“(ii) such failure is corrected during the 30-day period beginning on the 1st date that the employer knew, or exercising reasonable diligence would have known, that such failure existed. "(C) OVERALL LIMITATION FOR UNINTENTIONAL FAILURES.-In the case of failures which are due to reasonable cause and not to willful neglect, the penalty assessed under paragraph (1) for failures during any 1-year period shall not exceed the amount equal to the lesser of "(i) 10 percent of the aggregate amount paid or incurred by the employer (or predecessor employer) during the preceding taxable year for group health plans, or "(ii) $500,000. “(3) ADVANCE NOTIFICATION OF FAILURE PRIOR TO ASSESSMENT.-Before a reasonable time prior to the assessment of any penalty under paragraph (1) with respect to any failure by an employer, the Secretary shall inform the employer in writing of such failure and shall provide the employer information regarding efforts and procedures which may be undertaken by the employer to correct such failure. "(4) ACTIONS TO ENFORCE ASSESSMENTS.-The Secretary may bring a civil action in any District Court of the United States to collect any civil penalty under this subsection. "(5) COORDINATION WITH EXCISE TAX.-Under regulations prescribed in accordance with section 324 of the America's Affordable Health Choices Act of 2009, the Secretary and the Secretary of the Treasury shall coordinate the assessment of penalties under paragraph (1) in connection with failures to satisfy health coverage participation requirements with the imposition of excise taxes on such failures under section 4980H(b) of the Internal Revenue Code of 1986 so as to avoid duplication of penalties with respect to such failures. "(6) DEPOSIT OF PENALTY COLLECTED.-Any amount of penalty collected under this subsection shall be deposited as miscellaneous receipts in the Treasury of the United States. "(g) REGULATIONS.-The Secretary may promulgate such regulations as may be necessary or appropriate to carry out the provisions of this section, in accordance with section 324(a) of the America's Affordable Health Choices Act of 2009. The Secretary may promulgate any interim final rules as the Secretary determines are appropriate to carry out this section.". (b) EFFECTIVE DATE.-The amendments made by subsection (a) shall apply to periods beginning after December 31, 2012. SEC. 324. ADDITIONAL RULES RELATING TO HEALTH COVERAGE PARTICIPATION REQUIREMENTS. (a) ASSURING COORDINATION.-The officers consisting of the Secretary of Labor, the Secretary of the Treasury, the Secretary of Health and Human Services, and the Health Choices Commissioner shall ensure, through the execution of an interagency memorandum of understanding among such officers, that (1) regulations, rulings, and interpretations issued by such officers relating to the same matter over which two or more of such officers have responsibility under subpart B of part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, section 4980H of the Internal Revenue Code of 1986, and section 2793 of the Public Health Service Act are administered so as to have the same effect at all times; and (2) coordination of policies relating to enforcing the same requirements through such officers in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement. (b) MULTIEMPLOYER PLANS.-In the case of a group health plan that is a multiemployer plan (as defined in section 3(37) of the Employee Retirement Income Security Act of 1974), the regulations prescribed in accordance with subsection (a) by the officers referred to in subsection (a) shall provide for the application of the health coverage participation requirements to the plan sponsor and contributing sponsors of such plan. [TITLE IV-AMENDMENTS TO INTERNAL REVENUE CODE OF 1986] [For title IV, see text of bill as introduced on June 14, 2009.] DIVISION B-MEDICARE AND MEDICAID SEC. 1001. TABLE OF CONTENTS OF DIVISION. The table of contents for this division is as follows: DIVISION B-MEDICARE AND MEDICAID IMPROVEMENTS Sec. 1001. Table of contents of division. TITLE I-IMPROVING HEALTH CARE VALUE Sec. 1101. Skilled nursing facility payment update. Sec. 1102. Inpatient rehabilitation facility payment update. Sec. 1103. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements. PART 2-OTHER MEDICARE PART A PROVISIONS Sec. 1111. Payments to skilled nursing facilities. Sec. 1112. Medicare DSH report and payment adjustments in response to coverage expansion. PART 1-PHYSICIANS' SERVICES Sec. 1121. Sustainable growth rate reform. Sec. 1122. Misvalued codes under the physician fee schedule. Sec. 1123. Payments for efficient areas. Sec. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI). Sec. 1125. Adjustment to Medicare payment localities. Sec. 1126. Resource-based feedback program for physicians in Medicare. PART 2-MARKET BASKET UPDATES Sec. 1131. Incorporating productivity improvements into market basket updates that do not already incorporate such improvements. PART 3-OTHER PROVISIONS Sec. 1141. Rental and purchase of power-driven wheelchairs. Sec. 1141A. Election to take ownership, or to decline ownership, of a certain item of complex durable medical equipment after the 13-month capped rental period ends. Sec. 1142. Extension of payment rule for brachytherapy. Sec. 1143. Home infusion therapy report to congress. Sec. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and other data. Sec. 1145. Treatment of certain cancer hospitals. Sec. 1146. Medicare Improvement Fund. Sec. 1147. Payment for imaging services. Sec. 1148. Durable medical equipment program improvements. Sec. 1149. MedPAC study and report on bone mass measurement. Sec. 1149A. Exclusion of customary prompt pay discounts extended to wholesalers from manufacturer's average sales price for payments for drugs and biologicals under Medicare part B. Sec. 1149B. Timely access to postmastectomy items. Sec. 1149C. Moratorium on Medicare reductions in payment rates for certain interventional pain management procedures covered under the ASC fee schedule. Sec. 1149D. Medicare coverage of services of qualified respiratory therapists performed under the general supervision of a physician. Subtitle C-Provisions Related to Medicare Parts A and B Sec. 1151. Reducing potentially preventable hospital readmissions. Sec. 1152. Post acute care services payment reform plan and bundling pilot program. Sec. 1153. Home health payment update for 2010. Sec. 1154. Payment adjustments for home health care. Sec. 1155. Incorporating productivity improvements into market basket update for home health services. Sec. 1156. Limitation on Medicare exceptions to the prohibition on certain physician referrals made to hospitals. Sec. 1157. Institute of Medicine study of geographic adjustment factors under Medicare. Sec. 1158. Revision of Medicare payment systems to address geographic inequities. Subtitle D-Medicare Advantage Reforms PART 1-PAYMENT AND ADMINISTRATION Sec. 1161. Phase-in of payment based on fee-for-service costs. Sec. 1162. Quality bonus payments. Sec. 1163. Extension of Secretarial coding intensity adjustment authority. Sec. 1164. Simplification of annual beneficiary election periods. Sec. 1165. Extension of reasonable cost contracts. Sec. 1166. Limitation of waiver authority for employer group plans. Sec. 1167. Improving risk adjustment for payments. Sec. 1168. Elimination of MA Regional Plan Stabilization Fund. Sec. 1169. Study regarding the effects of calculating Medicare Advantage payment rates on a regional average of Medicare fee for service rates. PART 2-BENEFICIARY PROTECTIONS AND ANTI-FRAUD Sec. 1171. Limitation on cost-sharing for individual health services. Sec. 1172. Continuous open enrollment for enrollees in plans with enrollment suspension. Sec. 1173. Information for beneficiaries on MA plan administrative costs. Sec. 1174. Strengthening audit authority. Sec. 1175. Authority to deny plan bids. PART 3-TREATMENT OF SPECIAL NEEDS PLANS Sec. 1176. Limitation on enrollment outside open enrollment period of individuals into chronic care specialized MA plans for special needs individuals. Sec. 1177. Extension of authority of special needs plans to restrict enrollment. Subtitle E-Improvements to Medicare Part D Sec. 1181. Elimination of coverage gap. Sec. 1182. Discounts for certain part D drugs in original coverage gap. Sec. 1183. Repeal of provision relating to submission of claims by pharmacies located in or contracting with long-term care facilities. Sec. 1184. Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D. Sec. 1185. Permitting mid-year changes in enrollment for formulary changes that adversely impact an enrollee. Sec. 1186. Negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries. Sec. 1187. State certification prior to waiver of licensure requirements under Medicare prescription drug program. Subtitle F-Medicare Rural Access Protections Sec. 1191. Telehealth expansion and enhancements. Sec. 1192. Extension of outpatient hold harmless provision. Sec. 1193. Extension of section 508 hospital reclassifications. Sec. 1194. Extension of geographic floor for work. Sec. 1195. Extension of payment for technical component of certain physician pathology services. Sec. 1197. Ensuring proportional representation of interests of rural areas on MedPAC. TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS Subtitle A-Improving and Simplifying Financial Assistance for Low Income Medicare Beneficiaries Sec. 1201. Improving assets tests for Medicare Savings Program and low-income subsidy program. Sec. 1202. Elimination of part D cost-sharing for certain noninstitutionalized full-benefit dual eligible individuals. Sec. 1203. Eliminating barriers to enrollment. Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low income subsidy enrollment. Sec. 1206. Special enrollment period and automatic enrollment process for certain subsidy eligible individuals. Subtitle B-Reducing Health Disparities Sec. 1221. Ensuring effective communication in Medicare. Sec. 1222. Demonstration to promote access for Medicare beneficiaries with limited-English proficiency by providing reimbursement for culturally and linguistically appropriate services. Sec. 1223. IOM report on impact of language access services. Sec. 1224. Definitions. Subtitle C-Miscellaneous Improvements Sec. 1231. Extension of therapy caps exceptions process. Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions. Sec. 1233. Advance care planning consultation. Sec. 1234. Part B special enrollment period and waiver of limited enrollment penalty for TRICARE beneficiaries. Sec. 1235. Exception for use of more recent tax year in case of gains from sale of primary residence in computing part B income-related premium. Sec. 1236. Demonstration program on use of patient decisions aids. TITLE III-PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE Sec. 1301. Accountable Care Organization pilot program. Sec. 1302. Medical home pilot program. Sec. 1303. Independence at home pilot program. Sec. 1304. Payment incentive for selected primary care services. Sec. 1305. Increased reimbursement rate for certified nurse-midwives. Sec. 1306. Coverage and waiver of cost-sharing for preventive services. Sec. 1307. Waiver of deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal. Sec. 1308. Excluding clinical social worker services from coverage under the Medicare skilled nursing facility prospective payment system and consolidated payment. Sec. 1309. Coverage of marriage and family therapist services and mental health counselor services. Sec. 1310. Extension of physician fee schedule mental health add-on. Sec. 1311. Expanding access to vaccines. Sec. 1312. Recognition of certified diabetes educators as certified providers for purposes of Medicare diabetes outpatient self-management training services. TITLE IV-QUALITY Subtitle A-Comparative Effectiveness Research Sec. 1401. Comparative effectiveness research. Subtitle B-Nursing Home Transparency PART 1-IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING FACILITIES AND NURSING FACILITIES Sec. 1411. Required disclosure of ownership and additional disclosable parties information. Sec. 1412. Accountability requirements. Sec. 1421. Civil money penalties. PART 2-TARGETING ENFORCEMENT Sec. 1422. National independent monitor pilot program. PART 3-IMPROVING STAFF TRAINING Sec. 1431. Dementia and abuse prevention training. Sec. 1432. Study and report on training required for certified nurse aides and supervisory staff. Subtitle C-Quality Measurements Sec. 1441. Establishment of national priorities for quality improvement. Sec. 1442. Development of new quality measures; GAO evaluation of data collection process for quality meas urement. Sec. 1443. Multistakeholder prerulemaking input into selection of quality measures. Sec. 1444. Application of quality measures. Sec. 1445. Consensus-based entity funding. Sec. 1446. Quality indicators for care of people with Alzheimer's disease. Sec. 1447. Study on five star quality rating system. Subtitle D-Physician Payments Sunshine Provision Sec. 1451. Reports on financial relationships between manufacturers and distributors of covered drugs, devices, biologicals, or medical supplies under Medicare, Medicaid, or CHIP and physicians and other health care entities and between physicians and other health care entities. Subtitle E-Public Reporting on Health Care-Associated Infections Sec. 1461. Requirement for public reporting by hospitals and ambulatory surgical centers on health care-associated infections. TITLE V-MEDICARE GRADUATE MEDICAL EDUCATION Sec. 1501. Distribution of unused residency positions. Sec. 1502. Increasing training in nonprovider settings. Sec. 1503. Rules for counting resident time for didactic and scholarly activities and other activities. Sec. 1505. Improving accountability for approved medical residency training. TITLE VI-PROGRAM INTEGRITY Subtitle A-Increased Funding To Fight Waste, Fraud, and Abuse Sec. 1601. Increased funding and flexibility to fight fraud and abuse. Subtitle B-Enhanced Penalties for Fraud and Abuse Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment applications. Sec. 1613. Enhanced penalties for delaying inspections. Sec. 1614. Enhanced hospice program safeguards. Sec. 1615. Enhanced penalties for individuals excluded from program participation. Sec. 1616. Enhanced penalties for provision of false information by Medicare Advantage and part D plans. Sec. 1617. Enhanced penalties for Medicare Advantage and part Ď marketing violations. Sec. 1618. Enhanced penalties for obstruction of program audits. Sec. 1619. Exclusion of certain individuals and entities from participation in Medicare and State health care programs. Subtitle C-Enhanced Program and Provider Protections Sec. 1631. Enhanced CMS program protection authority. Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements relating to previous affiliations. Sec. 1633. Required inclusion of payment modifier for certain evaluation and management services. Sec. 1634. Evaluations and reports required under Medicare Integrity Program. Sec. 1635. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse. Sec. 1636. Maximum period for submission of Medicare claims reduced to not more than 12 months. Sec. 1637. Physicians who order durable medical equipment or home health services required to be Medicareenrolled physicians or eligible professionals. Sec. 1638. Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse. Sec. 1639. Face-to-face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare. Sec. 1640. Extension of testimonial subpoena authority to program exclusion investigations. Sec. 1641. Required repayments of Medicare and Medicaid overpayments. Sec. 1642. Expanded application of hardship waivers for OIG exclusions to beneficiaries of any Federal health care program. Sec. 1643. Access to certain information on renal dialysis facilities. Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to register under Medicare. Subtitle D-Access to Information Needed To Prevent Fraud, Waste, and Abuse Sec. 1651. Access to information necessary to identify fraud, waste, and abuse. Sec. 1652. Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank. Sec. 1653. Compliance with HIPAA privacy and security standards. TITLE VII-MEDICAID AND CHIP Subtitle A-Medicaid and Health Reform Sec. 1701. Eligibility for individuals with income below 1333 percent of the Federal poverty level. Sec. 1703. CHIP and Medicaid maintenance of eligibility. Sec. 1704. Reduction in Medicaid DSH. Sec. 1705. Expanded outstationing. Subtitle B-Prevention Sec. 1711. Required coverage of preventive services. Sec. 1712. Tobacco cessation. Sec. 1713. Optional coverage of nurse home visitation services. Subtitle C-Access Sec. 1721. Payments to primary care practitioners. Sec. 1723. Translation or interpretation services. Sec. 1724. Optional coverage for freestanding birth center services. Sec. 1725. Inclusion of public health clinics under the vaccines for children program. Sec. 1726. Requiring coverage of services of podiatrists. Sec. 1726A. Requiring coverage of services of optometrists. Sec. 1727. Therapeutic foster care. Sec. 1728. Assuring adequate payment levels for services. Sec. 1729. Preserving Medicaid coverage for youths upon release from public institutions. Subtitle D-Coverage Sec. 1731. Optional Medicaid coverage of low-income HIV-infected individuals. Sec. 1732. Extending transitional Medicaid Assistance (TMA). Sec. 1733. Requirement of 12-month continuous coverage under certain CHIP programs. Sec. 1734. Preventing the application under CHIP of coverage waiting periods for certain children. Sec. 1735. Adult day health care services. Sec. 1736. Medicaid coverage for citizens of Freely Associated States. Sec. 1737. Continuing requirement of Medicaid coverage of nonemergency transportation to medically necessary services. Sec. 1738. State option to disregard certain income in providing continued Medicaid coverage for certain individuals with extremely high prescription costs. Sec. 1741. Payments to pharmacists. Sec. 1742. Prescription drug rebates. Subtitle E-Financing Sec. 1743. Extension of prescription drug discounts to enrollees of Medicaid managed care organizations. Sec. 1745. Report on Medicaid payments. Sec. 1746. Reviews of Medicaid. Sec. 1747. Extension of delay in managed care organization provider tax elimination. Subtitle F-Waste, Fraud, and Abuse Sec. 1751. Health care acquired conditions. Sec. 1752. Evaluations and reports required under Medicaid Integrity Program. Sec. 1753. Require providers and suppliers to adopt programs to reduce waste, fraud, and abuse. Sec. 1755. Managed care organizations. Sec. 1756. Termination of provider participation under Medicaid and CHIP if terminated under Medicare or other State plan or child health plan. Sec. 1757. Medicaid and CHIP exclusion from participation relating to certain ownership, control, and management affiliations. Sec. 1758. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse. Sec. 1761. Mandatory State use of national correct coding initiative. Sec. 1771. Payment to territories. Subtitle G-Payments to the Territories Subtitle H-Miscellaneous Sec. 1781. Technical corrections. Sec. 1782. Extension of QI program. Sec. 1783. Outreach and enrollment of Medicaid and CHIP eligible individuals. Sec. 1784. Prohibitions on Federal Medicaid and CHIP payment for undocumented aliens. Sec. 1785. Demonstration project for stabilization of emergency medical conditions by nonpublicly owned or operated institutions for mental diseases. TITLE VIII-REVENUE-RELATED PROVISIONS Sec. 1801. Disclosures to facilitate identification of individuals likely to be ineligible for the low-income assistance under the Medicare prescription drug program to assist Social Security Administration's outreach to eligible individuals. Sec. 1802. Comparative Effectiveness Research Trust Fund; financing for Trust Fund. TITLE IX-MISCELLANEOUS PROVISIONS Sec. 1901. Repeal of trigger provision. Sec. 1902. Repeal of comparative cost adjustment (CCA) program. |