"(iii) the total number of units of each dosage form and strength of the line extension product paid for under the State plan in the rebate period (as reported by the State). In this subparagraph, the term 'line extension' means, with respect to a drug, an extended release formulation of the drug.". (2) EFFECTIVE DATE.-The amendment made by paragraph (1) shall apply to drugs dispensed after December 31, 2009. (b) INCREASE MINIMUM REBATE PERCENTAGE FOR SINGLE SOURCE DRUGS.-Section 1927(c)(1)(B)(i) of the Social Security Act (42 U.S.C. 1396r-8(c)(1)(B)(i)) is amend ed (1) in subclause (IV), by striking “and” at the end; (2) in subclause (V) (A) by inserting "and before January 1, 2010" after "December 31, 1995,"; and (B) by striking the period at the end and inserting "; and"; and (3) by adding at the end the following new subclause: "(VI) after December 31, 2009, is 22.1 percent.". SEC. 1743. EXTENSION OF PRESCRIPTION DRUG DISCOUNTS TO ENROLLEES OF MEDICAID MANAGED CARE ORGANIZATIONS. (a) IN GENERAL.-Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended (1) in clause (xi), by striking "and" at the end; (2) in clause (xii), by striking the period at the end and inserting “; and”; and (3) by adding at the end the following: "(xiii) such contract provides that the entity shall report to the State such information, on such timely and periodic basis as specified by the Secretary, as the State may require in order to include, in the information submitted by the State to a manufacturer under section 1927(b)(2)(A), information on covered outpatient drugs dispensed to individuals eligible for medical assistance who are enrolled with the entity and for which the entity is responsible for coverage of such drugs under this subsection.". (b) CONFORMING AMENDMENTS.-Section 1927 of such Act (42 U.S.C. 1396r-8) is amended (1) in the first sentence of subsection (b)(1)(A), by inserting before the period at the end the following: ", including such drugs dispensed to individuals enrolled with a medicaid managed care organization if the organization is responsible for coverage of such drugs"; (2) in subsection (b)(2), by adding at the end the following new subparagraph: "(C) REPORTING ON MMCO DRUGS.-On a quarterly basis, each State shall report to the Secretary the total amount of rebates in dollars received from pharmacy manufacturers for drugs provided to individuals enrolled with Medicaid managed care organizations that contract under section 1903(m).”; and (3) in subsection (j)— (A) in the heading by striking "EXEMPTION" and inserting "SPECIAL RULES"; and (B) in paragraph (1), by striking "not". (c) EFFECTIVE DATE.-The amendments made by this section take effect on July 1, 2010, and shall apply to drugs dispensed on or after such date, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. SEC. 1744. PAYMENTS FOR GRADUATE MEDICAL EDUCATION. (a) IN GENERAL.-Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by sections 1701(a)(2), 1711(a), and 1713(a), is amended by adding at the end the following new subsection: "(bb) PAYMENT FOR GRADUATE MEDICAL EDUCATION.— “(1) IN GENERAL.-The term 'medical assistance' includes payment for costs of graduate medical education consistent with this subsection, whether provided in or outside of a hospital. "(2) SUBMISSION OF INFORMATION.-For purposes of paragraph (1) and section 1902(a)(13)(A)(v), payment for such costs is not consistent with this subsection unless "(A) the State submits to the Secretary, in a timely manner and on an annual basis specified by the Secretary, information on total payments for graduate medical education and how such payments are being used for graduate medical education, including "(i) the institutions and programs eligible for receiving the funding; "(ii) the manner in which such payments are calculated; "(iii) the types and fields of education being supported; "(iv) the workforce or other goals to which the funding is being applied; "(v) State progress in meeting such goals; and "(vi) such other information as the Secretary determines will assist in carrying out paragraphs (3) and (4); and "(B) such expenditures are made consistent with such goals and requirements as are established under paragraph (4). "(3) REVIEW OF INFORMATION.-The Secretary shall make the information submitted under paragraph (2) available to the Advisory Committee on Health Workforce Evaluation and Assessment (established under section 2261 of the Public Health Service Act). The Secretary and the Advisory Committee shall independently review the information submitted under paragraph (2), taking into account State and local workforce needs. "(4) SPECIFICATION OF GOALS AND REQUIREMENTS.-The Secretary shall specify by rule, initially published by not later than December 31, 2011 "(A) program goals for the use of funds described in paragraph (1), taking into account recommendations of the such Advisory Committee and the goals for approved medical residency training programs described in section 1886(h)(1)(B); and “(B) requirements for use of such funds consistent with such goals. Such rule may be effective on an interim basis pending revision after an opportunity for public comment.". (b) CONFORMING AMENDMENT.-Section 1902(a)(13)(A) of such Act (42 U.S.C. 1396a(a)(13)(A)), as amended by section 1721(a)(1)(A), is amended— (1) by striking "and" at the end of clause (iii); (2) by striking the semicolon in clause (iv) and inserting “, and”; and (3) by adding at the end the following new clause: “(v) in the case of hospitals and at the option of a State, such rates may include, to the extent consistent with section 1905(bb), payment for graduate medical education; and". (c) EFFECTIVE DATE.-The amendments made by this section shall take effect on the date of the enactment of this Act. Nothing in this section shall be construed as affecting payments made before such date under a State plan under title XIX of the Social Security Act for graduate medical education. SEC. 1745. REPORT ON MEDICAID PAYMENTS. Section 1902 of the Social Security Act (42 U.S.C. 1396), as amended by sections 1703(a), 1714(a), and 1731(a), is amended by adding at the end the following new subsection: "(jj) REPORT ON MEDICAID PAYMENTS.-Each year, on or before a date determined by the Secretary, a State participating in the Medicaid program under this title shall submit to the Administrator of the Centers for Medicare & Medicaid Services "(1) information on the determination of rates of payment to providers for covered services under the State plan, including "(A) the final rates; "(B) the methodologies used to determine such rates; and "(C) justifications for the rates; and "(2) an explanation of the process used by the State to allow providers, beneficiaries and their representatives, and other concerned State residents a reasonable opportunity to review and comment on such rates, methodologies, and justifications before the State made such rates final.". SEC. 1746. REVIEWS OF MEDICAID. (a) GAO STUDY ON FMAP.-. (1) STUDY.-The Comptroller General of the United States shall conduct a study regarding federal payments made to the State Medicaid programs_under title XIX of the Social Security Act for the purposes of making recommendations to Congress. (2) REPORT.-Not later than February 15, 2011, the Comptroller General shall submit to the appropriate committees of Congress a report on the study conducted under paragraph (1) and the effect on the federal government, States, providers, and beneficiaries of (A) removing the 50 percent floor, or 83 percent ceiling, or both, in the Federal medical assistance percentage under section 1905(b)(1) of the Social Security Act; and (B) revising the current formula for such Federal medical assistance percentage to better reflect State fiscal capacity and State effort to pay for health and long-term care services and to better adjust for national or regional economic downturns. (b) GAO STUDY ON MEDICAID ADMINISTRATIVE COSTS.. (1) STUDY.-The Comptroller General of the United States shall conduct a study of the administration of the Medicaid program by the Department of Health and Human Services, State Medicaid agencies, and local government agencies. The report shall address the following issues: (A) The extent to which federal funds for each administrative function, such as survey and certification and claims processing, are being used effectively and efficiently. (B) The administrative functions on which federal Medicaid funds are expended and the amounts of such expenditures (whether spent directly or by contract). (2) REPORT.-Not later than February 15, 2011, the Comptroller General shall submit to the appropriate committees of Congress a report on the study conducted under paragraph (1). SEC. 1747. EXTENSION OF DELAY IN MANAGED CARE ORGANIZATION PROVIDER TAX ELIMINATION. Effective as if included in the enactment of section 6051 of the Deficit Reduction Act of 2005 (Public Law 109-171), subsection (b)(2)(A) of such section is amended by striking "October 1, 2009” and inserting "October 1, 2010". Subtitle F-Waste, Fraud, and Abuse SEC. 1751. HEALTH CARE ACQUIRED CONDITIONS. (a) MEDICAID NON-PAYMENT FOR CERTAIN HEALTH CARE-ACQUIRED CONDITIONS.— Section 1903(i) of the Social Security Act (42 U.S.C. 1396b(i)) is amended (1) by striking "or" at the end of paragraph (23); (2) by striking the period at the end of paragraph (24) and inserting "; or"; and (3) by inserting after paragraph (24) the following new paragraph: "(25) with respect to amounts expended for services related to the presence of a condition that could be identified by a secondary diagnostic code described in section 1886(d)(4)(D)(iv) and for any health care acquired condition determined as a non-covered service under title XVIII.". (b) APPLICATION TO CHIP.-Section 2107(e)(1)(G) of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by striking "and (17)" and inserting "(17), and (25)". (c) PERMISSION TO INCLUDE ADDITIONAL HEALTH CARE-ACQUIRED CONDITIONS.— Nothing in this section shall prevent a State from including additional health careacquired conditions for non-payment in its Medicaid program under title XIX of the Social Security Act. (d) EFFECTIVE DATE.-The amendments made by this section shall apply to discharges occurring on or after January 1, 2010. SEC. 1752. EVALUATIONS AND REPORTS REQUIRED UNDER MEDICAID INTEGRITY PROGRAM. Section 1936(c)(2)) of the Social Security Act (42 U.S.C. 1396u-7(c)(2)) is amended (1) by redesignating subparagraph (D) as subparagraph (E); and SEC. 1753. REQUIRE PROVIDERS AND SUPPLIERS TO ADOPT PROGRAMS TO REDUCE WASTE, Section 1902(a) of such Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by sections 1631(b)(1), 1703, and 1729, is further amended (1) in paragraph (75), by striking at the end "and"; (2) in paragraph (76), by striking at the end the period and inserting “; and”; and (3) by inserting after paragraph (76) the following new paragraph: "(77) provide that any provider or supplier (other than a physician or nursing facility) providing services under such plan shall, subject to paragraph (5) of section 1874(d), establish a compliance program described in paragraph (1) of such section in accordance with such section.". SEC. 1754. OVERPAYMENTS. (a) IN GENERAL.-Section 1903(d)(2)(C) of the Social Security Act (42 U.S.C. 1396b(d)(2)(C)) is amended (1) in the first sentence, by inserting "(or of 1 year in the case of overpayments due to fraud)" after "60 days"; and (2) in the second sentence, by striking "the 60 days" and inserting "such period". (b) EFFECTIVE DATE.-The amendments made by subsection (a) shall apply in the case of overpayments discovered on or after the date of the enactment of this Act. SEC. 1755. MANAGED CARE ORGANIZATIONS. (a) MINIMUM MEDICAL LOSS RATIO. (1) MEDICAID.-Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)), as amended by section 1743(a)(3), is amended (A) by striking "and" at the end of clause (xii); (B) by striking the period at the end of clause (xiii) and inserting “; and"; and (C) by adding at the end the following new clause: "(xiv) such contract has a medical loss ratio, as determined in accordance with a methodology specified by the Secretary that is a percentage (not less than 85 percent) as specified by the Secretary.". (2) CHIP.-Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is amended (A) by redesignating subparagraphs (H) through (L) as subparagraphs (I) through (M); and (B) by inserting after subparagraph (G) the following new subparagraph: "(H) Section 1903(m)(2)(A)(xiv) (relating to application of minimum loss ratios), with respect to comparable contracts under this title.". (3) EFFECTIVE DATE.-The amendments made by this subsection shall apply to contracts entered into or renewed on or after July 1, 2010. (b) PATIENT ENCOUNTER DATA. (1) IN GENERAL.-Section 1903(m)(2)(A)(xi) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)(xi)) is amended by inserting "and for the provision of such data to the State at a frequency and level of detail to be specified by the Secretary" after "patients". (2) EFFECTIVE DATE.-The amendment made by paragraph (1) shall apply with respect to contract years beginning on or after January 1, 2010. SEC. 1756. TERMINATION OF PROVIDER PARTICIPATION UNDER MEDICAID AND CHIP IF TERMINATED UNDER MEDICARE OR OTHER STATE PLAN OR CHILD HEALTH PLAN. (a) STATE PLAN REQUIREMENT.-Section 1902(a)(39) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)) is amended by inserting after "1128A," the following: "terminate the participation of any individual or entity in such program if (subject to such exceptions are are permitted with respect to exclusion under sections 1128(b)(3)(C) and 1128(d)(3)(B)) participation of such individual or entity is terminated under title XVIII, any other State plan under this title, or any child health plan under title XXI,". (b) APPLICATION TO CHIP.-Section 2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)) is amended by inserting before the period at the end the following: "and section 1902(a)(39) (relating to exclusion and termination of participation)". (c) EFFECTIVE DATE. (1) Except as provided in paragraph (2), the amendments made by this section shall apply to services furnished on or after January 1, 2011, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. (2) In the case of a State plan for medical assistance under title XIX of the Social Security Act or a child health plan under title XXI of such Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan or child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement 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 such session shall be deemed to be a separate regular session of the State legislature. SEC. 1757. MEDICAID AND CHIP EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS. (a) STATE PLAN REQUIREMENT.-Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by sections 1631(b)(1), 1703(a), 1729, and 1753, is further amended (1) in paragraph (76), by striking at the end "and"; (2) in paragraph (77), by striking at the end the period and inserting "; and"; and (3) by inserting after paragraph (77) the following new paragraph: "(78) provide that the State agency described in paragraph (9) exclude, with respect to a period, any individual or entity from participation in the program under the State plan if such individual or entity owns, controls, or manages an entity that (or if such entity is owned, controlled, or managed by an individual or entity that) "(A) has unpaid overpayments under this title during such period determined by the Secretary or the State agency to be delinquent; "(B) is suspended or excluded from participation under or whose participation is terminated under this title during such period; or "(C) is affiliated with an individual or entity that has been suspended or excluded from participation under this title or whose participation is terminated under this title during such period.". (b) CHILD HEALTH PLAN REQUIREMENT.-Section 2107(e)(1)(A) of such Act (42 U.S.C. 1397gg(e)(1)(A)), as amended by section 1756(b), is amended by striking "section 1902(a)(39)" and inserting "sections 1902(a)(39) and 1902(a)(78)". (c) EFFECTIVE DATE. (1) Except as provided in paragraph (2), the amendments made by this section shall apply to services furnished on or after January 1, 2011, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date. (2) In the case of a State plan for medical assistance under title XIX of the Social Security Act or a child health plan under title XXI of such Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this section, the State plan or child health plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement 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 such session shall be deemed to be a separate regular session of the State legislature. SEC. 1758. REQUIREMENT TO REPORT EXPANDED SET OF DATA ELEMENTS UNDER MMIS TO DETECT FRAUD AND ABUSE. Section 1903(r)(1)(F) of the Social Security Act (42 U.S.C. 1396b(r)(1)(F)) is amended by inserting after "necessary" the following: "and including, for data submitted to the Secretary on or after July 1, 2010, data elements from the automated data system that the Secretary determines to be necessary for detection of waste, fraud, and abuse". SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER ALTERNATE PAYEES REQUIRED TO REGISTER UNDER MEDICAID. (a) IN GENERAL.-Section 1902(a) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by sections 1631(b), 1703(a), 1729, 1753, and 1757(a), is further amended (1) in paragraph (77); by striking at the end "and"; (2) in paragraph (78), by striking the period at the end and inserting "and"; and (3) by inserting after paragraph (78) the following new paragraph: "(79) provide that any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must register with the State and the Secretary in a form and manner specified by the Secretary under section 1866(j)(1)(D).". (b) DENIAL OF PAYMENT.-Section 1903(i) of such Act (42 U.S.C. 1396b(i)), as amended by section 1751, is amended (1) by striking "or" at the end of paragraph (24); (2) by striking the period at the end of paragraph (25) and inserting "; or"; and (3) by inserting after paragraph (25) the following new paragraph: |