S.Amdt. 3119

SA 3119. Mr. WARNER (for himself, Mr. Udall of Colorado, Mr. Udall of
New Mexico, Mrs. Shaheen, Mrs. Hagan, Mr. Merkley, Mr. Begich, Mr.
Burris, Mr. Kaufman, Mr. Bennet, Mrs. Gillibrand, Mr. Franken, Mr.
Kirk, Ms. Collins, Ms. Klobuchar, and Mr. Whitehouse) submitted an
amendment intended to be proposed to amendment SA 2786 proposed by Mr.
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the
first-time homebuyers credit in the case of members of the Armed Forces
and certain other Federal employees, and for other purposes; which was
ordered to lie on the table; as follows:

On page 1134, strike line 3 and insert the following:
title).

Subtitle G--Modernizing America's Health Care System

PART I--IMPROVING QUALITY AND VALUE THROUGH DELIVERY SYSTEM REFORM

SEC. 3601. QUALITY REPORTING FOR PSYCHIATRIC HOSPITALS.

(a) In General.--Section 1886(s) of the Social Security
Act, as added by section 3401(f), is amended by adding at the
end the following new paragraph:
``(4) Quality reporting.--
``(A) Reduction in update for failure to report.--
``(i) In general.--Under the system described in paragraph
(1), for rate year 2014 and each subsequent rate year, in the
case of a psychiatric hospital or psychiatric unit that does
not submit data to the Secretary in accordance with
subparagraph (C) with respect to such a rate year, any annual
update to a standard Federal rate for discharges for the
hospital during the rate year, and after application of
paragraph (2), shall be reduced by 2 percentage points.
``(ii) Special rule.--The application of this subparagraph
may result in such annual update being less than 0.0 for a
rate year, and may result in payment rates under the system
described in paragraph (1) for a rate year being less than
such payment rates for the preceding rate year.
``(B) Noncumulative application.--Any reduction under
subparagraph (A) shall apply only with respect to the rate
year involved and the Secretary shall not take into account
such reduction in computing the payment amount under the
system described in paragraph (1) for a subsequent rate year.
``(C) Submission of quality data.--For rate year 2014 and
each subsequent rate year, each psychiatric hospital and
psychiatric unit shall submit to the Secretary data on
quality measures specified under subparagraph (D). Such data
shall be submitted in a form and manner, and at a time,
specified by the Secretary for purposes of this subparagraph.
``(D) Quality measures.--
``(i) In general.--Subject to clause (ii), any measure
specified by the Secretary under this subparagraph must have
been endorsed by the entity with a contract under section
1890(a).
``(ii) Exception.--In the case of a specified area or
medical topic determined appropriate by the Secretary for
which a feasible and practical measure has not been endorsed
by the entity with a contract under section 1890(a), the
Secretary may specify a measure that is not so endorsed as
long as due consideration is given to measures that have been
endorsed or adopted by a consensus organization identified by
the Secretary.
``(iii) Time frame.--Not later than October 1, 2012, the
Secretary shall publish the measures selected under this
subparagraph that will be applicable with respect to rate
year 2014.
``(E) Public availability of data submitted.--The Secretary
shall establish procedures for making data submitted under
subparagraph (C) available to the public. Such procedures
shall ensure that a psychiatric hospital and a psychiatric
unit has the opportunity to review the data that is to be
made public with respect to the hospital or unit prior to
such data being made public. The Secretary shall report
quality measures that relate to services furnished in
inpatient settings in psychiatric hospitals and psychiatric
units on the Internet website of the Centers for Medicare &
Medicaid Services.''.
(b) Conforming Amendment.--Section 1890(b)(7)(B)(i)(I) of
the Social Security Act, as added by section 3014, is amended
by inserting ``1886(s)(4)(D),'' after ``1886(o)(2),''.

SEC. 3602. PILOT TESTING PAY-FOR-PERFORMANCE PROGRAMS FOR
CERTAIN MEDICARE PROVIDERS.

(a) In General.--Not later than January 1, 2016, the
Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall, for each provider
described in subsection (b), conduct a separate pilot program
under title XVIII of the Social Security Act to test the
implementation of a value-based purchasing program for
payments under such title for the provider.
(b) Providers Described.--The providers described in this
paragraph are the following:
(1) Psychiatric hospitals (as described in clause (i) of
section 1886(d)(1)(B) of such Act (42 U.S.C.
1395ww(d)(1)(B))) and psychiatric units (as described in the
matter following clause (v) of such section).
(2) Long-term care hospitals (as described in clause (iv)
of such section).
(3) Rehabilitation hospitals (as described in clause (ii)
of such section).
(4) PPS-exempt cancer hospitals (as described in clause (v)
of such section).
(5) Hospice programs (as defined in section 1861(dd)(2) of
such Act (42 U.S.C. 1395x(dd)(2))).
(c) Waiver Authority.--The Secretary may waive such
requirements of titles XI and XVIII of the Social Security
Act as may be necessary solely for purposes of carrying out
the pilot programs under this section.
(d) No Additional Program Expenditures.--Payments under
this section under the separate pilot program for value based
purchasing (as described in subsection (a)) for each provider
type described in paragraphs (1) through (5) of subsection
(b) for applicable items and services under title XVIII of
the Social Security Act for a year shall be established in a
manner that does not result in spending more under each such
value based purchasing program for such year than would
otherwise be expended for such provider type for such year if
the pilot program were not implemented, as estimated by the
Secretary.

[[Page S12918]]

(e) Expansion of Pilot Program.--The Secretary may, at any
point after January 1, 2018, expand the duration and scope of
a pilot program conducted under this subsection, to the
extent determined appropriate by the Secretary, if--
(1) the Secretary determines that such expansion is
expected to--
(A) reduce spending under title XVIII of the Social
Security Act without reducing the quality of care; or
(B) improve the quality of care and reduce spending;
(2) the Chief Actuary of the Centers for Medicare &
Medicaid Services certifies that such expansion would reduce
program spending under such title XVIII; and
(3) the Secretary determines that such expansion would not
deny or limit the coverage or provision of benefits under
such title XIII for Medicare beneficiaries.

SEC. 3603. PLANS FOR A VALUE-BASED PURCHASING PROGRAM FOR
AMBULATORY SURGICAL CENTERS.

Section 3006 of this Act is amended by adding at the end
the following new subsection:
``(f) Ambulatory Surgical Centers.--
``(1) In general.--The Secretary shall develop a plan to
implement a value-based purchasing program for payments under
the Medicare program under title XVIII of the Social Security
Act for ambulatory surgical centers (as described in section
1833(i) of the Social Security Act (42 U.S.C. 1395l(i))).
``(2) Details.--In developing the plan under paragraph (1),
the Secretary shall consider the following issues:
``(A) The ongoing development, selection, and modification
process for measures (including under section 1890 of the
Social Security Act (42 U.S.C. 1395aaa) and section 1890A of
such Act, as added by section 3014), to the extent feasible
and practicable, of all dimensions of quality and efficiency
in ambulatory surgical centers.
``(B) The reporting, collection, and validation of quality
data.
``(C) The structure of value-based payment adjustments,
including the determination of thresholds or improvements in
quality that would substantiate a payment adjustment, the
size of such payments, and the sources of funding for the
value-based bonus payments.
``(D) Methods for the public disclosure of information on
the performance of ambulatory surgical centers.
``(E) Any other issues determined appropriate by the
Secretary.
``(3) Consultation.--In developing the plan under paragraph
(1), the Secretary shall--
``(A) consult with relevant affected parties; and
``(B) consider experience with such demonstrations that the
Secretary determines are relevant to the value-based
purchasing program described in paragraph (1).
``(4) Report to congress.--Not later than January 1, 2011,
the Secretary shall submit to Congress a report containing
the plan developed under paragraph (1).''.

SEC. 3604. REVISIONS TO NATIONAL PILOT PROGRAM ON PAYMENT
BUNDLING.

Section 1866D of the Social Security Act, as added by
section 3023, is amended--
(1) in paragraph (a)(2)(B), in the matter preceding clause
(i), by striking ``8 conditions'' and inserting ``10
conditions'';
(2) by striking subsection (c)(1)(B) and inserting the
following:
``(B) Expansion.--The Secretary may, at any point after
January 1, 2016, expand the duration and scope of the pilot
program, to the extent determined appropriate by the
Secretary, if--
``(i) the Secretary determines that such expansion is
expected to--

``(I) reduce spending under title XVIII of the Social
Security Act without reducing the quality of care; or
``(II) improve the quality of care and reduce spending;

``(ii) the Chief Actuary of the Centers for Medicare &
Medicaid Services certifies that such expansion would reduce
program spending under such title XVIII; and
``(iii) the Secretary determines that such expansion would
not deny or limit the coverage or provision of benefits under
this title for individuals.''; and
(3) by striking subsection (g).

SEC. 3605. IMPROVEMENTS TO THE MEDICARE SHARED SAVINGS
PROGRAM.

Section 1899 of the Social Security Act, as added by
section 3022, is amended by adding at the end the following
new subsections:
``(i) Option To Use Other Payment Models.--
``(1) In general.--If the Secretary determines appropriate,
the Secretary may use any of the payment models described in
paragraph (2) or (3) for making payments under the program
rather than the payment model described in subsection (d).
``(2) Partial capitation model.--
``(A) In general.--Subject to subparagraph (B), a model
described in this paragraph is a partial capitation model in
which an ACO is at financial risk for some, but not all, of
the items and services covered under parts A and B, such as
at risk for some or all physicians' services or all items and
services under part B. The Secretary may limit a partial
capitation model to ACOs that are highly integrated systems
of care and to ACOs capable of bearing risk, as determined to
be appropriate by the Secretary.
``(B) No additional program expenditures.--Payments to an
ACO for items and services under this title for beneficiaries
for a year under the partial capitation model shall be
established in a manner that does not result in spending more
for such ACO for such beneficiaries than would otherwise be
expended for such ACO for such beneficiaries for such year if
the model were not implemented, as estimated by the
Secretary.
``(3) Other payment models.--
``(A) In general.--Subject to subparagraph (B), a model
described in this paragraph is any payment model that the
Secretary determines will improve the quality and efficiency
of items and services furnished under this title.
``(B) No additional program expenditures.--Subparagraph (B)
of paragraph (2) shall apply to a payment model under
subparagraph (A) in a similar manner as such subparagraph (B)
applies to the payment model under paragraph (2).
``(j) Involvement in Private Payer and Other Third Party
Arrangements.--The Secretary may give preference to ACOs who
are participating in similar arrangements with other payers.
``(k) Treatment of Physician Group Practice
Demonstration.--During the period beginning on the date of
the enactment of this section and ending on the date the
program is established, the Secretary may enter into an
agreement with an ACO under the demonstration under section
1866A, subject to rebasing and other modifications deemed
appropriate by the Secretary.''.

SEC. 3606. INCENTIVES TO IMPLEMENT ACTIVITIES TO REDUCE
DISPARITIES.

Section 1311(g)(1) of this Act is amended--
(1) in subparagraph (C), by striking ``; and'' and
inserting a semicolon;
(2) in subparagraph (D), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following:
``(E) the implementation of activities to reduce health and
health care disparities, including through the use of
language services, community outreach, and cultural
competency trainings.''.

SEC. 3607. NATIONAL DIABETES PREVENTION PROGRAM.

Part P of title III of the Public Health Service Act 42
U.S.C. 280g et seq.), as amended by section 5405, is amended
by adding at the end the following:

``SEC. 399V-2. NATIONAL DIABETES PREVENTION PROGRAM.

``(a) In General.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall establish a national diabetes prevention program
(referred to in this section as the `program') targeted at
adults at high risk for diabetes in order to eliminate the
preventable burden of diabetes.
``(b) Program Activities.--The program described in
subsection (a) shall include--
``(1) a grant program for community-based diabetes
prevention program model sites;
``(2) a program within the Centers for Disease Control and
Prevention to determine eligibility of entities to deliver
community-based diabetes prevention services;
``(3) a training and outreach program for lifestyle
intervention instructors; and
``(4) evaluation, monitoring and technical assistance, and
applied research carried out by the Centers for Disease
Control and Prevention.
``(c) Eligible Entities.--To be eligible for a grant under
subsection (b)(1), an entity shall be a State or local health
department, a tribal organization, a national network of
community-based non-profits focused on health and wellbeing,
an academic institution, or other entity, as the Secretary
determines.
``(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of fiscal
years 2010 through 2014.''.

SEC. 3608. SELECTION OF EFFICIENCY MEASURES.

Sections 1890(b)(7) and 1890A of the Social Security Act,
as added by section 3014, are amended by striking ``quality''
each place it appears and inserting ``quality and
efficiency''.

SEC. 3609. REGIONAL TESTING OF PAYMENT AND SERVICE DELIVERY
MODELS UNDER THE CENTER FOR MEDICARE AND
MEDICAID INNOVATION.

Section 1115A(a) of the Social Security Act, as added by
section 3021, is amended by inserting at the end the
following new paragraph:
``(5) Testing within certain geographic areas.--For
purposes of testing payment and service delivery models under
this section, the Secretary may elect to limit testing of a
model to certain geographic areas.''.

SEC. 3610. ADDITIONAL IMPROVEMENTS UNDER THE CENTER FOR
MEDICARE AND MEDICAID INNOVATION.

Section 1115A(a) of the Social Security Act, as added by
section 3021, is amended--
(1) in subsection (b)(2)--
(A) in subparagraph (A)--
(i) in the second sentence, by striking ``the preceding
sentence may include'' and inserting ``this subparagraph may
include, but are not limited to,''; and
(ii) by inserting after the first sentence the following
new sentence: ``The Secretary shall focus on models expected
to reduce program costs under the applicable title while
preserving or enhancing the quality of care received by
individuals receiving benefits under such title.''; and
(B) in subparagraph (C), by adding at the end the following
new clause:
``(viii) Whether the model demonstrates effective linkage
with other public sector or private sector payers.'';

[[Page S12919]]

(2) in subsection (b)(4), by adding at the end the
following new subparagraph:
``(C) Measure selection.--To the extent feasible, the
Secretary shall select measures under this paragraph that
reflect national priorities for quality improvement and
patient-centered care consistent with the measures described
in 1890(b)(7)(B).''; and
(3) in subsection (c)--
(A) in paragraph (1)(B), by striking ``care and reduce
spending; and'' and inserting ``patient care without
increasing spending;'';
(B) in paragraph (2), by striking ``reduce program spending
under applicable titles.'' and inserting ``reduce (or would
not result in any increase in) net program spending under
applicable titles; and''; and
(C) by adding at the end the following:
``(3) the Secretary determines that such expansion would
not deny or limit the coverage or provision of benefits under
the applicable title for applicable individuals.
In determining which models or demonstration projects to
expand under the preceding sentence, the Secretary shall
focus on models and demonstration projects that improve the
quality of patient care and reduce spending.''.

SEC. 3611. IMPROVEMENTS TO THE PHYSICIAN QUALITY REPORTING
SYSTEM.

(a) In General.--Section 1848(m) of the Social Security Act
(42 U.S.C. 1395w-4(m)) is amended by adding at the end the
following new paragraph:
``(7) Additional incentive payment.--
``(A) In general.--For 2011 through 2014, if an eligible
professional meets the requirements described in subparagraph
(B), the applicable quality percent for such year, as
described in clauses (iii) and (iv) of paragraph (1)(B),
shall be increased by 0.5 percentage points.
``(B) Requirements described.--In order to qualify for the
additional incentive payment described in subparagraph (A),
an eligible professional shall meet the following
requirements:
``(i) The eligible professional shall--

``(I) satisfactorily submit data on quality measures for
purposes of paragraph (1) for a year; and
``(II) have such data submitted on their behalf through a
Maintenance of Certification Program (as defined in
subparagraph (C)(i)) that meets--

``(aa) the criteria for a registry (as described in
subsection (k)(4)); or
``(bb) an alternative form and manner determined
appropriate by the Secretary.
``(ii) The eligible professional, more frequently than is
required to qualify for or maintain board certification
status--

``(I) participates in such a Maintenance of Certification
program for a year; and
``(II) successfully completes a qualified Maintenance of
Certification Program practice assessment (as defined in
subparagraph (C)(ii)) for such year.

``(iii) A Maintenance of Certification program submits to
the Secretary, on behalf of the eligible professional,
information--

``(I) in a form and manner specified by the Secretary, that
the eligible professional has successfully met the
requirements of clause (ii) (which may be in the form of a
structural measure);
``(II) if requested by the Secretary, on the survey of
patient experience with care (as described in subparagraph
(C)(ii)(II)); and
``(III) as the Secretary may require, on the methods,
measures, and data used under the Maintenance of
Certification Program and the qualified Maintenance of
Certification Program practice assessment.

``(C) Definitions.--For purposes of this paragraph:
``(i) The term `Maintenance of Certification Program' means
a continuous assessment program, such as qualified American
Board of Medical Specialties Maintenance of Certification
program or an equivalent program (as determined by the
Secretary), that advances quality and the lifelong learning
and self-assessment of board certified specialty physicians
by focusing on the competencies of patient care, medical
knowledge, practice-based learning, interpersonal and
communication skills and professionalism. Such a program
shall include the following:

``(I) The program requires the physician to maintain a
valid, unrestricted medical license in the United States.
``(II) The program requires a physician to participate in
educational and self-assessment programs that require an
assessment of what was learned.
``(III) The program requires a physician to demonstrate,
through a formalized, secure examination, that the physician
has the fundamental diagnostic skills, medical knowledge, and
clinical judgment to provide quality care in their respective
specialty.
``(IV) The program requires successful completion of a
qualified Maintenance of Certification Program practice
assessment as described in clause (ii).

``(ii) The term `qualified Maintenance of Certification
Program practice assessment' means an assessment of a
physician's practice that--

``(I) includes an initial assessment of an eligible
professional's practice that is designed to demonstrate the
physician's use of evidence-based medicine;
``(II) includes a survey of patient experience with care;
and
``(III) requires a physician to implement a quality
improvement intervention to address a practice weakness
identified in the initial assessment under subclause (I) and
then to remeasure to assess performance improvement after
such intervention.''.

(b) Authority.--Section 3002(c) of this Act is amended by
adding at the end the following new paragraph:
``(3) Authority.--For years after 2014, if the Secretary of
Health and Human Services determines it to be appropriate,
the Secretary may incorporate participation in a Maintenance
of Certification Program and successful completion of a
qualified Maintenance of Certification Program practice
assessment into the composite of measures of quality of care
furnished pursuant to the physician fee schedule payment
modifier, as described in section 1848(p)(2) of the Social
Security Act (42 U.S.C. 1395w-4(p)(2)).''.
(c) Elimination of MA Regional Plan Stabilization Fund.--
(1) In general.--Section 1858 of the Social Security Act
(42 U.S.C. 1395w-27a) is amended by striking subsection (e).
(2) Transition.--Any amount contained in the MA Regional
Plan Stabilization Fund as of the date of the enactment of
this Act shall be transferred to the Federal Supplementary
Medical Insurance Trust Fund.

SEC. 3612. IMPROVEMENT IN PART D MEDICATION THERAPY
MANAGEMENT (MTM) PROGRAMS.

(a) In General.--Section 1860D-4(c)(2) of the Social
Security Act (42 U.S.C. 1395w-104(c)(2)) is amended--
(1) by redesignating subparagraphs (C), (D), and (E) as
subparagraphs (E), (F), and (G), respectively; and
(2) by inserting after subparagraph (B) the following new
subparagraphs:
``(C) Required interventions.--For plan years beginning on
or after the date that is 2 years after the date of the
enactment of the Patient Protection and Affordable Care Act,
prescription drug plan sponsors shall offer medication
therapy management services to targeted beneficiaries
described in subparagraph (A)(ii) that include, at a minimum,
the following to increase adherence to prescription
medications or other goals deemed necessary by the Secretary:
``(i) An annual comprehensive medication review furnished
person-to-person or using telehealth technologies (as defined
by the Secretary) by a licensed pharmacist or other qualified
provider. The comprehensive medication review--

``(I) shall include a review of the individual's
medications and may result in the creation of a recommended
medication action plan or other actions in consultation with
the individual and with input from the prescriber to the
extent necessary and practicable; and
``(II) shall include providing the individual with a
written or printed summary of the results of the review.

The Secretary, in consultation with relevant stakeholders,
shall develop a standardized format for the action plan under
subclause (I) and the summary under subclause (II).
``(ii) Follow-up interventions as warranted based on the
findings of the annual medication review or the targeted
medication enrollment and which may be provided person-to-
person or using telehealth technologies (as defined by the
Secretary).
``(D) Assessment.--The prescription drug plan sponsor shall
have in place a process to assess, at least on a quarterly
basis, the medication use of individuals who are at risk but
not enrolled in the medication therapy management program,
including individuals who have experienced a transition in
care, if the prescription drug plan sponsor has access to
that information.
``(E) Automatic enrollment with ability to opt-out.--The
prescription drug plan sponsor shall have in place a process
to--
``(i) subject to clause (ii), automatically enroll targeted
beneficiaries described in subparagraph (A)(ii), including
beneficiaries identified under subparagraph (D), in the
medication therapy management program required under this
subsection; and
``(ii) permit such beneficiaries to opt-out of enrollment
in such program.''.
(b) Rule of Construction.--Nothing in this section shall
limit the authority of the Secretary of Health and Human
Services to modify or broaden requirements for a medication
therapy management program under part D of title XVIII of the
Social Security Act or to study new models for medication
therapy management through the Center for Medicare and
Medicaid Innovation under section 1115A of such Act, as added
by section 3021.

SEC. 3613. EVALUATION OF TELEHEALTH UNDER THE CENTER FOR
MEDICARE AND MEDICAID INNOVATION.

Section 1115A(b)(2)(B) of the Social Security Act, as added
by section 3021, is amended by adding at the end the
following new clause:
``(xix) Utilizing, in particular in entities located in
medically underserved areas and facilities of the Indian
Health Service (whether operated by such Service or by an
Indian tribe or tribal organization (as those terms are
defined in section 4 of the Indian Health Care Improvement
Act)), telehealth services--

``(I) in treating behavioral health issues (such as post-
traumatic stress disorder) and stroke; and
``(II) to improve the capacity of non-medical providers and
non-specialized medical providers to provide health services
for patients with chronic complex conditions.''.

[[Page S12920]]

SEC. 3614. REVISIONS TO THE EXTENSION FOR THE RURAL COMMUNITY
HOSPITAL DEMONSTRATION PROGRAM.

(a) In General.--Subsection (g) of section 410A of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173; 117 Stat. 2272), as added by
section 3123(a) of this Act, is amended to read as follows:
``(g) Five-Year Extension of Demonstration Program.--
``(1) In general.--Subject to the succeeding provisions of
this subsection, the Secretary shall conduct the
demonstration program under this section for an additional 5-
year period (in this section referred to as the `5-year
extension period') that begins on the date immediately
following the last day of the initial 5-year period under
subsection (a)(5).
``(2) Expansion of demonstration states.--Notwithstanding
subsection (a)(2), during the 5-year extension period, the
Secretary shall expand the number of States with low
population densities determined by the Secretary under such
subsection to 20. In determining which States to include in
such expansion, the Secretary shall use the same criteria and
data that the Secretary used to determine the States under
such subsection for purposes of the initial 5-year period.
``(3) Increase in maximum number of hospitals participating
in the demonstration program.--Notwithstanding subsection
(a)(4), during the 5-year extension period, not more than 30
rural community hospitals may participate in the
demonstration program under this section.
``(4) Hospitals in demonstration program on date of
enactment.--In the case of a rural community hospital that is
participating in the demonstration program under this section
as of the last day of the initial 5-year period, the
Secretary--
``(A) shall provide for the continued participation of such
rural community hospital in the demonstration program during
the 5-year extension period unless the rural community
hospital makes an election, in such form and manner as the
Secretary may specify, to discontinue such participation; and
``(B) in calculating the amount of payment under subsection
(b) to the rural community hospital for covered inpatient
hospital services furnished by the hospital during such 5-
year extension period, shall substitute, under paragraph
(1)(A) of such subsection--
``(i) the reasonable costs of providing such services for
discharges occurring in the first cost reporting period
beginning on or after the first day of the 5-year extension
period, for
``(ii) the reasonable costs of providing such services for
discharges occurring in the first cost reporting period
beginning on or after the implementation of the demonstration
program.''.
(b) Conforming Amendments.--Subsection (a)(5) of section
410A of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat.
2272), as amended by section 3123(b) of this Act, is amended
by striking ``1-year extension'' and inserting ``5-year
extension''.

PART II--PROMOTING TRANSPARENCY AND COMPETITION

SEC. 3621. DEVELOPING METHODOLOGY TO ASSESS HEALTH PLAN
VALUE.

(a) Development.--The Secretary of Health and Human
Services (referred to in this section as the ``Secretary''),
in consultation with relevant stakeholders including health
insurance issuers, health care consumers, employers, health
care providers, and other entities determined appropriate by
the Secretary, shall develop a methodology to measure health
plan value. Such methodology shall take into consideration,
where applicable--
(1) the overall cost to enrollees under the plan;
(2) the quality of the care provided for under the plan;
(3) the efficiency of the plan in providing care;
(4) the relative risk of the plan's enrollees as compared
to other plans;
(5) the actuarial value or other comparative measure of the
benefits covered under the plan; and
(6) other factors determined relevant by the Secretary.
(b) Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall submit to Congress
a report concerning the methodology developed under
subsection (a).

SEC. 3622. DATA COLLECTION; PUBLIC REPORTING.

Section 399II(a) of the Public Health Service Act, as added
by section 3015, is amended to read as follows:
``(a) In General.--
``(1) Establishment of strategic framework.--The Secretary
shall establish and implement an overall strategic framework
to carry out the public reporting of performance information,
as described in section 399JJ. Such strategic framework may
include methods and related timelines for implementing
nationally consistent data collection, data aggregation, and
analysis methods.
``(2) Collection and aggregation of data.--The Secretary
shall collect and aggregate consistent data on quality and
resource use measures from information systems used to
support health care delivery, and may award grants or
contracts for this purpose. The Secretary shall align such
collection and aggregation efforts with the requirements and
assistance regarding the expansion of health information
technology systems, the interoperability of such technology
systems, and related standards that are in effect on the date
of enactment of the Patient Protection and Affordable Care
Act.
``(3) Scope.--The Secretary shall ensure that the data
collection, data aggregation, and analysis systems described
in paragraph (1) involve an increasingly broad range of
patient populations, providers, and geographic areas over
time.''.

SEC. 3623. MODERNIZING COMPUTER AND DATA SYSTEMS OF THE
CENTERS FOR MEDICARE & MEDICAID SERVICES TO
SUPPORT IMPROVEMENTS IN CARE DELIVERY.

(a) In General.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
develop a plan (and detailed budget for the resources needed
to implement such plan) to modernize the computer and data
systems of the Centers for Medicare & Medicaid Services (in
this section referred to as ``CMS'').
(b) Considerations.--In developing the plan, the Secretary
shall consider how such modernized computer system could--
(1) in accordance with the regulations promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996, make available data in a reliable
and timely manner to providers of services and suppliers to
support their efforts to better manage and coordinate care
furnished to beneficiaries of CMS programs; and
(2) support consistent evaluations of payment and delivery
system reforms under CMS programs.
(c) Posting of Plan.--By not later than 9 months after the
date of the enactment of this Act, the Secretary shall post
on the website of the Centers for Medicare & Medicaid
Services the plan described in subsection (a).

SEC. 3624. EXPANSION OF THE SCOPE OF THE INDEPENDENT MEDICARE
ADVISORY BOARD.

(a) Annual Public Report.--
(1) Report.--Section 1899A of the Social Security Act, as
added by section 3403, is amended by adding at the end the
following new subsection:
``(n) Annual Public Report.--
``(1) In general.--Not later than July 1, 2014, and
annually thereafter, the Board shall produce a public report
containing standardized information on system-wide health
care costs, patient access to care, utilization, and quality-
of-care that allows for comparison by region, types of
services, types of providers, and both private payers and the
program under this title.
``(2) Requirements.--Each report produced pursuant to
paragraph (1) shall include information with respect to the
following areas:
``(A) The quality and costs of care for the population at
the most local level determined practical by the Board (with
quality and costs compared to national benchmarks and
reflecting rates of change, taking into account quality
measures described in section 1890(b)(7)(B)).
``(B) Beneficiary and consumer access to care, patient and
caregiver experience of care, and the cost-sharing or out-of-
pocket burden on patients.
``(C) Epidemiological shifts and demographic changes.
``(D) The proliferation, effectiveness, and utilization of
health care technologies, including variation in provider
practice patterns and costs.
``(E) Any other areas that the Board determines affect
overall spending and quality of care in the private
sector.''.
(2) Alignment with medicare proposals.--Section
1899A(c)(2)(B) of the Social Security Act, as added by
section 3403, is amended--
(A) in clause (v), by striking ``and'' at the end;
(B) in clause (vi), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vii) take into account the data and findings contained
in the annual reports under subsection (n) in order to
develop proposals that can most effectively promote the
delivery of efficient, high quality care to Medicare
beneficiaries.''.
(b) Advisory Recommendations for Non-Federal Health Care
Programs.--Section 1899A of the Social Security Act, as added
by section 3403 and as amended by subsection (a)(1), is
amended by adding at the end the following new subsection:
``(o) Advisory Recommendations for Non-Federal Health Care
Programs.--
``(1) In general.--Not later than January 15, 2015, and at
least once every two years thereafter, the Board shall submit
to Congress and the President recommendations to slow the
growth in national health expenditures (excluding
expenditures under this title and in other Federal health
care programs) while preserving or enhancing quality of care,
such as recommendations--
``(A) that the Secretary or other Federal agencies can
implement administratively;
``(B) that may require legislation to be enacted by
Congress in order to be implemented;
``(C) that may require legislation to be enacted by State
or local governments in order to be implemented;
``(D) that private sector entities can voluntarily
implement; and
``(E) with respect to other areas determined appropriate by
the Board.

[[Page S12921]]

``(2) Coordination.--In making recommendations under
paragraph (1), the Board shall coordinate such
recommendations with recommendations contained in proposals
and advisory reports produced by the Board under subsection
(c).
``(3) Available to public.--The Board shall make
recommendations submitted to Congress and the President under
this subsection available to the public.''.
(c) Rule of Construction.--Nothing in the amendments made
by this section shall preclude the Independent Medicare
Advisory Board, as established under section 1899A of the
Social Security Act (as added by section 3403), from solely
using data from public or private sources to carry out the
amendments made by subsections (a)(1) and (b).

SEC. 3625. ADDITIONAL PRIORITY FOR THE NATIONAL HEALTH CARE
WORKFORCE COMMISSION.

Section 5101(d)(4)(A) of this Act is amended by adding at
the end the following new clause:
``(v) An analysis of, and recommendations for, eliminating
the barriers to entering and staying in primary care,
including provider compensation.''.

PART III--PROMOTING ACCOUNTABILITY AND RESPONSIBILITY

SEC. 3631. HEALTH CARE FRAUD ENFORCEMENT.

(a) Fraud Sentencing Guidelines.--
(1) Definition.--In this subsection, the term ``Federal
health care offense'' has the meaning given that term in
section 24 of title 18, United States Code, as amended by
this Act.
(2) Review and amendments.--Pursuant to the authority under
section 994 of title 28, United States Code, and in
accordance with this subsection, the United States Sentencing
Commission shall--
(A) review the Federal Sentencing Guidelines and policy
statements applicable to persons convicted of Federal health
care offenses;
(B) amend the Federal Sentencing Guidelines and policy
statements applicable to persons convicted of Federal health
care offenses involving Government health care programs to
provide that the aggregate dollar amount of fraudulent bills
submitted to the Government health care program shall
constitute prima facie evidence of the amount of the intended
loss by the defendant; and
(C) amend the Federal Sentencing Guidelines to provide--
(i) a 2-level increase in the offense level for any
defendant convicted of a Federal health care offense relating
to a Government health care program which involves a loss of
not less than $1,000,000 and less than $7,000,000;
(ii) a 3-level increase in the offense level for any
defendant convicted of a Federal health care offense relating
to a Government health care program which involves a loss of
not less than $7,000,000 and less than $20,000,000;
(iii) a 4-level increase in the offense level for any
defendant convicted of a Federal health care offense relating
to a Government health care program which involves a loss of
not less than $20,000,000; and
(iv) if appropriate, otherwise amend the Federal Sentencing
Guidelines and policy statements applicable to persons
convicted of Federal health care offenses involving
Government health care programs.
(3) Requirements.--In carrying this subsection, the United
States Sentencing Commission shall--
(A) ensure that the Federal Sentencing Guidelines and
policy statements--
(i) reflect the serious harms associated with health care
fraud and the need for aggressive and appropriate law
enforcement action to prevent such fraud; and
(ii) provide increased penalties for persons convicted of
health care fraud offenses in appropriate circumstances;
(B) consult with individuals or groups representing health
care fraud victims, law enforcement officials, the health
care industry, and the Federal judiciary as part of the
review described in paragraph (2);
(C) ensure reasonable consistency with other relevant
directives and with other guidelines under the Federal
Sentencing Guidelines;
(D) account for any aggravating or mitigating circumstances
that might justify exceptions, including circumstances for
which the Federal Sentencing Guidelines, as in effect on the
date of enactment of this Act, provide sentencing
enhancements;
(E) make any necessary conforming changes to the Federal
Sentencing Guidelines; and
(F) ensure that the Federal Sentencing Guidelines
adequately meet the purposes of sentencing.
(b) Intent Requirement for Health Care Fraud.--Section 1347
of title 18, United States Code, is amended--
(1) by inserting ``(a)'' before ``Whoever knowingly''; and
(2) by adding at the end the following:
``(b) With respect to violations of this section, a person
need not have actual knowledge of this section or specific
intent to commit a violation of this section.''.
(c) Health Care Fraud Offense.--Section 24(a) of title 18,
United States Code, is amended--
(1) in paragraph (1), by striking the semicolon and
inserting ``or section 1128B of the Social Security Act (42
U.S.C. 1320a-7b); or''; and
(2) in paragraph (2)--
(A) by inserting ``1349,'' after ``1343,''; and
(B) by inserting ``section 301 of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 331), or section 501 of the
Employee Retirement Income Security Act of 1974 (29 U.S.C.
1131),'' after ``title,''.
(d) Subpoena Authority Relating to Health Care.--
(1) Subpoenas under the health insurance portability and
accountability act of 1996.--Section 1510(b) of title 18,
United States Code, is amended--
(A) in paragraph (1), by striking ``to the grand jury'';
and
(B) in paragraph (2)--
(i) in subparagraph (A), by striking ``grand jury
subpoena'' and inserting ``subpoena for records''; and
(ii) in the matter following subparagraph (B), by striking
``to the grand jury''.
(2) Subpoenas under the civil rights of institutionalized
persons act.--The Civil Rights of Institutionalized Persons
Act (42 U.S.C. 1997 et seq.) is amended by inserting after
section 3 the following:

``SEC. 3A. SUBPOENA AUTHORITY.

``(a) Authority.--The Attorney General, or at the direction
of the Attorney General, any officer or employee of the
Department of Justice may require by subpoena access to any
institution that is the subject of an investigation under
this Act and to any document, record, material, file, report,
memorandum, policy, procedure, investigation, video or audio
recording, or quality assurance report relating to any
institution that is the subject of an investigation under
this Act to determine whether there are conditions which
deprive persons residing in or confined to the institution of
any rights, privileges, or immunities secured or protected by
the Constitution or laws of the United States.
``(b) Issuance and Enforcement of Subpoenas.--
``(1) Issuance.--Subpoenas issued under this section--
``(A) shall bear the signature of the Attorney General or
any officer or employee of the Department of Justice as
designated by the Attorney General; and
``(B) shall be served by any person or class of persons
designated by the Attorney General or a designated officer or
employee for that purpose.
``(2) Enforcement.--In the case of contumacy or failure to
obey a subpoena issued under this section, the United States
district court for the judicial district in which the
institution is located may issue an order requiring
compliance. Any failure to obey the order of the court may be
punished by the court as a contempt that court.
``(c) Protection of Subpoenaed Records and Information.--
Any document, record, material, file, report, memorandum,
policy, procedure, investigation, video or audio recording,
or quality assurance report or other information obtained
under a subpoena issued under this section--
``(1) may not be used for any purpose other than to protect
the rights, privileges, or immunities secured or protected by
the Constitution or laws of the United States of persons who
reside, have resided, or will reside in an institution;
``(2) may not be transmitted by or within the Department of
Justice for any purpose other than to protect the rights,
privileges, or immunities secured or protected by the
Constitution or laws of the United States of persons who
reside, have resided, or will reside in an institution; and
``(3) shall be redacted, obscured, or otherwise altered if
used in any publicly available manner so as to prevent the
disclosure of any personally identifiable information.''.

SEC. 3632. DEVELOPMENT OF STANDARDS FOR FINANCIAL AND
ADMINISTRATIVE TRANSACTIONS.

(a) Additional Transaction Standards and Operating Rules.--
(1) Development of additional transaction standards and
operating rules.--Section 1173(a) of the Social Security Act
(42 U.S.C. 1320d-2(a)), as amended by section 1104(b)(2), is
amended--
(A) in paragraph (1)(B), by inserting before the period the
following: ``, and subject to the requirements under
paragraph (5)''; and
(B) by adding at the end the following new paragraph:
``(5) Consideration of standardization of activities and
items.--
``(A) In general.--For purposes of carrying out paragraph
(1)(B), the Secretary shall solicit, not later than January
1, 2012, and not less than every 3 years thereafter, input
from entities described in subparagraph (B) on--
``(i) whether there could be greater uniformity in
financial and administrative activities and items, as
determined appropriate by the Secretary; and
``(ii) whether such activities should be considered
financial and administrative transactions (as described in
paragraph (1)(B)) for which the adoption of standards and
operating rules would improve the operation of the health
care system and reduce administrative costs.
``(B) Solicitation of input.--For purposes of subparagraph
(A), the Secretary shall seek input from--
``(i) the National Committee on Vital and Health
Statistics, the Health Information Technology Policy
Committee, and the Health Information Technology Standards
Committee; and
``(ii) standard setting organizations and stakeholders, as
determined appropriate by the Secretary.''.

[[Page S12922]]

(b) Activities and Items for Initial Consideration.--For
purposes of section 1173(a)(5) of the Social Security Act, as
added by subsection (a), the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall, not later than January 1, 2012, seek input on
activities and items relating to the following areas:
(1) Whether the application process, including the use of a
uniform application form, for enrollment of health care
providers by health plans could be made electronic and
standardized.
(2) Whether standards and operating rules described in
section 1173 of the Social Security Act should apply to the
health care transactions of automobile insurance, worker's
compensation, and other programs or persons not described in
section 1172(a) of such Act (42 U.S.C. 1320d-1(a)).
(3) Whether standardized forms could apply to financial
audits required by health plans, Federal and State agencies
(including State auditors, the Office of the Inspector
General of the Department of Health and Human Services, and
the Centers for Medicare & Medicaid Services), and other
relevant entities as determined appropriate by the Secretary.
(4) Whether there could be greater transparency and
consistency of methodologies and processes used to establish
claim edits used by health plans (as described in section
1171(5) of the Social Security Act (42 U.S.C. 1320d(5))).
(5) Whether health plans should be required to publish
their timeliness of payment rules.
(c) ICD Coding Crosswalks.--
(1) ICD-9 to icd-10 crosswalk.--The Secretary shall task
the ICD-9-CM Coordination and Maintenance Committee to
convene a meeting, not later than January 1, 2011, to receive
input from appropriate stakeholders (including health plans,
health care providers, and clinicians) regarding the
crosswalk between the Ninth and Tenth Revisions of the
International Classification of Diseases (ICD-9 and ICD-10,
respectively) that is posted on the website of the Centers
for Medicare & Medicaid Services, and make recommendations
about appropriate revisions to such crosswalk.
(2) Revision of crosswalk.--For purposes of the crosswalk
described in paragraph (1), the Secretary shall make
appropriate revisions and post any such revised crosswalk on
the website of the Centers for Medicare & Medicaid Services.
(3) Use of revised crosswalk.--For purposes of paragraph
(2), any revised crosswalk shall be treated as a code set for
which a standard has been adopted by the Secretary for
purposes of section 1173(c)(1)(B) of the Social Security Act
(42 U.S.C. 1320d-2(c)(1)(B)).
(4) Subsequent crosswalks.--For subsequent revisions of the
International Classification of Diseases that are adopted by
the Secretary as a standard code set under section 1173(c) of
the Social Security Act (42 U.S.C. 1320d-2(c)), the Secretary
shall, after consultation with the appropriate stakeholders,
post on the website of the Centers for Medicare & Medicaid
Services a crosswalk between the previous and subsequent
version of the International Classification of Diseases not
later than the date of implementation of such subsequent
revision.
______