H.R. 3590 Patient Protection and Affordable Care Act

© Brooke Clarke 2010 - 2017

Steps to Repeal
    Special Provisions
Organization of HR3590
Outline Table


HR 3590 has now passed the Senate and House and I'm trying to get a feel what it's about.

Steps to Repeal

The House passed HR1628, but the Senate has yet to weigh in.

H.R. 1628: American Health Care Act of 2017

Passed 217/213

The American Health Care Act of 2017 (AHCA), H.R. 1628, is the House Republicans' leading proposal to "repeal and replace" the Affordable Care Act (aka Obamacare, but we'll abbreviate it ACA) and "defund" Planned Parenthood.

Update - May 4, 2017

A new deal among the Republican factions was reached. The changes to the AHCA, as reported by the Rules committee, are:

  • States may opt-out of providing the ACA’s essential health benefits. (This requirement was already dropped in the bill for Medicaid but not for the individual market.)

  • States may opt-out of requiring premiums to be the same for all people of the same age, so while individuals with pre-existing conditions must be offered health insurance there is no ...

Trackers: Roll Call Votes.

This is not about health care, but rather about tax cuts.  For more on that see: NYT: The House Health Care Disaster Is Really About Taxes, by Peter Suderman, MAY 6, 2017


This is what passed the Senate (all democrats and two independents).  The house of Representatives passed the:
Health Care and Education Reconciliation Act of 2010 (H.R. 4872) (Wiki) which made some changes.
I think those changes are part of the bill as shown here, but I'm not positive about that.

Patient Protection and Affordable Care Act (Wiki, text of ) - is where the funding is defined.  HR 3590 on this page (reconciled version) is the PPAC. (text on line)

Obama made a deal with the medical insurance industry to take single payer health care (Wiki) off the table so it's not part of either bill that passed.
Obama also made a deal with PhRMA (Wiki) (the very same deal he criticized G.W. Bush for making) that the government would NOT negotiate the price of prescription drugs, i.e. the government would pay full retail for drugs they could get wholesale.

The bill that passed requires everyone (including m embers of Congress and their staff, see S1312 below) to buy medical insurance.  It also mandates that the insurance companies must accept everyone (something they have not done up to now).
The logical conclusion is that the cost of medical insurance is going to go up, so many will not be able to afford it.  They will either change to a lower cost plan or go naked.
Note the U.S. spends twice as much as most other industrial nations on medical care and we get poorer results.
People on Medicare have single payer already and are not effected by this bill.

Special Provisions

Health Plans for Congressmen and their staff

This bill requires congressmen and their staff to subscribe to this plan.  (there are a number of emails saying this should be done, but it's already part of the law)
See S1312 below.

Prior to Obama Care Congressmen were getting medical insurance through the Federal Employees Health Benefits Program (Wiki) where the government picks up about 72% of the plan cost.  So one of the reasons Republicans are so against Obama Care is that it impacts them personally.

Tax Hike for High-Income Individuals

This is another reason Republicans are against the plan.
See S9015 and S10906 Additional hospital insurance tax on high-income taxpayers.
Note S9015 is the house version and S10906 is the Senate version and they are the same.
There are two aspects to this.  There is a general tax increase for everyone for hospital insurance from 0.5% to 1.4%.
In addition there's an additional 0.9% increase for high-income individuals.
These show up as amendments to the IRS code (Wiki) (USC 26).

See S3308: Reducing part D premium subsidy for high-income beneficiaries.
This shows up an an amendment to the Social Security Act (Wiki) (USC 42, Ch 7 Social Security, sCh 8 Health Insurance, Part D Drugs, sP2 Plans, 1395W-113 Premiums, P7)
But it's a formula with an input needed from the SSA.

Sec 1402 of P.L. 111-152 Unearned Income Medical Contribution (Health Care and Education Reconciliation Act of 2010).
This adds an additional 3.8% of income tax to unearned income for those with a modified adjusted gross income over $200,000 or $250,000 depending...

There are other tax hikes for high-income individuals that are not part of Obama Care, for example see the Congressional Budget office report:
The Distribution of Household Income and Federal Taxes, 2010 -

Average Federal Tax Rates, by Income Group, 1979 to
              2010 and Under 2013 Law

How Will Changes in Tax Rules Between 2010 and 2013 Affect Average Federal Tax Rates?

Current federal tax rules differ from those of 2010 in important ways:

  • Several provisions affecting high-income taxpayers, originally enacted in the Economic Growth and Tax Relief Reconciliation Act of 2001 (Wiki) (EGTRRA)
    and the Jobs and Growth Tax Relief Reconciliation Act of 2003 (Wiki) (JGTRRA), were allowed to expire in 2013.
  • The Making Work Pay tax credit (Wiki) expired at the end of 2010, and payroll tax rates that had been reduced in 2011 and 2012 were reset in 2013 to their earlier amounts.
  • New taxes for high-income taxpayers, enacted with the Affordable Care Act, took effect in 2013.(See this paragraph above)


There are seven versions as of 25 March 2010 and this web page is about the current ENR version.
Introduced in House (IH)
Engrossed as Agreed to or Passed by House (EH)
Placed on Calendar in Senate (PCS)
Amendment in Senate (AS)
Public Print (PP)
Engrossed Amendment as Agreed to by Senate (EAS) (2,409 pdf pages because double spaced from text document)
Enrolled as Agreed to or Passed by Both House and Senate (ENR) (906 pages as tight searchable pdf document)

Organization of HR3590

The main subdivisions are called Titles (T in my table below) and there's ten of them.  Titles are subdivided into Sub Titles (sT).  Sub Titles are subdivided into Parts (P) which in turn are broken down into Sub Parts (sP).  Finally there are Sections (S).  The first digit of the section matches the number of the title.  The second digit increments for each sub title.

Sections may contain new laws or may modify other federal laws such as those for the IRS, SSA, etc.

The current on line pdf version of H.R. 3590 (ENR) is searchable but does not have any other pdf navigation features like internal or external links or bookmarks and so is extremely user hostile.  For more about pdf document navigation see my Making a pdf web page.

Jargon, Acronyms, Abbreviations

The section titles often use terminology that's not in the common vocabulary so I'm adding links to Wiki or other internet web pages to help explain these.

Outline Table

T1—Quality, Affordable Health Care for all Americans

   sT A—Immediate Improvements in Health Care Coverage for All Americans

     S1001.Amendments to the Public Health Service Act.
                Wiki: Public Health Service Act, Title 42 of the United States Code, USPHS

     S1002.Health insurance consumer information.

     S1003.Ensuring that consumers get value for their dollars.

     S1004.Effective dates.

   sT B—Immediate Actions to Preserve and Expand Coverage

     S1101.Immediate access to insurance for uninsured individuals with a preexisting condition.

     S1102.Reinsurance for early retirees.

     S1103.Immediate information that allows consumers to identify affordable coverage options.

     S1104.Administrative simplification.

     S1105.Effective date.

   sT C—Quality Health Insurance Coverage for All Americans

     P1—Health Insurance Market Reforms

       S1201.Amendment to the Public Health Service Act.
                 Wiki: Public Health Service Act, Text: Title 42 Ch 6

      P2—Other Provisions

        S1251.Preservation of right to maintain existing coverage.

        S1252.Rating reforms must apply uniformly to all health insurance issuers and group health plans.

        S1253.Effective dates.

   sT D—Available Coverage Choices for All Americans

     P1 —Establishment of Qualified Health Plans

       S1301.Qualified health plan defined.

       S1302.Essential health benefits requirements.

       S1303.Special rules.

       S1304.Related definitions.

     P2—Consumer Choices and Insurance Competition through Health Benefit Exchanges (HR3590enr1D2.pdf)

       S1311.Affordable choices of health benefit plans.

       S1312.Consumer choice.
(i) REQUIREMENT.—Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are—
(I) created under this Act (or an amendment made by this Act); or
(II) offered through an Exchange established under this Act (or an amendment made by this Act).
(ii) DEFINITIONS.—In this section:
(I) MEMBER OF CONGRESS.—The term ‘‘Member of Congress’’ means any member of the House of Representatives or the Senate.
(II) CONGRESSIONAL STAFF.—The term ‘‘congressional staff’’ means all full-time and parttime employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.

       S1313.Financial integrity.

     P3—State Flexibility Relating to Exchanges

       S1321.State flexibility in operation and enforcement of Exchanges and related requirements.

       S1322.Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers.
       S1323.Community health insurance option.
       S1324.Level playing field.
     P4—State Flexibility to Establish Alternative Programs

       S1331.State flexibility to establish basic health programs for low-income individuals not eligible for Medicaid.
       S1332.Waiver for State innovation.
       S1333.Provisions relating to offering of plans in more than one State.
     P5—Reinsurance and Risk Adjustment

       S1341.Transitional reinsurance program for individual and small group markets in each State.
       S1342.Establishment of risk corridors for plans in individual and small group markets.
       S1343.Risk adjustment.

   sT E—Affordable Coverage Choices for All Americans

     P1—Preimum Tax Credits and Cost-sharing Reductions

       sP A—Preimum Tax Credits and Cost-sharing Reductions

       S1401.Refundable tax credit providing premium assistance for coverage under a qualified health plan.
       S1402.Reduced cost-sharing for individuals enrolling in qualified health plans.
       sP B Eligibility Determinations

       S1411.Procedures for determining eligibility for Exchange participation, pre-mium tax credits and reduced cost-sharing, and individual responsibility exemptions.
       S1412.Advance determination and payment of premium tax credits and cost- sharing reductions.
       S1413.Streamlining of procedures for enrollment through an exchange and State Medicaid (Wiki), Children's Health Insurance Program (CHIP), and health subsidy programs.  (Wiki: SCHIP)

       S1414.Disclosures to carry out eligibility requirements for certain programs.
       S1415.Premium tax credit and cost-sharing reduction payments disregarded for Federal and Federally-assisted programs.
     P2—Small Business Tax Credit

       S1421.Credit for employee health insurance expenses of small businesses.

   sT F—Shared Responsibility for Health Care

     P1—Individual Responsibility

       S1501.Requirement to maintain minimum essential coverage.
       S1502.Reporting of health insurance coverage.
     P2—Employer Responsibility

       S1511.Automatic enrollment for employees of large employers.
       S1512.Employer requirement to inform employees of coverage options.
       S1513.Shared responsibility for employers.
       S1514.Reporting of employer health insurance coverage.
       S1515.Offering of Exchange-participating qualified health plans through cafeteria plans.

   sT G—Miscellaneous Provisions

       S1552.Transparency in government.
       S1553.Prohibition against discrimination on assisted suicide.
       S1554.Access to therapies.
       S1555.Freedom not to participate in Federal health insurance programs.
       S1556.Equity for certain eligible survivors.
       S1558.Protections for employees.
       S1560.Rules of construction.
       S1561.Health information technology enrollment standards and protocols.
       S1562.Conforming amendments.
       S1563.Sense of the Senate promoting fiscal responsibility.

T2—Role of Public Programs

   sT A—Improved Access to Medicaid

       S2001.Medicaid coverage for the lowest income populations.
       S2002.Income eligibility for nonelderly determined using modified gross in-come.
       S2003.Requirement to offer premium assistance for employer-sponsored insurance.
       S2004.Medicaid coverage for former foster care children.
       S2005.Payments to territories.
       S2006.Special adjustment to FMAP determination for certain States recovering from a major disaster.
                  Federal Medical Assistance Percentages (State assistance)
                  Wiki: FMAP, Official site: FMAP

       S2007.Medicaid Improvement Fund rescission.

   sT B—Enhanced Support for the Children’s Health Insurance Program

       S2101.Additional federal financial participation for CHIP.
       S2102.Technical corrections.

   sT C—Medicaid and CHIP Enrollment Simplification

              Wiki: Medicaid

       S2201.Enrollment Simplification and coordination with State Health Insurance Exchanges.
       S2202.Permitting hospitals to make presumptive eligibility determinations for all Medicaid eligible populations.

   sT D—Improvements to Medicaid Services

       S2301.Coverage for freestanding birth center services.
       S2302.Concurrent care for children.
       S2303.State eligibility option for family planning services.
       S2304.Clarification of definition of medical assistance.

   sT E—New Options for States to Provide Long-Term Services and Supports

       S2401.Community First Choice Option.
       S2402.Removal of barriers to providing home and community-based services.
       S2403.Money Follows the Person Rebalancing Demonstration.
       S2404.Protection for recipients of home and community-based services against spousal impoverishment.
       S2405.Funding to expand State Aging and Disability Resource Centers
       S2406.Sense of the Senate regarding long-term care.

   sT F—Medicaid Prescription Drug Coverage

       S2501.Prescription drug rebates.
       S2502.Elimination of exclusion of coverage of certain drugs.
       S2503.Providing adequate pharmacy reimbursement.

   sT G—Medicaid Disproportionate Share Hospital (DSH) Payments

              Wiki: Disproportionate share hospital

       S2551.Disproportionate share hospital payments.

   sT H—Improved Coordination for Dual Eligible Beneficiaries

       S2601.5-year period for demonstration projects.
       S2602.Providing Federal coverage and payment coordination for dual eligible beneficiaries.

   sT I—Improving the Quality of Medicaid for Patients and Providers

       S2701.Adult health quality measures.
       S2702.Payment Adjustment for Health Care-Acquired Conditions.
       S2703.State option to provide health homes for enrollees with chronic conditions.
       S2704.Demonstration project to evaluate integrated care around a hospitalization.
       S2705.Medicaid Global Payment System Demonstration Project.
       S2706.Pediatric Accountable Care Organization Demonstration Project.
       S2707.Medicaid emergency psychiatric demonstration project.

   sT J—Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)

            Title XXI—State Children's Health Insurance Program

       S2801.MACPAC assessment of policies affecting all Medicaid beneficiaries.

   sT K—Protections for American Indians and Alaska Natives

       S2901.Special rules relating to Indians.
       S2902.Elimination of sunset for reimbursement for all medicare part B services furnished by certain indian hospitals and clinics.
                  Wiki: medicare part B Medical Ins

   sT L—Maternal and Child Health Services

       S2951.Maternal, infant, and early childhood home visiting programs.
       S2952.Support, education, and research for postpartum depression.
       S2953.Personal responsibility education.
       S2954.Restoration of funding for abstinence education.
       S2955.Inclusion of information about the importance of having a health care power of attorney in transition planning for children aging out of foster care and independent living programs.

T3 Improving the Quality and Efficiency of Health Care

   sT A—Transforming the Health Care Delivery System

     P1—Linking Payment to Quality Outcomes Under the Medicare Program

       S3001.Hospital Value-Based purchasing program.
       S3002.Improvements to the physician quality reporting system.
       S3003.Improvements to the physician feedback program.
       S3004.Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs.
       S3005.Quality reporting for PPS-exempt cancer hospitals.
       S3006.Plans for a Value-Based purchasing program for skilled nursing facilities and home health agencies.
       S3007.Value-based payment modifier under the physician fee schedule.
       S3008.Payment adjustment for conditions acquired in hospitals.
     P2—National Strategy to Improve Health Care Quality

       S3011.National strategy.
       S3012.Interagency Working Group on Health Care Quality.
       S3013.Quality measure development.
       S3014.Quality measurement.
       S3015.Data collection; public reporting.
     P3—Encouraging Development of New Patient Care Models

       S3021.Establishment of Center for Medicare and Medicaid Innovation within CMS.
                   Wiki: Centers for Medicare and Medicaid Services
                    Comprehensive Primary Care Initiative (CPCI) - 2015 still in the trial stage in a few states.

       S3022.Medicare shared savings program.
       S3023.National pilot program on payment bundling.
       S3024.Independence at home demonstration program.
       S3025.Hospital readmissions reduction program.
       S3026.Community-Based Care Transitions Program.
       S3027.Extension of gain sharing demonstration.

   sT B—Improving Medicare for Patients and Providers

     P1—Ensuring Beneficiary Access to Physician Care and Other Services

       S3101.Increase in the physician payment update.
       S3102.Extension of the work geographic index floor and revisions to the prac-tice expense geographic adjustment under the Medicare physician fee schedule.

       S3103.Extension of exceptions process for Medicare therapy caps.
       S3104.Extension of payment for technical component of certain physician pathology services.
       S3105.Extension of ambulance add-ons.
       S3106.Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities.
       S3107.Extension of physician fee schedule mental health add-on.
       S3108.Permitting physician assistants to order post-Hospital extended care services.
       S3109.Exemption of certain pharmacies from accreditation requirements.
       S3110.Part B special enrollment period for disabled TRICARE beneficiaries.
                   Wiki: TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the Reserve Component.

       S3111.Payment for bone density tests.
       S3112.Revision to the Medicare Improvement Fund.
       S3113.Treatment of certain complex diagnostic laboratory tests.
       S3114.Improved access for certified nurse-midwife services.
     P2—Rural Protections

       S3121.Extension of outpatient hold harmless provision.
       S3122.Extension of Medicare reasonable costs payments for certain clinical di-agnostic laboratory tests furnished to hospital patients in certain rural areas.
       S3123.Extension of the Rural Community Hospital Demonstration Program.
                  CMS: Rural Community Hospital Demonstration Program

       S3124.Extension of the Medicare-dependent hospital (MDH) program.
                   Wiki: Disproportionate share hospital

       S3125.Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals.
       S3126.Improvements to the demonstration project on community health integration models in certain rural counties.
       S3127.MedPAC study on adequacy of Medicare payments for health care pro-viders serving in rural areas.
                   Wiki: Medicare Payment Advisory Commission

       S3128.Technical correction related to critical access hospital services.
       S3129.Extension of and revisions to Medicare rural hospital flexibility program.
     P3—Improving Payment Accuracy

       S3131.Payment adjustments for home health care.
       S3132.Hospice reform.
       S3133.Improvement to medicare disproportionate share hospital (DSH) payments.  Wiki: DSH

       S3134.Misvalued codes under the physician fee schedule.
       S3135.Modification of equipment utilization factor for advanced imaging services.
       S3136.Revision of payment for power-driven wheelchairs.
       S3137.Hospital wage index improvement.
       S3138.Treatment of certain cancer hospitals.
       S3139.Payment for biosimilar biological products.
       S3140.Medicare hospice concurrent care demonstration program.
       S3141.Application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor.
       S3142.HHS study on urban Medicare-dependent hospitals.
                  Wiki: Department of Health and Human Services, Official web page: HHS

       S3143.Protecting home health benefits.

   sT C—Provisions Relating to Part C (Advantage Plans, Supplements)

       S3201.Medicare Advantage payment.   Wiki: Medicare Advantage (MA)

       S3202.Benefit protection and simplification.
       S3203.Application of coding intensity adjustment during MA payment transition.
       S3204.Simplification of annual beneficiary election periods.
       S3205.Extension for specialized MA plans for special needs individuals.
       S3206.Extension of reasonable cost contracts.
       S3207.Technical correction to MA private fee-for-service plans.
       S3208.Making senior housing facility demonstration permanent.
       S3209.Authority to deny plan bids.
       S3210.Development of new standards for certain Medigap plans.

   sT D—Medicare Part D Improvements for Prescription Drug Plans and MA– PD Plans

       S3301.Medicare coverage gap discount program.
       S3302.Improvement in determination of Medicare part D low-income benchmark premium.
                   Wiki: Medicare part D  prescription drugs MA-PD

       S3303.Voluntary de minimis policy for subsidy eligible individuals under prescription drug plans and MA–PD plans.
       S3304.Special rule for widows and widowers regarding eligibility for low-income assistance.
       S3305.Improved information for subsidy eligible individuals reassigned to prescription drug plans and MA–PD plans.
       S3306.Funding outreach and assistance for low-income programs.
       S3307.Improving formulary requirements for prescription drug plans and MA– PD plans with respect to certain categories or classes of drugs.
       S3308.Reducing part D premium subsidy for high-income beneficiaries.
       S3309.Elimination of cost sharing for certain dual eligible individuals.
       S3310.Reducing wasteful dispensing of outpatient prescription drugs in longterm care facilities under prescription drug plans and MA–PD plans.
       S3311.Improved Medicare prescription drug plan and MA–PD plan complaint system.
       S3312.Uniform exceptions and appeals process for prescription drug plans and MA–PD plans.
       S3313.Office of the Inspector General studies and reports.
       S3314.Including costs incurred by AIDS drug assistance programs and Indian Health Service in providing prescription drugs toward the annual out-of-pocket threshold under part D.
       S3315.Immediate reduction in coverage gap in 2010.

   sT E—Ensuring Medicare Sustainability

       S3401.Revision of certain market basket updates and incorporation of productivity improvements into market basket updates that do not already incorporate such improvements.
       S3402.Temporary adjustment to the calculation of part B premiums.
       S3403.Independent Medicare Advisory Board.

   sT F—Health Care Quality Improvements

       S3501.Health care delivery system research; Quality improvement technical assistance.
       S3502.Establishing community health teams to support the patient-centered medical home.
       S3503.Medication management services in treatment of chronic disease.
       S3504.Design and implementation of regionalized systems for emergency care.
       S3505.Trauma care centers and service availability.
       S3506.Program to facilitate shared decision making.
       S3507.Presentation of prescription drug benefit and risk information.
       S3508.Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals.
       S3509.Improving women’s health.
       S3510.Patient navigator program.
       S3511.Authorization of appropriations.

   sT G—Protecting and Improving Guaranteed Medicare Benefits

       S3601.Protecting and improving guaranteed Medicare benefits.
       S3602.No cuts in guaranteed benefits.

T4 Prevention of Chronic Disease and Improving Public Health

   sT A—Modernizing Disease Prevention and Public Health Systems

       S4001.National Prevention, Health Promotion and Public Health Council.
       S4002.Prevention and Public Health Fund.
       S4003.Clinical and community preventive services.
       S4004.Education and outreach campaign regarding preventive benefits.

   sT B—Increasing Access to Clinical Preventive Services

       S4101.School-based health centers.
       S4102.Oral healthcare prevention activities.
       S4103.Medicare coverage of annual wellness visit providing a personalized prevention plan.
       S4104.Removal of barriers to preventive services in Medicare.
       S4105.Evidence-based coverage of preventive services in Medicare.
       S4106.Improving access to preventive services for eligible adults in Medicaid.
       S4107.Coverage of comprehensive tobacco cessation services for pregnant women in Medicaid.
       S4108.Incentives for prevention of chronic diseases in medicaid.

   sT C—Creating Healthier Communities

       S4201.Community transformation grants.
       S4202.Healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries.
       S4203.Removing barriers and improving access to wellness for individuals with disabilities.
       S4205.Nutrition labeling of standard menu items at chain restaurants.

       S4206.Demonstration project concerning individualized wellness plan.
       S4207.Reasonable break time for nursing mothers.

   sT D—Support for Prevention and Public Health Innovation

       S4301.Research on optimizing the delivery of public health services.
       S4302.Understanding health disparities: data collection and analysis.
       S4303.CDC and employer-based wellness programs.
                  Wiki: Centers for Disease Control and Prevention, Official web page: CDC

       S4304.Epidemiology-Laboratory Capacity Grants.
       S4305.Advancing research and treatment for pain care management.
       S4306.Funding for Childhood Obesity Demonstration Project.

   sT E—Miscellaneous Provisions

       S4401.Sense of the Senate concerning CBO scoring.
                  Wiki: Congressional Budget Office, Official web page: CBO

       S4402.Effectiveness of Federal health and wellness initiatives.

T5 Health Care Workforce

   sT A—Purpose and Definitions


   sT B—Innovations in the Health Care Workforce

       S5101.National health care workforce commission.
                  Health & Human Services - National Center for Health Workforce Analysis Reports

       S5102.State health care workforce development grants.
       S5103.Health care workforce assessment.

   sT C—Increasing the Supply of the Health Care Workforce

       S5201.Federally supported student loan funds.
       S5202.Nursing student loan program.
       S5203.Health care workforce loan repayment programs.
       S5204.Public health workforce recruitment and retention programs.
       S5205.Allied health workforce recruitment and retention programs.
       S5206.Grants for State and local programs.

       S5207.Funding for National Health Service Corps.
       S5208.Nurse-managed health clinics.
       S5209.Elimination of cap on commissioned corps.
       S5210.Establishing a Ready Reserve Corps.

   sT D—Enhancing Health Care Workforce Education and Training

       S5301.Training in family medicine, general internal medicine, general pediatrics, and physician assistantship.
       S5302.Training opportunities for direct care workers.
       S5303.Training in general, pediatric, and public health dentistry.
       S5304.Alternative dental health care providers demonstration project.
       S5305.Geriatric education and training; career awards; comprehensive geriatric education.
       S5306.Mental and behavioral health education and training grants.

       S5307.Cultural competency, prevention, and public health and individuals with disabilities training.
       S5308.Advanced nursing education grants.
       S5309.Nurse education, practice, and retention grants.
       S5310.Loan repayment and scholarship program.
       S5311.Nurse faculty loan program.
       S5312.Authorization of appropriations for parts B through D of title VIII.
       S5313.Grants to promote the community health workforce.
       S5314.Fellowship training in public health.
       S5315.United States Public Health Sciences Track.

   sT E—Supporting the Existing Health Care Workforce

       S5401.Centers of excellence.

       S5402.Health care professionals training for diversity.
       S5403.Interdisciplinary, community-based linkages.
       S5404.Workforce diversity grants.
       S5405.Primary care extension program.

   sT F—Strengthening Primary Care and Other Workforce Improvements

       S5501.Expanding access to primary care services and general surgery services.
       S5502.Medicare Federally qualified health center improvements.
       S5503.Distribution of additional residency positions.
       S5504.Counting resident time in nonprovider settings.
       S5505.Rules for counting resident time for didactic and scholarly activities and other activities.
       S5506.Preservation of resident cap positions from closed hospitals.
       S5507.Demonstration projects To address health professions workforce needs; extension of family-to-family health information centers.
       S5508.Increasing teaching capacity.
       S5509.Graduate nurse education demonstration.

   sT G—Improving Access to Health Care Services

       S5601.Spending for Federally Qualified Health Centers (FQHCs).
                  Wiki: FQHC, Health Resources & Services Administration

       S5602.Negotiated rulemaking for development of methodology and criteria for designating medically underserved populations and health professions shortage areas.
       S5603.Reauthorization of the Wakefield Emergency Medical Services for Children Program.
                    S. 760: Wakefield Act,
                   A bill to amend the Public Health Service Act to provide a means for continued improvement
                   in emergency medical services for children.

       S5604.Co-locating primary and specialty care in community-based mental health settings.
       S5605.Key National indicators.

   sT H—General Provisions


T6 Transparency and Program Integrity

   sT A—Physician Ownership and Other Transparency

       S6001.Limitation on Medicare exception to the prohibition on certain physician referrals for hospitals.
       S6002.Transparency reports and reporting of physician ownership or investment interests.
       S6003.Disclosure requirements for in-office ancillary services exception to the prohibition on physician self-referral for certain imaging services.

       S6004.Prescription drug sample transparency.
       S6005.Pharmacy benefit managers transparency requirements.

   sT B—Nursing Home Transparency and Improvement

     P1—Improving Transparency of Information

       S6101.Required disclosure of ownership and additional disclosable parties information.
       S6102.Accountability requirements for skilled nursing facilities and nursing facilities.

       S6103.Nursing home compare Medicare website.

       S6104.Reporting of expenditures.
       S6105.Standardized complaint form.
       S6106.Ensuring staffing accountability.
       S6107.GAO study and report on Five-Star Quality Rating System.
     P2—Targeting Enforcement

       S6111.Civil money penalties.
       S6112.National independent monitor demonstration project.
       S6113.Notification of facility closure.
       S6114.National demonstration projects on culture change and use of information technology in nursing homes.
     P3—Improving Staff Training

       S6121.Dementia and abuse prevention training.

   sT C—Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-term Care Facilities and Providers

       S6201.Nationwide program for National and State background checks on direct patient access employees of long-term care facilities and providers.

   sT D—Patient-Centered Outcomes Research

       S6301.Patient-Centered Outcomes Research.
       S6302.Federal coordinating council for comparative effectiveness research.

   sT E—Medicare, Medicaid, and CHIP Program Integrity Provisions

       S6401.Provider screening and other enrollment requirements under Medicare, Medicaid, and CHIP.
       S6402.Enhanced Medicare and Medicaid program integrity provisions.

       S6403.Elimination of duplication between the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank.
       S6404.Maximum period for submission of Medicare claims reduced to not more than 12 months.
       S6405.Physicians who order items or services required to be Medicare enrolled physicians or eligible professionals.
       S6406.Requirement for physicians to provide documentation on referrals to programs at high risk of waste and abuse.
       S6407.Face to face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare.
       S6408.Enhanced penalties.
       S6409.Medicare self-referral disclosure protocol.
       S6410.Adjustments to the Medicare durable medical equipment, prosthetics, orthotics, and supplies competitive acquisition program.
       S6411.Expansion of the Recovery Audit Contractor (RAC) program.
                  Wiki:  RAC,  CMS: RAC

   sT F—Additional Medicaid Program Integrity Provisions

       S6501.Termination of provider participation under Medicaid if terminated under Medicare or other State plan.
       S6502.Medicaid exclusion from participation relating to certain ownership, control, and management affiliations.
       S6503.Billing agents, clearinghouses, or other alternate payees required to reg-ister under Medicaid.
       S6504.Requirement to report expanded set of data elements under MMIS to detect fraud and abuse.
                  CMS: Medicaid Management Information Systems

       S6505.Prohibition on payments to institutions or entities located outside of the United States.

       S6507.Mandatory State use of national correct coding initiative.
       S6508.General effective date.

   sT G—Additional Program Integrity Provisions

       S6601.Prohibition on false statements and representations.
       S6602.Clarifying definition.
       S6603.Development of model uniform report form.
       S6604.Applicability of State law to combat fraud and abuse.
       S6605.Enabling the Department of Labor to issue administrative summary cease and desist orders and summary seizures orders against plans that are in financially hazardous condition.
                  Wiki: DOL, official site: DOL

       S6606.MEWA plan registration with Department of Labor.
                  DOL: Multiple Employer Welfare Arrangements

       S6607.Permitting evidentiary privilege and confidential communications.

   sT H—Elder Justice Act

       S6701.Short title of subtitle.
       S6703.Elder Justice.

   sT I—Sense of the Senate Regarding Medical Malpractice

       S6801.Sense of the Senate regarding medical malpractice.

T7 Improving Access to Innovative Medical Therapies

   sT A—Biologics Price Competition and Innovation

       S7001.Short title.
       S7002.Approval pathway for biosimilar biological products.

   sT B—More Affordable Medicines for Children and Underserved Communities

       S7101.Expanded participation in 340B program.
                  Wiki: 340B Drug Pricing Program

       S7102.Improvements to 340B program integrity.
       S7103.GAO study to make recommendations on improving the 340B program.

T8 Class Act (Wiki) Repealed by Obama in 2013

       S8001.Short title of title.
       S8002.Establishment of national voluntary insurance program for purchasing community living assistance services and support.
                  Long Term Care insurance program (Wiki)

T9 Revenue Provisions

   sT A—Revenue Offset Provisions

       S9001.Excise tax on high cost employer-sponsored health coverage.
       S9002.Inclusion of cost of employer-sponsored health coverage on W–2.
       S9003.Distributions for medicine qualified only if for prescribed drug or insulin.
       S9004.Increase in additional tax on distributions from HSAs and Archer MSAs not used for qualified medical expenses.
                  Wiki: Health savings account, Medical Savings AccountHigh-deductible health plan (HDHP),

       S9005.Limitation on health flexible spending arrangements under cafeteria plans.
                  Wiki: Cafeteria plan,

       S9006.Expansion of information reporting requirements.
       S9007.Additional requirements for charitable hospitals.
       S9008.Imposition of annual fee on branded prescription pharmaceutical manufacturers and importers.
       S9009.Imposition of annual fee on medical device manufacturers and importers.
       S9010.Imposition of annual fee on health insurance providers.
       S9011.Study and report of effect on veterans health care.
       S9012.Elimination of deduction for expenses allocable to Medicare Part D subsidy.
       S9013.Modification of itemized deduction for medical expenses.
       S9014.Limitation on excessive remuneration paid by certain health insurance providers.
       S9015.Additional hospital insurance tax on high-income taxpayers. (9015.pdf)
Increases the FICA tax from 0.5% to 1.4% for everyone and adds a 0.9% High-Income tax to the IRS code as shown below.
26 U.S.C.
United States Code, 2012 Edition
Subtitle C - Employment Taxes
Subchapter A - Tax on Employees
From the U.S. Government Printing Office, www.gpo.gov
Subchapter A—Tax on Employees

       S9016.Modification of section 833 treatment of certain health organizations.

       S9017.Excise tax on elective cosmetic medical procedures.

   sT B—Other Provisions

       S9021.Exclusion of health benefits provided by Indian tribal governments.
       S9022.Establishment of simple cafeteria plans for small businesses.
       S9023.Qualifying therapeutic discovery project credit.

T10 Strengthening Quality, Affordable Health Care for all Americans

   sT A—Provisions Relating to Title 1

       S10101.Amendments to subtitle A
       S10102.Amendments to subtitle B
       S10103.Amendments to subtitle C.
       S10104.Amendments to subtitle D.
       S10105.Amendments to subtitle E.
       S10106.Amendments to subtitle F.
       S10107.Amendments to subtitle G.
       S10108.Free choice vouchers.
       S10109.Development of standards for financial and administrative transactions.

   sT B—Provisions Relating to Title 2

     P1—Medicaid and CHIP

       S10201.Amendments to the Social Security Act and title II of this Act.
       S10202.Incentives for States to offer home and community-based services as a long-term care alternative to nursing homes.
       S10203.Extension of funding for CHIP through fiscal year 2015 and other CHIP-related provisions.
     P2—Support for Pregant and Parenting Teens and Women

       S10212.Establishment of pregnancy assistance fund.
       S10213.Permissible uses of Fund.
     P3—Indian Health Care Improvement

       S10221.Indian health care improvement.

   sT C—Provisions Relating to Title 3

       S10301.Plans for a Value-Based purchasing program for ambulatory surgical centers.

       S10302.Revision to national strategy for quality improvement in health care.
       S10303.Development of outcome measures.

       S10304.Selection of efficiency measures.
       S10305.Data collection; public reporting.
       S10306.Improvements under the Center for Medicare and Medicaid Innovation.
       S10307.Improvements to the Medicare shared savings program.
       S10308.Revisions to national pilot program on payment bundling.
       S10309.Revisions to hospital readmissions reduction program.
       S10310.Repeal of physician payment update.
       S10311.Revisions to extension of ambulance add-ons.
       S10312.Certain payment rules for long-term care hospital services and moratorium on the establishment of certain hospitals and facilities.
       S10313.Revisions to the extension for the rural community hospital demonstra-tion program.
       S10314.Adjustment to low-volume hospital provision.
       S10315.Revisions to home health care provisions.
       S10316.Medicare DSH.
       S10317.Revisions to extension of section 508 hospital provisions.
       S10318.Revisions to transitional extra benefits under Medicare Advantage.
       S10319.Revisions to market basket adjustments.
       S10320.Expansion of the scope of, and additional improvements to, the Independent Medicare Advisory Board.
       S10321.Revision to community health teams.
       S10322.Quality reporting for psychiatric hospitals.
       S10323.Medicare coverage for individuals exposed to environmental health hazards.
       S10324.Protections for frontier States.
       S10325.Revision to skilled nursing facility prospective payment system.
       S10326.Pilot testing pay-for-performance programs for certain Medicare providers.
       S10327.Improvements to the physician quality reporting system.
       S10328.Improvement in part D medication therapy management (MTM) programs.
       S10329.Developing methodology to assess health plan value.
       S10330.Modernizing computer and data systems of the Centers for Medicare & Medicaid services to support improvements in care delivery.
       S10331.Public reporting of performance information.

       S10332.Availability of medicare data for performance measurement.
       S10333.Community-based collaborative care networks.
       S10334.Minority health.
       S10335.Technical correction to the hospital value-based purchasing program.
       S10336.GAO study and report on Medicare beneficiary access to high-quality dialysis services.

   sT D—Provisions Relating to Title 4

       S10401.Amendments to subtitle A.
       S10402.Amendments to subtitle B.
       S10403.Amendments to subtitle C.
       S10404.Amendments to subtitle D.
       S10405.Amendments to subtitle E.
       S10406.Amendment relating to waiving coinsurance for preventive services.
       S10407.Better diabetes care.
       S10408.Grants for small businesses to provide comprehensive workplace wellness programs.
       S10409.Cures Acceleration Network.
       S10410.Centers of Excellence for Depression.

       S10411.Programs relating to congenital heart disease.
       S10412.Automated Defibrillation in Adam’s Memory Act.
                    S. 1164: Automated Defibrillation in Adam's Memory Reauthorization Act  

       S10413.Young women’s breast health awareness and support of young women diagnosed with breast cancer.

   sT E—Provisions Relating to Title 5

       S10501.Amendments to the Public Health Service Act, the Social Security Act, and title V of this Act.

       S10502.Infrastructure to Expand Access to Care.
       S10503.Community Health Centers and the National Health Service Corps Fund.

       S10504.Demonstration project to provide access to affordable care.

   sT F—Provisions Relating to Title 6

       S10601.Revisions to limitation on medicare exception to the prohibition on cer-tain physician referrals for hospitals.
       S10602.Clarifications to patient-centered outcomes research.

       S10603.Striking provisions relating to individual provider application fees.
       S10604.Technical correction to section 6405.
       S10605.Certain other providers permitted to conduct face to face encounter for home health services.

       S10606.Health care fraud enforcement.
       S10607.State demonstration programs to evaluate alternatives to current med-ical tort litigation.
       S10608.Extension of medical malpractice coverage to free clinics.
       S10609.Labeling changes.

   sT G—Provisions Relating to Title 8

       S10801.Provisions relating to title 8

   sT H—Provisions Relating to Title 9

       S10901.Modifications to excise tax on high cost employer-sponsored health coverage.
       S10902.Inflation adjustment of limitation on health flexible spending arrangements under cafeteria plans.
       S10903.Modification of limitation on charges by charitable hospitals.
       S10904.Modification of annual fee on medical device manufacturers and im-porters.

       S10905.Modification of annual fee on health insurance providers.
       S10906.Modifications to additional hospital insurance tax on high-income tax-payers.
       S10907.Excise tax on indoor tanning services in lieu of elective cosmetic medical procedures.
       S10908.Exclusion for assistance provided to participants in State student loan repayment programs for certain health professionals.
       S10909.Expansion of adoption credit and adoption assistance programs.


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