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carry out its duties. To the extent consistent with 
applicable laws and regulations, the head of such 
department or agency shall furnish the requested 
information to the review panel. 
‘‘(e) REPORTS.— 
‘‘(1) BY STATE.—Each State receiving a grant 
under subsection (a) shall submit to the Secretary an 
annual report evaluating the effectiveness of activities 
funded with grants awarded under such subsection. 
Such report shall, at a minimum, include the impact 
of the activities funded on patient safety and on the 
availability and price of medical liability insurance. 
‘‘(2) BY SECRETARY.—The Secretary shall sub-
mit to Congress an annual compendium of the reports 
submitted under paragraph (1) and an analysis of 
the activities funded under subsection (a) that exam-
ines any differences that result from such activities in 
terms of the quality of care, number and nature of 
medical errors, medical resources used, length of time 
for dispute resolution, and the availability and price 
of liability insurance. 
‘‘(f) TECHNICAL ASSISTANCE.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
technical assistance to the States applying for or 
awarded grants under subsection (a). 
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‘‘(2) 
REQUIREMENTS.—Technical 
assistance 
under paragraph (1) shall include— 
‘‘(A) guidance on non-economic damages, 
including the consideration of individual facts 
and circumstances in determining appropriate 
payment, guidance on identifying avoidable in-
juries, and guidance on disclosure to patients of 
health care errors and adverse events; and 
‘‘(B) the development, in consultation with 
States, of common definitions, formats, and data 
collection infrastructure for States receiving 
grants under this section to use in reporting to 
facilitate aggregation and analysis of data both 
within and between States. 
‘‘(3) USE OF COMMON DEFINITIONS, FORMATS, 
AND
DATA
COLLECTION
INFRASTRUCTURE.—States 
not receiving grants under this section may also use 
the common definitions, formats, and data collection 
infrastructure developed under paragraph (2)(B). 
‘‘(g) EVALUATION.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the review panel established under sub-
section (d)(2), shall enter into a contract with an ap-
propriate research organization to conduct an overall 
evaluation of the effectiveness of grants awarded 
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under subsection (a) and to annually prepare and 
submit a report to Congress. Such an evaluation shall 
begin not later than 18 months following the date of 
implementation of the first program funded by a 
grant under subsection (a). 
‘‘(2) CONTENTS.—The evaluation under para-
graph (1) shall include— 
‘‘(A) an analysis of the effects of the grants 
awarded under subsection (a) with regard to the 
measures described in paragraph (3); 
‘‘(B) for each State, an analysis of the ex-
tent to which the alternative developed under 
subsection (c)(1) is effective in meeting the ele-
ments described in subsection (c)(2); 
‘‘(C) a comparison among the States receiv-
ing grants under subsection (a) of the effective-
ness of the various alternatives developed by such 
States under subsection (c)(1); 
‘‘(D) a comparison, considering the meas-
ures described in paragraph (3), of States receiv-
ing grants approved under subsection (a) and 
similar States not receiving such grants; and 
‘‘(E) a comparison, with regard to the 
measures described in paragraph (3), of— 
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‘‘(i) States receiving grants under sub-
section (a); 
‘‘(ii) States that enacted, prior to the 
date of enactment of the Patient Protection 
and Affordable Care Act, any cap on non- 
economic damages; and 
‘‘(iii) States that have enacted, prior to 
the date of enactment of the Patient Protec-
tion and Affordable Care Act, a requirement 
that the complainant obtain an opinion re-
garding the merit of the claim, although the 
substance of such opinion may have no 
bearing on whether the complainant may 
proceed with a case. 
‘‘(3) MEASURES.—The evaluations under para-
graph (2) shall analyze and make comparisons on the 
basis of— 
‘‘(A) the nature and number of disputes 
over injuries allegedly caused by health care pro-
viders or health care organizations; 
‘‘(B) the nature and number of claims in 
which tort litigation was pursued despite the ex-
istence of an alternative under subsection (a); 
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‘‘(C) the disposition of disputes and claims, 
including the length of time and estimated costs 
to all parties; 
‘‘(D) the medical liability environment; 
‘‘(E) health care quality; 
‘‘(F) patient safety in terms of detecting, 
analyzing, and helping to reduce medical errors 
and adverse events; 
‘‘(G) patient and health care provider and 
organization satisfaction with the alternative 
under subsection (a) and with the medical liabil-
ity environment; and 
‘‘(H) impact on utilization of medical serv-
ices, appropriately adjusted for risk. 
‘‘(4) FUNDING.—The Secretary shall reserve 5 
percent of the amount appropriated in each fiscal 
year under subsection (k) to carry out this subsection. 
‘‘(h) MEDPAC AND MACPAC REPORTS.— 
‘‘(1) MEDPAC.—The Medicare Payment Advi-
sory Commission shall conduct an independent review 
of the alternatives to current tort litigation that are 
implemented under grants under subsection (a) to de-
termine the impact of such alternatives on the Medi-
care program under title XVIII of the Social Security 
Act, and its beneficiaries. 
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‘‘(2) MACPAC.—The Medicaid and CHIP Pay-
ment and Access Commission shall conduct an inde-
pendent review of the alternatives to current tort liti-
gation that are implemented under grants under sub-
section (a) to determine the impact of such alter-
natives on the Medicaid or CHIP programs under ti-
tles XIX and XXI of the Social Security Act, and 
their beneficiaries. 
‘‘(3) REPORTS.—Not later than December 31, 
2016, the Medicare Payment Advisory Commission 
and the Medicaid and CHIP Payment and Access 
Commission shall each submit to Congress a report 
that includes the findings and recommendations of 
each respective Commission based on independent re-
views conducted under paragraphs (1) and (2), in-
cluding an analysis of the impact of the alternatives 
reviewed on the efficiency and effectiveness of the re-
spective programs. 
‘‘(i) OPTION TO PROVIDE
FOR INITIAL PLANNING 
GRANTS.—Of the funds appropriated pursuant to sub-
section (k), the Secretary may use a portion not to exceed 
$500,000 per State to provide planning grants to such 
States for the development of demonstration project applica-
tions meeting the criteria described in subsection (c). In se-
lecting States to receive such planning grants, the Secretary 
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shall give preference to those States in which State law at 
the time of the application would not prohibit the adoption 
of an alternative to current tort litigation. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) HEALTH CARE SERVICES.—The term ‘health 
care services’ means any services provided by a health 
care provider, or by any individual working under 
the supervision of a health care provider, that relate 
to— 
‘‘(A) the diagnosis, prevention, or treatment 
of any human disease or impairment; or 
‘‘(B) the assessment of the health of human 
beings. 
‘‘(2) HEALTH CARE ORGANIZATION.—The term 
‘health care organization’ means any individual or 
entity which is obligated to provide, pay for, or ad-
minister health benefits under any health plan. 
‘‘(3) 
HEALTH
CARE
PROVIDER.—The 
term 
‘health care provider’ means any individual or enti-
ty— 
‘‘(A) licensed, registered, or certified under 
Federal or State laws or regulations to provide 
health care services; or 
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‘‘(B) required to be so licensed, registered, 
or certified but that is exempted by other statute 
or regulation. 
‘‘(k) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$50,000,000 for the 5-fiscal year period beginning with fis-
cal year 2011. 
‘‘(l) CURRENT STATE EFFORTS TO ESTABLISH AL-
TERNATIVE TO TORT LITIGATION.—Nothing in this section 
shall be construed to limit any prior, current, or future ef-
forts of any State to establish any alternative to tort litiga-
tion. 
‘‘(m) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as limiting states’ authority over 
or responsibility for their state justice systems.’’. 
SEC. 10608. EXTENSION OF MEDICAL MALPRACTICE COV-
ERAGE TO FREE CLINICS. 
(a) IN GENERAL.—Section 224(o)(1) of the Public 
Health Service Act (42 U.S.C. 233(o)(1)) is amended by 
inserting after ‘‘to an individual’’ the following: ‘‘, or an 
officer, governing board member, employee, or contractor of 
a free clinic shall in providing services for the free clinic,’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall take effect on the date of enactment of this Act 
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and apply to any act or omission which occurs on or after 
that date. 
SEC. 10609. LABELING CHANGES. 
Section 505(j) of the Federal Food, Drug, and Cos-
metic Act (21 U.S.C. 355(j)) is amended by adding at the 
end the following: 
‘‘(10)(A) If the proposed labeling of a drug that is the 
subject of an application under this subsection differs from 
the listed drug due to a labeling revision described under 
clause (i), the drug that is the subject of such application 
shall, notwithstanding any other provision of this Act, be 
eligible for approval and shall not be considered misbranded 
under section 502 if— 
‘‘(i) the application is otherwise eligible for ap-
proval under this subsection but for expiration of pat-
ent, an exclusivity period, or of a delay in approval 
described in paragraph (5)(B)(iii), and a revision to 
the labeling of the listed drug has been approved by 
the Secretary within 60 days of such expiration; 
‘‘(ii) the labeling revision described under clause 
(i) does not include a change to the ‘Warnings’ sec-
tion of the labeling; 
‘‘(iii) the sponsor of the application under this 
subsection agrees to submit revised labeling of the 
drug that is the subject of such application not later 
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than 60 days after the notification of any changes to 
such labeling required by the Secretary; and 
‘‘(iv) such application otherwise meets the appli-
cable requirements for approval under this subsection. 
‘‘(B) If, after a labeling revision described in subpara-
graph (A)(i), the Secretary determines that the continued 
presence in interstate commerce of the labeling of the listed 
drug (as in effect before the revision described in subpara-
graph (A)(i)) adversely impacts the safe use of the drug, 
no application under this subsection shall be eligible for ap-
proval with such labeling.’’. 
Subtitle G—Provisions Relating to 
Title VIII 
SEC. 10801. PROVISIONS RELATING TO TITLE VIII. 
(a) Title XXXII of the Public Health Service Act, as 
added by section 8002(a)(1), is amended— 
(1) in section 3203— 
(A) in subsection (a)(1), by striking sub-
paragraph (E); 
(B) in subsection (b)(1)(C)(i), by striking 
‘‘for enrollment’’ and inserting ‘‘for reenroll-
ment’’; and 
(C) in subsection (c)(1), by striking ‘‘, as 
part of their automatic enrollment in the 
CLASS program,’’; and 
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(2) in section 3204— 
(A) in subsection (c)(2), by striking sub-
paragraph (A) and inserting the following: 
‘‘(A) receives wages or income on which 
there is imposed a tax under section 3101(a) or 
3201(a) of the Internal Revenue Code of 1986; 
or’’; 
(B) in subsection (d), by striking ‘‘subpara-
graph (B) or (C) of subsection (c)(1)’’ and in-
serting ‘‘subparagraph (A) or (B) of subsection 
(c)(2)’’; 
(C) in subsection (e)(2)(A), by striking 
‘‘subparagraph (A)’’ and inserting ‘‘paragraph 
(1)’’; and 
(D) in subsection (g)(1), by striking ‘‘has 
elected to waive enrollment’’ and inserting ‘‘has 
not enrolled’’. 
(b) Section 8002 of this Act is amended in the heading 
for subsection (d), by striking ‘‘INFORMATION ON SUPPLE-
MENTAL COVERAGE’’ and inserting ‘‘CLASS PROGRAM IN-
FORMATION’’. 
(c) Section 6021(d)(2)(A)(iv) of the Deficit Reduction 
Act of 2005, as added by section 8002(d) of this Act, is 
amended by striking ‘‘and coverage available’’ and all that 
follows through ‘‘that program,’’. 
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Subtitle H—Provisions Relating to 
Title IX 
SEC. 10901. MODIFICATIONS TO EXCISE TAX ON HIGH COST 
EMPLOYER-SPONSORED HEALTH COVERAGE. 
(a) LONGSHORE WORKERS TREATED AS EMPLOYEES 
ENGAGED IN HIGH-RISK PROFESSIONS.—Paragraph (3) of 
section 4980I(f) of the Internal Revenue Code of 1986, as 
added by section 9001 of this Act, is amended by inserting 
‘‘individuals whose primary work is longshore work (as de-
fined in section 258(b) of the Immigration and Nationality 
Act (8 U.S.C. 1288(b)), determined without regard to para-
graph (2) thereof),’’ before ‘‘and individuals engaged in the 
construction, mining’’. 
(b) EXEMPTION FROM HIGH-COST INSURANCE TAX IN-
CLUDES CERTAIN ADDITIONAL EXCEPTED BENEFITS.— 
Clause (i) of section 4980I(d)(1)(B) of the Internal Revenue 
Code of 1986, as added by section 9001 of this Act, is 
amended by striking ‘‘section 9832(c)(1)(A)’’ and inserting 
‘‘section 9832(c)(1) (other than subparagraph (G) thereof)’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2012. 
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SEC. 10902. INFLATION ADJUSTMENT OF LIMITATION ON 
HEALTH 
FLEXIBLE 
SPENDING 
ARRANGE-
MENTS UNDER CAFETERIA PLANS. 
(a) IN GENERAL.—Subsection (i) of section 125 of the 
Internal Revenue Code of 1986, as added by section 9005 
of this Act, is amended to read as follows: 
‘‘(i) LIMITATION ON HEALTH FLEXIBLE SPENDING 
ARRANGEMENTS.— 
‘‘(1) IN GENERAL.—For purposes of this section, 
if a benefit is provided under a cafeteria plan through 
employer contributions to a health flexible spending 
arrangement, such benefit shall not be treated as a 
qualified benefit unless the cafeteria plan provides 
that an employee may not elect for any taxable year 
to have salary reduction contributions in excess of 
$2,500 made to such arrangement. 
‘‘(2) ADJUSTMENT FOR INFLATION.—In the case 
of any taxable year beginning after December 31, 
2011, the dollar amount in paragraph (1) shall be in-
creased by an amount equal to— 
‘‘(A) such amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which such taxable year begins by sub-
stituting ‘calendar year 2010’ for ‘calendar year 
1992’ in subparagraph (B) thereof. 
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If any increase determined under this paragraph is 
not a multiple of $50, such increase shall be rounded 
to the next lowest multiple of $50.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2010. 
SEC. 10903. MODIFICATION OF LIMITATION ON CHARGES BY 
CHARITABLE HOSPITALS. 
(a) IN
GENERAL.—Subparagraph (A) of section 
501(r)(5) of the Internal Revenue Code of 1986, as added 
by section 9007 of this Act, is amended by striking ‘‘the 
lowest amounts charged’’ and inserting ‘‘the amounts gen-
erally billed’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to taxable years beginning after the date 
of the enactment of this Act. 
SEC. 10904. MODIFICATION OF ANNUAL FEE ON MEDICAL 
DEVICE MANUFACTURERS AND IMPORTERS. 
(a) IN GENERAL.—Section 9009 of this Act is amend-
ed— 
(1) by striking ‘‘2009’’ in subsection (a)(1) and 
inserting ‘‘2010’’, 
(2) by inserting ‘‘($3,000,000,000 after 2017)’’ 
after ‘‘$2,000,000,000’’, and 
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(3) by striking ‘‘2008’’ in subsection (i) and in-
serting ‘‘2009’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall take effect as if included in the enactment of 
section 9009. 
SEC. 10905. MODIFICATION OF ANNUAL FEE ON HEALTH IN-
SURANCE PROVIDERS. 
(a) DETERMINATION OF FEE AMOUNT.—Subsection 
(b) of section 9010 of this Act is amended to read as follows: 
‘‘(b) DETERMINATION OF FEE AMOUNT.— 
‘‘(1) IN GENERAL.—With respect to each covered 
entity, the fee under this section for any calendar 
year shall be equal to an amount that bears the same 
ratio to the applicable amount as— 
‘‘(A) the covered entity’s net premiums 
written with respect to health insurance for any 
United States health risk that are taken into ac-
count during the preceding calendar year, bears 
to 
‘‘(B) the aggregate net premiums written 
with respect to such health insurance of all cov-
ered entities that are taken into account during 
such preceding calendar year. 
‘‘(2) AMOUNTS TAKEN INTO ACCOUNT.—For pur-
poses of paragraph (1), the net premiums written 
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with respect to health insurance for any United 
States health risk that are taken into account during 
any calendar year with respect to any covered entity 
shall be determined in accordance with the following 
table: 
‘‘With respect to a covered entity’s net premiums writ-
ten during the calendar year that are: 
The percentage of net 
premiums written that 
are taken into account 
is: 
Not more than $25,000,000 ........................................
0 percent 
More than $25,000,000 but not more than 
$50,000,000.
50 percent 
More than $50,000,000 ...............................................
100 percent. 
‘‘(3) SECRETARIAL DETERMINATION.—The Sec-
retary shall calculate the amount of each covered enti-
ty’s fee for any calendar year under paragraph (1). 
In calculating such amount, the Secretary shall deter-
mine such covered entity’s net premiums written with 
respect to any United States health risk on the basis 
of reports submitted by the covered entity under sub-
section (g) and through the use of any other source of 
information available to the Secretary.’’. 
(b) APPLICABLE AMOUNT.—Subsection (e) of section 
9010 of this Act is amended to read as follows: 
‘‘(e) APPLICABLE AMOUNT.—For purposes of sub-
section (b)(1), the applicable amount shall be determined 
in accordance with the following table: 
‘‘Calendar year 
Applicable 
amount 
2011 .............................................................................
$2,000,000,000 
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2012 .............................................................................
$4,000,000,000 
2013 .............................................................................
$7,000,000,000 
2014, 2015 and 2016 ..................................................
$9,000,000,000 
2017 and thereafter ....................................................
$10,000,000,000.’’. 
(c) EXEMPTION FROM ANNUAL FEE ON HEALTH IN-
SURANCE
FOR CERTAIN NONPROFIT ENTITIES.—Section 
9010(c)(2) of this Act is amended by striking ‘‘or’’ at the 
end of subparagraph (A), by striking the period at the end 
of subparagraph (B) and inserting a comma, and by add-
ing at the end the following new subparagraphs: 
‘‘(C) any entity— 
‘‘(i)(I) which is incorporated as, is a 
wholly owned subsidiary of, or is a wholly 
owned affiliate of, a nonprofit corporation 
under a State law, or 
‘‘(II) which is described in section 
501(c)(4) of the Internal Revenue Code of 
1986 and the activities of which consist of 
providing commercial-type insurance (with-
in the meaning of section 501(m) of such 
Code), 
‘‘(ii) the premium rate increases of 
which are regulated by a State authority, 
‘‘(iii) which, as of the date of the en-
actment of this section, acts as the insurer 
of last resort in the State and is subject to 
State guarantee issue requirements, and 
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‘‘(II) with respect to all such mar-
kets for such entity for the calendar 
year is not less than 92 percent, or 
‘‘(E) any entity— 
‘‘(i) which is a mutual insurance com-
pany, 
‘‘(ii) which for the period reported on 
the 2008 Accident and Health Policy Expe-
rience Exhibit of the National Association 
of Insurance Commissioners had— 
‘‘(I) a market share of the insured 
population of a State of at least 40 but 
not more than 60 percent, and 
‘‘(II) with respect to all markets 
described in subparagraph (D)(ii)(I), a 
medical loss ratio of not less than 90 
percent, and 
‘‘(iii) with respect to annual payment 
dates in calendar years after 2011, for 
which the medical loss ratio (determined in 
a manner consistent with the determination 
of such ratio under section 2718(b)(1)(A) of 
the Public Health Service Act) with respect 
to all such markets for such entity for the 
preceding calendar year is not less than 89 
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percent (except that with respect to such an-
nual payment date for 2012, the calculation 
under 2718(b)(1)(B)(ii) of such Act is deter-
mined by reference to the previous year, and 
with respect to such annual payment date 
for 2013, such calculation is determined by 
reference to the average for the previous 2 
years).’’. 
(d) CERTAIN INSURANCE EXEMPTED FROM FEE.— 
Paragraph (3) of section 9010(h) of this Act is amended 
to read as follows: 
‘‘(3) HEALTH INSURANCE.—The term ‘health in-
surance’ shall not include— 
‘‘(A) any insurance coverage described in 
paragraph (1)(A) or (3) of section 9832(c) of the 
Internal Revenue Code of 1986, 
‘‘(B) any insurance for long-term care, or 
‘‘(C) any medicare supplemental health in-
surance (as defined in section 1882(g)(1) of the 
Social Security Act).’’. 
(e) ANTI-AVOIDANCE GUIDANCE.—Subsection (i) of 
section 9010 of this Act is amended by inserting ‘‘and shall 
prescribe such regulations as are necessary or appropriate 
to prevent avoidance of the purposes of this section, includ-
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ing inappropriate actions taken to qualify as an exempt 
entity under subsection (c)(2)’’ after ‘‘section’’. 
(f) CONFORMING AMENDMENTS.— 
(1) Section 9010(a)(1) of this Act is amended by 
striking ‘‘2009’’ and inserting ‘‘2010’’. 
(2) Section 9010(c)(2)(B) of this Act is amended 
by striking ‘‘(except’’ and all that follows through 
‘‘1323)’’. 
(3) Section 9010(c)(3) of this Act is amended by 
adding at the end the following new sentence: ‘‘If any 
entity described in subparagraph (C)(i)(I), (D)(i)(I), 
or (E)(i) of paragraph (2) is treated as a covered en-
tity by reason of the application of the preceding sen-
tence, the net premiums written with respect to health 
insurance for any United States health risk of such 
entity shall not be taken into account for purposes of 
this section.’’. 
(4) Section 9010(g)(1) of this Act is amended by 
striking ‘‘and third party administration agreement 
fees’’. 
(5) Section 9010(j) of this Act is amended— 
(A) by striking ‘‘2008’’ and inserting 
‘‘2009’’, and 
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(B) by striking ‘‘, and any third party ad-
ministration agreement fees received after such 
date’’. 
(g) EFFECTIVE DATE.—The amendments made by this 
section shall take effect as if included in the enactment of 
section 9010. 
SEC. 10906. MODIFICATIONS TO ADDITIONAL HOSPITAL IN-
SURANCE TAX ON HIGH-INCOME TAXPAYERS. 
(a) FICA.—Section 3101(b)(2) of the Internal Revenue 
Code of 1986, as added by section 9015(a)(1) of this Act, 
is amended by striking ‘‘0.5 percent’’ and inserting ‘‘0.9 
percent’’. 
(b) SECA.—Section 1401(b)(2)(A) of the Internal 
Revenue Code of 1986, as added by section 9015(b)(1) of 
this Act, is amended by striking ‘‘0.5 percent’’ and inserting 
‘‘0.9 percent’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to remuneration received, 
and taxable years beginning, after December 31, 2012. 
SEC. 10907. EXCISE TAX ON INDOOR TANNING SERVICES IN 
LIEU OF ELECTIVE COSMETIC MEDICAL PRO-
CEDURES. 
(a) IN GENERAL.—The provisions of, and amendments 
made by, section 9017 of this Act are hereby deemed null, 
void, and of no effect. 
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(b) EXCISE TAX ON INDOOR TANNING SERVICES.— 
Subtitle D of the Internal Revenue Code of 1986, as amend-
ed by this Act, is amended by adding at the end the fol-
lowing new chapter: 
‘‘CHAPTER 49—COSMETIC SERVICES 
‘‘Sec. 5000B. Imposition of tax on indoor tanning services. 
‘‘SEC. 5000B. IMPOSITION OF TAX ON INDOOR TANNING 
SERVICES. 
‘‘(a) IN GENERAL.—There is hereby imposed on any 
indoor tanning service a tax equal to 10 percent of the 
amount paid for such service (determined without regard 
to this section), whether paid by insurance or otherwise. 
‘‘(b) INDOOR TANNING SERVICE.—For purposes of this 
section— 
‘‘(1) IN GENERAL.—The term ‘indoor tanning 
service’ means a service employing any electronic 
product designed to incorporate 1 or more ultraviolet 
lamps and intended for the irradiation of an indi-
vidual by ultraviolet radiation, with wavelengths in 
air between 200 and 400 nanometers, to induce skin 
tanning. 
‘‘(2) EXCLUSION
OF
PHOTOTHERAPY
SERV-
ICES.—Such term does not include any phototherapy 
service performed by a licensed medical professional. 
‘‘(c) PAYMENT OF TAX.— 
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‘‘(1) IN GENERAL.—The tax imposed by this sec-
tion shall be paid by the individual on whom the 
service is performed. 
‘‘(2) COLLECTION.—Every person receiving a 
payment for services on which a tax is imposed under 
subsection (a) shall collect the amount of the tax from 
the individual on whom the service is performed and 
remit such tax quarterly to the Secretary at such time 
and in such manner as provided by the Secretary. 
‘‘(3) SECONDARY LIABILITY.—Where any tax im-
posed by subsection (a) is not paid at the time pay-
ments for indoor tanning services are made, then to 
the extent that such tax is not collected, such tax shall 
be paid by the person who performs the service.’’. 
(c) CLERICAL AMENDMENT.—The table of chapter for 
subtitle D of the Internal Revenue Code of 1986, as amended 
by this Act, is amended by inserting after the item relating 
to chapter 48 the following new item: 
‘‘CHAPTER 49—COSMETIC SERVICES’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to services performed on or after July 
1, 2010. 
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SEC. 10908. EXCLUSION FOR ASSISTANCE PROVIDED TO 
PARTICIPANTS IN STATE STUDENT LOAN RE-
PAYMENT PROGRAMS FOR CERTAIN HEALTH 
PROFESSIONALS. 
(a) IN GENERAL.—Paragraph (4) of section 108(f) of 
the Internal Revenue Code of 1986 is amended to read as 
follows: 
‘‘(4) PAYMENTS UNDER NATIONAL HEALTH SERV-
ICE CORPS LOAN REPAYMENT PROGRAM AND CERTAIN 
STATE LOAN REPAYMENT PROGRAMS.—In the case of 
an individual, gross income shall not include any 
amount received under section 338B(g) of the Public 
Health Service Act, under a State program described 
in section 338I of such Act, or under any other State 
loan repayment or loan forgiveness program that is 
intended to provide for the increased availability of 
health care services in underserved or health profes-
sional shortage areas (as determined by such State).’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to amounts received by an individual 
in taxable years beginning after December 31, 2008. 
SEC. 10909. EXPANSION OF ADOPTION CREDIT AND ADOP-
TION ASSISTANCE PROGRAMS. 
(a) INCREASE IN DOLLAR LIMITATION.— 
(1) ADOPTION CREDIT.— 
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ing to $10,000 exclusion for adoption of child 
with special needs regardless of expenses) is 
amended— 
(i) in the text by striking ‘‘$10,000’’ 
and inserting ‘‘$13,170’’, and 
(ii) 
in 
the 
heading 
by 
striking 
‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(C) CONFORMING
AMENDMENT
TO
INFLA-
TION
ADJUSTMENT.—Subsection (f) of section 
137 of such Code (relating to adjustments for in-
flation) is amended to read as follows: 
‘‘(f) ADJUSTMENTS FOR INFLATION.— 
‘‘(1) DOLLAR
LIMITATIONS.—In the case of a 
taxable year beginning after December 31, 2010, each 
of the dollar amounts in subsections (a)(2) and (b)(1) 
shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
substituting ‘calendar year 2009’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10. 
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‘‘(2) INCOME LIMITATION.—In the case of a tax-
able year beginning after December 31, 2002, the dol-
lar amount in subsection (b)(2)(A) shall be increased 
by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
substituting ‘calendar year 2001’ for ‘calendar 
year 1992’ in subparagraph thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10.’’. 
(b) CREDIT MADE REFUNDABLE.— 
(1) CREDIT MOVED TO SUBPART RELATING TO 
REFUNDABLE CREDITS.—The Internal Revenue Code 
of 1986 is amended— 
(A) by redesignating section 23, as amended 
by subsection (a), as section 36C, and 
(B) by moving section 36C (as so redesig-
nated) from subpart A of part IV of subchapter 
A of chapter 1 to the location immediately before 
section 37 in subpart C of part IV of subchapter 
A of chapter 1. 
(2) CONFORMING AMENDMENTS.— 
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(A) Section 24(b)(3)(B) of such Code is 
amended by striking ‘‘23,’’. 
(B) Section 25(e)(1)(C) of such Code is 
amended by striking ‘‘23,’’ both places it ap-
pears. 
(C) Section 25A(i)(5)(B) of such Code is 
amended by striking ‘‘23, 25D,’’ and inserting 
‘‘25D’’. 
(D) Section 25B(g)(2) of such Code is 
amended by striking ‘‘23,’’. 
(E) Section 26(a)(1) of such Code is amend-
ed by striking ‘‘23,’’. 
(F) Section 30(c)(2)(B)(ii) of such Code is 
amended by striking ‘‘23, 25D,’’ and inserting 
‘‘25D’’. 
(G) Section 30B(g)(2)(B)(ii) of such Code is 
amended by striking ‘‘23,’’. 
(H) Section 30D(c)(2)(B)(ii) of such Code 
is amended by striking ‘‘sections 23 and’’ and 
inserting ‘‘section’’. 
(I) Section 36C of such Code, as so redesig-
nated, is amended— 
(i) by striking paragraph (4) of sub-
section (b), and 
(ii) by striking subsection (c). 
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(J) Section 137 of such Code is amended— 
(i) by striking ‘‘section 23(d)’’ in sub-
section (d) and inserting ‘‘section 36C(d)’’, 
and 
(ii) by striking ‘‘section 23’’ in sub-
section (e) and inserting ‘‘section 36C’’. 
(K) Section 904(i) of such Code is amended 
by striking ‘‘23,’’. 
(L) Section 1016(a)(26) is amended by 
striking ‘‘23(g)’’ and inserting ‘‘36C(g)’’. 
(M) Section 1400C(d) of such Code is 
amended by striking ‘‘23,’’. 
(N) Section 6211(b)(4)(A) of such Code is 
amended by inserting ‘‘36C,’’ before ‘‘53(e)’’. 
(O) The table of sections for subpart A of 
part IV of subchapter A of chapter 1 of such 
Code of 1986 is amended by striking the item re-
lating to section 23. 
(P) Paragraph (2) of section 1324(b) of title 
31, United States Code, as amended by this Act, 
is amended by inserting ‘‘36C,’’ after ‘‘36B,’’. 
(Q) The table of sections for subpart C of 
part IV of subchapter A of chapter 1 of the Inter-
nal Revenue Code of 1986, as amended by this 
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Act, is amended by inserting after the item relat-
ing to section 36B the following new item: 
‘‘Sec. 36C. Adoption expenses.’’. 
(c) APPLICATION AND EXTENSION OF EGTRRA SUN-
SET.—Notwithstanding section 901 of the Economic Growth 
and Tax Relief Reconciliation Act of 2001, such section 
shall apply to the amendments made by this section and 
the amendments made by section 202 of such Act by sub-
stituting ‘‘December 31, 2011’’ for ‘‘December 31, 2010’’ in 
subsection (a)(1) thereof. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2009. 
Amend the title so as to read: ‘‘An Act entitled The 
Patient Protection and Affordable Care Act.’’. 
Attest: 
Secretary. 
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111TH CONGRESS 
1ST SESSION 
H. R. 3590 
AMENDMENTS 
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