On September 17, 1787, George Washington, James Madison, Alexander Hamilton, and 36 other Constitutional Convention delegates completed four months of labors at Philadelphia’s Independence Hall and signed the glorious document that, upon its ratification, would become the Constitution of the United States of America. Here is the preamble for that charter of government:
“WE THE PEOPLE of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this CONSTITUTION for the United States of America.”
On March 23, 2010, 222-and-1/2 years later, the 44th president of the United States, Barack Obama, signed into law the Patient Protection and Affordable Care Act, popularly known as Obamacare. Here is the table of contents for that law:
PATIENT PROTECTION AND AFFORDABLE CARE ACT
CONTENTS
……………………………………………………………………………………………………………Page
Patient Protection and Affordable Care Act (Public Law 111–148) ………………. 1
Sec. 1. Short title; table of contents …………………………………………………………..1
TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Subtitle A—Immediate Improvements in Health Care Coverage for All Americans
Sec. 1001. Amendments to the Public Health Service Act …………………………. 13
Sec. 1002. Health insurance consumer information …………………………………. 27
Sec. 1003. Ensuring that consumers get value for their dollars …………………. 28
Sec. 1004. Effective dates ……………………………………………………………………. 30
Subtitle B—Immediate Actions to Preserve and Expand Coverage
Sec. 1101. Immediate access to insurance for uninsured individuals with
a preexisting condition ……………………………………………………………………………30
Sec. 1102. Reinsurance for early retirees ………………………………………………… 33
Sec. 1103. Immediate information that allows consumers to identify affordable
coverage options ……………………………………………………………………………………36
Sec. 1104. Administrative simplification …………………………………………………… 37
Sec. 1105. Effective date ………………………………………………………………………….44
Subtitle C—Quality Health Insurance Coverage for All Americans
PART 1—HEALTH INSURANCE MARKET REFORMS
Sec. 1201. Amendment to the Public Health Service Act ……………………………45
PART 2—OTHER PROVISIONS
Sec. 1251. Preservation of right to maintain existing coverage …………………..55
Sec. 1252. Rating reforms must apply uniformly to all health insurance
issuers and group health plans ……………………………………………………………..56
Sec. 1253. Annual report on self-insured plans ……………………………………….56
Sec. 1254. Study of large group market …………………………………………………..57
Sec. 1255. Effective dates ………………………………………………………………………57
Subtitle D—Available Coverage Choices for All Americans
PART 1—ESTABLISHMENT OF QUALIFIED HEALTH PLANS
Sec. 1301. Qualified health plan defined ………………………………………………….58
Sec. 1302. Essential health benefits requirements …………………………………….59
Sec. 1303. Special rules …………………………………………………………………………64
Sec. 1304. Related definitions …………………………………………………………………..68
PART 2—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH
BENEFIT EXCHANGES
Sec. 1311. Affordable choices of health benefit plans …………………………………69
Sec. 1312. Consumer choice ……………………………………………………………………..80
Sec. 1313. Financial integrity ……………………………………………………………………83
PART 3—STATE FLEXIBILITY RELATING TO EXCHANGES
Sec. 1321. State flexibility in operation and enforcement of Exchanges
and related requirements ………………………………………………………………….. 85
Sec. 1322. Federal program to assist establishment and operation of nonprofit,
member-run health insurance issuers ……………………………………… 86
Sec. 1323. Community health insurance option [stricken] ……………………. 92
Sec. 1323. Funding for the territories ………………………………………………….. 92
Sec. 1324. Level playing field ……………………………………………………………… 93
PART 4—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS
Sec. 1331. State flexibility to establish basic health programs for low-income
individuals not eligible for Medicaid ………………………………………. 93
Sec. 1332. Waiver for State innovation ………………………………………………… 98
Sec. 1333. Provisions relating to offering of plans in more than one
State ………………………………………………………………………………………………… 100
Sec. 1334. Multi-State plans ……………………………………………………………….. 101
PART 5—REINSURANCE AND RISK ADJUSTMENT
Sec. 1341. Transitional reinsurance program for individual market in
each State ………………………………………………………………………………………… 105
Sec. 1342. Establishment of risk corridors for plans in individual and
small group markets …………………………………………………………………………. 108
Sec. 1343. Risk adjustment …………………………………………………………………. 109
Subtitle E—Affordable Coverage Choices for All Americans
PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
Sec. 1401. Refundable tax credit providing premium assistance for coverage
under a qualified health plan …………………………………………………… 110
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified
health plans ……………………………………………………………………………………… 119
SUBPART B—ELIGIBILITY DETERMINATIONS
Sec. 1411. Procedures for determining eligibility for Exchange participation,
premium tax credits and reduced cost-sharing, and individual
responsibility exemptions ………………………………………………………………….. 123
Sec. 1412. Advance determination and payment of premium tax credits
and cost-sharing reductions ………………………………………………………………. 131
Sec. 1413. Streamlining of procedures for enrollment through an exchange
and State Medicaid, CHIP, and health subsidy programs ……….. 133
Sec. 1414. Disclosures to carry out eligibility requirements for certain
programs ………………………………………………………………………………………….. 135
Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded
for Federal and Federally-assisted programs ……………………….. 137
Sec. 1416. Study of geographic variation in application of FPL …………….. 137
PART II—SMALL BUSINESS TAX CREDIT
Sec. 1421. Credit for employee health insurance expenses of small businesses
………………………………………………………………………………………………. 138
Subtitle F—Shared Responsibility for Health Care
PART I—INDIVIDUAL RESPONSIBILITY
Sec. 1501. Requirement to maintain minimum essential coverage ………… 143
Sec. 1502. Reporting of health insurance coverage ……………………………….. 151
PART II—EMPLOYER RESPONSIBILITIES
Sec. 1511. Automatic enrollment for employees of large employers ……….. 154
Sec. 1512. Employer requirement to inform employees of coverage options
…………………………………………………………………………………………………. 154
Sec. 1513. Shared responsibility for employers …………………………………….. 155
Sec. 1514. Reporting of employer health insurance coverage ………………… 159
Sec. 1515. Offering of Exchange-participating qualified health plans
through cafeteria plans …………………………………………………………………….. 161
Subtitle G—Miscellaneous Provisions
Sec. 1551. Definitions …………………………………………………………………………. 164
Sec. 1552. Transparency in government ………………………………………………. 164
Sec. 1553. Prohibition against discrimination on assisted suicide …………. 164
Sec. 1554. Access to therapies ……………………………………………………………… 165
Sec. 1555. Freedom not to participate in Federal health insurance programs
………………………………………………………………………………………………. 165
Sec. 1556. Equity for certain eligible survivors …………………………………….. 165
Sec. 1557. Nondiscrimination ……………………………………………………………… 166
Sec. 1558. Protections for employees ……………………………………………………. 166
Sec. 1559. Oversight …………………………………………………………………………… 167
Sec. 1560. Rules of construction ………………………………………………………….. 167
Sec. 1561. Health information technology enrollment standards and protocols
……………………………………………………………………………………………….. 168
Sec. 1562. GAO study regarding the rate of denial of coverage and enrollment
by health insurance issuers and group health plans ……………… 170
Sec. 1563. Small business procurement ……………………………………………….. 170
Sec. 1563 [sic]. Conforming amendments …………………………………………….. 171
Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility ……….. 178
TITLE II—ROLE OF PUBLIC PROGRAMS
Subtitle A—Improved Access to Medicaid
Sec. 2001. Medicaid coverage for the lowest income populations …………… 179
Sec. 2002. Income eligibility for nonelderly determined using modified
gross income …………………………………………………………………………………….. 186
Sec. 2003. Requirement to offer premium assistance for employer-sponsored
insurance ………………………………………………………………………………… 190
Sec. 2004. Medicaid coverage for former foster care children ………………… 191
Sec. 2005. Payments to territories ……………………………………………………….. 191
Sec. 2006. Special adjustment to FMAP determination for certain States
recovering from a major disaster ……………………………………………………….. 192
Sec. 2007. Medicaid Improvement Fund rescission ………………………………. 193
Subtitle B—Enhanced Support for the Children’s Health Insurance Program
Sec. 2101. Additional federal financial participation for CHIP ……………… 194
Sec. 2102. Technical corrections ………………………………………………………….. 197
Subtitle C—Medicaid and CHIP Enrollment Simplification
Sec. 2201. Enrollment Simplification and coordination with State Health
Insurance Exchanges ………………………………………………………………………… 198
Sec. 2202. Permitting hospitals to make presumptive eligibility determinations
for all Medicaid eligible populations …………………………………… 200
Subtitle D—Improvements to Medicaid Services
Sec. 2301. Coverage for freestanding birth center services ……………………. 201
Sec. 2302. Concurrent care for children ……………………………………………….. 202
Sec. 2303. State eligibility option for family planning services ……………… 203
Sec. 2304. Clarification of definition of medical assistance ……………………. 206
Subtitle E—New Options for States to Provide Long-Term Services and Supports
Sec. 2401. Community First Choice Option ………………………………………….. 206
Sec. 2402. Removal of barriers to providing home and community-based
services …………………………………………………………………………………………….. 211
Sec. 2403. Money Follows the Person Rebalancing Demonstration ……….. 214
Sec. 2404. Protection for recipients of home and community-based services
against spousal impoverishment …………………………………………………. 215
Sec. 2405. Funding to expand State Aging and Disability Resource Centers
………………………………………………………………………………………………….. 215
Sec. 2406. Sense of the Senate regarding long-term care ……………………… 215
Subtitle F—Medicaid Prescription Drug Coverage
Sec. 2501. Prescription drug rebates ……………………………………………………. 216
Sec. 2502. Elimination of exclusion of coverage of certain drugs …………… 219
Sec. 2503. Providing adequate pharmacy reimbursement …………………….. 220
Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments
Sec. 2551. Disproportionate share hospital payments …………………………… 223
Subtitle H—Improved Coordination for Dual Eligible Beneficiaries
Sec. 2601. 5-year period for demonstration projects ……………………………… 224
Sec. 2602. Providing Federal coverage and payment coordination for dual
eligible beneficiaries …………………………………………………………………………. 225
Subtitle I—Improving the Quality of Medicaid for Patients and Providers
Sec. 2701. Adult health quality measures ……………………………………………. 227
Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions ….. 229
Sec. 2703. State option to provide health homes for enrollees with chronic
conditions ……………………………………………………………………………………… 229
Sec. 2704. Demonstration project to evaluate integrated care around a
hospitalization ………………………………………………………………………………….. 233
Sec. 2705. Medicaid Global Payment System Demonstration Project …….. 235
Sec. 2706. Pediatric Accountable Care Organization Demonstration
Project ……………………………………………………………………………………………… 236
Sec. 2707. Medicaid emergency psychiatric demonstration project ………… 237
Subtitle J—Improvements to the Medicaid and CHIP Payment and Access
Commission (MACPAC)
Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries
……………………………………………………………………………………………. 239
Subtitle K—Protections for American Indians and Alaska Natives
Sec. 2901. Special rules relating to Indians ………………………………………… 244
Sec. 2902. Elimination of sunset for reimbursement for all medicare part
B services furnished by certain indian hospitals and clinics ……………….. 244
Subtitle L—Maternal and Child Health Services
Sec. 2951. Maternal, infant, and early childhood home visiting programs 245
Sec. 2952. Support, education, and research for postpartum depression … 255
Sec. 2953. Personal responsibility education ………………………………………… 258
Sec. 2954. Restoration of funding for abstinence education …………………… 263
Sec. 2955. Inclusion of information about the importance of having a
health care power of attorney in transition planning for children aging
out of foster care and independent living programs ……………………………. 264
TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle A—Transforming the Health Care Delivery System
PART 1—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE
PROGRAM
Sec. 3001. Hospital Value-Based purchasing program ………………………….. 266
Sec. 3002. Improvements to the physician quality reporting system ……… 277
Sec. 3003. Improvements to the physician feedback program ……………….. 279
Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation
hospitals, and hospice programs …………………………………………. 282
Sec. 3005. Quality reporting for PPS-exempt cancer hospitals ………………. 285
Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing
facilities and home health agencies ……………………………………………… 286
Sec. 3007. Value-based payment modifier under the physician fee schedule
……………………………………………………………………………………………………. 288
Sec. 3008. Payment adjustment for conditions acquired in hospitals …….. 291
PART 2—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
Sec. 3011. National strategy ……………………………………………………………….. 293
Sec. 3012. Interagency Working Group on Health Care Quality ……………. 295
Sec. 3013. Quality measure development …………………………………………….. 296
Sec. 3014. Quality measurement …………………………………………………………. 300
Sec. 3015. Data collection; public reporting ………………………………………….. 304
PART 3—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation
within CMS ……………………………………………………………………………….. 306
Sec. 3022. Medicare shared savings program ……………………………………….. 313
Sec. 3023. National pilot program on payment bundling ………………………. 318
Sec. 3024. Independence at home demonstration program ……………………. 324
Sec. 3025. Hospital readmissions reduction program ……………………………. 328
Sec. 3026. Community-Based Care Transitions Program ……………………… 333
Sec. 3027. Extension of gainsharing demonstration ……………………………… 335
Subtitle B—Improving Medicare for Patients and Providers
PART I—ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES
Sec. 3101. Increase in the physician payment update [repealed] ……….. 336
Sec. 3102. Extension of the work geographic index floor and revisions
to the practice expense geographic adjustment under the Medicare
physician fee schedule ………………………………………………………………………. 336
Sec. 3103. Extension of exceptions process for Medicare therapy caps …… 338
Sec. 3104. Extension of payment for technical component of certain physician
pathology services …………………………………………………………………… 338
Sec. 3105. Extension of ambulance add-ons …………………………………………. 338
Sec. 3106. Extension of certain payment rules for long-term care hospital
services and of moratorium on the establishment of certain hospitals
and facilities …………………………………………………………………………………….. 338
Sec. 3107. Extension of physician fee schedule mental health add-on ……. 338
Sec. 3108. Permitting physician assistants to order post-Hospital extended
care services ………………………………………………………………………….. 339
Sec. 3109. Exemption of certain pharmacies from accreditation requirements
………………………………………………………………………………………………. 339
Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries
……………………………………………………………………………………………. 340
Sec. 3111. Payment for bone density tests …………………………………………… 341
Sec. 3112. Revision to the Medicare Improvement Fund ………………………. 342
Sec. 3113. Treatment of certain complex diagnostic laboratory tests …….. 342
Sec. 3114. Improved access for certified nurse-midwife services ……………. 343
PART II—RURAL PROTECTIONS
Sec. 3121. Extension of outpatient hold harmless provision ………………….. 344
Sec. 3122. Extension of Medicare reasonable costs payments for certain
clinical diagnostic laboratory tests furnished to hospital patients in
certain rural areas ……………………………………………………………………………. 344
Sec. 3123. Extension of the Rural Community Hospital Demonstration
Program …………………………………………………………………………………………… 344
Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program
………………………………………………………………………………………………… 345
Sec. 3125. Temporary improvements to the Medicare inpatient hospital
payment adjustment for low-volume hospitals ……………………………………. 346
Sec. 3126. Improvements to the demonstration project on community
health integration models in certain rural counties ……………………………. 346
Sec. 3127. MedPAC study on adequacy of Medicare payments for health
care providers serving in rural areas …………………………………………………. 347
Sec. 3128. Technical correction related to critical access hospital services
…………………………………………………………………………………………………… 347
Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility
program …………………………………………………………………………………… 347
PART III—IMPROVING PAYMENT ACCURACY
Sec. 3131. Payment adjustments for home health care …………………………. 348
Sec. 3132. Hospice reform …………………………………………………………………… 352
Sec. 3133. Improvement to medicare disproportionate share hospital
(DSH) payments ……………………………………………………………………………….. 354
Sec. 3134. Mis-valued codes under the physician fee schedule ……………….. 356
Sec. 3135. Modification of equipment utilization factor for advanced imaging
services …………………………………………………………………………………… 358
Sec. 3136. Revision of payment for power-driven wheelchairs ………………. 359
Sec. 3137. Hospital wage index improvement ………………………………………. 360
Sec. 3138. Treatment of certain cancer hospitals ………………………………….. 362
Sec. 3139. Payment for bio-similar biological products …………………………… 362
Sec. 3140. Medicare hospice concurrent care demonstration program ……. 363
Sec. 3141. Application of budget neutrality on a national basis in the
calculation of the Medicare hospital wage index floor …………………………. 364
Sec. 3142. HHS study on urban Medicare-dependent hospitals …………….. 364
Sec. 3143. Protecting home health benefits ………………………………………….. 365
Subtitle C—Provisions Relating to Part C
Sec. 3201. Medicare Advantage payment [repealed & replaced] …………. 365
Sec. 3202. Benefit protection and simplification …………………………………… 370
Sec. 3203. Application of coding intensity adjustment during MA payment
Transition [repealed and replaced] …………………………………………… 372
Sec. 3204. Simplification of annual beneficiary election periods ……………. 373
Sec. 3205. Extension for specialized MA plans for special needs individuals
………………………………………………………………………………………………….. 373
Sec. 3206. Extension of reasonable cost contracts ………………………………… 376
Sec. 3207. Technical correction to MA private fee-for-service plans ……….. 376
Sec. 3208. Making senior housing facility demonstration permanent …….. 376
Sec. 3209. Authority to deny plan bids ………………………………………………… 377
Sec. 3210. Development of new standards for certain Medigap plans ……. 377
Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and MA–
PD Plans
Sec. 3301. Medicare coverage gap discount program …………………………….. 378
Sec. 3302. Improvement in determination of Medicare part D low-income
benchmark premium …………………………………………………………………………. 386
Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals
under prescription drug plans and MA–PD plans ………………………………. 386
Sec. 3304. Special rule for widows and widowers regarding eligibility
for low-income assistance ………………………………………………………………….. 387
Sec. 3305. Improved information for subsidy eligible individuals reassigned
to prescription drug plans and MA–PD plans ………………………….. 387
Sec. 3306. Funding outreach and assistance for low-income programs ….. 388
Sec. 3307. Improving formulary requirements for prescription drug plans
and MA–PD plans with respect to certain categories or classes of drugs 389
Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries
……………………………………………………………………………………………. 390
Sec. 3309. Elimination of cost sharing for certain dual eligible individuals
………………………………………………………………………………………………….. 393
Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs
in long-term care facilities under prescription drug plans and MA–
PD plans ………………………………………………………………………………………….. 393
Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan
complaint system ……………………………………………………………………………… 394
Sec. 3312. Uniform exceptions and appeals process for prescription drug
plans and MA–PD plans ……………………………………………………………………. 394
Sec. 3313. Office of the Inspector General studies and reports ……………… 395
Sec. 3314. Including costs incurred by AIDS drug assistance programs
and Indian Health Service in providing prescription drugs toward the
annual out-of-pocket threshold under part D ……………………………………… 396
Sec. 3315. Immediate reduction in coverage gap in 2010 [repealed and
Replaced] ………………………………………………………………………………………….. 397
Subtitle E—Ensuring Medicare Sustainability
Sec. 3401. Revision of certain market basket updates and incorporation
of productivity improvements into market basket updates that do not
already incorporate such improvements …………………………………………….. 398
Sec. 3402. Temporary adjustment to the calculation of part B premiums . 407
Sec. 3403. Independent Medicare Payment Advisory Board ……………….. 407
Subtitle F—Health Care Quality Improvements
Sec. 3501. Health care delivery system research; Quality improvement
technical assistance ………………………………………………………………………….. 429
Sec. 3502. Establishing community health teams to support the patient-centered
medical home ……………………………………………………………………… 435
Sec. 3503. Medication management services in treatment of chronic disease
…………………………………………………………………………………………………. 438
Sec. 3504. Design and implementation of regionalized systems for emergency
care ………………………………………………………………………………………… 440
Sec. 3505. Trauma care centers and service availability ……………………….. 444
Sec. 3506. Program to facilitate shared decision-making ……………………….. 450
Sec. 3507. Presentation of prescription drug benefit and risk information
………………………………………………………………………………………………….. 453
Sec. 3508. Demonstration program to integrate quality improvement and
patient safety training into clinical education of health professionals ….. 453
Sec. 3509. Improving women’s health ………………………………………………….. 454
Sec. 3510. Patient navigator program ………………………………………………….. 460
Sec. 3511. Authorization of appropriations …………………………………………… 461
Sec. 3512. GAO study and report on causes of action …………………………… 461
Subtitle G—Protecting and Improving Guaranteed Medicare Benefits
Sec. 3601. Protecting and improving guaranteed Medicare benefits ………. 462
Sec. 3602. No cuts in guaranteed benefits ……………………………………………. 462
TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC
HEALTH
Subtitle A—Modernizing Disease Prevention and Public Health Systems
Sec. 4001. National Prevention, Health Promotion and Public Health
Council …………………………………………………………………………………………….. 463
Sec. 4002. Prevention and Public Health Fund …………………………………….. 466
Sec. 4003. Clinical and community Preventive Services ……………………….. 466
Sec. 4004. Education and outreach campaign regarding preventive benefits
…………………………………………………………………………………………………… 469
Subtitle B—Increasing Access to Clinical Preventive Services
Sec. 4101. School-based health centers ………………………………………………… 471
Sec. 4102. Oral healthcare prevention activities …………………………………… 476
Sec. 4103. Medicare coverage of annual wellness visit providing a personalized
prevention plan ………………………………………………………………….. 478
Sec. 4104. Removal of barriers to preventive services in Medicare ………… 482
Sec. 4105. Evidence-based coverage of preventive services in Medicare …. 483
Sec. 4106. Improving access to preventive services for eligible adults
in Medicaid ………………………………………………………………………………………. 484
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant
women in Medicaid …………………………………………………………………… 485
Sec. 4108. Incentives for prevention of chronic diseases in medicaid …….. 486
Subtitle C—Creating Healthier Communities
Sec. 4201. Community transformation grants ………………………………………. 489
Sec. 4202. Healthy aging, living well; evaluation of community-based
prevention and wellness programs for Medicare beneficiaries …………….. 492
Sec. 4203. Removing barriers and improving access to wellness for individuals
with disabilities ……………………………………………………………………. 496
Sec. 4204. Immunizations …………………………………………………………………… 496
Sec. 4205. Nutrition labeling of standard menu items at Chain Restaurants
…………………………………………………………………………………………… 499
Sec. 4206. Demonstration project concerning individualized wellness
plan …………………………………………………………………………………………………. 502
Sec. 4207. Reasonable break time for nursing mothers …………………………. 503
Subtitle D—Support for Prevention and Public Health Innovation
Sec. 4301. Research on optimizing the delivery of public health services . 504
Sec. 4302. Understanding health disparities: data collection and analysis
………………………………………………………………………………………………….. 504
Sec. 4303. CDC and employer-based wellness programs ……………………….. 509
Sec. 4304. Epidemiology-Laboratory Capacity Grants …………………………… 510
Sec. 4305. Advancing research and treatment for pain care management 511
Sec. 4306. Funding for Childhood Obesity Demonstration Project …………. 513
Subtitle E—Miscellaneous Provisions
Sec. 4401. Sense of the Senate concerning CBO scoring ……………………….. 514
Sec. 4402. Effectiveness of Federal health and wellness initiatives ……….. 514
TITLE V—HEALTH CARE WORKFORCE
Subtitle A—Purpose and Definitions
Sec. 5001. Purpose ……………………………………………………………………………… 515
Sec. 5002. Definitions …………………………………………………………………………. 515
Subtitle B—Innovations in the Health Care Workforce
Sec. 5101. National health care workforce commission …………………………. 519
Sec. 5102. State health care workforce development grants ………………….. 526
Sec. 5103. Health care workforce assessment ………………………………………. 531
Sec. 5104. Interagency task force to assess and improve access to health
care in the State of Alaska ………………………………………………………………… 534
Subtitle C—Increasing the Supply of the Health Care Workforce
Sec. 5201. Federally supported student loan funds ………………………………. 535
Sec. 5202. Nursing student loan program ……………………………………………. 535
Sec. 5203. Health care workforce loan repayment programs …………………. 536
Sec. 5204. Public health workforce recruitment and retention programs .. 538
Sec. 5205. Allied health workforce recruitment and retention programs .. 540
Sec. 5206. Grants for State and local programs ……………………………………. 540
Sec. 5207. Funding for National Health Service Corps …………………………. 541
Sec. 5208. Nurse-managed health clinics ……………………………………………… 542
Sec. 5209. Elimination of cap on commissioned corps …………………………… 534
Sec. 5210. Establishing a Ready Reserve Corps ……………………………………. 543
Subtitle D—Enhancing Health Care Workforce Education and Training
Sec. 5301. Training in family medicine, general internal medicine, general
pediatrics, and physician assistantship ……………………………………….. 544
Sec. 5302. Training opportunities for direct care workers …………………….. 547
Sec. 5303. Training in general, pediatric, and public health dentistry …… 548
Sec. 5304. Alternative dental health care providers demonstration
project ……………………………………………………………………………………………… 550
Sec. 5305. Geriatric education and training; career awards; comprehensive
geriatric education …………………………………………………………………….. 552
Sec. 5306. Mental and behavioral health education and training grants .. 555
Sec. 5307. Cultural competency, prevention, and public health and individuals
with disabilities training ……………………………………………………….. 558
Sec. 5308. Advanced nursing education grants …………………………………….. 559
Sec. 5309. Nurse education, practice, and retention grants …………………… 559
Sec. 5310. Loan repayment and scholarship program …………………………… 561
Sec. 5311. Nurse faculty loan program ………………………………………………… 561
Sec. 5312. Authorization of appropriations for parts B through D of title
VIII ………………………………………………………………………………………………….. 563
Sec. 5313. Grants to promote the community health workforce …………….. 564
Sec. 5314. Fellowship training in public health ……………………………………. 566
Sec. 5315. United States Public Health Sciences Track ………………………… 567
Sec. 5316. Demonstration grants for family nurse practitioner training
programs ………………………………………………………………………………………….. 572
Subtitle E—Supporting the Existing Health Care Workforce
Sec. 5401. Centers of excellence ………………………………………………………….. 574
Sec. 5402. Health care professionals training for diversity ……………………. 576
Sec. 5403. Interdisciplinary, community-based linkages ……………………….. 576
Sec. 5404. Workforce diversity grants ………………………………………………….. 581
Sec. 5405. Primary care extension program …………………………………………. 582
Subtitle F—Strengthening Primary Care and Other Workforce Improvements
Sec. 5501. Expanding access to primary care services and general surgery
services …………………………………………………………………………………….. 585
Sec. 5502. Medicare Federally qualified health center improvements
[repealed] ……………………………………………………………………………… 587
Sec. 5503. Distribution of additional residency positions ………………………. 587
Sec. 5504. Counting resident time in non-provider settings …………………… 590
Sec. 5505. Rules for counting resident time for didactic and scholarly
activities and other activities …………………………………………………………….. 591
Sec. 5506. Preservation of resident cap positions from closed hospitals …. 593
Sec. 5507. Demonstration projects To address health professions workforce
needs; extension of family-to-family health information centers ….. 595
Sec. 5508. Increasing teaching capacity ……………………………………………….. 601
Sec. 5509. Graduate nurse education demonstration ……………………………. 606
Subtitle G—Improving Access to Health Care Services
Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs) …… 609
Sec. 5602. Negotiated rulemaking for development of methodology and
criteria for designating medically underserved populations and health
professions shortage areas ………………………………………………………………… 610
Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services
for Children Program ………………………………………………………………………… 612
Sec. 5604. Co-locating primary and specialty care in community-based
mental health settings ………………………………………………………………………. 612
Sec. 5605. Key National indicators ………………………………………………………. 613
Sec. 5606. State grants to health care providers who provide services
to a high percentage of medically underserved populations or other
special populations ……………………………………………………………………………. 617
Subtitle H—General Provisions
Sec. 5701. Reports ………………………………………………………………………………. 618
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle A—Physician Ownership and Other Transparency
Sec. 6001. Limitation on Medicare exception to the prohibition on certain
physician referrals for hospitals ………………………………………………………… 619
Sec. 6002. Transparency reports and reporting of physician ownership
or investment interests ……………………………………………………………………… 624
Sec. 6003. Disclosure requirements for in-office ancillary services exception
to the prohibition on physician self-referral for certain imaging
services …………………………………………………………………………………………….. 632
Sec. 6004. Prescription drug sample transparency ……………………………….. 632
Sec. 6005. Pharmacy benefit managers transparency requirements ………. 633
Subtitle B—Nursing Home Transparency and Improvement
PART 1—IMPROVING TRANSPARENCY OF INFORMATION
Sec. 6101. Required disclosure of ownership and additional disclosable
parties information …………………………………………………………………………… 635
Sec. 6102. Accountability requirements for skilled nursing facilities and
nursing facilities ………………………………………………………………………………. 638
Sec. 6103. Nursing home compare Medicare website ……………………………. 640
Sec. 6104. Reporting of expenditures …………………………………………………… 647
Sec. 6105. Standardized complaint form ………………………………………………. 648
Sec. 6106. Ensuring staffing accountability ………………………………………….. 648
Sec. 6107. GAO study and report on Five-Star Quality Rating System …. 649
PART 2—TARGETING ENFORCEMENT
Sec. 6111. Civil money penalties …………………………………………………………. 649
Sec. 6112. National independent monitor demonstration project …………… 653
Sec. 6113. Notification of facility closure ……………………………………………… 655
Sec. 6114. National demonstration projects on culture change and use
of information technology in nursing homes ………………………………………. 656
PART 3—IMPROVING STAFF TRAINING
Sec. 6121. Dementia and abuse prevention training …………………………….. 657
Subtitle C—Nationwide Program for National and State Background Checks on
Direct Patient Access Employees of Long-term Care Facilities and Providers
Sec. 6201. Nationwide program for National and State background
checks on direct patient access employees of long-term care facilities
and providers ……………………………………………………………………………………. 658
Subtitle D—Patient-Centered Outcomes Research
Sec. 6301. Patient-Centered Outcomes Research ………………………………….. 664
Sec. 6302. Federal coordinating council for comparative effectiveness research
………………………………………………………………………………………………. 685
Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions
Sec. 6401. Provider screening and other enrollment requirements under
Medicare, Medicaid, and CHIP ………………………………………………………….. 685
Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions
………………………………………………………………………………………………… 691
Sec. 6403. Elimination of duplication between the Healthcare Integrity
and Protection Data Bank and the National Practitioner Data Bank ….. 702
Sec. 6404. Maximum period for submission of Medicare claims reduced
to not more than 12 months ………………………………………………………………. 707
Sec. 6405. Physicians who order items or services required to be Medicare
enrolled physicians or eligible professionals ………………………………… 708
Sec. 6406. Requirement for physicians to provide documentation on referrals
to programs at high risk of waste and abuse …………………………… 708
Sec. 6407. Face to face encounter with patient required before physicians
may certify eligibility for home health services or durable medical
equipment under Medicare ……………………………………………………………….. 709
Sec. 6408. Enhanced penalties …………………………………………………………….. 710
Sec. 6409. Medicare self-referral disclosure protocol …………………………….. 712
Sec. 6410. Adjustments to the Medicare durable medical equipment,
prosthetics, orthotics, and supplies competitive acquisition program …… 713
Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program … 714
Subtitle F—Additional Medicaid Program Integrity Provisions
Sec. 6501. Termination of provider participation under Medicaid if terminated
under Medicare or other State plan …………………………………………. 716
Sec. 6502. Medicaid exclusion from participation relating to certain
ownership, control, and management affiliations ……………………………….. 716
Sec. 6503. Billing agents, clearinghouses, or other alternate payees required
to register under Medicaid ……………………………………………………… 716
Sec. 6504. Requirement to report expanded set of data elements under
MMIS to detect fraud and abuse ……………………………………………………….. 717
Sec. 6505. Prohibition on payments to institutions or entities located
outside of the United States ……………………………………………………………… 717
Sec. 6506. Overpayments ……………………………………………………………………. 717
Sec. 6507. Mandatory State use of national correct coding initiative …….. 718
Sec. 6508. General effective date …………………………………………………………. 719
Subtitle G—Additional Program Integrity Provisions
Sec. 6601. Prohibition on false statements and representations ……………. 719
Sec. 6602. Clarifying definition ……………………………………………………………. 720
Sec. 6603. Development of model uniform report form …………………………. 720
Sec. 6604. Applicability of State law to combat fraud and abuse …………… 720
Sec. 6605. Enabling the Department of Labor to issue administrative
summary cease and desist orders and summary seizures orders against
plans that are in financially hazardous condition ……………………………….. 721
Sec. 6606. MEWA plan registration with Department of Labor …………….. 722
Sec. 6607. Permitting evidentiary privilege and confidential communications
…………………………………………………………………………………………………. 722
Subtitle H—Elder Justice Act
Sec. 6701. Short title of subtitle ………………………………………………………….. 722
Sec. 6702. Definitions …………………………………………………………………………. 722
Sec. 6703. Elder Justice ……………………………………………………………………… 722
Subtitle I—Sense of the Senate Regarding Medical Malpractice
Sec. 6801. Sense of the Senate regarding medical malpractice ……………… 745
TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES
Subtitle A—Biologics Price Competition and Innovation
Sec. 7001. Short title ………………………………………………………………………….. 747
Sec. 7002. Approval pathway for bio-similar biological products …………….. 747
Sec. 7003. Savings ………………………………………………………………………………. 764
Subtitle B—More Affordable Medicines for Children and Underserved
Communities
Sec. 7101. Expanded participation in 340B program …………………………….. 764
Sec. 7102. Improvements to 340B program integrity ……………………………. 767
Sec. 7103. GAO study to make recommendations on improving the 340B
program ……………………………………………………………………………………………. 771
TITLE VIII—CLASS ACT
Sec. 8001. Short title of title ……………………………………………………………….. 772
Sec. 8002. Establishment of national voluntary insurance program for
purchasing community living assistance services and support …………….. 772
TITLE IX—REVENUE PROVISIONS
Subtitle A—Revenue Offset Provisions
Sec. 9001. Excise tax on high cost employer-sponsored health coverage … 793
Sec. 9002. Inclusion of cost of employer-sponsored health coverage on
W–2 …………………………………………………………………………………………………. 800
Sec. 9003. Distributions for medicine qualified only if for prescribed drug
or insulin …………………………………………………………………………………………. 800
Sec. 9004. Increase in additional tax on distributions from HSAs and
Archer MSAs not used for qualified medical expenses ………………………… 801
Sec. 9005. Limitation on health flexible spending arrangements under
cafeteria plans ………………………………………………………………………………….. 801
Sec. 9006. Expansion of information reporting requirements ………………… 801
Sec. 9007. Additional requirements for charitable hospitals ………………….. 802
Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical
manufacturers and importers ……………………………………………….. 806
Sec. 9009. Imposition of annual fee on medical device manufacturers
and importers [repealed and replaced] …………………………………………….. 810
Sec. 9010. Imposition of annual fee on health insurance providers ……….. 811
Sec. 9011. Study and report of effect on veterans health care ……………….. 815
Sec. 9012. Elimination of deduction for expenses allocable to Medicare
Part D subsidy …………………………………………………………………………………. 816
Sec. 9013. Modification of itemized deduction for medical expenses ………. 816
Sec. 9014. Limitation on excessive remuneration paid by certain health
insurance providers ………………………………………………………………………….. 816
Sec. 9015. Additional hospital insurance tax on high-income taxpayers … 818
Sec. 9016. Modification of section 833 treatment of certain health organizations
……………………………………………………………………………………………… 820
Sec. 9017. Excise tax on elective cosmetic medical procedures
[nullified] ……………………………………………………………………………… 820
Subtitle B—Other Provisions
Sec. 9021. Exclusion of health benefits provided by Indian tribal governments
………………………………………………………………………………………………. 821
Sec. 9022. Establishment of simple cafeteria plans for small businesses .. 822
Sec. 9023. Qualifying therapeutic discovery project credit …………………….. 825
TITLE X—STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR
ALL AMERICANS
Subtitle A—Provisions Relating to Title I
Sec. 10101. Amendments to subtitle A [amendments fully incorporated] 833
Sec. 10102. Amendments to subtitle B [amendments fully incorporated] 833
Sec. 10103. Amendments to subtitle C [amendments fully incorporated] 833
Sec. 10104. Amendments to subtitle D ………………………………………………… 834
Sec. 10105. Amendments to subtitle E [amendments fully incorporated] 834
Sec. 10106. Amendments to subtitle F [amendments fully incorporated] 835
Sec. 10107. Amendments to subtitle G [amendments fully incorporated] 835
Sec. 10108. Free choice vouchers …………………………………………………………. 835
Sec. 10109. Development of standards for financial and administrative
transactions ……………………………………………………………………………………… 838
Subtitle B—Provisions Relating to Title II
PART 1—MEDICAID AND CHIP
Sec. 10201. Amendments to the Social Security Act and title II of this
Act …………………………………………………………………………………………………… 839
Sec. 10202. Incentives for States to offer home and community-based
services as a long-term care alternative to nursing homes ………………….. 845
Sec. 10203. Extension of funding for CHIP through fiscal year 2015 and
other CHIP-related provisions …………………………………………………………… 848
PART 2—SUPPORT FOR PREGNANT AND PARENTING TEENS AND WOMEN
Sec. 10211. Definitions ……………………………………………………………………….. 852
Sec. 10212. Establishment of pregnancy assistance fund ……………………… 853
Sec. 10213. Permissible uses of Fund ………………………………………………….. 853
Sec. 10214. Appropriations ………………………………………………………………….. 856
PART 3—INDIAN HEALTH CARE IMPROVEMENT
Sec. 10221. Indian health care improvement ……………………………………….. 857
Subtitle C—Provisions Relating to Title III
Sec. 10301. Plans for a Value-Based purchasing program for ambulatory
surgical centers [amendments fully incorporated] ……………………………… 858
Sec. 10302. Revision to national strategy for quality improvement in
health care [amendments fully incorporated] …………………………………….. 858
Sec. 10303. Development of outcome measures ……………………………………. 858
Sec. 10304. Selection of efficiency measures [amendments fully incorporated] …………………………………………………………………………………………… 858
Sec. 10305. Data collection; public reporting [amendments fully incorporated] …………………………………………………………………………………………… 858
Sec. 10306. Improvements under the Center for Medicare and Medicaid
Innovation [amendments fully incorporated] …………………………………….. 859
Sec. 10307. Improvements to the Medicare shared savings program
[amendments fully incorporated] ……………………………………………………… 859
Sec. 10308. Revisions to national pilot program on payment bundling
[amendments fully incorporated] ………………………………………………………. 859
Sec. 10309. Revisions to hospital readmissions reduction program
[amendments fully incorporated] ……………………………………………………… 859
Sec. 10310. Repeal of physician payment update [amendments fully incorporated] ………………………………………………………………………………………. 859
Sec. 10311. Revisions to extension of ambulance add-ons [amendments
fully incorporated] ……………………………………………………………………………. 859
Sec. 10312. Certain payment rules for long-term care hospital services
and moratorium on the establishment of certain hospitals and facilities
[amendments fully incorporated] ………………………………………………………. 859
Sec. 10313. Revisions to the extension for the rural community hospital
demonstration program [amendments fully incorporated] ………………….. 860
Sec. 10314. Adjustment to low-volume hospital provision [amendments
fully incorporated] ……………………………………………………………………………. 860
Sec. 10315. Revisions to home health care provisions [amendments fully
Incorporated] ……………………………………………………………………………………. 860
Sec. 10316. Medicare DSH [amendments fully incorporated] ……………….. 860
Sec. 10317. Revisions to extension of section 508 hospital provisions
[amendments fully incorporated] ……………………………………………………… 860
Sec. 10318. Revisions to transitional extra benefits under Medicare Advantage
[amendments fully incorporated] …………………………………………. 860
Sec. 10319. Revisions to market basket adjustments [amendments fully
Incorporated] ……………………………………………………………………………………. 860
Sec. 10320. Expansion of the scope of, and additional improvements to,
the Independent Medicare Advisory Board ………………………………………… 861
Sec. 10321. Revision to community health teams [amendments fully incorporated] ………………………………………………………………………………………. 861
Sec. 10322. Quality reporting for psychiatric hospitals …………………………. 861
Sec. 10323. Medicare coverage for individuals exposed to environmental
health hazards ………………………………………………………………………………….. 863
Sec. 10324. Protections for frontier States …………………………………………… 868
Sec. 10325. Revision to skilled nursing facility prospective ?payment system
………………………………………………………………………………………………….. 870
Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare
providers …………………………………………………………………………………… 870
Sec. 10327. Improvements to the physician quality reporting system ……. 871
Sec. 10328. Improvement in part D medication therapy management
(MTM) programs ………………………………………………………………………………. 873
Sec. 10329. Developing methodology to assess health plan value ………….. 874
Sec. 10330. Modernizing computer and data systems of the Centers for
Medicare & Medicaid services to support improvements in care delivery
…………………………………………………………………………………………………… 875
Sec. 10331. Public reporting of performance information ……………………… 875
Sec. 10332. Availability of medicare data for performance measurement . 877
Sec. 10333. Community-based collaborative care networks …………………… 879
Sec. 10334. Minority health ………………………………………………………………… 880
Sec. 10335. Technical correction to the hospital value-based purchasing
program [amendments fully incorporated] ………………………………………… 883
Sec. 10336. GAO study and report on Medicare beneficiary access to
high-quality dialysis services …………………………………………………………….. 884
Subtitle D—Provisions Relating to Title IV
Sec. 10401. Amendments to subtitle A [amendments fully incorporated] 884
Sec. 10402. Amendments to subtitle B [amendments fully incorporated] 884
Sec. 10403. Amendments to subtitle C [amendments fully incorporated] 884
Sec. 10404. Amendments to subtitle D [amendments fully incorporated] 885
Sec. 10405. Amendments to subtitle E [amendments fully incorporated] 885
Sec. 10406. Amendment relating to waiving coinsurance for preventive
services [amendments fully incorporated] …………………………………………. 885
Sec. 10407. Better diabetes care ………………………………………………………….. 885
Sec. 10408. Grants for small businesses to provide comprehensive workplace
wellness programs ……………………………………………………………………. 886
Sec. 10409. Cures Acceleration Network ……………………………………………… 887
Sec. 10410. Centers of Excellence for Depression …………………………………. 894
Sec. 10411. Programs relating to congenital heart disease ……………………. 898
Sec. 10412. Automated Defibrillation in Adam’s Memory Act ……………….. 899
Sec. 10413. Young women’s breast health awareness and support of
young women diagnosed with breast cancer ……………………………………….. 900
Subtitle E—Provisions Relating to Title V
Sec. 10501. Amendments to the Public Health Service Act, the Social
Security Act, and title V of this Act …………………………………………………… 903
Sec. 10502. Infrastructure to Expand Access to Care ……………………………. 910
Sec. 10503. Community Health Centers and the National Health Service
Corps Fund ………………………………………………………………………………………. 910
Sec. 10504. Demonstration project to provide access to affordable care …. 911
Subtitle F—Provisions Relating to Title VI
Sec. 10601. Revisions to limitation on medicare exception to the prohibition
on certain physician referrals for hospitals [amendments fully
incorporated] ……………………………………………………………………………………. 911
Sec. 10602. Clarifications to patient-centered outcomes research [amendments
fully incorporated] ………………………………………………………………….. 912
Sec. 10603. Striking provisions relating to individual provider application
fees [amendments fully incorporated] ………………………………………… 912
Sec. 10604. Technical correction to section 6405 [amendments fully incorporated] ………………………………………………………………………………………. 912
Sec. 10605. Certain other providers permitted to conduct face to face
encounter for home health services [amendments fully incorporated] …. 912
Sec. 10606. Health care fraud enforcement ………………………………………….. 912
Sec. 10607. State demonstration programs to evaluate alternatives to
current medical tort litigation …………………………………………………………… 915
Sec. 10608. Extension of medical malpractice coverage to free clinics ……. 920
Sec. 10609. Labeling changes ……………………………………………………………… 920
Subtitle G—Provisions Relating to Title VIII
Sec. 10801. Provisions relating to title VIII [amendments fully incorporated] …………………………………………………………………………………………… 921
Subtitle H—Provisions Relating to Title IX
Sec. 10901. Modifications to excise tax on high cost employer-sponsored
health coverage [amendments fully incorporated] ……………………………… 921
Sec. 10902. Inflation adjustment of limitation on health flexible spending
arrangements under cafeteria plans [amendments fully incorporated] .. 921
Sec. 10903. Modification of limitation on charges by charitable hospitals
[amendments fully incorporated] ………………………………………………………. 922
Sec. 10904. Modification of annual fee on medical device manufacturers
and importers [amendments fully incorporated] ………………………………… 922
Sec. 10905. Modification of annual fee on health insurance providers
[amendments fully incorporated] ………………………………………………………. 922
Sec. 10906. Modifications to additional hospital insurance tax on high-income
taxpayers [amendments fully incorporated] …………………………… 922
Sec. 10907. Excise tax on indoor tanning services in lieu of elective
cosmetic medical procedures [substitutes for section 9017 of PPACA] …. 922
Sec. 10908. Exclusion for assistance provided to participants in State
student loan repayment programs for certain health professionals ……… 923
Sec. 10909. Expansion of adoption credit and adoption assistance programs
………………………………………………………………………………………………. 924
Health Care and Education Reconciliation Act of 2010 (Public Law 111–
152) ………………………………………………………………………………………………………… 927
Sec. 1001. Tax credits [amendments fully incorporated into PPACA]. ….. 928
Sec. 1002. Individual responsibility [amendments fully incorporated into
PPACA]. ………………………………………………………………………………………….. 929
Sec. 1003. Employer responsibility [amendments fully incorporated into
PPACA]. ………………………………………………………………………………………….. 929
Sec. 1004. Income definitions. ……………………………………………………………… 929
Sec. 1005. Implementation funding. …………………………………………………….. 931
Subtitle B—Medicare
Sec. 1101. Closing the medicare prescription drug ‘‘donut
hole’’ [substitutes for section 3315 of PPACA]. ……………………………………. 931
Sec. 1102. Medicare Advantage payments [substitutes for sections 3201
& 3203 of PPACA]. …………………………………………………………………………… 934
Sec. 1103. Savings from limits on MA plan administrative costs. ………….. 939
Sec. 1104. Disproportionate share hospital (DSH) payments [amendment
fully incorporated into PPACA]. ………………………………………………………… 940
Sec. 1105. Market basket updates [amendments fully incorporated into
PPACA]. ………………………………………………………………………………………….. 940
Sec. 1106. Physician ownership-referral [amendments fully incorporated
into PPACA]. ……………………………………………………………………………………. 940
Sec. 1107. Payment for imaging services [amendments fully incorporated
into PPACA]. ……………………………………………………………………………………. 941
Sec. 1108. PE GPCI adjustment for 2010 [amendment fully incorporated
into PPACA]. ……………………………………………………………………………………. 941
Sec. 1109. Payment for qualifying hospitals. ………………………………………… 941
Subtitle C—Medicaid
Sec. 1201. Federal funding for States [amendments fully incorporated
into PPACA]. ……………………………………………………………………………………. 931
Sec. 1202. Payments to primary care physicians. …………………………………. 942
Sec. 1203. Disproportionate share hospital payments. ………………………….. 943
Sec. 1204. Funding for the territories. …………………………………………………. 943
Sec. 1205. Delay in Community First Choice option [amendment fully
incorporated into PPACA]. ……………………………………………………………….. 944
Sec. 1206. Drug rebates for new formulations of existing drugs [amendment
fully incorporated into PPACA]. ……………………………………………….. 944
Subtitle D—Reducing Fraud, Waste, and Abuse
Sec. 1301. Community mental health centers. ……………………………………… 944
Sec. 1302. Medicare prepayment medical review limitations. ……………….. 944
