P.L. 110–275, Approved July 15, 2008 (122 Stat. 2494)

Medicare Improvements for Patients and Providers Act of 2008

*    *    *    *    *    *    *

SECTION 1. [42 U.S.C. 1305 note] SHORT TITLE; TABLE OF CONTENTS.

(a)  Short Title.— This Act may be cited as the “Medicare Improvements for Patients and Providers Act of 2008”.

*    *    *    *    *    *    *

SEC. 101. MEDPAC IMPROVEMENTS TO COVERAGE OF PREVENTIVE SERVICES.

(a)  *  *  *

(4) [42 U.S.C. 1395l note]  Rule of construction.— Nothing in the provisions of, or amendments made by, this subsection shall be construed to provide coverage under title XVIII of the Social Security Act of items and services for the treatment of a medical condition that is not otherwise covered under such title.

*    *    *    *    *    *    *

SEC. 104. [42 U.S.C. 1396ss note]  IMPROVEMENTS TO THE MEDIGAP PROGRAM.

(a)  Implementation of NAIC Recommendations.—

(1)  In general.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall provide for implementation of the changes in the NAIC model law and regulations approved by the National Association of Insurance Commissioners in its Model #651 (“Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act”) on March 11, 2007, as modified to reflect the changes made under this Act and the Genetic Information Nondiscrimination Act of 2008 (Public Law 110-233).

(2)  Implementation dates.—

(A)  In general.—The modifications to Model #651 required under paragraph (1) shall be completed by the National Association of Insurance Commissioners not later than October 31, 2008. Except as provided in subparagraph (B), each State shall have 1 year from the date the National Association of Insurance Commissioners adopts the revised NAIC model law and regulations (as changed by Model #651, as so modified) to conform the regulatory program established by the State to such revised NAIC model law and regulations.

(B)  Extension of effective date for state law amendment.—In the case of a State which the Secretary determines requires State legislation in order to conform the regulatory program established by the State to such revised NAIC model law and regulations, the State shall not be regarded as failing to comply with the requirements of this section solely on the basis of its failure to meet such requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.

(C)  Transition dates.—No carrier may issue a new or revised medicare supplemental policy or certificate under section 1882 of the Social Security Act (42 U.S.C. 1395ss) that meets the requirements of such revised NAIC model law and regulations for coverage effective prior to June 1, 2010. A carrier may continue to offer or issue a medicare supplemental policy under such section that meets the requirements of the NAIC model law and regulations and State law (as in effect prior to the adoption of such revised NAIC model law and regulations) prior to June 1, 2010. Nothing shall preclude carriers from marketing new or revised medicare supplemental policies or certificates that meet the requirements of such revised NAIC model law and regulations on or after the date on which the State conforms the regulatory program established by the State to such revised NAIC model law and regulations.

*    *    *    *    *    *    *

(c) [42 U.S.C. 1395ss-1 note]  Clarification.—Any health insurance policy that provides reimbursement for expenses incurred for items and services for which payment may be made under title XVIII of the Social Security Act but which are not reimbursable by reason of the applicability of deductibles, coinsurance, copayments or other limitations imposed by a Medicare Advantage plan (including a Medicare Advantage private fee-for-service plan) under part C of such title shall comply with the requirements of section 1882(o) of the such Act (42 U.S.C. 1395ss(o)).

*    *    *    *    *    *    *

SEC. 119. [42 U.S.C. 1395b-3 note]  MEDICARE ENROLLMENT ASSISTANCE.

(a)  Additional Funding for State Health Insurance assistance Programs.—

(1)  Grants.—

(A)  In general.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall use amounts made available under subparagraph (B) to make grants to States for State health insurance assistance programs receiving assistance under section 4360 of the Omnibus Budget Reconciliation Act of 1990.

(B)  Funding.—For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), to the Centers for Medicare & Medicaid Services Program Management Account—

(i)  for fiscal year 2009, of $7,500,000;[227]

(ii)  for the period of fiscal years 2010 through 2012, of $15,000,000; and[228]

(iii)[229]  for fiscal year 2013, of $7,500,000;

Amounts appropriated under this subparagraph shall remain available until expended.

(2)  Amounts of grants.—The amount of a grant to a State under this subsection from the total amount made available under paragraph (1) shall be equal to the sum of the amount allocated to the State under paragraph (3)(A) and the amount allocated to the State under subparagraph (3)(B).

(3)  Allocation to states.—

(A)  Allocation based on percentage of low-income beneficiaries.—The amount allocated to a State under this subparagraph from 2/3of the total amount made available under paragraph (1) shall be based on the number of individuals who meet the requirement under subsection (a)(3)(A)(ii) of section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) but who have not enrolled to receive a subsidy under such section 1860D-14 relative to the total number of individuals who meet the requirement under such subsection (a)(3)(A)(ii) in each State, as estimated by the Secretary.

(B)  Allocation based on percentage of rural beneficiaries.—The amount allocated to a State under this subparagraph from 1/3of the total amount made available under paragraph (1) shall be based on the number of part D eligible individuals (as defined in section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-101(a)(3)(A))) residing in a rural area relative to the total number of such individuals in each State, as estimated by the Secretary.

(4)  Portion of grant based on percentage of low-income beneficiaries to be used to provide outreach to individuals who may be subsidy eligible individuals or eligible for the medicare savings program.—Each grant awarded under this subsection with respect to amounts allocated under paragraph (3)(A) shall be used to provide outreach to individuals who may be subsidy eligible individuals (as defined in section 1860D-14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(A)) or eligible for the Medicare Savings Program (as defined in subsection (f)).

(b)  Additional Funding for Area Agencies on Aging.—

(1)  Grants.—

(A)  In general.—The Secretary, acting through the Assistant Secretary for Aging, shall make grants to States for area agencies on aging (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)) and Native American programs carried out under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.).

(B)  Funding.—For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), to the Administration on Aging—

(i)  for fiscal year 2009, of $7,500,000;[230]

(ii)  for the period of fiscal years 2010 through 2012, of $15,000,000; and[231]

(iii)[232]  for fiscal year 2013, of $7,500,000;

Amounts appropriated under this subparagraph shall remain available until expended.

(2)  Amount of grant and allocation to states based on percentage of low-income and rural beneficiaries.—The amount of a grant to a State under this subsection from the total amount made available under paragraph (1) shall be in the same manner as the amount of a grant to a State under subsection (a), from the total amount made available under paragraph (1) of such subsection, is determined under paragraph (2) and subparagraphs (A) and (B) of paragraph (3) of such subsection.

(3)  Required use of funds.—

(A)  All funds.—Subject to subparagraph (B), each grant awarded under this subsection shall be used to provide outreach to eligible Medicare beneficiaries regarding the benefits available under title XVIII of the Social Security Act.

(B)  Outreach to individuals who may be subsidy eligible individuals or eligible for the medicare savings program.—Subsection (a)(4) shall apply to each grant awarded under this subsection in the same manner as it applies to a grant under subsection (a).

(c)  Additional Funding for Aging and Disability Resource Centers.—

(1)  Grants.—

(A)  In general.—The Secretary shall make grants to Aging and Disability Resource Centers under the Aging and Disability Resource Center grant program that are established centers under such program on the date of the enactment of this Act.

(B)  Funding.—For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), to the Administration on Aging—

(i)  for fiscal year 2009, of $5,000,000;[233]

(ii)  for the period of fiscal years 2010 through 2012, of $10,000,000; and[234]

(iii)[235]  for fiscal year 2013, of $5,000,000;

Amounts appropriated under this subparagraph shall remain available until expended.

(2)  Required use of funds.—Each grant awarded under this subsection shall be used to provide outreach to individuals regarding the benefits available under the Medicare prescription drug benefit under part D of title XVIII of the Social Security Act and under the Medicare Savings Program.

(d)  Coordination of Efforts to Inform Older Americans about Benefits Available under Federal and State Programs.—

(1)  In general.—The Secretary, acting through the Assistant Secretary for Aging, in cooperation with related Federal agency partners, shall make a grant to, or enter into a contract with, a qualified, experienced entity under which the entity shall—

(A)  maintain and update web-based decision support tools, and integrated, person-centered systems, designed to inform older individuals (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)) about the full range of benefits for which the individuals may be eligible under Federal and State programs;

(B)  utilize cost-effective strategies to find older individuals with the greatest economic need (as defined in such section 102) and inform the individuals of the programs;

(C)  develop and maintain an information clearinghouse on best practices and the most cost-effective methods for finding older individuals with greatest economic need and informing the individuals of the programs; and

(D)  provide, in collaboration with related Federal agency partners administering the Federal programs, training and technical assistance on the most effective outreach, screening, and follow-up strategies for the Federal and State programs.

(2)  Funding.—For purposes of making a grant or entering into a contract under paragraph (1), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), to the Administration on Aging—

(i)  for fiscal year 2009, of $5,000,000;[236]

(ii)  for the period of fiscal years 2010 through 2012, of $5,000,000; and[237]

(iii)[238]  for fiscal year 2013, of $5,000,000;

Amounts appropriated under this subparagraph shall remain available until expended.

Amounts appropriated under this subparagraph[239] shall remain available until expended.

(e)  Reprogramming Funds from Medicare, Medicaid, and SCHIP Extension Act of 2007.—The Secretary shall only use the $5,000,000 in funds allocated to make grants to States for Area Agencies on Aging and Aging Disability and Resource Centers for the period of fiscal years 2008 through 2009 under section 118 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) for the sole purpose of providing outreach to individuals regarding the benefits available under the Medicare prescription drug benefit under part D of title XVIII of the Social Security Act. The Secretary shall republish the request for proposals issued on April 17, 2008, in order to comply with the preceding sentence.

(f)  Medicare Savings Program Defined.—For purposes of this section, the term “Medicare Savings Program” means the program of medical assistance for payment of the cost of medicare cost-sharing under the Medicaid program pursuant to sections 1902(a)(10)(E) and 1933 of the Social Security Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).

(g)  Secretarial Authority To Enlist Support in Conducting Certain Outreach Activities.—The Secretary may request that an entity awarded a grant under this section support the conduct of outreach activities aimed at preventing disease and promoting wellness. Notwithstanding any other provision of this section, an entity may use a grant awarded under this subsection to support the conduct of activities described in the preceding sentence.

SEC. 123. [42 U.S.C. 1395i-4 note]  DEMONSTRATION PROJECT ON COMMUNITY HEALTH INTEGRATION MODELS IN CERTAIN RURAL COUNTIES.

(a)  In General.—The Secretary shall establish a demonstration project to allow eligible entities to develop and test new models for the delivery of health care services in eligible counties for the purpose of improving access to, and better integrating the delivery of, acute care, extended care, and other essential health care services to Medicare beneficiaries.

(b)  Purpose.—The purpose of the demonstration project under this section is to—

(1)  explore ways to increase access to, and improve the adequacy of, payments for acute care, extended care, and other essential health care services provided under the Medicare and Medicaid programs in eligible counties; and (2) evaluate regulatory challenges facing such providers and the communities they serve.

(2)  evaluate regulatory challenges facing such providers and the communities they serve.

(c)  Requirements.—The following requirements shall apply under the demonstration project:

(1)  Health care providers in eligible counties selected to participate in the demonstration project under subsection (d)(3) shall (when determined appropriate by the Secretary), instead of the payment rates otherwise applicable under the Medicare program, be reimbursed at a rate that covers at least the reasonable costs of the provider in furnishing acute care, extended care, and other essential health care services to Medicare beneficiaries.

(2)  Methods to coordinate the survey and certification process under the Medicare program and the Medicaid program across all health service categories included in the demonstration project shall be tested with the goal of assuring quality and safety while reducing administrative burdens, as appropriate, related to completing such survey and certification process.

(3)  Health care providers in eligible counties selected to participate in the demonstration project under subsection (d)(3) and the Secretary shall work with the State to explore ways to revise reimbursement policies under the Medicaid program to improve access to the range of health care services available in such eligible counties.

(4)  The Secretary shall identify regulatory requirements that may be revised appropriately to improve access to care in eligible counties.

(5)  Other essential health care services necessary to ensure access to the range of health care services in eligible counties selected to participate in the demonstration project under subsection (d)(3) shall be identified. Ways to ensure adequate funding for such services shall also be explored.

(d)  Application Process.—

(1)  Eligibility.—

(A)  In general.—Eligibility to participate in the demonstration project under this section shall be limited to eligible entities.

(B)  Eligible entity defined.—In this section, the term “eligible entity” means an entity that—

(i)  is a Rural Hospital Flexibility Program grantee under section 1820(g) of the Social Security Act (42 U.S.C. 1395i-4(g)); and

(ii)  is located in a State in which at least 65 percent of the counties in the State are counties that have 6 or less residents per square mile.

(2)  Application.—

(A)  In general.—An eligible entity seeking to participate in the demonstration project under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

(B)  Limitation.—The Secretary shall select eligible entities located in not more than 4 States to participate in the demonstration project under this section.

(3)  Selection of eligible counties.—An eligible entity selected by the Secretary to participate in the demonstration project under this section shall select eligible counties in the State in which the entity is located in which to conduct the demonstration project.

(4)  Eligible county defined.—In this section, the term “eligible county” means a county that meets the following requirements:

(A)  The county has 6 or less residents per square mile.

(B)  As of the date of the enactment of this Act, a facility designated as a critical access hospital which meets the following requirements was located in the county:

(i)  As of the date of the enactment of this Act, the critical access hospital furnished 1 or more of the following:

(I)  Home health services.

(II)  Hospice care.

(ii)  As of the date of the enactment of this Act, the critical access hospital has an average daily inpatient census of 5 or less.

(C)  As of the date of the enactment of this Act, skilled nursing facility services were available in the county in—

(i)  a critical access hospital using swing beds; or

(ii)  a local nursing home.

(e)  Administration.—

(1)  In general.—The demonstration project under this section shall be administered jointly by the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration and the Administrator of the Centers for Medicare & Medicaid Services, in accordance with paragraphs (2) and (3).

(2)  HRSA duties.—In administering the demonstration project under this section, the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration shall—

(A)  award grants to the eligible entities selected to participate in the demonstration project; and

(B)  work with such entities to provide technical assistance related to the requirements under the project.

(3)  CMS duties.—In administering the demonstration project under this section, the Administrator of the Centers for Medicare & Medicaid Services shall determine which provisions of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) the Secretary should waive under the waiver authority under subsection (i) that are relevant to the development of alternative reimbursement methodologies, which may include, as appropriate, covering at least the reasonable costs of the provider in furnishing acute care, extended care, and other essential health care services to Medicare beneficiaries and coordinating the survey and certification process under the Medicare and Medicaid programs, as appropriate, across all service categories included in the demonstration project.

(f)  Duration.—

(1)  In general.—The demonstration project under this section shall be conducted for a 3-year period beginning on October 1, 2009.

(2)  Beginning date of demonstration project.—The demonstration project under this section shall be considered to have begun in a State on the date on which the eligible counties selected to participate in the demonstration project under subsection (d)(3) begin operations in accordance with the requirements under the demonstration project.

(g)  Funding.—

(1)  CMS.—

(A)  In general.—The Secretary shall provide for the transfer, in appropriate part from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t), of such sums as are necessary for the costs to the Centers for Medicare & Medicaid Services of carrying out its duties under the demonstration project under this section.

(B)  Budget neutrality.—In conducting the demonstration project under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary estimates would have been paid if the demonstration project under this section was not implemented.

(2)  HRSA.—There are authorized to be appropriated to the Office of Rural Health Policy of the Health Resources and Services Administration $800,000 for each of fiscal years 2010, 2011, and 2012 for the purpose of carrying out the duties of such Office under the demonstration project under this section, to remain available for the duration of the demonstration project.

(h)  Report.—

(1)  Interim report.—Not later than the date that is 2 years after the date on which the demonstration project under this section is implemented, the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration, in coordination with the Administrator of the Centers for Medicare & Medicaid Services, shall submit a report to Congress on the status of the demonstration project that includes initial recommendations on ways to improve access to, and the availability of, health care services in eligible counties based on the findings of the demonstration project.

(2)  Final report.—Not later than 1 year after the completion of the demonstration project, the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration, in coordination with the Administrator of the Centers for Medicare & Medicaid Services, shall submit a report to Congress on such project, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

(i)  Waiver Authority.—The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary and appropriate for the purpose of carrying out the demonstration project under this section.

(j)  Definitions.—In this section:

(1)  Extended care services.—The term “extended care services” means the following:

(A)  Home health services.

(B)  Covered skilled nursing facility services.

(C)  Hospice care.

(2)  Covered skilled nursing facility services.—The term “covered skilled nursing facility services” has the meaning given such term in section 1888(e)(2)(A) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)).

(3)  Critical access hospital.—The term “critical access hospital” means a facility designated as a critical access hospital under section 1820(c) of such Act (42 U.S.C. 1395i-4(c)).

(4)  Home health services.—The term “home health services” has the meaning given such term in section 1861(m) of such Act (42 U.S.C. 1395x(m)).

(5)  Hospice care.—The term “hospice care” has the meaning given such term in section 1861(dd) of such Act (42 U.S.C. 1395x(dd)).

(6)  Medicaid program.—The term “Medicaid program” means the program under title XIX of such Act (42 U.S.C. 1396 et seq.).

(7)  Medicare program.—The term “Medicare program” means the program under title XVIII of such Act (42 U.S.C. 1395 et seq.).

(8)  Other essential health care services.—The term “other essential health care services” means the following:

(A)  Ambulance services (as described in section 1861(s)(7) of the Social Security Act (42 U.S.C. 1395x(s)(7))).

(B)  Physicians’ services (as defined in section 1861(q) of the Social Security Act (42 U.S.C. 1395x(q)).

(C)  Public health services (as defined by the Secretary).

(D)  Other health care services determined appropriate by the Secretary.

(9)  Secretary.—The term “Secretary” means the Secretary of Health and Human Services.

*    *    *    *    *    *    *

SEC. 125.  REVOCATION OF UNIQUE DEEMING AUTHORITY OF THE JOINT COMMISSION.

*    *    *    *    *    *    *

(c) [42 U.S.C. 1395bb note]  Authority to Recognize the Joint Commission as a National Accreditation Body.—The Secretary of Health and Human Services may recognize the Joint Commission as a national accreditation body under section 1865 of the Social Security Act (42 U.S.C. 1395bb), as amended by this section, upon such terms and conditions, and upon submission of such information, as the Secretary may require.

(d) [42 U.S.C. 1395bb note]  Effective Date; Transition Rule.—(1) Subject to paragraph (2), the amendments made by this section shall apply with respect to accreditations of hospitals granted on or after the date that is 24 months after the date of the enactment of this Act.

(2)  For purposes of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the amendments made by this section shall not effect the accreditation of a hospital by the Joint Commission, or under accreditation or comparable approval standards found to be essentially equivalent to accreditation or approval standards of the Joint Commission, for the period of time applicable under such accreditation.

*    *    *    *    *    *    *

SEC. 131.  PHYSICIAN PAYMENT, EFFICIENCY, AND QUALITY IMPROVEMENTS.

(a)  *  *  *

(3)  *  *  *

(B) [None Assigned]  Contingency.—If there is enacted, before, on, or after the date of the enactment of this Act, a Supplemental Appropriations Act, 2008 that includes a provision amending section 1848(l) of the Social Security Act, the alternative amendment described in subparagraph (C)—

(i)  shall apply instead of the amendments made by subparagraph (A); and

(ii)  shall be executed after such provision in such Supplemental Appropriations Act.

*    *    *    *    *    *    *

(b)  *  *  *

(4)  *  *  *

(B) [42 U.S.C. 1395w-4 note]  No change in billing.—Nothing in the amendment made by subparagraph (A) shall be construed to change the way in which billing for audiology services (as defined in section 1861(ll)(2) of the Social Security Act (42 U.S.C. 1395x(ll)(2))) occurs under title XVIII of such Act as of July 1, 2008.

*    *    *    *    *    *    *

(c)  *  *  *

(2) [None Assigned]  GAO study and report on the physician feedback program.—The Comptroller General of the United States shall conduct a study of the Physician Feedback Program conducted under section 1848(n) of the Social Security Act, as added by paragraph (1), including the implementation of the Program.

(A)  Study.—The Comptroller General of the United States shall conduct a study of the Physician Feedback Program conducted under section 1848(n) of the Social Security Act, as added by paragraph (1), including the implementation of the Program.

(B)  Report.—Not later than March 1, 2011, the Comptroller General of the United States shall submit a report to Congress containing the results of the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

(d) [None Assigned] Plan for Transition to Value-Based Purchasing Program for Physicians and Other Practitioners.—

(1)  In General.—The Secretary of Health and Human Services shall develop a plan to transition to a value-based purchasing program for payment under the Medicare program for covered professional services (as defined in section 1848(k)(3)(A) of the Social Security Act (42 U.S.C. 1395w-4(k)(3)(A))).

(2)  Report.—Not later than May 1, 2010, the Secretary of Health and Human Services shall submit a report to Congress containing the plan developed under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

SEC. 132.  INCENTIVES FOR ELECTRONIC PRESCRIBING.

*    *    *    *    *    *    *

(c) [None Assigned]  Gao Report on Electronic Publishing.—Not later than September 1, 2012, the Comptroller General of the United States shall submit to Congress a report on the implementation of the incentives for electronic prescribing established under the provisions of, and amendments made by, this section. Such report shall include information regarding the following:

(1)  The percentage of eligible professionals (as defined in section 1848(k)(3) of the Social Security Act (42 U.S.C. 1395w- 4(k)(3)) that are using electronic prescribing systems, including a determination of whether less than 50 percent of eligible professionals are using electronic prescribing systems.

(2)  If less than 50 percent of eligible professionals are using electronic prescribing systems, recommendations for increasing the use of electronic prescribing systems by eligible professionals, such as changes to the incentive payment adjustments established under section 1848(a)(5) of such Act, as added by subsection (b).

(3)  The estimated savings to the Medicare program under title XVIII of such Act resulting from the use of electronic prescribing systems.

(4)  Reductions in avoidable medical errors resulting from the use of electronic prescribing systems

(5)  The extent to which the privacy and security of the personal health information of Medicare beneficiaries is protected when such beneficiaries’ prescription drug data and usage information is used for purposes other than their direct clinical care, including—

(A)  whether information identifying the beneficiary is, and remains, removed from data regarding the beneficiary’s prescription drug utilization; and

(B)  the extent to which current law requires sufficient and appropriate oversight and audit capabilities to monitor the practice of prescription drug data mining.

(6)  Such other recommendations and administrative action as the Comptroller General determines to be appropriate.

*    *    *    *    *    *    *

SEC. 135.  IMAGING PROVISIONS.

*    *    *    *    *    *    *

(b) [42 U.S.C. 1395m note]  Demonstration Project to Access the Appropriate Use of Imaging Services.—

(1)  Conduct of demonstration project.—

(A)  In general.—The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall conduct a demonstration project using the models described in paragraph (2)(E) to collect data regarding physician compliance with appropriateness criteria selected under paragraph (2)(D) in order to determine the appropriateness of advanced diagnostic imaging services furnished to Medicare beneficiaries.

(B)  Advanced diagnostic imaging services.—In this subsection, the term “advanced diagnostic imaging services” has the meaning given such term in section 1834(e)(1)(B) of the Social Security Act, as added by subsection (a).

(C)  Authority to focus demonstration project.—The Secretary may focus the demonstration project with respect to certain advanced diagnostic imaging services, such as services that account for a large amount of expenditures under the Medicare program, services that have recently experienced a high rate of growth, or services for which appropriateness criteria exists.

(2)  Implementation and design of demonstration project.—

(A)  Implementation and duration.—

(i)  Implementation.—The Secretary shall implement the demonstration project under this subsection not later than January 1, 2010.

(ii)  Duration.—The Secretary shall conduct the demonstration project under this subsection for a 2-year period.

(B)  Application and selection of participating physicians.—

(i)  Application.—Each physician that desires to participate in the demonstration project under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

(ii)  Selection.—The Secretary shall select physicians to participate in the demonstration project under this subsection from among physicians submitting applications under clause (i). The Secretary shall ensure that the physicians selected—

(I)  represent a wide range of geographic areas, demographic characteristics (such as urban, rural, and suburban), and practice settings (such as private and academic practices); and

(II)  have the capability to submit data to the Secretary (or an entity under a subcontract with the Secretary) in an electronic format in accordance with standards established by the Secretary.

(C)  Administrative costs and incentives.—The Secretary shall—

(i)  reimburse physicians for reasonable administrative costs incurred in participating in the demonstration project under this subsection; and

(ii)  provide reasonable incentives to physicians to encourage participation in the demonstration project under this subsection.

(D)  Use of appropriateness criteria.—

(i)  In general.—The Secretary, in consultation with medical specialty societies and other stakeholders, shall select criteria with respect to the clinical appropriateness of advanced diagnostic imaging services for use in the demonstration project under this subsection.

(ii)  Criteria selected.—Any criteria selected under clause (i) shall—

(I)  be developed or endorsed by a medical specialty society; and

(II)  be developed in adherence to appropriateness principles developed by a consensus organization, such as the AQA alliance.

(E)  Models for collecting data regarding physician compliance with selected criteria.—Subject to subparagraph (H), in carrying out the demonstration project under this subsection, the Secretary shall use each of the following models for collecting data regarding physician compliance with appropriateness criteria selected under subparagraph (D):

(i)  A model described in subparagraph (F).

(ii)  A model described in subparagraph (G).

(iii)  Any other model that the Secretary determines to be useful in evaluating the use of appropriateness criteria for advanced diagnostic imaging services.

(F)  Point of service model described.—A model described in this subparagraph is a model that—

(i)  uses an electronic or paper intake form that—

(I)  contains a certification by the physician furnishing the imaging service that the data on the intake form was confirmed with the Medicare beneficiary before the service was furnished;

(II)  contains standardized data elements for diagnosis, service ordered, service furnished, and such other information determined by the Secretary, in consultation with medical specialty societies and other stakeholders, to be germane to evaluating the effectiveness of the use of appropriateness criteria selected under subparagraph (D); and

(III)  is accessible to physicians participating in the demonstration project under this subsection in a format that allows for the electronic submission of such form; and

(ii)  provides for feedback reports in accordance with paragraph (3)(B).

(G)  Point of Order model described.—A model described in this subparagraph is a model that—

(i)  uses a computerized order-entry system that requires the transmittal of relevant supporting information at the time of referral for advanced diagnostic imaging services and provides automated decision-support feedback to the referring physician regarding the appropriateness of furnishing such imaging services; and

(ii)  provides for feedback reports in accordance with paragraph (3)(B).

(H)  Limitation.—In no case may the Secretary use prior authorization—

(i)  as a model for collecting data regarding physician compliance with appropriateness criteria selected under subparagraph (D) under the demonstration project under this subsection; or

(ii)  under any model used for collecting such data under the demonstration project.

(I)  Required contracts and performance standards for certain entities.—

(i)  In General.—The Secretary shall enter into contracts with entities to carry out the model described in subparagraph (G).

(ii)  Performance standards.—The Secretary shall establish and enforce performance standards for such entities under the contracts entered into under clause (i), including performance standards with respect to—

(I)  the satisfaction of Medicare beneficiaries who are furnished advanced diagnostic imaging services by a physician participating in the demonstration project;

(II)  the satisfaction of physicians participating in the demonstration project;

(III)  if applicable, timelines for the provision of feedback reports under paragraph (3)(B); and

(IV)  any other areas determined appropriate by the Secretary.

(3)  Comparison of utilization of advanced diagnostic imaging services and feedback reports.—

(A)  Comparison of utilization of advanced diagnostic imaging services.—The Secretary shall consult with medical specialty societies and other stakeholders to develop mechanisms for comparing the utilization of advanced diagnostic imaging services by physicians participating in the demonstration project under this subsection against—

(i)  the appropriateness criteria selected under paragraph (2)(D); and

(ii)  to the extent feasible, the utilization of such services by physicians not participating in the demonstration project.

(B)  Feedback reports.—The Secretary shall, in consultation with medical specialty societies and other stakeholders, develop mechanisms to provide feedback reports to physicians participating in the demonstration project under this subsection. Such feedback reports shall include—

(i)  a profile of the rate of compliance by the physician with appropriateness criteria selected under paragraph (2)(D), including a comparison of—

(I)  the rate of compliance by the physician with such criteria; and

(II)  the rate of compliance by the physician’s peers (as defined by the Secretary) with such criteria; and

(ii)  to the extent feasible, a comparison of—

(I)  the rate of utilization of advanced diagnostic imaging services by the physician; and

(II)  the rate of utilization of such services by the physician’s peers (as defined by the Secretary) who are not participating in the demonstration project.

(4)  Conduct of demonstration project and waiver.—

(A)  Conduct of demonstration project.—Chapter 35 of title 44, United States Code, shall not apply to the conduct of the demonstration project under this subsection.

(B)  waiver.—The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 1395 et seq.) as may be necessary to carry out the demonstration project under this subsection.

(5)  Evaluation and report.—

(A)  Evaluation.—The Secretary shall evaluate the demonstration project under this subsection to—

(i)  assess the timeliness and efficacy of the demonstration project;

(ii)  assess the performance of entities under a contract entered into under paragraph (2)(I)(i);

(iii)  analyze data—

(I)  on the rates of appropriate, uncertain, and inappropriate advanced diagnostic imaging services furnished by physicians participating in the demonstration project;

(II)  on patterns and trends in the appropriateness and inappropriateness of such services furnished by such physicians;

(III)  on patterns and trends in national and regional variations of care with respect to the furnishing of such services; and

(IV)  on the correlation between the appropriateness of the services furnished and image results; and

(iv)  address—

(I)  the thresholds used under the demonstration project to identify acceptable and outlier levels of performance with respect to the appropriateness of advanced diagnostic imaging services furnished;

(II)  whether prospective use of appropriateness criteria could have an effect on the volume of such services furnished;

(III)  whether expansion of the use of appropriateness criteria with respect to such services to a broader population of Medicare beneficiaries would be advisable;

(IV)  whether, under such an expansion, physicians who demonstrate consistent compliance with such appropriateness criteria should be exempted from certain requirements;

(V)  the use of incident-specific versus practice-specific outlier information in formulating future recommendations with respect to the use of appropriateness criteria for such services under the Medicare program; and

(VI)  the potential for using methods (including financial incentives), in addition to those used under the models under the demonstration project, to ensure compliance with such criteria.

(B)  Report.—Not later than 1 year after the completion of the demonstration project under this subsection, the Secretary shall submit to Congress a report containing the results of the evaluation of the demonstration project conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

(6)  Funding.—The Secretary shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (42 U.S.C. 1395t) of $10,000,000, for carrying out the demonstration project under this subsection (including costs associated with administering the demonstration project, reimbursing physicians for administrative costs and providing incentives to encourage participation under paragraph (2)(C), entering into contracts under paragraph (2)(I), and evaluating the demonstration project under paragraph (5)).

(c)  GAO Study and Reports on Accreditation Requirement for Advanced Diagnostic Imaging Services.—

(1)  Study.—

(A)  In General.—The Comptroller General of the United States (in this subsection referred to as the “Comptroller General”) shall conduct a study, by imaging modality, on—

(i)  the effect of the accreditation requirement under section 1834(e) of the Social Security Act, as added by subsection (a); and

(ii)  any other relevant questions involving access to, and the value of, advanced diagnostic imaging services for Medicare beneficiaries.

(B)  Issues.—The study conducted under subparagraph (A) shall examine the following:

(i)  The impact of such accreditation requirement on the number, type, and quality of imaging services furnished to Medicare beneficiaries.

(ii)  The cost of such accreditation requirement, including costs to facilities of compliance with such requirement and costs to the Secretary of administering such requirement.

(iii)  Access to imaging services by Medicare beneficiaries, especially in rural areas, before and after implementation of such accreditation requirement.

(iv)  Such other issues as the Secretary determines appropriate.

(2)  Reports.—

(A)  Preliminary report.—Not later than March 1, 2013, the Comptroller General shall submit a preliminary report to Congress on the study conducted under paragraph (1).

(B)  Final report.—Not later than March 1, 2014, the Comptroller General shall submit a final report to Congress on the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

*    *    *    *    *    *    *

SEC. 138. [42 U.S.C. 1395w-4 note]  ADJUSTMENT FOR MEDICARE MENTAL HEALTH SERVICES.

(a)  Payment Adjustment.—

(1)  In general.—For purposes of payment for services furnished under the physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w-4) during the period beginning on July 1, 2008, and ending on February 29, 2012[240], the Secretary of Health and Human Services shall increase the fee schedule otherwise applicable for specified services by 5 percent. .

(2)  Rules of Application.—The budget neutrality provision of section 1848(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(ii)) shall not apply to the adjustments described in paragraph (1)

(b)  Definition of Specified Services.—In this section, the term “specified services” means procedure codes for services in the categories of the Health Care Common Procedure Coding System, established by the Secretary of Health and Human Services under section 1848(c)(5) of the Social Security Act (42 U.S.C. 1395w- 4(c)(5)), as of July 1, 2007, and as subsequently modified by the Secretary, consisting of psychiatric therapeutic procedures furnished in office or other outpatient facility settings or in inpatient hospital, partial hospital, or residential care facility settings, but only with respect to such services in such categories that are in the subcategories of services which are—

(1)  insight oriented, behavior modifying, or supportive psychotherapy; or

(2)  interactive psychotherapy.

(c)  Implementation.—Notwithstanding any other provision of law, the Secretary may implement this section by program instruction or otherwise.

*    *    *    *    *    *    *

SEC. 139.  IMPROVEMENTS FOR MEDICARE ANESTHIA TEACHING SERVICES.

*    *    *    *    *    *    *

(b) [42 U.S.C. 1395l note]  Treatment of Certified Registered Nurse Anesthetists.—With respect to items and services furnished on or after January 1, 2010, the Secretary of Health and Human Services shall make appropriate adjustments to payments under the Medicare program under title XVIII of the Social Security Act for teaching certified registered nurse anesthetists to implement a policy with respect to teaching certified registered nurse anesthetists that—

(1)  is consistent with the adjustments made by the special rule for teaching anesthesiologists under section 1848(a)(6) of the Social Security Act, as added by subsection (a); and

(2)  maintains the existing payment differences between teaching anesthesiologists and teaching certified registered nurse anesthetists.

*    *    *    *    *    *    *

SEC. 143.  SPEECH-LANGUAGE PATHOLOGY SERVICES.

*    *    *    *    *    *    *

(d) [42 U.S.C. 1395k note]  Construction.—Nothing in this section shall be construed to affect existing regulations and policies of the Centers for Medicare & Medicaid Services that require physician oversight of care as a condition of payment for speech-language pathology services under part B of the Medicare program.

*    *    *    *    *    *    *

SEC. 146.  IMPROVED ACCESS TO AMBULANCE SERVICES.

*    *    *    *    *    *    *

(b) [42 U.S.C. 1395m note]  Air Ambulance Payment Improvements.—

(1)  Treatment of certain areas for payment for air ambulance services under the ambulance fee schedule.— Notwithstanding any other provision of law, for purposes of making payments under section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) for air ambulance services furnished during the period beginning on July 1, 2008, and ending on June 30, 2013[241], any area that was designated as a rural area for purposes of making payments under such section for air ambulance services furnished on December 31, 2006, shall be treated as a rural area for purposes of making payments under such section for air ambulance services furnished during such period.

*    *    *    *    *    *    *

SEC. 150. [None Assigned]  MEDPAC STUDY AND REPORT ON IMPROVING CHRONIC CARE DEMONSTRATION PROGRAMS.

(a)  Study.—The Medicare Payment Advisory Commission (in this section referred to as the “Commission”) shall conduct a study on the feasability[242] and advisability of establishing a Medicare Chronic Care Practice Research Network that would serve as a standing network of providers testing new models of care coordination and other care approaches for chronically ill beneficiaries, including the initiation, operation, evaluation, and, if appropriate, expansion of such models to the broader Medicare patient population. In conducting such study, the Commission shall take into account the structure, implementation, and results of prior and existing care coordination and disease management demonstrations and pilots, including the Medicare Coordinated Care Demonstration Project under section 4016 of the Balanced Budget Act of 1997 (42 U.S.C. 1395b-1 note) and the chronic care improvement programs under section 1807 of the Social Security Act (42 U.S.C. 1395b-8), commonly known to as “Medicare Health Support”.

(b)  Report.—Not later than June 15, 2009, the Commission shall submit to Congress a report containing the results of the study conducted under subsection (a).

*    *    *    *    *    *    *

SEC. 151.  INCREASE OF FHQC PAYMENT LIMITS.

*    *    *    *    *    *    *

(b) [None Assigned]  Study and Report on the Effects and Adequacy of the Medicare Federally Qualified Health Center Payment Structure.—

(1)  Study.—The Comptroller General of the United States shall conduct a study to determine whether the structure for payments for services furnished by Federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act (42 U.S.C. 1395x(aa)(4)) under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) adequately reimburses Federally qualified health centers for the care furnished to Medicare beneficiaries. In conducting such study, the Comptroller General shall—

(A)  use the most current cost report data available;

(B)  examine the effects of the payment limits established with respect to such services under such part B on the ability of Federally qualified health centers to furnish care to Medicare beneficiaries; and

(C)  examine the cost of furnishing services covered under the Medicare program as of the date of the enactment of this Act that were not covered under such program as of the date on which the Secretary determined the payment rate for Federally qualified health centers in 1991.

(2)  Report.—Not later than 15 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations for such legislation and administrative action the Comptroller General determines appropriate, taking into consideration the structure and adequacy of the prospective payment methodology used to make payments to Federally qualified health centers.

*    *    *    *    *    *    *

SEC. 153.  RENAL DIALYSIS PROVISIONS.

*    *    *    *    *    *    *

(b)  Development of ESRD Bundled Payment System.—

*    *    *    *    *    *    *

(4) [42 U.S.C. 1395rr note]  Rule of construction.—Nothing in this subsection or the amendments made by this subsection shall be construed as authorizing or requiring the Secretary of Health and Human Services to make payments under the payment system implemented under paragraph (14)(A)(i) of section 1881(b) of the Social Security Act (42 U.S.C. 1395rr(b)), as added by paragraph (1), for any unrecovered amount for any bad debt attributable to deductible and coinsurance on items and services not included in the basic case-mix adjusted composite rate under paragraph (12) of such section as in effect before the date of the enactment of this Act.

*    *    *    *    *    *    *

(d) [None Assigned]  GAO Report on ESRD Bundling System and Quality Initiative.—Not later than March 1, 2013, the Comptroller General of the United States shall submit to Congress a report on the implementation of the payment system under subsection (b)(14) of section 1881 of the Social Security Act (as added by subsection (b)) for renal dialysis services and related services (defined in subparagraph (B) of such subsection (b)(14)) and the quality initiative under subsection (h) of such section 1881 (as added by subsection (b)). Such report shall include the following information:

(1)  The changes in utilization rates for erythropoiesis stimulating agents.

(2)  The mode of administering such agents, including information on the proportion of individuals receiving such agents intravenously as compared to subcutaneously.

(3)  An analysis of the payment adjustment under subparagraph (D)(iii) of such subsection (b)(14), including an examination of the extent to which costs incurred by rural, low-volume providers and facilities (as defined by the Secretary) in furnishing renal dialysis services exceed the costs incurred by other providers and facilities in furnishing such services, and a recommendation regarding the appropriateness of such adjustment.

(4)  The changes, if any, in utilization rates of drugs and biologicals that the Secretary identifies under subparagraph (B)(iii) of such subsection (b)(14), and any oral equivalent or oral substitutable forms of such drugs and biologicals or of drugs and biologicals described in clause (ii), that have occurred after implementation of the payment system under such subsection (b)(14).

(5)  Any other information or recommendations for legislative and administrative actions determined appropriate by the Comptroller General.

*    *    *    *    *    *    *

SEC. 154.  DELAY IN AND REFORM OF MEDICARE DMEPOS COMPETITIVE ACQUISITION PROGRAM.

*    *    *    *    *    *    *

(b)  Quality Standards.—

*    *    *    *    *    *    *

(1)  Application of accreditation requirement.—

*    *    *    *    *    *    *

(B) [42 U.S.C. 1395m note]  Construction.—Section 1834(a)(20)(F)(ii) of the Social Security Act, as added by subparagraph (A), shall not be construed as preventing the Secretary of Health and Human Services from implementing the first round of competition under section 1847 of such Act on a timely basis.

*    *    *    *    *    *    *

(c)  Changes in Reports and Deadlines.—

*    *    *    *    *    *    *

(3) [42 U.S.C. 1395m note]  Evaluation of certain codes.—The Secretary of Health and Human Services shall evaluate the existing Health Care Common Procedure Coding System (HCPCS) codes for negative pressure wound therapy to ensure accurate reporting and billing for items and services under such codes. In carrying out such evaluation, the Secretary shall use an existing process, administered by the Durable Medical Equipment Medicare Administrative Contractors, for the consideration of coding changes and consider all relevant studies and information furnished pursuant to such process.

*    *    *    *    *    *    *

(d)  Other Provisions.—

*    *    *    *    *    *    *

(5) [None Assigned]  Funding for implementation.—In addition to funds otherwise available, for purposes of implementing the provisions of, and amendments made by, this section, other than the amendment made by subsection (c)(1) and other than section 1847(a)(1)(E) of the Social Security Act, the Secretary of Health and Human Services shall provide for the transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of the Social Security Act (42 U.S.C. 1395t) to the Centers for Medicare & Medicaid Services Program Management Account of $20,000,000 for fiscal year 2008, and $25,000,000 for each of fiscal years 2009 through 2012. Amounts transferred under this paragraph for a fiscal year shall be available until expended.

*    *    *    *    *    *    *

SEC. 164.  REVISIONS RELATING TO SPECIALIZED MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS.

*    *    *    *    *    *    *

(b) [42 U.S.C. 1395w-21 note]  Moratorium on Authority to Designate Other Plans as Specialized MA Plans.—During the period beginning on January 1, 2010, and ending on December 31, 2010, the Secretary of Health and Human Services may not exercise the authority provided under section 231(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w-21 note) to designate other plans as specialized MA plans for special needs individuals.

(c)  Requirements for Enrollment.—

*    *    *    *    *    *    *

(2) [42 U.S.C. 1395w-28 note]  Authority to operate but no service area expansion for dual snps that do not meet certain requirements.—Notwithstanding subsection (f) of section 1859 of the Social Security Act (42 U.S.C. 1395w-28), during the period beginning on January 1, 2010, and ending on December 31, 2012, in the case of a specialized Medicare Advantage plan for special needs individuals described in subsection (b)(6)(B)(ii) of such section, as amended by this section, that does not meet the requirement described in subsection (f)(3)(D) of such section, the Secretary of Health and Human Services—

(A)  shall permit such plan to be offered under part C of title XVIII of such Act; and

(B)  shall not permit an expansion of the service area of the plan under such part C.

(3) [42 U.S.C. 1395w-28 note]  Resources for state medicaid agencies.—The Secretary of Health and Human Services shall provide for the designation of appropriate staff and resources that can address State inquiries with respect to the coordination of State and Federal policies for specialized MA plans for special needs individuals described in section 1859(b)(6)(B)(ii) of the Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(ii)), as amended by this section.

(4) [42 U.S.C. 1395w-28 note]  No requirement for contract.—Nothing in the provisions of, or amendments made by, this subsection shall require a State to enter into a contract with a Medicare Advantage organization with respect to a specialized MA plan for special needs individuals described in section 1859(b)(6)(B)(ii) of the Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(ii)), as amended by this section.

(e)  Clarification of the Definition of a Severe or Disabling Chronic Conditions Specialized Needs Individual.—

*    *    *    *    *    *    *

(2) [None Assigned]  Panel.—The Secretary of Health and Human Services shall convene a panel of clinical advisors to determine the conditions that meet the definition of severe and disabling chronic conditions under section 1859(b)(6)(B)(iii) of the Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)), as amended by paragraph (1). The panel shall include the Director of the Agency for Healthcare Research and Quality (or the Director’s designee).

*    *    *    *    *    *    *

(h) [42 U.S.C. 1395w-28 note]  No Affect on Medicaid Benefits for Duals.—Nothing in the provisions of, or amendments made by, this section shall affect the benefits available under the Medicaid program under title XIX of the Social Security Act for special needs individuals described in section 1859(b)(6)(B)(ii) of such Act (42 U.S.C. 1395w-28(b)(6)(B)(ii)).

*    *    *    *    *    *    *

SEC. 183.  CONTRACT WITH A CONSENSUS-BASED ENTITY REGARDING PERFORMANCE MEASUREMENT.

(a)  Contract.—

*    *    *    *    *    *    *

(2) [None Assigned]  Sense of the senate.—It is the Sense of the Senate that the selection by the Secretary of Health and Human Services of an entity to contract with under section 1890(a) of the Social Security Act, as added by paragraph (1), should not be construed as diminishing the significant contributions of the Boards of Medicine, the quality alliances, and other clinical and technical experts to efforts to measure and improve the quality of health care services.

(b) [None Assigned]  GAO Study and Reports on the Performance and Costs of the Consensus-Based Entity Under the Contract.—

(1)  In General.—The Comptroller General of the United States shall conduct a study on—

(A)  the performance of the entity with a contract with the Secretary of Health and Human Services under section 1890(a) of the Social Security Act, as added by subsection (a), of its duties under such contract; and

(B)  the costs incurred by such entity in performing such duties.

(2)  Reports.—Not later than 18 months and 36 months after the effective date of the first contract entered into under such section 1890(a), the Comptroller General of the United States shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

*    *    *    *    *    *    *

SEC. 186. [42 U.S.C. 1395b-4 note]  DEMONSTRATION TO IMPROVE CARE TO PREVIOUSLY UNINSURED.

(a)  Establishment.—Within one year after the date of the enactment of this Act, the Secretary (in this section referred to as the “Secretary”) shall establish a demonstration project to determine the greatest needs and most effective methods of outreach to medicare beneficiaries who were previously uninsured.

(b)  Scope.—The demonstration shall be in no fewer than 10 sites, and shall include state health insurance assistance programs, community health centers, community-based organizations, community health workers, and other service providers under parts A, B, and C of title XVIII of the Social Security Act. Grantees that are plans operating under part C shall document that enrollees who were previously uninsured receive the “Welcome to Medicare” physical exam

(c)  Duration.—The Secretary shall conduct the demonstration project for a period of 2 years.

(d)  Report and Evaluation.—The Secretary shall conduct an evaluation of the demonstration and not later than 1 year after the completion of the project shall submit to Congress a report including the following:

(1)  An analysis of the effectiveness of outreach activities targeting beneficiaries who were previously uninsured, such as revising outreach and enrollment materials (including the potential for use of video information), providing one-on-one counseling, working with community health workers, and amending the Medicare and You handbook.

(2)  The effect of such outreach on beneficiary access to care, utilization of services, efficiency and cost-effectiveness of health care delivery, patient satisfaction, and select health outcomes.

*    *    *    *    *    *    *

SEC. 187. [42 U.S.C. 1395cc note]  OFFICE OF THE INSPECTOR GENERAL REPORT ON COMPLIANCE WITH AND ENFORCEMENT OF NATIONAL STANDARDS ON CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN MEDICARE.

(a)  Implementation.—Not later than two years after the date of the enactment of this Act, the Inspector General of the Department of Health and Human Services shall prepare and publish a report on—

(1)  the extent to which Medicare providers and plans are complying with the Office for Civil Rights’ Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons and the Office of Minority Health’s Culturally and Linguistically Appropriate Services Standards in health care; and

(2)  a description of the costs associated with or savings related to the provision of language services.

(b)  Implementation.—Not later than one year after the date of publication of the report under subsection (a), the Department of Health and Human Services shall implement changes responsive to any deficiencies identified in the report.

*    *    *    *    *    *    *

SEC. 188.  MEDICARE IMPROVEMENT FUNDING.

*    *    *    *    *    *    *

(b) [None Assigned]  Implementation.—For purposes of carrying out the provisions of, and amendments made by, this title, in addition to any other amounts provided in such provisions and amendments, the Secretary of Health and Human Services shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $140,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for the period of fiscal years 2009 through 2013.

*    *    *    *    *    *    *

SEC. 203. [42 U.S.C. 1395r-8 note]  PHARMACY REIMBURSEMENT UNDER MEDICAID.

(a)  Delay in Application of New Payment Limit for Multiple Source Drugs Under Medicaid.—Notwithstanding paragraphs (4) and (5) of subsection (e) of section 1927 of the Social Security Act (42 U.S.C. 1396r-8) or part 447 of title 42, Code of Federal Regulations, as published on July 17, 2007 (72 Federal Register 39142)—

(1)  the specific upper limit under section 447.332 of title 42, Code of Federal Regulations (as in effect on December 31, 2006) applicable to payments made by a State for multiple source drugs under a State Medicaid plan shall continue to apply through September 30, 2009, for purposes of the availability of Federal financial participation for such payments; and (2) the Secretary of Health and Human Services shall not, prior to October 1, 2009, finalize, implement, enforce, or otherwise take any action (through promulgation of regulation, issuance of regulatory guidance, use of Federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to impose the specific upper limit established under section 447.514(b) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 Federal Register 39142).

(2)  the Secretary of Health and Human Services shall not, prior to October 1, 2009, finalize, implement, enforce, or otherwise take any action (through promulgation of regulation, issuance of regulatory guidance, use of Federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to impose the specific upper limit established under section 447.514(b) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 Federal Register 39142).

(b)  Temporary Suspension of Updated Publicly Available AMP Data.—Notwithstanding clause (v) of section 1927(b)(3)(D) of the Social Security Act (42 U.S.C. 1396r-8(b)(3)(D)), the Secretary of Health and Human Services shall not, prior to October 1, 2009, make publicly available any AMP disclosed to the Secretary.

(c)  Definitions.—In this subsection:

(1)  The term “multiple source drug” has the meaning given that term in section 1927(k)(7)(A)(i) of the Social Security Act (42 U.S.C. 1396r-8(k)(7)(A)(i)).(2) The term “AMP” has the meaning given “average manufacturer price” in section 1927(k)(1) of the Social Security Act (42 U.S.C. 1396r-8(k)(1)) and “AMP” in section 447.504(a) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 Federal Register 39142).

*    *    *    *    *    *    *

[Internal References.—SSAct Title XVIII, Parts A, B, and C of Title XVIII, §§1833, 1848, 1851, 1865, 1866, 1881, 1882, and 1927 headings and §§1814(b)(14), 1832(a), 1833(a)(1) and (g), 1834(a)(20), (e), and (l), 1848(l)(2) and (m), 1859(b)(6) and (f), 1861(e), (p), (ll) and (ddd), 1862(a), 1876(h), and 1881(b)have footnotes referring to P.L. 110-275.]



[227]  P.L. 112-240, §610(a)(1), struck out “and”.

[228]  P.L. 112-240, §610(a)(2), struck out the period and inserted “; and”.

[229]  P.L. 112-240, §610(a)(3), added this new clause (iii), effective January 2, 2013.

[230]  P.L. 112-240, §610(b)(1), struck out “and”.

[231]  P.L. 112-240, §610(b)(2), struck out the period and inserted “; and”.

[232]  P.L. 112-240, §610(b)(3), added this new clause (iii), effective January 2, 2013.

[233]  P.L. 112-240, §610(c)(1), struck out “and”.

[234]  P.L. 112-240, §610(c)(2), struck out the period and inserted “; and”.

[235]  P.L. 112-240, §610(c)(3), added this new clause (iii), effective January 2, 2013.

[236]  P.L. 112-240, §610(d)(1), struck out “and”.

[237]  P.L. 112-240, §610(d)(2), struck out the period and inserted “; and”.

[238]  P.L. 112-240, §610(d)(3), added this new clause (iii), effective January 2, 2013.

[239]  Probably should be “paragraph”.

[240]  P.L. 112-78, §307, struck out “December 31, 2011” and inserted “February 29, 2012”, effective December 23, 2011.

[241]  P.L. 112-78, §306(b), struck out “December 31, 2011” and inserted “February 29, 2012”, effective December 23, 2011.

P.L. 112-96, §3007(b), struck out “February 29, 2012” and inserted “December 31, 2012*”, effective February 22, 2012.

*P.L. 112-240, §604(b), struck out “December 31, 2012” and inserted “June 30, 2013”, effective January 2, 2013.

[242]  As in original.