223 
(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 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00223
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
224 
through providing a link to a Web site 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 Web site described in sec-
tion 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-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00224
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
225 
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. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00225
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
226 
(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. 
(g) HEALTH INSURANCE PLANS.—For purposes of 
this section, the term ‘‘health insurance plan’’ does not 
include coverage of excepted benefits, as defined in section 
2791(c) of the Public Health Service Act (42 U.S.C. 
300gg–91(c)). 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00226
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
227 
TITLE X—PATIENT FREEDOM OF 
CHOICE 
SEC. 1001. GUARANTEEING FREEDOM OF CHOICE AND CON-
TRACTING FOR PATIENTS UNDER MEDICARE. 
(a) IN GENERAL.—Section 1802 of the Social Secu-
rity Act (42 U.S.C. 1395a) is amended to read as follows: 
‘‘FREEDOM OF CHOICE AND CONTRACTING BY PATIENT 
GUARANTEED 
‘‘SEC. 1802. (a) BASIC FREEDOM OF CHOICE.—Any 
individual entitled to insurance benefits under this title 
may obtain health services from any institution, agency, 
or person qualified to participate under this title if such 
institution, agency, or person undertakes to provide that 
individual such services. 
‘‘(b) FREEDOM TO CONTRACT BY MEDICARE BENE-
FICIARIES.— 
‘‘(1) IN GENERAL.—Subject to the provisions of 
this subsection, nothing in this title shall prohibit a 
Medicare beneficiary from entering into a contract 
with an eligible professional (whether or not the pro-
fessional is a participating or non-participating phy-
sician or practitioner) for any item or service cov-
ered under this title. 
‘‘(2) SUBMISSION OF CLAIMS.—Any Medicare 
beneficiary that enters into a contract under this 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00227
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
228 
section with an eligible professional shall be per-
mitted to submit a claim for payment under this 
title for services furnished by such professional, and 
such payment shall be made in the amount that 
would otherwise apply to such professional under 
this title except that where such professional is con-
sidered to be non-participating, payment shall be 
paid as if the professional were participating. Pay-
ment made under this title for any item or service 
provided under the contract shall not render the pro-
fessional a participating or non-participating physi-
cian or practitioner, and as such, requirements of 
this title that may otherwise apply to a participating 
or non-participating physician or practitioner would 
not apply with respect to any items or services fur-
nished under the contract. 
‘‘(3) BENEFICIARY PROTECTIONS.— 
‘‘(A) IN
GENERAL.—Paragraph (1) shall 
not apply to any contract unless— 
‘‘(i) the contract is in writing, is 
signed by the Medicare beneficiary and the 
eligible professional, and establishes all 
terms of the contract (including specific 
payment for items and services covered by 
the contract) before any item or service is 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00228
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
229 
provided pursuant to the contract, and the 
beneficiary shall be held harmless for any 
subsequent payment charged for an item 
or service in excess of the amount estab-
lished under the contract during the period 
the contract is in effect; 
‘‘(ii) the contract contains the items 
described in subparagraph (B); and 
‘‘(iii) the contract is not entered into 
at a time when the Medicare beneficiary is 
facing an emergency medical condition or 
urgent health care situation. 
‘‘(B) ITEMS REQUIRED TO BE INCLUDED 
IN CONTRACT.—Any contract to provide items 
and services to which paragraph (1) applies 
shall clearly indicate to the Medicare beneficiary 
that by signing such contract the beneficiary— 
‘‘(i) agrees to be responsible for pay-
ment to such eligible professional for such 
items or services under the terms of and 
amounts established under the contract; 
‘‘(ii) agrees to be responsible for sub-
mitting claims under this title to the Sec-
retary, and to any other supplemental in-
surance plan that may provide supple-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00229
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
230 
mental insurance, for such items or serv-
ices furnished under the contract if such 
items or services are covered by this title, 
unless otherwise provided in the contract 
under subparagraph (C)(i); and 
‘‘(iii) acknowledges that no limits or 
other payment incentives that may other-
wise apply under this title (such as the 
limits under subsection (g) of section 1848 
or incentives under subsection (a)(5), (m), 
(q), and (p) of such section) shall apply to 
amounts that may be charged, or paid to 
a beneficiary for, such items or services. 
Such contract shall also clearly indicate whether 
the eligible professional is excluded from par-
ticipation under the Medicare program under 
section 1128. 
‘‘(C) BENEFICIARY
ELECTIONS
UNDER 
THE
CONTRACT.—Any Medicare beneficiary 
that enters into a contract under this section 
may elect to negotiate, as a term of the con-
tract, a provision under which— 
‘‘(i) the eligible professional shall file 
claims on behalf of the beneficiary with the 
Secretary and any supplemental insurance 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00230
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
231 
plan for items or services furnished under 
the contract if such items or services are 
covered under this title or under the plan; 
and 
‘‘(ii) the beneficiary assigns payment 
to the eligible professional for any claims 
filed by, or on behalf of, the beneficiary 
with the Secretary and any supplemental 
insurance plan for items or services fur-
nished under the contract. 
‘‘(D) EXCLUSION OF DUAL ELIGIBLE INDI-
VIDUALS.—Paragraph (1) shall not apply to 
any contract if a beneficiary who is eligible for 
medical assistance under title XIX is a party to 
the contract. 
‘‘(4) LIMITATION
ON
ACTUAL
CHARGE
AND 
CLAIM
SUBMISSION
REQUIREMENT
NOT
APPLICA-
BLE.—Section 1848(g) shall not apply with respect 
to any item or service provided to a Medicare bene-
ficiary under a contract described in paragraph (1). 
‘‘(5) CONSTRUCTION.—Nothing in this section 
shall be construed— 
‘‘(A) to prohibit any eligible professional 
from maintaining an election and acting as a 
participating or non-participating physician or 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00231
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
232 
practitioner with respect to any patient not cov-
ered under a contract established under this 
section; and 
‘‘(B) as changing the items and services 
for which an eligible professional may bill under 
this title. 
‘‘(6) DEFINITIONS.—In this subsection: 
‘‘(A) MEDICARE BENEFICIARY.—The term 
‘Medicare beneficiary’ means an individual who 
is entitled to benefits under part A or enrolled 
under part B. 
‘‘(B) ELIGIBLE PROFESSIONAL.—The term 
‘eligible professional’ has the meaning given 
such term in section 1848(k)(3)(B). 
‘‘(C) EMERGENCY MEDICAL CONDITION.— 
The term ‘emergency medical condition’ means 
a medical condition manifesting itself by acute 
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, with 
an average knowledge of health and medicine, 
could reasonably expect the absence of imme-
diate medical attention to result in— 
‘‘(i) serious jeopardy to the health of 
the individual or, in the case of a pregnant 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00232
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
233 
woman, the health of the woman or her 
unborn child; 
‘‘(ii) serious impairment to bodily 
functions; or 
‘‘(iii) serious dysfunction of any bodily 
organ or part. 
‘‘(D) URGENT
HEALTH
CARE
SITUA-
TION.—The term ‘urgent health care situation’ 
means services furnished to an individual who 
requires services to be furnished within 12 
hours in order to avoid the likely onset of an 
emergency medical condition.’’. 
SEC. 
1002. 
PREEMPTION 
OF 
STATE 
LAWS 
LIMITING 
CHARGES 
FOR 
ELIGIBLE 
PROFESSIONAL 
SERVICES. 
(a) IN GENERAL.—No State may impose a limit on 
the amount of charges for services, furnished by an eligible 
professional (as defined in subsection (k)(3)(B) of section 
1848 of the Social Security Act, 42 U.S.C. 1395w–4), for 
which payment is made under such section, and any such 
limit is hereby preempted. 
(b) STATE.—In this section, the term ‘‘State’’ in-
cludes the District of Columbia, Puerto Rico, the Virgin 
Islands, Guam, and American Samoa. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00233
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
234 
SEC. 1003. HEALTH CARE PROVIDER LICENSURE CANNOT 
BE CONDITIONED ON PARTICIPATION IN A 
HEALTH PLAN. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services and any State (as a condition of receiving 
Federal financial participation under title XIX of the So-
cial Security Act) may not require any health care pro-
vider to participate in any health plan as a condition of 
licensure of the provider in any State. 
(b) DEFINITIONS.—In this section: 
(1) HEALTH PLAN.—The term ‘‘health plan’’ 
has the meaning given such term in section 1171(5) 
of the Social Security Act (42 U.S.C. 1320d(5)). 
(2) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any person or entity 
that is required by State or Federal laws or regula-
tions to be licensed, registered, or certified to pro-
vide health care services and is so licensed, reg-
istered, or certified, or exempted from such require-
ment by other statute or regulation. 
(3) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00234
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
235 
SEC. 1004. BAD DEBT DEDUCTION FOR DOCTORS TO PAR-
TIALLY OFFSET THE COST OF PROVIDING UN-
COMPENSATED CARE REQUIRED TO BE PRO-
VIDED UNDER AMENDMENTS MADE BY THE 
EMERGENCY 
MEDICAL 
TREATMENT 
AND 
LABOR ACT. 
(a) IN GENERAL.—Section 166 of the Internal Rev-
enue Code of 1986 (relating to bad debts) is amended by 
redesignating subsection (f) as subsection (g) and by in-
serting after subsection (e) the following new subsection: 
‘‘(f) BAD DEBT TREATMENT FOR DOCTORS TO PAR-
TIALLY OFFSET COST OF PROVIDING UNCOMPENSATED 
CARE REQUIRED TO BE PROVIDED.— 
‘‘(1) AMOUNT OF DEDUCTION.— 
‘‘(A) IN GENERAL.—For purposes of sub-
section (a), the basis for determining the 
amount of any deduction for an eligible 
EMTALA debt shall be treated as being equal 
to the Medicare payment amount. 
‘‘(B) MEDICARE PAYMENT AMOUNT.—For 
purposes of subparagraph (A), the Medicare 
payment amount with respect to an eligible 
EMTALA debt is the fee schedule amount es-
tablished under section 1848 of the Social Secu-
rity Act for the physicians’ service (to which 
such debt relates) as if the service were pro-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00235
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
236 
vided to an individual enrolled under part B of 
title XVIIII of such Act. 
‘‘(2) ELIGIBLE EMTALA DEBT.—For purposes 
of this section, the term ‘eligible EMTALA debt’ 
means any debt if— 
‘‘(A) such debt arose as a result of physi-
cians’ services— 
‘‘(i) which were performed in an 
EMTALA hospital by a board-certified 
physician (whether as part of medical 
screening or necessary stabilizing treat-
ment and whether as an emergency depart-
ment physician, as an on-call physician, or 
otherwise), and 
‘‘(ii) which were required to be pro-
vided under section 1867 of the Social Se-
curity Act (42 U.S.C. 1395dd), and 
‘‘(B) such debt is owed— 
‘‘(i) to such physician, or 
‘‘(ii) to an entity if— 
‘‘(I) such entity is a corporation 
and the sole shareholder of such cor-
poration is such physician, or 
‘‘(II) such entity is a partnership 
and any deduction under this sub-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00236
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
237 
section with respect to such debt is al-
located to such physician or to an en-
tity described in subclause (I). 
‘‘(3) BOARD-CERTIFIED PHYSICIAN.—For pur-
poses of this subsection, the term ‘board-certified 
physician’ means any physician (as defined in sec-
tion 1861(r) of the Social Security Act (42 U.S.C. 
1395x(r)) who is certified by the American Board of 
Emergency Medicine or other appropriate medical 
specialty board for the specialty in which the physi-
cian practices, or who meets comparable require-
ments, as identified by the Secretary of the Treasury 
in consultation with Secretary of Health and Human 
Services. 
‘‘(4) OTHER
DEFINITIONS.—For purposes of 
this subsection— 
‘‘(A) EMTALA 
HOSPITAL.—The term 
‘EMTALA hospital’ means any hospital having 
a hospital emergency department which is re-
quired to comply with section 1867 of the So-
cial Security Act (42 U.S.C. 1395dd) (relating 
to examination and treatment for emergency 
medical conditions and women in labor). 
‘‘(B) PHYSICIANS’ SERVICES.—The term 
‘physicians’ services’ has the meaning given 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00237
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
238 
such term in section 1861(q) of the Social Se-
curity Act (42 U.S.C. 1395x(q)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to debts arising from services per-
formed in taxable years beginning after the date of the 
enactment of this Act. 
SEC. 1005. RIGHT OF CONTRACT WITH HEALTH CARE PRO-
VIDERS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall not preclude an enrollee, partici-
pant, or beneficiary in a health benefits plan from entering 
into any contract or arrangement for health care with any 
health care provider. 
(b) HEALTH BENEFITS PLAN DEFINED.— 
(1) IN GENERAL.—In this section, subject to 
paragraph (2), the term ‘‘health benefits plan’’ 
means any of the following: 
(A) Group health plan (as defined in sec-
tion 2791 of the Public Health Service Act). 
(B) Health insurance coverage (as defined 
in section 2791 of such Act). 
(C) A health benefits plan under chapter 
89 of title 5, United States Code. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00238
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
239 
(2) EXCLUSION OF MEDICAID AND TRICARE.— 
Such term does not include a health plan partici-
pating in— 
(A) the Medicaid program under title XIX 
of the Social Security Act; or 
(B) the TRICARE program under chapter 
55 of title 10, United States Code. 
(c) HEALTH CARE PROVIDER DEFINED.—In this 
section, the term ‘‘health care provider’’ means— 
(1) a physician, as defined in paragraphs (1), 
(2), (3), and (4) of section 1861(r) of the Social Se-
curity Act (42 U.S.C. 1395x(r)); and 
(2) a health care practitioner described in sec-
tion 1842(b)(18)(C) of such Act (42 U.S.C. 
1395u(b)(18)(C)). 
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— 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00239
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
240 
(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 $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 2012 and each fiscal 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: 
‘‘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. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00240
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
241 
‘‘(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— 
‘‘(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 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00241
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
242 
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 
2012 and each fiscal year thereafter.’’. 
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— 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00242
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
243 
(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 
(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. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00243
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
244 
TITLE XII—QUALITY HEALTH 
CARE COALITION 
SEC. 1201. QUALITY HEALTH CARE COALITION. 
(a) APPLICATION
OF
THE FEDERAL ANTITRUST 
LAWS TO HEALTH CARE PROFESSIONALS NEGOTIATING 
WITH HEALTH PLANS.— 
(1) IN
GENERAL.—Any health care profes-
sionals who are engaged in negotiations with a 
health plan regarding the terms of any contract 
under which the professionals provide health care 
items or services for which benefits are provided 
under such plan shall, in connection with such nego-
tiations, be exempt from the Federal antitrust laws. 
(2) LIMITATION.— 
(A) NO NEW RIGHT FOR COLLECTIVE CES-
SATION OF SERVICE.—The exemption provided 
in paragraph (1) shall not confer any new right 
to participate in any collective cessation of serv-
ice to patients not already permitted by existing 
law. 
(B) NO CHANGE IN NATIONAL LABOR RE-
LATIONS
ACT.—This section applies only to 
health care professionals excluded from the Na-
tional Labor Relations Act. Nothing in this sec-
tion shall be construed as changing or amend-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00244
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
245 
ing any provision of the National Labor Rela-
tions Act, or as affecting the status of any 
group of persons under that Act. 
(3) NO
APPLICATION
TO
FEDERAL
PRO-
GRAMS.—Nothing in this section shall apply to nego-
tiations between health care professionals and health 
plans pertaining to benefits provided under any of 
the following: 
(A) The Medicare Program under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(B) The Medicaid program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et 
seq.). 
(C) The SCHIP program under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.). 
(D) Chapter 55 of title 10, United States 
Code (relating to medical and dental care for 
members of the uniformed services). 
(E) Chapter 17 of title 38, United States 
Code (relating to Veterans’ medical care). 
(F) Chapter 89 of title 5, United States 
Code (relating to the Federal employees’ health 
benefits program). 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00245
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
246 
(G) The Indian Health Care Improvement 
Act (25 U.S.C. 1601 et seq.). 
(b) DEFINITIONS.—In this section, the following defi-
nitions shall apply: 
(1) ANTITRUST
LAWS.—The term ‘‘antitrust 
laws’’— 
(A) has the meaning given it in subsection 
(a) of the first section of the Clayton Act (15 
U.S.C. 12(a)), except that such term includes 
section 5 of the Federal Trade Commission Act 
(15 U.S.C. 45) to the extent such section ap-
plies to unfair methods of competition; and 
(B) includes any State law similar to the 
laws referred to in subparagraph (A). 
(2) GROUP HEALTH PLAN.—The term ‘‘group 
health plan’’ means an employee welfare benefit plan 
to the extent that the plan provides medical care (in-
cluding items and services paid for as medical care) 
to employees or their dependents (as defined under 
the terms of the plan) directly or through insurance, 
reimbursement, or otherwise. 
(3) GROUP HEALTH PLAN, HEALTH INSURANCE 
ISSUER.—The terms ‘‘group health plan’’ and 
‘‘health insurance issuer’’ include a third-party ad-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00246
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
247 
ministrator or other person acting for or on behalf 
of such plan or issuer. 
(4) 
HEALTH
CARE
SERVICES.—The 
term 
‘‘health care services’’ means any services for which 
payment may be made under a health plan, includ-
ing services related to the delivery or administration 
of such services. 
(5) HEALTH CARE PROFESSIONAL.—The term 
‘‘health care professional’’ means any individual or 
entity that provides health care items or services, 
treatment, assistance with activities of daily living, 
or medications to patients and who, to the extent re-
quired by State or Federal law, possesses specialized 
training that confers expertise in the provision of 
such items or services, treatment, assistance, or 
medications. 
(6) HEALTH INSURANCE COVERAGE.—The term 
‘‘health insurance coverage’’ means benefits con-
sisting of medical care (provided directly, through 
insurance or reimbursement, or otherwise and in-
cluding items and services paid for as medical care) 
under any hospital or medical service policy or cer-
tificate, hospital or medical service plan contract, or 
health maintenance organization contract offered by 
a health insurance issuer. 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00247
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
248 
(7) HEALTH
INSURANCE
ISSUER.—The term 
‘‘health insurance issuer’’ means an insurance com-
pany, insurance service, or insurance organization 
(including a health maintenance organization) that 
is licensed to engage in the business of insurance in 
a State and that is subject to State law regulating 
insurance. Such term does not include a group 
health plan. 
(8) HEALTH MAINTENANCE ORGANIZATION.— 
The 
term 
‘‘health 
maintenance 
organization’’ 
means— 
(A) a federally qualified health mainte-
nance organization (as defined in section 
1301(a) of the Public Health Service Act (42 
U.S.C. 300e(a))); 
(B) an organization recognized under State 
law as a health maintenance organization; or 
(C) a similar organization regulated under 
State law for solvency in the same manner and 
to the same extent as such a health mainte-
nance organization. 
(9) HEALTH PLAN.—The term ‘‘health plan’’ 
means a group health plan or a health insurance 
issuer that is offering health insurance coverage. 
VerDate Mar 15 2010 
05:20 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00248
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
249 
(10) MEDICAL
CARE.—The term ‘‘medical 
care’’ means amounts paid for— 
(A) the diagnosis, cure, mitigation, treat-
ment, or prevention of disease, or amounts paid 
for the purpose of affecting any structure or 
function of the body; and 
(B) transportation primarily for and essen-
tial to receiving items and services referred to 
in subparagraph (A). 
(11) PERSON.—The term ‘‘person’’ includes a 
State or unit of local government. 
(12) STATE.—The term ‘‘State’’ includes the 
several States, the District of Columbia, Puerto 
Rico, the Virgin Islands of the United States, Guam, 
American Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
(c) EFFECTIVE DATE.—This section shall take effect 
on on the date of the enactment of this Act and shall not 
apply with respect to conduct occurring before such date. 
TITLE XIII—OFFSETS 
Subtitle A—Discretionary 
Spending Limits 
SEC. 1301. DISCRETIONARY SPENDING LIMITS. 
Section 251(c) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985 (2 U.S.C. 901(c)), as 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00249
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
250 
amended by section 101 of the Budget Control Act of 
2011, is amended to read as follows: 
‘‘(c) DISCRETIONARY SPENDING LIMIT.—As used in 
this part, the term ‘discretionary spending limit’ means— 
‘‘(1) with respect to fiscal year 2012— 
‘‘(A) 
for 
the 
security 
category, 
$684,000,000,000 in new budget authority; and 
‘‘(B) 
for 
the 
nonsecurity 
category, 
$359,000,000,000 in new budget authority; 
‘‘(2) with respect to fiscal year 2013— 
‘‘(A) 
for 
the 
security 
category, 
$698,000,000,000 in new budget authority; and 
‘‘(B) 
for 
the 
nonsecurity 
category, 
$329,000,000,000 in new budget authority; 
‘‘(3) with respect to fiscal year 2014, for the 
discretionary category, $1,038,537,000,000 in new 
budget authority; 
‘‘(4) with respect to fiscal year 2015, for the 
discretionary category, $1,046,680,000,000 in new 
budget authority; 
‘‘(5) with respect to fiscal year 2016, for the 
discretionary category, $1,055,779,000,000 in new 
budget authority; 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00250
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
251 
‘‘(6) with respect to fiscal year 2017, for the 
discretionary category, $1,067,794,000,000 in new 
budget authority; 
‘‘(7) with respect to fiscal year 2018, for the 
discretionary category, $1,085,259,000,000 in new 
budget authority; 
‘‘(8) with respect to fiscal year 2019, for the 
discretionary category, $1,103,802,000,000 in new 
budget authority; 
‘‘(9) with respect to fiscal year 2020, for the 
discretionary category, $1,122,611,000,000 in new 
budget authority; and 
‘‘(10) with respect to fiscal year 2021, for the 
discretionary category, $1,141,640,000,000 in new 
budget authority; 
as adjusted in strict conformance with subsection (b).’’. 
Subtitle B—Savings From Health 
Care Efficiencies 
SEC. 1311. MEDICARE DSH REPORT AND PAYMENT ADJUST-
MENTS IN RESPONSE TO COVERAGE EXPAN-
SION. 
(a) DSH REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2016, the Secretary of Health and Human Services 
shall submit to Congress a report on Medicare DSH 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00251
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
252 
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. 
(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 1322(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 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00252
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
253 
of this Act (as determined under paragraph (2)(A)), 
then the Secretary of Health and Human Services 
shall, beginning in fiscal year 2017, 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-
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— 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00253
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
254 
(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 2012 to 2014 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. 
(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— 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00254
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
255 
(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. 
SEC. 1312. REDUCTION IN MEDICAID DSH. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2016, 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 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00255
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
256 
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. 
(3) COORDINATION WITH MEDICARE DSH RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicare 
DSH under section 1321. 
(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.— 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00256
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
257 
(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 
1321(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 2017, 
$2,500,000,000 
in 
fiscal 
year 
2018, 
and 
$6,000,000,000 in fiscal year 2019. 
(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— 
(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 
VerDate Mar 15 2010 
05:20 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00257
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
258 
(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). 
(B) PUBLICATION DEADLINE.—The publi-
cation deadline specified in this subparagraph 
is— 
(i) January 1, 2016, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2017; 
(ii) January 1, 2017, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2018; and 
(iii) January 1, 2018, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2019. 
(c) CONFORMING AMENDMENTS.— 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00258
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
259 
(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 2017, 
2018, AND 2019.—Notwithstanding paragraph (2), if 
the Secretary makes a reduction under section 
1322(b)(1) of the Empowering Patients First Act, 
the total DSH allotments for all States for— 
‘‘(A) fiscal year 2017, 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 2018, 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 2019, 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-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00259
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
260 
riod the following: ‘‘or to affect the authority of the 
Secretary to issue and implement the DSH Health 
Reform methodology under section 1322(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: 
‘‘(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 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00260
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
261 
‘‘(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, 2012. 
Subtitle C—Fraud, Waste, and 
Abuse 
SEC. 1321. 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 at the 
end ‘‘and’’; 
(B) in subclause (V)— 
(i) by striking ‘‘for each fiscal year 
after fiscal year 2010’’ and inserting ‘‘for 
fiscal year 2011’’; and 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00261
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
262 
‘‘(VI) for each fiscal year after 
fiscal year 2011, $300,000,000.’’; and 
(2) in clause (ii)— 
(A) in subclause (IX), by striking at the 
end ‘‘and’’; 
(B) in subclause (X)— 
(i) by striking ‘‘for each fiscal year 
after fiscal year 2010’’ and inserting ‘‘for 
fiscal year 2011’’; and 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(XI) for each fiscal year after 
fiscal year 2011, not less than the 
amount required under this clause for 
fiscal year 2011, plus the amount by 
which the amount made available 
under clause (i)(VI) for fiscal year 
2012 exceeds the amount made avail-
able under clause (i)(V) for fiscal year 
2011.’’. 
(b) OIG FUNDING.—There are authorized to be ap-
propriated for each of fiscal years 2012 through 2021 
$100,000,000 for the Office of the Inspector General of 
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00262
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS
268 
(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-
VerDate Mar 15 2010 
01:39 Sep 23, 2011
Jkt 099200
PO 00000
Frm 00268
Fmt 6652
Sfmt 6201
E:\BILLS\H3000.IH
H3000
pwalker on DSK5TPTVN1PROD with BILLS