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(2) ADVANCE PAYMENT; RETROSPECTIVE ADJUST-
MENT.—The process established under paragraph (1)
shall allow for making payments under this section
for each quarter of a fiscal year on the basis of ad-
vance estimates of expenditures submitted by appli-
cants for such payments and such other investigation
as the Secretary may find necessary, and for making
reductions or increases in the payments as necessary
to adjust for any overpayment or underpayment for
prior quarters of such fiscal year.
(e) DEFINITIONS.—In this section:
(1) HOSPITAL.—The term ‘‘hospital’’ has the
meaning given such term in section 1861(e) of the So-
cial Security Act (42 U.S.C. 1395x(e)).
(2) INDIAN TRIBE; TRIBAL ORGANIZATION.—The
terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ have
the meanings given such terms in section 4 of the In-
dian Health Care Improvement Act (25 U.S.C. 1603).
(3) PROVIDER.—The term ‘‘provider’’ includes a
physician, any other health care professional licensed
under State law, and any other entity that furnishes
emergency health services, including ambulance serv-
ices.
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
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(5) STATE.—The term ‘‘State’’ means the 50
States and the District of Columbia.
SEC. 611. INCREASE IN APPROPRIATION TO THE HEALTH
CARE 
FRAUD 
AND 
ABUSE 
CONTROL 
AC-
COUNT.
Section 1817(k)(3)(A) (42 U.S.C. 1395i(k)(3)(A)) is
amended—
(1) in clause (i)—
(A) in subclause (II), by striking ‘‘and’’ at
the end; and
(B) by striking subclause (III), and insert-
ing the following new subclauses:
‘‘(III) for fiscal year 2004, the
limit for fiscal year 2003 increased by
$10,000,000;
‘‘(IV) for fiscal year 2005, the
limit for fiscal year 2003 increased by
$15,000,000;
‘‘(V) for fiscal year 2006, the
limit for fiscal year 2003 increased by
$25,000,000; and
‘‘(VI) for each fiscal year after fis-
cal year 2006, the limit for fiscal year
2003.’’; and
(2) in clause (ii)—
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(A) in subclause (VI), by striking ‘‘and’’ at
the end;
(B) in subclause (VII)—
(i) by striking ‘‘each fiscal year after
fiscal year 2002’’ and inserting ‘‘fiscal year
2003’’; and
(ii) by striking the period and insert-
ing a semicolon; and
(3) by adding at the end the following:
‘‘(VIII) for fiscal year 2004,
$170,000,000;
‘‘(IX) 
for 
fiscal 
year 
2005,
$175,000,000;
‘‘(X) 
for 
fiscal 
year 
2006,
$185,000,000; and
‘‘(XI) for each fiscal year after fis-
cal 
year 
2006, 
not 
less 
than
$150,000,000 and not more than
$160,000,000.’’.
SEC. 612. INCREASE IN CIVIL PENALTIES UNDER THE FALSE
CLAIMS ACT.
(a) IN GENERAL.—Section 3729(a) of title 31, United
States Code, is amended—
(1) by striking ‘‘$5,000’’ and inserting ‘‘$7,500’’;
and
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(2) 
by 
striking 
‘‘$10,000’’ 
and 
inserting
‘‘$15,000’’.
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply to violations occurring on or after
January 1, 2004.
SEC. 613. INCREASE IN CIVIL MONETARY PENALTIES
UNDER THE SOCIAL SECURITY ACT.
(a) IN
GENERAL.—Section 1128A(a) (42 U.S.C.
1320a–7a(a)), in the matter following paragraph (7), is
amended—
(1) by striking ‘‘$10,000’’ each place it appears
and inserting ‘‘$12,500’’;
(2) 
by 
striking 
‘‘$15,000’’ 
and 
inserting
‘‘$18,750’’; and
(3) striking ‘‘$50,000’’ and inserting ‘‘$62,500’’.
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply to violations occurring on or after
January 1, 2004.
SEC. 614. EXTENSION OF CUSTOMS USER FEES.
Section 13031(j)(3) of the Consolidated Omnibus
Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is
amended by striking ‘‘September 30, 2003’’ and inserting
‘‘September 30, 2013’’.
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SEC. 615. REIMBURSEMENT FOR FEDERALLY QUALIFIED
HEALTH CENTERS PARTICIPATING IN MEDI-
CARE MANAGED CARE.
(a) REIMBURSEMENT.—
(1) IN GENERAL.—Section 1833(a)(3) (42 U.S.C.
1395l(a)(3)) is amended to read as follows:
‘‘(3) in the case of services described in section
1832(a)(2)(D)—
‘‘(A) except as provided in subparagraph
(B), the costs which are reasonable and related
to the cost of furnishing such services or which
are based on such other tests of reasonableness as
the Secretary may prescribe in regulations, in-
cluding 
those 
authorized 
under 
section
1861(v)(1)(A), less the amount a provider may
charge as described in clause (ii) of section
1866(a)(2)(A), but in no case may the payment
for such services (other than for items and serv-
ices described in section 1861(s)(10)(A)) exceed
80 percent of such costs; or
‘‘(B) with respect to the services described
in clause (ii) of section 1832(a)(2)(D) that are
furnished to an individual enrolled with a
MedicareAdvantage plan under part C pursuant
to a written agreement described in section
1853(j), the amount by which—
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‘‘(i) the amount of payment that would
have otherwise been provided under sub-
paragraph (A) (calculated as if ‘100 per-
cent’ were substituted for ‘80 percent’ in
such subparagraph) for such services if the
individual had not been so enrolled; exceeds
‘‘(ii) the amount of the payments re-
ceived under such written agreement for
such services (not including any financial
incentives provided for in such agreement
such as risk pool payments, bonuses, or
withholds),
less the amount the Federally qualified health
center may charge as described in section
1857(e)(3)(C);’’.
(b) CONTINUATION OF MEDICAREADVANTAGE MONTH-
LY PAYMENTS.—
(1) IN
GENERAL.—Section 1853 (42 U.S.C.
1395w–23), as amended by this Act, is amended by
adding at the end the following new subsection:
‘‘(j) PAYMENT RULE
FOR FEDERALLY QUALIFIED
HEALTH CENTER SERVICES.—If an individual who is en-
rolled with a MedicareAdvantage plan under this part re-
ceives a service from a Federally qualified health center that
has a written agreement with such plan for providing such
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a service (including any agreement required under section
1857(e)(3))—
‘‘(1) the Secretary shall pay the amount deter-
mined under section 1833(a)(3)(B) directly to the
Federally qualified health center not less frequently
than quarterly; and
‘‘(2) the Secretary shall not reduce the amount
of the monthly payments to the MedicareAdvantage
plan made under section 1853(a) as a result of the
application of paragraph (1).’’.
(2) CONFORMING AMENDMENTS.—
(A) Paragraphs (1) and (2) of section
1851(i) (42 U.S.C. 1395w–21(i)(1)), as amended
by this Act, are each amended by inserting
‘‘1853(j),’’ after ‘‘1853(i),’’.
(B) Section 1853(c)(5) is amended by strik-
ing ‘‘subsections (a)(3)(C)(iii) and (i)’’ and in-
serting ‘‘subsections (a)(3)(C)(iii), (i), and
(j)(1)’’.
(c) ADDITIONAL MEDICAREADVANTAGE CONTRACT RE-
QUIREMENTS.—Section 1857(e) (42 U.S.C. 1395w–27(e)) is
amended by adding at the end the following new paragraph:
‘‘(3) AGREEMENTS WITH FEDERALLY QUALIFIED
HEALTH CENTERS.—
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‘‘(A) PAYMENT LEVELS AND AMOUNTS.—A
contract under this part shall require the
MedicareAdvantage plan to provide, in any con-
tract between the plan and a Federally qualified
health center, for a level and amount of payment
to the Federally qualified health center for serv-
ices provided by such health center that is not
less than the level and amount of payment that
the plan would make for such services if the serv-
ices had been furnished by a provider of services
that was not a Federally qualified health center.
‘‘(B) COST-SHARING.—Under the written
agreement described in subparagraph (A), a Fed-
erally qualified health center must accept the
MedicareAdvantage contract price plus the Fed-
eral 
payment 
provided 
for 
in 
section
1833(a)(3)(B) as payment in full for services
covered by the contract, except that such a health
center may collect any amount of cost-sharing
permitted under the contract under this part, so
long as the amounts of any deductible, coinsur-
ance, or copayment comply with the require-
ments under section 1854(e).’’.
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(d) SAFE HARBOR FROM ANTIKICKBACK PROHIBI-
TION.—Section 1128B(b)(3) (42 U.S.C. 1320a–7b(b)(3)) is
amended—
(1) in subparagraph (E), by striking ‘‘and’’ after
the semicolon at the end;
(2) in subparagraph (F), by striking the period
at the end and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(G) any remuneration between a Federally
qualified health center (or an entity controlled
by 
such 
a 
health 
center) 
and 
a
MedicareAdvantage plan pursuant to the written
agreement described in section 1853(j).’’.
(e) EFFECTIVE DATE.—The amendments made by this
section shall apply to services provided on or after January
1, 2006, and contract years beginning on or after such date.
SEC. 616. PROVISION OF INFORMATION ON ADVANCE DI-
RECTIVES.
Section 1804(c) of the Social Security Act (42 U.S.C.
1395b-2(c)) is amended—
(1) by redesignating paragraphs (1) through (4)
as subparagraphs (A) through (D), respectively;
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(2) in the matter preceding subparagraph (A), as
so redesignated, by striking ‘‘The notice’’ and insert-
ing ‘‘(1) The notice’’; and
(3) by adding at the end the following:
‘‘(2)(A) The Secretary shall annually provide each
medicare beneficiary with information concerning advance
directives. Such information shall be provided by the Sec-
retary as part of the Medicare and You handbook that is
provided to each such beneficiary. Such handbook shall in-
clude a separate section on advanced directives and specific
details on living wills and the durable power of attorney
for health care. The Secretary shall ensure that the intro-
ductory letter that accompanies such handbook contain a
statement concerning the inclusion of such information.
‘‘(B) In this section:
‘‘(i) The term ‘advance directive’ has the mean-
ing given such term in section 1866(f)(3).
‘‘(ii) The term ‘medicare beneficiary’ means an
individual who is entitled to, or enrolled for, benefits
under part A or enrolled under part B, of this title.’’.
SEC. 617. SENSE OF THE SENATE REGARDING IMPLEMENTA-
TION OF THE PRESCRIPTION DRUG AND
MEDICARE IMPROVEMENT ACT OF 2003.
(a) IN GENERAL.—It is the sense of the Senate that
the Committee on Finance of the Senate should hold not
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less than 4 hearings to monitor implementation of the Pre-
scription Drug and Medicare Improvement Act of 2003
(hereinafter in this section referred to as the ‘‘Act’’) during
which the Secretary or his designee should testify before the
Committee.
(b) INITIAL HEARING.—It is the sense of the Senate
that the first hearing described in subsection (a) should be
held not later than 60 days after the date of the enactment
the Act. At the hearing, the Secretary or his designee should
submit written testimony and testify before the Committee
on Finance of the Senate on the following issues:
(1) The progress toward implementation of the
prescription drug discount card under section 111 of
the Act.
(2) Development of the blueprint that will direct
the implementation of the provisions of the Act, in-
cluding the implementation of title I (Medicare Pre-
scription Drug Benefit), title II (MedicareAdvantage),
and title III (Center for Medicare Choices) of the Act.
(3) Any problems that will impede the timely
implementation of the Act.
(4) The overall progress toward implementation
of the Act.
(c) SUBSEQUENT HEARINGS.—It is the sense of the
Senate that the additional hearings described in subsection
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(a) should be held in each of May 2004, October 2004, and
May 2005. At each hearing, the Secretary or his designee
should submit written testimony and testify before the Com-
mittee on Finance of the Senate on the following issues:
(1) Progress on implementation of title I (Medi-
care 
Prescription 
Drug 
Benefit), 
title 
II
(MedicareAdvantage), and title III (Center for Medi-
care Choices) of the Act.
(2) Any problems that will impede timely imple-
mentation of the Act.
SEC. 618. EXTENSION OF MUNICIPAL HEALTH SERVICE
DEMONSTRATION PROJECTS.
The last sentence of section 9215(a) of the Consolidated
Omnibus Budget Reconciliation Act of 1985 (42 U.S.C.
1395b–1 note), as previously amended, is amended by strik-
ing ‘‘December 31, 2004, and inserting ‘‘December 31, 2006.
SEC. 619. STUDY ON MAKING PRESCRIPTION PHARMA-
CEUTICAL INFORMATION ACCESSIBLE FOR
BLIND 
AND 
VISUALLY-IMPAIRED 
INDIVID-
UALS.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall undertake a study of how to
make prescription pharmaceutical information, in-
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cluding drug labels and usage instructions, accessible
to blind and visually-impaired individuals.
(2) STUDY TO INCLUDE EXISTING AND EMERGING
TECHNOLOGIES.—The study under paragraph (1)
shall include a review of existing and emerging tech-
nologies, including assistive technology, that makes es-
sential information on the content and prescribed use
of pharmaceutical medicines available in a usable for-
mat for blind and visually-impaired individuals.
(b) REPORT.—
(1) IN
GENERAL.—Not later than 18 months
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall submit a
report to Congress on the study required under sub-
section (a).
(2) CONTENTS OF REPORT.—The report required
under subsection (a) shall include recommendations
for the implementation of usable formats for making
prescription pharmaceutical information available to
blind and visually-impaired individuals and an esti-
mate of the costs associated with the implementation
of each format.
SEC. 620. HEALTH CARE THAT WORKS FOR ALL AMERICANS-
CITIZENS HEALTH CARE WORKING GROUP.
(a) FINDINGS.—Congress finds the following:
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(1) In order to improve the health care system,
the American public must engage in an informed na-
tional public debate to make choices about the services
they want covered, what health care coverage they
want, and how they are willing to pay for coverage.
(2) More than a trillion dollars annually is
spent on the health care system, yet—
(A) 41,000,000 Americans are uninsured;
(B) insured individuals do not always have
access to essential, effective services to improve
and maintain their health; and
(C) employers, who cover over 170,000,000
Americans, find providing coverage increasingly
difficult because of rising costs and double digit
premium increases.
(3) Despite increases in medical care spending
that are greater than the rate of inflation, population
growth, and Gross Domestic Product growth, there
has not been a commensurate improvement in our
health status as a nation.
(4) Health care costs for even just 1 member of
a family can be catastrophic, resulting in medical
bills potentially harming the economic stability of the
entire family.
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(5) Common life occurrences can jeopardize the
ability of a family to retain private coverage or jeop-
ardize access to public coverage.
(6) Innovations in health care access, coverage,
and quality of care, including the use of technology,
have often come from States, local communities, and
private sector organizations, but more creative poli-
cies could tap this potential.
(7) Despite our Nation’s wealth, the health care
system does not provide coverage to all Americans
who want it.
(b) PURPOSES.—The purposes of this Act are—
(1) to provide for a nationwide public debate
about improving the health care system to provide
every American with the ability to obtain quality, af-
fordable health care coverage; and
(2) to provide for a vote by Congress on the rec-
ommendations that result from the debate.
(c) ESTABLISHMENT.—The Secretary, acting through
the Agency for Healthcare Research and Quality, shall es-
tablish an entity to be known as the Citizens’ Health Care
Working Group (referred to in this Act as the ‘‘Working
Group’’).
(d) APPOINTMENT.—Not later than 45 days after the
date of enactment of this Act, the Speaker and Minority
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Leader of the House of Representatives and the Majority
Leader and Minority Leader of the Senate (in this section
referred to as the ‘‘leadership’’) shall each appoint individ-
uals to serve as members of the Working Group in accord-
ance with subsections (e), (f), and (g).
(e) MEMBERSHIP CRITERIA.—
(1) APPOINTED MEMBERS.—
(A) 
SEPARATE
APPOINTMENTS.—The
Speaker of the House of Representatives jointly
with the Minority Leader of the House of Rep-
resentatives, and the Majority Leader of the Sen-
ate jointly with the Minority Leader of the Sen-
ate, shall each appoint 1 member of the Working
Group described in subparagraphs (A), (G), (J),
(K), and (M) of paragraph (2).
(B) JOINT APPOINTMENTS.—Members of the
Working Group described in subparagraphs (B),
(C), (D), (E), (F), (I), and (N) of paragraph (2)
shall be appointed jointly by the leadership.
(C) COMBINED
APPOINTMENTS.—Members
of the Working Group described in subpara-
graphs (H) and (L) shall be appointed in the fol-
lowing manner:
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(i) One member of the Working Group
in each of such subparagraphs shall be ap-
pointed jointly by the leadership.
(ii) The remaining appointments of
the members in each of such subparagraphs
shall be divided equally such that the
Speaker of the House of Representatives
jointly with the Minority Leader of the
House of Representatives, and the Majority
Leader of the Senate jointly with the Minor-
ity Leader of the Senate each appoint an
equal number of members.
(2) CATEGORIES
OF
APPOINTED
MEMBERS.—
Members of the Working Group shall be appointed as
follows:
(A) 2 members shall be patients or family
members of patients who, at least 1 year prior
to the date of enactment of this Act, have had no
health insurance.
(B) 1 member shall be a representative of
children.
(C) 1 member shall be a representative of
the mentally ill.
(D) 1 member shall be a representative of
the disabled.
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(E) 1 member shall be over the age of 65
and a beneficiary under the medicare program
established under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.).
(F) 1 member shall be a recipient of benefits
under the medicaid program under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.).
(G) 2 members shall be State health offi-
cials.
(H) 
members 
shall 
be 
employers,
including—
(i) 1 large employer (an employer who
employed 50 or more employees on business
days during the preceding calendar year
and who employed at least 50 employees on
the first of the year);
(ii) 1 small employer (an employer
who employed an average of at least 2 em-
ployees but less than 50 employees on busi-
ness days in the preceding calendar year
and who employs at least 2 employees on
the first of the year); and
(iii) 1 multi-state employer.
(I) 1 member shall be a representative of
labor.
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(J) 2 members shall be health insurance
issuers.
(K) 2 members shall be health care pro-
viders.
(L) 5 members shall be appointed as fol-
lows:
(i) 1 economist.
(ii) 1 academician.
(iii) 1 health policy researcher.
(iv) 1 individual with expertise in
pharmacoeconomics.
(v) 1 health technology expert.
(M) 2 members shall be representatives of
community leaders who have developed State or
local community solutions to the problems ad-
dressed by the Working Group.
(N) 1 member shall be a representative of a
medical school.
(3) SECRETARY.—The Secretary, or the designee
of the Secretary, shall be a member of the Working
Group.
(f) PROHIBITED APPOINTMENTS.—Members of the
Working Group shall not include members of Congress or
other elected government officials (Federal, State, or local)
other than those individuals specified in subsection (e). To
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the extent possible, individuals appointed to the Working
Group shall have used the health care system within the
previous 2 years and shall not be paid employees or rep-
resentatives of associations or advocacy organizations in-
volved in the health care system.
(g) APPOINTMENT CRITERIA.—
(1) HOUSE OF REPRESENTATIVES.—The Speaker
and Minority Leader of the House of Representatives
shall make the appointments described in subsection
(d) in consultation with the chairperson and ranking
member of the following committees of the House of
Representatives:
(A) The Committee on Ways and Means.
(B) The Committee on Energy and Com-
merce.
(C) The Committee on Education and the
Workforce.
(2) SENATE.—The Majority Leader and Minor-
ity Leader of the Senate shall make the appointments
described in subsection (d) in consultation with the
chairperson and ranking member of the following
committees of the Senate:
(A) The Committee on Finance.
(B) The Committee on Health, Education,
Labor, and Pensions.
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(h) PERIOD OF APPOINTMENT.—Members of the Work-
ing Group shall be appointed for a term of 2 years. Such
term is renewable and any vacancies shall not affect the
power and duties of the Working Group but shall be filled
in the same manner as the original appointment.
(i) APPOINTMENT OF THE CHAIRPERSON.—Not later
than 15 days after the date on which all members of the
Working Group have been appointed under subsection (d),
the leadership shall make a joint designation of the chair-
person of the Working Group. If the leadership fails to make
such designation within such time period, the Working
Group Members shall, not later than 10 days after the end
of such time period, designate a chairperson by majority
vote.
(j) SUBCOMMITTEES.—The Working Group may estab-
lish subcommittees if doing so increases the efficiency of the
Working Group in completing its tasks.
(k) DUTIES.—
(1) HEARINGS.—Not later than 90 days after the
date of appointment of the chairperson under sub-
section (i), the Working Group shall hold hearings to
examine—
(A) the capacity of the public and private
health care systems to expand coverage options;
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(B) the cost of health care and the effective-
ness of care provided at all stages of disease;
(C) innovative State strategies used to ex-
pand health care coverage and lower health care
costs;
(D) local community solutions to accessing
health care coverage;
(E) efforts to enroll individuals currently el-
igible for public or private health care coverage;
(F) the role of evidence-based medical prac-
tices that can be documented as restoring, main-
taining, or improving a patient’s health, and the
use of technology in supporting providers in im-
proving quality of care and lowering costs; and
(G) strategies to assist purchasers of health
care, including consumers, to become more aware
of the impact of costs, and to lower the costs of
health care.
(2) 
ADDITIONAL
HEARINGS.—The 
Working
Group may hold additional hearings on subjects other
than those listed in paragraph (1) so long as such
hearings are determined to be necessary by the Work-
ing Group in carrying out the purposes of this Act.
Such additional hearings do not have to be completed
within the time period specified in paragraph (1) but
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‘‘(i) CONVICTION
FOR
A
RELEVANT
CRIME.—The term ‘conviction for a relevant
crime’ means any Federal or State criminal
conviction for—
‘‘(I) any offense described in
paragraphs (1) through (4) of section
1128(a); and
‘‘(II) such other types of offenses
as the Secretary may specify in regula-
tions, taking into account the severity
and relevance of such offenses, and
after consultation with representatives
of long-term care providers, representa-
tives of long-term care employees, con-
sumer advocates, and appropriate Fed-
eral and State officials.
‘‘(ii) DISQUALIFYING INFORMATION.—
The term ‘disqualifying information’ means
information about a conviction for a rel-
evant crime or a finding of patient or resi-
dent abuse.
‘‘(iii) FINDING OF PATIENT OR RESI-
DENT ABUSE.—The term ‘finding of patient
or resident abuse’ means any substantiated
finding by a State agency under subsection
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‘‘(D) FEES FOR PERFORMANCE OF CRIMI-
NAL BACKGROUND CHECKS.—
‘‘(i) AUTHORITY TO CHARGE FEES.—
‘‘(I) ATTORNEY
GENERAL.—The
Attorney General may charge a fee to
any State requesting a search and ex-
change of records pursuant to this
paragraph and subsection (b)(8) for
conducting the search and providing
the records. The amount of such fee
shall not exceed the lesser of the actual
cost of such activities or $50. Such fees
shall be available to the Attorney Gen-
eral, or, in the Attorney General’s dis-
cretion, to the Federal Bureau of Inves-
tigation until expended.
‘‘(II) 
STATE.—A 
State 
may
charge a skilled nursing facility a fee
for initiating the criminal background
check under this paragraph and sub-
section (b)(8), including fees charged
by the Attorney General, and for per-
forming the review and report required
by subparagraph (C). The amount of