1744 
•AMDT. NO. 2786 
(D) MEDICARE
INTEGRITY
PROGRAM.— 
Section 1817(k)(4)(C) of the Social Security 
Act (42 U.S.C. 1395i(k)(4)(C)) is amended by 
adding at the end the following new clause: 
‘‘(ii) For each fiscal year after 2010, 
by the percentage increase in the consumer 
price index for all urban consumers (all 
items; United States city average) over the 
previous year.’’. 
(j) MEDICARE INTEGRITY PROGRAM AND MEDICAID 
INTEGRITY PROGRAM.— 
(1) MEDICARE INTEGRITY PROGRAM.— 
(A) REQUIREMENT TO PROVIDE PERFORM-
ANCE STATISTICS.—Section 1893(c) of the So-
cial Security Act (42 U.S.C. 1395ddd(c)) is 
amended— 
(i) in paragraph (3), by striking 
‘‘and’’ at the end; 
(ii) by redesignating paragraph (4) as 
paragraph (5); and 
(iii) by inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) the entity agrees to provide the Secretary 
and the Inspector General of the Department of 
Health and Human Services with such performance 
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•AMDT. NO. 2786 
statistics (including the number and amount of over-
payments recovered, the number of fraud referrals, 
and the return on investment of such activities by 
the entity) as the Secretary or the Inspector General 
may request; and’’. 
(B) EVALUATIONS
AND
ANNUAL
RE-
PORT.—Section 1893 of the Social Security Act 
(42 U.S.C. 1395ddd) is amended by adding at 
the end the following new subsection: 
‘‘(i) EVALUATIONS AND ANNUAL REPORT.— 
‘‘(1) EVALUATIONS.—The Secretary shall con-
duct evaluations of eligible entities which the Sec-
retary contracts with under the Program not less 
frequently than every 3 years. 
‘‘(2) ANNUAL
REPORT.—Not later than 180 
days after the end of each fiscal year (beginning 
with fiscal year 2011), the Secretary shall submit a 
report to Congress which identifies— 
‘‘(A) the use of funds, including funds 
transferred from the Federal Hospital Insur-
ance Trust Fund under section 1817 and the 
Federal Supplementary Insurance Trust Fund 
under section 1841, to carry out this section; 
and 
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•AMDT. NO. 2786 
‘‘(B) the effectiveness of the use of such 
funds.’’. 
(C) FLEXIBILITY
IN
PURSUING
FRAUD 
AND ABUSE.—Section 1893(a) of the Social Se-
curity Act (42 U.S.C. 1395ddd(a)) is amended 
by inserting ‘‘, or otherwise,’’ after ‘‘entities’’. 
(2) MEDICAID INTEGRITY PROGRAM.— 
(A) REQUIREMENT TO PROVIDE PERFORM-
ANCE STATISTICS.—Section 1936(c)(2) of the 
Social Security Act (42 U.S.C. 1396u–6(c)(2)) 
is amended— 
(i) by redesignating subparagraph (D) 
as subparagraph (E); and 
(ii) by inserting after subparagraph 
(C) the following new subparagraph: 
‘‘(D) The entity agrees to provide the Sec-
retary and the Inspector General of the Depart-
ment of Health and Human Services with such 
performance statistics (including the number 
and amount of overpayments recovered, the 
number of fraud referrals, and the return on in-
vestment of such activities by the entity) as the 
Secretary or the Inspector General may re-
quest.’’. 
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•AMDT. NO. 2786 
(B) EVALUATIONS
AND
ANNUAL
RE-
PORT.—Section 1936(e) of the Social Security 
Act (42 U.S.C. 1396u–7(e)) is amended— 
(i) by redesignating paragraph (4) as 
paragraph (5); and 
(ii) by inserting after paragraph (3) 
the following new paragraph: 
‘‘(4) EVALUATIONS.—The Secretary shall con-
duct evaluations of eligible entities which the Sec-
retary contracts with under the Program not less 
frequently than every 3 years.’’. 
(k) EXPANDED APPLICATION OF HARDSHIP WAIV-
ERS FOR EXCLUSIONS.—Section 1128(c)(3)(B) of the So-
cial Security Act (42 U.S.C. 1320a–7(c)(3)(B)) is amend-
ed by striking ‘‘individuals entitled to benefits under part 
A of title XVIII or enrolled under part B of such title, 
or both’’ and inserting ‘‘beneficiaries (as defined in section 
1128A(i)(5)) of that program’’. 
SEC. 6403. ELIMINATION OF DUPLICATION BETWEEN THE 
HEALTHCARE INTEGRITY AND PROTECTION 
DATA BANK AND THE NATIONAL PRACTI-
TIONER DATA BANK. 
(a) INFORMATION REPORTED BY FEDERAL AGEN-
CIES AND HEALTH PLANS.—Section 1128E of the Social 
Security Act (42 U.S.C. 1320a–7e) is amended— 
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•AMDT. NO. 2786 
(1) by striking subsection (a) and inserting the 
following: 
‘‘(a) IN GENERAL.—The Secretary shall maintain a 
national health care fraud and abuse data collection pro-
gram under this section for the reporting of certain final 
adverse actions (not including settlements in which no 
findings of liability have been made) against health care 
providers, suppliers, or practitioners as required by sub-
section (b), with access as set forth in subsection (d), and 
shall furnish the information collected under this section 
to the National Practitioner Data Bank established pursu-
ant to the Health Care Quality Improvement Act of 1986 
(42 U.S.C. 11101 et seq.).’’; 
(2) by striking subsection (d) and inserting the 
following: 
‘‘(d) ACCESS TO REPORTED INFORMATION.— 
‘‘(1) AVAILABILITY.—The information collected 
under this section shall be available from the Na-
tional Practitioner Data Bank to the agencies, au-
thorities, and officials which are provided under sec-
tion 1921(b) information reported under section 
1921(a). 
‘‘(2) FEES FOR DISCLOSURE.—The Secretary 
may establish or approve reasonable fees for the dis-
closure of information under this section. The 
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•AMDT. NO. 2786 
amount of such a fee may not exceed the costs of 
processing the requests for disclosure and of pro-
viding such information. Such fees shall be available 
to the Secretary to cover such costs.’’; 
(3) by striking subsection (f) and inserting the 
following: 
‘‘(f) 
APPROPRIATE
COORDINATION.—In 
imple-
menting this section, the Secretary shall provide for the 
maximum appropriate coordination with part B of the 
Health Care Quality Improvement Act of 1986 (42 U.S.C. 
11131 et seq.) and section 1921.’’; and 
(4) in subsection (g)— 
(A) in paragraph (1)(A)— 
(i) in clause (iii)— 
(I) by striking ‘‘or State’’ each 
place it appears; 
(II) by redesignating subclauses 
(II) and (III) as subclauses (III) and 
(IV), respectively; and 
(III) by inserting after subclause 
(I) the following new subclause: 
‘‘(II) any dismissal or closure of 
the proceedings by reason of the pro-
vider, supplier, or practitioner surren-
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•AMDT. NO. 2786 
dering their license or leaving the 
State or jurisdiction’’; and 
(ii) by striking clause (iv) and insert-
ing the following: 
‘‘(iv) Exclusion from participation in a 
Federal health care program (as defined in 
section 1128B(f)).’’; 
(B) in paragraph (3)— 
(i) by striking subparagraphs (D) and 
(E); and 
(ii) by redesignating subparagraph 
(F) as subparagraph (D); and 
(C) in subparagraph (D) (as so redesig-
nated), by striking ‘‘or State’’. 
(b) INFORMATION REPORTED BY STATE LAW OR 
FRAUD ENFORCEMENT AGENCIES.—Section 1921 of the 
Social Security Act (42 U.S.C. 1396r–2) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘SYSTEM.—The State’’ 
and all that follows through the semicolon 
and inserting SYSTEM.— 
‘‘(A) LICENSING
OR
CERTIFICATION
AC-
TIONS.—The State must have in effect a system 
of reporting the following information with re-
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•AMDT. NO. 2786 
spect to formal proceedings (as defined by the 
Secretary in regulations) concluded against a 
health care practitioner or entity by a State li-
censing or certification agency:’’; 
(ii) by redesignating subparagraphs 
(A) through (D) as clauses (i) through 
(iv), respectively, and indenting appro-
priately; 
(iii) in subparagraph (A)(iii) (as so 
redesignated)— 
(I) by striking ‘‘the license of’’ 
and inserting ‘‘license or the right to 
apply for, or renew, a license by’’; and 
(II) 
by 
inserting 
‘‘nonrenew-
ability,’’ after ‘‘voluntary surrender,’’; 
and 
(iv) by adding at the end the following 
new subparagraph: 
‘‘(B) OTHER FINAL ADVERSE ACTIONS.— 
The State must have in effect a system of re-
porting information with respect to any final 
adverse action (not including settlements in 
which no findings of liability have been made) 
taken against a health care provider, supplier, 
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•AMDT. NO. 2786 
or practitioner by a State law or fraud enforce-
ment agency.’’; and 
(B) in paragraph (2), by striking ‘‘the au-
thority described in paragraph (1)’’ and insert-
ing ‘‘a State licensing or certification agency or 
State law or fraud enforcement agency’’; 
(2) in subsection (b)— 
(A) by striking paragraph (2) and insert-
ing the following: 
‘‘(2) to State licensing or certification agencies 
and Federal agencies responsible for the licensing 
and certification of health care providers, suppliers, 
and licensed health care practitioners;’’; 
(B) in each of paragraphs (4) and (6), by 
inserting ‘‘, but only with respect to information 
provided pursuant to subsection (a)(1)(A)’’ be-
fore the comma at the end; 
(C) by striking paragraph (5) and insert-
ing the following: 
‘‘(5) to State law or fraud enforcement agen-
cies,’’; 
(D) by redesignating paragraphs (7) and 
(8) as paragraphs (8) and (9), respectively; and 
(E) by inserting after paragraph (6) the 
following new paragraph: 
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•AMDT. NO. 2786 
‘‘(7) to health plans (as defined in section 
1128C(c));’’; 
(3) by redesignating subsection (d) as sub-
section (h), and by inserting after subsection (c) the 
following new subsections: 
‘‘(d) DISCLOSURE AND CORRECTION OF INFORMA-
TION.— 
‘‘(1) DISCLOSURE.—With respect to informa-
tion reported pursuant to subsection (a)(1), the Sec-
retary shall— 
‘‘(A) provide for disclosure of the informa-
tion, upon request, to the health care practi-
tioner who, or the entity that, is the subject of 
the information reported; and 
‘‘(B) establish procedures for the case 
where the health care practitioner or entity dis-
putes the accuracy of the information reported. 
‘‘(2) CORRECTIONS.—Each State licensing or 
certification agency and State law or fraud enforce-
ment agency shall report corrections of information 
already reported about any formal proceeding or 
final adverse action described in subsection (a), in 
such form and manner as the Secretary prescribes 
by regulation. 
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•AMDT. NO. 2786 
‘‘(e) FEES FOR DISCLOSURE.—The Secretary may 
establish or approve reasonable fees for the disclosure of 
information under this section. The amount of such a fee 
may not exceed the costs of processing the requests for 
disclosure and of providing such information. Such fees 
shall be available to the Secretary to cover such costs. 
‘‘(f) PROTECTION FROM LIABILITY FOR REPORT-
ING.—No person or entity, including any agency des-
ignated by the Secretary in subsection (b), shall be held 
liable in any civil action with respect to any reporting of 
information as required under this section, without knowl-
edge of the falsity of the information contained in the re-
port. 
‘‘(g) REFERENCES.—For purposes of this section: 
‘‘(1) STATE
LICENSING
OR
CERTIFICATION 
AGENCY.—The term ‘State licensing or certification 
agency’ includes any authority of a State (or of a 
political subdivision thereof) responsible for the li-
censing of health care practitioners (or any peer re-
view organization or private accreditation entity re-
viewing the services provided by health care practi-
tioners) or entities. 
‘‘(2) STATE
LAW
OR
FRAUD
ENFORCEMENT 
AGENCY.—The term ‘State law or fraud enforcement 
agency’ includes— 
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•AMDT. NO. 2786 
‘‘(A) a State law enforcement agency; and 
‘‘(B) a State medicaid fraud control unit 
(as defined in section 1903(q)). 
‘‘(3) FINAL ADVERSE ACTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘final adverse action’ in-
cludes— 
‘‘(i) civil judgments against a health 
care provider, supplier, or practitioner in 
State court related to the delivery of a 
health care item or service; 
‘‘(ii) State criminal convictions related 
to the delivery of a health care item or 
service; 
‘‘(iii) exclusion from participation in 
State health care programs (as defined in 
section 1128(h)); 
‘‘(iv) any licensing or certification ac-
tion described in subsection (a)(1)(A) 
taken against a supplier by a State licens-
ing or certification agency; and 
‘‘(v) any other adjudicated actions or 
decisions that the Secretary shall establish 
by regulation. 
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•AMDT. NO. 2786 
‘‘(B) EXCEPTION.—Such term does not in-
clude any action with respect to a malpractice 
claim.’’; and 
(4) in subsection (h), as so redesignated, by 
striking ‘‘The Secretary’’ and all that follows 
through the period at the end and inserting ‘‘In im-
plementing this section, the Secretary shall provide 
for the maximum appropriate coordination with part 
B of the Health Care Quality Improvement Act of 
1986 (42 U.S.C. 11131 et seq.) and section 
1128E.’’. 
(c) 
CONFORMING
AMENDMENT.—Section 
1128C(a)(1) of the Social Security Act (42 U.S.C. 1320a– 
7c(a)(1)) is amended— 
(1) in subparagraph (C), by adding ‘‘and’’ after 
the comma at the end; 
(2) in subparagraph (D), by striking ‘‘, and’’ 
and inserting a period; and 
(3) by striking subparagraph (E). 
(d) TRANSITION PROCESS; EFFECTIVE DATE.— 
(1) IN GENERAL.—Effective on the date of en-
actment of this Act, the Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall implement a transition process 
under which, by not later than the end of the transi-
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•AMDT. NO. 2786 
tion period described in paragraph (5), the Secretary 
shall cease operating the Healthcare Integrity and 
Protection Data Bank established under section 
1128E of the Social Security Act (as in effect before 
the effective date specified in paragraph (6)) and 
shall transfer all data collected in the Healthcare In-
tegrity and Protection Data Bank to the National 
Practitioner Data Bank established pursuant to the 
Health Care Quality Improvement Act of 1986 (42 
U.S.C. 11101 et seq.). During such transition proc-
ess, the Secretary shall have in effect appropriate 
procedures to ensure that data collection and access 
to the Healthcare Integrity and Protection Data 
Bank and the National Practitioner Data Bank are 
not disrupted. 
(2) REGULATIONS.—The Secretary shall pro-
mulgate regulations to carry out the amendments 
made by subsections (a) and (b). 
(3) FUNDING.— 
(A) AVAILABILITY
OF
FEES.—Fees col-
lected pursuant to section 1128E(d)(2) of the 
Social Security Act prior to the effective date 
specified in paragraph (6) for the disclosure of 
information in the Healthcare Integrity and 
Protection Data Bank shall be available to the 
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•AMDT. NO. 2786 
Secretary, without fiscal year limitation, for 
payment of costs related to the transition proc-
ess described in paragraph (1). Any such fees 
remaining after the transition period is com-
plete shall be available to the Secretary, without 
fiscal year limitation, for payment of the costs 
of operating the National Practitioner Data 
Bank. 
(B) 
AVAILABILITY
OF
ADDITIONAL 
FUNDS.—In addition to the fees described in 
subparagraph (A), any funds available to the 
Secretary or to the Inspector General of the 
Department of Health and Human Services for 
a purpose related to combating health care 
fraud, waste, or abuse shall be available to the 
extent necessary for operating the Healthcare 
Integrity and Protection Data Bank during the 
transition period, including systems testing and 
other activities necessary to ensure that infor-
mation formerly reported to the Healthcare In-
tegrity and Protection Data Bank will be acces-
sible through the National Practitioner Data 
Bank after the end of such transition period. 
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•AMDT. NO. 2786 
(4) SPECIAL PROVISION FOR ACCESS TO THE 
NATIONAL PRACTITIONER DATA BANK BY THE DE-
PARTMENT OF VETERANS AFFAIRS.— 
(A) IN
GENERAL.—Notwithstanding any 
other provision of law, during the 1-year period 
that begins on the effective date specified in 
paragraph (6), the information described in 
subparagraph (B) shall be available from the 
National Practitioner Data Bank to the Sec-
retary of Veterans Affairs without charge. 
(B) INFORMATION DESCRIBED.—For pur-
poses of subparagraph (A), the information de-
scribed in this subparagraph is the information 
that would, but for the amendments made by 
this section, have been available to the Sec-
retary of Veterans Affairs from the Healthcare 
Integrity and Protection Data Bank. 
(5) TRANSITION PERIOD DEFINED.—For pur-
poses of this subsection, the term ‘‘transition pe-
riod’’ means the period that begins on the date of 
enactment of this Act and ends on the later of— 
(A) the date that is 1 year after such date 
of enactment; or 
(B) the effective date of the regulations 
promulgated under paragraph (2). 
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•AMDT. NO. 2786 
(6) EFFECTIVE DATE.—The amendments made 
by subsections (a), (b), and (c) shall take effect on 
the first day after the final day of the transition pe-
riod. 
SEC. 6404. MAXIMUM PERIOD FOR SUBMISSION OF MEDI-
CARE CLAIMS REDUCED TO NOT MORE THAN 
12 MONTHS. 
(a) REDUCING MAXIMUM PERIOD
FOR SUBMIS-
SION.— 
(1) PART A.—Section 1814(a) of the Social Se-
curity Act (42 U.S.C. 1395f(a)(1)) is amended— 
(A) in paragraph (1), by striking ‘‘period 
of 3 calendar years’’ and all that follows 
through the semicolon and inserting ‘‘period 
ending 1 calendar year after the date of serv-
ice;’’; and 
(B) by adding at the end the following new 
sentence: ‘‘In applying paragraph (1), the Sec-
retary may specify exceptions to the 1 calendar 
year period specified in such paragraph.’’ 
(2) PART B.— 
(A) Section 1842(b)(3) of such Act (42 
U.S.C. 1395u(b)(3)(B)) is amended— 
(i) in subparagraph (B), in the flush 
language following clause (ii), by striking 
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•AMDT. NO. 2786 
(1) IN GENERAL.—The amendments made by 
subsection (a) shall apply to services furnished on or 
after January 1, 2010. 
(2) SERVICES
FURNISHED
BEFORE
2010.—In 
the case of services furnished before January 1, 
2010, a bill or request for payment under section 
1814(a)(1), 1842(b)(3)(B), or 1835(a) shall be filed 
not later that December 31, 2010. 
SEC. 6405. PHYSICIANS WHO ORDER ITEMS OR SERVICES 
REQUIRED TO BE MEDICARE ENROLLED PHY-
SICIANS OR ELIGIBLE PROFESSIONALS. 
(a) DME.—Section 1834(a)(11)(B) of the Social Se-
curity Act (42 U.S.C. 1395m(a)(11)(B)) is amended by 
striking ‘‘physician’’ and inserting ‘‘physician enrolled 
under section 1866(j) or an eligible professional under sec-
tion 1848(k)(3)(B) that is enrolled under section 
1866(j)’’. 
(b) HOME HEALTH SERVICES.— 
(1) PART A.—Section 1814(a)(2) of such Act 
(42 U.S.C. 1395(a)(2)) is amended in the matter 
preceding subparagraph (A) by inserting ‘‘in the 
case of services described in subparagraph (C), a 
physician enrolled under section 1866(j) or an eligi-
ble professional under section 1848(k)(3)(B),’’ be-
fore ‘‘or, in the case of services’’. 
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•AMDT. NO. 2786 
(2) PART B.—Section 1835(a)(2) of such Act 
(42 U.S.C. 1395n(a)(2)) is amended in the matter 
preceding subparagraph (A) by inserting ‘‘, or in the 
case of services described in subparagraph (A), a 
physician enrolled under section 1866(j) or an eligi-
ble professional under section 1848(k)(3)(B),’’ after 
‘‘a physician’’. 
(c) APPLICATION TO OTHER ITEMS OR SERVICES.— 
The Secretary may extend the requirement applied by the 
amendments made by subsections (a) and (b) to durable 
medical equipment and home health services (relating to 
requiring certifications and written orders to be made by 
enrolled physicians and health professions) to all other 
categories of items or services under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.), including 
covered part D drugs as defined in section 1860D–2(e) 
of such Act (42 U.S.C. 1395w–102), that are ordered, pre-
scribed, or referred by a physician enrolled under section 
1866(j) of such Act (42 U.S.C. 1395cc(j)) or an eligible 
professional under section 1848(k)(3)(B) of such Act (42 
U.S.C. 1395w–4(k)(3)(B)). 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to written orders and certifications 
made on or after July 1, 2010. 
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•AMDT. NO. 2786 
SEC. 6406. REQUIREMENT FOR PHYSICIANS TO PROVIDE 
DOCUMENTATION ON REFERRALS TO PRO-
GRAMS AT HIGH RISK OF WASTE AND ABUSE. 
(a) PHYSICIANS AND OTHER SUPPLIERS.—Section 
1842(h) of the Social Security Act (42 U.S.C. 1395u(h)) 
is amended by adding at the end the following new para-
graph 
‘‘(9) The Secretary may revoke enrollment, for a pe-
riod of not more than one year for each act, for a physi-
cian or supplier under section 1866(j) if such physician 
or supplier fails to maintain and, upon request of the Sec-
retary, provide access to documentation relating to written 
orders or requests for payment for durable medical equip-
ment, certifications for home health services, or referrals 
for other items or services written or ordered by such phy-
sician or supplier under this title, as specified by the Sec-
retary.’’. 
(b) PROVIDERS OF SERVICES.—Section 1866(a)(1) 
of such Act (42 U.S.C. 1395cc) is further amended— 
(1) in subparagraph (U), by striking at the end 
‘‘and’’; 
(2) in subparagraph (V), by striking the period 
at the end and adding ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
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•AMDT. NO. 2786 
‘‘(W) maintain and, upon request of the 
Secretary, provide access to documentation re-
lating to written orders or requests for payment 
for durable medical equipment, certifications for 
home health services, or referrals for other 
items or services written or ordered by the pro-
vider under this title, as specified by the Sec-
retary.’’. 
(c) OIG PERMISSIVE EXCLUSION AUTHORITY.—Sec-
tion 1128(b)(11) of the Social Security Act (42 U.S.C. 
1320a–7(b)(11)) is amended by inserting ‘‘, ordering, re-
ferring for furnishing, or certifying the need for’’ after 
‘‘furnishing’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to orders, certifications, and refer-
rals made on or after January 1, 2010. 
SEC. 6407. FACE TO FACE ENCOUNTER WITH PATIENT RE-
QUIRED BEFORE PHYSICIANS MAY CERTIFY 
ELIGIBILITY FOR HOME HEALTH SERVICES 
OR DURABLE MEDICAL EQUIPMENT UNDER 
MEDICARE. 
(a) CONDITION OF PAYMENT FOR HOME HEALTH 
SERVICES.— 
(1) PART
A.—Section 1814(a)(2)(C) of such 
Act is amended— 
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(A) by striking ‘‘and such services’’ and in-
serting ‘‘such services’’; and 
(B) by inserting after ‘‘care of a physi-
cian’’ the following: ‘‘, and, in the case of a cer-
tification made by a physician after January 1, 
2010, prior to making such certification the 
physician must document that the physician 
himself or herself has had a face-to-face en-
counter (including through use of telehealth, 
subject to the requirements in section 1834(m), 
and other than with respect to encounters that 
are incident to services involved) with the indi-
vidual within a reasonable timeframe as deter-
mined by the Secretary’’. 
(2) PART B.—Section 1835(a)(2)(A) of the So-
cial Security Act is amended— 
(A) by striking ‘‘and’’ before ‘‘(iii)’’; and 
(B) by inserting after ‘‘care of a physi-
cian’’ the following: ‘‘, and (iv) in the case of 
a certification after January 1, 2010, prior to 
making such certification the physician must 
document that the physician has had a face-to- 
face encounter (including through use of tele-
health and other than with respect to encoun-
ters that are incident to services involved) with 
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the individual during the 6-month period pre-
ceding such certification, or other reasonable 
timeframe as determined by the Secretary’’. 
(b) CONDITION OF PAYMENT FOR DURABLE MED-
ICAL EQUIPMENT.—Section 1834(a)(11)(B) of the Social 
Security Act (42 U.S.C. 1395m(a)(11)(B)) is amended— 
(1) by striking ‘‘ORDER.—The Secretary’’ and 
inserting ‘‘ORDER.— 
‘‘(i) IN
GENERAL.—The Secretary’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) REQUIREMENT
FOR
FACE
TO 
FACE
ENCOUNTER.—The Secretary shall 
require that such an order be written pur-
suant to the physician documenting that a 
physician, a physician assistant, a nurse 
practitioner, or a clinical nurse specialist 
(as those terms are defined in section 
1861(aa)(5)) has had a face-to-face en-
counter (including through use of tele-
health under subsection (m) and other 
than with respect to encounters that are 
incident to services involved) with the indi-
vidual involved during the 6-month period 
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preceding such written order, or other rea-
sonable timeframe as determined by the 
Secretary.’’. 
(c) APPLICATION TO OTHER AREAS UNDER MEDI-
CARE.—The Secretary may apply the face-to-face encoun-
ter requirement described in the amendments made by 
subsections (a) and (b) to other items and services for 
which payment is provided under title XVIII of the Social 
Security Act based upon a finding that such an decision 
would reduce the risk of waste, fraud, or abuse. 
(d) APPLICATION TO MEDICAID.—The requirements 
pursuant to the amendments made by subsections (a) and 
(b) shall apply in the case of physicians making certifi-
cations for home health services under title XIX of the 
Social Security Act in the same manner and to the same 
extent as such requirements apply in the case of physi-
cians making such certifications under title XVIII of such 
Act. 
SEC. 6408. ENHANCED PENALTIES. 
(a) CIVIL MONETARY PENALTIES FOR FALSE STATE-
MENTS OR DELAYING INSPECTIONS.—Section 1128A(a) 
of the Social Security Act (42 U.S.C. 1320a–7a(a)), as 
amended by section 5002(d)(2)(A), is amended— 
(1) in paragraph (6), by striking ‘‘or’’ at the 
end; and 
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(2) by inserting after paragraph (7) the fol-
lowing new paragraphs: 
‘‘(8) knowingly makes, uses, or causes to be 
made or used, a false record or statement material 
to a false or fraudulent claim for payment for items 
and services furnished under a Federal health care 
program; or 
‘‘(9) fails to grant timely access, upon reason-
able request (as defined by the Secretary in regula-
tions), to the Inspector General of the Department 
of Health and Human Services, for the purpose of 
audits, investigations, evaluations, or other statutory 
functions of the Inspector General of the Depart-
ment of Health and Human Services;’’; and 
(3) in the first sentence— 
(A) by striking ‘‘or in cases under para-
graph (7)’’ and inserting ‘‘in cases under para-
graph (7)’’; and 
(B) by striking ‘‘act)’’ and inserting ‘‘act, 
in cases under paragraph (8), $50,000 for each 
false record or statement, or in cases under 
paragraph (9), $15,000 for each day of the fail-
ure described in such paragraph)’’. 
(b) MEDICARE ADVANTAGE AND PART D PLANS.— 
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(1) ENSURING TIMELY INSPECTIONS RELATING 
TO CONTRACTS WITH MA ORGANIZATIONS.—Section 
1857(d)(2) of such Act (42 U.S.C. 1395w–27(d)(2)) 
is amended— 
(A) in subparagraph (A), by inserting 
‘‘timely’’ before ‘‘inspect’’; and 
(B) in subparagraph (B), by inserting 
‘‘timely’’ before ‘‘audit and inspect’’. 
(2) 
MARKETING
VIOLATIONS.—Section 
1857(g)(1) of the Social Security Act (42 U.S.C. 
1395w—27(g)(1)) is amended— 
(A) in subparagraph (F), by striking ‘‘or’’ 
at the end; 
(B) by inserting after subparagraph (G) 
the following new subparagraphs: 
‘‘(H) except as provided under subpara-
graph (C) or (D) of section 1860D–1(b)(1), en-
rolls an individual in any plan under this part 
without the prior consent of the individual or 
the designee of the individual; 
‘‘(I) transfers an individual enrolled under 
this part from one plan to another without the 
prior consent of the individual or the designee 
of the individual or solely for the purpose of 
earning a commission; 
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‘‘(J) fails to comply with marketing re-
strictions described in subsections (h) and (j) of 
section 1851 or applicable implementing regula-
tions or guidance; or 
‘‘(K) employs or contracts with any indi-
vidual or entity who engages in the conduct de-
scribed in subparagraphs (A) through (J) of 
this paragraph;’’; and 
(C) by adding at the end the following new 
sentence: ‘‘The Secretary may provide, in addi-
tion to any other remedies authorized by law, 
for any of the remedies described in paragraph 
(2), if the Secretary determines that any em-
ployee or agent of such organization, or any 
provider or supplier who contracts with such or-
ganization, has engaged in any conduct de-
scribed in subparagraphs (A) through (K) of 
this paragraph.’’. 
(3) PROVISION OF FALSE INFORMATION.—Sec-
tion 1857(g)(2)(A) of the Social Security Act (42 
U.S.C. 1395w—27(g)(2)(A)) is amended by insert-
ing ‘‘except with respect to a determination under 
subparagraph (E), an assessment of not more than 
the amount claimed by such plan or plan sponsor 
based upon the misrepresentation or falsified infor-
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mation involved,’’ after ‘‘for each such determina-
tion,’’. 
(c) OBSTRUCTION OF PROGRAM AUDITS.—Section 
1128(b)(2) of the Social Security Act (42 U.S.C. 1320a– 
7(b)(2)) is amended— 
(1) in the heading, by inserting ‘‘OR AUDIT’’ 
after ‘‘INVESTIGATION’’; and 
(2) by striking ‘‘investigation into’’ and all that 
follows through the period and inserting ‘‘investiga-
tion or audit related to—’’ 
‘‘(i) any offense described in para-
graph (1) or in subsection (a); or 
‘‘(ii) the use of funds received, directly 
or indirectly, from any Federal health care 
program 
(as 
defined 
in 
section 
1128B(f)).’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to acts committed on or after January 1, 
2010. 
(2) EXCEPTION.—The amendments made by 
subsection (b)(1) take effect on the date of enact-
ment of this Act. 
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•AMDT. NO. 2786 
SEC. 6409. MEDICARE SELF-REFERRAL DISCLOSURE PRO-
TOCOL. 
(a) DEVELOPMENT
OF SELF-REFERRAL DISCLO-
SURE PROTOCOL.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services, in cooperation with the Inspector 
General of the Department of Health and Human 
Services, shall establish, not later than 6 months 
after the date of the enactment of this Act, a pro-
tocol to enable health care providers of services and 
suppliers to disclose an actual or potential violation 
of section 1877 of the Social Security Act (42 
U.S.C. 1395nn) pursuant to a self-referral disclosure 
protocol (in this section referred to as an ‘‘SRDP’’). 
The SRDP shall include direction to health care pro-
viders of services and suppliers on— 
(A) a specific person, official, or office to 
whom such disclosures shall be made; and 
(B) instruction on the implication of the 
SRDP on corporate integrity agreements and 
corporate compliance agreements. 
(2) PUBLICATION ON INTERNET WEBSITE OF 
SRDP INFORMATION.—The Secretary of Health and 
Human Services shall post information on the public 
Internet website of the Centers for Medicare & Med-
icaid Services to inform relevant stakeholders of how 
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•AMDT. NO. 2786 
to disclose actual or potential violations pursuant to 
an SRDP. 
(3) RELATION
TO
ADVISORY
OPINIONS.—The 
SRDP shall be separate from the advisory opinion 
process set forth in regulations implementing section 
1877(g) of the Social Security Act. 
(b) REDUCTION IN AMOUNTS OWED.—The Secretary 
of Health and Human Services is authorized to reduce the 
amount due and owing for all violations under section 
1877 of the Social Security Act to an amount less than 
that specified in subsection (g) of such section. In estab-
lishing such amount for a violation, the Secretary may 
consider the following factors: 
(1) The nature and extent of the improper or 
illegal practice. 
(2) The timeliness of such self-disclosure. 
(3) The cooperation in providing additional in-
formation related to the disclosure. 
(4) Such other factors as the Secretary con-
siders appropriate. 
(c) REPORT.—Not later than 18 months after the 
date on which the SRDP protocol is established under sub-
section (a)(1), the Secretary shall submit to Congress a 
report on the implementation of this section. Such report 
shall include— 
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•AMDT. NO. 2786 
(1) the number of health care providers of serv-
ices and suppliers making disclosures pursuant to 
the SRDP; 
(2) the amounts collected pursuant to the 
SRDP; 
(3) the types of violations reported under the 
SRDP; and 
(4) such other information as may be necessary 
to evaluate the impact of this section. 
SEC. 6410. ADJUSTMENTS TO THE MEDICARE DURABLE 
MEDICAL 
EQUIPMENT, 
PROSTHETICS, 
ORTHOTICS, AND SUPPLIES COMPETITIVE 
ACQUISITION PROGRAM. 
(a) EXPANSION OF ROUND 2 OF THE DME COM-
PETITIVE BIDDING PROGRAM.—Section 1847(a)(1) of the 
Social Security Act (42 U.S.C. 1395w–3(a)(1)) is amend-
ed— 
(1) in subparagraph (B)(i)(II), by striking ‘‘70’’ 
and inserting ‘‘91’’; and 
(2) in subparagraph (D)(ii)— 
(A) in subclause (I), by striking ‘‘and’’ at 
the end; 
(B) by redesignating subclause (II) as sub-
clause (III); and 
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(C) by inserting after subclause (I) the fol-
lowing new subclause: 
‘‘(II) the Secretary shall include 
the next 21 largest metropolitan sta-
tistical areas by total population 
(after those selected under subclause 
(I)) for such round; and’’. 
(b) REQUIREMENT TO EITHER COMPETITIVELY BID 
AREAS OR USE COMPETITIVE BID PRICES BY 2016.— 
Section 1834(a)(1)(F) of the Social Security Act (42 
U.S.C. 1395m(a)(1)(F)) is amended— 
(1) in clause (i), by striking ‘‘and’’ at the end; 
(2) in clause (ii)— 
(A) by inserting ‘‘(and, in the case of cov-
ered items furnished on or after January 1, 
2016, subject to clause (iii), shall)’’ after 
‘‘may’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) in the case of covered items fur-
nished on or after January 1, 2016, the 
Secretary shall continue to make such ad-
justments described in clause (ii) as, under 
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such competitive acquisition programs, ad-
ditional covered items are phased in or in-
formation is updated as contracts under 
section 1847 are recompeted in accordance 
with section 1847(b)(3)(B).’’. 
SEC. 6411. EXPANSION OF THE RECOVERY AUDIT CON-
TRACTOR (RAC) PROGRAM. 
(a) EXPANSION TO MEDICAID.— 
(1) 
STATE
PLAN
AMENDMENT.—Section 
1902(a)(42) of the Social Security Act (42 U.S.C. 
1396a(a)(42)) is amended— 
(A) by striking ‘‘that the records’’ and in-
serting ‘‘that— 
‘‘(A) the records’’; 
(B) by inserting ‘‘and’’ after the semicolon; 
and 
(C) by adding at the end the following: 
‘‘(B) not later than December 31, 2010, 
the State shall— 
‘‘(i) establish a program under which 
the State contracts (consistent with State 
law and in the same manner as the Sec-
retary enters into contracts with recovery 
audit contractors under section 1893(h), 
subject to such exceptions or requirements 
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as the Secretary may require for purposes 
of this title or a particular State) with 1 
or more recovery audit contractors for the 
purpose of identifying underpayments and 
overpayments and recouping overpayments 
under the State plan and under any waiver 
of the State plan with respect to all serv-
ices for which payment is made to any en-
tity under such plan or waiver; and 
‘‘(ii) provide assurances satisfactory 
to the Secretary that— 
‘‘(I) under such contracts, pay-
ment shall be made to such a con-
tractor only from amounts recovered; 
‘‘(II) from such amounts recov-
ered, payment— 
‘‘(aa) shall be made on a 
contingent basis for collecting 
overpayments; and 
‘‘(bb) may be made in such 
amounts as the State may specify 
for identifying underpayments; 
‘‘(III) the State has an adequate 
process for entities to appeal any ad-
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verse determination made by such 
contractors; and 
‘‘(IV) such program is carried 
out in accordance with such require-
ments as the Secretary shall specify, 
including— 
‘‘(aa) for purposes of section 
1903(a)(7), that amounts ex-
pended by the State to carry out 
the program shall be considered 
amounts expended as necessary 
for the proper and efficient ad-
ministration of the State plan or 
a waiver of the plan; 
‘‘(bb) that section 1903(d) 
shall apply to amounts recovered 
under the program; and 
‘‘(cc) that the State and any 
such contractors under contract 
with the State shall coordinate 
such recovery audit efforts with 
other contractors or entities per-
forming audits of entities receiv-
ing payments under the State 
plan or waiver in the State, in-
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cluding efforts with Federal and 
State law enforcement with re-
spect to the Department of Jus-
tice, including the Federal Bu-
reau of Investigations, the In-
spector General of the Depart-
ment of Health and Human 
Services, and the State medicaid 
fraud control unit; and’’. 
(2) COORDINATION; REGULATIONS.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services, acting through the 
Administrator of the Centers for Medicare & 
Medicaid Services, shall coordinate the expan-
sion of the Recovery Audit Contractor program 
to Medicaid with States, particularly with re-
spect to each State that enters into a contract 
with a recovery audit contractor for purposes of 
the State’s Medicaid program prior to Decem-
ber 31, 2010. 
(B) REGULATIONS.—The Secretary of 
Health and Human Services shall promulgate 
regulations to carry out this subsection and the 
amendments made by this subsection, including 
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•AMDT. NO. 2786 
view the effectiveness of each such anti-fraud 
plan; 
‘‘(B) ensure that each prescription drug 
plan under part D has an anti- fraud plan in 
effect and to review the effectiveness of each 
such anti-fraud plan; 
‘‘(C) examine claims for reinsurance pay-
ments under section 1860D–15(b) to determine 
whether prescription drug plans submitting 
such claims incurred costs in excess of the al-
lowable reinsurance costs permitted under para-
graph (2) of that section; and 
‘‘(D) review estimates submitted by pre-
scription drug plans by private plans with re-
spect to the enrollment of high cost bene-
ficiaries (as defined by the Secretary) and to 
compare such estimates with the numbers of 
such beneficiaries actually enrolled by such 
plans.’’. 
(c) ANNUAL REPORT.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall submit 
an annual report to Congress concerning the effectiveness 
of the Recovery Audit Contractor program under Medicaid 
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•AMDT. NO. 2786 
and Medicare and shall include such reports recommenda-
tions for expanding or improving the program. 
Subtitle F—Additional Medicaid 
Program Integrity Provisions 
SEC. 6501. TERMINATION OF PROVIDER PARTICIPATION 
UNDER MEDICAID IF TERMINATED UNDER 
MEDICARE OR OTHER STATE PLAN. 
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 individual or entity in such program if (subject to 
such exceptions as are permitted with respect to exclusion 
under sections 1128(c)(3)(B) and 1128(d)(3)(B)) partici-
pation of such individual or entity is terminated under title 
XVIII or any other State plan under this title,’’. 
SEC. 6502. MEDICAID EXCLUSION FROM PARTICIPATION 
RELATING TO CERTAIN OWNERSHIP, CON-
TROL, AND MANAGEMENT AFFILIATIONS. 
Section 1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)), as amended by section 6401(b), is amended by 
inserting after paragraph (77) the following: 
‘‘(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 
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•AMDT. NO. 2786 
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 (as defined 
by the Secretary) under this title during such 
period determined by the Secretary 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 
‘‘(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;’’. 
SEC. 6503. 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 section 6502(a), is amended by inserting after para-
graph (78), the following: 
‘‘(79) provide that any agent, clearinghouse, or 
other alternate payee (as defined by the Secretary) 
that submits claims on behalf of a health care pro-
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vider must register with the State and the Secretary 
in a form and manner specified by the Secretary;’’. 
SEC. 6504. REQUIREMENT TO REPORT EXPANDED SET OF 
DATA ELEMENTS UNDER MMIS TO DETECT 
FRAUD AND ABUSE. 
(a) IN GENERAL.—Section 1903(r)(1)(F) of the So-
cial Security Act (42 U.S.C. 1396b(r)(1)(F)) is amended 
by inserting after ‘‘necessary’’ the following: ‘‘and includ-
ing, for data submitted to the Secretary on or after Janu-
ary 1, 2010, data elements from the automated data sys-
tem that the Secretary determines to be necessary for pro-
gram integrity, program oversight, and administration, at 
such frequency as the Secretary shall determine’’. 
(b) MANAGED CARE ORGANIZATIONS.— 
(1) IN
GENERAL.—Section 1903(m)(2)(A)(xi) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(m)(2)(A)(xi)) is amended by inserting ‘‘and 
for the provision of such data to the State at a fre-
quency and level of detail to be specified by the Sec-
retary’’ after ‘‘patients’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply with respect to contract 
years beginning on or after January 1, 2010. 
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•AMDT. NO. 2786 
SEC. 6505. PROHIBITION ON PAYMENTS TO INSTITUTIONS 
OR ENTITIES LOCATED OUTSIDE OF THE 
UNITED STATES. 
Section 1902(a) of the Social Security Act (42 U.S.C. 
1396b(a)), as amended by section 6503, is amended by 
inserting after paragraph (79) the following new para-
graph: 
‘‘(80) provide that the State shall not provide 
any payments for items or services provided under 
the State plan or under a waiver to any financial in-
stitution or entity located outside of the United 
States;’’. 
SEC. 6506. OVERPAYMENTS. 
(a) EXTENSION OF PERIOD FOR COLLECTION OF 
OVERPAYMENTS DUE TO FRAUD.— 
(1) IN GENERAL.—Section 1903(d)(2) of the 
Social Security Act (42 U.S.C. 1396b(d)(2)) is 
amended— 
(A) in subparagraph (C)— 
(i) in the first sentence, by striking 
‘‘60 days’’ and inserting ‘‘1 year’’; and 
(ii) in the second sentence, by striking 
‘‘60 days’’ and inserting ‘‘1-year period’’; 
and 
(B) in subparagraph (D)— 
(i) in inserting ‘‘(i)’’ after ‘‘(D)’’; and 
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•AMDT. NO. 2786 
(ii) by adding at the end the fol-
lowing: 
‘‘(ii) In any case where the State is unable to recover 
a debt which represents an overpayment (or any portion 
thereof) made to a person or other entity due to fraud 
within 1 year of discovery because there is not a final de-
termination of the amount of the overpayment under an 
administrative or judicial process (as applicable), includ-
ing as a result of a judgment being under appeal, no ad-
justment shall be made in the Federal payment to such 
State on account of such overpayment (or portion thereof) 
before the date that is 30 days after the date on which 
a final judgment (including, if applicable, a final deter-
mination on an appeal) is made.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection take effect on the date of enact-
ment of this Act and apply to overpayments discov-
ered on or after that date. 
(b) CORRECTIVE ACTION.—The Secretary shall pro-
mulgate regulations that require States to correct Feder-
ally identified claims overpayments, of an ongoing or re-
curring nature, with new Medicaid Management Informa-
tion System (MMIS) edits, audits, or other appropriate 
corrective action. 
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•AMDT. NO. 2786 
SEC. 6507. 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’’ after 
the semi-colon; and 
(C) by adding at the end the following new 
clause: 
‘‘(iv) effective for claims filed on or 
after October 1, 2010, incorporate compat-
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: 
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•AMDT. NO. 2786 
‘‘(4) For purposes of paragraph (1)(B)(iv), the Sec-
retary shall do the following: 
‘‘(A) Not later than September 1, 2010: 
‘‘(i) Identify those methodologies of the 
National Correct Coding Initiative administered 
by the Secretary (or any successor initiative to 
promote correct coding and to control improper 
coding leading to inappropriate payment) which 
are compatible to claims filed under this title. 
‘‘(ii) Identify those methodologies of such 
Initiative (or such other national correct coding 
methodologies) that should be incorporated into 
claims filed under this title with respect to 
items or services for which States provide med-
ical assistance under this title and no national 
correct coding methodologies have been estab-
lished under such Initiative with respect to title 
XVIII. 
‘‘(iii) Notify States of— 
‘‘(I) 
the 
methodologies 
identified 
under subparagraphs (A) and (B) (and of 
any other national correct coding meth-
odologies identified under subparagraph 
(B)); and 
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•AMDT. NO. 2786 
‘‘(II) how States are to incorporate 
such methodologies into claims filed under 
this title. 
‘‘(B) Not later than March 1, 2011, submit a 
report to Congress that includes the notice to States 
under clause (iii) of subparagraph (A) and an anal-
ysis supporting the identification of the methodolo-
gies made under clauses (i) and (ii) of subparagraph 
(A).’’. 
SEC. 6508. GENERAL EFFECTIVE DATE. 
(a) IN GENERAL.—Except as otherwise provided in 
this subtitle, this subtitle and the amendments made by 
this subtitle take effect on January 1, 2011, without re-
gard to whether final regulations to carry out such amend-
ments and subtitle have been promulgated by that date. 
(b) DELAY IF STATE LEGISLATION REQUIRED.—In 
the case of a State plan for medical assistance under title 
XIX of the Social Security Act or a child health plan 
under title XXI of such Act which the Secretary of Health 
and Human Services determines requires State legislation 
(other than legislation appropriating funds) in order for 
the plan to meet the additional requirement imposed by 
the amendments made by this subtitle, the State plan or 
child health plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis of 
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•AMDT. NO. 2786 
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 
such session shall be deemed to be a separate regular ses-
sion of the State legislature. 
Subtitle G—Additional Program 
Integrity Provisions 
SEC. 6601. PROHIBITION ON FALSE STATEMENTS AND REP-
RESENTATIONS. 
(a) PROHIBITION.—Part 5 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1131 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 519. PROHIBITION ON FALSE STATEMENTS AND REP-
RESENTATIONS. 
‘‘No person, in connection with a plan or other ar-
rangement that is multiple employer welfare arrangement 
described in section 3(40), shall make a false statement 
or false representation of fact, knowing it to be false, in 
connection with the marketing or sale of such plan or ar-
rangement, to any employee, any member of an employee 
organization, any beneficiary, any employer, any employee 
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•AMDT. NO. 2786 
organization, the Secretary, or any State, or the represent-
ative or agent of any such person, State, or the Secretary, 
concerning— 
‘‘(1) the financial condition or solvency of such 
plan or arrangement; 
‘‘(2) the benefits provided by such plan or ar-
rangement; 
‘‘(3) the regulatory status of such plan or other 
arrangement under any Federal or State law gov-
erning collective bargaining, labor management rela-
tions, or intern union affairs; or 
‘‘(4) the regulatory status of such plan or other 
arrangement regarding exemption from state regu-
latory authority under this Act. 
This section shall not apply to any plan or arrangement 
that does not fall within the meaning of the term ‘multiple 
employer welfare arrangement’ under section 3(40)(A).’’. 
(b) CRIMINAL PENALTIES.—Section 501 of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1131) is amended— 
(1) by inserting ‘‘(a)’’ before ‘‘Any person’’; and 
(2) by adding at the end the following: 
‘‘(b) Any person that violates section 519 shall upon 
conviction be imprisoned not more than 10 years or fined 
under title 18, United States Code, or both.’’. 
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•AMDT. NO. 2786 
(c) CONFORMING AMENDMENT.—The table of sec-
tions for part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 is amended by 
adding at the end the following: 
‘‘Sec. 519. Prohibition on false statement and representations.’’. 
SEC. 6602. CLARIFYING DEFINITION. 
Section 24(a)(2) of title 18, United States Code, is 
amended by inserting ‘‘or section 411, 518, or 511 of the 
Employee Retirement Income Security Act of 1974,’’ after 
‘‘1954 of this title’’. 
SEC. 6603. DEVELOPMENT OF MODEL UNIFORM REPORT 
FORM. 
Part C of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-91 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 2794. UNIFORM FRAUD AND ABUSE REFERRAL FOR-
MAT. 
‘‘The Secretary shall request the National Associa-
tion of Insurance Commissioners to develop a model uni-
form report form for private health insurance issuer seek-
ing to refer suspected fraud and abuse to State insurance 
departments or other responsible State agencies for inves-
tigation. The Secretary shall request that the National As-
sociation of Insurance Commissioners develop rec-
ommendations for uniform reporting standards for such 
referrals.’’. 
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•AMDT. NO. 2786 
SEC. 6604. APPLICABILITY OF STATE LAW TO COMBAT 
FRAUD AND ABUSE. 
(a) IN GENERAL.—Part 5 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1131 et seq.), as amended by section 6601, 
is further amended by adding at the end the following: 
‘‘SEC. 520. APPLICABILITY OF STATE LAW TO COMBAT 
FRAUD AND ABUSE. 
‘‘The Secretary may, for the purpose of identifying, 
preventing, or prosecuting fraud and abuse, adopt regu-
latory standards establishing, or issue an order relating 
to a specific person establishing, that a person engaged 
in the business of providing insurance through a multiple 
employer welfare arrangement described in section 3(40) 
is subject to the laws of the States in which such person 
operates which regulate insurance in such State, notwith-
standing section 514(b)(6) of this Act or the Liability Risk 
Retention Act of 1986, and regardless of whether the law 
of the State is otherwise preempted under any of such pro-
visions. This section shall not apply to any plan or ar-
rangement that does not fall within the meaning of the 
term ‘multiple employer welfare arrangement’ under sec-
tion 3(40(A).’’. 
(b) CONFORMING AMENDMENT.—The table of sec-
tions for part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974, as amended by 
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•AMDT. NO. 2786 
section 6601, is further amended by adding at the end 
the following: 
‘‘Sec. 520. Applicability of State law to combat fraud and abuse.’’. 
SEC. 6605. ENABLING THE DEPARTMENT OF LABOR TO 
ISSUE ADMINISTRATIVE SUMMARY CEASE 
AND DESIST ORDERS AND SUMMARY SEI-
ZURES ORDERS AGAINST PLANS THAT ARE IN 
FINANCIALLY HAZARDOUS CONDITION. 
(a) IN GENERAL.—Part 5 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1131 et seq.), as amended by section 6604, 
is further amended by adding at the end the following: 
‘‘SEC. 521. ADMINISTRATIVE SUMMARY CEASE AND DESIST 
ORDERS AND SUMMARY SEIZURE ORDERS 
AGAINST MULTIPLE EMPLOYER WELFARE 
ARRANGEMENTS 
IN 
FINANCIALLY 
HAZ-
ARDOUS CONDITION. 
‘‘(a) IN GENERAL.—The Secretary may issue a cease 
and desist (ex parte) order under this title if it appears 
to the Secretary that the alleged conduct of a multiple em-
ployer welfare arrangement described in section 3(40), 
other than a plan or arrangement described in subsection 
(g), is fraudulent, or creates an immediate danger to the 
public safety or welfare, or is causing or can be reasonably 
expected to cause significant, imminent, and irreparable 
public injury. 
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•AMDT. NO. 2786 
‘‘(b) HEARING.—A person that is adversely affected 
by the issuance of a cease and desist order under sub-
section (a) may request a hearing by the Secretary regard-
ing such order. The Secretary may require that a pro-
ceeding under this section, including all related informa-
tion and evidence, be conducted in a confidential manner. 
‘‘(c) BURDEN OF PROOF.—The burden of proof in 
any hearing conducted under subsection (b) shall be on 
the party requesting the hearing to show cause why the 
cease and desist order should be set aside. 
‘‘(d) DETERMINATION.—Based upon the evidence 
presented at a hearing under subsection (b), the cease and 
desist order involved may be affirmed, modified, or set 
aside by the Secretary in whole or in part. 
‘‘(e) SEIZURE.—The Secretary may issue a summary 
seizure order under this title if it appears that a multiple 
employer welfare arrangement is in a financially haz-
ardous condition. 
‘‘(f) REGULATIONS.—The Secretary may promulgate 
such regulations or other guidance as may be necessary 
or appropriate to carry out this section. 
‘‘(g) EXCEPTION.—This section shall not apply to 
any plan or arrangement that does not fall within the 
meaning of the term ‘multiple employer welfare arrange-
ment’ under section 3(40(A).’’. 
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•AMDT. NO. 2786 
(b) CONFORMING AMENDMENT.—The table of sec-
tions for part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974, as amended by 
section 6604, is further amended by adding at the end 
the following: 
‘‘Sec. 521. Administrative summary cease and desist orders and summary sei-
zure orders against health plans in financially hazardous condi-
tion.’’. 
SEC. 6606. MEWA PLAN REGISTRATION WITH DEPARTMENT 
OF LABOR. 
Section 101(g) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1021(g)) is amended— 
(1) by striking ‘‘Secretary may’’ and inserting 
‘‘Secretary shall’’; and 
(2) by inserting ‘‘to register with the Secretary 
prior to operating in a State and may, by regulation, 
require such multiple employer welfare arrange-
ments’’ after ‘‘not group health plans’’. 
SEC. 6607. PERMITTING EVIDENTIARY PRIVILEGE AND 
CONFIDENTIAL COMMUNICATIONS. 
Section 504 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1134) is amended by adding 
at the end the following: 
‘‘(d) The Secretary may promulgate a regulation that 
provides an evidentiary privilege for, and provides for the 
confidentiality of communications between or among, any 
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•AMDT. NO. 2786 
of the following entities or their agents, consultants, or 
employees: 
‘‘(1) A State insurance department. 
‘‘(2) A State attorney general. 
‘‘(3) The National Association of Insurance 
Commissioners. 
‘‘(4) The Department of Labor. 
‘‘(5) The Department of the Treasury. 
‘‘(6) The Department of Justice. 
‘‘(7) The Department of Health and Human 
Services. 
‘‘(8) Any other Federal or State authority that 
the Secretary determines is appropriate for the pur-
poses of enforcing the provisions of this title. 
‘‘(e) The privilege established under subsection (d) 
shall apply to communications related to any investigation, 
audit, examination, or inquiry conducted or coordinated 
by any of the agencies. A communication that is privileged 
under subsection (d) shall not waive any privilege other-
wise available to the communicating agency or to any per-
son who provided the information that is communicated.’’. 
Subtitle H—Elder Justice Act 
SEC. 6701. SHORT TITLE OF SUBTITLE. 
This subtitle may be cited as the ‘‘Elder Justice Act 
of 2009’’. 
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•AMDT. NO. 2786 
SEC. 6702. DEFINITIONS. 
Except as otherwise specifically provided, any term 
that is defined in section 2011 of the Social Security Act 
(as added by section 6703(a)) and is used in this subtitle 
has the meaning given such term by such section. 
SEC. 6703. ELDER JUSTICE. 
(a) ELDER JUSTICE.— 
(1) IN GENERAL.—Title XX of the Social Secu-
rity Act (42 U.S.C. 1397 et seq.) is amended— 
(A) in the heading, by inserting ‘‘AND 
ELDER 
JUSTICE’’ 
after 
‘‘SOCIAL 
SERVICES’’; 
(B) by inserting before section 2001 the 
following: 
‘‘Subtitle A—Block Grants to States 
for Social Services’’; 
and 
(C) by adding at the end the following: 
‘‘Subtitle B—Elder Justice 
‘‘SEC. 2011. DEFINITIONS. 
‘‘In this subtitle: 
‘‘(1) ABUSE.—The term ‘abuse’ means the 
knowing infliction of physical or psychological harm 
or the knowing deprivation of goods or services that 
are necessary to meet essential needs or to avoid 
physical or psychological harm. 
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•AMDT. NO. 2786 
‘‘(2) ADULT PROTECTIVE SERVICES.—The term 
‘adult protective services’ means such services pro-
vided to adults as the Secretary may specify and in-
cludes services such as— 
‘‘(A) receiving reports of adult abuse, ne-
glect, or exploitation; 
‘‘(B) investigating the reports described in 
subparagraph (A); 
‘‘(C) case planning, monitoring, evaluation, 
and other case work and services; and 
‘‘(D) providing, arranging for, or facili-
tating the provision of medical, social service, 
economic, legal, housing, law enforcement, or 
other protective, emergency, or support services. 
‘‘(3) CAREGIVER.—The term ‘caregiver’ means 
an individual who has the responsibility for the care 
of an elder, either voluntarily, by contract, by receipt 
of payment for care, or as a result of the operation 
of law, and means a family member or other indi-
vidual who provides (on behalf of such individual or 
of a public or private agency, organization, or insti-
tution) compensated or uncompensated care to an 
elder who needs supportive services in any setting. 
‘‘(4) DIRECT
CARE.—The term ‘direct care’ 
means care by an employee or contractor who pro-
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•AMDT. NO. 2786 
vides assistance or long-term care services to a re-
cipient. 
‘‘(5) ELDER.—The term ‘elder’ means an indi-
vidual age 60 or older. 
‘‘(6) ELDER JUSTICE.—The term ‘elder justice’ 
means— 
‘‘(A) from a societal perspective, efforts 
to— 
‘‘(i) prevent, detect, treat, intervene 
in, and prosecute elder abuse, neglect, and 
exploitation; and 
‘‘(ii) protect elders with diminished 
capacity while maximizing their autonomy; 
and 
‘‘(B) from an individual perspective, the 
recognition of an elder’s rights, including the 
right to be free of abuse, neglect, and exploi-
tation. 
‘‘(7) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means a State or local government agency, In-
dian tribe or tribal organization, or any other public 
or private entity that is engaged in and has expertise 
in issues relating to elder justice or in a field nec-
essary to promote elder justice efforts. 
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•AMDT. NO. 2786 
‘‘(8) EXPLOITATION.—The term ‘exploitation’ 
means the fraudulent or otherwise illegal, unauthor-
ized, or improper act or process of an individual, in-
cluding a caregiver or fiduciary, that uses the re-
sources of an elder for monetary or personal benefit, 
profit, or gain, or that results in depriving an elder 
of rightful access to, or use of, benefits, resources, 
belongings, or assets. 
‘‘(9) FIDUCIARY.—The term ‘fiduciary’— 
‘‘(A) means a person or entity with the 
legal responsibility— 
‘‘(i) to make decisions on behalf of 
and for the benefit of another person; and 
‘‘(ii) to act in good faith and with 
fairness; and 
‘‘(B) includes a trustee, a guardian, a con-
servator, an executor, an agent under a finan-
cial power of attorney or health care power of 
attorney, or a representative payee. 
‘‘(10) GRANT.—The term ‘grant’ includes a 
contract, cooperative agreement, or other mechanism 
for providing financial assistance. 
‘‘(11) GUARDIANSHIP.—The term ‘guardian-
ship’ means— 
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•AMDT. NO. 2786 
‘‘(A) the process by which a State court 
determines that an adult individual lacks capac-
ity to make decisions about self-care or prop-
erty, and appoints another individual or entity 
known as a guardian, as a conservator, or by a 
similar term, as a surrogate decisionmaker; 
‘‘(B) the manner in which the court-ap-
pointed surrogate decisionmaker carries out du-
ties to the individual and the court; or 
‘‘(C) the manner in which the court exer-
cises oversight of the surrogate decisionmaker. 
‘‘(12) INDIAN TRIBE.— 
‘‘(A) IN
GENERAL.—The term ‘Indian 
tribe’ has the meaning given such term in sec-
tion 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450b). 
‘‘(B) 
INCLUSION
OF
PUEBLO
AND 
RANCHERIA.—The term ‘Indian tribe’ includes 
any Pueblo or Rancheria. 
‘‘(13) LAW ENFORCEMENT.—The term ‘law en-
forcement’ means the full range of potential re-
sponders to elder abuse, neglect, and exploitation in-
cluding— 
‘‘(A) police, sheriffs, detectives, public safe-
ty officers, and corrections personnel; 
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•AMDT. NO. 2786 
‘‘(B) prosecutors; 
‘‘(C) medical examiners; 
‘‘(D) investigators; and 
‘‘(E) coroners. 
‘‘(14) LONG-TERM CARE.— 
‘‘(A) IN GENERAL.—The term ‘long-term 
care’ means supportive and health services spec-
ified by the Secretary for individuals who need 
assistance because the individuals have a loss of 
capacity for self-care due to illness, disability, 
or vulnerability. 
‘‘(B) LOSS
OF
CAPACITY
FOR
SELF- 
CARE.—For purposes of subparagraph (A), the 
term ‘loss of capacity for self-care’ means an in-
ability to engage in 1 or more activities of daily 
living, including eating, dressing, bathing, man-
agement of one’s financial affairs, and other ac-
tivities the Secretary determines appropriate. 
‘‘(15) LONG-TERM CARE FACILITY.—The term 
‘long-term care facility’ means a residential care pro-
vider that arranges for, or directly provides, long- 
term care. 
‘‘(16) NEGLECT.—The term ‘neglect’ means— 
‘‘(A) the failure of a caregiver or fiduciary 
to provide the goods or services that are nec-
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•AMDT. NO. 2786 
essary to maintain the health or safety of an 
elder; or 
‘‘(B) self-neglect. 
‘‘(17) NURSING FACILITY.— 
‘‘(A) IN GENERAL.—The term ‘nursing fa-
cility’ has the meaning given such term under 
section 1919(a). 
‘‘(B) INCLUSION OF SKILLED NURSING FA-
CILITY.—The term ‘nursing facility’ includes a 
skilled nursing facility (as defined in section 
1819(a)). 
‘‘(18) SELF-NEGLECT.—The term ‘self-neglect’ 
means an adult’s inability, due to physical or mental 
impairment or diminished capacity, to perform es-
sential self-care tasks including— 
‘‘(A) obtaining essential food, clothing, 
shelter, and medical care; 
‘‘(B) obtaining goods and services nec-
essary to maintain physical health, mental 
health, or general safety; or 
‘‘(C) managing one’s own financial affairs. 
‘‘(19) SERIOUS BODILY INJURY.— 
‘‘(A) IN
GENERAL.—The term ‘serious 
bodily injury’ means an injury— 
‘‘(i) involving extreme physical pain; 
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•AMDT. NO. 2786 
‘‘(ii) involving substantial risk of 
death; 
‘‘(iii) involving protracted loss or im-
pairment of the function of a bodily mem-
ber, organ, or mental faculty; or 
‘‘(iv) requiring medical intervention 
such as surgery, hospitalization, or phys-
ical rehabilitation. 
‘‘(B) CRIMINAL SEXUAL ABUSE.—Serious 
bodily injury shall be considered to have oc-
curred if the conduct causing the injury is con-
duct described in section 2241 (relating to ag-
gravated sexual abuse) or 2242 (relating to sex-
ual abuse) of title 18, United States Code, or 
any similar offense under State law. 
‘‘(20) SOCIAL.—The term ‘social’, when used 
with respect to a service, includes adult protective 
services. 
‘‘(21) 
STATE
LEGAL
ASSISTANCE
DEVEL-
OPER.—The term ‘State legal assistance developer’ 
means an individual described in section 731 of the 
Older Americans Act of 1965. 
‘‘(22) STATE LONG-TERM CARE OMBUDSMAN.— 
The term ‘State Long-Term Care Ombudsman’ 
means the State Long-Term Care Ombudsman de-
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•AMDT. NO. 2786 
scribed in section 712(a)(2) of the Older Americans 
Act of 1965. 
‘‘SEC. 2012. GENERAL PROVISIONS. 
‘‘(a) PROTECTION OF PRIVACY.—In pursuing activi-
ties under this subtitle, the Secretary shall ensure the pro-
tection of individual health privacy consistent with the reg-
ulations promulgated under section 264(c) of the Health 
Insurance Portability and Accountability Act of 1996 and 
applicable State and local privacy regulations. 
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sub-
title shall be construed to interfere with or abridge an el-
der’s right to practice his or her religion through reliance 
on prayer alone for healing when this choice— 
‘‘(1) is contemporaneously expressed, either 
orally or in writing, with respect to a specific illness 
or injury which the elder has at the time of the deci-
sion by an elder who is competent at the time of the 
decision; 
‘‘(2) is previously set forth in a living will, 
health care proxy, or other advance directive docu-
ment that is validly executed and applied under 
State law; or 
‘‘(3) may be unambiguously deduced from the 
elder’s life history. 
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•AMDT. NO. 2786 
‘‘PART I—NATIONAL COORDINATION OF ELDER 
JUSTICE ACTIVITIES AND RESEARCH 
‘‘Subpart A—Elder Justice Coordinating Council and 
Advisory Board on Elder Abuse, Neglect, and Ex-
ploitation 
‘‘SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Secretary an Elder Justice Coordinating 
Council (in this section referred to as the ‘Council’). 
‘‘(b) MEMBERSHIP.— 
‘‘(1) IN GENERAL.—The Council shall be com-
posed of the following members: 
‘‘(A) The Secretary (or the Secretary’s 
designee). 
‘‘(B) The Attorney General (or the Attor-
ney General’s designee). 
‘‘(C) The head of each Federal department 
or agency or other governmental entity identi-
fied by the Chair referred to in subsection (d) 
as having responsibilities, or administering pro-
grams, relating to elder abuse, neglect, and ex-
ploitation. 
‘‘(2) REQUIREMENT.—Each member of the 
Council shall be an officer or employee of the Fed-
eral Government. 
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•AMDT. NO. 2786 
‘‘(c) VACANCIES.—Any vacancy in the Council shall 
not affect its powers, but shall be filled in the same man-
ner as the original appointment was made. 
‘‘(d) CHAIR.—The member described in subsection 
(b)(1)(A) shall be Chair of the Council. 
‘‘(e) MEETINGS.—The Council shall meet at least 2 
times per year, as determined by the Chair. 
‘‘(f) DUTIES.— 
‘‘(1) IN
GENERAL.—The Council shall make 
recommendations to the Secretary for the coordina-
tion of activities of the Department of Health and 
Human Services, the Department of Justice, and 
other relevant Federal, State, local, and private 
agencies and entities, relating to elder abuse, ne-
glect, and exploitation and other crimes against el-
ders. 
‘‘(2) REPORT.—Not later than the date that is 
2 years after the date of enactment of the Elder 
Justice Act of 2009 and every 2 years thereafter, 
the Council shall submit to the Committee on Fi-
nance of the Senate and the Committee on Ways 
and Means and the Committee on Energy and Com-
merce of the House of Representatives a report 
that— 
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•AMDT. NO. 2786 
‘‘(A) describes the activities and accom-
plishments of, and challenges faced by— 
‘‘(i) the Council; and 
‘‘(ii) the entities represented on the 
Council; and 
‘‘(B) makes such recommendations for leg-
islation, model laws, or other action as the 
Council determines to be appropriate. 
‘‘(g) POWERS OF THE COUNCIL.— 
‘‘(1) INFORMATION
FROM
FEDERAL
AGEN-
CIES.—Subject to the requirements of section 
2012(a), the Council may secure directly from any 
Federal department or agency such information as 
the Council considers necessary to carry out this sec-
tion. Upon request of the Chair of the Council, the 
head of such department or agency shall furnish 
such information to the Council. 
‘‘(2) POSTAL SERVICES.—The Council may use 
the United States mails in the same manner and 
under the same conditions as other departments and 
agencies of the Federal Government. 
‘‘(h) TRAVEL EXPENSES.—The members of the 
Council shall not receive compensation for the perform-
ance of services for the Council. The members shall be 
allowed travel expenses, including per diem in lieu of sub-
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•AMDT. NO. 2786 
sistence, at rates authorized for employees of agencies 
under subchapter I of chapter 57 of title 5, United States 
Code, while away from their homes or regular places of 
business in the performance of services for the Council. 
Notwithstanding section 1342 of title 31, United States 
Code, the Secretary may accept the voluntary and uncom-
pensated services of the members of the Council. 
‘‘(i) DETAIL OF GOVERNMENT EMPLOYEES.—Any 
Federal Government employee may be detailed to the 
Council without reimbursement, and such detail shall be 
without interruption or loss of civil service status or privi-
lege. 
‘‘(j) STATUS AS PERMANENT COUNCIL.—Section 14 
of the Federal Advisory Committee Act (5 U.S.C. App.) 
shall not apply to the Council. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as are nec-
essary to carry out this section. 
‘‘SEC. 2022. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, 
AND EXPLOITATION. 
‘‘(a) ESTABLISHMENT.—There is established a board 
to be known as the ‘Advisory Board on Elder Abuse, Ne-
glect, and Exploitation’ (in this section referred to as the 
‘Advisory Board’) to create short- and long-term multi-
disciplinary strategic plans for the development of the field 
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•AMDT. NO. 2786 
‘‘(A) IN GENERAL.—Any vacancy on the 
Advisory Board shall not affect its powers, but 
shall be filled in the same manner as the origi-
nal appointment was made. 
‘‘(B) FILLING UNEXPIRED TERM.—An in-
dividual chosen to fill a vacancy shall be ap-
pointed for the unexpired term of the member 
replaced. 
‘‘(3) EXPIRATION OF TERMS.—The term of any 
member shall not expire before the date on which 
the member’s successor takes office. 
‘‘(e) ELECTION OF OFFICERS.—The Advisory Board 
shall elect a Chair and Vice Chair from among its mem-
bers. The Advisory Board shall elect its initial Chair and 
Vice Chair at its initial meeting. 
‘‘(f) DUTIES.— 
‘‘(1) ENHANCE
COMMUNICATION
ON
PRO-
MOTING QUALITY OF, AND PREVENTING ABUSE, NE-
GLECT, AND EXPLOITATION IN, LONG-TERM CARE.— 
The Advisory Board shall develop collaborative and 
innovative approaches to improve the quality of, in-
cluding preventing abuse, neglect, and exploitation 
in, long-term care. 
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•AMDT. NO. 2786 
‘‘(2) COLLABORATIVE
EFFORTS
TO
DEVELOP 
CONSENSUS
AROUND
THE
MANAGEMENT
OF
CER-
TAIN QUALITY-RELATED FACTORS.— 
‘‘(A) IN GENERAL.—The Advisory Board 
shall establish multidisciplinary panels to ad-
dress, and develop consensus on, subjects relat-
ing to improving the quality of long-term care. 
At least 1 such panel shall address, and develop 
consensus on, methods for managing resident- 
to-resident abuse in long-term care. 
‘‘(B) ACTIVITIES CONDUCTED.—The multi-
disciplinary panels established under subpara-
graph (A) shall examine relevant research and 
data, identify best practices with respect to the 
subject of the panel, determine the best way to 
carry out those best practices in a practical and 
feasible manner, and determine an effective 
manner of distributing information on such 
subject. 
‘‘(3) REPORT.—Not later than the date that is 
18 months after the date of enactment of the Elder 
Justice Act of 2009, and annually thereafter, the 
Advisory Board shall prepare and submit to the 
Elder Justice Coordinating Council, the Committee 
on Finance of the Senate, and the Committee on 
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•AMDT. NO. 2786 
Ways and Means and the Committee on Energy and 
Commerce of the House of Representatives a report 
containing— 
‘‘(A) information on the status of Federal, 
State, and local public and private elder justice 
activities; 
‘‘(B) 
recommendations 
(including 
rec-
ommended priorities) regarding— 
‘‘(i) elder justice programs, research, 
training, services, practice, enforcement, 
and coordination; 
‘‘(ii) coordination between entities 
pursuing elder justice efforts and those in-
volved in related areas that may inform or 
overlap with elder justice efforts, such as 
activities to combat violence against women 
and child abuse and neglect; and 
‘‘(iii) activities relating to adult fidu-
ciary systems, including guardianship and 
other fiduciary arrangements; 
‘‘(C) recommendations for specific modi-
fications needed in Federal and State laws (in-
cluding regulations) or for programs, research, 
and training to enhance prevention, detection, 
and treatment (including diagnosis) of, inter-
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•AMDT. NO. 2786 
vention in (including investigation of), and 
prosecution of elder abuse, neglect, and exploi-
tation; 
‘‘(D) recommendations on methods for the 
most effective coordinated national data collec-
tion with respect to elder justice, and elder 
abuse, neglect, and exploitation; and 
‘‘(E) recommendations for a multidisci-
plinary strategic plan to guide the effective and 
efficient development of the field of elder jus-
tice. 
‘‘(g) POWERS OF THE ADVISORY BOARD.— 
‘‘(1) INFORMATION
FROM
FEDERAL
AGEN-
CIES.—Subject to the requirements of section 
2012(a), the Advisory Board may secure directly 
from any Federal department or agency such infor-
mation as the Advisory Board considers necessary to 
carry out this section. Upon request of the Chair of 
the Advisory Board, the head of such department or 
agency shall furnish such information to the Advi-
sory Board. 
‘‘(2) SHARING OF DATA AND REPORTS.—The 
Advisory Board may request from any entity pur-
suing elder justice activities under the Elder Justice 
Act of 2009 or an amendment made by that Act, 
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•AMDT. NO. 2786 
any data, reports, or recommendations generated in 
connection with such activities. 
‘‘(3) POSTAL SERVICES.—The Advisory Board 
may use the United States mails in the same man-
ner and under the same conditions as other depart-
ments and agencies of the Federal Government. 
‘‘(h) TRAVEL EXPENSES.—The members of the Advi-
sory Board shall not receive compensation for the perform-
ance of services for the Advisory Board. The members 
shall be allowed travel expenses for up to 4 meetings per 
year, including per diem in lieu of subsistence, at rates 
authorized for employees of agencies under subchapter I 
of chapter 57 of title 5, United States Code, while away 
from their homes or regular places of business in the per-
formance of services for the Advisory Board. Notwith-
standing section 1342 of title 31, United States Code, the 
Secretary may accept the voluntary and uncompensated 
services of the members of the Advisory Board. 
‘‘(i) DETAIL OF GOVERNMENT EMPLOYEES.—Any 
Federal Government employee may be detailed to the Ad-
visory Board without reimbursement, and such detail shall 
be without interruption or loss of civil service status or 
privilege. 
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•AMDT. NO. 2786 
‘‘(j) STATUS
AS
PERMANENT
ADVISORY
COM-
MITTEE.—Section 14 of the Federal Advisory Committee 
Act (5 U.S.C. App.) shall not apply to the advisory board. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as are nec-
essary to carry out this section. 
‘‘SEC. 2023. RESEARCH PROTECTIONS. 
‘‘(a) GUIDELINES.—The Secretary shall promulgate 
guidelines to assist researchers working in the area of 
elder abuse, neglect, and exploitation, with issues relating 
to human subject protections. 
‘‘(b) DEFINITION OF LEGALLY AUTHORIZED REP-
RESENTATIVE FOR APPLICATION OF REGULATIONS.—For 
purposes of the application of subpart A of part 46 of title 
45, Code of Federal Regulations, to research conducted 
under this subpart, the term ‘legally authorized represent-
ative’ means, unless otherwise provided by law, the indi-
vidual or judicial or other body authorized under the appli-
cable law to consent to medical treatment on behalf of an-
other person. 
‘‘SEC. 2024. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated to carry out 
this subpart— 
‘‘(1) for fiscal year 2011, $6,500,000; and 
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•AMDT. NO. 2786 
‘‘(2) for each of fiscal years 2012 through 
2014, $7,000,000. 
‘‘Subpart B—Elder Abuse, Neglect, and Exploitation 
Forensic Centers 
‘‘SEC. 2031. ESTABLISHMENT AND SUPPORT OF ELDER 
ABUSE, NEGLECT, AND EXPLOITATION FO-
RENSIC CENTERS. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with the Attorney General, shall make grants to eligible 
entities to establish and operate stationary and mobile fo-
rensic centers, to develop forensic expertise regarding, and 
provide services relating to, elder abuse, neglect, and ex-
ploitation. 
‘‘(b) STATIONARY FORENSIC CENTERS.—The Sec-
retary shall make 4 of the grants described in subsection 
(a) to institutions of higher education with demonstrated 
expertise in forensics or commitment to preventing or 
treating elder abuse, neglect, or exploitation, to establish 
and operate stationary forensic centers. 
‘‘(c) MOBILE CENTERS.—The Secretary shall make 
6 of the grants described in subsection (a) to appropriate 
entities to establish and operate mobile forensic centers. 
‘‘(d) AUTHORIZED ACTIVITIES.— 
‘‘(1) DEVELOPMENT
OF
FORENSIC
MARKERS 
AND METHODOLOGIES.—An eligible entity that re-
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•AMDT. NO. 2786 
ceives a grant under this section shall use funds 
made available through the grant to assist in deter-
mining whether abuse, neglect, or exploitation oc-
curred and whether a crime was committed and to 
conduct research to describe and disseminate infor-
mation on— 
‘‘(A) forensic markers that indicate a case 
in which elder abuse, neglect, or exploitation 
may have occurred; and 
‘‘(B) methodologies for determining, in 
such a case, when and how health care, emer-
gency service, social and protective services, and 
legal service providers should intervene and 
when the providers should report the case to 
law enforcement authorities. 
‘‘(2) DEVELOPMENT
OF
FORENSIC
EXPER-
TISE.—An eligible entity that receives a grant under 
this section shall use funds made available through 
the grant to develop forensic expertise regarding 
elder abuse, neglect, and exploitation in order to 
provide medical and forensic evaluation, therapeutic 
intervention, victim support and advocacy, case re-
view, and case tracking. 
‘‘(3) COLLECTION
OF
EVIDENCE.—The Sec-
retary, in coordination with the Attorney General, 
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•AMDT. NO. 2786 
shall use data made available by grant recipients 
under this section to develop the capacity of geriatric 
health care professionals and law enforcement to col-
lect forensic evidence, including collecting forensic 
evidence relating to a potential determination of 
elder abuse, neglect, or exploitation. 
‘‘(e) APPLICATION.—To be eligible to receive a grant 
under this section, an entity shall submit an application 
to the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
‘‘(1) for fiscal year 2011, $4,000,000; 
‘‘(2) for fiscal year 2012, $6,000,000; and 
‘‘(3) for each of fiscal years 2013 and 2014, 
$8,000,000. 
‘‘PART II—PROGRAMS TO PROMOTE ELDER 
JUSTICE 
‘‘SEC. 2041. ENHANCEMENT OF LONG-TERM CARE. 
‘‘(a) GRANTS
AND INCENTIVES
FOR LONG-TERM 
CARE STAFFING.— 
‘‘(1) IN GENERAL.—The Secretary shall carry 
out activities, including activities described in para-
graphs (2) and (3), to provide incentives for individ-
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•AMDT. NO. 2786 
uals to train for, seek, and maintain employment 
providing direct care in long-term care. 
‘‘(2) SPECIFIC PROGRAMS TO ENHANCE TRAIN-
ING, RECRUITMENT, AND RETENTION OF STAFF.— 
‘‘(A) COORDINATION WITH SECRETARY OF 
LABOR
TO
RECRUIT
AND
TRAIN
LONG-TERM 
CARE STAFF.—The Secretary shall coordinate 
activities under this subsection with the Sec-
retary of Labor in order to provide incentives 
for individuals to train for and seek employ-
ment providing direct care in long-term care. 
‘‘(B) CAREER
LADDERS
AND
WAGE
OR 
BENEFIT INCREASES TO INCREASE STAFFING IN 
LONG-TERM CARE.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall make grants to eligible entities to 
carry out programs through which the en-
tities— 
‘‘(I) offer, to employees who pro-
vide direct care to residents of an eli-
gible entity or individuals receiving 
community-based long-term care from 
an eligible entity, continuing training 
and varying levels of certification, 
based on observed clinical care prac-
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•AMDT. NO. 2786 
tices and the amount of time the em-
ployees spend providing direct care; 
and 
‘‘(II) provide, or make arrange-
ments to provide, bonuses or other in-
creased compensation or benefits to 
employees who achieve certification 
under such a program. 
‘‘(ii) APPLICATION.—To be eligible to 
receive a grant under this subparagraph, 
an eligible entity shall submit an applica-
tion to the Secretary at such time, in such 
manner, and containing such information 
as the Secretary may require (which may 
include evidence of consultation with the 
State in which the eligible entity is located 
with respect to carrying out activities fund-
ed under the grant). 
‘‘(iii) AUTHORITY TO LIMIT NUMBER 
OF APPLICANTS.—Nothing in this subpara-
graph shall be construed as prohibiting the 
Secretary from limiting the number of ap-
plicants for a grant under this subpara-
graph. 
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•AMDT. NO. 2786 
‘‘(3) SPECIFIC
PROGRAMS
TO
IMPROVE
MAN-
AGEMENT PRACTICES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
make grants to eligible entities to enable the en-
tities to provide training and technical assist-
ance. 
‘‘(B) AUTHORIZED ACTIVITIES.—An eligi-
ble entity that receives a grant under subpara-
graph (A) shall use funds made available 
through the grant to provide training and tech-
nical assistance regarding management prac-
tices using methods that are demonstrated to 
promote retention of individuals who provide di-
rect care, such as— 
‘‘(i) the establishment of standard 
human resource policies that reward high 
performance, including policies that pro-
vide for improved wages and benefits on 
the basis of job reviews; 
‘‘(ii) the establishment of motivational 
and thoughtful work organization prac-
tices; 
‘‘(iii) the creation of a workplace cul-
ture that respects and values caregivers 
and their needs; 
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•AMDT. NO. 2786 
‘‘(iv) the promotion of a workplace 
culture that respects the rights of residents 
of an eligible entity or individuals receiving 
community-based long-term care from an 
eligible entity and results in improved care 
for the residents or the individuals; and 
‘‘(v) the establishment of other pro-
grams that promote the provision of high 
quality care, such as a continuing edu-
cation program that provides additional 
hours of training, including on-the-job 
training, for employees who are certified 
nurse aides. 
‘‘(C) APPLICATION.—To be eligible to re-
ceive a grant under this paragraph, an eligible 
entity shall submit an application to the Sec-
retary at such time, in such manner, and con-
taining such information as the Secretary may 
require (which may include evidence of con-
sultation with the State in which the eligible en-
tity is located with respect to carrying out ac-
tivities funded under the grant). 
‘‘(D) AUTHORITY TO LIMIT NUMBER OF 
APPLICANTS.—Nothing in this paragraph shall 
be construed as prohibiting the Secretary from 
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•AMDT. NO. 2786 
limiting the number of applicants for a grant 
under this paragraph. 
‘‘(4) ACCOUNTABILITY
MEASURES.—The Sec-
retary shall develop accountability measures to en-
sure that the activities conducted using funds made 
available under this subsection benefit individuals 
who provide direct care and increase the stability of 
the long-term care workforce. 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) 
COMMUNITY-BASED
LONG-TERM 
CARE.—The term ‘community-based long-term 
care’ has the meaning given such term by the 
Secretary. 
‘‘(B) ELIGIBLE ENTITY.—The term ‘eligi-
ble entity’ means the following: 
‘‘(i) A long-term care facility. 
‘‘(ii) A community-based long-term 
care entity (as defined by the Secretary). 
‘‘(b) CERTIFIED EHR TECHNOLOGY GRANT PRO-
GRAM.— 
‘‘(1) GRANTS AUTHORIZED.—The Secretary is 
authorized to make grants to long-term care facili-
ties for the purpose of assisting such entities in off-
setting the costs related to purchasing, leasing, de-
veloping, and implementing certified EHR tech-
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•AMDT. NO. 2786 
nology (as defined in section 1848(o)(4)) designed to 
improve patient safety and reduce adverse events 
and health care complications resulting from medica-
tion errors. 
‘‘(2) USE OF GRANT FUNDS.—Funds provided 
under grants under this subsection may be used for 
any of the following: 
‘‘(A) Purchasing, leasing, and installing 
computer software and hardware, including 
handheld computer technologies. 
‘‘(B) Making improvements to existing 
computer software and hardware. 
‘‘(C) Making upgrades and other improve-
ments to existing computer software and hard-
ware to enable e-prescribing. 
‘‘(D) Providing education and training to 
eligible long-term care facility staff on the use 
of such technology to implement the electronic 
transmission of prescription and patient infor-
mation. 
‘‘(3) APPLICATION.— 
‘‘(A) IN GENERAL.—To be eligible to re-
ceive a grant under this subsection, a long-term 
care facility shall submit an application to the 
Secretary at such time, in such manner, and 
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•AMDT. NO. 2786 
containing such information as the Secretary 
may require (which may include evidence of 
consultation with the State in which the long- 
term care facility is located with respect to car-
rying out activities funded under the grant). 
‘‘(B) AUTHORITY
TO
LIMIT
NUMBER
OF 
APPLICANTS.—Nothing in this subsection shall 
be construed as prohibiting the Secretary from 
limiting the number of applicants for a grant 
under this subsection. 
‘‘(4) PARTICIPATION
IN
STATE
HEALTH
EX-
CHANGES.—A long-term care facility that receives a 
grant under this subsection shall, where available, 
participate in activities conducted by a State or a 
qualified State-designated entity (as defined in sec-
tion 3013(f) of the Public Health Service Act) under 
a grant under section 3013 of the Public Health 
Service Act to coordinate care and for other pur-
poses determined appropriate by the Secretary. 
‘‘(5) ACCOUNTABILITY
MEASURES.—The Sec-
retary shall develop accountability measures to en-
sure that the activities conducted using funds made 
available under this subsection help improve patient 
safety and reduce adverse events and health care 
complications resulting from medication errors. 
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•AMDT. NO. 2786 
‘‘(c) ADOPTION OF STANDARDS FOR TRANSACTIONS 
INVOLVING CLINICAL DATA BY LONG-TERM CARE FA-
CILITIES.— 
‘‘(1) STANDARDS
AND
COMPATIBILITY.—The 
Secretary shall adopt electronic standards for the ex-
change of clinical data by long-term care facilities, 
including, where available, standards for messaging 
and nomenclature. Standards adopted by the Sec-
retary under the preceding sentence shall be compat-
ible with standards established under part C of title 
XI, 
standards 
established 
under 
subsections 
(b)(2)(B)(i) and (e)(4) of section 1860D–4, stand-
ards adopted under section 3004 of the Public 
Health Service Act, and general health information 
technology standards. 
‘‘(2) ELECTRONIC
SUBMISSION
OF
DATA
TO 
THE SECRETARY.— 
‘‘(A) IN
GENERAL.—Not later than 10 
years after the date of enactment of the Elder 
Justice Act of 2009, the Secretary shall have 
procedures in place to accept the optional elec-
tronic submission of clinical data by long-term 
care facilities pursuant to the standards adopt-
ed under paragraph (1). 
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•AMDT. NO. 2786 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in this subsection shall be construed to require 
a long-term care facility to submit clinical data 
electronically to the Secretary. 
‘‘(3) REGULATIONS.—The Secretary shall pro-
mulgate regulations to carry out this subsection. 
Such regulations shall require a State, as a condi-
tion of the receipt of funds under this part, to con-
duct such data collection and reporting as the Sec-
retary determines are necessary to satisfy the re-
quirements of this subsection. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
‘‘(1) for fiscal year 2011, $20,000,000; 
‘‘(2) for fiscal year 2012, $17,500,000; and 
‘‘(3) for each of fiscal years 2013 and 2014, 
$15,000,000. 
‘‘SEC. 2042. ADULT PROTECTIVE SERVICES FUNCTIONS AND 
GRANT PROGRAMS. 
‘‘(a) SECRETARIAL RESPONSIBILITIES.— 
‘‘(1) IN GENERAL.—The Secretary shall ensure 
that the Department of Health and Human Serv-
ices— 
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•AMDT. NO. 2786 
‘‘(A) provides funding authorized by this 
part to State and local adult protective services 
offices that investigate reports of the abuse, ne-
glect, and exploitation of elders; 
‘‘(B) collects and disseminates data annu-
ally relating to the abuse, exploitation, and ne-
glect of elders in coordination with the Depart-
ment of Justice; 
‘‘(C) develops and disseminates informa-
tion on best practices regarding, and provides 
training on, carrying out adult protective serv-
ices; 
‘‘(D) conducts research related to the pro-
vision of adult protective services; and 
‘‘(E) provides technical assistance to 
States and other entities that provide or fund 
the provision of adult protective services, in-
cluding through grants made under subsections 
(b) and (c). 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, $3,000,000 for fiscal year 2011 and 
$4,000,000 for each of fiscal years 2012 through 
2014. 
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•AMDT. NO. 2786 
‘‘(b) GRANTS TO ENHANCE
THE PROVISION
OF 
ADULT PROTECTIVE SERVICES.— 
‘‘(1) ESTABLISHMENT.—There is established an 
adult protective services grant program under which 
the Secretary shall annually award grants to States 
in the amounts calculated under paragraph (2) for 
the purposes of enhancing adult protective services 
provided by States and local units of government. 
‘‘(2) AMOUNT OF PAYMENT.— 
‘‘(A) IN GENERAL.—Subject to the avail-
ability of appropriations and subparagraphs (B) 
and (C), the amount paid to a State for a fiscal 
year under the program under this subsection 
shall equal the amount appropriated for that 
year to carry out this subsection multiplied by 
the percentage of the total number of elders 
who reside in the United States who reside in 
that State. 
‘‘(B) GUARANTEED
MINIMUM
PAYMENT 
AMOUNT.— 
‘‘(i) 50 STATES.—Subject to clause 
(ii), if the amount determined under sub-
paragraph (A) for a State for a fiscal year 
is less than 0.75 percent of the amount ap-
propriated for such year, the Secretary 
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•AMDT. NO. 2786 
shall increase such determined amount so 
that the total amount paid under this sub-
section to the State for the year is equal 
to 0.75 percent of the amount so appro-
priated. 
‘‘(ii) TERRITORIES.—In the case of a 
State other than 1 of the 50 States, clause 
(i) shall be applied as if each reference to 
‘0.75’ were a reference to ‘0.1’. 
‘‘(C) PRO RATA REDUCTIONS.—The Sec-
retary shall make such pro rata reductions to 
the amounts described in subparagraph (A) as 
are necessary to comply with the requirements 
of subparagraph (B). 
‘‘(3) AUTHORIZED ACTIVITIES.— 
‘‘(A) ADULT
PROTECTIVE
SERVICES.— 
Funds made available pursuant to this sub-
section may only be used by States and local 
units of government to provide adult protective 
services and may not be used for any other pur-
pose. 
‘‘(B) USE BY AGENCY.—Each State receiv-
ing funds pursuant to this subsection shall pro-
vide such funds to the agency or unit of State 
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•AMDT. NO. 2786 
government having legal responsibility for pro-
viding adult protective services within the State. 
‘‘(C) SUPPLEMENT NOT SUPPLANT.—Each 
State or local unit of government shall use 
funds made available pursuant to this sub-
section to supplement and not supplant other 
Federal, State, and local public funds expended 
to provide adult protective services in the State. 
‘‘(4) STATE
REPORTS.—Each State receiving 
funds under this subsection shall submit to the Sec-
retary, at such time and in such manner as the Sec-
retary may require, a report on the number of elders 
served by the grants awarded under this subsection. 
‘‘(5) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, $100,000,000 for each of fiscal 
years 2011 through 2014. 
‘‘(c) STATE DEMONSTRATION PROGRAMS.— 
‘‘(1) ESTABLISHMENT.—The Secretary shall 
award grants to States for the purposes of con-
ducting demonstration programs in accordance with 
paragraph (2). 
‘‘(2) 
DEMONSTRATION
PROGRAMS.—Funds 
made available pursuant to this subsection may be 
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•AMDT. NO. 2786 
used by States and local units of government to con-
duct demonstration programs that test— 
‘‘(A) training modules developed for the 
purpose of detecting or preventing elder abuse; 
‘‘(B) methods to detect or prevent financial 
exploitation of elders; 
‘‘(C) methods to detect elder abuse; 
‘‘(D) whether training on elder abuse 
forensics enhances the detection of elder abuse 
by employees of the State or local unit of gov-
ernment; or 
‘‘(E) other matters relating to the detec-
tion or prevention of elder abuse. 
‘‘(3) APPLICATION.—To be eligible to receive a 
grant under this subsection, a State shall submit an 
application to the Secretary at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
‘‘(4) STATE
REPORTS.—Each State that re-
ceives funds under this subsection shall submit to 
the Secretary a report at such time, in such manner, 
and containing such information as the Secretary 
may require on the results of the demonstration pro-
gram conducted by the State using funds made 
available under this subsection. 
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•AMDT. NO. 2786 
‘‘(5) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, $25,000,000 for each of fiscal years 
2011 through 2014. 
‘‘SEC. 2043. LONG-TERM CARE OMBUDSMAN PROGRAM 
GRANTS AND TRAINING. 
‘‘(a) GRANTS TO SUPPORT THE LONG-TERM CARE 
OMBUDSMAN PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall make 
grants to eligible entities with relevant expertise and 
experience in abuse and neglect in long-term care fa-
cilities or long-term care ombudsman programs and 
responsibilities, for the purpose of— 
‘‘(A) improving the capacity of State long- 
term care ombudsman programs to respond to 
and resolve complaints about abuse and neglect; 
‘‘(B) conducting pilot programs with State 
long-term care ombudsman offices or local om-
budsman entities; and 
‘‘(C) providing support for such State 
long-term care ombudsman programs and such 
pilot programs (such as through the establish-
ment of a national long-term care ombudsman 
resource center). 
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•AMDT. NO. 2786 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection— 
‘‘(A) for fiscal year 2011, $5,000,000; 
‘‘(B) for fiscal year 2012, $7,500,000; and 
‘‘(C) for each of fiscal years 2013 and 
2014, $10,000,000. 
‘‘(b) OMBUDSMAN TRAINING PROGRAMS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish programs to provide and improve ombudsman 
training with respect to elder abuse, neglect, and ex-
ploitation for national organizations and State long- 
term care ombudsman programs. 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, for each of fiscal years 2011 
through 2014, $10,000,000. 
‘‘SEC. 2044. PROVISION OF INFORMATION REGARDING, AND 
EVALUATIONS 
OF, 
ELDER 
JUSTICE 
PRO-
GRAMS. 
‘‘(a) PROVISION OF INFORMATION.—To be eligible to 
receive a grant under this part, an applicant shall agree— 
‘‘(1) except as provided in paragraph (2), to 
provide the eligible entity conducting an evaluation 
under subsection (b) of the activities funded through 
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•AMDT. NO. 2786 
the grant with such information as the eligible entity 
may require in order to conduct such evaluation; or 
‘‘(2) in the case of an applicant for a grant 
under section 2041(b), to provide the Secretary with 
such information as the Secretary may require to 
conduct an evaluation or audit under subsection (c). 
‘‘(b) USE
OF ELIGIBLE ENTITIES TO CONDUCT 
EVALUATIONS.— 
‘‘(1) EVALUATIONS REQUIRED.—Except as pro-
vided in paragraph (2), the Secretary shall— 
‘‘(A) reserve a portion (not less than 2 per-
cent) of the funds appropriated with respect to 
each program carried out under this part; and 
‘‘(B) use the funds reserved under sub-
paragraph (A) to provide assistance to eligible 
entities to conduct evaluations of the activities 
funded under each program carried out under 
this part. 
‘‘(2) CERTIFIED EHR TECHNOLOGY GRANT PRO-
GRAM NOT INCLUDED.—The provisions of this sub-
section shall not apply to the certified EHR tech-
nology grant program under section 2041(b). 
‘‘(3) AUTHORIZED ACTIVITIES.—A recipient of 
assistance described in paragraph (1)(B) shall use 
the funds made available through the assistance to 
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•AMDT. NO. 2786 
conduct a validated evaluation of the effectiveness of 
the activities funded under a program carried out 
under this part. 
‘‘(4) APPLICATIONS.—To be eligible to receive 
assistance under paragraph (1)(B), an entity shall 
submit an application to the Secretary at such time, 
in such manner, and containing such information as 
the Secretary may require, including a proposal for 
the evaluation. 
‘‘(5) REPORTS.—Not later than a date specified 
by the Secretary, an eligible entity receiving assist-
ance under paragraph (1)(B) shall submit to the 
Secretary, the Committee on Ways and Means and 
the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Fi-
nance of the Senate a report containing the results 
of the evaluation conducted using such assistance to-
gether with such recommendations as the entity de-
termines to be appropriate. 
‘‘(c) EVALUATIONS AND AUDITS OF CERTIFIED EHR 
TECHNOLOGY GRANT PROGRAM BY THE SECRETARY.— 
‘‘(1) EVALUATIONS.—The Secretary shall con-
duct an evaluation of the activities funded under the 
certified EHR technology grant program under sec-
tion 2041(b). Such evaluation shall include an eval-
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•AMDT. NO. 2786 
(ii) respond to complaints with opti-
mum effectiveness and timeliness; and 
(iii) optimize the collaboration be-
tween local authorities, consumers, and 
providers, including— 
(I) such State agency; 
(II) the State Long-Term Care 
Ombudsman; 
(III) local law enforcement agen-
cies; 
(IV) advocacy and consumer or-
ganizations; 
(V) State aging units; 
(VI) Area Agencies on Aging; 
and 
(VII) other appropriate entities. 
(C) AUTHORIZATION.—There are author-
ized to be appropriated to carry out this para-
graph, for each of fiscal years 2011 through 
2014, $5,000,000. 
(3) REPORTING
OF
CRIMES
IN
FEDERALLY 
FUNDED LONG-TERM CARE FACILITIES.—Part A of 
title XI of the Social Security Act (42 U.S.C. 1301 
et seq.), as amended by section 6005, is amended by 
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•AMDT. NO. 2786 
construed to require the Secretary to ap-
prove a product with respect to which the 
Secretary has not indicated in a guidance 
document that the science and experience, 
as described in clause (i), does not allow 
approval of such an application. 
‘‘(l) PATENTS.— 
‘‘(1) CONFIDENTIAL
ACCESS
TO
SUBSECTION 
(k) APPLICATION.— 
‘‘(A) APPLICATION OF PARAGRAPH.—Un-
less otherwise agreed to by a person that sub-
mits an application under subsection (k) (re-
ferred to in this subsection as the ‘subsection 
(k) applicant’) and the sponsor of the applica-
tion for the reference product (referred to in 
this subsection as the ‘reference product spon-
sor’), the provisions of this paragraph shall 
apply to the exchange of information described 
in this subsection. 
‘‘(B) IN GENERAL.— 
‘‘(i) PROVISION OF CONFIDENTIAL IN-
FORMATION.—When a subsection (k) ap-
plicant submits an application under sub-
section (k), such applicant shall provide to 
the persons described in clause (ii), subject 
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•AMDT. NO. 2786 
to the terms of this paragraph, confidential 
access to the information required to be 
produced pursuant to paragraph (2) and 
any other information that the subsection 
(k) applicant determines, in its sole discre-
tion, to be appropriate (referred to in this 
subsection as the ‘confidential informa-
tion’). 
‘‘(ii) RECIPIENTS OF INFORMATION.— 
The persons described in this clause are 
the following: 
‘‘(I) OUTSIDE COUNSEL.—One or 
more attorneys designated by the ref-
erence product sponsor who are em-
ployees of an entity other than the 
reference product sponsor (referred to 
in this paragraph as the ‘outside 
counsel’), provided that such attor-
neys do not engage, formally or infor-
mally, in patent prosecution relevant 
or related to the reference product. 
‘‘(II) IN-HOUSE COUNSEL.—One 
attorney that represents the reference 
product sponsor who is an employee 
of the reference product sponsor, pro-
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•AMDT. NO. 2786 
(2) EXCEPTION.—An application for a biologi-
cal product may be submitted under section 505 of 
the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 355) if— 
(A) such biological product is in a product 
class for which a biological product in such 
product class is the subject of an application 
approved under such section 505 not later than 
the date of enactment of this Act; and 
(B) such application— 
(i) has been submitted to the Sec-
retary of Health and Human Services (re-
ferred to in this subtitle as the ‘‘Sec-
retary’’) before the date of enactment of 
this Act; or 
(ii) is submitted to the Secretary not 
later than the date that is 10 years after 
the date of enactment of this Act. 
(3) LIMITATION.—Notwithstanding paragraph 
(2), an application for a biological product may not 
be submitted under section 505 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 355) if there is 
another biological product approved under sub-
section (a) of section 351 of the Public Health Serv-
ice Act that could be a reference product with re-
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•AMDT. NO. 2786 
‘‘(2) 
ALTERNATIVE
ENROLLMENT
PROCE-
DURES.—The procedures established under para-
graph (1) shall provide for an alternative enrollment 
process for an individual described in subsection (c) 
in the case of such an individual— 
‘‘(A) who is self-employed; 
‘‘(B) who has more than 1 employer; or 
‘‘(C) whose employer does not elect to par-
ticipate in the automatic enrollment process es-
tablished by the Secretary. 
‘‘(3) ADMINISTRATION.— 
‘‘(A) IN GENERAL.—The Secretary and the 
Secretary of the Treasury shall, by regulation, 
establish procedures to ensure that an indi-
vidual is not automatically enrolled in the 
CLASS program by more than 1 employer. 
‘‘(B) FORM.—Enrollment in the CLASS 
program shall be made in such manner as the 
Secretary may prescribe in order to ensure ease 
of administration. 
‘‘(b) ELECTION
TO OPT-OUT.—An individual de-
scribed in subsection (c) may elect to waive enrollment in 
the CLASS program at any time in such form and manner 
as the Secretary and the Secretary of the Treasury shall 
prescribe. 
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•AMDT. NO. 2786 
SEC. 9003. DISTRIBUTIONS FOR MEDICINE QUALIFIED 
ONLY IF FOR PRESCRIBED DRUG OR INSU-
LIN. 
(a) HSAS.—Subparagraph (A) of section 223(d)(2) 
of the Internal Revenue Code of 1986 is amended by add-
ing at the end the following: ‘‘Such term shall include an 
amount paid for medicine or a drug only if such medicine 
or drug is a prescribed drug (determined without regard 
to whether such drug is available without a prescription) 
or is insulin.’’. 
(b) ARCHER MSAS.—Subparagraph (A) of section 
220(d)(2) of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following: ‘‘Such term shall 
include an amount paid for medicine or a drug only if such 
medicine or drug is a prescribed drug (determined without 
regard to whether such drug is available without a pre-
scription) or is insulin.’’. 
(c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS 
AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec-
tion 106 of the Internal Revenue Code of 1986 is amended 
by adding at the end the following new subsection: 
‘‘(f) REIMBURSEMENTS FOR MEDICINE RESTRICTED 
TO PRESCRIBED DRUGS AND INSULIN.—For purposes of 
this section and section 105, reimbursement for expenses 
incurred for a medicine or a drug shall be treated as a 
reimbursement for medical expenses only if such medicine 
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