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TheWeekInCongress.com (TM) Week Ending August 3, 2007
H.R.3162 To amend titles XVIII, XIX, and XXI of the Social Security Act to extend and improve the children's health insurance program, to improve beneficiary protections under the Medicare, Medicaid, and the CHIP program, and for other purposes.
The primary purpose of the bill is to extend and improve health insurance coverage to millions of low-income American children currently uncovered. HR 3162 also modifies other programs and procedures in the Medicare and Medicaid programs.
The bill increases payments to States to cover a larger segment of their child populations with required attention to minorities. Beneficiary enrollment would be facilitated by outreach programs. Simplified means-testing procedures would allow for self-qualification in some cases and assumed qualification for re-enrollees. Assets such as a retirement plan of life insurance policy will not be counted against the applicant’s net worth. The total applicant co-pay for services may not exceed 3.5% of the beneficiary’s income.
The decision on what documents are required to prove legal citizenship status would be left to the States. Access to translation services are to be increased with grants to organizations that can provide translation services in a timely fashion where needed. A study is ordered to determine if payment would be best to interpreters who work as independent contractors or interpreters who work for agencies that provide on-site interpretation at Medicare provider facilities.
States have the option of covering older children (to age 19), low income pregnant adult women and legal immigrants who are pregnant women or children under 19. Recent reports highlighted that in some states, adults are enrolled in the Federal healthcare for children. The bill provides no specific language on that issue but requires that if a state is going to extend coverage to anyone other than low-income children and pregnant women it must first certify that there is no waiting list for targeted low-income children to receive child health assistance and that there is an outreach program to reach all targeted low-income children in families with incomes less than 200 percent of the poverty line in place.
The bill includes provisions for other Medicare programs. Part D Medicare commonly known as the prescription drug plan, is modified requiring all plans to offer 95 percent of the 100 most commonly prescribed generic drugs covered in part D and 95 percent of the 100 most commonly prescribed brand name drugs covered in part D for Medicare A and B beneficiaries. The bill also prohibits late enrollment for those earning under 135% of the poverty line. Unless a drug is recalled or otherwise not approved by the FDA, a beneficiary can change plans mid-year if his plan reduces the drugs covered or increases the cost-sharing of a drug under the plan.
Medicare Advantage plans now become Medicare Part C but continue to be offered by the private sector. The bill requires HHS to develop and implement standards for sales and advertising techniques used by Medicare private plans, agents and brokers in selling plans, including defining and prohibiting cold calls, unsolicited door-to-door sales, cross-selling, and co-branding. Buyers must be thoroughly informed of all aspects of the plan they buy. To be prohibited in the standards are commissions in the first year that are more than 200 percent of subsequent year commissions. The standards must at least consider that a sales agent disclose commissions to a beneficiary upon request before enrollment. Plans that violate the standards can face financial sanctions up to $200,000.
Other areas of the bill will study and report on Medicare beneficiary access to rehabilitative care, long term hospital care, speech and physical therapy services, marriage and family planning services and including language therapy as an outpatient benefit. ‘Never events’, the delivery of (or failure to deliver) services in an ambulatory surgical facility in which there is an error clearly identifiable, usually preventable, and serious in consequences to patients, and that indicates a deficiency in the safety and process controls of the services furnished with respect to the physician, hospital, or ambulatory surgical center involved can loose funding unless the hospital can show specific procedures designed to avoid such events.
Copayments for current Medicare beneficiaries in some programs are removed including the inclusion of preventive care services.
A health information technology project is required to move forward with the provisions that the system protects the privacy and security of individually identifiable health information., maintains and provides permitted access to health information in an electronic format (such as through computerized patient records or a clinical data repository), utilizes interface software that allows for interoperability, includes clinical decision support incorporates e-prescribing and computerized physician order entry. incorporates patient tracking and reminders, utilizes technology that is open source (if available).
Revenues The bill would increase direct spending by $27.5 billion through 2012 and then $132 billion through 2017. Revenues would increase by $28.9 billion over five years and $59.7 billion through 2017. The bill aims to pay for its expanded provisions and the regular cost-of-living increases by an tax increase on tobacco products. Included in the taxed products are cigarettes, cigars, snuff and chewing tobacco, pipe tobacco, cigarette papers and roll-your-own tobacco. Other revenues would come from reducing payments to providers, HMO's in particular. Physician payments, slated to change in January, would remain unchanged.
On the reverse of the revenue increases the bill would prohibit taxes being imposed on fuels used in, a helicopter or a fixed-wing aircraft for purposes of providing medical transportation. and for fuels any ambulance for purposes of providing transportation for emergency medical services. The prohibition would not be in effect after December 31, 2009.'.
Sponsor: Rep. John Dingell (D-MI-15th) Vote: The bill Passed the House 225 to 204 RC 787 August 1, 2007. The motion to recommit the bill failed 202 to 226 RC 786 The motion to recommit the bill with instructions The Motion to Recommit the bill with instructions required the bill to be returned to the floor forthwith and to limit all spending provisions in the bill to those established the last fiscal year and extend them for one more year. Opposition to the Motion held that the increased spending for this fiscal year was required because spending last fiscal year was insufficient to thoroughly cover the million of children currently not covered with the insurance. The motion to recommit the bill failed 202 to 226 RV 786 Cost to the taxpayers: Estimated at $91 billion. “CBO estimates that enacting this legislation would increase federal direct spending by $27.5 billion over the 2008-2012 period and by $132.6 billion over the 2008-2017 period. CBO and JCT estimate that net revenues would increase under the bill by $28.9 billion over the next five years and $59.7 billion over the 10-year period. (A portion of that increase would be in off-budget revenues: $0.8 billion for the 2008-2012 period and $2.4 billion over the 2008-2017 period.)” “On balance, the spending and revenue changes would reduce federal deficits by $1.4 billion through 2012, but would increase federal deficits by $72.9 billion for the 2008-2017 period.” Earmark Certification: ## All Rights Reserved. © 2007 TheWeekInCongress.com(TM) No reproduction, language translation or distribution without written permission from TheWeekInCongress.com.(TM)
MORE INFORMATION TITLE I — CHILDREN’S HEALTH INSURANCE PROGRAM TITLE II --- MEDICARE BENEFICIARY IMPROVEMENTS TITLE III --- PHYSICIAN’S SERVICE PAYMENT REFORM TITLE IV --- MEDICARE ADVANTAGE REFORMS TITLE V --- PROVISIONS RELATING TO MEDICARE PART A TITLE VI --- PROVISIONS RELATING TO MEDICARE PART B TITLE VII --- PROVISIONS RELATING TO MEICARE PARTS A AND B
TITLE I — CHILDREN’S HEALTH INSURANCE PROGRAM It is the purpose of this title to provide dependable and stable funding for children's health insurance under titles XXI and XIX of the Social Security Act in order to enroll all six million uninsured children who are eligible, but not enrolled, for coverage today through such titles. Two year availability of CHIP allotments Unused allotments for State funding shortfalls Culturally appropriate enrollment and retention Ensuring Child-centered coverage Optional coverage for older children Optional coverage for legal immigrants Limitation on waiver authority Children’s Access, Payment and Equality Commission Pediatric health measurement program
New Base CHIP Allotments FOR FISCAL YEAR 2008- For fiscal year 2008, the allotment of a State is equal to the greater of the State projection of Federal payments to the State multiplied by the allotment increase factor = 1 plus the percentage increase in the projected per capita amount of National Health Expenditures from the calendar year in which the previous fiscal year ends to the calendar year in which the fiscal year involved ends. CHILD POPULATION GROWTH FACTOR- 1 plus the percentage increase (if any) in the population of children under 19 years of age in the State from July 1 in the previous fiscal year to July 1 in the fiscal year involved, Two year availability of CHIP allotments amounts allotted to a State pursuant to this section-- `(A) for each of fiscal years 1998 through 2007, shall remain available for expenditure by the State through the end of the second succeeding fiscal year; and `(B) for fiscal year 2008 and each fiscal year thereafter, shall remain available for expenditure by the State through the end of the succeeding fiscal year.
Unused allotments for State funding shortfalls The amount of allotments not expended or redistributed under the previous sentence shall remain available for redistribution in the succeeding fiscal year
Culturally appropriate enrollment and retention An amount equal to 75 percent of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to translation or interpretation services in connection with the enrollment and retention under this title of children of families for whom English is not the primary language.
COVERAGE Ensuring Child-centered coverage The child health assistance provided to a targeted low-income child (whether through benchmark coverage or benchmark-equivalent coverage or otherwise) shall include coverage of the following: `(A) Dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions. `(B) Federally-qualified health center services (rural health clinic services). A State, at its option, may provide such additional benefits to benchmark coverage
Premium grace period The State child health plan shall afford individuals enrolled under the plan a grace period of at least 30 days from the beginning of a new coverage period to make premium payments before the individual's coverage under the plan may be terminated and shall provide to such an individual, not later than 7 days after the first day of such grace period, notice that failure to make a premium payment within the grace period will result in termination of coverage under the State child health plan; and of the individual's right to challenge the proposed termination pursuant to the applicable Federal regulations.
Optional coverage for older children States may elect to cover children up to 19 years old. In later years the limit is age 23.
Optional coverage for legal immigrants A State may elect to provide medical assistance for aliens who are lawfully residing in the United States and who are otherwise eligible for such assistance, within either or both of the following eligibility categories: Women during pregnancy; children under 19 yrs.
State option to expand or add coverage Low-income pregnant women Notwithstanding any other provision of this title, a State may provide for coverage of assistance for pregnant women for targeted low-income pregnant women in accordance with this section, but only if they are below 185% of the poverty line.
Limitation on waiver authority Notwithstanding any other provision of this title, the Secretary may not, through the exercise of any waiver authority on or after January 1, 2008, provide for Federal financial participation to a State under this title for health care services for individuals who are not targeted low-income children or pregnant women unless the Secretary determines that no eligible targeted low-income child in the State would be denied coverage. In making such determination, the Secretary must receive assurances that-- `(1) there is no waiting list under this title in the State for targeted low-income children to receive child health assistance under this title; and `(2) the State has in place an outreach program to reach all targeted low-income children in families with incomes less than 200 percent of the poverty line.'.
Children’s Access, Payment and Equality Commission There is hereby established as an agency of Congress the Children's Access, Payment, and Equality Commission. The Commission shall— review Federal and State payment policies of the Medicaid program established under this title; review access to, and affordability of, coverage and services for enrollees under Medicaid and CHIP; make recommendations to Congress; by not later than March 1 of each year, submit to Congress a report containing the results of such reviews and its recommendations concerning such policies; review the following; The factors affecting expenditures for services in different sectors (such as physician, hospital and other sectors), payment methodologies, and their relationship to access and quality of care for Medicaid and CHIP beneficiaries. The impact of Federal and State Medicaid and CHIP payment policies on access to services; The impact of Federal and State Medicaid and CHIP policies on reducing health disparities; The overall financial stability of the health care safety net, including Federally-qualified health centers, rural health centers, school-based clinics, disproportionate share hospitals, public hospitals, providers and grantees; The relation (if any) between payment rates for providers and improvement in care for children; The affordability, cost effectiveness, and accessibility of services needed by special populations under Medicaid and CHIP as compared with private-sector coverage;
The Comptroller General of the United States, in consultation with State Medicaid and CHIP directors and organizations representing program beneficiaries, shall develop a model process for the coordination of the enrollment, retention, and coverage under such programs of children who, because of migration of families, emergency evacuations, educational needs, or otherwise, frequently change their State of residency or otherwise are temporarily located outside of the State of their residency.
State Option To Require Children To Present Satisfactory Documentary Evidence of Proof of Citizenship or Nationality for Purposes of Eligibility for Medicaid. States may set the standards for documentation of the child’s legal alien status. Errors after audits may not exceed 3%. The Secretary of Health and Human Services shall develop and implement, through entities that fund or provide perinatal care services to targeted low-income children under a State child health plan under title XXI of the Social Security Act, a program to deliver oral health educational materials that inform new parents about risks for, and prevention of, early childhood caries and the need for a dental visit within their newborn's first year of life.
Pediatric health measurement program The Secretary of Health and Human Services (in this section referred to as the `Secretary') shall establish a child health care quality measurement program to develop and implement pediatric quality measures on children's health care that may be used by public and private health care purchasers (and a system for reporting such measures); and measures of overall program performance that may be used by public and private health care purchasers.
Such measures shall include measures relating to at least the following aspects of health care for children: The proportion of insured (and uninsured) children who receive age-appropriate preventive health and dental care (including age appropriate immunizations) at each stage of child health development. The proportion of insured (and uninsured) children who receive dental care for restoration of teeth, relief of pain and infection, and maintenance of dental health. The effectiveness of early health care interventions for children whose assessments indicate the presence or risk of physical or mental conditions that could adversely affect growth and development. The effectiveness of treatment to ameliorate the effects of diagnosed physical and mental health conditions, including chronic conditions. The proportion of children under age 21 who are continuously insured for a period of 12 months or longer. The effectiveness of health care for children with disabilities. analysis based on each of the following pediatric characteristics: (ii) Gender. (iii) Race. (iv) Ethnicity. (v) Primary language of the child's parents (or caretaker relative). (vi) Disability or chronic condition (including cystic fibrosis). (vii) Geographic location. (viii) Coverage status under public and private health insurance programs.
The Secretary, directly or through contracts or interagency agreements, shall conduct an independent subsequent evaluation of 10 States with approved child health plans. Not later than December 31, 2010, the Secretary shall submit to Congress the results of the evaluation conducted under this paragraph. Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated $10,000,000 for fiscal year 2009 for the purpose of conducting the evaluation
TITLE II --- MEDICARE BENEFICIARY IMPROVEMENTS Cost share for preventive services Exemptions to eligibility for low-income subsidy BENEFICIARY IMPROVEMENTS Expanding prescription drugs available Mid-year changes in enrollment Drugs to be included in formulary REDUCING HEALTH DISPARITIES
Medicare data on race, ethnicity and language Effective communication in Medicare
preventive services Preventive services' means the following: `(A) Prostate cancer screening tests `(B) Colorectal cancer screening tests ` (C) Diabetes outpatient self-management training services `(D) Screening for glaucoma for certain individuals `(E) Medical nutrition therapy services for certain individuals `(F) An initial preventive physical examination (as defined in subsection (ww)). `(G) Cardiovascular screening blood `(H) Diabetes screening tests `(I) Ultrasound screening for abdominal aortic aneurysm for certain individuals `(J) Pneumococcal and influenza vaccine and their administration `(K) Hepatitis B vaccine and its administration for certain individuals `(L) Screening mammography `(M) Screening pap smear and screening pelvic exam `(N) Bone mass measurement `(O) Additional preventive services
$17,000 increasing by $1000 yearly under which the applicant will qualify.
In the case of an individual who is a full-benefit dual eligible individual and with respect to whom there has been a determination that but for the provision of home and community based care the individual would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded any beneficiary coinsurance are available.
Exemptions to eligibility for low-income subsidy No part of the value of any life insurance policy shall be taken into account, No balance in any pension or retirement plan shall be taken into account Cost-sharing protections In the case of all such individuals, a limitation on aggregate cost-sharing under this part for a year not to exceed 2.5 percent of income Intelligent enrollment No part D eligible individual described in such subparagraph shall be enrolled in a prescription drug plan which does not meet the following requirements: The plan has a formulary that covers at least-- 95 percent of the 100 most commonly prescribed non-duplicative generic covered part D drugs for the population of individuals entitled to benefits under part A or enrolled under part B; and 95 percent of the 100 most commonly prescribed non-duplicative brand name covered part D drugs for such population
BENEFICIARY IMPROVEMENTS Expanding prescription drugs available Increases access to AIDs drugs
Mid-year changes in enrollment Mid-year changes in enrollment in a plan is authorized if the formulary of the plan is materially changed (other than at the end of a contract year) so to reduce the coverage (or increase the cost-sharing) of the drug under the plan. Shall not apply in the case that a drug is removed from the formulary of a plan because of a recall or withdrawal of the drug issued by the Food and Drug Administration.’
Allow drugs for providing drugs to quit smoking
Drugs to be included in formulary The formulary must include all or substantially all covered part D drugs in each of the following therapeutic classes of covered part D drugs: `(I) Anticonvulsants. `(II) Antineoplastics. `(III) Antiretrovirals. `(IV) Antidepressants. `(V) Antipsychotics. `(VI) Immunosuppresessants Late enrollment penalties Individuals With Income Below 135 Percent of Poverty Line are relieved of 100 percent of any late enrollment penalties With Income Between 135 and 150 Percent of Poverty Line are relieved of 100 percent of the amount. In the case of an applicable subsidy eligible individual is the 90-day period beginning on the date the individual receives notification. an applicable subsidy eligible individual who fails to enroll in a prescription drug plan or an MA-PD plan during the special enrollment period a process for the facilitated enrollment of the individual in the prescription drug plan or MA-PD plan that is most appropriate for such individual. Nothing in the previous sentence shall prevent an individual described in such sentence from declining enrollment in a plan determined appropriate. REDUCING HEALTH DISPARITIES Medicare data on race, ethnicity and language The Secretary of Health and Human Services (in this subtitle referred to as the `Secretary') shall collect data on the race, ethnicity, and primary language of each applicant for and recipient of benefits using, at a minimum, the categories for race and ethnicity. such data be collected from the parent or legal guardian of such an applicant or recipient Effective communication in Medicare The Secretary of Health and Human Services shall conduct a study that examines ways that Medicare should develop payment systems for language services. The study shall include an analysis of each of the following: (A) How to develop and structure appropriate payment systems for language services for all Medicare service providers. (B) The feasibility of adopting a payment methodology for on-site interpreters, including interpreters who work as independent contractors and interpreters who work for agencies that provide on-site interpretation, pursuant to which such interpreters could directly bill Medicare for services provided in support of physician office services for an LEP Medicare patient. (C) The feasibility of Medicare contracting directly with agencies that provide off-site interpretation including telephonic and video interpretation pursuant to which such contractors could directly bill Medicare for the services provided in support of physician office services for an LEP Medicare patient. (D) The feasibility of modifying the existing Medicare resource-based relative value scale (RBRVS) by using adjustments (such as multipliers or add-ons) when a patient is LEP. (E) How each of options described in a previous paragraph would be funded and how such funding would affect physician payments, a physician's practice, and beneficiary cost-sharing. The Secretary shall submit a report on the study conducted under subsection (a) to appropriate committees of Congress not later than 1 year. Within one year after the date of the enactment of this Act the Secretary, acting through the Centers for Medicare & Medicaid Services, shall award 24 3-year demonstration grants to eligible Medicare service providers to improve effective communication between such providers and Medicare beneficiaries who are limited English proficient. The Secretary shall not authorize a grant larger than $500,000 over three years for any grantee. A grantee shall use grant funds received under this section to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient. Competent interpreter services may be provided through on-site interpretation, telephonic interpretation, or video interpretation or direct provision of health care or health care related services by a bilingual health care provider. A grantee may use bilingual providers, staff, or contract interpreters. A grantee may use grant funds to pay for competent translation services. A grantee may use up to 10 percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under subsection (E). (2) ORGANIZATIONS- Grantees that are part C organizations or PDP sponsors must ensure that their network providers receive at least 50 percent of the grant funds to pay for the provision of competent language services to Medicare beneficiaries who are limited English proficient, including physicians and pharmacies. Payments to grantees shall be calculated based on the estimated numbers of LEP Medicare beneficiaries in a grantee's service in the case of a Medicare beneficiary who is limited English proficient (who has been informed in the beneficiary's primary language of the availability of free interpreter and translation services) and who requests the use of family, friends, or other persons untrained in interpretation or translation and the grantee documents the request in the beneficiary's record. Nothing in clause (ii)(II) shall be construed to exempt an emergency rooms or similar entities that regularly provide health care services in medical emergencies from having in place systems to provide competent interpreter and translation services without undue delay No Cost Sharing- LEP Beneficiaries shall not have to pay cost-sharing or co-pays for language services provided through this demonstration program.
Previously uninsured Within one year after the date of enactment of this Act, the Secretary shall establish a demonstration project to determine the greatest needs and most effective methods of outreach to Medicare beneficiaries who were previously uninsured. The demonstration shall be in no fewer than 10 sites, and shall include state health insurance assistance programs, community health centers, community-based organizations, community health workers, and other service providers under parts A, B, and C of title XVIII of the Social Security Act. Grantees that are plans operating under part C shall document that enrollees who were previously uninsured receive the `Welcome to Medicare' physical exam.
TITLE III --- PHYSICIAN’S SERVICE PAYMENT REFORM Payments to efficient physicians Medical home demonstration project
For services furnished on or after January 1, 2008, each of the following categories of physicians' services shall be treated as a separate `service category': `(A) Evaluation and management services for primary care (including new and established patient office visits delivered by physicians who the Secretary determines provide accessible, continuous, coordinated, and comprehensive care for Medicare beneficiaries, emergency department visits, and home visits), and for preventive services (including screening mammography, colorectal cancer screening, and other services as defined by the Secretary, limited to the recommendations of the United States Preventive Services Task Force). `(B) Evaluation and management services not described in subparagraph (A). `(C) Imaging services (as defined in subsection (b)(4)(B)) and diagnostic tests (other than clinical diagnostic laboratory tests) not described in subparagraph (A). `(D) Procedures that are subject (under regulations promulgated to carry out this section) to a 10-day or 90-day global period (in this paragraph referred to as `major procedures'), except that the Secretary may reclassify as minor procedures under subparagraph (F) any procedures that would otherwise be included in this category if the Secretary determines that such procedures are not major procedures. `(E) Anesthesia services that are paid on the basis of the separate conversion factor for anesthesia services determined under subsection (d)(1)(D). `(F) Minor procedures and any other physicians' services that are not described in a preceding subparagraph.'. FLOOR FOR UPDATES FOR 2008 AND 2009- The update to the conversion factors for each service category for each of 2008 and 2009 shall be not less than 0.5 percent.
Accuracy of relative values Use of Expert Panel To Identify Misvalued Physicians' Services. The Secretary shall establish an expert panel to identify, through data analysis, physicians' services for which the relative value under this subsection is potentially misvalued, particularly those services for which such relative value may be overvalued; `(ii) to assess whether those misvalued services warrant review using existing processes (referred to in paragraph (2)(J)(ii)) for the consideration of coding changes; and `(iii) to advise the Secretary concerning the exercise of authority conduct a five-year review of physicians' services in conjunction with the RUC 5-year review, particularly for services that have experienced substantial changes in length of stay, site of service, volume, practice expense, or other factors that may indicate changes in physician work; `(B) identify new services to determine if they are likely to experience a reduction in relative value over time and forward a list of the services so identified for such five-year review; and `(C) for physicians' services that are otherwise unreviewed under the process the Secretary has established, periodically review a sample of relative value units within different types of services to assess the accuracy of the relative values contained in the Medicare physician fee schedule.'.
Physician feedback By not later than July 1, 2008, the Secretary of Health and Human Services shall develop and implement a mechanism to measure resource use on a per capita and an episode basis in order to provide confidential feedback to physicians in the Medicare program on how their practice patterns compare to physicians generally, both in the same locality as well as nationally. Payments to efficient physicians Incentive Payments for Efficient Physicians In the case of physicians' services furnished on or after January 1, 2009, and before January 1, 2011, by a participating physician in an efficient area (as identified under paragraph (2)), in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid an amount equal to 5 percent of the payment amount for the services under this part.
Physician fee schedule Recommendations on Consolidated Coding for Services Commonly Performed Together (1) complete an analysis of codes paid under the Medicare physician fee schedule to determine whether the codes for procedures that are commonly furnished together should be combined; and (2) submit to Congress a report on such analysis and include in the report recommendations on whether an adjustment should be made to the relative value units for such combined code. (b) Recommendations on Increased Use of Bundled Payments- Not later than December 31, 2008, the Comptroller General of the United States shall-- (1) complete an analysis of those procedures under the Medicare physician fee schedule for which no global payment methodology is applied but for which a `bundled' payment methodology would be appropriate; and (2) submit to Congress a report on such analysis and include in the report recommendations on increasing the use of `bundled' payment methodology under such schedule.
Medical home demonstration project The Secretary of Health and Human Services (in this section referred to as the `Secretary') shall establish under title XVIII of the Social Security Act an expanded medical home demonstration project (in this section referred to as the `expanded project') under this section. The expanded project supersedes the project that was initiated under section 204 of the Medicare Improvement and Extension Act of 2006 (division B of Public Law 109-432). The purpose of the expanded project is-- (1) to guide the redesign of the health care delivery system to provide accessible, continuous, comprehensive, and coordinated, care to Medicare beneficiaries; and (2) to provide care management fees to personal physicians delivering continuous and comprehensive care in qualified medical homes. (b) Nature and Scope of Project- (1) DURATION; SCOPE- The expanded project shall operate during a period of three years, beginning not later than October 1, 2009, and shall include a nationally representative sample of physicians serving urban, rural, and underserved areas throughout the United States. (2) ENCOURAGING PARTICIPATION OF SMALL PHYSICIAN PRACTICES- (A) IN GENERAL- The expanded project shall be designed to include the participation of physicians in practices with fewer than four full-time equivalent physicians, as well as physicians in larger practices particularly in rural and underserved areas. (B) TECHNICAL ASSISTANCE- In order to facilitate the participation under the expanded project of physicians in such practices, the Secretary shall make available additional technical assistance to such practices during the first year of the expanded project. (3) SELECTION OF HOMES TO PARTICIPATE- The Secretary shall select up to 500 medical homes to participate in the expanded project and shall give priority to-- (A) the selection of up to 100 HIT-enhanced medical homes; and (B) the selection of other medical homes that serve communities whose populations are at higher risk for health disparities, (4) BENEFICIARY PARTICIPATION- The Secretary shall establish a process for any Medicare beneficiary who is served by a medical home participating in the expanded project to elect to participate in the project. Each beneficiary who elects to so participate shall be eligible-- (A) for enhanced medical home services under the project with no cost sharing for the additional services; and (B) for a reduction of up to 50 percent in the coinsurance for services furnished under the physician fee schedule under section 1848 of the Social Security Act by the medical home. The Secretary shall develop standard recruitment materials and election processes for Medicare beneficiaries who are electing to participate in the expanded project.
The Secretary shall revise the fee schedule areas used for payment under this section applicable to the State of California using the county-based geographic adjustment factor In the case of imaging services that are diagnostic imaging services described in clause (ii), the payment amount for the technical component and the professional component of the services established for a year under the fee schedule described in paragraph (1) shall each be zero, unless the services are furnished at a diagnostic imaging services facility that meets the certificate requirement. diagnostic imaging services' means all imaging modalities, including diagnostic magnetic resonance imaging (`MRI'), computed tomography (`CT'), positron emission tomography (`PET'), nuclear medicine procedures, x-rays, sonograms, ultrasounds, echocardiograms, and such emerging diagnostic imaging technologies as specified by the Secretary.
TITLE IV --- MEDICARE ADVANTAGE REFORMS The program under part C of title XVIII of the Social Security Act is henceforth to be known as the `Medicare Part C program'. Marketing, advertising protections
Marketing, advertising protections The National Association of Insurance Commissioners (in this subsection referred to as the `NAIC') is requested to develop, and to submit to the Secretary of Health and Human Services not later than 12 months after the date of the enactment of this Act, model regulations (in this section referred to as `model regulations') regarding Medicare plan marketing, enrollment, broker and agent training and certification, agent and broker commissions, and market conduct by plans, agents and brokers. The model regulations shall address the sales and advertising techniques used by Medicare private plans, agents and brokers in selling plans, including defining and prohibiting cold calls, unsolicited door-to-door sales, cross-selling, and co-branding. The model regulations shall specifically address the marketing-- `(i) of plans to full benefit dual-eligible individuals and qualified medicare beneficiaries; `(ii) of plans to populations with limited English proficiency; `(iii) of plans to beneficiaries in senior living facilities; and `(iv) of plans at educational events. The model regulations shall specially address beneficiary understanding of the Medicare plan through required disclosure (or beneficiary verification) of each of the following: `(i) The type of Medicare private plan involved. `(ii) Attributes of the plan, including premiums, cost sharing, formularies (if applicable), benefits, and provider access limitations in the plan. `(iii) Comparative quality of the plan. `(iv) The fact that plan attributes may change annually. The model regulations shall establish procedures and requirements for appointment, certification (and periodic recertification), and training of agents and brokers that market or sell Medicare private plans consistent with existing State appointment and certification procedures. The model regulations shall establish standards for fair and appropriate commissions for agents and brokers. The model regulations shall specifically prohibit the following: `(i) Differential commissions-- `(I) for Medicare Part C plans based on the type of Medicare private plan; or `(II) prescription drug plans under part D based on the type of prescription drug plan. `(ii) Commissions in the first year that are more than 200 percent of subsequent year commissions. In developing the model regulations, the NAIC shall consider requiring agents and brokers to disclose commissions to a beneficiary upon request of the beneficiary before enrollment. The model regulations shall consider the opportunity for fraud and abuse and beneficiary steering in setting standards under this paragraph and shall provide for the ability of State commissioners to investigate commission structures. The model regulations shall establish standards for the market conduct of organizations offering Medicare private plans, and of agents and brokers selling such plans, and for State review of plan market conduct. `(B) MATTERS TO BE INCLUDED- Such standards shall include standards for-- `(i) timely payment of claims; `(ii) beneficiary complaint reporting and disclosure; and `(iii) State reporting of market conduct violations and sanctions. Any Medicare private plan that violates marketing and enrollment standards is subject to sanctions Nothing in this subsection or section 1857(g) shall prohibit States from imposing sanctions against Medicare private plans, agents, or brokers for violations of the marketing and enrollment standards. ENHANCED CIVIL MONEY SANCTIONS by striking `$25,000', `$100,000', and `$15,000' and inserting `$50,000', `$200,000', and `$30,000' in subparagraphs (A), (B), and (D) of paragraph (3), by striking `$25,000', `$10,000', and `$100,000', respectively, and inserting `$50,000', `$20,000', and `$200,000', respectively.
The Secretary is authorized, in connection with conducting audits and other activities under subsection (d), to take such actions, including pursuit of financial recoveries, necessary to address deficiencies identified in such audits or other activities.
TITLE V --- PROVISIONS RELATING TO MEDICARE PART A
(1) REPORT TO CONGRESS- Not later than 12 months after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with physicians (including geriatricians and physiatrists), administrators of inpatient rehabilitation, acute care hospitals, skilled nursing facilities, and other settings providing rehabilitation services, Medicare beneficiaries, trade organizations representing inpatient rehabilitation hospitals and units and skilled nursing facilities, and the Medicare Payment Advisory Commission, shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report that includes-- (A) an examination of Medicare beneficiaries' access to medically necessary rehabilitation services; (B) alternatives or refinements to the 75 percent rule policy for determining exclusion criteria for inpatient rehabilitation hospital and unit designation under the Medicare program, including determining clinical appropriateness of inpatient rehabilitation hospital and unit admissions and alternative criteria which would consider a patient's functional status, diagnosis, co-morbidities, and other relevant factors; and (C) an examination that identifies any condition for which individuals are commonly admitted to inpatient rehabilitation hospitals that is not included as a condition described in section 412.23(b)(2)(iii) of title 42, Code of Federal Regulations, to determine the appropriate setting of care, and any variation in patient outcomes and costs, across settings of care, for treatment of such conditions. For the purposes of this subsection, the term `75 percent rule' means the requirement of section 412.23(b)(2) of title 42, Code of Federal Regulations, that 75 percent of the patients of a rehabilitation hospital or converted rehabilitation unit are in 1 or more of 13 listed treatment categories. (2) CONSIDERATIONS- In developing the report described in paragraph (1), the Secretary shall include the following: (A) The potential effect of the 75 percent rule on access to rehabilitation care by Medicare beneficiaries for the treatment of a condition, whether or not such condition is described in section 412.23(b)(2)(iii) of title 42, Code of Federal Regulations. (B) An analysis of the effectiveness of rehabilitation care for the treatment of conditions, whether or not such conditions are described in section 412.23(b)(2)(iii) of title 42, Code of Federal Regulations, available to Medicare beneficiaries in various health care settings, taking into account variation in patient outcomes and costs across different settings of care, and which may include whether the Medicare program and Medicare beneficiaries may incur higher costs of care for the entire episode of illness due to readmissions, extended lengths of stay, and other factors. The term `long-term care hospital' means an institution which-- `(1) is primarily engaged in providing inpatient services, by or under the supervision of a physician, to Medicare beneficiaries whose medically complex conditions require a long hospital stay and programs of care provided by a long-term care hospital; `(2) has an average inpatient length of stay (as determined by the Secretary) for Medicare beneficiaries of greater than 25 days, or as otherwise defined in section 1886(d)(1)(B)(iv); `(3) satisfies the requirements of subsection (e); `(4) meets the following facility criteria: `(A) the institution has a patient review process, documented in the patient medical record, that screens patients prior to admission for appropriateness of admission to a long-term care hospital, validates within 48 hours of admission that patients meet admission criteria for long-term care hospitals, regularly evaluates patients throughout their stay for continuation of care in a long-term care hospital, and assesses the available discharge options when patients no longer meet such continued stay criteria; `(B) the institution has active physician involvement with patients during their treatment through an organized medical staff, physician-directed treatment with physician on-site availability on a daily basis to review patient progress, and consulting physicians on call and capable of being at the patient's side within a moderate period of time, as determined by the Secretary; `(C) the institution has interdisciplinary team treatment for patients, requiring interdisciplinary teams of health care professionals, including physicians, to prepare and carry out an individualized treatment plan for each patient; and `(5) meets patient criteria relating to patient mix and severity appropriate to the medically complex cases that long-term care hospitals are designed to treat. To be eligible for prospective payment under this section as a long-term care hospital, a long-term care hospital must admit not less than a majority of patients who have a high level of severity, as defined by the Secretary, and who are assigned to one or more of the following major diagnostic categories: `(A) Circulatory diagnoses. `(B) Digestive, endocrine, and metabolic diagnoses. `(C) Infection disease diagnoses. `(D) Neurological diagnoses. `(E) Renal diagnoses. `(F) Respiratory diagnoses. `(G) Skin diagnoses. `(H) Other major diagnostic categories as selected by the Secretary. ) To an existing long-term care hospital that requests to increase its number of long-term care hospital beds, if the Secretary determines there is a need at the long-term care hospital for additional beds to accommodate-- (aa) infectious disease issues for isolation of patients; (bb) bedside dialysis services; (cc) single-sex accommodation issues; (dd) behavioral issues; (ee) any requirements of State or local law; or (ff) other clinical issues the Secretary determines warrant additional beds, in the best interest of Medicare beneficiaries.
TITLE VI --- PROVISIONS RELATING TO MEDICARE PART B Definition of out-patient language therapy Chronic kidney disease demonstration project Kidney disease education services Patient care dialysis training
Payment for therapy services The Secretary of Health and Human Services, in consultation with appropriate stakeholders, shall conduct a study on refined and alternative payment systems to the Medicare payment cap for physical therapy services and speech-language pathology services Such study shall consider, with respect to payment amounts under Medicare, the following: (A) The creation of multiple payment caps for such services to better reflect costs associated with specific health conditions. (B) The development of a prospective payment system, including an episode-based system of payments, for such services. (C) The data needed for the development of a system of multiple payment caps (or an alternative payment methodology) for such services and the availability of such data.
Definition of out-patient language therapy The term `outpatient speech-language pathology services' has the meaning given the term `outpatient physical therapy services' in subsection (p), except that in applying such subsection-- `(A) `speech-language pathology' shall be substituted for `physical therapy' each place it appears; and `(B) `speech-language pathologist' shall be substituted for `physical therapist' each place it appears.'.
Marriage and family therapy The term `marriage and family therapist services' means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, provided such services are covered under this title, as would otherwise be covered if furnished by a physician or as incident to a physician's professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services. `(2) The term `marriage and family therapist' means an individual who-- `(A) possesses a master's or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law; `(B) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and `(C) is licensed or certified as a marriage and family therapist in the State in which marriage and family therapist services are performed.'. (3) PROVISION FOR PAYMENT UNDER PART B- by adding at the end the following new clause: ` marriage and family therapist services;'.
The Secretary of Health and Human Services shall conduct a study to examine the service component and the equipment component of the provision of oxygen to Medicare beneficiaries. The study shall assess-- (A) the type of services provided and variation across suppliers in providing such services; (B) whether the services are medically necessary or affect patient outcomes; (C) whether the Medicare program pays appropriately for equipment in connection with the provision of oxygen; (D) whether such program pays appropriately for necessary services; (E) whether such payment in connection with the provision of oxygen should be divided between equipment and services, and if so, how; and (F) how such payment rate compares to a competitively bid rate.
Chronic kidney disease demonstration project The Secretary of Health and Human Services (in this section referred to as the `Secretary'), acting through the Director of the National Institutes of Health, shall establish demonstration projects to-- (1) increase public and medical community awareness (particularly of those who treat patients with diabetes and hypertension) about the factors that lead to chronic kidney disease, how to prevent it, how to diagnose it, and how to treat it; (2) increase screening and use of prevention techniques for chronic kidney disease for Medicare beneficiaries and the general public (particularly among patients with diabetes and hypertension, where prevention techniques are well established and early detection makes prevention possible); and (3) enhance surveillance systems and expand research to better assess the prevalence and incidence of chronic kidney disease, (building on work done by Centers for Disease Control and Prevention). (b) Scope and Duration- (1) SCOPE- The Secretary shall select at least 3 States in which to conduct demonstration projects under this section. In selecting the States under this paragraph, the Secretary shall take into account the size of the population of individuals with end-stage renal disease who are enrolled in part B of title XVIII of the Social Security Act and ensure the participation of individuals who reside in rural and urban areas. (2) DURATION- The demonstration projects under this section shall be conducted for a period that is not longer than 5 years and shall begin on January 1, 2009. (c) Evaluation and Report- (1) EVALUATION- The Secretary shall conduct an evaluation of the demonstration projects conducted under this section. (2) REPORT- Not later than 12 months after the date on which the demonstration projects under this section are completed, the Secretary shall submit to Congress a report on the evaluation conducted under paragraph (1) together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
Kidney disease education services The term `kidney disease education services' means educational services that are-- `(A) furnished to an individual with stage IV chronic kidney disease who, according to accepted clinical guidelines identified by the Secretary, will require dialysis or a kidney transplant; `(B) furnished, upon the referral of the physician managing the individual's kidney condition, by a qualified person (as defined in paragraph (2)); and `(C) designed-- `(i) to provide comprehensive information (consistent with the standards developed under paragraph (3)) regarding-- `(I) the management of comorbidities, including for purposes of delaying the need for dialysis; `(II) the prevention of uremic complications; and `(III) each option for renal replacement therapy (including hemodialysis and peritoneal dialysis at home and in-center as well as vascular access options and transplantation); `(ii) to ensure that the individual has the opportunity to actively participate in the choice of therapy; and `(iii) to be tailored to meet the needs of the individual involved
Patient care dialysis training a provider of services or a renal dialysis facility may not use, for more than 12 months during 2009, or for any period beginning on January 1, 2010, any individual as a patient care dialysis technician unless the individual-- `(A) has completed a training program in the care and treatment of an individual with chronic kidney failure who is undergoing dialysis treatment; and `(B) has been certified by a nationally recognized certification entity for dialysis technicians. `(2)(A) A provider of services or a renal dialysis facility may permit an individual enrolled in a training program described in paragraph (1)(A) to serve as a patient care dialysis technician while they are so enrolled. does not apply to an individual who has performed dialysis-related services for at least 5 years. A provider of services or a renal dialysis facility shall provide regular performance review and regular in-service education as assures that individuals serving as patient care dialysis technicians for the provider or facility are competent to perform dialysis-related services.'.
The payment amounts under this title for erythropoietin furnished during 2008 or 2009 to an individual with end stage renal disease by a large dialysis facility (as defined in subparagraph (D)) (whether to individuals in the facility or at home), in an amount equal to $8.75 per thousand units (rounded to the nearest 100 units) or, if less, 102 percent of the average sales price (as determined under section 1847A) for such drug or biological. `(ii) The payment amounts under this title for darbepoetin alfa furnished during 2008 or 2009 to an individual with end stage renal disease by a large dialysis facility (as defined in clause (iii)) (whether to individuals in the facility or at home), in an amount equal to $2.92 per microgram or, if less, 102 percent of the average sales price (as determined under section 1847A) for such drug or biological.
TITLE VII --- PROVISIONS RELATING TO MEDICARE PARTS A AND B .PLAN FOR MEDICARE PAYMENT ADJUSTMENTS FOR NEVER EVENTS.The term `never event' means an event involving the delivery of (or failure to deliver) physicians' services, inpatient or outpatient hospital services, or facility services furnished in an ambulatory surgical facility in which there is an error in medical care that is clearly identifiable, usually preventable, and serious in consequences to patients, and that indicates a deficiency in the safety and process controls of the services furnished with respect to the physician, hospital, or ambulatory surgical center involved.The Secretary of Health and Human Services (in this section referred to as the `Secretary') shall develop a plan (in this section referred to as the `never events plan') to implement, beginning in fiscal year 2010, a policy to reduce or eliminate payments under title XVIII of the Social Security Act for never events. Insofar as the hospital admits a patient and does not have any physician available on the premises to provide services during all hours in which the hospital is providing services to such patient, before admitting the patient-- `(I) the hospital discloses such fact to a patient; and `(II) following such disclosure, the hospital receives from the patient a signed acknowledgment that the patient understands such fact. `(ii) The hospital has the capacity to-- `(I) provide assessment and initial treatment for patients; and `(II) refer and transfer patients to hospitals with the capability to treat the needs of the patient involved.
TITLE VIII --- MEDICAID
Puerto Rico and the territories Employer buy-in demonstration projects
State plan may provide for making medical assistance available to an individual (relating to individuals who meet certain income eligibility standard) during a presumptive eligibility period. An individual such medical assistance shall be limited to family planning services and supplies and, at the State's option, medical diagnosis or treatment services that are provided in conjunction with a family planning service in a family planning setting provided during the period in which such an individual is eligible.
Health and Human Services shall not-- (1) withhold, suspend, disallow, or otherwise deny Federal financial for the provision of adult day health care services, day activity and health services, or adult medical day care service
Puerto Rico and the territories For Puerto Rico, $250,000,000 for fiscal year 2009, $350,000,000 for fiscal year 2010, $500,000,000 for fiscal year 2011, and $600,000,000 for fiscal year 2012. `(B) VIRGIN ISLANDS- For the Virgin Islands, $5,000,000 for each of fiscal years 2009 through 2012. `(C) GUAM- For Guam, $5,000,000 for each of fiscal years 2009 through 2012.
Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to the date that is 1 year after the date of enactment of this Act, take any action (through promulgation of regulation, issuance of regulatory guidance, use of federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to restrict coverage or payment under title XIX of the Social Security Act for rehabilitation services, or school-based administration, transportation, or medical services if such restrictions are more restrictive in any aspect than those applied to such coverage or payment as of July 1, 2007.
Tennessee The DSH allotments for Tennessee for each fiscal year beginning with fiscal year 2008 under subsection (f)(3) of section 1923 of the Social Security Act (42 U.S.C. 13961396r-4) are deemed to be $30,000,000. The Secretary of Health and Human Services may impose a limitation on the total amount of payments made to hospitals under the TennCare Section 1115
Regional Medical Centers Nothing in section 1903(w) of the Social Security Act (42 U.S.C. 1396b(w)) shall be construed by the Secretary of Health and Human Services as prohibiting a State's use of funds as the non-Federal share of expenditures under title XIX of such Act where such funds are transferred from or certified by a publicly-owned regional medical center located in another State and described in subsection (b), so long as the Secretary determines that such use of funds is proper and in the interest of the program under title XIX. (b) Center Described- A center described in this subsection is a publicly-owned regional medical center that-- (1) provides level 1 trauma and burn care services; (2) provides level 3 neonatal care services; (3) is obligated to serve all patients, regardless of ability to pay; (4) is located within a Standard Metropolitan Statistical Area (SMSA) that includes at least 3 States; (5) provides services as a tertiary care provider for patients residing within a 125-mile radius; and (6) meets the criteria for a disproportionate share hospital under section 1923 of such Act (42 U.S.C. 1396r-4) in at least one State other than the State in which the center is located.
Employer buy-in demonstration projects The Secretary shall establish a demonstration project under which up to 10 States (each referred to in this section as a `participating State') under its State child health plan for a period of 5 years, for child health assistance in relation to family coverage described in subsection (d) for children who would be targeted low-income children but for coverage as beneficiaries under a group health plan as the children of participants by virtue of a qualifying employer's contribution.
Diabetes grants `(1) $150,000,000 is hereby transferred and made available in such fiscal year for grants under section 330B of the Public Health Service Act; and `(2) $150,000,000 is hereby transferred and made available in such fiscal year for grants under section 330C of such Act.'.
TITLE IX --- MISCELLANEOUS
REPEAL OF TRIGGER PROVISION REPEAL OF COMPARATIVE COST ADJUSTMENT (CCA) PROGRAM Comparative effectiveness research Comparative effectiveness research trust fund Developing, reporting and use of health care measures
Comparative effectiveness research
Comparative effectiveness research trust fund The Secretary shall establish within the Agency of Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the `Center') to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically. While serving on the business of the Commission (including traveltime), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code; and while so serving away from home and the member's regular place of business, a member may be allowed travel expenses, as authorized by the Director of the Commission. `(1) For fiscal year 2008, $90,000,000. `(2) For fiscal year 2009, $100,000,000. `(3) For fiscal year 2010, $110,000,000. `(4) For each fiscal year beginning with fiscal year 2011-- `(A) an amount equivalent to the net revenues received in the Treasury from the fees imposed under subchapter B of chapter 34 (relating to fees on health insurance and self-insured plans) for such fiscal year; and There is hereby imposed on each specified health insurance policy for each policy year a fee equal to the fair share per capita = $2.00 ) EXEMPTION OF CERTAIN POLICIES- The term `specified health insurance policy' does not include any insurance policy if substantially all of the coverage provided under such policy relates to-- `(A) liabilities incurred under workers' compensation laws, `(B) tort liabilities, `(C) liabilities relating to ownership or use of property, `(D) credit insurance, `(E) medicare supplemental coverage, or `(F) such other similar liabilities as the Secretary may specify by regulations.
Self-insured plans In the case of any applicable self-insured health plan for each plan year, there is hereby imposed a fee equal to the fair share per capita. `(1) ACCIDENT AND HEALTH COVERAGE- The term `accident and health coverage' means any coverage which, if provided by an insurance policy, would cause such policy to be a specified health insurance policy (as defined in section 4375(c)). `(2) INSURANCE POLICY- The term `insurance policy' means any policy or other instrument whereby a contract of insurance is issued, renewed, or extended.
Treatment as Tax- For purposes of subtitle F, the fees imposed by this subchapter shall be treated as if they were taxes. policies issued by foreign insurers `subchapter b. insured and self-insured health plans `Subchapter A--Policies Issued By Foreign Insurers'
Health information technology Not later than January 1, 2010, the Secretary of Health and Human Services shall submit to Congress a report that includes-- (1) a plan to develop and implement a health information technology (health IT) system for all health care providers under the Medicare program that meets the specifications described in subsection (b); and (2) an analysis of the impact, feasibility, and costs associated with the use of health information technology in medically underserved communities. (b) Plan Specification- The specifications described in this subsection, with respect to a health information technology system described in subsection (a), are the following: (1) The system protects the privacy and security of individually identifiable health information. (2) The system maintains and provides permitted access to health information in an electronic format (such as through computerized patient records or a clinical data repository). (3) The system utilizes interface software that allows for interoperability. (4) The system includes clinical decision support. (5) The system incorporates e-prescribing and computerized physician order entry. (6) The system incorporates patient tracking and reminders. (7) The system utilizes technology that is open source (if available) or technology that has been developed by the government. The report shall include an analysis of the financial and administrative resources necessary to develop such system and recommendations regarding the level of subsidies needed for all such health care providers to adopt the system.
Developing, reporting and use of health care measures The Secretary shall designate, and have in effect an arrangement with, a single organization (such as the National Quality Forum) that meets the requirements described in subsection (c), under which such organization provides the Secretary with advice on, and recommendations with respect to, the key elements and priorities of a national system for establishing health care measures. The arrangement shall be effective beginning no sooner than January 1, 2008, and no later than September 30, 2008. `(b) Duties- The duties of the organization designated under subsection (a) (in this title referred to as the `designated organization') shall, in accordance with subsection (d), include-- `(1) establishing and managing an integrated national strategy and process for setting priorities and goals in establishing health care measures; `(2) coordinating the development and specifications of such measures; `(3) establishing standards for the development and testing of such measures; `(4) endorsing national consensus health care measures; and `(5) advancing the use of electronic health records for automating the collection, aggregation, and transmission of measurement information.
- The Secretary of Health and Human Services shall provide for implementation of the changes in the NAIC model law and regulations recommended by the National Association of Insurance Commissioners in its Model #651 (`Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act') on March 11, 2007, as modified to reflect the changes made under this Act. In carrying out the previous sentence, the benefit packages classified as `K' and `L' shall be eliminated and such NAIC recommendations shall be treated as having been adopted by such Association as of January 1, 2008.
TITLE X --- REVENUES Increasing the tax on tobacco products Exemption for emergency medical services
Increasing the tax on tobacco products (a) Small Cigarettes- Paragraph (1) of section 5701(b) of the Internal Revenue Code of 1986 is amended by striking `$19.50 per thousand ($17 per thousand on cigarettes removed during 2000 or 2001)' and inserting `$42 per thousand'. (b) Large Cigarettes- Paragraph (2) of section 5701(b) of such Code is amended by striking `$40.95 per thousand ($35.70 per thousand on cigarettes removed during 2000 or 2001)' and inserting `$88.20 per thousand'. (c) Small Cigars- Paragraph (1) of section 5701(a) of such Code is amended by striking `$1.828 cents per thousand ($1.594 cents per thousand on cigars removed during 2000 or 2001)' and inserting `$42 per thousand'. (d) Large Cigars- Paragraph (2) of section 5701(a) of such Code is amended-- (1) by striking `20.719 percent (18.063 percent on cigars removed during 2000 or 2001)' and inserting `44.63 percent', and (2) by striking `$48.75 per thousand ($42.50 per thousand on cigars removed during 2000 or 2001)' and inserting `$1 per cigar'. (e) Cigarette Papers- Subsection (c) of section 5701 of such Code is amended by striking `1.22 cents (1.06 cents on cigarette papers removed during 2000 or 2001)' and inserting `2.63 cents'. (f) Cigarette Tubes- Subsection (d) of section 5701 of such Code is amended by striking `2.44 cents (2.13 cents on cigarette tubes removed during 2000 or 2001)' and inserting `5.26 cents'. (g) Snuff- Paragraph (1) of section 5701(e) of such Code is amended by striking `58.5 cents (51 cents on snuff removed during 2000 or 2001)' and inserting `$1.26'. (h) Chewing Tobacco- Paragraph (2) of section 5701(e) of such Code is amended by striking `19.5 cents (17 cents on chewing tobacco removed during 2000 or 2001)' and inserting `42 cents'. (i) Pipe Tobacco- Subsection (f) of section 5701 of such Code is amended by striking `$1.0969 cents (95.67 cents on pipe tobacco removed during 2000 or 2001)' and inserting `$2.36'. (j) Roll-Your-Own Tobacco- (1) IN GENERAL- Subsection (g) of section 5701 of such Code is amended by striking `$1.0969 cents (95.67 cents on roll-your-own tobacco removed during 2000 or 2001)' and inserting `$7.4667'. (2) INCLUSION OF CIGAR TOBACCO- Subsection (o) of section 5702 of such Code is amended by inserting `or cigars, or for use as wrappers for making cigars' before the period at the end. (k) Effective Date- The amendments made by this section shall apply to articles removed after December 31, 2007. On cigarettes manufactured in or imported into the United States which are removed before January 1, 2008, and held on such date for sale by any person, there is hereby imposed a tax in an amount equal to the excess of-- (A) the tax which would be imposed under section 5701 of the Internal Revenue Code of 1986 on the article if the article had been removed on such date, over (B) the prior tax (if any) imposed under section 5701 of such Code on such article. AUTHORITY TO EXEMPT CIGARETTES HELD IN VENDING MACHINES- To the extent provided in regulations prescribed by the Secretary, no tax shall be imposed by paragraph (1) on cigarettes held for retail sale on January 1, 2008, by any person in any vending machine. If the Secretary provides such a benefit with respect to any person, the Secretary may reduce the $500 amount.
Exemption for emergency medical services Exemption for Certain Uses- `(1) CERTAIN AIRCRAFT- No tax shall be imposed under this section on any liquid sold for use in, or used in, a helicopter or a fixed-wing aircraft for purposes of providing medical transportation.
EMERGENCY MEDICAL SERVICES- No tax shall be imposed under this section on any liquid sold for use in, or used in, any ambulance for purposes of providing transportation for emergency medical services. The preceding sentence shall not apply to any liquid used after December 31, 2009.'.
AMENDMENTS
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