H. R. 3590—642 
(42 U.S.C. 1395y) is amended by adding at the end the following 
new subsection: 
‘‘(n) REQUIREMENT OF A SURETY BOND FOR CERTAIN PROVIDERS 
OF SERVICES AND SUPPLIERS.— 
‘‘(1) IN GENERAL.—The Secretary may require a provider 
of services or supplier described in paragraph (2) to provide 
the Secretary on a continuing basis with a surety bond in 
a form specified by the Secretary in an amount (not less than 
$50,000) that the Secretary determines is commensurate with 
the volume of the billing of the provider of services or supplier. 
The Secretary may waive the requirement of a bond under 
the preceding sentence in the case of a provider of services 
or supplier that provides a comparable surety bond under State 
law. 
‘‘(2) PROVIDER
OF
SERVICES
OR
SUPPLIER
DESCRIBED.—A 
provider of services or supplier described in this paragraph 
is a provider of services or supplier the Secretary determines 
appropriate based on the level of risk involved with respect 
to the provider of services or supplier, and consistent with 
the surety bond requirements under sections 1834(a)(16)(B) 
and 1861(o)(7)(C).’’. 
(h) SUSPENSION
OF
MEDICARE
AND
MEDICAID
PAYMENTS 
PENDING INVESTIGATION OF CREDIBLE ALLEGATIONS OF FRAUD.— 
(1) MEDICARE.—Section 1862 of the Social Security Act 
(42 U.S.C. 1395y), as amended by subsection (g)(3), is amended 
by adding at the end the following new subsection: 
‘‘(o) SUSPENSION
OF PAYMENTS PENDING INVESTIGATION
OF 
CREDIBLE ALLEGATIONS OF FRAUD.— 
‘‘(1) IN GENERAL.—The Secretary may suspend payments 
to a provider of services or supplier under this title pending 
an investigation of a credible allegation of fraud against the 
provider of services or supplier, unless the Secretary determines 
there is good cause not to suspend such payments. 
‘‘(2) CONSULTATION.—The Secretary shall consult with the 
Inspector General of the Department of Health and Human 
Services in determining whether there is a credible allegation 
of fraud against a provider of services or supplier. 
‘‘(3) PROMULGATION OF REGULATIONS.—The Secretary shall 
promulgate regulations to carry out this subsection and section 
1903(i)(2)(C).’’. 
(2) MEDICAID.—Section 1903(i)(2) of such Act (42 U.S.C. 
1396b(i)(2)) is amended— 
(A) in subparagraph (A), by striking ‘‘or’’ at the end; 
and 
(B) by inserting after subparagraph (B), the following: 
‘‘(C) by any individual or entity to whom the State 
has failed to suspend payments under the plan during 
any period when there is pending an investigation of a 
credible allegation of fraud against the individual or entity, 
as determined by the State in accordance with regulations 
promulgated by the Secretary for purposes of section 
1862(o) and this subparagraph, unless the State determines 
in accordance with such regulations there is good cause 
not to suspend such payments; or’’. 
(i) INCREASED FUNDING TO FIGHT FRAUD AND ABUSE.— 
(1) IN GENERAL.—Section 1817(k) of the Social Security 
Act (42 U.S.C. 1395i(k)) is amended—
H. R. 3590—643 
(A) by adding at the end the following new paragraph: 
‘‘(7) ADDITIONAL FUNDING.—In addition to the funds other-
wise appropriated to the Account from the Trust Fund under 
paragraphs (3) and (4) and for purposes described in paragraphs 
(3)(C) and (4)(A), there are hereby appropriated an additional 
$10,000,000 to such Account from such Trust Fund for each 
of fiscal years 2011 through 2020. The funds appropriated 
under this paragraph shall be allocated in the same proportion 
as the total funding appropriated with respect to paragraphs 
(3)(A) and (4)(A) was allocated with respect to fiscal year 2010, 
and shall be available without further appropriation until 
expended.’’; and 
(B) in paragraph (4)(A), by inserting ‘‘until expended’’ 
after ‘‘appropriation’’. 
(2) INDEXING OF AMOUNTS APPROPRIATED.— 
(A) DEPARTMENTS OF HEALTH AND HUMAN SERVICES 
AND JUSTICE.—Section 1817(k)(3)(A)(i) of the Social Secu-
rity Act (42 U.S.C. 1395i(k)(3)(A)(i)) is amended— 
(i) in subclause (III), by inserting ‘‘and’’ at the 
end; 
(ii) in subclause (IV)— 
(I) by striking ‘‘for each of fiscal years 2007, 
2008, 2009, and 2010’’ and inserting ‘‘for each fiscal 
year after fiscal year 2006’’; and 
(II) by striking ‘‘; and’’ and inserting a period; 
and 
(iii) by striking subclause (V). 
(B) OFFICE OF THE INSPECTOR GENERAL OF THE DEPART-
MENT
OF
HEALTH
AND
HUMAN
SERVICES.—Section 
1817(k)(3)(A)(ii) of such Act (42 U.S.C. 1395i(k)(3)(A)(ii)) 
is amended— 
(i) in subclause (VIII), by inserting ‘‘and’’ at the 
end; 
(ii) in subclause (IX)— 
(I) by striking ‘‘for each of fiscal years 2008, 
2009, and 2010’’ and inserting ‘‘for each fiscal year 
after fiscal year 2007’’; and 
(II) by striking ‘‘; and’’ and inserting a period; 
and 
(iii) by striking subclause (X). 
(C) FEDERAL
BUREAU
OF
INVESTIGATION.—Section 
1817(k)(3)(B) of the Social Security Act (42 U.S.C. 
1395i(k)(3)(B)) is amended— 
(i) in clause (vii), by inserting ‘‘and’’ at the end; 
(ii) in clause (viii)— 
(I) by striking ‘‘for each of fiscal years 2007, 
2008, 2009, and 2010’’ and inserting ‘‘for each fiscal 
year after fiscal year 2006’’; and 
(II) by striking ‘‘; and’’ and inserting a period; 
and 
(iii) by striking clause (ix). 
(D) 
MEDICARE
INTEGRITY
PROGRAM.—Section 
1817(k)(4)(C) of the Social Security Act (42 U.S.C. 
1395i(k)(4)(C)) is amended by adding at the end the fol-
lowing new clause: 
‘‘(ii) For each fiscal year after 2010, by the percent-
age increase in the consumer price index for all urban
H. R. 3590—644 
consumers (all items; United States city average) over 
the previous year.’’. 
(j) MEDICARE INTEGRITY PROGRAM AND MEDICAID INTEGRITY 
PROGRAM.— 
(1) MEDICARE INTEGRITY PROGRAM.— 
(A) REQUIREMENT TO PROVIDE PERFORMANCE STATIS-
TICS.—Section 1893(c) of the Social Security Act (42 U.S.C. 
1395ddd(c)) is amended— 
(i) in paragraph (3), by striking ‘‘and’’ at the end; 
(ii) by redesignating paragraph (4) as paragraph 
(5); and 
(iii) by inserting after paragraph (3) the following 
new paragraph: 
‘‘(4) the entity agrees to provide the Secretary and the 
Inspector General of the Department of Health and Human 
Services with such performance statistics (including the number 
and amount of overpayments recovered, the number of fraud 
referrals, and the return on investment of such activities by 
the entity) as the Secretary or the Inspector General may 
request; and’’. 
(B) EVALUATIONS AND ANNUAL REPORT.—Section 1893 
of the Social Security Act (42 U.S.C. 1395ddd) is amended 
by adding at the end the following new subsection: 
‘‘(i) EVALUATIONS AND ANNUAL REPORT.— 
‘‘(1) EVALUATIONS.—The Secretary shall conduct evalua-
tions of eligible entities which the Secretary contracts with 
under the Program not less frequently than every 3 years. 
‘‘(2) ANNUAL REPORT.—Not later than 180 days after the 
end of each fiscal year (beginning with fiscal year 2011), the 
Secretary shall submit a report to Congress which identifies— 
‘‘(A) the use of funds, including funds transferred from 
the Federal Hospital Insurance Trust Fund under section 
1817 and the Federal Supplementary Insurance Trust Fund 
under section 1841, to carry out this section; and 
‘‘(B) the effectiveness of the use of such funds.’’. 
(C) FLEXIBILITY IN PURSUING FRAUD AND ABUSE.—Sec-
tion 1893(a) of the Social Security Act (42 U.S.C. 
1395ddd(a)) is amended by inserting ‘‘, or otherwise,’’ after 
‘‘entities’’. 
(2) MEDICAID INTEGRITY PROGRAM.— 
(A) REQUIREMENT TO PROVIDE PERFORMANCE STATIS-
TICS.—Section 1936(c)(2) of the Social Security Act (42 
U.S.C. 1396u–6(c)(2)) is amended— 
(i) by redesignating subparagraph (D) as subpara-
graph (E); and 
(ii) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(D) The entity agrees to provide the Secretary and 
the Inspector General of the Department of Health and 
Human 
Services 
with 
such 
performance 
statistics 
(including the number and amount of overpayments recov-
ered, the number of fraud referrals, and the return on 
investment of such activities by the entity) as the Secretary 
or the Inspector General may request.’’. 
(B) 
EVALUATIONS
AND
ANNUAL
REPORT.—Section 
1936(e) of the Social Security Act (42 U.S.C. 1396u–7(e)) 
is amended—
H. R. 3590—645 
(i) by redesignating paragraph (4) as paragraph 
(5); and 
(ii) by inserting after paragraph (3) the following 
new paragraph: 
‘‘(4) EVALUATIONS.—The Secretary shall conduct evalua-
tions of eligible entities which the Secretary contracts with 
under the Program not less frequently than every 3 years.’’. 
(k) EXPANDED APPLICATION OF HARDSHIP WAIVERS FOR EXCLU-
SIONS.—Section 1128(c)(3)(B) of the Social Security Act (42 U.S.C. 
1320a–7(c)(3)(B)) is amended by striking ‘‘individuals entitled to 
benefits under part A of title XVIII or enrolled under part B 
of such title, or both’’ and inserting ‘‘beneficiaries (as defined in 
section 1128A(i)(5)) of that program’’. 
SEC. 
6403. 
ELIMINATION 
OF 
DUPLICATION 
BETWEEN 
THE 
HEALTHCARE INTEGRITY AND PROTECTION DATA BANK 
AND THE NATIONAL PRACTITIONER DATA BANK. 
(a) INFORMATION REPORTED BY FEDERAL AGENCIES AND HEALTH 
PLANS.—Section 1128E of the Social Security Act (42 U.S.C. 1320a– 
7e) is amended— 
(1) by striking subsection (a) and inserting the following: 
‘‘(a) IN GENERAL.—The Secretary shall maintain a national 
health care fraud and abuse data collection program under this 
section for the reporting of certain final adverse actions (not 
including settlements in which no findings of liability have been 
made) against health care providers, suppliers, or practitioners 
as required by subsection (b), with access as set forth in subsection 
(d), and shall furnish the information collected under this section 
to the National Practitioner Data Bank established pursuant to 
the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 
et seq.).’’; 
(2) by striking subsection (d) and inserting the following: 
‘‘(d) ACCESS TO REPORTED INFORMATION.— 
‘‘(1) AVAILABILITY.—The information collected under this 
section shall be available from the National Practitioner Data 
Bank to the agencies, authorities, and officials which are pro-
vided under section 1921(b) information reported under section 
1921(a). 
‘‘(2) FEES FOR DISCLOSURE.—The Secretary may establish 
or approve reasonable fees for the disclosure of information 
under this section. The amount of such a fee may not exceed 
the costs of processing the requests for disclosure and of pro-
viding such information. Such fees shall be available to the 
Secretary to cover such costs.’’; 
(3) by striking subsection (f) and inserting the following: 
‘‘(f) APPROPRIATE COORDINATION.—In implementing this section, 
the Secretary shall provide for the maximum appropriate coordina-
tion with part B of the Health Care Quality Improvement Act 
of 1986 (42 U.S.C. 11131 et seq.) and section 1921.’’; and 
(4) in subsection (g)— 
(A) in paragraph (1)(A)— 
(i) in clause (iii)— 
(I) by striking ‘‘or State’’ each place it appears; 
(II) by redesignating subclauses (II) and (III) 
as subclauses (III) and (IV), respectively; and 
(III) by inserting after subclause (I) the fol-
lowing new subclause:
H. R. 3590—646 
‘‘(II) any dismissal or closure of the pro-
ceedings by reason of the provider, supplier, or 
practitioner surrendering their license or leaving 
the State or jurisdiction’’; and 
(ii) by striking clause (iv) and inserting the fol-
lowing: 
‘‘(iv) Exclusion from participation in a Federal 
health care program (as defined in section 1128B(f)).’’; 
(B) in paragraph (3)— 
(i) by striking subparagraphs (D) and (E); and 
(ii) by redesignating subparagraph (F) as subpara-
graph (D); and 
(C) in subparagraph (D) (as so redesignated), by 
striking ‘‘or State’’. 
(b) INFORMATION REPORTED BY STATE LAW OR FRAUD ENFORCE-
MENT AGENCIES.—Section 1921 of the Social Security Act (42 U.S.C. 
1396r–2) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘SYSTEM.—The State’’ and all that 
follows through the semicolon and inserting SYSTEM.— 
‘‘(A) LICENSING OR CERTIFICATION ACTIONS.—The State 
must have in effect a system of reporting the following 
information with respect to formal proceedings (as defined 
by the Secretary in regulations) concluded against a health 
care practitioner or entity by a State licensing or certifi-
cation agency:’’; 
(ii) by redesignating subparagraphs (A) through 
(D) as clauses (i) through (iv), respectively, and 
indenting appropriately; 
(iii) in subparagraph (A)(iii) (as so redesignated)— 
(I) by striking ‘‘the license of’’ and inserting 
‘‘license or the right to apply for, or renew, a 
license by’’; and 
(II) by inserting ‘‘nonrenewability,’’ after ‘‘vol-
untary surrender,’’; and 
(iv) by adding at the end the following new 
subparagraph: 
‘‘(B) OTHER FINAL ADVERSE ACTIONS.—The State must 
have in effect a system of reporting information with 
respect to any final adverse action (not including settle-
ments in which no findings of liability have been made) 
taken against a health care provider, supplier, or practi-
tioner by a State law or fraud enforcement agency.’’; and 
(B) in paragraph (2), by striking ‘‘the authority 
described in paragraph (1)’’ and inserting ‘‘a State licensing 
or certification agency or State law or fraud enforcement 
agency’’; 
(2) in subsection (b)— 
(A) by striking paragraph (2) and inserting the fol-
lowing: 
‘‘(2) to State licensing or certification agencies and Federal 
agencies responsible for the licensing and certification of health 
care providers, suppliers, and licensed health care practi-
tioners;’’;
H. R. 3590—647 
(B) in each of paragraphs (4) and (6), by inserting 
‘‘, but only with respect to information provided pursuant 
to subsection (a)(1)(A)’’ before the comma at the end; 
(C) by striking paragraph (5) and inserting the fol-
lowing: 
‘‘(5) to State law or fraud enforcement agencies,’’; 
(D) by redesignating paragraphs (7) and (8) as para-
graphs (8) and (9), respectively; and 
(E) by inserting after paragraph (6) the following new 
paragraph: 
‘‘(7) to health plans (as defined in section 1128C(c));’’; 
(3) by redesignating subsection (d) as subsection (h), and 
by inserting after subsection (c) the following new subsections: 
‘‘(d) DISCLOSURE AND CORRECTION OF INFORMATION.— 
‘‘(1) DISCLOSURE.—With respect to information reported 
pursuant to subsection (a)(1), the Secretary shall— 
‘‘(A) provide for disclosure of the information, upon 
request, to the health care practitioner who, or the entity 
that, is the subject of the information reported; and 
‘‘(B) establish procedures for the case where the health 
care practitioner or entity disputes the accuracy of the 
information reported. 
‘‘(2) CORRECTIONS.—Each State licensing or certification 
agency and State law or fraud enforcement agency shall report 
corrections of information already reported about any formal 
proceeding or final adverse action described in subsection (a), 
in such form and manner as the Secretary prescribes by regula-
tion. 
‘‘(e) FEES FOR DISCLOSURE.—The Secretary may establish or 
approve reasonable fees for the disclosure of information under 
this section. The amount of such a fee may not exceed the costs 
of processing the requests for disclosure and of providing such 
information. Such fees shall be available to the Secretary to cover 
such costs. 
‘‘(f) PROTECTION FROM LIABILITY FOR REPORTING.—No person 
or entity, including any agency designated by the Secretary in 
subsection (b), shall be held liable in any civil action with respect 
to any reporting of information as required under this section, 
without knowledge of the falsity of the information contained in 
the report. 
‘‘(g) REFERENCES.—For purposes of this section: 
‘‘(1) STATE LICENSING OR CERTIFICATION AGENCY.—The term 
‘State licensing or certification agency’ includes any authority 
of a State (or of a political subdivision thereof) responsible 
for the licensing of health care practitioners (or any peer review 
organization or private accreditation entity reviewing the serv-
ices provided by health care practitioners) or entities. 
‘‘(2) STATE
LAW
OR
FRAUD
ENFORCEMENT
AGENCY.—The 
term ‘State law or fraud enforcement agency’ includes— 
‘‘(A) a State law enforcement agency; and 
‘‘(B) a State medicaid fraud control unit (as defined 
in section 1903(q)). 
‘‘(3) FINAL ADVERSE ACTION.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
term ‘final adverse action’ includes—
H. R. 3590—648 
‘‘(i) civil judgments against a health care provider, 
supplier, or practitioner in State court related to the 
delivery of a health care item or service; 
‘‘(ii) State criminal convictions related to the 
delivery of a health care item or service; 
‘‘(iii) exclusion from participation in State health 
care programs (as defined in section 1128(h)); 
‘‘(iv) any licensing or certification action described 
in subsection (a)(1)(A) taken against a supplier by a 
State licensing or certification agency; and 
‘‘(v) any other adjudicated actions or decisions that 
the Secretary shall establish by regulation. 
‘‘(B) EXCEPTION.—Such term does not include any 
action with respect to a malpractice claim.’’; and 
(4) in subsection (h), as so redesignated, by striking ‘‘The 
Secretary’’ and all that follows through the period at the end 
and inserting ‘‘In implementing this section, the Secretary shall 
provide for the maximum appropriate coordination with part 
B of the Health Care Quality Improvement Act of 1986 (42 
U.S.C. 11131 et seq.) and section 1128E.’’. 
(c) CONFORMING
AMENDMENT.—Section 1128C(a)(1) of the 
Social Security Act (42 U.S.C. 1320a–7c(a)(1)) is amended— 
(1) in subparagraph (C), by adding ‘‘and’’ after the comma 
at the end; 
(2) in subparagraph (D), by striking ‘‘, and’’ and inserting 
a period; and 
(3) by striking subparagraph (E). 
(d) TRANSITION PROCESS; EFFECTIVE DATE.— 
(1) IN GENERAL.—Effective on the date of enactment of 
this Act, the Secretary of Health and Human Services (in 
this section referred to as the ‘‘Secretary’’) shall implement 
a transition process under which, by not later than the end 
of the transition period described in paragraph (5), the Sec-
retary shall cease operating the Healthcare Integrity and 
Protection Data Bank established under section 1128E of the 
Social Security Act (as in effect before the effective date speci-
fied in paragraph (6)) and shall transfer all data collected 
in the Healthcare Integrity and Protection Data Bank to the 
National Practitioner Data Bank established pursuant to the 
Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 
et seq.). During such transition process, the Secretary shall 
have in effect appropriate procedures to ensure that data collec-
tion and access to the Healthcare Integrity and Protection 
Data Bank and the National Practitioner Data Bank are not 
disrupted. 
(2) REGULATIONS.—The Secretary shall promulgate regula-
tions to carry out the amendments made by subsections (a) 
and (b). 
(3) FUNDING.— 
(A) AVAILABILITY
OF
FEES.—Fees collected pursuant 
to section 1128E(d)(2) of the Social Security Act prior to 
the effective date specified in paragraph (6) for the disclo-
sure of information in the Healthcare Integrity and Protec-
tion Data Bank shall be available to the Secretary, without 
fiscal year limitation, for payment of costs related to the 
transition process described in paragraph (1). Any such 
fees remaining after the transition period is complete shall
H. R. 3590—649 
be available to the Secretary, without fiscal year limitation, 
for payment of the costs of operating the National Practi-
tioner Data Bank. 
(B) AVAILABILITY OF ADDITIONAL FUNDS.—In addition 
to the fees described in subparagraph (A), any funds avail-
able to the Secretary or to the Inspector General of the 
Department of Health and Human Services for a purpose 
related to combating health care fraud, waste, or abuse 
shall be available to the extent necessary for operating 
the Healthcare Integrity and Protection Data Bank during 
the transition period, including systems testing and other 
activities necessary to ensure that information formerly 
reported to the Healthcare Integrity and Protection Data 
Bank will be accessible through the National Practitioner 
Data Bank after the end of such transition period. 
(4) SPECIAL
PROVISION
FOR
ACCESS
TO
THE
NATIONAL 
PRACTITIONER DATA BANK BY THE DEPARTMENT OF VETERANS 
AFFAIRS.— 
(A) IN GENERAL.—Notwithstanding any other provision 
of law, during the 1-year period that begins on the effective 
date specified in paragraph (6), the information described 
in subparagraph (B) shall be available from the National 
Practitioner Data Bank to the Secretary of Veterans Affairs 
without charge. 
(B) 
INFORMATION
DESCRIBED.—For 
purposes 
of 
subparagraph (A), the information described in this 
subparagraph is the information that would, but for the 
amendments made by this section, have been available 
to the Secretary of Veterans Affairs from the Healthcare 
Integrity and Protection Data Bank. 
(5) TRANSITION PERIOD DEFINED.—For purposes of this sub-
section, the term ‘‘transition period’’ means the period that 
begins on the date of enactment of this Act and ends on the 
later of— 
(A) the date that is 1 year after such date of enactment; 
or 
(B) the effective date of the regulations promulgated 
under paragraph (2). 
(6) EFFECTIVE
DATE.—The amendments made by sub-
sections (a), (b), and (c) shall take effect on the first day 
after the final day of the transition period. 
SEC. 6404. MAXIMUM PERIOD FOR SUBMISSION OF MEDICARE CLAIMS 
REDUCED TO NOT MORE THAN 12 MONTHS. 
(a) REDUCING MAXIMUM PERIOD FOR SUBMISSION.— 
(1) PART
A.—Section 1814(a) of the Social Security Act 
(42 U.S.C. 1395f(a)(1)) is amended— 
(A) in paragraph (1), by striking ‘‘period of 3 calendar 
years’’ and all that follows through the semicolon and 
inserting ‘‘period ending 1 calendar year after the date 
of service;’’; and 
(B) by adding at the end the following new sentence: 
‘‘In applying paragraph (1), the Secretary may specify 
exceptions to the 1 calendar year period specified in such 
paragraph.’’ 
(2) PART B.—
H. R. 3590—650 
(A) Section 1842(b)(3) of such Act (42 U.S.C. 
1395u(b)(3)(B)) is amended— 
(i) in subparagraph (B), in the flush language fol-
lowing clause (ii), by striking ‘‘close of the calendar 
year following the year in which such service is fur-
nished (deeming any service furnished in the last 3 
months of any calendar year to have been furnished 
in the succeeding calendar year)’’ and inserting ‘‘period 
ending 1 calendar year after the date of service’’; and 
(ii) by adding at the end the following new sen-
tence: ‘‘In applying subparagraph (B), the Secretary 
may specify exceptions to the 1 calendar year period 
specified in such subparagraph.’’ 
(B) Section 1835(a) of such Act (42 U.S.C. 1395n(a)) 
is amended— 
(i) in paragraph (1), by striking ‘‘period of 3 cal-
endar years’’ and all that follows through the semicolon 
and inserting ‘‘period ending 1 calendar year after 
the date of service;’’; and 
(ii) by adding at the end the following new sen-
tence: ‘‘In applying paragraph (1), the Secretary may 
specify exceptions to the 1 calendar year period speci-
fied in such paragraph.’’ 
(b) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendments made by subsection 
(a) shall apply to services furnished on or after January 1, 
2010. 
(2) SERVICES FURNISHED BEFORE 2010.—In the case of serv-
ices furnished before January 1, 2010, a bill or request for 
payment under section 1814(a)(1), 1842(b)(3)(B), or 1835(a) 
shall be filed not later that December 31, 2010. 
SEC. 6405. PHYSICIANS WHO ORDER ITEMS OR SERVICES REQUIRED 
TO BE MEDICARE ENROLLED PHYSICIANS OR ELIGIBLE 
PROFESSIONALS. 
(a) DME.—Section 1834(a)(11)(B) of the Social Security Act 
(42 U.S.C. 1395m(a)(11)(B)) is amended by striking ‘‘physician’’ 
and inserting ‘‘physician enrolled under section 1866(j) or an eligible 
professional under section 1848(k)(3)(B) that is enrolled under sec-
tion 1866(j)’’. 
(b) HOME HEALTH SERVICES.— 
(1) PART
A.—Section 1814(a)(2) of such Act (42 U.S.C. 
1395(a)(2)) is amended in the matter preceding subparagraph 
(A) by inserting ‘‘in the case of services described in subpara-
graph (C), a physician enrolled under section 1866(j) or an 
eligible professional under section 1848(k)(3)(B),’’ before ‘‘or, 
in the case of services’’. 
(2) PART
B.—Section 1835(a)(2) of such Act (42 U.S.C. 
1395n(a)(2)) is amended in the matter preceding subparagraph 
(A) by inserting ‘‘, or in the case of services described in 
subparagraph (A), a physician enrolled under section 1866(j) 
or an eligible professional under section 1848(k)(3)(B),’’ after 
‘‘a physician’’. 
(c) APPLICATION TO OTHER ITEMS OR SERVICES.—The Secretary 
may extend the requirement applied by the amendments made 
by subsections (a) and (b) to durable medical equipment and home 
health services (relating to requiring certifications and written
H. R. 3590—651 
orders to be made by enrolled physicians and health professions) 
to all other categories of items or services under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.), including covered 
part D drugs as defined in section 1860D–2(e) of such Act (42 
U.S.C. 1395w–102), that are ordered, prescribed, or referred by 
a physician enrolled under section 1866(j) of such Act (42 U.S.C. 
1395cc(j)) or an eligible professional under section 1848(k)(3)(B) 
of such Act (42 U.S.C. 1395w–4(k)(3)(B)). 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply to written orders and certifications made on or after 
July 1, 2010. 
SEC. 6406. REQUIREMENT FOR PHYSICIANS TO PROVIDE DOCUMENTA-
TION ON REFERRALS TO PROGRAMS AT HIGH RISK OF 
WASTE AND ABUSE. 
(a) PHYSICIANS AND OTHER SUPPLIERS.—Section 1842(h) of the 
Social Security Act (42 U.S.C. 1395u(h)) is amended by adding 
at the end the following new paragraph: 
‘‘(9) The Secretary may revoke enrollment, for a period of not 
more than one year for each act, for a physician or supplier under 
section 1866(j) if such physician or supplier fails to maintain and, 
upon request of the Secretary, provide access to documentation 
relating to written orders or requests for payment for durable 
medical equipment, certifications for home health services, or refer-
rals for other items or services written or ordered by such physician 
or supplier under this title, as specified by the Secretary.’’. 
(b) PROVIDERS OF SERVICES.—Section 1866(a)(1) of such Act 
(42 U.S.C. 1395cc) is further amended— 
(1) in subparagraph (U), by striking at the end ‘‘and’’; 
(2) in subparagraph (V), by striking the period at the 
end and adding ‘‘; and’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(W) maintain and, upon request of the Secretary, pro-
vide access to documentation relating to written orders 
or requests for payment for durable medical equipment, 
certifications for home health services, or referrals for other 
items or services written or ordered by the provider under 
this title, as specified by the Secretary.’’. 
(c) 
OIG 
PERMISSIVE
EXCLUSION
AUTHORITY.—Section 
1128(b)(11) of the Social Security Act (42 U.S.C. 1320a–7(b)(11)) 
is amended by inserting ‘‘, ordering, referring for furnishing, or 
certifying the need for’’ after ‘‘furnishing’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply to orders, certifications, and referrals made on or after 
January 1, 2010. 
SEC. 6407. FACE TO FACE ENCOUNTER WITH PATIENT REQUIRED 
BEFORE PHYSICIANS MAY CERTIFY ELIGIBILITY FOR 
HOME HEALTH SERVICES OR DURABLE MEDICAL EQUIP-
MENT UNDER MEDICARE. 
(a) CONDITION OF PAYMENT FOR HOME HEALTH SERVICES.— 
(1) PART A.—Section 1814(a)(2)(C) of such Act is amended— 
(A) by striking ‘‘and such services’’ and inserting ‘‘such 
services’’; and 
(B) by inserting after ‘‘care of a physician’’ the fol-
lowing: ‘‘, and, in the case of a certification made by a 
physician after January 1, 2010, prior to making such
H. R. 3590—652 
certification the physician must document that the physi-
cian himself or herself has had a face-to-face encounter 
(including through use of telehealth, subject to the require-
ments in section 1834(m), and other than with respect 
to encounters that are incident to services involved) with 
the individual within a reasonable timeframe as deter-
mined by the Secretary’’. 
(2) PART B.—Section 1835(a)(2)(A) of the Social Security 
Act is amended— 
(A) by striking ‘‘and’’ before ‘‘(iii)’’; and 
(B) by inserting after ‘‘care of a physician’’ the fol-
lowing: ‘‘, and (iv) in the case of a certification after January 
1, 2010, prior to making such certification the physician 
must document that the physician has had a face-to-face 
encounter (including through use of telehealth and other 
than with respect to encounters that are incident to services 
involved) with the individual during the 6-month period 
preceding such certification, or other reasonable timeframe 
as determined by the Secretary’’. 
(b) CONDITION
OF PAYMENT
FOR DURABLE MEDICAL EQUIP-
MENT.—Section 1834(a)(11)(B) of the Social Security Act (42 U.S.C. 
1395m(a)(11)(B)) is amended— 
(1) by striking ‘‘ORDER.—The Secretary’’ and inserting 
‘‘ORDER.— 
‘‘(i) IN GENERAL.—The Secretary’’; and 
(2) by adding at the end the following new clause: 
‘‘(ii) 
REQUIREMENT
FOR
FACE
TO
FACE 
ENCOUNTER.—The Secretary shall require that such 
an order be written pursuant to the physician docu-
menting that a physician, a physician assistant, a 
nurse practitioner, or a clinical nurse specialist (as 
those terms are defined in section 1861(aa)(5)) has 
had a face-to-face encounter (including through use 
of telehealth under subsection (m) and other than with 
respect to encounters that are incident to services 
involved) with the individual involved during the 6- 
month period preceding such written order, or other 
reasonable timeframe as determined by the Secretary.’’. 
(c) APPLICATION TO OTHER AREAS UNDER MEDICARE.—The Sec-
retary may apply the face-to-face encounter requirement described 
in the amendments made by subsections (a) and (b) to other items 
and services for which payment is provided under title XVIII of 
the Social Security Act based upon a finding that such an decision 
would reduce the risk of waste, fraud, or abuse. 
(d) APPLICATION TO MEDICAID.—The requirements pursuant to 
the amendments made by subsections (a) and (b) shall apply in 
the case of physicians making certifications for home health services 
under title XIX of the Social Security Act in the same manner 
and to the same extent as such requirements apply in the case 
of physicians making such certifications under title XVIII of such 
Act. 
SEC. 6408. ENHANCED PENALTIES. 
(a) CIVIL MONETARY PENALTIES
FOR FALSE STATEMENTS
OR 
DELAYING INSPECTIONS.—Section 1128A(a) of the Social Security 
Act (42 U.S.C. 1320a–7a(a)), as amended by section 5002(d)(2)(A), 
is amended—
H. R. 3590—653 
(1) in paragraph (6), by striking ‘‘or’’ at the end; and 
(2) by inserting after paragraph (7) the following new para-
graphs: 
‘‘(8) knowingly makes, uses, or causes to be made or used, 
a false record or statement material to a false or fraudulent 
claim for payment for items and services furnished under a 
Federal health care program; or 
‘‘(9) fails to grant timely access, upon reasonable request 
(as defined by the Secretary in regulations), to the Inspector 
General of the Department of Health and Human Services, 
for the purpose of audits, investigations, evaluations, or other 
statutory functions of the Inspector General of the Department 
of Health and Human Services;’’; and 
(3) in the first sentence— 
(A) by striking ‘‘or in cases under paragraph (7)’’ and 
inserting ‘‘in cases under paragraph (7)’’; and 
(B) by striking ‘‘act)’’ and inserting ‘‘act, in cases under 
paragraph (8), $50,000 for each false record or statement, 
or in cases under paragraph (9), $15,000 for each day 
of the failure described in such paragraph)’’. 
(b) MEDICARE ADVANTAGE AND PART D PLANS.— 
(1) ENSURING TIMELY INSPECTIONS RELATING TO CONTRACTS 
WITH MA ORGANIZATIONS.—Section 1857(d)(2) of such Act (42 
U.S.C. 1395w–27(d)(2)) is amended— 
(A) in subparagraph (A), by inserting ‘‘timely’’ before 
‘‘inspect’’; and 
(B) in subparagraph (B), by inserting ‘‘timely’’ before 
‘‘audit and inspect’’. 
(2) MARKETING
VIOLATIONS.—Section 1857(g)(1) of the 
Social Security Act (42 U.S.C. 1395w–27(g)(1)) is amended— 
(A) in subparagraph (F), by striking ‘‘or’’ at the end; 
(B) by inserting after subparagraph (G) the following 
new subparagraphs: 
‘‘(H) except as provided under subparagraph (C) or 
(D) of section 1860D–1(b)(1), enrolls an individual in any 
plan under this part without the prior consent of the indi-
vidual or the designee of the individual; 
‘‘(I) transfers an individual enrolled under this part 
from one plan to another without the prior consent of 
the individual or the designee of the individual or solely 
for the purpose of earning a commission; 
‘‘(J) fails to comply with marketing restrictions 
described in subsections (h) and (j) of section 1851 or 
applicable implementing regulations or guidance; or 
‘‘(K) employs or contracts with any individual or entity 
who engages in the conduct described in subparagraphs 
(A) through (J) of this paragraph;’’; and 
(C) by adding at the end the following new sentence: 
‘‘The Secretary may provide, in addition to any other rem-
edies authorized by law, for any of the remedies described 
in paragraph (2), if the Secretary determines that any 
employee or agent of such organization, or any provider 
or supplier who contracts with such organization, has 
engaged in any conduct described in subparagraphs (A) 
through (K) of this paragraph.’’. 
(3) 
PROVISION
OF
FALSE
INFORMATION.—Section 
1857(g)(2)(A) of the Social Security Act (42 U.S.C. 1395w–
H. R. 3590—654 
27(g)(2)(A)) is amended by inserting ‘‘except with respect to 
a determination under subparagraph (E), an assessment of 
not more than the amount claimed by such plan or plan sponsor 
based upon the misrepresentation or falsified information 
involved,’’ after ‘‘for each such determination,’’. 
(c) OBSTRUCTION OF PROGRAM AUDITS.—Section 1128(b)(2) of 
the Social Security Act (42 U.S.C. 1320a–7(b)(2)) is amended— 
(1) in the heading, by inserting ‘‘OR AUDIT’’ after ‘‘INVESTIGA-
TION’’; and 
(2) by striking ‘‘investigation into’’ and all that follows 
through the period and inserting ‘‘investigation or audit related 
to—’’ 
‘‘(i) any offense described in paragraph (1) or in 
subsection (a); or 
‘‘(ii) the use of funds received, directly or indirectly, 
from any Federal health care program (as defined in 
section 1128B(f)).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in paragraph (2), the 
amendments made by this section shall apply to acts committed 
on or after January 1, 2010. 
(2) EXCEPTION.—The amendments made by subsection 
(b)(1) take effect on the date of enactment of this Act. 
SEC. 6409. MEDICARE SELF-REFERRAL DISCLOSURE PROTOCOL. 
(a) DEVELOPMENT OF SELF-REFERRAL DISCLOSURE PROTOCOL.— 
(1) IN
GENERAL.—The Secretary of Health and Human 
Services, in cooperation with the Inspector General of the 
Department of Health and Human Services, shall establish, 
not later than 6 months after the date of the enactment of 
this Act, a protocol to enable health care providers of services 
and suppliers to disclose an actual or potential violation of 
section 1877 of the Social Security Act (42 U.S.C. 1395nn) 
pursuant to a self-referral disclosure protocol (in this section 
referred to as an ‘‘SRDP’’). The SRDP shall include direction 
to health care providers of services and suppliers on— 
(A) a specific person, official, or office to whom such 
disclosures shall be made; and 
(B) instruction on the implication of the SRDP on 
corporate integrity agreements and corporate compliance 
agreements. 
(2) PUBLICATION ON INTERNET WEBSITE OF SRDP INFORMA-
TION.—The Secretary of Health and Human Services shall post 
information on the public Internet website of the Centers for 
Medicare & Medicaid Services to inform relevant stakeholders 
of how to disclose actual or potential violations pursuant to 
an SRDP. 
(3) RELATION TO ADVISORY OPINIONS.—The SRDP shall be 
separate from the advisory opinion process set forth in regula-
tions implementing section 1877(g) of the Social Security Act. 
(b) REDUCTION IN AMOUNTS OWED.—The Secretary of Health 
and Human Services is authorized to reduce the amount due and 
owing for all violations under section 1877 of the Social Security 
Act to an amount less than that specified in subsection (g) of 
such section. In establishing such amount for a violation, the Sec-
retary may consider the following factors:
H. R. 3590—655 
(1) The nature and extent of the improper or illegal prac-
tice. 
(2) The timeliness of such self-disclosure. 
(3) The cooperation in providing additional information 
related to the disclosure. 
(4) Such other factors as the Secretary considers appro-
priate. 
(c) REPORT.—Not later than 18 months after the date on which 
the SRDP protocol is established under subsection (a)(1), the Sec-
retary shall submit to Congress a report on the implementation 
of this section. Such report shall include— 
(1) the number of health care providers of services and 
suppliers making disclosures pursuant to the SRDP; 
(2) the amounts collected pursuant to the SRDP; 
(3) the types of violations reported under the SRDP; and 
(4) such other information as may be necessary to evaluate 
the impact of this section. 
SEC. 6410. ADJUSTMENTS TO THE MEDICARE DURABLE MEDICAL 
EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES 
COMPETITIVE ACQUISITION PROGRAM. 
(a) EXPANSION OF ROUND 2 OF THE DME COMPETITIVE BIDDING 
PROGRAM.—Section 1847(a)(1) of the Social Security Act (42 U.S.C. 
1395w–3(a)(1)) is amended— 
(1) in subparagraph (B)(i)(II), by striking ‘‘70’’ and inserting 
‘‘91’’; and 
(2) in subparagraph (D)(ii)— 
(A) in subclause (I), by striking ‘‘and’’ at the end; 
(B) by redesignating subclause (II) as subclause (III); 
and 
(C) by inserting after subclause (I) the following new 
subclause: 
‘‘(II) the Secretary shall include the next 21 
largest metropolitan statistical areas by total popu-
lation (after those selected under subclause (I)) 
for such round; and’’. 
(b) REQUIREMENT
TO EITHER COMPETITIVELY BID AREAS
OR 
USE COMPETITIVE BID PRICES BY 2016.—Section 1834(a)(1)(F) of 
the Social Security Act (42 U.S.C. 1395m(a)(1)(F)) is amended— 
(1) in clause (i), by striking ‘‘and’’ at the end; 
(2) in clause (ii)— 
(A) by inserting ‘‘(and, in the case of covered items 
furnished on or after January 1, 2016, subject to clause 
(iii), shall)’’ after ‘‘may’’; and 
(B) by striking the period at the end and inserting 
‘‘; and’’; and 
(3) by adding at the end the following new clause: 
‘‘(iii) in the case of covered items furnished on 
or after January 1, 2016, the Secretary shall continue 
to make such adjustments described in clause (ii) as, 
under such competitive acquisition programs, addi-
tional covered items are phased in or information is 
updated as contracts under section 1847 are recom-
peted in accordance with section 1847(b)(3)(B).’’. 
SEC. 6411. EXPANSION OF THE RECOVERY AUDIT CONTRACTOR (RAC) 
PROGRAM. 
(a) EXPANSION TO MEDICAID.—
H. R. 3590—656 
(1) STATE PLAN AMENDMENT.—Section 1902(a)(42) of the 
Social Security Act (42 U.S.C. 1396a(a)(42)) is amended— 
(A) by striking ‘‘that the records’’ and inserting ‘‘that— 
‘‘(A) the records’’; 
(B) by inserting ‘‘and’’ after the semicolon; and 
(C) by adding at the end the following: 
‘‘(B) not later than December 31, 2010, the State 
shall— 
‘‘(i) establish a program under which the State 
contracts (consistent with State law and in the same 
manner as the Secretary enters into contracts with 
recovery audit contractors under section 1893(h), sub-
ject to such exceptions or requirements as the Secretary 
may require for purposes of this title or a particular 
State) with 1 or more recovery audit contractors for 
the purpose of identifying underpayments and overpay-
ments and recouping overpayments under the State 
plan and under any waiver of the State plan with 
respect to all services for which payment is made to 
any entity under such plan or waiver; and 
‘‘(ii) provide assurances satisfactory to the Sec-
retary that— 
‘‘(I) under such contracts, payment shall be 
made to such a contractor only from amounts 
recovered; 
‘‘(II) from such amounts recovered, payment— 
‘‘(aa) shall be made on a contingent basis 
for collecting overpayments; and 
‘‘(bb) may be made in such amounts as 
the State may specify for identifying under-
payments; 
‘‘(III) the State has an adequate process for 
entities to appeal any adverse determination made 
by such contractors; and 
‘‘(IV) such program is carried out in accordance 
with such requirements as the Secretary shall 
specify, including— 
‘‘(aa) for purposes of section 1903(a)(7), 
that amounts expended by the State to carry 
out the program shall be considered amounts 
expended as necessary for the proper and effi-
cient administration of the State plan or a 
waiver of the plan; 
‘‘(bb) that section 1903(d) shall apply to 
amounts recovered under the program; and 
‘‘(cc) that the State and any such contrac-
tors under contract with the State shall coordi-
nate such recovery audit efforts with other 
contractors or entities performing audits of 
entities receiving payments under the State 
plan or waiver in the State, including efforts 
with Federal and State law enforcement with 
respect to the Department of Justice, including 
the Federal Bureau of Investigations, the 
Inspector General of the Department of Health 
and Human Services, and the State medicaid 
fraud control unit; and’’.
H. R. 3590—657 
(2) COORDINATION; REGULATIONS.— 
(A) IN GENERAL.—The Secretary of Health and Human 
Services, acting through the Administrator of the Centers 
for Medicare & Medicaid Services, shall coordinate the 
expansion of the Recovery Audit Contractor program to 
Medicaid with States, particularly with respect to each 
State that enters into a contract with a recovery audit 
contractor for purposes of the State’s Medicaid program 
prior to December 31, 2010. 
(B) REGULATIONS.—The Secretary of Health and 
Human Services shall promulgate regulations to carry out 
this subsection and the amendments made by this sub-
section, including with respect to conditions of Federal 
financial participation, as specified by the Secretary. 
(b) EXPANSION TO MEDICARE PARTS C AND D.—Section 1893(h) 
of the Social Security Act (42 U.S.C. 1395ddd(h)) is amended— 
(1) in paragraph (1), in the matter preceding subparagraph 
(A), by striking ‘‘part A or B’’ and inserting ‘‘this title’’; 
(2) in paragraph (2), by striking ‘‘parts A and B’’ and 
inserting ‘‘this title’’; 
(3) in paragraph (3), by inserting ‘‘(not later than December 
31, 2010, in the case of contracts relating to payments made 
under part C or D)’’ after ‘‘2010’’; 
(4) in paragraph (4), in the matter preceding subparagraph 
(A), by striking ‘‘part A or B’’ and inserting ‘‘this title’’; and 
(5) by adding at the end the following: 
‘‘(9) SPECIAL
RULES
RELATING
TO
PARTS
C
AND
D.—The 
Secretary shall enter into contracts under paragraph (1) to 
require recovery audit contractors to— 
‘‘(A) ensure that each MA plan under part C has an 
anti-fraud plan in effect and to review the effectiveness 
of each such anti-fraud plan; 
‘‘(B) ensure that each prescription drug plan under 
part D has an anti-fraud plan in effect and to review 
the effectiveness of each such anti-fraud plan; 
‘‘(C) examine claims for reinsurance payments under 
section 1860D–15(b) to determine whether prescription 
drug plans submitting such claims incurred costs in excess 
of the allowable reinsurance costs permitted under para-
graph (2) of that section; and 
‘‘(D) review estimates submitted by prescription drug 
plans by private plans with respect to the enrollment of 
high cost beneficiaries (as defined by the Secretary) and 
to compare such estimates with the numbers of such bene-
ficiaries actually enrolled by such plans.’’. 
(c) ANNUAL REPORT.—The Secretary of Health and Human 
Services, acting through the Administrator of the Centers for Medi-
care & Medicaid Services, shall submit an annual report to Congress 
concerning the effectiveness of the Recovery Audit Contractor pro-
gram under Medicaid and Medicare and shall include such reports 
recommendations for expanding or improving the program.
H. R. 3590—658 
Subtitle F—Additional Medicaid Program 
Integrity Provisions 
SEC. 6501. TERMINATION OF PROVIDER PARTICIPATION UNDER MED-
ICAID IF TERMINATED UNDER MEDICARE OR OTHER 
STATE PLAN. 
Section 1902(a)(39) of the Social Security Act (42 U.S.C. 42 
U.S.C. 1396a(a)) is amended by inserting after ‘‘1128A,’’ the fol-
lowing: ‘‘terminate the participation of any individual or entity 
in such program if (subject to such exceptions as are permitted 
with respect to exclusion under sections 1128(c)(3)(B) and 
1128(d)(3)(B)) participation of such individual or entity is termi-
nated under title XVIII or any other State plan under this title,’’. 
SEC. 6502. MEDICAID EXCLUSION FROM PARTICIPATION RELATING TO 
CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT 
AFFILIATIONS. 
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), 
as amended by section 6401(b), is amended by inserting after para-
graph (77) the following: 
‘‘(78) provide that the State agency described in paragraph 
(9) exclude, with respect to a period, any individual or entity 
from participation in the program under the State plan if 
such individual or entity owns, controls, or manages an entity 
that (or if such entity is owned, controlled, or managed by 
an individual or entity that)— 
‘‘(A) has unpaid overpayments (as defined by the Sec-
retary) under this title during such period determined by 
the Secretary or the State agency to be delinquent; 
‘‘(B) is suspended or excluded from participation under 
or whose participation is terminated under this title during 
such period; or 
‘‘(C) is affiliated with an individual or entity that has 
been suspended or excluded from participation under this 
title or whose participation is terminated under this title 
during such period;’’. 
SEC. 6503. BILLING AGENTS, CLEARINGHOUSES, OR OTHER ALTER-
NATE PAYEES REQUIRED TO REGISTER UNDER MED-
ICAID. 
(a) IN GENERAL.—Section 1902(a) of the Social Security Act 
(42 U.S.C. 42 U.S.C. 1396a(a)), as amended by section 6502(a), 
is amended by inserting after paragraph (78), the following: 
‘‘(79) provide that any agent, clearinghouse, or other alter-
nate payee (as defined by the Secretary) that submits claims 
on behalf of a health care provider must register with the 
State and the Secretary in a form and manner specified by 
the Secretary;’’. 
SEC. 6504. REQUIREMENT TO REPORT EXPANDED SET OF DATA ELE-
MENTS UNDER MMIS TO DETECT FRAUD AND ABUSE. 
(a) IN GENERAL.—Section 1903(r)(1)(F) of the Social Security 
Act (42 U.S.C. 1396b(r)(1)(F)) is amended by inserting after ‘‘nec-
essary’’ the following: ‘‘and including, for data submitted to the 
Secretary on or after January 1, 2010, data elements from the
H. R. 3590—659 
automated data system that the Secretary determines to be nec-
essary for program integrity, program oversight, and administra-
tion, at such frequency as the Secretary shall determine’’. 
(b) MANAGED CARE ORGANIZATIONS.— 
(1) IN GENERAL.—Section 1903(m)(2)(A)(xi) of the Social 
Security Act (42 U.S.C. 1396b(m)(2)(A)(xi)) is amended by 
inserting ‘‘and for the provision of such data to the State 
at a frequency and level of detail to be specified by the Sec-
retary’’ after ‘‘patients’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall apply with respect to contract years beginning on 
or after January 1, 2010. 
SEC. 6505. PROHIBITION ON PAYMENTS TO INSTITUTIONS OR ENTITIES 
LOCATED OUTSIDE OF THE UNITED STATES. 
Section 1902(a) of the Social Security Act (42 U.S.C. 1396b(a)), 
as amended by section 6503, is amended by inserting after para-
graph (79) the following new paragraph: 
‘‘(80) provide that the State shall not provide any payments 
for items or services provided under the State plan or under 
a waiver to any financial institution or entity located outside 
of the United States;’’. 
SEC. 6506. OVERPAYMENTS. 
(a) EXTENSION OF PERIOD FOR COLLECTION OF OVERPAYMENTS 
DUE TO FRAUD.— 
(1) IN GENERAL.—Section 1903(d)(2) of the Social Security 
Act (42 U.S.C. 1396b(d)(2)) is amended— 
(A) in subparagraph (C)— 
(i) in the first sentence, by striking ‘‘60 days’’ and 
inserting ‘‘1 year’’; and 
(ii) in the second sentence, by striking ‘‘60 days’’ 
and inserting ‘‘1-year period’’; and 
(B) in subparagraph (D)— 
(i) in inserting ‘‘(i)’’ after ‘‘(D)’’; and 
(ii) by adding at the end the following: 
‘‘(ii) In any case where the State is unable to recover a debt 
which represents an overpayment (or any portion thereof) made 
to a person or other entity due to fraud within 1 year of discovery 
because there is not a final determination of the amount of the 
overpayment under an administrative or judicial process (as 
applicable), including as a result of a judgment being under appeal, 
no adjustment shall be made in the Federal payment to such 
State on account of such overpayment (or portion thereof) before 
the date that is 30 days after the date on which a final judgment 
(including, if applicable, a final determination on an appeal) is 
made.’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section take effect on the date of enactment of this Act and 
apply to overpayments discovered on or after that date. 
(b) CORRECTIVE ACTION.—The Secretary shall promulgate regu-
lations that require States to correct Federally identified claims 
overpayments, of an ongoing or recurring nature, with new Medicaid 
Management Information System (MMIS) edits, audits, or other 
appropriate corrective action.
H. R. 3590—660 
SEC. 6507. MANDATORY STATE USE OF NATIONAL CORRECT CODING 
INITIATIVE. 
Section 1903(r) of the Social Security Act (42 U.S.C. 1396b(r)) 
is amended— 
(1) in paragraph (1)(B)— 
(A) in clause (ii), by striking ‘‘and’’ at the end; 
(B) in clause (iii), by adding ‘‘and’’ after the semi- 
colon; and 
(C) by adding at the end the following new clause: 
‘‘(iv) effective for claims filed on or after October 
1, 2010, incorporate compatible methodologies of the 
National Correct Coding Initiative administered by the 
Secretary (or any successor initiative to promote correct 
coding and to control improper coding leading to 
inappropriate payment) and such other methodologies 
of that Initiative (or such other national correct coding 
methodologies) as the Secretary identifies in accord-
ance with paragraph (4);’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(4) For purposes of paragraph (1)(B)(iv), the Secretary shall 
do the following: 
‘‘(A) Not later than September 1, 2010: 
‘‘(i) Identify those methodologies of the National Cor-
rect Coding Initiative administered by the Secretary (or 
any successor initiative to promote correct coding and to 
control improper coding leading to inappropriate payment) 
which are compatible to claims filed under this title. 
‘‘(ii) Identify those methodologies of such Initiative (or 
such other national correct coding methodologies) that 
should be incorporated into claims filed under this title 
with respect to items or services for which States provide 
medical assistance under this title and no national correct 
coding methodologies have been established under such 
Initiative with respect to title XVIII. 
‘‘(iii) Notify States of— 
‘‘(I) the methodologies identified under subpara-
graphs (A) and (B) (and of any other national correct 
coding methodologies identified under subparagraph 
(B)); and 
‘‘(II) how States are to incorporate such methodolo-
gies into claims filed under this title. 
‘‘(B) Not later than March 1, 2011, submit a report to 
Congress that includes the notice to States under clause (iii) 
of subparagraph (A) and an analysis supporting the identifica-
tion of the methodologies made under clauses (i) and (ii) of 
subparagraph (A).’’. 
SEC. 6508. GENERAL EFFECTIVE DATE. 
(a) IN GENERAL.—Except as otherwise provided in this subtitle, 
this subtitle and the amendments made by this subtitle take effect 
on January 1, 2011, without regard to whether final regulations 
to carry out such amendments and subtitle have been promulgated 
by that date. 
(b) DELAY IF STATE LEGISLATION REQUIRED.—In the case of 
a State plan for medical assistance under title XIX of the Social 
Security Act or a child health plan under title XXI of such Act 
which the Secretary of Health and Human Services determines