In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

[EX Q]: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Emergency Acute Care Hospital 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the University of North Carolina's Center 
        for Health Services Research, 55 rural hospitals have closed in 
        the Unites States since January 2010.
            (2) In 2014, iVantage conducted a study for the National 
        Rural Health Association and found 283 hospitals at risk of 
        closure based upon performance indicators that matched those 
        facilities already forced to close in this decade.
            (3) Researchers at the University of North Carolina 
        identified inpatient volume as a substantial contributing 
        factor to the financial performance of rural hospitals, with 
        many of the at-risk hospitals having an average daily bed 
        census of less than 2.
            (4) Adverse impacts to the local economy and the loss of 
        timely access to emergency medical care are 2 major effects of 
        rural hospital closures.
            (5) According to the National Center for Rural Health 
        Works, the typical rural hospital creates over 140 jobs and 
        generates $6,800,000 in compensation while serving an average 
        population of 14,600.
            (6) The 2014 iVantage study estimates that the 283 at-risk 
        hospitals could result in the loss of 36,000 health care jobs, 
        50,000 community jobs, and $10,600,000,000 in gross domestic 
        product.
            (7) Time is the most critical factor for achieving 
        successful outcomes in emergency medicine, and emergency 
        medical clinicians refer to the time-sensitive period during 
        which successful outcomes may be best achieved as the ``golden 
        hour''.
            (8) The National Conference of State Legislatures states 
        that 60 percent of trauma deaths in the United States occur in 
        rural areas, where only 15 percent of the population is 
        represented.
            (9) The disproportionate percentage of trauma deaths in 
        rural areas is likely attributable in large part to a 
        combination of response time to the scene and distance to the 
        nearest emergency room to stabilize trauma victims.
            (10) The percentage of trauma deaths occurring in rural 
        areas could continue to increase as more rural hospitals close, 
        further limiting access to emergency services and requiring 
        patients to travel longer distances to receive emergency 
        medical care.
            (11) The creation of a rural emergency hospital designation 
        under the Medicare program will allow facilities in rural areas 
        to provide emergency medical services without having to 
        maintain inpatient beds.
            (12) In addition to providing emergency care, rural 
        emergency hospitals could convert the space previously used for 
        inpatient services to provide other medical services including, 
        but not limited to, observation care, skilled nursing facility 
        care, infusion services, hemodialysis, home health, hospice, 
        nursing home care, population health, and telemedicine 
        services.

SEC. 3. RURAL EMERGENCY HOSPITAL PROGRAM.

    (a) In General.--
            (1) Rural emergency hospital and services defined.--Section 
        1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
                    (A) in subsection (e), in the last sentence of the 
                matter following paragraph (9), by inserting ``or a 
                rural emergency hospital (as defined in section 
                1861(iii)(1))'' before the period at the end; and
                    (B) by adding at the end the following subsection:

    ``Rural Emergency Hospital; Rural Emergency Hospital Outpatient 
                                Services

    ``(iii)(1) The term `rural emergency hospital' means a facility 
that--
            ``(A)(i) as of December 31, 2014--
                            ``(I) was a critical access hospital; or
                            ``(II) was a hospital with not more than 50 
                        beds located in a county (or equivalent unit of 
                        local government) in a rural area (as defined 
                        in section 1886(d)(2)(D)), or was a hospital 
                        with not more than 50 beds that was treated as 
                        being located in a rural area pursuant to 
                        section 1886(d)(8)(E); or
                    ``(ii) was a critical access hospital described in 
                clause (i)(I) or a hospital described in clause (i)(II) 
                that ceased operations during the period beginning on 
                the date that is 5 years prior to the date of the 
                enactment of this subsection and ending on December 30, 
                2014;
            ``(B) provides 24-hour emergency medical care and 
        observation care that does not exceed an annual per patient 
        average of 24 hours or more than 1 midnight;
            ``(C) does not provide any acute care inpatient beds and 
        has protocols in place for the timely transfer of patients who 
        require acute care inpatient services or other inpatient 
        services;
            ``(D) has elected to be designated as a rural emergency 
        hospital;
            ``(E) has received approval to operate as a rural emergency 
        hospital from the State under section 1834(r)(3)(A); and
            ``(F) is certified by the Secretary under section 
        1834(r)(3)(B).
    ``(2) The term `rural emergency hospital outpatient services' means 
medical and other health services furnished by a rural emergency 
hospital on an outpatient basis.
    ``(3) Nothing in this subsection or section 1834(r)(3) shall be 
construed to prohibit a rural emergency hospital from providing 
extended care services.''.
            (2) Payment for rural emergency hospital services.--
                    (A) In general.--Section 1833(a) of the Social 
                Security Act (42 U.S.C. 1395l(a)) is amended--
                            (i) in paragraph (8), by striking ``and'' 
                        at the end;
                            (ii) in paragraph (9), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by inserting after paragraph (9) the 
                        following new paragraph:
            ``(10) in the case of rural emergency hospital emergency 
        services and services provided by a rural emergency hospital or 
        other provider of ambulance services to transport patients who 
        require acute care inpatient services or other inpatient 
        services from such rural emergency hospital to a hospital or 
        critical access hospital, the amounts described in section 
        1834(r).''.
                    (B) Payment amount.--Section 1834 of the Social 
                Security Act (42 U.S.C. 1395m) is amended by adding at 
                the end the following subsection:
    ``(r) Payment Rules Relating to Rural Emergency Hospitals.--
            ``(1) Payment for rural emergency hospital outpatient 
        services.--
                    ``(A) In general.--The amount of payment for rural 
                emergency hospital outpatient services of a rural 
                emergency hospital is equal to 110 percent of the 
                reasonable costs of providing such services.
                    ``(B) Telehealth services.--For purposes of this 
                paragraph, in determining the reasonable costs of 
                providing rural emergency hospital outpatient services, 
                costs associated with having a backup physician 
                available via a telecommunications system shall be 
                considered reasonable costs.
            ``(2) Payment for transportation services.--The amount of 
        payment for services provided by a rural emergency hospital or 
        other provider of ambulance services to transport patients who 
        require acute care inpatient services or other inpatient 
        services from such rural emergency hospital to a hospital or 
        critical access hospital is equal to 110 percent of the 
        reasonable costs of providing such services.
            ``(3) Requirements for rural emergency hospitals.--
                    ``(A) State approval to operate as a rural 
                emergency hospital.--No payment shall be made under 
                this subsection to a facility, or to a provider of 
                ambulance services providing transportation services 
                from such facility, unless the State in which the 
                facility is located has approved the facility's 
                designation as a rural emergency hospital.
                    ``(B) Certification of rural emergency hospital.--
                            ``(i) In general.--No payment shall be made 
                        under this subsection to a facility, or to a 
                        provider of ambulance services providing 
                        transportation services from such facility, 
                        unless the facility has been certified by the 
                        Secretary as a rural emergency hospital.
                            ``(ii) Certification requirements.--The 
                        Secretary shall certify a facility as a rural 
                        emergency hospital if the facility--
                                    ``(I) meets the criteria for rural 
                                emergency hospitals described in 
                                subparagraphs (A) through (E) of 
                                section 1861(iii)(1);
                                    ``(II) either--
                                            ``(aa) is verified by the 
                                        American College of Surgeons as 
                                        having the resources required 
                                        of a level IV trauma center or 
                                        higher; or
                                            ``(bb) employs healthcare 
                                        professionals that successfully 
                                        completed the Advanced Trauma 
                                        Life Support Course offered by 
                                        the American College of 
                                        Surgeons within the preceding 4 
                                        years;
                                    ``(III) has in effect a transfer 
                                agreement with a level I or level II 
                                trauma center; and
                                    ``(IV) meets such staff training 
                                and certification requirements as the 
                                Secretary may require.
            ``(4) Coinsurance.--
                    ``(A) In general.--The amount of payment for rural 
                emergency hospital services or transportation services 
                made to a rural emergency hospital or other provider of 
                ambulance services under this subsection shall be 
                reduced by the coinsurance amount described in 
                subparagraph (B).
                    ``(B) Coinsurance amount.--The coinsurance amount 
                described in this subparagraph, with respect to an item 
                or service provided by a rural emergency hospital or 
                provider of ambulance services, shall be calculated in 
                the same manner as the coinsurance amount for an 
                outpatient critical access hospital service is 
                calculated under section 1866(a)(2).''.
    (b) Waiver of Distance Requirement for Replacement CAHs; Subsequent 
Redesignation of Rural Emergency Hospitals as CAHs.--Section 1820(c)(2) 
of the Social Security Act (42 U.S.C. 1395i-4(c)(2)) is amended--
            (1) in subparagraph (B)(i)(I), by inserting ``subject to 
        subparagraph (F),'' before ``is located''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(F) Option to waive distance requirement.--
                Beginning on the date of the enactment of this 
                subparagraph, for every critical access hospital 
                located in a State that is certified as a rural 
                emergency hospital under section 1834(r)(3)(B), the 
                State shall have the option of waiving the distance 
                requirement described in subparagraph (B)(i)(I) with 
                respect to another facility located in the State that 
                is seeking designation as a critical access hospital 
                under this paragraph.
                    ``(G) Redesignation of a rural emergency hospital 
                as a critical access hospital.--A rural emergency 
                hospital that was previously designated as a critical 
                access hospital under this paragraph may elect to be 
                redesignated as a critical access hospital (in the same 
                manner that the hospital was originally designated as a 
                critical access hospital) at any time, subject to such 
                conditions as the Secretary may establish.''.
    (c) Studies and Reports.--
            (1) Studies.--The Secretary of Health & Human Services 
        shall conduct 3 studies to evaluate the impact of rural 
        emergency hospitals on the availability of health care and 
        health outcomes in rural areas (as defined in section 
        1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww)). 
        The Secretary shall conduct a study--
                    (A) 2 years after the date of the enactment of this 
                Act;
                    (B) 5 years after the date of the enactment of this 
                Act; and
                    (C) 10 years after the date of the enactment of 
                this Act.
            (2) Reports.--Not later than 6 months after each date that 
        the Secretary of Health & Human Services is required to conduct 
        a study under paragraph (1), the Secretary shall submit a 
        report to Congress containing the results of each such study.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date that is 1 
year after the date of the enactment of this Act.

SEC. 4. INCLUSION OF EMERGENCY MEDICINE AS HEALTH SERVICES UNDER THE 
              NATIONAL HEALTH SERVICE CORPS.

    Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 
254d(a)(3)(D)) is amended by inserting ``, and includes emergency 
medicine provided by physicians in a rural emergency hospital (as 
defined in section 1861(iii) of the Social Security Act)'' before the 
period.

SEC. 5. PERMITTING HOSPITALS WITH APPROVED RESIDENCY PROGRAMS IN 
              EMERGENCY MEDICINE TO INCLUDE TIME SPENT BY INTERNS AND 
              RESIDENTS IN THE EMERGENCY DEPARTMENT OF A RURAL HOSPITAL 
              IN FULL-TIME EQUIVALENT COUNT.

    (a) Indirect Medical Education.--Section 1886(d)(5)(B)(iv) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amended by 
adding at the end the following new subclause:
            ``(III) Effective for discharges occurring on or after 
        October 1, 2015, all of the time spent in patient care 
        activities in the emergency department of a rural hospital by 
        interns and residents in emergency medicine from a hospital 
        with an approved medical residency training program (as defined 
        in subsection (h)(5)(A)) in such specialty shall be included in 
        determining the number of full-time equivalent interns and 
        residents in such program if the hospital with such program 
        incurs the costs of the stipends and fringe benefits of the 
        interns or residents during the time the interns or residents 
        spend in that rural hospital in accordance with subclause (II). 
        In this subclause, the term `rural hospital' means a hospital 
        that is located in a rural area (as defined for purposes of 
        paragraph (2)(D)).''.
    (b) Direct Medical Education.--Section 1886(h)(4)(E) of the Social 
Security Act (42 U.S.C. 1395(h)(4)) is amended--
            (1) in clause (ii), by striking the period at the end and 
        inserting ``; and'';
            (2) by inserting after clause (ii) the following new 
        clause:
                            ``(iii) effective for cost reporting 
                        periods beginning on or after July 1, 2015, all 
                        of the time so spent in the emergency 
                        department of a rural hospital by residents in 
                        emergency medicine from a hospital with an 
                        approved medical residency training program in 
                        such specialty shall be counted towards the 
                        determination of full-time equivalency in such 
                        program if the hospital with such program bears 
                        all, or substantially all, of the costs of 
                        training such residents in the rural hospital. 
                        In this subparagraph, the term `rural hospital' 
                        means a hospital that is located in a rural 
                        area (as defined for purposes of subsection 
                        (d)(2)(D)).''; and
            (3) by adding at the end the following new sentence: ``For 
        purposes of this subparagraph, the emergency department of a 
        rural hospital described in clause (iii) is a nonprovider 
        setting.''.
[EX A]: Rural Emergency Acute Care Hospital Act  This bill amends title XVIII (Medicare) of the Social Security Act to designate as a rural emergency hospital any facility that as of December 31, 2014, was:   a critical access hospital (CAH) or a hospital with at most 50 beds located in a county in a rural area or treated as located in a rural area, or one of such hospitals that ceased operations during the period beginning five years before enactment of this Act and ending on December 30, 2014.  A rural emergency hospital:  must provide 24-hour emergency medical care and observation care not exceeding an annual per patient average of 24 hours or more than 1 midnight, does not provide any acute care inpatient beds and has protocols in place for the timely transfer of patients who require acute care inpatient services or other inpatient services, has elected to be designated as a rural emergency hospital, has received approval to operate as one from the state, and is certified by the Department of Health and Human Services (HHS).  Medicare part B (Supplementary Medical Insurance Benefits) shall cover rural emergency hospital emergency services as well as ambulance services provided by a rural emergency hospital or other provider to transport patients who require acute care inpatient services or other inpatient services from the rural emergency hospital to a hospital or a CAH. Payment for rural emergency hospital outpatient services of a rural emergency hospital, including telehealth and ambulance services, shall be 110% percent of their reasonable costs. Rural emergency hospitals must be approved by the state and certified by HHS. States shall have the option of waiving a specified distance requirement between a CAH certified as a rural emergency hospital and another facility located in the state that is seeking designation as a CAH. Primary health services which the National Health Service Corps may provide under the Public Health Service Act shall include emergency medicine provided by physicians in a rural emergency hospital. Hospitals with approved residency programs in emergency medicine shall include time spent by interns and residents in the emergency department of a rural hospital in the full-time equivalent count with respect to reimbursement for the indirect (stipend, fringe benefit) and direct (all or substantially all training) costs of medical education in subsection (d) hospitals. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system [IPPS] when providing covered inpatient services to eligible beneficiaries.)

[EX Q]: SECTION 1. SHORT TITLE; AMENDMENT OF 1986 CODE.

    (a) Short Title.--This Act may be cited as the ``Long-Term 
Investment Incentive Act of 1997''.
    (b) Amendment of 1986 Code.--Except as otherwise expressly 
provided, whenever in this Act an amendment or repeal is expressed in 
terms of an amendment to, or repeal of, a section or other provision, 
the reference shall be considered to be made to a section or other 
provision of the Internal Revenue Code of 1986.

SEC. 2. REDUCTION OF TAX ON LONG-TERM CAPITAL GAINS ON ASSETS HELD MORE 
              THAN 2 YEARS.

    (a) In General.--Part I of subchapter P of chapter 1 (relating to 
treatment of capital gains) is amended by redesignating section 1202 as 
section 1203 and by inserting after section 1201 the following new 
section:

``SEC. 1202. CAPITAL GAINS DEDUCTION FOR ASSETS HELD BY NONCORPORATE 
              TAXPAYERS MORE THAN 2 YEARS.

    ``(a) General Rule.--If a taxpayer other than a corporation has a 
net capital gain for any taxable year, there shall be allowed as a 
deduction an amount equal to the sum of the applicable percentages of 
the classes of net capital gain described in the table under subsection 
(b).
    ``(b) Applicable Percentage.--For purposes of this subsection, the 
applicable percentage shall be the percentage determined in accordance 
with the following table:

          
                                                         The applicable
          ``In the case of:
                                                         percentage is:
                  2-year gain........................        7.145     
                  3-year gain........................        14.29     
                  4-year gain........................        21.45     
                  5-year gain........................        28.57     
                  6-year gain........................        35.71     
                  7-year gain........................        42.86     
                  8-year gain........................        50.00.    
    ``(c) Gain to Which Deduction Applies.--For purposes of this 
section--
            ``(1) 2-year gain.--The term `2-year gain' means the lesser 
        of--
                    ``(A) the net capital gain for the taxable year, or
                    ``(B) the amount of long-term capital gain which 
                would be computed for the taxable year if only gain 
                from the sale or exchange of property held by the 
                taxpayer for more than 2 years but not more than 3 
                years were taken into account.
            ``(2) 3-year gain, etc.--The terms `3-, 4-,
        5-, 6-, or 7-year gain' mean the amounts determined under 
        paragraph (1)--
                    ``(A) by reducing the amount of the net capital 
                gain under subparagraph (A) thereof by an amount equal 
                to the long-term capital gain from the sale or exchange 
                of property with a holding period less than the minimum 
                holding period for any such category, and
                    ``(B) by substituting 3, 4, 5, 6, or 7 years for 2 
                years and 4, 5, 6, 7, or 8 years for 3 years, 
                respectively, in subparagraph (B) thereof.
            ``(3) 8-year gain.--The term `8-year gain' means the lesser 
        of--
                    ``(A) the net capital gain for the taxable year, 
                reduced by in the same manner as under paragraph 
                (2)(A), or
                    ``(B) the amount of the long-term capital gain 
                which would be computed for the taxable year if only 
                gain from the sale or exchange of property held by the 
                taxpayer for more than 8 years were taken into account.
    ``(d) Estates and Trusts.--In the case of an estate or trust, the 
deduction under subsection (a) shall be computed by excluding the 
portion (if any) of the gains for the taxable year from sales or 
exchanges of capital assets which, under sections 652 and 662 (relating 
to inclusions of amounts in gross income of beneficiaries of trusts), 
is includible by the income beneficiaries as gain derived from the sale 
or exchange of capital assets.
    ``(e) Coordination With Treatment of Capital Gain Under Limitation 
on Investment Interest.--For purposes of this section, the net capital 
gain for any taxable year shall be reduced (but not below zero) by the 
amount which the taxpayer takes into account as investment income under 
section 163(d)(4)(B)(iii).
    ``(f) Treatment of Collectibles.--
            ``(1) In general.--Solely for purposes of this section, any 
        gain or loss from the sale or exchange of a collectible shall 
be treated as a short-term capital gain or loss (as the case may be), 
without regard to the period such asset was held. The preceding 
sentence shall apply only to the extent the gain or loss is taken into 
account in computing taxable income.
            ``(2) Treatment of certain sales of interest in 
        partnership, etc.--For purposes of paragraph (1), any gain from 
        the sale or exchange of an interest in a partnership, S 
        corporation, or trust which is attributable to unrealized 
        appreciation in the value of collectibles held by such entity 
        shall be treated as gain from the sale or exchange of a 
        collectible. Rules similar to the rules of section 751(f) shall 
        apply for purposes of the preceding sentence.
            ``(3) Collectible.--For purposes of this subsection, the 
        term `collectible' means any capital asset which is a 
        collectible (as defined in section 408(m) without regard to 
        paragraph (3) thereof).
    ``(g) Transitional Rule.--
            ``(1) In general.--Gain may be taken into account under 
        subsection (c) only if such gain is properly taken into account 
        on or after May 7, 1997.
            ``(2) Special rules for pass-thru entities.--
                    ``(A) In general.--In applying paragraph (1) with 
                respect to any pass-thru entity, the determination of 
                when gains and losses are properly taken into account 
                shall be made at the entity level.
                    ``(B) Pass-thru entity defined.--For purposes of 
                subparagraph (A), the term `pass-thru entity' means--
                            ``(i) a regulated investment company,
                            ``(ii) a real estate investment trust,
                            ``(iii) an S corporation,
                            ``(iv) a partnership,
                            ``(v) an estate or trust, and
                            ``(vi) a common trust fund.''
    (b) Deduction Allowable in Computing Adjusted Gross Income.--
Subsection (a) of section 62 is amended by inserting after paragraph 
(16) the following new paragraph:
            ``(17) Long-term capital gains.--The deduction allowed by 
        section 1202.''
    (c) Maximum Capital Gains Rate.--Section 1(h) is amended by adding 
at the end the following new sentence: ``For purposes of this 
subsection, taxable income shall be computed without regard to the 
deduction allowed under section 1202.''
    (d) Treatment of Certain Pass-Thru Entities.--
            (1) Capital gain dividends of regulated investment 
        companies.--
                    (A) Subparagraph (B) of section 852(b)(3) is 
                amended to read as follows:
                    ``(B) Treatment of capital gain dividends by 
                shareholders.--A capital gain dividend shall be treated 
                by the shareholders as gain from the sale or exchange 
                of a capital asset held for more than 1 year but not 
                more than 2 years; except that the portion of any such 
                dividend designated by the company as allocable 2-, 3-, 
                4-, 5-, 6-, 7-, or 8-year gain of the company shall be 
                treated as gain from the sale or exchange of a capital 
                asset held for the amount of years in such class for 
                purposes of section 1202. Rules similar to the rules of 
                subparagraph (C) shall apply to any designation under 
                the preceding sentence.''
                    (B) Clause (i) of section 852(b)(3)(D) is amended 
                by adding at the end the following new sentence: 
                ``Rules similar to the rules of subparagraph (B) shall 
                apply in determining character of the amount to be so 
                included by any such shareholder.''
            (2) Capital gain dividends of real estate investment 
        trusts.--Subparagraph (B) of section 857(b)(3) is amended to 
        read as follows:
                    ``(B) Treatment of capital gain dividends by 
                shareholders.--A capital gain dividend shall be treated 
                by the shareholders or holders of beneficial interests 
                as gain from the sale or exchange of a capital asset 
                held for more than 1 year but not more than 2 years; 
                except that the portion of any such dividend designated 
                by the company as allocable to 2-, 3-, 4-, 5-, 6-, 7-, 
                or 8-year gain of the company shall be treated as gain 
                from the sale or exchange of a capital asset held for 
                the amount of years in such class for purposes of 
                section 1202. Rules similar to the rules of 
                subparagraph (C) shall apply to any designation under 
                the preceding sentence.''
            (3) Common trust funds.--Subsection (c) of section 584 is 
        amended--
                    (A) by inserting ``and not more than 2 years'' 
                after ``1 year'' each place it appears in paragraph 
                (2),
                    (B) by striking ``and'' at the end of paragraph 
                (2), and
                    (C) by redesignating paragraph (3) as paragraph (4) 
                and inserting after paragraph (2) the following new 
                paragraph:
            ``(3) as part of its gains from sales or exchanges of 
        capital assets held for periods described in the classes of 
        gains under section 1202(c), its proportionate share of the 
        gains of the common trust fund from sales or exchanges of 
        capital assets held for such periods, and''.
    (e) Technical and Conforming Changes.--
            (1) Subparagraph (B) of section 170(e)(1) is amended by 
        inserting ``(or, in the case of a taxpayer other than a 
        corporation, the percentage of such gain equal to 100 percent 
        minus the percentage applicable to such gain under section 
        1202(a))'' after ``the amount of gain''.
            (2) Subparagraph (B) of section 172(d)(2) is amended to 
        read as follows:
                    ``(B) the deduction under section 1202 and the 
                exclusion under section 1203 shall not be allowed.''
            (3)(A) Section 221 (relating to cross reference) is amended 
        to read as follows:

``SEC. 221. CROSS REFERENCES.

    ``(1) For deduction for net capital gains in the case of a taxpayer 
other than a corporation, see section 1202.
    ``(2) For deductions in respect of a decedent, see section 691.''
            (B) The table of sections for part VII of subchapter B of 
        chapter 1 is amended by striking ``reference'' in the item 
        relating to section 221 and inserting ``references''.
            (4) The last sentence of section 453A(c)(3) is amended by 
        striking all that follows ``long-term capital gain,'' and 
        inserting ``the maximum rate on net capital gain under section 
        1(h) or 1201 or the deduction under section 1202 (whichever is 
        appropriate) shall be taken into account.''
            (5) Paragraph (4) of section 642(c) is amended to read as 
        follows:
            ``(4) Adjustments.--To the extent that the amount otherwise 
        allowable as a deduction under this subsection consists of gain 
        from the sale or exchange of capital assets held for more than 
        1 year, proper adjustment shall be made for any deduction 
        allowable to the estate or trust under section 1202 or any 
        exclusion allowable to the estate or trust under section 
        1203(a). In the case of a trust, the deduction allowed by this 
        subsection shall be subject to section 681 (relating to 
        unrelated business income).''
            (6) The last sentence of paragraph (3) of section 643(a) is 
        amended to read as follows: ``The deduction under section 1202 
        and the exclusion under section 1203 shall not be taken into 
        account.''
            (7) Subparagraph (C) of section 643(a)(6) is amended by 
        inserting ``(i)'' before ``there shall'' and by inserting 
        before the period ``, and (ii) the deduction under section 1202 
        (relating to capital gains deduction) shall not be taken into 
        account''.
            (8) Paragraph (4) of section 691(c) is amended by striking 
        ``sections 1(h), 1201, and 1211'' and inserting ``sections 
        1(h), 1201, 1202, and 1211''.
            (9) The second sentence of section 871(a)(2) is amended by 
        inserting ``or 1203'' after ``1202''.
            (10) Subsection (d) of section 1044 is amended by striking 
        ``1202'' and inserting ``1203''.
            (11) Paragraph (1) of section 1402(i) is amended by 
        inserting ``, and the deduction provided by section 1202 shall 
        not apply'' before the period at the end thereof.
    (f) Clerical Amendment.--The table of sections for part I of 
subchapter P of chapter 1 is amended by inserting after the item 
relating to section 1201 the following new item:

                              ``Sec. 1202. Capital gains deduction for 
                                        assets held by noncorporate 
                                        taxpayers more than 2 years.''
    (g) Effective Date.--
            (1) In general.--Except as otherwise provided in this 
        subsection, the amendments made by this section shall apply to 
        taxable years ending on and after May 7, 1997.
            (2) Contributions.--The amendment made by subsection (e)(1) 
        shall apply to contributions on or after May 7, 1997.
[EX A]: Long-Term Investment Incentive Act of 1997 - Amends the Internal Revenue Code to establish a sliding scale capital gains deduction on assets held between two years and eight years by noncorporate taxpayers.

[EX Q]: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Eliminating Disparities in Breast 
Cancer Treatment Act of 2008''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Delays in receiving care after breast cancer diagnosis 
        are reported to be greater for African-American women than 
        white women.
            (2) Recent studies indicate that African-American women 
        with breast cancer are less likely to receive standard therapy 
        than white women.
            (3) African-American and Hispanic patients are 
        significantly more likely than white patients to be diagnosed 
        at a more advanced stage of breast cancer.
            (4) Investigators found that regardless of insurance 
        status, African-American women are 1.9 times more likely to be 
        diagnosed with an advanced stage of breast cancer than white 
        women and Hispanic women are 1.4 times more likely to be 
        diagnosed with an advanced stage of breast cancer than white 
        women.
            (5) African-American women are ten percent more likely not 
        to receive tests to determine if breast cancer has spread to 
        axillary (underarm) lymph nodes. Studies show that health 
        insurance status, race, income, and educational background are 
        directly linked to irregularity in administering this vital 
        screening.
            (6) According to American Cancer Society researchers, 
        substantial disparities remain or persist regarding cancer 
        diagnosis and treatment.

SEC. 3. PURPOSE.

    The purpose of this Act is to promote the implementation of 
standardized health care practices for breast cancer treatment under 
the Medicare program to eliminate disparities in the provision of care 
to such patients based on race, level of education, income, and health 
insurance status of such patients.

SEC. 4. CONSENSUS-BASED BREAST CANCER TREATMENT PERFORMANCE MEASURES 
              SYSTEM UNDER MEDICARE.

    Title XVIII of the Social Security Act is amended by adding at the 
end the following new section:

``SEC. 1898. BREAST CANCER TREATMENT PERFORMANCE MEASURES SYSTEM.

    ``(a) In General.--Not later than October 1, 2009, the Secretary 
shall establish, in accordance with the provisions of this section, a 
6-year breast cancer treatment quality performance system (in this 
section referred to as the `system') to--
            ``(1) assess and publicly disclose, through the use of 
        quality measures, the quality of care provided for the 
        treatment of breast cancer by specified health care providers; 
        and
            ``(2) beginning October 1, 2012, base payment under this 
        title to such providers for such treatment on the performance 
        of such providers based on such measures.
    ``(b) Specified Health Care Providers.--
            ``(1) In general.--The Secretary shall specify classes of 
        providers of services and suppliers, including hospitals, 
        cancer centers, physicians, primary care providers, and 
        specialty providers, to which the provisions of this section 
        shall apply.
            ``(2) Definition.--For purposes of this section, the term 
        `specified health care provider' means a provider of services 
        or supplier specified under paragraph (1).
    ``(c) Identification and Endorsement of Breast Cancer Treatment 
Performance Measures.--
            ``(1) In general.--Under the system, the Secretary, shall 
        enter into agreements with the National Quality Forum, an 
        organization that operates as a voluntary consensus standards 
        body as defined for purposes of section 12(d) of the National 
        Technology Transfer and Advancement Act of 1995 (Public Law 
        104-113) and Office of Management and Budget Revised Circular 
        A-119 (published in the Federal Register on February 10, 1998), 
        under which the National Quality Forum shall identify a uniform 
        set of consensus-based performance measures to evaluate the 
        quality of care provided by specified health care providers for 
        the treatment of breast cancer, endorse such set of measures 
        through its multistakeholder consensus development process, and 
        annually update such set of measures.
            ``(2) Measures described.--The set of measures described in 
        paragraph (1) shall include, with respect to the treatment of 
        breast cancer, measures of patient outcomes, the process for 
        delivering medical care related to such treatment, patient 
        counseling and engagement in decision-making, patient 
        experience of care, resource use, and practice capabilities, 
        such as care coordination.
    ``(d) Reporting Process.--
            ``(1) In general.--Under the system, for periods (as 
        specified by the Secretary) beginning on or after October 1, 
        2009, the Secretary shall establish a reporting process, with 
        respect to treatment furnished for breast cancer, that provides 
        for a method for specified health care providers to submit to 
        the Secretary data on the performance of such providers during 
        each period through use of the performance measures developed 
        pursuant to subsection (c)(1). Such data shall be submitted in 
        a form and manner and at a time specified by the Secretary.
            ``(2) Voluntary submission during initial 3 years.--The 
        reporting process under paragraph (1) shall provide for the 
        voluntary submission of data (and incentives for such 
        submission) under the process for periods ending before October 
        1, 2012.
            ``(3) Characteristics of data submitted under reporting 
        process.--Data submitted by a specified health care provider 
        under the reporting process under paragraph (1) shall--
                    ``(A) take into account the quality of breast 
                cancer treatment furnished to all patients of the 
                provider, regardless of the type of health insurance 
                coverage of the patient or whether or not the patient 
                has such coverage; and
                    ``(B) be structured in a manner that allows for 
                comparison according to race, educational level, 
                income, insurance status, and any other category 
                specified by the Secretary.
    ``(e) Public Disclosure.--Under the system, the Secretary shall 
establish procedures to require that information with respect to the 
quality demonstrated by a specified health care provider of treatment 
furnished for breast cancer during a period (based on the performance 
measures data submitted pursuant to subsection (c)(1) by the provider 
for such period) is made available on the official public Internet site 
of the Department of Health and Human Services in a clear and 
understandable form. Such procedures shall ensure that a specified 
health care provider has the opportunity to review the information that 
is to be made public with respect to the provider at least 30 days 
prior to such data being made public and shall provide for an appeals 
process in the case a provider claims such information to be incorrect 
or incomplete.
    ``(f) Value-Based Purchasing for Periods Beginning October 1, 
2012.--
            ``(1) In general.--Under the system, for periods beginning 
        on or after October 1, 2012 and ending before October 1, 2015, 
        the Secretary shall establish and implement, a value-based 
        purchasing program, with respect to specified health care 
        providers that furnish treatment for breast cancer during such 
        a period, under which--
                    ``(A) in the case of such a provider that does not 
                submit data in accordance with the reporting process 
                under subsection (d)(1) for such treatment furnished 
                during such period, the Secretary shall reduce payment 
                under this title for such treatment by an amount 
                specified by the Secretary; and
                    ``(B) in the case of such a provider that submits 
                data in accordance with the reporting process under 
                subsection (d)(1) for such treatment furnished during 
                such period--
                            ``(i) subject to clause (ii), if the 
                        Secretary determines such provider furnished 
                        low quality care (in accordance with a method 
                        specified by the Secretary) for such treatment, 
                        the Secretary shall reduce the amount that 
                        would otherwise be paid to such provider under 
                        this title for such treatment by an amount 
                        specified by the Secretary;
                            ``(ii) if the Secretary determines such 
                        provider furnished low quality care (in 
                        accordance with the method specified under 
                        clause (i)) for such treatment, but the quality 
                        of care has improved as compared to the quality 
                        of care the provider furnished during the 
                        previous period, the Secretary shall reduce the 
                        amount that would otherwise be paid to such 
                        provider under this title for such treatment in 
                        accordance with an incremental method 
                        established by the Secretary that ensures that 
                        the amount of such reduction--
                                    ``(I) is less than the amount 
                                specified by the Secretary under clause 
                                (i); and
                                    ``(II) is based on the extent of 
                                improvement in the quality of care; and
                            ``(iii) if the Secretary determines such 
                        provider did not furnish low quality care (in 
                        accordance with the method specified under 
                        clause (i)) for such treatment, the Secretary 
                        shall provide to such provider the amount to be 
                        paid to such provider under this title for such 
                        treatment.
            ``(2) Results-based payments.--The amount of a reduction 
        under subparagraph (A) or (B)(i) of paragraph (1) shall be 
        determined in accordance with a method established by the 
        Secretary.
    ``(g) Reports.--Not later than October 1, 2010, and for each 6-
month period thereafter (before fiscal year 2016), the Secretary shall 
submit to Congress a report that evaluates the development and 
implementation of the system, including--
            ``(1) an evaluation of the number of specified health care 
        providers that submit data pursuant to subsection (c)(1);
            ``(2) an analysis of the effect of such system on reducing 
        disparities in the provision of breast cancer treatment to 
        patients based on race, level of education, income, and health 
        insurance status of such patients;
            ``(3) recommendations on whether (and to what extent) to 
        extend the system under this section.
    ``(h) Application to Part C.--The Secretary shall provide for a 
method to apply the provisions of this section to treatment furnished 
under a plan under part C.''.
[EX A]:
Eliminating Disparities in Breast Cancer Treatment Act of 2008 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services to establish a breast cancer treatment quality performance system to: (1) assess and disclose publicly, through the use of quality measures, the quality of care provided for the treatment of breast cancer by specified health care providers; and (2) base payment to such providers for such treatment on their performance with respect to such measures.

Requires reduced payments to providers that either do not submit data in accordance with the reporting process in the system, or furnish low quality care for treatment of breast cancer.