Legislation mandating additional reductions

Requires the Secretary to negotiate provider reimbursement rates, but they must not be higher than average rates paid by private qualified health plans. State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid. This provision would extend the demonstration through September 30, 2011 and extend the date for the final report to Congress on the demonstration to September 30, 2012. Also provides immediate relief to areas negatively impacted by the geographic adjustment for practice expenses, and requires the Secretary of HHS to improve the methodology for calculating practice expense adjustments beginning in 2012. Extends the process allowing exceptions to limitations on medically necessary therapy until December 31, 2010. Extends a provision that directly reimburses qualified rural hospitals for certain clinical laboratory services through the end of 2010.

Subjects the option to State and Federal solvency standards and to State consumer protection laws. Requires qualified health plans offered under the CO-OP program, as a Community Health Insurance Option, or as a nationwide plan, to be subject to all Federal and State laws that apply to private health insurers. Allows States to contract, through a competitive process that includes negotiation of premiums, cost-sharing, and benefits, with standard health plans for individuals who are not eligible for Medicaid or other affordable coverage and have income below 200 percent of the Federal Poverty Level (FPL). Beginning in 2017, allows States to apply for a waiver for up to 5 years of requirements relating to qualified health plans, Exchanges, cost-sharing reductions, tax credits, the individual responsibility requirement, and shared responsibility for employers. Provides funding to hospitals and community-based entities that furnish evidence-based care transition services to Medicare beneficiaries at high risk for readmission. It would also authorize an additional

Requires the Secretary to negotiate provider reimbursement rates, but they must not be higher than average rates paid by private qualified health plans. State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid. This provision would extend the demonstration through September 30, 2011 and extend the date for the final report to Congress on the demonstration to September 30, 2012. Also provides immediate relief to areas negatively impacted by the geographic adjustment for practice expenses, and requires the Secretary of HHS to improve the methodology for calculating practice expense adjustments beginning in 2012. Extends the process allowing exceptions to limitations on medically necessary therapy until December 31, 2010. Extends a provision that directly reimburses qualified rural hospitals for certain clinical laboratory services through the end of 2010. Subjects the option to State and Federal solvency standards and to State consumer protection laws. Requires qualified health plans offered under the CO-OP program, as a Community Health Insurance Option, or as a nationwide plan, to be subject to all Federal and State laws that apply to private health insurers. Allows States to contract, through a competitive process that includes negotiation of premiums, cost-sharing, and benefits, with standard health plans for individuals who are not eligible for Medicaid or other affordable coverage and have income below 200 percent of the Federal Poverty Level (FPL). Beginning in 2017, allows States to apply for a waiver for up to 5 years of requirements relating to qualified health plans, Exchanges, cost-sharing reductions, tax credits, the individual responsibility requirement, and shared responsibility for employers. Provides funding to hospitals and community-based entities that furnish evidence-based care transition services to Medicare beneficiaries at high risk for readmission. It would also authorize an additional $1.6 million in FY2010 for carrying out the demonstration. If you are looking for a specific title or provision please use the basic find command on your browser. The first section of the PPACA contains amendments to the Public Health Service Act of 1944. Requires States to implement these standards by 2014. Extends the existing outpatient hold harmless provision through the end of FY2010 and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of FY2010. Reinstates the policy included in the Medicare Modernization Act of 2003 (P. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals from July 1, 2010 to July 1, 2011. Extends the program for one year and expands eligible sites to additional States and additional rural hospitals. Extends the Medicare-dependent hospital program by one year through October 1, 2012. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Improvements to the demonstration project on community health integration models in certain rural counties. This provision would direct the Secretary to improve payment accuracy through rebasing home health payments starting in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. This provision would require the Secretary to update Medicare hospice claims forms and cost reports by 2011. Also requires an evaluation of Medicare Advantage risk adjustment for chronically ill populations. Under this program, CDC will provide grants to States to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions. Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of health care Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title VIIII Revenue provisions Title X Reauthorization of the Indian Health Care Improvement Act Sec. If the Secretary determines before 2013 that a State will not have an Exchange operational by 2014, or will not implement the standards, requires the Secretary to establish and operate an Exchange in the State and to implement the standards. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. It would also require HHS to study whether certain urban hospitals should qualify for the MDH program. Expands the program providing a temporary adjustment to inpatient hospital payments for certain low-volume hospitals through FY2012 and would modify eligibility requirements regarding distance from another facility and number of eligible discharges. The Medicare Improvements for Patients and Providers Act (MIPPA, P. 110-275) authorized a demonstration project that will allow eligible rural entities to test new models for the delivery of health care services in rural areas. Med PAC study on adequacy of Medicare payments for health care providers serving in rural areas. Technical correction related to critical access hospital services. Extension of and revisions to Medicare rural hospital flexibility program. The provision would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments and would reinstate an add-on payment for rural home health providers from April 1, 2010 through 2015. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy in FY2013. Improvement to Medicare disproportionate share hospital (DSH) payments. Directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare, including services that have experienced high growth rates. Modification of equipment utilization factor for advanced imaging services. Directs the Secretary to study whether existing cancer hospitals that are exempt from the inpatient prospective payment system have costs under the outpatient prospective payment system (OPPS) that exceed costs of other hospitals, and to make an appropriate payment adjustment under OPPS based on that analysis. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits. This initiative would amend the Fair Labor Standard Act to require employers to provide break time and a place for breastfeeding mothers to express milk. Research on optimizing the delivery of public health services. Establishes a program at the CDCthat awards grants to assist State, local, and tribal public health agencies in improving surveillance for and responses to infectious diseases and other conditions of public health importance.

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Requires the Secretary to negotiate provider reimbursement rates, but they must not be higher than average rates paid by private qualified health plans. State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid. This provision would extend the demonstration through September 30, 2011 and extend the date for the final report to Congress on the demonstration to September 30, 2012. Also provides immediate relief to areas negatively impacted by the geographic adjustment for practice expenses, and requires the Secretary of HHS to improve the methodology for calculating practice expense adjustments beginning in 2012. Extends the process allowing exceptions to limitations on medically necessary therapy until December 31, 2010. Extends a provision that directly reimburses qualified rural hospitals for certain clinical laboratory services through the end of 2010.

Subjects the option to State and Federal solvency standards and to State consumer protection laws. Requires qualified health plans offered under the CO-OP program, as a Community Health Insurance Option, or as a nationwide plan, to be subject to all Federal and State laws that apply to private health insurers. Allows States to contract, through a competitive process that includes negotiation of premiums, cost-sharing, and benefits, with standard health plans for individuals who are not eligible for Medicaid or other affordable coverage and have income below 200 percent of the Federal Poverty Level (FPL). Beginning in 2017, allows States to apply for a waiver for up to 5 years of requirements relating to qualified health plans, Exchanges, cost-sharing reductions, tax credits, the individual responsibility requirement, and shared responsibility for employers. Provides funding to hospitals and community-based entities that furnish evidence-based care transition services to Medicare beneficiaries at high risk for readmission. It would also authorize an additional $1.6 million in FY2010 for carrying out the demonstration.

If you are looking for a specific title or provision please use the basic find command on your browser. The first section of the PPACA contains amendments to the Public Health Service Act of 1944. Requires States to implement these standards by 2014. Extends the existing outpatient hold harmless provision through the end of FY2010 and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of FY2010. Reinstates the policy included in the Medicare Modernization Act of 2003 (P. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals from July 1, 2010 to July 1, 2011. Extends the program for one year and expands eligible sites to additional States and additional rural hospitals. Extends the Medicare-dependent hospital program by one year through October 1, 2012. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Improvements to the demonstration project on community health integration models in certain rural counties. This provision would direct the Secretary to improve payment accuracy through rebasing home health payments starting in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. This provision would require the Secretary to update Medicare hospice claims forms and cost reports by 2011. Also requires an evaluation of Medicare Advantage risk adjustment for chronically ill populations. Under this program, CDC will provide grants to States to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions.

Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of health care Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title VIIII Revenue provisions Title X Reauthorization of the Indian Health Care Improvement Act Sec. If the Secretary determines before 2013 that a State will not have an Exchange operational by 2014, or will not implement the standards, requires the Secretary to establish and operate an Exchange in the State and to implement the standards. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. It would also require HHS to study whether certain urban hospitals should qualify for the MDH program. Expands the program providing a temporary adjustment to inpatient hospital payments for certain low-volume hospitals through FY2012 and would modify eligibility requirements regarding distance from another facility and number of eligible discharges. The Medicare Improvements for Patients and Providers Act (MIPPA, P. 110-275) authorized a demonstration project that will allow eligible rural entities to test new models for the delivery of health care services in rural areas. Med PAC study on adequacy of Medicare payments for health care providers serving in rural areas. Technical correction related to critical access hospital services. Extension of and revisions to Medicare rural hospital flexibility program. The provision would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments and would reinstate an add-on payment for rural home health providers from April 1, 2010 through 2015. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy in FY2013. Improvement to Medicare disproportionate share hospital (DSH) payments. Directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare, including services that have experienced high growth rates. Modification of equipment utilization factor for advanced imaging services. Directs the Secretary to study whether existing cancer hospitals that are exempt from the inpatient prospective payment system have costs under the outpatient prospective payment system (OPPS) that exceed costs of other hospitals, and to make an appropriate payment adjustment under OPPS based on that analysis. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits. This initiative would amend the Fair Labor Standard Act to require employers to provide break time and a place for breastfeeding mothers to express milk. Research on optimizing the delivery of public health services. Establishes a program at the CDCthat awards grants to assist State, local, and tribal public health agencies in improving surveillance for and responses to infectious diseases and other conditions of public health importance.

Each health insurance issuer must accept every employer and individual in the State that applies for coverage, permitting annual and special open enrollment periods for those with qualifying lifetime events. Authorizes a 10-State demonstration to apply such a program in the individual market. The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill. Defines the small group market as the market in which a plan is offered by a small employer that employs 1-100 employees. Strengthens the health care safety-net by creating a $50 million grant program administered by HRSA to support nurse-managed health clinics.

Permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs. In making the estimate, the Secretary would also be required to estimate the costs as if coverage were included for the entire covered population, but the costs could not be estimated at less than $1 per enrollee, per month. No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions. State laws regarding the prohibition of or requirement of coverage or funding for abortions and State laws involving abortion-related procedural requirements are not preempted.

.6 million in FY2010 for carrying out the demonstration.

If you are looking for a specific title or provision please use the basic find command on your browser. The first section of the PPACA contains amendments to the Public Health Service Act of 1944. Requires States to implement these standards by 2014. Extends the existing outpatient hold harmless provision through the end of FY2010 and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of FY2010. Reinstates the policy included in the Medicare Modernization Act of 2003 (P. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals from July 1, 2010 to July 1, 2011. Extends the program for one year and expands eligible sites to additional States and additional rural hospitals. Extends the Medicare-dependent hospital program by one year through October 1, 2012. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Improvements to the demonstration project on community health integration models in certain rural counties. This provision would direct the Secretary to improve payment accuracy through rebasing home health payments starting in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. This provision would require the Secretary to update Medicare hospice claims forms and cost reports by 2011. Also requires an evaluation of Medicare Advantage risk adjustment for chronically ill populations. Under this program, CDC will provide grants to States to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions.

Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of health care Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title VIIII Revenue provisions Title X Reauthorization of the Indian Health Care Improvement Act Sec. If the Secretary determines before 2013 that a State will not have an Exchange operational by 2014, or will not implement the standards, requires the Secretary to establish and operate an Exchange in the State and to implement the standards. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. It would also require HHS to study whether certain urban hospitals should qualify for the MDH program. Expands the program providing a temporary adjustment to inpatient hospital payments for certain low-volume hospitals through FY2012 and would modify eligibility requirements regarding distance from another facility and number of eligible discharges. The Medicare Improvements for Patients and Providers Act (MIPPA, P. 110-275) authorized a demonstration project that will allow eligible rural entities to test new models for the delivery of health care services in rural areas. Med PAC study on adequacy of Medicare payments for health care providers serving in rural areas. Technical correction related to critical access hospital services. Extension of and revisions to Medicare rural hospital flexibility program. The provision would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments and would reinstate an add-on payment for rural home health providers from April 1, 2010 through 2015. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy in FY2013. Improvement to Medicare disproportionate share hospital (DSH) payments. Directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare, including services that have experienced high growth rates. Modification of equipment utilization factor for advanced imaging services. Directs the Secretary to study whether existing cancer hospitals that are exempt from the inpatient prospective payment system have costs under the outpatient prospective payment system (OPPS) that exceed costs of other hospitals, and to make an appropriate payment adjustment under OPPS based on that analysis. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits. This initiative would amend the Fair Labor Standard Act to require employers to provide break time and a place for breastfeeding mothers to express milk. Research on optimizing the delivery of public health services. Establishes a program at the CDCthat awards grants to assist State, local, and tribal public health agencies in improving surveillance for and responses to infectious diseases and other conditions of public health importance.

Each health insurance issuer must accept every employer and individual in the State that applies for coverage, permitting annual and special open enrollment periods for those with qualifying lifetime events. Authorizes a 10-State demonstration to apply such a program in the individual market. The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill. Defines the small group market as the market in which a plan is offered by a small employer that employs 1-100 employees. Strengthens the health care safety-net by creating a million grant program administered by HRSA to support nurse-managed health clinics.

Permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs. In making the estimate, the Secretary would also be required to estimate the costs as if coverage were included for the entire covered population, but the costs could not be estimated at less than

Requires the Secretary to negotiate provider reimbursement rates, but they must not be higher than average rates paid by private qualified health plans. State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid. This provision would extend the demonstration through September 30, 2011 and extend the date for the final report to Congress on the demonstration to September 30, 2012. Also provides immediate relief to areas negatively impacted by the geographic adjustment for practice expenses, and requires the Secretary of HHS to improve the methodology for calculating practice expense adjustments beginning in 2012. Extends the process allowing exceptions to limitations on medically necessary therapy until December 31, 2010. Extends a provision that directly reimburses qualified rural hospitals for certain clinical laboratory services through the end of 2010. Subjects the option to State and Federal solvency standards and to State consumer protection laws. Requires qualified health plans offered under the CO-OP program, as a Community Health Insurance Option, or as a nationwide plan, to be subject to all Federal and State laws that apply to private health insurers. Allows States to contract, through a competitive process that includes negotiation of premiums, cost-sharing, and benefits, with standard health plans for individuals who are not eligible for Medicaid or other affordable coverage and have income below 200 percent of the Federal Poverty Level (FPL). Beginning in 2017, allows States to apply for a waiver for up to 5 years of requirements relating to qualified health plans, Exchanges, cost-sharing reductions, tax credits, the individual responsibility requirement, and shared responsibility for employers. Provides funding to hospitals and community-based entities that furnish evidence-based care transition services to Medicare beneficiaries at high risk for readmission. It would also authorize an additional $1.6 million in FY2010 for carrying out the demonstration. If you are looking for a specific title or provision please use the basic find command on your browser. The first section of the PPACA contains amendments to the Public Health Service Act of 1944. Requires States to implement these standards by 2014. Extends the existing outpatient hold harmless provision through the end of FY2010 and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of FY2010. Reinstates the policy included in the Medicare Modernization Act of 2003 (P. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals from July 1, 2010 to July 1, 2011. Extends the program for one year and expands eligible sites to additional States and additional rural hospitals. Extends the Medicare-dependent hospital program by one year through October 1, 2012. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Improvements to the demonstration project on community health integration models in certain rural counties. This provision would direct the Secretary to improve payment accuracy through rebasing home health payments starting in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. This provision would require the Secretary to update Medicare hospice claims forms and cost reports by 2011. Also requires an evaluation of Medicare Advantage risk adjustment for chronically ill populations. Under this program, CDC will provide grants to States to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions. Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of health care Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title VIIII Revenue provisions Title X Reauthorization of the Indian Health Care Improvement Act Sec. If the Secretary determines before 2013 that a State will not have an Exchange operational by 2014, or will not implement the standards, requires the Secretary to establish and operate an Exchange in the State and to implement the standards. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. It would also require HHS to study whether certain urban hospitals should qualify for the MDH program. Expands the program providing a temporary adjustment to inpatient hospital payments for certain low-volume hospitals through FY2012 and would modify eligibility requirements regarding distance from another facility and number of eligible discharges. The Medicare Improvements for Patients and Providers Act (MIPPA, P. 110-275) authorized a demonstration project that will allow eligible rural entities to test new models for the delivery of health care services in rural areas. Med PAC study on adequacy of Medicare payments for health care providers serving in rural areas. Technical correction related to critical access hospital services. Extension of and revisions to Medicare rural hospital flexibility program. The provision would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments and would reinstate an add-on payment for rural home health providers from April 1, 2010 through 2015. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy in FY2013. Improvement to Medicare disproportionate share hospital (DSH) payments. Directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare, including services that have experienced high growth rates. Modification of equipment utilization factor for advanced imaging services. Directs the Secretary to study whether existing cancer hospitals that are exempt from the inpatient prospective payment system have costs under the outpatient prospective payment system (OPPS) that exceed costs of other hospitals, and to make an appropriate payment adjustment under OPPS based on that analysis. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits. This initiative would amend the Fair Labor Standard Act to require employers to provide break time and a place for breastfeeding mothers to express milk. Research on optimizing the delivery of public health services. Establishes a program at the CDCthat awards grants to assist State, local, and tribal public health agencies in improving surveillance for and responses to infectious diseases and other conditions of public health importance.

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Requires the Secretary to negotiate provider reimbursement rates, but they must not be higher than average rates paid by private qualified health plans. State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid. This provision would extend the demonstration through September 30, 2011 and extend the date for the final report to Congress on the demonstration to September 30, 2012. Also provides immediate relief to areas negatively impacted by the geographic adjustment for practice expenses, and requires the Secretary of HHS to improve the methodology for calculating practice expense adjustments beginning in 2012. Extends the process allowing exceptions to limitations on medically necessary therapy until December 31, 2010. Extends a provision that directly reimburses qualified rural hospitals for certain clinical laboratory services through the end of 2010.

Subjects the option to State and Federal solvency standards and to State consumer protection laws. Requires qualified health plans offered under the CO-OP program, as a Community Health Insurance Option, or as a nationwide plan, to be subject to all Federal and State laws that apply to private health insurers. Allows States to contract, through a competitive process that includes negotiation of premiums, cost-sharing, and benefits, with standard health plans for individuals who are not eligible for Medicaid or other affordable coverage and have income below 200 percent of the Federal Poverty Level (FPL). Beginning in 2017, allows States to apply for a waiver for up to 5 years of requirements relating to qualified health plans, Exchanges, cost-sharing reductions, tax credits, the individual responsibility requirement, and shared responsibility for employers. Provides funding to hospitals and community-based entities that furnish evidence-based care transition services to Medicare beneficiaries at high risk for readmission. It would also authorize an additional $1.6 million in FY2010 for carrying out the demonstration.

If you are looking for a specific title or provision please use the basic find command on your browser. The first section of the PPACA contains amendments to the Public Health Service Act of 1944. Requires States to implement these standards by 2014. Extends the existing outpatient hold harmless provision through the end of FY2010 and would allow Sole Community Hospitals with more than 100 beds to also be eligible to receive this adjustment through the end of FY2010. Reinstates the policy included in the Medicare Modernization Act of 2003 (P. 108-173) that provides reasonable cost reimbursement for laboratory services provided by certain small rural hospitals from July 1, 2010 to July 1, 2011. Extends the program for one year and expands eligible sites to additional States and additional rural hospitals. Extends the Medicare-dependent hospital program by one year through October 1, 2012. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals. Improvements to the demonstration project on community health integration models in certain rural counties. This provision would direct the Secretary to improve payment accuracy through rebasing home health payments starting in 2013 based on an analysis of the current mix of services and intensity of care provided to home health patients. This provision would require the Secretary to update Medicare hospice claims forms and cost reports by 2011. Also requires an evaluation of Medicare Advantage risk adjustment for chronically ill populations. Under this program, CDC will provide grants to States to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions.

Title I Quality, affordable health care for all Americans Title II The role of public programs Title III Improving the quality and efficiency of health care Title IV Preventing chronic disease and improving public health Title V Health care workforce Title VI Transparency and program integrity Title VII Improving access to innovative medical therapies Title VIII Community living assistance services and supports Title VIIII Revenue provisions Title X Reauthorization of the Indian Health Care Improvement Act Sec. If the Secretary determines before 2013 that a State will not have an Exchange operational by 2014, or will not implement the standards, requires the Secretary to establish and operate an Exchange in the State and to implement the standards. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers. It would also require HHS to study whether certain urban hospitals should qualify for the MDH program. Expands the program providing a temporary adjustment to inpatient hospital payments for certain low-volume hospitals through FY2012 and would modify eligibility requirements regarding distance from another facility and number of eligible discharges. The Medicare Improvements for Patients and Providers Act (MIPPA, P. 110-275) authorized a demonstration project that will allow eligible rural entities to test new models for the delivery of health care services in rural areas. Med PAC study on adequacy of Medicare payments for health care providers serving in rural areas. Technical correction related to critical access hospital services. Extension of and revisions to Medicare rural hospital flexibility program. The provision would also establish a 10 percent cap on the amount of reimbursement a home health provider can receive from outlier payments and would reinstate an add-on payment for rural home health providers from April 1, 2010 through 2015. Based on this information, the Secretary would be required to implement changes to the hospice payment system to improve payment accuracy in FY2013. Improvement to Medicare disproportionate share hospital (DSH) payments. Directs the Secretary to regularly review fee schedule rates for physician services paid for by Medicare, including services that have experienced high growth rates. Modification of equipment utilization factor for advanced imaging services. Directs the Secretary to study whether existing cancer hospitals that are exempt from the inpatient prospective payment system have costs under the outpatient prospective payment system (OPPS) that exceed costs of other hospitals, and to make an appropriate payment adjustment under OPPS based on that analysis. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits. This initiative would amend the Fair Labor Standard Act to require employers to provide break time and a place for breastfeeding mothers to express milk. Research on optimizing the delivery of public health services. Establishes a program at the CDCthat awards grants to assist State, local, and tribal public health agencies in improving surveillance for and responses to infectious diseases and other conditions of public health importance.

Each health insurance issuer must accept every employer and individual in the State that applies for coverage, permitting annual and special open enrollment periods for those with qualifying lifetime events. Authorizes a 10-State demonstration to apply such a program in the individual market. The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill. Defines the small group market as the market in which a plan is offered by a small employer that employs 1-100 employees. Strengthens the health care safety-net by creating a $50 million grant program administered by HRSA to support nurse-managed health clinics.

Permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs. In making the estimate, the Secretary would also be required to estimate the costs as if coverage were included for the entire covered population, but the costs could not be estimated at less than $1 per enrollee, per month. No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions. State laws regarding the prohibition of or requirement of coverage or funding for abortions and State laws involving abortion-related procedural requirements are not preempted.

per enrollee, per month. No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions. State laws regarding the prohibition of or requirement of coverage or funding for abortions and State laws involving abortion-related procedural requirements are not preempted.

Preservation of right to maintain existing coverage. Rating reforms must apply uniformly to all health insurance issuers and group health plans. Also, if an insurer offers a qualified health plan, it must offer a child-only plan at the same level of coverage. The Secretary may not determine that the public plan provide coverage for abortions beyond those allowed by Hyde unless the Secretary: 1) is in compliance with the provision prohibiting the use of Federal funds to pay for abortions (beyond those allowed by Hyde); 2) guarantees that, according to three different accounting standards, no Federal funds will be used; and (3) takes all necessary steps to ensure that the United States does not bear the insurance risk for abortions that do not meet the Hyde exceptions in the public plan. Awards grants to nursing schools to strengthen nurse education and training programs and to improve nurse retention.

Requires guaranteed renewability of coverage regardless of health status, utilization of health services or any other related factor. No group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past. No group health plan or insurer offering group or individual coverage may set eligibility rules based on health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability – including acts of domestic violence or disability. Prohibits discrimination against health care providers acting within the scope of their professional license and applicable State laws. In making such estimates, the Secretary may take into account the impact of including such coverage on overall costs, but may not consider any cost reduction estimated to result from providing such abortions, such as prenatal care. Eliminates the artificial cap on the number of Commissioned Corps members, allowing the Corps to expand to meet national public health needs. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home.

Prohibition of preexisting condition exclusions or other discrimination based on health status. Prohibiting discrimination against individual participants and beneficiaries based on health status. The Secretary would ensure that in each State Exchange, at least one plan provides coverage of abortions beyond those permitted by Hyde and at least one plan does not provide coverage of abortions beyond those permitted by Hyde. No tax credit or cost-sharing credits may be used to pay for abortions beyond those permitted by the Hyde Amendment. Issuers of plans that offer coverage for abortion beyond those permitted by the Hyde amendment must segregate from any premium and cost-sharing credits an amount of each enrollee’s private premium dollars that is determined by the Secretary to be sufficient to cover the provision of those services. The Secretary would be required to estimate, on an average actuarial basis, the basic per enrollee, per month cost of including coverage of abortions beyond those permitted by the Hyde Amendment. Ready Reserve Corps members may be called to active duty to respond to national emergencies and public health crises and to fill critical public health positions left vacant by members of the Regular Corps who have been called to duty elsewhere. Provides grants to develop and operate training programs, provide financial assistance to trainees and faculty, enhance faculty development in primary care and physician assistant programs, and to establish, maintain, and improve academic units in primary care. Allows dental schools and education programs to use grants for pre-doctoral training, faculty development, dental faculty loan repayment, and academic administrative units. Authorizes the Secretary to award grants to establish training programs for alternative dental health care providers to increase access to dental health care services in rural, tribal, and underserved communities. Authorizes funding to geriatric education centers to support training in geriatrics, chronic care management, and long-term care for faculty in health professions schools and family caregivers; develop curricula and best practices in geriatrics; expand the geriatric career awards to advanced practice nurses, clinical social workers, pharmacists, and psychologists; and establish traineeships for individuals who are preparing for advanced education nursing degrees in geriatric nursing. Awards grants to schools for the development, expansion, or enhancement of training programs in social work, graduate psychology, professional training in child and adolescent mental health, and pre-service or in-service training to paraprofessionals in child and adolescent mental health. Reauthorizes and expands programs to support the development, evaluation, and dissemination of model curricula for cultural competency, prevention, and public health proficiency and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs.

These independent offices will assist consumers with filing complaints and appeals, educate consumers on their rights and responsibilities, and collect, track, and quantify consumer problems and inquiries. Ensuring that consumers get value for their dollars. Immediate access to insurance for people with a preexisting condition. Establishes that premiums in the individual and small group markets may vary only by family structure, geography, the actuarial value of the benefit, age (limited to a ratio of 3 to 1), and tobacco use (limited to a ratio of 1.5 to 1). In addition, this bill does not affect State or Federal laws, including section 1867 of the Social Security Act (EMTALA), requiring health care providers to provide emergency services. Before 2016, a State may limit the small group market to 50 employees. By 2014, requires States to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans and includes a SHOP Exchange for small businesses. Creates an interagency council dedicated to promoting healthy policies at the Federal level. Preventive Services Task Force is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness of clinical preventive services such as colorectal cancer screening or aspirin to prevent heart disease, and develops recommendations for their use. Education and outreach campaign regarding preventive benefits. Increases and extends the authorization of appropriations for the National Health Service Corps scholarship and loan repayment program for FY10-15.

The Secretary shall award grants to States to enable them (or the Exchange) to establish, expand, or provide support for offices of health insurance consumer assistance or health insurance ombudsman programs. The rights and obligations of employees and employers under Title VII of the Civil Rights Act of 1964 would also not be affected by the bill. Defines the large group market as the market in which a plan is offered by a large employer that employs more than 100 employees. Requires the Secretary to award grants, available until 2015, to States for planning and establishment of American Health Benefit Exchanges. National Prevention, Health Promotion and Public Health Council.

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