202 
pointed by the head of the State agency respon-
sible for health. Each expert panel shall be 
composed of no fewer than 3 members and not 
more than 7 members. At least one-half of such 
members shall be medical experts (either physi-
cians or health care professionals). 
‘‘(B) LICENSURE AND EXPERTISE.—Each 
physician or health care professional appointed 
to an expert panel under subparagraph (A) 
shall— 
‘‘(i) be appropriately credentialed or 
licensed in 1 or more States to deliver 
health care services; and 
‘‘(ii) typically treat the condition, 
make the diagnosis, or provide the type of 
treatment that is under review. 
‘‘(C) INDEPENDENCE.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), each individual appointed to an expert 
panel under this paragraph shall— 
‘‘(I) not have a material familial, 
financial, or professional relationship 
with a party involved in the dispute 
reviewed by the panel; and 
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‘‘(II) not otherwise have a con-
flict of interest with such a party. 
‘‘(ii) EXCEPTION.—Nothing in clause 
(i) shall be construed to prohibit an indi-
vidual who has staff privileges at an insti-
tution where the treatment involved in the 
dispute was provided from serving as a 
member of an expert panel merely on the 
basis of such affiliation, if the affiliation is 
disclosed to the parties and neither party 
objects. 
‘‘(D) PRACTICING HEALTH CARE PROFES-
SIONAL IN SAME FIELD.— 
‘‘(i) IN GENERAL.—In a dispute be-
fore an expert panel that involves treat-
ment, or the provision of items or serv-
ices— 
‘‘(I) by a physician, the medical 
experts on the expert panel shall be 
practicing physicians (allopathic or os-
teopathic) of the same or similar spe-
cialty as a physician who typically 
treats the condition, makes the diag-
nosis, or provides the type of treat-
ment under review; or 
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‘‘(II) by a health care profes-
sional other than a physician, at least 
two medical experts on the expert 
panel shall be practicing physicians 
(allopathic or osteopathic) of the same 
or similar specialty as the health care 
professional who typically treats the 
condition, makes the diagnosis, or 
provides the type of treatment under 
review, and, if determined appropriate 
by the State agency, an additional 
medical expert shall be a practicing 
health care professional (other than 
such a physician) of such a same or 
similar specialty. 
‘‘(ii) PRACTICING DEFINED.—In this 
paragraph, the term ‘practicing’ means, 
with respect to an individual who is a phy-
sician or other health care professional, 
that the individual provides health care 
services to individual patients on average 
at least 2 days a week. 
‘‘(E) PEDIATRIC EXPERTISE.—In the case 
of dispute relating to a child, at least 1 medical 
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expert on the expert panel shall have expertise 
described in subparagraph (D)(i) in pediatrics. 
‘‘(3) DETERMINATION.—After a review under 
paragraph (1), an expert panel shall make a deter-
mination as to the liability of the parties involved 
and compensation. 
‘‘(4) ACCEPTANCE.—If the parties to a dispute 
before an expert panel under this subsection accept 
the determination of the expert panel concerning li-
ability and compensation, such compensation shall 
be paid to the claimant and the claimant shall agree 
to forgo any further action against the health care 
providers involved. 
‘‘(5) FAILURE TO ACCEPT.—If any party de-
cides not to accept the expert panel’s determination, 
the matter shall be referred to an administrative 
health care tribunal created pursuant to this section. 
‘‘(e) ADMINISTRATIVE HEALTH CARE TRIBUNALS.— 
‘‘(1) IN GENERAL.—Upon the failure of any 
party to accept the determination of an expert panel 
under subsection (d), the parties shall have the right 
to request a hearing concerning the liability or com-
pensation involved by an administrative health care 
tribunal established by the State involved. 
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206 
‘‘(2) REQUIREMENTS.—In establishing an ad-
ministrative health care tribunal under this section, 
a State shall— 
‘‘(A) ensure that such tribunals are pre-
sided over by special judges with health care ex-
pertise; 
‘‘(B) provide authority to such judges to 
make binding rulings, rendered in written deci-
sions, on standards of care, causation, com-
pensation, and related issues with reliance on 
independent expert witnesses commissioned by 
the tribunal; 
‘‘(C) establish gross negligence as the legal 
standard for the tribunal; 
‘‘(D) allow the admission into evidence of 
the recommendation made by the expert panel 
under subsection (d); and 
‘‘(E) provide for an appeals process to 
allow for review of decisions by State courts. 
‘‘(f) REVIEW BY STATE COURT AFTER EXHAUSTION 
OF ADMINISTRATIVE REMEDIES.— 
‘‘(1) RIGHT TO FILE.—If any party to a dispute 
before a health care tribunal under subsection (e) is 
not satisfied with the determinations of the tribunal, 
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the party shall have the right to file their claim in 
a State court of competent jurisdiction. 
‘‘(2) FORFEIT OF AWARDS.—Any party filing 
an action in a State court in accordance with para-
graph (1) shall forfeit any compensation award 
made under subsection (e). 
‘‘(3) ADMISSIBILITY.—The determinations of 
the expert panel and the administrative health care 
tribunal pursuant to subsections (d) and (e) with re-
spect to a State court proceeding under paragraph 
(1) shall be admissible into evidence in any such 
State court proceeding. 
‘‘(g) DEFINITION.—In this section, the term ‘health 
care provider’ has the meaning given such term for pur-
poses of part A of title VII. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated for any fiscal year such 
sums as may be necessary for purposes of making grants 
to States under this section.’’. 
(b) TECHNICAL AMENDMENTS.— 
(1) Section 399R of the Public Health Service 
Act (as added by section 2 of the ALS Registry Act 
(Public Law 110–373; 122 Stat. 4047)) is redesig-
nated as section 399S. 
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(2) Section 399R of such Act (as added by sec-
tion 3 of the Prenatally and Postnatally Diagnosed 
Conditions Awareness Act (Public Law 110–374; 
122 Stat. 4051)) is redesignated as section 399T. 
SEC. 515. AFFIRMATIVE DEFENSE BASED ON COMPLIANCE 
WITH BEST PRACTICE GUIDELINES. 
(a) SELECTION AND ISSUANCE OF BEST PRACTICES 
GUIDELINES.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall provide for the selection and 
issuance of best practice guidelines (each in this sub-
section referred to as a ‘‘guideline’’) in accordance 
with paragraphs (2) and (3). 
(2) DEVELOPMENT PROCESS.—Not later than 
90 days after the date of the enactment of this Act, 
the Secretary shall enter into a contract with a 
qualified physician consensus-building organization 
(such as the Physician Consortium for Performance 
Improvement), in concert and agreement with physi-
cian specialty organizations, to develop guidelines for 
treatment of medical conditions for application 
under subsection (b). Under the contract, the orga-
nization shall take into consideration any endorsed 
performance-based quality measures described in 
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209 
section 802. Under the contract and not later than 
18 months after the date of the enactment of this 
Act, the organization shall submit best practice 
guidelines for issuance as guidelines under para-
graph (3). 
(3) ISSUANCE.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this Act, the 
Secretary shall issue, by regulation, after notice 
and opportunity for public comment, guidelines 
that have been recommended under paragraph 
(2) for application under subsection (b). 
(B) LIMITATION.—The Secretary may not 
issue guidelines unless they have been approved 
or endorsed by qualified physician consensus- 
building organization involved and physician 
specialty organizations. 
(C) DISSEMINATION.—The Secretary shall 
broadly disseminate the guidelines so issued. 
(b) LIMITATION ON DAMAGES.— 
(1) LIMITATION ON NONECONOMIC DAMAGES.— 
In any health care lawsuit, no noneconomic damages 
may awarded with respect to treatment that is with-
in a guideline issued under subsection (a). 
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210 
(2) LIMITATION
ON
PUNITIVE
DAMAGES.—In 
any health care lawsuit, no punitive damages may be 
awarded against a health care practitioner based on 
a claim that such treatment caused the claimant 
harm if— 
(A) such treatment was subject to the 
quality review by a qualified physician con-
sensus-building organization; 
(B) such treatment was approved in a 
guideline that underwent full review by such or-
ganization, public comment, approval by the 
Secretary, and dissemination as described in 
subparagraph (a); and 
(C) such medical treatment is generally 
recognized among qualified experts (including 
medical providers and relevant physician spe-
cialty organizations) as safe, effective, and ap-
propriate. 
(c) USE.— 
(1) INTRODUCTION AS EVIDENCE.—Guidelines 
under subsection (a) may not be introduced as evi-
dence of negligence or deviation in the standard of 
care in any civil action unless they have previously 
been introduced by the defendant. 
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211 
(2) NO PRESUMPTION OF NEGLIGENCE.—There 
would be no presumption of negligence if a partici-
pating physician does not adhere to such guidelines. 
(d) CONSTRUCTION.—Nothing in this section shall be 
construed as preventing a State from— 
(1) replacing their current medical malpractice 
rules with rules that rely, as a defense, upon a 
health care provider’s compliance with a guideline 
issued under subsection (a); or 
(2) applying additional guidelines or safe-har-
bors that are in addition to, but not in lieu of, the 
guidelines issued under subsection (a). 
SEC. 516. BAD DEBT DEDUCTION FOR DOCTORS TO PAR-
TIALLY OFFSET THE COST OF PROVIDING UN-
COMPENSATED CARE REQUIRED TO BE PRO-
VIDED UNDER AMENDMENTS MADE BY THE 
EMERGENCY 
MEDICAL 
TREATMENT 
AND 
LABOR ACT. 
(a) IN GENERAL.—Section 166 of the Internal Rev-
enue Code of 1986 (relating to bad debts) is amended by 
redesignating subsection (f) as subsection (g) and by in-
serting after subsection (e) the following new subsection: 
‘‘(f) BAD DEBT TREATMENT FOR DOCTORS TO PAR-
TIALLY OFFSET COST OF PROVIDING UNCOMPENSATED 
CARE REQUIRED TO BE PROVIDED.— 
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‘‘(1) AMOUNT OF DEDUCTION.— 
‘‘(A) IN GENERAL.—For purposes of sub-
section (a), the basis for determining the 
amount of any deduction for an eligible 
EMTALA debt shall be treated as being equal 
to the Medicare payment amount. 
‘‘(B) MEDICARE PAYMENT AMOUNT.—For 
purposes of subparagraph (A), the Medicare 
payment amount with respect to an eligible 
EMTALA debt is the fee schedule amount es-
tablished under section 1848 of the Social Secu-
rity Act for the physicians’ service (to which 
such debt relates) as if the service were pro-
vided to an individual enrolled under part B of 
title XVIIII of such Act. 
‘‘(2) ELIGIBLE EMTALA DEBT.—For purposes 
of this section, the term ‘eligible EMTALA debt’ 
means any debt if— 
‘‘(A) such debt arose as a result of physi-
cians’ services— 
‘‘(i) which were performed in an 
EMTALA hospital by a board-certified 
physician (whether as part of medical 
screening or necessary stabilizing treat-
ment and whether as an emergency depart-
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213 
ment physician, as an on-call physician, or 
otherwise), and 
‘‘(ii) which were required to be pro-
vided under section 1867 of the Social Se-
curity Act (42 U.S.C. 1395dd), and 
‘‘(B) such debt is owed— 
‘‘(i) to such physician, or 
‘‘(ii) to an entity if— 
‘‘(I) such entity is a corporation 
and the sole shareholder of such cor-
poration is such physician, or 
‘‘(II) such entity is a partnership 
and any deduction under this sub-
section with respect to such debt is al-
located to such physician or to an en-
tity described in subclause (I). 
‘‘(3) BOARD-CERTIFIED PHYSICIAN.—For pur-
poses of this subsection, the term ‘board-certified 
physician’ means any physician (as defined in sec-
tion 1861(r) of the Social Security Act (42 U.S.C. 
1395x(r)) who is certified by the American Board of 
Emergency Medicine or other appropriate medical 
specialty board for the specialty in which the physi-
cian practices, or who meets comparable require-
ments, as identified by the Secretary of the Treasury 
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214 
in consultation with Secretary of Health and Human 
Services. 
‘‘(4) OTHER
DEFINITIONS.—For purposes of 
this subsection— 
‘‘(A) EMTALA 
HOSPITAL.—The term 
‘EMTALA hospital’ means any hospital having 
a hospital emergency department which is re-
quired to comply with section 1867 of the So-
cial Security Act (42 U.S.C. 1395dd) (relating 
to examination and treatment for emergency 
medical conditions and women in labor). 
‘‘(B) PHYSICIANS’ SERVICES.—The term 
‘physicians’ services’ has the meaning given 
such term in section 1861(q) of the Social Se-
curity Act (42 U.S.C. 1395x(q)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to debts arising from services per-
formed in taxable years beginning after the date of the 
enactment of this Act. 
TITLE VI—WELLNESS AND 
PREVENTION 
SEC. 601. PROVIDING FINANCIAL INCENTIVES FOR TREAT-
MENT COMPLIANCE. 
(a) ERISA LIMITATION
ON
EXCEPTION
FOR 
WELLNESS PROGRAMS UNDER HIPAA DISCRIMINATION 
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215 
RULES.—Section 702(b)(2) of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1182(b)(2)) is 
amended by adding after and below subparagraph (B) the 
following: 
‘‘In applying subparagraph (B), a group health plan 
(or a health insurance issuer with respect to health 
insurance coverage) may vary premiums and cost- 
sharing by up to 50 percent of the value of the bene-
fits under the plan (or coverage) based on participa-
tion (or lack of participation) in a standards-based 
wellness program.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to plan years beginning more 
than 1 year after the date of the enactment of this Act. 
TITLE VII—TRANSPARENCY AND 
INSURANCE REFORM MEASURES 
SEC. 701. RECEIPT AND RESPONSE TO REQUESTS FOR 
CLAIM INFORMATION. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act is amended by inserting after section 2713 the 
following new section: 
‘‘SEC. 2714. RECEIPT AND RESPONSE TO REQUESTS FOR 
CLAIM INFORMATION. 
‘‘(a) REQUIREMENT.— 
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216 
‘‘(1) IN GENERAL.—In the case of health insur-
ance coverage offered in connection with a group 
health plan, not later than the 30th day after the 
date a health insurance issuer receives a written re-
quest for a written report of claim information from 
the plan, plan sponsor, or plan administrator, the 
health insurance issuer shall provide the requesting 
party the report, subject to the succeeding provisions 
of this section. 
‘‘(2) EXCEPTION.—The health insurance issuer 
is not obligated to provide a report under this sub-
section regarding a particular employer or group 
health plan more than twice in any 12-month period 
and is not obligated to provide such a report in the 
case of an employer with fewer than 50 employees. 
‘‘(3) DEADLINE.—A plan, plan sponsor, or plan 
administrator must request a report under this sub-
section before or on the second anniversary of the 
date of termination of coverage under a group health 
plan issued by the health insurance issuer. 
‘‘(b) FORM OF REPORT; INFORMATION TO BE IN-
CLUDED.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
shall provide the report of claim information under 
subsection (a)— 
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‘‘(A) in a written report; 
‘‘(B) through an electronic file transmitted 
by secure electronic mail or a file transfer pro-
tocol site; or 
‘‘(C) by making the required information 
available through a secure website or web portal 
accessible by the requesting plan, plan sponsor, 
or plan administrator. 
‘‘(2) INFORMATION TO BE INCLUDED.—A re-
port of claim information provided under subsection 
(a) shall contain all information available to the 
health insurance issuer that is responsive to the re-
quest made under such subsection, including, subject 
to subsection (c), protected health information, for 
the 36-month period preceding the date of the report 
or the period specified by subparagraphs (D), (E), 
and (F) of paragraph (3), if applicable, or for the 
entire period of coverage, whichever period is short-
er. 
‘‘(3) REQUIRED
INFORMATION.—Subject to 
subsection (c), a report provided under subsection 
(a) shall include the following: 
‘‘(A) Aggregate paid claims experience by 
month, including claims experience for medical, 
dental, and pharmacy benefits, as applicable. 
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218 
‘‘(B) Total premium paid by month. 
‘‘(C) Total number of covered employees 
on a monthly basis by coverage tier, including 
whether coverage was for— 
‘‘(i) an employee only; 
‘‘(ii) an employee with dependents 
only; 
‘‘(iii) an employee with a spouse only; 
or 
‘‘(iv) an employee with a spouse and 
dependents. 
‘‘(D) The total dollar amount of claims 
pending as of the date of the report. 
‘‘(E) A separate description and individual 
claims report for any individual whose total 
paid claims exceed $15,000 during the 12- 
month period preceding the date of the report, 
including the following information related to 
the claims for that individual— 
‘‘(i) a unique identifying number, 
characteristic, or code for the individual; 
‘‘(ii) the amounts paid; 
‘‘(iii) dates of service; and 
‘‘(iv) applicable procedure codes and 
diagnosis codes. 
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219 
‘‘(F) For claims that are not part of the 
information described in a previous subpara-
graph, a statement describing precertification 
requests for hospital stays of 5 days or longer 
that were made during the 30-day period pre-
ceding the date of the report. 
‘‘(c) LIMITATIONS ON DISCLOSURE.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
may not disclose protected health information in a 
report of claim information provided under this sec-
tion if the health insurance issuer is prohibited from 
disclosing that information under another State or 
federal law that imposes more stringent privacy re-
strictions than those imposed under federal law 
under the HIPAA privacy regulations. To withhold 
information in accordance with this subsection, the 
health insurance issuer must— 
‘‘(A) notify the plan, plan sponsor, or plan 
administrator requesting the report that infor-
mation is being withheld; and 
‘‘(B) provide to the plan, plan sponsor, or 
plan administrator a list of categories of claim 
information that the health insurance issuer has 
determined are subject to the more stringent 
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220 
privacy restrictions under another State or Fed-
eral law. 
‘‘(2) PROTECTION.—A plan sponsor is entitled 
to receive protected health information under sub-
paragraph (E) and (F) of subsection (b)(3) and sub-
section (d) only after an appropriately authorized 
representative of the plan sponsor makes to the 
health insurance issuer a certification substantially 
similar to the following certification: ‘I hereby certify 
that the plan documents comply with the require-
ments of section 164.504(f)(2) of title 45, Code of 
Federal Regulations, and that the plan sponsor will 
safeguard and limit the use and disclosure of pro-
tected health information that the plan sponsor may 
receive from the group health plan to perform the 
plan administration functions.’. 
‘‘(3) RESULTS.—A plan sponsor that does not 
provide the certification required by paragraph (2) is 
not entitled to receive the protected health informa-
tion described by subparagraphs (E) and (F) of sub-
section (b)(3) and subsection (d), but is entitled to 
receive a report of claim information that includes 
the information described by subparagraphs (A) 
through (D) of subsection (b)(3). 
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221 
‘‘(4) INFORMATION.—In the case of a request 
made under subsection (a) after the date of termi-
nation of coverage, the report must contain all infor-
mation available to the health insurance issuer as of 
the date of the report that is responsive to the re-
quest, including protected health information, and 
including the information described by subsection 
(b)(3), for the period described by subsection (b)(2) 
preceding the date of termination of coverage or for 
the entire policy period, whichever period is shorter. 
Notwithstanding this subsection, the report may not 
include the protected health information described 
by subparagraphs (E) and (F) of subsection (b)(3) 
unless a certification has been provided in accord-
ance with paragraph (2). 
‘‘(d) REQUEST FOR ADDITIONAL INFORMATION.— 
‘‘(1) REVIEW.—On receipt of the report re-
quired by subsection (a), the plan, plan sponsor, or 
plan administrator may review the report and, not 
later than the 10th day after the date the report is 
received, may make a written request to the health 
insurance issuer for additional information in ac-
cordance with this subsection for specified individ-
uals. 
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222 
‘‘(2) REQUEST.—With respect to a request for 
additional information concerning specified individ-
uals for whom claims information has been provided 
under subsection (b)(3)(E), the health insurance 
issuer shall provide additional information on the 
prognosis or recovery if available and, for individuals 
in active case management, the most recent case 
management information, including any future ex-
pected costs and treatment plan, that relate to the 
claims for that individual. 
‘‘(3) RESPONSE.—The health insurance issuer 
must respond to the request for additional informa-
tion under this subsection not later than the 15th 
day after the date of such request unless the re-
questing plan, plan sponsor, or plan administrator 
agrees to a request for additional time. 
‘‘(4) LIMITATION.—The health insurance issuer 
is not required to produce the report described by 
this subsection unless a certification has been pro-
vided in accordance with subsection (c)(2). 
‘‘(5) COMPLIANCE
WITH
SECTION
DOES
NOT 
CREATE LIABILITY.—A health insurance issuer that 
releases information, including protected health in-
formation, in accordance with this subsection has 
not violated a standard of care and is not liable for 
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223 
civil damages resulting from, and is not subject to 
criminal prosecution for, releasing that information. 
‘‘(e) LIMITATION ON PREEMPTION.—Nothing in this 
section is meant to limit States from enacting additional 
laws in addition to this, but not in lieu of. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘employer’, ‘plan administrator’, 
and ‘plan sponsor’ have the meanings given such 
terms in section 3 of the Employee Retirement In-
come Security Act of 1974. 
‘‘(2) The term ‘HIPAA privacy regulations’ has 
the meaning given such term in section 1180(b)(3) 
of the Social Security Act. 
‘‘(3) The term ‘protected health information’ 
has the meaning given such term under the HIPAA 
privacy regulations.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
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TITLE VIII—QUALITY 
SEC. 801. PROHIBITION ON CERTAIN USES OF DATA OB-
TAINED FROM COMPARATIVE EFFECTIVE-
NESS RESEARCH; ACCOUNTING FOR PERSON-
ALIZED MEDICINE AND DIFFERENCES IN PA-
TIENT TREATMENT RESPONSE. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, the Secretary of Health and Human Serv-
ices— 
(1) shall not use data obtained from the con-
duct of comparative effectiveness research, including 
such research that is conducted or supported using 
funds appropriated under the American Recovery 
and Reinvestment Act of 2009 (Public Law 111–5), 
to deny coverage of an item or service under a Fed-
eral health care program (as defined in section 
1128B(f) of the Social Security Act (42 U.S.C. 
1320a–7b(f))); and 
(2) shall ensure that comparative effectiveness 
research conducted or supported by the Federal 
Government accounts for factors contributing to dif-
ferences in the treatment response and treatment 
preferences of patients, including patient-reported 
outcomes, genomics and personalized medicine, the 
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unique needs of health disparity populations, and in-
direct patient benefits. 
(b) CONSULTATION
AND APPROVAL REQUIRED.— 
Nothing the Federal Coordinating Council for Compara-
tive Effectiveness Research finds can be released in final 
form until after consultation with and approved by rel-
evant physician specialty organizations. 
(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as affecting the authority of the 
Commissioner of Food and Drugs under the Federal 
Food, Drug, and Cosmetic Act or the Public Health Serv-
ice Act. 
SEC. 
802. 
ESTABLISHMENT 
OF 
PERFORMANCE-BASED 
QUALITY MEASURES. 
Not later than January 1, 2012, the Secretary of 
Health and Human Services shall submit to Congress a 
proposal for a formalized process for the development of 
performance-based quality measures that could be applied 
to physicians’ services under the Medicare program. Such 
proposal shall be in concert and agreement with the Physi-
cian Consortium for Performance Improvement and shall 
only utilize measures agreed upon by each physician spe-
cialty organization. 
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TITLE IX—STATE 
TRANSPARENCY PLAN PORTAL 
SEC. 901. PROVIDING INFORMATION ON HEALTH COV-
ERAGE OPTIONS AND HEALTH CARE PRO-
VIDERS. 
(a) STATE-BASED PORTAL.—A State (by itself or 
jointly with other States) may contract with a private enti-
ty to establish a Health Plan and Provider Portal website 
(referred to in this section as a ‘‘plan portal’’) for the pur-
poses of providing standardized information— 
(1) on health insurance plans that have been 
certified to be available for purchase in that State; 
and 
(2) on price and quality information on health 
care providers (including physicians, hospitals, and 
other health care institutions). 
(b) PILOT PROGRAM.— 
(1) IN GENERAL.—Not later than 90 days after 
the date of the enactment of this Act the Secretary 
of Health and Human Services shall work with 
States to establish no later than 2013, consistent 
with this title, a website that will serve as a pilot 
program for a national portal for information struc-
tured in a manner so individuals may directly link 
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to the State plan portal for the State in which they 
reside. 
(2) CONTRACTS WITH STATE.—The Secretary 
shall enter into contracts with States, in a number 
and distribution determined by the Secretary, to de-
velop State plan portals that follow the applicable 
standards and regulations under this section. 
(3) COMMON
STANDARDS
FOR
PLAN
POR-
TALS.— 
(A) IN GENERAL.—In connection with such 
website, the Secretary shall establish standards 
for interoperability and consistency for State 
plan portals so that individuals can access and 
view information in a similar manner on plan 
portals of different States. Such standards shall 
include standard definitions for health insur-
ance plan benefits so that individuals can accu-
rately compare health insurance plans within 
such portals and standards for the inclusion of 
information described in subsection (c). 
(B) CONSULTATION.—The Secretary shall 
consult with a group consisting of a balanced 
representation of the critical stakeholders (in-
cluding States, health insurance issuers, the 
National Association of Insurance Commis-
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sioners, qualified health care provider-based en-
tities (including physicians, hospitals, and other 
health care institutions), and a standards devel-
opment organization) to develop such stand-
ards. 
(C) ISSUANCE.— 
(i) IN GENERAL.—Not later than 6 
months after the date of the enactment of 
this Act, the Secretary shall issue, by regu-
lation, after notice and opportunity for 
public comment, standards that are con-
sistent with the recommendations made by 
the group under subparagraph (B). 
(ii) DISSEMINATION.—The Secretary 
shall broadly disseminate the standards so 
issued. 
(D) REVIEW.—One year after the date of 
establishment of the pilot program under this 
subsection, the Secretary, in consultation with 
stakeholder group described in subparagraph 
(B), shall review the standards established and 
make such changes in such standards as may 
be appropriate. 
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(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to the Sec-
retary such amounts as may be necessary for— 
(A) the development and operation of the 
national website under this subsection; and 
(B) contracts with States under paragraph 
(2) to assist in the development and initial op-
eration of plan portals in accordance with 
standards established under paragraph (3) and 
other applicable provisions of this section. 
(c) INFORMATION IN PLAN PORTALS.—The stand-
ards for plan portals under subsection (b)(3) shall include 
the following: 
(1) HEALTH INSURANCE INFORMATION.—Each 
plan portal shall meet the following requirements 
with respect to information on health insurance 
plans: 
(A) The plan portal shall present complete 
information on the costs and benefits of health 
insurance plans (including information on 
monthly premium, copayments, deductibles, and 
covered benefits) in a uniform manner that— 
(i) uses the standard definitions devel-
oped under subsection (b)(3); and 
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(ii) is designed to allow consumers to 
easily compare such plans. 
(B) The plan portal shall be available on 
the internet and accessible to all individuals in 
the United States. 
(C) The plan portal shall allow consumers 
to search and sort data on the health insurance 
plans in the plan portal on criteria such as cov-
erage of specific benefits (such as coverage of 
disease management services or pediatric care 
services), as well as data available respecting 
quality of plans. 
(D) The plan portal shall meet all relevant 
State laws and regulations, including laws and 
regulations related to the marketing of insur-
ance products. 
(E) Notwithstanding subsection (d)(1), the 
plan portal shall provide information to individ-
uals who are eligible for the Medicaid program 
under title XIX of the Social Security Act or 
State Children’s Health Insurance Program 
under title XXI of such Act by including infor-
mation on options, eligibility, and how to enroll 
through providing a link to a website main-
tained with respect to such State programs. 
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(F) The plan portal shall provide support 
to individuals who are eligible for tax credits 
and deductions under the amendments made by 
this Act to enhance such individual’s ability to 
access such credits and deductions. 
(G) The plan portal shall allow consumers 
to access quality data on providers as made 
available through a website described in section 
802 once that data is available. 
(2) PROVIDER INFORMATION.—Each plan por-
tal shall meet the following requirements with re-
spect to information on health care providers: 
(A) Identifying and licensure information. 
(B) Self-pay prices charged, including vari-
ation in such prices. 
For purposes of subparagraph (B), the term ‘‘self- 
pay price’’ means the price charged by a provider to 
individuals for items or services where the price is 
not established or negotiated through a health care 
program or third party. 
(3) TAX
CREDIT
AND
DEDUCTION
INFORMA-
TION.—Each plan portal shall also include informa-
tion on tax credits and deductions that may be avail-
able for purpose of qualified health plans. 
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(4) INCLUSION
OF
QUALITY
INFORMATION.— 
The Secretary, after collaboration with States and 
health care providers (including practicing physi-
cians, hospitals, and other health care institutions), 
shall submit to Congress recommendations on how 
to include on plan portals information on perform-
ance-based quality measures obtained under section 
802. 
(d) PROHIBITIONS.— 
(1) DIRECT ENROLLMENT.—A plan portal may 
not directly enroll individuals in health insurance 
plans or under a State Medicaid plan or a State 
children’s health insurance plan. 
(2) CONFLICTS OF INTEREST.— 
(A) 
COMPANIES.—A 
health 
insurance 
issuer offering a health insurance plan through 
a plan portal may not— 
(i) be the private entity developing 
and maintaining a plan portal under this 
section; or 
(ii) have an ownership interest in such 
private entity or in the plan portal. 
(B) 
INDIVIDUALS.—An 
individual 
em-
ployed by a health insurance issuer offering a 
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health insurance plan through a plan portal 
may not serve as a director or officer for— 
(i) the private entity developing and 
maintaining a plan portal under this sec-
tion; or 
(ii) the plan portal. 
(e) CONSTRUCTION.—Nothing in this section shall be 
construed to prohibit health insurance brokers and agents 
from— 
(1) utilizing the plan portal for any purpose; or 
(2) marketing or offering health insurance 
products. 
(f) STATE DEFINED.—In this section, the term 
‘‘State’’ has the meaning given such term for purposes of 
title XIX of the Social Security Act. 
TITLE X—PHYSICIAN PAYMENT 
REFORM 
SEC. 1001. SUSTAINABLE GROWTH RATE REFORM. 
(a) TRANSITIONAL
UPDATE
FOR
2012.—Section 
1848(d) of the Social Security Act (42 U.S.C. 1395w– 
4(d)) is amended by adding at the end the following new 
paragraph: 
‘‘(12) UPDATE FOR 2012.—The update to the 
single conversion factor established in paragraph 
(1)(C) for 2012 shall be the percentage increase in 
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the MEI (as defined in section 1842(i)(3)) for that 
year.’’. 
(b) REBASING SGR USING 2010; LIMITATION ON 
CUMULATIVE ADJUSTMENT PERIOD.—Section 1848(d)(4) 
of such Act (42 U.S.C. 1395w–4(d)(4)) is amended— 
(1) in subparagraph (B), by striking ‘‘subpara-
graph (D)’’ and inserting ‘‘subparagraphs (D) and 
(G)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(G) REBASING USING 2010 FOR FUTURE 
UPDATE
ADJUSTMENTS.—In determining the 
update adjustment factor under subparagraph 
(B) for 2012 and subsequent years— 
‘‘(i) the allowed expenditures for 2010 
shall be equal to the amount of the actual 
expenditures for physicians’ services during 
2010; and 
‘‘(ii) the reference in subparagraph 
(B)(ii)(I) to ‘April 1, 1996’ shall be treat-
ed as a reference to ‘January 1, 2010 (or, 
if later, the first day of the fifth year be-
fore the year involved)’.’’. 
(c) LIMITATION
ON
PHYSICIANS’ SERVICES
IN-
CLUDED IN TARGET GROWTH RATE COMPUTATION TO 
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SERVICES COVERED UNDER PHYSICIAN FEE SCHED-
ULE.—Effective for services furnished on or after January 
1, 2010, section 1848(f)(4)(A) of such Act is amended 
striking ‘‘(such as clinical’’ and all that follows through 
‘‘in a physician’s office’’ and inserting ‘‘for which payment 
under this part is made under the fee schedule under this 
section, for services for practitioners described in section 
1842(b)(18)(C) on a basis related to such fee schedule, 
or for services described in section 1861(p) (other than 
such services when furnished in the facility of a provider 
of services)’’. 
(d) 
ESTABLISHMENT
OF
SEPARATE
TARGET 
GROWTH RATES FOR CATEGORIES OF SERVICES.— 
(1) 
ESTABLISHMENT
OF
SERVICE
CAT-
EGORIES.—Subsection (j) of section 1848 of the So-
cial Security Act (42 U.S.C. 1395w–4) is amended 
by adding at the end the following new paragraph: 
‘‘(5) SERVICE CATEGORIES.—For services fur-
nished on or after January 1, 2010, each of the fol-
lowing categories of physicians’ services (as defined 
in paragraph (3)) shall be treated as a separate 
‘service category’: 
‘‘(A) Evaluation and management services 
that are procedure codes (for services covered 
under this title) for— 
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‘‘(i) services in the category des-
ignated Evaluation and Management in the 
Health Care Common Procedure Coding 
System (established by the Secretary under 
subsection (c)(5) as of December 31, 2010, 
and as subsequently modified by the Sec-
retary); and 
‘‘(ii) preventive services (as defined in 
section 1861(iii)) for which payment is 
made under this section. 
‘‘(B) All other services not described in 
subparagraph (A). 
Service categories established under this paragraph 
shall apply without regard to the specialty of the 
physician furnishing the service.’’. 
(2) ESTABLISHMENT
OF
SEPARATE
CONVER-
SION
FACTORS
FOR
EACH
SERVICE
CATEGORY.— 
Subsection (d)(1) of section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) is amended— 
(A) in subparagraph (A)— 
(i) by designating the sentence begin-
ning ‘‘The conversion factor’’ as clause (i) 
with the heading ‘‘APPLICATION OF SIN-
GLE
CONVERSION
FACTOR.—’’ and with 
appropriate indentation; 
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(ii) by striking ‘‘The conversion fac-
tor’’ and inserting ‘‘Subject to clause (ii), 
the conversion factor’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(ii) APPLICATION OF MULTIPLE CON-
VERSION
FACTORS
BEGINNING
WITH 
2012.— 
‘‘(I) IN
GENERAL.—In applying 
clause (i) for years beginning with 
2012, separate conversion factors 
shall be established for each service 
category of physicians’ services (as de-
fined in subsection (j)(5)) and any 
reference in this section to a conver-
sion factor for such years shall be 
deemed to be a reference to the con-
version factor for each of such cat-
egories. 
‘‘(II) INITIAL CONVERSION FAC-
TORS.—Such factors for 2012 shall be 
based upon the single conversion fac-
tor for the previous year multiplied by 
the update established under para-
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graph (11) for such category for 
2012. 
‘‘(III) UPDATING
OF
CONVER-
SION
FACTORS.—Such factor for a 
service category for a subsequent year 
shall be based upon the conversion 
factor for such category for the pre-
vious year and adjusted by the update 
established for such category under 
paragraph (11) for the year in-
volved.’’; and 
(B) in subparagraph (D), by striking 
‘‘other physicians’ services’’ and inserting ‘‘for 
physicians’ services described in the service cat-
egory described in subsection (j)(5)(B)’’. 
(3) ESTABLISHING UPDATES FOR CONVERSION 
FACTORS
FOR
SERVICE
CATEGORIES.—Section 
1848(d) of the Social Security Act (42 U.S.C. 
1395w–4(d)), as amended by subsection (a), is 
amended— 
(A) in paragraph (4)(C)(iii), by striking 
‘‘The allowed’’ and inserting ‘‘Subject to para-
graph (11)(B), the allowed’’; and 
(B) by adding at the end the following new 
paragraph: 
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‘‘(13) UPDATES FOR SERVICE CATEGORIES BE-
GINNING WITH 2012.— 
‘‘(A) IN GENERAL.—In applying paragraph 
(4) for a year beginning with 2012, the fol-
lowing rules apply: 
‘‘(i) APPLICATION OF SEPARATE UP-
DATE ADJUSTMENTS FOR EACH SERVICE 
CATEGORY.—Pursuant 
to 
paragraph 
(1)(A)(ii)(I), the update shall be made to 
the conversion factor for each service cat-
egory (as defined in subsection (j)(5)) 
based upon an update adjustment factor 
for the respective category and year and 
the update adjustment factor shall be com-
puted, for a year, separately for each serv-
ice category. 
‘‘(ii) COMPUTATION OF ALLOWED AND 
ACTUAL EXPENDITURES BASED ON SERV-
ICE CATEGORIES.—In computing the prior 
year adjustment component and the cumu-
lative adjustment component under clauses 
(i) and (ii) of paragraph (4)(B), the fol-
lowing rules apply: 
‘‘(I) APPLICATION
BASED
ON 
SERVICE
CATEGORIES.—The allowed 
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expenditures and actual expenditures 
shall be the allowed and actual ex-
penditures for the service category, as 
determined under subparagraph (B). 
‘‘(II) APPLICATION OF CATEGORY 
SPECIFIC
TARGET
GROWTH
RATE.— 
The growth rate applied under clause 
(ii)(II) of such paragraph shall be the 
target growth rate for the service cat-
egory involved under subsection (f)(5). 
‘‘(B) DETERMINATION
OF
ALLOWED
EX-
PENDITURES.—In applying paragraph (4) for a 
year beginning with 2011, notwithstanding sub-
paragraph (C)(iii) of such paragraph, the al-
lowed expenditures for a service category for a 
year is an amount computed by the Secretary 
as follows: 
‘‘(i) FOR 2011.—For 2011: 
‘‘(I) TOTAL
2010
ACTUAL
EX-
PENDITURES FOR ALL SERVICES IN-
CLUDED
IN
SGR
COMPUTATION
FOR 
EACH SERVICE CATEGORY.—Compute 
total actual expenditures for physi-
cians’ services (as defined in sub-
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section (f)(4)(A)) for 2010 for each 
service category. 
‘‘(II) 
INCREASE
BY
GROWTH 
RATE TO OBTAIN 2011 ALLOWED EX-
PENDITURES
FOR
SERVICE
CAT-
EGORY.—Compute allowed expendi-
tures for the service category for 2011 
by increasing the allowed expenditures 
for the service category for 2010 com-
puted under subclause (I) by the tar-
get growth rate for such service cat-
egory under subsection (f) for 2011. 
‘‘(ii) FOR SUBSEQUENT YEARS.—For 
a subsequent year, take the amount of al-
lowed expenditures for such category for 
the preceding year (under clause (i) or this 
clause) and increase it by the target 
growth rate determined under subsection 
(f) for such category and year.’’. 
(4) 
APPLICATION
OF
SEPARATE
TARGET 
GROWTH RATES FOR EACH CATEGORY.— 
(A) IN GENERAL.—Section 1848(f) of the 
Social Security Act (42 U.S.C. 1395w–4(f)) is 
amended by adding at the end the following 
new paragraph: 
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‘‘(5) APPLICATION
OF
SEPARATE
TARGET 
GROWTH RATES FOR EACH SERVICE CATEGORY BE-
GINNING WITH 2011.—The target growth rate for a 
year beginning with 2011 shall be computed and ap-
plied separately under this subsection for each serv-
ice category (as defined in subsection (j)(5)) and 
shall be computed using the same method for com-
puting the target growth rate except that the factor 
described in paragraph (2)(C) for— 
‘‘(A) the service category described in sub-
section (j)(5)(A) shall be increased by 0.02; and 
‘‘(B) the service category described in sub-
section (j)(5)(B) shall be increased by 0.01.’’. 
(B) USE OF TARGET GROWTH RATES.— 
Section 1848 of such Act is further amended— 
(i) in subsection (d)— 
(I) in paragraph (1)(E)(ii), by in-
serting ‘‘or target’’ after ‘‘sustain-
able’’; and 
(II) in paragraph (4)(B)(ii)(II), 
by inserting ‘‘or target’’ after ‘‘sus-
tainable’’; and 
(ii) in the heading of subsection (f), 
by inserting ‘‘AND
TARGET
GROWTH 
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243 
RATE’’ 
after 
‘‘SUSTAINABLE
GROWTH 
RATE’’; 
(iii) in subsection (f)(1)— 
(I) by striking ‘‘and’’ at the end 
of subparagraph (A); 
(II) in subparagraph (B), by in-
serting ‘‘before 2011’’ after ‘‘each 
succeeding year’’ and by striking the 
period at the end and inserting ‘‘; 
and’’; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(C) November 1 of each succeeding year 
the target growth rate for such succeeding year 
and each of the 2 preceding years.’’; and 
(iv) in subsection (f)(2), in the matter 
before subparagraph (A), by inserting after 
‘‘beginning with 2000’’ the following: ‘‘and 
ending with 2010’’. 
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TITLE XI—INCENTIVES TO 
REDUCE PHYSICIAN SHORTAGES 
Subtitle 
A—Federally 
Supported 
Student Loan Funds for Medical 
Students 
SEC. 1101. FEDERALLY SUPPORTED STUDENT LOAN FUNDS 
FOR MEDICAL STUDENTS. 
(a) PRIMARY HEALTH CARE MEDICAL STUDENTS.— 
Subpart II of part A of the Public Health Service Act (42 
U.S.C. 292q et seq.) is amended— 
(1) by redesignating section 735 as section 729; 
and 
(2) in subsection (f) of section 729 (as so redes-
ignated), by striking ‘‘is authorized to be appro-
priated to be appropriated $10,000,000 for each of 
the fiscal years 1994 through 1996’’ and inserting 
‘‘are authorized to be appropriated such sums as 
may be necessary for fiscal year 2012 and each fis-
cal year thereafter’’. 
(b) OTHER MEDICAL STUDENTS.—Part A of title VII 
of the Public Health Service Act (42 U.S.C. 292 et seq.) 
is amended by adding at the end the following: 
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‘‘Subpart III—Federally Supported Student Loan 
Funds for Certain Medical Students 
‘‘SEC. 730. SCHOOL LOAN FUNDS FOR CERTAIN MEDICAL 
STUDENTS. 
‘‘(a) FUND AGREEMENTS.—For the purpose de-
scribed in subsection (b), the Secretary is authorized to 
enter into an agreement for the establishment and oper-
ation of a student loan fund with any public or nonprofit 
school of medicine or osteopathic medicine. 
‘‘(b) PURPOSE.—The purpose of this subpart is to 
provide for loans to medical students who would be eligible 
for a loan under subpart II, except for the student’s deci-
sion to enter a residency training program in a field other 
than primary health care. 
‘‘(c) COMMENCEMENT
OF REPAYMENT PERIOD.— 
The repayment period for a loan under this section shall 
not begin before the end of any period during which the 
student is participating in an internship, residency, or fel-
lowship training program directly related to the field of 
medicine which the student agrees to enter pursuant to 
subsection (d). 
‘‘(d) REQUIREMENTS FOR STUDENTS.—Each agree-
ment under this section for the establishment of a student 
loan fund shall provide that the school of medicine or os-
teopathic medicine will make a loan to a student from such 
fund only if the student agrees— 
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‘‘(1) to enter and complete a residency training 
program (in a field of medicine other than primary 
health care) not later than a period determined by 
the Secretary to be reasonable after the date on 
which the student graduates from such school; and 
‘‘(2) to practice medicine through the date on 
which the loan is repaid in full. 
‘‘(e) REQUIREMENTS FOR SCHOOLS.—The provisions 
of section 723(b) (regarding graduates in primary health 
care) shall not apply to a student loan fund established 
under this section. 
‘‘(f) APPLICABILITY OF OTHER PROVISIONS.—Ex-
cept as inconsistent with this section, the provisions of 
subpart II shall apply to the program of student loan 
funds established under this section to the same extent 
and in the same manner as such provisions apply to the 
program of student loan funds established under subpart 
II. 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated such sums as may be necessary for fiscal year 
2012 and each fiscal year thereafter.’’. 
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Subtitle B—Loan Forgiveness for 
Primary Care Providers 
SEC. 1111. LOAN FORGIVENESS FOR PRIMARY CARE PRO-
VIDERS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall carry out a program of entering into 
contracts with eligible individuals under which— 
(1) the individual agrees to serve for a period 
of not less than 5 years as a primary care provider; 
and 
(2) in consideration of such service, the Sec-
retary agrees to pay not more than $50,000 on the 
principal and interest on the individual’s graduate 
educational loans. 
(b) ELIGIBILITY.—To be eligible to enter into a con-
tract under subsection (a), an individual must— 
(1) have a graduate degree in medicine, osteo-
pathic medicine, or another health profession from 
an accredited (as determined by the Secretary of 
Health and Human Services) institution of higher 
education; and 
(2) have practiced as a primary care provider 
for a period (excluding any residency or fellowship 
training period) of not less than— 
(A) 5 years; or 
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(B) 3 years in a medically underserved 
community (as defined in section 799B of the 
Public Health Service Act (42 U.S.C. 295p)). 
(c) INSTALLMENTS.—Payments under this section 
may be made in installments of not more than $10,000 
for each year of service described in subsection (a)(1). 
(d) APPLICABILITY OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D of title III of the Public 
Health Service Act shall, except as inconsistent with this 
section, apply to the program established under this sec-
tion in the same manner and to the same extent as such 
provisions apply to the National Health Service Corps 
Loan Repayment Program established in such subpart. 
TITLE XII—OFFSETS 
Subtitle A—Enforcing 
Discretionary Spending Limits 
SEC. 1201. ENFORCING DISCRETIONARY SPENDING LIMITS. 
(a) DISCRETIONARY SPENDING LIMITS.—Sections 
251(b) and (c) of the Balanced Budget and Emergency 
Deficit Control of Act of 1985 are amended to read as 
follows: 
‘‘(b) DISCRETIONARY SPENDING LIMIT.—As used in 
this part, the term ‘discretionary spending limit’ means— 
‘‘(1) 
with 
respect 
to 
fiscal 
year 
2011, 
$1,173,000,000,000 in new budget authority of 
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