		I
		111th CONGRESS
		1st Session
		H. R. 972
		IN THE HOUSE OF REPRESENTATIVES

			February 10, 2009
			Mr. Wilson of South
			 Carolina (for himself and Mr. Kline of
			 Minnesota) introduced the following bill; which was referred to the
			 Committee on Armed
			 Services

		A BILL
		To amend title 10, United States Code, to eliminate the
		  requirement that certain former members of the reserve components of the Armed
		  Forces be at least 60 years of age in order to be eligible to receive health
		  care benefits.

		1.Elimination of the age
			 requirement for health care benefits for NON-REGULAR SERVICE
			 RETIREESSection 1074(b) of
			 title 10, United States Code, is amended—
			(1)by striking
			 (1); and
			(2)by striking
			 paragraph (2).


110 HR 4832 IH: Wildland Fire Safety and Transparency

U.S. House of Representatives
2007-12-18
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

		I
		110th CONGRESS
		1st Session
		H. R. 4832
		IN THE HOUSE OF REPRESENTATIVES

			December 18, 2007
			Mr. Udall of Colorado
			 introduced the following bill; which was referred to the
			 Committee on Natural
			 Resources, and in addition to the Committee on
			 Agriculture, for a period
			 to be subsequently determined by the Speaker, in each case for consideration of
			 such provisions as fall within the jurisdiction of the committee
			 concerned

		A BILL
		To promote wildland firefighter safety.

		1.Short titleThis Act may be cited as the
			 Wildland Fire Safety and Transparency
			 Act of 2007.
		2.Wildland
			 firefighter safety
			(a)DefinitionsIn
			 this section:
				(1)SecretariesThe
			 term Secretaries means—
					(A)the Secretary of
			 the Interior, acting through the Directors of the Bureau of Land Management,
			 the United States Fish and Wildlife Service, the National Park Service, and the
			 Bureau of Indian Affairs; and
					(B)the Secretary of
			 Agriculture, acting through the Chief of the Forest Service.
					(2)Wildland
			 firefighterThe term wildland firefighter means
			 any person who participates in wildland firefighting activities—
					(A)under the
			 direction of either of the Secretaries; or
					(B)under a contract
			 or compact with a federally recognized Indian tribe.
					(b)Annual Report to
			 Congress
				(1)In
			 generalThe Secretaries shall jointly submit to Congress an
			 annual report on the wildland firefighter safety practices of the Secretaries,
			 including training programs and activities for wildland fire suppression,
			 prescribed burning, and wildland fire use, during the preceding calendar
			 year.
				(2)TimelineEach
			 report under paragraph (1) shall—
					(A)be submitted by
			 not later than March of the year following the calendar year covered by the
			 report; and
					(B)include—
						(i)a
			 description of, and any changes to, wildland firefighter safety practices,
			 including training programs and activities for wildland fire suppression,
			 prescribed burning, and wildland fire use;
						(ii)statistics and
			 trend analyses;
						(iii)an
			 estimate of the amount of Federal funds expended by the Secretaries on wildland
			 firefighter safety practices, including training programs and activities for
			 wildland fire suppression, prescribed burning, and wildland fire use;
						(iv)progress made in
			 implementing recommendations from the Inspector General, the Government
			 Accountability Office, the Occupational Safety and Health Administration, or an
			 agency report relating to a wildland firefighting fatality issued during the
			 preceding 10 years; and
						(v)a
			 description of—
							(I)the provisions
			 relating to wildland firefighter safety practices in any Federal contract or
			 other agreement governing the provision of wildland firefighters by a
			 non-Federal entity;
							(II)a
			 summary of any actions taken by the Secretaries to ensure that the provisions
			 relating to safety practices, including training, are complied with by the
			 non-Federal entity; and
							(III)the results of
			 those actions.


115 HR 4143 IH: Dialysis Patient Access To Integrated-care, Empowerment, Nephrologists, Treatment, and Services Demonstration Act of 2017
U.S. House of Representatives
2017-10-26
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I115th CONGRESS1st SessionH. R. 4143IN THE HOUSE OF REPRESENTATIVESOctober 26, 2017Mr. Smith of Missouri (for himself, Mr. Blumenauer, Mrs. McMorris Rodgers, and Mr. Cárdenas) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such
			 provisions as fall within the jurisdiction of the committee concernedA BILLTo establish a demonstration program to provide integrated care for Medicare beneficiaries with
			 end-stage renal disease, and for other purposes.

 1.Short titleThis Act may be cited as the Dialysis Patient Access To Integrated-care, Empowerment, Nephrologists, Treatment, and Services Demonstration Act of 2017 or the Dialysis PATIENTS Demonstration Act of 2017.
		2.Demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal
			 disease
 (a)In generalTitle XVIII of the Social Security Act is amended by inserting after section 1866E the following new section:

					1866F.Demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal
			 disease(a)Establishment
 (1)In generalThe Secretary shall conduct under this section the ESRD Integrated Care Demonstration Program (in this section referred to as the Program) which is voluntary for patients and providers to assess the effects of alternative care delivery models and payment methodologies on patient care improvements under this title for Program-eligible beneficiaries (as defined in paragraph (2)). Under the Program—
 (A)Program-eligible beneficiaries shall be considered enrolled under the original Medicare fee-for-service program under parts A and B;
 (B)eligible participating providers (as defined in such paragraph) may form an ESRD Integrated Care Organization (in this section referred to as an Organization); and
 (C)an Organization shall integrate care and serve as the medical home under the original medicare fee-for-service program under parts A and B for Program-eligible beneficiaries.
 (2)DefinitionsIn this section: (A)Eligible participating providerThe term eligible participating provider means the following:
 (i)A facility certified as a renal dialysis facility under this title. (ii)A dialysis organization that owns one or more of such facilities described in clause (i).
 (iii)A nephrologist or nephrology practice. (iv)Any other physician group practice or a group of affiliated physicians or providers.
 (B)Eligible participating partnerThe term eligible participating partner means, with respect to an Organization, the following: (i)A Medicare Advantage plan described in section 1851(a)(2) or a Medicare Advantage organization offering such a plan.
 (ii)A prescription drug plan (as defined in section 1860D–41(a)(14)). (iii)A medicaid managed care organization (as defined in section 1903(m)).
 (iv)An entity that is able to bear risk as deemed by a State, including public medical educational institutions experienced in the care of patients receiving dialysis, and that chooses to bear risk as a condition of partnership in such organization.
 (v)A third-party administrator organization. (C)Program-eligible beneficiaryThe term Program-eligible beneficiary means, with respect to an Organization offering an ESRD Integrated Care Model, an individual entitled to benefits under part A and enrolled under part B who—
 (i)is identified by the Secretary or the Organization as receiving renal dialysis services under the original medicare fee-for-service program under parts A and B;
 (ii)resides in the service area of such Organization; (iii)receives renal dialysis services primarily from a facility that participates in such Organization;
 (iv)has not received a successful kidney transplant; and (v)has experienced a failed transplant.
									(b)ESRD integrated care organization eligibility requirements
							(1)Organizations
 (A)In generalOne or more eligible participating providers may establish an Organization or may enter into, subject to subparagraph (B), one or more partnership, ownership, or co-ownership agreements with one or more eligible participating partners to establish an Organization.
 (B)Limitation on number of agreementsThe Secretary may specify a limitation on the number of Organizations in which an eligible participating partner may participate under agreements described in subparagraph (A).
								(2)ESRD integrated care model
								(A)Benefits requirements
 (i)In generalSubject to clause (iii), an Organization shall offer at least one ESRD Integrated Care Model that is an open network model (as described in subparagraph (B)(i)) in each of its service areas and may offer one or more ESRD Integrated Care Models that is a preferred network model (as described in subparagraph (B)(ii)) in each of its service areas. For purposes of this section an ESRD Integrated Care Model (in this section referred to as the Model), subject to subsection (f)(3)(B)—
 (I)shall cover all benefits under parts A and B (other than hospice care) and include benefits for transition (particularly including education) into transplantation, palliative care, or hospice; and
 (II)may, through a partnership or other agreement with an MA–PD plan under part C or prescription drug plan under part D, cover all prescription drug benefits under such part D.
										(ii)Treatment of savings
 (I)In generalAny Organization offering an ESRD Integrated Care Model shall provide for the return under subclause (IV) to a Program-eligible beneficiary enrolled in the Organization of the amount, if any, by which the payment amount described in subclause (III) with respect to the Program-eligible beneficiary for a year exceeds the revenue amount described in subclause (II) with respect to the Program-eligible beneficiary for the year.
 (II)Revenue amount describedThe revenue amount described in this subclause, with respect to an Organization offering an ESRD Integrated Care Model and a Program-eligible beneficiary enrolled in such Organization, is the Organization’s estimated average revenue requirements, including administrative costs and return on investment, for the Organization to provide the benefits described in clause (i) under the Model for the Program-eligible beneficiary for the year.
 (III)Payment amount describedThe payment amount described in this subclause, with respect to an Organization offering an ESRD Integrated Care Model and a Program-eligible beneficiary enrolled in such Organization, is the payment amount to the Organization under subsection (f)(1) made with respect to the Program-eligible beneficiary for the year.
 (IV)Means of returning savings to program-eligible beneficiaries enrolled in OrganizationsAn Organization shall return the amount under subclause (I) to a Program-eligible beneficiary enrolled in the Organization in a manner specified by the Organization, which may include, as applicable, cost-sharing lower than otherwise applicable, benefits not covered under the original medicare fee-for-service program (including preventive services related to chronic kidney disease and education surrounding the importance of transplantation), or financial incentives (such as reduced cost sharing) for Program-eligible beneficiaries enrolled in the Organization to promote the delivery of high-value and efficient care and services.
 (iii)Benefit requirements for dual eligiblesIn the case of a Program-eligible beneficiary who is eligible for benefits under this title and title XIX, an Organization, in accordance with an agreement entered into under subsection (f)(4)—
 (I)may be responsible for providing, or arranging for the provision of, all benefits (other than long-term services and supports) for which the Program-eligible beneficiary is eligible for under the State Medicaid program under title XIX in which the Program-eligible beneficiary is enrolled; and
 (II)may elect to provide, or arrange for the provision of, long-term services and supports available to the Program-eligible beneficiary under the State Medicaid program, including services related to the transition into palliative care or hospice.
										(B)Requirements for open network and preferred network models
 (i)Open network modelUnder an ESRD Integrated Care Model offered by an Organization that is an open network model, the Organization shall—
 (I)allow Program-eligible beneficiaries to receive such covered benefits from any provider of services or supplier regardless of whether such provider is within the network assembled under clause (ii)(I);
 (II)pay any Medicare-certified provider or supplier that is not within the network assembled under subclause (I) for such covered benefits an amount equal to the amount the provider or supplier would otherwise receive under this title; and
 (III)not apply any additional premium or cost sharing requirements for such covered benefits in addition to premium or cost sharing requirements, respectively, that would be applicable under part A or part B for such benefits.
 (ii)Preferred network modelUnder an ESRD Integrated Care Model offered by an Organization that is a preferred network model, the Organization—
 (I)shall assemble a network of providers of services and suppliers identified by the Organization and confirmed by the Secretary as including providers of services and suppliers with significant expertise in caring for individuals with end-stage renal disease through which Program-eligible beneficiaries shall receive covered benefits as described in subparagraph (A) that are required to be covered under the Model;
 (II)shall provide for payment for items and services furnished by providers of services and suppliers within such network to Program-eligible beneficiaries enrolled in such Organization in accordance with payment rates determined pursuant to an agreement entered into between the Organization and such providers of services and suppliers and shall provide for payment for items and services furnished by providers of services and suppliers not within such network to such beneficiaries so enrolled in accordance that would be determined under section 1853(a)(1)(H);
 (III)may apply premium and cost-sharing requirements, in addition to premium or cost-sharing requirements, respectively, that would be applicable under part B, for benefits in addition to those required to be covered under the Model; and
 (IV)shall apply network standards as defined by the Secretary. (iii)Promoting access to high-quality providersAn Organization offering an ESRD Integrated Care Model may develop and implement performance-based incentives for providers of services and suppliers to promote delivery of high quality and efficient care. Such incentives shall be based on clinical measures and non-clinical measures, such as with respect to notification of patient discharge from a hospital, patient education (such as with respect to treatment options, including chronic kidney disease maintenance, and nutrition), and the interoperability of electronic health records developed by an Organization according to requirements and standards specified by the Secretary pursuant to subparagraph (C).
									(iv)Application of medicare advantage requirement with respect to medicare services furnished by
			 out-of-network providers and suppliers
 (I)In generalSection 1852(k)(1) (relating to limitations on balance billing against MA organizations for noncontract physicians and other entities with respect to services covered under this title) shall apply to Organizations, Program-eligible beneficiaries enrolled in such Organizations, and physicians and other entities that do not have a contract or other agreement with the Organization establishing payment amounts for services furnished to such a beneficiary in the same manner as such section applies to MA organizations, individuals enrolled with such organizations, and physicians and other entities referred to in such section.
 (II)Reference for additional provisionFor the provision relating to limitations on balance billing against Organizations for services covered under this title furnished by noncontract providers of services and suppliers, see section 1866(a)(1)(O).
										(C)Quality and reporting requirements
 (i)Clinical measuresUnder the Program, the Secretary shall— (I)require each participating Organization to submit to the Secretary data on clinical measures consistent with those measures submitted by organizations participating in the Comprehensive ESRD Care Initiative operated by the Center for Medicare and Medicaid Innovation as of October 1, 2016, to assess the quality of care provided;
 (II)establish requirements for participating Organizations to report to the Secretary, in a form and manner specified by the Secretary, information on such measures; and
 (III)establish quality performance standards on such measures to assess the quality of care. (ii)Requirement for stakeholder inputIn developing requirements and standards under subclauses (II) and (III) of clause (i), the Secretary shall request and consider input from a stakeholder board, at least one nephrologist, other suppliers and providers of services, renal dialysis facilities, and beneficiary advocates.
 (iii)Additional assessments and reporting requirementsThe Secretary shall assess the extent to which an Organization delivers integrated and patient-centered care through analysis of information obtained from Program-eligible beneficiaries enrolled in the Organization through surveys, such as the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems.
									(D)Requirements for esrd integrated care strategy
 (i)In generalAn Organization seeking a contract under this section to offer one or more ESRD Integrated Care Models must develop and submit for the Secretary’s approval, subject to clauses (ii) and (iii), an ESRD Integrated Care Strategy.
 (ii)ESRD integrated care strategyIn assessing an ESRD Integrated Care Strategy under clause (i), the Secretary shall consider the extent to which the Strategy includes elements, such as the following:
 (I)Interdisciplinary care teams led by at least one nephrologist, and comprised of registered nurses, social workers, renal dialysis facility managers, and other representatives from alternative settings described in subclause (VIII).
 (II)A decision process for care plans and care management that includes the nephrologist and other practitioners responsible for direct delivery of care to Program-eligible beneficiaries enrolled in the Organization involved.
 (III)Health risk and other assessments to determine the physical, psychosocial, nutrition, language, cultural, and other needs of Program-eligible beneficiaries enrolled in the Organization involved.
 (IV)Development and at least annual updating of individualized care plans that incorporate at least the medical, social, and functional needs, preferences, and care goals of Program-eligible beneficiaries enrolled in the Organization.
 (V)Coordination and delivery of non-clinical services, such as transportation, aimed at improving the adherence of Program-eligible beneficiaries enrolled in the Organization with care recommendations.
 (VI)Services, such as transplant evaluation, palliative care, evaluation for hospice eligibility, and vascular access care.
 (VII)In the case of an individual who, while enrolled in the Organization, receives confirmation that a kidney transplant is imminent, the provision by an interdisciplinary care team described in subclause (I) of counseling services to such individual on preparation for and potential challenges surrounding such transplant.
 (VIII)Delivery of benefits and services in alternative settings, such as the home of the Program-eligible beneficiary enrolled in the Organization, in coordination with the provider or other appropriate stakeholder involved in such delivery serving on an interdisciplinary care team described in subclause (I).
 (IX)Use of patient reminder systems. (X)Education programs for patients, families, and caregivers.
 (XI)Use of health care advice resources, such as nurse advice lines. (XII)Use of team-based health care delivery models that provide comprehensive and continuous medical care, such as medical homes.
 (XIII)Co-location of providers and services. (XIV)Use of a demonstrated capacity to share electronic health record information across sites of care.
 (XV)Use of programs to promote better adherence to recommended treatment regimens by individuals, including by addressing barriers to access to care by such individuals.
 (XVI)Defined protocols to facilitate the transition of pediatric patients into adult end stage renal disease care, developed in conjunction with the pediatric nephrology community.
 (XVII)Other services, strategies, and approaches identified by the Organization to improve care coordination and delivery.
 (iii)RequirementsThe Secretary may not approve an ESRD Integrated Care Strategy of an Organization unless under such Strategy the Organization—
 (I)provides services to Program-eligible beneficiaries enrolled in the Organization through a comprehensive, multidisciplinary health and social services delivery system which integrates acute and long-term care services pursuant to regulations;

											(II)
 specifies the covered items and services that will not be provided directly by the Organization, and to arrange for delivery of those items and services through contracts meeting the requirements of regulations; and
 (III)establishes a governing body that— (aa)consists of representation from each eligible participating provider of such Organization;
 (bb)includes at least one nephrologist who may be affiliated with a participating provider in the preferred network, at least one nephrologist in the open network, and at least one beneficiary advocate; and
 (cc)has responsibility for the oversight of the activities of the Organization. (3)Requirement for capital reserves (A)In generalThe Secretary shall enter into contracts under this section only with Organizations that demonstrate sufficient capital reserves, measured as a percentage of capitated payments and consistent with requirements established by the State in which the Organization operates.
 (B)Alternative mechanism to demonstrate capacity to bear riskAn Organization shall be considered to meet the requirement in subparagraph (A) if the Organization includes at least one eligible participating provider or eligible participating partner that—
 (i)is licensed as a risk-bearing entity or deemed by a State as able to bear risk; and (ii)chooses to bear risk as a condition of partnership in such Organization.
									(4)Beneficiary protections
 (A)Seamless access to careThe Secretary shall establish processes and take steps as necessary, including educating Medicare-certified providers and suppliers about the Program, to ensure that Program-eligible beneficiaries assigned into an open network model or who elect into a preferred network model offered by an Organization experience no disruption of access to Medicare-certified providers or suppliers furnishing items or services to such beneficiary immediately before such assignment or election and for purposes of receipt of such items or services. Assignment into an open network model or election into a preferred network model under the Program shall in no way be construed as affecting a Program-eligible beneficiary’s ability to receive covered benefits from any Medicare-certified provider or supplier as described in subsection (b)(2)(A).
 (B)Continuity of careTo provide for continuity of care, each contract entered into with an Organization under this section shall provide for a transition period during which a Program-eligible beneficiary who is first enrolled in the Organization or who elects to opt out of the Program or otherwise disenroll from the Organization maintains access to eligible participating providers furnishing items or services to such beneficiary immediately before such enrollment or election for purposes of receipt of such items or services. Payment for such items or services covered under this title furnished to such Program-eligible beneficiary during such transition period shall be made in accordance with this title and in such amounts as would otherwise be determined for such items and services provided to such a beneficiary not enrolled under the Program.
 (C)AntidiscriminationEach contract entered into with an Organization under this section shall provide that each eligible participating provider of such Organization may not deny, limit, or condition the furnishing of services, or affect the quality of services furnished, under this title to Program-eligible beneficiaries on whether or not such a beneficiary is enrolled with the Organization.
 (D)Quality assurance; patient safeguardsEach contract entered into with an Organization under this section shall require that such Organization have in effect at a minimum—
 (i)a written plan of quality assurance and improvement, and procedures implementing such plan, in accordance with regulations; and
 (ii)written safeguards of the rights of Program-eligible beneficiaries enrolled in the Organization (including a patient bill of rights and procedures for grievances and appeals) in accordance with regulations and with other requirements of this title and Federal and State law that are designed for the protection of patients.
 (E)OversightThe Secretary shall oversee the marketing and assignment practices of each Organization entering into a contract under this section as part of the approval and renewal processes of Organizations under this section.
 (5)Non-Application of certain provisions of lawFor purposes of sections 162(m)(6) and 414(m) of the Internal Revenue Code of 1986 and section 9010 of the Patient Protection and Affordable Care Act (26 U.S.C. 4001 note prec.), in the case of an eligible participating provider that establishes an Organization or that enters into a partnership, ownership, or co-ownership agreement to establish an Organization, or an Organization with a contract under this section, risk-based payments in exchange for providing medical care shall not be considered premiums for health insurance coverage.
 (6)Treatment as Medicare advanced alternative payment modelAlternative care delivery models under the Program shall be treated under this title as an advanced alternative payment model.
							(c)Program operation and scope
 (1)In generalNot later than one year after the date of enactment of this section, the Secretary shall establish a process through which an Organization can apply to offer one or more ESRD Integrated Care Models. Such application shall include information on at least the following:
 (A)The estimated average revenue amount described in subsection (b)(2)(A)(ii)(II) for the Organization to deliver benefits described in subsection (b)(2)(A).
 (B)Any benefits offered by the Organization beyond those described in such subsection. (C)A listing of network providers of services and supplier.
 (D)Information on the expertise of network providers of services and suppliers in serving ESRD patients.
 (E)A description of the ESRD Integrated Care Strategy of the Organization described in subsection (b)(2)(D).
 (2)Program initiationThe Secretary shall initiate the Program such that Organizations begin serving Program-eligible beneficiaries not later than January 1, 2018.
 (3)Contract award and periodThe Secretary shall enter into contracts for an initial period of not less than 5 years with all Organizations that meet Program requirements.
 (4)Allowance for larger service areas and expansion of service areasOrganizations shall demonstrate in their application that the proposed service area has the capacity to serve Program-eligible beneficiaries through an adequate provider network and is reflective of the communities in which beneficiaries live, work, and obtain health care services.
							(5)Contract termination and suspension
 (A)In generalThe Secretary may terminate a contract with an Organization under this section if the Secretary determines that an Organization has failed to meet quality requirements described in subsection (b) or (e)(2)(C)(iii) or violates other terms of the contract.
 (B)Insufficient beneficiary participationThe Secretary shall, in the case of an Organization with a contract under this section with respect to which, for any period of at least 30 consecutive days during a year for which such contract applies, fewer than 50 percent of the total number of Program-eligible beneficiaries served by the Organization receive benefits through the Organization under this section—
 (i)suspend such contract for the remainder of such year; and (ii)provide for the Organization to return any prospective payments made to the Organization under this section for items and services not provided pursuant to clause (i).
 (C)Remedy and appeals processPrior to the Secretary terminating or suspending a contract with an Organization under this section, the Secretary shall afford such Organization sufficient opportunity to remedy any contract violations and appeal a contract termination.
 (D)Program-eligible beneficiary Notice at Time of Contract TerminationEach contract under this section with an Organization shall require the Organization to provide (and pay for) written notice in advance of the contract’s termination or suspension, as well as a description of alternatives for obtaining benefits under this title, to each Program-eligible beneficiary assigned to or who elected to receive benefits through the Organization under this section.
 (6)Program expansionThe Secretary may, through rulemaking, expand the duration and scope of the Program under this section, to the extent determined appropriate by the Secretary, if—
 (A)the Secretary determines that such expansion is expected to— (i)reduce spending under this title without reducing the quality of patient care; or
 (ii)improve the quality of patient care without increasing spending under this title; (B)the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce (or would not result in any increase in) net program spending under this title; and
 (C)the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits under this title for applicable individuals.
 (7)StudyThe Secretary shall conduct a study on an appropriate payment adjustor under the Program to ensure there are not disincentives in under the payment method under the Program from providing proper transplant evaluations.
 (d)Identification of program-Eligible beneficiariesThe Secretary shall establish a process for the initial and ongoing identification of Program-eligible beneficiaries.
						(e)Program-Eligible Beneficiaries assigned Into an ESRD Integrated Care Organization Open Network
			 Model
							(1)Assignment
 (A)In generalUnder the Program, subject to the succeeding provisions of this paragraph, the Secretary shall, upon the Secretary identifying a beneficiary as a Program-eligible beneficiary, assign all such Program-eligible beneficiary to an open network model offered by an Organization that includes the dialysis facility at which the Program-eligible beneficiary primarily receives renal dialysis services.
								(B)Program-eligible beneficiary notification of assignment
 (i)In generalUpon assignment of a Program-eligible beneficiary to an Organization, the Secretary shall provide to the Organization written notification of such assignment of such Program-eligible beneficiary and not later than 15 business days after the date of receipt of such notification, the Organization shall provide written notice to the Program-eligible beneficiary—
 (I)of such assignment; and (II)including education regarding the importance of transplantation as the best health outcome, as well as the minimum health requirements for transplant eligibility before and during dialysis treatment.
 (ii)Opt-out period and changes upon initial assignmentThe Secretary shall provide for a 75-day period beginning on the date on which the assignment of a Program-eligible beneficiary into an open network model offered by an Organization becomes effective during which a Program-eligible beneficiary may—
 (I)opt out of the Program; (II)make a one-time change of assignment into an open network model offered by a different Organization; or
 (III)elect a preferred network model offered by the same or different Organization. (C)Additional opt-in population in case of beneficiary relocation or choiceAn individual who, without application of clause (iv) of subsection (a)(2)(C), would be treated as a Program-eligible beneficiary, may elect to enroll in an Organization under the Program under this section if such individual agrees to receive renal dialysis services primarily from a facility that participates in such Organization. For purposes of this section (other than subparagraphs (A) and (B) of this paragraph, paragraph (2), and subsection (d)), an individual making an election pursuant to the previous sentence shall be treated as a Program-eligible beneficiary.
 (D)Deemed re-enrollmentA Program-eligible beneficiary assigned under this paragraph to an ESRD Integrated Care Model offered by an Organization with respect to a year is deemed, unless the individual elects otherwise under this paragraph, to have elected to continue such assignment with respect to the subsequent year.
 (E)Additional opportunity to opt out or elect different model or organizationOn the date that is one year after the effective date of the initial assignment of a Program-eligible beneficiary to an open network model offered by an Organization (and annually thereafter), a Program-eligible beneficiary shall be given the opportunity to—
 (i)opt out of the Program; (ii)make a one-time change of assignment into an open network model offered by a different Organization; or
 (iii)elect a preferred network model offered by the same or different Organization. (F)Change in principal diagnosis opt outIn addition to any other period during which a Program-eligible beneficiary may, pursuant to this paragraph, opt out of the Program, in the case of a Program-eligible beneficiary who, after assignment under this paragraph, is diagnosed with a principal diagnosis (as defined by the Secretary) other than end-stage renal disease, such individual shall be given the opportunity to opt out of the Program during such period as specified by the Secretary.
 (G)Special election periodsThe Secretary shall offer Program-eligible beneficiaries special election periods consistent with those described in section 1851(e)(4).
								(2)Program-eligible beneficiary notification
 (A)In generalThe Secretary shall notify Program-eligible beneficiaries about the Program under this section and provide them with information about receiving benefits under this title through an Organization.
 (B)RequirementsNotwithstanding any other provision of law, subject to subparagraph (C), such notification shall allow for eligible participating providers that are part of an Organization to—
 (i)inform Program-eligible beneficiaries about the Program; (ii)distribute Program materials to Program-eligible beneficiaries; and
 (iii)assist Program-eligible beneficiaries in assessing the options of such beneficiaries under the Program.
									(C)Limitation on unsolicited marketing
 (i)In generalUnder the Program, an eligible participating provider may not provide marketing information or materials, including information, materials, and assistance described in subparagraph (B), to a Program-eligible beneficiary unless the Program-eligible beneficiary requests such marketing information or materials.
 (ii)Exception for providers treating beneficiariesAn eligible participating provider that is part of an Organization may provide information, materials, and assistance described in subparagraph (B) to a Program-eligible beneficiary, without prior request of such beneficiary, if such beneficiary is receiving renal dialysis services from such provider.
 (iii)Parity in marketingIn any case that an Organization participates in any form of marketing, such form of marketing shall be the same for all Program-eligible beneficiaries to which, pursuant to (ii), the Organization may provide information, materials, and assistance described in such clause.
 (3)Program-eligible beneficiary appeal rightsProgram-eligible beneficiaries enrolled in an Organization shall have the same right to appeal any denial of benefits under this title as such a Program-eligible beneficiary would have under this title if such Program-eligible beneficiary were not so enrolled.
							(f)Payment
 (1)In generalFor each Program-eligible beneficiary receiving care through an Organization, the Secretary shall make a monthly capitated payment in accordance with payment rates that would be determined under section 1853(a)(1)(H), as adjusted pursuant to paragraph (2).
 (2)Application of health status risk adjustment methodologyThe Secretary shall adjust the payment amount to an Organization under this subsection in the same manner in which the payment amount to a Medicare Advantage plan is adjusted under section 1853(a)(1)(C).
							(3)Treatment of kidney acquisition costs
 (A)Excluding costs for kidney acquisitions from ma benchmarkThe Secretary shall adjust the payment amount to an Organization to exclude from such payment amount the Secretary’s estimate of the standardized costs for payments for organ acquisitions for kidney transplants in the area involved for the year.
 (B)FFS converge of kidney acquisitionsAn Organization shall provide all benefits described in subclause (I) of subsection (b)(2)(A)(i), except for kidney acquisition costs. Payment for kidney acquisition costs covered under this title furnished to a Program-eligible beneficiary shall be made in accordance with this title and in such amounts as would otherwise be made and determined for such items and services provided to such a beneficiary not enrolled under the Program.
 (4)Payment for part D benefitsIn the case where an Organization elects to offer part D prescription drug coverage under the Program under this section, payments to the Organization for such benefits provided to Program-eligible beneficiaries by the Organization shall be made in the same manner and amounts as those payments would be made in the case of an organization with a contract under such part.
 (5)Agreement with State Medicaid AgencyIn the event of an Organization that elects to cover benefits under title XIX for Program-eligible beneficiaries eligible for benefits under this title and title XIX such Organization shall enter into an agreement with the State Medicaid agency to provide benefits, or arrange for benefits to be provided, for which such beneficiaries are entitled to receive medical assistance under title XIX and to receive payment from the State for providing or arranging for the provision of such benefits.
							(6)Affirmation of State obligations to pay premium and cost-sharing amounts
 (A)In generalA State shall continue to make medical assistance under the State plan under title XIX available in the amount described in subparagraph (B) for the duration of the Program for cost-sharing (as defined in section 1905(p)(3)) under this title for qualified medicare beneficiaries described in section 1905(p)(1) and other individuals who are Program-eligible beneficiaries enrolled in an Organization and entitled to medical assistance for premiums and such cost-sharing under the State plan under title XIX.
 (B)Amounts made available for cost-sharingFor purposes of subparagraph (A): (i)In generalSubject to clause (ii), the amount of medical assistance described in this clause to be made available for cost-sharing pursuant to subparagraph (A) for an individual described in such subparagraph entitled to medical assistance for such cost-sharing under a State plan under title XIX shall be equal to the amount of medical assistance that would be made available under such State plan as in effect as of January 1, 2016.
 (ii)Amounts in the case of a State that increases payments for cost-sharingIf a State increases the amount of medical assistance made available under the State plan under title XIX for cost-sharing described in subparagraph (A) after such date, such increased amounts shall be made available under subparagraph (A) for the remaining duration of the Program.
									(g)Waiver authority
 (1)In generalIn order to carry out the Program under this section, the Secretary shall waive those requirements waived under section 1899 and may waive such additional requirements consistent with those waived under programs administered through the Center for Medicare and Medicaid Innovation as may be necessary.
 (2)Notice of waiversNot later than 3 months after the date of enactment of this section, the Secretary shall publish a notice of waivers that will apply in connection with the Program. The notice shall include the specific conditions that an Organization must meet to qualify for each waiver, and commentary explaining the waiver requirements.
 (h)ReportNot later than December 31, 2024, the Medicare Payment Advisory Commission shall submit to Congress an interim report on the Program..
 (b)Conforming amendment relating to balanced billingSection 1866(a)(1)(O) of the Social Security Act (42 U.S.C. 1395cc(a)(1)(O)) is amended— (1)by inserting with an ESRD Integrated Care Organization under section 1866F, after with a PACE provider under section 1894 or 1934,;
 (2)by inserting or ESRD Integrated Care Organization after in the case of a PACE provider; (3)by striking or PACE program eligible individuals enrolled with the PACE provider and inserting , Program-eligible beneficiaries enrolled in the ESRD Integrated Care Organization, or PACE program eligible individuals enrolled with the PACE provider; and
 (4)by inserting (or in the case of a Program-eligible beneficiary enrolled in the ESRD Integrated Care Organization, the amounts that would be made in accordance with payment rates that would be determined under section 1853(a)(1)(H)) after the amounts that would be made.
				(c)Extension of guaranteed issue rights under Medigap
 (1)In generalSection 1882(s)(3)(B) of the Social Security Act (42 U.S.C. 1395ss(s)(3)(B)) is amended by adding at the end the following new clause:

 (vii)The individual is participating in the demonstration program established under section 1866F, regardless of the duration of the individual’s participation in the program and regardless of any previous enrollment in, or disenrollment from, a medicare supplemental policy under this section..
 (2)NotificationThe Secretary of Health and Human Services shall develop a process to notify (and shall notify) individuals described in clause (vii) of section 1882(s)(3)(B) of the Social Security Act (42 U.S.C. 1395ss(s)(3)(B)), as added by paragraph (1), of their guaranteed issue rights under such section.


		II
		111th CONGRESS
		1st Session
		S. 45
		IN THE SENATE OF THE UNITED STATES

			January 6, 2009
			Mr. Ensign (for himself,
			 Mr. McConnell, Mr. Gregg, Mr.
			 Cornyn, Mr. Burr,
			 Mr. Vitter, Mr.
			 Inhofe, Mr. Voinovich, and
			 Mr. Coburn) introduced the following
			 bill; which was read twice and referred to the
			 Committee on Health, Education, Labor,
			 and Pensions

		A BILL
		To improve patient access to health care services and
		  provide improved medical care by reducing the excessive burden the liability
		  system places on the health care delivery system.

		1.Short
			 titleThis Act may be cited as
			 the Medical Care Access Protection Act
			 of 2009 or the MCAP
			 Act.
		2.Findings and
			 purpose
			(a)Findings
				(1)Effect on
			 health care access and costsCongress finds that our current
			 civil justice system is adversely affecting patient access to health care
			 services, better patient care, and cost-efficient health care, in that the
			 health care liability system is a costly and ineffective mechanism for
			 resolving claims of health care liability and compensating injured patients,
			 and is a deterrent to the sharing of information among health care
			 professionals which impedes efforts to improve patient safety and quality of
			 care.
				(2)Effect on
			 interstate commerceCongress finds that the health care and
			 insurance industries are industries affecting interstate commerce and the
			 health care liability litigation systems existing throughout the United States
			 are activities that affect interstate commerce by contributing to the high
			 costs of health care and premiums for health care liability insurance purchased
			 by health care system providers.
				(3)Effect on
			 Federal spendingCongress finds that the health care liability
			 litigation systems existing throughout the United States have a significant
			 effect on the amount, distribution, and use of Federal funds because of—
					(A)the large number
			 of individuals who receive health care benefits under programs operated or
			 financed by the Federal Government;
					(B)the large number
			 of individuals who benefit because of the exclusion from Federal taxes of the
			 amounts spent to provide them with health insurance benefits; and
					(C)the large number
			 of health care providers who provide items or services for which the Federal
			 Government makes payments.
					(b)PurposeIt
			 is the purpose of this Act to implement reasonable, comprehensive, and
			 effective health care liability reforms designed to—
				(1)improve the
			 availability of health care services in cases in which health care liability
			 actions have been shown to be a factor in the decreased availability of
			 services;
				(2)reduce the
			 incidence of defensive medicine and lower the cost of health
			 care liability insurance, all of which contribute to the escalation of health
			 care costs;
				(3)ensure that
			 persons with meritorious health care injury claims receive fair and adequate
			 compensation, including reasonable noneconomic damages;
				(4)improve the
			 fairness and cost-effectiveness of our current health care liability system to
			 resolve disputes over, and provide compensation for, health care liability by
			 reducing uncertainty in the amount of compensation provided to injured
			 individuals; and
				(5)provide an
			 increased sharing of information in the health care system which will reduce
			 unintended injury and improve patient care.
				3.DefinitionsIn this Act:
			(1)Alternative
			 dispute resolution system; ADRThe term alternative dispute
			 resolution system or ADR means a system that provides for
			 the resolution of health care lawsuits in a manner other than through a civil
			 action brought in a State or Federal court.
			(2)ClaimantThe
			 term claimant means any person who brings a health care lawsuit,
			 including a person who asserts or claims a right to legal or equitable
			 contribution, indemnity or subrogation, arising out of a health care liability
			 claim or action, and any person on whose behalf such a claim is asserted or
			 such an action is brought, whether deceased, incompetent, or a minor.
			(3)Collateral
			 source benefitsThe term collateral source benefits
			 means any amount paid or reasonably likely to be paid in the future to or on
			 behalf of the claimant, or any service, product or other benefit provided or
			 reasonably likely to be provided in the future to or on behalf of the claimant,
			 as a result of the injury or wrongful death, pursuant to—
				(A)any State or
			 Federal health, sickness, income-disability, accident, or workers’ compensation
			 law;
				(B)any health,
			 sickness, income-disability, or accident insurance that provides health
			 benefits or income-disability coverage;
				(C)any contract or
			 agreement of any group, organization, partnership, or corporation to provide,
			 pay for, or reimburse the cost of medical, hospital, dental, or income
			 disability benefits; and
				(D)any other
			 publicly or privately funded program.
				(4)Compensatory
			 damagesThe term compensatory damages means
			 objectively verifiable monetary losses incurred as a result of the provision
			 of, use of, or payment for (or failure to provide, use, or pay for) health care
			 services or medical products, such as past and future medical expenses, loss of
			 past and future earnings, cost of obtaining domestic services, loss of
			 employment, and loss of business or employment opportunities, damages for
			 physical and emotional pain, suffering, inconvenience, physical impairment,
			 mental anguish, disfigurement, loss of enjoyment of life, loss of society and
			 companionship, loss of consortium (other than loss of domestic service),
			 hedonic damages, injury to reputation, and all other nonpecuniary losses of any
			 kind or nature. Such term includes economic damages and noneconomic damages, as
			 such terms are defined in this section.
			(5)Contingent
			 feeThe term contingent fee includes all
			 compensation to any person or persons which is payable only if a recovery is
			 effected on behalf of one or more claimants.
			(6)Economic
			 damagesThe term economic damages means objectively
			 verifiable monetary losses incurred as a result of the provision of, use of, or
			 payment for (or failure to provide, use, or pay for) health care services or
			 medical products, such as past and future medical expenses, loss of past and
			 future earnings, cost of obtaining domestic services, loss of employment, and
			 loss of business or employment opportunities.
			(7)Health care
			 goods or servicesThe term health care goods or
			 services means any goods or services provided by a health care
			 institution, provider, or by any individual working under the supervision of a
			 health care provider, that relates to the diagnosis, prevention, care, or
			 treatment of any human disease or impairment, or the assessment of the health
			 of human beings.
			(8)Health care
			 institutionThe term health care institution means
			 any entity licensed under Federal or State law to provide health care services
			 (including but not limited to ambulatory surgical centers, assisted living
			 facilities, emergency medical services providers, hospices, hospitals and
			 hospital systems, nursing homes, or other entities licensed to provide such
			 services).
			(9)Health care
			 lawsuitThe term health care lawsuit means any
			 health care liability claim concerning the provision of health care goods or
			 services affecting interstate commerce, or any health care liability action
			 concerning the provision of (or the failure to provide) health care goods or
			 services affecting interstate commerce, brought in a State or Federal court or
			 pursuant to an alternative dispute resolution system, against a health care
			 provider or a health care institution regardless of the theory of liability on
			 which the claim is based, or the number of claimants, plaintiffs, defendants,
			 or other parties, or the number of claims or causes of action, in which the
			 claimant alleges a health care liability claim.
			(10)Health care
			 liability actionThe term health care liability
			 action means a civil action brought in a State or Federal Court or
			 pursuant to an alternative dispute resolution system, against a health care
			 provider or a health care institution regardless of the theory of liability on
			 which the claim is based, or the number of plaintiffs, defendants, or other
			 parties, or the number of causes of action, in which the claimant alleges a
			 health care liability claim.
			(11)Health care
			 liability claimThe term health care liability claim
			 means a demand by any person, whether or not pursuant to ADR, against a health
			 care provider or health care institution, including third-party claims,
			 cross-claims, counter-claims, or contribution claims, which are based upon the
			 provision of, use of, or payment for (or the failure to provide, use, or pay
			 for) health care services, regardless of the theory of liability on which the
			 claim is based, or the number of plaintiffs, defendants, or other parties, or
			 the number of causes of action.
			(12)Health care
			 provider
				(A)In
			 generalThe term health care provider means any
			 person (including but not limited to a physician (as defined by section 1861(r)
			 of the Social Security Act (42 U.S.C. 1395x(r)), registered nurse, dentist,
			 podiatrist, pharmacist, chiropractor, or optometrist) required by State or
			 Federal law to be licensed, registered, or certified to provide health care
			 services, and being either so licensed, registered, or certified, or exempted
			 from such requirement by other statute or regulation.
				(B)Treatment of
			 certain professional associationsFor purposes of this Act, a
			 professional association that is organized under State law by an individual
			 physician or group of physicians, a partnership or limited liability
			 partnership formed by a group of physicians, a nonprofit health corporation
			 certified under State law, or a company formed by a group of physicians under
			 State law shall be treated as a health care provider under subparagraph
			 (A).
				(13)Malicious
			 intent to injureThe term malicious intent to injure
			 means intentionally causing or attempting to cause physical injury other than
			 providing health care goods or services.
			(14)Noneconomic
			 damagesThe term noneconomic damages means damages
			 for physical and emotional pain, suffering, inconvenience, physical impairment,
			 mental anguish, disfigurement, loss of enjoyment of life, loss of society and
			 companionship, loss of consortium (other than loss of domestic service),
			 hedonic damages, injury to reputation, and all other nonpecuniary losses of any
			 kind or nature.
			(15)Punitive
			 damagesThe term punitive damages means damages
			 awarded, for the purpose of punishment or deterrence, and not solely for
			 compensatory purposes, against a health care provider or health care
			 institution. Punitive damages are neither economic nor noneconomic
			 damages.
			(16)RecoveryThe
			 term recovery means the net sum recovered after deducting any
			 disbursements or costs incurred in connection with prosecution or settlement of
			 the claim, including all costs paid or advanced by any person. Costs of health
			 care incurred by the plaintiff and the attorneys’ office overhead costs or
			 charges for legal services are not deductible disbursements or costs for such
			 purpose.
			(17)StateThe
			 term State means each of the several States, the District of
			 Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American
			 Samoa, the Northern Mariana Islands, the Trust Territory of the Pacific
			 Islands, and any other territory or possession of the United States, or any
			 political subdivision thereof.
			4.Encouraging
			 speedy resolution of claims
			(a)In
			 generalExcept as otherwise provided for in this section, the
			 time for the commencement of a health care lawsuit shall be 3 years after the
			 date of manifestation of injury or 1 year after the claimant discovers, or
			 through the use of reasonable diligence should have discovered, the injury,
			 whichever occurs first.
			(b)General
			 exceptionThe time for the commencement of a health care lawsuit
			 shall not exceed 3 years after the date of manifestation of injury unless the
			 tolling of time was delayed as a result of—
				(1)fraud;
				(2)intentional
			 concealment; or
				(3)the presence of a
			 foreign body, which has no therapeutic or diagnostic purpose or effect, in the
			 person of the injured person.
				(c)MinorsAn
			 action by a minor shall be commenced within 3 years from the date of the
			 alleged manifestation of injury except that if such minor is under the full age
			 of 6 years, such action shall be commenced within 3 years of the manifestation
			 of injury, or prior to the eighth birthday of the minor, whichever provides a
			 longer period. Such time limitation shall be tolled for minors for any period
			 during which a parent or guardian and a health care provider or health care
			 institution have committed fraud or collusion in the failure to bring an action
			 on behalf of the injured minor.
			(d)Rule 11
			 sanctionsWhenever a Federal or State court determines (whether
			 by motion of the parties or whether on the motion of the court) that there has
			 been a violation of Rule 11 of the Federal Rules of Civil Procedure (or a
			 similar violation of applicable State court rules) in a health care liability
			 action to which this Act applies, the court shall impose upon the attorneys,
			 law firms, or pro se litigants that have violated Rule 11 or are responsible
			 for the violation, an appropriate sanction, which shall include an order to pay
			 the other party or parties for the reasonable expenses incurred as a direct
			 result of the filing of the pleading, motion, or other paper that is the
			 subject of the violation, including a reasonable attorneys' fee. Such sanction
			 shall be sufficient to deter repetition of such conduct or comparable conduct
			 by others similarly situated, and to compensate the party or parties injured by
			 such conduct.
			5.Compensating
			 patient injury
			(a)Unlimited
			 amount of damages for actual economic losses in health care
			 lawsuitsIn any health care lawsuit, nothing in this Act shall
			 limit the recovery by a claimant of the full amount of the available economic
			 damages, notwithstanding the limitation contained in subsection (b).
			(b)Additional
			 noneconomic damages
				(1)Health care
			 providersIn any health care lawsuit where final judgment is
			 rendered against a health care provider, the amount of noneconomic damages
			 recovered from the provider, if otherwise available under applicable Federal or
			 State law, may be as much as $250,000, regardless of the number of parties
			 other than a health care institution against whom the action is brought or the
			 number of separate claims or actions brought with respect to the same
			 occurrence.
				(2)Health care
			 institutions
					(A)Single
			 institutionIn any health care lawsuit where final judgment is
			 rendered against a single health care institution, the amount of noneconomic
			 damages recovered from the institution, if otherwise available under applicable
			 Federal or State law, may be as much as $250,000, regardless of the number of
			 parties against whom the action is brought or the number of separate claims or
			 actions brought with respect to the same occurrence.
					(B)Multiple
			 institutionsIn any health care lawsuit where final judgment is
			 rendered against more than one health care institution, the amount of
			 noneconomic damages recovered from each institution, if otherwise available
			 under applicable Federal or State law, may be as much as $250,000, regardless
			 of the number of parties against whom the action is brought or the number of
			 separate claims or actions brought with respect to the same occurrence, except
			 that the total amount recovered from all such institutions in such lawsuit
			 shall not exceed $500,000.
					(c)No discount of
			 award for noneconomic damagesIn any health care lawsuit—
				(1)an award for
			 future noneconomic damages shall not be discounted to present value;
				(2)the jury shall
			 not be informed about the maximum award for noneconomic damages under
			 subsection (b);
				(3)an award for
			 noneconomic damages in excess of the limitations provided for in subsection (b)
			 shall be reduced either before the entry of judgment, or by amendment of the
			 judgment after entry of judgment, and such reduction shall be made before
			 accounting for any other reduction in damages required by law; and
				(4)if separate
			 awards are rendered for past and future noneconomic damages and the combined
			 awards exceed the limitations described in subsection (b), the future
			 noneconomic damages shall be reduced first.
				(d)Fair share
			 ruleIn any health care lawsuit, each party shall be liable for
			 that party’s several share of any damages only and not for the share of any
			 other person. Each party shall be liable only for the amount of damages
			 allocated to such party in direct proportion to such party’s percentage of
			 responsibility. A separate judgment shall be rendered against each such party
			 for the amount allocated to such party. For purposes of this section, the trier
			 of fact shall determine the proportion of responsibility of each party for the
			 claimant’s harm.
			6.Maximizing
			 patient recovery
			(a)Court
			 supervision of share of damages actually paid to claimants
				(1)In
			 generalIn any health care lawsuit, the court shall supervise the
			 arrangements for payment of damages to protect against conflicts of interest
			 that may have the effect of reducing the amount of damages awarded that are
			 actually paid to claimants.
				(2)Contingency
			 fees
					(A)In
			 generalIn any health care lawsuit in which the attorney for a
			 party claims a financial stake in the outcome by virtue of a contingent fee,
			 the court shall have the power to restrict the payment of a claimant’s damage
			 recovery to such attorney, and to redirect such damages to the claimant based
			 upon the interests of justice and principles of equity.
					(B)LimitationThe
			 total of all contingent fees for representing all claimants in a health care
			 lawsuit shall not exceed the following limits:
						(i)40
			 percent of the first $50,000 recovered by the claimant(s).
						(ii)331/3
			 percent of the next $50,000 recovered by the claimant(s).
						(iii)25 percent of
			 the next $500,000 recovered by the claimant(s).
						(iv)15
			 percent of any amount by which the recovery by the claimant(s) is in excess of
			 $600,000.
						(b)Applicability
				(1)In
			 generalThe limitations in subsection (a) shall apply whether the
			 recovery is by judgment, settlement, mediation, arbitration, or any other form
			 of alternative dispute resolution.
				(2)MinorsIn
			 a health care lawsuit involving a minor or incompetent person, a court retains
			 the authority to authorize or approve a fee that is less than the maximum
			 permitted under this section.
				(c)Expert
			 witnesses
				(1)RequirementNo
			 individual shall be qualified to testify as an expert witness concerning issues
			 of negligence in any health care lawsuit against a defendant unless such
			 individual—
					(A)except as
			 required under paragraph (2), is a health care professional who—
						(i)is
			 appropriately credentialed or licensed in 1 or more States to deliver health
			 care services; and
						(ii)typically treats
			 the diagnosis or condition or provides the type of treatment under review;
			 and
						(B)can demonstrate
			 by competent evidence that, as a result of training, education, knowledge, and
			 experience in the evaluation, diagnosis, and treatment of the disease or injury
			 which is the subject matter of the lawsuit against the defendant, the
			 individual was substantially familiar with applicable standards of care and
			 practice as they relate to the act or omission which is the subject of the
			 lawsuit on the date of the incident.
					(2)Physician
			 reviewIn a health care lawsuit, if the claim of the plaintiff
			 involved treatment that is recommended or provided by a physician (allopathic
			 or osteopathic), an individual shall not be qualified to be an expert witness
			 under this subsection with respect to issues of negligence concerning such
			 treatment unless such individual is a physician.
				(3)Specialties and
			 subspecialtiesWith respect to a lawsuit described in paragraph
			 (1), a court shall not permit an expert in one medical specialty or
			 subspecialty to testify against a defendant in another medical specialty or
			 subspecialty unless, in addition to a showing of substantial familiarity in
			 accordance with paragraph (1)(B), there is a showing that the standards of care
			 and practice in the two specialty or subspecialty fields are similar.
				(4)LimitationThe
			 limitations in this subsection shall not apply to expert witnesses testifying
			 as to the degree or permanency of medical or physical impairment.
				7.Additional
			 health benefits
			(a)In
			 generalThe amount of any damages received by a claimant in any
			 health care lawsuit shall be reduced by the court by the amount of any
			 collateral source benefits to which the claimant is entitled, less any
			 insurance premiums or other payments made by the claimant (or by the spouse,
			 parent, child, or legal guardian of the claimant) to obtain or secure such
			 benefits.
			(b)Preservation of
			 current lawWhere a payor of collateral source benefits has a
			 right of recovery by reimbursement or subrogation and such right is permitted
			 under Federal or State law, subsection (a) shall not apply.
			(c)Application of
			 provisionThis section shall apply to any health care lawsuit
			 that is settled or resolved by a fact finder.
			8.Punitive
			 damages
			(a)Punitive
			 damages permitted
				(1)In
			 generalPunitive damages may, if otherwise available under
			 applicable State or Federal law, be awarded against any person in a health care
			 lawsuit only if it is proven by clear and convincing evidence that such person
			 acted with malicious intent to injure the claimant, or that such person
			 deliberately failed to avoid unnecessary injury that such person knew the
			 claimant was substantially certain to suffer.
				(2)Filing of
			 lawsuitNo demand for punitive damages shall be included in a
			 health care lawsuit as initially filed. A court may allow a claimant to file an
			 amended pleading for punitive damages only upon a motion by the claimant and
			 after a finding by the court, upon review of supporting and opposing affidavits
			 or after a hearing, after weighing the evidence, that the claimant has
			 established by a substantial probability that the claimant will prevail on the
			 claim for punitive damages.
				(3)Separate
			 proceedingAt the request of any party in a health care lawsuit,
			 the trier of fact shall consider in a separate proceeding—
					(A)whether punitive
			 damages are to be awarded and the amount of such award; and
					(B)the amount of
			 punitive damages following a determination of punitive liability.
					If a
			 separate proceeding is requested, evidence relevant only to the claim for
			 punitive damages, as determined by applicable State law, shall be inadmissible
			 in any proceeding to determine whether compensatory damages are to be
			 awarded.(4)Limitation
			 where no compensatory damages are awardedIn any health care
			 lawsuit where no judgment for compensatory damages is rendered against a
			 person, no punitive damages may be awarded with respect to the claim in such
			 lawsuit against such person.
				(b)Determining
			 amount of punitive damages
				(1)Factors
			 consideredIn determining the amount of punitive damages under
			 this section, the trier of fact shall consider only the following:
					(A)the severity of
			 the harm caused by the conduct of such party;
					(B)the duration of
			 the conduct or any concealment of it by such party;
					(C)the profitability
			 of the conduct to such party;
					(D)the number of
			 products sold or medical procedures rendered for compensation, as the case may
			 be, by such party, of the kind causing the harm complained of by the
			 claimant;
					(E)any criminal
			 penalties imposed on such party, as a result of the conduct complained of by
			 the claimant; and
					(F)the amount of any
			 civil fines assessed against such party as a result of the conduct complained
			 of by the claimant.
					(2)Maximum
			 awardThe amount of punitive damages awarded in a health care
			 lawsuit may not exceed an amount equal to two times the amount of economic
			 damages awarded in the lawsuit or $250,000, whichever is greater. The jury
			 shall not be informed of the limitation under the preceding sentence.
				(c)Liability of
			 health care providers
				(1)In
			 generalA health care
			 provider who prescribes, or who dispenses pursuant to a prescription, a drug,
			 biological product, or medical device approved by the Food and Drug
			 Administration, for an approved indication of the drug, biological product, or
			 medical device, shall not be named as a party to a product liability lawsuit
			 invoking such drug, biological product, or medical device and shall not be
			 liable to a claimant in a class action lawsuit against the manufacturer,
			 distributor, or product seller of such drug, biological product, or medical
			 device.
				(2)Medical
			 productThe term medical product means a drug or
			 device intended for humans. The terms drug and device
			 have the meanings given such terms in sections 201(g)(1) and 201(h) of the
			 Federal Food, Drug and Cosmetic Act (21 U.S.C. 321), respectively,
			 including any component or raw material used therein, but excluding health care
			 services.
				9.Authorization of
			 payment of future damages to claimants in health care lawsuits
			(a)In
			 generalIn any health care lawsuit, if an award of future
			 damages, without reduction to present value, equaling or exceeding $50,000 is
			 made against a party with sufficient insurance or other assets to fund a
			 periodic payment of such a judgment, the court shall, at the request of any
			 party, enter a judgment ordering that the future damages be paid by periodic
			 payments in accordance with the Uniform Periodic Payment of Judgments Act
			 promulgated by the National Conference of Commissioners on Uniform State
			 Laws.
			(b)ApplicabilityThis
			 section applies to all actions which have not been first set for trial or
			 retrial before the effective date of this Act.
			10.Effect on other
			 laws
			(a)General vaccine
			 injury
				(1)In
			 generalTo the extent that title XXI of the
			 Public Health Service Act establishes
			 a Federal rule of law applicable to a civil action brought for a
			 vaccine-related injury or death—
					(A)this Act shall
			 not affect the application of the rule of law to such an action; and
					(B)any rule of law
			 prescribed by this Act in conflict with a rule of law of such title XXI shall
			 not apply to such action.
					(2)ExceptionIf
			 there is an aspect of a civil action brought for a vaccine-related injury or
			 death to which a Federal rule of law under title XXI of the
			 Public Health Service Act does not
			 apply, then this Act or otherwise applicable law (as determined under this Act)
			 will apply to such aspect of such action.
				(b)Smallpox
			 vaccine injury
				(1)In
			 generalTo the extent that part C of title II of the
			 Public Health Service Act establishes
			 a Federal rule of law applicable to a civil action brought for a smallpox
			 vaccine-related injury or death—
					(A)this Act shall
			 not affect the application of the rule of law to such an action; and
					(B)any rule of law
			 prescribed by this Act in conflict with a rule of law of such part C shall not
			 apply to such action.
					(2)ExceptionIf
			 there is an aspect of a civil action brought for a smallpox vaccine-related
			 injury or death to which a Federal rule of law under part C of title II of the
			 Public Health Service Act does not
			 apply, then this Act or otherwise applicable law (as determined under this Act)
			 will apply to such aspect of such action.
				(c)Other Federal
			 lawExcept as provided in this section, nothing in this Act shall
			 be deemed to affect any defense available, or any limitation on liability that
			 applies to, a defendant in a health care lawsuit or action under any other
			 provision of Federal law.
			11.State
			 flexibility and protection of states’ rights
			(a)Health care
			 lawsuitsThe provisions governing health care lawsuits set forth
			 in this Act shall preempt, subject to subsections (b) and (c), State law to the
			 extent that State law prevents the application of any provisions of law
			 established by or under this Act. The provisions governing health care lawsuits
			 set forth in this Act supersede chapter 171 of title 28, United States Code, to
			 the extent that such chapter—
				(1)provides for a
			 greater amount of damages or contingent fees, a longer period in which a health
			 care lawsuit may be commenced, or a reduced applicability or scope of periodic
			 payment of future damages, than provided in this Act; or
				(2)prohibits the
			 introduction of evidence regarding collateral source benefits.
				(b)Preemption of
			 certain State lawsNo provision of this Act shall be construed to
			 preempt any State law (whether effective before, on, or after the date of the
			 enactment of this Act) that specifies a particular monetary amount of
			 compensatory or punitive damages (or the total amount of damages) that may be
			 awarded in a health care lawsuit, regardless of whether such monetary amount is
			 greater or lesser than is provided for under this Act, notwithstanding section
			 5(a).
			(c)Protection of
			 state’s rights and other laws
				(1)In
			 generalAny issue that is not governed by a provision of law
			 established by or under this Act (including the State standards of negligence)
			 shall be governed by otherwise applicable Federal or State law.
				(2)Rule of
			 constructionNothing in this Act shall be construed to—
					(A)preempt or
			 supersede any Federal or State law that imposes greater procedural or
			 substantive protections (such as a shorter statute of limitations) for a health
			 care provider or health care institution from liability, loss, or damages than
			 those provided by this Act;
					(B)preempt or
			 supercede any State law that permits and provides for the enforcement of any
			 arbitration agreement related to a health care liability claim whether enacted
			 prior to or after the date of enactment of this Act;
					(C)create a cause of
			 action that is not otherwise available under Federal or State law; or
					(D)affect the scope
			 of preemption of any other Federal law.
					12.Applicability;
			 effective dateThis Act shall
			 apply to any health care lawsuit brought in a Federal or State court, or
			 subject to an alternative dispute resolution system, that is initiated on or
			 after the date of the enactment of this Act, except that any health care
			 lawsuit arising from an injury occurring prior to the date of enactment of this
			 Act shall be governed by the applicable statute of limitations provisions in
			 effect at the time the injury occurred.


116 S30 IS: Chiropractic Health Parity for Military Beneficiaries Act
U.S. Senate
2019-01-08
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II116th CONGRESS1st SessionS. 30IN THE SENATE OF THE UNITED STATESJanuary 8, 2019Ms. Baldwin (for herself, Mr. Moran, and Ms. Klobuchar) introduced the following bill; which was read twice and referred to the Committee on Armed ServicesA BILLTo require the Secretary of Defense to develop and implement a plan to provide chiropractic health
			 care services for certain covered beneficiaries as part of the TRICARE
			 program.

 1.Short titleThis Act may be cited as the Chiropractic Health Parity for Military Beneficiaries Act. 2.Chiropractic health care services from the Department of Defense for certain covered beneficiaries (a)Plan requiredNot later than 30 days after the date of the enactment of this Act, the Secretary of Defense shall complete development of a plan to provide chiropractic health care services and benefits for eligible covered beneficiaries as a permanent part of the TRICARE program.
 (b)Contents of planThe plan developed under subsection (a) shall require that a contract entered into under section 1097 of title 10, United States Code, for the delivery of health care services shall—
 (1)include the delivery of chiropractic services to eligible covered beneficiaries; (2)require that chiropractic services may be provided only by a doctor of chiropractic; and
 (3)provide that an eligible covered beneficiary may select and have direct access to a doctor of chiropractic without referral by another health practitioner.
 (c)Implementation of planThe plan developed under subsection (a) shall provide for implementation of the plan to begin not later than 60 days after the date on which the plan is completed.
 (d)DefinitionsIn this section: (1)The term chiropractic services—
 (A)includes diagnosis (including by diagnostic x-ray tests), evaluation and management, and therapeutic services for the treatment of a patient's health condition, including neuromusculoskeletal conditions and the subluxation complex, and such other services determined appropriate by the Secretary of Defense and as authorized under State law; and
 (B)does not include the use of drugs or surgery. (2)The term covered beneficiary has the meaning given that term in section 1072(5) of title 10, United States Code.
 (3)The term eligible covered beneficiary means a covered beneficiary excluding a dependent of a member or former member of a uniformed service.
 (4)The term dependent has the meaning given that term in section 1072(2) of title 10, United States Code. (5)The term doctor of chiropractic means only a doctor of chiropractic who is licensed as a doctor of chiropractic, chiropractic physician, or chiropractor by a State, the District of Columbia, or a territory or possession of the United States.
 (6)The term TRICARE program has the meaning given that term in section 1072(7) of title 10, United States Code.


115 HR 1838 IH: Ambulatory Surgical Center Quality and Access Act of 2017
U.S. House of Representatives
2017-03-30
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I115th CONGRESS1st SessionH. R. 1838IN THE HOUSE OF REPRESENTATIVESMarch 30, 2017Mr. Nunes (for himself, Mr. Larson of Connecticut, Mr. Stewart, Mr. Schweikert, Mr. Garamendi, Mr. Smith of Washington, Mrs. Blackburn, Mr. Lamborn, Mr. Veasey, Mr. Tipton, Mr. Young of Alaska, Mr. Sessions, Mr. Roe of Tennessee, Mrs. Walorski, Mr. Norcross, Mr. Pascrell, Mr. Bucshon, Mr. Hensarling, Ms. Sánchez, Mr. Lance, Mr. Stivers, Mr. Swalwell of California, Mr. David Scott of Georgia, Ms. Jenkins of Kansas, Mr. Loebsack, Mr. Kildee, Mr. Peters, Mr. Farenthold, and Mr. Sam Johnson of Texas) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such
			 provisions as fall within the jurisdiction of the committee concernedA BILLTo amend title XVIII of the Social Security Act to modernize payments for ambulatory surgical
			 centers under the Medicare program, and for other purposes.

 1.Short titleThis Act may be cited as the Ambulatory Surgical Center Quality and Access Act of 2017. 2.Aligning updates for ambulatory surgical center services with updates for OPD servicesSection 1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is amended—
 (1)in clause (v)— (A)in the first sentence, by inserting before the period the following: and, in the case of 2018 or a subsequent year, by the adjustment described in subsection (t)(3)(G) for the respective year; and
 (B)by moving the margin 6 ems to the left; (2)by redesignating clause (vi) as clause (vii); and
 (3)by inserting after clause (v) the following new clause:  (vi)In implementing the system described in clause (i) for 2018 and each subsequent year, there shall be an annual update under such system for the year equal to the OPD fee schedule increase factor specified under subsection (t)(3)(C)(iv) for such year, adjusted in accordance with clauses (iv) and (v)..
 3.Transparency of quality reporting and Medicare beneficiary informationParagraph (7) of section 1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the following new subparagraphs:

 (C)To the extent that quality measures implemented by the Secretary under this paragraph for ambulatory surgical centers and under section 1833(t)(17) for hospital outpatient departments are applicable to the provision of surgical services in both ambulatory surgical centers and hospital outpatient departments, the Secretary shall make reported data on such centers and departments available on the website Medicare.gov in a manner that will permit side-by-side comparisons on such measures for ambulatory surgical centers and hospital outpatient departments in the same geographic area.
 (D)The Secretary shall ensure that an ambulatory surgery center and a hospital has the opportunity to review, and submit any corrections for, the data to be made public with respect to the ambulatory surgery center under subparagraph (C) prior to such data being made public.
 (E)The Secretary shall develop materials and inform beneficiaries under this title of publicly available comparisons provided for in subparagraph (C)..
		4.Advisory Panel on Hospital Outpatient Payment Representation
 (a)ASC representativeThe second sentence of section 1833(t)(9)(A) of the Social Security Act (42 U.S.C. 1395l(t)(9)(A)) is amended by inserting and suppliers subject to the prospective payment system (including at least one ambulatory surgical center representative) after an appropriate selection of representatives of providers.
 (b)Effective dateThe amendment made by subsection (a) shall take effect on the date of the enactment of this Act. 5.Reasons for excluding additional procedures from ASC approved list (a)In generalSection 1833(i)(1) of the Social Security Act (42 U.S.C. 1395l(i)(1)) is amended by adding at the end the following: In updating such lists for application in years beginning after the date of the enactment of this sentence, for each procedure that was requested to be included in such lists during the public comment period but which the Secretary does not propose (in the final rule updating such lists) to so include in such lists, Secretary shall cite in such final rule the specific criteria in paragraph (b) or (c) of section 416.166 of title 42, Code of Federal Regulations, based on which the procedure was excluded. If paragraph (b) of such section is cited for exclusion of a procedure, the Secretary shall identify the peer reviewed research or the evidence upon which such determination is based. The Secretary may not use or cite section 416.166(c)(7) of such title as criteria or a basis for exclusion of a procedure from such lists..
 (b)Effective dateThe amendment made by subsection (a) shall apply to lists of ambulatory surgery procedures for application in years beginning after the date of the enactment of this Act.


109 HR 4035 IH: Economic Relief for Gulf Coast Families and Businesses Act
U.S. House of Representatives
2005-10-07
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
109th CONGRESS 1st Session
H. R. 4035
IN THE HOUSE OF REPRESENTATIVES

October 7, 2005
Mr. Garrett of New Jersey introduced the following bill; which was referred to the Committee on Ways and Means

A BILL
To amend the Internal Revenue Code of 1986 to eliminate capital gains taxes on investments in the Hurricane Katrina disaster area to reduce the estate tax for victims of Hurricane Katrina.

1.Short titleThis Act may be cited as the Economic Relief for Gulf Coast Families and Businesses Act.
2.Tax benefits related to Hurricane Katrina disaster area
(a)In generalSubchapter Y of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

1400M.Tax benefits related to Hurricane Katrina disaster area
(a)Zero percent capital gains rate
(1)ExclusionGross income shall not include qualified capital gain from the sale or exchange of any Katrina Zone asset held for more than 5 years.
(2)Katrina ZoneFor purposes of this subsection, the term Katrina Zone asset means—
(A)any Katrina Zone business stock,
(B)any Katrina Zone partnership interest, and
(C)any Katrina Zone business property.
(3)Katrina Zone business stockFor purposes of this subsection—
(A)In generalThe term Katrina Zone business stock means any stock in a domestic corporation which is originally issued after August 28, 2005, if—
(i)such stock is acquired by the taxpayer, before January 1, 2007, at its original issue (directly or through an underwriter) solely in exchange for cash,
(ii)as of the time such stock was issued, such corporation was a Katrina Zone business (or, in the case of a new corporation, such corporation was being organized for purposes of being a Katrina Zone business), and
(iii)during substantially all of the taxpayer’s holding period for such stock, such corporation qualified as a Katrina Zone business.
(B)RedemptionsA rule similar to the rule of section 1202(c)(3) shall apply for purposes of this paragraph.
(4)Katrina Zone partnership interestFor purposes of this subsection, the term Katrina Zone partnership interest means any capital or profits interest in a domestic partnership which is originally issued after August 28, 2005, if—
(A)such interest is acquired by the taxpayer, before January 1, 2007, from the partnership solely in exchange for cash,
(B)as of the time such interest was acquired, such partnership was a Katrina Zone business (or, in the case of a new partnership, such partnership was being organized for purposes of being a Katrina Zone business), and
(C)during substantially all of the taxpayer’s holding period for such interest, such partnership qualified as a Katrina Zone business. A rule similar to the rule of subparagraph (B)(ii) shall apply for purposes of this paragraph.
(5)Katrina Zone business propertyFor purposes of this subsection—
(A)In generalThe term Katrina Zone business property means tangible property if—
(i)such property was acquired by the taxpayer by purchase (as defined in section 179(d)(2)) after August 28, 2005, and before January 1, 2007,
(ii)the original use of such property in the Katrina Zone commences with the taxpayer, and
(iii)during substantially all of the taxpayer’s holding period for such property, substantially all of the use of such property was in a Katrina Zone business of the taxpayer.
(B)Special rule for buildings which are substantially improved
(i)In generalThe requirements of clauses (i) and (ii) of subparagraph (A) shall be treated as met with respect to—
(I)property which is substantially improved by the taxpayer before January 1, 2007, and
(II)any land on which such property is located.
(ii)Substantial improvementFor purposes of clause (i), property shall be treated as substantially improved by the taxpayer only if, during any 24-month period beginning after August 28, 2005, additions to basis with respect to such property in the hands of the taxpayer exceed the greater of—
(I)an amount equal to the adjusted basis of such property at the beginning of such 24-month period in the hands of the taxpayer, or
(II)$5,000.
(6)Katrina Zone businessFor purposes of this subsection, the term Katrina Zone business means any corporation, partnership, or business which would be an enterprise zone business (as defined in section 1397C) if such section were applied by substituting Katrina Zone for empowerment zone each place it appears.
(7)Special rules related to Katrina Zone assetsFor purposes of this subsection—
(A)Treatment of subsequent purchasers, etcFor purposes of this subsection, the term Katrina Zone asset includes any property which would be a Katrina Zone asset but for paragraph (3)(A)(i), (4)(A), or (5)(A)(i) or (ii) in the hands of the taxpayer if such property was a Katrina Zone asset in the hands of a prior holder.
(B)5-year safe harborIf any property ceases to be a Katrina Zone asset by reason of paragraph (3)(A)(iii), (4)(C), or (5)(A)(iii) after the 5-year period beginning on the date the taxpayer acquired such property, such property shall continue to be treated as meeting the requirements of such paragraph; except that the amount of gain to which paragraph (1) applies on any sale or exchange of such property shall not exceed the amount which would be qualified capital gain had such property been sold on the date of such cessation.
(8)Qualified capital gainFor purposes of this subsection—
(A)In generalExcept as otherwise provided in this paragraph, the term qualified capital gain means any gain recognized on the sale or exchange of—
(i)a capital asset, or
(ii)property used in the trade or business (as defined in section 1231(b).
(B)Gain before Hurricane or after 2011 not qualifiedThe term qualified capital gain shall not include any gain attributable to periods before August 29, 2005, or after December 31, 2011.
(C)Certain ordinary income gain not qualifiedThe term qualified capital gain shall not include any gain which would be treated as ordinary income under section 1245 or under section 1250 if section 1250 applied to all depreciation rather than the additional depreciation.
(D)Intangibles and land not integral part of Katrina Zone businessThe term qualified capital gain shall not include any gain which is attributable to real property, or an intangible asset, which is not an integral part of a Katrina Zone business.
(E)Related party transactionsThe term qualified capital gain shall not include any gain attributable, directly or indirectly, in whole or in part, to a transaction with a related person. For purposes of this subparagraph, persons are related to each other if such persons are described in section 267(b) or 707(b)(1).
(9)Certain other rules to applyRules similar to the rules of subsections (g), (h), (i)(2), and (j) of section 1202 shall apply for purposes of this subsection.
(10)Sales and exchanges of interests in partnerships and S corporations which are Katrina Zone businessesIn the case of the sale or exchange of an interest in a partnership, or of stock in an S corporation, which was a Katrina Zone business during substantially all of the period the taxpayer held such interest or stock, the amount of qualified capital gain shall be determined without regard to—
(A)any gain which is attributable to real property, or an intangible asset, which is not an integral part of a Katrina Zone business, and
(B)any gain attributable to periods before August 29, 2005, or after December 31, 2011.
(b)Estate tax reduction for Hurricane Katrina victims
(1)In general For purposes of this title, a Hurricane Katrina victim shall be treated as a qualified decedent within the meaning of section 2201(b).
(2)Hurricane Katrina victimFor purposes of this section, the term Hurricane Katrina victim means any decedent who dies after August 28, 2005, as a result of wounds or injuries incurred in the Katrina Zone as a result of Hurricane Katrina.
(c)Katrina ZoneFor purposes of this section, the term Katrina Zone means an area determined by the President to warrant individual or individual and public assistance from the Federal Government under the Robert T. Stafford Disaster Relief and Emergency Assistance Act by reason of Hurricane Katrina..
(b)Conforming amendments
(1)The heading for subchapter Y of chapter 1 of such Code is amended to read as follows:

YShort-term regional benefits.
(2)The table of sections for such subchapter is amended by adding at the end the following new item:

Sec. 1400M. Tax benefits related to Hurricane Katrina disaster area .


115 HR 2747 IH: Economic Growth and Development Act
U.S. House of Representatives
2017-05-25
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I115th CONGRESS1st SessionH. R. 2747IN THE HOUSE OF REPRESENTATIVESMay 25, 2017Mr. Yoho (for himself, Mr. Smith of Washington, Mr. Kinzinger, Mr. Rush, Mr. Thomas J. Rooney of Florida, Mr. Ellison, and Mr. Polis) introduced the following bill; which was referred to the Committee on Foreign AffairsA BILLTo catalyze market-based economic growth in developing countries, create opportunities for the
			 private sector of the United States to effectively engage in foreign
			 assistance programs, improve planning and coordination among relevant
			 United States departments and agencies, and for other purposes.

 1.Short titleThis Act may be cited as the Economic Growth and Development Act. 2.Sense of Congress on United States development assistanceIt is the sense of Congress that—
 (1)United States development assistance— (A)is most effective in countries with governments that demonstrate a commitment to the rule of law, human rights, investing in their own people, combating corruption, and creating a policy environment and legal framework that enables trade, investment, and enduring economic growth;
 (B)is most likely to produce sustainable results when it aligns with the development priorities of the recipient country, creates opportunities for growth lead by the private sector, and complements rather than replacing government investments in priority sectors through a transparent and accountable system of domestic resource mobilization;
 (C)should be guided by a unified strategy, ambitious targets, and robust monitoring and evaluation to ensure that it is efficient, effective, and results-oriented;
 (D)should be targeted in recipient countries in a manner that— (i)advances the rule of law;
 (ii)builds and strengthens civic institutions and trade capacity; (iii)addresses binding constraints to market-based economic growth;
 (iv)catalyzes private sector investment in key development areas, such as utilities, infrastructure, agriculture, health, and education;
 (v)promotes transparency and accountability among donors, governments, and citizens; and (vi)places recipient countries on a trajectory toward graduation from foreign assistance; and
 (E)should prioritize and better coordinate resources that support enhanced trade capacity and facilitate fairer and more sustainable trade with partner countries; and
 (2)United States development finance programs, which mobilize private capital to achieve development objectives and may soon outpace traditional grant-based assistance programs in terms of total capital investments, should—
 (A)be appropriately leveraged to complement, rather than replace, other forms of private capital; (B)drive inclusive, enduring economic growth; and
 (C)have stability and predictability by being provided a multi-year authorization. 3.Interagency mechanism to coordinate United States development programs and private sector investment (a)In generalThe President shall establish a primary interagency mechanism to coordinate United States development assistance programs carried out by Federal departments and agencies engaged in planning or providing such assistance overseas with the investment activities of the private sector.
 (b)DutiesThe interagency mechanism established under subsection (a) shall— (1)streamline the private-sector liaison, coordination, and investment promotion functions of such Federal departments and agencies;
 (2)facilitate the use of development and finance tools across such Federal departments and agencies to attract greater participation in development activities by the private sector; and
 (3)establish a single point of contact for entities in the private sector of the United States to pursue partnership opportunities with such Federal departments and agencies.
 (c)Annual reportNot later than one year after the date of the enactment of this Act, and annually thereafter through 2022, the President shall submit to the Committee on Foreign Affairs of the House of Representatives and the Committee on Foreign Relations of the Senate a report evaluating the progress of the interagency mechanism in carrying out the duties described in subsection (b).
			4.Development strategies
 (a)In generalThe heads of Federal departments and agencies engaged in planning or providing United States development assistance overseas shall ensure that—
 (1)a rigorous analysis of the constraints to economic growth and investment within a country receiving such assistance guides any development strategy of the United States with respect to such country; and
 (2)the development strategies of the United States are coordinated with activities carried out by the private sector within countries receiving such assistance, to the greatest extent practicable and appropriate.
 (b)Matters To be includedEach analysis required under subsection (a)(1) shall include an identification and analysis of— (1)the constraints posed by inadequacies in critical infrastructure, the education system, the rule of law, the tax and investment codes, or the customs or regulatory regimes in the recipient country; and
 (2)the particular economic sectors, such as the agriculture, transportation, energy, education, or financial services sectors, that are central to achieving economic growth in the recipient country.
 (c)ResultsThe results of each analysis required under subsection (a)(1) shall be— (1)incorporated into any relevant development strategy, as defined in subsection (d); and
 (2)used to inform and guide the allocation of resources by Federal departments and agencies engaged in planning or providing United States development assistance overseas.
 (d)Development strategy definedIn this section, the term development strategy means any global, sectoral, or country development strategy of the United States and includes any integrated country strategy, regional or functional strategy, country development cooperation strategy, or mission strategic resource plan.