		I
		112th CONGRESS
		1st Session
		H. R. 1578
		IN THE HOUSE OF REPRESENTATIVES

			April 15, 2011
			Ms. Slaughter (for
			 herself, Mrs. Lowey,
			 Ms. Roybal-Allard,
			 Ms. Moore,
			 Ms. Norton,
			 Ms. Schakowsky,
			 Ms. Hanabusa,
			 Mr. Hastings of Florida,
			 Mr. Holden, and
			 Ms. DeLauro) introduced the following
			 bill; which was referred to the Committee
			 on Energy and Commerce

		A BILL
		To amend the Public Health Service Act to improve the
		  health care system’s assessment and response to domestic violence, dating
		  violence, sexual assault, and stalking, and for other
		  purposes.

		1.Short title; table of
			 contents
			(a)Short
			 titleThis Act may be cited as the Violence Against Women Health Initiative Act of
			 2011.
			(b)Table of
			 contentsThe table of contents of this Act is as follows:

					Sec. 1. Short title; table of contents.
					Sec. 2. Findings.
					Sec. 3. Purpose.
					Title I—Coordinated Public Health Initiative to End Violence
				Against Women
					Sec. 101. Grants to foster public health responses to intimate
				partner violence and sexual assault.
					Sec. 102. Training and education of health
				professionals.
					Title II—Research on effective public health approaches to end
				violence against women
					Sec. 201. Research on effective interventions to end domestic
				violence, sexual assault, and stalking against women in the health care
				setting.

			2.FindingsThe Congress finds the following:
			(1)Domestic violence and sexual violence are
			 public health problems and among the most significant social determinants of
			 health for women and girls.
			(2)Nearly one in four
			 women in the United States reports experiencing violence by a current or former
			 spouse or boyfriend at some point in her life, and one in six women reported
			 experiencing a completed sexual assault.
			(3)Violence and abuse
			 can affect health in many ways from physical injuries sustained during violent
			 episodes, trauma symptoms including depression and thoughts of suicide, and
			 harmful health coping behaviors such as alcohol and substance abuse.
			(4)Research published
			 in the Journal of Women’s Health in 2007 found that women who are victims of
			 violence have 17 percent more primary care doctor visits, 14 percent more
			 specialist visits, and 27 percent more prescription refills than non-abused
			 women.
			(5)Women who have
			 experienced violence and abuse are 80 percent more likely to have a stroke, 70
			 percent more likely to have heart disease, and 60 percent more likely to have
			 asthma than non-abused women.
			(6)In addition to
			 utilizing the health system at higher rates, victims are more likely to
			 experience a wide range of reproductive health problems including unintended
			 pregnancies, sexually transmitted disease/HIV transmission, miscarriages, and
			 more. Abuse increases the likelihood of teen pregnancy; adolescent girls in
			 abusive relationships are 3.5 times more likely to become pregnant than their
			 non-abused peers.
			(7)The Centers for
			 Disease Control and Prevention (CDC) have also linked childhood exposure to
			 violence with long-term, chronic health conditions including obesity,
			 arthritis, stroke, and heart disease.
			(8)The CDC
			 conservatively estimates that intimate partner rape, physical assault, and
			 stalking costs the health system and employers $8.3 billion annually from
			 direct injuries and services and lost productivity from work.
			(9)Most professional
			 health organizations, including the American Medical Association, American
			 Nurses Association, American College of Obstetricians and Gynecologists,
			 American Psychological Association, American Academy of Pediatrics, and the
			 Joint Commission on the Accreditation of Health Care Organizations, endorse
			 routine assessment for domestic violence.
			(10)The health system
			 provides an important entry point to reduce violence and abuse and can improve
			 the health status of women, but without training and support on how to assess
			 and respond, providers are not routinely assessing and responding to abuse,
			 missing an important opportunity to help victims and prevent more serious
			 abuse.
			3.PurposeIt is the purpose of this Act to develop a
			 public health response to abuse by—
			(1)strengthening the
			 health care system’s assessment of and response to domestic violence, dating
			 violence, sexual assault, and stalking;
			(2)increasing the
			 number of victims identified and assisted in health or public health settings;
			 and
			(3)expanding research
			 on effective interventions in health settings.
			ICoordinated Public
			 Health Initiative to End Violence Against Women
			101.Grants to
			 foster public health responses to intimate partner violence and sexual
			 assaultSection 399P of the
			 Public Health Service Act (42 U.S.C. 280g–4) is amended—
				(1)in subsection (a)—
					(A)by amending paragraph (1) to read as
			 follows:

							(1)In
				generalThe Secretary, acting
				through the Director of the Office on Women’s Health in the Office of the
				Secretary, and in consultation with the Director of the Family Violence
				Prevention and Services Office, shall award grants to eligible State, tribal,
				territorial, or local entities to strengthen the response of State, tribal,
				territorial, or local health care systems to domestic violence, dating
				violence, sexual assault, and stalking and prevent and respond to physical and
				sexual violence across the
				lifespan.
							;
					(B)in paragraph (2),
			 by amending subparagraph (A) to read as follows:

							(A)be—
								(i)a State department (or other division) of
				health, a State, tribal, or territorial domestic violence or sexual assault
				coalition or victim services program, a State law enforcement task force, or
				any other nonprofit, nongovernmental State, tribal, or territorial entity with
				a history of effective work in the fields of domestic violence, dating
				violence, sexual assault, or stalking, and health care, including physical or
				mental health care; or
								(ii)a local victim services program, a local
				department (or other division) of health, a local health clinic, hospital, or
				health system, or any other community-based organization with a history of
				effective work in the field of domestic violence, dating violence, sexual
				assault, or stalking, and health care, including physical or mental health
				care;
								;
				and
					(C)in paragraph (3),
			 by striking 2 years and by inserting 36 months;
			 and
					(2)in subsection
			 (b)—
					(A)by amending
			 paragraph (1) to read as follows:

							(1)In
				generalAn entity shall use
				amounts received under a grant under this section to design or enhance and
				implement comprehensive strategies to improve the response of the health care
				system to domestic violence, dating violence, sexual assault, or stalking in
				clinical, public health, hospital, managed care (including behavioral and
				mental health), and other health
				settings.
							;
					(B)by amending
			 paragraph (2) to read as follows:

							(2)Mandatory
				strategiesStrategies
				implemented under paragraph (1) shall include the following:
								(A)The implementation, dissemination, and
				evaluation of policies and procedures to guide health professionals and public
				health staff in responding to domestic violence, dating violence, sexual
				assault, and stalking, including strategies to ensure that health information
				is maintained in a manner that protects the patient’s privacy and safety and
				health information technology is used to improve documentation, identification,
				assessment, treatment, and follow-up care.
								(B)The development of on-site access to
				services to address the safety, medical, mental health, and economic needs of
				patients who are victims of domestic violence, dating violence, sexual assault,
				or stalking, either by increasing the capacity of existing health professionals
				and public health staff to address domestic violence, dating violence, sexual
				assault, and stalking, or by contracting with or hiring victim service
				providers to provide the services or to model other services appropriate to the
				geographic and cultural needs of a site.
								(C)The provision of training and followup
				technical assistance to health professionals, public health staff, and allied
				health professionals to identify, assess, treat, and refer clients who are
				victims of domestic violence, dating violence, sexual assault, or
				stalking.
								(D)The development,
				replication, refinement, and testing of model strategies in adolescent health
				settings to prevent and respond to violence and
				abuse.
								;
					(C)in paragraph
			 (3)—
						(i)by
			 amending subparagraph (A) to read as follows:

								(A)The development of training modules and
				policies that address domestic violence, dating violence, sexual assault, and
				stalking over the lifespan, including child abuse, childhood exposure to
				domestic and sexual violence, and elder
				abuse.
								;
						(ii)in
			 subparagraph (B), by striking and stalking prevention and by
			 inserting , stalking prevention, and healthy
			 relationships;
						(iii)by
			 amending subparagraph (D) to read as follows:

								(D)The inclusion of the health effects of
				lifetime exposure to violence and abuse as well as related behavioral risk
				factors in health professional training schools including medical, dental,
				nursing, social work, and mental health curricula, and allied health service
				training courses.
								;
						(iv)by
			 amending subparagraph (E) to read as follows:

								(E)The integration of knowledge of domestic
				violence, dating violence, sexual assault, and stalking into health care
				accreditation and professional licensing examinations, such as medical, dental,
				social work, and nursing boards, and where appropriate, other allied health
				exams.
								;
				and
						(v)by
			 adding at the end the following new subparagraph:

								(F)The development, expansion, and
				implementation of sexual assault forensic medical examination
				programs.
								;
				and
						(D)by adding at the
			 end the following:

							(4)Building
				evidence of model programsStrategies implemented under paragraph (1)
				may include research and evaluation of programs funded under this section to
				build evidence of model programs to be disseminated. As a condition on receipt
				of a grant for such research and evaluation, an applicant shall agree to
				release any findings resulting from the research and evaluation to the general
				public no later than 90 days after the findings are available. The Secretary
				shall facilitate the wide dissemination of such findings by means of multiple
				media, including the Internet.
							;
				and
					(3)by striking
			 subsections (c) and (d) and inserting the following:

						(c)PreferenceIn selecting grant recipients under this
				section, the Secretary shall give preference to applicants based on the
				strength of their evaluation strategies, with outcome-based evaluations
				prioritized.
						(d)Technical
				assistance
							(1)In
				generalThe Secretary may provide technical assistance with
				respect to the planning, development, and operation of any program or service
				carried out pursuant to this section. The Secretary may provide such technical
				assistance directly or through grants or contracts.
							(2)Availability of
				materialsThe Secretary shall
				make materials on training, best practices, evaluation, and other subjects
				developed by grantees under this section publicly available to the extent
				feasible, including through the use of electronic media, replication of
				materials, and tailoring of materials to meet varying geographic and
				jurisdictional needs.
							(e)ReportingThe Secretary shall publish a biennial
				report on—
							(1)the distribution
				of funds under this section; and
							(2)the programs and
				activities supported by such funds.
							(f)DefinitionsExcept as inconsistent with this section,
				the definitions in section 40002 of the Violence Against Women Act of 1994
				shall apply to this section.
						(g)Authorization of
				Appropriations
							(1)In
				generalThere is authorized to be appropriated to carry out this
				section $5,000,000 for each of fiscal years 2012 through 2016, to remain
				available until expended.
							(2)Allocation of
				funds
								(A)Administrative
				costsOf the funds made
				available to carry out this section for any fiscal year, the Secretary shall
				not use more than 2.5 percent for administration and monitoring of grants
				awarded under this section.
								(B)Research and
				evaluationOf the funds made
				available to carry out this section for any fiscal year, the Secretary shall
				not use more than 15 percent to award funds for research and evaluation under
				subsection
				(b)(4).
								.
				102.Training and
			 education of health professionalsSection 758 of the Public Health Service Act
			 (42 U.S.C. 294h) is amended to read as follows:

					758.Interdisciplinary
				training and education on domestic violence, sexual assault, and other types of
				violence and abuse
						(a)GrantsThe Secretary, acting through the Director
				of the Office on Women’s Health in the Office of the Secretary, and in
				consultation with the Administrator of the Health Resources and Services
				Administration and the Director of the Family Violence Prevention and Services
				Office, shall award grants to eligible entities to develop interdisciplinary
				training for health professionals, public health staff, and allied health
				professionals, and education programs that provide undergraduate, graduate, or
				postgraduate medical, psychology, and nursing (including advanced practice
				nursing) students, and current health professionals, with an understanding of,
				and clinical skills pertinent to, domestic violence, dating violence, sexual
				assault, and stalking across the lifespan.
						(b)Eligibility
							(1)In
				generalTo be eligible to receive a grant under this section, an
				entity shall be—
								(A)an accredited
				school of allopathic or osteopathic medicine, psychology, nursing, social work,
				or allied health;
								(B)a health care
				provider membership or professional organization, or a health care
				system;
								(C)a nonprofit
				organization with a history of effective work in the field of training health
				professionals with an understanding of, and clinical skills pertinent to,
				domestic violence, dating violence, sexual assault, or stalking, and lifetime
				exposure to violence and abuse; or
								(D)a State, tribal,
				territorial, or local entity.
								(2)Additional
				requirementsTo be eligible to receive a grant under this
				section, an entity shall prepare and submit an application to the Secretary
				including at a minimum—
								(A)strategies for the
				dissemination and sharing of curricula and other educational materials
				developed under the grant to other interested medical, psychology, social work,
				and nursing schools and national resource repositories for materials on
				domestic violence, dating violence, sexual assault, and stalking; and
								(B)a plan for
				consulting with domestic violence or sexual assault coalitions, or national
				nonprofit organizations or racial and ethnic minority-specific organizations
				with demonstrated experience and expertise in domestic violence, dating
				violence, sexual assault, or stalking.
								(3)PreferenceIn selecting grant recipients under this
				section, the Secretary shall give preference to applicants based on the
				strength of their evaluation strategies, with outcome-based evaluations
				prioritized.
							(c)Use of
				funds
							(1)Required
				usesAmounts provided under a
				grant under this section shall be used—
								(A)to plan and
				develop—
									(i)interdisciplinary
				health training and education for medical, psychology, social work, nursing,
				and other health professions students, interns, residents, fellows, or current
				health care providers to identify and provide health care services (including
				mental or behavioral health care services and referrals to appropriate
				community services) to individuals who are victims of domestic violence, dating
				violence, sexual assault, or stalking; and
									(ii)culturally and
				linguistically competent clinical components for integration into approved
				internship, residency, and fellowship training or continuing medical education
				training that address physical and mental health issues related to domestic
				violence, dating violence, sexual assault, and stalking, along with other forms
				of violence as appropriate, and include the primacy of victim safety and
				confidentiality; or
									(B)in the case of a
				grant recipient described in subsection (b)(1)(B), to—
									(i)develop and
				provide guidance to members, constituents, institutions, and stakeholders to
				increase assessment and referral to services; and
									(ii)facilitate
				cross-training and provide collaborative opportunities between partners and
				public health agencies.
									(2)Permissive
				usesAmounts provided under a grant under this section may be
				used to—
								(A)offer
				community-based training opportunities in rural areas, which may include the
				use of distance learning networks and other available technologies needed to
				reach isolated rural areas to train health professions students, interns,
				residents, and fellows on domestic violence, dating violence, sexual assault,
				stalking, and other forms of violence and abuse;
								(B)provide stipends
				to students who are underrepresented in the health professions as necessary to
				promote and enable their participation in offsite training experiences designed
				to develop health care clinical skills related to domestic violence, dating
				violence, sexual assault, and stalking;
								(C)provide clinical
				research fellowships to explore the relationship between victimization or
				exposure to abuse, and physical and mental health status; or
								(D)evaluate
				innovative curricula, training models, or programs.
								(3)Building
				evidence of model programsAmounts provided under a grant under
				this section may be used to conduct research and evaluation of programs funded
				under this section to build evidence of model programs to be disseminated. As a
				condition on receipt of a grant for such research and evaluation, an applicant
				shall agree to release any findings resulting from the research and evaluation
				to the general public no later than 90 days after the findings are available.
				The Secretary shall facilitate the wide dissemination of such findings by means
				of multiple media, including the Internet.
							(4)Requirements
								(A)Confidentiality
				and safetyGrantees under
				this section shall ensure that all educational programs developed with grant
				funds address issues of confidentiality and patient safety, and that faculty
				and staff associated with delivering educational components are fully trained
				in procedures that will protect the immediate and ongoing security of the
				patients, patient records, and staff. Organizations with demonstrated expertise
				in the confidentiality and safety needs of victims of domestic violence, dating
				violence, sexual assault, and stalking shall be consulted on the development
				and adequacy of confidentially and security procedures, and shall be fairly
				compensated by grantees for their services.
								(B)Rural
				programsRural training programs carried out under paragraph
				(2)(A) shall reflect adjustments in protocols and procedures or referrals that
				may be needed to protect the confidentiality and safety of patients who live in
				small or isolated communities and who are currently or have previously
				experienced violence or abuse.
								(C)Child and elder
				abuseIssues related to child and elder abuse may be addressed as
				part of a comprehensive programmatic approach implemented under a grant under
				this section.
								(d)Technical
				assistance
							(1)In
				generalThe Secretary may provide technical assistance with
				respect to the planning, development, and operation of any program or service
				carried out pursuant to this section. The Secretary may provide such technical
				assistance directly or through grants or contracts.
							(2)Availability of
				materialsThe Secretary shall
				make materials on training, best practices, evaluation and other subjects
				developed by grantees under this section publicly available to the extent
				feasible, including through the use of electronic media, replication of
				materials, and tailoring of materials to meet varying geographic and
				jurisdictional needs.
							(e)ReportingThe Secretary shall publish a biennial
				report on—
							(1)the distribution
				of funds under this section; and
							(2)the programs and
				activities supported by such funds.
							(f)DefinitionsExcept
				as inconsistent with this section, the definitions in section 40002 of the
				Violence Against Women Act of 1994 shall apply to this section.
						(g)Authorization of
				appropriations
							(1)In
				generalThere is authorized to be appropriated to carry out this
				section $3,000,000 for each of fiscal years 2012 through 2016, to remain
				available until expended.
							(2)Allocation of
				funds
								(A)Administrative
				CostsOf the funds made
				available to carry out this section for any fiscal year, the Secretary shall
				not use more than 2.5 percent for administration and monitoring of grants
				awarded under this section.
								(B)Research and
				EvaluationOf the funds made
				available to carry out this section for any fiscal year, the Secretary shall
				not use more than 15 percent to award funds for research and evaluation under
				subsection
				(c)(3).
								.
			IIResearch on
			 effective public health approaches to end violence against women
			201.Research on
			 effective interventions to end domestic violence, sexual assault, and stalking
			 against women in the health care settingSection 40297 of the Violence Against Women
			 Act of 1994 (42 U.S.C. 13973) is amended—
				(1)in the section
			 heading, by inserting after effective interventions the following:
			 to end domestic violence,
			 sexual assault, and stalking against women;
				(2)in subsection
			 (b)(1)—
					(A)in subparagraph
			 (B)—
						(i)by
			 striking and after the semicolon; and
						(ii)by inserting before the semicolon ,
			 including evaluating programs using evidence-based process and outcome
			 indicators;
						(B)in subparagraph
			 (C), by striking the period at the end and inserting a semicolon; and
					(C)by adding at the
			 end the following new subparagraphs:

							(D)research on effective health care
				interventions to domestic and sexual violence and sexual coercion, including
				evaluating programs using evidence-based process and outcome indicators;
				or
							(E)research into factors that increase
				resiliency for children exposed to dating violence, sexual assault, stalking,
				or individuals who have a lifetime exposure to violence and
				abuse.
							;
					(3)in subsection
			 (b)(2)(B)—
					(A)by striking within primary care and
			 emergency health care settings and inserting within community
			 health centers and primary care, emergency health care, or adolescent health
			 settings; and
					(B)by striking
			 domestic violence and inserting dating violence, sexual
			 assault, or stalking; and
					(4)in subsection
			 (d)—
					(A)by striking
			 2007 through 2011 and inserting 2012 through
			 2016; and
					(B)by inserting
			 , to remain available until expended before the period.


114 HR 5497 IH: Hospital Price Transparency and Disclosure Act of 2016
U.S. House of Representatives
2016-06-16
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
		114th CONGRESS
		2d Session
		H. R. 5497
		IN THE HOUSE OF REPRESENTATIVES

			June 16, 2016
			Mr. Lipinski introduced the following bill; which was referred to the Committee on Energy and Commerce

		A BILL
		To amend the Public Health Service Act to provide for the public disclosure of charges for certain
			 hospital and ambulatory surgical center treatment episodes.

 1.Short titleThis Act may be cited as the Hospital Price Transparency and Disclosure Act of 2016. 2.Public disclosure of hospital dataPart B of title II of the Public Health Service Act (42 U.S.C. 238 et seq.) is amended by adding at the end the following new section:

 249.Data reporting by hospitals and ambulatory surgical centers and public posting(a)Semiannual reporting requirementNot later than 80 days after the end of each semiannual period beginning January 1 or July 1 (beginning more than one year after the date of the enactment of this section), a hospital and an ambulatory surgical center shall report to the Secretary the following data:
 (1)In the case of a hospital— (A)the frequency of occurrence for such hospital during such period of each treatment episode identified under subsection (c)(1) for a condition or disease selected under subparagraph (A) or (B) of such subsection (or updated under subsection (c)(3)), furnished in an inpatient or outpatient setting, respectively; and
 (B)if care was furnished for such a treatment episode by such hospital during such period— (i)the total number of such treatment episodes for which care was so furnished by the hospital during such period;
 (ii)the insured individual average charge (as computed under subsection (e)(3)) by the hospital for such treatment episode during such period; and
 (iii)the uninsured individual average charge (as computed under subsection (e)(4)) by the hospital for such treatment episode during such period.
 (2)In the case of an ambulatory surgical center— (A)the frequency of occurrence for such center during such period of each treatment episode identified under subsection (c)(1) for a condition or disease selected under subparagraph (C) of such subsection (or updated under subsection (c)(3)); and
 (B)if care was furnished for such a treatment episode by such center during such period— (i)the total number of such treatment episodes for which care was so furnished by the center during such period;
 (ii)the insured individual average charge (as computed under subsection (e)(3)) by the center for such episode during such period; and
 (iii)the uninsured individual average charge (as computed under subsection (e)(4)) by the center for such episode during such period.
								(b)Public availability of data
 (1)Public posting of dataThe Secretary shall promptly post, on the official public Internet site of the Department of Health and Human Services, the data reported under subsection (a) and an appropriate link, with respect to a hospital or center for which the data is reported, to other consumer quality information maintained on such site (or a site maintained by the Centers for Medicare & Medicaid Services) relating to the hospital or center. Such data shall be set forth in a manner that promotes charge comparison among hospitals and among ambulatory surgical centers.
 (2)Notice of availabilityA hospital and an ambulatory surgical center shall prominently post at each admission site of the hospital or center a notice of the availability of the data reported under subsection (a) on the official public Internet site under paragraph (1).
 (c)Specification of treatment episodesFor purposes of this section: (1)In generalThe Secretary shall identify treatment episodes for each of the following:
 (A)The 100 conditions and diseases selected by the Secretary as being the most frequently treated conditions and diseases in a hospital inpatient setting.
 (B)The 100 conditions and diseases selected by the Secretary as being the most frequently treated conditions and diseases in a hospital outpatient setting.
 (C)The 100 conditions and diseases selected by the Secretary as being the most frequently treated conditions and diseases in an ambulatory surgical center setting.
 (2)Agreement with IOMIn carrying out paragraph (1), the Secretary may enter into an agreement with the Institute of Medicine to define a treatment episode for any condition or disease selected by the Secretary under this subsection. Such a definition may take into account the varying complexity associated with respect to different treatments.
 (3)Updating selectionThe Secretary shall periodically update the conditions and diseases selected under paragraph (1). (d)Civil money penaltyThe Secretary may impose a civil money penalty of not more than $10,000 for each knowing violation of subsection (a) or (b)(2) by a hospital or an ambulatory surgical center. The provisions of subsection (i)(2) of section 351A shall apply with respect to civil money penalties under this subsection in the same manner as such provisions apply to civil money penalties under subsection (i)(1) of such section.
					(e)Administrative provisions
 (1)In generalThe Secretary shall prescribe such regulations and issue such guidelines as may be required to carry out this section.
 (2)Classification of servicesThe regulations and guidelines under paragraph (1) shall include rules on the classification of different treatment episodes and the assignment of items and procedures to those episodes.
						(3)Computation of insured individual average charges
 (A)In generalFor purposes of subsections (a)(1)(B)(ii) and (a)(2)(B)(ii), an insured individual average charge for a treatment episode, with respect to a hospital or ambulatory surgical center during a period, shall be computed as the average of the rates (including any applicable copayment, coinsurance, other cost sharing, or other fees, such as facility fees, associated with treatment in the hospital or center) for such episode that have been negotiated by the hospital or ambulatory surgical center, respectively, with the 5 most used health insurance providers for such hospital or center during such period.
 (B)5 most used health insurance providersFor purposes of subparagraph (A), the 5 most used health insurance providers, with respect to a hospital or ambulatory surgical center during a period, are the 5 group health plans or insurance issuers offering health insurance coverage—
 (i)that have negotiated with the hospital or center a rate for the treatment episode involved; and (ii)the enrollees of which represent the highest number of patients of the hospital or center, respectively.
								(4)Computation of uninsured individual average charges
 (A)In generalFor purposes of subsections (a)(1)(B)(iii) and (a)(2)(B)(iii), an uninsured individual average charge for a treatment episode, with respect to a hospital or ambulatory surgical center during a period, shall be computed as the average of the total amounts charged for such an episode for which care was furnished to an uninsured individual by such hospital or ambulatory surgical center during such period.
 (B)Uninsured individual definedFor purposes of subparagraph (A), the term uninsured individual means, with respect to care furnished to the individual by a hospital or ambulatory surgical center, an individual who does not have insurance or other third-party contractual benefits that provides payment for costs incurred for such care.
 (5)Form of report and noticeThe regulations and guidelines under paragraph (1) shall specify the electronic form and manner by which a hospital or an ambulatory surgical center shall report data under subsection (a) and the form for posting of notices under subsection (b)(2).
						(f)Rules of Construction
 (1)Non-preemption of State lawsNothing in this section shall be construed as preempting or otherwise affecting any provision of State law relating to the disclosure of charges or other information for a hospital or an ambulatory surgical center.
 (2)ChargesNothing in this section shall be construed to regulate or set hospital or ambulatory surgical center charges.
 (g)Hospital and ambulatory surgical center definedFor purposes of this section, the terms hospital and ambulatory surgical center have the meaning given such terms by the Secretary..


		II
		112th CONGRESS
		1st Session
		S. 1699
		IN THE SENATE OF THE UNITED STATES

			October 12, 2011
			Mr. Kohl introduced the
			 following bill; which was read twice and referred to the
			 Committee on
			 Finance

		A BILL
		To reduce the costs of prescription drugs under the
		  Medicare program, and for other purposes.

		1.Short
			 title; table of contents
			(a)Short
			 titleThis Act may be cited
			 as the Prescription Drug Cost
			 Reduction Act.
			(b)Table of
			 contentsThe table of contents for this Act is as follows:

					Sec. 1. Short title; table of
				contents.
					Sec. 2. Medicare part B drug rebate program.
					Sec. 3. Negotiation of drug prices under Medicare part
				B.
					Sec. 4. Payment for least costly alternative for Medicare part
				B drugs.
					Sec. 5. Study and report on physician reimbursement for drugs
				and biologicals under Medicare part B.
					Sec. 6. Requirements of pharmacy benefit managers.
					Sec. 7. Certification for off-label prescribing of certain
				drugs prescribed in a nursing home setting.
					Sec. 8. Expansion of 340B program covered entities to include
				PACE programs.

			2.Medicare part B
			 drug rebate programSection
			 1842 of the Social Security Act (42 U.S.C. 1395u) is amended by adding at the
			 end the following new subsection:

				(v)(1)Not later than 2 years
				after the date of enactment of this subsection, the Secretary shall establish a
				program under which a manufacturer shall provide a rebate to the Secretary for
				drugs or biologicals of the manufacturer that are furnished under this
				part.
					(2)The program established under
				paragraph (1)—
						(A)shall be similar to rebate agreements
				under section 1927 (including the application of an additional rebate for
				certain drugs whose costs exceed an annual inflation target as described in
				subsection (c)(2) of such section); and
						(B)may use the average manufacturer price
				(as determined under section 1927(k)(1)) or the average sales price (as defined
				in section 1847A(c)) as the basis for calculating the amount of the rebate
				under the program.
						(3)The Secretary shall promulgate
				regulations to carry out this
				subsection.
					.
		3.Negotiation of
			 drug prices under Medicare part B
			(a)In
			 generalSection 1842 of the
			 Social Security Act (42 U.S.C. 1395u), as amended by section 2, is amended by
			 adding at the end the following new subsection:

					(w)Negotiation of
				Prices for Drugs and Biologicals
						(1)In
				generalNotwithstanding any other provision of law, the Secretary
				shall negotiate a contract with a manufacturer to establish the amount of
				payment under this part for any drug or biological for which the program under
				this part is the majority purchaser (as determined under paragraph (2)). The
				Secretary shall negotiate such contracts with the goal of ensuring appropriate
				and adequate access to necessary drugs and biologicals for individuals enrolled
				under this part, while minimizing costs to such individuals and to the program
				under this part to the greatest extent possible.
						(2)Majority
				purchaserFor purposes of paragraph (1), the Secretary shall, by
				regulation, establish a method to identify, based upon drug utilization rates,
				any drug or biological for which greater than 50 percent of the units sold by
				the manufacturer of such drug or biological in the preceding calendar year were
				provided to individuals enrolled under this part.
						(3)DefinitionsIn
				this subsection:
							(A)Drugs and
				biologicalsThe term drug and the term
				biological have the same meaning as provided under section
				1861(t).
							(B)ManufacturerThe
				term manufacturer has the same meaning as provided under section
				1847A(c)(6)(A).
							.
			(b)Effective
			 dateThe amendments made by this section shall apply to drugs and
			 biologicals that are furnished on or after July 1, 2012.
			4.Payment for
			 least costly alternative for Medicare part B drugsSection
			 1847A(b) of the Social Security Act (42 U.S.C. 1395w–3a(b)) is amended—
			(1)in paragraph (1),
			 in the matter preceding subparagraph (A), by striking paragraph
			 (7) and inserting paragraphs (7) and (9); and
			(2)by adding at the
			 end the following new paragraph:

					(9)Treatment of
				functionally equivalent drugs and biologicalsIn the case of a
				drug or biological furnished on or after the date that is 180 days after the
				date of enactment of this paragraph, for which payment is determined under this
				section, if the drug or biological is functionally equivalent (as defined by
				the Secretary) to another drug or biological for which payment is determined
				under this section, the amount of payment for both such drugs or biologicals
				shall be equal to the payment amount otherwise determined under this section
				(without regard to the application of this paragraph) for the least costly of
				such drugs or
				biologicals.
					.
			5.Study and report
			 on physician reimbursement for drugs and biologicals under Medicare part
			 B
			(a)StudyThe
			 Secretary of Health and Human Services (in this section referred to as the
			 Secretary) shall conduct a study on physician reimbursement for
			 drugs and biologicals furnished under part B of title XVIII of the Social
			 Security Act (42 U.S.C. 1395j et seq.). Such study shall include an evaluation
			 and assessment of the following:
				(1)The ability of
			 physicians to afford and profit from drugs and biologicals purchased at the
			 current reimbursement rate of average sales price plus 6 percent under section
			 1847A of the Social Security Act (42 U.S.C. 1395w–3a), including any profit
			 margins with respect to such drugs and biologicals.
				(2)The rate at which
			 physicians furnish the higher priced drug or biological under such part when
			 there is a cheaper alternative drug or biological.
				(3)The feasibility
			 and merits of other reimbursement structures that are not based on the price of
			 the drug or biological, such as a flat, universal fee issued for every drug or
			 biological furnished under such part, or any other relevant reimbursement
			 structures.
				(b)ConsultationIn
			 conducting the study under subsection (a), the Secretary shall consult with the
			 Administrator of the Centers for Medicare & Medicaid Services and the
			 Inspector General of the Department of Health and Human Services.
			(c)Report
				(1)In
			 generalNot later than 1 year after the date of enactment of this
			 Act, the Secretary shall submit to Congress a report containing the results of
			 the study conducted under subsection (a), together with recommendations for
			 changing physician reimbursement for drugs and biologicals under Medicare part
			 B.
				(2)Consideration
			 of recommendations to remove incentives to prescribe higher priced
			 drugsIn making recommendations under paragraph (1), the
			 Secretary shall consider including recommendations that would—
					(A)move
			 reimbursement for drugs and biologicals under Medicare part B away from being
			 based on the price of the drug or biological; and
					(B)reduce or
			 eliminate incentives to furnish higher priced drugs and biologicals under such
			 part.
					6.Requirements of
			 pharmacy benefit managers
			(a)In
			 generalA pharmacy benefit manager (referred to in this section
			 as a PBM) shall owe a fiduciary duty, in accordance with this
			 section, to each covered entity.
			(b)Covered entity
			 definedIn this section, the term covered entity
			 means the head of each Federal agency with which the PBM contracts,
			 including—
				(1)the Secretary of
			 Health and Human Services with respect to the programs under part C of title
			 XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.) and part D of
			 such title;
				(2)the Secretary of
			 Veterans Affairs with respect to health coverage offered through the Department
			 of Veterans Affairs;
				(3)the Secretary of
			 Defense with respect to the TRICARE program under chapter 55 of title 10,
			 United States Code; and
				(4)the Director of
			 the Office of Personnel Management with respect to the Federal employee health
			 benefits program under chapter 89 of title 5, United States Code.
				(c)Requirements
				(1)In
			 generalThe fiduciary duty described in subsection (a) shall
			 include the duty to—
					(A)notify each
			 covered entity, on a quarterly basis, if the PBM substitutes a drug that costs
			 more than the drug prescribed to an individual by a practitioner, and disclose
			 the aggregate costs of the drug prescribed and the drug provided by the PBM and
			 any benefit or payment directly or indirectly received by the PBM as a result
			 of the substitution for all individuals receiving such substitute drug during
			 the applicable quarter;
					(B)pass through any
			 benefit, rebate, or payment the PBM receives for promoting a drug that is more
			 expensive than a drug prescribed;
					(C)in the case that
			 a PBM receives a payment or benefit for increasing volume of sales for a
			 particular drug, class of drug, or brand of drug, disclose the payment or
			 benefit with the covered entity; and
					(D)disclose to
			 covered entities all financial terms and arrangements between the PBM and a
			 pharmaceutical drug company, including formulary management and drug-switch
			 agreements, educational support, claims processing and pharmacy network fees
			 that are charged from retail pharmacies, data sales fees, and other direct or
			 indirect remunerations, including discounts, charge backs or rebates, cash
			 discounts, free goods contingent on a purchase agreement, up-front payments,
			 coupons, goods in-kind, free or reduced-price services, grants, or other price
			 concessions or similar benefits offered to some or all purchasers from any
			 source, including manufacturers, pharmacies, enrollees, or any other person
			 that would serve to decrease the costs incurred under the plan.
					(2)Reporting of
			 drug substitutionsThe Secretary of Health and Human Services
			 shall establish categories that describe reasons, such as a concern about drug
			 interactions or discretion of the PBM, for a PBM to substitute a drug that
			 costs more than the drug prescribed to an individual by a practitioner, as
			 described in paragraph (1)(A). In reporting drug substitutions under such
			 paragraph, a PBM shall state the category under which each type of substitution
			 falls.
				(3)Direct or
			 indirect remunerationFor purposes of paragraph (1)(D), the term
			 direct or indirect remuneration includes discounts, chargebacks or
			 rebates, cash discounts, free goods contingent on a purchase agreement,
			 up-front payments, coupons, goods in-kind, free or reduced-price services,
			 grants, or other price concessions or similar benefits from manufacturers,
			 pharmacies or similar entities obtained by an intermediary contracting
			 organization with which the plan sponsor has contracted, regardless of whether
			 the intermediary contracting organization retains all or a portion of the
			 direct and indirect remuneration or passes the entire direct and indirect
			 remuneration to the plan sponsor and regardless of the terms of the contract
			 between the plan sponsor and the intermediary contracting organization.
				(d)Confidentiality
				(1)In
			 generalA PBM may require covered entities to keep the
			 information described in subsection (c)(4) confidential.
				(2)Restrictions on
			 the use of information
					(A)In
			 generalOfficers, employees, and contractors of the Department of
			 Health and Human Services may use the information disclosed or obtained in
			 accordance with the provisions of this Act only for the purposes of, and to the
			 extent necessary in, carrying out this Act, including determination of
			 payments, payment-related oversight, and program integrity activities.
					(B)Limitations
						(i)Authority of
			 the OIGThe restriction described in subparagraph (A) does not
			 limit the authority of the Inspector General of the United States to fulfill
			 the responsibilities of the Inspector General in accordance with applicable
			 Federal law.
						(ii)Authority of
			 CMSThe restriction described in subparagraph (A) does not limit
			 the authority of the Centers for Medicare & Medicaid Services to use data
			 regarding drug claims in accordance with section 1848(m) of the Social Security
			 Act (42 U.S.C. 1395w–4(m)).
						(e)AuditsTo
			 ensure compliance with the requirements of this section, each covered entity
			 shall conduct audits of the PBMs with which the covered entity
			 contracts.
			7.Certification
			 for off-label prescribing of certain drugs prescribed in a nursing home
			 settingTitle XVIII of the
			 Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end
			 the following new section:

				1899B.Certification for off-label prescribing of certain drugs
		  prescribed in a nursing home setting(a)In
				generalThe Secretary shall
				develop a form for use by physicians and practitioners (as defined in section
				1842(b)(18)(C)) to certify that, in the case of an applicable drug prescribed
				for an off-label use under this title, such use is for a medically accepted
				indication.
					(b)DefinitionsIn
				this section:
						(1)Applicable
				drugThe term applicable drug means an atypical
				antipsychotic prescribed for use in a nursing home setting (as defined by the
				Secretary).
						(2)Off-label
				useThe term off-label use means a use which has not
				been approved by the Food and Drug Administration.
						(3)Medically
				accepted indicationThe term medically accepted
				indication means the applicable drug is included in the compendia
				described in section 1861(t)(1) or is approved by a committee described in such
				section (or, in the case of an applicable drug that is a covered part D drug
				(as defined in section 1860D–2(e)), has the meaning given such term in
				paragraph (4) of such section 1860D–2(e)).
						(c)RegulationsThe Secretary shall establish by regulation
				requirements that, effective not later than 1 year after the date of enactment
				of this section, physicians and practitioners use the form developed under
				subsection (a) to make the certification under such subsection with respect to
				an applicable drug prescribed by the physician or practitioner for an off-label
				use under this title. In order to carry out these requirements in a timely
				manner, the Secretary shall promulgate regulations that take effect on an
				interim basis, after notice and pending opportunity for public
				comment.
					.
		8.Expansion of
			 340B program covered entities to include PACE programs
			(a)ExpansionSection 340B(a) of the Public Health
			 Service Act (42 U.S.C. 256b(a)) is amended—
				(1)in paragraph (4), by adding at the end the
			 following:

						(P)An entity that is
				a PACE provider offering a PACE program under section 1894 and section 1934 of
				the Social Security Act.
						;
				and
				(2)in paragraph
			 (5)(A), by adding at the end the following:

						(iii)Additional
				mechanismThe Secretary shall establish a mechanism to ensure
				that a manufacturer does not pay a duplicate discount with respect to a drug
				that is subject to an agreement under this section if the PACE program receives
				any rebate (including any negotiated price concessions) for the drug under part
				D of title XVIII of the Social Security Act. Such mechanism shall be similar to
				the mechanism established under clause
				(ii).
						.
				(b)Requirements
				(1)MedicareSection
			 1894(e) of the Social Security Act (42 U.S.C. 1395eee(e)) is amended by adding
			 at the end the following new paragraph:

						(9)Participation
				in 340B program
							(A)In
				generalIn the case of a PACE program that serves part D eligible
				individuals who are enrolled under such program, the PACE program agreement for
				such program shall require the PACE provider offering the program to
				participate in the drug discount program under section 340B of the Public
				Health Service Act for purposes of purchasing covered part D drugs with respect
				to qualified prescription drug coverage provided to such individuals.
							(B)AttestationThe
				Secretary may accept an attestation by a PACE provider, at the time of
				submitting a bid pursuant to section 1860D–21(f), as sufficient evidence of
				participation in the drug discount program under section 340B of the Public
				Health Service Act for purposes of subparagraph (A).
							(C)Ensuring timely access to covered
				outpatient drugsNothing in
				this paragraph shall prevent a PACE program from providing enrollees access to
				covered outpatient drugs (including covered part D drugs) through a retail
				community pharmacy (as defined in section 1927(k)(10)) that is not a contract
				pharmacy under the drug discount program under section 340B of the Public
				Health Service Act in the case where such access is necessary to ensure that
				such drugs are dispensed to enrollees on a timely basis.
							(D)DefinitionsIn
				this paragraph:
								(i)Covered
				outpatient drugThe term covered outpatient drug has
				the meaning given such term for purposes of section 340B of the Public Health
				Service Act.
								(ii)Covered part D
				drugThe term covered part D drug has the meaning
				given such term in section 1860D–2(e).
								(iii)Part D
				eligible individualThe term part D eligible
				individual has the meaning given such term in section
				1860D–1(a)(3)(A).
								(iv)Qualified
				prescription drug coverageThe term qualified prescription
				drug coverage has the meaning given such term in section
				1860D–2(a).
								.
				(2)MedicaidSection
			 1934(e) of the Social Security Act (42 U.S.C. 1396u–4(e)) is amended by adding
			 at the end the following new paragraph:

						(9)Participation
				in 340B program
							(A)In
				generalIn the case of a PACE program that serves part D eligible
				individuals who are enrolled under such program, the PACE program agreement for
				such program shall require the PACE provider offering the program to
				participate in the drug discount program under section 340B of the Public
				Health Service Act for purposes of purchasing covered part D drugs with respect
				to qualified prescription drug coverage provided to such individuals.
							(B)AttestationThe
				Secretary may accept an attestation by a PACE provider, at the time of
				submitting a bid pursuant to section 1860D–21(f), as sufficient evidence of
				participation in the drug discount program under section 340B of the Public
				Health Service Act for purposes of subparagraph (A).
							(C)Ensuring timely access to covered
				outpatient drugsNothing in
				this paragraph shall prevent a PACE program from providing enrollees access to
				covered outpatient drugs (including covered part D drugs) through a retail
				community pharmacy (as defined in section 1927(k)(10)) that is not a contract
				pharmacy under the drug discount program under section 340B of the Public
				Health Service Act in the case where such access is necessary to ensure that
				such drugs are dispensed to enrollees on a timely basis.
							(D)DefinitionsIn
				this paragraph:
								(i)Covered
				outpatient drugThe term covered outpatient drug has
				the meaning given such term for purposes of section 340B of the Public Health
				Service Act.
								(ii)Covered part D
				drugThe term covered part D drug has the meaning
				given such term in section 1860D–2(e).
								(iii)Part D
				eligible individualThe term part D eligible
				individual has the meaning given such term in section
				1860D–1(a)(3)(A).
								(iv)Qualified
				prescription drug coverageThe term qualified prescription
				drug coverage has the meaning given such term in section
				1860D–2(a).
								.
				(3)Effective
			 dateThe amendments made by this subsection shall apply to PACE
			 program agreements entered into on or after the date that is 2 years after the
			 date of enactment of this section.
				(c)Inclusion of
			 savings in bids submitted by PACE programs providing qualified prescription
			 drug coverage
				(1)In
			 generalSection 1860D–21(f) of the Social Security Act (42 U.S.C.
			 1395w–131(f)) is amended by adding at the end the following new
			 paragraph:

						(4)Participation
				in 340B program
							(A)Inclusion of
				savings in bids submitted
								(i)Determination
				of savingsAn organization offering prescription drug coverage
				under this subsection shall determine the estimated annual savings to the
				organization as a result of participation in the drug discount program under
				section 340B of the Public Health Service Act (as described in sections
				1894(e)(2)(C) and 1934(e)(2)(C)).
								(ii)Inclusion in
				bids submittedThe bid of an organization offering prescription
				drug coverage under this subsection shall reflect the estimated savings
				determined by the organization under clause (i) for the plan year involved, and
				shall take into account any additional costs to the organization as a result of
				the implementation and administration of such drug discount program during the
				plan year involved. Such bid shall include an attestation by the organization
				that such savings are reflected in the bid amount.
								(iii)Consideration
				of applicable ceiling pricesIn making the determination under
				clause (i), the organization shall consider the applicable ceiling prices for
				covered outpatient drugs (using the access provided under section
				340B(d)(1)(B)(iii) of the Public Health Service Act).
								(B)Receipt of
				percentage of savings
								(i)In
				generalSubject to clause (ii), an organization offering
				prescription drug coverage under this subsection shall be eligible to receive
				from the Secretary an amount equal to 10 percent of the estimated annual
				savings to the Federal government (as determined by the Secretary under
				regulations promulgated under subparagraph (C)) to the organization as a result
				of participation in the drug discount program under section 340B of the Public
				Health Service Act (as described in sections 1894(e)(2)(C) and 1934(e)(2)(C)).
				In making the determination under the preceding sentence, the Secretary shall
				consider the determination of the organization under subparagraph
				(A)(i).
								(ii)RequirementsAn
				organization shall only be eligible to receive the amount under clause (i) for
				the plan year involved if the organization—
									(I)submits to the
				Secretary an application in such form and manner, and containing such
				information, as the Secretary may specify; and
									(II)has in effect a
				plan approved by the Secretary for the use of any amounts received under such
				clause to—
										(aa)provide to
				enrollees enhanced formulary coverage, medication management, or disease
				management;
										(bb)invest in the
				development of the organization (including through the use of a significant
				proportion of the savings to invest in the development and use of qualified
				electronic health records (as defined in section 3000(13) of the Public Health
				Service Act) or other health information technology); or
										(cc)carry out other
				initiatives approved by the Secretary.
										(C)RegulationsThe
				Secretary shall promulgate regulations to carry out this paragraph and sections
				1894(e)(9) and
				1934(e)(9).
							.
				(2)Effective
			 dateThe amendment made by this subsection shall apply to plan
			 years beginning on or after the date that is 2 years after the date of
			 enactment of this Act.
				(d)Not treated as
			 change in law for purposes of determining manufacturer
			 complianceSection 1927(a)(5) of the Social Security Act (42
			 U.S.C. 1396r–8(a)(5)) is amended—
				(1)in subparagraph
			 (D)—
					(A)by striking
			 amendments.—In determining and inserting
			 “amendments.—

							(i)In
				generalSubject to clause (ii), in
				determining
							;
				and
					(B)by adding at the
			 end the following new clause:

							(ii)ExceptionThe
				Secretary shall take into account the amendments made by section 9 of the
				Prescription Drug Cost Reduction
				Act for purposes of determining whether an agreement under
				subparagraph (A) meets the requirements of section 340B of the Public Health
				Service Act and an agreement under such subparagraph shall not be determined to
				meet such requirements if it does not meet the requirements under such section
				with respect to covered outpatient drugs purchased by a covered entity
				described in subsection (a)(4)(P) of such section on or after the date that is
				1 year after the date of enactment of such
				Act.
							;
				and
					(2)in subparagraph
			 (E)—
					(A)by striking
			 compliance.—A manufacturer and inserting
			 “compliance.—

							(i)In
				generalSubject to clause (ii), a
				manufacturer
							;
				and
					(B)by adding at the
			 end the following new clause:

							(ii)ExceptionThe
				amendments made by section 9 of the Prescription Drug Cost Reduction Act shall
				not be treated as a legislative change for purposes of applying clause (i) and
				a manufacturer shall not be deemed to be in compliance with the requirements of
				this paragraph if the manufacturer has not entered into an agreement with the
				Secretary that meets the requirements under section 340B of the Public Health
				Service Act with respect to covered outpatient drugs purchased by a covered
				entity described in subsection (a)(4)(P) of such section on or after the date
				that is 1 year after the date of enactment of such
				Act.
							.


		II
		112th CONGRESS
		2d Session
		S. 3069
		IN THE SENATE OF THE UNITED STATES

			May 9, 2012
			Mr. Wyden introduced the
			 following bill; which was read twice and referred to the
			 Committee on
			 Finance

		A BILL
		To reduce temporarily the duty on certain sports footwear
		  valued over $6.50 but not over $12/pair.

		1.Certain sports footwear
			 valued over $6.50 but not over $12/pair
			(a)In
			 generalSubchapter II of chapter 99 of the Harmonized Tariff
			 Schedule of the United States is amended by inserting in numerical sequence the
			 following new heading:

								9902.01.00Sports footwear with outer soles and uppers of rubber or
						plastics, valued over $6.50 but not over $12/pair, the foregoing not for men
						(provided for in subheading 6402.19.70)47¢/pr. + 10.5%No changeNo changeOn or before
						12/31/2015

					.
			(b)Effective
			 dateThe amendment made by subsection (a) applies with respect to
			 goods entered, or withdrawn from warehouse for consumption, on or after the
			 15th day after the date of the enactment of this Act.


		II
		109th CONGRESS
		1st Session
		S. 71
		IN THE SENATE OF THE UNITED STATES

			January 24, 2005
			Mr. Inouye introduced the following bill; which was read twice and referred to the Committee on Finance

		A BILL
		To amend title XVIII of the Social Security Act to provide for patient protection by establishing
			 minimum nurse staffing ratios at certain Medicare providers, and for other
			 purposes.

			1.
			Short title
			This Act may be cited as the Registered Nurse Safe Staffing Act of 2005.

			2.
			Findings
			Congress makes the following findings:

				(1)
				There are hospitals throughout the United States that have inadequate staffing of registered nurses
			 to protect the well-being and health of the patients.

				(2)
				Studies show that the health of patients in hospitals is directly proportionate to the number of
			 registered nurses working in the hospital.

				(3)
				There is a critical shortage of registered nurses in the United States.

				(4)
				The effect of that shortage is revealed in unsafe staffing levels in hospitals.

				(5)
				Patient safety is adversely affected by these unsafe staffing levels, creating a public health
			 crisis.

				(6)
				Registered nurses are being required to perform professional services under conditions that do not
			 support quality health care or a healthful work environment for registered
			 nurses.

				(7)
				As a payer for inpatient and outpatient hospital services for individuals entitled to benefits
			 under the medicare program established under title XVIII of the Social Security Act, the Federal Government has a compelling interest in promoting the safety of such individuals by
			 requiring any hospital participating in such program to establish minimum
			 safe staffing levels for registered nurses.

			3.
			Establishment of minimum staffing ratios by medicare participating hospitals

				(a)
				Requirement of medicare provider agreement
				Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended—

					(1)
					in subparagraph (R), by striking and after the comma at the end;

					(2)
					in subparagraph (S), by striking the period at the end and inserting , and; and

					(3)
					by inserting after subparagraph (S) the following new subparagraph:

							(T)
							in the case of a hospital, to meet the requirements of section 1889.
						.

				(b)
				Requirements
				Part D of title XVIII of the Social Security Act is amended by inserting after section 1888 the following new section:

						1889.
						Staffing requirements for medicare participating hospitals(a)Establishment of staffing system

								(1)
								In general
								Each participating hospital shall adopt and implement a staffing system that ensures a number of
			 registered nurses on each shift and in each unit of the hospital to ensure
			 appropriate staffing levels for patient care.

								(2)
								Staffing system requirements
								Subject to paragraph (3), a staffing system adopted and implemented under this section shall—

									(A)
									be based upon input from the direct care-giving registered nurse staff or their exclusive
			 representatives, as well as the chief nurse executive;

									(B)
									be based upon the number of patients and the level and variability of intensity of care to be
			 provided, with appropriate consideration given to admissions, discharges,
			 and transfers during each shift;

									(C)
									account for contextual issues affecting staffing and the delivery of care, including architecture
			 and geography of the environment and available technology;

									(D)
									reflect the level of preparation and experience of those providing care;

									(E)
									account for staffing level effectiveness or deficiencies in related health care classifications,
			 including but not limited to, certified nurse assistants, licensed
			 vocational nurses, licensed psychiatric technicians, nursing assistants,
			 aides, and orderlies;

									(F)
									reflect staffing levels recommended by specialty nursing organizations;

									(G)
									establish upwardly adjustable registered nurse-to-patient ratios based upon registered nurses'
			 assessment of patient acuity and existing conditions;

									(H)
									provide that a registered nurse shall not be assigned to work in a particular unit without first
			 having established the ability to provide professional care in such unit;
			 and

									(I)
									be based on methods that assure validity and reliability.

								(3)
								Limitation
								A staffing system adopted and implemented under paragraph (1) may not—

									(A)
									set registered-nurse levels below those required by any Federal or State law or regulation; or

									(B)
									utilize any minimum registered nurse-to-patient ratio established pursuant to paragraph (2)(G) as
			 an upper limit on the staffing of the hospital to which such ratio
			 applies.

							(b)
							Reporting, and release to public, of certain staffing information

								(1)
								Requirements for hospitals
								Each participating hospital shall—

									(A)
									post daily for each shift, in a clearly visible place, a document that specifies in a uniform
			 manner (as prescribed by the Secretary) the current number of licensed and
			 unlicensed nursing staff directly responsible for patient care in each
			 unit of the hospital, identifying specifically the number of registered
			 nurses;

									(B)
									upon request, make available to the public—

										(i)
										the nursing staff information described in subparagraph (A); and

										(ii)
										a detailed written description of the staffing system established by the hospital pursuant to
			 subsection (a); and

									(C)
									submit to the Secretary in a uniform manner (as prescribed by the Secretary) the nursing staff
			 information described in subparagraph (A) through electronic data
			 submission not less frequently than quarterly.

								(2)
								Secretarial responsibilities
								The Secretary shall—

									(A)
									make the information submitted pursuant to paragraph (1)(C) publicly available, including by
			 publication of such information on the Internet site of the Department of
			 Health and Human Services; and

									(B)
									provide for the auditing of such information for accuracy as a part of the process of determining
			 whether an institution is a hospital for purposes of this title.

							(c)
							Recordkeeping; data collection; evaluation

								(1)
								Recordkeeping
								Each participating hospital shall maintain for a period of at least 3 years (or, if longer, until
			 the conclusion of pending enforcement activities) such records as the
			 Secretary deems necessary to determine whether the hospital has adopted
			 and implemented a staffing system pursuant to subsection (a).

								(2)
								Data collection on certain outcomes
								The Secretary shall require the collection, maintenance, and submission of data by each
			 participating hospital sufficient to establish the link between the
			 staffing system established pursuant to subsection (a) and—

									(A)
									patient acuity from maintenance of acuity data through entries on patients' charts;

									(B)
									patient outcomes that are nursing sensitive, such as patient falls, adverse drug events, injuries
			 to patients, skin breakdown, pneumonia, infection rates, upper
			 gastrointestinal bleeding, shock, cardiac arrest, length of stay, and
			 patient readmissions;

									(C)
									operational outcomes, such as work-related injury or illness, vacancy and turnover rates, nursing
			 care hours per patient day, on-call use, overtime rates, and needle-stick
			 injuries; and

									(D)
									patient complaints related to staffing levels.

								(3)
								Evaluation
								Each participating hospital shall annually evaluate its staffing system and establish minimum
			 registered nurse staffing ratios to assure ongoing reliability and
			 validity of the system and ratios. The evaluation shall be conducted by a
			 joint management-staff committee comprised of at least 50 percent of
			 registered nurses who provide direct patient care.

							(d)
							Enforcement

								(1)
								Responsibility
								The Secretary shall enforce the requirements and prohibitions of this section in accordance with
			 the succeeding provisions of this subsection.

								(2)
								Procedures for receiving and investigating complaints
								The Secretary shall establish procedures under which—

									(A)
									any person may file a complaint that a participating hospital has violated a requirement or a
			 prohibition of this section; and

									(B)
									such complaints are investigated by the Secretary.

								(3)
								Remedies
								If the Secretary determines that a participating hospital has violated a requirement of this
			 section, the Secretary—

									(A)
									shall require the facility to establish a corrective action plan to prevent the recurrence of such
			 violation; and

									(B)
									may impose civil money penalties under paragraph (4).

								(4)
								Civil money penalties

									(A)
									In general
									In addition to any other penalties prescribed by law, the Secretary may impose a civil money
			 penalty of not more than $10,000 for each knowing violation of a
			 requirement of this section, except that the Secretary shall impose a
			 civil money penalty of more than $10,000 for each such violation in the
			 case of a participating hospital that the Secretary determines has a
			 pattern or practice of such violations (with the amount of such additional
			 penalties being determined in accordance with a schedule or methodology
			 specified in regulations).

									(B)
									Procedures
									The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money
			 penalty under this paragraph in the same manner as such provisions apply
			 to a penalty or proceeding under section 1128A.

									(C)
									Public notice of violations

										(i)
										Internet site
										The Secretary shall publish on the Internet site of the Department of Health and Human Services the
			 names of participating hospitals on which civil money penalties have been
			 imposed under this section, the violation for which the penalty was
			 imposed, and such additional information as the Secretary determines
			 appropriate.

										(ii)
										Change of ownership
										With respect to a participating hospital that had a change in ownership, as determined by the
			 Secretary, penalties imposed on the hospital while under previous
			 ownership shall no longer be published by the Secretary of such Internet
			 site after the 1-year period beginning on the date of change in ownership.

							(e)
							Whistleblower protections

								(1)
								Prohibition of discrimination and retaliation
								A participating hospital shall not discriminate or retaliate in any manner against any patient or
			 employee of the hospital because that patient or employee, or any other
			 person, has presented a grievance or complaint, or has initiated or
			 cooperated in any investigation or proceeding of any kind, relating to the
			 staffing system or other requirements and prohibitions of this section.

								(2)
								Relief for prevailing employees
								An employee of a participating hospital who has been discriminated or retaliated against in
			 employment in violation of this subsection may initiate judicial action in
			 a United States district court and shall be entitled to reinstatement,
			 reimbursement for lost wages, and work benefits caused by the unlawful
			 acts of the employing hospital. Prevailing employees are entitled to
			 reasonable attorney's fees and costs associated with pursuing the case.

								(3)
								Relief for prevailing patients
								A patient who has been discriminated or retaliated against in violation of this subsection may
			 initiate judicial action in a United States district court. A prevailing
			 patient shall be entitled to liquidated damages of $5,000 for a violation
			 of this statute in addition to any other damages under other applicable
			 statutes, regulations, or common law. Prevailing patients are entitled to
			 reasonable attorney's fees and costs associated with pursuing the case.

								(4)
								Limitation on actions
								No action may be brought under paragraph (2) or (3) more than 2 years after the discrimination or
			 retaliation with respect to which the action is brought.

								(5)
								Treatment of adverse employment actions
								For purposes of this subsection—

									(A)
									an adverse employment action shall be treated as retaliation or discrimination; and

									(B)
									the term adverse employment action includes—

										(i)
										the failure to promote an individual or provide any other employment-related benefit for which the
			 individual would otherwise be eligible;

										(ii)
										an adverse evaluation or decision made in relation to accreditation, certification, credentialing,
			 or licensing of the individual; and

										(iii)
										a personnel action that is adverse to the individual concerned.

							(f)
							Relationship to state laws
							Nothing in this section shall be construed as exempting or relieving any person from any liability,
			 duty, penalty, or punishment provided by any present or future law of any
			 State or political subdivision of a State, other than any such law which
			 purports to require or permit the doing of any act which would be an
			 unlawful practice under this title.

							(g)
							Relationship To conduct prohibited under the National Labor Relations Act or other collective
			 bargaining laws
							Nothing in this section shall be construed as permitting conduct prohibited under the National
			 Labor Relations Act or under any other Federal, State, or local collective
			 bargaining law.

							(h)
							Regulations
							The Secretary shall promulgate such regulations as are appropriate and necessary to implement this
			 section.

							(i)
							Definitions
							In this section:

								(1)
								Participating hospital
								The term participating hospital means a hospital that has entered into a provider agreement under section 1866.

								(2)
								Registered nurse
								The term registered nurse means an individual who has been granted a license to practice as a registered nurse in at least 1
			 State.

								(3)
								Unit
								The term unit of a hospital is an organizational department or separate geographic area of a hospital, such as a
			 burn unit, a labor and delivery room, a post-anesthesia service area, an
			 emergency department, an operating room, a pediatric unit, a stepdown or
			 intermediate care unit, a specialty care unit, a telemetry unit, a general
			 medical care unit, a subacute care unit, and a transitional inpatient care
			 unit.

								(4)
								Shift
								The term shift means a scheduled set of hours or duty period to be worked at a participating hospital.

								(5)
								Person
								The term person means 1 or more individuals, associations, corporations, unincorporated organizations, or labor
			 unions.
							.

				(c)
				Effective date
				The amendments made by this section shall take effect on January 1, 2006.


115 S352 IS: Master Sergeant Roddie Edmonds Congressional Gold Medal Act
U.S. Senate
2017-02-13
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.

		II
		115th CONGRESS1st Session
		S. 352
		IN THE SENATE OF THE UNITED STATES

			February 13, 2017
			Mr. Corker (for himself, Mr. Cardin, Mr. Alexander, and Mr. Kaine) introduced the following bill; which was read twice and referred to the Committee on Banking, Housing, and Urban Affairs

		A BILL
		To award a Congressional Gold Medal to Master Sergeant Rodrick Roddie Edmonds in recognition of his heroic actions during World War II.

		1.Short title
 This Act may be cited as the Master Sergeant Roddie Edmonds Congressional Gold Medal Act.
		2.Findings
 Congress finds the following: (1)Rodrick W. Edmonds (in this Act referred to as Roddie Edmonds or Edmonds) was born in 1919 in South Knoxville, Tennessee, and graduated from Knoxville High School in 1938.
 (2)Roddie Edmonds was a Master Sergeant in the United States Army and a member of the 422nd Infantry Regiment while serving during World War II.
 (3)Roddie Edmonds landed in Europe in 1944 and fought to the border between Belgium and Germany. In December of 1944, while fighting in the Battle of the Bulge, Edmonds was captured by Nazi forces and detained in Stalag IX–A, a prisoner of war camp in Ziegenhain, Germany.
 (4)Stalag IX–A was a site used to identify, segregate, and remove Jewish soldiers from the general population of prisoners of war and many of the Jewish soldiers who were so removed were sent to labor camps or murdered. Members of the Armed Forces were warned of this policy and aware that their fellow servicemen could be at risk.
 (5)As the senior noncommissioned officer in Stalag IX–A, Master Sergeant Edmonds was responsible for 1,275 members of the Armed Forces at the camp. Approximately 1 month after the date on which Edmonds was detained, Edmonds was directed to order the Jewish-American soldiers under his command to fall out in order to separate the Jewish-American soldiers from their fellow prisoners.
 (6)Disregarding the orders of the Nazis, Roddie Edmonds commanded all of his men to fall out and, the following morning, all of the 1,275 members of the Armed Forces under the command of Edmonds stood outside of their prison barracks.
 (7)Upon seeing the soldiers, a German officer angrily shouted, They cannot all be Jews!, to which Edmonds replied, We are all Jews here. (8)The German officer took out his pistol and pointed the gun at the head of Edmonds, but Edmonds refused to identify the Jewish soldiers. Instead, Edmonds responded, According to the Geneva Convention, we only have to give our name, rank, and serial number. If you shoot me, you will have to shoot all of us and, after the war, you will be tried for war crimes.
 (9)The German officer turned away from Edmonds and the other soldiers and left the scene. The actions taken by Edmonds saved the lives of approximately 200 Jewish-American members of the Armed Forces.
 (10)Lester Tanner, a Jewish-American member of the Armed Forces also captured during the Battle of the Bulge, witnessed the incident and stated that, There was no question in my mind, or that of Master Sergeant Edmonds, that the Germans were removing the Jewish prisoners from the general population at great risk to their survival. The U.S. Army’s standing command to its ranking officers in POW camps is that you resist the enemy and care for the safety of your men to the greatest extent possible. Master Sergeant Edmonds, at the risk of his immediate death, defied the Germans with the unexpected consequences that the Jewish prisoners were saved.
 (11)Edmonds survived 100 days in captivity and returned home after the war. Later, Edmonds served the United States in Korea as a member of the National Guard. Edmonds died in 1985, but never told his family or anyone else of his brave actions outside the barracks of Stalag IX–A during World War II.
 (12)Edmonds was posthumously recognized by Yad Vashem, the World Holocaust Remembrance Center in Jerusalem, as Righteous Among the Nations, the first member of the Armed Forces and 1 of only 5 people of the United States to be so recognized. Avner Shalev, Chairman of Yad Vashem, announced the selection of Edmonds by saying, Master Sergeant Roddie Edmonds seemed like an ordinary American soldier, but he had an extraordinary sense of responsibility and dedication to his fellow human beings. … The choices and actions of Master Sergeant Edmonds set an example for his fellow American soldiers as they stood united against the barbaric evil of the Nazis.
			3.Congressional gold medal
 (a)Award authorizedThe Speaker of the House of Representatives and the President pro tempore of the Senate shall make appropriate arrangements for the posthumous award, on behalf of Congress, of a gold medal of appropriate design to Roddie Edmonds in recognition of his achievements and heroic actions during World War II.
 (b)Design and strikingFor the purpose of the award referred to in subsection (a), the Secretary of the Treasury (referred to in this Act as the Secretary) shall strike a gold medal with suitable emblems, devices, and inscriptions to be determined by the Secretary.
 (c)Presentation and award of medalThe gold medal referred to in subsection (a) shall be presented, and following the presentation awarded, to the next of kin of Roddie Edmonds.
 4.Duplicate medalsThe Secretary may strike and sell duplicates in bronze of the gold medal struck under section 3 under such regulations as the Secretary may prescribe, at a price sufficient to cover the cost thereof, including labor, materials, dies, use of machinery, and overhead expenses, and the cost of the gold medal.
		5.Status of medals
 (a)National medalsThe medals struck under this Act are national medals for purposes of chapter 51 of title 31, United States Code.
 (b)Numismatic itemsFor purposes of sections 5134 and 5136 of title 31, United States Code, all medals struck under this Act shall be considered to be numismatic items.


117 HRES 120 IH: Recognizing the cultural and historical significance of Lunar New Year in 2021.
U.S. House of Representatives
2021-02-11
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.

IV117th CONGRESS1st SessionH. RES. 120IN THE HOUSE OF REPRESENTATIVESFebruary 11, 2021Ms. Meng (for herself, Ms. Velázquez, Mr. Horsford, Mr. Carson, Mr. Lowenthal, Mr. Brendan F. Boyle of Pennsylvania, Mr. Suozzi, Mrs. Kim of California, Mrs. Napolitano, Mrs. Steel, Mr. San Nicolas, Mr. Trone, Mrs. Carolyn B. Maloney of New York, Ms. Titus, Mr. Bera, Ms. Clarke of New York, Mr. Kim of New Jersey, Mrs. Watson Coleman, Ms. Lee of California, Mr. Johnson of Georgia, Mr. Foster, Ms. Kaptur, Ms. Jayapal, Mr. Nadler, Mr. Jeffries, Mr. Raskin, Ms. Clark of Massachusetts, Ms. Ocasio-Cortez, Mr. Gomez, Mrs. Lee of Nevada, Mr. Takano, Mr. Kilmer, Mr. Connolly, Ms. Eshoo, Mr. Rush, Mr. Garamendi, Mr. Payne, Mr. Espaillat, Ms. Roybal-Allard, Ms. Norton, Ms. DelBene, Mr. Larsen of Washington, Mr. McNerney, Ms. Sánchez, Ms. Strickland, Ms. Spanberger, Mr. Case, Ms. Ross, Mr. Jones, Ms. Johnson of Texas, Mr. Danny K. Davis of Illinois, Mr. Peters, Mr. Schiff, Mr. Lieu, Ms. Schakowsky, Mr. Torres of New York, Mr. Bowman, Mr. Sires, Mr. McGovern, Mr. Pallone, Mr. Stanton, Mr. Kahele, and Ms. Bourdeaux) submitted the following resolution; which was referred to the Committee on Oversight and ReformRESOLUTIONRecognizing the cultural and historical significance of Lunar New Year in 2021.Whereas Lunar New Year begins on the second new moon following the winter solstice, or the first day of the new year according to the lunisolar calendar, and extends until the full moon 15 days later;Whereas the 15th day of the new year, according to the lunisolar calendar, is called the Lantern Festival;Whereas Lunar New Year is often referred to as Spring Festival in various Asian countries;Whereas many religious and ethnic communities use lunar-based calendars;Whereas Lunar New Year began in China more than 4,000 years ago and is widely celebrated in East and Southeast Asia;Whereas the Asian diaspora has expanded the Lunar New Year celebration into an annual worldwide event;Whereas Lunar New Year is celebrated by millions of Asian Americans, and by many non-Asian Americans, in the United States;Whereas Lunar New Year is celebrated with community activities and cultural performances;Whereas participants celebrating Lunar New Year travel to spend the holiday reuniting with family and friends; andWhereas Lunar New Year is traditionally a time to wish upon others good fortune, health, prosperity, and happiness: Now, therefore, be itThat the House of Representatives—(1)recognizes the cultural and historical significance of Lunar New Year;(2)in observance of this Lunar New Year, the Year of the Ox, expresses its deepest respect for Asian Americans and all individuals throughout the world who celebrate this significant occasion; and(3)wishes Asian Americans and all individuals who observe this holiday a happy and prosperous new year.


114 HR 2414 IH: To facilitate the responsible communication of scientific and medical developments.
U.S. House of Representatives
2015-05-19
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
114th CONGRESS
1st Session
H. R. 2414
IN THE HOUSE OF REPRESENTATIVES

May 19, 2015
Mr. Burgess (for himself, Mr. Long, and Mr. Schrader) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL
To facilitate the responsible communication of scientific and medical developments.

1.Facilitating responsible communication of scientific and medical developments
(a)GuidanceNot later than 18 months after the date of enactment of this Act, the Secretary of Health and Human Services shall issue draft guidance on facilitating the responsible dissemination of truthful and non-misleading scientific and medical information not included in the approved labeling of drugs and devices.  (b)DefinitionIn this section, the terms drug and device have the meaning given to such terms in section 201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321).


116 S3888 IS: To ensure that veterans receive timely and effective health care under the Veterans Community Care Program and Veterans Care Agreements during the COVID–19 emergency, and for other purposes.
U.S. Senate
2020-06-03
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 CONGRESS2d SessionS. 3888IN THE SENATE OF THE UNITED STATESJune 3, 2020Mrs. Shaheen introduced the following bill; which was read twice and referred to the Committee on Veterans' AffairsA BILLTo ensure that veterans receive timely and effective health care under the Veterans Community Care Program and Veterans Care Agreements during the COVID–19 emergency, and for other purposes. 1.Community care for veterans during COVID–19 emergency(a)Veterans Community Care Program and Veterans Care Agreements(1)Eligibility for COVID–19 careDuring the period of a covered public health emergency, the Secretary of Veterans Affairs shall furnish COVID–19 care, regardless of whether such care is for a service-connected disability—(A)under section 1703 of title 38, United States Code, to any veteran described in subsection (b) of such section; and(B)under section 1703A of such title, to any individual described in subsection (l) of such section.(2)Preauthorization for certain services not required(A)In generalDuring the period of a covered public health emergency, in carrying out section 1703(a)(3) of title 38, United States Code, the Secretary of Veterans Affairs shall treat medical care and services described in subparagraph (B) as being authorized by the Secretary under such section, regardless of whether the Secretary is notified of such care by any deadline otherwise required by the Secretary for purposes of such section.(B)Medical care and services describedThe medical care and services described in this subparagraph are the following:(i)COVID–19 care.(ii)Emergency medical care and services.(b)Emergency treatment(1)RuleDuring the period of a covered public health emergency, the Secretary of Veterans Affairs shall administer claims for payments relating to emergency COVID–19 care as follows:(A)If the community care provider that furnished the care is an eligible provider under section 1703 of title 38, United States Code, the Secretary shall administer the claim pursuant to that section.(B)If the community care provider has entered into a Veterans Care Agreement under section 1703A of such title, the Secretary shall administer the claim pursuant to that section.(C)If the community care provider is not described in subparagraph (A) or (B), the Secretary shall administer the claim pursuant to section 1725 or 1728 of such title, as the case may be.(2)Scope of treatmentDuring the period of a covered public health emergency, emergency COVID–19 care furnished to veterans shall be deemed to be emergency treatment for purposes of sections 1725 and 1728 of title 38, United States Code, regardless of whether—(A)such care meets the requirements of subparagraphs (A) and (B) of subsection (f)(1) of such section 1725; or(B)such care is furnished after the veteran can be transferred, or is accepted for a transfer, to a facility of the Department of Veterans Affairs or other Federal facility as described in clauses (i) and (ii) of subparagraph (C) of such subsection.(3)Enrollment requirementsDuring the period of a covered public health emergency, in carrying out section 1725 of title 38, United States Code, the Secretary shall determine whether a veteran who receives emergency COVID–19 care is an active Department health care participant under subsection (b) of such section without regard to whether the veteran meets the requirement in paragraph (2)(B) of such subsection.(4)Submission of claimsDuring the period of a covered public health emergency, subsection (b) of section 1703D of title 38, United States Code, shall apply with respect to community care providers furnishing emergency COVID–19 care to veterans pursuant to sections 1725 and 1728 of title 38, United States Code.(c)Primary payer(1)In generalDuring the period of a covered public health emergency, notwithstanding section 1725 of title 38, United States Code, or any other provision of law, the Secretary of Veterans Affairs shall be the primary payer with respect to COVID–19 care furnished to veterans, including with respect to the transportation of a veteran by ambulance.(2)ReimbursementThe Secretary may seek reimbursement from any third party that would otherwise be liable for COVID–19 care furnished to a veteran or obligated to provide or to pay the expenses of such care, including pursuant to a health-plan contract.(d)ApplicationThis section shall apply to medical care or services furnished during the period of a covered public health emergency, regardless of whether such care or services were furnished before the date of the enactment of this Act.(e)DefinitionsIn this section:(1)The term community care provider has the meaning given the term health care entity or provider in section 1703D(i) of title 38, United States Code. (2)The term covered public health emergency means the declaration—(A)of a public health emergency, based on an outbreak of COVID–19, by the Secretary of Health and Human Services under section 319 of the Public Health Service Act (42 U.S.C. 247d); or (B)of a domestic emergency, based on an outbreak of COVID–19, by the President, the Secretary of Homeland Security, or a State or local authority.(3)The term COVID–19 care means medical care or services furnished to a veteran by a community care provider pursuant to chapter 17 of title 38, United States Code, or any other law administered by the Secretary of Veterans Affairs, for the diagnosis or treatment of COVID–19.(4)The term health-plan contract and third party have the meanings given those terms in section 1725 of title 38, United States Code.


113 S1331 IS: To extend the Generalized System of Preferences, and for other purposes.
U.S. Senate
2013-07-18
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.

		II
		113th CONGRESS
		1st Session
		S. 1331
		IN THE SENATE OF THE UNITED STATES

			July 18, 2013
			Mr. Baucus (for himself
			 and Mr. Hatch) introduced the following
			 bill; which was read twice and referred to the
			 Committee on
			 Finance

		A BILL
		To extend the Generalized System of Preferences, and for
		  other purposes.

		1.Extension of Generalized
			 System of PreferencesSection
			 505 of the Trade Act of 1974 (19 U.S.C. 2465) is amended by striking
			 July 31, 2013 and inserting September 30,
			 2015.
		2.Customs user
			 feesSection 13031(j)(3) of
			 the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C.
			 58c(j)(3)) is amended—
			(1)in subparagraph
			 (A), by striking October 22, 2021 and inserting January
			 21, 2022; and
			(2)in subparagraph
			 (B)(i), by striking October 29, 2021 and inserting
			 January 28, 2022.
			3.Time for payment
			 of corporate estimated taxesNotwithstanding section 6655 of the Internal
			 Revenue Code of 1986, in the case of a corporation with assets of not less than
			 $1,000,000,000 (determined as of the end of the preceding taxable year)—
			(1)the amount of any
			 required installment of corporate estimated tax which is otherwise due in July,
			 August, or September of 2018 shall be increased by 1.25 percent of such amount
			 (determined without regard to any increase in such amount not contained in such
			 Code); and
			(2)the amount of the
			 next required installment after an installment referred to in paragraph (1)
			 shall be appropriately reduced to reflect the amount of the increase by reason
			 of such paragraph.