ment methodology for patient-centered medical 
home services (as defined in paragraph (1) of 
section 1861(hhh)). Under such payment meth-
odology, the Secretary shall pay qualified pa-
tient-centered medical homes (as defined in 
paragraph (2) of such section) a monthly fee 
for each individual who elects to receive patient- 
centered medical home services at that medical 
home. Such fee shall be paid on a prospective 
basis. 
‘‘(B) CONSIDERATIONS.—The Secretary 
shall take into account the results of the Medi-
care medical home demonstration project under 
section 204 of Division B of the Tax Relief and 
Health Care Act of 2008 (42 U.S.C. 1395b–1 
note) in establishing the payment methodology 
under subparagraph (A). 
‘‘(2) AMOUNT OF PAYMENT.— 
‘‘(A) CONSIDERATIONS.—In determining 
the amount of such fee, subject to paragraph 
(3), the Secretary shall consider the following: 
‘‘(i) The clinical work and practice ex-
penses involved in providing care coordina-
tion services consistent with the patient- 
centered medical home model (such as pro-
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viding increased access, care coordination, 
disease population management, and edu-
cation) for which payment is not made 
under this section as of the date of enact-
ment of this subsection. 
‘‘(ii) Ensuring that the amount of 
payment is sufficient to support the acqui-
sition, use, and maintenance of clinical in-
formation systems which— 
‘‘(I) are needed by a qualified pa-
tient-centered medical home (as so de-
fined); and 
‘‘(II) have been shown to facili-
tate improved outcomes through care 
coordination. 
‘‘(iii) The establishment of a tiered 
monthly care management fee that pro-
vides for a range of payment depending on 
how advanced the capabilities of a qualified 
patient-centered medical home (as so de-
fined) are in having the information sys-
tems needed to support care coordination. 
‘‘(B) RISK-ADJUSTMENT.—The Secretary 
shall use appropriate risk-adjustment in deter-
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mining the amount of the monthly fee under 
this paragraph. 
‘‘(3) FUNDING.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
determine the aggregate estimated savings for a 
calendar year as a result of the implementation 
of this subsection on reducing preventable hos-
pital admissions, duplicate testing, medication 
errors and drug interactions, and other savings 
under this part and part A (including any sav-
ings with respect to items and services for 
which payment is not made under this section). 
‘‘(B) FUNDING.—Subject to subparagraph 
(C), the aggregate amount available for pay-
ment of the monthly fee under this subsection 
during a calendar year shall be equal to the ag-
gregate estimated savings (as determined under 
subparagraph (A)) for the calendar year (as de-
termined by the Secretary). 
‘‘(C) ADDITIONAL FUNDING.—In the case 
where the amount of the aggregate actual sav-
ings during the preceding 3 years exceeds the 
amount of the aggregate estimated savings (as 
determined under subparagraph (A)) during 
such period, the aggregate amount available for 
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payment of the monthly fee under this sub-
section during the calendar year (as determined 
under subparagraph (B)) shall be increased by 
the amount of such excess. 
‘‘(D) ADDITIONAL
FUNDING
AS
DETER-
MINED
NECESSARY
BY
THE
SECRETARY.—In 
addition to any funding made available under 
subparagraphs (B) and (C), there shall also be 
available to the Secretary, for purposes of effec-
tively implementing this subsection, such addi-
tional funds as the Secretary determines are 
necessary. 
‘‘(4) 
PERFORMANCE-BASED
BONUS
PAY-
MENTS.—The Secretary shall establish a process for 
paying a performance-based bonus to qualified pa-
tient-centered medical homes which meet or achieve 
substantial improvements in performance (as speci-
fied under clinical, patient satisfaction, and effi-
ciency benchmarks established by the Secretary). 
Such bonus shall be in an amount determined appro-
priate by the Secretary. 
‘‘(5) NO EFFECT ON PAYMENTS FOR EVALUA-
TION AND MANAGEMENT SERVICES.—The monthly 
fee under this subsection shall have no effect on the 
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amount of payment for evaluation and management 
services under this title.’’. 
(d) COINSURANCE.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and’’ before ‘‘(W)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (X) with respect to patient-cen-
tered medical home services (as defined in section 
1861(hhh)(1)), the amount paid shall be (i) in the 
case of such services which are physicians’ services, 
the amount determined under subparagraph (N), 
and (ii) in the case of all other such services, 80 per-
cent of the lesser of the actual charge for the service 
or the amount determined under a fee schedule es-
tablished by the Secretary for purposes of this sub-
paragraph’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2012. 
SEC. 303. MEDICARE PRIMARY CARE PAYMENT EQUITY AND 
ACCESS PROVISION. 
(a) IN GENERAL.—Section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4), as amended by section 202, 
is amended by adding at the end the following new sub-
section: 
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‘‘(p) PRIMARY CARE PAYMENT EQUITY
AND AC-
CESS.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2010, the Secretary shall develop a methodology, in 
consultation with primary care physician organiza-
tions, the Medicare Payment Advisory Commission, 
and other experts, to increase payments under this 
section for designated evaluation and management 
services provided by primary and principal care phy-
sicians through 1 or more of the following: 
‘‘(A) A service-specific modifier to the rel-
ative value units established for such services. 
‘‘(B) Service-specific bonus payments. 
‘‘(C) Any other methodology determined 
appropriate by the Secretary. 
‘‘(2) INCLUSION OF PROPOSED CRITERIA.—The 
methodology developed under paragraph (1) shall in-
clude proposed criteria for physicians to qualify for 
such increased payments, including consideration 
of— 
‘‘(A) the type of service being rendered; 
‘‘(B) the specialty of the physician pro-
viding the service; and 
‘‘(C) demonstration by the physician of 
voluntary participation in programs to improve 
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quality, such as participation in the Physician 
Quality Reporting Initiative (as determined by 
the Secretary) or practice-level qualification as 
a patient-centered medical home. 
‘‘(3) FUNDING.— 
‘‘(A) 
DETERMINATION.—The 
Secretary 
shall determine the aggregate estimated savings 
for a calendar year as a result of such increased 
payments on reducing preventable hospital ad-
missions, duplicate testing, medication errors 
and drug interactions, Intensive Care Unit ad-
missions, per capita health care expenditures, 
and other savings under this part and part A 
(including any savings with respect to items 
and services for which payment is not made 
under this section). 
‘‘(B) FUNDING.—The aggregate amount 
available for such increased payments during a 
calendar year shall be equal to the aggregate 
estimated savings (as determined under sub-
paragraph (A)) for the calendar year (as deter-
mined by the Secretary). 
‘‘(C) ADDITIONAL
FUNDING
AS
DETER-
MINED
NECESSARY
BY
THE
SECRETARY.—In 
addition to any funding made available under 
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subparagraph (B), there shall also be available 
to the Secretary, for purposes of effectively im-
plementing this subsection, such additional 
funds as the Secretary determines are nec-
essary.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to services furnished on or after 
January 1, 2010. 
SEC. 304. ADDITIONAL INCENTIVE PAYMENT PROGRAM 
FOR PRIMARY CARE SERVICES FURNISHED 
IN 
HEALTH 
PROFESSIONAL 
SHORTAGE 
AREAS. 
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by adding at the 
end the following new subsection: 
‘‘(v) ADDITIONAL INCENTIVE PAYMENTS FOR PRI-
MARY CARE SERVICES FURNISHED IN HEALTH PROFES-
SIONAL SHORTAGE AREAS.— 
‘‘(1) IN GENERAL.—In the case of primary care 
services furnished on or after January 1, 2009, by 
a primary care physician in an area that is des-
ignated (under section 332(a)(1)(A) of the Public 
Health Service Act) as a health professional short-
age area as identified by the Secretary prior to the 
beginning of the year involved, in addition to the 
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amount of payment that would otherwise be made 
for such services under this part, there also shall be 
paid (on a monthly or quarterly basis) an amount 
equal to 10 percent of the payment amount for the 
service under this part. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) PRIMARY
CARE
PHYSICIAN.—The 
term ‘primary care physician’ means a physi-
cian (as described in section 1861(r)(1)) for 
whom primary care services accounted for at 
least a specified percent (as determined by the 
Secretary) of the allowed charges under this 
part for such physician in a prior period as de-
termined appropriate by the Secretary. 
‘‘(B) PRIMARY CARE SERVICES.—The term 
‘primary care services’ means procedure codes 
for services in the category of the Healthcare 
Common Procedure Coding System, as estab-
lished 
by 
the 
Secretary 
under 
section 
1848(c)(5) (as of December 31, 2008 and as 
subsequently modified by the Secretary) con-
sisting of evaluation and management services, 
but limited to such procedure codes in the cat-
egory of office or other outpatient services, and 
consisting of subcategories of such procedure 
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codes for services for both new and established 
patients. 
‘‘(3) JUDICIAL REVIEW.—There shall be no ad-
ministrative or judicial review under section 1869, 
1878, or otherwise, respecting the identification of 
primary care physicians or primary care services 
under this subsection.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1834(g)(2)(B) of the Social Security Act (42 U.S.C. 
1395m(g)(2)(B)) is amended by adding at the end the fol-
lowing sentence: ‘‘Section 1833(v) shall not be taken into 
account in determining the amounts that would otherwise 
be paid pursuant to the preceding sentence.’’. 
SEC. 305. PERMANENT EXTENSION OF FLOOR ON MEDI-
CARE 
WORK 
GEOGRAPHIC 
ADJUSTMENT 
UNDER 
THE 
MEDICARE 
PHYSICIAN 
FEE 
SCHEDULE. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)), as amended by section 134 of 
the Medicare Improvements for Patients and Providers 
Act of 2008 (Public Law 110–275), is amended by strik-
ing ‘‘and before January 1, 2010,’’. 
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SEC. 306. PERMANENT EXTENSION OF MEDICARE INCEN-
TIVE PAYMENT PROGRAM FOR PHYSICIAN 
SCARCITY AREAS. 
Section 1833(u) of the Social Security Act (42 U.S.C. 
1395l(u)), as amended by section 102 of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (Public Law 
110–173), is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘, and before July 1, 
2008’’; and 
(B) by inserting ‘‘(or, in the case of serv-
ices furnished on or after July 1, 2008, 10 per-
cent)’’ after ‘‘5 percent’’; and 
(2) in paragraph (4)(D), by striking ‘‘before 
July 1, 2008’’ and inserting ‘‘before January 1, 
2010’’. 
SEC. 307. HHS STUDY AND REPORT ON THE PROCESS FOR 
DETERMINING RELATIVE VALUE UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE. 
(a) STUDY.—The Secretary shall conduct a study on 
the process used by the Secretary for determining relative 
value under the Medicare physician fee schedule under 
section 1848(c) of the Social Security Act (42 U.S.C. 
1395w–4(c)). Such study shall include an analysis of the 
following: 
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(1)(A) Whether the existing process includes 
equitable representation of primary care physicians 
(as defined in section 3(a)(4)); and 
(B) any changes that may be necessary to en-
sure such equitable representation. 
(2)(A) Whether the existing process provides 
the Secretary with expert and impartial input from 
physicians in medical specialties that provide pri-
mary care to patients with multiple chronic diseases, 
the fastest growing part of the Medicare population; 
and 
(B) any changes that may be necessary to en-
sure such input. 
(3)(A) Whether the existing process includes 
equitable representation of physician medical special-
ties in proportion to their relative contributions to-
ward caring for Medicare beneficiaries, as deter-
mined by the percentage of Medicare billings per 
specialty, percentage of Medicare encounters by spe-
cialty, or such other measures of relative contribu-
tions to patient care as determined by the Secretary; 
and 
(B) any changes that may be necessary to re-
flect such equitable representation. 
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(4)(A) Whether the existing process, including 
the application of budget neutrality rules, unfairly 
disadvantages primary care physicians and other 
physicians who principally provide evaluation and 
management services; and 
(B) any changes that may be necessary to 
eliminate such disadvantages. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
Subtitle B—Preventive Services 
SEC. 311. ELIMINATING TIME RESTRICTION FOR INITIAL 
PREVENTIVE PHYSICAL EXAMINATION. 
(a) IN GENERAL.—Section 1862(a)(1)(K) of the So-
cial Security Act (42 U.S.C. 1395y(a)(1)(K)), as amended 
by section 101(b)(3) of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110– 
275), is amended by striking ‘‘more than’’ and all that 
follows before the comma at the end and inserting ‘‘more 
than one time during the lifetime of the individual’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2009. 
SEC. 312. ELIMINATION OF COST-SHARING FOR PREVEN-
TIVE BENEFITS UNDER THE MEDICARE PRO-
GRAM. 
(a) DEFINITION OF PREVENTIVE SERVICES.—Sec-
tion 1861(ddd) of the Social Security Act, as added by 
section 101 of the Medicare Improvements for Patients 
and Providers Act of 2008 (Public Law 110–275), is 
amended— 
(1) in the heading, by inserting ‘‘; Preventive 
Services’’ after ‘‘Services’’; 
(2) in paragraph (1), by striking ‘‘not otherwise 
described in this title’’ and inserting ‘‘not described 
in subparagraphs (A) through (N) of paragraph 
(3)’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(3) The term ‘preventive services’ means the fol-
lowing: 
‘‘(A) Prostate cancer screening tests (as defined 
in subsection (oo)). 
‘‘(B) Colorectal cancer screening tests (as de-
fined in subsection (pp)). 
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‘‘(C) 
Diabetes 
outpatient 
self-management 
training services (as defined in subsection (qq)). 
‘‘(D) Screening for glaucoma for certain indi-
viduals (as described in subsection (s)(2)(U)). 
‘‘(E) Medical nutrition therapy services for cer-
tain 
individuals 
(as 
described 
in 
subsection 
(s)(2)(V)). 
‘‘(F) An initial preventive physical examination 
(as defined in subsection (ww)). 
‘‘(G) Cardiovascular screening blood tests (as 
defined in subsection (xx)(1)). 
‘‘(H) Diabetes screening tests (as defined in 
subsection (yy)). 
‘‘(I) Ultrasound screening for abdominal aortic 
aneurysm for certain individuals (as described in 
subsection (s)(2)(AA)). 
‘‘(J) Pneumococcal and influenza vaccine and 
their administration (as described in subsection 
(s)(10)(A)). 
‘‘(K) Hepatitis B vaccine and its administration 
for certain individuals (as described in subsection 
(s)(10)(B)). 
‘‘(L) Screening mammography (as defined in 
subsection (jj)). 
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‘‘(M) Screening pap smear and screening pelvic 
exam (as described in subsection (s)(14)). 
‘‘(N) Bone mass measurement (as defined in 
subsection (rr)). 
‘‘(O) Additional preventive services (as deter-
mined under paragraph (1)).’’. 
(b) COINSURANCE.— 
(1) GENERAL APPLICATION.— 
(A) IN GENERAL.—Section 1833(a)(1) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395l(a)(1)), as amended by section 101 of the 
Medicare Improvements for Patients and Pro-
viders Act of 2008 (Public Law 110–275) and 
section 202, is amended— 
(i) in subparagraph (T), by striking 
‘‘80 percent’’ and inserting ‘‘100 percent’’; 
(ii) in subparagraph (W), by striking 
‘‘80 percent’’ and inserting ‘‘100 percent’’; 
(iii) by striking ‘‘and’’ before ‘‘(X)’’; 
and 
(iv) by inserting before the semicolon 
at the end the following: ‘‘, and (Y) with 
respect to preventive services described in 
subparagraphs (A) through (O) of section 
1861(ddd)(1), the amount paid shall be 
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100 percent of the lesser of the actual 
charge for the services or the amount de-
termined under the fee schedule that ap-
plies to such services under this part’’. 
(2) 
ELIMINATION
OF
COINSURANCE
FOR 
SCREENING
SIGMOIDOSCOPIES
AND 
COLONOSCOPIES.—Section 1834(d) of the Social Se-
curity Act (42 U.S.C. 1395m(d)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by inserting 
‘‘, except that payment for such tests 
under such section shall be 100 percent of 
the payment determined under such sec-
tion for such tests’’ before the period at 
the end; and 
(ii) in subparagraph (C)— 
(I) by striking clause (ii); and 
(II) in clause (i)— 
(aa) by striking ‘‘(i) IN GEN-
ERAL.—Notwithstanding’’ 
and 
inserting ‘‘Notwithstanding’’; 
(bb) by redesignating sub-
clauses (I) and (II) as clauses (i) 
and (ii), respectively, and moving 
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such clauses 2 ems to the left; 
and 
(cc) in the flush matter fol-
lowing clause (ii), as so redesig-
nated, by inserting ‘‘100 percent 
of’’ after ‘‘based on’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (A), by inserting 
‘‘, except that payment for such tests 
under such section shall be 100 percent of 
the payment determined under such sec-
tion for such tests’’ before the period at 
the end; and 
(ii) in subparagraph (C)— 
(I) by striking clause (ii); and 
(II) in clause (i)— 
(aa) by striking ‘‘(i) IN GEN-
ERAL.—Notwithstanding’’ 
and 
inserting ‘‘Notwithstanding’’; and 
(bb) by inserting ‘‘100 per-
cent of’’ after ‘‘based on’’. 
(3) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION FROM OPD FEE SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
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Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 
amended by striking ‘‘and diagnostic mammog-
raphy’’ and inserting ‘‘, diagnostic mammog-
raphy, and preventive services (as defined in 
section 1861(ddd)(3))’’. 
(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)) is amended— 
(i) in subparagraph (F), by striking 
‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (G)(ii), by adding 
‘‘and’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(H) with respect to preventive services (as 
defined in section 1861(ddd)(3)) furnished by 
an outpatient department of a hospital, the 
amount determined under paragraph (1)(W) or 
(1)(X), as applicable;’’. 
(c) WAIVER OF APPLICATION OF DEDUCTIBLE.—The 
first sentence of section 1833(b) of the Social Security Act 
(42 U.S.C. 1395l(b)), as amended by section 101 of the 
Medicare Improvements for Patients and Providers Act of 
2008 (Public Law 110–275), is amended— 
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(1) in clause (1), by striking ‘‘items and serv-
ices described in section 1861(s)(10)(A)’’ and insert-
ing ‘‘preventive services (as defined in section 
1861(ddd)(3))’’; 
(2) by inserting ‘‘and’’ before ‘‘(4)’’; and 
(3) by striking subparagraphs (5) through (9). 
SEC. 313. HHS STUDY AND REPORT ON FACILITATING THE 
RECEIPT OF MEDICARE PREVENTIVE SERV-
ICES BY MEDICARE BENEFICIARIES. 
(a) STUDY.—The Secretary, in consultation with phy-
sician organizations and other appropriate stakeholders, 
shall conduct a study on— 
(1) ways to assist primary care physicians (as 
defined in section 3(a)(4)) in— 
(A) furnishing appropriate preventive serv-
ices (as defined in section 1861(ddd)(3) of the 
Social Security Act, as added by section 212) to 
individuals enrolled under part B of title XVIII 
of such Act; and 
(B) referring such individuals for other 
items and services furnished by other physicians 
and health care providers; and 
(2) the advisability and feasability of making 
additional payments under the Medicare program to 
physicians for— 
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(A) the work involved in ensuring that 
such individuals receive appropriate preventive 
services furnished by other physicians and 
health care providers; and 
(B) incorporating the resulting clinical in-
formation into the treatment plan for the indi-
vidual. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
Subtitle C—Other Provisions 
SEC. 321. HHS STUDY AND REPORT ON IMPROVING THE 
ABILITY OF PHYSICIANS TO ASSIST MEDI-
CARE BENEFICIARIES IN OBTAINING NEEDED 
PRESCRIPTIONS UNDER MEDICARE PART D. 
(a) STUDY.—The Secretary, in consultation with phy-
sician organizations and other appropriate stakeholders, 
shall conduct a study on the development and implementa-
tion of mechanisms to facilitate increased efficiency relat-
ing to the physician’s role in Medicare beneficiaries obtain-
ing needed prescription drugs under the Medicare pre-
scription drug program under part D of title XVIII of the 
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Social Security Act. Such study shall include an analysis 
of ways to— 
(1) improve the accessibility of formulary infor-
mation; 
(2) streamline the prior authorization, excep-
tion, and appeals processes, through, at a minimum, 
standardizing formats and allowing electronic ex-
change of information; and 
(3) recognize the physician work involved in the 
prescribing process, especially work that may extend 
beyond the amount considered to be bundled into 
payment for evaluation and management services. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
SEC. 322. QUALITY IMPROVEMENT ORGANIZATION ASSIST-
ANCE FOR PHYSICIAN PRACTICES SEEKING 
TO BE PATIENT-CENTERED MEDICAL HOME 
PRACTICES. 
Not later than 90 days after the date of enactment 
of this Act, the Secretary shall revise the 9th Statement 
of Work under the Quality Improvement Program to in-
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clude a requirement that, in order to be an eligible Quality 
Improvement Organization (in this section referred to as 
a ‘‘QIO’’) for the 9th Statement of Work contract cycle, 
a QIO shall provide assistance, including technical assist-
ance, to physicians under the Medicare program under 
title XVIII of the Social Security Act that seek to acquire 
the elements necessary to be recognized as a patient-cen-
tered medical home practice under the National Com-
mittee for Quality Assurance’s Physician Practice Connec-
tions-PCMH module (or any successor module issued by 
such Committee). 
SEC. 323. HHS STUDY AND REPORT ON IMPROVED PATIENT 
CARE THROUGH INCREASED CAREGIVER AND 
PHYSICIAN INTERACTION. 
(a) STUDY.—The Secretary, in consultation with ap-
propriate stakeholders, shall conduct a study on the devel-
opment and implementation of mechanisms to promote 
and increase interaction between physicians and the fami-
lies of Medicare beneficiaries, as well as other caregivers 
who support such beneficiaries, for the purpose of improv-
ing patient care under the Medicare program. Such study 
shall include an analysis of— 
(1) ways to recognize the physician work in-
volved in discussing clinical issues with caregivers 
that relate to the care of the beneficiary; and 
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(2) regulations under the Medicare program 
that are barriers to interactions between physicians 
and caregivers and how such regulations should be 
revised to eliminate such barriers. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
SEC. 324. IMPROVED PATIENT CARE THROUGH EXPANDED 
SUPPORT 
FOR 
LIMITED 
ENGLISH 
PRO-
FICIENCY SERVICES. 
(a) ADDITIONAL PAYMENTS FOR PHYSICIANS.—Sec-
tion 1833 of the Social Security Act (42 U.S.C. 1395l), 
as amended by section 204, is amended by adding at the 
end the following new subsection: 
‘‘(w) ADDITIONAL PAYMENTS FOR PROVIDING SERV-
ICES
TO INDIVIDUALS WITH LIMITED ENGLISH PRO-
FICIENCY.— 
‘‘(1) IN GENERAL.—In the case of physicians’ 
services furnished on or after January 1, 2010 to an 
individual with limited English proficiency by a phy-
sician, in addition to the amount of payment that 
would otherwise be made for such services under this 
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part, there shall also be paid an appropriate amount 
(as determined by the Secretary) in order to recog-
nize the additional time involved in furnishing the 
service to such individual. 
‘‘(2) JUDICIAL REVIEW.—There shall be no ad-
ministrative or judicial review under section 1869, 
1878, or otherwise, respecting the determination of 
the amount of additional payment under this sub-
section.’’. 
(b) NATIONAL CLEARINGHOUSE.—Not later than 
180 days after the date of enactment of this Act, the Sec-
retary shall establish a national clearinghouse to make 
available to the providers, patients, and States translated 
documents regarding patient care and education under the 
Medicare program, the Medicaid program, and the State 
Children’s Health Insurance Program under titles XVIII, 
XIX, and XXI, respectively, of the Social Security Act. 
(c) GRANTS TO SUPPORT LANGUAGE TRANSLATION 
SERVICES IN UNDERSERVED COMMUNITIES.— 
(1) AUTHORITY TO AWARD GRANTS.—The Sec-
retary shall award grants to support language trans-
lation services for primary care practices in medi-
cally underserved areas (as defined in section 3(c)). 
(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to the Sec-
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retary to award grants under this subsection, such 
sums as are necessary for fiscal years beginning with 
fiscal year 2009. 
SEC. 325. HHS STUDY AND REPORT ON USE OF REAL-TIME 
MEDICARE CLAIMS ADJUDICATION. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Secretary’’) 
shall conduct a study to assess the ability of the Medicare 
program under title XVIII of the Social Security Act to 
engage in real-time claims adjudication for items and serv-
ices furnished to Medicare beneficiaries. 
(b) CONSULTATION.—In conducting the study under 
subsection (a), the Secretary consult with stakeholders in 
the private sector, including stakeholders who are using 
or are testing real-time claims adjudication systems. 
(c) REPORT.—Not later than January 1, 2010, the 
Secretary shall submit to Congress a report containing the 
results of the study conducted under subsection (a), to-
gether with recommendations for such legislation and ad-
ministrative action as the Secretary determines appro-
priate. 
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TITLE IV—STUDIES 
SEC. 401. STUDY CONCERNING THE DESIGNATION OF PRI-
MARY CARE AS A SHORTAGE PROFESSION. 
(a) IN GENERAL.—Not later than June 30, 2009, the 
Secretary of Labor shall conduct a study and submit to 
the Committee on Education and Labor of the House of 
Representatives and the Committee on Health, Education, 
Labor, and Pensions a report that contains— 
(1) a description of the criteria for the designa-
tion of primary care physicians as professions in 
shortage as defined by the Secretary under section 
212(a)(5)(A) of the Immigration and Nationality 
Act; 
(2) the findings of the Secretary on whether 
primary care physician professions will, on the date 
on which the report is submitted, or within the 5- 
year period beginning on such date, satisfy the cri-
teria referred to in paragraph (1); and 
(3) if the Secretary finds that such professions 
will not satisfy such criteria, recommendations for 
modifications to such criteria to enable primary care 
physicians to be so designated as a profession in 
shortage. 
(b) REQUIREMENTS.—In conducting the study under 
subsection (a), the Secretary of Labor shall consider work-
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force data from the Health Resources and Services Admin-
istration, the Council on Graduate Medical Education, the 
Association of American Medical Colleges, and input from 
physician membership organizations that represent pri-
mary care physicians. 
SEC. 402. STUDY CONCERNING THE EDUCATION DEBT OF 
MEDICAL SCHOOL GRADUATES. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study to evaluate the higher edu-
cation-related indebtedness of medical school graduates in 
the United States at the time of graduation from medical 
school, and the impact of such indebtedness on specialty 
choice, including the impact on the field of primary care. 
(b) REPORT.— 
(1) SUBMISSION AND DISSEMINATION OF RE-
PORT.—Not later than 1 year after the date of en-
actment of this Act, the Comptroller General shall 
submit a report on the study required by subsection 
(a) to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on 
Education and Labor of the House of Representa-
tives, and shall make such report widely available to 
the public. 
(2) ADDITIONAL
REPORTS.—The Comptroller 
General may periodically prepare and release as nec-
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essary additional reports on the topic described in 
subsection (a). 
SEC. 403. STUDY ON MINORITY REPRESENTATION IN PRI-
MARY CARE. 
(a) STUDY.—The Secretary of Health and Human 
Services, acting through the Administrator of the Health 
Resources and Services Administration, shall conduct a 
study of minority representation in training, and in prac-
tice, in primary care specialties. 
(b) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration, shall sub-
mit to the appropriate committees of Congress a report 
concerning the study conducted under subsection (a), in-
cluding recommendations for achieving a primary care 
workforce that is more representative of the population of 
the United States. 
Æ 
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