2160 
return for the applicable year, the 
social security number (if reason-
ably available) of the spouse on 
such return, 
‘‘(v) if the individual files a 
joint return for the applicable 
year, the social security number, 
unearned 
income 
information, 
and 
income 
information 
from 
partnerships, trusts, estates, and 
subchapter S corporations of the 
individual’s spouse on such re-
turn, and 
‘‘(vi) such other return infor-
mation relating to the individual 
(or the individual’s spouse in the 
case of a joint return) as is pre-
scribed by the Secretary by regu-
lation as might indicate that the 
individual is likely to be ineligible 
for 
a 
low-income 
prescription 
drug 
subsidy 
under 
section 
1860D–14 of the Social Security 
Act. 
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‘‘(B) APPLICABLE
YEAR.—For the 
purposes of this paragraph, the term 
‘applicable year’ means the most re-
cent taxable year for which informa-
tion is available in the Internal Rev-
enue Service’s taxpayer information 
records. 
‘‘(C) RESTRICTION
ON
INDIVIDUALS 
FOR
WHOM
DISCLOSURE
MAY
BE
RE-
QUESTED.—The Commissioner of So-
cial Security shall request informa-
tion under this paragraph only with 
respect to— 
‘‘(i) individuals the Social Se-
curity Administration has identi-
fied, using all other reasonably 
available information, as likely to 
be eligible for a low-income pre-
scription drug subsidy under sec-
tion 1860D–14 of the Social Secu-
rity Act and who have not applied 
for such subsidy, and 
‘‘(ii) any individual the Social 
Security Administration has iden-
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tified as a spouse of an individual 
described in clause (i). 
‘‘(D) RESTRICTION
ON
USE
OF
DIS-
CLOSED
INFORMATION.—Return infor-
mation disclosed under this para-
graph may be used only by officers 
and employees of the Social Security 
Administration solely for purposes of 
identifying individuals likely to be in-
eligible for a low-income prescription 
drug subsidy under section 1860D–14 
of the Social Security Act for use in 
outreach efforts under section 1144 of 
the Social Security Act.’’. 
(b) SAFEGUARDS.—Paragraph (4) of section 
6103(p) of such Code is amended— 
(1) by striking ‘‘(19),’’ each place it ap-
pears, and 
(2) by striking ‘‘or (17)’’ each place it 
appears and inserting ‘‘(17), or (19)’’. 
(c) CONFORMING AMENDMENT.—Paragraph 
(3) of section 6103(a) of such Code is amended 
by striking ‘‘(19),’’. 
(d) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to disclosures 
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made after the date which is 12 months after 
the date of the enactment of this Act. 
SEC. 
1802. 
COMPARATIVE 
EFFECTIVENESS 
RESEARCH 
TRUST FUND; FINANCING FOR TRUST FUND. 
(a) ESTABLISHMENT OF TRUST FUND.— 
(1) IN
GENERAL.—Subchapter A of 
chapter 98 of the Internal Revenue Code 
of 1986 (relating to trust fund code) is 
amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is 
established in the Treasury of the United 
States a trust fund to be known as the ‘Health 
Care Comparative Effectiveness Research 
Trust Fund’ (hereinafter in this section re-
ferred to as the ‘CERTF’), consisting of such 
amounts as may be appropriated or credited 
to such Trust Fund as provided in this section 
and section 9602(b). 
‘‘(b) TRANSFERS TO FUND.—There are here-
by appropriated to the Trust Fund the fol-
lowing: 
‘‘(1) For fiscal year 2010, $90,000,000. 
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‘‘(2) For fiscal year 2011, $100,000,000. 
‘‘(3) For fiscal year 2012, $110,000,000. 
‘‘(4) For each fiscal year beginning 
with fiscal year 2013— 
‘‘(A) an amount equivalent to the 
net revenues received in the Treasury 
from the fees imposed under sub-
chapter B of chapter 34 (relating to 
fees on health insurance and self-in-
sured plans) for such fiscal year; and 
‘‘(B) subject to subsection (c)(2), 
amounts determined by the Secretary 
of Health and Human Services to be 
equivalent to the fair share per cap-
ita amount computed under sub-
section (c)(1) for the fiscal year multi-
plied by the average number of indi-
viduals entitled to benefits under 
part A, or enrolled under part B, of 
title XVIII of the Social Security Act 
during such fiscal year. 
The amounts appropriated under paragraphs 
(1), (2), (3), and (4)(B) shall be transferred 
from the Federal Hospital Insurance Trust 
Fund and from the Federal Supplementary 
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Medical Insurance Trust Fund (established 
under section 1841 of such Act), and from the 
Medicare Prescription Drug Account within 
such Trust Fund, in proportion (as estimated 
by the Secretary) to the total expenditures 
during such fiscal year that are made under 
title XVIII of such Act from the respective 
trust fund or account. 
‘‘(c) FAIR SHARE PER CAPITA AMOUNT.— 
‘‘(1) COMPUTATION.— 
‘‘(A) IN GENERAL.—Subject to sub-
paragraph (B), the fair share per cap-
ita amount under this paragraph for 
a fiscal year (beginning with fiscal 
year 2013) is an amount computed by 
the Secretary of Health and Human 
Services for such fiscal year that, 
when applied under this section and 
subchapter B of chapter 34 of the In-
ternal Revenue Code of 1986, will re-
sult in revenues to the CERTF of 
$375,000,000 for the fiscal year. 
‘‘(B) ALTERNATIVE COMPUTATION.— 
‘‘(i) IN
GENERAL.—If the Sec-
retary is unable to compute the 
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Any amount determined under 
subclause (II) shall be rounded to 
the nearest penny. 
‘‘(2) LIMITATION
ON
MEDICARE
FUND-
ING.—In no case shall the amount trans-
ferred under subsection (b)(4)(B) for any 
fiscal year exceed $90,000,000. 
‘‘(d) EXPENDITURES FROM FUND.— 
‘‘(1) IN
GENERAL.—Subject to para-
graph (2), amounts in the CERTF are 
available, without the need for further 
appropriations and without fiscal year 
limitation, to the Secretary of Health and 
Human Services for carrying out section 
1181 of the Social Security Act. 
‘‘(2) ALLOCATION FOR COMMISSION.—Not 
less than the following amounts in the 
CERTF for a fiscal year shall be available 
to carry out the activities of the Com-
parative Effectiveness Research Commis-
sion established under section 1181(b) of 
the Social Security Act for such fiscal 
year: 
‘‘(A) 
For 
fiscal 
year 
2010, 
$7,000,000. 
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‘‘(B) 
For 
fiscal 
year 
2011, 
$9,000,000. 
‘‘(C) For each fiscal year begin-
ning with 2012, $10,000,000. 
Nothing in this paragraph shall be con-
strued as preventing additional amounts 
in the CERTF from being made available 
to the Comparative Effectiveness Re-
search Commission for such activities. 
‘‘(e) NET REVENUES.—For purposes of this 
section, the term ‘net revenues’ means the 
amount estimated by the Secretary based on 
the excess of— 
‘‘(1) the fees received in the Treasury 
under subchapter B of chapter 34, over 
‘‘(2) the decrease in the tax imposed 
by chapter 1 resulting from the fees im-
posed by such subchapter.’’. 
(2) CLERICAL
AMENDMENT.—The table 
of sections for such subchapter A is 
amended by adding at the end thereof 
the following new item: 
‘‘Sec. 9511. Health Care Comparative Effectiveness Research 
Trust Fund.’’. 
(b) FINANCING FOR FUND FROM FEES ON IN-
SURED AND SELF-INSURED HEALTH PLANS.— 
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(1) GENERAL RULE.—Chapter 34 of the 
Internal Revenue Code of 1986 is amend-
ed by adding at the end the following 
new subchapter: 
‘‘Subchapter B—Insured and Self-Insured 
Health Plans 
‘‘Sec. 4375. Health insurance. 
‘‘Sec. 4376. Self-insured health plans. 
‘‘Sec. 4377. Definitions and special rules. 
‘‘SEC. 4375. HEALTH INSURANCE. 
‘‘(a) IMPOSITION OF FEE.—There is hereby 
imposed on each specified health insurance 
policy for each policy year a fee equal to the 
fair share per capita amount determined 
under section 9511(c)(1) multiplied by the av-
erage number of lives covered under the pol-
icy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed 
by subsection (a) shall be paid by the issuer 
of the policy. 
‘‘(c) SPECIFIED
HEALTH
INSURANCE
POL-
ICY.—For purposes of this section: 
‘‘(1) IN GENERAL.—Except as otherwise 
provided in this section, the term ‘speci-
fied health insurance policy’ means any 
accident 
or 
health 
insurance 
policy 
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issued with respect to individuals resid-
ing in the United States. 
‘‘(2) EXEMPTION
FOR
CERTAIN
POLI-
CIES.—The term ‘specified health insur-
ance policy’ does not include any insur-
ance if substantially all of its coverage is 
of excepted benefits described in section 
9832(c). 
‘‘(3) TREATMENT
OF
PREPAID
HEALTH 
COVERAGE ARRANGEMENTS.— 
‘‘(A) IN
GENERAL.—In the case of 
any arrangement described in sub-
paragraph (B)— 
‘‘(i) such arrangement shall be 
treated as a specified health in-
surance policy, and 
‘‘(ii) the person referred to in 
such subparagraph shall be treat-
ed as the issuer. 
‘‘(B) 
DESCRIPTION
OF
ARRANGE-
MENTS.—An arrangement is described 
in this subparagraph if under such 
arrangement fixed payments or pre-
miums are received as consideration 
for any person’s agreement to provide 
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or arrange for the provision of acci-
dent or health coverage to residents 
of the United States, regardless of 
how such coverage is provided or ar-
ranged to be provided. 
‘‘SEC. 4376. SELF-INSURED HEALTH PLANS. 
‘‘(a) IMPOSITION OF FEE.—In the case of any 
applicable self-insured health plan for each 
plan year, there is hereby imposed a fee equal 
to the fair share per capita amount deter-
mined under section 9511(c)(1) multiplied by 
the average number of lives covered under 
the plan. 
‘‘(b) LIABILITY FOR FEE.— 
‘‘(1) IN GENERAL.—The fee imposed by 
subsection (a) shall be paid by the plan 
sponsor. 
‘‘(2) PLAN SPONSOR.—For purposes of 
paragraph (1) the term ‘plan sponsor’ 
means— 
‘‘(A) the employer in the case of a 
plan established or maintained by a 
single employer, 
‘‘(B) the employee organization in 
the case of a plan established or 
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maintained by an employee organiza-
tion, 
‘‘(C) in the case of— 
‘‘(i) 
a 
plan 
established 
or 
maintained by 2 or more employ-
ers or jointly by 1 or more em-
ployers and 1 or more employee 
organizations, 
‘‘(ii) a multiple employer wel-
fare arrangement, or 
‘‘(iii) a voluntary employees’ 
beneficiary association described 
in section 501(c)(9), 
the 
association, 
committee, 
joint 
board of trustees, or other similar 
group of representatives of the par-
ties who establish or maintain the 
plan, or 
‘‘(D) the cooperative or associa-
tion described in subsection (c)(2)(F) 
in the case of a plan established or 
maintained by such a cooperative or 
association. 
‘‘(c) 
APPLICABLE
SELF-INSURED
HEALTH 
PLAN.—For purposes of this section, the term 
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graphs, by a multiple employer wel-
fare arrangement (as defined in sec-
tion 3(40) of Employee Retirement In-
come Security Act of 1974), a rural 
electric cooperative (as defined in 
section 3(40)(B)(iv) of such Act), or a 
rural telephone cooperative associa-
tion (as defined in section 3(40)(B)(v) 
of such Act). 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this 
subchapter— 
‘‘(1) 
ACCIDENT
AND
HEALTH
COV-
ERAGE.—The term ‘accident and health 
coverage’ means any coverage which, if 
provided by an insurance policy, would 
cause such policy to be a specified health 
insurance policy (as defined in section 
4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘in-
surance policy’ means any policy or other 
instrument whereby a contract of insur-
ance is issued, renewed, or extended. 
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‘‘(3) UNITED STATES.—The term ‘United 
States’ includes any possession of the 
United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTI-
TIES.— 
‘‘(1) IN GENERAL.—For purposes of this 
subchapter— 
‘‘(A) the term ‘person’ includes 
any governmental entity, and 
‘‘(B) notwithstanding any other 
law or rule of law, governmental enti-
ties shall not be exempt from the fees 
imposed by this subchapter except as 
provided in paragraph (2). 
‘‘(2) TREATMENT
OF
EXEMPT
GOVERN-
MENTAL PROGRAMS.—In the case of an ex-
empt governmental program, no fee shall 
be imposed under section 4375 or section 
4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM 
DEFINED.—For 
purposes 
of 
this 
sub-
chapter, the term ‘exempt governmental 
program’ means— 
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‘‘(A) any insurance program es-
tablished under title XVIII of the So-
cial Security Act, 
‘‘(B) the medical assistance pro-
gram established by title XIX or XXI 
of the Social Security Act, 
‘‘(C) any program established by 
Federal law for providing medical 
care (other than through insurance 
policies) 
to 
individuals 
(or 
the 
spouses and dependents thereof) by 
reason of such individuals being— 
‘‘(i) members of the Armed 
Forces of the United States, or 
‘‘(ii) veterans, and 
‘‘(D) any program established by 
Federal law for providing medical 
care (other than through insurance 
policies) to members of Indian tribes 
(as defined in section 4(d) of the In-
dian Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of 
subtitle F, the fees imposed by this sub-
chapter shall be treated as if they were taxes. 
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‘‘(d) NO COVER OVER TO POSSESSIONS.—Not-
withstanding any other provision of law, no 
amount collected under this subchapter shall 
be covered over to any possession of the 
United States.’’. 
(2) CLERICAL AMENDMENTS.— 
(A) Chapter 34 of such Code is 
amended by striking the chapter 
heading and inserting the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS 
‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(B) The table of chapters for sub-
title D of such Code is amended by 
striking the item relating to chapter 
34 and inserting the following new 
item: 
‘‘CHAPTER 34—TAXES ON CERTAIN INSURANCE POLICIES’’. 
(3) EFFECTIVE DATE.—The amendments 
made by this subsection shall apply with 
respect to policies and plans for portions 
of policy or plan years beginning on or 
after October 1, 2012. 
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2178 
TITLE IX—MISCELLANEOUS 
PROVISIONS 
SEC. 1901. REPEAL OF TRIGGER PROVISION. 
Subtitle A of title VIII of the Medicare 
Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173) is 
repealed and the provisions of law amended 
by such subtitle are restored as if such sub-
title had never been enacted. 
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT 
(CCA) PROGRAM. 
Section 1860C–1 of the Social Security Act 
(42 U.S.C. 1395w–29), as added by section 
241(a) of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 
(Public Law 108–173), is repealed. 
SEC. 1903. EXTENSION OF GAINSHARING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (d)(3) of sec-
tion 5007 of the Deficit Reduction Act of 2005 
(Public Law 109–171) is amended by inserting 
‘‘(or September 30, 2011, in the case of a dem-
onstration project in operation as of October 
1, 2008)’’ after ‘‘December 31, 2009’’. 
(b) FUNDING.— 
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(1) IN
GENERAL.—Subsection (f)(1) of 
such section is amended by inserting 
‘‘and for fiscal year 2010, $1,600,000,’’ 
after ‘‘$6,000,000,’’. 
(2) AVAILABILITY.—Subsection (f)(2) of 
such section is amended by striking 
‘‘2010’’ and inserting ‘‘2014 or until ex-
pended’’. 
(c) REPORTS.— 
(1) QUALITY
IMPROVEMENT
AND
SAV-
INGS.—Subsection (e)(3) of such section is 
amended by striking ‘‘December 1, 2008’’ 
and inserting ‘‘March 31, 2011’’. 
(2) FINAL
REPORT.—Subsection (e)(4) 
of such section is amended by striking 
‘‘May 1, 2010’’ and inserting ‘‘March 31, 
2013’’. 
SEC. 1904. GRANTS TO STATES FOR QUALITY HOME VISITA-
TION PROGRAMS FOR FAMILIES WITH YOUNG 
CHILDREN AND FAMILIES EXPECTING CHIL-
DREN. 
Part B of title IV of the Social Security Act 
(42 U.S.C. 621–629i) is amended by adding at 
the end the following: 
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‘‘Subpart 3—Support for Quality Home Visitation 
Programs 
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES 
WITH YOUNG CHILDREN AND FAMILIES EX-
PECTING CHILDREN. 
‘‘(a) PURPOSE.—The purpose of this section 
is to improve the well-being, health, and de-
velopment of children by enabling the estab-
lishment and expansion of high quality pro-
grams providing voluntary home visitation 
for families with young children and families 
expecting children. 
‘‘(b) GRANT APPLICATION.—A State that de-
sires to receive a grant under this section 
shall submit to the Secretary for approval, at 
such time and in such manner as the Sec-
retary may require, an application for the 
grant that includes the following: 
‘‘(1) DESCRIPTION OF HOME VISITATION 
PROGRAMS.—A description of the high 
quality programs of home visitation for 
families with young children and families 
expecting children that will be supported 
by a grant made to the State under this 
section, the outcomes the programs are 
intended to achieve, and the evidence 
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supporting the effectiveness of the pro-
grams. 
‘‘(2) RESULTS OF NEEDS ASSESSMENT.— 
The results of a statewide needs assess-
ment that describes— 
‘‘(A) the number, quality, and ca-
pacity of home visitation programs 
for families with young children and 
families expecting children in the 
State; 
‘‘(B) the number and types of fam-
ilies who are receiving services under 
the programs; 
‘‘(C) the sources and amount of 
funding provided to the programs; 
‘‘(D) the gaps in home visitation 
in the State, including identification 
of communities that are in high need 
of the services; and 
‘‘(E) training and technical assist-
ance activities designed to achieve or 
support the goals of the programs. 
‘‘(3) 
ASSURANCES.—Assurances 
from 
the State that— 
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‘‘(A) in supporting home visitation 
programs using funds provided under 
this section, the State shall identify 
and prioritize serving communities 
that are in high need of such services, 
especially communities with a high 
proportion of low-income families or 
a high incidence of child maltreat-
ment; 
‘‘(B) the State will reserve 5 per-
cent of the grant funds for training 
and technical assistance to the home 
visitation programs using such funds; 
‘‘(C) in supporting home visitation 
programs using funds provided under 
this section, the State will promote 
coordination and collaboration with 
other home visitation programs (in-
cluding programs funded under title 
XIX) and with other child and family 
services, health services, income sup-
ports, and other related assistance; 
‘‘(D) home visitation programs 
supported using such funds will, 
when appropriate, provide referrals 
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to other programs serving children 
and families; and 
‘‘(E) the State will comply with 
subsection (i), and cooperate with 
any evaluation conducted under sub-
section (j). 
‘‘(4) OTHER INFORMATION.—Such other 
information as the Secretary may re-
quire. 
‘‘(c) ALLOTMENTS.— 
‘‘(1) INDIAN TRIBES.—From the amount 
reserved under subsection (l)(2) for a fis-
cal year, the Secretary shall allot to each 
Indian tribe that meets the requirement 
of subsection (d), if applicable, for the fis-
cal year the amount that bears the same 
ratio to the amount so reserved as the 
number of children in the Indian tribe 
whose families have income that does not 
exceed 200 percent of the poverty line 
bears to the total number of children in 
such Indian tribes whose families have 
income that does not exceed 200 percent 
of the poverty line. 
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‘‘(2) STATES
AND
TERRITORIES.—From 
the amount appropriated under sub-
section (m) for a fiscal year that remains 
after making the reservations required 
by subsection (l), the Secretary shall allot 
to each State that is not an Indian tribe 
and that meets the requirement of sub-
section (d), if applicable, for the fiscal 
year the amount that bears the same 
ratio to the remainder of the amount so 
appropriated as the number of children 
in the State whose families have income 
that does not exceed 200 percent of the 
poverty line bears to the total number of 
children in such States whose families 
have income that does not exceed 200 
percent of the poverty line. 
‘‘(3) REALLOTMENTS.—The amount of 
any allotment to a State under a para-
graph of this subsection for any fiscal 
year that the State certifies to the Sec-
retary will not be expended by the State 
pursuant to this section shall be available 
for reallotment using the allotment meth-
odology specified in that paragraph. Any 
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amount so reallotted to a State is deemed 
part of the allotment of the State under 
this subsection. 
‘‘(d) MAINTENANCE OF EFFORT.—Beginning 
with fiscal year 2011, a State meets the re-
quirement of this subsection for a fiscal year 
if the Secretary finds that the aggregate ex-
penditures by the State from State and local 
sources for programs of home visitation for 
families with young children and families ex-
pecting children for the then preceding fiscal 
year was not less than 100 percent of such ag-
gregate expenditures for the then 2nd pre-
ceding fiscal year. 
‘‘(e) PAYMENT OF GRANT.— 
‘‘(1) IN GENERAL.—The Secretary shall 
make a grant to each State that meets the 
requirements of subsections (b) and (d), if 
applicable, for a fiscal year for which 
funds are appropriated under subsection 
(m), in an amount equal to the reimburs-
able percentage of the eligible expendi-
tures of the State for the fiscal year, but 
not more than the amount allotted to the 
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State under subsection (c) for the fiscal 
year. 
‘‘(2) REIMBURSABLE
PERCENTAGE
DE-
FINED.—In paragraph (1), the term ‘reim-
bursable percentage’ means, with respect 
to a fiscal year— 
‘‘(A) 85 percent, in the case of fis-
cal year 2010; 
‘‘(B) 80 percent, in the case of fis-
cal year 2011; or 
‘‘(C) 75 percent, in the case of fis-
cal year 2012 and any succeeding fis-
cal year. 
‘‘(f) ELIGIBLE EXPENDITURES.— 
‘‘(1) IN GENERAL.—In this section, the 
term ‘eligible expenditures’— 
‘‘(A) means expenditures to pro-
vide voluntary home visitation for as 
many families with young children 
(under the age of school entry) and 
families expecting children as prac-
ticable, through the implementation 
or expansion of high quality home 
visitation programs that— 
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‘‘(i) adhere to clear evidence- 
based models of home visitation 
that have demonstrated positive 
effects on important program-de-
termined child and parenting out-
comes, such as reducing abuse 
and neglect and improving child 
health and development; 
‘‘(ii) employ well-trained and 
competent staff, maintain high 
quality supervision, provide for 
ongoing training and professional 
development, and show strong or-
ganizational capacity to imple-
ment such a program; 
‘‘(iii) 
establish 
appropriate 
linkages and referrals to other 
community resources and sup-
ports; 
‘‘(iv) monitor fidelity of pro-
gram implementation to ensure 
that services are delivered ac-
cording to the specified model; 
and 
‘‘(v) provide parents with— 
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‘‘(VII) activities designed 
to help parents become full 
partners in the education of 
their children; 
‘‘(B) includes expenditures for 
training, technical assistance, and 
evaluations related to the programs; 
and 
‘‘(C) does not include any expend-
iture with respect to which a State 
has submitted a claim for payment 
under any other provision of Federal 
law. 
‘‘(2) PRIORITY FUNDING FOR PROGRAMS 
WITH STRONGEST EVIDENCE.— 
‘‘(A) IN
GENERAL.—The expendi-
tures, described in paragraph (1), of a 
State for a fiscal year that are attrib-
utable to the cost of programs that do 
not adhere to a model of home visita-
tion with the strongest evidence of ef-
fectiveness shall not be considered el-
igible expenditures for the fiscal year 
to the extent that the total of the ex-
penditures exceeds the applicable 
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percentage for the fiscal year of the 
allotment of the State under sub-
section (c) for the fiscal year. 
‘‘(B) APPLICABLE
PERCENTAGE
DE-
FINED.—In subparagraph (A), the term 
‘applicable percentage’ means, with 
respect to a fiscal year— 
‘‘(i) 60 percent for fiscal year 
2010; 
‘‘(ii) 55 percent for fiscal year 
2011; 
‘‘(iii) 50 percent for fiscal year 
2012; 
‘‘(iv) 45 percent for fiscal year 
2013; or 
‘‘(v) 40 percent for fiscal year 
2014. 
‘‘(g) NO USE OF OTHER FEDERAL FUNDS FOR 
STATE MATCH.—A State to which a grant is 
made under this section may not expend any 
Federal funds to meet the State share of the 
cost of an eligible expenditure for which the 
State receives a payment under this section. 
‘‘(h) WAIVER AUTHORITY.— 
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‘‘(1) IN GENERAL.—The Secretary may 
waive or modify the application of any 
provision of this section, other than sub-
section (b) or (f), to an Indian tribe if the 
failure to do so would impose an undue 
burden on the Indian tribe. 
‘‘(2) SPECIAL RULE.—An Indian tribe is 
deemed to meet the requirement of sub-
section (d) for purposes of subsections (c) 
and (e) if— 
‘‘(A) the Secretary waives the re-
quirement; or 
‘‘(B) the Secretary modifies the re-
quirement, 
and 
the 
Indian 
tribe 
meets the modified requirement. 
‘‘(i) STATE REPORTS.—Each State to which 
a grant is made under this section shall sub-
mit to the Secretary an annual report on the 
progress made by the State in addressing the 
purposes of this section. Each such report 
shall include a description of— 
‘‘(1) the services delivered by the pro-
grams that received funds from the grant; 
‘‘(2) the characteristics of each such 
program, including information on the 
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service model used by the program and 
the performance of the program; 
‘‘(3) the characteristics of the pro-
viders of services through the program, 
including staff qualifications, work expe-
rience, and demographic characteristics; 
‘‘(4) the characteristics of the recipi-
ents of services provided through the 
program, including the number of the re-
cipients, the demographic characteristics 
of the recipients, and family retention; 
‘‘(5) the annual cost of implementing 
the program, including the cost per fam-
ily served under the program; 
‘‘(6) the outcomes experienced by re-
cipients of services through the program; 
‘‘(7) the training and technical assist-
ance provided to aid implementation of 
the program, and how the training and 
technical assistance contributed to the 
outcomes achieved through the program; 
‘‘(8) the indicators and methods used 
to monitor whether the program is being 
implemented as designed; and 
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‘‘(9) other information as determined 
necessary by the Secretary. 
‘‘(j) EVALUATION.— 
‘‘(1) IN GENERAL.—The Secretary shall, 
by grant or contract, provide for the con-
duct of an independent evaluation of the 
effectiveness of home visitation programs 
receiving funds provided under this sec-
tion, which shall examine the following: 
‘‘(A) The effect of home visitation 
programs on child and parent out-
comes, including child maltreatment, 
child health and development, school 
readiness, and links to community 
services. 
‘‘(B) The effectiveness of home 
visitation programs on different pop-
ulations, 
including 
the 
extent 
to 
which the ability of programs to im-
prove outcomes varies across pro-
grams and populations. 
‘‘(2) REPORTS TO THE CONGRESS.— 
‘‘(A) INTERIM
REPORT.—Within 3 
years after the date of the enactment 
of this section, the Secretary shall 
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submit to the Congress an interim re-
port on the evaluation conducted 
pursuant to paragraph (1). 
‘‘(B) 
FINAL
REPORT.—Within 
years after the date of the enactment 
of this section, the Secretary shall 
submit to the Congress a final report 
on the evaluation conducted pursu-
ant to paragraph (1). 
‘‘(k) ANNUAL REPORTS TO THE CONGRESS.— 
The Secretary shall submit annually to the 
Congress a report on the activities carried out 
using funds made available under this sec-
tion, which shall include a description of the 
following: 
‘‘(1) The high need communities tar-
geted by States for programs carried out 
under this section. 
‘‘(2) The service delivery models used 
in the programs receiving funds provided 
under this section. 
‘‘(3) The characteristics of the pro-
grams, including— 
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‘‘(A) the qualifications and demo-
graphic characteristics of program 
staff; and 
‘‘(B) recipient characteristics in-
cluding 
the 
number 
of 
families 
served, the demographic characteris-
tics of the families served, and family 
retention and duration of services. 
‘‘(4) The outcomes reported by the 
programs. 
‘‘(5) The research-based instruction, 
materials, and activities being used in 
the activities funded under the grant. 
‘‘(6) The training and technical activi-
ties, including on-going professional de-
velopment, provided to the programs. 
‘‘(7) The annual costs of implementing 
the programs, including the cost per fam-
ily served under the programs. 
‘‘(8) The indicators and methods used 
by States to monitor whether the pro-
grams are being been implemented as de-
signed. 
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‘‘(n) INDIAN TRIBES TREATED AS STATES.—In 
this section, paragraphs (4), (5), and (6) of sec-
tion 431(a) shall apply.’’. 
SEC. 1905. IMPROVED COORDINATION AND PROTECTION 
FOR DUAL ELIGIBLES. 
Title XI of the Social Security Act is 
amended by inserting after section 1150 the 
following new section: 
‘‘IMPROVED COORDINATION AND PROTECTION FOR 
DUAL ELIGIBLES 
‘‘SEC. 1150A. (a) IN GENERAL.—The Sec-
retary shall provide, through an identifiable 
office or program within the Centers for 
Medicare & Medicaid Services, for a focused 
effort to provide for improved coordination 
between Medicare and Medicaid and protec-
tion in the case of dual eligibles (as defined 
in subsection (e)). The office or program 
shall— 
‘‘(1) review Medicare and Medicaid 
policies related to enrollment, benefits, 
service delivery, payment, and grievance 
and appeals processes under parts A and 
B of title XVIII, under the Medicare Ad-
vantage program under part C of such 
title, and under title XIX; 
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‘‘(2) identify areas of such policies 
where better coordination and protection 
could improve care and costs; and 
‘‘(3) issue guidance to States regard-
ing improving such coordination and pro-
tection. 
‘‘(b) ELEMENTS.—The improved coordina-
tion and protection under this section shall 
include efforts— 
‘‘(1) to simplify access of dual eligi-
bles to benefits and services under Medi-
care and Medicaid; 
‘‘(2) to improve care continuity for 
dual eligibles and ensure safe and effec-
tive care transitions; 
‘‘(3) to harmonize regulatory conflicts 
between Medicare and Medicaid rules 
with regard to dual eligibles; and 
‘‘(4) to improve total cost and quality 
performance under Medicare and Med-
icaid for dual eligibles. 
‘‘(c) RESPONSIBILITIES.—In carrying out 
this section, the Secretary shall provide for 
the following: 
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‘‘(1) An examination of Medicare and 
Medicaid payment systems to develop 
strategies to foster more integrated and 
higher quality care. 
‘‘(2) Development of methods to facili-
tate access to post-acute and community- 
based services and to identify actions 
that could lead to better coordination of 
community-based care. 
‘‘(3) A study of enrollment of dual eli-
gibles in the Medicare Savings Program 
(as defined in section 1144(c)(7)), under 
Medicaid, and in the low-income subsidy 
program under section 1860D–14 to iden-
tify methods to more efficiently and effec-
tively reach and enroll dual eligibles. 
‘‘(4) An assessment of communication 
strategies for dual eligibles to determine 
whether additional informational mate-
rials or outreach is needed, including an 
assessment of the Medicare website, 1– 
800–MEDICARE, and the Medicare hand-
book. 
‘‘(5) Research and evaluation of areas 
where service utilization, quality, and ac-
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cess to cost sharing protection could be 
improved and an assessment of factors 
related to enrollee satisfaction with serv-
ices and care delivery. 
‘‘(6) Collection (and making available 
to the public) of data and a database that 
describe the eligibility, benefit and cost- 
sharing assistance available to dual eligi-
bles by State. 
‘‘(7) Monitoring total combined Medi-
care and Medicaid program costs in serv-
ing 
dual 
eligibles 
and 
making 
rec-
ommendations for optimizing total qual-
ity and cost performance across both pro-
grams. 
‘‘(8) Coordination of activities relat-
ing to Medicare Advantage plans under 
1859(b)(6)(B)(ii) and Medicaid. 
‘‘(d) PERIODIC REPORTS.—Not later than 1 
year after the date of the enactment of this 
section and every 3 years thereafter the Sec-
retary shall submit to Congress a report on 
progress in activities conducted under this 
section. 
‘‘(e) DEFINITIONS.—In this section: 
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‘‘(1) DUAL
ELIGIBLE.—The term ‘dual 
eligible’ means an individual who is du-
ally eligible for benefits under title XVIII, 
and medical assistance under title XIX, 
including such individuals who are eligi-
ble for benefits under the Medicare Sav-
ings Program (as defined in section 
1144(c)(7)). 
‘‘(2) MEDICARE; MEDICAID.—The terms 
‘Medicare’ and ‘Medicaid’ mean the pro-
grams under titles XVIII and XIX, respec-
tively.’’. 
SEC. 1906. ASSESSMENT OF MEDICARE COST-INTENSIVE 
DISEASES AND CONDITIONS. 
(a) INITIAL ASSESSMENT.— 
(1) IN GENERAL.—The Administrator of 
the Centers for Medicare & Medicaid 
Services shall conduct an assessment of 
the diseases and conditions that are the 
most cost-intensive for the Medicare pro-
gram. The assessment shall inform re-
search priorities within the Department 
of Health and Human Services in order 
improve the prevention, or treatment or 
cure, of such diseases and conditions. 
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(2) REPORT.—Not later than January 
1, 2011, the Administrator shall submit to 
the Secretary of Health and Human Serv-
ices a report on such assessment and the 
Secretary shall transmit such report to 
the Congress. 
(b) UPDATES
OF ASSESSMENT.—Not later 
than January 1, 2013, and biennially there-
after, the Administrator of the Centers for 
Medicare & Medicaid Services shall review 
and update the assessment described in sub-
section (a) and make such recommendations 
to the Secretary on changes in research prior-
ities referred to in such subsection as may be 
appropriate. The Secretary shall submit to 
the Congress a report on such recommenda-
tions. 
(c) MEDICARE
COST-INTENSIVE
RESEARCH 
FUND.—There is established in the Treasury of 
the United States a Fund to be known as the 
Medicare Cost-Intensive Research Fund (in 
this subsection referred to as the ‘‘Fund’’), 
consisting of such amounts as may be appro-
priated or credited to such Fund for research 
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priorities identified as a result of the assess-
ments conducted under this section. 
øDIVISION C—PUBLIC HEALTH 
AND WORKFORCE DEVELOP-
MENT¿ 
øFor division C, see text of bill as intro-
duced on July 14, 2009.¿ 
SECTION 1. SHORT TITLE; TABLE OF DIVISIONS, TITLES, 
AND SUBTITLES. 
(a) TABLE OF DIVISIONS, TITLES, AND SUB-
TITLES.—This Act is divided into divisions, ti-
tles, and subtitles as follows: 
DIVISION A—AFFORDABLE HEALTH CARE CHOICES 
TITLE I—PROTECTIONS AND STANDARDS FOR QUALIFIED 
HEALTH BENEFITS PLANS 
Subtitle A—General Standards 
Subtitle B—Standards Guaranteeing Access to Affordable Cov-
erage 
Subtitle C—Standards Guaranteeing Access to Essential Bene-
fits 
Subtitle D—Additional Consumer Protections 
Subtitle E—Governance 
Subtitle F—Relation to other requirements; Miscellaneous 
Subtitle G—Early Investments 
TITLE II—HEALTH INSURANCE EXCHANGE AND RELATED 
PROVISIONS 
Subtitle A—Health Insurance Exchange 
Subtitle B—Public health insurance option 
Subtitle C—Individual Affordability Credits 
Subtitle D—State innovation 
TITLE III—SHARED RESPONSIBILITY 
Subtitle A—Individual responsibility 
Subtitle B—Employer Responsibility 
[FOR DIVISION B—SEE TEXT OF INTRODUCED BILL] 
DIVISION C—PUBLIC HEALTH AND WORKFORCE 
DEVELOPMENT 
[For titles I through IV of division C, see text of introduced bill.] 
TITLE V—OTHER PROVISIONS 
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[For subtitles A , B, and C of title V, see text of introduced bill.] 
Subtitle D—Grants for comprehensive programs to provide edu-
cation to nurses and create a pipeline to nursing 
[For subtitle E of title V, see text of introduced bill.] 
Subtitle F—Standards for accessibility to medical equipment for 
individuals with disabilities. 
Subtitle G—Other grant programs 
Subtitle H—Long-term care and family caregiver support 
Subtitle I—Online resources 
(b) SHORT TITLE.—This Act may be cited as 
the ‘‘America’s Affordable Health Choices Act 
of 2009’’. 
DIVISION A—AFFORDABLE 
HEALTH CARE CHOICES 
SEC. 100. PURPOSE; TABLE OF CONTENTS OF DIVISION; 
GENERAL DEFINITIONS. 
(a) PURPOSE.— 
(1) IN GENERAL.—The purpose of this 
division is to provide affordable, quality 
health care for all Americans and reduce 
the growth in health care spending. 
(2) BUILDING
ON
CURRENT
SYSTEM.— 
This division achieves this purpose by 
building on what works in today’s health 
care system, while repairing the aspects 
that are broken. 
(3) INSURANCE
REFORMS.—This divi-
sion— 
(A) enacts strong insurance mar-
ket reforms; 
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(B) creates a new Health Insur-
ance Exchange, with a public health 
insurance option alongside private 
plans; 
(C) includes sliding scale afford-
ability credits; and 
(D) initiates shared responsibility 
among workers, employers, and the 
government; 
so that all Americans have coverage of es-
sential health benefits. 
(4) HEALTH DELIVERY REFORM.—This di-
vision institutes health delivery system re-
forms both to increase quality and to re-
duce growth in health spending so that 
health care becomes more affordable for 
businesses, families, and government. 
(b) TABLE OF CONTENTS OF DIVISION.—The 
table of contents of this division is as follows: 
Sec. 100. Purpose; table of contents of division; general defini-
tions. 
TITLE I—PROTECTIONS AND STANDARDS FOR QUALIFIED 
HEALTH BENEFITS PLANS 
Subtitle A—General Standards 
Sec. 101. Requirements reforming health insurance market-
place. 
Sec. 102. Protecting the choice to keep current coverage. 
Subtitle B—Standards Guaranteeing Access to Affordable 
Coverage 
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Sec. 111. Prohibiting pre-existing condition exclusions. 
Sec. 112. Guaranteed issue and renewal for insured plans. 
Sec. 113. Insurance rating rules. 
Sec. 114. Nondiscrimination in benefits; parity in mental health 
and substance abuse disorder benefits. 
Sec. 115. Ensuring adequacy of provider networks. 
Sec. 116. Ensuring value and lower premiums. 
Sec. 117. Consistency of costs and coverage under qualified 
health benefits plans during plan year. 
Subtitle C—Standards Guaranteeing Access to Essential 
Benefits 
Sec. 121. Coverage of essential benefits package. 
Sec. 122. Essential benefits package defined. 
Sec. 123. Health Benefits Advisory Committee. 
Sec. 124. Process for adoption of recommendations; adoption of 
benefit standards. 
Sec. 125. Prohibition of discrimination in health care services 
based on religious or spiritual content. 
Subtitle D—Additional Consumer Protections 
Sec. 131. Requiring fair marketing practices by health insurers. 
Sec. 132. Requiring fair grievance and appeals mechanisms. 
Sec. 133. Requiring information transparency and plan disclo-
sure. 
Sec. 134. Application to qualified health benefits plans not of-
fered through the Health Insurance Exchange. 
Sec. 135. Timely payment of claims. 
Sec. 136. Standardized rules for coordination and subrogation 
of benefits. 
Sec. 137. Application of administrative simplification. 
Sec. 138. Records relative to prescription information. 
Subtitle E—Governance 
Sec. 141. Health Choices Administration; Health Choices Com-
missioner. 
Sec. 142. Duties and authority of Commissioner. 
Sec. 143. Consultation and coordination. 
Sec. 144.
Health Insurance Ombudsman. 
Subtitle F—Relation to Other Requirements; Miscellaneous 
Sec. 151. Relation to other requirements. 
Sec. 152. Prohibiting discrimination in health care. 
Sec. 153. Whistleblower protection. 
Sec. 154. Construction regarding collective bargaining. 
Sec. 155. Severability. 
Sec. 156. Rule of construction regarding Hawaii Prepaid Health 
Care Act. 
Sec. 157. Increasing meaningful use of electronic health records. 
Sec. 158. Private right of contract with health care providers. 
Subtitle G—Early Investments 
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[For sections 161-163. See text of introduced bill.] 
Sec. 164. Reinsurance program for retirees. 
Sec. 165. Prohibition against post-retirement reductions of re-
tiree health benefits by group health plans. 
Sec. 166. Limitations on preexisting condition exclusions in 
group health plans in advance of applicability of 
new prohibition of preexisting condition exclu-
sions. 
Sec. 167. Extension of COBRA continuation coverage. 
TITLE II—HEALTH INSURANCE EXCHANGE AND RELATED 
PROVISIONS 
Subtitle A—Health Insurance Exchange 
Sec. 201. Establishment of Health Insurance Exchange; outline 
of duties; definitions. 
Sec. 202. Exchange-eligible individuals and employers. 
Sec. 203. Benefits package levels. 
Sec. 204. Contracts for the offering of Exchange-participating 
health benefits plans. 
Sec. 205. Outreach and enrollment of Exchange-eligible individ-
uals and employers in Exchange-participating 
health benefits plan. 
Sec. 206. Other functions. 
Sec. 207. Health Insurance Exchange Trust Fund. 
Sec. 208. Optional operation of State-based health insurance 
exchanges. 
Sec. 209. Participation of small employer benefit arrangements. 
Subtitle B—Public Health Insurance Option 
Sec. 221. Establishment and administration of a public health 
insurance option as an Exchange-qualified health 
benefits plan. 
Sec. 222. Premiums and financing. 
Sec. 223. Payment rates for items and services. 
Sec. 224. Modernized payment initiatives and delivery system 
reform. 
Sec. 225. Provider participation. 
Sec. 226. Application of fraud and abuse provisions. 
Sec. 227. Sense of the House regarding enrollment of Members in 
the public option. 
Subtitle C—Individual Affordability Credits 
Sec. 241. Availability through Health Insurance Exchange. 
Sec. 242. Affordable credit eligible individual. 
Sec. 243. Affordable premium credit. 
Sec. 244. Affordability cost-sharing credit. 
Sec. 245. Income determinations. 
Sec. 246. No Federal payment for undocumented aliens. 
Subtitle D—State Innovation 
Sec. 251. Waiver of ERISA limitation; application instead of 
state single payer system. 
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