252 
utable to hospital characteristics, including bed 
size. 
(B) Subject to paragraph (3), make an ad-
ditional payment to a hospital by an amount 
that is estimated based on the amount of un-
compensated care provided by the hospital 
based on criteria for uncompensated care as de-
termined by the Secretary, which shall exclude 
bad debt. 
(2) SIGNIFICANT DECREASE IN NATIONAL RATE 
OF UNINSURANCE AS A RESULT OF THIS ACT.—For 
purposes of this subsection— 
(A) IN GENERAL.—There is a ‘‘significant 
decrease in the national rate of uninsurance as 
a result of this Act’’ if there is a decrease in 
the national rate of uninsurance (as defined in 
subparagraph (B)) from 2010 to 2012 that ex-
ceeds 8 percentage points. 
(B) NATIONAL
RATE
OF
UNINSURANCE 
DEFINED.—The 
term 
‘‘national 
rate 
of 
uninsurance’’ means, for a year, such rate for 
the under-65 population for the year as deter-
mined and published by the Bureau of the Cen-
sus in its Current Population Survey in or 
about September of the succeeding year. 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00252
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
253 
(3) UNCOMPENSATED CARE INCREASE.— 
(A) COMPUTATION OF DSH SAVINGS.—For 
each fiscal year (beginning with fiscal year 
2015), the Secretary shall estimate the aggre-
gate reduction in Medicare DSH that will result 
from the adjustment under paragraph (1)(A). 
(B) 
STRUCTURE
OF
PAYMENT
IN-
CREASE.—The Secretary shall compute the in-
crease in Medicare DSH under paragraph 
(1)(B) for a fiscal year in accordance with a 
formula established by the Secretary that pro-
vides that— 
(i) the aggregate amount of such in-
crease for the fiscal year does not exceed 
50 percent of the aggregate reduction in 
Medicare DSH estimated by the Secretary 
for such fiscal year; and 
(ii) hospitals with higher levels of un-
compensated care receive a greater in-
crease. 
(c) MEDICARE DSH.—In this section, the term 
‘‘Medicare DSH’’ means adjustments in payments under 
section 1886(d)(5)(F) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services 
furnished by disproportionate share hospitals. 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00253
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
254 
SEC. 1222. REDUCTION IN MEDICAID DSH. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2014, the Secretary of Health and Human Services 
(in this title referred to as the ‘‘Secretary’’) shall 
submit to Congress a report concerning the extent to 
which, based upon the impact of the health care re-
forms carried out under this Act in reducing the 
number of uninsured individuals, there is a contin-
ued role for Medicaid DSH. In preparing the report, 
the Secretary shall consult with community-based 
health care networks serving low-income bene-
ficiaries. 
(2) MATTERS TO BE INCLUDED.—The report 
shall include the following: 
(A) 
RECOMMENDATIONS.—Recommenda-
tions regarding— 
(i) the appropriate targeting of Med-
icaid DSH within States; and 
(ii) the distribution of Medicaid DSH 
among the States. 
(B) SPECIFICATION OF DSH HEALTH RE-
FORM METHODOLOGY.—The DSH Health Re-
form methodology described in paragraph (2) of 
subsection (b) for purposes of implementing the 
requirements of such subsection. 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00254
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
255 
(3) COORDINATION WITH MEDICARE DSH RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicare 
DSH under section 1221. 
(4) MEDICAID DSH.—In this section, the term 
‘‘Medicaid DSH’’ means adjustments in payments 
under section 1923 of the Social Security Act for in-
patient hospital services furnished by dispropor-
tionate share hospitals. 
(b) MEDICAID DSH REDUCTIONS.— 
(1) IN GENERAL.—If there is a significant de-
crease in the national rate of uninsurance as a result 
of 
this 
Act 
(as 
determined 
under 
section 
1221(a)(2)(A)), then the Secretary of Health and 
Human Services shall reduce Medicaid DSH so as to 
reduce total Federal payments to all States for such 
purpose by $1,500,000,000 in fiscal year 2015, 
$2,500,000,000 
in 
fiscal 
year 
2016, 
and 
$6,000,000,000 in fiscal year 2017. 
(2) DSH HEALTH REFORM METHODOLOGY.— 
The Secretary shall carry out paragraph (1) through 
use of a DSH Health Reform methodology issued by 
the Secretary that imposes the largest percentage re-
ductions on the States that— 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00255
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
256 
(A) have the lowest percentages of unin-
sured individuals (determined on the basis of 
audited hospital cost reports) during the most 
recent year for which such data are available; 
or 
(B) do not target their DSH payments 
on— 
(i) hospitals with high volumes of 
Medicaid inpatients (as defined in section 
1923(b)(1)(A) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(1)(A)); and 
(ii) hospitals that have high levels of 
uncompensated care (excluding bad debt). 
(3) DSH ALLOTMENT PUBLICATIONS.— 
(A) IN GENERAL.—Not later than the pub-
lication deadline specified in subparagraph (B), 
the Secretary shall publish in the Federal Reg-
ister a notice specifying the DSH allotment to 
each State under 1923(f) of the Social Security 
Act for the respective fiscal year specified in 
such subparagraph, consistent with the applica-
tion of the DSH Health Reform methodology 
described in paragraph (2). 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00256
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
257 
(B) PUBLICATION DEADLINE.—The publi-
cation deadline specified in this subparagraph 
is— 
(i) January 1, 2014, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2015; 
(ii) January 1, 2015, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2016; and 
(iii) January 1, 2016, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2017. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4(f)) is amended— 
(A) by redesignating paragraph (7) as 
paragraph (8); and 
(B) by inserting after paragraph (6) the 
following new paragraph: 
‘‘(7) SPECIAL RULE FOR FISCAL YEARS 2015, 
2016, AND 2017.—Notwithstanding paragraph (2), if 
the Secretary makes a reduction under section 
1222(b)(1) of the Siding with America’s Patients 
Act, the total DSH allotments for all States for— 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00257
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
259 
‘‘(4) No hospital may be defined or deemed as 
a disproportionate share hospital, or as an essential 
access 
hospital 
(for 
purposes 
of 
subsection 
(f)(6)(A)(iv), under a State plan under this title or 
subsection (b) of this section (including any waiver 
under section 1115) unless the hospital— 
‘‘(A) provides services to beneficiaries 
under this title without discrimination on the 
ground of race, color, national origin, creed, 
source of payment, status as a beneficiary 
under this title, or any other ground unrelated 
to such beneficiary’s need for the services or the 
availability of the needed services in the hos-
pital; and 
‘‘(B) makes arrangements for, and accepts, 
reimbursement under this title for services pro-
vided to eligible beneficiaries under this title.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall be apply to expenditures 
made on or after July 1, 2010. 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00259
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
260 
Subtitle D—Fraud, Waste, and 
Abuse 
SEC. 1231. PROVIDE ADEQUATE FUNDING TO HHS OIG AND 
HCFAC. 
(a) HCFAC FUNDING.—Section 1817(k)(3)(A) of 
the Social Security Act (42 U.S.C. 1395i(k)(3)(A)) is 
amended— 
(1) in clause (i)— 
(A) in subclause (IV), by striking ‘‘2009, 
and 2010’’ and inserting ‘‘and 2009’’; and 
(B) by amending subclause (V) to read as 
follows: 
‘‘(V) for each fiscal year after fis-
cal year 2009, $300,000,000.’’; and 
(2) in clause (ii)— 
(A) in subclause (IX), by striking ‘‘2009, 
and 2010’’ and inserting ‘‘and 2009’’; and 
(B) in subclause (X), by striking ‘‘2010’’ 
and inserting ‘‘2009’’ and by inserting before 
the period at the end the following: ‘‘, plus the 
amount by which the amount made available 
under clause (i)(V) for fiscal year 2010 exceeds 
the amount made available under clause (i)(IV) 
for 2009’’. 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00260
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
261 
(b) OIG FUNDING.—There are authorized to be ap-
propriated for each of fiscal years 2010 through 2019 
$100,000,000 for the Office of the Inspector General of 
the Department of Health and Human Services for fraud 
prevention activities under the Medicare and Medicaid 
programs. 
SEC. 1232. IMPROVED ENFORCEMENT OF THE MEDICARE 
SECONDARY PAYOR PROVISIONS. 
(a) IN GENERAL.—The Secretary, in coordination 
with the Inspector General of the Department of Health 
and Human Services, shall provide through the Coordina-
tion of Benefits Contractor for the identification of in-
stances where the Medicare program should be, but is not, 
acting as a secondary payer to an individual’s private 
health benefits coverage under section 1862(b) of the So-
cial Security Act (42 U.S.C. 1395y(b)). 
(b) UPDATING PROCEDURES.—The Secretary shall 
update procedures for identifying and resolving credit bal-
ance situations which occur under the Medicare program 
when payment under such title and from other health ben-
efit plans exceed the providers’ charges or the allowed 
amount. 
(c) REPORT
ON IMPROVED ENFORCEMENT.—Not 
later than 1 year after the date of the enactment of this 
Act, the Secretary shall submit a report to Congress on 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00261
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
262 
progress made in improved enforcement of the Medicare 
secondary payor provisions, including recoupment of credit 
balances. 
SEC. 1233. STRENGTHEN MEDICARE PROVIDER ENROLL-
MENT STANDARDS AND SAFEGUARDS. 
(a) STRENGTHENING MEDICARE PROVIDER NUM-
BERS.— 
(1) SCREENING NEW PROVIDERS.—As a condi-
tion of a provider of services or a supplier, including 
durable medical equipment suppliers and home 
health agencies, applying for the first time for a pro-
vider number under the Medicare program and be-
fore granting billing privileges under such title, the 
Secretary shall screen the provider or supplier for a 
criminal background or other financial or oper-
ational irregularities through fingerprinting, licen-
sure checks, site-visits, other database checks. 
(2) APPLICATION FEES.—The Secretary shall 
impose an application charge on such a provider or 
supplier in order to cover the Secretary’s costs in 
performing the screening required under paragraph 
(1). 
(3) PROVISIONAL APPROVAL.—During an ini-
tial, provisional period (specified by the Secretary) 
In which such a provider or supplier has been issued 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00262
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
263 
such a number, the Secretary shall provide enhanced 
oversight of the activities of such provider or sup-
plier under the Medicare program, such as through 
prepayment review and payment limitations. 
(4) PENALTIES FOR FALSE STATEMENTS.—In 
the case of a provider or supplier that knowingly 
makes a false statement in an application for such 
a number, the Secretary may exclude the provider or 
supplier from participation under the Medicare pro-
gram, or may impose a civil money penalty (in the 
amount described in section 1128A(a)(4) of the So-
cial Security Act) , in the same manner as the Sec-
retary may impose such an exclusion or penalty 
under sections 1128 and 1128A, respectively, of 
such Act in the case of knowing presentation of a 
false claim described in section 1128A(a)(1)(A) of 
such Act. 
(5) DISCLOSURE
REQUIREMENTS.—With re-
spect to approval of such an application, the Sec-
retary— 
(A) shall require applicants to disclose pre-
vious affiliation with enrolled entities that have 
uncollected debt related to the Medicare or 
Medicaid programs; 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00263
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
264 
(B) may deny approval if the Secretary de-
termines that these affiliations pose undue risk 
to the Medicare or Medicaid program, subject 
to an appeals process for the applicant as deter-
mined by the Secretary; and 
(C) may implement enhanced safeguards 
(such as surety bonds). 
(b) MORATORIA.—The Secretary may impose mora-
toria on approval of provider and supplier numbers under 
the Medicare program for new providers of services and 
suppliers as determined necessary to prevent or combat 
fraud a period of delay for any one applicant cannot ex-
ceed 30 days unless cause is shown by the Secretary. 
(c) FUNDING.—There are authorized to be appro-
priated to carry out this section such sums as may be nec-
essary. 
SEC. 1234. TRACKING BANNED PROVIDERS ACROSS STATE 
LINES. 
(a) GREATER COORDINATION.—The Secretary shall 
provide for increased coordination between the Adminis-
trator of the Centers for Medicare & Medicaid Services 
(in this section referred to as ‘‘CMS’’) and its regional 
offices to ensure that providers of services and suppliers 
that have operated in one State and are excluded from 
participation in the Medicare program are unable to begin 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00264
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
265 
operation and participation in the Medicare program in 
another State. 
(b) IMPROVED INFORMATION SYSTEMS.— 
(1) IN GENERAL.—The Secretary shall improve 
information systems to allow greater integration be-
tween databases under the Medicare program so 
that— 
(A) medicare administrative contractors, 
fiscal intermediaries, and carriers have imme-
diate access to information identifying providers 
and suppliers excluded from participation in the 
Medicare and Medicaid program and other Fed-
eral health care programs; and 
(B) such information can be shared across 
Federal health care programs and agencies, in-
cluding between the Departments of Health and 
Human Services, the Social Security Adminis-
tration, the Department of Veterans Affairs, 
the Department of Defense, the Department of 
Justice, and the Office of Personnel Manage-
ment. 
(c) MEDICARE/MEDICAID ‘‘ONE PI’’ DATABASE.— 
The Secretary shall implement a database that includes 
claims and payment data for all components of the Medi-
care program and the Medicaid program. 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00265
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
266 
(d) AUTHORIZING EXPANDED DATA MATCHING.— 
Notwithstanding any provision of the Computer Matching 
and Privacy Protection Act of 1988 to the contrary— 
(1) the Secretary and the Inspector General in 
the Department of Health and Human Services may 
perform data matching of data from the Medicare 
program with data from the Medicaid program; and 
(2) the Commissioner of Social Security and the 
Secretary may perform data matching of data of the 
Social Security Administration with data from the 
Medicare and Medicaid programs. 
(e) CONSOLIDATION
OF DATA BASES.—The Sec-
retary shall consolidate and expand into a centralized data 
base for individuals and entities that have been excluded 
from Federal health care programs the Healthcare Integ-
rity and Protection Data Bank, the National Practitioner 
Data Bank, the List of Excluded Individuals/Entities, and 
a national patient abuse/neglect registry. 
(f) COMPREHENSIVE PROVIDER DATABASE.— 
(1) ESTABLISHMENT.—The Secretary shall es-
tablish a comprehensive database that includes infor-
mation on providers of services, suppliers, and re-
lated entities participating in the Medicare program, 
the Medicaid program, or both. Such database shall 
include, information on ownership and business rela-
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00266
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
267 
tionships, history of adverse actions, results of site 
visits or other monitoring by any program. 
(2) USE.—Prior to issuing a provider or sup-
plier number for an entity under the Medicare pro-
gram, the Secretary shall obtain information on the 
entity from such database to assure the entity quali-
fies for the issuance of such a number. 
(g) COMPREHENSIVE SANCTIONS DATABASE.—The 
Secretary shall establish a comprehensive sanctions data-
base on sanctions imposed on providers of services, sup-
pliers, and related entities. Such database shall be over-
seen by the Inspector General of the Department of 
Health and Human Services and shall be linked to related 
databases maintained by State licensure boards and by 
Federal or State law enforcement agencies. 
(h) ACCESS
TO
CLAIMS
AND
PAYMENT
DATA-
BASES.—The Secretary shall ensure that the Inspector 
General of the Department of Health and Human Services 
and Federal law enforcement agencies have direct access 
to all claims and payment databases of the Secretary 
under the Medicare or Medicaid programs. 
(i) CIVIL MONEY PENALTIES FOR SUBMISSION OF 
ERRONEOUS INFORMATION.—In the case of a provider of 
services, supplier, or other entity that knowingly submits 
erroneous information that serves as a basis for payment 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00267
Fmt 6652
Sfmt 6201
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS
268 
of any entity under the Medicare or Medicaid program, 
the Secretary may impose a civil money penalty of not to 
exceed $50,000 for each such erroneous submission. A 
civil money penalty under this subsection shall be imposed 
and collected in the same manner as a civil money penalty 
under subsection (a) of section 1128A of the Social Secu-
rity Act is imposed and collected under that section. 
SEC. 1235. REINSTATE THE MEDICARE TRIGGER. 
Section 3 of House Resolution 5 of the One Hundred 
Eleventh Congress is amended by striking subsection (e) 
(relating to Medicare cost containment). 
Æ 
VerDate Nov 24 2008 
00:29 Mar 27, 2010
Jkt 089200
PO 00000
Frm 00268
Fmt 6652
Sfmt 6301
E:\BILLS\H4944.IH
H4944
tjames on DSKG8SOYB1PROD with BILLS