116 S4694 IS: Russian Suspension Agreement Extension Act of 2020
U.S. Senate
2020-09-24
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. 4694IN THE SENATE OF THE UNITED STATESSeptember 24, 2020Mr. Barrasso (for himself, Mr. Heinrich, Ms. Murkowski, Mr. Risch, Mr. Graham, Mr. Cramer, Mr. Cotton, and Mr. Manchin) introduced the following bill; which was read twice and referred to the Committee on Energy and Natural ResourcesA BILLTo extend and expand limitations on the importation of uranium from the Russian Federation, and for other purposes.1.Short titleThis Act may be cited as the Russian Suspension Agreement Extension Act of 2020.2.Extension and expansion of limitations on importation of uranium from Russian Federation(a)In generalSection 3112A of the USEC Privatization Act (42 U.S.C. 2297h–10a) is amended—(1)in subsection (a)—(A)by redesignating paragraph (7) as paragraph (8); and(B)by inserting after paragraph (6) the following:(7)Suspension AgreementThe term Suspension Agreement has the meaning given that term in section 3102(13).;(2)in subsection (b)—(A)by striking United States to support and inserting the following: “United States—(1)to support;(B)by striking the period at the end and inserting a semicolon; and(C)by adding at the end the following:(2)to reduce reliance on uranium imports in order to protect essential national security interests;(3)to revive and strengthen the supply chain for nuclear fuel produced and used in the United States; and(4)to expand production of nuclear fuel in the United States.; and(3)in subsection (c)—(A)in paragraph (2)—(i)in subparagraph (A)—(I)in clause (vi), by striking ; and and inserting a semicolon;(II)in clause (vii), by striking the period at the end and inserting a semicolon; and(III)by adding at the end the following:(viii)in calendar year 2021, 596,682 kilograms;(ix)in calendar year 2022, 489,617 kilograms;(x)in calendar year 2023, 578,877 kilograms;(xi)in calendar year 2024, 476,536 kilograms;(xii)in calendar year 2025, 470,376 kilograms;(xiii)in calendar year 2026, 464,183 kilograms;(xiv)in calendar year 2027, 459,083 kilograms;(xv)in calendar year 2028, 344,312 kilograms;(xvi)in calendar year 2029, 340,114 kilograms;(xvii)in calendar year 2030, 332,141 kilograms;(xviii)in calendar year 2031, 328,862 kilograms;(xix)in calendar year 2032, 322,255 kilograms;(xx)in calendar year 2033, 317,536 kilograms;(xxi)in calendar year 2034, 298,088 kilograms;(xxii)in calendar year 2035, 294,511 kilograms;(xxiii)in calendar year 2036, 286,066 kilograms;(xxiv)in calendar year 2037, 281,272 kilograms;(xxv)in calendar year 2038, 277,124 kilograms;(xxvi)in calendar year 2039, 277,124 kilograms; and(xxvii)in calendar year 2040, 267,685 kilograms.;(ii)by redesignating subparagraph (B) as subparagraph (C); and(iii)by inserting after subparagraph (A) the following:(B)Administration(i)In generalThe Secretary of Commerce shall administer the import limitations described in subparagraph (A) in accordance with the provisions of the Suspension Agreement, including—(I)the limitations on sales of enriched uranium product and separative work units plus conversion, in amounts determined in accordance with Section IV.B.1 of the Suspension Agreement (as amended by the draft amendment published in the Federal Register on September 16, 2020 (85 Fed. Reg. 57826)), and Appendix 5 of the Suspension Agreement; (II)the requirements for natural uranium returned feed associated with imports of low-enriched uranium, including pursuant to sales of enrichment, with or without conversion, from the Russian Federation, as set forth in such Section IV.B.1; and (III)any other provisions of the Suspension Agreement. (ii)Effect of termination of Suspension AgreementClause (i) shall remain in effect if the Suspension Agreement is terminated.;(B)in paragraph (3)—(i)in subparagraph (A), by striking the semicolon and inserting ; or;(ii)in subparagraph (B), by striking ; or and inserting a period; and(iii)by striking subparagraph (C);(C)in paragraph (5)—(i)in subparagraph (A), by striking reference data and all that follows through 2019 and inserting the following: lower scenario data in the report of the World Nuclear Association entitled The Nuclear Fuel Report: Global Scenarios for Demand and Supply Availability 2019–2040. In each of calendar years 2023, 2029, and 2035; and(ii)by redesignating subparagraphs (B) and (C) as subparagraphs (C) and (D), respectively; (iii)by inserting after subparagraph (A) the following:(B)Report requiredNot later than one year after the date of the enactment of the Russian Suspension Agreement Extension Act of 2020, and every 3 years thereafter, the Secretary shall submit to Congress a report that includes—(i)a recommendation on the use of all publicly available data to ensure accurate forecasting by scenario data to comport to actual demand for low-enriched uranium for nuclear reactors in the United States; and(ii)an identification of the steps to be taken to adjust the import limitations described in paragraph (2)(A) based on the most accurate scenario data.; and(iv)in subparagraph (D), as redesignated by clause (ii), by striking subparagraph (B) and inserting subparagraph (C);(D)in paragraph (9), by striking 2020 and inserting 2040; (E)in paragraph (12)(B), by inserting or the Suspension Agreement after the Russian HEU Agreement; and(F)by striking (2)(B) each place it appears and inserting (2)(C).(b)ApplicabilityThe amendments made by subsection (a) apply with respect to uranium imported from the Russian Federation on or after January 1, 2021.


		III
		111th CONGRESS
		2d Session
		S. RES. 440
		IN THE SENATE OF THE UNITED STATES

			March 4, 2010
			Mr. Bennet submitted the
			 following resolution; which was referred to the
			 Committee on Rules and
			 Administration

		RESOLUTION
		Improving the Senate cloture
		  process.

		Whereas the Senate rules regarding cloture serve the
			 legitimate purpose of protecting the rights of the minority;
		Whereas the Senate has never been intended to operate
			 solely on the basis of majority rule; and
		Whereas the Senate rules should not be abused for the
			 purpose of delaying or otherwise preventing the business of the Senate: Now,
			 therefore, be it

		1.Motions to
			 proceedParagraph 2 of rule
			 VIII of the Standing Rules of the Senate is amended to read as follows:

				2.All motions to proceed to the
				consideration of any matter shall be determined without debate, except motions
				to proceed to a proposal to change the Standing Rules which shall be
				debatable.
				.
		2.Process for
			 ending the debate
			(a)Motion To
			 reduce time for cloture petition To ripenThe first sentence of
			 paragraph 2 of rule XXII of the Standing Rules of the Senate is amended by
			 inserting after but one the following: (unless by
			 two-thirds affirmative vote of the Senators duly chosen and sworn the Senate
			 has agreed to a motion to reduce time).
			(b)Allowing for a
			 motion To reduce time postclotureThe fourth undesignated
			 paragraph of paragraph 2 of rule XXII of the Standing Rules of the Senate is
			 amended by striking the second and third sentences and inserting: The
			 thirty hours may be increased or decreased by the adoption of a motion, decided
			 without debate, by a three-fifths affirmative vote of the Senators present and
			 voting, and any such time thus agreed upon shall be equally divided and
			 controlled by the Majority and Minority Leaders or their designees. However,
			 only one motion to reduce or extend time, specified above, may be made in any
			 one calendar day..
			(c)Minority must
			 vote in the negative, or else cloture is invokedThe second
			 undesignated paragraph of paragraph 2 of rule XXII of the Standing Rules of the
			 Senate is amended by striking And if that question shall be decided in
			 the affirmative by three-fifths of the Senators duly chosen and sworn
			 and inserting And if that question is decided in the affirmative and
			 there are not negative votes by at least forty-one hundredths of the Senators
			 duly chosen and sworn.
			(d)Encouraging
			 bipartisan negotiations and bipartisan coalition
			 buildingParagraph 2 of rule XXII of the Standing Rules of the
			 Senate is amended by inserting at the end the following:
			In the
			 event that 3 attempts to bring the debate to a close on any particular measure,
			 motion, other matter pending before the Senate, or the unfinished business,
			 have not received the requisite number of votes to bring the debate to a close
			 under this paragraph, then for any subsequent attempt to bring the debate to a
			 close on that particular measure, motion, other matter pending before the
			 Senate, or the unfinished business, the threshold required of those voting in
			 the negative in order to prevent the debate from coming to a close shall be 45
			 hundredths of the Senators duly chosen and sworn, unless at least one of the
			 Senators present and voting in the negative, caucuses with the party of the
			 Majority Leader, in which case the threshold required of those voting in the
			 negative in order to prevent the debate from coming to a close shall remain 41
			 hundredths of the Senators duly chosen and sworn. If there is one member of the
			 Majority voting to maintain the filibuster for purposes of the preceding
			 sentence maintaining the threshold for blocking cloture at 41 hundredths, the
			 threshold shall be raised to 45 hundredths if 3 of those voting in the
			 affirmative to bring debate to a close caucus with the party of the Minority
			 Leader. For purposes of this undesignated paragraph, only those Senators
			 permitted to caucus with the party of the Majority Leader, by the Majority
			 Leader, shall be considered to caucus with the party of the Majority Leader.
			 The Majority Leader shall request that a list of Senators caucusing with the
			 party of the Majority Leader be listed in the Congressional Record, and any
			 time that the Majority Leader shall regard composition of such list as having
			 changed, the Majority Leader shall request that a new and updated list be
			 printed in the Congressional Record..
			3.HoldsThe Standing Rules of the Senate are amended
			 by inserting at the end the following:

				Rule
			 XLV
				Process for
			 holds
					1.A Senator who provides notice either
				to leadership or during open public debate in the full Senate of intention to
				object to proceeding to a motion or matter shall disclose the objection in the
				Congressional Record not later than 2 session days after the date of such
				notice. Upon the placement of the disclosure of objection in the Congressional
				Record, the Senate shall only continue to recognize the objection if the
				objection is raised as provided in this paragraph at least by one Senator who
				caucuses with the party of the Majority Leader and by one Senator who caucuses
				with the party of the Minority Leader. Under no circumstance shall a particular
				objection to a nomination be recognized for more than 30 days.
					2.If a second objection is raised to a
				nomination, no additional time beyond the 30-day limit of the first objection
				to the nominee shall be in order unless the second objection is raised by both
				at least one Senator who caucuses with the party of the Majority Leader but who
				did not raise the first objection, and also at least one Senator who caucuses
				with the party of the Minority Leader but who did not raise the first
				objection.
					3.In this rule, the term with the
				party of the Majority Leader has the same meaning as in rule XXII. The
				process for determining what Senator caucuses with the party of the Minority
				Leader under this rule shall be at the discretion of the Minority Leader but
				shall follow the analogous rule XXII
				process.
					.


117 S1812 IS: Lincoln Home National Historic Site Boundary Modification Act
U.S. Senate
2021-05-25
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II117th CONGRESS1st SessionS. 1812IN THE SENATE OF THE UNITED STATESMay 25, 2021Mr. Durbin (for himself and Ms. Duckworth) introduced the following bill; which was read twice and referred to the Committee on Energy and Natural ResourcesA BILLTo modify the boundary of the Lincoln Home National Historic Site in the State of Illinois.1.Short titleThis Act may be cited as the Lincoln Home National Historic Site Boundary Modification Act.2.Lincoln Home National Historic Site boundary modificationPublic Law 92–127 (54 U.S.C. 320101 note; 85 Stat. 347) is amended—(1)in the first section—(A)by striking That, in order to and inserting the following:1.Establishment of Lincoln Home National Historic Site(a)In generalTo; and(B)by adding at the end the following:(b)Boundary modificationThe boundary of the Lincoln Home National Historic Site established under subsection (a) is modified as generally depicted on the map entitled Proposed Boundary Expansion of the Lincoln Home National Historic Site and dated February 26, 2021.;(2)in section 2—(A)by striking the section designation and all that follows through The and inserting the following:2.Administration(a)In generalThe; and(B)by adding at the end the following:(b)AccessibilityTo improve accessibility, the Secretary of the Interior shall modify the following areas located within the boundary of the Lincoln Home National Historic Site to provide universal design and accessibility by raising the height of the street to match the height of the sidewalk with no sloped surfaces: (1)The intersection at 8th Street and Jackson Street. (2)The area in front of the home of Abraham Lincoln.; and(3)in section 3, by striking the section designation and all that follows through There are and inserting the following:3.Authorization of appropriationsThere are.


110 HR 296 IH: Urban Area Security Initiative Improvement Act of 2007
U.S. House of Representatives
2007-01-05
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I
110th CONGRESS
1st Session
H. R. 296
IN THE HOUSE OF REPRESENTATIVES

January 5, 2007
Ms. Matsui introduced the following bill; which was referred to the Committee on Homeland Security

A BILL
To specify that the 100 most populous urban areas of the United States, as determined by the Secretary of Homeland Security, shall be eligible for grants under the Urban Area Security Initiative of the Department of Homeland Security, and for other purposes.

1.Short titleThis Act may be cited as the Urban Area Security Initiative Improvement Act of 2007.
2.Grants under Urban Area Security Initiative
(a)Eligibility
(1)In generalEach of the 100 most populous urban areas of the United States shall be eligible for a grant under the Urban Area Security Initiative.
(2)DeterminationFor purposes of this subsection, the Secretary of Homeland Security shall determine the urban areas referred to in paragraph (1) in accordance with the data collected in the most recent census of the United States.
(b)Sensitivity analysisThe Secretary of Homeland Security shall award grants under the Urban Area Security Initiative after considering a study of how the variation in the output of models (numerical or otherwise) used for such awards can be apportioned, qualitatively or quantitatively, to different sources of variation (commonly referred to as sensitivity analysis).
(c)Urban Area Security Initiative DefinedIn this section the term Urban Area Security Initiative means the Urban Area Security Initiative grant program administered by the Department of Homeland Security from funds appropriated for discretionary grants to high-threat, high-density urban areas.


114 S3264 IS: To amend the Internal Revenue Code of 1986 to modify the credit for production of electricity from renewable resources to allow a credit for certain open-loop biomass and trash facilities placed in service before the date of the enactment of this Act and to modify the definition of municipal solid waste.
U.S. Senate
2016-07-14
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
		114th CONGRESS2d Session
		S. 3264
		IN THE SENATE OF THE UNITED STATES

			July 14, 2016
			Mr. Menendez (for himself, Ms. Stabenow, Mr. Cardin, Ms. Collins, Mr. King, Ms. Ayotte, Ms. Klobuchar, and Mrs. Feinstein) introduced the following bill; which was read twice and referred to the Committee on Finance

		A BILL
		To amend the Internal Revenue Code of 1986 to modify the credit for production of electricity from
			 renewable resources to allow a credit for certain open-loop biomass and
			 trash facilities placed in service before the date of the enactment of
			 this Act and to modify the definition of municipal solid waste.

		1.Special rule for certain facilities generating electricity from biomass and municipal solid waste
 (a)In generalSection 45(e) of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:

					(12)Special rule for certain qualified facilities
 (A)In generalIn the case of electricity produced at a qualified facility described in paragraph (3) or (7) of subsection (d) and placed in service before the date of the enactment of this paragraph, a taxpayer may elect to apply subsection (a)(2)(A)(ii) by substituting the period beginning after December 31, 2016, and ending before January 1, 2018 for the 10-year period beginning on the date the facility was originally placed in service.
 (B)LimitationNo credit shall be allowed under subsection (a) to any taxpayer making an election under this paragraph with respect to electricity produced and sold at a facility during any period which, when aggregated with all other periods for which a credit is allowed under this section with respect to electricity produced and sold at such facility, is in excess of 10 years..
 (b)Effective dateThe amendment made by this section shall take effect on January 1, 2017. 2.Modification to definition of municipal solid waste (a)In generalParagraph (6) of section 45(c) of the Internal Revenue Code of 1986 is amended to read as follows:

					(6)Municipal solid waste
 (A)In generalThe term municipal solid waste has the meaning given the term solid waste under section 2(27) of the Solid Waste Disposal Act (42 U.S.C. 6903), except that such term does not include—
 (i)paper which is commonly recycled and which has been segregated from other solid waste (as so defined), or
 (ii)solid waste (as so defined) which is collected as part of a system which commingles commonly recycled paper with other solid waste which is not commonly recycled at any point from the time of collection through any materials recovery.
 (B)Special rule with respect to incidental and residual wasteSubparagraph (A)(ii) shall not apply to— (i)solid waste (as so defined) which only contains an incidental amount of commonly recycled paper, and
 (ii)solid waste (as so defined) which is residual waste generated at a materials recovery facility that receives and processes only paper and other recyclable materials containing no more than an incidental amount of non-recyclable solid waste.
 (C)No effect on existing processesNothing in subparagraph (A) shall be interpreted to require a State or a political subdivision of a State, directly or indirectly, to change the systems, processes, or equipment it uses to collect, treat, dispose, or otherwise use municipal solid waste, within the meaning of the Solid Waste Disposal Act (42 U.S.C. 6903 et seq.), nor require a change to the regulations that implement subtitle D of such Act (42 U.S.C. 6901 et seq.)..
 (b)Rules with respect to electricity produced from solid wasteSubsection (e) of section 45 of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new paragraph:

 (13)Source of municipal solid waste feedstockIn the case of a qualified facility that produces electricity both from municipal solid waste and other solid waste that is not a qualified energy resource—
 (A)such facility shall be considered a qualified facility if it otherwise meets the requirements of subsection (d), and
 (B)subsection (a) shall only apply to that portion of the electricity produced from municipal solid waste..
 (c)Effective dateThe amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.


		II
		112th CONGRESS
		2d Session
		S. 2329
		IN THE SENATE OF THE UNITED STATES

			April 23, 2012
			Mr. Levin introduced the
			 following bill; which was read twice and referred to the
			 Committee on
			 Finance

		A BILL
		To reduce temporarily the duty on certain direct
		  injection fuel injectors.

		1.Certain direct injection fuel
			 injectors
			(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:

								9902.01.00Direct injection fuel injectors (solenoid valves) (provided for
						in subheading 8481.8090) designed to inject gasoline/ethanol fuel blends
						directly into the combustion chamber of a spark-ignition combustion piston
						engine in a high-pressure non-port injection system in a motor
						vehicle1.1%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
		112th CONGRESS
		1st Session
		S. 850
		IN THE SENATE OF THE UNITED STATES

			April 14, 2011
			Mr. Durbin (for himself,
			 Mr. Casey, Mr.
			 Menendez, Mr. Lautenberg, and
			 Mrs. Gillibrand) introduced the following
			 bill; which was read twice and referred to the
			 Committee on Health, Education, Labor,
			 and Pensions

		A BILL
		To provide for enhanced treatment, support, services, and
		  research for individuals with autism spectrum disorders and their
		  families.

		1.Short
			 title; table of contents
			(a)Short
			 titleThis Act may be cited
			 as the Autism Services and Workforce
			 Acceleration Act of 2011.
			(b)Table of
			 contentsThe table of contents for this Act is as follows:

					Sec. 1. Short title; table of
				contents.
					Sec. 2. Findings.
					Sec. 3. Parental rights rule of construction.
					Sec. 4. Definitions; technical amendment to the Public Health
				Service Act.
					Sec. 5. Autism Care Programs Demonstration Project.
					Sec. 6. Planning and demonstration grants for services for
				transitioning youth and adults.
					Sec. 7. Multimedia campaign.
					Sec. 8. National training initiatives on autism spectrum
				disorders.
					Sec. 9. Authorization of appropriations.

			2.FindingsCongress makes the following
			 findings:
			(1)Autism (sometimes
			 called classical autism) is the most common condition in a group
			 of developmental disorders known as autism spectrum disorders.
			(2)Autism spectrum
			 disorders include autism as well as Asperger syndrome, Retts syndrome,
			 childhood disintegrative disorder, and pervasive developmental disorder not
			 otherwise specified (usually referred to as PDD–NOS), as well as other related
			 developmental disorders.
			(3)Individuals with
			 autism spectrum disorders have the same rights as other individuals to exert
			 control and choice over their own lives, to live independently, and to
			 participate fully in, and contribute to, their communities and society through
			 full integration and inclusion in the economic, political, social, cultural,
			 and educational mainstream of society. Individuals with autism spectrum
			 disorders have the right to a life with dignity and purpose.
			(4)While there is no
			 uniform prevalence or severity of symptoms associated with autism spectrum
			 disorders, the National Institutes of Health has determined that autism
			 spectrum disorders are characterized by 3 distinctive behaviors: impaired
			 social interaction, problems with verbal and nonverbal communication, and
			 unusual, repetitive, or severely limited activities and interests.
			(5)Both children and
			 adults with autism spectrum disorders can show difficulties in verbal and
			 nonverbal communication, social interactions, and sensory processing.
			 Individuals with autism spectrum disorders exhibit different symptoms or
			 behaviors, which may range from mild to significant, and require varying
			 degrees of support from friends, families, service providers, and
			 communities.
			(6)Individuals with
			 autism spectrum disorders often need assistance in the areas of comprehensive
			 early intervention, health, recreation, job training, employment, housing,
			 transportation, and early, primary, and secondary education. Greater
			 coordination and streamlining within the service delivery system will enable
			 individuals with autism spectrum disorders and their families to access
			 assistance from all sectors throughout an individual’s lifespan.
			(7)A 2009 report
			 from the Centers for Disease Control and Prevention found that the prevalence
			 of autism spectrum disorders is estimated to be 1 in 110 people in the United
			 States.
			(8)The Harvard
			 School of Public Health reported that the cost of caring for and treating
			 individuals with autism spectrum disorders in the United States is more than
			 $35,000,000,000 annually (an estimated $3,200,000 over an individual’s
			 lifetime).
			(9)Although the
			 overall incidence of autism is consistent around the globe, researchers with
			 the Journal of Paediatrics and Child Health have found that males are 4 times
			 more likely to develop an autism spectrum disorder than females. Autism
			 spectrum disorders know no racial, ethnic, or social boundaries, nor
			 differences in family income, lifestyle, or educational levels, and can affect
			 any child.
			(10)Individuals with
			 autism spectrum disorders from low-income, rural, and minority communities
			 often face significant obstacles to accurate diagnosis and necessary
			 specialized services, supports, and education.
			(11)There is strong
			 consensus within the research community that intensive treatment as soon as
			 possible following diagnosis not only can reduce the cost of lifelong care by
			 two-thirds, but also yields the most positive life outcomes for children with
			 autism spectrum disorders.
			(12)Individuals with
			 autism spectrum disorders and their families experience a wide range of medical
			 issues. Few common standards exist for the diagnosis and management of many
			 aspects of clinical care. Behavioral difficulties may be attributed to the
			 overarching disorder rather than to the pain and discomfort of a medical
			 condition, which may go undetected and untreated. The health care and other
			 treatments available in different communities can vary widely. Many families,
			 lacking access to comprehensive and coordinated health care, must fend for
			 themselves to find the best health care, treatments, and services in a complex
			 clinical world.
			(13)Effective health
			 care, treatment, and services for individuals with autism spectrum disorders
			 depends upon a continuous exchange among researchers and caregivers.
			 Evidence-based and promising autism practices should move quickly into
			 communities, allowing individuals with autism spectrum disorders and their
			 families to benefit from the newest research and enabling researchers to learn
			 from the life experiences of the people whom their work most directly
			 affects.
			(14)There is a
			 critical shortage of appropriately trained personnel across numerous important
			 disciplines who can assess, diagnose, treat, and support children and adults
			 with autism spectrum disorders and their families. Practicing professionals, as
			 well as those in training to become professionals, need the most up-to-date
			 practices informed by the most current research findings.
			(15)The appropriate
			 goals of the Nation regarding individuals with autism spectrum disorder are the
			 same as the appropriate goals of the Nation regarding individuals with
			 disabilities in general, as established in the Americans with Disabilities Act
			 of 1990 (42 U.S.C. 12101 et seq.): to assure equality of opportunity, full
			 participation, independent living, and economic self-sufficiency for such
			 individuals.
			(16)Finally,
			 individuals with autism spectrum disorders are often denied health care
			 benefits solely because of their diagnosis, even though proven, effective
			 treatments for autism spectrum disorders do exist.
			3.Parental rights
			 rule of constructionNothing
			 in this Act shall be construed to modify the legal rights of parents or legal
			 guardians under Federal, State, or local law regarding the care of their
			 children.
		4.Definitions;
			 technical amendment to the Public Health Service ActPart R of title III of the Public Health
			 Service Act (42 U.S.C. 280i et seq.) is amended—
			(1)by inserting after the header for part R
			 the following:

					1Surveillance and
				Research Program; Education, Early Detection, and Intervention; and
				Reporting
					;
			(2)in section
			 399AA(d), by striking part and inserting subpart;
			 and
			(3)by adding at the
			 end the following:

					2Care for people
				with autism spectrum disorders; public education
						399GG.DefinitionsExcept as otherwise provided, in this
				subpart:
							(1)Adult with
				autism spectrum disorderThe term adult with autism
				spectrum disorder means an individual with an autism spectrum disorder
				who has attained 22 years of age.
							(2)Affected
				individualThe term affected individual means an
				individual with an autism spectrum disorder.
							(3)AutismThe
				term autism means an autism spectrum disorder or a related
				developmental disability.
							(4)Autism care
				programIn this subpart, the term autism care
				program means a program that is directed by a care coordinator who is an
				expert in autism spectrum disorder treatment and practice and provides an array
				of medical, psychological, behavioral, educational, and family services to
				individuals with autism and their families. Such a program shall—
								(A)incorporate the
				attributes of the care management model;
								(B)offer, through an
				array of services or through detailed referral and coordinated care
				arrangements, an autism management team of appropriate providers, including
				behavioral specialists, physicians, psychologists, social workers, family
				therapists, nurse practitioners, nurses, educators, and other appropriate
				personnel; and
								(C)have the
				capability to achieve improvements in the management and coordination of care
				for targeted beneficiaries.
								(5)Autism
				management teamThe term autism management team
				means a group of autism care providers, including behavioral specialists,
				physicians, psychologists, social workers, family therapists, nurse
				practitioners, nurses, educators, other appropriate personnel, and family
				members who work in a coordinated manner to treat individuals with autism
				spectrum disorders and their families. Such team shall determine the specific
				structure and operational model of its specific autism care program, taking
				into consideration cultural, regional, and geographical factors.
							(6)Autism spectrum
				disorderThe term autism spectrum disorder means a
				developmental disability that causes substantial impairments in the areas of
				social interaction, emotional regulation, communication, and the integration of
				higher-order cognitive processes and which may be characterized by the presence
				of unusual behaviors and interests. Such term includes autistic disorder,
				pervasive developmental disorder (not otherwise specified), Asperger syndrome,
				Retts disorder, childhood disintegrative disorder, and other related
				developmental disorders.
							(7)Care management
				modelThe term care management model means a model
				of care that with respect to autism—
								(A)is centered on
				the relationship between an individual with an autism spectrum disorder and his
				or her family and their personal autism care coordinator;
								(B)provides services
				to individuals with autism spectrum disorders to improve the management and
				coordination of care provided to individuals and their families; and
								(C)has established,
				where practicable, effective referral relationships between the autism care
				coordinator and the major medical, educational, and behavioral specialties and
				ancillary services in the region.
								(8)Child with
				autism spectrum disorderThe term child with autism
				spectrum disorder means an individual with an autism spectrum disorder
				who has not attained 22 years of age.
							(9)InterventionsThe
				term interventions means the educational methods and positive
				behavioral support strategies designed to improve or ameliorate symptoms
				associated with autism spectrum disorders.
							(10)Personal care
				coordinatorThe term personal care coordinator means
				a physician, nurse, nurse practitioner, psychologist, social worker, family
				therapist, educator, or other appropriate personnel (as determined by the
				Secretary) who has extensive expertise in treatment and services for
				individuals with autism spectrum disorders, who—
								(A)practices in an
				autism care program; and
								(B)has been trained
				to coordinate and manage comprehensive autism care for the whole person.
								(11)ProjectThe
				term project means the autism care program demonstration project
				established under section 399GG–1.
							(12)ServicesThe
				term services means services to assist individuals with autism
				spectrum disorders to live more independently in their communities and to
				improve their quality of life.
							(13)TreatmentsThe
				term treatments means the health services, including mental health
				and behavioral therapy services, designed to improve or ameliorate symptoms
				associated with autism spectrum
				disorders.
							.
			5.Autism Care
			 Programs Demonstration ProjectPart R of title III of the Public Health
			 Service Act (42 U.S.C. 280i), as amended by section 4, is further amended by
			 adding at the end the following:

				399GG–1.Autism
				Care Programs demonstration project
					(a)In
				generalNot later than 1 year
				after the date of enactment of the Autism
				Services and Workforce Acceleration Act of 2011, the Secretary,
				acting through the Administrator of the Health Resources and Services
				Administration, shall establish a demonstration project for the implementation
				of an Autism Care Program (referred to in this section as the
				Program) to provide grants and other assistance to improve the
				effectiveness and efficiency in providing comprehensive care to individuals
				diagnosed with autism spectrum disorders and their families.
					(b)GoalsThe
				Program shall be designed—
						(1)to
				increase—
							(A)comprehensive
				autism spectrum disorder care delivery;
							(B)access to
				appropriate health care services, especially wellness and prevention care, at
				times convenient for individuals;
							(C)satisfaction of
				individuals with autism spectrum disorders;
							(D)communication
				among autism spectrum disorder health care providers, behaviorists, educators,
				specialists, hospitals, and other autism spectrum disorder care
				providers;
							(E)academic progress
				of students with autism spectrum disorders;
							(F)successful
				transition to postsecondary education, vocational or job training and
				placement, and comprehensive adult services for individuals with autism
				spectrum disorders, focusing in particular upon the transitional period for
				individuals between the ages of 18 and 25;
							(G)the quality of
				health care services, taking into account nationally developed standards and
				measures;
							(H)development,
				review, and promulgation of common clinical standards and guidelines for
				medical care to individuals with autism spectrum disorders;
							(I)development of
				clinical research projects to support clinical findings in a search for
				recommended practices; and
							(J)the quality of
				life of individuals with autism spectrum disorders, including communication
				abilities, social skills, community integration, self-determination, and
				employment and other related services; and
							(2)to
				decrease—
							(A)inappropriate
				emergency room utilization;
							(B)avoidable
				hospitalizations;
							(C)the duplication
				of health care services;
							(D)the inconvenience
				of multiple provider locations;
							(E)health
				disparities and inequalities that individuals with autism spectrum disorders
				face; and
							(F)preventable and
				inappropriate involvement with the juvenile and criminal justice
				systems.
							(c)Eligible
				entitiesTo be eligible to receive assistance under the Program,
				an entity shall—
						(1)be a State or a
				public or private nonprofit entity;
						(2)coordinate
				activities with the applicable University Centers for Excellence in
				Developmental Disabilities, the Council on Developmental Disabilities, and the
				Protection and Advocacy System;
						(3)demonstrate a
				capacity to provide services to individuals with developmental disabilities and
				autism spectrum disorder;
						(4)agree to
				establish and implement treatments, interventions, and services that—
							(A)enable targeted
				beneficiaries to designate a personal care coordinator to be their source of
				first contact and to recommend comprehensive and coordinated care for the whole
				of the individual;
							(B)provide for the
				establishment of a coordination of care committee that is composed of
				clinicians and practitioners trained in and working in autism spectrum disorder
				intervention;
							(C)establish a
				network of physicians, psychologists, family therapists, behavioral
				specialists, social workers, educators, and health centers that have
				volunteered to participate as consultants to patient-centered autism care
				programs to provide high-quality care, focusing on autism spectrum disorder
				care, at the appropriate times and places and in a cost-effective
				manner;
							(D)work in
				cooperation with hospitals, local public health departments, and the network of
				patient-centered autism care programs, to coordinate and provide health
				care;
							(E)utilize health
				information technology to facilitate the provision and coordination of health
				care by network participants; and
							(F)collaborate with
				other entities to further the goals of the program, particularly by
				collaborating with entities that provide transitional adult services to
				individuals between the ages of 18 and 25 with autism spectrum disorder, to
				ensure successful transition of such individuals to adulthood; and
							(5)submit to the
				Secretary an application, at such time, in such manner, and containing such
				information as the Secretary may require, including—
							(A)a description of
				the treatments, interventions, or services that the eligible entity proposes to
				provide under the Program;
							(B)a demonstration
				of the capacity of the eligible entity to provide or establish such treatments,
				interventions, and services within such entity;
							(C)a description of
				the treatments, interventions, or services that are available to individuals
				with autism in the State;
							(D)a description of
				the gaps in services that exist in different geographic segments of the
				State;
							(E)a demonstration
				of the capacity of the eligible entity to monitor and evaluate the outcomes of
				the treatments, interventions, and services described in subparagraph
				(A);
							(F)estimates of the
				number of individuals and families who will be served by the eligible entity
				under the Program, including an estimate of the number of such individuals and
				families in medically underserved areas;
							(G)a description of
				the ability of the eligible entity to enter into partnerships with
				community-based or nonprofit providers of treatments, interventions, and
				services, which may include providers that act as advocates for individuals
				with autism spectrum disorders and local governments that provide services for
				individuals with autism spectrum disorders at the community level;
							(H)a description of
				the ways in which access to such treatments and services may be sustained
				following the Program period;
							(I)a description of
				the ways in which the eligible entity plans to collaborate with other entities
				to develop and sustain an effective protocol for successful transition from
				children's services to adult services for individuals with autism spectrum
				disorder, particularly for individuals between the ages of 18 and 25;
				and
							(J)a description of
				the compliance of the eligible entity with the integration requirement provided
				under section 302 of the Americans with Disabilities Act of 1990 (42 U.S.C.
				12182).
							(d)GrantsThe
				Secretary shall award 3-year grants to eligible entities whose applications are
				approved under subsection (c). Such grants shall be used to—
						(1)carry out a
				program designed to meet the goals described in subsection (b) and the
				requirements described in subsection (c); and
						(2)facilitate
				coordination with local communities to be better prepared and positioned to
				understand and meet the needs of the communities served by autism care
				programs.
						(e)Advisory
				councils
						(1)In
				generalEach recipient of a grant under this section shall
				establish an autism care program advisory council, which shall advise the
				autism care program regarding policies, priorities, and services.
						(2)MembershipEach
				recipient of a grant shall appoint members of the recipient's advisory council,
				which shall include a variety of autism care program service providers,
				individuals from the public who are knowledgeable about autism spectrum
				disorders, individuals receiving services through the Program, and family
				members of such individuals. At least 60 percent of the membership shall be
				comprised of individuals who have received, or are receiving, services through
				the Program or who are family members of such individuals.
						(3)ChairpersonThe
				recipient of a grant shall appoint a chairperson to the advisory council of the
				recipient's autism care program who shall be—
							(A)an individual
				with autism spectrum disorder who has received, or is receiving, services
				through the Program; or
							(B)a family member
				of such an individual.
							(f)EvaluationThe
				Secretary shall enter into a contract with an independent third-party
				organization with expertise in evaluation activities to conduct an evaluation
				and, not later than 180 days after the conclusion of the 3-year grant program
				under this section, submit a report to the Secretary, which may include
				measures such as whether and to what degree the treatments, interventions, and
				services provided through the Program have resulted in improved health,
				educational, employment, and community integration outcomes for individuals
				with autism spectrum disorders, or other measures, as the Secretary determines
				appropriate.
					(g)Administrative
				expensesOf the amounts appropriated to carry out this section,
				the Secretary shall allocate not more than 7 percent for administrative
				expenses, including the expenses related to carrying out the evaluation
				described in subsection (f).
					(h)Supplement not
				supplantAmounts provided to an entity under this section shall
				be used to supplement, not supplant, amounts otherwise expended for existing
				treatments, interventions, and services for individuals with autism spectrum
				disorders.
					.
		6.Planning and
			 demonstration grants for services for transitioning youth and
			 adultsPart R of title III of
			 the Public Health Service Act (42 U.S.C. 280i), as amended by section 5, is
			 further amended by adding at the end the following:

				399GG–2.Planning
				and demonstration grants for services for transitioning youth and
				adults
					(a)In
				general
						(1)EstablishmentThe
				Secretary shall establish the grants described in paragraph (2) in order to
				enable selected eligible entities to provide appropriate services—
							(A)to youth with
				autism spectrum disorders who are transitioning from secondary education to
				careers or postsecondary education (referred to in this section as
				transitioning youth); and
							(B)to adults with
				autism spectrum disorders, including individuals who are typically underserved,
				to enable such individuals to be as independent as possible.
							(2)GrantsThe
				grants described in this paragraph are—
							(A)a one-time,
				single-year planning grant program for eligible entities; and
							(B)a multiyear
				service provision demonstration grant program for selected eligible
				entities.
							(b)Purpose of
				grantsGrants shall be awarded to eligible entities to provide
				all or part of the funding needed to carry out programs that focus on critical
				aspects of life for transitioning youth and adults with autism spectrum
				disorders, such as—
						(1)postsecondary
				education, vocational training, self-advocacy skills, and employment;
						(2)residential
				services and supports, housing, and transportation;
						(3)nutrition, health
				and wellness, recreational and social activities; and
						(4)personal safety
				and the needs of individuals with autism spectrum disorders who become involved
				with the criminal justice system.
						(c)Eligible
				entityAn eligible entity desiring to receive a grant under this
				section shall be a State or other public or private nonprofit organization,
				including an autism care program.
					(d)Planning
				grants
						(1)In
				generalThe Secretary shall award one-time grants to eligible
				entities to support the planning and development of initiatives that will
				expand and enhance service delivery systems for transitioning youth and adults
				with autism spectrum disorders.
						(2)ApplicationIn
				order to receive such a grant, an eligible entity shall—
							(A)submit an
				application at such time and containing such information as the Secretary may
				require; and
							(B)demonstrate the
				ability to carry out such planning grant in coordination with the State
				Developmental Disabilities Council and organizations representing or serving
				individuals with autism spectrum disorders and their families.
							(e)Implementation
				grants
						(1)In
				generalThe Secretary shall award grants to eligible entities
				that have received a planning grant under subsection (d) to enable such
				entities to provide appropriate services to transitioning youth and adults with
				autism spectrum disorders.
						(2)ApplicationIn
				order to receive a grant under paragraph (1), the eligible entity shall submit
				an application at such time and containing such information as the Secretary
				may require, including—
							(A)the services that
				the eligible entity proposes to provide and the expected outcomes for
				individuals with autism spectrum disorders who receive such services;
							(B)the number of
				individuals and families who will be served by such grant, including an
				estimate of the individuals and families in underserved areas who will be
				served by such grant;
							(C)the ways in which
				services will be coordinated among both public and nonprofit providers of
				services for transitioning youth and adults with disabilities, including
				community-based services;
							(D)where applicable,
				the process through which the eligible entity will distribute funds to a range
				of community-based or nonprofit providers of services, including local
				governments, and such entity's capacity to provide such services;
							(E)the process
				through which the eligible entity will monitor and evaluate the outcome of
				activities funded through the grant, including the effect of the activities
				upon adults with autism spectrum disorders who receive such services;
							(F)the plans of the
				eligible entity to coordinate and streamline transitions from youth to adult
				services;
							(G)the process by
				which the eligible entity will ensure compliance with the integration
				requirement provided under section 302 of the Americans With Disabilities Act
				of 1990 (42 U.S.C. 12182); and
							(H)a description of
				how such services may be sustained following the grant period.
							(f)EvaluationThe
				Secretary shall contract with a third-party organization with expertise in
				evaluation to evaluate such demonstration grant program and, not later than 180
				days after the conclusion of the grant program under subsection (e), submit a
				report to the Secretary. The evaluation and report may include an analysis of
				whether and to what extent the services provided through the grant program
				described in this section resulted in improved health, education, employment,
				and community integration outcomes for adults with autism spectrum disorders,
				or other measures, as the Secretary determines appropriate.
					(g)Administrative
				expensesOf the amounts appropriated to carry out this section,
				the Secretary shall set aside not more than 7 percent for administrative
				expenses, including the expenses related to carrying out the evaluation
				described in subsection (f).
					(h)Supplement, not
				supplantDemonstration grant funds provided under this section
				shall supplement, not supplant, existing treatments, interventions, and
				services for individuals with autism spectrum
				disorders.
					.
		7.Multimedia
			 campaignPart R of title III
			 of the Public Health Service Act (42 U.S.C. 280i), as amended by section 6, is
			 further amended by adding at the end the following:

				399GG–3.Multimedia
				campaign
					(a)In
				generalThe Secretary, in order to enhance existing awareness
				campaigns and provide for the implementation of new campaigns, shall award
				grants to public and nonprofit private entities for the purpose of carrying out
				multimedia campaigns to increase public education and awareness and reduce
				stigma concerning—
						(1)healthy
				developmental milestones for infants and children that may assist in the early
				identification of the signs and symptoms of autism spectrum disorders;
				and
						(2)autism spectrum
				disorders through the lifespan and the challenges that individuals with autism
				spectrum disorders face, which may include transitioning into adulthood,
				securing appropriate job training or postsecondary education, securing and
				holding jobs, finding suitable housing, interacting with the correctional
				system, increasing independence, and attaining a good quality of life.
						(b)EligibilityTo
				be eligible to receive a grant under subsection (a), an entity shall—
						(1)submit to the
				Secretary an application at such time, in such manner, and containing such
				information as the Secretary may require; and
						(2)provide assurance
				that the multimedia campaign implemented under such grant will provide
				information that is tailored to the intended audience, which may be a diverse
				public audience or a specific audience, such as health professionals, criminal
				justice professionals, or emergency response
				professionals.
						.
		8.National
			 training initiatives on autism spectrum disordersPart R of title III of the Public Health
			 Service Act (42 U.S.C. 280i), as amended by section 7, is further amended by
			 adding at the end the following:

				399GG–4.National
				training initiatives on autism spectrum disorders
					(a)National
				training initiative supplemental grants
						(1)In
				generalThe Secretary shall award multiyear national training
				initiative supplemental grants to eligible entities so that such entities may
				provide training and technical assistance and to disseminate information, in
				order to enable such entities to address the unmet needs of individuals with
				autism spectrum disorders and their families.
						(2)Eligible
				entityTo be eligible to receive assistance under this section an
				entity shall—
							(A)be a public or
				private nonprofit entity, including University Centers for Excellence in
				Developmental Disabilities and other service, training, and academic entities;
				and
							(B)submit an
				application as described in paragraph (3).
							(3)RequirementsAn
				eligible entity that desires to receive a grant under this paragraph shall
				submit to the Secretary an application containing such agreements and
				information as the Secretary may require, including agreements that the
				training program shall—
							(A)provide training
				and technical assistance in evidence-based practices of effective
				interventions, services, treatments, and supports to children and adults on the
				autism spectrum and their families, and evaluate the implementation of such
				practices;
							(B)provide trainees
				with an appropriate balance of interdisciplinary academic and community-based
				experiences;
							(C)have a
				demonstrated capacity to include individuals with autism spectrum disorders,
				parents, and family members as part of the training program to ensure that a
				person and family-centered approach is used;
							(D)provide to the
				Secretary, in the manner prescribed by the Secretary, data regarding the
				outcomes of the provision of training and technical assistance;
							(E)demonstrate a
				capacity to share and disseminate materials and practices that are developed
				and evaluated to be effective in the provision of training and technical
				assistance; and
							(F)provide
				assurances that training, technical assistance, and information dissemination
				performed under grants made pursuant to this paragraph shall be consistent with
				the goals established under already existing disability programs authorized
				under Federal law and conducted in coordination with other relevant State
				agencies and service providers.
							(4)ActivitiesAn
				entity that receives a grant under this section shall expand and develop
				interdisciplinary training and continuing education initiatives for health,
				allied health, and educational professionals by engaging in the following
				activities:
							(A)Promoting and
				engaging in training for health, allied health, and educational professionals
				to identify, diagnose, and develop interventions for individuals with, or at
				risk of developing, autism spectrum disorders.
							(B)Expanding the
				availability of training and dissemination of information regarding effective,
				lifelong interventions, educational services, and community supports.
							(C)Providing
				training and technical assistance in collaboration with relevant State,
				regional, or national agencies, institutions of higher education, and advocacy
				groups or community-based service providers, including health and allied health
				professionals, employment providers, direct support professionals, emergency
				first responder personnel, and law enforcement officials.
							(D)Developing
				mechanisms to provide training and technical assistance, including for-credit
				courses, intensive summer institutes, continuing education programs,
				distance-based programs, and Web-based information dissemination
				strategies.
							(E)Collecting data
				on the outcomes of training and technical assistance programs to meet statewide
				needs for the expansion of services to children with autism spectrum disorders
				and adults with autism spectrum disorders.
							(b)Technical
				assistanceThe Secretary shall reserve 2 percent of the
				appropriated funds to make a grant to a national organization with demonstrated
				capacity for providing training and technical assistance to the entities
				receiving grants under subsection (a) to enable such entities to—
						(1)assist in
				national dissemination of specific information, including evidence-based and
				promising best practices, from interdisciplinary training programs, and when
				appropriate, other entities whose findings would inform the work performed by
				entities awarded grants;
						(2)compile and
				disseminate strategies and materials that prove to be effective in the
				provision of training and technical assistance so that the entire network can
				benefit from the models, materials, and practices developed in individual
				programs;
						(3)assist in the
				coordination of activities of grantees under this section;
						(4)develop an
				Internet Web portal that will provide linkages to each of the individual
				training initiatives and provide access to training modules, promising
				training, and technical assistance practices and other materials developed by
				grantees;
						(5)convene experts
				from multiple interdisciplinary training programs and individuals with autism
				spectrum disorders and their families to discuss and make recommendations with
				regard to training issues related to the assessment, diagnosis of, treatment,
				interventions and services for, children and adults with autism spectrum
				disorders; and
						(6)undertake any
				other functions that the Secretary determines to be appropriate.
						(c)Supplement not
				supplantAmounts provided under this section shall be used to
				supplement, not supplant, amounts otherwise expended for existing network or
				organizational
				structures.
					.
		9.Authorization of
			 appropriationsThere are
			 authorized to be appropriated for fiscal years 2012 through 2016 such sums as
			 may be necessary to carry out this Act.


		II
		110th CONGRESS
		2d Session
		S. 3613
		IN THE SENATE OF THE UNITED STATES

			September 26
			 (legislative day, September 17), 2008
			Mr. Wyden (for himself,
			 Ms. Mikulski, Mr. Whitehouse, and Mr.
			 Cardin) 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 certain high cost Medicare beneficiaries suffering from multiple
		  chronic conditions with access to Independence at Home services in lower cost
		  treatment settings, such as their residences, under a plan of care developed by
		  an Independence at Home physician or Independence at Home nurse
		  practitioner.

		1.Short titleThis Act may be cited as the
			 Independence at Home Act of
			 2008.
		2.FindingsCongress makes the following
			 findings:
			(1)According to the November 2007
			 Congressional Budget Office Long Term Outlook for Health Care Spending, unless
			 changes are made to the way health care is delivered, growing demand for
			 resources caused by rising health care costs and to a lesser extent the
			 Nation’s expanding elderly population will confront Americans with increasingly
			 difficult choices between health care and other priorities. However,
			 opportunities exist to constrain health care costs without adverse health care
			 consequences.
			(2)Medicare beneficiaries with multiple
			 chronic conditions account for a disproportionate share of Medicare spending
			 compared to their representation in the overall Medicare population, and
			 evidence suggests that such patients often receive poorly coordinated care,
			 including conflicting information from health providers and different diagnoses
			 of the same symptoms.
			(3)People with
			 chronic conditions account for 76 percent of all hospital admissions, 88
			 percent of all prescriptions filled, and 72 percent of physician visits.
			(4)More than 60
			 percent of physicians treating patients with chronic conditions believe that
			 their training did not adequately prepare them to coordinate in-home and
			 community services; educate patients with chronic conditions; manage the
			 psychological and social aspects of chronic care; provide effective nutritional
			 guidance; and manage chronic pain.
			(5)Recent studies cited by the Congressional
			 Budget Office found substantial differences among regions of the country in the
			 cost to Medicare of treating beneficiaries with multiple chronic conditions
			 with lower cost regions experiencing better outcomes and lower mortality rates.
			 These studies have suggested that Medicare spending could be reduced by 30
			 percent if more conservative practice styles were adopted, however, the current
			 Medicare fee-for-service program creates incentives to provide fragmented, high
			 cost health care services.
			(6)Studies show that hospital utilization and
			 emergency room visits for patients with multiple chronic conditions can be
			 reduced and significant savings can be achieved through the use of
			 interdisciplinary teams of health care professionals caring for patients in
			 their places of residence.
			(7)The Independence at Home program, designed
			 to fund better health care and improved health care technology through savings
			 it achieves, uses a patient-centered health care delivery model to permit the
			 growing number of Medicare beneficiaries with multiple chronic conditions to
			 remain as independent as possible for as long as possible and to receive care
			 in a setting that is preferred by the beneficiary involved and the family of
			 such beneficiary.
			(8)The Independence at Home program begins
			 Medicare reform by creating incentives for practitioners and providers to
			 develop methods and technologies for providing better and lower cost health
			 care to the highest cost Medicare beneficiaries with the greatest incentives
			 provided in the case of highest cost beneficiaries.
			(9)The Independence at Home program
			 incorporates lessons learned from prior demonstration projects and phase I of
			 the Voluntary Chronic Care Improvement program under section 1807 of the Social
			 Security Act, enacted in sections 721 and 722 of the Medicare Prescription
			 Drug, Improvement and Modernization Act of 2003 (Public Law 108–173).
			(10)The Independence
			 at Home Act provides for a chronic care coordination demonstration for the
			 highest cost Medicare beneficiaries with multiple chronic conditions that holds
			 providers accountable for quality outcomes, patient satisfaction, and mandatory
			 minimum savings on an annual basis.
			(11)The Independence
			 at Home Act generates savings by providing better, more coordinated care to the
			 highest cost Medicare beneficiaries with multiple chronic conditions, reducing
			 duplicative and unnecessary services, and avoiding unnecessary hospitalizations
			 and emergency room visits.
			3.Establishment of
			 voluntary Independence at Home chronic care coordination demonstration project
			 under traditional Medicare fee-for-service program
			(a)In
			 generalTitle XVIII of the
			 Social Security Act is amended—
				(1)by amending subsection (c) of section 1807
			 (42 U.S.C. 1395b–8) to read as follows:

						(c)Independence at
				Home chronic care coordination demonstration projectA demonstration project for Independence at
				Home chronic care coordination programs for high cost Medicare beneficiaries
				with multiple chronic conditions is set forth in section
				1807A.
						;
				and
				(2)by inserting after
			 section 1807 the following new section:

						1807A.Independence at Home chronic care coordination demonstration
		  project(a)In general
								(1)ImplementationThe Secretary shall, where possible, enter
				into agreements with at least two unaffiliated Independence at Home
				organizations, as described in this section, to provide chronic care
				coordination services for a period of three years in each of the 13 highest
				cost States and the District of Columbia and in 13 additional States that are
				representative of other regions of the United States. Such organizations shall
				have documented experience in furnishing the types of services covered by this
				section to eligible beneficiaries in non-institutional settings using qualified
				teams of health care professionals that are directed by Independence at Home
				physicians or Independence at Home nurse practitioners and that use health
				information technology and individualized plans of care.
								(2)EligibilityAny organization shall be eligible for an
				Independence at Home agreement in the developmental phase if it is an
				Independence at Home organization (as defined in subsection (b)(7)) and has the
				demonstrated capacity to provide the services covered under this section to the
				number of eligible beneficiaries specified in subsection (e)(3)(C). No
				organization shall be prohibited from participating because of its small size
				as long as it meets the eligibility requirements of this section.
								(3)Independent
				evaluationThe Secretary
				shall contract for an independent evaluation of the Independence at Home
				demonstration project under this section with an interim report to be provided
				after the first year and a final report to be provided after the third year of
				the project. Such an evaluation shall be conducted by a contractor with
				knowledge of chronic care coordination programs for the targeted patient
				population and demonstrated experience in the evaluation of such programs. Each
				such report shall include an assessment of the following factors and shall
				identify the characteristics of individual Independence at Home programs that
				are the most effective:
									(A)Quality
				improvement measures.
									(B)Beneficiary,
				caregiver, and provider satisfaction.
									(C)Health outcomes
				appropriate for patients with multiple chronic conditions.
									(D)Cost savings to
				the program under this title.
									(4)AgreementsThe
				Secretary shall enter into agreements, beginning not later than one year after
				the date of the enactment of this section, with Independence at Home
				organizations that meet the participation requirements of this section,
				including minimum performance standards developed under subsection (e)(3), in
				order to provide access by eligible beneficiaries to Independence at Home
				programs under this section.
								(5)RegulationsAt least three months before entering into
				the first agreement under this section, the Secretary shall publish in the
				Federal Register the specifications for implementing this section.
								(6)Periodic progress
				reportsSemi-annually during the first year in which this section
				is implemented and annually thereafter during the period of implementation of
				this section, the Secretary shall submit to the Committees on Ways and Means
				and Energy and Commerce of the House of Representatives and the Committee on
				Finance of the Senate a report that describes the progress of implementation of
				this section and explaining any variation from the Independence at Home program
				as described in this section.
								(b)DefinitionsFor
				purposes of this section:
								(1)Activities of
				daily livingThe term activities of daily living
				means bathing, dressing, grooming, transferring, feeding, or toileting.
								(2)CaregiverThe
				term caregiver means, with respect to an individual with a
				qualifying functional impairment, a family member, friend, or neighbor who
				provides assistance to the individual.
								(3)Eligible
				beneficiary
									(A)In
				generalThe term eligible beneficiary means, with
				respect to an Independence at Home program, an individual who—
										(i)is
				entitled to benefits under part A and enrolled under part B, but not enrolled
				in a plan under part C;
										(ii)has a qualifying
				functional impairment and has been diagnosed with two or more of the chronic
				conditions described in subparagraph (C); and
										(iii)within the 12
				months prior to the individual first enrolling with an Independence at Home
				program under this section, has received benefits under this title for services
				described in each of clauses (i), (ii) and (iii) of subparagraph (D).
										(B)DisqualificationsSuch
				term does not include an individual—
										(i)who is receiving
				benefits under section 1881;
										(ii)who is enrolled
				in a PACE program under section 1894;
										(iii)who is enrolled in (and is not disenrolled
				from) a chronic care improvement program under section 1807;
										(iv)who within the previous year has been a
				resident for more than 90 days in a skilled nursing facility, a nursing
				facility (as defined in section 1919), or any other facility identified by the
				Secretary;
										(v)who resides in a
				setting that presents a danger to the safety of in-home health care providers
				and primary caregivers; or
										(vi)whose enrollment
				in an Independence at Home program the Secretary determines would be
				inappropriate.
										(C)Chronic
				conditions describedThe chronic conditions described in this
				subparagraph are the following:
										(i)Congestive heart
				failure.
										(ii)Diabetes.
										(iii)Chronic
				obstructive pulmonary disease.
										(iv)Ischemic heart
				disease.
										(v)Peripheral
				arterial disease.
										(vi)Stroke.
										(vii)Alzheimer’s
				Disease and other dementias designated by the Secretary.
										(viii)Pressure
				ulcers.
										(ix)Hypertension.
										(x)Neurodegenerative diseases designated by
				the Secretary which result in high costs under this title, including amyotropic
				lateral sclerosis (ALS), multiple sclerosis, and Parkinson’s disease.
										(xi)Any other chronic condition that the
				Secretary identifies as likely to result in high costs to the program under
				this title when such condition is present in combination with one or more of
				the chronic conditions specified in the preceding clauses.
										(D)Services
				describedThe services described in this subparagraph are the
				following:
										(i)Non-elective
				inpatient hospital services.
										(ii)Services in the
				emergency department of a hospital.
										(iii)Any of the
				following services:
											(I)Extended care
				services.
											(II)Services in an
				acute rehabilitation facility.
											(III)Home health
				services.
											(4)Independence at
				home assessmentThe term Independence at Home
				assessment means, with respect to an eligible beneficiary, a
				comprehensive medical history, physical examination, and assessment of the
				beneficiary’s clinical and functional status that—
									(A)is conducted
				by—
										(i)an
				Independence at Home physician or an Independence at Home nurse
				practitioner;
										(ii)a
				physician assistant, nurse practitioner, or clinical nurse specialist, as
				defined in section 1861(aa)(5), who is employed by an Independence at Home
				organization and is working in collaboration with an Independence at Home
				physician or Independence at Home nurse practitioner; or
										(iii)any other health
				care professional that meets such conditions as the Secretary may specify;
				and
										(B)includes an
				assessment of—
										(i)activities of
				daily living and other co-morbidities;
										(ii)medications and
				medication adherence;
										(iii)affect,
				cognition, executive function, and presence of mental disorders;
										(iv)functional status,
				including mobility, balance, gait, risk of falling, and sensory
				function;
										(v)social functioning
				and social integration;
										(vi)environmental
				needs and a safety assessment;
										(vii)the ability of
				the beneficiary’s primary caregiver to assist with the beneficiary’s care as
				well as the caregiver’s own physical and emotional capacity, education, and
				training;
										(viii)whether the
				beneficiary is likely to benefit from an Independence at Home program;
										(ix)whether the
				conditions in the beneficiary’s home or place of residence would permit the
				safe provision of services in the home or residence, respectively, under an
				Independence at Home program; and
										(x)other factors
				determined appropriate by the Secretary.
										(5)Independence at
				Home care teamThe term Independence at Home care
				team—
									(A)means, with respect to a participant, a
				team of qualified individuals that provides services to the participant as part
				of an Independence at Home program; and
									(B)includes an
				Independence at Home physician or an Independence at Home nurse practitioner
				and an Independence at Home coordinator (who may also be an Independence at
				Home physician or an Independence at Home nurse practitioner).
									(6)Independence at
				Home coordinatorThe term Independence at Home
				coordinator means, with respect to a participant, an individual
				who—
									(A)is employed by an
				Independence at Home organization and is responsible for coordinating all of
				the elements of the participant’s Independence at Home plan;
									(B)is a licensed health professional, such as
				a physician, registered nurse, nurse practitioner, clinical nurse specialist,
				physician assistant, or other health care professional as the Secretary
				determines appropriate, who has at least one year of experience providing and
				coordinating medical and related services for individuals in their homes;
				and
									(C)serves as the
				primary point of contact responsible for communications with the participant
				and for facilitating communications with other health care providers under the
				plan.
									(7)Independence at
				home organizationThe term
				Independence at Home organization means a provider of services, a
				physician or physician group practice, a nurse practitioner or nurse
				practitioner group practice, or other legal entity which receives payment for
				services furnished under this title (other than only under this section) and
				which—
									(A)has entered into
				an agreement under subsection (a)(2) to provide an Independence at Home program
				under this section;
									(B)(i)is able to provide all
				of the elements of the Independence at Home plan in a participant’s home or
				place of residence, or
										(ii)if the organization is not able to
				provide all such elements in such home or residence, has adequate mechanisms
				for ensuring the provision of such elements by one or more qualified
				entities;
										(C)has Independence at Home physicians,
				clinical nurse specialists, nurse practitioners, or physician assistants
				available to respond to patient emergencies 24 hours a day, seven days a
				week;
									(D)accepts all eligible beneficiaries from the
				organization’s service area except to the extent that qualified staff are not
				available; and
									(E)meets other
				requirements for such an organization under this section.
									(8)Independence at
				Home physicianThe term Independence at Home
				physician means a physician who—
									(A)is employed by or affiliated with an
				Independence at Home organization, as required under paragraph (7)(C), or has
				another contractual relationship with the Independence at Home organization
				that requires the physician to be responsible for the plans of care for the
				physician’s patients;
									(B)is
				certified—
										(i)by
				the American Board of Family Physicians, the American Board of Internal
				Medicine, the American Osteopathic Board of Family Physicians, the American
				Osteopathic Board of Internal Medicine, the American Board of Emergency
				Medicine, or the American Board of Physical Medicine and Rehabilitation;
				or
										(ii)by a Board
				recognized by the American Board of Medical Specialties and determined by the
				Secretary to be appropriate for the Independence at Home program;
										(C)has—
										(i)a certification in geriatric medicine as
				provided by American Board of Medical Specialties; or
										(ii)passed the clinical competency examination
				of the American Academy of Home Care Physicians and has substantial experience
				in the delivery of medical care in the home, including at least two years of
				experience in the management of Medicare patients and one year of experience in
				home-based medical care including at least 200 house calls; and
										(D)has furnished
				services during the previous 12 months for which payment is made under this
				title.
									(9)Independence at
				Home nurse practitionerThe
				term Independence at Home nurse practitioner means a nurse
				practitioner who—
									(A)is employed by or affiliated with an
				Independence at Home organization, as required under paragraph (7)(C), or has
				another contractual relationship with the Independence at Home organization
				that requires the nurse practitioner to be responsible for the plans of care
				for the nurse practitioner’s patients;
									(B)practices in
				accordance with State law regarding scope of practice for nurse
				practitioners;
									(C)is
				certified—
										(i)as a Gerontologic Nurse Practitioner by the
				American Academy of Nurse Practitioners Certification Program or the American
				Nurses Credentialing Center; or
										(ii)as a family nurse
				practitioner or adult nurse practitioner by the American Academy of Nurse
				Practitioners Certification Board or the American Nurses Credentialing Center
				and holds a certificate of Added Qualification in gerontology, elder care or
				care of the older adult provided by the American Academy of Nurse
				Practitioners, the American Nurses Credentialing Center or a national nurse
				practitioner certification board deemed by the Secretary to be appropriate for
				an Independence at Home program; and
										(D)has furnished services during the previous
				12 months for which payment is made under this title.
									(10)Independence at
				Home planThe term Independence at Home plan means a
				plan established under subsection (d)(2) for a specific participant in an
				Independence at Home program.
								(11)Independence at
				Home programThe term Independence at Home program
				means a program described in subsection (d) that is operated by an Independence
				at Home organization.
								(12)ParticipantThe
				term participant means an eligible beneficiary who has voluntarily
				enrolled in an Independence at Home program.
								(13)Qualified
				entityThe term qualified entity means a person or
				organization that is licensed or otherwise legally permitted to provide the
				specific element (or elements) of an Independence at Home plan that the entity
				has agreed to provide.
								(14)Qualifying
				functional impairmentThe term qualifying functional
				impairment means an inability to perform, without the assistance of
				another person, two or more activities of daily living.
								(c)Identification
				and enrollment of prospective program participants
								(1)Notice to
				eligible independence at home beneficiariesThe Secretary shall
				develop a model notice to be made available to Medicare beneficiaries (and to
				their caregivers) who are potentially eligible for an Independence at Home
				program by participating providers and by Independence at Home programs. Such
				notice shall include the following information:
									(A)A description of
				the potential advantages to the beneficiary participating in an Independence at
				Home program.
									(B)A description of
				the eligibility requirements to participate.
									(C)Notice that
				participation is voluntary.
									(D)A statement that
				all other Medicare benefits remain available to beneficiaries who enroll in an
				Independence at Home program.
									(E)Notice that those who enroll in an
				Independence at Home program may have co-payments for house calls by
				Independence at Home physicians or by Independence at Home nurse practitioners
				reduced or eliminated at the discretion of the Independence at Home physician
				or Independence at Home nurse practitioner involved.
									(F)A description of
				the services that could potentially be provided under an Independence at Home
				plan.
									(G)A description of
				the method for participating, or withdrawing from participation, in an
				Independence at Home program or becoming no longer eligible to so
				participate.
									(2)Voluntary
				participation and choiceAn eligible beneficiary may participate
				in an Independence at Home program through enrollment in such program on a
				voluntary basis and may terminate such participation at any time. Such a
				beneficiary may also receive Independence at Home services from the
				Independence at Home organization of the beneficiary’s choice but may not
				receive Independence at Home services from more than one Independence at Home
				organization at a time.
								(d)Independence at
				Home program requirements
								(1)In
				generalEach Independence at Home program shall, for each
				participant enrolled in the program—
									(A)designate—
										(i)an Independence at Home physician or an
				Independence at Home nurse practitioner; and
										(ii)an Independence
				at Home coordinator;
										(B)have a process to
				ensure that the participant received an Independence at Home assessment before
				enrollment in the program;
									(C)with the
				participation of the participant (or the participant’s representative or
				caregiver), an Independence at Home physician or an Independence at Home nurse
				practitioner, and Independence at Home coordinator, develop an Independence at
				Home plan for the participant in accordance with paragraph (2);
									(D)ensure that the
				participant receives an Independence at Home assessment at least annually after
				the original assessment to ensure that the Independence at Home plan for the
				participant remains current and appropriate;
									(E)implement all of
				the elements of the participant’s Independence at Home plan and in instances in
				which the Independence at Home organization does not provide specific elements
				of the Independence at Home plan, ensure that qualified entities successfully
				implement those specific elements;
									(F)provide for an electronic medical record
				and electronic health information technology to coordinate the participant’s
				care and to exchange information with the Medicare program and electronic
				monitoring and communication technologies and mobile diagnostic and therapeutic
				technologies as appropriate and accepted by the participant; and
									(G)respect the
				participant’s right to health information privacy and obtain permission from
				the participant (or responsible person) for the use and disclosure of
				identifiable health information necessary for treatment, payment, or health
				care operations.
									(2)Independence at
				home plan
									(A)In
				generalAn Independence at
				Home plan for a participant shall be developed with the participant, an
				Independence at Home physician or an Independence at Home nurse practitioner,
				an Independence at Home coordinator, and, if appropriate, one or more of the
				participant’s caregivers and shall—
										(i)document the
				chronic conditions, co-morbidities, and other health needs identified in the
				participant’s Independence at Home assessment;
										(ii)determine which elements of an Independence
				at Home plan described in subparagraph (C) are appropriate for the participant;
				and
										(iii)identify the
				qualified entity responsible for providing each element of such plan.
										(B)Communication of
				individualized independence at home plan to the independence at home
				coordinatorIf the Independence at Home physician or Independence
				at Home nurse practitioner responsible for conducting the participant’s
				Independence at Home assessment and developing the Independence at Home plan is
				not the participant’s Independence at Home coordinator, the Independence at
				Home physician or Independence at Home nurse practitioner is responsible for
				ensuring that the participant’s Independence at Home coordinator has such plan
				and is familiar with the requirements of the plan and has the appropriate
				contact information for all of the members of the Independence at Home care
				team.
									(C)Elements of
				independence at home planAn
				Independence at Home organization shall have the capability to provide,
				directly or through a qualified entity, and shall offer all of the following
				elements of an Independence at Home plan to the extent they are appropriate and
				accepted by a participant:
										(i)Self-care education and preventive care
				consistent with the participant’s condition.
										(ii)Coordination of
				all medical treatment furnished to the participant, regardless of whether such
				treatment is covered and available to the participant under this title.
										(iii)Information
				about, and access to, hospice care.
										(iv)Pain and
				palliative care and end-of-life care.
										(v)Education for
				primary caregivers and family members.
										(vi)Caregiver
				counseling services and information about, and referral to, other caregiver
				support and health care services in the community.
										(vii)Monitoring and
				management of medications as well as assistance to participants and their
				caregivers with respect to selection of a prescription drug plan under part D
				that best meets the needs of the participant’s chronic conditions.
										(viii)Referral to
				social services, such as personal care, meals, volunteers, and individual and
				family therapy.
										(ix)Access to
				phlebotomy and ancillary laboratory and imaging services, including point of
				care laboratory and imaging diagnostics.
										(3)Primary treatment
				role within an Independence at Home care teamAn Independence at
				Home physician or an Independence at Home nurse practitioner may assume the
				primary treatment role as permitted under State law.
								(4)Additional
				responsibilities
									(A)Outcomes
				reportEach Independence at
				Home organization offering an Independence at Home program shall monitor and
				report to the Secretary, in a manner specified by the Secretary, on—
										(i)patient
				outcomes;
										(ii)beneficiary,
				caregiver, and provider satisfaction with respect to coordination of the
				participant’s care; and
										(iii)the achievement
				of mandatory minimum savings described in subsection (e)(6).
										(B)Additional
				requirementsEach such organization and program shall comply with
				such additional requirements as the Secretary may specify.
									(e)Terms and
				conditions
								(1)In
				generalAn agreement under this section with an Independence at
				Home organization shall contain such terms and conditions as the Secretary may
				specify consistent with this section.
								(2)Clinical, quality
				improvement, and financial requirementsThe Secretary may not
				enter into an agreement with such an organization under this section for the
				operation of an Independence at Home program unless—
									(A)the program and organization meet the
				requirements of subsection (d), minimum quality and performance standards
				developed under paragraph (3), and such clinical, quality improvement,
				financial, and other requirements as the Secretary deems to be appropriate for
				participants to be served; and
									(B)the organization
				demonstrates to the satisfaction of the Secretary that the organization is able
				to assume financial risk for performance under the agreement with respect to
				payments made to the organization under such agreement through available
				reserves, reinsurance, or withholding of funding provided under this title, or
				such other means as the Secretary determines appropriate.
									(3)Minimum quality
				and performance standards
									(A)In
				generalThe Secretary shall develop mandatory minimum quality and
				performance standards for Independence at Home organizations and
				programs.
									(B)Standards to be
				includedSuch standards shall include measures of—
										(i)participant
				outcomes;
										(ii)satisfaction of
				the beneficiary, caregiver, and provider involved; and
										(iii)cost savings
				consistent with paragraph (6).
										(C)Minimum
				participation standardSuch
				standards shall include a requirement that, for any year after the first year,
				an Independence at Home program had an average number of participants during
				the previous year of at least 100 participants.
									(4)Term of
				agreement and modificationThe agreement under this subsection shall
				be, subject to paragraphs (3)(C) and (5), for a period of three years, and the
				terms and conditions may be modified during the contract period only upon the
				request of the Independence at Home organization.
								(5)Termination and
				non-renewal of agreement
									(A)In
				generalIf the Secretary
				determines that an Independence at Home organization has failed to meet the
				minimum performance standards under paragraph (3) or other requirements under
				this section, the Secretary may terminate the agreement of the organization at
				the end of the contract year.
									(B)Required
				termination where risk to health or safety of a participantThe
				Secretary shall terminate an agreement with an Independence at Home
				organization at any time the Secretary determines that the care being provided
				by such organization poses a threat to the health and safety of a
				participant.
									(C)Termination by
				Independence at Home organizationsNotwithstanding any other provision of this
				subsection, an Independence at Home organization may terminate an agreement
				with the Secretary under this section to provide an Independence at Home
				program at the end of a contract year if the organization provides to the
				Secretary and to the beneficiaries participating in the program notification of
				such termination more than 90 days before the end of such year. Paragraphs (6),
				(8), and (9)(B) shall apply to the organization until the date of
				termination.
									(D)Notice of
				involuntary terminationThe
				Secretary shall notify the participants in an Independence at Home program as
				soon as practicable if a determination is make to terminate an agreement with
				the Independence at Home organization involuntarily as provided in
				subparagraphs (A) and (B). Such notice shall inform the beneficiary of any
				other Independence at Home organizations that might be available to the
				beneficiary.
									(6)Mandatory
				minimum savings
									(A)In
				generalUnder an agreement
				under this subsection, each Independence at Home organization shall ensure that
				during any year of the agreement for its Independence at Home program, there is
				an aggregate savings in the cost to the program under this title for
				participating beneficiaries, as calculated under subparagraph (B), that is not
				less than the product of—
										(i)5
				percent of the estimated average monthly costs that would have been incurred
				under parts A, B, and D if those beneficiaries had not participated in the
				Independence at Home program; and
										(ii)the number of
				participant-months for that year.
										(B)Computation of
				aggregate savings
										(i)Model for
				calculating savingsThe
				Secretary shall contract with a nongovernmental organization or academic
				institution to independently develop an analytical model for determining
				whether an Independence at Home program achieves at least savings required
				under subparagraph (A) relative to costs that would have been incurred by
				Medicare in the absence of Independence at Home programs. The analytical model
				developed by the independent research organization for making these
				determinations shall utilize state-of-the-art econometric techniques, such as
				Heckman’s selection correction methodologies, to account for sample selection
				bias, omitted variable bias, or problems with endogeneity.
										(ii)Application of
				the modelUsing the model developed under clause (i), the
				Secretary shall compare the actual costs to Medicare of beneficiaries
				participating in an Independence at Home program to the predicted costs to
				Medicare of such beneficiaries to determine whether an Independence at Home
				program achieves the savings required under subparagraph (A).
										(iii)Revisions of
				the modelThe Secretary shall require that the model developed
				under clause (i) for determining savings shall be designed according to
				instructions that will control, or adjust for, inflation as well as risk
				factors including, age, race, gender, disability status, socioeconomic status,
				region of country (such as State, county, metropolitan statistical area, or zip
				code), and such other factors as the Secretary determines to be appropriate,
				including adjustment for prior health care utilization. The Secretary may add
				to, modify, or substitute for such adjustment factors if such changes will
				improve the sensitivity or specificity of the calculation of costs
				savings.
										(iv)Participant-monthIn
				making the calculation described in subparagraph (A), each month or part of a
				month in a program year that a beneficiary participates in an Independence at
				Home program shall be counted as a participant-month.
										(C)Notice of savings
				calculationNo later than 120
				days before the beginning of any Independence at Home program year, the
				Secretary shall publish in the Federal Register a description of the model
				developed under subparagraph (B)(i) and information for calculating savings
				required under subparagraph (A), including any revisions, sufficient to permit
				Independence at Home organizations to determine the savings they will be
				required to achieve during the program year to meet the savings requirement
				under such subparagraph. In order to facilitate this notice, the Secretary may
				designate a single annual date for the beginning of all Independence at Home
				program years that shall not be later than one year from the date of enactment
				of this section.
									(7)Manner of
				paymentSubject to paragraph (8), payments shall be made by the
				Secretary to an Independence at Home organization at a rate negotiated between
				the Secretary and the organization under the agreement for—
									(A)Independence at Home assessments;
				and
									(B)on a per-participant, per-month basis for
				the items and services required to be provided or made available under
				subsection (d).
									(8)Ensuring
				mandatory minimum savingsThe Secretary shall require any
				Independence at Home organization that fails in any year to achieve the
				mandatory minimum savings described in paragraph (6) to provide those savings
				by refunding payments made to the organization under paragraph (7) during such
				year.
								(9)Budget neutral
				payment condition
									(A)In
				generalUnder this section, the Secretary shall ensure that the
				cumulative, aggregate sum of Medicare program benefit expenditures under parts
				A, B, and D for participants in Independence at Home programs and funds paid to
				Independence at Home organizations under this section, shall not exceed the
				Medicare program benefit expenditures under such parts that the Secretary
				estimates would have been made for such participants in the absence of such
				programs.
									(B)Treatment of
				savingsIf an Independence at Home organization achieves
				aggregate savings in a year in excess of the mandatory minimum savings
				described in paragraph (6), 80 percent of such aggregate savings shall be paid
				to the organization and the remainder shall be retained by the programs under
				this title.
									(f)Waiver of
				coinsurance for house callsA
				physician or nurse practitioner furnishing services in the home or residence of
				a participant in an Independence at Home program may waive collection of any
				coinsurance that might otherwise be payable under section 1833(a) with respect
				to such services.
							(g)ReportNot later than one year after the end of
				the Independence at Home demonstration project under this section, the
				Secretary shall submit to Congress a report on such project. Such report shall
				include information on—
								(1)whether
				Independence at Home programs under the project met the performance standards
				for beneficiary, caregiver, and provider satisfaction; and
								(2)participant outcomes and cost savings, as
				well as the characteristics of the programs that were most effective and
				whether the participant eligibility criteria identified beneficiaries who were
				in the top ten percent of the highest cost Medicare
				beneficiaries.
								.
				(b)Conforming
			 amendments
				(1)Section 1833(a) of
			 such Act (42 U.S.C. 1395l(a)) is amended, in the matter before paragraph (1),
			 by inserting and section 1807A(f) after section
			 1876.
				(2)Section 1128B(b)(3) of such Act (42 U.S.C.
			 1320a–7b(b)(3)) is amended—
					(A)by striking
			 and at the end of subparagraph (G);
					(B)by striking
			 1853(a)(4). at the end of the first subparagraph (H) and
			 inserting 1853(a)(4);;
					(C)by redesignating
			 the second subparagraph (H) as subparagraph (I) and by striking the period at
			 the end and inserting ; and; and
					(D)by adding at the
			 end the following new subparagraph:

							(J)a waiver of coinsurance under section
				1807A(f).
							.