‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D shall, except as incon-
sistent with this section, apply to the program established 
in subsection (a) in the same manner and to the same 
extent as such provisions apply to the National Health 
Service Corps Scholarship Program established in such 
subpart. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) CRITICAL SHORTAGE HEALTH FACILITY.— 
The term ‘critical shortage health facility’ means a 
public or private nonprofit health facility that does 
not serve a health professional shortage area (as 
designated under section 332), but has a critical 
shortage of physicians (as determined by the Sec-
retary) in a primary care field. 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual who is enrolled, or 
accepted for enrollment, as a full-time student in an 
accredited school of medicine or school of osteo-
pathic medicine. 
‘‘SEC. 340J. LOAN REPAYMENT PROGRAM. 
‘‘(a) PURPOSE.—It is the purpose of this section to 
alleviate critical shortages of primary care physicians and 
primary care providers. 
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‘‘(b) LOAN REPAYMENTS.—The Secretary, acting 
through the Administrator of the Health Resources and 
Services Administration, shall establish a program of en-
tering into contracts with eligible individuals under 
which— 
‘‘(1) the individual agrees to serve— 
‘‘(A) as a primary care physician or pri-
mary care provider in a primary care field; and 
‘‘(B) in an area that is not a health profes-
sional shortage area (as designated under sec-
tion 332), but has a critical shortage of primary 
care physicians and primary care providers (as 
determined by the Secretary) in such field; and 
‘‘(2) the Secretary agrees to pay, for each year 
of such service, not more than $35,000 of the prin-
cipal and interest of the undergraduate or graduate 
educational loans of the individual. 
‘‘(c) SERVICE REQUIREMENT.—A contract entered 
into under this section shall allow the individual receiving 
the loan repayment to satisfy the service requirement de-
scribed in subsection (a)(1) through employment in a solo 
or group practice, a clinic, a public or private nonprofit 
hospital, or any other appropriate health care entity. 
‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D shall, except as incon-
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sistent with this section, apply to the program established 
in subsection (a) in the same manner and to the same 
extent as such provisions apply to the National Health 
Service Corps Scholarship Program established in such 
subpart. 
‘‘(e) DEFINITION.—In this section, the term ‘eligible 
individual’ means— 
‘‘(1) an individual with a degree in medicine or 
osteopathic medicine; or 
‘‘(2) a nurse practitioner. 
‘‘SEC. 340K. LOAN REPAYMENTS FOR PHYSICIANS IN THE 
FIELDS OF OBSTETRICS AND GYNECOLOGY 
AND CERTIFIED NURSE MIDWIVES. 
‘‘(a) PURPOSE.—It is the purpose of this section to 
alleviate critical shortages of physicians in the fields of 
obstetrics and gynecology and certified nurse midwives. 
‘‘(b) LOAN REPAYMENTS.—The Secretary, acting 
through the Administrator of the Health Resources and 
Services Administration, shall establish a program of en-
tering into contracts with eligible individuals under 
which— 
‘‘(1) the individual agrees to serve— 
‘‘(A) as a physician in the field of obstet-
rics and gynecology or as a certified nurse mid-
wife; and 
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‘‘(B) in an area that is not a health profes-
sional shortage area (as designated under sec-
tion 332), but has a critical shortage of physi-
cians in the fields of obstetrics and gynecology 
or certified nurse midwives (as determined by 
the Secretary), respectively; and 
‘‘(2) the Secretary agrees to pay, for each year 
of such service, not more than $35,000 of the prin-
cipal and interest of the undergraduate or graduate 
educational loans of the individual. 
‘‘(c) SERVICE REQUIREMENT.—A contract entered 
into under this section shall allow the individual receiving 
the loan repayment to satisfy the service requirement de-
scribed in subsection (a)(1) through employment in a solo 
or group practice, a clinic, a public or private nonprofit 
hospital, or any other appropriate health care entity. 
‘‘(d) APPLICATION OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D shall, except as incon-
sistent with this section, apply to the program established 
in subsection (a) in the same manner and to the same 
extent as such provisions apply to the National Health 
Service Corps Scholarship Program established in such 
subpart. 
‘‘(e) DEFINITION.—In this section, the term ‘eligible 
individual’ means— 
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‘‘(1) a physician in the field of obstetrics and 
gynecology; or 
‘‘(2) a certified nurse midwife. 
‘‘SEC. 340L. REPORTS. 
‘‘Not later than 18 months after the date of enact-
ment of this section, and annually thereafter, the Sec-
retary shall submit to Congress a report that describes 
the programs carried out under this subpart, including 
statements concerning— 
‘‘(1) the number of enrollees, scholarships, loan 
repayments, and grant recipients; 
‘‘(2) the number of graduates; 
‘‘(3) the amount of scholarship payments and 
loan repayments made; 
‘‘(4) which educational institution the recipients 
attended; 
‘‘(5) the number and placement location of the 
scholarship and loan repayment recipients at health 
care facilities with a critical shortage of primary 
care physicians; 
‘‘(6) the default rate and actions required; 
‘‘(7) the amount of outstanding default funds of 
both the scholarship and loan repayment programs; 
‘‘(8) to the extent that it can be determined, 
the reason for the default; 
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‘‘(9) the demographics of the individuals par-
ticipating in the scholarship and loan repayment 
programs; 
‘‘(10) the justification for the allocation of 
funds between the scholarship and loan repayment 
programs; and 
‘‘(11) an evaluation of the overall costs and 
benefits of the programs. 
‘‘SEC. 340M. AUTHORIZATION OF APPROPRIATIONS. 
‘‘To carry out sections 340I, 340J, and 340K there 
are authorized to be appropriated $55,000,000 for fiscal 
year 2010, $90,000,000 for fiscal year 2011, and 
$125,000,000 for fiscal year 2012, to be used solely for 
scholarships and loan repayment awards for primary care 
physicians and primary care providers.’’. 
SEC. 103. DEFERMENT OF LOANS DURING RESIDENCY AND 
INTERNSHIPS. 
(a) LOAN REQUIREMENTS.—Section 427(a)(2)(C)(i) 
of the Higher Education Act of 1965 (20 U.S.C. 
1077(a)(2)(C)(i)) is amended by inserting ‘‘unless the 
medical internship or residency program is in a primary 
care field (as defined in section 3(a)(5) of the Preserving 
Patient Access to Primary Care Act of 2009)’’ after ‘‘resi-
dency program’’. 
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(b) FFEL LOANS.—Section 428(b)(1)(M)(i) of the 
Higher 
Education 
Act 
of 
1965 
(20 
U.S.C. 
1078(b)(1)(M)(i)) is amended by inserting ‘‘unless the 
medical internship or residency program is in a primary 
care field (as defined in section 3(a)(5) of the Preserving 
Patient Access to Primary Care Act of 2009)’’ after ‘‘resi-
dency program’’. 
(c) FEDERAL DIRECT LOANS.—Section 455(f)(2)(A) 
of the Higher Education Act of 1965 (20 U.S.C. 
1087e(f)(2)(A)) is amended by inserting ‘‘unless the med-
ical internship or residency program is in a primary care 
field (as defined in section 3(a)(5) of the Preserving Pa-
tient Access to Primary Care Act of 2009)’’ after ‘‘resi-
dency program’’. 
(d) 
FEDERAL
PERKINS
LOANS.—Section 
464(c)(2)(A)(i) of the Higher Education Act of 1965 (20 
U.S.C. 1087dd(c)(2)(A)(i)) is amended by inserting ‘‘un-
less the medical internship or residency program is in a 
primary care field (as defined in section 3(a)(5) of the 
Preserving Patient Access to Primary Care Act of 2009)’’ 
after ‘‘residency program’’. 
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SEC. 104. EDUCATING MEDICAL STUDENTS ABOUT PRI-
MARY CARE CAREERS. 
Part C of title VII of the Public Health Service Act 
(42 U.S.C. 293k) is amended by adding at the end the 
following: 
‘‘SEC. 749. EDUCATING MEDICAL STUDENTS ABOUT PRI-
MARY CARE CAREERS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to eligible State and local government entities for 
the development of informational materials that promote 
careers in primary care by highlighting the advantages 
and rewards of primary care, and that encourage medical 
students, particularly students from disadvantaged back-
grounds, to become primary care physicians. 
‘‘(b) ANNOUNCEMENT.—The grants described in sub-
section (a) shall be announced through a publication in 
the Federal Register and through appropriate media out-
lets in a manner intended to reach medical education insti-
tutions, associations, physician groups, and others who 
communicate with medical students. 
‘‘(c) ELIGIBILITY.—To be eligible to receive a grant 
under this section an entity shall— 
‘‘(1) be a State or local entity; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
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‘‘(d) USE OF FUNDS.— 
‘‘(1) 
IN
GENERAL.—An 
entity 
shall 
use 
amounts received under a grant under this section to 
support State and local campaigns through appro-
priate media outlets to promote careers in primary 
care and to encourage individuals from disadvan-
taged backgrounds to enter and pursue careers in 
primary care. 
‘‘(2) SPECIFIC USES.—In carrying out activities 
under paragraph (1), an entity shall use grants 
funds to develop informational materials in a man-
ner intended to reach as wide and diverse an audi-
ence of medical students as possible, in order to— 
‘‘(A) advertise and promote careers in pri-
mary care; 
‘‘(B) promote primary care medical edu-
cation programs; 
‘‘(C) inform the public of financial assist-
ance regarding such education programs; 
‘‘(D) highlight individuals in the commu-
nity who are practicing primary care physicians; 
or 
‘‘(E) provide any other information to re-
cruit individuals for careers in primary care. 
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‘‘(e) LIMITATION.—An entity shall not use amounts 
received under a grant under this section to advertise par-
ticular employment opportunities. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2010 through 2013.’’. 
SEC. 105. TRAINING IN A FAMILY MEDICINE, GENERAL IN-
TERNAL MEDICINE, GENERAL GERIATRICS, 
GENERAL PEDIATRICS, PHYSICIAN ASSIST-
ANCE, GENERAL DENTISTRY, AND PEDIATRIC 
DENTISTRY. 
Section 747(e) of the Public Health Service Act (42 
U.S.C. 293k) is amended by striking paragraph (1) and 
inserting the following: 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
For the purpose of carrying out this section, there 
is authorized to be appropriated $198,000,000 for 
each of fiscal years 2010 through 2012.’’. 
SEC. 106. INCREASED FUNDING FOR NATIONAL HEALTH 
SERVICE CORPS SCHOLARSHIP AND LOAN 
REPAYMENT PROGRAMS. 
(a) IN GENERAL.—There is authorized to be appro-
priated $332,000,000 for the period of fiscal years 2010 
through 2012 for the purpose of carrying out subpart III 
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of part D of title III of the Public Health Service Act 
(42 U.S.C. 254l et seq.). Such authorization of appropria-
tions is in addition to the authorization of appropriations 
in section 338H of such Act (42 U.S.C. 254q) and any 
other authorization of appropriations for such purpose. 
(b) ALLOCATION.—Of the amounts appropriated 
under subsection (a) for the period of fiscal years 2010 
through 2012, the Secretary shall obligate $96,000,000 
for the purpose of providing contracts for scholarships and 
loan repayments to individuals who— 
(1) are primary care physicians or primary care 
providers; and 
(2) have not previously received a scholarship or 
loan repayment under subpart III of part D of title 
III of the Public Health Service Act (42 U.S.C. 254l 
et seq.). 
TITLE II—MEDICAID RELATED 
PROVISIONS 
SEC. 201. TRANSFORMATION GRANTS TO SUPPORT PA-
TIENT CENTERED MEDICAL HOMES UNDER 
MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 1903(z) of the Social Se-
curity Act (42 U.S.C. 1396b(z)) is amended— 
(1) in paragraph (2), by adding at the end the 
following new subparagraph: 
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2010, 2011, and 2012 shall be allocated among 
States that design programs to adopt the inno-
vative methods described in paragraph (2)(G), 
with preference given to States that design pro-
grams involving multipayers (including under 
title XVIII and private health plans) test 
projects for implementation of the elements nec-
essary to be recognized as a patient centered 
medical home practice under the National Com-
mittee for Quality Assurance Physicians Prac-
tice Connection—PCMH module (or any other 
equivalent process, as determined by the Sec-
retary).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2010. 
TITLE III—MEDICARE 
PROVISIONS 
Subtitle A—Primary Care 
SEC. 301. REFORMING PAYMENT SYSTEMS UNDER MEDI-
CARE TO SUPPORT PRIMARY CARE. 
(a) INCREASING
BUDGET
NEUTRALITY
LIMITS 
UNDER THE PHYSICIAN FEE SCHEDULE TO ACCOUNT 
FOR ANTICIPATED SAVINGS RESULTING FROM PAYMENTS 
FOR CERTAIN SERVICES
AND
THE COORDINATION
OF 
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BENEFICIARY CARE.—Section 1848(c)(2)(B) of the Social 
Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amended— 
(1) in clause (ii)(II), by striking ‘‘(iv) and (v)’’ 
and inserting ‘‘(iv), (v), and (vii)’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(vii) INCREASE
IN
LIMITATION
TO 
ACCOUNT FOR CERTAIN ANTICIPATED SAV-
INGS.— 
‘‘(I) IN GENERAL.—Effective for 
fee schedules established beginning 
with 2010, the Secretary shall in-
crease the limitation on annual ad-
justments under clause (ii)(II) by an 
amount equal to the anticipated sav-
ings under parts A, B, and D (includ-
ing any savings with respect to items 
and services for which payment is not 
made under this section) which are a 
result of payments for designated pri-
mary care services and comprehensive 
care coordination services under sec-
tion 1834(m) and the coverage of pa-
tient centered medical home services 
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under section 1861(s)(2)(FF) (as de-
termined by the Secretary). 
‘‘(II) MECHANISM
TO
DETER-
MINE
APPLICATION
OF
INCREASE.— 
The Secretary shall establish a mecha-
nism for determining which relative 
value units established under this 
paragraph for physicians’ services 
shall be subject to an adjustment 
under clause (ii)(I) as a result of the 
increase under subclause (I). 
‘‘(III) ADDITIONAL FUNDING AS 
DETERMINED
NECESSARY
BY
THE 
SECRETARY.—In 
addition 
to 
any 
funding that may be made available 
as a result of an increase in the limi-
tation on annual adjustments under 
subclause (I), there shall also be avail-
able to the Secretary, for purposes of 
making payments under this title for 
new services and capabilities to im-
prove care provided to individuals 
under this title and to generate effi-
ciencies under this title, such addi-
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tional funds as the Secretary deter-
mines are necessary.’’. 
(b) SEPARATE
MEDICARE
PAYMENT
FOR
DES-
IGNATED PRIMARY CARE SERVICES AND COMPREHENSIVE 
CARE COORDINATION SERVICES.— 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
‘‘(n) PAYMENT FOR DESIGNATED PRIMARY CARE 
SERVICES
AND COMPREHENSIVE CARE COORDINATION 
SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary shall pay for 
designated primary care services and comprehensive 
care coordination services furnished to an individual 
enrolled under this part. 
‘‘(2) PAYMENT AMOUNT.—The Secretary shall 
determine the amount of payment for designated 
primary care services and comprehensive care co-
ordination services under this subsection. 
‘‘(3) DOCUMENTATION
REQUIREMENTS.—The 
Secretary shall propose appropriate documentation 
requirements to justify payments for designated pri-
mary care services and comprehensive care coordina-
tion services under this subsection. 
‘‘(4) DEFINITIONS.— 
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‘‘(A) COMPREHENSIVE
CARE
COORDINA-
TION SERVICES.—The term ‘comprehensive care 
coordination services’ means care coordination 
services with procedure codes established by the 
Secretary (as appropriate) which are furnished 
to an individual enrolled under this part by a 
primary care provider or principal care physi-
cian. 
‘‘(B) DESIGNATED PRIMARY CARE SERV-
ICES.—The term ‘designated primary care serv-
ice’ means a service which the Secretary deter-
mines has a procedure code which involves a 
clinical interaction with an individual enrolled 
under this part that is inherent to care coordi-
nation, including interactions outside of a face- 
to-face encounter. Such term includes the fol-
lowing: 
‘‘(i) Care plan oversight. 
‘‘(ii) Evaluation and management pro-
vided by phone. 
‘‘(iii) Evaluation and management 
provided using internet resources. 
‘‘(iv) Collection and review of physio-
logic data, such as from a remote moni-
toring device. 
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‘‘(v) Education and training for pa-
tient self management. 
‘‘(vi) 
Anticoagulation 
management 
services. 
‘‘(vii) Any other service determined 
appropriate by the Secretary.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by this section shall apply to items and services fur-
nished on or after January 1, 2010. 
SEC. 302. COVERAGE OF PATIENT CENTERED MEDICAL 
HOME SERVICES. 
(a) IN GENERAL.—Section 1861(s)(2) of the Social 
Security Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (DD), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (EE), by inserting ‘‘and’’ 
at the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(FF) patient centered medical home services 
(as defined in subsection (hhh)(1));’’. 
(b) DEFINITION OF PATIENT CENTERED MEDICAL 
HOME SERVICES.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
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home. Such fee shall be paid on a prospective 
basis. 
‘‘(B) CONSIDERATIONS.—The Secretary 
shall take into account the results of the Medi-
care medical home demonstration project under 
section 204 of the Medicare Improvement and 
Extension Act of 2006 (42 U.S.C. 1395b–1 
note; division B of Public Law 109–432) in es-
tablishing the payment methodology under sub-
paragraph (A). 
‘‘(2) AMOUNT OF PAYMENT.— 
‘‘(A) CONSIDERATIONS.—In determining 
the amount of such fee, subject to paragraph 
(3), the Secretary shall consider the following: 
‘‘(i) The clinical work and practice ex-
penses involved in providing care coordina-
tion services consistent with the patient 
centered medical home model (such as pro-
viding increased access, care coordination, 
disease population management, and edu-
cation) for which payment is not made 
under this section as of the date of enact-
ment of this subsection. 
‘‘(ii) Ensuring that the amount of 
payment is sufficient to support the acqui-
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sition, use, and maintenance of clinical in-
formation systems which— 
‘‘(I) are needed by a qualified pa-
tient centered medical home; and 
‘‘(II) have been shown to facili-
tate improved outcomes through care 
coordination. 
‘‘(iii) The establishment of a tiered 
monthly care management fee that pro-
vides for a range of payment depending on 
how advanced the capabilities of a qualified 
patient centered medical home are in hav-
ing the information systems needed to sup-
port care coordination. 
‘‘(B) RISK-ADJUSTMENT.—The Secretary 
shall use appropriate risk-adjustment in deter-
mining the amount of the monthly fee under 
this paragraph. 
‘‘(3) FUNDING.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
determine the aggregate estimated savings for a 
calendar year as a result of the implementation 
of this subsection on reducing preventable hos-
pital admissions, duplicate testing, medication 
errors and drug interactions, and other savings 
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under this part and part A (including any sav-
ings with respect to items and services for 
which payment is not made under this section). 
‘‘(B) FUNDING.—Subject to subparagraph 
(C), the aggregate amount available for pay-
ment of the monthly fee under this subsection 
during a calendar year shall be equal to the ag-
gregate estimated savings (as determined under 
subparagraph (A)) for the calendar year (as de-
termined by the Secretary). 
‘‘(C) ADDITIONAL FUNDING.—In the case 
where the amount of the aggregate actual sav-
ings during the preceding 3 years exceeds the 
amount of the aggregate estimated savings (as 
determined under subparagraph (A)) during 
such period, the aggregate amount available for 
payment of the monthly fee under this sub-
section during the calendar year (as determined 
under subparagraph (B)) shall be increased by 
the amount of such excess. 
‘‘(D) ADDITIONAL
FUNDING
AS
DETER-
MINED
NECESSARY
BY
THE
SECRETARY.—In 
addition to any funding made available under 
subparagraphs (B) and (C), there shall also be 
available to the Secretary, for purposes of effec-
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tively implementing this subsection, such addi-
tional funds as the Secretary determines are 
necessary. 
‘‘(4) 
PERFORMANCE-BASED
BONUS
PAY-
MENTS.—The Secretary shall establish a process for 
paying a performance-based bonus to qualified pa-
tient centered medical homes which meet or achieve 
substantial improvements in performance (as speci-
fied under clinical, patient satisfaction, and effi-
ciency benchmarks established by the Secretary). 
Such bonus shall be in an amount determined appro-
priate by the Secretary. 
‘‘(5) NO EFFECT ON PAYMENTS FOR EVALUA-
TION AND MANAGEMENT SERVICES.—The monthly 
fee under this subsection shall have no effect on the 
amount of payment for evaluation and management 
services under this title.’’. 
(d) COINSURANCE.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and’’ before ‘‘(W)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (X) with respect to patient cen-
tered medical home services (as defined in section 
1861(hhh)(1)), the amount paid shall be (i) in the 
case of such services which are physicians’ services, 
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the amount determined under subparagraph (N), 
and (ii) in the case of all other such services, 80 per-
cent of the lesser of the actual charge for the service 
or the amount determined under a fee schedule es-
tablished by the Secretary for purposes of this sub-
paragraph’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2012. 
SEC. 303. MEDICARE PRIMARY CARE PAYMENT EQUITY AND 
ACCESS PROVISION. 
(a) IN GENERAL.—Section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4), as amended by section 
302(c), is amended by adding at the end the following new 
subsection: 
‘‘(q) PRIMARY CARE PAYMENT EQUITY
AND AC-
CESS.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2010, the Secretary shall develop a methodology, in 
consultation with primary care physician organiza-
tions and primary care provider organizations, the 
Medicare Payment Advisory Commission, and other 
experts, to increase payments under this section for 
designated evaluation and management services pro-
vided by primary care physicians, primary care pro-
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viders, and principal care providers through 1 or 
more of the following: 
‘‘(A) A service-specific modifier to the rel-
ative value units established for such services. 
‘‘(B) Service-specific bonus payments. 
‘‘(C) Any other methodology determined 
appropriate by the Secretary. 
‘‘(2) INCLUSION OF PROPOSED CRITERIA.—The 
methodology developed under paragraph (1) shall in-
clude proposed criteria for providers to qualify for 
such increased payments, including consideration 
of— 
‘‘(A) the type of service being rendered; 
‘‘(B) the specialty of the provider providing 
the service; and 
‘‘(C) demonstration by the provider of vol-
untary participation in programs to improve 
quality, such as participation in the Physician 
Quality Reporting Initiative (as determined by 
the Secretary) or practice-level qualification as 
a patient centered medical home. 
‘‘(3) FUNDING.— 
‘‘(A) 
DETERMINATION.—The 
Secretary 
shall determine the aggregate estimated savings 
for a calendar year as a result of such increased 
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payments on reducing preventable hospital ad-
missions, duplicate testing, medication errors 
and drug interactions, Intensive Care Unit ad-
missions, per capita health care expenditures, 
and other savings under this part and part A 
(including any savings with respect to items 
and services for which payment is not made 
under this section). 
‘‘(B) FUNDING.—The aggregate amount 
available for such increased payments during a 
calendar year shall be equal to the aggregate 
estimated savings (as determined under sub-
paragraph (A)) for the calendar year (as deter-
mined by the Secretary). 
‘‘(C) ADDITIONAL
FUNDING
AS
DETER-
MINED
NECESSARY
BY
THE
SECRETARY.—In 
addition to any funding made available under 
subparagraph (B), there shall also be available 
to the Secretary, for purposes of effectively im-
plementing this subsection, such additional 
funds as the Secretary determines are nec-
essary.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to services furnished on or after 
January 1, 2010. 
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SEC. 304. ADDITIONAL INCENTIVE PAYMENT PROGRAM 
FOR PRIMARY CARE SERVICES FURNISHED 
IN 
HEALTH 
PROFESSIONAL 
SHORTAGE 
AREAS. 
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by adding at the 
end the following new subsection: 
‘‘(x) ADDITIONAL INCENTIVE PAYMENTS FOR PRI-
MARY CARE SERVICES FURNISHED IN HEALTH PROFES-
SIONAL SHORTAGE AREAS.— 
‘‘(1) IN GENERAL.—In the case of primary care 
services furnished on or after January 1, 2010, by 
a primary care physician or primary care provider in 
an 
area 
that 
is 
designated 
(under 
section 
332(a)(1)(A) of the Public Health Service Act) as a 
health professional shortage area as identified by the 
Secretary prior to the beginning of the year involved, 
in addition to the amount of payment that would 
otherwise be made for such services under this part, 
there also shall be paid (on a monthly or quarterly 
basis) an amount equal to 10 percent of the pay-
ment amount for the service under this part. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) PRIMARY CARE PHYSICIAN; PRIMARY 
CARE
PROVIDER.—The terms ‘primary care 
physician’ and ‘primary care provider’ have the 
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meaning given such terms in paragraphs (6) 
and (7), respectively, of section 3(a) of the Pre-
serving Patient Access to Primary Care Act of 
2009. 
‘‘(B) PRIMARY CARE SERVICES.—The term 
‘primary care services’ means procedure codes 
for services in the category of the Healthcare 
Common Procedure Coding System, as estab-
lished 
by 
the 
Secretary 
under 
section 
1848(c)(5) (as of December 31, 2008, and as 
subsequently modified by the Secretary) con-
sisting of evaluation and management services, 
but limited to such procedure codes in the cat-
egory of office or other outpatient services, and 
consisting of subcategories of such procedure 
codes for services for both new and established 
patients. 
‘‘(3) JUDICIAL REVIEW.—There shall be no ad-
ministrative or judicial review under section 1869, 
1878, or otherwise, respecting the identification of 
primary care physicians, primary care providers, or 
primary care services under this subsection.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1834(g)(2)(B) of the Social Security Act (42 U.S.C. 
1395m(g)(2)(B)) is amended by adding at the end the fol-
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lowing sentence: ‘‘Section 1833(x) shall not be taken into 
account in determining the amounts that would otherwise 
be paid pursuant to the preceding sentence.’’. 
SEC. 305. PERMANENT EXTENSION OF FLOOR ON MEDI-
CARE 
WORK 
GEOGRAPHIC 
ADJUSTMENT 
UNDER 
THE 
MEDICARE 
PHYSICIAN 
FEE 
SCHEDULE. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘and 
before January 1, 2010,’’. 
SEC. 306. PERMANENT EXTENSION OF MEDICARE INCEN-
TIVE PAYMENT PROGRAM FOR PHYSICIAN 
SCARCITY AREAS. 
Section 1833(u) of the Social Security Act (42 U.S.C. 
1395l(u)) is amended— 
(1) in paragraph (1)— 
(A) by inserting ‘‘or on or after July 1, 
2009’’ after ‘‘before July 1, 2008’’; and 
(B) by inserting ‘‘(or, in the case of serv-
ices furnished on or after July 1, 2009, 10 per-
cent)’’ after ‘‘5 percent’’; and 
(2) in paragraph (4)(D), by striking ‘‘before 
July 1, 2008’’ and inserting ‘‘before January 1, 
2010’’. 
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SEC. 307. HHS STUDY AND REPORT ON THE PROCESS FOR 
DETERMINING RELATIVE VALUE UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE. 
(a) STUDY.—The Secretary shall conduct a study on 
the process used by the Secretary for determining relative 
value under the Medicare physician fee schedule under 
section 1848(c) of the Social Security Act (42 U.S.C. 
1395w–4(c)). Such study shall include an analysis of the 
following: 
(1)(A) Whether the existing process includes 
equitable representation of primary care physicians 
(as defined in section 3(a)(6)); and 
(B) any changes that may be necessary to en-
sure such equitable representation. 
(2)(A) Whether the existing process provides 
the Secretary with expert and impartial input from 
physicians in medical specialties that provide pri-
mary care to patients with multiple chronic diseases, 
the fastest growing part of the Medicare population; 
and 
(B) any changes that may be necessary to en-
sure such input. 
(3)(A) Whether the existing process includes 
equitable representation of physician medical special-
ties in proportion to their relative contributions to-
ward caring for Medicare beneficiaries, as deter-
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mined by the percentage of Medicare billings per 
specialty, percentage of Medicare encounters by spe-
cialty, or such other measures of relative contribu-
tions to patient care as determined by the Secretary; 
and 
(B) any changes that may be necessary to re-
flect such equitable representation. 
(4)(A) Whether the existing process, including 
the application of budget neutrality rules, unfairly 
disadvantages primary care physicians, primary care 
providers, or other physicians who principally pro-
vide evaluation and management services; and 
(B) any changes that may be necessary to 
eliminate such disadvantages. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
Subtitle B—Preventive Services 
SEC. 311. ELIMINATING TIME RESTRICTION FOR INITIAL 
PREVENTIVE PHYSICAL EXAMINATION. 
(a) IN GENERAL.—Section 1862(a)(1)(K) of the So-
cial Security Act (42 U.S.C. 1395y(a)(1)(K)) is amended 
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by striking ‘‘more than’’ and all that follows before the 
comma at the end and inserting ‘‘more than one time dur-
ing the lifetime of the individual’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2010. 
SEC. 312. ELIMINATION OF COST-SHARING FOR PREVEN-
TIVE BENEFITS UNDER THE MEDICARE PRO-
GRAM. 
(a) DEFINITION OF PREVENTIVE SERVICES.—Sec-
tion 1861(ddd) of the Social Security Act (42 U.S.C. 
1395w(dd)) is amended— 
(1) in the heading, by inserting ‘‘; Preventive 
Services’’ after ‘‘Services’’; 
(2) in paragraph (1), by striking ‘‘not otherwise 
described in this title’’ and inserting ‘‘not described 
in subparagraphs (A) through (N) of paragraph 
(3)’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(3) The term ‘preventive services’ means the fol-
lowing: 
‘‘(A) Prostate cancer screening tests (as defined 
in subsection (oo)). 
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‘‘(B) Colorectal cancer screening tests (as de-
fined in subsection (pp)). 
‘‘(C) 
Diabetes 
outpatient 
self-management 
training services (as defined in subsection (qq)). 
‘‘(D) Screening for glaucoma for certain indi-
viduals (as described in subsection (s)(2)(U)). 
‘‘(E) Medical nutrition therapy services for cer-
tain 
individuals 
(as 
described 
in 
subsection 
(s)(2)(V)). 
‘‘(F) An initial preventive physical examination 
(as defined in subsection (ww)). 
‘‘(G) Cardiovascular screening blood tests (as 
defined in subsection (xx)(1)). 
‘‘(H) Diabetes screening tests (as defined in 
subsection (yy)). 
‘‘(I) Ultrasound screening for abdominal aortic 
aneurysm for certain individuals (as described in 
subsection (s)(2)(AA)). 
‘‘(J) Pneumococcal and influenza vaccine and 
their administration (as described in subsection 
(s)(10)(A)). 
‘‘(K) Hepatitis B vaccine and its administration 
for certain individuals (as described in subsection 
(s)(10)(B)). 
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‘‘(L) Screening mammography (as defined in 
subsection (jj)). 
‘‘(M) Screening pap smear and screening pelvic 
exam (as described in subsection (s)(14)). 
‘‘(N) Bone mass measurement (as defined in 
subsection (rr)). 
‘‘(O) Additional preventive services (as deter-
mined under paragraph (1)).’’. 
(b) COINSURANCE.— 
(1) GENERAL APPLICATION.— 
(A) IN GENERAL.—Section 1833(a)(1) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395l(a)(1)), as amended by section 302, is 
amended— 
(i) in subparagraph (T), by striking 
‘‘80 percent’’ and inserting ‘‘100 percent’’; 
(ii) in subparagraph (W), by striking 
‘‘80 percent’’ and inserting ‘‘100 percent’’; 
(iii) by striking ‘‘and’’ before ‘‘(X)’’; 
and 
(iv) by inserting before the semicolon 
at the end the following: ‘‘, and (Y) with 
respect to preventive services described in 
subparagraphs (A) through (O) of section 
1861(ddd)(3), the amount paid shall be 
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100 percent of the lesser of the actual 
charge for the services or the amount de-
termined under the fee schedule that ap-
plies to such services under this part’’. 
(2) 
ELIMINATION
OF
COINSURANCE
FOR 
SCREENING
SIGMOIDOSCOPIES
AND 
COLONOSCOPIES.—Section 1834(d) of the Social Se-
curity Act (42 U.S.C. 1395m(d)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by inserting 
‘‘, except that payment for such tests 
under such section shall be 100 percent of 
the payment determined under such sec-
tion for such tests’’ before the period at 
the end; and 
(ii) in subparagraph (C)— 
(I) by striking clause (ii); and 
(II) in clause (i)— 
(aa) by striking ‘‘(i) IN GEN-
ERAL.—Notwithstanding’’ 
and 
inserting ‘‘Notwithstanding’’; 
(bb) by redesignating sub-
clauses (I) and (II) as clauses (i) 
and (ii), respectively, and moving 
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such clauses 2 ems to the left; 
and 
(cc) in the flush matter fol-
lowing clause (ii), as so redesig-
nated, by inserting ‘‘100 percent 
of’’ after ‘‘based on’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (A), by inserting 
‘‘, except that payment for such tests 
under such section shall be 100 percent of 
the payment determined under such sec-
tion for such tests’’ before the period at 
the end; and 
(ii) in subparagraph (C)— 
(I) by striking clause (ii); and 
(II) in clause (i)— 
(aa) by striking ‘‘(i) IN GEN-
ERAL.—Notwithstanding’’ 
and 
inserting ‘‘Notwithstanding’’; and 
(bb) by inserting ‘‘100 per-
cent of’’ after ‘‘based on’’. 
(3) ELIMINATION
OF
COINSURANCE
IN
OUT-
PATIENT HOSPITAL SETTINGS.— 
(A) EXCLUSION FROM OPD FEE SCHED-
ULE.—Section 1833(t)(1)(B)(iv) of the Social 
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Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 
amended by striking ‘‘and diagnostic mammog-
raphy’’ and inserting ‘‘, diagnostic mammog-
raphy, and preventive services (as defined in 
section 1861(ddd)(3))’’. 
(B) CONFORMING AMENDMENTS.—Section 
1833(a)(2) of the Social Security Act (42 
U.S.C. 1395l(a)(2)) is amended— 
(i) in subparagraph (F), by striking 
‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (G)(ii), by adding 
‘‘and’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(H) with respect to preventive services (as 
defined in section 1861(ddd)(3)) furnished by 
an outpatient department of a hospital, the 
amount determined under paragraph (1)(W) or 
(1)(X), as applicable;’’. 
(c) WAIVER OF APPLICATION OF DEDUCTIBLE.—The 
first sentence of section 1833(b) of the Social Security Act 
(42 U.S.C. 1395l(b)) is amended— 
(1) in clause (1), by striking ‘‘items and serv-
ices described in section 1861(s)(10)(A)’’ and insert-
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ing ‘‘preventive services (as defined in section 
1861(ddd)(3))’’; 
(2) by inserting ‘‘and’’ before ‘‘(4)’’; and 
(3) by striking ‘‘, (5)’’ and all that follows up 
to the period at the end. 
SEC. 313. HHS STUDY AND REPORT ON FACILITATING THE 
RECEIPT OF MEDICARE PREVENTIVE SERV-
ICES BY MEDICARE BENEFICIARIES. 
(a) STUDY.—The Secretary, in consultation with pro-
vider organizations and other appropriate stakeholders, 
shall conduct a study on— 
(1) ways to assist primary care physicians and 
primary care providers (as defined in section 3(a)) 
in— 
(A) furnishing appropriate preventive serv-
ices (as defined in section 1861(ddd)(3) of the 
Social Security Act, as added by section 312) to 
individuals enrolled under part B of title XVIII 
of such Act; and 
(B) referring such individuals for other 
items and services furnished by other physicians 
and health care providers; and 
(2) the advisability and feasability of making 
additional payments under the Medicare program to 
physicians and primary care providers for— 
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(A) the work involved in ensuring that 
such individuals receive appropriate preventive 
services furnished by other physicians and 
health care providers; and 
(B) incorporating the resulting clinical in-
formation into the treatment plan for the indi-
vidual. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
Subtitle C—Other Provisions 
SEC. 321. HHS STUDY AND REPORT ON IMPROVING THE 
ABILITY OF PHYSICIANS AND PRIMARY CARE 
PROVIDERS TO ASSIST MEDICARE BENE-
FICIARIES IN OBTAINING NEEDED PRESCRIP-
TIONS UNDER MEDICARE PART D. 
(a) STUDY.—The Secretary, in consultation with phy-
sician organizations and other appropriate stakeholders, 
shall conduct a study on the development and implementa-
tion of mechanisms to facilitate increased efficiency relat-
ing to the role of physicians and primary care providers 
in Medicare beneficiaries obtaining needed prescription 
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drugs under the Medicare prescription drug program 
under part D of title XVIII of the Social Security Act. 
Such study shall include an analysis of ways to— 
(1) improve the accessibility of formulary infor-
mation; 
(2) streamline the prior authorization, excep-
tion, and appeals processes, through, at a minimum, 
standardizing formats and allowing electronic ex-
change of information; and 
(3) recognize the work of the physician and pri-
mary care provider involved in the prescribing proc-
ess, especially work that may extend beyond the 
amount considered to be bundled into payment for 
evaluation and management services. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
SEC. 322. HHS STUDY AND REPORT ON IMPROVED PATIENT 
CARE THROUGH INCREASED CAREGIVER AND 
PHYSICIAN INTERACTION. 
(a) STUDY.—The Secretary, in consultation with ap-
propriate stakeholders, shall conduct a study on the devel-
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opment and implementation of mechanisms to promote 
and increase interaction between physicians or primary 
care providers and the families of Medicare beneficiaries, 
as well as other caregivers who support such beneficiaries, 
for the purpose of improving patient care under the Medi-
care program. Such study shall include an analysis of— 
(1) ways to recognize the work of physicians 
and primary care providers involved in discussing 
clinical issues with caregivers that relate to the care 
of the beneficiary; and 
(2) regulations under the Medicare program 
that are barriers to interactions between caregivers 
and physicians or primary care providers and how 
such regulations should be revised to eliminate such 
barriers. 
(b) REPORT.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall submit 
to Congress a report containing the results of the study 
conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
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SEC. 323. IMPROVED PATIENT CARE THROUGH EXPANDED 
SUPPORT 
FOR 
LIMITED 
ENGLISH 
PRO-
FICIENCY (LEP) SERVICES. 
(a) ADDITIONAL PAYMENTS
FOR PRIMARY CARE 
PHYSICIANS AND PRIMARY CARE PROVIDERS.—Section 
1833 of the Social Security Act (42 U.S.C. 1395l), as 
amended by section 304, is amended by adding at the end 
the following new subsection: 
‘‘(y) ADDITIONAL PAYMENTS FOR PROVIDING SERV-
ICES
TO INDIVIDUALS WITH LIMITED ENGLISH PRO-
FICIENCY.— 
‘‘(1) IN GENERAL.—In the case of primary care 
physicians and primary care providers’ services fur-
nished on or after January 1, 2010, to an individual 
with limited English proficiency by a provider, in ad-
dition to the amount of payment that would other-
wise be made for such services under this part, there 
shall also be paid an appropriate amount (as deter-
mined by the Secretary) in order to recognize the 
additional time involved in furnishing the service to 
such individual. 
‘‘(2) JUDICIAL REVIEW.—There shall be no ad-
ministrative or judicial review under section 1869, 
1878, or otherwise, respecting the determination of 
the amount of additional payment under this sub-
section.’’. 
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