SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Health Care and Education Reconciliation Act of 2010’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—COVERAGE, MEDICARE, MEDICAID, AND REVENUES 
Subtitle A—Coverage 
Sec. 1001. Tax credits. 
Sec. 1002. Individual responsibility. 
Sec. 1003. Employer responsibility. 
Sec. 1004. Income definitions. 
Sec. 1005. Implementation funding. 
Subtitle B—Medicare 
Sec. 1101. Closing the medicare prescription drug ‘‘donut hole’’. 
Sec. 1102. Medicare Advantage payments. 
Sec. 1103. Savings from limits on MA plan administrative costs. 
Sec. 1104. Disproportionate share hospital (DSH) payments. 
Sec. 1105. Market basket updates. 
Sec. 1106. Physician ownership-referral. 
Sec. 1107. Payment for imaging services. 
Sec. 1108. PE GPCI adjustment for 2010. 
Sec. 1109. Payment for qualifying hospitals. 
Subtitle C—Medicaid 
Sec. 1201. Federal funding for States. 
Sec. 1202. Payments to primary care physicians. 
Sec. 1203. Disproportionate share hospital payments. 
Sec. 1204. Funding for the territories. 
Sec. 1205. Delay in Community First Choice option. 
Sec. 1206. Drug rebates for new formulations of existing drugs. 
Subtitle D—Reducing Fraud, Waste, and Abuse 
Sec. 1301. Community mental health centers. 
Sec. 1302. Medicare prepayment medical review limitations. 
Sec. 1303. Funding to fight fraud, waste, and abuse. 
Sec. 1304. 90-day period of enhanced oversight for initial claims of DME sup-
pliers. 
Subtitle E—Provisions Relating to Revenue 
Sec. 1401. High-cost plan excise tax. 
Sec. 1402. Unearned income Medicare contribution. 
Sec. 1403. Delay of limitation on health flexible spending arrangements under 
cafeteria plans.
Sec. 1404. Brand name pharmaceuticals. 
Sec. 1405. Excise tax on medical device manufacturers. 
Sec. 1406. Health insurance providers. 
Sec. 1407. Delay of elimination of deduction for expenses allocable to medicare 
part D subsidy. 
Sec. 1408. Elimination of unintended application of cellulosic biofuel producer 
credit. 
Sec. 1409. Codification of economic substance doctrine and penalties. 
Sec. 1410. Time for payment of corporate estimated taxes. 
Subtitle F—Other Provisions 
Sec. 1501. Community college and career training grant program. 
TITLE II—EDUCATION AND HEALTH 
Subtitle A—Education 
Sec. 2001. Short title; references. 
PART I—INVESTING IN STUDENTS AND FAMILIES 
Sec. 2101. Federal Pell Grants. 
Sec. 2102. College access challenge grant program. 
Sec. 2103. Investment in historically black colleges and universities and minor-
ity-serving institutions. 
PART II—STUDENT LOAN REFORM 
Sec. 2201. Termination of Federal Family Education Loan appropriations. 
Sec. 2202. Termination of Federal loan insurance program. 
Sec. 2203. Termination of applicable interest rates. 
Sec. 2204. Termination of Federal payments to reduce student interest costs. 
Sec. 2205. Termination of FFEL PLUS Loans. 
Sec. 2206. Federal Consolidation Loans. 
Sec. 2207. Termination of Unsubsidized Stafford Loans for middle-income bor-
rowers. 
Sec. 2208. Termination of special allowances. 
Sec. 2209. Origination of Direct Loans at institutions outside the United 
States. 
Sec. 2210. Conforming amendments. 
Sec. 2211. Terms and conditions of loans. 
Sec. 2212. Contracts; mandatory funds. 
Sec. 2213. Income-based repayment. 
Subtitle B—Health 
Sec. 2301. Insurance reforms. 
Sec. 2302. Drugs purchased by covered entities. 
Sec. 2303. Community health centers.
TITLE I—COVERAGE, MEDICARE, 
MEDICAID, AND REVENUES 
Subtitle A—Coverage 
SEC. 1001. TAX CREDITS. 
(a) PREMIUM TAX CREDITS.—Section 36B of the In-
ternal Revenue Code of 1986, as added by section 1401 
of the Patient Protection and Affordable Care Act and 
amended by section 10105 of such Act, is amended— 
(1) in subsection (b)(3)(A)— 
(A) in clause (i), by striking ‘‘with respect 
to any taxpayer’’ and all that follows up to the 
end period and inserting: ‘‘for any taxable year 
shall be the percentage such that the applicable 
percentage for any taxpayer whose household 
income is within an income tier specified in the 
following table shall increase, on a sliding scale 
in a linear manner, from the initial premium 
percentage to the final premium percentage 
specified in such table for such income tier: 
‘‘In the case of household in-
come (expressed as a percent of 
poverty line) within the fol-
lowing income tier: 
The initial premium 
percentage is— 
The final premium 
percentage is— 
Up to 133% 
2.0% 
2.0% 
133% up to 150% 
3.0% 
4.0% 
150% up to 200% 
4.0% 
6.3% 
200% up to 250% 
6.3% 
8.05% 
250% up to 300% 
8.05% 
9.5% 
300% up to 400% 
9.5% 
9.5%’’; 
and
(B) by striking clauses (ii) and (iii), and 
inserting the following: 
‘‘(ii) INDEXING.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), in the case of taxable 
years beginning in any calendar year 
after 2014, the initial and final appli-
cable percentages under clause (i) (as 
in effect for the preceding calendar 
year after application of this clause) 
shall be adjusted to reflect the excess 
of the rate of premium growth for the 
preceding calendar year over the rate 
of income growth for the preceding 
calendar year. 
‘‘(II) 
ADDITIONAL
ADJUST-
MENT.—Except as provided in sub-
clause (III), in the case of any cal-
endar year after 2018, the percent-
ages described in subclause (I) shall, 
in addition to the adjustment under 
subclause (I), be adjusted to reflect 
the excess (if any) of the rate of pre-
mium growth estimated under sub-
clause (I) for the preceding calendar
year over the rate of growth in the 
consumer price index for the pre-
ceding calendar year. 
‘‘(III) FAILSAFE.—Subclause (II) 
shall apply for any calendar year only 
if the aggregate amount of premium 
tax credits under this section and 
cost-sharing reductions under section 
1402 of the Patient Protection and 
Affordable Care Act for the preceding 
calendar year exceeds an amount 
equal to 0.504 percent of the gross 
domestic product for the preceding 
calendar year.’’; and 
(2) in subsection (c)(2)(C)— 
(A) by striking ‘‘9.8 percent’’ in clauses 
(i)(II) and (iv) and inserting ‘‘9.5 percent’’; and 
(B) by striking ‘‘(b)(3)(A)(iii)’’ in clause 
(iv) and inserting ‘‘(b)(3)(A)(ii)’’. 
(b) COST SHARING.—Section 1402(c) of the Patient 
Protection and Affordable Care Act is amended— 
(1) in paragraph (1)(B)(i)— 
(A) in subclause (I), by striking ‘‘90’’ and 
inserting ‘‘94’’; 
(B) in subclause (II)—