(1) in general. a state may use amounts received under a grant under section 10212 to make funding available tp its state attorney general to assist statewide offices in providing- (a) intervention services, accompaniment, and supportive social services for eligible pregnant women who are victims of domestic violence, sexual violence, sexual assault, or stalking. (b) technical assistance and training (as described in subsection (c)) relating to violence against eligible pregnant women to be made available to the following: (i) federal, state, tribal, territorial, and local governments, law enforcement agencies, and courts. (ii) professionals working in legal, social service, and health care settings. (iii) nonprofit organizations. (iv) faith-based organizations. (2) eligibility.

to be eligible for a grant under paragraph (1), a state attorney general shall submit an application to the designated state agency at such time, in such manner, and containing such information, as specified by the state. (3) technical assistance and training described. for purposes of paragraph (1)(b), technical assistance and training is- (a) the identification of eligible pregnant women experiencing domestic violence, sexual violence, sexual assault, or stalking; (b) the assessment of the immediate and short-term safety of such a pregnant woman, the evaluation of the impact of the violence or stalking on the pregnant woman's health, and the assistance of the pregnant woman in developing a plan aimed at preventing further domestic violence, sexual violence, sexual assault, or stalking, as appropriate; (c) t (c) the maintenance of complete medical or forensic records that include the documentation of any examination, treatment given, and referrals made, recording

the location and nature of the pregnant woman's injuries, and the establishment of mechanisms to ensure the privacy and confidentiality of those medical records; and (d) the identification and referral of the pregnant woman to appropriate public and private nonprofit entities that provide intervention services, accompaniment, and supportive social services. (4) eligible pregnant woman. in this subsection, the term "eligible pregnant woman" means any woman who is pregnant on the date on which such woman becomes a victim of domestic violence, sexual violence, sexual assault, or stalking or who was pregnant during the one-year period before such date. (e) public awareness and education. a state may use amounts received under a grant under section 10212 to make funding available to increase public awareness and education concerning any services available to pregnant and parenting teens and women

under this part, or any other resources available to pregnant and parenting women in keeping with the intent and purposes of this part. the state shall be responsible for setting guidelines or limits as to how much of funding may be utilized for public awareness and education in any funding award. sec. 10214. appropriations. there is authorized to be appropriated, and there are appropriated, $25,000,000 for each of fiscal years 2010 through 2019, to carry out this part. part iii-indian health care improvement sec. 10221. indian health care improvement. (a) in general. except as provided in subsection (b), s. 1790 entitled "a bill to amend the indian health care improvement act to revise and extend that act, and for other purposes.", as reported by the committee on indian affairs of the senate in december 2009, is enacted into law. (b) amendments.

(1) section 119 of the indian health care improvement act (as amended by section 111 of the bill referred to in subsection (a)) is amended- (a) in subsection (d)- (i) in paragraph (2), by striking "in establishing" and inserting "subject to paragraphs (3) and (4), in establishing"; and (ii) by adding at the end the following: "(3) election of indian tribe or tribal organization. "(a) in general. subparagraph (b) of paragraph (2) shall not apply in the case of an election made by an indian tribe or tribal organization located in a state (other than alaska) in which the use of dental health aide therapist services or midlevel dental health provider services is authorized under state law to supply such services in accordance with state law. "(b) action by secretary. on an election by an indian tribe or tribal organization under subparagraph (a), the secretary, acting through the

service, shall facilitate implementation of the services elected. "(4) vacancies. the secretary shall not fill any vacancy for a certified dentist in a program operated by the service with a dental health aide therapist."; and (b) by adding at the end the following: "(e) effect of section. nothing in this section shall restrict the ability of the service, an indian tribe, or a tribal organization to participate in any program or to provide any service authorized by any other federal law.". (2) the indian health care improvement act (as amended by section 134(b) of the bill referred to in subsection (a)) is amended by striking section 125 (relating to treatment of scholarships for certain purposes). (3) section 806 of the indian health care improvement act (25 u.s.c. 1676) is amended-

(a) by striking "any limitation" and inserting the following: "(a) hhs appropriations.-any limitation"; and (b) by adding at the end the following: "(b) limitations pursuant to other federal law. any limitation pursuant to other federal laws on the use of federal funds appropriated to the service shall apply with respect to the performance or coverage of abortions." (4) the bill referred to in subsection (a) is amended by striking section 201. subtitle c-provisions relating to title iii sec. 10301. plans for a value-based purchasing program for ambulatory surgical centers. (a) in general. section 3006 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).". (b) technical. section 3006(a)(2)(a) is amended by striking clauses (i) and (ii). sec. 10302. revision to national strategy for quality improvement in health care. section 399hh(a)(2)(b)(iii) of the public health service act, as added by section 3011, is amended by inserting "(taking into consideration the limitations set forth in subsections (c) and (d) of section 1182 of the social security act)" after "information". sec. 10303. development of outcome measures. (a) development. section 931 of the public health service act, as added by section 3013(a), is amended by adding at

the end the following new subsection: "(f) development of outcome measures. "(1) in general. the secretary shall develop, and periodically update (not less than every 3 years), provider-level outcome measures for hospitals and physicians, as well as other providers as determined appropriate by the secretary. "(2) categories of measures. the measures developed under this subsection shall include, to the extent determined appropriate by the secretary "(a) outcome measurement for acute and chronic diseases, including, to the extent feasible, the 5 most prevalent and resource-intensive acute and chronic medical conditions; and "(b) outcome measurement for primary and preventative care, including, to the extent feasible, measurements that cover provision of such care for distinct patient populations (such as healthy children, chronically ill adults, or infirm elderly individuals).

"(3) goals. in developing such measures, the secretary shall seek to- "(a) address issues regarding risk adjustment, accountability, and sample size; "(b) include the full scope of services that comprise a cycle of care; and "(c) include multiple dimensions. "(4) timeframe. "(a) acute and chronic diseases. not later than 24 months after the date of enactment of this act, the secretary shall develop not less than 10 measures described in paragraph (2)(a). "(b) primary and preventive care. not later than 36 months after the date of enactment of this act, the secretary shall develop not less than 10 measures described in paragraph (2)(b).". (b) hospital-acquired conditions. section 1890a of the social security act, as amended by section 3013(b), is amended by adding at the end the following new subsection: "(f) hospital acquired

conditions. the secretary shall, to the extent practicable, publicly report on measures for hospital-acquired conditions that are currently utilized by the centers for medicare & medicaid services for the adjustment of the amount of payment to hospitals based on rates of hospital-acquired infections.". (c) clinical practice guidelines. section 304(b) of the medicare improvements for patients and providers act of 2008 (public law 110-275) is amended by adding at the end the following new paragraph: "(4) identification. "(a) in general. following receipt of the report submitted under paragraph (2), and not less than every 3 years thereafter, the secretary shall contract with the institute to employ the results of the study performed under paragraph (1) and the best methods identified by the institute for the purpose of identifying existing and new clinical practice guidelines

that were developed using such best methods, including guidelines listed in the national guideline clearinghouse. "(b) consultation. in carrying out the identification process under subparagraph (a), the secretary shall allow for consultation with professional societies, voluntary health care organizations, and expert panels.". sec. 10304. 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. 10305. 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. 10306. improvements under the center for medicare and medicaid innovation. section 1115a of the social security act, as added by section 3021, is amended- (1) in subsection (a), 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."; (2) 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."; (b) in subparagraph (b), by adding at the end the following new clauses: "(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.

"(xx) utilizing a diverse network of providers of services and suppliers to improve care coordination for applicable individuals described in subsection (a)(4)(a)(i) with 2 or more chronic conditions and a history of prior-year hospitalization through interventions developed under the medicare coordinated care demonstration project under section 4016 of the balanced budget act of 1997 (42 u.s.c. 1395b-1 note)."; and (c) 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."; (3) 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 (4) 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. 10307. 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. 10308. revisions to national pilot program on payment bundling. (a) in general.-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) and inserting the following new subsection: "(g) application of pilot program to continuing care hospitals.- "(1) in general.-in conducting the pilot program, the secretary shall apply the provisions of the program so as to separately pilot test the continuing care hospital model. "(2) special rules.-in pilot testing the continuing care hospital model under paragraph (1), the following rules shall apply: "(a) such model shall be tested without the limitation to the conditions selected under subsection (a)(2)(b). "(b) notwithstanding subsection (a)(2)(d), an episode of care shall be defined as the full period that a patient stays in the continuing care hospital plus the first 30 days following discharge from such hospital. "(3) continuing care hospital defined.-in this subsection, the term 'continuing care hospital' means an entity that has demonstrated the ability to meet patient care and patient safety

standards and that provides under common management the medical and rehabilitation services provided in inpatient rehabilitation hospitals and units (as defined in section 1886(d)(1)(b)(ii)), long term care hospitals (as defined in section1886(d)(1)(b)(iv)(i)), and skilled nursing facilities (as defined in section 1819(a)) that are located in a hospital described in section 1886(d).". (b) technical amendments.- (1) section 3023 is amended by striking "1886c" and inserting "1866c". (2) title xviii of the social security act is amended by redesignating section 1866d, as added by section 3024, as section 1866e.

sec. 10309. revisions to hospital readmissions reduction program. section 1886(q)(1) of the social security act, as added by section 3025, in the matter preceding subparagraph (a), is amended by striking "the secretary shall reduce the payments" and all that follows through "the product of" and inserting "the secretary shall make payments (in addition to the payments described in paragraph (2)(a)(ii)) for such a discharge to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) in an amount equal to the product of". sec. 10310. repeal of physician payment update. the provisions of, and the amendment made by, section 3101 are repealed sec. 10311. revisions to extension of ambulance add-ons. (a) ground ambulance.-section

1834(l)(13)(a) of the social security act (42 u.s.c. 1395m(l)(13)(a)), as amended by section 3105(a), is further amended- (1) in the matter preceding clause (i)- (a) by striking "2007, for" and inserting "2007, and for"; and (b) by striking "2010, and for such services furnished on or after april 1, 2010, and before january 1, 2011" and inserting "2011"; and (2) in each of clauses (i) and (ii)- (a) by striking ", and on or after april 1, 2010, and before january 1, 2011" each place it appears; and (b) by striking "january 1, 2010" and inserting "january 1, 2011" each place it appears. (b) air ambulance.-section

146(b)(1) of the medicare improvements for patients and providers act of 2008 (public law 110-275), as amended by section 3105(b), is further amended by striking "december 31, 2009, and during the period beginning on april 1, 2010, and ending on january 1, 2011" and inserting "december 31, 2010". (c) super rural ambulance.-section 1834(l)(12)(a) of the social security act (42 u.s.c. 1395m(l)(12)(a)), as amended by section 3105(c), is further amended by striking "2010, and on or after april 1, 2010, and before january 1, 2011" and inserting "2011". sec. 10312. certain payment rules for long-term care

hospital services and moratorium on the establishment of certain hospitals and facilities. (a) certain payment rules.-section 114(c) of the medicare, medicaid, and schip extension act of 2007 (42 u.s.c. 1395ww note), as amended by section 4302(a) of the american recovery and reinvestment act (public law 111-5) and section 3106(a) of this act, is further amended by striking "4-year period" each place it appears and inserting "5-year period". (b) moratorium.-section 114(d) of such act (42 u.s.c. 1395ww note), as amended by section 3106(b) of this act, in the matter preceding subparagraph (a), is amended by striking "4-year period" and inserting "5-year period". sec. 10313. 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". sec. 10314. adjustment to low-volume hospital provision. section 1886(d)(12) of the social security act (42 u.s.c. 1395ww(d)(12), as amended by section 3125, is amended- (1) in subparagraph (c)(i), by striking "1,500 discharges" and inserting "1,600 discharges"; and (2) in subparagraph (d), by striking "1,500 discharges" and inserting "1,600 discharges". sec. 10315. revisions to home health care provisions. (a) rebasing.-section 1895(b)(3)(a)(iii) of the social security act, as added by section 3131, is amended-

(1) in the clause heading, by striking "2013" and inserting "2014"; (2) in subclause (i), by striking "2013" and inserting "2014"; and (3) in subclause (ii), by striking "2016" and inserting "2017". (b) revision of home health study and report.-section 3131(d) is amended to read as follows: "(d) study and report on the development of home health payment revisions in order to ensure access to care and payment for severity of illness.- "(1) in general.-the secretary of health and human services (in this section referred to as the 'secretary') shall conduct a study on home health agency costs involved with providing ongoing access to care to low-income medicare beneficiaries or beneficiaries in medically underserved areas, and in treating beneficiaries with varying levels of severity of illness. in conducting the study, the secretary may analyze

items such as the following: "(a) methods to potentially revise the home health prospective payment system under section 1895 of the social security act (42 u.s.c. 1395fff) to account for costs related to patient severity of illness or to improving beneficiary access to care, such as- "(i) payment adjustments for services that may involve additional or fewer resources; "(ii) changes to reflect resources involved with providing home health services to low-income medicare beneficiaries or medicare beneficiaries residing in medically underserved areas; "(iii) ways outlier payments might be revised to reflect costs of treating medicare beneficiaries with high levels of severity of illness; and "(iv) other issues determined appropriate by the secretary. "(b) operational issues involved with potential implementation of potential revisions to the home health payment system, including impacts for both home health

agencies and administrative and systems issues for the centers for medicare & medicaid services, and any possible payment vulnerabilities associated with implementing potential revisions. "(c) whether additional research might be needed. "(d) other items determined appropriate by the secretary. "(2) considerations.-in conducting the study under paragraph (1), the secretary may consider whether patient severity of illness and access to care could be measured by factors, such as- "(a) population density and relative patient access to care; "(b) variations in service costs for providing care to individuals who are dually eligible under the medicare and medicaid programs; "(c) the presence of severe or chronic diseases, which might be measured by multiple, discontinuous home health episodes; "(d) poverty status, such as evidenced by the receipt of supplemental security income under title xvi of the social

security act; and "(e) other factors determined appropriate by the secretary. "(3) report.-not later than march 1, 2014, the secretary shall submit to congress a report on the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the secretary determines appropriate. "(4) consultations.-in conducting the study under paragraph (1), the secretary shall consult with appropriate stakeholders, such as groups representing home health agencies and groups representing medicare beneficiaries. "(5) medicare demonstration project based on the results of the study.- "(a) in general.-subject to subparagraph (d), taking into account the results of the study conducted under paragraph (1), the secretary may, as determined appropriate, provide for a demonstration project to test whether making payment adjustments for home health services under the medicare program would substantially improve access to care for patients with high severity levels of illness or for low-income or underserved

medicare beneficiaries. "(b) waiving budget neutrality.-the secretary shall not reduce the standard prospective payment amount (or amounts) under section 1895 of the social security act (42 u.s.c. 1395fff) applicable to home health services furnished during a period to offset any increase in payments during such period resulting from the application of the payment adjustments under subparagraph (a). "(c) no effect on subsequent periods.-a payment adjustment resulting from the application of subparagraph (a) for a period- "(i) shall not apply to payments for home health services under title xviii after such period; and "(ii) shall not be taken into account in calculating the payment amounts applicable for such services after such period. "(d) duration.-if the secretary determines it appropriate to conduct the demonstration project under this subsection, the secretary shall conduct the project for a four year period beginning not later than january 1, 2015.

"(e) funding.-the secretary shall provide for the transfer from the federal hospital insurance trust fund under section 1817 of the social security act (42 u.s.c. 1395i) and the federal supplementary medical insurance trust fund established under section 1841 of such act (42 u.s.c. 1395t), in such proportion as the secretary determines appropriate, of $500,000,000 for the period of fiscal years 2015 through 2018. such funds shall be made available for the study described in paragraph (1) and the design, implementation and evaluation of the demonstration described in this paragraph. amounts available under this subparagraph shall be available until expended. "(f) evaluation and report.-if the secretary determines it appropriate to conduct the demonstration project under this subsection, the secretary shall- "(i) provide for an evaluation of the project; and

"(ii) submit to congress, by a date specified by the secretary, a report on the project. "(g) administration.-chapter 35 of title 44, united states code, shall not apply with respect to this subsection.". sec. 10316. medicare dsh. section 1886(r)(2)(b) of the social security act, as added by section 3133, is amended- (1) in clause (i)- (a) in the matter preceding subclause (i), by striking "(divided by 100)"; (b) in subclause (i), by striking "2012" and inserting "2013"; (c) in subclause (ii), by striking the period at the end and inserting a comma; and (d) by adding at the end the following flush matter: "minus 1.5 percentage points.". (2) in clause (ii)-

(a) in the matter preceding subclause (i), by striking "(divided by 100)"; (b) in subclause (i), by striking "2012" and inserting "2013"; (c) in subclause (ii), by striking the period at the end and inserting a comma; and (d) by adding at the end the following flush matter: "and, for each of 2018 and 2019, minus 1.5 percentage points.". sec. 10317. revisions to extension of section 508 hospital provisions. section 3137(a) is amended to read as follows: "(a) extension.- "(1) in general.-subsection (a) of section 106 of division b of the tax relief and health care act of 2006 (42 u.s.c. 1395 note), as amended by section 117 of the medicare, medicaid, and schip extension act of 2007 (public law 110-173) and section

124 of the medicare improvements for patients and providers act of 2008 (public law 110-275), is amended by striking 'september 30, 2009' and inserting 'september 30, 2010'. "(2) special rule for fiscal year 2010.- "(a) in general.-subject to subparagraph (b), for purposes of implementation of the amendment made by paragraph (1), including (notwithstanding paragraph (3) of section 117(a) of the medicare, medicaid and schip extension act of 2007 (public law 110-173), as amended by section 124(b) of the medicare improvements for patients and providers act of 2008 (public law 110-275)) for purposes of the implementation of paragraph (2) of such section 117(a), during fiscal year 2010, the secretary of health and human services (in this subsection referred to as the

'secretary') shall use the hospital wage index that was promulgated by the secretary in the federal register on august 27, 2009 (74 fed. reg. 43754), and any subsequent corrections. "(b) exception.-beginning on april 1, 2010, in determining the wage index applicable to hospitals that qualify for wage index reclassification, the secretary shall include the average hourly wage data of hospitals whose reclassification was extended pursuant to the amendment made by paragraph (1) only if including such data results in a higher applicable reclassified wage index. "(3) adjustment for certain hospitals in fiscal year 2010.- "(a) in general.-in the case of a subsection (d) hospital (as defined in subsection (d)(1)(b) of section 1886 of the social security act (42 u.s.c. 1395ww))

with respect to which- "(i) a reclassification of its wage index for purposes of such section was extended pursuant to the amendment made by paragraph (1); and "(ii) the wage index applicable for such hospital for the period beginning on october 1, 2009, and ending on march 31, 2010, was lower than for the period beginning on april 1, 2010, and ending on september 30, 2010, by reason of the application of paragraph (2)(b); the secretary shall pay such hospital an additional payment that reflects the difference between the wage index for such periods. "(b) timeframe for payments.-the secretary shall make payments required under subparagraph by not later than december 31, 2010.". sec. 10318. revisions to transitional extra benefits under medicare advantage.

section 1853(p)(3)(a) of the social security act, as added by section 3201(h), is amended by inserting "in 2009" before the period at the end. sec. 10319. revisions to market basket adjustments. (a) inpatient acute hospitals.-section 1886(b)(3)(b)(xii) of the social security act, as added by section 3401(a), is amended- (1) in subclause (i), by striking "and" at the end; (2) by redesignating subclause (ii) as subclause (iii); (3) by inserting after subclause (ii) the following new subclause: "(ii) for each of fiscal years 2012 and 2013, by 0.1 percentage point; and"; and (4) in subclause (iii), as redesignated by paragraph (2), by striking "2012" and inserting "2014". (b) long-term care hospitals.-section 1886(m)(4) of

the social security act, as added by section 3401(c), is amended- (1) in subparagraph (a)- (a) in clause (i)- (i) by striking "each of rate years 2010 and 2011" and inserting "rate year 2010"; and (ii) by striking "and" at the end; 2012 and 2013, by 0.1 percentage point; and"; and (4) in subclause (iii), as 2012 and 2013, by 0.1 percentage point; and"; and (4) in subclause (iii), as redesignated by paragraph (2), by striking "2012" and inserting "2014". (b) long-term care hospitals.-section 1886(m)(4) of the social security act, as added by section 3401(c), is amended- (1) in subparagraph (a)- (a) in clause (i)- (i) by striking "each of rate years 2010 and 2011" and inserting "rate year 2010"; and (ii) by striking "and" at the

(1) in subclause (i), by striking "and" at the end; (2) by redesignating subclause (ii) as subclause (iii); (3) by inserting after subclause (ii) the following new subclause: "(ii) for each of fiscal years 2012 and 2013, 0.1 percentage point; and"; and (4) in subclause (iii), as redesignated by paragraph (2), by striking "2012" and inserting "2014". (d) home health agencies.-section 1895(b)(3)(b)(vi)(ii) of such act, as added by section 3401(e), is amended by striking "and 2012" and inserting ", 2012, and 2013".

(e) psychiatric hospitals.-section 1886(s)(3)(a) of the social security act, as added by section 3401(f), is amended- (1) in clause (i), by striking "and" at the end; (2) by redesignating clause (ii) as clause (iii); (3) by inserting after clause (ii) the following new clause: "(ii) for each of the rate years beginning in 2012 and 2013, 0.1 percentage point; and"; and (4) in clause (iii), as redesignated by paragraph (2), by striking "2012" and inserting "2014". (f) hospice care. section 1814(i)(1)(c) of the social security act (42 u.s.c. 1395f(i)(1)(c)), as amended by section 3401(g), is amended- (1) in clause (iv)(ii), by

striking "0.5" and inserting "0.3"; and (2) in clause (v), in the matter preceding subclause (i), by striking "0.5" and inserting "0.3". (g) outpatient (g) outpatient hospitals. section 1833(t)(3)(g)(i) of the social security act, as added by section 3401(i), is amended- (1) in subclause (i), by striking "and" at the end; (2) by redesignating subclause (ii) as subclause (iii); (3) by inserting after subclause (ii) the following new subclause: "(ii) for each of 2012 and 2013, 0.1 percentage point; and"; and (4) in subclause (iii), as redesignated by paragraph (2), by striking "2012" and inserting "2014". sec. 10320. expansion of the scope of, and additional improvements to, the independent

medicare advisory board. (a) in general. section 1899a of the social security act, as added by section 3403, is amended- (1) in subsection (c)- (a) in paragraph (1)(b), by adding at the end the following new sentence: "in any year (beginning with 2014) that the board is not required to submit a proposal under this section, the board shall submit to congress an advisory report on matters related to the medicare program."; (b) in paragraph (2)(a)- (i) in clause (iv), by inserting "or the full premium subsidy under section 1860d-14(a)" before the period at the end of the last sentence; and (ii) by adding at the end the following new clause: "(vii) if the chief actuary of the centers for medicare & medicaid services has made a determination described in subsection (e)(3)(b)(i)(ii) in the determination year, the

proposal shall be designed to help reduce the growth rate described in paragraph (8) while maintaining or enhancing beneficiary access to quality care under this title."; (c) in paragraph (2)(b)- (i) in clause (v), by striking "and" at the end; (ii) in clause (vi), by striking the period at the end and inserting "; and"; and (iii) 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."; (d) in paragraph (3)- (i) in the heading, by striking "transmission of board proposal to president" and inserting "submission of board proposal to congress and the president"; (ii) in subparagraph (a)(i), by striking "transmit a proposal under this section to the president" and insert "submit a

proposal under this section to congress and the president"; and (iii) in subparagraph (a)(ii)- (i) in subclause (i), by inserting "or" at the end; (ii) in subclause (ii), by striking "; or" and inserting a period; and (iii) by striking subclause (iii); (e) in paragraph (4)- (i) by striking "the board under paragraph (3)(a)(i) or"; and (ii) by striking "immediately" and inserting "within 2 days"; (f) in paragraph (5)- (i) by striking "to but" and inserting "but"; and (ii) by inserting "congress and" after "submit a proposal to"; and (g) in paragraph (6)(b)(i), by striking "per unduplicated enrollee" and inserting "(calculated as the sum of per capita spending under each of parts a, b, and d)"; (2) in subsection (d)- (a) in paragraph (1)(a)- (i) by inserting "the board or"

after "a proposal is submitted by"; and (ii) by inserting "subsection (c)(3)(a)(i) or" after "the senate under"; and (b) in paragraph (2)(a), by inserting "the board or" after "a proposal is submitted by"; (3) in subsection (e)- (a) in paragraph (1), by inserting "the board or" after "a proposal submitted by"; and (b) in paragraph (3)- (i) by striking "exception. the secretary shall not be required to implement the recommendations contained in a proposal submitted in a proposal year by" and inserting "exceptions. "(a) in general.-the secretary shall not implement the recommendations contained in a proposal submitted in a proposal year by the board or"; (ii) by redesignating subparagraphs (a) and (b) as clauses (i) and (ii), respectively, and indenting appropriately; and (iii) by adding at the end the following new subparagraph:

"(b) limited additional exception. "(i) in general. subject to clause (ii), the secretary shall not implement the recommendations contained in a proposal submitted by the board or the president to congress pursuant to this section in a proposal year (beginning with proposal year 2019) if- "(i) the board was required to submit a proposal to congress under this section in the year preceding the proposal year; and "(ii) the chief actuary of the centers for medicare & medicaid services makes a determination in the determination year that the growth rate described in subsection (c)(8) exceeds the growth rate described in subsection (c)(6)(a)(i). "(ii) limited additional exception may not be applied in two consecutive years. this subparagraph shall not apply if the recommendations contained in a proposal submitted by the board or the president to congress pursuant to this section in the year preceding the proposal year were

not required to be implemented by reason of this subparagraph. "(iii) no affect on requirement to submit proposals or for congressional consideration of proposals. clause (i) and (ii) shall not affect- "(i) the requirement of the board or the president to submit a proposal to congress in a proposal year in accordance with the provisions of this section; or "(ii) congressional consideration of a legislative proposal (described in subsection (c)(3)(b)(iv)) contained such a proposal in accordance with subsection (d)."; (4) in subsection (f)(3)(b)- (a) by striking "or advisory reports to congress" and inserting ", advisory reports, or advisory recommendations"; and (b) by inserting "or produce the public report under subsection (n)" after "this section"; and (5) by adding at the end the following new subsections: "(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. "(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. "(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.". (b) name change. any reference in the provisions of, or amendments made by, section 3403 to the "independent medicare advisory board" shall be deemed to be a reference to the "independent payment advisory board". (c) rule of (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 subsection (a)(4). sec. 10321. revision to community health teams. section 3502(c)(2)(a) is amended by inserting "or other primary care providers" after "physicians". sec. 10322. 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 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 "(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 for rate year 2014 and each subsequent rate year, each psychiatric hospital and psychiatric unit shall submit to the secretary data on quality measurpe