"(ii) at least one Federally qualified health center (as defined in section 1905(1)(2)(B) of such Act), unless no such a center serves the geographic area proposed to be served by the network, a center exists but refuses to participate, or a center places unreasonable conditions on such participation.

"(C) ADDITIONAL INCLUSIONS.-Each such network may include any of the following additional providers:

"(i) A hospital.

"(ii) A county or municipal department of health.
"(iii) A rural health clinic.

"(iv) A community clinic, including a mental health clinic, substance abuse clinic, or a reproductive health clinic.

"(v) A private practice physician or group practice. "(vi) A nurse or physician assistant or group practice.

"(vii) An adult day care center.

"(viii) A home health provider.

"(ix) Any other type of provider specified by the Secretary, which has a desire to serve low-income and uninsured patients.

"(D) CONSTRUCTION.-Nothing in this section shall prohibit a single entity from qualifying as collaborative care network so long as such single entity meets the criteria of a collaborative care network. If the network does not include at least one Federally qualified health center (as defined in section 1905(1)(2)(B) of the Social Security Act), the application must explain the reason pursuant to subsection (b)(2)(A).

"(2) COMPREHENSIVE RANGE OF COORDINATED AND INTEGRATED HEALTH CARE SERVICES.-The Secretary may define criteria for evaluating the services offered by a collaborative care network. Such criteria may include the following:

"(A) Requiring collaborative care networks to include at least the suggested core services identified under subsection (b)(4), or whichever subset of the suggested core services is applicable to a particular network.

"(B) Requiring such networks to assign each patient of the network to a primary care provider responsible for managing that patient's care.

"(C) Requiring the services provided by a collaborative care network to include support services appropriate to meet the health needs of low-income populations in the network's community, which may include chronic care management, nutritional counseling, transportation, language services, enrollment counselors, social services and other services as proposed by the network.

"(D) Providing that the services provided by a collaborative care network may also include long term care services and other services not specified in this subsection.

"(E) Providing for the approval by the Secretary of a scope of collaborative care network services for each network that addresses an appropriate minimum scope of

work consistent with the setting of the network and the health professionals available in the community the network serves.

"(3) CLARIFICATION.-Participation in a collaborative care network shall not disqualify a health care provider from reimbursement under title XVIII, XIX, or XXI of the Social Security Act with respect to services otherwise reimbursable under such title. Nothing in this section shall prevent a collaborative care network that is otherwise eligible to contract with Medicare, a private health insurer, or any other appropriate entity to provide care under Medicare, under health insurance coverage offered by the insurer, or otherwise.

"(e) EVALUATIONS.

“(1) PARTICIPANT REPORTS.-Beginning in the third year following an initial grant, each eligible program participant shall submit to the Secretary, with respect to each year the participant has received a grant, an evaluation on the activities carried out by the collaborative care network of such participant under the collaborative care network program and shall include

"(A) the number of people served;

"(B) the most common health problems treated;
"(C) any reductions in emergency department use;

"(D) an accounting of how amounts received were used; and

"(E) to the extent requested by the Secretary, any quality measures or any other measures specified by the Secretary.

"(2) PROGRAM REPORTS.-The Secretary shall submit to Congress an annual evaluation (beginning not later than 6 months after the first reports under paragraph (1) are submitted) on the extent to which emergency department use was reduced as a result of the activities carried out by the participant under the program. Each such evaluation shall also include information on

"(A) the prevalence of certain chronic conditions in various populations, including a comparison of such prevalence in the general population versus in the population of individuals with inadequate health insurance coverage;

"(B) demographic characteristics of the population of uninsured and underinsured individuals served by the collaborative care network involved; and

"(C) the conditions of such individuals for whom services were requested at such emergency departments of participating hospitals.

"(3) AUDIT AUTHORITY.-The Secretary may conduct periodic audits and request periodic spending reports of participants under the collaborative care network program.

“(f) CLARIFICATION.-Nothing in this section requires a provider to report individually identifiable information of an individual to government agencies unless the individual consents, consistent with HIPAA privacy and security law, as defined in section 3009(a)(2).

"(g) AUTHORIZATION OF APPROPRIATIONS.-There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2015.".

[Sarbanes/Dingell Medicaid-FQHC__001:]

Add at the end of subtitle C of title VII of division B the following:

SEC. 1730C. FQHC COVERAGE.

Section 1905(1)(2)(B) of the Social Security Act (42 U.S.C. 1396d(1)(2)(B)) is amended

(1) by striking "or" at the end of clause (iii);

(2) by striking the semicolon at the end of clause (iv) and inserting", and"; and

(3) by inserting after clause (iv) the following new clause:

"(v) is receiving a grant under section 399Z-1 of the Public Health Service Act;".

[Sarbanes1 001:]

In part 1 of subtitle D of title I of division B, add at the end the following new section:

SEC. 1169A. MEDICARE SENIOR HOUSING PLANS.

Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the following new subsection: "(g) SPECIAL RULES FOR SENIOR HOUSING FACILITY PLANS.

“(1) IN GENERAL.-Notwithstanding any other provision of this part, in the case of a Medicare Advantage senior housing facility plan described in paragraph (2), the service area of such plan may be limited to a senior housing facility in a geographic area.

"(2) MEDICARE ADVANTAGE SENIOR HOUSING FACILITY PLAN DESCRIBED. For purposes of this subsection, a Medicare Advantage senior housing facility plan is a Medicare Advantage plan that

“(A)(i) restricts enrollment of individuals under this part to individuals who reside in a continuing care retirement community (as defined in section 1852(1)(4)(B));

"(ii) provides primary care services onsite and has a ratio of accessible providers to beneficiaries that the Secretary determines is adequate, taking into consideration the number of residents onsite, the health needs of those residents, and the accessibility of providers offsite;

"(iii) provides transportation services for beneficiaries to providers outside of the facility; and

"(iv) makes meaningful use of health information technology (as defined in section 3000(5) of the Public Health Service Act (42 U.S.C. 300jj(5)); and

"(B) is offered by a Medicare Advantage organization that has offered at least 1 plan described in subparagraph (A) for at least 1 year prior to January 1, 2010, under a demonstration project established by the Secretary. "(3) BUDGET NEUTRALITY.-The Secretary of Health and Human Services shall ensure that payments made to qualified health plans described in this Section are no greater than the payments that would have been made before the date of the enactment of this subsection, or that would have been made

had these beneficiaries been enrolled in the traditional fee for service Medicare program."

[Stupak__009:]

In section 1743(b)(3), strike subparagraph (B) and insert the following:

(B) in paragraph (1), by striking "are not subject to the requirements of this section" and inserting "are subject to the requirements of this section unless such drugs are subject to discounts under section 340B of the Public Health Service Act".

[Sutton 22 001:]

In section 144(b)(1), after "by individuals" insert the following: "through means such as the mail, by telephone, electronically, and in person".

[Waxman 340B-Integrity_001:]

Amend the heading of subtitle A of title V of division C to read:

Subtitle A-Drug Discount for Rural and Other Hospitals; 340B Program Integrity

After the heading of subtitle A of title V of division C, insert the following:

PART 1-DRUG DISCOUNT FOR RURAL AND

OTHER HOSPITALS

At the end of subtitle A of title V of division C, add the following:

PART 2-340B PROGRAM INTEGRITY

SEC. 2505. IMPROVEMENTS TO 340B PROGRAM INTEGRITY.

(a) INTEGRITY IMPROVEMENTS.-Subsection (d) of section 340B (42 U.S.C. 256b) is amended to read as follows: "(d) IMPROVEMENTS IN PROGRAM INTEGRITY.—

"(1) MANUFACTURER COMPLIANCE.

"(A) IN GENERAL.-From amounts appropriated under paragraph (4), the Secretary shall provide for improvements in compliance by manufacturers with the requirements of this section in order to prevent overcharges and other violations of the discounted pricing requirements specified in this section.

“(B) IMPROVEMENTS.-The improvements described in subparagraph (A) shall include the following:

"(i) The establishment of a process to enable the Secretary to verify the accuracy of ceiling prices calculated by manufacturers under subsection (a)(1) and charged to covered entities, which shall include the following:

"(I) Developing and publishing, through an appropriate policy or regulatory issuance, standards and methodology for the calculation of ceiling prices under such subsection.

"(II) Comparing regularly the ceiling prices calculated by the Secretary with the quarterly pricing data that is reported by manufacturers to the Secretary.

"(III) Conducting periodic monitoring of sales transactions to covered entities.

"(IV) Inquiring into any discrepancies between ceiling prices and manufacturer pricing data that may be identified and taking, or requiring manufacturers to take, corrective action in response to such discrepancies.

"(ii) The establishment of procedures for the issuance of refunds to covered entities by manufacturers in the event that the Secretary finds there has been an overcharge, including the following:

"(I) Submission to the Secretary by manufacturers of an explanation of why and how the overcharge occurred, how the refunds will be calculated, and to whom the refunds will be issued.

"(II) Oversight by the Secretary to ensure that the refunds are issued accurately and within a reasonable period of time.

"(iii) Notwithstanding any other provision of law prohibiting the disclosure of ceiling prices or data used to calculate the ceiling price, the provision of access to covered entities through an Internet website of the Department of Health and Human Services or contractor to the applicable ceiling prices for covered drugs as calculated and verified by the Secretary in a manner that ensures protection of privileged pricing data from unauthorized disclosure.

"(iv) The development of a mechanism by which

"(I) rebates, discounts, or other price concessions provided by manufacturers to other purchasers subsequent to the sale of covered drugs to covered entities are reported to the Secretary; and

"(II) appropriate credits and refunds are issued to covered entities if such rebates, discounts, or other price concessions have the effect of lowering the applicable ceiling price for the relevant quarter for the drugs involved.

"(v) The selective auditing of manufacturers and wholesalers by the Secretary or the Secretary's contractor to ensure the integrity of the drug discount program under this section.

"(vi) The establishment of a requirement that manufacturers and wholesalers use the identification system developed by the Secretary for purposes of facilitating the ordering, purchasing, and delivery of covered drugs under this section, including the processing of chargebacks for such drugs.

"(vii) The imposition of sanctions in the form of civil monetary penalties, which