829 
SEC. 1728. ASSURING ADEQUATE PAYMENT LEVELS FOR 
SERVICES. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended by inserting after section 1925 the following 
new section: 
‘‘ASSURING ADEQUATE PAYMENT LEVELS FOR SERVICES 
‘‘SEC. 1926. (a) IN GENERAL.—A State plan under 
this title shall not be considered to meet the requirement 
of section 1902(a)(30)(A) for a year (beginning with 2011) 
unless, by not later than April 1 before the beginning of 
such year, the State submits to the Secretary an amendment 
to the plan that specifies the payment rates to be used for 
such services under the plan in such year and includes in 
such submission such additional data as will assist the Sec-
retary in evaluating the State’s compliance with such re-
quirement, including data relating to how rates established 
for payments to medicaid managed care organizations 
under sections 1903(m) and 1932 take into account such 
payment rates. 
‘‘(b) SECRETARIAL REVIEW.—The Secretary, by not 
later than 90 days after the date of submission of a plan 
amendment under subsection (a), shall— 
‘‘(1) review each such amendment for compliance 
with the requirement of section 1902(a)(30)(A); and 
‘‘(2) approve or disapprove each such amend-
ment. 
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If the Secretary disapproves such an amendment, the State 
shall immediately submit a revised amendment that meets 
such requirement.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect on the date of the enactment 
of this Act. 
SEC. 1729. PRESERVING MEDICAID COVERAGE FOR YOUTHS 
UPON RELEASE FROM PUBLIC INSTITUTIONS. 
Section 1902(a) of the Social Security Act (42 U.S.C. 
1396a), as amended by section 1631(b) and 1703(a), is 
amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(74); 
(2) by striking the period at the end of para-
graph (75) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (75) the fol-
lowing new paragraph: 
‘‘(76) provide that in the case of any youth who 
is 18 years of age or younger, was enrolled for med-
ical assistance under the State plan immediately be-
fore becoming an inmate of a public institution, is 18 
years of age or younger upon release from such insti-
tution, and is eligible for such medical assistance 
under the State plan at the time of release from such 
institution— 
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‘‘(A) during the period such youth is incar-
cerated in a public institution, the State shall 
not terminate eligibility for medical assistance 
under the State plan for such youth; 
‘‘(B) during the period such youth is incar-
cerated in a public institution, the State shall es-
tablish a process that ensures— 
‘‘(i) that the State does not claim fed-
eral financial participation for services that 
are provided to such youth and that are ex-
cluded under subsection 1905(a)(28)(A); 
and 
‘‘(ii) that the youth receives medical 
assistance for which federal participation is 
available under this title; 
‘‘(C) on or before the date such youth is re-
leased from such institution, the State shall en-
sure that such youth is enrolled for medical as-
sistance under this title, unless and until there 
is a determination that the individual is no 
longer eligible to be so enrolled; and 
‘‘(D) the State shall ensure that enrollment 
under subparagraph (C) will be completed before 
such date so that the youth can access medical 
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assistance under this title immediately upon 
leaving the institution.’’ 
SEC. 1730. QUALITY MEASURES FOR MATERNITY AND 
ADULT HEALTH SERVICES UNDER MEDICAID 
AND CHIP. 
Title XI of the Social Security Act (42 U.S.C. 1301 
et seq.) is amended by inserting after section 1139A the fol-
lowing new section: 
‘‘SEC. 1139B. QUALITY MEASURES FOR MATERNITY AND 
ADULT HEALTH SERVICES UNDER MEDICAID 
AND CHIP. 
‘‘(a) MATERNITY CARE QUALITY MEASURES UNDER 
MEDICAID AND CHIP.— 
‘‘(1) DEVELOPMENT
OF
MEASURES.—No later 
than January 1, 2011, the Secretary shall develop 
and publish for comment a proposed set of measures 
that accurately describe the quality of maternity care 
provided under State plans under titles XIX and 
XXI. The Secretary shall publish a final rec-
ommended set of such measures no later than July 1, 
2011. 
‘‘(2) STANDARDIZED
REPORTING
FORMAT.—No 
later than January 1, 2012, the Secretary shall de-
velop and publish a standardized reporting format for 
maternity care quality measures for use by State pro-
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grams under titles XIX and XXI to collect data from 
managed care entities and providers and practi-
tioners that participate in such programs and to re-
port maternity care quality measures to the Sec-
retary. 
‘‘(b) OTHER ADULT HEALTH QUALITY MEASURES 
UNDER MEDICAID.— 
‘‘(1) DEVELOPMENT
OF
MEASURES.—The Sec-
retary shall develop quality measures that are not 
otherwise developed under section 1192 for services re-
ceived under State plans under title XIX by individ-
uals who are 21 years of age or older but have not 
attained age 65. The Secretary shall publish such 
quality measures through notice and comment rule-
making. 
‘‘(2) STANDARDIZED REPORTING FORMAT.—The 
Secretary shall develop and publish a standardized 
reporting format for quality measures developed 
under paragraph (1) and section 1192 for services 
furnished under State plans under title XIX to indi-
viduals who are 21 years of age or older but have not 
attained age 65 for use under such plans and State 
plans under title XXI. The format shall enable State 
agencies administering such plans to collect data from 
managed care entities and providers and practi-
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tioners that participate in such plans and to report 
quality measures to the Secretary. 
‘‘(c) DEVELOPMENT PROCESS.—With respect to the de-
velopment of quality measures under subsections (a) and 
(b)— 
‘‘(1) USE
OF
QUALIFIED
ENTITIES.—The Sec-
retary may enter into agreements with public, non-
profit, or academic institutions with technical exper-
tise in the area of health quality measurement to as-
sist in such development. The Secretary may carry 
out these agreements by contract, grant, or otherwise. 
‘‘(2) 
MULTI-STAKEHOLDER
PRE-RULEMAKING 
INPUT.—The Secretary shall obtain the input of 
stakeholders with respect to such quality measures 
using a process similar to that described in section 
1808(d). 
‘‘(3) COORDINATION.—The Secretary shall co-
ordinate the development of such measures under such 
subsections and with the development of child health 
quality measures under section 1139A. 
‘‘(d) ANNUAL REPORT TO CONGRESS.—No later than 
January 1, 2013, and annually thereafter, the Secretary 
shall report to the Committee on Energy and Commerce of 
the House of Representatives the Committee on Finance of 
the Senate regarding— 
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‘‘(1) the availability of reliable data relating to 
the quality of maternity care furnished under State 
plans under titles XIX and XXI; 
‘‘(2) the availability of reliable data relating to 
the quality of services furnished under State plans 
under title XIX to adults who are 21 years of age or 
older but have not attained age 65; and 
‘‘(3) recommendations for improving the quality 
of such care and services furnished under such State 
plans. 
‘‘(e) RULE OF CONSTRUCTION.—Notwithstanding any 
other provision in this section, no quality measure devel-
oped, published, or used as a basis of measurement or re-
porting under this section may be used to establish an irref-
utable presumption regarding either the medical necessity 
of care or the maximum permissible coverage for any indi-
vidual who receives medical assistance under title XIX or 
child health assistance under title XXI. 
‘‘(f) APPROPRIATION.—For purposes of carrying out 
this section, in addition to funds otherwise available, out 
of any funds in the Treasury not otherwise appropriated, 
there are appropriated $40,000,000 for the 5-fiscal-year pe-
riod beginning with fiscal year 2010. Funds appropriated 
under this subsection shall remain available until ex-
pended.’’. 
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SEC. 1730A. ACCOUNTABLE CARE ORGANIZATION PILOT 
PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish under this section an ac-
countable care program under which a State may apply 
to the Secretary for approval of an accountable care organi-
zation pilot program described in subsection (b) (in this 
section referred to as a ‘‘pilot program’’) for the application 
of the accountable care organization concept under title XIX 
of the Social Security Act. 
(b) PILOT PROGRAM DESCRIBED.— 
(1) IN GENERAL.—The pilot program described 
in this subsection is a program that applies one or 
more of the accountable care organization models de-
scribed in section 1866E of the Social Security Act, 
as added by section 1301 of this Act. 
(2) LIMITATION.—The pilot program shall oper-
ate for a period of not more than 5 years. 
(c) ADDITIONAL INCENTIVES.—In the case of the pilot 
program under this section, the Secretary may— 
(1) waive the requirements of— 
(A) section 1902(a)(1) of the Social Secu-
rity Act (relating to statewideness); 
(B) section 1902(a)(10)(B) of such Act (re-
lating to comparability); and 
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(2) increase the matching percentage for admin-
istrative expenditures up to— 
(A) 90 percent (for the first 2 years of the 
pilot program); and 
(B) 75 percent (for the next 3 years). 
(d) EVALUATION; REPORT.— 
(1) EVALUATION.—The Secretary, using the cri-
teria described in section 1866D(f)(1) of the Social 
Security Act (as inserted by section 1301 of this Act), 
shall conduct an evaluation of the pilot program 
under this section. 
(2) REPORT.—Not later than 60 days after the 
date of completion of the evaluation under paragraph 
(1), the Secretary shall submit to Congress and make 
available to the public a report on the findings of the 
evaluation under such paragraph. 
Subtitle D—Coverage 
SEC. 1731. OPTIONAL MEDICAID COVERAGE OF LOW-IN-
COME HIV-INFECTED INDIVIDUALS. 
(a) IN GENERAL.—Section 1902 of the Social Security 
Act (42 U.S.C. 1396a), as amended by section 1714(a)(1), 
is amended— 
(1) in subsection (a)(10)(A)(ii)— 
(A) by striking ‘‘or’’ at the end of subclause 
(XIX); 
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(B) by adding ‘‘or’’ at the end of subclause 
(XX); and 
(C) by adding at the end the following: 
‘‘(XXI) who are described in sub-
section (ii) (relating to HIV-infected 
individuals);’’; and 
(2) by adding at the end, as amended by sections 
1703 and 1714(a), the following: 
‘‘(ii) Individuals described in this subsection are indi-
viduals not described in subsection (a)(10)(A)(i)— 
‘‘(1) who have HIV infection; 
‘‘(2) whose income (as determined under the 
State plan under this title with respect to disabled in-
dividuals) does not exceed the maximum amount of 
income a disabled individual described in subsection 
(a)(10)(A)(i) may have and obtain medical assistance 
under the plan; and 
‘‘(3) whose resources (as determined under the 
State plan under this title with respect to disabled in-
dividuals) do not exceed the maximum amount of re-
sources a disabled individual described in subsection 
(a)(10)(A)(i) may have and obtain medical assistance 
under the plan.’’. 
(b) ENHANCED MATCH.—The first sentence of section 
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by 
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striking ‘‘section 1902(a)(10)(A)(ii)(XVIII)’’ and inserting 
‘‘subclause (XVIII) or (XXI) of section 1902(a)(10)(A)(ii)’’. 
(c) CONFORMING AMENDMENTS.—Section 1905(a) of 
such Act (42 U.S.C. 1396d(a)) is amended, in the matter 
preceding paragraph (1)— 
(1) by striking ‘‘or’’ at the end of clause (xii); 
(2) by adding ‘‘or’’ at the end of clause (xiii); 
and 
(3) by inserting after clause (xiii) the following: 
‘‘(xiv) 
individuals 
described 
in 
section 
1902(ii),’’. 
(d) EXEMPTION FROM FUNDING LIMITATION FOR TER-
RITORIES.—Section 1108(g) of the Social Security Act (42 
U.S.C. 1308(g)) is amended by adding at the end the fol-
lowing: 
‘‘(5) DISREGARDING MEDICAL ASSISTANCE FOR 
OPTIONAL
LOW-INCOME
HIV-INFECTED
INDIVID-
UALS.—The limitations under subsection (f) and the 
previous provisions of this subsection shall not apply 
to amounts expended for medical assistance for indi-
viduals described in section 1902(ii) who are only eli-
gible for such assistance on the basis of section 
1902(a)(10)(A)(ii)(XXI).’’. 
(e) EFFECTIVE DATE; SUNSET.—The amendments 
made by this section shall apply to expenditures for cal-
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endar quarters beginning on or after the date of the enact-
ment of this Act, and before January 1, 2013, without re-
gard to whether or not final regulations to carry out such 
amendments have been promulgated by such date. 
SEC. 1732. EXTENDING TRANSITIONAL MEDICAID ASSIST-
ANCE (TMA). 
Sections 1902(e)(1)(B) and 1925(f) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)), as amend-
ed by section 5004(a)(1) of the American Recovery and Re-
investment Act of 2009 (Public Law 111–5), are each 
amended by striking ‘‘December 31, 2010’’ and inserting 
‘‘December 31, 2012’’. 
SEC. 1733. REQUIREMENT OF 12-MONTH CONTINUOUS COV-
ERAGE UNDER CERTAIN CHIP PROGRAMS. 
(a) IN GENERAL.—Section 2102(b) of the Social Secu-
rity Act (42 U.S.C. 1397bb(b)) is amended by adding at 
the end the following new paragraph: 
‘‘(6) REQUIREMENT FOR 12-MONTH CONTINUOUS 
ELIGIBILITY.—In the case of a State child health plan 
that provides child health assistance under this title 
through a means other than described in section 
2101(a)(2), the plan shall provide for implementation 
under this title of the 12-month continuous eligibility 
option described in section 1902(e)(12) for targeted 
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841 
low-income children whose family income is below 
200 percent of the poverty line.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to determinations (and redetermina-
tions) of eligibility made on or after January 1, 2010. 
SEC. 1734. PREVENTING THE APPLICATION UNDER CHIP OF 
COVERAGE WAITING PERIODS FOR CERTAIN 
CHILDREN. 
(a) IN GENERAL.—Section 2102(b)(1) of the Social Se-
curity Act (42 U.S.C. 1397bb(b)(1)) is amended— 
(1) in subparagraph (B)— 
(A) in clause (iii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iv), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(v) may not apply a waiting period 
(including a waiting period to carry out 
paragraph (3)(C)) in the case of a child de-
scribed in subparagraph (C).’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) DESCRIPTION OF CHILDREN NOT SUB-
JECT TO WAITING PERIOD.—For purposes of this 
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paragraph, a child described in this subpara-
graph is a child who, on the date an application 
is submitted for such child for child health assist-
ance under this title, meets any of the following 
requirements: 
‘‘(i) INFANTS
AND
TODDLERS.—The 
child is under two years of age. 
‘‘(ii) LOSS OF GROUP HEALTH PLAN 
COVERAGE.—The child previously had pri-
vate health insurance coverage through a 
group health plan or health insurance cov-
erage offered through an employer and lost 
such coverage due to— 
‘‘(I) termination of an individ-
ual’s employment; 
‘‘(II) a reduction in hours that an 
individual works for an employer; 
‘‘(III) elimination of an individ-
ual’s retiree health benefits; or 
‘‘(IV) termination of an individ-
ual’s group health plan or health in-
surance coverage offered through an 
employer. 
‘‘(iii) UNAFFORDABLE
PRIVATE
COV-
ERAGE.— 
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‘‘(I) IN GENERAL.—The family of 
the child demonstrates that the cost of 
health insurance coverage (including 
the cost of premiums, co-payments, 
deductibles, and other cost sharing) for 
such family exceeds 10 percent of the 
income of such family. 
‘‘(II) DETERMINATION OF FAMILY 
INCOME.—For purposes of subclause 
(I), family income shall be determined 
in the same manner specified by the 
State for purposes of determining a 
child’s eligibility for child health as-
sistance under this title.’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall take effect as of the date that is 90 days after 
the date of the enactment of this Act. 
SEC. 1735. ADULT DAY HEALTH CARE SERVICES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall not— 
(1) withhold, suspend, disallow, or otherwise 
deny Federal financial participation under section 
1903(a) of the Social Security Act (42 U.S.C. 
1396b(a)) for the provision of adult day health care 
services, day activity and health services, or adult 
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medical day care services, as defined under a State 
Medicaid plan approved during or before 1994, dur-
ing such period if such services are provided con-
sistent with such definition and the requirements of 
such plan; or 
(2) withdraw Federal approval of any such State 
plan or part thereof regarding the provision of such 
services (by regulation or otherwise). 
(b) EFFECTIVE DATE.—Subsection (a) shall apply 
with respect to services provided on or after October 1, 2008. 
SEC. 1736. MEDICAID COVERAGE FOR CITIZENS OF FREELY 
ASSOCIATED STATES. 
(a) IN GENERAL.—Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the 
end the following: 
‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
OF FREELY ASSOCIATED STATES.—With respect 
to eligibility for benefits for the designated Fed-
eral program defined in paragraph (3)(C) (relat-
ing to the Medicaid program), section 401(a) 
and paragraph (1) shall not apply to any indi-
vidual who lawfully resides in the United States 
(including territories and possessions of the 
United States) in accordance with the Compacts 
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of Free Association between the Government of 
the United States and the Governments of the 
Federated States of Micronesia, the Republic of 
the Marshall Islands, and the Republic of 
Palau.’’. 
(b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 
Section 403(d) of such Act (8 U.S.C. 1613(d)) is amended— 
(1) in paragraph (1), by striking ‘‘or’’ at the 
end; 
(2) in paragraph (2), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following: 
‘‘(3) 
an 
individual 
described 
in 
section 
402(b)(2)(G), but only with respect to the designated 
Federal program defined in section 402(b)(3)(C).’’. 
(c) DEFINITION
OF
QUALIFIED
ALIEN.—Section 
431(b) of such Act (8 U.S.C. 1641(b)) is amended— 
(1) in paragraph (6), by striking ‘‘; or’’ at the 
end and inserting a comma; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘, or’’; and 
(3) by adding at the end the following: 
‘‘(8) an individual who lawfully resides in the 
United States (including territories and possessions of 
the United States) in accordance with a Compact of 
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Free Association referred to in section 402(b)(2)(G), 
but only with respect to the designated Federal pro-
gram defined in section 402(b)(3)(C) (relating to the 
Medicaid program).’’. 
SEC. 1737. CONTINUING REQUIREMENT OF MEDICAID COV-
ERAGE 
OF 
NONEMERGENCY 
TRANSPOR-
TATION TO MEDICALLY NECESSARY SERV-
ICES. 
(a) REQUIREMENT.—Section 1902(a)(10) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)) is amended— 
(1) in subparagraph (A), in the matter preceding 
clause (i), by striking ‘‘and (21)’’ and inserting ‘‘, 
(21), and (28)’’; and 
(2) in subparagraph (C)(iv), by striking ‘‘and 
(17)’’ and inserting ‘‘, (17), and (28)’’. 
(b) DESCRIPTION OF SERVICES.—Section 1905(a) of 
such Act (42 U.S.C. 1395d(a)), as amended by sections 
1713(a)(1) and 1724(a)(1), is amended— 
(1) in paragraph (29), by striking ‘‘and’’ at the 
end; 
(2) 
by 
redesignating 
paragraph 
(30) 
as 
pararaph (31) and by striking the comma at the end 
and inserting a semicolon; and 
(3) by inserting after paragraph (29) the fol-
lowing new paragraph: 
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‘‘(30) nonemergency transportation to medically 
necessary services, consistent with the requirement of 
section 431.53 of title 42, Code of Federal Regula-
tions, as in effect as of June 1, 2008; and’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the date of the enactment of this 
Act and shall apply to transportation on or after such date. 
SEC. 1738. STATE OPTION TO DISREGARD CERTAIN INCOME 
IN PROVIDING CONTINUED MEDICAID COV-
ERAGE FOR CERTAIN INDIVIDUALS WITH EX-
TREMELY HIGH PRESCRIPTION COSTS. 
Section 1902(e) of the Social Security Act (42 U.S.C. 
1396b(e)), as amended by section 203(a) of the Children’s 
Health Insurance Program Reauthorization Act of 2009 
(Public Law 111–3), is amended by adding at the end the 
following new paragraph: 
‘‘(14)(A) At the option of the State, in the case of an 
individual with extremely high prescription drug costs de-
scribed in subparagraph (B) who has been determined 
(without the application of this paragraph) to be eligible 
for medical assistance under this title, the State may, in 
redetermining the individual’s eligibility for medical assist-
ance under this title, disregard any family income of the 
individual to the extent such income is less than an amount 
that is specified by the State and does not exceed the 
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amount specified in subparagraph (C), or, if greater, in-
come equal to the cost of the orphan drugs described in sub-
paragraph (B)(iii). 
‘‘(B) An individual with extremely high prescription 
drug costs described in this subparagraph for a 12-month 
period is an individual— 
‘‘(i) who is covered under health insurance or a 
health benefits plan that has a maximum lifetime 
limit of not less than $1,000,000 which includes all 
prescription drug coverage; 
‘‘(ii) who has exhausted all available prescrip-
tion drug coverage under the plan as of the beginning 
of such period; 
‘‘(iii) who incurs (or is reasonably expected to 
incur) on an annual basis during the period costs for 
orphan drugs in excess of the amount specified in sub-
paragraph (C) for the period; and 
‘‘(iv) whose annual family income (determined 
without regard to this paragraph) as of the beginning 
of the period does not exceed 75 percent of the amount 
incurred for such drugs (as described in clause (iii)). 
‘‘(C) The amount specified in this subparagraph for 
a 12-month period beginning in— 
‘‘(i) 2009 or 2010, is $200,000; or 
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‘‘(ii) a subsequent year, is the amount specified 
in clause (i) (or this subparagraph) for the previous 
year increased by the annual rate of increase in the 
medical care component of the consumer price index 
(U.S. city average) for the 12-month period ending in 
August of the previous year. 
Any amount computed under clause (ii) that is not a mul-
tiple of $1,000 shall be rounded to the nearest multiple of 
$1,000. 
‘‘(D) In applying this paragraph, amounts incurred 
for prescription drugs for cosmetic purposes shall not be 
taken into account. 
‘‘(E) With respect to an individual described in sub-
paragraph (A), notwithstanding section 1916, the State 
plan— 
‘‘(i) shall provide for the application of cost- 
sharing that is at least nominal as determined under 
section 1916; and 
‘‘(ii) may provide, consistent with section 1916A, 
for such additional cost-sharing as does not exceed a 
maximum level of cost-sharing that is specified by the 
Secretary and is adjusted by the Secretary on an an-
nual basis. 
‘‘(F) A State electing the option under this paragraph 
shall provide for a determination on an individual’s appli-
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cation for continued medical assistance under this title 
within 30 days of the date the application if filed with the 
State. 
‘‘(G) In this paragraph: 
‘‘(i) The term ‘orphan drugs’ means prescription 
drugs designated under section 526 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360bb) as 
a drug for a rare disease or condition. 
‘‘(ii) The term ‘health benefits plan’ includes cov-
erage under a plan offered under a State high risk 
pool.’’. 
Subtitle E—Financing 
SEC. 1741. PAYMENTS TO PHARMACISTS. 
(a) PHARMACY REIMBURSEMENT LIMITS.— 
(1) IN GENERAL.—Section 1927(e) of the Social 
Security Act (42 U.S.C. 1396r–8(e)) is amended— 
(A) by striking paragraph (5) and inserting 
the following: 
‘‘(5) USE OF AMP IN UPPER PAYMENT LIMITS.— 
The Secretary shall calculate the Federal upper reim-
bursement limit established under paragraph (4) as 
130 percent of the weighted average (determined on 
the basis of manufacturer utilization) of monthly av-
erage manufacturer prices.’’ 
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(2) DEFINITION OF AMP.—Section 1927(k)(1)(B) 
of such Act (42 U.S.C. 1396r–8(k)(1)(B)) is amend-
ed— 
(B) in the heading, by striking ‘‘EXTENDED 
TO WHOLESALERS’’ and inserting ‘‘AND OTHER 
PAYMENTS’’; and 
(C) by striking ‘‘regard to’’ and all that fol-
lows through the period and inserting the fol-
lowing: ‘‘regard to— 
‘‘(i) customary prompt pay discounts 
extended to wholesalers; 
‘‘(ii) bona fide service fees paid by 
manufacturers; 
‘‘(iii) reimbursement by manufacturers 
for recalled, damaged, expired, or otherwise 
unsalable returned goods, including reim-
bursement for the cost of the goods and any 
reimbursement of costs associated with re-
turn goods handling and processing, reverse 
logistics, and drug destruction; 
‘‘(iv) sales directly to, or rebates, dis-
counts, or other price concessions provided 
to, pharmacy benefit managers, managed 
care organizations, health maintenance or-
ganizations, insurers, mail order phar-
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macies that are not open to all members of 
the public, or long term care providers, pro-
vided that these rebates, discounts, or price 
concessions are not passed through to retail 
pharmacies; 
‘‘(v) sales directly to, or rebates, dis-
counts, or other price concessions provided 
to, hospitals, clinics, and physicians, unless 
the drug is an inhalation, infusion, or 
injectable drug, or unless the Secretary de-
termines, as allowed for in Agency adminis-
trative procedures, that it is necessary to 
include such sales, rebates, discounts, and 
price concessions in order to obtain an ac-
curate AMP for the drug. Such a deter-
mination shall not be subject to judicial re-
view; or 
‘‘(vi) rebates, discounts, and other 
price concessions required to be provided 
under agreements under subsections (f) and 
(g) of section 1860D–2(f).’’. 
(3) 
MANUFACTURER
REPORTING
REQUIRE-
MENTS.—Section 1927(b)(3)(A) of such Act (42 
U.S.C. 1396r–8(b)(3)(A)) is amended— 
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(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) by striking the period at the end of 
clause (iii) and inserting ‘‘; and’’; and 
(C) by inserting after clause (iii) the fol-
lowing new clause: 
‘‘(iv) not later than 30 days after the 
last day of each month of a rebate period 
under the agreement, on the manufacturer’s 
total number of units that are used to cal-
culate the monthly average manufacturer 
price for each covered outpatient drug.’’. 
(4) AUTHORITY TO PROMULGATE REGULATION.— 
The Secretary of Health and Human Services may 
promulgate regulations to clarify the requirements for 
upper payment limits and for the determination of 
the average manufacturer price in an expedited man-
ner. Such regulations may become effective on an in-
terim final basis, pending opportunity for public 
comment. 
(5) PHARMACY REIMBURSEMENTS THROUGH DE-
CEMBER 31, 2010.—The specific upper limit under sec-
tion 447.332 of title 42, Code of Federal Regulations 
(as in effect on December 31, 2006) applicable to pay-
ments made by a State for multiple source drugs 
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under a State Medicaid plan shall continue to apply 
through December 31, 2010, for purposes of the avail-
ability of Federal financial participation for such 
payments. 
(b) DISCLOSURE
OF PRICE INFORMATION
TO
THE 
PUBLIC.—Section 1927(b)(3) of such Act (42 U.S.C. 1396r– 
8(b)(3)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i), in the matter preceding 
subclause (I), by inserting ‘‘month of a’’ after 
‘‘each’’; and 
(B) in the last sentence, by striking ‘‘and 
shall,’’ and all that follows up to the period; and 
(2) in subparagraph (D)(v), by inserting 
‘‘weighted’’ before ‘‘average manufacturer prices’’. 
SEC. 1742. PRESCRIPTION DRUG REBATES. 
(a) ADDITIONAL REBATE FOR NEW FORMULATIONS OF 
EXISTING DRUGS.— 
(1) IN GENERAL.—Section 1927(c)(2) of the So-
cial Security Act (42 U.S.C. 1396r–8(c)(2)) is 
amended by adding at the end the following new sub-
paragraph: 
‘‘(C) 
TREATMENT
OF
NEW
FORMULA-
TIONS.—In the case of a drug that is a line ex-
tension of a single source drug or an innovator 
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multiple source drug that is an oral solid dosage 
form, the rebate obligation with respect to such 
drug under this section shall be the amount com-
puted under this section for such new drug or, 
if greater, the product of— 
‘‘(i) the average manufacturer price of 
the line extension of a single source drug or 
an innovator multiple source drug that is 
an oral solid dosage form; 
‘‘(ii) the highest additional rebate (cal-
culated as a percentage of average manufac-
turer price) under this section for any 
strength of the original single source drug 
or innovator multiple source drug; and 
‘‘(iii) the total number of units of each 
dosage form and strength of the line exten-
sion product paid for under the State plan 
in the rebate period (as reported by the 
State). 
In this subparagraph, the term ‘line extension’ 
means, with respect to a drug, an extended re-
lease formulation of the drug.’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply to drugs dispensed after 
December 31, 2009. 
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(b) INCREASE MINIMUM REBATE PERCENTAGE FOR 
SINGLE SOURCE DRUGS.—Section 1927(c)(1)(B)(i) of the 
Social Security Act (42 U.S.C. 1396r–8(c)(1)(B)(i)) is 
amended— 
(1) in subclause (IV), by striking ‘‘and’’ at the 
end; 
(2) in subclause (V)— 
(A) by inserting ‘‘and before January 1, 
2010’’ after ‘‘December 31, 1995,’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
clause: 
‘‘(VI) after December 31, 2009, is 
22.1 percent.’’. 
SEC. 1743. EXTENSION OF PRESCRIPTION DRUG DIS-
COUNTS TO ENROLLEES OF MEDICAID MAN-
AGED CARE ORGANIZATIONS. 
(a) IN GENERAL.—Section 1903(m)(2)(A) of the So-
cial Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended— 
(1) in clause (xi), by striking ‘‘and’’ at the end; 
(2) in clause (xii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
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‘‘(xiii) such contract provides that the entity 
shall report to the State such information, on such 
timely and periodic basis as specified by the Sec-
retary, as the State may require in order to include, 
in the information submitted by the State to a manu-
facturer under section 1927(b)(2)(A), information on 
covered outpatient drugs dispensed to individuals eli-
gible for medical assistance who are enrolled with the 
entity and for which the entity is responsible for cov-
erage of such drugs under this subsection.’’. 
(b) CONFORMING AMENDMENTS.—Section 1927 of such 
Act (42 U.S.C. 1396r-8) is amended—— 
(1) in the first sentence of subsection (b)(1)(A), 
by inserting before the period at the end the following: 
‘‘, including such drugs dispensed to individuals en-
rolled with a medicaid managed care organization if 
the organization is responsible for coverage of such 
drugs’’; 
(2) in subsection (b)(2), by adding at the end the 
following new subparagraph: 
‘‘(C) REPORTING ON MMCO DRUGS.—On a 
quarterly basis, each State shall report to the 
Secretary the total amount of rebates in dollars 
received from pharmacy manufacturers for drugs 
provided to individuals enrolled with Medicaid 
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managed care organizations that contract under 
section 1903(m).’’; and 
(3) in subsection (j)— 
(A) in the heading by striking ‘‘EXEMP-
TION’’ and inserting ‘‘SPECIAL RULES’’; and 
(B) in paragraph (1), by striking ‘‘not’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section take effect on July 1, 2010, and shall apply to drugs 
dispensed on or after such date, without regard to whether 
or not final regulations to carry out such amendments have 
been promulgated by such date. 
SEC. 1744. PAYMENTS FOR GRADUATE MEDICAL EDU-
CATION. 
(a) IN GENERAL.—Section 1905 of the Social Security 
Act (42 U.S.C. 1396d), as amended by sections 1701(a)(2), 
1711(a), and 1713(a), is amended by adding at the end the 
following new subsection: 
‘‘(bb) PAYMENT
FOR
GRADUATE
MEDICAL
EDU-
CATION.— 
‘‘(1) IN
GENERAL.—The term ‘medical assist-
ance’ includes payment for costs of graduate medical 
education consistent with this subsection, whether 
provided in or outside of a hospital. 
‘‘(2) SUBMISSION OF INFORMATION.—For pur-
poses of paragraph (1) and section 1902(a)(13)(A)(v), 
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payment for such costs is not consistent with this sub-
section unless— 
‘‘(A) the State submits to the Secretary, in 
a timely manner and on an annual basis speci-
fied by the Secretary, information on total pay-
ments for graduate medical education and how 
such payments are being used for graduate med-
ical education, including— 
‘‘(i) the institutions and programs eli-
gible for receiving the funding; 
‘‘(ii) the manner in which such pay-
ments are calculated; 
‘‘(iii) the types and fields of education 
being supported; 
‘‘(iv) the workforce or other goals to 
which the funding is being applied; 
‘‘(v) State progress in meeting such 
goals; and 
‘‘(vi) such other information as the 
Secretary determines will assist in carrying 
out paragraphs (3) and (4); and 
‘‘(B) such expenditures are made consistent 
with such goals and requirements as are estab-
lished under paragraph (4). 
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‘‘(3) REVIEW OF INFORMATION.—The Secretary 
shall make the information submitted under para-
graph (2) available to the Advisory Committee on 
Health Workforce Evaluation and Assessment (estab-
lished under section 2261 of the Public Health Service 
Act). The Secretary and the Advisory Committee shall 
independently review the information submitted 
under paragraph (2), taking into account State and 
local workforce needs. 
‘‘(4) SPECIFICATION OF GOALS AND REQUIRE-
MENTS.—The Secretary shall specify by rule, initially 
published by not later than December 31, 2011— 
‘‘(A) program goals for the use of funds de-
scribed in paragraph (1), taking into account 
recommendations of the such Advisory Com-
mittee and the goals for approved medical resi-
dency training programs described in section 
1886(h)(1)(B); and 
‘‘(B) requirements for use of such funds con-
sistent with such goals. 
Such rule may be effective on an interim basis pend-
ing revision after an opportunity for public com-
ment.’’. 
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(b) 
CONFORMING
AMENDMENT.—Section 
1902(a)(13)(A) of such Act (42 U.S.C. 1396a(a)(13)(A)), as 
amended by section 1721(a)(1)(A), is amended— 
(1) by striking ‘‘and’’ at the end of clause (iii); 
(2) by striking the semicolon in clause (iv) and 
inserting ‘‘, and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(v) in the case of hospitals and at the 
option of a State, such rates may include, 
to 
the 
extent 
consistent 
with 
section 
1905(bb), payment for graduate medical 
education; and’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the date of the enactment of this 
Act. Nothing in this section shall be construed as affecting 
payments made before such date under a State plan under 
title XIX of the Social Security Act for graduate medical 
education. 
SEC. 1745. REPORT ON MEDICAID PAYMENTS. 
Section 1902 of the Social Security Act (42 U.S.C. 
1396), as amended by sections 1703(a), 1714(a), and 
1731(a), is amended by adding at the end the following new 
subsection: 
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‘‘(jj) REPORT ON MEDICAID PAYMENTS.—Each year, 
on or before a date determined by the Secretary, a State 
participating in the Medicaid program under this title 
shall submit to the Administrator of the Centers for Medi-
care & Medicaid Services— 
‘‘(1) information on the determination of rates of 
payment to providers for covered services under the 
State plan, including— 
‘‘(A) the final rates; 
‘‘(B) the methodologies used to determine 
such rates; and 
‘‘(C) justifications for the rates; and 
‘‘(2) an explanation of the process used by the 
State to allow providers, beneficiaries and their rep-
resentatives, and other concerned State residents a 
reasonable opportunity to review and comment on 
such rates, methodologies, and justifications before the 
State made such rates final.’’. 
SEC. 1746. REVIEWS OF MEDICAID. 
(a) GAO STUDY ON FMAP.—. 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study regarding federal 
payments made to the State Medicaid programs 
under title XIX of the Social Security Act for the 
purposes of making recommendations to Congress. 
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(2) REPORT.—Not later than February 15, 2011, 
the Comptroller General shall submit to the appro-
priate committees of Congress a report on the study 
conducted under paragraph (1) and the effect on the 
federal government, States, providers, and bene-
ficiaries of— 
(A) removing the 50 percent floor, or 83 
percent ceiling, or both, in the Federal medical 
assistance percentage under section 1905(b)(1) of 
the Social Security Act; and 
(B) revising the current formula for such 
Federal medical assistance percentage to better 
reflect State fiscal capacity and State effort to 
pay for health and long-term care services and 
to better adjust for national or regional economic 
downturns. 
(b) GAO STUDY
ON
MEDICAID
ADMINISTRATIVE 
COSTS..— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study of the adminis-
tration of the Medicaid program by the Department 
of Health and Human Services, State Medicaid agen-
cies, and local government agencies. The report shall 
address the following issues: 
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(A) The extent to which federal funds for 
each administrative function, such as survey and 
certification and claims processing, are being 
used effectively and efficiently. 
(B) The administrative functions on which 
federal Medicaid funds are expended and the 
amounts of such expenditures (whether spent di-
rectly or by contract). 
(2) REPORT.—Not later than February 15, 2011, 
the Comptroller General shall submit to the appro-
priate committees of Congress a report on the study 
conducted under paragraph (1). 
SEC. 1747. EXTENSION OF DELAY IN MANAGED CARE ORGA-
NIZATION PROVIDER TAX ELIMINATION. 
Effective as if included in the enactment of section 
6051 of the Deficit Reduction Act of 2005 (Public Law 109– 
171), subsection (b)(2)(A) of such section is amended by 
striking ‘‘October 1, 2009’’ and inserting ‘‘October 1, 2010’’. 
Subtitle F—Waste, Fraud, and 
Abuse 
SEC. 1751. HEALTH CARE ACQUIRED CONDITIONS. 
(a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH 
CARE-ACQUIRED CONDITIONS.—Section 1903(i) of the So-
cial Security Act (42 U.S.C. 1396b(i)) is amended— 
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(1) by striking ‘‘or’’ at the end of paragraph 
(23); 
(2) by striking the period at the end of para-
graph (24) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (24) the fol-
lowing new paragraph: 
‘‘(25) with respect to amounts expended for serv-
ices related to the presence of a condition that could 
be identified by a secondary diagnostic code described 
in section 1886(d)(4)(D)(iv) and for any health care 
acquired condition determined as a non-covered serv-
ice under title XVIII.’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1)(G) of 
such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by strik-
ing ‘‘and (17)’’ and inserting ‘‘(17), and (25)’’. 
(c) PERMISSION TO INCLUDE ADDITIONAL HEALTH 
CARE-ACQUIRED CONDITIONS.—Nothing in this section 
shall prevent a State from including additional health care- 
acquired conditions for non-payment in its Medicaid pro-
gram under title XIX of the Social Security Act. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to discharges occurring on or after Jan-
uary 1, 2010. 
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SEC. 1752. EVALUATIONS AND REPORTS REQUIRED UNDER 
MEDICAID INTEGRITY PROGRAM. 
Section 1936(c)(2)) of the Social Security Act (42 
U.S.C. 1396u–7(c)(2)) is amended— 
(1) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(2) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(D) For the contract year beginning in 
2011 and each subsequent contract year, the enti-
ty provides assurances to the satisfaction of the 
Secretary that the entity will conduct periodic 
evaluations of the effectiveness of the activities 
carried out by such entity under the Program 
and will submit to the Secretary an annual re-
port on such activities.’’. 
SEC. 1753. REQUIRE PROVIDERS AND SUPPLIERS TO ADOPT 
PROGRAMS TO REDUCE WASTE, FRAUD, AND 
ABUSE. 
Section 1902(a) of such Act (42 U.S.C. 42 U.S.C. 
1396a(a)), as amended by sections 1631(b)(1), 1703, and 
1729, is further amended— 
(1) in paragraph (75), by striking at the end 
‘‘and’’; 
(2) in paragraph (76), by striking at the end the 
period and inserting ‘‘; and’’; and 
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(3) by inserting after paragraph (76) the fol-
lowing new paragraph: 
‘‘(77) provide that any provider or supplier 
(other than a physician or nursing facility) providing 
services under such plan shall, subject to paragraph 
(5) of section 1874(d), establish a compliance pro-
gram described in paragraph (1) of such section in 
accordance with such section.’’. 
SEC. 1754. OVERPAYMENTS. 
(a) IN GENERAL.—Section 1903(d)(2)(C) of the Social 
Security Act (42 U.S.C. 1396b(d)(2)(C)) is amended— 
(1) in the first sentence, by inserting ‘‘(or of 1 
year in the case of overpayments due to fraud)’’ after 
‘‘60 days’’; and 
(2) in the second sentence, by striking ‘‘the 60 
days’’ and inserting ‘‘such period’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply in the case of overpayments discov-
ered on or after the date of the enactment of this Act. 
SEC. 1755. MANAGED CARE ORGANIZATIONS. 
(a) MINIMUM MEDICAL LOSS RATIO.— 
(1) MEDICAID.—Section 1903(m)(2)(A) of the 
Social Security Act (42 U.S.C. 1396b(m)(2)(A)), as 
amended by section 1743(a)(3), is amended— 
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(A) by striking ‘‘and’’ at the end of clause 
(xii); 
(B) by striking the period at the end of 
clause (xiii) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(xiv) such contract has a medical loss ratio, as 
determined in accordance with a methodology speci-
fied by the Secretary that is a percentage (not less 
than 85 percent) as specified by the Secretary.’’. 
(2) CHIP.—Section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)) is amended— 
(A) by redesignating subparagraphs (H) 
through (L) as subparagraphs (I) through (M); 
and 
(B) by inserting after subparagraph (G) the 
following new subparagraph: 
‘‘(H) Section 1903(m)(2)(A)(xiv) (relating 
to application of minimum loss ratios), with re-
spect to comparable contracts under this title.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to contracts entered 
into or renewed on or after July 1, 2010. 
(b) PATIENT ENCOUNTER DATA.— 
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(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 frequency 
and level of detail to be specified by the Secretary’’ 
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. 
SEC. 1756. TERMINATION OF PROVIDER PARTICIPATION 
UNDER MEDICAID AND CHIP IF TERMINATED 
UNDER MEDICARE OR OTHER STATE PLAN OR 
CHILD HEALTH PLAN. 
(a) STATE PLAN REQUIREMENT.—Section 1902(a)(39) 
of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)) 
is amended by inserting after ‘‘1128A,’’ the following: ‘‘ter-
minate the participation of any individual or entity in 
such program if (subject to such exceptions are are per-
mitted 
with 
respect 
to 
exclusion 
under 
sections 
1128(b)(3)(C) and 1128(d)(3)(B)) participation of such in-
dividual or entity is terminated under title XVIII, any 
other State plan under this title, or any child health plan 
under title XXI,’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1)(A) of 
such Act (42 U.S.C. 1397gg(e)(1)(A)) is amended by insert-
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ing before the period at the end the following: ‘‘and section 
1902(a)(39) (relating to exclusion and termination of par-
ticipation)’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to serv-
ices furnished on or after January 1, 2011, without 
regard to whether or not final regulations to carry 
out such amendments have been promulgated by such 
date. 
(2) In the case of a State plan for medical assist-
ance 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 deter-
mines requires State legislation (other than legisla-
tion appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, 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 its failure to meet this additional require-
ment 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 
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871 
sentence, in the case of a State that has a 2-year leg-
islative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 1757. MEDICAID AND CHIP EXCLUSION FROM PARTICI-
PATION RELATING TO CERTAIN OWNERSHIP, 
CONTROL, AND MANAGEMENT AFFILIATIONS. 
(a) STATE PLAN REQUIREMENT.—Section 1902(a) of 
the Social Security Act (42 U.S.C. 1396a(a)), as amended 
by sections 1631(b)(1), 1703(a), 1729, and 1753, is further 
amended— 
(1) in paragraph (76), by striking at the end 
‘‘and’’; 
(2) in paragraph (77), by striking at the end the 
period and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (77) the fol-
lowing new paragraph: 
‘‘(78) provide that the State agency described in 
paragraph (9) exclude, with respect to a period, any 
individual or entity from participation in the pro-
gram under the State plan if such individual or enti-
ty owns, controls, or manages an entity that (or if 
such entity is owned, controlled, or managed by an 
individual or entity that)— 
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‘‘(A) has unpaid overpayments under this 
title during such period determined by the Sec-
retary or the State agency to be delinquent; 
‘‘(B) is suspended or excluded from partici-
pation under or whose participation is termi-
nated under this title during such period; or 
‘‘(C) is affiliated with an individual or en-
tity that has been suspended or excluded from 
participation under this title or whose participa-
tion is terminated under this title during such 
period.’’. 
(b) CHILD HEALTH PLAN REQUIREMENT.—Section 
2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)), as 
amended by section 1756(b), is amended by striking ‘‘sec-
tion 1902(a)(39)’’ and inserting ‘‘sections 1902(a)(39) and 
1902(a)(78)’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to serv-
ices furnished on or after January 1, 2011, without 
regard to whether or not final regulations to carry 
out such amendments have been promulgated by such 
date. 
(2) In the case of a State plan for medical assist-
ance under title XIX of the Social Security Act or a 
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child health plan under title XXI of such Act which 
the Secretary of Health and Human Services deter-
mines requires State legislation (other than legisla-
tion appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, 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 its failure to meet this additional require-
ment 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 leg-
islative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 1758. REQUIREMENT TO REPORT EXPANDED SET OF 
DATA ELEMENTS UNDER MMIS TO DETECT 
FRAUD AND ABUSE. 
Section 1903(r)(1)(F) of the Social Security Act (42 
U.S.C. 1396b(r)(1)(F)) is amended by inserting after ‘‘nec-
essary’’ the following: ‘‘and including, for data submitted 
to the Secretary on or after July 1, 2010, data elements 
from the automated data system that the Secretary deter-
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mines to be necessary for detection of waste, fraud, and 
abuse’’. 
SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER 
ALTERNATE PAYEES REQUIRED TO REGISTER 
UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902(a) of the Social Secu-
rity Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by 
sections 1631(b), 1703(a), 1729, 1753, and 1757(a), is fur-
ther amended— 
(1) in paragraph (77); by striking at the end 
‘‘and’’; 
(2) in paragraph (78), by striking the period at 
the end and inserting ‘‘and’’; and 
(3) by inserting after paragraph (78) the fol-
lowing new paragraph: 
‘‘(79) provide that any agent, clearinghouse, or 
other alternate payee that submits claims on behalf of 
a health care provider must register with the State 
and the Secretary in a form and manner specified by 
the Secretary under section 1866(j)(1)(D).’’. 
(b) DENIAL OF PAYMENT.—Section 1903(i) of such Act 
(42 U.S.C. 1396b(i)), as amended by section 1751, is 
amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(24); 
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(2) by striking the period at the end of para-
graph (25) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (25) the fol-
lowing new paragraph: 
‘‘(26) with respect to any amount paid to a bill-
ing agent, clearinghouse, or other alternate payee that 
is not registered with the State and the Secretary as 
required under section 1902(a)(79).’’. 
(c) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by this section shall apply to 
claims submitted on or after January 1, 2012, with-
out regard to whether or not final regulations to 
carry out such amendments have been promulgated by 
such date. 
(2) In the case of a State plan for medical assist-
ance under title XIX of the Social Security Act which 
the Secretary of Health and Human Services deter-
mines requires State legislation (other than legisla-
tion appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, 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 its failure to meet this additional require-
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876 
ment 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 leg-
islative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 1760. DENIAL OF PAYMENTS FOR LITIGATION-RE-
LATED MISCONDUCT. 
(a) IN GENERAL.—Section 1903(i) of the Social Secu-
rity Act (42 U.S.C. 1396b(i)), as amended by sections 
1751(a) and 1759(b), is amended— 
(1) by striking ‘‘or’’ at the end of paragraph 
(25); 
(2) by striking the period at the end of para-
graph (26) and inserting ‘‘; or’’; and 
(3) by inserting after paragraph (26) the fol-
lowing new paragraph: 
‘‘(27) with respect to any amount expended— 
‘‘(A) on litigation in which a court imposes 
sanctions on the State, its employees, or its coun-
sel for litigation-related misconduct; or 
‘‘(B) to reimburse (or otherwise compensate) 
a managed care entity for payment of legal ex-
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penses associated with any action in which a 
court imposes sanctions on the managed care en-
tity for litigation-related misconduct.’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply to amounts expended on or after 
January 1, 2010. 
SEC. 1761. MANDATORY STATE USE OF NATIONAL CORRECT 
CODING INITIATIVE. 
(a) IN GENERAL.—Section 1903(r) of the Social Secu-
rity 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 semicolon; 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 improper 
coding leading to inappropriate payment) 
and such other methodologies of that Initia-
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tive (or such other national correct coding 
methodologies) as the Secretary identifies in 
accordance with paragraph (3);’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(3) Not later than September 1, 2010, the Secretary 
shall do the following: 
‘‘(A) Identify those methodologies of the National 
Correct Coding Initiative administered by the Sec-
retary (or any successor initiative to promote correct 
coding and to control improper coding leading to in-
appropriate payment) which are compatible to claims 
filed under this title. 
‘‘(B) Identify those methodologies of such Initia-
tive (or such other national correct coding methodolo-
gies) that should be incorporated into claims filed 
under this title with respect to items or services for 
which States provide medical assistance under this 
title and no national correct coding methodologies 
have been established under such Initiative with re-
spect to title XVIII. 
‘‘(C) Notify States of— 
‘‘(i) the methodologies identified under sub-
paragraphs (A) and (B) (and of any other na-
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tional correct coding methodologies identified 
under subparagraph (B)); and 
‘‘(ii) how States are to incorporate such 
methodologies into claims filed under this title. 
‘‘(D) Submit a report to Congress that includes 
the notice to States under subparagraph (C) and an 
analysis supporting the identification of the meth-
odologies made under subparagraphs (A) and (B).’’. 
(b) EXTENSION FOR STATE LAW AMENDMENT.—In the 
case of a State plan under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) which the Secretary of Health 
and Human Services determines requires State legislation 
in order for the plan to meet the additional requirements 
imposed by the amendment made by subsection (a)(1)(C), 
the State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis of 
its failure to meet these additional requirements 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 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 the session is consid-
ered to be a separate regular session of the State legislature. 
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Subtitle G—Payments to the 
Territories 
SEC. 1771. PAYMENT TO TERRITORIES. 
(a) INCREASE IN CAP.—Section 1108 of the Social Se-
curity Act (42 U.S.C. 1308) is amended— 
(1) in subsection (f), by striking ‘‘subsection (g)’’ 
and inserting ‘‘subsections (g) and (h)’’; 
(2) in subsection (g)(1), by striking ‘‘With re-
spect to’’ and inserting ‘‘Subject to subsection (h), 
with respect to’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(h) ADDITIONAL INCREASE FOR FISCAL YEARS 2011 
THROUGH 2019.—With respect to fiscal years 2011 through 
2019, the amounts otherwise determined under subsections 
(f) and (g) for Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands and American Samoa shall be 
increased by the following amounts: 
‘‘(1) For Puerto Rico, for fiscal year 2011, 
$727,600,000; for fiscal year 2012, $775,000,000; for 
fiscal year 2013, $850,000,000; for fiscal year 2014, 
$925,000,000; for fiscal year 2015, $1,000,000,000; for 
fiscal year 2016, $1,075,000,000; for fiscal year 2017, 
$1,150,000,000; for fiscal year 2018, $1,225,000,000; 
and for fiscal year 2019, $1,396,400,000. 
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‘‘(2) For the Virgin Islands, for fiscal year 2011, 
$34,000,000; for fiscal year 2012, $37,000,000; for fis-
cal year 2013, $40,000,000; for fiscal year 2014, 
$43,000,000; for fiscal year 2015, $46,000,000; for fis-
cal year 2016, $49,000,000; for fiscal year 2017, 
$52,000,000; for fiscal year 2018, $55,000,000; and 
for fiscal year 2019, $58,000,000. 
‘‘(3) 
For 
Guam, 
for 
fiscal 
year 
2011, 
$34,000,000; for fiscal year 2012, $37,000,000; for fis-
cal year 2013, $40,000,000; for fiscal year 2014, 
$43,000,000; for fiscal year 2015, $46,000,000; for fis-
cal year 2016, $49,000,000; for fiscal year 2017, 
$52,000,000; for fiscal year 2018, $55,000,000; and 
for fiscal year 2019, $58,000,000. 
‘‘(4) For the Northern Mariana Islands, for fis-
cal year 2011, $13,500,000; fiscal year 2012, 
$14,500,000; for fiscal year 2013, $15,500,000; for fis-
cal year 2014, $16,500,000; for fiscal year 2015, 
$17,500,000; for fiscal year 2016, $18,500,000; for fis-
cal year 2017, $19,500,000; for fiscal year 2018, 
$21,000,000; and for fiscal year 2019, $22,000,000. 
‘‘(5) For American Samoa, fiscal year 2011, 
$22,000,000; fiscal year 2012, $23,687,500; for fiscal 
year 2013, $24,687,500; for fiscal year 2014, 
$25,687,500; for fiscal year 2015, $26,687,500; for fis-
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cal year 2016, $27,687,500; for fiscal year 2017, 
$28,687,500; for fiscal year 2018, $29,687,500; and 
for fiscal year 2019, $30,687,500.’’. 
(b) REPORT ON ACHIEVING MEDICAID PARITY PAY-
MENTS BEGINNING WITH FISCAL YEAR 2020.— 
(1) IN
GENERAL.—Not later than October 1, 
2013, the Secretary of Health and Human Services 
shall submit to Congress a report that details a plan 
for the transition of each territory to full parity in 
Medicaid with the 50 States and the District of Co-
lumbia in fiscal year 2020 by modifying their exist-
ing Medicaid programs and outlining actions the Sec-
retary and the governments of each territory must 
take by fiscal year 2020 to ensure parity in financ-
ing. Such report shall include what the Federal med-
ical assistance percentages would be for each territory 
if the formula applicable to the 50 States were ap-
plied. Such report shall also include any rec-
ommendations that the Secretary may have as to 
whether the mandatory ceiling amounts for each terri-
tory provided for in section 1108 of the Social Secu-
rity Act (42 U.S.C. 1308) should be increased any 
time before fiscal year 2020 due to any factors that 
the Secretary deems relevant. 
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(2) PER CAPITA DATA.—As part of such report 
the Secretary shall include information about per 
capita income data that could be used to calculate 
Federal medical assistance percentages under section 
1905(b) of the Social Security Act, under section 
1108(a)(8)(B) of such Act, for each territory on how 
such data differ from the per capita income data used 
to promulgate Federal medical assistance percentages 
for the 50 States. The report under this subsection 
shall include recommendations on how the Federal 
medical assistance percentages can be calculated for 
the territories beginning in fiscal year 2020 to ensure 
parity with the 50 States. 
(3) SUBSEQUENT REPORTS.—The Secretary shall 
submit subsequent reports to Congress in 2015, 2017, 
and 2019 detailing the progress that the Secretary 
and the governments of each territory have made in 
fulfilling the actions outlined in the plan submitted 
under paragraph (1). 
(c) 
APPLICATION
OF
FMAP 
FOR
ADDITIONAL 
FUNDS.—Section 1905(b) of such Act (42 U.S.C. 1396d(b)) 
is amended by adding at the end the following sentence: 
‘‘Notwithstanding the first sentence of this subsection and 
any other provision of law, for fiscal years 2011 through 
2019, the Federal medical assistance percentage for Puerto 
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Rico, the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa shall be the highest Federal 
medical assistance percentage applicable to any of the 50 
States or the District of Columbia for the fiscal year in-
volved, taking into account the application of subsections 
(a) and (b)(1) of section 5001 of division B of the American 
Recovery and Reinvestment Act of 2009 (Public Law 111– 
5) to such States and the District for calendar quarters dur-
ing such fiscal years for which such subsections apply.’’. 
(d) WAIVERS.— 
(1) IN GENERAL.—Section 1902(j) of the Social 
Security Act (42 U.S.C. 1396a(j)) is amended— 
(A) by striking ‘‘American Samoa and the 
Northern Mariana Islands’’ and inserting ‘‘Puer-
to Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa’’; and 
(B) by striking ‘‘American Samoa or the 
Northern Mariana Islands’’ and inserting ‘‘Puer-
to Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, or American Samoa’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply beginning with fiscal 
year 2011. 
(e) TECHNICAL ASSISTANCE.—The Secretary shall 
provide technical assistance to the governments of Puerto 
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Rico, the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa in upgrading their existing 
computer systems in order to anticipate meeting reporting 
requirements necessary to implement the plan contained in 
the report under subsection (b)(1). The provision of such 
technical assistance shall not be counted against any limi-
tation on payment to the territories under section 1108 of 
the Social Security Act. 
Subtitle H—Miscellaneous 
SEC. 1781. TECHNICAL CORRECTIONS. 
(a) TECHNICAL CORRECTION TO SECTION 1144 OF 
THE SOCIAL SECURITY ACT.—The first sentence of section 
1144(c)(3) of the Social Security Act (42 U.S.C. 1320b— 
14(c)(3)) is amended— 
(1) by striking ‘‘transmittal’’; and 
(2) by inserting before the period the following: 
‘‘as specified in section 1935(a)(4)’’. 
(b) CLARIFYING AMENDMENT TO SECTION 1935 OF 
THE SOCIAL SECURITY ACT.—Section 1935(a)(4) of the So-
cial Security Act (42 U.S.C. 1396u—5(a)(4)), as amended 
by section 113(b) of Public Law 110–275, is amended— 
(1) by striking the second sentence; 
(2) by redesignating the first sentence as a sub-
paragraph (A) with appropriate indentation and 
with the following heading: ‘‘IN GENERAL.—’’; 
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(3) by adding at the end the following subpara-
graphs: 
‘‘(B) FURNISHING
MEDICAL
ASSISTANCE 
WITH REASONABLE PROMPTNESS.—For the pur-
pose of a State’s obligation under section 
1902(a)(8) to furnish medical assistance with 
reasonable promptness, the date of the electronic 
transmission of low-income subsidy program 
data, as described in section 1144(c), from the 
Commissioner of Social Security to the State 
Medicaid Agency, shall constitute the date of fil-
ing of such application for benefits under the 
Medicare Savings Program. 
‘‘(C) DETERMINING AVAILABILITY OF MED-
ICAL
ASSISTANCE.—For the purpose of deter-
mining when medical assistance will be made 
available, the State shall consider the date of the 
individual’s application for the low income sub-
sidy program to constitute the date of filing for 
benefits under the Medicare Savings Program.’’. 
(c) EFFECTIVE DATE RELATING TO MEDICAID AGENCY 
CONSIDERATION OF LOW-INCOME SUBSIDY APPLICATION 
AND DATA TRANSMITTAL.—The amendments made by sub-
sections (a) and (b) shall be effective as if included in the 
enactment of section 113(b) of Public Law 110–275. 
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(d) TECHNICAL CORRECTION
TO SECTION 605 OF 
CHIPRA.—Section 605 of the Children’s Health Insurance 
Program Reauthorization Act of 2009 (Public Law 111– 
3) is amended by striking ‘‘legal residents’’ and inserting 
‘‘lawfully residing in the United States’’. 
(e) TECHNICAL CORRECTION TO SECTION 1905 OF THE 
SOCIAL SECURITY ACT.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended by inserting 
‘‘or the care and services themselves, or both’’ before ‘‘(if 
provided in or after’’. 
(f) CLARIFYING AMENDMENT TO SECTION 1115 OF THE 
SOCIAL SECURITY ACT.—Section 1115(a) of the Social Se-
curity Act (42 U.S.C. 1315(a)) is amended by adding at 
the end the following: ‘‘If an experimental, pilot, or dem-
onstration project that relates to title XIX is approved pur-
suant to any part of this subsection, such project shall be 
treated as part of the State plan, all medical assistance pro-
vided on behalf of any individuals affected by such project 
shall be medical assistance provided under the State plan, 
and all provisions of this Act not explicitly waived in ap-
proving such project shall remain fully applicable to all in-
dividuals receiving benefits under the State plan.’’. 
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SEC. 1782. EXTENSION OF QI PROGRAM. 
(a) IN GENERAL.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iv)) is 
amended— 
(1) by striking ‘‘sections 1933 and’’ and by in-
serting ‘‘section’’; and 
(2) by striking ‘‘December 2010’’ and inserting 
‘‘December 2012’’. 
(b) ELIMINATION OF FUNDING LIMITATION.— 
(1) IN GENERAL.—Section 1933 of such Act (42 
U.S.C. 1396u–3) is amended— 
(A) in subsection (a), by striking ‘‘who are 
selected to receive such assistance under sub-
section (b)’’; 
(B) by striking subsections (b), (c), (e), and 
(g); 
(C) in subsection (d), by striking ‘‘furnished 
in a State’’ and all that follows and inserting 
‘‘the Federal medical assistance percentage shall 
be equal to 100 percent.’’; and 
(D) by redesignating subsections (d) and (f) 
as subsections (b) and (c), respectively. 
(2) CONFORMING AMENDMENT.—Section 1905(b) 
of such Act (42 U.S.C. 1396d(b)) is amended by strik-
ing ‘‘1933(d)’’ and inserting ‘‘1933(b)’’. 
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(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on January 1, 
2011. 
SEC. 1783. OUTREACH AND ENROLLMENT OF MEDICAID 
AND CHIP ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Not later than 12 months after date 
of enactment of this Act, the Secretary of Health and 
Human Services shall issue guidance regarding standards 
and best practices for conducting outreach to inform eligible 
individuals about healthcare coverage under Medicaid 
under title XIX of the Social Security Act or for child health 
assistance under CHIP under title XXI of such Act, pro-
viding assistance to such individuals for enrollment in ap-
plicable programs, and establishing methods or procedures 
for eliminating application and enrollment barriers. Such 
guidance shall include provisions to ensure that outreach, 
enrollment assistance, and administrative simplification ef-
forts are targeted specifically to vulnerable populations such 
as children, unaccompanied homeless youth, victims of 
abuse or trauma, individuals with mental health or sub-
stance related disorders, and individuals with HIV/AIDS. 
Guidance issued pursuant to this section relating to meth-
ods to increase outreach and enrollment provided for under 
titles XIX and XXI of the Social Security Act shall specifi-
cally target such vulnerable and underserved populations 
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and shall include, but not be limited to, guidance on 
outstationing of eligibility workers, express lane eligibility, 
residence requirements, documentation of income and as-
sets, presumptive eligibility, continuous eligibility, and 
automatic renewal. 
(b) IMPLEMENTATION.—In implementing the require-
ments under subsection (a), the Secretary may use such au-
thorities as are available under law and may work with 
such entities as the Secretary deems appropriate to facili-
tate effective implementation of such programs. Not later 
than 2 years after the enactment of this Act and annually 
thereafter, the Secretary shall review and report to Congress 
on progress in implementing targeted outreach, application 
and enrollment assistance, and administrative simplifica-
tion methods for such vulnerable and underserved popu-
lations as are specified in subsection (a). 
SEC. 1784. PROHIBITIONS ON FEDERAL MEDICAID AND 
CHIP 
PAYMENT 
FOR 
UNDOCUMENTED 
ALIENS. 
Nothing in this title shall change current prohibitions 
against Federal Medicaid and CHIP payments under titles 
XIX and XXI of the Social Security Act on behalf of indi-
viduals who are not lawfully present in the United States. 
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SEC. 1785. DEMONSTRATION PROJECT FOR STABILIZATION 
OF EMERGENCY MEDICAL CONDITIONS BY 
NONPUBLICLY OWNED OR OPERATED INSTI-
TUTIONS FOR MENTAL DISEASES. 
(a) 
AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—The Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall estab-
lish a demonstration project under which an eligible State 
(as described in subsection (c)) shall provide reimbursement 
under the State Medicaid plan under title XIX of the Social 
Security Act to an institution for mental diseases that is 
not publicly owned or operated and that is subject to the 
requirements of section 1867 of the Social Security Act (42 
U.S.C. 1395dd) for the provision of medical assistance 
available under such plan to an individual who— 
(1) has attained age 21, but has not attained age 
65; 
(2) is eligible for medical assistance under such 
plan; and 
(3) requires such medical assistance to stabilize 
an emergency medical condition. 
(b) IN-STAY REVIEW.—The Secretary shall establish a 
mechanism for in-stay review to determine whether or not 
the patient has been stabilized (as defined in subsection 
(h)(5)). This mechanism shall commence before the third 
day of the inpatient stay. States participating in the dem-
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onstration project may manage the provision of these bene-
fits under the project through utilization review, authoriza-
tion, or management practices, or the application of med-
ical necessity and appropriateness criteria applicable to be-
havioral health. 
(c) ELIGIBLE STATE DEFINED.— 
(1) APPLICATION.—Upon approval of an appli-
cation submitted by a State described in paragraph 
(2), the State shall be an eligible State for purposes 
of conducting a demonstration project under this sec-
tion. 
(2) STATE DESCRIBED.—States shall be selected 
by the Secretary in a manner so as to provide geo-
graphic diversity on the basis of the application to 
conduct a demonstration project under this section 
submitted by such States. 
(d) LENGTH
OF DEMONSTRATION PROJECT.—The 
demonstration project established under this section shall 
be conducted for a period of 3 consecutive years. 
(e) LIMITATIONS ON FEDERAL FUNDING.— 
(1) APPROPRIATION.— 
(A) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is 
appropriated 
to 
carry 
out 
this 
section, 
$75,000,000 for fiscal year 2010. 
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(B) BUDGET
AUTHORITY.—Subparagraph 
(A) constitutes budget authority in advance of 
appropriations Act and represents the obligation 
of the Federal Government to provide for the 
payment of the amounts appropriated under that 
subparagraph. 
(2) 3-YEAR AVAILABILITY.—Funds appropriated 
under paragraph (1) shall remain available for obli-
gation through December 31, 2012. 
(3) LIMITATION
ON
PAYMENTS.—In no case 
may— 
(A) the aggregate amount of payments made 
by the Secretary to eligible States under this sec-
tion exceed $75,000,000; or 
(B) payments be provided by the Secretary 
under this section after December 31, 2012. 
(4) FUNDS ALLOCATED TO STATES.—The Sec-
retary shall allocate funds to eligible States based on 
their applications and the availability of funds. 
(5) PAYMENTS TO STATES.—The Secretary shall 
pay to each eligible State, from its allocation under 
paragraph (4), an amount each quarter equal to the 
Federal medical assistance percentage of expenditures 
in the quarter for medical assistance described in sub-
section (a). 
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(f) REPORTS.— 
(1) ANNUAL
PROGRESS
REPORTS.—The Sec-
retary shall submit annual reports to Congress on the 
progress of the demonstration project conducted under 
this section. 
(2) FINAL REPORT AND RECOMMENDATION.—An 
evaluation shall be conducted of the demonstration 
project’s impact on the functioning of the health and 
mental health service system and on individuals en-
rolled in the Medicaid program. This evaluation shall 
include collection of baseline data for one-year prior 
to the initiation of the demonstration project as well 
as collection of data from matched comparison states 
not participating in the demonstration. The evalua-
tion measures shall include the following: 
(A) A determination, by State, as to wheth-
er the demonstration project resulted in in-
creased access to inpatient mental health services 
under the Medicaid program and whether aver-
age length of stays were longer (or shorter) for 
individuals admitted under the demonstration 
project compared with individuals otherwise ad-
mitted in comparison sites. 
(B) An analysis, by State, regarding wheth-
er the demonstration project produced a signifi-
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cant reduction in emergency room visits for in-
dividuals eligible for assistance under the Med-
icaid program or in the duration of emergency 
room lengths of stay. 
(C) An assessment of discharge planning by 
participating hospitals that ensures access to 
further (non-emergency) inpatient or residential 
care as well as continuity of care for those dis-
charged to outpatient care. 
(D) An assessment of the impact of the dem-
onstration project on the costs of the full range 
of mental health services (including inpatient, 
emergency and ambulatory care) under the plan 
as contrasted with the comparison areas. 
(E) Data on the percentage of consumers 
with Medicaid coverage who are admitted to in-
patient facilities as a result of the demonstration 
project as compared to those admitted to these 
same facilities through other means. 
(F) A recommendation regarding whether 
the demonstration project should be continued 
after December 31, 2012, and expanded on a na-
tional basis. 
(g) WAIVER AUTHORITY.— 
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(1) IN GENERAL.—The Secretary shall waive the 
limitation of subdivision (B) following paragraph 
(28) of section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) (relating to limitations on pay-
ments for care or services for individuals under 65 
years of age who are patients in an institution for 
mental diseases) for purposes of carrying out the dem-
onstration project under this section. 
(2) LIMITED OTHER WAIVER AUTHORITY.—The 
Secretary may waive other requirements of titles XI 
and XIX of the Social Security Act (including the re-
quirements 
of 
sections 
1902(a)(1) 
(relating 
to 
statewideness) and 1902(1)(10)(B) (relating to com-
parability)) only to extent necessary to carry out the 
demonstration project under this section. 
(h) DEFINITIONS.—In this section: 
(1) EMERGENCY MEDICAL CONDITION.—The term 
‘‘emergency medical condition’’ means, with respect to 
an individual, an individual who expresses suicidal 
or homicidal thoughts or gestures, if determined dan-
gerous to self or others. 
(2) FEDERAL
MEDICAL
ASSISTANCE
PERCENT-
AGE.—The term ‘‘Federal medical assistance percent-
age’’ has the meaning given that term with respect to 
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a State under section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)). 
(3) INSTITUTION FOR MENTAL DISEASES.—The 
term ‘‘institution for mental diseases’’ has the mean-
ing given to that term in section 1905(i) of the Social 
Security Act (42 U.S.C. 1396d(i)). 
(4) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ has the meaning given to that term in sec-
tion 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)). 
(5) STABILIZED.—The term ‘‘stabilized’’ means, 
with respect to an individual, that the emergency 
medical condition no longer exists with respect to the 
individual and the individual is no longer dangerous 
to self or others. 
(6) STATE.—The term ‘‘State’’ has the meaning 
given that term for purposes of title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). 
ƒTITLE VIII—REVENUE-RELATED 
PROVISIONS≈ 
ƒFor title VIII, see text of bill as introduced on July 
14, 2009.≈ 
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TITLE IX—MISCELLANEOUS 
PROVISIONS 
SEC. 1901. REPEAL OF TRIGGER PROVISION. 
Subtitle A of title VIII of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108–173) is repealed and the provisions of law amend-
ed by such subtitle are restored as if such subtitle had never 
been enacted. 
SEC. 1902. REPEAL OF COMPARATIVE COST ADJUSTMENT 
(CCA) PROGRAM. 
Section 1860C–1 of the Social Security Act (42 U.S.C. 
1395w–29), as added by section 241(a) of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173), is repealed. 
SEC. 1903. EXTENSION OF GAINSHARING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (d)(3) of section 5007 
of the Deficit Reduction Act of 2005 (Public Law 109-171) 
is amended by inserting ‘‘(or September 30, 2011, in the 
case of a demonstration project in operation as of October 
1, 2008)’’ after ‘‘December 31, 2009’’. 
(b) FUNDING.— 
(1) IN GENERAL.—Subsection (f)(1) of such sec-
tion is amended by inserting ‘‘and for fiscal year 
2010, $1,600,000,’’ after ‘‘$6,000,000,’’. 
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(2) AVAILABILITY.—Subsection (f)(2) of such sec-
tion is amended by striking ‘‘2010’’ and inserting 
‘‘2014 or until expended’’. 
(c) REPORTS.— 
(1) QUALITY IMPROVEMENT AND SAVINGS.—Sub-
section (e)(3) of such section is amended by striking 
‘‘December 1, 2008’’ and inserting ‘‘March 31, 2011’’. 
(2) FINAL REPORT.—Subsection (e)(4) of such 
section is amended by striking ‘‘May 1, 2010’’ and 
inserting ‘‘March 31, 2013’’. 
SEC. 1904. GRANTS TO STATES FOR QUALITY HOME VISITA-
TION PROGRAMS FOR FAMILIES WITH YOUNG 
CHILDREN AND FAMILIES EXPECTING CHIL-
DREN. 
Part B of title IV of the Social Security Act (42 U.S.C. 
621–629i) is amended by adding at the end the following: 
‘‘Subpart 3—Support for Quality Home Visitation 
Programs 
‘‘SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES 
WITH YOUNG CHILDREN AND FAMILIES EX-
PECTING CHILDREN. 
‘‘(a) PURPOSE.—The purpose of this section is to im-
prove the well-being, health, and development of children 
by enabling the establishment and expansion of high quality 
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programs providing voluntary home visitation for families 
with young children and families expecting children. 
‘‘(b) GRANT APPLICATION.—A State that desires to re-
ceive a grant under this section shall submit to the Sec-
retary for approval, at such time and in such manner as 
the Secretary may require, an application for the grant that 
includes the following: 
‘‘(1) DESCRIPTION
OF
HOME
VISITATION
PRO-
GRAMS.—A description of the high quality programs 
of home visitation for families with young children 
and families expecting children that will be supported 
by a grant made to the State under this section, the 
outcomes the programs are intended to achieve, and 
the evidence supporting the effectiveness of the pro-
grams. 
‘‘(2) RESULTS OF NEEDS ASSESSMENT.—The re-
sults of a statewide needs assessment that describes— 
‘‘(A) the number, quality, and capacity of 
home visitation programs for families with 
young children and families expecting children 
in the State; 
‘‘(B) the number and types of families who 
are receiving services under the programs; 
‘‘(C) the sources and amount of funding 
provided to the programs; 
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‘‘(D) the gaps in home visitation in the 
State, including identification of communities 
that are in high need of the services; and 
‘‘(E) training and technical assistance ac-
tivities designed to achieve or support the goals 
of the programs. 
‘‘(3) ASSURANCES.—Assurances from the State 
that— 
‘‘(A) in supporting home visitation pro-
grams using funds provided under this section, 
the State shall identify and prioritize serving 
communities that are in high need of such serv-
ices, especially communities with a high propor-
tion of low-income families or a high incidence 
of child maltreatment; 
‘‘(B) the State will reserve 5 percent of the 
grant funds for training and technical assistance 
to the home visitation programs using such 
funds; 
‘‘(C) in supporting home visitation pro-
grams using funds provided under this section, 
the State will promote coordination and collabo-
ration with other home visitation programs (in-
cluding programs funded under title XIX) and 
with other child and family services, health serv-
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ices, income supports, and other related assist-
ance; 
‘‘(D) home visitation programs supported 
using such funds will, when appropriate, provide 
referrals to other programs serving children and 
families; and 
‘‘(E) the State will comply with subsection 
(i), and cooperate with any evaluation conducted 
under subsection (j). 
‘‘(4) OTHER
INFORMATION.—Such other infor-
mation as the Secretary may require. 
‘‘(c) ALLOTMENTS.— 
‘‘(1) INDIAN TRIBES.—From the amount reserved 
under subsection (l)(2) for a fiscal year, the Secretary 
shall allot to each Indian tribe that meets the require-
ment of subsection (d), if applicable, for the fiscal 
year the amount that bears the same ratio to the 
amount so reserved as the number of children in the 
Indian tribe whose families have income that does not 
exceed 200 percent of the poverty line bears to the 
total number of children in such Indian tribes whose 
families have income that does not exceed 200 percent 
of the poverty line. 
‘‘(2) STATES
AND
TERRITORIES.—From the 
amount appropriated under subsection (m) for a fis-
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903 
cal year that remains after making the reservations 
required by subsection (l), the Secretary shall allot to 
each State that is not an Indian tribe and that meets 
the requirement of subsection (d), if applicable, for the 
fiscal year the amount that bears the same ratio to 
the remainder of the amount so appropriated as the 
number of children in the State whose families have 
income that does not exceed 200 percent of the poverty 
line bears to the total number of children in such 
States whose families have income that does not ex-
ceed 200 percent of the poverty line. 
‘‘(3) REALLOTMENTS.—The amount of any allot-
ment to a State under a paragraph of this subsection 
for any fiscal year that the State certifies to the Sec-
retary will not be expended by the State pursuant to 
this section shall be available for reallotment using 
the allotment methodology specified in that para-
graph. Any amount so reallotted to a State is deemed 
part of the allotment of the State under this sub-
section. 
‘‘(d) MAINTENANCE OF EFFORT.—Beginning with fis-
cal year 2011, a State meets the requirement of this sub-
section for a fiscal year if the Secretary finds that the aggre-
gate expenditures by the State from State and local sources 
for programs of home visitation for families with young 
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children and families expecting children for the then pre-
ceding fiscal year was not less than 100 percent of such 
aggregate expenditures for the then 2nd preceding fiscal 
year. 
‘‘(e) PAYMENT OF GRANT.— 
‘‘(1) IN GENERAL.—The Secretary shall make a 
grant to each State that meets the requirements of 
subsections (b) and (d), if applicable, for a fiscal year 
for which funds are appropriated under subsection 
(m), in an amount equal to the reimbursable percent-
age of the eligible expenditures of the State for the fis-
cal year, but not more than the amount allotted to the 
State under subsection (c) for the fiscal year. 
‘‘(2) REIMBURSABLE
PERCENTAGE
DEFINED.— 
In paragraph (1), the term ‘reimbursable percentage’ 
means, with respect to a fiscal year— 
‘‘(A) 85 percent, in the case of fiscal year 
2010; 
‘‘(B) 80 percent, in the case of fiscal year 
2011; or 
‘‘(C) 75 percent, in the case of fiscal year 
2012 and any succeeding fiscal year. 
‘‘(f) ELIGIBLE EXPENDITURES.— 
‘‘(1) IN GENERAL.—In this section, the term ‘eli-
gible expenditures’— 
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‘‘(A) means expenditures to provide vol-
untary home visitation for as many families 
with young children (under the age of school 
entry) and families expecting children as prac-
ticable, through the implementation or expansion 
of high quality home visitation programs that— 
‘‘(i) adhere to clear evidence-based 
models of home visitation that have dem-
onstrated positive effects on important pro-
gram-determined child and parenting out-
comes, such as reducing abuse and neglect 
and improving child health and develop-
ment; 
‘‘(ii) employ well-trained and com-
petent staff, maintain high quality super-
vision, provide for ongoing training and 
professional development, and show strong 
organizational capacity to implement such 
a program; 
‘‘(iii) establish appropriate linkages 
and referrals to other community resources 
and supports; 
‘‘(iv) monitor fidelity of program im-
plementation to ensure that services are de-
livered according to the specified model; and 
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‘‘(v) provide parents with— 
‘‘(I) knowledge of age-appropriate 
child development in cognitive, lan-
guage, social, emotional, and motor do-
mains (including knowledge of second 
language acquisition, in the case of 
English language learners); 
‘‘(II) knowledge of realistic expec-
tations of age-appropriate child behav-
iors; 
‘‘(III) knowledge of health and 
wellness issues for children and par-
ents; 
‘‘(IV) modeling, consulting, and 
coaching on parenting practices; 
‘‘(V) skills to interact with their 
child to enhance age-appropriate devel-
opment; 
‘‘(VI) skills to recognize and seek 
help for issues related to health, devel-
opmental delays, and social, emotional, 
and behavioral skills; and 
‘‘(VII) activities designed to help 
parents become full partners in the 
education of their children; 
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‘‘(B) includes expenditures for training, 
technical assistance, and evaluations related to 
the programs; and 
‘‘(C) does not include any expenditure with 
respect to which a State has submitted a claim 
for payment under any other provision of Fed-
eral law. 
‘‘(2) PRIORITY FUNDING FOR PROGRAMS WITH 
STRONGEST EVIDENCE.— 
‘‘(A) IN GENERAL.—The expenditures, de-
scribed in paragraph (1), of a State for a fiscal 
year that are attributable to the cost of programs 
that do not adhere to a model of home visitation 
with the strongest evidence of effectiveness shall 
not be considered eligible expenditures for the fis-
cal year to the extent that the total of the ex-
penditures exceeds the applicable percentage for 
the fiscal year of the allotment of the State under 
subsection (c) for the fiscal year. 
‘‘(B) APPLICABLE PERCENTAGE DEFINED.— 
In subparagraph (A), the term ‘applicable per-
centage’ means, with respect to a fiscal year— 
‘‘(i) 60 percent for fiscal year 2010; 
‘‘(ii) 55 percent for fiscal year 2011; 
‘‘(iii) 50 percent for fiscal year 2012; 
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‘‘(iv) 45 percent for fiscal year 2013; 
or 
‘‘(v) 40 percent for fiscal year 2014. 
‘‘(g) NO USE OF OTHER FEDERAL FUNDS FOR STATE 
MATCH.—A State to which a grant is made under this sec-
tion may not expend any Federal funds to meet the State 
share of the cost of an eligible expenditure for which the 
State receives a payment under this section. 
‘‘(h) WAIVER AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may waive or 
modify the application of any provision of this sec-
tion, other than subsection (b) or (f), to an Indian 
tribe if the failure to do so would impose an undue 
burden on the Indian tribe. 
‘‘(2) SPECIAL RULE.—An Indian tribe is deemed 
to meet the requirement of subsection (d) for purposes 
of subsections (c) and (e) if— 
‘‘(A) the Secretary waives the requirement; 
or 
‘‘(B) the Secretary modifies the require-
ment, and the Indian tribe meets the modified 
requirement. 
‘‘(i) STATE REPORTS.—Each State to which a grant 
is made under this section shall submit to the Secretary 
an annual report on the progress made by the State in ad-
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‘‘(8) the indicators and methods used to monitor 
whether the program is being implemented as de-
signed; and 
‘‘(9) other information as determined necessary 
by the Secretary. 
‘‘(j) EVALUATION.— 
‘‘(1) IN
GENERAL.—The Secretary shall, by 
grant or contract, provide for the conduct of an inde-
pendent evaluation of the effectiveness of home visita-
tion programs receiving funds provided under this 
section, which shall examine the following: 
‘‘(A) The effect of home visitation programs 
on child and parent outcomes, including child 
maltreatment, child health and development, 
school readiness, and links to community serv-
ices. 
‘‘(B) The effectiveness of home visitation 
programs on different populations, including the 
extent to which the ability of programs to im-
prove outcomes varies across programs and pop-
ulations. 
‘‘(2) REPORTS TO THE CONGRESS.— 
‘‘(A) INTERIM
REPORT.—Within 3 years 
after the date of the enactment of this section, the 
Secretary shall submit to the Congress an in-
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terim report on the evaluation conducted pursu-
ant to paragraph (1). 
‘‘(B) FINAL REPORT.—Within 5 years after 
the date of the enactment of this section, the Sec-
retary shall submit to the Congress a final report 
on the evaluation conducted pursuant to para-
graph (1). 
‘‘(k) ANNUAL REPORTS TO THE CONGRESS.—The Sec-
retary shall submit annually to the Congress a report on 
the activities carried out using funds made available under 
this section, which shall include a description of the fol-
lowing: 
‘‘(1) The high need communities targeted by 
States for programs carried out under this section. 
‘‘(2) The service delivery models used in the pro-
grams receiving funds provided under this section. 
‘‘(3) The characteristics of the programs, includ-
ing— 
‘‘(A) the qualifications and demographic 
characteristics of program staff; and 
‘‘(B) recipient characteristics including the 
number of families served, the demographic char-
acteristics of the families served, and family re-
tention and duration of services. 
‘‘(4) The outcomes reported by the programs. 
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‘‘(5) The research-based instruction, materials, 
and activities being used in the activities funded 
under the grant. 
‘‘(6) The training and technical activities, in-
cluding on-going professional development, provided 
to the programs. 
‘‘(7) The annual costs of implementing the pro-
grams, including the cost per family served under the 
programs. 
‘‘(8) The indicators and methods used by States 
to monitor whether the programs are being been im-
plemented as designed. 
‘‘(l) RESERVATIONS OF FUNDS.—From the amounts 
appropriated for a fiscal year under subsection (m), the 
Secretary shall reserve— 
‘‘(1) an amount equal to 5 percent of the 
amounts to pay the cost of the evaluation provided for 
in subsection (j), and the provision to States of train-
ing and technical assistance, including the dissemina-
tion of best practices in early childhood home visita-
tion; and 
‘‘(2) after making the reservation required by 
paragraph (1), an amount equal to 3 percent of the 
amount so appropriated, to pay for grants to Indian 
tribes under this section. 
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‘‘(m) APPROPRIATIONS.—Out of any money in the 
Treasury of the United States not otherwise appropriated, 
there is appropriated to the Secretary to carry out this sec-
tion— 
‘‘(1) $50,000,000 for fiscal year 2010; 
‘‘(2) $100,000,000 for fiscal year 2011; 
‘‘(3) $150,000,000 for fiscal year 2012; 
‘‘(4) $200,000,000 for fiscal year 2013; and 
‘‘(5) $250,000,000 for fiscal year 2014. 
‘‘(n) INDIAN TRIBES TREATED AS STATES.—In this 
section, paragraphs (4), (5), and (6) of section 431(a) shall 
apply.’’. 
SEC. 1905. IMPROVED COORDINATION AND PROTECTION 
FOR DUAL ELIGIBLES. 
Title XI of the Social Security Act is amended by in-
serting after section 1150 the following new section: 
‘‘IMPROVED COORDINATION AND PROTECTION FOR DUAL 
ELIGIBLES 
‘‘SEC. 1150A. (a) IN GENERAL.—The Secretary shall 
provide, through an identifiable office or program within 
the Centers for Medicare & Medicaid Services, for a focused 
effort to provide for improved coordination between Medi-
care and Medicaid and protection in the case of dual eligi-
bles (as defined in subsection (e)). The office or program 
shall— 
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‘‘(1) review Medicare and Medicaid policies re-
lated to enrollment, benefits, service delivery, pay-
ment, and grievance and appeals processes under 
parts A and B of title XVIII, under the Medicare Ad-
vantage program under part C of such title, and 
under title XIX; 
‘‘(2) identify areas of such policies where better 
coordination and protection could improve care and 
costs; and 
‘‘(3) issue guidance to States regarding improv-
ing such coordination and protection. 
‘‘(b) ELEMENTS.—The improved coordination and 
protection under this section shall include efforts— 
‘‘(1) to simplify access of dual eligibles to bene-
fits and services under Medicare and Medicaid; 
‘‘(2) to improve care continuity for dual eligibles 
and ensure safe and effective care transitions; 
‘‘(3) to harmonize regulatory conflicts between 
Medicare and Medicaid rules with regard to dual eli-
gibles; and 
‘‘(4) to improve total cost and quality perform-
ance under Medicare and Medicaid for dual eligibles. 
‘‘(c) RESPONSIBILITIES.—In carrying out this section, 
the Secretary shall provide for the following: 
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‘‘(1) An examination of Medicare and Medicaid 
payment systems to develop strategies to foster more 
integrated and higher quality care. 
‘‘(2) Development of methods to facilitate access 
to post-acute and community-based services and to 
identify actions that could lead to better coordination 
of community-based care. 
‘‘(3) A study of enrollment of dual eligibles in 
the Medicare Savings Program (as defined in section 
1144(c)(7)), under Medicaid, and in the low-income 
subsidy program under section 1860D–14 to identify 
methods to more efficiently and effectively reach and 
enroll dual eligibles. 
‘‘(4) An assessment of communication strategies 
for dual eligibles to determine whether additional in-
formational materials or outreach is needed, includ-
ing an assessment of the Medicare website, 1-800- 
MEDICARE, and the Medicare handbook. 
‘‘(5) Research and evaluation of areas where 
service utilization, quality, and access to cost sharing 
protection could be improved and an assessment of 
factors related to enrollee satisfaction with services 
and care delivery. 
‘‘(6) Collection (and making available to the 
public) of data and a database that describe the eligi-
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bility, benefit and cost-sharing assistance available to 
dual eligibles by State. 
‘‘(7) Monitoring total combined Medicare and 
Medicaid program costs in serving dual eligibles and 
making recommendations for optimizing total quality 
and cost performance across both programs. 
‘‘(8) Coordination of activities relating to Medi-
care Advantage plans under 1859(b)(6)(B)(ii) and 
Medicaid. 
‘‘(d) PERIODIC REPORTS.—Not later than 1 year after 
the date of the enactment of this section and every 3 years 
thereafter the Secretary shall submit to Congress a report 
on progress in activities conducted under this section. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) DUAL ELIGIBLE.—The term ‘dual eligible’ 
means an individual who is dually eligible for bene-
fits under title XVIII, and medical assistance under 
title XIX, including such individuals who are eligible 
for benefits under the Medicare Savings Program (as 
defined in section 1144(c)(7)). 
‘‘(2) MEDICARE; MEDICAID.—The terms ‘Medi-
care’ and ‘Medicaid’ mean the programs under titles 
XVIII and XIX, respectively.’’. 
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SEC. 1906. STANDARDIZED MARKETING REQUIREMENTS 
UNDER THE MEDICARE ADVANTAGE AND 
MEDICARE PRESCRIPTION DRUG PROGRAMS. 
(a) MEDICARE ADVANTAGE PROGRAM.— 
(1) IN GENERAL.—Section 1856 of the Social Se-
curity Act (42 U.S.C. 1395w–26) is amended— 
(A) in subsection (b)(1), by inserting ‘‘or 
subsection (c)’’ after ‘‘subsection (a)’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(c) STANDARDIZED MARKETING REQUIREMENTS.— 
‘‘(1) DEVELOPMENT BY THE NAIC.— 
‘‘(A) REQUIREMENTS.—The Secretary shall 
request the National Association of Insurance 
Commissioners (in this subsection referred to as 
the ‘NAIC’) to— 
‘‘(i) develop standardized marketing 
requirements for Medicare Advantage orga-
nizations with respect to Medicare Advan-
tage plans and PDP sponsors with respect 
to prescription drug plans under part D; 
and 
‘‘(ii) submit a report containing such 
requirements to the Secretary by not later 
than the date that is 9 months after the date 
of the enactment of this subsection. 
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‘‘(B) PROHIBITED
ACTIVITIES.—Such re-
quirements shall include prohibitions on the pro-
hibited activities described in section 1851(j)(1). 
‘‘(C) 
LIMITATIONS.—Such 
requirements 
shall establish limitations that include at least 
the limitations described in section 1851(j)(2), 
except for those relating to compensation. 
‘‘(D) ELECTION FORM.—Such requirements 
may prohibit a Medicare Advantage organiza-
tion or a PDP sponsor (or an agent of such an 
organization or sponsor) from completing any 
portion of any election form used to carry out 
elections under section 1851 or 1860D–1 on be-
half of any individual. 
‘‘(E) AGENT
AND
BROKER
COMMISSIONS 
AND
COMPENSATION.—Such requirements shall 
establish standards— 
‘‘(i) for fair and appropriate commis-
sions for agents and brokers of Medicare Ad-
vantage organizations and PDP sponsors, 
including a prohibition on extra bonuses or 
incentives; 
‘‘(ii) for the disclosure of such commis-
sions; and 
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‘‘(iii) for the use of compensation for 
agents and brokers other than such commis-
sions. 
Such standards shall ensure that the use of com-
pensation creates incentives for agents and bro-
kers to enroll individuals in the Medicare Ad-
vantage plan that is intended to best meet their 
health care needs. 
‘‘(F) CERTAIN CONDUCT OF AGENTS.—Such 
requirements shall address the conduct of agents 
engaged in on-site promotion at a facility of an 
organization with which the Medicare Advantage 
organization or PDP sponsor has a co-branding 
relationship. 
‘‘(G) OTHER
STANDARDS.—Such require-
ments may establish such other standards relat-
ing to unfair trade practices and marketing 
under Medicare Advantage plans and prescrip-
tion drug plans under part D as the NAIC deter-
mines appropriate. 
‘‘(2) IMPLEMENTATION OF REQUIREMENTS.— 
‘‘(A) ADOPTION OF NAIC DEVELOPED RE-
QUIREMENTS.—If the NAIC develops standard-
ized marketing requirements and submits the re-
port pursuant to paragraph (1), the Secretary 
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shall promulgate regulations for the adoption of 
such requirements. The Secretary shall ensure 
that such regulations take effect beginning with 
the first open enrollment period beginning 12 
months after the date of the enactment of this 
subsection. 
‘‘(B) REQUIREMENTS
IF
NAIC
DOES
NOT 
SUBMIT REPORT.—If the NAIC does not develop 
standardized marketing requirements and submit 
the report pursuant to paragraph (1), the Sec-
retary shall promulgate regulations for standard-
ized marketing requirements for Medicare Ad-
vantage organizations with respect to Medicare 
Advantage plans and PDP sponsors with respect 
to prescription drug plans under part D. Such 
regulations shall meet the requirements of sub-
paragraphs (B) through (F) of paragraph (1), 
and may establish such other standards relating 
to marketing under Medicare Advantage plans 
and prescription drug plans as the Secretary de-
termines appropriate. The Secretary shall ensure 
that such regulations take effect beginning with 
the first open enrollment period beginning 12 
months after the date of the enactment of this 
subsection. 
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‘‘(C) CONSULTATION.—In establishing re-
quirements under this subsection, the NAIC or 
Secretary (as the case may be) shall consult with 
a working group composed of representatives of 
Medicare Advantage organizations and PDP 
sponsors, consumer groups, and other qualified 
individuals. Such representatives shall be selected 
in a manner so as to insure balanced representa-
tion among the interested groups. 
‘‘(3) STATE
REPORTING
OF
VIOLATIONS
OF 
STANDARDIZED
MARKETING
REQUIREMENTS.—The 
Secretary shall request that States report any viola-
tions of the standardized marketing requirements 
under the regulations under subparagraph (A) or (B) 
of paragraph (2) to national and regional offices of 
the Centers for Medicare & Medicaid Services. 
‘‘(4) REPORT.—The Secretary shall submit an 
annual report to Congress on the enforcement of the 
standardized marketing requirements under the regu-
lations under subparagraph (A) or (B) of paragraph 
(2), together with such recommendations as the Sec-
retary determines appropriate. Such report shall in-
clude— 
‘‘(A) a list of any alleged violations of such 
requirements reported to the Secretary by a 
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State, a Medicare Advantage organization, or a 
PDP sponsor; and 
‘‘(B) the disposition of such reported viola-
tions.’’. 
(2) STATE AUTHORITY TO ENFORCE STANDARD-
IZED MARKETING REQUIREMENTS.— 
(A) IN GENERAL.—Section 1856(b)(3) of the 
Social Security Act (42 U.S.C. 1395w–26(b)(3)) 
is amended— 
(i) by striking ‘‘or State’’ and insert-
ing ‘‘, State’’; and 
(ii) by inserting ‘‘, or State laws or 
regulations enacting the standardized mar-
keting requirements under subsection (c)’’ 
after ‘‘plan solvency’’. 
(B) NO
PREEMPTION
OF
STATE
SANC-
TIONS.—Nothing in title XVIII of the Social Se-
curity Act or the provisions of, or amendments 
made by, this Act, shall be construed to prohibit 
a State from conducting a market conduct exam-
ination or from imposing sanctions against 
Medicare Advantage organizations, PDP spon-
sors, or agents or brokers of such organizations 
or sponsors for violations of the standardized 
marketing requirements under subsection (c) of 
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section 1856 of the Social Security Act (as added 
by paragraph (1)) as enacted by that State. 
(3) 
CONFORMING
AMENDMENT.—Section 
1851(h)(4) of the Social Security Act (42 U.S.C. 
1395w–21(h)(4)) is amended by adding at the end the 
following flush sentence: 
‘‘Beginning on the effective date of the implementa-
tion of the regulations under subparagraph (A) or (B) 
of section 1856(c)(2), each Medicare Advantage orga-
nization with respect to a Medicare Advantage plan 
offered by the organization (and agents of such orga-
nization) shall comply with the standardized mar-
keting requirements under section 1856(c).’’. 
(b) MEDICARE PRESCRIPTION DRUG PROGRAM.—Sec-
tion 1860D–4 of the Social Security Act (42 U.S.C. 1395w– 
104) is amended by adding at the end the following new 
subsection: 
‘‘(m) STANDARDIZED MARKETING REQUIREMENTS.— 
A PDP sponsor with respect to a prescription drug plan 
offered by the sponsor (and agents of such sponsor) shall 
comply with the standardized marketing requirements 
under section 1856(c).’’. 
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924 
SEC. 1907. NAIC RECOMMENDATIONS ON THE ESTABLISH-
MENT OF STANDARDIZED BENEFIT PACKAGES 
FOR MEDICARE ADVANTAGE PLANS AND PRE-
SCRIPTION DRUG PLANS. 
Not later than 30 days after the date of the enactment 
of this Act, the Secretary of Health and Human Services 
shall request the National Association of Insurance Com-
missioners to establish a committee to study and make rec-
ommendations to the Secretary and Congress on— 
(1) the establishment of standardized benefit 
packages for Medicare Advantage plans under part C 
of title XVIII of the Social Security Act and for pre-
scription drug plans under part D of such Act; and 
(2) the regulation of such plans. 
SEC. 1908. APPLICATION OF EMERGENCY SERVICES LAWS. 
Nothing in this Act shall be construed to relieve any 
health care provider from providing emergency services as 
required by State or Federal law, including section 1867 
of the Social Security Act (popularly known as 
‘‘EMTALA’’). 
SEC. 1909. NATIONWIDE PROGRAM FOR NATIONAL AND 
STATE BACKGROUND CHECKS ON DIRECT PA-
TIENT ACCESS EMPLOYEES OF LONG-TERM 
CARE FACILITIES AND PROVIDERS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
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925 
retary’’), shall establish a program to identify efficient, ef-
fective, and economical procedures for long term care facili-
ties or providers to conduct background checks on prospec-
tive direct patient access employees on a nationwide basis 
(in this subsection, such program shall be referred to as the 
‘‘nationwide program’’). Except for the following modifica-
tions, the Secretary shall carry out the nationwide program 
under similar terms and conditions as the pilot program 
under section 307 of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2257), including the prohibition on hir-
ing abusive workers and the authorization of the imposition 
of penalties by a participating State under subsections 
(b)(3)(A) and (b)(6), respectively, of such section 307: 
(1) AGREEMENTS.— 
(A) NEWLY
PARTICIPATING
STATES.—The 
Secretary shall enter into agreements with each 
State— 
(i) that the Secretary has not entered 
into an agreement with under subsection 
(c)(1) of such section 307; 
(ii) that agrees to conduct background 
checks under the nationwide program on a 
Statewide basis; and 
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(iii) that submits an application to the 
Secretary containing such information and 
at such time as the Secretary may specify. 
(B) CERTAIN
PREVIOUSLY
PARTICIPATING 
STATES.—The Secretary shall enter into agree-
ments with each State— 
(i) that the Secretary has entered into 
an agreement with under such subsection 
(c)(1), but only in the case where such 
agreement did not require the State to con-
duct background checks under the program 
established under subsection (a) of such sec-
tion 307 on a Statewide basis; 
(ii) that agrees to conduct background 
checks under the nationwide program on a 
Statewide basis; and 
(iii) that submits an application to the 
Secretary containing such information and 
at such time as the Secretary may specify. 
(2) NONAPPLICATION OF SELECTION CRITERIA.— 
The selection criteria required under subsection 
(c)(3)(B) of such section 307 shall not apply. 
(3) REQUIRED FINGERPRINT CHECK AS PART OF 
CRIMINAL HISTORY BACKGROUND CHECK.—The proce-
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dures established under subsection (b)(1) of such sec-
tion 307 shall— 
(A) require that the long-term care facility 
or provider (or the designated agent of the long- 
term care facility or provider) obtain State and 
national criminal history background checks on 
the prospective employee through such means as 
the Secretary determines appropriate that utilize 
a search of State-based abuse and neglect reg-
istries and databases, including the abuse and 
neglect registries of another State in the case 
where a prospective employee previously resided 
in that State, State criminal history records, the 
records of any proceedings in the State that may 
contain disqualifying information about prospec-
tive employees (such as proceedings conducted by 
State professional licensing and disciplinary 
boards and State Medicaid Fraud Control 
Units), and Federal criminal history records, in-
cluding a fingerprint check using the Integrated 
Automated Fingerprint Identification System of 
the Federal Bureau of Investigation; and 
(B) require States to describe and test meth-
ods that reduce duplicative fingerprinting, in-
cluding providing for the development of ‘‘rap 
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back’’ capability by the State such that, if a di-
rect patient access employee of a long-term care 
facility or provider is convicted of a crime fol-
lowing the initial criminal history background 
check conducted with respect to such employee, 
and the employee’s fingerprints match the prints 
on file with the State law enforcement depart-
ment, the department will immediately inform 
the State and the State will immediately inform 
the long-term care facility or provider which em-
ploys the direct patient access employee of such 
conviction. 
(4) STATE REQUIREMENTS.—An agreement en-
tered into under paragraph (1) shall require that a 
participating State— 
(A) be responsible for monitoring compli-
ance with the requirements of the nationwide 
program; 
(B) have procedures in place to— 
(i) conduct screening and criminal his-
tory background checks under the nation-
wide program in accordance with the re-
quirements of this section; 
(ii) monitor compliance by long-term 
care facilities and providers with the proce-
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dures and requirements of the nationwide 
program; 
(iii) as appropriate, provide for a pro-
visional period of employment by a long- 
term care facility or provider of a direct 
patient access employee, not to exceed 30 
days, pending completion of the required 
criminal history background check and, in 
the case where the employee has appealed 
the results of such background check, pend-
ing completion of the appeals process, dur-
ing which the employee shall be subject to 
direct on-site supervision (in accordance 
with procedures established by the State to 
ensure that a long-term care facility or pro-
vider furnishes such direct on-site super-
vision); 
(iv) provide an independent process by 
which a provisional employee or an em-
ployee may appeal or dispute the accuracy 
of the information obtained in a back-
ground check performed under the nation-
wide program, including the specification of 
criteria for appeals for direct patient access 
employees found to have disqualifying infor-
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mation which shall include consideration of 
the passage of time, extenuating cir-
cumstances, demonstration of rehabilitation, 
and relevancy of the particular disquali-
fying information with respect to the cur-
rent employment of the individual; 
(v) provide for the designation of a 
single State agency as responsible for— 
(I) overseeing the coordination of 
any State and national criminal his-
tory background checks requested by a 
long-term care facility or provider (or 
the designated agent of the long-term 
care facility or provider) utilizing a 
search of State and Federal criminal 
history records, including a fingerprint 
check of such records; 
(II) overseeing the design of ap-
propriate privacy and security safe-
guards for use in the review of the re-
sults of any State or national criminal 
history background checks conducted 
regarding a prospective direct patient 
access employee to determine whether 
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the employee has any conviction for a 
relevant crime; 
(III) immediately reporting to the 
long-term care facility or provider that 
requested the criminal history back-
ground check the results of such review; 
and 
(IV) in the case of an employee 
with a conviction for a relevant crime 
that is subject to reporting under sec-
tion 1128E of the Social Security Act 
(42 U.S.C. 1320a–7e), reporting the ex-
istence of such conviction to the data-
base established under that section; 
(vi) determine which individuals are 
direct patient access employees (as defined 
in paragraph (6)(B)) for purposes of the 
nationwide program; 
(vii) as appropriate, specify offenses, 
including convictions for violent crimes, for 
purposes of the nationwide program; and 
(viii) describe and test methods that re-
duce duplicative fingerprinting, including 
providing for the development of ‘‘rap back’’ 
capability such that, if a direct patient ac-
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cess employee of a long-term care facility or 
provider is convicted of a crime following 
the initial criminal history background 
check conducted with respect to such em-
ployee, and the employee’s fingerprints 
match the prints on file with the State law 
enforcement department— 
(I) the department will imme-
diately inform the State agency des-
ignated under clause (v) and such 
agency will immediately inform the fa-
cility or provider which employs the 
direct patient access employee of such 
conviction; and 
(II) the State will provide, or will 
require the facility to provide, to the 
employee a copy of the results of the 
criminal history background check con-
ducted with respect to the employee at 
no charge in the case where the indi-
vidual requests such a copy. 
(5) PAYMENTS.— 
(A) NEWLY PARTICIPATING STATES.— 
(i) IN GENERAL.—As part of the appli-
cation submitted by a State under para-
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graph (1)(A)(iii), the State shall guarantee, 
with respect to the costs to be incurred by 
the State in carrying out the nationwide 
program, that the State will make available 
(directly or through donations from public 
or private entities) a particular amount of 
non-Federal contributions, as a condition of 
receiving the Federal match under clause 
(ii). 
(ii) FEDERAL MATCH.—The payment 
amount to each State that the Secretary en-
ters into an agreement with under para-
graph (1)(A) shall be 3 times the amount 
that the State guarantees to make available 
under clause (i), except that in no case may 
the payment amount exceed $3,000,000. 
(B) PREVIOUSLY PARTICIPATING STATES.— 
(i) IN GENERAL.—As part of the appli-
cation submitted by a State under para-
graph (1)(B)(iii), the State shall guarantee, 
with respect to the costs to be incurred by 
the State in carrying out the nationwide 
program, that the State will make available 
(directly or through donations from public 
or private entities) a particular amount of 
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non-Federal contributions, as a condition of 
receiving the Federal match under clause 
(ii). 
(ii) FEDERAL MATCH.—The payment 
amount to each State that the Secretary en-
ters into an agreement with under para-
graph (1)(B) shall be 3 times the amount 
that the State guarantees to make available 
under clause (i), except that in no case may 
the payment amount exceed $1,500,000. 
(6) DEFINITIONS.—Under the nationwide pro-
gram: 
(A) LONG-TERM
CARE
FACILITY
OR
PRO-
VIDER.—The term ‘‘long-term care facility or 
provider’’ means the following facilities or pro-
viders which receive payment for services under 
title XVIII or XIX of the Social Security Act: 
(i) A skilled nursing facility (as de-
fined in section 1819(a) of the Social Secu-
rity Act (42 U.S.C. 1395i–3(a))). 
(ii) A nursing facility (as defined in 
section 1919(a) of such Act (42 U.S.C. 
1396r(a))). 
(iii) A home health agency. 
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(iv) A provider of hospice care (as de-
fined in section 1861(dd)(1) of such Act (42 
U.S.C. 1395x(dd)(1))). 
(v) A long-term care hospital (as de-
scribed in section 1886(d)(1)(B)(iv) of such 
Act (42 U.S.C. 1395ww(d)(1)(B)(iv))). 
(vi) A provider of personal care serv-
ices. 
(vii) A provider of adult day care. 
(viii) A residential care provider that 
arranges for, or directly provides, long-term 
care services, including an assisted living 
facility that provides a level of care estab-
lished by the Secretary. 
(ix) An intermediate care facility for 
the mentally retarded (as defined in section 
1905(d) of such Act (42 U.S.C. 1396d(d))). 
(x) Any other facility or provider of 
long-term care services under such titles as 
the participating State determines appro-
priate. 
(B) DIRECT PATIENT ACCESS EMPLOYEE.— 
The term ‘‘direct patient access employee’’ means 
any individual who has access to a patient or 
resident of a long-term care facility or provider 
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through employment or through a contract with 
such facility or provider and has duties that in-
volve (or may involve) one-on-one contact with a 
patient or resident of the facility or provider, as 
determined by the State for purposes of the na-
tionwide program. Such term does not include a 
volunteer unless the volunteer has duties that are 
equivalent to the duties of a direct patient access 
employee and those duties involve (or may in-
volve) one-on-one contact with a patient or resi-
dent of the long-term care facility or provider. 
(7) EVALUATION AND REPORT.— 
(A) EVALUATION.—The Inspector General of 
the Department of Health and Human Services 
shall conduct an evaluation of the nationwide 
program. 
(B) REPORT.—Not later than 180 days 
after the completion of the nationwide program, 
the Inspector General of the Department of 
Health and Human Services shall submit a re-
port to Congress containing the results of the 
evaluation conducted under subparagraph (A). 
(b) FUNDING.— 
(1) NOTIFICATION.—The Secretary of Health and 
Human Services shall notify the Secretary of the 
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Treasury of the amount necessary to carry out the na-
tionwide program under this section for the period of 
fiscal years 2010 through 2012, except that in no case 
shall such amount exceed $160,000,000. 
(2) TRANSFER OF FUNDS.—Out of any funds in 
the Treasury not otherwise appropriated, the Sec-
retary of the Treasury shall provide for the transfer 
to the Secretary of Health and Human Services of the 
amount specified as necessary to carry out the na-
tionwide program under paragraph (1). Such amount 
shall remain available until expended. 
SEC. 1910. ESTABLISHMENT OF CENTER FOR MEDICARE 
AND MEDICAID PAYMENT INNOVATION WITH-
IN CMS. 
(a) IN GENERAL.—Title XI of the Social Security Act 
is amended by inserting after section 1115 the following 
new section: 
‘‘CENTER FOR MEDICARE AND MEDICAID PAYMENT 
INNOVATION 
‘‘SEC. 1115A. (a) CENTER FOR MEDICARE AND MED-
ICAID PAYMENT INNOVATION ESTABLISHED.— 
‘‘(1) IN GENERAL.—There is created within the 
Centers for Medicare & Medicaid Services a Center 
for Medicare and Medicaid Payment Innovation (in 
this section referred to as the ‘CMPI’) to carry out the 
duties described in paragraph (4). 
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‘‘(2) DIRECTOR.—The CMPI shall be headed by 
a Director who shall report directly to the Adminis-
trator of the Centers for Medicare & Medicaid Serv-
ices. 
‘‘(3) DEADLINE.—The Secretary shall ensure 
that the CMPI is carrying out the duties described in 
paragraph (4) by not later than January 1, 2011. 
‘‘(4) DUTIES.—The duties described in this 
paragraph are the following: 
‘‘(A) To carry out the duties described in 
this section. 
‘‘(B) Such other duties as the Secretary 
may specify. 
‘‘(5) CONSULTATION.—In carrying out the duties 
under paragraph (4), the CMPI shall consult rep-
resentatives of relevant Federal agencies and outside 
clinical and analytical experts with expertise in med-
icine and health care management. The CMPI shall 
use open door forums or other mechanisms to seek 
input from interested parties. 
‘‘(b) TESTING OF MODELS (PHASE I).— 
‘‘(1) IN GENERAL.—The CMPI shall test pay-
ment models in accordance with selection criteria 
under paragraph (2) to determine the effect of apply-
ing such models under title XVIII, title XIX, or both 
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titles on program expenditures under such titles and 
the quality of care received by individuals receiving 
benefits under such titles. 
‘‘(2) SELECTION OF MODELS TO BE TESTED.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
give preference to testing models for which, as de-
termined by the professional staff at the Centers 
for Medicare & Medicaid Services and using 
such input from outside the Centers as the Sec-
retary determines appropriate, there is evidence 
that the model addresses a defined population for 
which there are deficits in care leading to poor 
clinical outcomes or potentially avoidable ex-
penditures. The Secretary shall focus on models 
expected to reduce program costs under title 
XVIII, title XIX, or both titles while preserving 
or enhancing the quality of care received by in-
dividuals receiving benefits under such titles. 
‘‘(B) APPLICATION TO OTHER DEMONSTRA-
TIONS.—The Secretary shall operate the dem-
onstration programs under sections 1222 and 
1236 of the America’s Affordable Health Choices 
Act of 2009 through the CMPI in accordance 
with the rules applicable under this section, in-
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cluding those relating to evaluations, termi-
nations, and expansions. 
‘‘(3) BUDGET NEUTRALITY.— 
‘‘(A) INITIAL PERIOD.—The Secretary shall 
not require as a condition for testing a model 
under paragraph (1) that the design of the model 
ensure that the model is budget neutral initially 
with respect to expenditures under titles XVIII 
and XIX. 
‘‘(B) TERMINATION.—The Secretary shall 
terminate or modify the design and implementa-
tion of a model unless the Secretary determines 
(and the Chief Actuary of the Centers for Medi-
care & Medicaid Services, with respect to spend-
ing under such titles, certifies), after testing has 
begun, that the model is expected to— 
‘‘(i) improve the quality of patient 
care (as determined by the Administrator of 
the Centers for Medicare & Medicaid Serv-
ices) without increasing spending under 
such titles; 
‘‘(ii) reduce spending under such titles 
without reducing the quality of patient 
care; or 
‘‘(iii) do both. 
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Such termination may occur at any time after 
such testing has begun and before completion of 
the testing. 
‘‘(4) EVALUATION.—The Secretary shall conduct 
an evaluation of each model tested under this sub-
section. Such evaluation shall include an analysis 
of— 
‘‘(A) the quality of patient care furnished 
under the model, including through the use of 
patient-level outcomes measures; and 
‘‘(B) the changes in spending under titles 
XVIII and XIX by reason of the model. 
The Secretary shall make the results of each evalua-
tion under this paragraph available to the public in 
a timely fashion. 
‘‘(c) EXPANSION OF MODELS (PHASE II).—The Sec-
retary may expand the duration and the scope of a model 
that is being tested under subsection (b) (including imple-
mentation on a nationwide basis), to the extent determined 
appropriate by the Secretary, if— 
‘‘(1) the Secretary determines that such expan-
sion is expected— 
‘‘(A) to improve the quality of patient care 
without increasing spending under titles XVIII 
and XIX; 
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‘‘(B) to reduce spending under such titles 
without reducing the quality of patient care; or 
‘‘(C) to do both; and 
‘‘(2) the Chief Actuary of the Centers for Medi-
care & Medicaid Services certifies that such expan-
sion would reduce (or not result in any increase in) 
net program spending under such titles. 
‘‘(d) IMPLEMENTATION.— 
‘‘(1) WAIVER AUTHORITY.—The Secretary may 
waive such requirements of title XVIII and of sections 
1902(a)(1), 1902(a)(13), and 1903(m)(2)(A)(iii) as 
may be necessary solely for purposes of carrying out 
this section with respect to testing models described in 
subsection (b). 
‘‘(2) LIMITATIONS ON REVIEW.—There shall be 
no administrative or judicial review under section 
1869, section 1878, or otherwise of— 
‘‘(A) the selection of models for testing or 
expansion under this section; 
‘‘(B) the elements, parameters, scope, and 
duration of such models for testing or dissemina-
tion; 
‘‘(C) the termination or modification of the 
design and implementation of a model under 
subsection (b)(3)(B); and 
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‘‘(D) determinations about expansion of the 
duration and scope of a model under subsection 
(c) including the determination that a model is 
not expected to meet criteria described in para-
graphs (1) or (2) of such subsection. 
‘‘(3) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code shall not apply to this section and 
testing and evaluation of models or expansion of such 
models under this section. 
‘‘(4) FUNDING FOR TESTING ITEMS AND SERV-
ICES
AND
ADMINISTRATIVE
COSTS.—There shall be 
available from the Federal Supplementary Medical 
Insurance Trust Fund for payments for designing, 
conducting, and evaluating payment models, as well 
as for additional benefits for items and services under 
models tested under subsection (b) not otherwise cov-
ered under this title and the evaluation of such mod-
els, $350,000,000 for fiscal year 2010 and, for a sub-
sequent fiscal year, the amount determined under this 
sentence for the preceding fiscal year increased by the 
annual percentage rate of increase in total expendi-
tures under this title for the previous fiscal year. 
There are also appropriated, from any amounts in 
the Treasury not otherwise appropriated, $25,000,000 
for each fiscal year (beginning with fiscal year 2010) 
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for administrative costs of administering this section 
with respect to the Medicaid program under title XIX 
of the Social Security Act. 
‘‘(e) REPORT TO CONGRESS.—Beginning in 2012, and 
not less than once every other year thereafter, the Secretary 
shall submit to Congress a report on activities under this 
section. Each such report shall describe the payment models 
tested under subsection (b), any models chosen for expansion 
under subsection (c), and the results from evaluations under 
subsection (b)(4). In addition, each such report shall pro-
vide such recommendations as the Secretary believes are ap-
propriate for legislative action to facilitate the development 
and expansion of successful payment models.’’. 
(b) MEDICAID CONFORMING AMENDMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), 
as amended by sections 1631(b), 1703(a), 1729, 1753, 
1757(a), and 1759(a), is amended— 
(1) in paragraph (78), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (79), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (79) the fol-
lowing new paragraph: 
‘‘(80) provide for implementation of the payment 
models specified by the Secretary under section 
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1115A(c) for implementation on a nationwide basis 
unless the State demonstrates to the satisfaction of the 
Secretary that implementation would not be adminis-
tratively feasible or appropriate to the health care de-
livery system of the State.’’. 
DIVISION 
C—PUBLIC 
HEALTH 
AND WORKFORCE DEVELOP-
MENT 
SEC. 2001. TABLE OF CONTENTS; REFERENCES. 
(a) TABLE OF CONTENTS.—The table of contents of 
this division is as follows: 
Sec. 2001. Table of contents; references. 
Sec. 2002. Public Health Investment Fund. 
TITLE I—COMMUNITY HEALTH CENTERS 
Sec. 2101. Increased funding. 
TITLE II—WORKFORCE 
Subtitle A—Primary Care Workforce 
PART 1—NATIONAL HEALTH SERVICE CORPS 
Sec. 2201. National Health Service Corps. 
Sec. 2202. Authorizations of appropriations. 
PART 2—PROMOTION OF PRIMARY CARE AND DENTISTRY 
Sec. 2211. Frontline health providers. 
Sec. 2212. Primary care student loan funds. 
Sec. 2213. Training in family medicine, general internal medicine, general pedi-
atrics, geriatrics, and physician assistants. 
Sec. 2214. Training of medical residents in community-based settings. 
Sec. 2215. Training for general, pediatric, and public health dentists and dental 
hygienists. 
Sec. 2216. Authorization of appropriations. 
Sec. 2217. Study on effectiveness of scholarships and loan repayments. 
Subtitle B—Nursing Workforce 
Sec. 2221. Amendments to Public Health Service Act. 
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Subtitle C—Public Health Workforce 
Sec. 2231. Public Health Workforce Corps. 
Sec. 2232. Enhancing the public health workforce. 
Sec. 2233. Public health training centers. 
Sec. 2234. Preventive medicine and public health training grant program. 
Sec. 2235. Authorization of appropriations. 
Subtitle D—Adapting Workforce to Evolving Health System Needs 
PART 1—HEALTH PROFESSIONS TRAINING FOR DIVERSITY 
Sec. 2241. Scholarships for disadvantaged students, loan repayments and fellow-
ships regarding faculty positions, and educational assistance in 
the health professions regarding individuals from disadvantaged 
backgrounds. 
Sec. 2242. Nursing workforce diversity grants. 
Sec. 2243. Coordination of diversity and cultural competency programs. 
PART 2—INTERDISCIPLINARY TRAINING PROGRAMS 
Sec. 2251. Cultural and linguistic competency training for health professionals. 
Sec. 2252. Innovations in interdisciplinary care training. 
PART 3—ADVISORY COMMITTEE ON HEALTH WORKFORCE EVALUATION AND 
ASSESSMENT 
Sec. 2261. Health workforce evaluation and assessment. 
PART 4—HEALTH WORKFORCE ASSESSMENT 
Sec. 2271. Health workforce assessment. 
PART 5—AUTHORIZATION OF APPROPRIATIONS 
Sec. 2281. Authorization of appropriations. 
TITLE III—PREVENTION AND WELLNESS 
Sec. 2301. Prevention and wellness. 
‘‘TITLE XXXI—PREVENTION AND WELLNESS 
‘‘Subtitle A—Prevention and Wellness Trust 
‘‘Sec. 3111. Prevention and Wellness Trust. 
‘‘Subtitle B—National Prevention and Wellness Strategy 
‘‘Sec. 3121. National Prevention and Wellness Strategy. 
‘‘Subtitle C—Prevention Task Forces 
‘‘Sec. 3131. Task Force on Clinical Preventive Services. 
‘‘Sec. 3132. Task Force on Community Preventive Services. 
‘‘Subtitle D—Prevention and Wellness Research 
‘‘Sec. 3141. Prevention and wellness research activity coordination. 
‘‘Sec. 3142. Community prevention and wellness research grants. 
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‘‘Subtitle E—Delivery of Community Prevention and Wellness Services 
‘‘Sec. 3151. Community prevention and wellness services grants. 
‘‘Subtitle F—Core Public Health Infrastructure 
‘‘Sec. 3161. Core public health infrastructure for State, local, and tribal 
health departments. 
‘‘Sec. 3162. Core public health infrastructure and activities for CDC. 
‘‘Subtitle G—General Provisions 
‘‘Sec. 3171. Definitions. 
TITLE IV—QUALITY AND SURVEILLANCE 
Sec. 2401. Implementation of best practices in the delivery of health care. 
Sec. 2402. Assistant Secretary for Health Information. 
Sec. 2403. Authorization of appropriations. 
TITLE V—OTHER PROVISIONS 
Subtitle A—Drug Discount for Rural and Other Hospitals 
Sec. 2501. Expanded participation in 340B program. 
Sec. 2502. Extension of discounts to inpatient drugs. 
Sec. 2503. Effective date. 
Subtitle B—Programs 
PART 1—GRANTS FOR CLINICS AND CENTERS 
Sec. 2511. School-based health clinics. 
Sec. 2512. Nurse-managed health centers. 
Sec. 2513. Federally qualified behavioral health centers. 
PART 2—OTHER GRANT PROGRAMS 
Sec. 2521. Comprehensive programs to provide education to nurses and create a 
pipeline to nursing. 
Sec. 2522. Mental and behavioral health training. 
Sec. 2523. Programs to increase awareness of advance care planning issues. 
Sec. 2524. Reauthorization of telehealth and telemedicine grant programs. 
Sec. 2525. No child left unimmunized against influenza: demonstration program 
using elementary and secondary schools as influenza vaccination 
centers. 
Sec. 2526. Extension of Wisewoman Program. 
Sec. 2527. Healthy teen initiative to prevent teen pregnancy. 
Sec. 2528. National training initiative on autism supplemental grants and tech-
nical assistance. 
Sec. 2529. Implementation of medication management services in treatment of 
chronic diseases. 
Sec. 2530. Postpartum depression. 
Sec. 2531. Grants to promote positive health behaviors and outcomes. 
PART 3—EMERGENCY CARE-RELATED PROGRAMS 
Sec. 2541. Trauma care centers. 
Sec. 2542. Emergency care coordination. 
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Sec. 2543. Pilot programs to improve emergency medical care. 
Sec. 2544. Assisting veterans with military emergency medical training to become 
State-licensed or certified emergency medical technicians 
(EMTs). 
Sec. 2545. Dental emergency responders: public health and medical response. 
Sec. 2546. Dental emergency responders: homeland security. 
PART 4—PAIN CARE AND MANAGEMENT PROGRAMS 
Sec. 2551. Institute of Medicine Conference on Pain. 
Sec. 2552. Pain research at National Institutes of Health. 
Sec. 2553. Public awareness campaign on pain management. 
Subtitle C—Food and Drug Administration 
PART 1—IN GENERAL 
Sec. 2561. National medical device registry. 
Sec. 2562. Nutrition labeling of standard menu items at chain restaurants and 
of articles of food sold from vending machines. 
Sec. 2563. Protecting consumer access to generic drugs. 
PART 2—BIOSIMILARS 
Sec. 2565. Licensure pathway for biosimilar biological products. 
Sec. 2566. Fees relating to biosimilar biological products. 
Subtitle D—Community Living Assistance Services and Supports 
Sec. 2571. Establishment of national voluntary insurance program for pur-
chasing community living assistance services and supports. 
Subtitle E—Miscellaneous 
Sec. 2581. States failing to adhere to certain employment obligations. 
Sec. 2582. Study, report, and termination of duplicative grant programs. 
Sec. 2583. Health centers under Public Health Service Act; liability protections 
for volunteer practitioners. 
Sec. 2584. Report to Congress on the current state of parasitic diseases that have 
been overlooked among the poorest Americans. 
Sec. 2585. Study of impact of optometrists on access to health care and on avail-
ability of support under Federal health programs for optometry. 
(b) REFERENCES.—Except as otherwise specified, 
whenever in this division an amendment is expressed in 
terms of an amendment to a section or other provision, the 
reference shall be considered to be made to a section or other 
provision of the Public Health Service Act (42 U.S.C. 201 
et seq.). 
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SEC. 2002. PUBLIC HEALTH INVESTMENT FUND. 
(a) ESTABLISHMENT OF FUNDS.— 
(1) IN GENERAL.—There is established a fund to 
be known as the Public Health Investment Fund (re-
ferred to in this section as the ‘‘Fund’’). 
(2) FUNDING.— 
(A) There shall be deposited into the 
Fund— 
(i) 
for 
fiscal 
year 
2010, 
$4,600,000,000; 
(ii) 
for 
fiscal 
year 
2011, 
$5,600,000,000; 
(iii) 
for 
fiscal 
year 
2012, 
$6,900,000,000; 
(iv) 
for 
fiscal 
year 
2013, 
$7,800,000,000; and 
(v) 
for 
fiscal 
year 
2014, 
$9,000,000,000. 
(B) Amounts deposited into the Fund shall 
be derived from general revenues of the Treasury. 
(b) AUTHORIZATION OF APPROPRIATIONS FROM THE 
FUND.— 
(1) NEW FUNDING.— 
(A) IN GENERAL.—Amounts in the Fund 
are authorized to be appropriated by the Com-
mittees on Appropriations of the House of Rep-
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resentatives and the Senate for carrying out ac-
tivities under designated public health provi-
sions. 
(B) DESIGNATED
PROVISIONS.—For pur-
poses of this paragraph, the term ‘‘designated 
public health provisions’’ means the provisions 
for which amounts are authorized to be appro-
priated under section 330(s), 338(c), 338H–1, 
799C, 872, or 3111 of the Public Health Service 
Act, as added by this division. 
(2) BASELINE FUNDING.— 
(A) IN GENERAL.—Amounts in the Fund 
are authorized to be appropriated (as described 
in paragraph (1)) for a fiscal year only if (ex-
cluding any amounts in or appropriated from 
the Fund)— 
(i) the amounts specified in subpara-
graph (B) for the fiscal year involved are 
equal to or greater than the amounts speci-
fied in subparagraph (B) for fiscal year 
2008; and 
(ii) the amounts appropriated, out of 
the general fund of the Treasury, to the Pre-
vention and Wellness Trust under section 
3111 of the Public Health Service Act, as 
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added by this division, for the fiscal year 
involved are equal to or greater than the 
funds— 
(I) appropriated under the head-
ing ‘‘Prevention and Wellness Fund’’ 
in title VIII of division A of the Amer-
ican Recovery and Reinvestment Act of 
2009 (Public Law 111–5); and 
(II) allocated by the second pro-
viso under such heading for evidence- 
based clinical and community-based 
prevention and wellness strategies. 
(B) AMOUNTS
SPECIFIED.—The amounts 
specified in this subparagraph, with respect to a 
fiscal year, are the amounts appropriated for the 
following: 
(i) Community health centers (includ-
ing funds appropriated under the authority 
of section 330 of the Public Health Service 
Act (42 U.S.C. 254b)). 
(ii) The National Health Service Corps 
Program (including funds appropriated 
under the authority of section 338 of such 
Act (42 U.S.C. 254k)). 
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(iii) The National Health Service 
Corps Scholarship and Loan Repayment 
Programs (including funds appropriated 
under the authority of section 338H of such 
Act (42 U.S.C. 254q)). 
(iv) Primary care education programs 
(including funds appropriated under the 
authority of sections 736, 740, 741, and 747 
of such Act (42 U.S.C. 293, 293d, and 
293k)). 
(v) Sections 761 and 770 of such Act 
(42 U.S.C. 294n and 295e). 
(vi) Nursing workforce development 
(including funds appropriated under the 
authority of title VIII of such Act (42 
U.S.C. 296 et seq.)). 
(vii) The National Center for Health 
Statistics (including funds appropriated 
under the authority of sections 304, 306, 
307, and 308 of such Act (42 U.S.C. 242b, 
242k, 242l, and 242m)). 
(viii) The Agency for Healthcare Re-
search and Quality (including funds appro-
priated under the authority of title IX of 
such Act (42 U.S.C. 299 et seq.)). 
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(3) BUDGETARY
IMPLICATIONS.—Amounts ap-
propriated under this section, and outlays flowing 
from such appropriations, shall not be taken into ac-
count for purposes of any budget enforcement proce-
dures including allocations under section 302(a) and 
(b) of the Balanced Budget and Emergency Deficit 
Control Act and budget resolutions for fiscal years 
during which appropriations are made from the 
Fund. 
TITLE I—COMMUNITY HEALTH 
CENTERS 
SEC. 2101. INCREASED FUNDING. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended— 
(1) in subsection (r)(1)— 
(A) in subparagraph (D), by striking ‘‘and’’ 
at the end; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by inserting at the end the following: 
‘‘(F) such sums as may be necessary for 
each of fiscal years 2013 and 2014.’’; and 
(2) by inserting after subsection (r) the fol-
lowing: 
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‘‘(s) ADDITIONAL FUNDING.—For the purpose of car-
rying out this section, in addition to any other amounts 
authorized to be appropriated for such purpose, there are 
authorized to be appropriated, out of any monies in the 
Public Health Investment Fund, the following: 
‘‘(1) For fiscal year 2010, $1,000,000,000. 
‘‘(2) For fiscal year 2011, $1,500,000,000. 
‘‘(3) For fiscal year 2012, $2,500,000,000. 
‘‘(4) For fiscal year 2013, $3,000,000,000. 
‘‘(5) For fiscal year 2014, $4,000,000,000.’’. 
TITLE II—WORKFORCE 
Subtitle A—Primary Care 
Workforce 
PART 1—NATIONAL HEALTH SERVICE CORPS 
SEC. 2201. NATIONAL HEALTH SERVICE CORPS. 
(a) FULFILLMENT OF OBLIGATED SERVICE REQUIRE-
MENT THROUGH HALF-TIME SERVICE.— 
(1) WAIVERS.—Subsection (i) of section 331 (42 
U.S.C. 254d) is amended— 
(A) in paragraph (1), by striking ‘‘In car-
rying out subpart III’’ and all that follows 
through the period and inserting ‘‘In carrying 
out subpart III, the Secretary may, in accord-
ance with this subsection, issue waivers to indi-
viduals who have entered into a contract for obli-
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gated service under the Scholarship Program or 
the Loan Repayment Program under which the 
individuals are authorized to satisfy the require-
ment of obligated service through providing clin-
ical practice that is half-time.’’; 
(B) in paragraph (2)— 
(i) in subparagraphs (A)(ii) and (B), 
by striking ‘‘less than full time’’ each place 
it appears and inserting ‘‘half time’’; 
(ii) in subparagraphs (C) and (F), by 
striking ‘‘less than full-time service’’ each 
place it appears and inserting ‘‘half-time 
service’’; and 
(iii) by amending subparagraphs (D) 
and (E) to read as follows: 
‘‘(D) the entity and the Corps member agree in 
writing that the Corps member will perform half-time 
clinical practice; 
‘‘(E) the Corps member agrees in writing to ful-
fill all of the service obligations under section 338C 
through half-time clinical practice and either— 
‘‘(i) double the period of obligated service 
that would otherwise be required; or 
‘‘(ii) in the case of contracts entered into 
under section 338B, accept a minimum service 
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TITLE I—IMPROVING HEALTH 
CARE VALUE 
Subtitle A—Provisions Related to 
Medicare Part A 
PART 1—MARKET BASKET UPDATES 
SEC. 1101. SKILLED NURSING FACILITY PAYMENT UPDATE. 
(a) IN GENERAL.—Section 1888(e)(4)(E)(ii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395yy(e)(4)(E)(ii)) is amended— 
(1) in subclause (III), by striking 
‘‘and’’ at the end; 
(2) by redesignating subclause (IV) as 
subclause (VI); and 
(3) by inserting after subclause (III) 
the following new subclauses: 
‘‘(IV) for each of fiscal 
years 2004 through 2009, the 
rate computed for the pre-
vious fiscal year increased by 
the skilled nursing facility 
market 
basket 
percentage 
change for the fiscal year in-
volved; 
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‘‘(i) AGGREGATE
CAP.—The ag-
gregate amount of the payment 
adjustment under this paragraph 
for a fiscal year shall not exceed 5 
percent 
of 
the 
estimated 
dif-
ference 
in 
the 
spending 
that 
would occur for such fiscal year 
with and without application of 
the adjustment factor described 
in paragraph (3) and applied pur-
suant to paragraph (1). 
‘‘(ii) HOSPITAL-SPECIFIC LIMIT.— 
The aggregate amount of the pay-
ment adjustment for a hospital 
under this paragraph shall not ex-
ceed the estimated difference in 
spending that would occur for 
such fiscal year for such hospital 
with and without application of 
the adjustment factor described 
in paragraph (3) and applied pur-
suant to paragraph (1). 
‘‘(D) FORM OF PAYMENT.—The Sec-
retary may make the additional pay-
ments under this paragraph on a 
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