 
description of the relationship of each such 
person or entity to the facility and to one 
another. 
‘‘(B) SPECIAL RULE WHERE INFORMATION 
IS
ALREADY
REPORTED
OR
SUBMITTED.—To 
the extent that information reported by a facil-
ity to the Internal Revenue Service on Form 
990, information submitted by a facility to the 
Securities and Exchange Commission, or infor-
mation otherwise submitted to the Secretary or 
any other Federal agency contains the informa-
tion described in clauses (i), (ii), or (iii) of sub-
paragraph (A), the Secretary may allow, to the 
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604 
which the informal dispute reso-
lution process under item (aa) is 
completed; 
‘‘(cc) may provide for the 
collection of such civil money 
penalty and the placement of 
such amounts collected in an es-
crow account under the direction 
of the Secretary on the earlier of 
the date on which the informal 
dispute resolution process under 
item (aa) is completed or the 
date that is 90 days after the 
date of the imposition of the pen-
alty; 
‘‘(dd) may provide that such 
amounts collected are kept in 
such account pending the resolu-
tion of any subsequent appeals; 
‘‘(ee) in the case where the 
facility successfully appeals the 
penalty, may provide for the re-
turn of such amounts collected 
(plus interest) to the facility; and 
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