1126 
shall submit to the Administrator of the Centers for Medi-
care & Medicaid Services— 
‘‘(1) information on the determination of rates 
of payment to providers for covered services under 
the State plan, including— 
‘‘(A) the final rates; 
‘‘(B) the methodologies used to determine 
such rates; and 
‘‘(C) justifications for the rates; and 
‘‘(2) an explanation of the process used by the 
State to allow providers, beneficiaries and their rep-
resentatives, and other concerned State residents a 
reasonable opportunity to review and comment on 
such rates, methodologies, and justifications before 
the State made such rates final.’’. 
SEC. 1747. REVIEWS OF MEDICAID. 
(a) GAO STUDY ON FMAP.—. 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study regarding Fed-
eral payments made to the State Medicaid programs 
under title XIX of the Social Security Act for the 
purposes of making recommendations to Congress. 
(2) REPORT.—Not later than February 15, 
2011, the Comptroller General shall submit to the 
appropriate committees of Congress a report on the
1127 
study conducted under paragraph (1) and the effect 
on the Federal government, States, providers, and 
beneficiaries of— 
(A) removing the 50 percent floor, or 83 
percent ceiling, or both, in the Federal medical 
assistance percentage under section 1905(b)(1) 
of the Social Security Act; and 
(B) revising the current formula for such 
Federal medical assistance percentage to better 
reflect State fiscal capacity and State effort to 
pay for health and long-term care services and 
to better adjust for national or regional eco-
nomic downturns. 
(b) GAO STUDY
ON MEDICAID ADMINISTRATIVE 
COSTS.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study of the adminis-
tration of the Medicaid program by the Department 
of Health and Human Services, State Medicaid 
agencies, and local government agencies. The report 
shall address the following issues: 
(A) The extent to which Federal funds for 
each administrative function, such as survey 
and certification and claims processing, are 
being used effectively and efficiently.
1128 
(B) The administrative functions on which 
Federal Medicaid funds are expended and the 
amounts of such expenditures (whether spent 
directly or by contract). 
(2) REPORT.—Not later than February 15, 
2011, the Comptroller General shall submit to the 
appropriate committees of Congress a report on the 
study conducted under paragraph (1). 
SEC. 1748. EXTENSION OF DELAY IN MANAGED CARE ORGA-
NIZATION PROVIDER TAX ELIMINATION. 
Effective as if included in the enactment of section 
6051 of the Deficit Reduction Act of 2005 (Public Law 
109–171), subsection (b)(2)(A) of such section is amended 
by striking ‘‘October 1, 2009’’ and inserting ‘‘October 1, 
2010’’. 
SEC. 1749. EXTENSION OF ARRA INCREASE IN FMAP. 
Section 5001 of the American Recovery and Reinvest-
ment Act of 2009 (Public Law 111–5) is amended— 
(1) in subsection (a)(3), by striking ‘‘first cal-
endar quarter’’ and inserting ‘‘first 3 calendar quar-
ters’’; 
(2) in subsection (b)(2), by inserting before the 
period at the end the following: ‘‘and such para-
graph shall not apply to calendar quarters beginning 
on or after October 1, 2010’’;
1129 
(3) in subsection (c)(4)(C)(ii), by striking ‘‘De-
cember 2009’’ and ‘‘January 2010’’ and inserting 
‘‘June 2010’’ and ‘‘July 2010’’, respectively; 
(4) in subsection (d), by inserting ‘‘ending be-
fore October 1, 2010’’ after ‘‘entire fiscal years’’ and 
after ‘‘with respect to fiscal years’’; 
(5) in subsection (g)(1), by striking ‘‘September 
30, 2011’’ and inserting ‘‘December 31, 2011’’; and 
(6) in subsection (h)(3), by striking ‘‘December 
31, 2010’’ and inserting ‘‘June 30, 2011’’. 
Subtitle F—Waste, Fraud, and 
Abuse 
SEC. 1751. HEALTH CARE ACQUIRED CONDITIONS. 
(a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH 
CARE-ACQUIRED CONDITIONS.—Section 1903(i) of the 
Social Security Act (42 U.S.C. 1396b(i)) is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(23); 
(2) by striking the period at the end of para-
graph (24) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (24) the fol-
lowing new paragraph: 
‘‘(25) with respect to amounts expended for 
services related to the presence of a condition that 
could be identified by a secondary diagnostic code
1130 
described in section 1886(d)(4)(D)(iv) and for any 
health care acquired condition determined as a non- 
covered service under title XVIII.’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1)(G) 
of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by 
striking ‘‘and (17)’’ and inserting ‘‘(17), and (25)’’. 
(c) PERMISSION TO INCLUDE ADDITIONAL HEALTH 
CARE-ACQUIRED CONDITIONS.—Nothing in this section 
shall prevent a State from including additional health 
care-acquired conditions for non-payment in its Medicaid 
program under title XIX of the Social Security Act. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to discharges occurring on or after 
January 1, 2010. 
SEC. 1752. EVALUATIONS AND REPORTS REQUIRED UNDER 
MEDICAID INTEGRITY PROGRAM. 
Section 1936(c)(2)) of the Social Security Act (42 
U.S.C. 1396u–7(c)(2)) is amended— 
(1) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(2) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(D) For the contract year beginning in 
2011 and each subsequent contract year, the 
entity provides assurances to the satisfaction of
1131 
the Secretary that the entity will conduct peri-
odic evaluations of the effectiveness of the ac-
tivities carried out by such entity under the 
Program and will submit to the Secretary an 
annual report on such activities.’’. 
SEC. 1753. REQUIRE PROVIDERS AND SUPPLIERS TO 
ADOPT 
PROGRAMS 
TO 
REDUCE 
WASTE, 
FRAUD, AND ABUSE. 
Section 1902(a) of such Act (42 U.S.C. 42 U.S.C. 
1396a(a)), as amended by sections 1631(b)(1), 1703, and 
1729, is further amended— 
(1) in paragraph (75), by striking at the end 
‘‘and’’; 
(2) in paragraph (76), by striking at the end 
the period and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (76) the fol-
lowing new paragraph: 
‘‘(77) provide that any provider or supplier 
(other than a physician or nursing facility) providing 
services under such plan shall, subject to paragraph 
(5) of section 1874(d), establish a compliance pro-
gram described in paragraph (1) of such section in 
accordance with such section.’’.
1134 
SEC. 1756. TERMINATION OF PROVIDER PARTICIPATION 
UNDER MEDICAID AND CHIP IF TERMINATED 
UNDER MEDICARE OR OTHER STATE PLAN 
OR CHILD HEALTH PLAN. 
(a) 
STATE
PLAN
REQUIREMENT.—Section 
1902(a)(39) of the Social Security Act (42 U.S.C. 42 
U.S.C. 1396a(a)) is amended by inserting after ‘‘1128A,’’ 
the following: ‘‘terminate the participation of any indi-
vidual or entity in such program if (subject to such excep-
tions are permitted with respect to exclusion under sec-
tions 1128(b)(3)(C) and 1128(d)(3)(B)) participation of 
such individual or entity is terminated under title XVIII, 
any other State plan under this title, or any child health 
plan under title XXI,’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1)(A) 
of such Act (42 U.S.C. 1397gg(e)(1)(A)) is amended by 
inserting before the period at the end the following: ‘‘and 
section 1902(a)(39) (relating to exclusion and termination 
of participation)’’. 
(c) EFFECTIVE DATE.—Except as provided in section 
1790, the amendments made by this section shall apply 
to services furnished on or after January 1, 2011, without 
regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date.
1135 
SEC. 1757. MEDICAID AND CHIP EXCLUSION FROM PARTICI-
PATION RELATING TO CERTAIN OWNERSHIP, 
CONTROL, AND MANAGEMENT AFFILIATIONS. 
(a) STATE PLAN REQUIREMENT.—Section 1902(a) 
of the Social Security Act (42 U.S.C. 1396a(a)), as 
amended by sections 1631(b)(1), 1703(a), 1729, and 
1753, is further amended— 
(1) in paragraph (76), by striking at the end 
‘‘and’’; 
(2) in paragraph (77), by striking at the end 
the period and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (77) the fol-
lowing new paragraph: 
‘‘(78) provide that the State agency described 
in paragraph (9) exclude, with respect to a period, 
any individual or entity from participation in the 
program under the State plan if such individual or 
entity owns, controls, or manages an entity that (or 
if such entity is owned, controlled, or managed by an 
individual or entity that)— 
‘‘(A) has unpaid overpayments under this 
title during such period determined by the Sec-
retary or the State agency to be delinquent; 
‘‘(B) is suspended or excluded from par-
ticipation under or whose participation is termi-
nated under this title during such period; or
1136 
‘‘(C) is affiliated with an individual or enti-
ty that has been suspended or excluded from 
participation under this title or whose participa-
tion is terminated under this title during such 
period.’’. 
(b) CHILD HEALTH PLAN REQUIREMENT.—Section 
2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)), 
as amended by section 1756(b), is amended by striking 
‘‘section 
1902(a)(39)’’ 
and 
inserting 
‘‘sections 
1902(a)(39) and 1902(a)(78)’’. 
(c) EFFECTIVE DATE.—Except as provided in section 
1790, the amendments made by this section shall apply 
to services furnished on or after January 1, 2011, without 
regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date. 
SEC. 1758. REQUIREMENT TO REPORT EXPANDED SET OF 
DATA ELEMENTS UNDER MMIS TO DETECT 
FRAUD AND ABUSE. 
Section 1903(r)(1)(F) of the Social Security Act (42 
U.S.C. 1396b(r)(1)(F)) is amended by inserting after 
‘‘necessary’’ the following: ‘‘and including, for data sub-
mitted to the Secretary on or after July 1, 2010, data 
elements from the automated data system that the Sec-
retary determines to be necessary for detection of waste, 
fraud, and abuse’’.
1137 
SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER 
ALTERNATE PAYEES REQUIRED TO REG-
ISTER UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended 
by sections 1631(b), 1703(a), 1729, 1753, and 1757(a), 
is further amended— 
(1) in paragraph (77); by striking at the end 
‘‘and’’; 
(2) in paragraph (78), by striking the period at 
the end and inserting ‘‘and’’; and 
(3) by inserting after paragraph (78) the fol-
lowing new paragraph: 
‘‘(79) provide that any agent, clearinghouse, or 
other alternate payee that submits claims on behalf 
of a health care provider must register with the 
State and the Secretary in a form and manner speci-
fied by the Secretary under section 1866(j)(1)(D).’’. 
(b) DENIAL OF PAYMENT.—Section 1903(i) of such 
Act (42 U.S.C. 1396b(i)), as amended by section 1751, 
is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(24); 
(2) by striking the period at the end of para-
graph (25) and inserting ‘‘; or’’; and
1138 
(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
‘‘(26) with respect to any amount paid to a bill-
ing agent, clearinghouse, or other alternate payee 
that is not registered with the State and the Sec-
retary as required under section 1902(a)(79).’’. 
(c) EFFECTIVE DATE.—Except as provided in section 
1790, the amendments made by this section shall apply 
to claims submitted on or after January 1, 2012, without 
regard to whether or not final regulations to carry out 
such amendments have been promulgated by such date. 
SEC. 1760. DENIAL OF PAYMENTS FOR LITIGATION-RE-
LATED MISCONDUCT. 
(a) IN GENERAL.—Section 1903(i) of the Social Se-
curity Act (42 U.S.C. 1396b(i)), as amended by sections 
1751(a) and 1759(b), is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(25); 
(2) by striking the period at the end of para-
graph (26) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (26) the fol-
lowing new paragraph: 
‘‘(27) with respect to any amount expended—
1139 
‘‘(A) on litigation in which a court imposes 
sanctions on the State, its employees, or its 
counsel for litigation-related misconduct; or 
‘‘(B) to reimburse (or otherwise com-
pensate) a managed care entity for payment of 
legal expenses associated with any action in 
which a court imposes sanctions on the man-
aged care entity for litigation-related mis-
conduct.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to amounts expended on or after 
January 1, 2010. 
SEC. 1761. MANDATORY STATE USE OF NATIONAL CORRECT 
CODING INITIATIVE. 
Section 1903(r) of the Social Security Act (42 U.S.C. 
1396b(r)) is amended— 
(1) in paragraph (1)(B)— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by adding ‘‘and’’ at the 
end; and 
(C) by adding at the end the following new 
clause: 
‘‘(iv) effective for claims filed on or 
after October 1, 2010, incorporate compat-
1140 
ible methodologies of the National Correct 
Coding Initiative administered by the Sec-
retary (or any successor initiative to pro-
mote correct coding and to control im-
proper coding leading to inappropriate pay-
ment) and such other methodologies of 
that Initiative (or such other national cor-
rect coding methodologies) as the Sec-
retary identifies in accordance with para-
graph (4);’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) Not later than September 1, 2010, the Secretary 
shall do the following: 
‘‘(A) Identify those methodologies of the Na-
tional Correct Coding Initiative administered by the 
Secretary (or any successor initiative to promote cor-
rect coding and to control improper coding leading 
to inappropriate payment) which are compatible to 
claims filed under this title. 
‘‘(B) Identify those methodologies of such Ini-
tiative (or such other national correct coding meth-
odologies) that should be incorporated into claims 
filed under this title with respect to items or services 
for which States provide medical assistance under
1141 
this title and no national correct coding methodolo-
gies have been established under such Initiative with 
respect to title XVIII. 
‘‘(C) Notify States of— 
‘‘(i) the methodologies identified under 
subparagraphs (A) and (B) (and of any other 
national correct coding methodologies identified 
under subparagraph (B)); and 
‘‘(ii) how States are to incorporate such 
methodologies into claims filed under this title. 
‘‘(D) Submit a report to Congress that includes 
the notice to States under subparagraph (C) and an 
analysis supporting the identification of the meth-
odologies made under subparagraphs (A) and (B).’’. 
Subtitle G—Payments to the 
Territories 
SEC. 1771. PAYMENT TO TERRITORIES. 
(a) INCREASE IN CAP.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
(1) in subsection (f), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; 
(2) in subsection (g)(1), by striking ‘‘With re-
spect to’’ and inserting ‘‘Subject to subsection (h), 
with respect to’’; and
1142 
(3) by adding at the end the following new sub-
section: 
‘‘(h) ADDITIONAL INCREASE
FOR FISCAL YEARS 
2011 THROUGH 2019.—Subject to section 347(b)(1) of 
the Affordable Health Care for America Act, with respect 
to fiscal years 2011 through 2019, the amounts otherwise 
determined under subsections (f) and (g) for Puerto Rico, 
the Virgin Islands, Guam, the Northern Mariana Islands 
and American Samoa shall be increased by the following 
amounts: 
‘‘(1) For Puerto Rico, for fiscal year 2011, 
$727,600,000; for fiscal year 2012, $775,000,000; 
for fiscal year 2013, $850,000,000; for fiscal year 
2014, 
$925,000,000; 
for 
fiscal 
year 
2015, 
$1,000,000,000; 
for 
fiscal 
year 
2016, 
$1,075,000,000; 
for 
fiscal 
year 
2017, 
$1,150,000,000; 
for 
fiscal 
year 
2018, 
$1,225,000,000; 
and 
for 
fiscal 
year 
2019, 
$1,396,400,000. 
‘‘(2) For the Virgin Islands, for fiscal year 
2011, 
$34,000,000; 
for 
fiscal 
year 
2012, 
$37,000,000; for fiscal year 2013, $40,000,000; for 
fiscal year 2014, $43,000,000; for fiscal year 2015, 
$46,000,000; for fiscal year 2016, $49,000,000; for
1143 
fiscal year 2017, $52,000,000; for fiscal year 2018, 
$55,000,000; and for fiscal year 2019, $58,000,000. 
‘‘(3) 
For 
Guam, 
for 
fiscal 
year 
2011, 
$34,000,000; for fiscal year 2012, $37,000,000; for 
fiscal year 2013, $40,000,000; for fiscal year 2014, 
$43,000,000; for fiscal year 2015, $46,000,000; for 
fiscal year 2016, $49,000,000; for fiscal year 2017, 
$52,000,000; for fiscal year 2018, $55,000,000; and 
for fiscal year 2019, $58,000,000. 
‘‘(4) For the Northern Mariana Islands, for fis-
cal year 2011, $13,500,000; fiscal year 2012, 
$14,500,000; for fiscal year 2013, $15,500,000; for 
fiscal year 2014, $16,500,000; for fiscal year 2015, 
$17,500,000; for fiscal year 2016, $18,500,000; for 
fiscal year 2017, $19,500,000; for fiscal year 2018, 
$21,000,000; and for fiscal year 2019, $22,000,000. 
‘‘(5) For American Samoa, fiscal year 2011, 
$22,000,000; fiscal year 2012, $23,687,500; for fis-
cal year 2013, $24,687,500; for fiscal year 2014, 
$25,687,500; for fiscal year 2015, $26,687,500; for 
fiscal year 2016, $27,687,500; for fiscal year 2017, 
$28,687,500; for fiscal year 2018, $29,687,500; and 
for fiscal year 2019, $30,687,500.’’. 
(b) REPORT ON ACHIEVING MEDICAID PARITY PAY-
MENTS BEGINNING WITH FISCAL YEAR 2020.—
1144 
(1) IN GENERAL.—Not later than October 1, 
2013, the Secretary of Health and Human Services 
shall submit to Congress a report that details a plan 
for the transition of each territory to full parity in 
Medicaid with the 50 States and the District of Co-
lumbia in fiscal year 2020 by modifying their exist-
ing Medicaid programs and outlining actions the 
Secretary and the governments of each territory 
must take by fiscal year 2020 to ensure parity in fi-
nancing. Such report shall include what the Federal 
medical assistance percentages would be for each 
territory if the formula applicable to the 50 States 
were applied. Such report shall also include any rec-
ommendations that the Secretary may have as to 
whether the mandatory ceiling amounts for each ter-
ritory provided for in section 1108 of the Social Se-
curity Act (42 U.S.C. 1308) should be increased any 
time before fiscal year 2020 due to any factors that 
the Secretary deems relevant. 
(2) PER CAPITA DATA.—As part of such report 
the Secretary shall include information about per 
capita income data that could be used to calculate 
Federal medical assistance percentages under section 
1905(b) of the Social Security Act, under section 
1108(a)(8)(B) of such Act, for each territory on how
1145 
such data differ from the per capita income data 
used to promulgate Federal medical assistance per-
centages for the 50 States. The report under this 
subsection shall include recommendations on how 
the Federal medical assistance percentages can be 
calculated for the territories beginning in fiscal year 
2020 to ensure parity with the 50 States. 
(3) SUBSEQUENT
REPORTS.—The Secretary 
shall submit subsequent reports to Congress in 
2015, 2017, and 2019 detailing the progress that 
the Secretary and the governments of each territory 
have made in fulfilling the actions outlined in the 
plan submitted under paragraph (1). 
(c) APPLICATION
OF
FMAP 
FOR
ADDITIONAL 
FUNDS.—Section 1905(b) of such Act (42 U.S.C. 
1396d(b)) is amended by adding at the end the following 
sentence: ‘‘Notwithstanding the first sentence of this sub-
section and any other provision of law, for fiscal years 
2011 through 2019, the Federal medical assistance per-
centage for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, and American Samoa shall be 
the highest Federal medical assistance percentage applica-
ble to any of the 50 States or the District of Columbia 
for the fiscal year involved, taking into account the appli-
cation of subsections (a) and (b)(1) of section 5001 of di-
1147 
pate meeting reporting requirements necessary to imple-
ment the plan contained in the report under subsection 
(b)(1). 
Subtitle H—Miscellaneous 
SEC. 1781. TECHNICAL CORRECTIONS. 
(a) TECHNICAL CORRECTION TO SECTION 1144 OF 
THE SOCIAL SECURITY ACT.—The first sentence of sec-
tion 1144(c)(3) of the Social Security Act (42 U.S.C. 
1320b—14(c)(3)) is amended— 
(1) by striking ‘‘transmittal’’; and 
(2) by inserting before the period the following: 
‘‘as specified in section 1935(a)(4)’’. 
(b) CLARIFYING AMENDMENT TO SECTION 1935 OF 
THE SOCIAL SECURITY ACT.—Section 1935(a)(4) of the 
Social Security Act (42 U.S.C. 1396u—5(a)(4)), as 
amended by section 113(b) of Public Law 110–275, is 
amended— 
(1) by striking the second sentence; 
(2) by redesignating the first sentence as a sub-
paragraph (A) with appropriate indentation and 
with the following heading: ‘‘IN GENERAL.—’’; 
(3) by adding at the end the following subpara-
graphs: 
‘‘(B) FURNISHING
MEDICAL
ASSISTANCE 
WITH
REASONABLE
PROMPTNESS.—For the
1148 
purpose of a State’s obligation under section 
1902(a)(8) to furnish medical assistance with 
reasonable promptness, the date of the elec-
tronic transmission of low-income subsidy pro-
gram data, as described in section 1144(c), 
from the Commissioner of Social Security to the 
State Medicaid Agency, shall constitute the date 
of filing of such application for benefits under 
the Medicare Savings Program. 
‘‘(C) 
DETERMINING
AVAILABILITY
OF 
MEDICAL ASSISTANCE.—For the purpose of de-
termining when medical assistance will be made 
available, the State shall consider the date of 
the individual’s application for the low income 
subsidy program to constitute the date of filing 
for benefits under the Medicare Savings Pro-
gram.’’. 
(c) EFFECTIVE
DATE
RELATING
TO
MEDICAID 
AGENCY CONSIDERATION OF LOW-INCOME SUBSIDY AP-
PLICATION AND DATA TRANSMITTAL.—The amendments 
made by subsections (a) and (b) shall be effective as if 
included in the enactment of section 113(b) of Public Law 
110–275. 
(d) TECHNICAL CORRECTION TO SECTION 605 OF 
CHIPRA.—Section 605 of the Children’s Health Insur-
1149 
ance Program Reauthorization Act of 2009 (Public Law 
111–3) is amended by striking ‘‘legal residents’’ and in-
serting ‘‘lawfully residing in the United States’’. 
(e) TECHNICAL CORRECTION TO SECTION 1905 OF 
THE SOCIAL SECURITY ACT.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amended by in-
serting ‘‘or the care and services themselves, or both’’ be-
fore ‘‘(if provided in or after’’. 
(f) CLARIFYING AMENDMENT TO SECTION 1115 OF 
THE SOCIAL SECURITY ACT.—Section 1115(a) of the So-
cial Security Act (42 U.S.C. 1315(a)) is amended by add-
ing at the end the following: ‘‘If an experimental, pilot, 
or demonstration project that relates to title XIX is ap-
proved pursuant to any part of this subsection, such 
project shall be treated as part of the State plan, all med-
ical assistance provided on behalf of any individuals af-
fected by such project shall be medical assistance provided 
under the State plan, and all provisions of this Act not 
explicitly waived in approving such project shall remain 
fully applicable to all individuals receiving benefits under 
the State plan.’’. 
SEC. 1782. EXTENSION OF QI PROGRAM. 
(a) IN GENERAL.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iv)) is 
amended—
1150 
(1) by striking ‘‘sections 1933 and’’ and by in-
serting ‘‘section’’; and 
(2) by striking ‘‘December 2010’’ and inserting 
‘‘December 2012’’. 
(b) ELIMINATION OF FUNDING LIMITATION.— 
(1) IN GENERAL.—Section 1933 of such Act 
(42 U.S.C. 1396u–3) is amended— 
(A) in subsection (a), by striking ‘‘who are 
selected to receive such assistance under sub-
section (b)’’; 
(B) by striking subsections (b), (c), (e), 
and (g); 
(C) in subsection (d), by striking ‘‘fur-
nished in a State’’ and all that follows and in-
serting ‘‘the Federal medical assistance percent-
age shall be equal to 100 percent.’’; and 
(D) by redesignating subsections (d) and 
(f) as subsections (b) and (c), respectively. 
(2) 
CONFORMING
AMENDMENT.—Section 
1905(b) of such Act (42 U.S.C. 1396d(b)) is amend-
ed by striking ‘‘1933(d)’’ and inserting ‘‘1933(b)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on January 1, 
2011.
1151 
SEC. 1783. ASSURING TRANSPARENCY OF INFORMATION. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 1396a(a)), as amended by sections 
1631(b), 1703(a), 1729, 1753, 1757(a), 1759(a), and 
1907(b), is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(79); 
(2) by striking the period at the end of para-
graph (80) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (80) the fol-
lowing new paragraph: 
‘‘(81) provide that the State will establish and 
maintain laws, in accordance with the requirements 
of section 1921A, to require disclosure of informa-
tion on hospital charges and quality and to make 
such information available to the public and the Sec-
retary.’’; and 
(4) by inserting after section 1921 the following 
new section: 
‘‘HOSPITAL PRICE TRANSPARENCY 
‘‘SEC. 1921A. (a) IN GENERAL.—The requirements 
referred to in section 1902(a)(81) are that the laws of a 
State must— 
‘‘(1) require reporting to the State (or its 
agent) by each hospital located therein, of informa-
tion on—
1152 
‘‘(A) the charges for the most common in-
patient and outpatient hospital services; 
‘‘(B) the Medicare and Medicaid reim-
bursement amount for such services; and 
‘‘(C) if the hospitals allows for or provides 
reduced charges for individuals based on finan-
cial need, the factors considered in making de-
terminations for reductions in charges, includ-
ing any formula for such determination and the 
contact information for the specific department 
of a hospital that responds to such inquiries; 
‘‘(2) provide for notice to individuals seeking or 
requiring such services of the availability of informa-
tion on charges described in paragraph (1); 
‘‘(3) provide for timely access to such informa-
tion, including at least through an Internet website, 
by individuals seeking or requiring such services; 
and 
‘‘(4) provide for timely access to information re-
garding the quality of care at each hospital made 
publicly available in accordance with section 501 of 
the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173), 
section 1139A, or section 1139B.
1153 
The Secretary shall consult with stakeholders (including 
those entities in section 1808(d)(6) and the National Gov-
ernors Association) through a formal process to obtain 
guidance prior to issuing implementing policies under this 
section. 
‘‘(b) HOSPITAL DEFINED.—For purposes of this sec-
tion, the term ‘hospital’ means an institution that meets 
the requirements of paragraphs (1) and (7) of section 
1861(e) and includes those to which section 1820(c) ap-
plies.’’. 
(b) EFFECTIVE DATE; ADMINISTRATION.— 
(1) IN GENERAL.—Except as provided in para-
graphs (2)(B) and section 1790, the amendments 
made by subsection (a) shall take effect on October 
1, 2010. 
(2) EXISTING PROGRAMS.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services shall establish a 
process by which a State with an existing pro-
gram may certify to the Secretary that its pro-
gram satisfies the requirements of section 
1921A of the Social Security Act, as inserted 
by subsection (a). 
(B) 2-YEAR PERIOD TO BECOME IN COM-
PLIANCE.—States that, as of the date of the en-
1154 
actment of this Act, administer hospital price 
transparency policies that do not meet such re-
quirements shall have 2 years from such date to 
make necessary modifications to come into com-
pliance and shall not be regarded as failing to 
comply with such requirements during such 2- 
year period. 
SEC. 1784. MEDICAID AND CHIP PAYMENT AND ACCESS 
COMMISSION. 
(a) REPORT ON NURSING FACILITY PAYMENT POLI-
CIES.—Section 1900(b) of the Social Security Act (42 
U.S.C. 1396(b)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(10) REPORTS ON SPECIAL TOPICS ON PAY-
MENT POLICIES.— 
‘‘(A) NURSING FACILITY PAYMENT POLI-
CIES.—Not later than January 1, 2012, the 
Commission shall submit to Congress a report 
on nursing facility payment policies under Med-
icaid that includes— 
‘‘(i) information on the difference be-
tween the amount paid by each State to 
nursing facilities in such State under the 
Medicaid program under this title and the 
cost to such facilities of providing efficient
1155 
quality care to Medicaid eligible individ-
uals; 
‘‘(ii) an evaluation of patient out-
comes and quality as a result of the sup-
plemental payments under section 1745(b) 
of the Affordable Health Care for America 
Act; and 
‘‘(iii) whether adjustments should be 
made under the Medicaid program to the 
rates that States pay skilled nursing facili-
ties to ensure that such rates are sufficient 
to provide efficient quality care to Med-
icaid eligible individuals.’’. 
(b) PEDIATRIC
SUBSPECIALIST
PAYMENT
POLI-
CIES.—Section 1900(b)(10) of the Social Security Act, as 
added by subsection (a) is amended by adding at the end 
the following new subparagraph: 
‘‘(B) PEDIATRIC SUBSPECIALIST PAYMENT 
POLICIES.—Not later than January 1, 2011, 
the Commission shall submit to Congress a re-
port on payment policies for pediatric sub-
specialist services under Medicaid that in-
cludes— 
‘‘(i) a comprehensive review of each 
State’s Medicaid payment rates for inpa-
1156 
tient and outpatient pediatric speciality 
services; 
‘‘(ii) a comparison, on a State-by- 
State basis, of the rates under clause (i) to 
Medicare payments for similar services; 
‘‘(iii) information on any limitations 
in patient access to pediatric speciality 
care, such as delays in receiving care or 
wait times for receiving care; 
‘‘(iv) an analysis of the extent to 
which low Medicaid payment rates in any 
State contributes to limits in access to pe-
diatric subspecialty services in such State; 
and 
‘‘(v) recommendations to ameliorate 
any problems found with such payment 
rates or with access to such services.’’. 
(c) ADDITIONAL AMENDMENTS.— 
(1) COMMISSION STATUS.—Section 1900(a) of 
the Social Security Act is amended by inserting ‘‘as 
an agency of Congress’’ after ‘‘established’’. 
(2) 
EXPANSION
OF
SCOPE.—Section 
1900(b)(1)(A) of the Social Security Act is amended 
by striking ‘‘children’s access’’ and inserting ‘‘access
1157 
by low-income children and other eligible individ-
uals’’. 
(3) CHANGE IN REPORT DEADLINES.—Subpara-
graphs (C) and (D) of section 1900(b)(1) of such 
Act are amended by striking ‘‘2010’’ and inserting 
‘‘2011’’ each place it appears. 
(4) REPORT
IN
HEALTH
REFORM.—Section 
1900(b)(2) of such Act is amended— 
(A) in subparagraph (A)(i), by striking 
‘‘skilled’’; 
(B) by striking subparagraph (B); 
(C) by redesignating subparagraph (C) as 
subparagraph (B); and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(C) IMPLEMENTATION
OF
HEALTH
RE-
FORM.—The implementation of the provisions 
of the Affordable Health Care for America Act 
that relate to Medicaid or CHIP by the Sec-
retary, the Health Choices Commissioner, and 
the States, including the effect of such imple-
mentation on the access to needed health care 
items and services by low-income individuals 
and families.’’.
1158 
(5) CLARIFICATION OF MEMBERSHIP.—Section 
1900(c)(2)(B) of such Act is amended by striking 
‘‘consumers’’ and inserting ‘‘individuals’’. 
(6) AUTHORIZATION OF APPROPRIATIONS.— 
(A) CURRENT
AUTHORIZATION.—Section 
1900(f)(2) of such Act is amended— 
(i) in the heading, by inserting ‘‘OF 
APPROPRIATIONS
PRIOR
TO
2010’’ after 
‘‘AUTHORIZATION’’; and 
(ii) by striking ‘‘There are’’ and in-
serting ‘‘Prior to January 1, 2010, there 
are’’ 
(B) FUTURE
AUTHORIZATION.—Section 
1900(f) of such Act is further amended by add-
ing at the end the following new paragraph: 
after the period the following: 
‘‘(3) AUTHORIZATION OF APPROPRIATIONS FOR 
2010.—Beginning on January 1, 2010, there is au-
thorized to be appropriated $11,800,000 to carry 
out the provisions of this section. Such funds shall 
remain available until expended.’’. 
SEC. 1785. OUTREACH AND ENROLLMENT OF MEDICAID 
AND CHIP ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Not later than 12 months after 
date of enactment of this Act, the Secretary of Health and
1159 
Human Services shall issue guidance regarding standards 
and best practices for conducting outreach to inform eligi-
ble individuals about healthcare coverage under Medicaid 
under title XIX of the Social Security Act or for child 
health assistance under CHIP under title XXI of such 
Act, providing assistance to such individuals for enroll-
ment in applicable programs, and establishing methods or 
procedures for eliminating application and enrollment bar-
riers. Such guidance shall include provisions to ensure 
that outreach, enrollment assistance, and administrative 
simplification efforts are targeted specifically to vulnerable 
populations such as children, unaccompanied homeless 
youth, victims of abuse or trauma, individuals with mental 
health or substance related disorders, and individuals with 
HIV/AIDS. Guidance issued pursuant to this section re-
lating to methods to increase outreach and enrollment pro-
vided for under titles XIX and XXI of the Social Security 
Act shall specifically target such vulnerable and under-
served populations and shall include, but not be limited 
to, guidance on outstationing of eligibility workers, express 
lane eligibility, residence requirements, documentation of 
income and assets, presumptive eligibility, continuous eli-
gibility, and automatic renewal. 
(b) IMPLEMENTATION.—In implementing the re-
quirements under subsection (a), the Secretary may use
1160 
such authorities as are available under law and may work 
with such entities as the Secretary deems appropriate to 
facilitate effective implementation of such programs. Not 
later than 2 years after the enactment of this Act and 
annually thereafter, the Secretary shall review and report 
to Congress on progress in implementing targeted out-
reach, application and enrollment assistance, and adminis-
trative simplification methods for such vulnerable and un-
derserved populations as are specified in subsection (a). 
SEC. 1786. PROHIBITIONS ON FEDERAL MEDICAID AND 
CHIP 
PAYMENT 
FOR 
UNDOCUMENTED 
ALIENS. 
Nothing in this title shall change current prohibitions 
against Federal Medicaid and CHIP payments under titles 
XIX and XXI of the Social Security Act on behalf of indi-
viduals who are not lawfully present in the United States. 
SEC. 1787. DEMONSTRATION PROJECT FOR STABILIZATION 
OF EMERGENCY MEDICAL CONDITIONS BY 
INSTITUTIONS FOR MENTAL DISEASES. 
(a) AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall estab-
lish a demonstration project under which an eligible State 
(as described in subsection (c)) shall provide reimburse-
ment under the State Medicaid plan under title XIX of
1161 
the Social Security Act to an institution for mental dis-
eases that is subject to the requirements of section 1867 
of the Social Security Act (42 U.S.C. 1395dd) for the pro-
vision of medical assistance available under such plan to 
an individual who— 
(1) has attained age 21, but has not attained 
age 65; 
(2) is eligible for medical assistance under such 
plan; and 
(3) requires such medical assistance to stabilize 
an emergency medical condition. 
(b) IN-STAY REVIEW.—The Secretary shall establish 
a mechanism for in-stay review to determine whether or 
not the patient has been stabilized (as defined in sub-
section (h)(5)). This mechanism shall commence before 
the third day of the inpatient stay. States participating 
in the demonstration project may manage the provision 
of these benefits under the project through utilization re-
view, authorization, or management practices, or the ap-
plication of medical necessity and appropriateness criteria 
applicable to behavioral health. 
(c) ELIGIBLE STATE DEFINED.— 
(1) APPLICATION.—Upon approval of an appli-
cation submitted by a State described in paragraph 
(2), the State shall be an eligible State for purposes
1162 
of conducting a demonstration project under this 
section. 
(2) STATE
DESCRIBED.—States shall be se-
lected by the Secretary in a manner so as to provide 
geographic diversity on the basis of the application 
to conduct a demonstration project under this sec-
tion submitted by such States. 
(d) LENGTH OF DEMONSTRATION PROJECT.—The 
demonstration project established under this section shall 
be conducted for a period of 3 consecutive years. 
(e) LIMITATIONS ON FEDERAL FUNDING.— 
(1) APPROPRIATION.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated 
to 
carry 
out 
this 
section, 
$75,000,000 for fiscal year 2010. 
(B) BUDGET AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obliga-
tion of the Federal Government to provide for 
the payment of the amounts appropriated under 
that subparagraph. 
(2) 
3-YEAR
AVAILABILITY.—Funds 
appro-
priated under paragraph (1) shall remain available 
for obligation through December 31, 2012.
1163 
(3) LIMITATION
ON
PAYMENTS.—In no case 
may— 
(A) the aggregate amount of payments 
made by the Secretary to eligible States under 
this section exceed $75,000,000; or 
(B) payments be provided by the Secretary 
under this section after December 31, 2012. 
(4) FUNDS ALLOCATED TO STATES.—The Sec-
retary shall allocate funds to eligible States based on 
their applications and the availability of funds. 
(5) PAYMENTS
TO
STATES.—The Secretary 
shall pay to each eligible State, from its allocation 
under paragraph (4), an amount each quarter equal 
to the Federal medical assistance percentage of ex-
penditures in the quarter for medical assistance de-
scribed in subsection (a). 
(f) REPORTS.— 
(1) ANNUAL
PROGRESS
REPORTS.—The Sec-
retary shall submit annual reports to Congress on 
the progress of the demonstration project conducted 
under this section. 
(2) FINAL REPORT AND RECOMMENDATION.— 
An evaluation shall be conducted of the demonstra-
tion project’s impact on the functioning of the health 
and mental health service system and on individuals
1164 
enrolled in the Medicaid program. This evaluation 
shall include collection of baseline data for one-year 
prior to the initiation of the demonstration project 
as well as collection of data from matched compari-
son states not participating in the demonstration. 
The evaluation measures shall include the following: 
(A) A determination, by State, as to 
whether the demonstration project resulted in 
increased access to inpatient mental health 
services under the Medicaid program and 
whether average length of stays were longer (or 
shorter) for individuals admitted under the 
demonstration project compared with individ-
uals otherwise admitted in comparison sites. 
(B) An analysis, by State, regarding 
whether the demonstration project produced a 
significant reduction in emergency room visits 
for individuals eligible for assistance under the 
Medicaid program or in the duration of emer-
gency room lengths of stay. 
(C) An assessment of discharge planning 
by participating hospitals that ensures access to 
further (non-emergency) inpatient or residential 
care as well as continuity of care for those dis-
charged to outpatient care.
1165 
(D) An assessment of the impact of the 
demonstration project on the costs of the full 
range of mental health services (including inpa-
tient, emergency and ambulatory care) under 
the plan as contrasted with the comparison 
areas. 
(E) Data on the percentage of consumers 
with Medicaid coverage who are admitted to in-
patient facilities as a result of the demonstra-
tion project as compared to those admitted to 
these same facilities through other means. 
(F) A recommendation regarding whether 
the demonstration project should be continued 
after December 31, 2012, and expanded on a 
national basis. 
(g) WAIVER AUTHORITY.— 
(1) IN GENERAL.—The Secretary shall waive 
the limitation of subdivision (B) following paragraph 
(28) of section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) (relating to limitations on pay-
ments for care or services for individuals under 65 
years of age who are patients in an institution for 
mental diseases) for purposes of carrying out the 
demonstration project under this section.
1166 
(2) LIMITED OTHER WAIVER AUTHORITY.—The 
Secretary may waive other requirements of title XIX 
of the Social Security Act (including the require-
ments 
of 
sections 
1902(a)(1) 
(relating 
to 
statewideness) and 1902(1)(10)(B) (relating to com-
parability)) only to extent necessary to carry out the 
demonstration project under this section. 
(h) DEFINITIONS.—In this section: 
(1) EMERGENCY
MEDICAL
CONDITION.—The 
term ‘‘emergency medical condition’’ means, with re-
spect to an individual, an individual who expresses 
suicidal or homicidal thoughts or gestures, if deter-
mined dangerous to self or others. 
(2) FEDERAL MEDICAL ASSISTANCE PERCENT-
AGE.—The term ‘‘Federal medical assistance per-
centage’’ has the meaning given that term with re-
spect to a State under section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)). 
(3) INSTITUTION FOR MENTAL DISEASES.—The 
term ‘‘institution for mental diseases’’ has the mean-
ing given to that term in section 1905(i) of the So-
cial Security Act (42 U.S.C. 1396d(i)). 
(4) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ has the meaning given to that term in
1167 
section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)). 
(5) 
STABILIZED.—The 
term 
‘‘stabilized’’ 
means, with respect to an individual, that the emer-
gency medical condition no longer exists with respect 
to the individual and the individual is no longer dan-
gerous to self or others. 
(6) STATE.—The term ‘‘State’’ has the mean-
ing given that term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
SEC. 1788. APPLICATION OF MEDICAID IMPROVEMENT 
FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 1396w–1(b)(1)) is amended by striking ‘‘from the 
Fund’’ and all that follows and inserting ‘‘from the Fund, 
only such amounts as may be appropriated or otherwise 
made available by law.’’. 
SEC. 1789. TREATMENT OF CERTAIN MEDICAID BROKERS. 
Section 1903(b)(4) of the Social Security Act (42 
U.S.C. 1396b(b)(4)) is amended— 
(1) in the matter before subparagraph (A), by 
inserting after ‘‘respect to the broker’’ the following: 
‘‘(or, in the case of subparagraph (A) and subpara-
graph (B)(i), if the Inspector General of Department 
of Health and Human Services finds that the broker
1168 
has established and maintains procedures to ensure 
the independence of its enrollment activities from 
the interests of any managed care entity or pro-
vider)’’; and 
(2) in subparagraph (B)— 
(A) by inserting ‘‘(i)’’ after ‘‘either’’; and 
(B) by inserting ‘‘(ii)’’ after ‘‘health care 
provider or’’. 
SEC. 1790. RULE FOR CHANGES REQUIRING STATE LEGIS-
LATION. 
In the case of a State plan for medical assistance 
under title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines requires 
State legislation (other than legislation appropriating 
funds) in order for the plan to meet an additional require-
ment imposed by an amendment made by this title, the 
State plan shall not be regarded as failing to comply with 
the requirements of such title XIX solely on the basis of 
its failure to meet this additional requirement before the 
first day of the first calendar quarter beginning after the 
close of the first regular session of the State legislature 
that begins after the date of the enactment of this Act. 
For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of
1169 
such session shall be deemed to be a separate regular ses-
sion of the State legislature. 
TITLE VIII—REVENUE-RELATED 
PROVISIONS 
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION 
OF INDIVIDUALS LIKELY TO BE INELIGIBLE 
FOR THE LOW-INCOME ASSISTANCE UNDER 
THE MEDICARE PRESCRIPTION DRUG PRO-
GRAM TO ASSIST SOCIAL SECURITY ADMINIS-
TRATION’S OUTREACH TO ELIGIBLE INDIVID-
UALS. 
(a) IN GENERAL.—Paragraph (19) of section 6103(l) 
of the Internal Revenue Code of 1986 is amended to read 
as follows: 
‘‘(19) DISCLOSURES
TO
FACILITATE
IDENTI-
FICATION
OF
INDIVIDUALS
LIKELY
TO
BE
INELI-
GIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDI-
CARE PRESCRIPTION DRUG PROGRAM TO ASSIST SO-
CIAL
SECURITY
ADMINISTRATION’S
OUTREACH
TO 
ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN GENERAL.—Upon written request 
from the Commissioner of Social Security, the 
following return information (including such in-
formation disclosed to the Social Security Ad-
ministration under paragraph (1) or (5)) shall
1170 
be disclosed to officers and employees of the So-
cial Security Administration, with respect to 
any taxpayer identified by the Commissioner of 
Social Security— 
‘‘(i) return information for the appli-
cable year from returns with respect to 
wages (as defined in section 3121(a) or 
3401(a)) and payments of retirement in-
come (as described in paragraph (1) of this 
subsection), 
‘‘(ii) unearned income information 
and income information of the taxpayer 
from partnerships, trusts, estates, and sub-
chapter S corporations for the applicable 
year, 
‘‘(iii) if the individual filed an income 
tax return for the applicable year, the fil-
ing status, number of dependents, income 
from farming, and income from self-em-
ployment, on such return, 
‘‘(iv) if the individual is a married in-
dividual filing a separate return for the ap-
plicable year, the social security number (if 
reasonably available) of the spouse on such 
return,
1171 
‘‘(v) if the individual files a joint re-
turn for the applicable year, the social se-
curity number, unearned income informa-
tion, and income information from partner-
ships, trusts, estates, and subchapter S 
corporations of the individual’s spouse on 
such return, and 
‘‘(vi) such other return information 
relating to the individual (or the individ-
ual’s spouse in the case of a joint return) 
as is prescribed by the Secretary by regula-
tion 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. 
‘‘(B) APPLICABLE
YEAR.—For the pur-
poses of this paragraph, the term ‘applicable 
year’ means the most recent taxable year for 
which information is available in the Internal 
Revenue Service’s taxpayer information records. 
‘‘(C) RESTRICTION ON INDIVIDUALS FOR 
WHOM DISCLOSURE MAY BE REQUESTED.—The 
Commissioner of Social Security shall request 
information under this paragraph only with re-
spect to—
1172 
‘‘(i) individuals the Social Security 
Administration has identified, using all 
other reasonably available information, as 
likely to be eligible for a low-income pre-
scription 
drug 
subsidy 
under 
section 
1860D–14 of the Social Security Act and 
who have not applied for such subsidy, and 
‘‘(ii) any individual the Social Security 
Administration has identified as a spouse 
of an individual described in clause (i). 
‘‘(D) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under this paragraph may be used only by offi-
cers and employees of the Social Security Ad-
ministration solely for purposes of identifying 
individuals likely to be ineligible for a low-in-
come prescription drug subsidy under section 
1860D–14 of the Social Security Act for use in 
outreach efforts under section 1144 of the So-
cial Security Act.’’. 
(b) SAFEGUARDS.—Paragraph (4) of section 6103(p) 
of such Code is amended— 
(1) by striking ‘‘(19),’’ each place it appears, 
and
1173 
(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 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 following new section: 
‘‘SEC. 9511. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a trust fund 
to be known as the ‘Health Care Comparative Effective-
ness 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).
1174 
‘‘(b) TRANSFERS TO FUND.— 
‘‘(1) IN GENERAL.—There are hereby appro-
priated to the Trust Fund the following: 
‘‘(A) For fiscal year 2010, $90,000,000. 
‘‘(B) For fiscal year 2011, $100,000,000. 
‘‘(C) For fiscal year 2012, $110,000,000. 
‘‘(D) For each fiscal year beginning with 
fiscal year 2013— 
‘‘(i) an amount equivalent to the net 
revenues received in the Treasury from the 
fees imposed under subchapter B of chap-
ter 34 (relating to fees on health insurance 
and self-insured plans) for such fiscal year; 
and 
‘‘(ii) subject to subsection (c)(2), 
amounts determined by the Secretary of 
Health and Human Services to be equiva-
lent to the fair share per capita amount 
computed under subsection (c)(1) for the 
fiscal year multiplied by the average num-
ber of individuals entitled to benefits under 
part A, or enrolled under part B, of title 
XVIII of the Social Security Act during 
such fiscal year. 
‘‘(2) ADMINISTRATIVE PROVISIONS.—
1175 
‘‘(A) TRANSFERS
FROM
OTHER
TRUST 
FUNDS.—The amounts appropriated by sub-
paragraphs (A), (B), (C), and (D)(ii) of para-
graph (1) shall be transferred from the Federal 
Hospital Insurance Trust Fund and from the 
Federal 
Supplementary 
Medical 
Insurance 
Trust Fund (established under section 1841 of 
such Act), and from the Medicare Prescription 
Drug Account within such Trust Fund, in pro-
portion (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. 
‘‘(B) APPROPRIATIONS NOT SUBJECT TO 
FISCAL YEAR LIMITATION.—The amounts ap-
propriated by paragraph (1) shall not be sub-
ject to any fiscal year limitation. 
‘‘(C) PERIODIC
TRANSFERS, ESTIMATES, 
AND
ADJUSTMENTS.—Except as provided in 
subparagraph (A), the provisions of section 
9601 shall apply to the amounts appropriated 
by paragraph (1). 
‘‘(c) FAIR SHARE PER CAPITA AMOUNT.— 
‘‘(1) COMPUTATION.—
1176 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the fair share per capita amount 
under this paragraph for a fiscal year (begin-
ning with fiscal year 2013) is an amount com-
puted 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 Internal Revenue Code of 1986, will 
result 
in 
revenues 
to 
the 
CERTF 
of 
$375,000,000 for the fiscal year. 
‘‘(B) ALTERNATIVE COMPUTATION.— 
‘‘(i) IN GENERAL.—If the Secretary is 
unable to compute the fair share per capita 
amount under subparagraph (A) for a fis-
cal year, the fair share per capita amount 
under this paragraph for the fiscal year 
shall be the default amount determined 
under clause (ii) for the fiscal year. 
‘‘(ii) DEFAULT AMOUNT.—The default 
amount under this clause for— 
‘‘(I) fiscal year 2013 is equal to 
$2; or 
‘‘(II) a subsequent year is equal 
to the default amount under this 
clause for the preceding fiscal year in-
1177 
creased by the annual percentage in-
crease in the medical care component 
of the consumer price index (United 
States city average) for the 12-month 
period ending with April of the pre-
ceding fiscal year. 
Any amount determined under subclause 
(II) shall be rounded to the nearest penny. 
‘‘(2) LIMITATION ON MEDICARE FUNDING.—In 
no case shall the amount transferred under sub-
section (b)(4)(B) for any fiscal year exceed 
$90,000,000. 
‘‘(d) EXPENDITURES FROM FUND.— 
‘‘(1) IN GENERAL.—Subject to paragraph (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 to carry out section 1181 of the So-
cial Security Act. 
‘‘(2) ALLOCATION FOR COMMISSION.—The fol-
lowing amounts in the CERTF shall be available, 
without the need for further appropriations and 
without fiscal year limitation, to the Commission to 
carry out the activities of the Comparative Effective-
1178 
ness Research Commission established under section 
1181(b) of the Social Security Act: 
‘‘(A) For fiscal year 2010, $7,000,000. 
‘‘(B) For fiscal year 2011, $9,000,000. 
‘‘(C) For each fiscal year beginning with 
2012, 2.6 percent of the total amount appro-
priated to the CERTF under subsection (b) for 
the fiscal year. 
‘‘(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 imposed by such sub-
chapter.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions 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 INSURED 
AND SELF-INSURED HEALTH PLANS.— 
(1) GENERAL RULE.—Chapter 34 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new subchapter:
1179 
‘‘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 deter-
mined under section 9511(c)(1) multiplied by the average 
number of lives covered under the policy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub-
section (a) shall be paid by the issuer of the policy. 
‘‘(c) SPECIFIED HEALTH INSURANCE POLICY.—For 
purposes of this section: 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, the term ‘specified health in-
surance policy’ means any accident or health insur-
ance policy issued with respect to individuals resid-
ing in the United States. 
‘‘(2) EXEMPTION FOR CERTAIN POLICIES.—The 
term ‘specified health insurance policy’ does not in-
clude any insurance if substantially all of its cov-
erage is of excepted benefits described in section 
9832(c). 
‘‘(3) TREATMENT OF PREPAID HEALTH COV-
ERAGE ARRANGEMENTS.—
1180 
‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B)— 
‘‘(i) such arrangement shall be treated 
as a specified health insurance policy, and 
‘‘(ii) the person referred to in such 
subparagraph shall be treated as the 
issuer. 
‘‘(B) DESCRIPTION OF ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed pay-
ments or premiums are received as consider-
ation for any person’s agreement to provide or 
arrange for the provision of accident or health 
coverage to residents of the United States, re-
gardless 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 appli-
cable self-insured health plan for each plan year, there is 
hereby imposed a fee equal to the fair share per capita 
amount determined 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 sub-
section (a) shall be paid by the plan sponsor.
1181 
‘‘(2) PLAN SPONSOR.—For purposes of para-
graph (1) the term ‘plan sponsor’ means— 
‘‘(A) the employer in the case of a plan es-
tablished or maintained by a single employer, 
‘‘(B) the employee organization in the case 
of a plan established or maintained by an em-
ployee organization, 
‘‘(C) in the case of— 
‘‘(i) a plan established or maintained 
by 2 or more employers or jointly by 1 or 
more employers and 1 or more employee 
organizations, 
‘‘(ii) a multiple employer welfare ar-
rangement, or 
‘‘(iii) a voluntary employees’ bene-
ficiary association described in section 
501(c)(9), 
the association, committee, joint board of trust-
ees, or other similar group of representatives of 
the parties who establish or maintain the plan, 
or 
‘‘(D) the cooperative or association de-
scribed in subsection (c)(2)(F) in the case of a 
plan established or maintained by such a coop-
erative or association.
1182 
‘‘(c) APPLICABLE SELF-INSURED HEALTH PLAN.— 
For purposes of this section, the term ‘applicable self-in-
sured health plan’ means any plan for providing accident 
or health coverage if— 
‘‘(1) any portion of such coverage is provided 
other than through an insurance policy, and 
‘‘(2) such plan is established or maintained— 
‘‘(A) by one or more employers for the 
benefit of their employees or former employees, 
‘‘(B) by one or more employee organiza-
tions for the benefit of their members or former 
members, 
‘‘(C) jointly by 1 or more employers and 1 
or more employee organizations for the benefit 
of employees or former employees, 
‘‘(D) by a voluntary employees’ beneficiary 
association described in section 501(c)(9), 
‘‘(E) by any organization described in sec-
tion 501(c)(6), or 
‘‘(F) in the case of a plan not described in 
the preceding subparagraphs, by a multiple em-
ployer welfare arrangement (as defined in sec-
tion 3(40) of Employee Retirement Income Se-
curity Act of 1974), a rural electric cooperative 
(as defined in section 3(40)(B)(iv) of such Act),
1183 
or a rural telephone cooperative association (as 
defined in section 3(40)(B)(v) of such Act). 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this sub-
chapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health in-
surance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument where-
by a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED
STATES.—The term ‘United 
States’ includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any gov-
ernmental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be ex-
empt from the fees imposed by this subchapter 
except as provided in paragraph (2).
1184 
‘‘(2) TREATMENT OF EXEMPT GOVERNMENTAL 
PROGRAMS.—In the case of an exempt 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
DE-
FINED.—For purposes of this subchapter, the term 
‘exempt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
‘‘(B) the medical assistance program es-
tablished by title XIX or XXI of the Social Se-
curity 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 In-
1185 
dian 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 subchapter shall be treated 
as if they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion 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 subtitle D of 
such Code is amended by striking the item re-
lating 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
1186 
and plans for portions of policy or plan years begin-
ning on or after October 1, 2012. 
TITLE IX—MISCELLANEOUS 
PROVISIONS 
SEC. 1901. REPEAL OF TRIGGER PROVISION. 
Subtitle A of title VIII of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173) is repealed and the provisions of law 
amended by such subtitle are restored as if such subtitle 
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, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173), is repealed. 
SEC. 1903. EXTENSION OF GAINSHARING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (d)(3) of section 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 demonstration project in operation as of 
October 1, 2008)’’ after ‘‘December 31, 2009’’. 
(b) FUNDING.—
1187 
(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 expended’’. 
(c) REPORTS.— 
(1) QUALITY
IMPROVEMENT
AND
SAVINGS.— 
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:
1188 
‘‘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 im-
prove the well-being, health, and development of children 
by enabling the establishment and expansion of high qual-
ity programs providing voluntary home visitation for fami-
lies with young children and families expecting children. 
‘‘(b) GRANT APPLICATION.—A State that desires to 
receive a grant under this section shall submit to the Sec-
retary for approval, at such time and in such manner as 
the Secretary may require, an application for the grant 
that includes the following: 
‘‘(1) DESCRIPTION OF HOME VISITATION PRO-
GRAMS.—A description of the high quality programs 
of home visitation for families with young children 
and families expecting children that will be sup-
ported by a grant made to the State under this sec-
tion, the outcomes the programs are intended to 
achieve, and the evidence supporting the effective-
ness of the programs. 
‘‘(2) RESULTS OF NEEDS ASSESSMENT.—The 
results of a statewide needs assessment that de-
scribes—
1189 
‘‘(A) the number, quality, and capacity of 
home visitation programs for families with 
young children and families expecting children 
in the State; 
‘‘(B) the number and types of families 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 assistance ac-
tivities designed to achieve or support the goals 
of the programs. 
‘‘(3) ASSURANCES.—Assurances from the State 
that— 
‘‘(A) in supporting home visitation pro-
grams using funds provided under this section, 
the State shall identify and prioritize serving 
communities that are in high need of such serv-
ices, especially communities with a high propor-
tion of low-income families or a high incidence 
of child maltreatment; 
‘‘(B) the State will reserve 5 percent of the 
grant funds for training and technical assist-
1190 
ance to the home visitation programs using 
such funds; 
‘‘(C) in supporting home visitation pro-
grams using funds provided under this section, 
the State will promote coordination and collabo-
ration with other home visitation programs (in-
cluding programs funded under title XIX) and 
with other child and family services, health 
services, income supports, and other related as-
sistance; 
‘‘(D) home visitation programs supported 
using such funds will, when appropriate, pro-
vide referrals to other programs serving chil-
dren and families; and 
‘‘(E) the State will comply with subsection 
(i), and cooperate with any evaluation con-
ducted under subsection (j). 
‘‘(4) OTHER INFORMATION.—Such other infor-
mation as the Secretary may require. 
‘‘(c) ALLOTMENTS.— 
‘‘(1) INDIAN
TRIBES.—From the amount re-
served under subsection (l)(2) for a fiscal year, the 
Secretary shall allot to each Indian tribe that meets 
the requirement of subsection (d), if applicable, for 
the fiscal year the amount that bears the same ratio
1191 
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. 
‘‘(2) STATES
AND
TERRITORIES.—From the 
amount appropriated under subsection (m) for a fis-
cal 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 subsection (d), if applica-
ble, for the fiscal year the amount that bears the 
same ratio to the remainder of the amount so appro-
priated as the number of children in the State whose 
families have income that does not exceed 200 per-
cent 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 al-
lotment to a State under a paragraph of this sub-
section for any fiscal year that the State certifies to 
the Secretary will not be expended by the State pur-
suant to this section shall be available for reallot-
ment using the allotment methodology specified in
1192 
that paragraph. Any 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 requirement of this 
subsection for a fiscal year if the Secretary finds that the 
aggregate expenditures by the State from State and local 
sources for programs of home visitation for families with 
young children and families expecting children for the then 
preceding fiscal year was not less than 100 percent of such 
aggregate expenditures for the then 2nd preceding 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 sub-
section (m), in an amount equal to the reimbursable 
percentage of the eligible expenditures of the State 
for the fiscal year, but not more than the amount 
allotted to the State under subsection (c) for the fis-
cal year. 
‘‘(2) REIMBURSABLE PERCENTAGE DEFINED.— 
In paragraph (1), the term ‘reimbursable percent-
age’ means, with respect to a fiscal year—
1193 
‘‘(A) 85 percent, in the case of fiscal year 
2010; 
‘‘(B) 80 percent, in the case of fiscal year 
2011; or 
‘‘(C) 75 percent, in the case of fiscal year 
2012 and any succeeding fiscal year. 
‘‘(f) ELIGIBLE EXPENDITURES.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘eligible expenditures’— 
‘‘(A) means expenditures to provide vol-
untary 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 expan-
sion of high quality home visitation programs 
that— 
‘‘(i) adhere to clear evidence-based 
models of home visitation that have dem-
onstrated positive effects on important pro-
gram-determined child and parenting out-
comes, such as reducing abuse and neglect 
and improving child health and develop-
ment; 
‘‘(ii) employ well-trained and com-
petent staff, maintain high quality super-
1194 
vision, provide for ongoing training and 
professional development, and show strong 
organizational capacity to implement such 
a program; 
‘‘(iii) establish appropriate linkages 
and referrals to other community resources 
and supports; 
‘‘(iv) monitor fidelity of program im-
plementation to ensure that services are 
delivered according to the specified model; 
and 
‘‘(v) provide parents with— 
‘‘(I) knowledge of age-appro-
priate child development in cognitive, 
language, social, emotional, and motor 
domains (including knowledge of sec-
ond language acquisition, in the case 
of English language learners); 
‘‘(II) knowledge of realistic ex-
pectations of age-appropriate child be-
haviors; 
‘‘(III) knowledge of health and 
wellness issues for children and par-
ents;
1195 
‘‘(IV) modeling, consulting, and 
coaching on parenting practices; 
‘‘(V) skills to interact with their 
child to enhance age-appropriate de-
velopment; 
‘‘(VI) skills to recognize and seek 
help for issues related to health, devel-
opmental delays, and social, emo-
tional, and behavioral skills; and 
‘‘(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 expenditure with 
respect to which a State has submitted a claim 
for payment under any other provision of Fed-
eral law. 
‘‘(2) PRIORITY FUNDING FOR PROGRAMS WITH 
STRONGEST EVIDENCE.— 
‘‘(A) IN GENERAL.—The expenditures, de-
scribed in paragraph (1), of a State for a fiscal 
year that are attributable to the cost of pro-
grams that do not adhere to a model of home
1196 
visitation with the strongest evidence of effec-
tiveness shall not be considered eligible expendi-
tures for the fiscal year to the extent that the 
total of the expenditures exceeds the applicable 
percentage for the fiscal year of the allotment 
of the State under subsection (c) for the fiscal 
year. 
‘‘(B) 
APPLICABLE
PERCENTAGE
DE-
FINED.—In subparagraph (A), the term ‘appli-
cable 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.— 
‘‘(1) IN GENERAL.—The Secretary may waive 
or modify the application of any provision of this
1197 
section, other than subsection (b) or (f), to an In-
dian 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 subsection (d) 
for purposes of subsections (c) and (e) if— 
‘‘(A) the Secretary waives the requirement; 
or 
‘‘(B) the Secretary modifies the require-
ment, and the Indian tribe meets the modified 
requirement. 
‘‘(i) STATE REPORTS.—Each State to which a grant 
is made under this section shall submit 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 programs that 
received funds from the grant; 
‘‘(2) the characteristics of each such program, 
including information on the service model used by 
the program and the performance of the program; 
‘‘(3) the characteristics of the providers of serv-
ices through the program, including staff qualifica-
tions, work experience, and demographic characteris-
tics;
1198 
‘‘(4) the characteristics of the recipients of serv-
ices provided through the program, including the 
number of the recipients, the demographic charac-
teristics of the recipients, and family retention; 
‘‘(5) the annual cost of implementing the pro-
gram, including the cost per family served under the 
program; 
‘‘(6) the outcomes experienced by recipients of 
services through the program; 
‘‘(7) the training and technical assistance pro-
vided to aid implementation of the program, and 
how the training and technical assistance contrib-
uted to the outcomes achieved through the program; 
‘‘(8) the indicators and methods used to mon-
itor whether the program is being implemented as 
designed; and 
‘‘(9) other information as determined necessary 
by the Secretary. 
‘‘(j) EVALUATION.— 
‘‘(1) IN
GENERAL.—The Secretary shall, by 
grant or contract, provide for the conduct of an 
independent evaluation of the effectiveness of home 
visitation programs receiving funds provided under 
this section, which shall examine the following:
1199 
‘‘(A) The effect of home visitation pro-
grams on child and parent outcomes, including 
child maltreatment, child health and develop-
ment, school readiness, and links to community 
services. 
‘‘(B) The effectiveness of home visitation 
programs on different populations, including 
the extent to which the ability of programs to 
improve outcomes varies across programs 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 submit to the Congress an 
interim report on the evaluation conducted pur-
suant to paragraph (1). 
‘‘(B) FINAL
REPORT.—Within 5 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
1200 
under this section, which shall include a description of the 
following: 
‘‘(1) The high need communities targeted by 
States for programs carried out under this section. 
‘‘(2) The service delivery models used in the 
programs receiving funds provided under this sec-
tion. 
‘‘(3) The characteristics of the programs, in-
cluding— 
‘‘(A) the qualifications and demographic 
characteristics of program staff; and 
‘‘(B) recipient characteristics including the 
number of families served, the demographic 
characteristics of the families served, and fam-
ily 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 activities, in-
cluding on-going professional development, provided 
to the programs. 
‘‘(7) The annual costs of implementing the pro-
grams, including the cost per family served under 
the programs.
1201 
‘‘(8) The indicators and methods used by States 
to monitor whether the programs are being been im-
plemented as designed. 
‘‘(l) RESERVATIONS OF FUNDS.—From the amounts 
appropriated for a fiscal year under subsection (m), the 
Secretary shall reserve— 
‘‘(1) an amount equal to 5 percent of the 
amounts to pay the cost of the evaluation provided 
for in subsection (j), and the provision to States of 
training and technical assistance, including the dis-
semination of best practices in early childhood home 
visitation; and 
‘‘(2) after making the reservation required by 
paragraph (1), an amount equal to 3 percent of the 
amount so appropriated, to pay for grants to Indian 
tribes under this section. 
‘‘(m) APPROPRIATIONS.—Out of any money in the 
Treasury of the United States not otherwise appropriated, 
there is appropriated to the Secretary to carry out this 
section— 
‘‘(1) $50,000,000 for fiscal year 2010; 
‘‘(2) $100,000,000 for fiscal year 2011; 
‘‘(3) $150,000,000 for fiscal year 2012; 
‘‘(4) $200,000,000 for fiscal year 2013; and 
‘‘(5) $250,000,000 for fiscal year 2014.
1202 
‘‘(n) INDIAN TRIBES TREATED AS STATES.—In this 
section, paragraphs (4), (5), and (6) of section 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 Secretary shall 
provide, through an identifiable office or program within 
the Centers for Medicare & Medicaid Services, for a fo-
cused effort to provide for improved coordination between 
Medicare and Medicaid and protection in the case of dual 
eligibles (as defined in subsection (g)). The office or pro-
gram shall— 
‘‘(1) review Medicare and Medicaid policies re-
lated to enrollment, benefits, service delivery, pay-
ment, and grievance and appeals processes under 
parts A and B of title XVIII, under the Medicare 
Advantage program under part C of such title, and 
under title XIX; 
‘‘(2) identify areas of such policies where better 
coordination and protection could improve care and 
costs; and
1203 
‘‘(3) issue guidance to States regarding improv-
ing such coordination and protection. 
‘‘(b) ELEMENTS.—The improved coordination and 
protection under this section shall include efforts— 
‘‘(1) to simplify access of dual eligibles to bene-
fits and services under Medicare and Medicaid; 
‘‘(2) to improve care continuity for dual eligi-
bles and ensure safe and effective care transitions; 
‘‘(3) to harmonize regulatory conflicts between 
Medicare and Medicaid rules with regard to dual eli-
gibles; and 
‘‘(4) to improve total cost and quality perform-
ance under Medicare and Medicaid for dual eligibles. 
‘‘(c) RESPONSIBILITIES.—In carrying out this sec-
tion, the Secretary shall provide for the following: 
‘‘(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 facilitate ac-
cess to post-acute and community-based services and 
to identify actions that could lead to better coordina-
tion of community-based care. 
‘‘(3) A study of enrollment of dual eligibles in 
the Medicare Savings Program (as defined in section 
1144(c)(7)), under Medicaid, and in the low-income
1204 
subsidy program under section 1860D–14 to identify 
methods to more efficiently and effectively reach and 
enroll dual eligibles. 
‘‘(4) An assessment of communication strate-
gies for dual eligibles to determine whether addi-
tional informational materials or outreach is needed, 
including an assessment of the Medicare website, 1– 
800–MEDICARE, and the Medicare handbook. 
‘‘(5) Research and evaluation of areas where 
service utilization, quality, and access to cost sharing 
protection could be improved and an assessment of 
factors related to enrollee satisfaction with services 
and care delivery. 
‘‘(6) Collection (and making available to the 
public) of data and a database that describe the eli-
gibility, benefit and cost-sharing assistance available 
to dual eligibles by State. 
‘‘(7) Support for coordination of State and Fed-
eral contracting and oversight for dual coordination 
programs supportive of the goals described in sub-
section (b). 
‘‘(8) Support for State Medicaid agencies 
through the provision of technical assistance for 
Medicare and Medicaid coordination initiatives de-
1205 
signed to improve acute and long-term care for dual 
eligibles. 
‘‘(9) Monitoring total combined Medicare and 
Medicaid program costs in serving dual eligibles and 
making recommendations for optimizing total quality 
and cost performance across both programs. 
‘‘(10) Coordination of activities relating to 
Medicare Advantage plans under 1859(b)(6)(B)(ii) 
and Medicaid. 
‘‘(d) REPORTING.—The Office or program shall work 
with relevant State agencies and any appropriate quality 
measurement entities to improve and coordinate reporting 
requirements for Medicare and Medicaid. In addition, the 
Office or program shall seek to minimize duplication in 
reporting requirements, where appropriate, and to identify 
opportunities to combine assessment requirements, where 
appropriate. The Office or program shall seek to identify 
quality metrics and assessment requirements that facili-
tate comparisons of the quality of care received by bene-
ficiaries enrolled in or entitled to benefits under fee-for- 
service Medicare, the Medicare Advantage program, fee- 
for-service Medicaid, and Medicaid managed care, and 
combinations thereof (including integrated Medicare-Med-
icaid programs for dual eligibles).
1206 
‘‘(e) ENDORSEMENT.—The Secretary shall seek en-
dorsement by the entity with a contract under section 
1890(a) of quality measures and benchmarks developed 
under this section. 
‘‘(f) CONSULTATION WITH STAKEHOLDERS.—The 
Office or program shall consult with relevant stakeholders, 
including dual eligible beneficiaries representatives for 
dual eligible beneficiaries, health plans, providers, and rel-
evant State agencies, in the development of policies related 
to integrated Medicare-Medicaid programs for dual eligi-
bles. 
‘‘(g) PERIODIC REPORTS.—Not later than 1 year 
after the date of the enactment of this section and every 
3 years thereafter the Secretary shall submit to Congress 
a report on progress in activities conducted under this sec-
tion. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) DUAL ELIGIBLE.—The term ‘dual eligible’ 
means an individual who is dually eligible for bene-
fits under title XVIII, and medical assistance under 
title XIX, including such individuals who are eligible 
for benefits under the Medicare Savings Program 
(as defined in section 1144(c)(7)).
1207 
‘‘(2) MEDICARE; MEDICAID.—The terms ‘Medi-
care’ and ‘Medicaid’ mean the programs under titles 
XVIII and XIX, respectively.’’. 
SEC. 1906. ASSESSMENT OF MEDICARE COST-INTENSIVE 
DISEASES AND CONDITIONS. 
(a) INITIAL ASSESSMENT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall conduct an assessment of the 
diseases and conditions that are the most cost-inten-
sive for the Medicare program and, to the extent 
possible, assess the diseases and conditions that 
could become cost-intensive for Medicare in the fu-
ture. In conducting the assessment, the Secretary 
shall include the input of relevant research agencies, 
including the National Institutes of Health, the 
Agency for Healthcare Research and Quality, the 
Food and Drug Administration, and the Centers for 
Medicare & Medicaid Services. 
(2) REPORT.—Not later than January 1, 2011, 
the Secretary shall transmit a report to the Commit-
tees on Energy and Commerce, Ways and Means, 
and Appropriations of the House of Representatives 
and the Committees on Health, Education, Labor 
and Pensions, Finance, and Appropriations of the
1208 
Senate on the assessment conducted under para-
graph (1). Such report shall— 
(A) include the assessment of current and 
future trends of cost-intensive diseases and con-
ditions described in such paragraph; 
(B) address whether current research pri-
orities are appropriately addressing current and 
future cost-intensive conditions so identified; 
and 
(C) include recommendations concerning 
research in the Department of Health and 
Human Services that should be funded to im-
prove the prevention, treatment, or cure of such 
cost-intensive diseases and conditions. 
(b) UPDATES OF ASSESSMENT.—Not later than Jan-
uary 1, 2013, and biennially thereafter, the Secretary 
shall— 
(1) review and update the assessment and rec-
ommendations described in subsection (a)(1); and 
(2) submit a report described in subsection 
(a)(2) to the Committees specified in subsection 
(a)(2) on such updated assessment and rec-
ommendations.
1209 
SEC. 1907. ESTABLISHMENT OF CENTER FOR MEDICARE 
AND MEDICAID INNOVATION WITHIN CMS. 
(a) IN GENERAL.—Title XI of the Social Security Act 
is amended by inserting after section 1115 the following 
new section: 
‘‘CENTER FOR MEDICARE AND MEDICAID INNOVATION 
‘‘SEC. 1115A. (a) CENTER
FOR MEDICARE
AND 
MEDICAID INNOVATION ESTABLISHED.— 
‘‘(1) IN GENERAL.—There is created within the 
Centers for Medicare & Medicaid Services a Center 
for Medicare and Medicaid Innovation (in this sec-
tion referred to as the ‘CMI’) to carry out the duties 
described in this section. The purpose of the CMI is 
to test innovative payment and service delivery mod-
els to improve the coordination, quality, and effi-
ciency of health care services provided to applicable 
individuals defined in paragraph (4)(A). 
‘‘(2) DEADLINE.—The Secretary shall ensure 
that the CMI is carrying out the duties described in 
this section by not later than January 1, 2011. 
‘‘(3) CONSULTATION.—In carrying out the du-
ties under this section, the CMI shall consult rep-
resentatives of relevant Federal agencies, clinical 
and analytical experts with expertise in medicine and 
health care management, and States. The CMI shall
1210 
use open door forums or other mechanisms to seek 
input from interested parties. 
‘‘(4) DEFINITIONS.—In this section: 
‘‘(A) APPLICABLE INDIVIDUAL.—The term 
‘applicable individual’ means— 
‘‘(i) an individual who is enrolled 
under part B and entitled to benefits 
under part A of title XVIII; 
‘‘(ii) an individual who is eligible for 
medical assistance under title XIX; or 
‘‘(iii) an individual who meets the cri-
teria of both clauses (i) and (ii). 
‘‘(B) APPLICABLE TITLE.—The term ‘ap-
plicable title’ means title XVIII, title XIX, or 
both. 
‘‘(b) TESTING OF MODELS (PHASE I).— 
‘‘(1) IN GENERAL.—The CMI shall test pay-
ment and service delivery models in accordance with 
selection criteria under paragraph (2) to determine 
the effect of applying such models under the applica-
ble title (as defined in subsection (a)(4)(B)) on pro-
gram expenditures under such titles and the quality 
of care received by individuals receiving benefits 
under such title. 
‘‘(2) SELECTION OF MODELS TO BE TESTED.—
1211 
‘‘(A) IN
GENERAL.—The Secretary shall 
give preference to testing models for which, as 
determined by the Administrator of the Centers 
for Medicare & Medicaid Services and using 
such input from outside the Centers as the Ad-
ministrator determines appropriate, there is evi-
dence that the model addresses a defined popu-
lation for which there are deficits in care lead-
ing to poor clinical outcomes or potentially 
avoidable expenditures. The Administrator shall 
focus on models expected to reduce program 
costs under the applicable title while preserving 
or enhancing the quality of care received by in-
dividuals receiving benefits under such title. 
‘‘(B) 
APPLICATION
TO
OTHER
DEM-
ONSTRATIONS.—The Secretary shall operate the 
demonstration programs under sections 1222 
and 1236 of the Affordable Health Care for 
America Act through the CMI in accordance 
with the rules applicable under this section, in-
cluding those relating to evaluations, termi-
nations, and expansions. 
‘‘(3) BUDGET NEUTRALITY.— 
‘‘(A) INITIAL
PERIOD.—The Secretary 
shall not require, as a condition for testing a