Summary: Patient Protection and Affordable Care Act - Title I: Quality, Affordable Health Care for All Americans - Subtitle A: Immediate Improvements in Health Care Coverage for All Americans - (Sec. 1001, as modified by Sec. 10101) Amends the Public Health Service Act to prohibit a health plan ("health plan under this subtitle excludes any grandfathered health plan as defined in section 1251) from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. Permits a restricted annual limit for plan years beginning prior to January 1, 2014. Declares that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted. Prohibits a health plan from rescinding coverage of an enrollee except in the case of fraud or intentional misrepresentation of material fact. Requires health plans to provide coverage for, and to not impose any cost sharing requirements for: (1) specified preventive items or services; (2) recommended immunizations; and (3) recommended preventive care and screenings for women and children. Requires a health plan that provides dependent coverage of children to make such coverage available for an unmarried, adult child until the child turns 26 years of age. Requires the Secretary of Health and Human Services (HHS) to develop standards for health plans (including grandfathered health plans) to provide an accurate summary of benefits and coverage explanation. Directs each such health plan, prior to any enrollment restriction, to provide such a summary of benefits and coverage explanation to: (1) the applicant at the time of application; (2) an enrollee prior to the time of enrollment or re-enrollment; and (3) a policy or certificate holder at the time of issuance of the policy or delivery of the certificate. Requires group health plans to comply with requirements relating to the prohibition against discrimination in favor of highly compensated individuals. Requires the Secretary to develop reporting requirements for health plans on benefits or reimbursement structures that: (1) improve health outcomes; (2) prevent hospital readmissions; (3) improve patient safety and reduce medical errors; and (4) promote wellness and health. Requires a health plan (including a grandfathered health plan) to: (1) submit to the Secretary a report concerning the ratio of the incurred loss (or incurred claims) plus the loss adjustment expense (or change in contract reserves) to earned premiums; and (2) provide an annual rebate to each enrollee if the ratio of the amount of premium revenue expended by the issuer on reimbursement for clinical services provided to enrollees and activities that improve health care quality to the total amount of premium revenue for the plan year is less than a 85% for large group markets or 80% for small group or individual markets. Requires each U.S. hospital to establish and make public a list of its standard charges for items and services. Requires a health plan to implement an effective process for appeals of coverage determinations and claims. Sets forth requirements for health plans related to: (1) designation of a primary care provider; (2) coverage of emergency services; and (3) elimination of referral requirements for obstetrical or gynecological care. (Sec. 1002) Requires the Secretary to award grants to states for offices of health insurance consumer assistance or health insurance ombudsman programs. (Sec. 1003, as modified by Sec. 10101) Requires the Secretary to establish a process for the annual review of unreasonable increases in premiums for health insurance coverage. (Sec. 1004) Makes this subtitle effective for plan years beginning six months after enactment of this Act, with certain exceptions. Subtitle B: Immediate Actions to Preserve and Expand Coverage - (Sec. 1101) Requires the Secretary to establish a temporary high risk health insurance pool program to provide health insurance coverage to eligible individuals with a preexisting condition. Terminates such coverage on January 1, 2014, and provides for a transition to an American Health Benefit Exchange (Exchange). (Sec. 1102, as modified by Sec. 10102) Requires the Secretary to establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for a portion of the cost of providing health insurance coverage to early retirees before January 1, 2014. (Sec. 1103, as modified by Sec. 10102) Requires the Secretary to establish a mechanism, including an Internet website, through which a resident of, or small business in, any state may identify affordable health insurance coverage options in that state. (Sec. 1104) Sets forth provisions governing electronic health care transactions. Establishes penalties for health plans failing to comply with requirements. (Sec. 1105) Makes this subtitle effective on the date of enactment of this Act. Subtitle C: Quality Health Insurance Coverage for All Americans - Part I: Health Insurance Market Reforms - (Sec. 1201, as modified by Sec. 10103) Prohibits a health plan ("health plan under this subtitle excludes any grandfathered health plan as defined in section 1251) from: (1) imposing any preexisting condition exclusion; or (2) discriminating on the basis of any health status-related factor. Allows premium rates to vary only by individual or family coverage, rating area, age, or tobacco use. Requires health plans in a state to: (1) accept every employer and individual in the state that applies for coverage; and (2) renew or continue coverage at the option of the plan sponsor or the individual, as applicable. Prohibits a health plan from establishing individual eligibility rules based on health status-related factors, including medical condition, claims experience, receipt of health care, medical history, genetic information, and evidence of insurability. Sets forth provisions governing wellness programs under the health plan, including allowing cost variances for coverage for participation in such a program. Prohibits a health plan from discriminating with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law. Requires health plans that offer health insurance coverage in the individual or small group market to ensure that such coverage includes the essential health benefits package. Requires a group health plan to ensure that any annual cost-sharing imposed under the plan does not exceed specified limitations. Prohibits a health plan from: (1) applying any waiting period for coverage that exceeds 90 days; or (2) discriminating against individual participation in clinical trials with respect to treatment of cancer or any other life-threatening disease or condition. Part II: Other Provisions - (Sec. 1251, as modified by Sec. 10103) Provides that nothing in this Act shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act. Allows family members of individuals currently enrolled in a plan to enroll in such plan or coverage if such enrollment was permitted under the terms of the plan. Allows new employees and their families to enroll in a group health plan that provides coverage on the date of enactment of this Act. Defines a "grandfathered health plan" as a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act. States that this subtitle and subtitle A shall not apply to: (1) a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act, regardless of whether the individual renews such coverage after such date of enactment; (2) an existing group health plan that enrolls new employees under this section; and (3) health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before the date of enactment of this Act until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Applies provisions related to uniform coverage documents and medical loss ratios to grandfathered health plans for plan years beginning after enactment of this Act. (Sec. 1252) Requires uniform application of standards or requirements adopted by states to all health plans in each applicable insurance market. (Sec. 1253, as added by Sec. 10103) Directs the Secretary of Labor to prepare an annual report on self-insured group health plans and self-insured employers. (Sec. 1254, as added by Sec. 10103) Requires the HHS Secretary to conduct a study of the fully-insured and self-insured group health plan markets related to financial solvency and the effect of insurance market reforms. (Sec. 1255, as modified by Sec. 10103) Sets forth effective dates for specified provisions of this subtitle. Subtitle D: Available Coverage Choices for All Americans - Part I: Establishment of Qualified Health Plans - (Sec. 1301, as modified by Sec. 10104) Defines "qualified health plan" to require that such a plan provides essential health benefits and offers at least one plan in the silver level at one plan in the gold level in each Exchange through which such plan is offered. (Sec. 1302, as modified by Sec. 10104) Requires the essential health benefits package to provide essential health benefits and limit cost-sharing. Directs the Secretary to: (1) define essential health benefits and include emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care; (2) ensure that the scope of the essential health benefits is equal to the scope of benefits provided under a typical employer plan; and (3) provide notice and an opportunity for public comment in defining the essential health benefits. Establishes: (1) an annual limit on cost-sharing beginning in 2014; and (2) a limitation on the deductible under a small group market health plan. Sets forth levels of coverage for health plans defined by a certain percentage of the costs paid by the plan. Allows health plans in the individual market to offer catastrophic coverage for individuals under age 30, with certain limitations. (Sec. 1303, as modified by Sec. 10104) Sets forth special rules for abortion coverage, including: (1) permitting states to elect to prohibit abortion coverage in qualified health plans offered through an Exchange in the state; (2) prohibiting federal funds from being used for abortion services; and (3) requiring separate accounts for payments for such services. Prohibits any qualified health plan offered through an Exchange from discriminating against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions. (Sec. 1304, as modified by Sec. 10104) Sets forth definitions for terms used in this title. Part II: Consumer Choices and Insurance Competition Through Health Benefit Exchanges - (Sec. 1311, as modified by Sec. 10104) Requires states to establish an American Health Benefit Exchange that: (1) facilitates the purchase of qualified health plans; and (2) provides for the establishment of a Small Business Health Options Program (SHOP Exchange) that is designed to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the state. Requires the Secretary to establish criteria for the certification of health plans as qualified health plans, including requirements for: (1) meeting market requirements; and (2) ensuring a sufficient choice of providers. Sets forth the requirements for an Exchange, including that an Exchange: (1) must be a governmental agency or nonprofit entity that is established by a state; (2) may not make available any health plan that is not a qualified health plan; (3) must implement procedures for certification of health plans as qualified health plans; and (4) must require health plans seeking certification to submit a justification of any premium increase prior to implementation of such increase. Permits states to require qualified health plans to offer additional benefits. Requires states to pay for the cost of such additional benefits. Allows a state to establish one or more subsidiary Exchanges for geographically distinct areas of a certain size. Applies mental health parity provisions to qualified health plans. (Sec. 1312, as modified by Sec. 10104) Allows an employer to select a level of coverage to be made available to employees through an Exchange. Allows employees to choose to enroll in any qualified health plan that offers that level of coverage. Restricts the health plans that the federal government may make available to Members of Congress and congressional staff after the effective date of this subtitle to only those health plans that are created under this Act or offered through an Exchange. Permits states to allow large employers to join an Exchange after 2017. (Sec. 1313, as modified by Sec. 10104) Requires an Exchange to keep an accurate accounting of all activities, receipts, and expenditures and to submit to the Secretary, annually, a report concerning such accountings. Requires the Secretary to take certain action to reduce fraud and abuse in the administration of this title. Requires the Comptroller General to conduct an ongoing study of Exchange activities and the enrollees in qualified health plans offered through Exchanges. Part III: State Flexibility Relating to Exchanges - (Sec. 1321) Requires the Secretary to issue regulations setting standards related to: (1) the establishment and operation of Exchanges; (2) the offering of qualified health plans through Exchanges; and (3) the establishment of the reinsurance and risk adjustment programs under part V. Requires the Secretary to: (1) establish and operate an Exchange within a state if the state does not have one operational by January 1, 2014; and (2) presume that an Exchange operating in a state before January 1, 2010, that insures a specified percentage of its population meets the standards under this section. (Sec. 1322, as modified by Sec. 10104) Requires the Secretary to establish the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of qualified nonprofit health insurance issuers to offer qualified health plans in the individual and small group markets. Requires the Secretary to provide for loans and grants to persons applying to become qualified nonprofit health insurance issuers. Sets forth provisions governing the establishment and operation of CO-OP program plans. (Sec. 1323, deleted by Sec. 10104) (Sec. 1324, as modified by Sec. 10104) Declares that health insurance coverage offered by a private health insurance issuer shall not be subject to federal or state laws if a qualified health plan offered under the CO-OP program is not subject to such law. Part IV: State Flexibility to Establish Alternative Programs - (Sec. 1331, as modified by Sec. 10104) Requires the Secretary to establish a basic health program under which a state may enter into contracts to offer one or more standard health plans providing at least the essential health benefits to eligible individuals in lieu of offering such individuals coverage through an Exchange. Sets forth requirements for such a plan. Transfers funds that would have gone to the Exchange for such individuals to the state. (Sec. 1332) Authorizes a state to apply to the Secretary for the waiver of specified requirements under this Act with respect to health insurance coverage within that state for plan years beginning on or after January 1, 2017. Directs the Secretary to provide for an alternative means by which the aggregate amounts of credits or reductions that would have been paid on behalf of participants in the Exchange will be paid to the state for purposes of implementing the state plan. (Sec. 1333, as modified by Sec. 10104) Requires the Secretary to issue regulations for the creation of health care choice compacts under which two or more states may enter into an agreement that: (1) qualified health plans could be offered in the individual markets in all such states only subject to the laws and regulations of the state in which the plan was written or issued; and (2) the issuer of any qualified health plan to which the compact applies would continue to be subject to certain laws of the state in which the purchaser resides, would be required to be licensed in each state, and must clearly notify consumers that the policy may not be subject to all the laws and regulations of the state in which the purchaser resides. Sets forth provisions regarding the Secretary's approval of such compacts. (Sec. 1334, as added by Sec. 10104) Requires the Director of the Office of Personnel Management (OPM) to: (1) enter into contracts with health insurance issuers to offer at least two multistate qualified health plans through each Exchange in each state to provide individual or group coverage; and (2) implement this subsection in a manner similar to the manner in which the Director implements the Federal Employees Health Benefits Program. Sets forth requirements for a multistate qualified health plan. Part V: Reinsurance and Risk Adjustment - (Sec. 1341, as modified by Sec. 10104) Directs each state, not later than January 1, 2014, to establish one or more reinsurance entities to carry out the reinsurance program under this section. Requires the Secretary to establish standards to enable states to establish and maintain a reinsurance program under which: (1) health insurance issuers and third party administrators on behalf of group health plans are required to make payments to an applicable reinsurance entity for specified plan years; and (2) the applicable reinsurance entity uses amounts collected to make reinsurance payments to health insurance issuers that cover high risk individuals in the individual market. Directs the state to eliminate or modify any state high-risk pool to the extent necessary to carry out the reinsurance program established under this section. (Sec. 1342) Requires the Secretary to establish and administer a program of risk corridors for calendar years 2014 through 2016 under which a qualified health plan offered in the individual or small group market shall participate in a payment adjusted system based on the ratio of the allowable costs of the plan to the plan's aggregate premiums. Directs the Secretary to make payments when a plan's allowable costs exceed the target amount by a certain percentage and directs a plan to make payments to the Secretary when its allowable costs are less than target amount by a certain percentage. (Sec. 1343) Requires each state to assess a charge on health plans and health insurance issuers if the actuarial risk of the enrollees of such plans or coverage for a year is less than the average actuarial risk of all enrollees in all plans or coverage in the state for the year. Requires each state to provide a payment to health plans and health insurance issuers if the actuarial risk of the enrollees of such plan or coverage for a year is greater than the average actuarial risk of all enrollees in all plans and coverage in the state for the year. Excludes self-insured group health plans from this section. 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, as modified by section 10105) Amends the Internal Revenue Code to allow individual taxpayers whose household income equals or exceeds 100%, but does not exceed 400%, of the federal poverty line (as determined in the Social Security Act [SSA]) a refundable tax credit for a percentage of the cost of premiums for coverage under a qualified health plan. Sets forth formulae and rules for the calculation of credit amounts based upon taxpayer household income as a percentage of the poverty line. Directs the Comptroller General, not later than five years after enactment of this Act, to conduct a study and report to specified congressional committees on the affordability of health insurance coverage. (Sec. 1402) Requires reductions in the maximum limits for out-of-pocket expenses for individuals enrolled in qualified health plans whose incomes are between 100% and 400% of the poverty line. Subpart B: Eligibility Determinations - (Sec. 1411) - Requires the Secretary to establish a program for verifying the eligibility of applicants for participation in a qualified health plan offered through an Exchange or for a tax credit for premium assistance based upon their income or their citizenship or immigration status. Requires an Exchange to submit information received from an applicant to the Secretary for verification of applicant eligibility. Provides for confidentiality of applicant information and for an appeals and redetermination process for denials of eligibility. Imposes civil penalties on applicants for providing false or fraudulent information relating to eligibility. Requires the Secretary to study and report to Congress by January 1, 2013, on procedures necessary to ensure the protection of privacy and due process rights in making eligibility and other determinations under this Act. (Sec. 1412) Requires the Secretary to establish a program for advance payments of the tax credit for premium assistance and for reductions of cost-sharing. Prohibits any federal payments, tax credit, or cost-sharing reductions for individuals who are not lawfully present in the United States. (Sec. 1413) Requires the Secretary to establish a system to enroll state residents who apply to an Exchange in state health subsidy programs, including Medicaid or the Children's Health Insurance Program (CHIP, formerly known as SCHIP), if such residents are found to be eligible for such programs after screening. (Sec. 1414) Requires the Secretary of the Treasury to disclose to HHS personnel certain taxpayer information to determine eligibility for programs under this Act or certain other social security programs. (Sec. 1415) Disregards the premium assistance tax credit and cost-sharing reductions in determining eligibility for federal and federally-assisted programs. (Sec. 1416, as added by section 10105) Directs the HHS Secretary to study and report to Congress by January 1, 2013, on the feasibility and implication of adjusting the application of the federal poverty level under this subtitle for different geographic areas in the United States, including its territories. Part II: Small Business Tax Credit - (Sec. 1421, as modified by section 10105) Allows qualified small employers to elect, beginning in 2010, a tax credit for 50% of their employee health care coverage expenses. Defines "qualified small employer" as an employer who has no more than 25 employees with average annual compensation levels not exceeding $50,000. Requires a phase-out of such credit based on employer size and employee compensation. Subtitle F: Shared Responsibility for Health Care - Part I: Individual Responsibility - (Sec. 1501, as modified by section 10106) Requires individuals to maintain minimal essential health care coverage beginning in 2014. Imposes a penalty for failure to maintain such coverage beginning in 2014, except for certain low-income individuals who cannot afford coverage, members of Indian tribes, and individuals who suffer hardship. Exempts from the coverage requirement individuals who object to health care coverage on religious grounds, individuals not lawfully present in the United States, and individuals who are incarcerated. (Sec. 1502) Requires providers of minimum essential coverage to file informational returns providing identifying information of covered individuals and the dates of coverage. Requires the IRS to send a notice to taxpayers who are not enrolled in minimum essential coverage about services available through the Exchange operating in their state. Part II: Employer Responsibilities - (Sec. 1511) Amends the Fair Labor Standards Act of 1938 to: (1) require employers with more than 200 full-time employees to automatically enroll new employees in a health care plan and provide notice of the opportunity to opt-out of such coverage; and (2) provide notice to employees about an Exchange, the availability of a tax credit for premium assistance, and the loss of an employer's contribution to an employer-provided health benefit plan if the employee purchases a plan through an Exchange. (Sec. 1513, as modified by section 10106) Imposes fines on large employers (employers with more than 50 full-time employees) who fail to offer their full-time employees the opportunity to enroll in minimum essential coverage or who have a waiting period for enrollment of more than 60 days. Requires the Secretary of Labor to study and report to Congress on whether employees' wages are reduced due to fines imposed on employers. (Sec. 1514, as modified by section 10106) Requires large employers to file a report with the Secretary of the Treasury on health insurance coverage provided to their full-time employees. Requires such reports to contain: (1) a certification as to whether such employers provide their full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan; (2) the length of any waiting period for such coverage; (3) the months during which such coverage was available; (4) the monthly premium for the lowest cost option in each of the enrollment categories under the plan; (5) the employer's share of the total allowed costs of benefits provided under the plan; and (6) identifying information about the employer and full-time employees. Imposes a penalty on employers who fail to provide such report. Authorizes the Secretary of the Treasury to review the accuracy of information provided by large employers. (Sec. 1515) Allows certain small employers to include as a benefit in a tax-exempt cafeteria plan a qualified health plan offered through an Exchange. Subtitle G: Miscellaneous Provisions - (Sec. 1551) Applies the definitions under the Public Health Service Act related to health insurance coverage to this title. (Sec. 1552) Requires the HHS Secretary to publish on the HHS website a list of all of the authorities provided to the Secretary under this Act. (Sec. 1553) Prohibits the federal government, any state or local government or health care provider that receives federal financial assistance under this Act, or any health plan created under this Act from discriminating against an individual or institutional health care entity on the basis that such individual or entity does not provide a health care item or service furnished for the purpose of causing, or assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing. (Sec. 1554) Prohibits the Secretary from promulgating any regulation that: (1) creates an unreasonable barrier to the ability of individuals to obtain appropriate medical care; (2) impedes timely access to health care services; (3) interferes with communications regarding a full range of treatment options between the patient and the health care provider; (4) restricts the ability of health care providers to provide full disclosure of all relevant information to patients making health care decisions; (5) violates the principle of informed consent and the ethical standards of health care professionals; or (6) limits the availability of health care treatment for the full duration of a patient's medical needs. (Sec. 1555) Declares that no individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any federal health insurance program created by or expanded under this Act. Prohibits any penalty from being imposed upon any such issuer for choosing not to participate in any such program. (Sec. 1556) Amends the Black Lung Benefits Act, with respect to claims filed on or after the effective date of the Black Lung Benefits Amendments of 1981, to eliminate exceptions to: (1) the applicability of certain provisions regarding rebuttable presumptions; and (2) the prohibition against requiring eligible survivors of a miner determined to be eligible for black lung benefits to file a new claim or to refile or otherwise revalidate the miner's claim. (Sec. 1557) Prohibits discrimination by any federal health program or activity on the grounds of race, color, national origin, sex, age, or disability. (Sec. 1558) Amends the Fair Labor Standards Act of 1938 to prohibit an employer from discharging or discriminating against any employee because the employee: (1) has received a health insurance credit or subsidy; (2) provides information relating to any violation of any provision of such Act; or (3) objects to, or refuses to participate in, any activity, policy, practice, or assigned task that the employee reasonably believed to be in violation of such Act. (Sec. 1559) Gives the HHS Inspector General oversight authority with respect to the administration and implementation of this title. (Sec. 1560) Declares that nothing in this title shall be construed to modify, impair, or supersede the operation of any antitrust laws. (Sec. 1561) Amends the Public Health Service Act to require the Secretary to: (1) develop interoperable and secure standards and protocols that facilitate enrollment of individuals in federal and state health and human services programs; and (2) award grants to develop and adapt technology systems to implement such standards and protocols. (Sec. 1562, as added by Sec. 10107) Directs the Comptroller General to study denials by health plans of coverage for medical services and of applications to enroll in health insurance. (Sec. 1563, as added by Sec. 10107) Disallows the waiver of laws or regulations establishing procurement requirements relating to small business concerns with respect to any contract awarded under any program or other authority under this Act. (Sec. 1563 [sic], as modified by Sec. 10107) Makes technical and conforming amendments. (Sec. 1563 [sic]) Expresses the sense of the Senate that: (1) the additional surplus in the Social Security trust fund generated by this Act should be reserved for Social Security; and (2) the net savings generated by the CLASS program (established under Title VIII of this Act) should be reserved for such program. Title II: Role of Public Programs - Subtitle A: Improved Access to Medicaid - (Sec. 2001, as modified by Sec. 10201) Amends title XIX (Medicaid) of the SSA to extend Medicaid coverage, beginning in calendar 2014, to individuals under age 65 who are not entitled to or enrolled in Medicare and have incomes at or below 133% of the federal poverty line. Grants a state the option to expand Medicaid eligibility to such individuals as early as April 1, 2010. Provides that, for between 2014 and 2016, the federal government will pay 100% of the cost of covering newly-eligible individuals. Increases the federal medical assistance percentage (FMAP): (1) with respect to newly eligible individuals; and (2) between January 1, 2014, and December 31, 2016, for states meeting certain eligibility requirements. Requires Medicaid benchmark benefits to include coverage of prescription drugs and mental health services. Grants states the option to extend Medicaid coverage to individuals who have incomes that exceed 133% of the federal poverty line beginning January 1, 2014. (Sec. 2002) Requires a state to use an individual's or household's modified gross income to determine income eligibility for Medicaid for non-elderly individuals, without applying any income or expense disregards or assets or resources test. Exempts from this requirement: (1) individuals eligible for Medicaid through another program; (2) the elderly or Social Security Disability Insurance (SSDI) program beneficiaries; (3) the medically needy; (4) enrollees in a Medicare Savings Program; and (5) the disabled. (Sec. 2003) Revises state authority to offer a premium assistance subsidy for qualified employer-sponsored coverage to children under age 19 to extend such a subsidy to all individuals, regardless of age. Prohibits a state from requiring, as a condition of Medicaid eligibility, that an individual (or the individual's parent) apply for enrollment in qualified employer-sponsored coverage. (Sec. 2004, as modified by Sec. 10201) Extends Medicaid coverage to former foster care children who are under 26 years of age. (Sec. 2005, as modified by Sec. 10201) Revises requirements for Medicaid payments to territories, including an increase in the limits on payments for FY2011 and thereafter. (Sec. 2006, as modified by Sec. 10201) Prescribes an adjustment to the FMAP determination for certain states recovering from a major disaster. (Sec. 2007) Rescinds any unobligated amounts available to the Medicaid Improvement Fund for FY2014-FY2018. Subtitle B: Enhanced Support for the Children's Health Insurance Program - (Sec. 2101, as modified by Sec. 10201) Amends SSA title XXI (State Children's Health Insurance Program) (CHIP, formerly known as SCHIP) to increase the FY2016-FY2019 enhanced FMAP for states, subject to a 100% cap. Prohibits states from applying, before the end of FY2019, CHIP eligibility standards that are more restrictive than those under this Act. Deems ineligible for CHIP any targeted low-income children who cannot enroll in CHIP because allotments are capped, but who are therefore eligible for tax credits in the Exchanges. Requires the Secretary to: (1) review benefits offered for children, and related cost-sharing imposed, by qualified health plans offered through an Exchange; and (2) certify those plans whose benefits and cost-sharing are at least comparable to those provided under the particular state's CHIP plan. Prohibits enrollment bonus payments for children enrolled in CHIP after FY2013. Requires a state CHIP plan, beginning January 1, 2014, to use modified gross income and household income to determine CHIP eligibility. Requires a state to treat as a targeted low-income child eligible for CHIP any child determined ineligible for Medicaid as a result of the elimination of an income disregard based on expense or type of income. (Sec. 2102) Makes technical corrections to the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Subtitle C: Medicaid and CHIP Enrollment Simplification - (Sec. 2201) Amends SSA title XIX (Medicaid) to require enrollment application simplification and coordination with state health insurance Exchanges and CHIP via state-run websites. (Sec. 2202) Permits hospitals to provide Medicaid services during a period of presumptive eligibility to members of all Medicaid eligibility categories. Subtitle D: Improvements to Medicaid Services - (Sec. 2301) Requires Medicaid coverage of: (1) freestanding birth center services; and (2) concurrent care for children receiving hospice care. (Sec. 2303) Gives states the option of extending Medicaid coverage to family planning services and supplies under a presumptive eligibility period for a categorically needy group of individuals. Subtitle E: New Options for States to Provide Long-Term Services and Supports - (Sec. 2401) Authorizes states to offer home and community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases. (Sec. 2402) Gives states the option of: (1) providing home and community-based services to individuals eligible for services under a waiver; and (2) offering home and community-based services to specific, targeted populations Creates an optional eligibility category to provide full Medicaid benefits to individuals receiving home and community-based services under a state plan amendment. (Sec. 2403) Amends the Deficit Reduction Act of 2005 to: (1) extend through FY2016 the Money Follows the Person Rebalancing Demonstration; and (2) reduce to 90 days the institutional residency period. (Sec. 2404) Applies Medicaid eligibility criteria to recipients of home and community-based services, during calendar 2014 through 2019, in such a way as to protect against spousal impoverishment. (Sec. 2405) Makes appropriations for FY2010-FY2014 to the Secretary, acting through the Assistant Secretary for Aging, to expand state aging and disability resource centers. (Sec. 2406) Expresses the sense of the Senate that: (1) during the 111th session of Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need; and (2) long-term services and supports should be made available in the community in addition to institutions. Subtitle F: Medicaid Prescription Drug Coverage - (Sec. 2501) Amends SSA title XIX (Medicaid) to: (1) increase the minimum rebate percentage for single source drugs and innovator multiple source drugs; (2) increase the rebate for other drugs; (3) require contracts with Medicaid managed care organizations to extend prescription drug rebates (discounts) to their enrollees; (4) provide an additional rebate for new formulations of existing drugs; and (5) set a maximum rebate amount. (Sec. 2502) Eliminates the exclusion from Medicaid coverage of, thereby extending coverage to, certain drugs used to promote smoking cessation, as well as barbiturates and benzodiazepines. (Sec. 2503) Revises requirements with respect to pharmacy reimbursements. Subtitle G: Medicaid Disproportionate Share Hospital (DSH) Payments - (Sec. 2551, as modified by Sec. 10201) Reduces state disproportionate share hospital (DSH) allotments, except for Hawaii, by 50% or 35% once a state's uninsurance rate decreases by 45%, depending on whether they have spent at least or more than 99.9% of their allotments on average during FY2004-FY2008. Requires a reduction of only 25% or 17.5% for low DSH states, depending on whether they have spent at least or more than 99.9% of their allotments on average during FY2004-FY2008. Prescribes allotment reduction requirements for subsequent fiscal years. Revises DSH allotments for Hawaii for the last three quarters of FY2012 and for FY2013 and succeeding fiscal years. Subtitle H: Improved Coordination for Dual Eligible Beneficiaries - (Sec. 2601) Declares that any Medicaid waiver for individuals dually eligible for both Medicaid and Medicare may be conducted for a period of five years, with a five-year extension, upon state request, unless the Secretary determines otherwise for specified reasons. (Sec. 2602) Directs the Secretary to establish a Federal Coordinated Health Care Office to bring together officers and employees of the Medicare and Medicaid programs at the Centers for Medicare and Medicaid Services (CMS) to: (1) integrate Medicaid and Medicare benefits more effectively; and (2) improve the coordination between the federal government and states for dual eligible individuals to ensure that they get full access to the items and services to which they are entitled. Subtitle I: Improving the Quality of Medicaid for Patients and Providers - (Sec. 2701) Amends SSA title XI, as modified by CHIPRA, to direct the Secretary to: (1) identify and publish a recommended core set of adult health quality measures for Medicaid eligible adults; and (2) establish a Medicaid Quality Measurement Program. (Sec. 2702) Requires the Secretary to identify current state practices that prohibit payment for health care-acquired conditions and to incorporate them, or elements of them, which are appropriate for application in regulations to the Medicaid program. Requires such regulations to prohibit payments to states for any amounts expended for providing medical assistance for specified health care-acquired conditions. (Sec. 2703) Gives states the option to provide coordinated care through a health home for individuals with chronic conditions. Authorizes the Secretary to award planning grants to states to develop a state plan amendment to that effect. (Sec. 2704) Directs the Secretary to establish a demonstration project to evaluate the use of bundled payments for the provision of integrated care for a Medicaid beneficiary: (1) with respect to an episode of care that includes a hospitalization; and (2) for concurrent physicians services provided during a hospitalization. (Sec. 2705) Requires the Secretary to establish a Medicaid Global Payment System Demonstration Project under which a participating state shall adjust payments made to an eligible safety net hospital or network from a fee-for-service payment structure to a global capitated payment model. Authorizes appropriations. (Sec. 2706) Directs the Secretary to establish the Pediatric Accountable Care Organization Demonstration Project to authorize a participating state to allow pediatric medical providers meeting specified requirements to be recognized as an accountable care organization for the purpose of receiving specified incentive payments. Authorizes appropriations. (Sec. 2707) Requires the Secretary to establish a three-year Medicaid emergency psychiatric demonstration project. Makes appropriations for FY2011. Subtitle J: Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC) - (Sec. 2801) Revises requirements with respect to the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MEDPAC), including those for MACPAC membership, topics to be reviewed, and MEDPAC review of Medicaid trends in spending, utilization, and financial performance. Requires MACPAC and MEDPAC to consult with one another on related issues. Makes appropriations to MACPAC for FY2010. Subtitle K: Protections for American Indians and Alaska Natives - (Sec. 2901) Sets forth special rules relating to Indians. Declares that health programs operated by the Indian Health Service (IHS), Indian tribes, tribal organizations, and Urban Indian organizations shall be the payer of last resort for services they provide to eligible individuals. Makes such organizations Express Lane agencies for determining Medicaid and CHIP eligibility. (Sec. 2902) Makes permanent the requirement that the Secretary reimburse certain Indian hospitals and clinics for all Medicare part B services. Subtitle L: Maternal and Child Health Services - (Sec. 2951) Amends SSA title V (Maternal and Child Health Services) to direct the Secretary to make grants to eligible entities for early childhood home visitation programs. Makes appropriations for FY2010-FY2014. (Sec. 2952) Encourages the Secretary to continue activities on postpartum depression or postpartum psychosis, including research to expand the understanding of their causes and treatment. Authorizes the Secretary to make grants to eligible entities for projects to establish, operate, and coordinate effective and cost-efficient systems for the delivery of essential services to individuals with or at risk for postpartum conditions and their families. Authorizes appropriations for FY2010-FY2012. (Sec. 2953, as modified by Sec. 10201) Directs the Secretary to allot funds to states to award grants to local organizations and other specified entities to carry out personal responsibility education programs to educate adolescents on both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections, as well as on certain adulthood preparation subjects. Makes appropriations for FY2010-FY2014. (Sec. 2954) Makes appropriations for FY2010-FY2014 for abstinence education. (Sec. 2955) Requires the case review system for children aging out of foster care and independent living programs to include information about the importance of having a health care power of attorney in transition planning. Title III: Improving the Quality and Efficiency of Health Care - Subtitle A: Transforming the Health Care Delivery System - Part I: Linking Payment to Quality Outcomes under the Medicare Program - (Sec. 3001) Amends SSA title XVIII (Medicare) to direct the Secretary to establish a hospital value-based purchasing program under which value-based incentive payments are made in a fiscal year to hospitals that meet specified performance standards for a certain performance period. Directs the Secretary to establish value-based purchasing demonstration programs for: (1) inpatient critical access hospital services; and (2) hospitals excluded from the program because of insufficient numbers of measures and cases. (Sec. 3002) Extends through 2013 the authority for incentive payments under the physician quality reporting system. Prescribes an incentive (penalty) for providers who do not report quality measures satisfactorily, beginning in 2015. Requires the Secretary to integrate reporting on quality measures with reporting requirements for the meaningful use of electronic health records. (Sec. 3003) Requires specified new types of reports and data analysis under the physician feedback program. (Sec. 3004) Requires long-term care hospitals, inpatient rehabilitation hospitals, and hospices, starting in rate year 2014, to submit data on specified quality measures. Requires reduction of the annual update of entities which do not comply. (Sec. 3005) Directs the Secretary, starting FY2014, to establish quality reporting programs for inpatient cancer hospitals exempt from the prospective payment system. (Sec. 3006, as modified by Sec. 10301) Directs the Secretary to develop a plan to implement value-based purchasing programs for Medicare payments for skilled nursing facilities (SNFs), home health agencies, and ambulatory surgical centers. (Sec. 3007) Directs the Secretary to establish a value-based payment modifier, under the physician fee schedule, based upon the quality of care furnished compared to cost. (Sec. 3008) Subjects hospitals to a penalty adjustment to hospital payments for high rates of hospital acquired conditions. Part II: National Strategy to Improve Health Care Quality - (Sec. 3011, as modified by Sec. 10302) Amends the Public Health Service Act to direct the Secretary, through a transparent collaborative process, to establish a National Strategy for Quality Improvement in health care services, patient health outcomes, and population health, taking into consideration certain limitations on the use of comparative effectiveness data. (Sec. 3012) Directs the President to convene an Interagency Working Group on Health Care Quality. (Sec. 3013, as modified by Sec. 10303) Directs the Secretary, at least triennially, to identify gaps where no quality measures exist as well as existing quality measures that need improvement, updating, or expansion, consistent with the national strategy for use in federal health programs. Directs the Secretary to award grants, contracts, or intergovernmental agreements to eligible entities for purposes of developing, improving, updating, or expanding such quality measures. Requires the Secretary to develop and update periodically provider-level outcome measures for hospitals and physicians, as well as other appropriate providers. (Sec. 3014, as modified by Sec. 10304) Requires the convening of multi-stakeholder groups to provide input into the selection of quality and efficiency measures. (Sec. 3015, as modified by Sec. 10305) Directs the Secretary to: (1) establish an overall strategic framework to carry out the public reporting of performance information; and (2) collect and aggregate consistent data on quality and resource use measures from information systems used to support health care delivery. Authorizes the Secretary to award grants for such purpose. Directs the Secretary to make available to the public, through standardized Internet websites, performance information summarizing data on quality measures. Part III: Encouraging Development of New Patient Care Models - (Sec. 3021, as modified by Sec. 10306) Creates within CMS a Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care furnished to individuals. Makes appropriations for FY2010-FY2019. (Sec. 3022, as modified by Sec. 10307) Directs the Secretary to establish a shared savings program that: (1) promotes accountability for a patient population; (2) coordinates items and services under Medicare parts A and B; and (3) encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery. (Sec. 3023, as modified by Sec. 10308) Directs the Secretary to establish a pilot program for integrated care (involving payment bundling) during an episode of care provided to an applicable beneficiary around a hospitalization in order to improve the coordination, quality, and efficiency of health care services. (Sec. 3024) Directs the Secretary to conduct a demonstration program to test a payment incentive and service delivery model that utilizes physician and nurse practitioner directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services to applicable beneficiaries. (Sec. 3025, as modified by Sec. 10309) Requires the Secretary to establish a hospital readmissions reduction program involving certain payment adjustments, effective for discharges on or after October 1, 2012, for certain potentially preventable Medicare inpatient hospital readmissions. Directs the Secretary to make available a program for hospitals with a high severity adjusted readmission rate to improve their readmission rates through the use of patient safety organizations. (Sec. 3026) Directs the Secretary to establish a Community-Based Care Transitions Program which provides funding to eligible entities that furnish improved care transitions services to high-risk Medicare beneficiaries. (Sec. 3027) Amends the Deficit Reduction Act of 2005 to extend certain Gainsharing Demonstration Projects through FY2011. Subtitle B: Improving Medicare for Patients and Providers - Part 1: Ensuring Beneficiary Access to Physician Care and Other Services - (Sec. 3101, deleted by section 10310) (Sec. 3102) Extends through calendar 2010 the floor on geographic indexing adjustments to the work portion of the physician fee schedule. Revises requirements for calculation of the practice expense portion of the geographic adjustment factor applied in a fee schedule area for services furnished in 2010 or 2011. Directs the Secretary to analyze current methods of establishing practice expense geographic adjustments and make appropriate further adjustments (a new methodology) to such adjustments for 2010 and subsequent years. (Sec. 3103) Extends the process allowing exceptions to limitations on medically necessary therapy caps through December 31, 2010. (Sec. 3104) Amends the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 to extend until January 1, 2010, an exception to a payment rule that permits laboratories to receive direct Medicare reimbursement when providing the technical component of certain physician pathology services that had been outsourced by certain (rural) hospitals. (Sec. 3105, as modified by Sec. 10311) Amends SSA title XVIII (Medicare) to extend the bonus and increased payments for ground ambulance services until January 1, 2011. Amends the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) to extend the payment of certain urban air ambulance services until January 1, 2011. (Sec. 3106, as modified by Sec. 10312) Amends the Medicare, Medicaid, and SCHIP Extension Act of 2007, as modified by the American Recovery and Reinvestment Act, to extend for two years: (1) certain payment rules for long-term care hospital services; and (2) a certain moratorium on the establishment of certain hospitals and facilities. (Sec. 3107) Amends MIPPA to extend the physician fee schedule mental health add-on payment provision through December 31, 2010. (Sec. 3108) Allows a physician assistant who does not have an employment relationship with a SNF, but who is working in collaboration with a physician, to certify the need for post-hospital extended care services for Medicare payment purposes. (Sec. 3109) Amends title XVIII, as modified by MIPPA, to exempt certain pharmacies from accreditation requirements until the Secretary develops pharmacy-specific standards. (Sec. 3110) Creates a special part B enrollment period for military retirees, their spouses (including widows/ widowers), and dependent children, who are otherwise eligible for TRICARE (the health care plan under the Department of Defense [DOD]) and entitled to Medicare part A (Hospital Insurance) based on disability or end stage renal disease, but who have declined Medicare part B (Supplementary Medical Insurance). (Sec. 3111) Sets payments for dual-energy x-ray absorptiometry services in 2010 and 2011 at 70% of the 2006 reimbursement rates. Directs the Secretary to arrange with the Institute of Medicine of the National Academies to study and report to the Secretary and Congress on the ramifications of Medicare reimbursement reductions for such services on beneficiary access to bone mass measurement benefits. (Sec. 3112) Eliminates funding in the Medicare Improvement Fund FY2014. (Sec. 3113) Directs the Secretary to conduct a demonstration project under Medicare part B of separate payments for complex diagnostic laboratory tests provided to individuals. (Sec. 3114) Increases from 65% to 100% of the fee schedule amount provided for the same service performed by a physician the fee schedule for certified-midwife services provided on or after January 1, 2011. Part II: Rural Protections - (Sec. 3121) Extends through 2010 hold harmless provisions under the prospective payment system for hospital outpatient department services. Removes the 100-bed limitation for sole community hospitals so all such hospitals receive an 85% increase in the payment difference in 2010. (Sec. 3122) Amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as modified by other federal law, to extend from July 1, 2010, until July 1, 2011, the reasonable cost reimbursement for clinical diagnostic laboratory service for qualifying rural hospitals with under 50 beds. (Sec. 3123, as modified by Sec. 10313) Extends the Rural Community Hospital Demonstration Program for five additional years. Expands the maximum number of participating hospitals to 30, and to 20 the number of demonstration states with low population densities. (Sec. 3124) Extends the Medicare-dependent Hospital Program through FY2012. (Sec. 3125, as modified by Sec. 10314) Modifies the Medicare inpatient hospital payment adjustment for low-volume hospitals for FY2011-FY2012. (Sec. 3126) Revises requirements for the Demonstration Project on Community Health Integration Models in Certain Rural Counties to allow additional counties as well as physicians to participate. (Sec. 3127) Directs MEDPAC to study and report to Congress on the adequacy of payments for items and services furnished by service providers and suppliers in rural areas under the Medicare program. (Sec. 3128) Allows a critical access hospital to continue to be eligible to receive 101% of reasonable costs for providing: (1) outpatient care regardless of the eligible billing method such hospital uses; and (2) qualifying ambulance services. (Sec. 3129) Extends through FY2012 FLEX grants under the Medicare Rural Hospital Flexibility Program. Allows the use of grant funding to assist small rural hospitals to participate in delivery system reforms. Part III: Improving Payment Accuracy - (Sec. 3131, as modified by Sec. 10315) Requires the Secretary, starting in 2014, to rebase home health payments by an appropriate percentage, among other things, to reflect the number, mix, and level of intensity of home health services in an episode, and the average cost of providing care. Directs the Secretary to study and report to Congress on home health agency costs involved with providing ongoing access to care to low-income Medicare beneficiaries or beneficiaries in medically underserved areas, and in treating beneficiaries with varying levels of severity of illness. Authorizes a Medicare demonstration project based on the study results. (Sec. 3132) Requires the Secretary, by January 1, 2011, to begin collecting additional data and information needed to revise payments for hospice care. Directs the Secretary, not earlier than October 1, 2013, to implement, by regulation, budget neutral revisions to the methodology for determining hospice payments for routine home care and other services, which may include per diem payments reflecting changes in resource intensity in providing such care and services during the course of an entire episode of hospice care. Requires the Secretary to impose new requirements on hospice providers participating in Medicare, including requirements for: (1) a hospice physician or nurse practitioner to have a face-to-face encounter with the individual regarding eligibility and recertification; and (2) a medical review of any stays exceeding 180 days, where the number of such cases exceeds a specified percentage of them for all hospice programs. (Sec. 3133, as modified by Sec. 10316) Specifies reductions to Medicare DSH payments for FY2015 and ensuing fiscal years, especially to subsection (d) hospitals, to reflect lower uncompensated care costs relative to increases in the number of insured.(Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system when providing covered inpatient services to eligible beneficiaries.) (Sec. 3134) Directs the Secretary periodically to identify physician services as being potentially misvalued and make appropriate adjustments to the relative values of such services under the Medicare physician fee schedule. (Sec. 3135) Increases the presumed utilization rate for calculating the payment for advanced imaging equipment other than low-tech imaging such as ultrasound, x-rays and EKGs. Increases the technical component payment "discount" for sequential imaging services on contiguous body parts during the same visit. (Sec. 3136) Restricts the lump-sum payment option for new or replacement chairs to the complex, rehabilitative power-driven wheelchairs only. Eliminates the lump-sum payment option for all other power-driven wheelchairs. Makes the rental payment for power-driven wheelchairs 15% of the purchase price for each of the first three months (instead of 10%), and 6% of the purchase price for each of the remaining 10 months of the rental period (instead of 7.5%). (Sec. 3137, as modified by Sec. 10317) Amends the Tax Relief and Health Care Act of 2006, as modified by other federal law, to extend "Section 508" hospital reclassifications until September 30, 2010, with a special rule for FY2010. ("Section 508" refers to Section 508 of the Medicare Modernization Act of 2003, which allows the temporary reclassification of a hospital with a low Medicare area wage index, for reimbursement purposes, to a nearby location with a higher Medicare area wage index, so that the "Section 508 hospital" will receive the higher Medicare reimbursement rate.) Directs the Secretary to report to Congress a plan to reform the hospital wage index system. (Sec. 3138) Requires the Secretary to determine if the outpatient costs incurred by inpatient prospective payment system-exempt cancer hospitals, including those for drugs and biologicals, with respect to Medicare ambulatory payment classification groups, exceed those costs incurred by other hospitals reimbursed under the outpatient prospective payment system (OPPS). Requires the Secretary, if this is so, to provide for an appropriate OPPS adjustment to reflect such higher costs for services furnished on or after January 1, 2011. (Sec. 3139) Allows a biosimilar biological product to be reimbursed at 6% of the average sales price of the brand biological product. (Sec. 3140) Directs the Secretary to establish a Medicare Hospice Concurrent Care demonstration program under which Medicare beneficiaries are furnished, during the same period, hospice care and any other Medicare items or services from Medicare funds otherwise paid to such hospice programs. (Sec. 3141) Requires application of the budget neutrality requirement associated with the effect of the imputed rural floor on the area wage index under the Balanced Budget Act of 1997 through a uniform national, instead of state-by-state, adjustment to the area hospital wage index floor. (Sec. 3142) Directs the Secretary to study and report to Congress on the need for an additional payment for urban Medicare-dependent hospitals for inpatient hospital services under Medicare. (Sec. 3143) Declares that nothing in this Act shall result in the reduction of guaranteed home health benefits under the Medicare program. Subtitle C: Provisions Relating to Part C - (Sec. 3201, as modified by Sec. 10318) Bases the MedicareAdvantage (MA) benchmark on the average of the bids from MA plans in each market. Revises the formula for calculating the annual Medicare+Choice capitation rate to reduce the national MA per capita Medicare+Choice growth percentage used to increase benchmarks in 2011. Increases the monthly MA plan rebates from 75% to 100% of the average per capita savings. Requires that bid information which MA plans are required to submit to the Secretary be certified by a member of the American Academy of Actuaries and meet actuarial guidelines and rules established by the Secretary. Directs the Secretary, acting through the CMS Chief Actuary, to establish actuarial guidelines for the submission of bid information and bidding rules that are appropriate to ensure accurate bids and fair competition among MA plans. Directs the Secretary to: (1) establish new MA payment areas for urban areas based on the Core Based Statistical Area; and (2) make monthly care coordination and management performance bonus payments, quality performance bonus payments, and quality bonuses for new and low enrollment MA plans, to MA plans that meet certain criteria. Directs the Secretary to provide transitional rebates for the provision of extra benefits to enrollees. (Sec. 3202) Prohibits MA plans from charging beneficiaries cost sharing for chemotherapy administration services, renal dialysis services, or skilled nursing care that is greater than what is charged under the traditional fee-for-service program. Requires MA plans to apply the full amount of rebates, bonuses, and supplemental premiums according to the following order: (1) reduction of cost sharing, (2) coverage of preventive care and wellness benefits, and (3) other benefits not covered under the original Medicare fee-for-service program. (Sec. 3203) Requires the Secretary to analyze the differences in coding patterns between MA and the original Medicare fee-for-service programs. Authorizes the Secretary to incorporate the results of the analysis into risk scores for 2014 and subsequent years. (Sec. 3204) Allows beneficiaries to disenroll from an MA plan and return to the traditional Medicare fee-for-service program from January 1 to March 15 of each year. Revises requirements for annual beneficiary election periods. (Sec. 3205) Amends SSA title XVIII (Medicare), as modified by MIPPA, to extend special needs plan (SNP) authority through December 31, 2013. Authorizes the Secretary to establish a frailty payment adjustment under PACE payment rules for fully-integrated, dual-eligible SNPs. Extends authority through calendar 2012 for SNPs that do not have contracts with state Medicaid programs to continue to operate, but not to expand their service areas. Directs the Secretary to require an MA organization offering a specialized MA plan for special needs individuals to be approved by the National Committee for Quality Assurance. Requires the Secretary to use a risk score reflecting the known underlying risk profile and chronic health status of similar individuals, instead of the default risk score, for new enrollees in MA plans that are not specialized MA SNPs. (Sec. 3206) Extends through calendar 2012 the length of time reasonable cost plans may continue operating regardless of any other MA plans serving the area. (Sec. 3208) Creates a new type of MA plan called an MA Senior Housing Facility Plan, which would be allowed to limit its service area to a senior housing facility (continuing care retirement community) within a geographic area. (Sec. 3209) Declares that the Secretary is not required to accept any or every bid submitted by an MA plan or Medicare part D prescription drug plan that proposes to increase significantly any beneficiary cost sharing or decrease benefits offered. (Sec. 3210) Directs the Secretary to request the National Association of Insurance Commissioners (NAIC) to develop new standards for certain Medigap plans. Subtitle D: Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans - (Sec. 3301) Amends Medicare part D (Voluntary Prescription Drug Benefit Program) to establish conditions for the availability of coverage for part D drugs. Requires the manufacturer to participate in the Medicare coverage gap discount program. Directs the Secretary to establish such a program. (Sec. 3302) Excludes the MA rebate amounts and quality bonus payments from calculation of the regional low-income subsidy benchmark premium for MA monthly prescription drug beneficiaries. (Sec. 3303) Directs the Secretary to permit a prescription drug plan or an MA-PD plan to waive the monthly beneficiary premium for a subsidy eligible individual if the amount of such premium is de minimis. Provides that, if such premium is waived, the Secretary shall not reassign subsidy eligible individuals enrolled in the plan to other plans based on the fact that the monthly beneficiary premium under the plan was greater than the low-income benchmark premium amount. Authorizes the Secretary to auto-enroll subsidy eligible individuals in plans that waive de minimis premiums. (Sec. 3304) Sets forth a special rule for widows and widowers regarding eligibility for low-income assistance. Allows the surviving spouse of an eligible couple to delay redetermination of eligibility for one year after the death of a spouse. (Sec. 3305) Directs the Secretary, in the case of a subsidy eligible individual enrolled in one prescription drug plan but subsequently reassigned by the Secretary to a new prescription drug plan, to provide the individual with: (1) information on formulary differences between the individual's former plan and the new plan with respect to the individual's drug regimens; and (2) a description of the individual's right to request a coverage determination, exception, or reconsideration, bring an appeal, or resolve a grievance. (Sec. 3306) Amends MIPPA to provide additional funding for FY2010-FY2012 for outreach and education activities related to specified Medicare low-income assistance programs. (Sec. 3307) Authorizes the Secretary to identify classes of clinical concern through rulemaking, including anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants for the treatment of transplant rejection. Requires prescription drug plan sponsors to include all drugs in these classes in their formularies. (Sec. 3308) Requires part D enrollees who exceed certain income thresholds to pay higher premiums. Revises the current authority of the IRS to disclose income information to the Social Security Administration for purposes of adjusting the part B subsidy. (Sec. 3309) Eliminates cost sharing for certain dual eligible individuals receiving care under a home and community-based waiver program who would otherwise require institutional care. (Sec. 3310) Directs the Secretary to require sponsors of prescription drug plans to utilize specific, uniform techniques for dispensing covered part D drugs to enrollees who reside in an long-term care facility in order to reduce waste associated with 30-day refills. (Sec. 3311) Directs the Secretary to develop and maintain an easy to use complaint system to collect and maintain information on MA-PD plan and prescription drug complaints received by the Secretary until the complaint is resolved. (Sec. 3312) Requires a prescription drug plan sponsor to: (1) use a single, uniform exceptions and appeals process for determination of a plan enrollee's prescription drug coverage; and (2) provide instant access to this process through a toll-free telephone number and an Internet website. (Sec. 3313) Requires the HHS Inspector General to study and report to Congress on the inclusion in formularies of: (1) drugs commonly used by dual eligibles; and (2) prescription drug prices under Medicare part D and Medicaid. (Sec. 3314) Allows the costs incurred by AIDS drug assistance programs and by IHS in providing prescription drugs to count toward the annual out-of-pocket threshold. (Sec. 3315) Increases by $500 the 2010 standard initial coverage limit (thus decreasing the time that a part D enrollee would be in the coverage gap). Subtitle E: Ensuring Medicare Sustainability - (Sec. 3401, as modified by Sec. 10319 and Sec. 10322) Revises certain market basket updates and incorporates a full productivity adjustment into any updates that do not already incorporate such adjustments, including inpatient hospitals, home health providers, nursing homes, hospice providers, inpatient psychiatric facilities, long-term care hospitals, inpatient rehabilitation facilities, and Part B providers. Establishes a quality measure reporting program for psychiatric hospitals beginning in FY2014. (Sec. 3402) Revises requirements for reduction of the Medicare part B premium subsidy based on income. Maintains the current 2010 income thresholds for the period of 2011 through 2019. (Sec. 3403, as modified by Sec. 10320) Establishes an Independent Payment Advisory Board to develop and submit detailed proposals to reduce the per capita rate of growth in Medicare spending to the President for Congress to consider. Establishes a consumer advisory council to advise the Board on the impact of payment policies under this title on consumers. Subtitle F: Health Care Quality Improvements - (Sec. 3501) Amends the Public Health Service Act to direct the Center for Quality Improvement and Patient Safety of the Agency for Healthcare Research and Quality (AHRQ) to conduct or support activities for best practices in the delivery of health care services and support research on the development of tools to facilitate adoption of best practices that improve the quality, safety, and efficiency of health care delivery services. Authorizes appropriations for FY2010-FY2014. Requires the AHRQ Director, through the AHRQ Center for Quality Improvement and Patient Safety, to award grants or contracts to eligible entities to provide technical support or to implement models and practices identified in the research conducted by the Center. (Sec. 3502, as modified by Sec. 10321) Directs the Secretary to establish a program to provide grants to or enter into contracts with eligible entities to establish community-based interdisciplinary, interprofessional teams to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. (Sec. 3503) Directs the Secretary, acting through the Patient Safety Research Center, to establish a program to provide grants or contracts to eligible entities to implement medication management services provided by licensed pharmacists, as a collaborative multidisciplinary, inter-professional approach to the treatment of chronic diseases for targeted individuals, to improve the quality of care and reduce overall cost in the treatment of such disease. (Sec. 3504) Directs the Secretary, acting through the Assistant Secretary for Preparedness and Response, to award at least four multiyear contracts or competitive grants to eligible entities to support pilot projects that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems. Requires the Secretary to support federal programs administered by the National Institutes of Health (NIH), the AHRQ, the Health Resources and Services Administration (HRSA), the CMS, and other agencies involved in improving the emergency care system to expand and accelerate research in emergency medical care systems and emergency medicine. Directs the Secretary to support federal programs administered by the such agencies to coordinate and expand research in pediatric emergency medical care systems and pediatric emergency medicine. Authorizes appropriations for FY2010-FY2014. (Sec. 3505) Requires the Secretary to establish three programs to award grants to qualified public, nonprofit IHS, Indian tribal, and urban Indian trauma centers to: (1) assist in defraying substantial uncompensated care costs; (2) further the core missions of such trauma centers, including by addressing costs associated with patient stabilization and transfer; and (3) provide emergency relief to ensure the continued and future availability of trauma services. Authorizes appropriations for FY2010-FY2015. Directs the Secretary to provide funding to states to enable them to award grants to eligible entities for trauma services. Authorizes appropriations for FY2010-FY2015. (Sec. 3506) Directs the Secretary to: (1) establish a program to award grants or contracts to develop, update, and produce patient decision aids to assist health care providers and patients; (2) establish a program to provide for the phased-in development, implementation, and evaluation of shared decision making using patient decision aids to meet the objective of improving the understanding of patients of their medical treatment options; and (3) award grants for establishment and support of Shared Decisionmaking Resource Centers. Authorizes appropriations for FY2010 and subsequent fiscal years. (Sec. 3507) Requires the Secretary, acting through the Commissioner of Food and Drugs, to determine whether the addition of quantitative summaries of the benefits and risks of prescription drugs in a standardized format to the promotional labeling or print advertising of such drugs would improve heath care decisionmaking by clinicians and patients and consumers. (Sec. 3508) Authorizes the Secretary to award grants to eligible entities or consortia to carry out demonstration projects to develop and implement academic curricula that integrate quality improvement and patient safety in the clinical education of health professionals. (Sec. 3509) Establishes an Office on Women's Health within the Office of the Secretary, the Office of the Director of the Centers for Disease Control and Prevention (CDC), the Office of the AHRQ Director, the Office of the Administrator of HRSA, and the Office of the Commissioner of Food and Drugs. Authorizes appropriations for FY2010-FY2014 for all such Offices on Women's Health. (Sec. 3510) Extends from three years to four years the duration of a patient navigator grant. Prohibits the Secretary from awarding such a grant unless the recipient entity provides assurances that patient navigators recruited, assigned, trained, or employed using grant funds meet minimum core proficiencies tailored for the main focus or intervention of the navigator involved. Authorizes appropriations for FY2010-FY2015. (Sec. 3511) Authorizes appropriations to carry out this title, except where otherwise provided in the title. (Sec. 3512, as added by Sec. 10201) Directs the Comptroller General to study and report to Congress on whether the development, recognition, or implementation of any guideline or other standards under specified provisions of this Act would result in the establishment of a new cause of action or claim. Subtitle G: Protecting and Improving Guaranteed Medicare Benefits - (Sec. 3601) Provides that nothing in this Act shall result in a reduction of guaranteed benefits under the Medicare program. States that savings generated for the Medicare program under this Act shall extend the solvency of the Medicare trust funds, reduce Medicare premiums and other cost-sharing for beneficiaries, and improve or expand guaranteed Medicare benefits and protect access to Medicare providers. (Sec. 3602) Declares that nothing in this Act shall result in the reduction or elimination of any benefits guaranteed by law to participants in MA plans. Title IV: Prevention of Chronic Disease and Improving Public Health - Subtitle A: Modernizing Disease Prevention and Public Health Systems - (Sec. 4001, as modified by Sec. 10401) Requires the President to: (1) establish the National Prevention, Health Promotion and Public Health Council; (2) establish the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health; and (3) appoint the Surgeon General as Chairperson of the Council in order to develop a national prevention, health promotion, and public health strategy. Requires the Secretary and the Comptroller General to conduct periodic reviews and evaluations of every federal disease prevention and health promotion initiative, program, and agency. (Sec. 4002, as modified by Sec. 10401) Establishes a Prevention and Public Health Fund to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. Authorizes appropriations and appropriates money to such Fund. (Sec 4003) Requires (currently, allows) the Director of AHRQ to convene the Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community. Requires the Director of CDC to convene an independent Community Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations for individuals and organizations delivering populations-based services and other policy makers (Sec. 4004, as modified by Sec. 10401) Requires the Secretary to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Requires the Secretary, acting through the Director of CDC, to: (1) establish and implement a national science-based media campaign on health promotion and disease prevention; and (2) enter into a contract for the development and operation of a federal website personalized prevention plan tool. Subtitle B: Increasing Access to Clinical Preventive Services - (Sec. 4101, as modified by Sec. 10402) Requires the Secretary to establish a program to award grants to eligible entities to support the operation of school-based health centers. (Sec. 4102) Requires the Secretary, acting through the Director of CDC, to carry out oral health activities, including: (1) establishing a national public education campaign that is focused on oral health care prevention and education; (2) awarding demonstration grants for research-based dental caries disease management activities; (3) awarding grants for the development of school-based dental sealant programs; and (4) entering into cooperative agreements with state, territorial, and Indian tribes or tribal organizations for oral health data collection and interpretation, a delivery system for oral health, and science-based programs to improve oral health. Requires the Secretary to: (1) update and improve the Pregnancy Risk Assessment Monitoring System as it relates to oral health care; (2) develop oral health care components for inclusion in the National Health and Nutrition Examination Survey; and (3) ensure that the Medical Expenditures Panel Survey by AHRQ includes the verification of dental utilization, expenditure, and coverage findings through conduct of a look-back analysis. (Sec. 4103, as modified by Sec. 10402) Amends SSA title XVIII (Medicare) to provide coverage of personalized prevention plan services, including a health risk assessment, for individuals. Prohibits cost-sharing for such services. (Sec. 4104, as modified by Sec. 10406) Eliminates cost-sharing for certain preventive services recommended by the United States Preventive Services Task Force. (Sec. 4105) Authorizes the Secretary to modify Medicare coverage of any preventive service consistent with the recommendations of such Task Force. (Sec. 4106) Amends SSA title XIX (Medicaid) to provide Medicaid coverage of preventive services and approved vaccines. Increases the FMAP for such services and vaccines. (Sec. 4107) Provides for Medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use by pregnant women. (Sec. 4108) Requires the Secretary to award grants to states to carry out initiatives to provide incentives to Medicaid beneficiaries who participate in programs to lower health risk and demonstrate changes in health risk and outcomes. Subtitle C: Creating Healthier Communities - (Sec. 4201, as modified by Sec. 10403) Requires the Secretary, acting through the Director of CDC, to award grants to state and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence base of effective prevention programming. (Sec. 4202) Requires the Secretary, acting through the Director of CDC, to award grants to state or local health departments and Indian tribes to carry out pilot programs to provide public health community interventions, screenings, and clinical referrals for individuals who are between 55 and 64 years of age. Requires the Secretary to: (1) conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries; and (2) evaluate community prevention and wellness programs that have demonstrated potential to help Medicare beneficiaries reduce their risk of disease, disability, and injury by making healthy lifestyle choices. (Sec. 4203) Amends the Rehabilitation Act of 1973 to require the Architectural and Transportation Barriers Compliance Board to promulgate standards setting forth the minimum technical criteria for medical diagnostic equipment used in medical settings to ensure that such equipment is accessible to, and usable by, individuals with accessibility needs. (Sec. 4204) Authorizes the Secretary to negotiate and enter into contracts with vaccine manufacturers for the purchase and delivery of vaccines for adults. Allows a state to purchase additional quantities of adult vaccines from manufacturers at the applicable price negotiated by the Secretary. Requires the Secretary, acting through the Director of CDC, to establish a demonstration program to award grants to states to improve the provision of recommended immunizations for children and adults through the use of evidence-based, population-based interventions for high-risk populations. Reauthorizes appropriations for preventive health service programs to immunize children and adults against vaccine-preventable diseases without charge. Requires the Comptroller General to study the ability of Medicare beneficiaries who are 65 years or older to access routinely recommended vaccines covered under the prescription drug program since its establishment. (Sec. 4205) Amends the Federal Food, Drug, and Cosmetic Act to require the labeling of a food item offered for sale in a retail food establishment that is part of a chain with 20 or more locations under the same name to disclose on the menu and menu board: (1) the number of calories contained in the standard menu item; (2) the suggested daily caloric intake; and (3) the availability on the premises and upon request of specified additional nutrient information. Requires self-service facilities to place adjacent to each food offered a sign that lists calories per displayed food item or per serving. Requires vending machine operators who operate 20 or more vending machines to provide a sign disclosing the number of calories contained in each article of food. (Sec. 4206) Requires the Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers an individualized wellness plan designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment. (Sec. 4207) Amends the Fair Labor Standards Act of 1938 to require employers to provide a reasonable break time and a suitable place, other than a bathroom, for an employee to express breast milk for her nursing child. Excludes an employer with fewer than 50 employees if such requirements would impose an undue hardship. Subtitle D: Support for Prevention and Public Health Innovation - (Sec. 4301) Requires the Secretary, acting through the Director of CDC, to provide funding for research in the area of public health services and systems. (Sec. 4302) Requires the Secretary to ensure that any federally conduced or supported health care or public health program, activity, or survey collects and reports specified demographic data regarding health disparities. Requires the Secretary, acting through the National Coordinator for Health Information Technology, to develop: (1) national standards for the management of data collected; and (2) interoperability and security systems for data management. (Sec. 4303, as modified by Sec. 10404) Requires the Director of CDC to: (1) provide employers with technical assistance, consultation, tools, and other resources in evaluating employer-based wellness programs; and (2) build evaluation capacity among workplace staff by training employers on how to evaluate such wellness programs and ensuring that evaluation resources, technical assistance, and consultation are available. Requires the Director of CDC to conduct a national worksite health policies and programs survey to assess employer-based health policies and programs. (Sec. 4304) Requires the Secretary, acting through the Director of CDC, to establish an Epidemiology and Laboratory Capacity Grant Program to award grants to assist public health agencies in improving surveillance for, and response to, infectious diseases and other conditions of public health importance. (Sec. 4305) Requires the Secretary to: (1) enter into an agreement with the Institute of Medicine to convene a Conference on Pain, the purposes of which shall include to increase the recognition of pain as a significant public health problem in the United States; and (2) establish the Interagency Pain Research Coordinating Committee. (Sec. 4306) Appropriates funds to carry out childhood obesity demonstration projects. Subtitle E: Miscellaneous Provisions - (Sec. 4402) Requires the Secretary to evaluate programs to determine whether existing federal health and wellness initiatives are effective in achieving their stated goals. Title V: Health Care Workforce - Subtitle A: Purpose and Definitions - (Sec. 5001) Declares that the purpose of this title is to improve access to and the delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Subtitle B: Innovations in the Health Care Workforce - (Sec. 5101, as modified by Sec. 10501) Establishes a National Health Care Workforce Commission to: (1) review current and projected health care workforce supply and demand; and (2) make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies. (Sec. 5102) Establishes a health care workforce development grant program. (Sec. 5103) Requires the Secretary to establish the National Center for Health Care Workforce Analysis to provide for the development of information describing and analyzing the health care workforce and workforce related issues. Transfers the responsibilities and resources of the National Center for Health Workforce Analysis to the Center created under this section. (Sec. 5104, as added by Sec. 10501) Establishes the Interagency Access to Health Care in Alaska Task Force to: (1) assess access to health care for beneficiaries of federal health care systems in Alaska; and (2) develop a strategy to improve delivery to such beneficiaries. Subtitle C: Increasing the Supply of the Health Care Workforce - (Sec. 5201) Revises student loan repayment provisions related to the length of service requirement for the primary health care loan repayment program. (Sec. 5202) Increases maximum amount of loans made by schools of nursing to students. (Sec. 5203) Directs the Secretary to establish and carry out a pediatric specialty loan repayment program. (Sec. 5204) Requires the Secretary to establish the Public Health Workforce Loan Repayment Program to assure an adequate supply of public health professionals to eliminate critical public health workforce shortages in federal, state, local, and tribal public health agencies. (Sec. 5205) Amends the Higher Education Act of 1965 to expand student loan forgiveness to include allied health professionals employed in public health agencies. (Sec. 5206) Includes public health workforce loan repayment programs as permitted activities under a grant program to increase the number of individuals in the public health workforce. Authorizes the Secretary to provide for scholarships for mid-career professionals in the public health and allied health workforce to receive additional training in the field of public health and allied health. (Sec. 5207) Authorizes appropriations for the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program. (Sec. 5208) Requires the Secretary to award grants for the cost of the operation of nurse-managed health clinics. (Sec. 5209) Eliminates the cap on the number of commissioned officers in the Public Health Service Regular Corps. (Sec. 5210) Revises the Regular Corps and the Reserve Corps (renamed the Ready Reserve Corps) in the Public Health Service. Sets forth the uses of the Ready Reserve Corps. Subtitle D: Enhancing Health Care Workforce Education and Training - (Sec. 5301) Sets forth provisions providing for health care professional training programs. (Sec. 5302) Requires the Secretary to award grants for new training opportunities for direct care workers who are employed in long-term care settings. (Sec. 5303) Sets forth provisions providing for dentistry professional training programs. (Sec. 5304) Authorizes the Secretary to award grants for demonstration programs to establish training programs for alternative dental health care providers in order to increase access to dental health services in rural and other underserved communities. (Sec. 5305) Requires the Secretary to award grants or contracts to entities that operate a geriatric education center to offer short-term, intensive courses that focus on geriatrics, chronic care management, and long-term care. Expands geriatric faculty fellowship programs to make dentists eligible. Reauthorizes and revises the geriatric education programs to allow grant funds to be used for the establishment of traineeships for individuals who are preparing for advanced education nursing degrees in areas that specialize in the care of elderly populations. (Sec. 5306) Authorizes the Secretary to award grants to institutions of higher education to support the recruitment of students for, and education and clinical experience of the students in, social work programs, psychology programs, child and adolescent mental health, and training of paraprofessional child and adolescent mental health workers. (Sec. 5307) Authorizes the Secretary, acting through the Administrator of HRSA, to award grants, contracts, or cooperative agreements for the development, evaluation, and dissemination of research, demonstration projects, and model curricula for health professions training in cultural competency, prevention, public health proficiency, reducing health disparities, and working with individuals with disabilities. (Sec. 5308) Requires nurse-midwifery programs, in order to be eligible for advanced education nursing grants, to have as their objective the education of midwives and to be accredited by the American College of Nurse-Midwives Accreditation Commission for Midwifery Education. (Sec. 5309) Authorizes the Secretary to award grants or enter into contracts to enhance the nursing workforce by initiating and maintaining nurse retention programs. (Sec. 5310) Makes nurse faculty at an accredited school of nursing eligible for the nursing education loan repayment program. (Sec. 5311) Revises the nurse faculty loan repayment program, including to increase the amount of such loans. Authorizes the Secretary, acting through the Administrator of HRSA, to enter into an agreement for the repayment of education loans in exchange for service as a member of a faculty at an accredited school of nursing. (Sec. 5312) Authorizes appropriations for carrying out nursing workforce programs. (Sec. 5313, as modified by Sec. 10501) Requires the Director of CDC to award grants to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers. (Sec. 5314) Authorizes the Secretary to carry out activities to address documented workforce shortages in state and local health departments in the critical areas of applied public health epidemiology and public health laboratory science and informatics. (Sec. 5315) Authorizes the establishment of the United States Public Health Sciences Track, which is authorized to award advanced degrees in public health, epidemiology, and emergency preparedness and response. Directs the Surgeon General to develop: (1) an integrated longitudinal plan for health professions continuing education; and (2) faculty development programs and curricula in decentralized venues of health care to balance urban, tertiary, and inpatient venues. (Sec. 5316, as added by Sec. 10501) Requires the Secretary to establish a training demonstration program for family nurse practitioners to employ and provide one-year training for nurse practitioners serving as primary care providers in federally qualified health centers or nurse-managed health centers. Subtitle E: Supporting the Existing Health Care Workforce - (Sec. 5401) Revises the allocation of funds to assist schools in supporting programs of excellence in health professions education for underrepresented minority individuals and schools designated as centers of excellence. (Sec. 5402, as modified by Sec. 10501) Makes schools offering physician assistant education programs eligible for loan repayment for health profession faculty. Increases the amount of loan repayment for such program. Authorizes appropriations for: (1) scholarships for disadvantaged students attending health professions or nursing schools; (2) loan repayment for health professions faculty; and (3) grants to health professions school to assist individuals from disadvantaged backgrounds. (Sec. 5403) Requires the Secretary to: (1) make awards for area health education center programs; and (2) provide for timely dissemination of research findings using relevant resources. (Sec. 5404) Makes revisions to the grant program to increase nursing education opportunities for individuals from disadvantaged backgrounds to include providing: (1) stipends for diploma or associate degree nurses to enter a bridge or degree completion program; (2) student scholarships or stipends for accelerated nursing degree programs; and (3) advanced education preparation. (Sec. 5405, as modified by Sec. 10501) Requires the Secretary, acting through the Director of AHRQ, to establish a Primary Care Extension Program to provide support and assistance to educate primary care providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services, and evidence-based and evidence-informed therapies and techniques. Requires the Secretary to award grants to states for the establishment of Primary Care Extension Program State Hubs to coordinate state health care functions with quality improvement organizations and area health education centers. Subtitle F: Strengthening Primary Care and Other Workforce Improvements - (Sec. 5501, as modified by Sec. 10501) Requires Medicare incentive payments to: (1) primary care practitioners providing primary care services on or after January 1, 2011, and before January 1, 2016; and (2) general surgeons performing major surgical procedures on or after January 1, 2011, and before January 1, 2016, in a health professional shortage area. (Sec. 5502, deleted by Sec. 10501) (Sec. 5503) Reallocates unused residency positions to qualifying hospitals for primary care residents for purposes of payments to hospitals for graduate medical education costs. (Sec. 5504) Revises provisions related to graduate medical education costs to count the time residents spend in nonprovider settings toward the full-time equivalency if the hospital incurs the costs of the stipends and fringe benefits of such residents during such time. (Sec. 5505, as modified by Sec. 10501) Includes toward the determination of full-time equivalency for graduate medical education costs time spent by an intern or resident in an approved medical residency training program in a nonprovider setting that is primarily engaged in furnishing patient care in nonpatient care activities. (Sec. 5506) Directs the Secretary, when a hospital with an approved medical residency program closes, to increase the resident limit for other hospitals based on proximity criteria. (Sec. 5507) Requires the Secretary to: (1) award grants for demonstration projects that are designed to provide certain low-income individuals with the opportunity to obtain education and training for health care occupations that pay well and that are expected to experience labor shortages or be in high demand; and (2) award grants to states to conduct demonstration projects for purposes of developing core training competencies and certification programs for personal or home care aides. Authorizes appropriations for FY2009-FY2012 for family-to-family health information centers. (Sec. 5508) Authorizes the Secretary to award grants to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs. Allows up to 50% of time spent teaching by a member of the National Health Service Corps to be considered clinical practice for purposes of fulfilling the service obligation. Requires the Secretary to make payments for direct and indirect expenses to qualified teaching health centers for expansion or establishment of approved graduate medical residency training programs. (Sec. 5509) Requires the Secretary to establish a graduate nurse education demonstration under which a hospital may receive payment for the hospital's reasonable costs for the provision of qualified clinical training to advance practice nurses. Subtitle G: Improving Access to Health Care Services - (Sec. 5601) Reauthorizes appropriations for health centers to serve medically underserved populations. (Sec. 5602) Requires the Secretary to establish through the negotiated rulemaking process a comprehensive methodology and criteria for designation of medically underserved populations and health professions shortage areas. (Sec. 5603) Reauthorizes appropriations for FY2010-FY2014 for the expansion and improvement of emergency medical services for children who need treatment for trauma or critical care. (Sec. 5604) Authorizes the Secretary, acting through the Administrator of the Substance Abuse and Mental Health Services Administration, to award grants and cooperative agreements for demonstration projects for the provision of coordinated and integrated services to special populations through the co-location of primary and specialty care services in community-based mental and behavioral health settings. (Sec. 5605) Establishes a Commission on Key National Indicators to: (1) conduct comprehensive oversight of a newly established key national indicators system; and (2) make recommendations on how to improve such system. Directs the National Academy of Sciences to enable the establishment of such system by creating its own institutional capability or by partnering with an independent private nonprofit organization to implement such system. Directs the Comptroller General to study previous work conducted by all public agencies, private organizations, or foreign countries with respect to best practices for such systems. (Sec. 5606, as added by Sec. 10501) Authorizes a state to award grants to health care providers who treat a high percentage of medically underserved populations or other special populations in the state. Subtitle H: General Provisions - (Sec. 5701) Requires the Secretary to submit to the appropriate congressional committees a report on activities carried out under this title and the effectiveness of such activities. Title VI: Transparency and Program Integrity - Subtitle A: Physician Ownership and Other Transparency - (Sec. 6001, as modified by Sec. 10601) Amends SSA title XVIII (Medicare) to prohibit physician-owned hospitals that do not have a provider agreement by August 1, 2010, to participate in Medicare. Allows their participation in Medicare under a rural provider and hospital exception to the ownership or investment prohibition if they meet certain requirements addressing conflict of interest, bona fide investments, patient safety issues, and expansion limitations. (Sec. 6002) Amends SSA title XI to require drug, device, biological and medical supply manufacturers to report to the Secretary transfers of value made to a physician, physician medical practice, a physician group practice, and/or teaching hospital, as well as information on any physician ownership or investment interest in the manufacturer. Provides penalties for noncompliance. Preempts duplicative state or local laws. (Sec. 6003) Amends SSA title XVIII (Medicare), with respect to the Medicare in-office ancillary exception to the prohibition against physician self-referrals, to require a referring physician to inform the patient in writing that the patient may obtain a specified imaging service from a person other than the referring physician, a physician who is a member of the same group practice as the referring physician, or an individual directly supervised by the physician or by another physician in the group practice. Requires the referring physician also to provide the patient with a written list of suppliers who furnish such services in the area in which the patient resides. (Sec. 6004) Amends SSA title XI to require prescription drug manufacturers and authorized distributors of record to report to the Secretary specified information pertaining to drug samples. (Sec. 6005) Amends SSA title XI to require a pharmacy benefit manager (PBM) or a health benefits plan that manages prescription drug coverage under a contract with a Medicare or Exchange health plan to report to the Secretary information regarding the generic dispensing rate, the rebates, discounts, or price concessions negotiated by the PBM, and the payment difference between health plans and PBMs and the PBMs and pharmacies. Subtitle B: Nursing Home Transparency and Improvement - Part I: Improving Transparency of Information - (Sec. 6101) Amends SSA title XI to require SNFs under Medicare and nursing facilities (NFs) under Medicaid to make available, upon request by the Secretary, the HHS Inspector General, the states, or a state long-term care ombudsman, information on ownership of the SNF or NF, including a description of the facility's governing body and organizational structure, as well as information regarding additional disclosable parties. (Sec. 6102) Requires SNFs and NFs to operate a compliance and ethics program effective in preventing and detecting criminal, civil, and administrative violations. Directs the Secretary to establish and implement a quality assurance and performance improvement program for SNFs and NFs, including multi-unit chains of facilities. (Sec. 6103) Amends SSA title XVIII (Medicare) to require the Secretary to publish on the Nursing Home Compare Medicare website: (1) standardized staffing data; (2) links to state websites regarding state survey and certification programs; (3) the model standardized complaint form; (4) a summary of substantiated complaints; and (5) the number of adjudicated instances of criminal violations by a facility or its employees. (Sec. 6104) Requires SNFs to report separately expenditures on wages and benefits for direct care staff, breaking out registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff. (Sec. 6105) Requires the Secretary to develop a standardized complaint form for use by residents (or a person acting on a residents behalf) in filing complaints with a state survey and certification agency and a state long-term care ombudsman program. Requires states to to establish complaint resolution processes. (Sec. 6106) Amends SSA title XI to require the Secretary to develop a program for facilities to report direct care staffing information on payroll and other verifiable and auditable data in a uniform format based. (Sec. 6107) Requires the Comptroller General to study and report to Congress on the Five-Star Quality Rating System for nursing homes of CMS. Part II: Targeting Enforcement - (Sec. 6111) Amends SSA title XVIII (Medicare) to authorize the Secretary to reduce civil monetary penalties by 50% for certain SNFs and NFs that self-report and promptly correct deficiencies within 10 calendar days of imposition of the penalty. Directs the Secretary to issue regulations providing for an informal dispute resolution process after imposition of a penalty, as well as an escrow account for money penalties pending resolution of any appeals. (Sec. 6112) Directs the Secretary to establish a demonstration project for developing, testing, and implementing a national independent monitor program to oversee interstate and large intrastate chains of SNFs and NFs. (Sec. 6113) Requires the administrator of a SNF or a NF that is preparing to close to notify in writing residents, legal representatives of residents or other responsible parties, the Secretary, and the state long-term care ombudsman program in advance of the closure by at least 60 days. Requires the notice to include a plan for the transfer and adequate relocation of residents to another facility or alternative setting. Requires the state to ensure a successful relocation of residents. (Sec. 6114) Requires the Secretary to conduct two SNF- and NF-based demonstration projects to develop best practice models in two areas: (1) one for facilities involved in the culture change movement; and (2) one for the use of information technology to improve resident care. Part III: Improving Staff Training - (Sec. 6121) Requires SNFs and NFs to include dementia management and abuse prevention training as part of pre-employment initial training and, if appropriate, as part of ongoing in-service training for permanent and contract or agency staff. Subtitle C: Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers - (Sec. 6201) Requires the Secretary to establish a nationwide program for national and state background checks on prospective direct patient access employees of long-term care facilities and providers. Subtitle D: Patient-Centered Outcomes Research - (Sec. 6301, as modified by Sec. 10602) Amends SSA title XI to establish the Patient-Centered Outcomes Research Institute to identify priorities for, and establish, update, and carry out, a national comparative outcomes research project agenda. Provides for a peer review process for primary research. Prohibits the Institute from allowing the subsequent use of data from original research in work-for-hire contracts with individuals, entities, or instrumentalities that have a financial interest in the results, unless approved by the Institute under a data use agreement. Amends the Public Health Service Act to direct the Office of Communication and Knowledge Transfer at AHRQ to disseminate broadly the research findings published by the Institute and other government-funded research relevant to comparative clinical effective research. Prohibits the Secretary from using evidence and findings from Institute research to make a determination regarding Medicare coverage unless such use is through an iterative and transparent process which includes public comment and considers the effect on subpopulations. Amends the Internal Revenue Code to establish in the Treasury the Patient-Centered Outcomes Research Trust Fund. Directs the Secretary to make transfers to that Trust Fund from the Medicare Trust Funds. Imposes annual fees of $2 times the number of insured lives on each specified health insurance policy and on self-insured health plans. (Sec. 6302) Terminates the Federal Coordinating Council for Comparative Effectiveness Research upon enactment of this Act. Subtitle E: Medicare, Medicaid, and CHIP Program Integrity Provisions - (Sec. 6401, as modified by Sec. 10603) Amends SSA title XVIII (Medicare) to require the Secretary to: (1) establish procedures for screening providers and suppliers participating in Medicare, Medicaid, and CHIP; and (2) determine the level of screening according to the risk of fraud, waste, and abuse with respect to each category of provider or supplier. Requires providers and suppliers applying for enrollment or revalidation of enrollment in Medicare, Medicaid, or CHIP to disclose current or previous affiliations with any provider or supplier that: (1) has uncollected debt; (2) has had its payments suspended; (3) has been excluded from participating in a federal health care program; or (4) has had billing privileges revoked. Authorizes the Secretary to deny enrollment in a program if these affiliations pose an undue risk to it. Requires providers and suppliers to establish a compliance program containing specified core elements. Directs the CMS Administrator to establish a process for making available to each state agency with responsibility for administering a state Medicaid plan or a child health plan under SSA title XXI the identity of any provider or supplier under Medicare or CHIP who is terminated. (Sec. 6402) Requires CMS to include in the integrated data repository claims and payment data from Medicare, Medicaid, CHIP, and health-related programs administered by the Departments of Veterans Affairs (VA) and DOD, the Social Security Administration, and IHS. Directs the Secretary to enter into data-sharing agreements with the Commissioner of Social Security, the VA and DOD Secretaries, and the IHS Director to help identity fraud, waste, and abuse. Requires that overpayments be reported and returned within 60 days from the date the overpayment was identified or by the date a corresponding cost report was due, whichever is later. Directs the Secretary to issue a regulation requiring all Medicare, Medicaid, and CHIP providers to include their National Provider Identifier on enrollment applications. Authorizes the Secretary to withhold the federal matching payment to states for medical assistance expenditures whenever a state does not report enrollee encounter data in a timely manner to the states Medicaid Management Information System. Authorizes the Secretary to exclude providers and suppliers participation in any federal health care program for providing false information on any application to enroll or participate. Subjects to civil monetary penalties excluded individuals who: (1) order or prescribe an item or service; (2) make false statements on applications or contracts to participate in a federal health care program; or (3) know of an overpayment and do not return it. Subjects the latter offense to civil monetary penalties of up to $50,000 or triple the total amount of the claim involved. Authorizes the Secretary to issue subpoenas and require the attendance and testimony of witnesses and the production of any other evidence that relates to matters under investigation or in question. Requires the Secretary take into account the volume of billing for a durable medical equipment (DME) supplier or home health agency when determining the size of the supplier's and agency's surety bond. Authorizes the Secretary to require other providers and suppliers to post a surety bond if the Secretary considers them to be at risk. Authorizes the Secretary to suspend payments to a provider or supplier pending a fraud investigation. Appropriates an additional $10 million, adjusted for inflation, to the Health Care Fraud and Abuse Control each of FY2011-FY2020. Applies inflation adjustments as well to Medicare Integrity Program funding. Requires the Medicaid Integrity Program and Program contractors to provide the Secretary and the HHS Office of Inspector General with performance statistics, including the number and amount of overpayments recovered, the number of fraud referrals, and the return on investment for such activities. (Sec. 6403) Requires the Secretary to furnish the National Practitioner Data Bank (NPDB) with all information reported to the national health care fraud and abuse data collection program on certain final adverse actions taken against health care providers, suppliers, and practitioners. Requires the Secretary to establish a process to terminate the Healthcare Integrity and Protection Databank (HIPDB) and ensure that the information formerly collected in it is transferred to the NPDB. (Sec. 6404) Reduces from three years to one year after the date of service the maximum period for submission of Medicare claims. (Sec. 6405, as modified by Sec. 10604) Requires DME or home health services to be ordered by an enrolled Medicare eligible professional or physician. Authorizes the Secretary to extend these requirements to other Medicare items and services to reduce fraud, waste, and abuse. (Sec. 6406) Authorizes the Secretary to disenroll, for up to one year, a Medicare enrolled physician or supplier that fails to maintain and provide access to written orders or requests for payment for DME, certification for home health services, or referrals for other items and services. Authorizes the Secretary to exclude from participation in any federal health care program any individual or entity ordering, referring for furnishing, or certifying the need for an item or service that fails to provide adequate documentation to verify payment. (Sec. 6407, as modified by Sec. 10605) Requires a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant to have a face-to-face encounter with an individual before issuing a certification for home health services or DME. Authorizes the Secretary to apply the same face-to-face encounter requirement to other items and services based upon a finding that doing so would reduce the risk of fraud, waste, and abuse. Applies the same requirement, as well, to physicians making certifications for home health services under Medicaid. (Sec. 6408) Revises civil monetary penalties for making false statements or delaying inspections. Applies specified enhanced sanctions and civil monetary penalties to MA or Part D plans that: (1) enroll individuals in an MA or Part D plan without their consent; (2) transfer an individual from one plan to another for the purpose of earning a commission; (3) fail to comply with marketing requirements and CMS guidance; or (4) employ or contract with an individual or entity that commits a violation. (Sec. 6409) Requires the Secretary to establish a self-referral disclosure protocol to enable health care providers and suppliers to disclose actual or potential violations of the physician self-referral law. Authorizes the Secretary to reduce the amount due and owing for all violations of such law. (Sec. 6410) Requires the Secretary to: (1) expand the number of areas to be included in round two of the competitive bidding program from 79 to 100 of the largest metropolitan statistical areas; and (2) use competitively bid prices in all areas by 2016. (Sec. 6411) Requires states to establish contracts with one or more Recovery Audit Contractors (RACs), which shall identify underpayments and overpayments and recoup overpayments made for services provided under state Medicaid plans as well as state plan waivers. Requires the Secretary to expand the RAC program to Medicare parts C (Medicare+Choice) and D (Prescription Drug Program). Subtitle F: Additional Medicaid Program Integrity Provisions - (Sec. 6501) Amends SSA title XIX (Medicaid) to require states to terminate individuals or entities (providers) from their Medicaid programs if they were terminated from Medicare or another states Medicaid program. (Sec. 6502) Requires Medicaid agencies to exclude individuals or entities from participating in Medicaid for a specified period of time if the entity or individual owns, controls, or manages an entity that: (1) has failed to repay overpayments during a specified period; (2) is suspended, excluded, or terminated from participation in any Medicaid program; or (3) is affiliated with an individual or entity that has been suspended, excluded, or terminated from Medicaid participation. (Sec. 6503) Requires state Medicaid plans to require any billing agents, clearinghouses, or other alternate payees that submit claims on behalf of health care providers to register with the state and the Secretary. (Sec. 6504) Requires states to submit data elements from the state mechanized claims processing and information retrieval system (under the Medicaid Statistical Information System) that the Secretary determines necessary for program integrity, program oversight, and administration. Requires a Medicaid managed care entity contract to provide for maintenance of sufficient patient encounter data to identify the physician who delivers services to patients (as under current law) at a frequency and level of detail to be specified by the Secretary. (Sec. 6505) Requires a state Medicaid plan to prohibit the state from making any payments for items or services under a Medicaid state plan or a waiver to any financial institution or entity located outside of the United States. (Sec. 6506) Extends the period for states to recover overpayments from 60 days to one year after discovery of the overpayment. Declares that, when overpayments due to fraud are pending, state repayments of the federal portion of such overpayments shall not be due until 30 days after the date of the final administrative or judicial judgment on the matter. (Sec. 6507) Requires state mechanized Medicaid claims processing and information retrieval systems to incorporate methodologies compatible with Medicares National Correct Coding Initiative . Subtitle G: Additional Program Integrity Provisions - (Sec. 6601) Amends the Employee Retirement Income Security Act of 1974 (ERISA) to prohibit employees and agents of multiple employer welfare arrangements (MEWAs), subject to criminal penalties, from making false statements in marketing materials regarding an employee welfare benefit plans financial solvency, benefits, or regulatory status. (Sec. 6603) Amends the Public Health Service Act to direct the Secretary to request NAIC to develop a model uniform report form for a private health insurance issuer seeking to refer suspected fraud and abuse to state insurance departments or other responsible state agencies for investigation. (Sec. 6604) Amends ERISA to direct the Secretary of Labor to adopt regulatory standards and/or issue orders to subject MEWAs to state law relating to fraud and abuse. (Sec. 6605) Authorizes the Secretary of Labor to: (1) issue cease-and-desist orders to shut down temporarily the operations of MEWAs conducting fraudulent activities or posing a serious threat to the public, until hearings can be completed; and (2) seize a plan's assets if it appears that the plan is in a financially hazardous condition. (Sec. 6606) Directs the Secretary of Labor to require MEWAs which are not group health plans to register with the Department of Labor before operating in a state. (Sec. 6607) Authorizes the Secretary of Labor to promulgate a regulation providing an evidentiary privilege that allows confidential communication among specified federal and state officials relating to investigation of fraud and abuse. Subtitle H: Elder Justice Act - Elder Justice Act of 2009 - (Sec. 6702) Amends SSA title XX (Block Grants to States for Social Services) with respect to elder abuse, neglect, and exploitation and their prevention. Requires the HHS Secretary to award grants and carry out activities that provide: (1) greater protection to those individuals seeking care in facilities that provide long-term care services and supports; and (2) greater incentives for individuals to train and seek employment at such facilities. Requires facility owners, operators, and certain employees to report suspected crimes committed at a facility. Requires facility owners or operators also to: (1) submit to the Secretary and to the state written notification of an impending closure of a facility within 60 days before the closure; and (2) include a plan for transfer and adequate relocation of all residents. Establishes an Elder Justice Coordinating Council. Subtitle I: Sense of the Senate Regarding Medical Malpractice - (Sec. 6801) Expresses the sense of the Senate that: (1) health reform presents an opportunity to address issues related to medical malpractice and medical liability insurance; (2) states should be encouraged to develop and test alternative models to the existing civil litigation system; and (3) Congress should consider state demonstration projects to evaluate such alternatives. Title VII: Improving Access to Innovative Medical Therapies - Subtitle A: Biologics Price Competition and Innovation - Biologics Price Competition and Innovation Act of 2009 - (Sec. 7002) Amends the Public Health Service Act to allow a person to submit an application for licensure of a biological product based on its similarity to a licensed biological product (the reference product). Requires the Secretary to license the biological product if it is biosimilar to or interchangeable with the reference product. Prohibits the Secretary from determining that a second or subsequent biological product is interchangeable with a reference product for any condition of use for specified periods based on the marketing of, and the presence or status of litigation involving, the first biosimilar biological product deemed interchangeable with the same reference product. Prohibits the Secretary from making approval of an application under this Act effective until 12 years after the date on which the reference product was first licensed. Subtitle B: More Affordable Medicine for Children and Underserved Communities - (Sec. 7101) Expands the 340B drug discount program (a program limiting the cost of covered outpatient drugs to certain federal grantees) to allow participation as a covered entity by certain: (1) children's hospitals; (2) freestanding cancer hospitals; (3) critical access hospitals; (4) rural referral centers; and (5) sole community hospitals. Expands the program to include drugs used in connection with an inpatient or outpatient service by enrolled hospitals (currently, only outpatient drugs are covered under the program). Requires the Secretary to establish reasonable exceptions to the prohibition on enrolled hospitals obtaining covered outpatient drugs through a group purchasing organization or other group purchasing arrangement, including for drugs unavailable through the program and to facilitate generic substitution when a generic covered drug is available at a lower price. Allows such hospitals to purchase covered drugs for inpatients through any such arrangement. Requires a hospital enrolled in the 340B drug discount program to issue a credit to a state Medicaid program for inpatient covered drugs provided to Medicaid recipients. (Sec. 7102) Requires the Secretary to: (1) provide for improvements in compliance by manufacturers and covered entities with the requirements of the 340B drug discount program; and (2) establish and implement an administrative process for resolving claims by covered entities and manufacturers of violations of such requirements. Requires manufacturers to offer each covered entity covered drugs for purchase at or below the applicable ceiling price if such a drug is made available to any other purchaser at any price. (Sec. 7103) Requires the Comptroller General to report to Congress on whether those individuals served by the covered entities under the 340B drug discount program are receiving optimal health care services. Title VIII: Class Act - Community Living Assistance Services and Supports Act or the CLASS Act - (Sec. 8002, as modified by Sec. 10801) Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program) under which: (1) all employees are automatically enrolled, but are allowed to waive enrollment; (2) payroll deductions pay monthly premiums; and (3) benefits under a CLASS Independence Benefit Plan provide individuals with functional limitations with tools that will allow them to maintain their personal and financial independence and live in the community. Title IX: Revenue Provisions - Subtitle A: Revenue Offset Provisions - (Sec. 9001, as modified by section 10901) Amends the Internal Revenue Code to impose an excise tax of 40% of the excess benefit from certain high cost employer-sponsored health coverage. Deems any amount which exceeds payment of $8,500 for an employee self-only coverage plan and $23,000 for employees with other than self-only coverage (family plans) as an excess benefit. Increases such amounts for certain retirees and employees who are engaged in high-risk professions (e.g., law enforcement officers, emergency medical first responders, or longshore workers). Imposes a penalty on employers and coverage providers for failure to calculate the proper amount of an excess benefit. (Sec. 9002) Requires employers to include in the W-2 form of each employee the aggregate cost of applicable employer-sponsored group health coverage that is excludable from the employee's gross income (excluding the value of contributions to flexible spending arrangements). (Sec. 9003) Restricts payments from health savings accounts, medical savings accounts, and health flexible spending arrangements for medications to prescription drugs or insulin. (Sec. 9004) Increases to 20% the penalty for distributions from a health savings account or Archer medical savings account not used for qualified medical expenses. (Sec. 9005, as modified by section 10902) Limits annual salary reduction contributions by an employee to a health flexible spending arrangement under a cafeteria plan to $2,500. Allows an annual inflation adjustment to such amount after 2011. (Sec. 9006) Applies to corporations reporting requirements for payments of $600 or more to persons engaged in a trade or business. (Sec. 9007, as modified by section 10903) Requires tax-exempt charitable hospitals to: (1) conduct a community health needs assessment every two years; (2) adopt a written financial assistance policy for patients who require financial assistance for hospital care; and (3) refrain from taking extraordinary collection actions against a patient until the hospital has made reasonable efforts to determine whether the patient is eligible for financial assistance. Imposes a penalty tax on hospitals who fail to comply with the requirements of this Act. Requires the Secretary of the Treasury to report to Congress on information with respect to private tax-exempt, taxable, and government-owned hospitals regarding levels of charity care provided, bad debt expenses, unreimbursed costs, and costs for community benefit activities. (Sec. 9008) Imposes an annual fee on the branded prescription drug sales exceeding $5 million of manufacturers and importers of such drugs beginning in 2010. Requires the HHS, VA, and DOD Secretaries to report to the Secretary of the Treasury on the total branded prescription drug sales within government programs within their departments. (Sec. 9009, as modified by section 10904) Imposes an annual fee on the gross sales receipts exceeding $5 million of manufacturers and importers of certain medical devices beginning in 2011. (Sec. 9010, as modified by section 10905) Imposes on any entity that provides health insurance for any United States health risk an annual fee beginning in 2011. Defines "United States health risk" as the health risk of an individual who is a U.S. citizen or resident or is located in the United States with respect to the period the individual is so located. Exempts entities whose net premiums written are not more than $25 million. Requires all entities subject to such fee to report to the Secretary of the Treasury on their net written premiums and imposes a penalty for failure to report. (Sec. 9011) Requires the VA Secretary to study and report to Congress by December 31, 2012, on the effect of fees assessed by this Act on the cost of medical care provided to veterans and on veterans' access to medical devices and branded prescription drugs. (Sec. 9012) Eliminates the tax deduction for expenses for determining the subsidy for employers who maintain prescription drug plans for Medicare Part D eligible retirees. (Sec. 9013) Increases the adjusted gross income threshold for claiming the itemized deduction for medical expenses from 7.5% to 10% beginning after 2012. Retains the 7.5% threshold through 2016 for individual taxpayers who have attained age 65 before the close of an applicable taxable year. (Sec. 9014) Imposes a limitation after December 31, 2012, of $500,000 on the deductibility of remuneration paid to officers, directors, employees, and service providers of health insurance issuers who derive at least 25% of their gross premiums from providing health insurance coverage that meets the minimum essential coverage requirements established by this Act. (Sec. 9015, as modified by section 10906) Increases after December 31, 2012, the hospital insurance tax rate by .9% for individual taxpayers earning over $200,000 ($250,000 for married couples filing joint tax returns). (Sec. 9016) Requires Blue Cross or Blue Shield organizations or other nonprofit organizations that provide health insurance to reimburse at least 85% of the cost of clinical services provided to their enrollees to be eligible for special tax benefits currently provided to such organizations. Subtitle B: Other Provisions - (Sec. 9021) Excludes from gross income the value of certain health benefits provided to members of Indian tribes, including: (1) health services or benefits provided or purchased by IHS; (2) medical care provided by an Indian tribe or tribal organization to a member of an Indian tribe; (3) accident or health plan coverage provided by an Indian tribe or tribal organization for medical care to a member of an Indian tribe and dependents; and (4) any other medical care provided by an Indian tribe that supplements, replaces, or substitutes for federal programs. (Sec. 9022) Establishes a new employee benefit cafeteria plan to be known as a Simple Cafeteria Plan, defined as a plan that: (1) is established and maintained by an employer with an average of 100 or fewer employees during a two-year period; (2) requires employers to make contributions or match employee contributions to the plan; and (3) requires participating employees to have at least 1,000 hours of service for the preceding plan year; and (4) allows such employees to elect any benefit available under the plan. (Sec. 9023) Allows a 50% tax credit for investment in any qualifying therapeutic discovery project, defined as a project that is designed to: (1) treat or prevent diseases by conducting pre-clinical activities, clinical trials, and clinical studies, or carrying out research projects to approve new drugs or other biologic products; (2) diagnose diseases or conditions to determine molecular factors related to diseases or conditions; or (3) develop a product, process, or technology to further the delivery or administration of therapeutics. Directs the Secretary of the Treasury to award grants for 50% of the investment in 2009 or 2010 in such a project, in lieu of the tax credit. Title X: Strengthening Quality, Affordable Health Care for All Americans - Subtitle A: Provisions Relating to Title I - (Sec. 10101) Revises provisions of or related to Subtitles A, B, and C of Title I of this Act (as reflected in the summary of those provisions). (Sec. 10104) Revises provisions of or related to Subtitle D of Title I of this Act (as reflected in the summary of those provisions). Makes changes to the False Claims Act related to the public disclosure bar on filing civil claims. (Sec. 10105) Revises provisions of or related to Subtitles E, F, and G of Title I of this Act (as reflected in the summary of those provisions). (Sec. 10108) Requires an offering employer to provide free choice vouchers to each qualified employee. Defines "offering employer" to mean any employer who offers minimum essential coverage to its employees consisting of coverage through an eligible employer-sponsored plan and who pays any portion of the costs of such plan. Defines "qualified employee" as an employee whose required contribution for such coverage and household income fall within a specified range. Requires: (1) a Health Insurance Exchange to credit the amount of any free choice voucher to the monthly premium of any qualified health plan in which the employee is enrolled; and (2) the offering employer to pay any amounts so credited to the Exchange. Excludes the amount of any free choice voucher from the gross income of the employee. Permits a deduction by employers for such costs. (Sec. 10109) Amends the SSA to require the HHS Secretary to seek input to determine if there could be greater uniformity in financial and administrative health care activities and items. Requires the Secretary to: (1) task the ICD-9-CM Coordination and Maintenance Committee to convene a meeting to receive input regarding and recommend revisions to the crosswalk between the Ninth and Tenth Revisions of the International Classification of Diseases; and (2) make appropriate revisions to such crosswalk. Subtitle B: Provisions Relating to Title II - Part I: Medicaid and CHIP - (Sec. 10201) Revises provisions of Subtitles A through L of Title II of this Act (as reflected in the summary of those provisions). Amends SSA title XIX (Medicaid) to set the FMAP for the state of Nebraska, with respect to all or any portion of a fiscal year that begins on or after January 1, 2017, at 100% (thus requiring the federal government to pay 100% of the cost of covering newly-eligible individuals in Nebraska). Directs the Comptroller General to study and report to Congress on whether the development, recognition, or implementation of any specified health care quality guideline or other standards would result in the establishment of a new cause of action or claim. (Sec. 10202) Creates a State Balancing Incentive Payments Program to increase the FMAP for states which offer home and community-based services as a long-term care alternative to nursing homes. (Sec. 10203) Amends SSA title XXI (CHIP) to make appropriations for CHIP through FY2015 and revise other CHIP-related requirements. Part II: Support for Pregnant and Parenting Teens and Women - (Sec. 10212) Requires the Secretary to establish a Pregnancy Assistance Fund for grants to states to assist pregnant and parenting teens and women. (Sec. 10214) Authorizes appropriations for FY2010-FY2019. Part III: Indian Health Care Improvement - (Sec. 10221) Enacts into law the Indian Health Care Improvement Reauthorization and Extension Act of 2009 (S. 1790) as reported by the Senate Committee on Indian Affairs in December 2009 and with the following changes. Amends the Indian Health Care Improvement Act, as amended by the Indian Health Care Improvement Reauthorization and Extension Act of 2009, to make an exception to the requirement that a national Community Health Aide Program exclude dental health aide therapist services. Declares that the exclusion of dental health aide therapist services from services covered under the national program shall not apply where an Indian tribe or tribal organization, located in a state (other than Alaska) in which state law authorizes the use of dental health aide therapist services or midlevel dental health provider services, elects to supply such services in accordance with state law. Subtitle C: Provisions Relating to Title III - (Sec. 10301) Revises provisions of Subtitles A through G of Title III of this Act (as reflected in the summary of those provisions). (Sec. 10323) Amends SSA title XVIII (Medicare) to deem eligible for Medicare coverage certain individuals exposed to environmental health hazards. Directs the Secretary to establish a pilot program for care of certain individuals residing in emergency declaration areas. Amends SSA title XX (Block Grants to States for Social Services) to direct the Secretary to establish a program for early detection of certain medical conditions related to environmental health hazards. Makes appropriations for FY2012-FY2019. (Sec. 10324) Establishes floors: (1) on the area wage index for hospitals in frontier states; (2) on the area wage adjustment factor for hospital outpatient department services in frontier states; and (3) for the practice expense index for services furnished in frontier states. (Sec. 10325) Revises the SNF prospective payment system to delay specified changes until FY2011. (Sec. 10326) Directs the Secretary to conduct separate pilot programs, for specified kinds of hospitals and hospice programs, to test the implementation of a value-based purchasing program for payments to the provider. (Sec. 10327) Authorizes an additional incentive payment under the physician quality reporting system in 2011 through 2014 to eligible professionals who report quality measures to CMS via a qualified Maintenance of Certification program. Eliminates the MedicareAdvantage Regional Plan Stabilization Fund. (Sec. 10328) Requires Medicare part D prescription drug plans to include a comprehensive review of medications as part of their medication therapy management programs. Requires automatic quarterly enrollment of qualified beneficiaries, with an allowance for them to opt out. (Sec. 10329) Requires the Secretary to develop a methodology to measure health plan value. (Sec. 10330) Directs the Secretary to develop a plan to modernize CMS computer and data systems. (Sec. 10331) Requires the Secretary to: (1) develop a Physician Compare website with information on physicians enrolled in the Medicare program and other eligible professionals who participate in the Physician Quality Reporting Initiative; and (2) implement a plan to make information on physician performance public through Physician Compare, particularly quality and patient experience measures. Authorizes the Secretary to provide financial incentives to Medicare beneficiaries furnished services by high quality physicians. (Sec. 10332) Directs the Secretary to make available to qualified entities standardized extracts of Medicare claims data for the evaluation of the performance of service providers and suppliers. (Sec. 10333) Amends the Public Health Service Act to authorize the Secretary to award grants to eligible entities to support community-based collaborative care networks for low-income populations. (Sec. 10334) Transfers the Office of Minority Health to the Office of the Secretary. Authorizes appropriations for FY2011-FY2016. Establishes individual offices of minority health within HHS. Redesignates the National Center on Minority Health and Health Disparities in NIH as the National Institute on Minority Health and Health Disparities. (Sec. 10336) Directs the Comptroller General to study and report to Congress on the impact on Medicare beneficiary access to high-quality dialysis services of including specified oral drugs furnished to them for the treatment of end stage renal disease in the related bundled prospective payment system. Subtitle D: Provisions Relating to Title IV - (Sec. 10401) Revises provisions of or related to Subtitles A, B, C, D, and E of Title IV of this Act (as reflected in the summary of those provisions). (Sec. 10407) Catalyst to Better Diabetes Care Act of 2009 - Requires the Secretary to prepare biennially a national diabetes report card and, to the extent possible, one for each state. Requires the Secretary, acting through the Director of CDC, to: (1) promote the education and training of physicians on the importance of birth and death certificate data and on how to properly complete these documents; (2) encourage state adoption of the latest standard revisions of birth and death certificates; and (3) work with states to reengineer their vital statistics systems in order to provide cost-effective, timely, and accurate vital systems data. Allows the Secretary to promote improvements to the collection of diabetes mortality data. Directs the Secretary to conduct a study of the impact of diabetes on the practice of medicine in the United States and the level of diabetes medical education that should be required prior to licensure, board certification, and board recertification. (Sec. 10408) Requires the Secretary to award grants to eligible employers to provide their employees with access to comprehensive workplace wellness programs. (Sec. 10409) Cures Acceleration Network Act of 2009 - Amends the Public Health Service Act to require the Secretary, acting through the Director of NIH, to implement the Cures Acceleration Network under which grants and contracts will be awarded to accelerate the development of high need cures. Defines "high need cure" as a drug, biological product, or device: (1) that is a priority to diagnose, mitigate, prevent, or treat harm from any disease or condition; and (2) for which the incentives of the commercial market are unlikely to result in its adequate or timely development. Establishes a Cures Acceleration Network Review Board. (Sec. 10410) Establishing a Network of Health-Advancing National Centers of Excellence for Depression Act of 2009 or the ENHANCED Act of 2009 - Requires the Secretary, acting through the Administrator of the Substance Abuse and Mental Health Services Administration, to: (1) award grants to establish national centers of excellence for depression; and (2) designate one such center as a coordinating center. Requires the coordinating center to establish and maintain a national, publicly available database to improve prevention programs, evidence-based interventions, and disease management programs for depressive disorders using data collected from the national centers. (Sec. 10411) Congenital Heart Futures Act - Authorizes the Secretary, acting through the Director of CDC, to: (1) enhance and expand infrastructure to track the epidemiology of congenital heart disease and to organize such information into the National Congenital Heart Disease Surveillance System; or (2) award a grant to an eligible entity to undertake such activities. Authorizes the Director of the National Heart, Lung, and Blood Institute to expand, intensify, and coordinate research and related Institute activities on congenital heart disease. (Sec. 10412) Reauthorizes appropriations for grants for public access defibrillation programs. Requires an information clearinghouse to increase public access to defibrillation in schools established under such program to be administered by an organization that has substantial expertise in pediatric education, pediatric medicine, and electrophysiology and sudden death. (Sec. 10413) Young Women's Breast Health Education and Awareness Requires Learning Young Act of 2009 or the EARLY Act - Requires the Secretary, acting through the Director of CDC, to conduct: (1) a national education campaign to increase awareness of young women's knowledge regarding breast health and breast cancer; (2) an education campaign among physicians and other health care professionals to increase awareness of breast health of young women; and (3) prevention research on breast cancer in younger women. Requires the Secretary, acting through the Director of NIH, to conduct research to develop and validate new screening tests and methods for prevention and early detection of breast cancer in young women. Directs the Secretary to award grants for the provision of health information to young women diagnosed with breast cancer and pre-neoplastic breast diseases. Subtitle E: Provisions Relating to Title V - (Sec. 10501) Revises provisions of or related to Title V of this Act (as reflected in the summary of those provisions). Requires the Secretary, acting through the Director of CDC, to establish a national diabetes prevention program targeted at adults at high risk for diabetes. Directs the Secretary to develop a Medicare prospective payment system for payment for services furnished by federally qualified health centers. Requires the Secretary, acting through the Administrator of the HRSA, to establish a grant program to assist accredited schools of allopathic or osteopathic medicine in: (1) recruiting students most likely to practice medicine in underserved rural communities; (2) providing rural-focused training and experience; and (3) increasing the number of recent allopathic and osteopathic medical school graduates who practice in underserved rural communities. Directs the Secretary, acting through the Administrator of HRSA, to award grants or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties. Reauthorizes appropriations for public health workforce activities. Revises provisions related to fulfillment of service obligations under the National Health Service Corps related to half-time clinical practice and teaching. (Sec. 10502) Authorizes appropriations to HHS for debt service on, or direct construction or renovation of, a health care facility that provides research, inpatient tertiary care, or outpatient clinical services and that meets certain requirements, including that it is critical for the provision of greater access to health care within the state. (Sec. 10503) Establishes a Community Health Center Fund to provide for expanded and sustained national investment in community health centers. Authorizes appropriations to such Fund. (Sec. 10504) Requires the Secretary, acting through the Administrator of HRSA, to establish a demonstration project to provide access to comprehensive health care services to the uninsured at reduced fees. Subtitle F: Provisions Relating to Title VI - (Sec. 10601) Revises provisions of Subtitles A through E of Title IV of this Act (as reflected in the summary of those provisions). (Sec. 10606) Directs the U.S. Sentencing Commission to amend the Federal Sentencing Guidelines to provide two-level, three-level, and four-level increases in the offense level for any defendant convicted of a federal health care offense relating to a government health care program of a loss between $1 million and $7 million, between $7 million and $20 million, and at least $20 million, respectively. Provides that a person need not have actual knowledge of the prohibition against health care fraud nor specific intent to violate it in order to commit health care fraud. Expands the scope of violations constituting a federal health care offense. Amends the Civil Rights of Institutionalized Persons Act to authorize the Attorney General to require access to an institution by subpoena to investigate conditions depriving residents of specified constitutional or federal rights. (Sec. 10607) Authorizes the Secretary to award demonstration grants to states for the development, implementation, and evaluation of alternatives to current tort litigation for resolving disputes over injuries allegedly caused by health care providers or health care organizations. (Sec. 10608) Amends the Public Health Service Act to extend medical malpractice coverage to free clinics by deeming their officers, employees, board members, and contractors to be employees of the Public Health Service. (Sec. 10609) Amends the Federal Food, Drug, and Cosmetic Act to set forth circumstances under which a generic drug may be approved with a label different from the listed drug. Subtitle G: Provisions Relating to Title VIII - (Sec. 10801) Revises provisions of or related to Title VIII of this Act (as reflected in the summary of those provisions). Subtitle H: Provisions Relating to Title IX: (Sec. 10901) Revises provisions of or related to Title IX of this Act (as reflected in the summary of those provisions). (Sec. 10907) Amends the Internal Revenue Code to impose a 10% excise tax on any amount paid for indoor tanning services on or after July 1, 2010. Exempts phototherapy services performed by a licensed medical professional from the definition of "indoor tanning services." (Sec. 10908) Excludes from gross income any payments under the National Health Service Corps Loan Repayment Program and any other state loan repayment or forgiveness programs intended to increase the availability of health care services in underserved or health professional shortage areas. (Sec. 10909) Increases from $10,000 to $13,170 the dollar limitation on: (1) the tax credit for adoption expenses; and (2) the tax exclusion for employer-provided adoption assistance. Allows an inflation adjustment to such limitation after 2010. Makes such credit refundable. Extends through 2011 the general terminating date of the Economic Growth and Tax Relief Reconciliation Act of 2001 with respect to such credit and exclusion.

patient_protection affordable care act title quality affordable health_care americans subtitle immediate improvements health_care coverage americans sec modified sec amends public_health_service_act prohibit health plan health subtitle excludes health defined section establishing lifetime limits annual limits dollar value benefits participant beneficiary january permits restricted annual limit plan years beginning prior january declares health plan shall prevented placing annual lifetime beneficiary limits covered benefits essential health benefits extent limits permitted prohibits health plan rescinding coverage enrollee case fraud intentional misrepresentation material fact requires health plans provide coverage impose cost sharing requirements specified preventive items services recommended immunizations recommended preventive care screenings women children requires health plan provides dependent coverage children coverage available unmarried adult child child turns years age requires secretary health_and_human_services hhs develop standards health plans including grandfathered health plans provide accurate summary benefits coverage explanation directs health plan prior enrollment restriction provide summary benefits coverage explanation applicant time application enrollee prior time enrollment enrollment policy certificate holder time issuance policy delivery certificate requires group health plans comply requirements relating prohibition discrimination favor highly compensated individuals requires secretary develop reporting requirements health plans benefits reimbursement structures improve health outcomes prevent hospital improve patient safety reduce medical errors promote wellness health requires health plan including grandfathered health plan submit secretary report concerning ratio incurred loss incurred claims plus loss adjustment expense change contract reserves earned premiums provide annual rebate enrollee ratio premium revenue expended issuer reimbursement clinical services provided enrollees activities improve health_care quality total premium revenue plan year large group markets small group individual markets requires hospital establish public list standard charges items services requires health plan implement effective process appeals coverage determinations claims sets forth requirements health plans related designation primary care provider coverage emergency services elimination referral requirements obstetrical care sec requires secretary award grants states offices health insurance consumer assistance health insurance ombudsman programs sec modified sec requires secretary establish process annual review unreasonable increases premiums health insurance coverage sec makes subtitle effective plan years beginning months enactment act certain exceptions subtitle immediate actions preserve expand coverage sec requires secretary establish temporary high risk health insurance pool program provide health insurance coverage eligible individuals preexisting condition terminates coverage january provides transition american_health_benefit_exchange exchange sec modified sec requires secretary establish temporary reinsurance program provide reimbursement participating employment based plans portion cost providing health insurance coverage early retirees january sec modified sec requires secretary establish mechanism including internet website resident small business state identify affordable health insurance coverage options state sec sets forth provisions governing electronic health_care transactions establishes penalties health plans failing comply requirements sec makes subtitle effective date enactment act subtitle quality health insurance coverage americans health insurance market reforms sec modified sec prohibits health plan health subtitle excludes health defined section imposing preexisting condition exclusion discriminating basis health status related factor allows premium rates vary individual family coverage rating area age tobacco use requires health plans state accept employer individual state applies coverage renew continue coverage option plan sponsor individual applicable prohibits health plan establishing individual eligibility rules based health status related factors including medical condition claims experience receipt health_care medical history genetic information evidence sets forth provisions governing wellness programs health plan including allowing cost variances coverage participation program prohibits health plan discriminating respect participation plan coverage health_care provider acting scope provider license certification applicable state law requires health plans offer health insurance coverage individual small group market ensure coverage includes essential health benefits package requires group health plan ensure annual cost sharing imposed plan exceed specified limitations prohibits health plan applying waiting period coverage exceeds days discriminating individual participation clinical trials respect treatment cancer life threatening disease condition provisions sec modified sec provides act shall construed require individual terminate coverage group health plan health insurance coverage individual enrolled date enactment act allows family members individuals currently enrolled plan enroll plan coverage enrollment permitted terms plan allows new employees families enroll group health plan provides coverage date enactment act defines grandfathered health plan group health plan health insurance coverage individual enrolled date enactment act states subtitle subtitle shall apply group health plan health insurance coverage individual enrolled date enactment act regardless individual renews coverage date enactment existing group health plan enrolls new employees section health insurance coverage maintained pursuant collective bargaining agreements employee representatives employers ratified date enactment act date collective bargaining agreements relating coverage terminates applies provisions related uniform coverage documents medical loss ratios grandfathered health plans plan years beginning enactment act sec requires uniform application standards requirements adopted states health plans applicable insurance market sec added sec directs secretary labor prepare annual report self insured group health plans self insured employers sec added sec requires hhs secretary conduct study fully insured self insured group health plan markets related financial solvency effect insurance market reforms sec modified sec sets forth effective dates specified provisions subtitle subtitle available coverage choices americans establishment qualified health plans sec modified sec defines qualified health plan require plan provides essential health benefits offers plan silver level plan gold level exchange plan offered sec modified sec requires essential health benefits package provide essential health benefits limit cost sharing directs secretary define essential health benefits include emergency services hospitalization maternity newborn care mental health substance use disorder services prescription drugs preventive wellness services chronic disease management pediatric services including oral vision care ensure scope essential health benefits equal scope benefits provided typical employer plan provide notice opportunity public comment defining essential health benefits establishes annual limit cost sharing beginning limitation deductible small group market health plan sets forth levels coverage health plans defined certain percentage costs paid plan allows health plans individual market offer catastrophic coverage individuals age certain limitations sec modified sec sets forth special rules abortion coverage including permitting states elect prohibit abortion coverage qualified health plans offered exchange state prohibiting federal funds abortion services requiring separate accounts payments services prohibits qualified health plan offered exchange discriminating individual health_care provider health_care facility unwillingness provide pay provide coverage refer abortions sec modified sec sets forth definitions terms title consumer choices insurance competition health benefit exchanges sec modified sec requires states establish american_health_benefit_exchange facilitates purchase qualified health plans provides establishment small business health options program shop exchange designed assist qualified small employers facilitating enrollment employees qualified health plans offered small group market state requires secretary establish criteria certification health plans qualified health plans including requirements meeting market requirements ensuring sufficient choice providers sets forth requirements exchange including exchange governmental agency nonprofit entity established state available health plan qualified health plan implement procedures certification health plans qualified health plans require health plans seeking certification submit justification premium increase prior implementation increase permits states require qualified health plans offer additional benefits requires states pay cost additional benefits allows state establish subsidiary exchanges geographically distinct areas certain size applies mental health parity provisions qualified health plans sec modified sec allows employer select level coverage available employees exchange allows employees choose enroll qualified health plan offers level coverage restricts health plans federal_government available members congress congressional staff effective date subtitle health plans created act offered exchange permits states allow large employers join exchange sec modified sec requires exchange accurate accounting activities receipts expenditures submit secretary annually report concerning requires secretary certain action reduce fraud abuse administration title requires comptroller_general conduct ongoing study exchange activities enrollees qualified health plans offered exchanges iii state flexibility relating exchanges sec requires secretary issue regulations setting standards related establishment operation exchanges offering qualified health plans exchanges establishment reinsurance risk adjustment programs requires secretary establish operate exchange state state operational january presume exchange operating state january insures specified percentage population meets standards section sec modified sec requires secretary establish consumer operated oriented plan program foster creation qualified nonprofit health insurance issuers offer qualified health plans individual small group markets requires secretary provide loans grants persons applying qualified nonprofit health insurance issuers sets forth provisions governing establishment operation program plans sec deleted sec sec modified sec declares health insurance coverage offered private health insurance issuer shall subject federal state laws qualified health plan offered program subject law state flexibility establish alternative programs sec modified sec requires secretary establish basic health program state enter contracts offer standard health plans providing essential health benefits eligible individuals lieu offering individuals coverage exchange sets forth requirements plan transfers funds exchange individuals state sec authorizes state apply secretary waiver specified requirements act respect health insurance coverage state plan years beginning january directs secretary provide alternative means aggregate amounts credits reductions paid behalf participants exchange paid state purposes implementing state plan sec modified sec requires secretary issue regulations creation health_care choice compacts states enter agreement qualified health plans offered individual markets states subject laws regulations state plan written issued issuer qualified health plan compact applies continue subject certain laws state purchaser resides required licensed state clearly notify consumers policy subject laws regulations state purchaser resides sets forth provisions secretary approval compacts sec added sec requires director office_of_personnel_management opm enter contracts health insurance issuers offer multistate qualified health plans exchange state provide individual group coverage implement subsection manner similar manner director implements federal_employees_health_benefits_program sets forth requirements multistate qualified health plan reinsurance risk adjustment sec modified sec directs state later january establish reinsurance entities carry reinsurance program section requires secretary establish standards enable states establish maintain reinsurance program health insurance issuers party administrators behalf group health plans required payments applicable reinsurance entity specified plan years applicable reinsurance entity uses amounts collected reinsurance payments health insurance issuers cover high risk individuals individual market directs state eliminate modify state high risk pool extent necessary carry reinsurance program established section sec requires secretary establish administer program risk corridors calendar years qualified health plan offered individual small group market shall participate payment adjusted system based ratio allowable costs plan plan aggregate premiums directs secretary payments plan allowable costs exceed target certain percentage directs plan payments secretary allowable costs target certain percentage sec requires state assess charge health plans health insurance issuers actuarial risk enrollees plans coverage year average actuarial risk enrollees plans coverage state year requires state provide payment health plans health insurance issuers actuarial risk enrollees plan coverage year greater average actuarial risk enrollees plans coverage state year excludes self insured group health plans section subtitle affordable coverage choices americans premium tax credits cost sharing reductions subpart premium tax credits cost sharing reductions sec modified section amends_the_internal_revenue_code allow individual taxpayers household income equals exceeds exceed federal poverty line determined social_security_act ssa refundable tax credit percentage cost premiums coverage qualified health plan sets forth formulae rules calculation credit amounts based taxpayer household income percentage poverty line directs comptroller_general later years enactment act conduct study report specified congressional committees affordability health insurance coverage sec requires reductions maximum limits pocket expenses individuals enrolled qualified health plans incomes poverty line subpart eligibility determinations sec requires secretary establish program verifying eligibility applicants participation qualified health plan offered exchange tax credit premium assistance based income citizenship immigration status requires exchange submit information received applicant secretary verification applicant eligibility provides confidentiality applicant information appeals redetermination process denials eligibility imposes civil penalties applicants providing false fraudulent information relating eligibility requires secretary study report congress january procedures necessary ensure protection privacy process rights making eligibility determinations act sec requires secretary establish program advance payments tax credit premium assistance reductions cost sharing prohibits federal payments tax credit cost sharing reductions individuals lawfully present united_states sec requires secretary establish system enroll state residents apply exchange state health subsidy programs including medicaid children health insurance program chip known schip residents found eligible programs screening sec requires secretary treasury disclose hhs personnel certain taxpayer information determine eligibility programs act certain social_security programs sec disregards premium assistance tax credit cost sharing reductions determining eligibility federal federally assisted programs sec added section directs hhs secretary study report congress january feasibility adjusting application federal poverty level subtitle different geographic areas united_states including territories small business tax credit sec modified section allows qualified small employers elect beginning tax credit employee health_care coverage expenses defines qualified small employer employer employees average annual compensation levels exceeding requires phase credit based employer size employee compensation subtitle shared responsibility health_care individual responsibility sec modified section requires individuals maintain minimal essential health_care coverage beginning imposes penalty failure maintain coverage beginning certain low income individuals afford coverage members indian tribes individuals suffer hardship exempts coverage requirement individuals object health_care coverage religious grounds individuals lawfully present united_states individuals incarcerated sec requires providers minimum essential coverage file informational returns providing identifying information covered individuals dates coverage requires irs send notice taxpayers enrolled minimum essential coverage services available exchange operating state employer responsibilities sec amends fair labor standards act require employers time employees automatically enroll new employees health_care plan provide notice opportunity opt coverage provide notice employees exchange availability tax credit premium assistance loss employer contribution employer provided health benefit plan employee purchases plan exchange sec modified section imposes fines large employers employers time employees fail offer time employees opportunity enroll minimum essential coverage waiting period enrollment days requires secretary labor study report congress employees wages reduced fines imposed employers sec modified section requires large employers file report secretary treasury health insurance coverage provided time employees requires reports contain certification employers provide time employees dependents opportunity enroll minimum essential coverage eligible employer sponsored plan length waiting period coverage months coverage available monthly premium lowest cost option enrollment categories plan employer share total allowed costs benefits provided plan identifying information employer time employees imposes penalty employers fail provide report authorizes secretary treasury review accuracy information provided large employers sec allows certain small employers include benefit tax exempt cafeteria plan qualified health plan offered exchange subtitle miscellaneous provisions sec applies definitions public_health_service_act related health insurance coverage title sec requires hhs secretary publish hhs website list authorities provided secretary act sec prohibits federal_government state local government health_care provider receives federal financial assistance act health plan created act discriminating individual institutional health_care entity basis individual entity provide health_care item service furnished purpose causing assisting causing death individual assisted suicide killing sec prohibits secretary promulgating regulation creates unreasonable barrier ability individuals obtain appropriate medical care impedes timely access health_care services interferes communications range treatment options patient health_care provider restricts ability health_care providers provide disclosure relevant information patients making health_care decisions violates principle informed consent ethical standards health_care professionals limits availability health_care treatment duration patient medical needs sec declares individual company business nonprofit entity health insurance issuer offering group individual health insurance coverage shall required participate federal health insurance program created expanded act prohibits penalty imposed issuer choosing participate program sec amends black lung benefits act respect claims filed effective date black lung benefits amendments eliminate exceptions applicability certain provisions rebuttable presumptions prohibition requiring eligible survivors miner determined eligible black lung benefits file new claim miner claim sec prohibits discrimination federal health program activity grounds race color national origin sex age disability sec amends fair labor standards act prohibit employer discharging discriminating employee employee received health insurance credit subsidy provides information relating violation provision act objects refuses participate activity policy practice assigned task employee reasonably believed violation act sec gives hhs_inspector general oversight authority respect administration implementation title sec declares title shall construed modify impair supersede operation antitrust laws sec amends public_health_service_act require secretary develop interoperable secure standards protocols facilitate enrollment individuals federal state health_and_human_services programs award grants develop adapt technology systems implement standards protocols sec added sec directs comptroller_general study denials health plans coverage medical services applications enroll health insurance sec added sec disallows waiver laws regulations establishing procurement requirements relating small business concerns respect contract awarded program authority act sec sic modified sec makes technical conforming amendments sec sic expresses sense senate additional surplus social_security_trust_fund generated act reserved social_security net savings generated class program established title viii act reserved program title role public programs subtitle improved access medicaid sec modified sec amends title xix medicaid ssa extend medicaid coverage beginning calendar individuals age entitled enrolled medicare incomes federal poverty line grants state option expand medicaid eligibility individuals early april provides federal_government pay cost covering newly eligible individuals increases federal medical assistance percentage fmap respect newly eligible individuals january december states meeting certain eligibility requirements requires medicaid benchmark benefits include coverage prescription drugs mental health services grants states option extend medicaid coverage individuals incomes exceed federal poverty line beginning january sec requires state use individual household modified gross income determine income eligibility medicaid non elderly individuals applying income expense disregards assets resources test exempts requirement individuals eligible medicaid program elderly social_security_disability_insurance program beneficiaries medically needy enrollees medicare_savings_program disabled sec revises state authority offer premium assistance subsidy qualified employer sponsored coverage children age extend subsidy individuals regardless age prohibits state requiring condition medicaid eligibility individual individual parent apply enrollment qualified employer sponsored coverage sec modified sec extends medicaid coverage foster care children years age sec modified sec revises requirements medicaid payments territories including increase limits payments fy2011 sec modified sec prescribes adjustment fmap determination certain states recovering major disaster sec rescinds unobligated amounts available medicaid_improvement_fund fy2014-fy2018 subtitle enhanced support children health insurance program sec modified sec amends ssa title xxi state children health insurance program chip known schip increase fy2016 fy2019 enhanced fmap states subject cap prohibits states applying end fy2019 chip eligibility standards restrictive act deems ineligible chip targeted low income children enroll chip allotments capped eligible tax credits exchanges requires secretary review benefits offered children related cost sharing imposed qualified health plans offered exchange certify plans benefits cost sharing comparable provided particular state chip plan prohibits enrollment bonus payments children enrolled chip fy2013 requires state chip plan beginning january use modified gross income household income determine chip eligibility requires state treat targeted low income child eligible chip child determined ineligible medicaid result elimination income disregard based expense type income sec makes technical corrections children health insurance program reauthorization act subtitle medicaid chip enrollment simplification sec amends ssa title xix medicaid require enrollment application simplification coordination state health insurance exchanges chip state run websites sec permits hospitals provide medicaid_services period presumptive eligibility members medicaid eligibility categories subtitle improvements medicaid_services sec requires medicaid coverage freestanding birth center services concurrent care children receiving hospice care sec gives states option extending medicaid coverage family planning services supplies presumptive eligibility period categorically needy group individuals subtitle new options states provide long term services supports sec authorizes states offer home community based attendant services supports medicaid beneficiaries disabilities require care hospital nursing facility intermediate care facility mentally retarded institution mental diseases sec gives states option providing home community based services individuals eligible services waiver offering home community based services specific targeted populations creates optional eligibility category provide medicaid benefits individuals receiving home community based services state plan amendment sec amends deficit reduction act extend fy2016 money follows person demonstration reduce days institutional residency period sec applies medicaid eligibility criteria recipients home community based services calendar way protect spousal impoverishment sec makes appropriations fy2010 fy2014 secretary acting assistant secretary aging expand state aging_and_disability_resource_centers sec expresses sense senate session congress congress address long term services supports comprehensive way guarantees elderly disabled individuals care need long term services supports available community addition institutions subtitle medicaid prescription drug coverage sec amends ssa title xix medicaid increase minimum rebate percentage single source drugs innovator multiple source drugs increase rebate drugs require contracts medicaid managed care organizations extend prescription drug rebates discounts enrollees provide additional rebate new formulations existing drugs set maximum rebate sec eliminates exclusion medicaid coverage extending coverage certain drugs promote smoking cessation benzodiazepines sec revises requirements respect pharmacy reimbursements subtitle medicaid disproportionate share hospital dsh payments sec modified sec reduces state disproportionate share hospital dsh allotments hawaii state rate decreases depending spent allotments average fy2004 fy2008 requires reduction low dsh states depending spent allotments average fy2004 fy2008 prescribes allotment reduction requirements subsequent fiscal years revises dsh allotments hawaii quarters fy2012 fy2013 succeeding fiscal years subtitle improved coordination dual eligible beneficiaries sec declares medicaid waiver individuals dually eligible medicaid medicare conducted period years year extension state request secretary determines specified reasons sec directs secretary establish federal coordinated health_care office bring officers employees medicare medicaid programs centers medicare medicaid_services cms integrate medicaid medicare benefits effectively improve coordination federal_government states dual eligible individuals ensure access items services entitled subtitle improving quality medicaid patients providers sec amends ssa title modified direct secretary identify publish recommended core set adult health quality measures medicaid eligible adults establish medicaid quality measurement program sec requires secretary identify current state practices prohibit payment health_care acquired conditions incorporate elements appropriate application regulations medicaid program requires regulations prohibit payments states amounts expended providing medical assistance specified health_care acquired conditions sec gives states option provide coordinated care health home individuals chronic conditions authorizes secretary award planning grants states develop state plan amendment effect sec directs secretary establish demonstration project evaluate use bundled payments provision integrated care medicaid beneficiary respect episode care includes hospitalization concurrent physicians services provided hospitalization sec requires secretary establish medicaid global payment system demonstration project participating state shall adjust payments eligible safety net hospital network fee service payment structure global capitated payment model authorizes appropriations sec directs secretary establish pediatric accountable care organization demonstration project authorize participating state allow pediatric medical providers meeting specified requirements recognized accountable care organization purpose receiving specified incentive payments authorizes appropriations sec requires secretary establish year medicaid emergency psychiatric demonstration project makes appropriations fy2011 subtitle improvements medicaid chip payment access commission sec revises requirements respect medicaid chip payment access commission medicare_payment_advisory_commission medpac including membership topics reviewed medpac review medicaid trends spending utilization financial performance requires medpac consult related issues makes appropriations fy2010 subtitle protections american indians alaska_natives sec sets forth special rules relating indians declares health programs operated indian_health_service ihs indian tribes tribal organizations urban indian organizations shall payer resort services provide eligible individuals makes organizations express lane agencies determining medicaid chip eligibility sec makes permanent requirement secretary reimburse certain indian hospitals clinics medicare services subtitle maternal child health services sec amends ssa title maternal child health services direct secretary grants eligible entities early childhood home visitation programs makes appropriations fy2010 fy2014 sec encourages secretary continue activities postpartum depression postpartum including research expand understanding causes treatment authorizes secretary grants eligible entities projects establish operate coordinate effective cost efficient systems delivery essential services individuals risk postpartum conditions families authorizes appropriations fy2010 fy2012 sec modified sec directs secretary allot funds states award grants local organizations specified entities carry personal responsibility education programs educate adolescents abstinence contraception prevention pregnancy sexually transmitted infections certain adulthood preparation subjects makes appropriations fy2010 fy2014 sec makes appropriations fy2010 fy2014 abstinence education sec requires case review system children aging foster care independent living programs include information importance having health_care power attorney transition planning title iii improving quality efficiency health_care subtitle transforming health_care delivery system linking payment quality outcomes medicare program sec amends ssa title xviii medicare direct secretary establish hospital value based purchasing program value based incentive payments fiscal year hospitals meet specified performance standards certain performance period directs secretary establish value based purchasing demonstration programs inpatient critical access hospital services hospitals excluded program insufficient numbers measures cases sec extends authority incentive payments physician quality reporting system prescribes incentive penalty providers report quality measures satisfactorily beginning requires secretary integrate reporting quality measures reporting requirements meaningful use electronic health records sec requires specified new types reports data analysis physician feedback program sec requires long-term_care hospitals inpatient rehabilitation hospitals starting rate year submit data specified quality measures requires reduction annual update entities comply sec directs secretary starting fy2014 establish quality reporting programs inpatient cancer hospitals exempt prospective payment system sec modified sec directs secretary develop plan implement value based purchasing programs medicare payments skilled nursing facilities snfs home health agencies ambulatory surgical centers sec directs secretary establish value based payment physician fee schedule based quality care furnished compared cost sec subjects hospitals penalty adjustment hospital payments high rates hospital acquired conditions national strategy improve health_care quality sec modified sec amends public_health_service_act direct secretary transparent collaborative process establish national strategy quality improvement health_care services patient health outcomes population health taking consideration certain limitations use comparative effectiveness data sec directs president convene interagency_working_group health_care quality sec modified sec directs secretary triennially identify gaps quality measures exist existing quality measures need improvement updating expansion consistent national strategy use federal health programs directs secretary award grants contracts intergovernmental agreements eligible entities purposes developing improving updating expanding quality measures requires secretary develop update periodically provider level outcome measures hospitals physicians appropriate providers sec modified sec requires convening multi stakeholder groups provide input selection quality efficiency measures sec modified sec directs secretary establish overall strategic framework carry public reporting performance information collect aggregate consistent data quality resource use measures information systems support health_care delivery authorizes secretary award grants purpose directs secretary available public standardized internet websites performance information summarizing data quality measures iii encouraging development new patient care models sec modified sec creates cms center medicare medicaid_innovation test innovative payment service delivery models reduce program expenditures preserving enhancing quality care furnished individuals makes appropriations fy2010 fy2019 sec modified sec directs secretary establish shared savings program promotes accountability patient population coordinates items services medicare parts encourages investment infrastructure care processes high quality efficient service delivery sec modified sec directs secretary establish pilot program integrated care involving payment bundling episode care provided applicable beneficiary hospitalization order improve coordination quality efficiency health_care services sec directs secretary conduct demonstration program test payment incentive service delivery model utilizes physician nurse practitioner directed home based primary care teams designed reduce expenditures improve health outcomes provision items services applicable beneficiaries sec modified sec requires secretary establish hospital reduction program involving certain payment adjustments effective discharges october certain potentially preventable medicare inpatient hospital directs secretary available program hospitals high severity adjusted rate improve rates use patient safety organizations sec directs secretary establish community based care transitions program provides funding eligible entities furnish improved care transitions services high risk medicare beneficiaries sec amends deficit reduction act extend certain gainsharing demonstration projects fy2011 subtitle improving medicare patients providers ensuring beneficiary access physician care services sec deleted section sec extends calendar floor geographic indexing adjustments work portion physician fee schedule revises requirements calculation practice expense portion geographic adjustment factor applied fee schedule area services furnished directs secretary analyze current methods establishing practice expense geographic adjustments appropriate adjustments new methodology adjustments subsequent years sec extends process allowing exceptions limitations medically necessary therapy caps december sec amends medicare medicaid schip benefits improvement protection act extend january exception payment rule permits laboratories receive direct medicare reimbursement providing technical component certain physician_pathology_services certain rural hospitals sec modified sec amends ssa title xviii medicare extend bonus increased payments ground ambulance services january amends medicare_improvements_for_patients_and_providers_act extend payment certain urban air ambulance services january sec modified sec amends medicare medicaid schip extension act modified american_recovery_and_reinvestment_act extend years certain payment rules long-term_care hospital services certain moratorium establishment certain hospitals facilities sec amends extend physician fee schedule mental health add payment provision december sec allows physician assistant employment relationship snf working collaboration physician certify need post hospital extended care services medicare payment purposes sec amends title xviii modified exempt certain pharmacies accreditation requirements secretary develops pharmacy specific standards sec creates special enrollment period military retirees spouses including widowers dependent children eligible tricare health_care plan department_of_defense dod entitled medicare hospital insurance based disability end stage renal disease declined medicare supplementary_medical_insurance sec sets payments dual energy ray absorptiometry services reimbursement rates directs secretary arrange institute_of_medicine_of_the_national_academies study report secretary congress ramifications medicare reimbursement reductions services beneficiary access bone mass measurement benefits sec eliminates funding medicare_improvement_fund fy2014 sec directs secretary conduct demonstration project medicare separate payments complex diagnostic laboratory tests provided individuals sec increases fee schedule provided service performed physician fee schedule certified midwife services provided january rural protections sec extends hold harmless provisions prospective payment system hospital outpatient department services removes bed limitation sole community hospitals hospitals receive increase payment difference sec amends medicare_prescription_drug improvement modernization act modified federal law extend july july reasonable cost reimbursement clinical diagnostic laboratory service qualifying rural hospitals beds sec modified sec extends rural community hospital demonstration program additional years expands maximum number participating hospitals number demonstration states low population sec extends medicare dependent hospital program fy2012 sec modified sec modifies medicare inpatient hospital payment adjustment low volume hospitals fy2011 fy2012 sec revises requirements demonstration project community health integration models certain rural counties allow additional counties physicians participate sec directs medpac study report congress adequacy payments items services furnished service providers suppliers rural areas medicare program sec allows critical access hospital continue eligible receive reasonable costs providing outpatient care regardless eligible billing method hospital uses qualifying ambulance services sec extends fy2012 flex grants medicare rural hospital flexibility program allows use grant funding assist small rural hospitals participate delivery system reforms iii improving payment accuracy sec modified sec requires secretary starting home health payments appropriate percentage things reflect number mix level intensity home health services episode average cost providing care directs secretary study report congress home health agency costs involved providing ongoing access care low income medicare beneficiaries beneficiaries medically underserved areas treating beneficiaries varying levels severity illness authorizes medicare demonstration project based study results sec requires secretary january begin collecting additional data information needed revise payments hospice care directs secretary earlier october implement regulation budget neutral revisions methodology determining hospice payments routine home care services include diem payments reflecting changes resource intensity providing care services course entire episode hospice care requires secretary impose new requirements hospice providers participating medicare including requirements hospice physician nurse practitioner face face encounter individual eligibility recertification medical review stays exceeding days number cases exceeds specified percentage hospice programs sec modified sec specifies reductions medicare dsh payments fy2015 ensuing fiscal years especially subsection hospitals reflect lower uncompensated care costs relative increases number subsection hospital acute care hospital particularly receives payments medicare inpatient prospective payment system providing covered inpatient services eligible beneficiaries sec directs secretary periodically identify physician services potentially misvalued appropriate adjustments relative values services medicare physician fee schedule sec increases presumed utilization rate calculating payment advanced imaging equipment low tech imaging ultrasound rays increases technical component payment discount sequential imaging services contiguous body parts visit sec restricts lump sum payment option new replacement chairs complex rehabilitative power driven wheelchairs eliminates lump sum payment option power driven wheelchairs makes rental payment power driven wheelchairs purchase price months instead purchase price remaining months rental period instead sec modified sec amends tax relief health_care act modified federal law extend section hospital reclassifications september special rule fy2010 section refers section medicare modernization act allows temporary reclassification hospital low medicare area wage index reimbursement purposes nearby location higher medicare area wage index section hospital receive higher medicare reimbursement rate directs secretary report congress plan reform hospital wage index system sec requires secretary determine outpatient costs incurred inpatient prospective payment system exempt cancer hospitals including drugs biologicals respect medicare ambulatory payment classification groups exceed costs incurred hospitals reimbursed outpatient prospective payment system requires secretary provide appropriate adjustment reflect higher costs services furnished january sec allows biosimilar biological product reimbursed average sales price brand biological product sec directs secretary establish medicare hospice concurrent care demonstration program medicare beneficiaries furnished period hospice care medicare items services medicare funds paid hospice programs sec requires application budget neutrality requirement associated effect imputed rural floor area wage index balanced_budget act uniform national instead state state adjustment area hospital wage index floor sec directs secretary study report congress need additional payment urban medicare dependent hospitals inpatient hospital services medicare sec declares act shall result reduction guaranteed home health benefits medicare program subtitle provisions relating sec modified sec bases medicareadvantage benchmark average bids plans market revises formula calculating annual capitation rate reduce national capita growth percentage increase benchmarks increases monthly plan rebates average capita savings requires bid information plans required submit secretary certified member american academy meet actuarial guidelines rules established secretary directs secretary acting cms chief actuary establish actuarial guidelines submission bid information bidding rules appropriate ensure accurate bids fair competition plans directs secretary establish new payment areas urban areas based core based statistical area monthly care coordination management performance bonus payments quality performance bonus payments quality bonuses new low enrollment plans plans meet certain criteria directs secretary provide transitional rebates provision extra benefits enrollees sec prohibits plans charging beneficiaries cost sharing chemotherapy administration services renal dialysis services skilled nursing care greater charged traditional fee service program requires plans apply rebates bonuses supplemental premiums according following order reduction cost sharing coverage preventive care wellness benefits benefits covered original medicare fee service program sec requires secretary analyze differences coding patterns original medicare fee service programs authorizes secretary incorporate results analysis risk scores subsequent years sec allows beneficiaries plan return traditional medicare fee service program january march year revises requirements annual beneficiary election periods sec amends ssa title xviii medicare modified extend special needs plan authority december authorizes secretary establish payment adjustment pace payment rules fully integrated dual eligible extends authority calendar contracts state medicaid programs continue operate expand service areas directs secretary require organization offering specialized plan special needs individuals approved national committee quality assurance requires secretary use risk score reflecting known underlying risk profile chronic health status similar individuals instead default risk score new enrollees plans specialized sec extends calendar length time reasonable cost plans continue operating regardless plans serving area sec creates new type plan called senior housing facility plan allowed limit service area senior housing facility continuing care retirement community geographic area sec declares secretary required accept bid submitted plan medicare prescription drug plan proposes increase significantly beneficiary cost sharing decrease benefits offered sec directs secretary request national_association_of_insurance_commissioners naic develop new standards certain medigap plans subtitle medicare improvements prescription drug plans ma-pd plans sec amends medicare voluntary prescription drug benefit program establish conditions availability coverage drugs requires manufacturer participate medicare coverage gap discount program directs secretary establish program sec excludes rebate amounts quality bonus payments calculation regional low income subsidy benchmark premium monthly prescription drug beneficiaries sec directs secretary permit prescription drug plan ma-pd plan waive monthly beneficiary premium subsidy eligible individual premium minimis provides premium waived secretary shall reassign subsidy eligible individuals enrolled plan plans based fact monthly beneficiary premium plan greater low income benchmark premium authorizes secretary auto enroll subsidy eligible individuals plans waive minimis premiums sec sets forth special rule widows widowers eligibility low income assistance allows surviving spouse eligible couple delay redetermination eligibility year death spouse sec directs secretary case subsidy eligible individual enrolled prescription drug plan subsequently reassigned secretary new prescription drug plan provide individual information formulary differences individual plan new plan respect individual drug description individual right request coverage determination exception reconsideration bring appeal resolve grievance sec amends provide additional funding fy2010 fy2012 outreach education activities related specified medicare low income assistance programs sec authorizes secretary identify classes clinical concern rulemaking including antidepressants treatment transplant rejection requires prescription drug plan sponsors include drugs classes formularies sec requires enrollees exceed certain income thresholds pay higher premiums revises current authority irs disclose income information social_security_administration purposes adjusting subsidy sec eliminates cost sharing certain dual eligible individuals receiving care home community based waiver program require institutional care sec directs secretary require sponsors prescription drug plans utilize specific uniform techniques dispensing covered drugs enrollees reside long-term_care facility order reduce waste associated day sec directs secretary develop maintain easy use complaint system collect maintain information ma-pd plan prescription drug complaints received secretary complaint resolved sec requires prescription drug plan sponsor use single uniform exceptions appeals process determination plan enrollee prescription drug coverage provide instant access process toll free telephone number internet website sec requires hhs_inspector general study report congress inclusion formularies drugs commonly dual eligibles prescription drug prices medicare medicaid sec allows costs incurred aids drug assistance programs ihs providing prescription drugs count annual pocket threshold sec increases standard initial coverage limit decreasing time enrollee coverage gap subtitle ensuring medicare sustainability sec modified sec sec revises certain market basket updates incorporates productivity adjustment updates incorporate adjustments including inpatient hospitals home health providers nursing homes hospice providers inpatient psychiatric facilities long-term_care hospitals inpatient rehabilitation facilities providers establishes quality measure reporting program psychiatric hospitals beginning fy2014 sec revises requirements reduction medicare premium subsidy based income maintains current income thresholds period sec modified sec establishes independent_payment_advisory_board develop submit detailed proposals reduce capita rate growth medicare spending president congress consider establishes consumer advisory_council advise board impact payment policies title consumers subtitle health_care quality improvements sec amends public_health_service_act direct center quality improvement patient safety agency healthcare_research_and_quality ahrq conduct support activities best practices delivery health_care services support research development tools facilitate adoption best practices improve quality safety efficiency health_care delivery services authorizes appropriations fy2010 fy2014 requires ahrq director ahrq center quality improvement patient safety award grants contracts eligible entities provide technical support implement models practices identified research conducted center sec modified sec directs secretary establish program provide grants enter contracts eligible entities establish community based interdisciplinary teams support primary care practices including obstetrics gynecology practices hospital service areas served eligible entities sec directs secretary acting patient safety research_center establish program provide grants contracts eligible entities implement medication management services provided licensed pharmacists collaborative multidisciplinary inter professional approach treatment chronic diseases targeted individuals improve quality care reduce overall cost treatment disease sec directs secretary acting assistant secretary preparedness response award multiyear contracts competitive grants eligible entities support pilot projects design implement evaluate innovative models comprehensive accountable emergency care trauma systems requires secretary support federal programs administered national_institutes_of_health nih ahrq health_resources_and_services_administration hrsa cms agencies involved improving emergency care system expand accelerate research emergency medical care systems emergency medicine directs secretary support federal programs administered agencies coordinate expand research pediatric emergency medical care systems pediatric emergency medicine authorizes appropriations fy2010 fy2014 sec requires secretary establish programs award grants qualified public nonprofit ihs indian tribal urban indian trauma centers assist defraying substantial uncompensated care costs core missions trauma centers including addressing costs associated patient stabilization transfer provide emergency relief ensure continued future availability trauma services authorizes appropriations fy2010 fy2015 directs secretary provide funding states enable award grants eligible entities trauma services authorizes appropriations fy2010 fy2015 sec directs secretary establish program award grants contracts develop update produce patient decision aids assist health_care providers patients establish program provide phased development implementation evaluation shared decision making patient decision aids meet objective improving understanding patients medical treatment options award grants establishment support shared decisionmaking resource centers authorizes appropriations fy2010 subsequent fiscal years sec requires secretary acting commissioner food_and_drugs determine addition quantitative summaries benefits risks prescription drugs standardized format promotional labeling print advertising drugs improve heath care decisionmaking clinicians patients consumers sec authorizes secretary award grants eligible entities consortia carry demonstration projects develop implement academic curricula integrate quality improvement patient safety clinical education health professionals sec establishes office women health office_of_the_secretary office_of_the_director centers_for_disease_control_and_prevention cdc office ahrq director office administrator hrsa office_of_the_commissioner food_and_drugs authorizes appropriations fy2010 fy2014 offices women health sec extends years years duration patient navigator grant prohibits secretary awarding grant recipient entity provides assurances patient navigators recruited assigned trained employed grant funds meet minimum core tailored main focus intervention navigator involved authorizes appropriations fy2010 fy2015 sec authorizes appropriations carry title provided title sec added sec directs comptroller_general study report congress development recognition implementation guideline standards specified provisions act result establishment new cause action claim subtitle protecting improving guaranteed medicare benefits sec provides act shall result reduction guaranteed benefits medicare program states savings generated medicare program act shall extend solvency medicare trust funds reduce medicare premiums cost sharing beneficiaries improve expand guaranteed medicare benefits protect access medicare providers sec declares act shall result reduction elimination benefits guaranteed law participants plans title prevention chronic disease improving public health subtitle modernizing disease prevention public health systems sec modified sec requires president establish national prevention health promotion public health council establish advisory group prevention health promotion integrative public health appoint surgeon general chairperson council order develop national prevention health promotion public health strategy requires secretary comptroller_general conduct periodic reviews evaluations federal disease prevention health promotion initiative program agency sec modified sec establishes prevention_and_public_health_fund provide expanded sustained national investment prevention public health programs improve health help restrain rate growth private public sector health_care costs authorizes appropriations appropriates money fund sec requires currently allows director ahrq convene preventive services task_force review scientific evidence related effectiveness appropriateness cost effectiveness clinical preventive services purpose developing recommendations health_care community requires director cdc convene independent community preventive services task_force review scientific evidence related effectiveness appropriateness cost effectiveness community preventive interventions purpose developing recommendations individuals organizations delivering populations based services policy makers sec modified sec requires secretary provide planning implementation national public private partnership prevention health promotion outreach education campaign raise public awareness health improvement life span requires secretary acting director cdc establish implement national science based media campaign health promotion disease prevention enter contract development operation federal website personalized prevention plan tool subtitle increasing access clinical preventive services sec modified sec requires secretary establish program award grants eligible entities support operation school based health centers sec requires secretary acting director cdc carry oral health activities including establishing national public education campaign focused oral health_care prevention education awarding demonstration grants research based dental caries disease management activities awarding grants development school based dental programs entering cooperative agreements state territorial indian tribes tribal organizations oral health data collection interpretation delivery system oral health science based programs improve oral health requires secretary update improve pregnancy risk assessment monitoring system relates oral health_care develop oral health_care components inclusion national health nutrition examination survey ensure medical expenditures panel survey ahrq includes verification dental utilization expenditure coverage findings conduct look analysis sec modified sec amends ssa title xviii medicare provide coverage personalized prevention plan services including health risk assessment individuals prohibits cost sharing services sec modified sec eliminates cost sharing certain preventive services recommended united_states_preventive_services_task_force sec authorizes secretary modify medicare coverage preventive service consistent recommendations task_force sec amends ssa title xix medicaid provide medicaid coverage preventive services approved vaccines increases fmap services vaccines sec provides medicaid coverage counseling cessation tobacco use pregnant women sec requires secretary award grants states carry initiatives provide incentives medicaid beneficiaries participate programs lower health risk demonstrate changes health risk outcomes subtitle creating healthier communities sec modified sec requires secretary acting director cdc award grants state local governmental agencies community based organizations implementation evaluation dissemination evidence based community preventive health activities order reduce chronic disease rates prevent development secondary conditions address health disparities develop stronger evidence base effective prevention programming sec requires secretary acting director cdc award grants state local health departments indian tribes carry pilot programs provide public health community interventions screenings clinical referrals individuals years age requires secretary conduct evaluation community based prevention wellness programs develop plan promoting healthy lifestyles chronic disease self management medicare beneficiaries evaluate community prevention wellness programs demonstrated potential help medicare beneficiaries reduce risk disease disability injury making healthy lifestyle choices sec amends rehabilitation act require architectural_and_transportation_barriers_compliance_board promulgate standards setting forth minimum technical criteria medical diagnostic equipment medical settings ensure equipment accessible usable individuals accessibility needs sec authorizes secretary negotiate enter contracts vaccine manufacturers purchase delivery vaccines adults allows state purchase additional quantities adult vaccines manufacturers applicable price negotiated secretary requires secretary acting director cdc establish demonstration program award grants states improve provision recommended immunizations children adults use evidence based population based interventions high risk populations reauthorizes appropriations preventive health service programs children adults vaccine preventable diseases charge requires comptroller_general study ability medicare beneficiaries years older access routinely recommended vaccines covered prescription drug program establishment sec amends federal food drug cosmetic act require labeling food item offered sale retail food establishment chain locations disclose menu menu board number calories contained standard menu item suggested daily caloric intake availability premises request specified additional nutrient information requires self service facilities place adjacent food offered sign lists calories displayed food item serving requires vending machine operators operate vending machines provide sign disclosing number calories contained article food sec requires secretary establish pilot program test impact providing risk populations utilize community health centers individualized wellness plan designed reduce risk factors preventable conditions identified comprehensive risk factor assessment sec amends fair labor standards act require employers provide reasonable break time suitable place bathroom employee express breast milk nursing child excludes employer fewer employees requirements impose undue hardship subtitle support prevention public health innovation sec requires secretary acting director cdc provide funding research area public health services systems sec requires secretary ensure federally supported health_care public health program activity survey collects reports specified demographic data health disparities requires secretary acting national coordinator health information technology develop national standards management data collected interoperability security systems data management sec modified sec requires director cdc provide employers technical assistance consultation tools resources evaluating employer based wellness programs build evaluation capacity workplace staff training employers evaluate wellness programs ensuring evaluation resources technical assistance consultation available requires director cdc conduct national worksite health policies programs survey assess employer based health policies programs sec requires secretary acting director cdc establish epidemiology laboratory capacity grant program award grants assist public health agencies improving surveillance response infectious diseases conditions public health importance sec requires secretary enter agreement institute_of_medicine convene conference pain purposes shall include increase recognition pain significant public health problem united_states establish interagency pain research coordinating committee sec appropriates funds carry childhood obesity demonstration projects subtitle miscellaneous provisions sec requires secretary evaluate programs determine existing federal health wellness initiatives effective achieving stated goals title health_care workforce subtitle purpose definitions sec declares purpose title improve access delivery health_care services individuals particularly low income underserved uninsured minority health disparity rural populations subtitle innovations health_care workforce sec modified sec establishes national_health_care_workforce_commission review current projected health_care workforce supply demand recommendations congress administration concerning national health_care workforce priorities goals policies sec establishes health_care workforce development grant program sec requires secretary establish national center health_care workforce analysis provide development information describing analyzing health_care workforce workforce related issues transfers responsibilities resources national center health workforce analysis center created section sec added sec establishes interagency access health_care alaska task_force assess access health_care beneficiaries federal health_care systems alaska develop strategy improve delivery beneficiaries subtitle increasing supply health_care workforce sec revises student loan repayment provisions related length service requirement primary health_care loan repayment program sec increases maximum loans schools nursing students sec directs secretary establish carry pediatric specialty loan repayment program sec requires secretary establish public health workforce loan repayment program assure adequate supply public health professionals eliminate critical public health workforce shortages federal state local tribal public health agencies sec amends higher education act expand student loan forgiveness include allied health professionals employed public health agencies sec includes public health workforce loan repayment programs permitted activities grant program increase number individuals public health workforce authorizes secretary provide scholarships mid career professionals public health allied health workforce receive additional training field public health allied health sec authorizes appropriations national_health_service_corps_scholarship_program national_health_service_corps_loan_repayment_program sec requires secretary award grants cost operation nurse managed health clinics sec eliminates cap number commissioned officers public_health_service regular_corps sec revises regular_corps reserve corps renamed ready_reserve corps public_health_service sets forth uses ready_reserve corps subtitle enhancing health_care workforce education training sec sets forth provisions providing health_care professional training programs sec requires secretary award grants new training opportunities direct care workers employed long-term_care settings sec sets forth provisions providing dentistry professional training programs sec authorizes secretary award grants demonstration programs establish training programs alternative dental health_care providers order increase access dental health services rural underserved communities sec requires secretary award grants contracts entities operate geriatric education center offer short term intensive courses focus geriatrics chronic care management long-term_care expands geriatric faculty fellowship programs dentists eligible reauthorizes revises geriatric education programs allow grant funds establishment traineeships individuals preparing advanced education nursing degrees areas specialize care elderly populations sec authorizes secretary award grants institutions higher education support recruitment students education clinical experience students social work programs psychology programs child adolescent mental health training paraprofessional child adolescent mental health workers sec authorizes secretary acting administrator hrsa award grants contracts cooperative agreements development evaluation dissemination research demonstration projects model curricula health professions training cultural competency prevention public health proficiency reducing health disparities working individuals disabilities sec requires nurse programs order eligible advanced education nursing grants objective education midwives accredited american college nurse midwives accreditation commission education sec authorizes secretary award grants enter contracts enhance nursing workforce initiating maintaining nurse retention programs sec makes nurse faculty accredited school nursing eligible nursing education loan repayment program sec revises nurse faculty loan repayment program including increase loans authorizes secretary acting administrator hrsa enter agreement repayment education loans exchange service member faculty accredited school nursing sec authorizes appropriations carrying nursing workforce programs sec modified sec requires director cdc award grants eligible entities promote positive health behaviors outcomes populations medically underserved communities use community health workers sec authorizes secretary carry activities address documented workforce shortages state local health departments critical areas applied public health epidemiology public health laboratory science informatics sec authorizes establishment united_states public health sciences track authorized award advanced degrees public health epidemiology emergency preparedness response directs surgeon general develop integrated longitudinal plan health professions continuing education faculty development programs curricula decentralized venues health_care balance urban tertiary inpatient venues sec added sec requires secretary establish training demonstration program family nurse practitioners employ provide year training nurse practitioners serving primary care providers federally qualified health centers nurse managed health centers subtitle supporting existing health_care workforce sec revises allocation funds assist schools supporting programs excellence health professions education underrepresented minority individuals schools designated centers_of_excellence sec modified sec makes schools offering physician assistant education programs eligible loan repayment health profession faculty increases loan repayment program authorizes appropriations scholarships disadvantaged students attending health professions nursing schools loan repayment health professions faculty grants health professions school assist individuals disadvantaged backgrounds sec requires secretary awards area health education center programs provide timely dissemination research findings relevant resources sec makes revisions grant program increase nursing education opportunities individuals disadvantaged backgrounds include providing stipends diploma associate degree nurses enter bridge degree completion program student scholarships stipends accelerated nursing degree programs advanced education preparation sec modified sec requires secretary acting director ahrq establish primary care extension program provide support assistance educate primary care providers preventive medicine health promotion chronic disease management mental behavioral health services evidence based evidence informed therapies techniques requires secretary award grants states establishment primary care extension program state hubs coordinate state health_care functions quality improvement organizations area health education centers subtitle strengthening primary care workforce improvements sec modified sec requires medicare incentive payments primary care practitioners providing primary care services january january general surgeons performing major surgical procedures january january health professional shortage area sec deleted sec sec unused residency positions qualifying hospitals primary care residents purposes payments hospitals graduate medical education costs sec revises provisions related graduate medical education costs count time residents spend settings time equivalency hospital incurs costs stipends fringe benefits residents time sec modified sec includes determination time equivalency graduate medical education costs time spent intern resident approved medical residency training program setting primarily engaged furnishing patient care care activities sec directs secretary hospital approved medical residency program closes increase resident limit hospitals based proximity criteria sec requires secretary award grants demonstration projects designed provide certain low income individuals opportunity obtain education training health_care occupations pay expected experience labor shortages high demand award grants states conduct demonstration projects purposes developing core training competencies certification programs personal home care aides authorizes appropriations fy2009 fy2012 family family health information centers sec authorizes secretary award grants teaching health centers purpose establishing new accredited expanded primary care residency programs allows time spent teaching member national_health_service_corps considered clinical practice purposes fulfilling service obligation requires secretary payments direct indirect expenses qualified teaching health centers expansion establishment approved graduate medical residency training programs sec requires secretary establish graduate nurse education demonstration hospital receive payment hospital reasonable costs provision qualified clinical training advance practice nurses subtitle improving access health_care services sec reauthorizes appropriations health centers serve medically underserved populations sec requires secretary establish negotiated rulemaking process comprehensive methodology criteria designation medically underserved populations health professions shortage areas sec reauthorizes appropriations fy2010 fy2014 expansion improvement emergency medical services children need treatment trauma critical care sec authorizes secretary acting administrator substance_abuse_and_mental_health_services_administration award grants cooperative agreements demonstration projects provision coordinated integrated services special populations location primary specialty care services community based mental behavioral health settings sec establishes commission key national indicators conduct comprehensive oversight newly established key national indicators system recommendations improve system directs national_academy_of_sciences enable establishment system creating institutional capability partnering independent private nonprofit organization implement system directs comptroller_general study previous work conducted public agencies private organizations foreign countries respect best practices systems sec added sec authorizes state award grants health_care providers treat high percentage medically underserved populations special populations state subtitle general_provisions sec requires secretary submit appropriate congressional committees report activities carried title effectiveness activities title transparency program integrity subtitle physician ownership transparency sec modified sec amends ssa title xviii medicare prohibit physician owned hospitals provider agreement august participate medicare allows participation medicare rural provider hospital exception ownership investment prohibition meet certain requirements addressing conflict interest bona fide investments patient safety issues expansion limitations sec amends ssa title require drug device biological medical supply manufacturers report secretary transfers value physician physician medical practice physician group practice teaching hospital information physician ownership investment interest manufacturer provides penalties noncompliance preempts duplicative state local laws sec amends ssa title xviii medicare respect medicare office ancillary exception prohibition physician self referrals require referring physician inform patient writing patient obtain specified imaging service person referring physician physician member group practice referring physician individual directly supervised physician physician group practice requires referring physician provide patient written list suppliers furnish services area patient resides sec amends ssa title require prescription drug manufacturers authorized distributors record report secretary specified information pertaining drug samples sec amends ssa title require pharmacy benefit manager pbm health benefits plan manages prescription drug coverage contract medicare exchange health plan report secretary information generic dispensing rate rebates discounts price concessions negotiated pbm payment difference health plans pharmacies subtitle nursing home transparency improvement improving transparency information sec amends ssa title require snfs medicare nursing facilities nfs medicaid available request secretary hhs_inspector general states state long-term_care ombudsman information ownership snf including description facility governing body organizational structure information additional parties sec requires snfs nfs operate compliance ethics program effective preventing detecting criminal civil administrative violations directs secretary establish implement quality assurance performance improvement program snfs nfs including multi unit chains facilities sec amends ssa title xviii medicare require secretary publish nursing home compare medicare website standardized staffing data links state websites state survey certification programs model standardized complaint form summary substantiated complaints number adjudicated instances criminal violations facility employees sec requires snfs report separately expenditures wages benefits direct care staff breaking registered nurses licensed professional nurses certified nurse assistants medical therapy staff sec requires secretary develop standardized complaint form use residents person acting behalf filing complaints state survey certification agency state long-term_care ombudsman program requires states establish complaint resolution processes sec amends ssa title require secretary develop program facilities report direct care staffing information payroll verifiable data uniform format based sec requires comptroller_general study report congress star quality rating system nursing homes cms targeting enforcement sec amends ssa title xviii medicare authorize secretary reduce civil monetary penalties certain snfs nfs self report promptly correct deficiencies calendar days imposition penalty directs secretary issue regulations providing informal dispute resolution process imposition penalty escrow account money penalties pending resolution appeals sec directs secretary establish demonstration project developing testing implementing national independent monitor program oversee interstate large intrastate chains snfs nfs sec requires administrator snf preparing close notify writing residents legal representatives residents responsible parties secretary state long-term_care ombudsman program advance closure days requires notice include plan transfer adequate relocation residents facility alternative setting requires state ensure successful relocation residents sec requires secretary conduct based demonstration projects develop best practice models areas facilities involved movement use information technology improve resident care iii improving staff training sec requires snfs nfs include dementia management abuse prevention training pre employment initial training appropriate ongoing service training permanent contract agency staff subtitle nationwide program national state background checks direct patient access employees long term care facilities providers sec requires secretary establish nationwide program national state background checks prospective direct patient access employees long-term_care facilities providers subtitle patient centered outcomes research sec modified sec amends ssa title establish patient centered outcomes research institute identify priorities establish update carry national comparative outcomes research project agenda provides peer_review process primary research prohibits institute allowing subsequent use data original research work hire contracts individuals entities instrumentalities financial interest results approved institute data use agreement amends public_health_service_act direct office communication knowledge transfer ahrq disseminate broadly research findings published institute government funded research relevant comparative clinical effective research prohibits secretary evidence findings institute research determination medicare coverage use transparent process includes public comment considers effect subpopulations amends_the_internal_revenue_code establish treasury patient centered outcomes research trust_fund directs secretary transfers trust_fund medicare trust funds imposes annual fees times number insured lives specified health insurance policy self insured health plans sec terminates federal coordinating council comparative effectiveness research enactment act subtitle medicare medicaid chip program integrity provisions sec modified sec amends ssa title xviii medicare require secretary establish procedures screening providers suppliers participating medicare medicaid chip determine level screening according risk fraud waste abuse respect category provider supplier requires providers suppliers applying enrollment enrollment medicare medicaid chip disclose current previous affiliations provider supplier debt payments suspended excluded participating federal health_care program billing privileges revoked authorizes secretary deny enrollment program affiliations pose undue risk requires providers suppliers establish compliance program containing specified core elements directs cms administrator establish process making available state agency responsibility administering state medicaid plan child health plan ssa title xxi identity provider supplier medicare chip terminated sec requires cms include integrated data repository claims payment data medicare medicaid chip health related programs administered departments_of_veterans_affairs dod social_security_administration ihs directs secretary enter data sharing agreements commissioner_of_social_security dod secretaries ihs director help identity fraud waste abuse requires overpayments reported returned days date overpayment identified date corresponding cost report whichever later directs secretary issue regulation requiring medicare medicaid chip providers include national provider identifier enrollment applications authorizes secretary withhold federal matching payment states medical assistance expenditures state report enrollee encounter data timely manner medicaid management information system authorizes secretary exclude providers suppliers participation federal health_care program providing false information application enroll participate subjects civil monetary penalties excluded individuals order prescribe item service false statements applications contracts participate federal health_care program know overpayment return subjects offense civil monetary penalties triple total claim involved authorizes secretary issue subpoenas require attendance testimony witnesses production evidence relates matters investigation question requires secretary account volume billing durable medical equipment dme supplier home health agency determining size supplier agency surety bond authorizes secretary require providers suppliers post surety bond secretary considers risk authorizes secretary suspend payments provider supplier pending fraud investigation appropriates additional million adjusted inflation health_care fraud abuse control fy2011-fy2020 applies inflation adjustments medicare_integrity_program funding requires medicaid_integrity_program program contractors provide secretary hhs office_of_inspector_general performance statistics including number overpayments recovered number fraud referrals return investment activities sec requires secretary furnish national_practitioner_data_bank information reported national health_care fraud abuse data collection program certain final adverse actions taken health_care providers suppliers practitioners requires secretary establish process terminate healthcare integrity protection ensure information collected transferred sec reduces years year date service maximum period submission medicare claims sec modified sec requires dme home health services ordered enrolled medicare eligible professional physician authorizes secretary extend requirements medicare items services reduce fraud waste abuse sec authorizes secretary year medicare enrolled physician supplier fails maintain provide access written orders requests payment dme certification home health services referrals items services authorizes secretary exclude participation federal health_care program individual entity ordering referring furnishing certifying need item service fails provide adequate documentation verify payment sec modified sec requires physician nurse practitioner clinical nurse specialist certified nurse midwife physician assistant face face encounter individual issuing certification home health services dme authorizes secretary apply face face encounter requirement items services based finding reduce risk fraud waste abuse applies requirement physicians making certifications home health services medicaid sec revises civil monetary penalties making false statements delaying inspections applies specified enhanced sanctions civil monetary penalties plans enroll individuals plan consent transfer individual plan purpose earning commission fail comply marketing requirements cms guidance employ contract individual entity commits violation sec requires secretary establish self referral disclosure protocol enable health_care providers suppliers disclose actual potential violations physician self referral law authorizes secretary reduce owing violations law sec requires secretary expand number areas included round competitive bidding program largest metropolitan statistical areas use competitively bid prices areas sec requires states establish contracts recovery audit contractors shall identify underpayments overpayments recoup overpayments services provided state medicaid plans state plan waivers requires secretary expand program medicare parts prescription drug program subtitle additional medicaid program integrity provisions sec amends ssa title xix medicaid require states terminate individuals entities providers medicaid programs terminated medicare medicaid program sec requires medicaid agencies exclude individuals entities participating medicaid specified period time entity individual owns controls manages entity failed repay overpayments specified period suspended excluded terminated participation medicaid program affiliated individual entity suspended excluded terminated medicaid participation sec requires state medicaid plans require billing agents clearinghouses alternate payees submit claims behalf health_care providers register state secretary sec requires states submit data elements state mechanized claims processing information retrieval system medicaid statistical information system secretary determines necessary program integrity program oversight administration requires medicaid managed care entity contract provide maintenance sufficient patient encounter data identify physician delivers services patients current law frequency level detail specified secretary sec requires state medicaid plan prohibit state making payments items services medicaid state plan waiver financial institution entity located outside united_states sec extends period states recover overpayments days year discovery overpayment declares overpayments fraud pending state repayments federal portion overpayments shall days date final administrative judicial judgment matter sec requires state mechanized medicaid claims processing information retrieval systems incorporate methodologies compatible national correct coding initiative subtitle additional program integrity provisions sec amends employee retirement income security act erisa prohibit employees agents multiple employer welfare arrangements subject criminal penalties making false statements marketing materials employee welfare benefit financial solvency benefits regulatory status sec amends public_health_service_act direct secretary request naic develop model uniform report form private health insurance issuer seeking refer suspected fraud abuse state insurance departments responsible state agencies investigation sec amends erisa direct secretary labor adopt regulatory standards issue orders subject state law relating fraud abuse sec authorizes secretary labor issue cease desist orders shut temporarily operations conducting fraudulent activities posing threat public hearings completed seize plan assets appears plan financially hazardous condition sec directs secretary labor require group health plans register department_of_labor operating state sec authorizes secretary labor promulgate regulation providing evidentiary privilege allows confidential communication specified federal state officials relating investigation fraud abuse subtitle elder justice act elder justice act sec amends ssa title block grants states social_services respect elder abuse neglect exploitation prevention requires hhs secretary award grants carry activities provide greater protection individuals seeking care facilities provide long-term_care services supports greater incentives individuals train seek employment facilities requires facility owners operators certain employees report suspected crimes committed facility requires facility owners operators submit secretary state written notification impending closure facility days closure include plan transfer adequate relocation residents establishes elder_justice_coordinating_council subtitle sense senate medical malpractice sec expresses sense senate health reform presents opportunity address issues related medical malpractice medical liability insurance states encouraged develop test alternative models existing civil litigation system congress consider state demonstration projects evaluate alternatives title vii improving access innovative medical therapies subtitle biologics price competition innovation biologics price competition innovation_act sec amends public_health_service_act allow person submit application licensure biological product based similarity licensed biological product reference product requires secretary license biological product biosimilar interchangeable reference product prohibits secretary determining second subsequent biological product interchangeable reference product condition use specified periods based marketing presence status litigation involving biosimilar biological product deemed interchangeable reference product prohibits secretary making approval application act effective years date reference product licensed subtitle affordable medicine children underserved communities sec expands 340b drug discount program program limiting cost covered outpatient drugs certain federal grantees allow participation covered entity certain children hospitals freestanding cancer hospitals critical access hospitals rural referral centers sole community hospitals expands program include drugs connection inpatient outpatient service enrolled hospitals currently outpatient drugs covered program requires secretary establish reasonable exceptions prohibition enrolled hospitals obtaining covered outpatient drugs group purchasing organization group purchasing arrangement including drugs unavailable program facilitate generic substitution generic covered drug available lower price allows hospitals purchase covered drugs arrangement requires hospital enrolled 340b drug discount program issue credit state medicaid program inpatient covered drugs provided medicaid recipients sec requires secretary provide improvements compliance manufacturers covered entities requirements 340b drug discount program establish implement administrative process resolving claims covered entities manufacturers violations requirements requires manufacturers offer covered entity covered drugs purchase applicable ceiling price drug available purchaser price sec requires comptroller_general report congress individuals served covered entities 340b drug discount program receiving optimal health_care services title viii class act community_living_assistance_services supports_act class act sec modified sec establishes national voluntary insurance program purchasing community_living_assistance_services supports class program employees automatically enrolled allowed waive enrollment payroll deductions pay monthly premiums benefits class independence benefit plan provide individuals functional limitations tools allow maintain