228 
(i) uses the standard definitions devel-
oped under subsection (b)(3); and 
(ii) is designed to allow consumers to 
easily compare such plans. 
(B) The plan portal shall be available on 
the internet and accessible to all individuals in 
the United States. 
(C) The plan portal shall allow consumers 
to search and sort data on the health insurance 
plans in the plan portal on criteria such as cov-
erage of specific benefits (such as coverage of 
disease management services or pediatric care 
services), as well as data available respecting 
quality of plans. 
(D) The plan portal shall meet all relevant 
State laws and regulations, including laws and 
regulations related to the marketing of insur-
ance products. 
(E) Notwithstanding subsection (d)(1), the 
plan portal shall provide information to individ-
uals who are eligible for the Medicaid program 
under title XIX of the Social Security Act or 
State Children’s Health Insurance Program 
under title XXI of such Act by including infor-
mation on options, eligibility, and how to enroll 
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229 
through providing a link to a website main-
tained with respect to such State programs. 
(F) The plan portal shall provide support 
to individuals who are eligible for tax credits 
and deductions under the amendments made by 
this Act to enhance such individual’s ability to 
access such credits and deductions. 
(G) The plan portal shall allow consumers 
to access quality data on providers as made 
available through a website described in section 
802 once that data is available. 
(2) PROVIDER INFORMATION.—Each plan por-
tal shall meet the following requirements with re-
spect to information on health care providers: 
(A) Identifying and licensure information. 
(B) Self-pay prices charged, including vari-
ation in such prices. 
For purposes of subparagraph (B), the term ‘‘self- 
pay price’’ means the price charged by a provider to 
individuals for items or services where the price is 
not established or negotiated through a health care 
program or third party. 
(3) TAX
CREDIT
AND
DEDUCTION
INFORMA-
TION.—Each plan portal shall also include informa-
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230 
tion on tax credits and deductions that may be avail-
able for purpose of qualified health plans. 
(4) INCLUSION
OF
QUALITY
INFORMATION.— 
The Secretary, after collaboration with States and 
health care providers (including practicing physi-
cians, hospitals, and other health care institutions), 
shall submit to Congress recommendations on how 
to include on plan portals information on perform-
ance-based quality measures obtained under section 
802. 
(d) PROHIBITIONS.— 
(1) DIRECT ENROLLMENT.—A plan portal may 
not directly enroll individuals in health insurance 
plans or under a State Medicaid plan or a State 
children’s health insurance plan. 
(2) CONFLICTS OF INTEREST.— 
(A) 
COMPANIES.—A 
health 
insurance 
issuer offering a health insurance plan through 
a plan portal may not— 
(i) be the private entity developing 
and maintaining a plan portal under this 
section; or 
(ii) have an ownership interest in such 
private entity or in the plan portal. 
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231 
(B) 
INDIVIDUALS.—An 
individual 
em-
ployed by a health insurance issuer offering a 
health insurance plan through a plan portal 
may not serve as a director or officer for— 
(i) the private entity developing and 
maintaining a plan portal under this sec-
tion; or 
(ii) the plan portal. 
(e) CONSTRUCTION.—Nothing in this section shall be 
construed to prohibit health insurance brokers and agents 
from— 
(1) utilizing the plan portal for any purpose; or 
(2) marketing or offering health insurance 
products. 
(f) STATE DEFINED.—In this section, the term 
‘‘State’’ has the meaning given such term for purposes of 
title XIX of the Social Security Act. 
TITLE X—PHYSICIAN PAYMENT 
REFORM 
SEC. 1001. SUSTAINABLE GROWTH RATE REFORM. 
(a) TRANSITIONAL
UPDATE
FOR
2010.—Section 
1848(d) of the Social Security Act (42 U.S.C. 1395w– 
4(d)) is amended by adding at the end the following new 
paragraph: 
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232 
‘‘(10) UPDATE FOR 2010.—The update to the 
single conversion factor established in paragraph 
(1)(C) for 2010 shall be the percentage increase in 
the MEI (as defined in section 1842(i)(3)) for that 
year.’’. 
(b) REBASING SGR USING 2009; LIMITATION ON 
CUMULATIVE ADJUSTMENT PERIOD.—Section 1848(d)(4) 
of such Act (42 U.S.C. 1395w–4(d)(4)) is amended— 
(1) in subparagraph (B), by striking ‘‘subpara-
graph (D)’’ and inserting ‘‘subparagraphs (D) and 
(G)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(G) REBASING USING 2009 FOR FUTURE 
UPDATE
ADJUSTMENTS.—In determining the 
update adjustment factor under subparagraph 
(B) for 2011 and subsequent years— 
‘‘(i) the allowed expenditures for 2009 
shall be equal to the amount of the actual 
expenditures for physicians’ services during 
2009; and 
‘‘(ii) the reference in subparagraph 
(B)(ii)(I) to ‘April 1, 1996’ shall be treat-
ed as a reference to ‘January 1, 2009 (or, 
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233 
if later, the first day of the fifth year be-
fore the year involved)’.’’. 
(c) LIMITATION
ON
PHYSICIANS’ SERVICES
IN-
CLUDED IN TARGET GROWTH RATE COMPUTATION TO 
SERVICES COVERED UNDER PHYSICIAN FEE SCHED-
ULE.—Effective for services furnished on or after January 
1, 2009, section 1848(f)(4)(A) of such Act is amended 
striking ‘‘(such as clinical’’ and all that follows through 
‘‘in a physician’s office’’ and inserting ‘‘for which payment 
under this part is made under the fee schedule under this 
section, for services for practitioners described in section 
1842(b)(18)(C) on a basis related to such fee schedule, 
or for services described in section 1861(p) (other than 
such services when furnished in the facility of a provider 
of services)’’. 
(d) 
ESTABLISHMENT
OF
SEPARATE
TARGET 
GROWTH RATES FOR CATEGORIES OF SERVICES.— 
(1) 
ESTABLISHMENT
OF
SERVICE
CAT-
EGORIES.—Subsection (j) of section 1848 of the So-
cial Security Act (42 U.S.C. 1395w–4) is amended 
by adding at the end the following new paragraph: 
‘‘(5) SERVICE CATEGORIES.—For services fur-
nished on or after January 1, 2009, each of the fol-
lowing categories of physicians’ services (as defined 
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234 
in paragraph (3)) shall be treated as a separate 
‘service category’: 
‘‘(A) Evaluation and management services 
that are procedure codes (for services covered 
under this title) for— 
‘‘(i) services in the category des-
ignated Evaluation and Management in the 
Health Care Common Procedure Coding 
System (established by the Secretary under 
subsection (c)(5) as of December 31, 2009, 
and as subsequently modified by the Sec-
retary); and 
‘‘(ii) preventive services (as defined in 
section 1861(iii)) for which payment is 
made under this section. 
‘‘(B) All other services not described in 
subparagraph (A). 
Service categories established under this paragraph 
shall apply without regard to the specialty of the 
physician furnishing the service.’’. 
(2) ESTABLISHMENT
OF
SEPARATE
CONVER-
SION
FACTORS
FOR
EACH
SERVICE
CATEGORY.— 
Subsection (d)(1) of section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) is amended— 
(A) in subparagraph (A)— 
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(i) by designating the sentence begin-
ning ‘‘The conversion factor’’ as clause (i) 
with the heading ‘‘APPLICATION OF SIN-
GLE
CONVERSION
FACTOR.—’’ and with 
appropriate indentation; 
(ii) by striking ‘‘The conversion fac-
tor’’ and inserting ‘‘Subject to clause (ii), 
the conversion factor’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(ii) APPLICATION OF MULTIPLE CON-
VERSION
FACTORS
BEGINNING
WITH 
2011.— 
‘‘(I) IN
GENERAL.—In applying 
clause (i) for years beginning with 
2011, separate conversion factors 
shall be established for each service 
category of physicians’ services (as de-
fined in subsection (j)(5)) and any 
reference in this section to a conver-
sion factor for such years shall be 
deemed to be a reference to the con-
version factor for each of such cat-
egories. 
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‘‘(II) INITIAL CONVERSION FAC-
TORS.—Such factors for 2011 shall be 
based upon the single conversion fac-
tor for the previous year multiplied by 
the update established under para-
graph (11) for such category for 
2011. 
‘‘(III) UPDATING
OF
CONVER-
SION
FACTORS.—Such factor for a 
service category for a subsequent year 
shall be based upon the conversion 
factor for such category for the pre-
vious year and adjusted by the update 
established for such category under 
paragraph (11) for the year in-
volved.’’; and 
(B) in subparagraph (D), by striking 
‘‘other physicians’ services’’ and inserting ‘‘for 
physicians’ services described in the service cat-
egory described in subsection (j)(5)(B)’’. 
(3) ESTABLISHING UPDATES FOR CONVERSION 
FACTORS
FOR
SERVICE
CATEGORIES.—Section 
1848(d) of the Social Security Act (42 U.S.C. 
1395w–4(d)), as amended by subsection (a), is 
amended— 
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(A) in paragraph (4)(C)(iii), by striking 
‘‘The allowed’’ and inserting ‘‘Subject to para-
graph (11)(B), the allowed’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(11) UPDATES FOR SERVICE CATEGORIES BE-
GINNING WITH 2011.— 
‘‘(A) IN GENERAL.—In applying paragraph 
(4) for a year beginning with 2011, the fol-
lowing rules apply: 
‘‘(i) APPLICATION OF SEPARATE UP-
DATE ADJUSTMENTS FOR EACH SERVICE 
CATEGORY.—Pursuant 
to 
paragraph 
(1)(A)(ii)(I), the update shall be made to 
the conversion factor for each service cat-
egory (as defined in subsection (j)(5)) 
based upon an update adjustment factor 
for the respective category and year and 
the update adjustment factor shall be com-
puted, for a year, separately for each serv-
ice category. 
‘‘(ii) COMPUTATION OF ALLOWED AND 
ACTUAL EXPENDITURES BASED ON SERV-
ICE CATEGORIES.—In computing the prior 
year adjustment component and the cumu-
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238 
lative adjustment component under clauses 
(i) and (ii) of paragraph (4)(B), the fol-
lowing rules apply: 
‘‘(I) APPLICATION
BASED
ON 
SERVICE
CATEGORIES.—The allowed 
expenditures and actual expenditures 
shall be the allowed and actual ex-
penditures for the service category, as 
determined under subparagraph (B). 
‘‘(II) APPLICATION OF CATEGORY 
SPECIFIC
TARGET
GROWTH
RATE.— 
The growth rate applied under clause 
(ii)(II) of such paragraph shall be the 
target growth rate for the service cat-
egory involved under subsection (f)(5). 
‘‘(B) DETERMINATION
OF
ALLOWED
EX-
PENDITURES.—In applying paragraph (4) for a 
year beginning with 2010, notwithstanding sub-
paragraph (C)(iii) of such paragraph, the al-
lowed expenditures for a service category for a 
year is an amount computed by the Secretary 
as follows: 
‘‘(i) FOR 2010.—For 2010: 
‘‘(I) TOTAL
2009
ACTUAL
EX-
PENDITURES FOR ALL SERVICES IN-
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239 
CLUDED
IN
SGR
COMPUTATION
FOR 
EACH SERVICE CATEGORY.—Compute 
total actual expenditures for physi-
cians’ services (as defined in sub-
section (f)(4)(A)) for 2009 for each 
service category. 
‘‘(II) 
INCREASE
BY
GROWTH 
RATE TO OBTAIN 2010 ALLOWED EX-
PENDITURES
FOR
SERVICE
CAT-
EGORY.—Compute allowed expendi-
tures for the service category for 2010 
by increasing the allowed expenditures 
for the service category for 2009 com-
puted under subclause (I) by the tar-
get growth rate for such service cat-
egory under subsection (f) for 2010. 
‘‘(ii) FOR SUBSEQUENT YEARS.—For 
a subsequent year, take the amount of al-
lowed expenditures for such category for 
the preceding year (under clause (i) or this 
clause) and increase it by the target 
growth rate determined under subsection 
(f) for such category and year.’’. 
(4) 
APPLICATION
OF
SEPARATE
TARGET 
GROWTH RATES FOR EACH CATEGORY.— 
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(A) IN GENERAL.—Section 1848(f) of the 
Social Security Act (42 U.S.C. 1395w–4(f)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(5) APPLICATION
OF
SEPARATE
TARGET 
GROWTH RATES FOR EACH SERVICE CATEGORY BE-
GINNING WITH 2010.—The target growth rate for a 
year beginning with 2010 shall be computed and ap-
plied separately under this subsection for each serv-
ice category (as defined in subsection (j)(5)) and 
shall be computed using the same method for com-
puting the target growth rate except that the factor 
described in paragraph (2)(C) for— 
‘‘(A) the service category described in sub-
section (j)(5)(A) shall be increased by 0.02; and 
‘‘(B) the service category described in sub-
section (j)(5)(B) shall be increased by 0.01.’’. 
(B) USE OF TARGET GROWTH RATES.— 
Section 1848 of such Act is further amended— 
(i) in subsection (d)— 
(I) in paragraph (1)(E)(ii), by in-
serting ‘‘or target’’ after ‘‘sustain-
able’’; and 
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(II) in paragraph (4)(B)(ii)(II), 
by inserting ‘‘or target’’ after ‘‘sus-
tainable’’; and 
(ii) in the heading of subsection (f), 
by inserting ‘‘AND
TARGET
GROWTH 
RATE’’ 
after 
‘‘SUSTAINABLE
GROWTH 
RATE’’; 
(iii) in subsection (f)(1)— 
(I) by striking ‘‘and’’ at the end 
of subparagraph (A); 
(II) in subparagraph (B), by in-
serting ‘‘before 2010’’ after ‘‘each 
succeeding year’’ and by striking the 
period at the end and inserting ‘‘; 
and’’; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(C) November 1 of each succeeding year 
the target growth rate for such succeeding year 
and each of the 2 preceding years.’’; and 
(iv) in subsection (f)(2), in the matter 
before subparagraph (A), by inserting after 
‘‘beginning with 2000’’ the following: ‘‘and 
ending with 2009’’. 
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242 
TITLE XI—INCENTIVES TO 
REDUCE PHYSICIAN SHORTAGES 
Subtitle 
A—Federally 
Supported 
Student Loan Funds for Medical 
Students 
SEC. 1101. FEDERALLY SUPPORTED STUDENT LOAN FUNDS 
FOR MEDICAL STUDENTS. 
(a) PRIMARY HEALTH CARE MEDICAL STUDENTS.— 
Subpart II of part A of the Public Health Service Act (42 
U.S.C. 292q et seq.) is amended— 
(1) by redesignating section 735 as section 729; 
and 
(2) in subsection (f) of section 729 (as so redes-
ignated), by striking ‘‘is authorized to be appro-
priated to be appropriated $10,000,000 for each of 
the fiscal years 1994 through 1996’’ and inserting 
‘‘are authorized to be appropriated such sums as 
may be necessary for fiscal year 2010 and each fis-
cal year thereafter’’. 
(b) OTHER MEDICAL STUDENTS.—Part A of title VII 
of the Public Health Service Act (42 U.S.C. 292 et seq.) 
is amended by adding at the end the following: 
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‘‘Subpart III—Federally Supported Student Loan 
Funds for Certain Medical Students 
‘‘SEC. 730. SCHOOL LOAN FUNDS FOR CERTAIN MEDICAL 
STUDENTS. 
‘‘(a) FUND AGREEMENTS.—For the purpose de-
scribed in subsection (b), the Secretary is authorized to 
enter into an agreement for the establishment and oper-
ation of a student loan fund with any public or nonprofit 
school of medicine or osteopathic medicine. 
‘‘(b) PURPOSE.—The purpose of this subpart is to 
provide for loans to medical students who would be eligible 
for a loan under subpart II, except for the student’s deci-
sion to enter a residency training program in a field other 
than primary health care. 
‘‘(c) COMMENCEMENT
OF REPAYMENT PERIOD.— 
The repayment period for a loan under this section shall 
not begin before the end of any period during which the 
student is participating in an internship, residency, or fel-
lowship training program directly related to the field of 
medicine which the student agrees to enter pursuant to 
subsection (d). 
‘‘(d) REQUIREMENTS FOR STUDENTS.—Each agree-
ment under this section for the establishment of a student 
loan fund shall provide that the school of medicine or os-
teopathic medicine will make a loan to a student from such 
fund only if the student agrees— 
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‘‘(1) to enter and complete a residency training 
program (in a field of medicine other than primary 
health care) not later than a period determined by 
the Secretary to be reasonable after the date on 
which the student graduates from such school; and 
‘‘(2) to practice medicine through the date on 
which the loan is repaid in full. 
‘‘(e) REQUIREMENTS FOR SCHOOLS.—The provisions 
of section 723(b) (regarding graduates in primary health 
care) shall not apply to a student loan fund established 
under this section. 
‘‘(f) APPLICABILITY OF OTHER PROVISIONS.—Ex-
cept as inconsistent with this section, the provisions of 
subpart II shall apply to the program of student loan 
funds established under this section to the same extent 
and in the same manner as such provisions apply to the 
program of student loan funds established under subpart 
II. 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated such sums as may be necessary for fiscal year 
2010 and each fiscal year thereafter.’’. 
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Subtitle B—Loan Forgiveness for 
Primary Care Providers 
SEC. 1111. LOAN FORGIVENESS FOR PRIMARY CARE PRO-
VIDERS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall carry out a program of entering into 
contracts with eligible individuals under which— 
(1) the individual agrees to serve for a period 
of not less than 5 years as a primary care provider; 
and 
(2) in consideration of such service, the Sec-
retary agrees to pay not more than $50,000 on the 
principal and interest on the individual’s graduate 
educational loans. 
(b) ELIGIBILITY.—To be eligible to enter into a con-
tract under subsection (a), an individual must— 
(1) have a graduate degree in medicine, osteo-
pathic medicine, or another health profession from 
an accredited (as determined by the Secretary of 
Health and Human Services) institution of higher 
education; and 
(2) have practiced as a primary care provider 
for a period (excluding any residency or fellowship 
training period) of not less than— 
(A) 5 years; or 
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(B) 3 years in a medically underserved 
community (as defined in section 799B of the 
Public Health Service Act (42 U.S.C. 295p)). 
(c) INSTALLMENTS.—Payments under this section 
may be made in installments of not more than $10,000 
for each year of service described in subsection (a)(1). 
(d) APPLICABILITY OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D of title III of the Public 
Health Service Act shall, except as inconsistent with this 
section, apply to the program established under this sec-
tion in the same manner and to the same extent as such 
provisions apply to the National Health Service Corps 
Loan Repayment Program established in such subpart. 
TITLE XII—OFFSETS 
Subtitle A—Enforcing 
Discretionary Spending Limits 
SEC. 1201. ENFORCING DISCRETIONARY SPENDING LIMITS. 
(a) DISCRETIONARY SPENDING LIMITS.—Sections 
251(b) and (c) of the Balanced Budget and Emergency 
Deficit Control of Act of 1985 are amended to read as 
follows: 
‘‘(b) DISCRETIONARY SPENDING LIMIT.—As used in 
this part, the term ‘discretionary spending limit’ means— 
‘‘(1) 
with 
respect 
to 
fiscal 
year 
2010, 
$1,173,000,000,000 in new budget authority of 
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which no more than $481,140,000,000 shall be for 
the nondefense category; 
‘‘(2) 
with 
respect 
to 
fiscal 
year 
2011, 
$1,096,439,000,000 in new budget authority of 
which no more than $476,329,000,000 shall be for 
the nondefense category; 
‘‘(3) 
with 
respect 
to 
fiscal 
year 
2012, 
$1,100,705,000 in new budget authority of which no 
more than $471,565,000,000 shall be for the non-
defense category; 
‘‘(4) 
with 
respect 
to 
fiscal 
year 
2013, 
$1,106,750,000,000 in new budget authority of 
which no more than $466,850,000,000 shall be for 
the nondefense category; 
‘‘(5) 
with 
respect 
to 
fiscal 
year 
2014, 
$1,116,011,000,000 in new budget authority of 
which no more than $462,181,000,000 shall be for 
the nondefense category; 
‘‘(6) 
with 
respect 
to 
fiscal 
year 
2015, 
$1,117,559,000,000 in new budget authority of 
which no more than $457,559,000,000 shall be for 
the nondefense category; 
‘‘(7) 
with 
respect 
to 
fiscal 
year 
2016, 
$1,117,984,000,000 in new budget authority of 
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which no more than $452,984,000,000 shall be for 
the nondefense category; 
‘‘(8) 
with 
respect 
to 
fiscal 
year 
2017, 
$1,118,454,000,000 in new budget authority of 
which no more than $448,454,000,000 shall be for 
the nondefense category; 
‘‘(9) 
with 
respect 
to 
fiscal 
year 
2018, 
$1,118,969,000,000 in new budget authority of 
which no more than 443,969,000,000 shall be for 
the nondefense category; and 
‘‘(10) with respect to fiscal year 2019, 
$1,127,530,000,000 in new budget authority of 
which no more than $439,530,000,000 shall be for 
the nondefense category.’’. 
(b) DISCRETIONARY SPENDING LIMIT POINT
OF 
ORDER.—Section 312 of the Congressional Budget Act of 
1974 (as amended by section 214(a)) is further amended 
by adding at the end the following new subsection: 
‘‘(h) DISCRETIONARY SPENDING LIMIT POINT OF 
ORDER.—It shall not be in order in the House of Rep-
resentatives or the Senate to consider any bill, joint resolu-
tion, amendment, or conference report that— 
‘‘(1) increases the discretionary spending limits 
for any ensuing fiscal year after the budget year; or 
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‘‘(2) would cause the discretionary spending 
limits for the budget year to be breached.’’. 
(c) ADVANCE APPROPRIATION POINT OF ORDER.— 
Section 312 of the Congressional Budget Act of 1974 (as 
amended by this section) is further amended by adding 
at the end the following new subsection: 
‘‘(i) ADVANCE APPROPRIATION POINT OF ORDER.— 
It shall not be in order in the House of Representatives 
or the Senate to consider any appropriation bill or joint 
resolution, or amendment thereto or conference report 
thereon, that provides advance discretionary new budget 
authority that first becomes available for any fiscal year 
after the budget year at an amount for any program, 
project, or activity above the amount of appropriations for 
fiscal year 2007 for such program, project, or activity.’’. 
Subtitle B—Repeal of Unused 
Stimulus Funds 
SEC. 1211. RESCISSION AND REPEAL IN ARRA. 
(a) RESCISSION.—Of the discretionary appropria-
tions made available in division A of the American Recov-
ery and Reinvestment Act of 2009 (Public Law 111–5), 
all unobligated balances are rescinded. 
(b) REPEAL.—Subtitles B and C of title II and titles 
III through VII of division B of the American Recovery 
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and Reinvestment Act of 2009 (Public Law 111–5) are 
repealed. 
Subtitle C—Savings From Health 
Care Efficiencies 
SEC. 1221. MEDICARE DSH REPORT AND PAYMENT ADJUST-
MENTS IN RESPONSE TO COVERAGE EXPAN-
SION. 
(a) DSH REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2014, the Secretary of Health and Human Services 
shall submit to Congress a report on Medicare DSH 
taking into account the impact of the health care re-
forms carried out under this Act in reducing the 
number of uninsured individuals. The report shall 
include recommendations relating to the following: 
(A) The appropriate amount, targeting, 
and distribution of Medicare DSH to com-
pensate for higher Medicare costs associated 
with serving low-income beneficiaries (taking 
into account variations in the empirical jus-
tification for Medicare DSH attributable to hos-
pital characteristics, including bed size), con-
sistent with the original intent of Medicare 
DSH. 
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251 
(B) The appropriate amount, targeting, 
and distribution of Medicare DSH to hospitals 
given their continued uncompensated care costs, 
to the extent such costs remain. 
(2) COORDINATION WITH MEDICAID DSH RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicaid 
DSH under section 1222(a). 
(b) PAYMENT ADJUSTMENTS IN RESPONSE TO COV-
ERAGE EXPANSION.— 
(1) IN GENERAL.—If there is a significant de-
crease in the national rate of uninsurance as a result 
of this Act (as determined under paragraph (2)(A)), 
then the Secretary of Health and Human Services 
shall, beginning in fiscal year 2015, implement the 
following adjustments to Medicare DSH: 
(A) In lieu of the amount of Medicare 
DSH payment that would otherwise be made 
under section 1886(d)(5)(F) of the Social Secu-
rity Act, the amount of Medicare DSH payment 
shall be an amount based on the recommenda-
tions of the report under subsection (a)(1)(A) 
and shall take into account variations in the 
empirical justification for Medicare DSH attrib-
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utable to hospital characteristics, including bed 
size. 
(B) Subject to paragraph (3), make an ad-
ditional payment to a hospital by an amount 
that is estimated based on the amount of un-
compensated care provided by the hospital 
based on criteria for uncompensated care as de-
termined by the Secretary, which shall exclude 
bad debt. 
(2) SIGNIFICANT DECREASE IN NATIONAL RATE 
OF UNINSURANCE AS A RESULT OF THIS ACT.—For 
purposes of this subsection— 
(A) IN GENERAL.—There is a ‘‘significant 
decrease in the national rate of uninsurance as 
a result of this Act’’ if there is a decrease in 
the national rate of uninsurance (as defined in 
subparagraph (B)) from 2010 to 2012 that ex-
ceeds 8 percentage points. 
(B) NATIONAL
RATE
OF
UNINSURANCE 
DEFINED.—The 
term 
‘‘national 
rate 
of 
uninsurance’’ means, for a year, such rate for 
the under-65 population for the year as deter-
mined and published by the Bureau of the Cen-
sus in its Current Population Survey in or 
about September of the succeeding year. 
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253 
(3) UNCOMPENSATED CARE INCREASE.— 
(A) COMPUTATION OF DSH SAVINGS.—For 
each fiscal year (beginning with fiscal year 
2015), the Secretary shall estimate the aggre-
gate reduction in Medicare DSH that will result 
from the adjustment under paragraph (1)(A). 
(B) 
STRUCTURE
OF
PAYMENT
IN-
CREASE.—The Secretary shall compute the in-
crease in Medicare DSH under paragraph 
(1)(B) for a fiscal year in accordance with a 
formula established by the Secretary that pro-
vides that— 
(i) the aggregate amount of such in-
crease for the fiscal year does not exceed 
50 percent of the aggregate reduction in 
Medicare DSH estimated by the Secretary 
for such fiscal year; and 
(ii) hospitals with higher levels of un-
compensated care receive a greater in-
crease. 
(c) MEDICARE DSH.—In this section, the term 
‘‘Medicare DSH’’ means adjustments in payments under 
section 1886(d)(5)(F) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services 
furnished by disproportionate share hospitals. 
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SEC. 1222. REDUCTION IN MEDICAID DSH. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2014, the Secretary of Health and Human Services 
(in this title referred to as the ‘‘Secretary’’) shall 
submit to Congress a report concerning the extent to 
which, based upon the impact of the health care re-
forms carried out under this Act in reducing the 
number of uninsured individuals, there is a contin-
ued role for Medicaid DSH. In preparing the report, 
the Secretary shall consult with community-based 
health care networks serving low-income bene-
ficiaries. 
(2) MATTERS TO BE INCLUDED.—The report 
shall include the following: 
(A) 
RECOMMENDATIONS.—Recommenda-
tions regarding— 
(i) the appropriate targeting of Med-
icaid DSH within States; and 
(ii) the distribution of Medicaid DSH 
among the States. 
(B) SPECIFICATION OF DSH HEALTH RE-
FORM METHODOLOGY.—The DSH Health Re-
form methodology described in paragraph (2) of 
subsection (b) for purposes of implementing the 
requirements of such subsection. 
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(3) COORDINATION WITH MEDICARE DSH RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicare 
DSH under section 1221. 
(4) MEDICAID DSH.—In this section, the term 
‘‘Medicaid DSH’’ means adjustments in payments 
under section 1923 of the Social Security Act for in-
patient hospital services furnished by dispropor-
tionate share hospitals. 
(b) MEDICAID DSH REDUCTIONS.— 
(1) IN GENERAL.—If there is a significant de-
crease in the national rate of uninsurance as a result 
of 
this 
Act 
(as 
determined 
under 
section 
1221(a)(2)(A)), then the Secretary of Health and 
Human Services shall reduce Medicaid DSH so as to 
reduce total Federal payments to all States for such 
purpose by $1,500,000,000 in fiscal year 2015, 
$2,500,000,000 
in 
fiscal 
year 
2016, 
and 
$6,000,000,000 in fiscal year 2017. 
(2) DSH HEALTH REFORM METHODOLOGY.— 
The Secretary shall carry out paragraph (1) through 
use of a DSH Health Reform methodology issued by 
the Secretary that imposes the largest percentage re-
ductions on the States that— 
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256 
(A) have the lowest percentages of unin-
sured individuals (determined on the basis of 
audited hospital cost reports) during the most 
recent year for which such data are available; 
or 
(B) do not target their DSH payments 
on— 
(i) hospitals with high volumes of 
Medicaid inpatients (as defined in section 
1923(b)(1)(A) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(1)(A)); and 
(ii) hospitals that have high levels of 
uncompensated care (excluding bad debt). 
(3) DSH ALLOTMENT PUBLICATIONS.— 
(A) IN GENERAL.—Not later than the pub-
lication deadline specified in subparagraph (B), 
the Secretary shall publish in the Federal Reg-
ister a notice specifying the DSH allotment to 
each State under 1923(f) of the Social Security 
Act for the respective fiscal year specified in 
such subparagraph, consistent with the applica-
tion of the DSH Health Reform methodology 
described in paragraph (2). 
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(B) PUBLICATION DEADLINE.—The publi-
cation deadline specified in this subparagraph 
is— 
(i) January 1, 2014, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2015; 
(ii) January 1, 2015, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2016; and 
(iii) January 1, 2016, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2017. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4(f)) is amended— 
(A) by redesignating paragraph (7) as 
paragraph (8); and 
(B) by inserting after paragraph (6) the 
following new paragraph: 
‘‘(7) SPECIAL RULE FOR FISCAL YEARS 2015, 
2016, AND 2017.—Notwithstanding paragraph (2), if 
the Secretary makes a reduction under section 
1222(b)(1) of the Empowering Patients First Act, 
the total DSH allotments for all States for— 
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‘‘(A) fiscal year 2015, shall be the total 
DSH allotments that would otherwise be deter-
mined under this subsection for such fiscal year 
decreased by $1,500,000,000; 
‘‘(B) fiscal year 2016, shall be the total 
DSH allotments that would otherwise be deter-
mined under this subsection for such fiscal year 
decreased by $2,500,000,000; and 
‘‘(C) fiscal year 2017, shall be the total 
DSH allotments that would otherwise be deter-
mined under this subsection for such fiscal year 
decreased by $6,000,000,000.’’. 
(2) Section 1923(b)(4) of such Act (42 U.S.C. 
1396r–4(b)(4)) is amended by adding before the pe-
riod the following: ‘‘or to affect the authority of the 
Secretary to issue and implement the DSH Health 
Reform methodology under section 1704(b)(2) of the 
Empowering Patients First Act’’. 
(d) DISPROPORTIONATE SHARE HOSPITALS (DSH) 
AND ESSENTIAL ACCESS HOSPITAL (EAH) NON-DIS-
CRIMINATION.— 
(1) IN GENERAL.—Section 1923(d) of the So-
cial Security Act (42 U.S.C. 1396r–4) is amended 
by adding at the end the following new paragraph: 
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‘‘(4) No hospital may be defined or deemed as 
a disproportionate share hospital, or as an essential 
access 
hospital 
(for 
purposes 
of 
subsection 
(f)(6)(A)(iv), under a State plan under this title or 
subsection (b) of this section (including any waiver 
under section 1115) unless the hospital— 
‘‘(A) provides services to beneficiaries 
under this title without discrimination on the 
ground of race, color, national origin, creed, 
source of payment, status as a beneficiary 
under this title, or any other ground unrelated 
to such beneficiary’s need for the services or the 
availability of the needed services in the hos-
pital; and 
‘‘(B) makes arrangements for, and accepts, 
reimbursement under this title for services pro-
vided to eligible beneficiaries under this title.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall be apply to expenditures 
made on or after July 1, 2010. 
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Subtitle D—Fraud, Waste, and 
Abuse 
SEC. 1231. PROVIDE ADEQUATE FUNDING TO HHS OIG AND 
HCFAC. 
(a) HCFAC FUNDING.—Section 1817(k)(3)(A) of 
the Social Security Act (42 U.S.C. 1395i(k)(3)(A)) is 
amended— 
(1) in clause (i)— 
(A) in subclause (IV), by striking ‘‘2009, 
and 2010’’ and inserting ‘‘and 2009’’; and 
(B) by amending subclause (V) to read as 
follows: 
‘‘(V) for each fiscal year after fis-
cal year 2009, $300,000,000.’’; and 
(2) in clause (ii)— 
(A) in subclause (IX), by striking ‘‘2009, 
and 2010’’ and inserting ‘‘and 2009’’; and 
(B) in subclause (X), by striking ‘‘2010’’ 
and inserting ‘‘2009’’ and by inserting before 
the period at the end the following: ‘‘, plus the 
amount by which the amount made available 
under clause (i)(V) for fiscal year 2010 exceeds 
the amount made available under clause (i)(IV) 
for 2009’’. 
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(d) AUTHORIZING EXPANDED DATA MATCHING.— 
Notwithstanding any provision of the Computer Matching 
and Privacy Protection Act of 1988 to the contrary— 
(1) the Secretary and the Inspector General in 
the Department of Health and Human Services may 
perform data matching of data from the Medicare 
program with data from the Medicaid program; and 
(2) the Commissioner of Social Security and the 
Secretary may perform data matching of data of the 
Social Security Administration with data from the 
Medicare and Medicaid programs. 
(e) CONSOLIDATION
OF DATA BASES.—The Sec-
retary shall consolidate and expand into a centralized data 
base for individuals and entities that have been excluded 
from Federal health care programs the Healthcare Integ-
rity and Protection Data Bank, the National Practitioner 
Data Bank, the List of Excluded Individuals/Entities, and 
a national patient abuse/neglect registry. 
(f) COMPREHENSIVE PROVIDER DATABASE.— 
(1) ESTABLISHMENT.—The Secretary shall es-
tablish a comprehensive database that includes infor-
mation on providers of services, suppliers, and re-
lated entities participating in the Medicare program, 
the Medicaid program, or both. Such database shall 
include, information on ownership and business rela-
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