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1,968 New and Expanded Secretarial Powers Under the Health Reform Law, P.L.

111-148, Signed into Law March 23, 2010


1001
1 HHS/Labor/Treasury
COVERAGE OF PREVENT VE HEALTH SERV CES The Sec e a y sha es ab sh a
1102 HHS
c PAYMENTS 2 PROGRAM PAYMENTS — he Sec e a y de e m nes ha a
Title I: Health Insurance Coverage
2701 HHS
FA R HEALTH NSURANCE PREM UMS a PROH B T NG D SCR M NATORY
1311 HHS
3 RAT NG SYSTEM —The Sec e a y sha deve op a a ng sys em ha wou d
1323 HHS
(304 Delegations)

6 RE MBURSEMENT RATES — A NEGOT ATED RATES —The Sec e a y sha ne-


1333 HHS
5 APPL CABLE RULES —The Sec e a y sha n consu a on w h he Na ona
1413 HHS
STREAML N NG OF PROCEDURES FOR ENROLLMENT THROUGH AN EXCHANGE
3
3001 l HHS
HOSPITAL VALUE-BASED PURCHASING PROGRAM … the Secretary shall
3005 l HHS
(2) SUBMISSION OF QUALITY DATA.— … each hospital described in such
3014 l HHS
Title III: Health Care Delivery (588 Delegations)
(c) REVIEW OF QUALITY [AND EFFICIENCY] MEASURES USED BY THE
3022 l HHS
(3) OTHER PAYMENT MODELS. (A) … a model … is any payment model that
3025 l HHS
(C) HOSPITAL SUBMISSION OF ALL PATIENT DATA. (i) … each hospital …
3134 l HHS
(ii) IDENTIFICATION OF POTENTIALLY MISVALUED CODES … the Secretary
3303 l HHS
(5) WAIVER OF DE MINIMIS PREMIUMS. The Secretary shall, under proce-
3504 l HHS
(a) The Secretary, acting through the Assistant Secretary for Prepared-
4
4001 l Executive
Title IV Chronic Disease and Public Health (171 Delegations)
4004 l HHS 4102 l HHS 4108 HHS 4204 HHS 4302 HHS
6001
6 HHS
The hosp a has p ocedu es n p ace o equ e ha any e e ng phys c an
Title VI Transparency and Program Integrity (336 Delegations)
6103 HHS
… D ha he S a e ma n a n a consume -o en ed webs e p ov d ng use u
6301 HHS
BU LD NG DATA FOR RESEARCH The Sec e a y sha p ov de o he coo d na on
6402 HHS
e NCLUS ON OF NAT ONAL PROV DER DENT F ER ON ALL APPL CAT ONS AND
6407 HHS
REQU REMENT FOR FACE TO FACE ENCOUNTER The Sec e a y sha equ e ha
6703 HHS
A COORD NAT ON W TH SECRETARY OF LABOR TO RECRU T AND TRA N LONG-
10 Title X: Medicaid, CHIP,
Women’s Health, Indian Health (148 Delegations)
m n mum n e va be ween he da e on wh ch a ecommenda on … s ssued pa c pa ng emp oymen -based p an has subm ed a va d c a m unde pa a- PREM UM RATES — B SECRETAR AL REV EW —The Sec e a y sha ev ew he a e qua fied hea h p ans o e ed h ough an Exchange n each benefi s eve on go a e a es o he e mbu semen o hea h ca e p ov de s o benefi s cove ed Assoc a on o nsu ance Comm ss one s ssue u es o he o e ng o na on- AND STATE MED CA D CH P AND HEALTH SUBS DY PROGRAMS a The Sec e a y establish a hospital value-based purchasing program … under which value- section shall submit to the Secretary data on quality measures …Such data SECRETARY. (1) The Secretary shall (A) periodically (but in no case less the Secretary determines will improve the quality and efficiency of items and shall submit to the Secretary, in a form, manner and time specified by the shall examine (as the Secretary determines to be appropriate) … codes dures established by the Secretary, permit a prescription drug plan or an ness and Response, shall award not fewer than 4 multiyear contracts or (a) ESTABLISHMENT. The President shall establish, within HHS, a council to be (f) PERSONALIZED PREVENTION PLANS. (1) CONTRACT. The Secretary, acting (d) ORAL HEALTH INFRASTRUCTURE. (1) COOPERATIVE AGREEMENTS. The Secre- 2 DURAT ON A N T AT ON OF PROGRAM RESOURCES The Sec e a y sha 2 STATE PURCHASE —A S a e may ob a n add ona quan es o such adu e PROTECT ON AND SHAR NG OF DATA — 1 PR VACY AND OTHER SAFE- owne o nves o d sc oses o he pa en be ng e e ed by a me ha pe m s he n o ma on o consume s ega d ng a sk ed nu s ng ac es and a nu s ng o e evan Fede a hea h p og ams o bu d da a capac y o compa a ve c n ca CLA MS The Sec e a y sha p omu ga e a egu a on ha equ es no a e han such an o de be w en pu suan o he phys c an documen ng ha a phys c an TERM CARE STAFF The Sec e a y sha coo d na e ac v es unde h s subsec on
and he p an yea … s e ec ve g aph 1 he Sec e a y sha e mbu se such p an o 80 pe cen o ha po on a ng a eas es ab shed by each S a e … he Sec e a y de e m nes a S a e s he bas s o he e a ve qua y and p ce … unde a commun y hea h nsu ance op on w de qua fied hea h p ans … sha es ab sh a sys em mee ng he equ emen s o h s sec on unde wh ch based incentive payments are made in a fiscal year to hospitals that meet shall be submitted in a form and manner, and at a time, specified by the often than once every 3 years) review quality and efficiency measures … services…. Secretary, data and information determined necessary by the Secretary for which have not been subject to review since the implementation of the MA–PD plan to waive the monthly beneficiary premium … if the amount … competitive grants … to support pilot projects that design, implement, and known as the ‘‘National Prevention, Health Promotion and Public Health Council. through the Director of the CDC, shall enter into a contract with a qualified entity tary, acting through the CDC, shall enter into cooperative agreements with State, awa ds g an s o S a es … The Sec e a y sha deve op p og am c e a o vacc nes … h ough he pu chase o vacc nes om manu ac u e s a he ap- GUARDS —The Sec e a y sha ensu e … ha — A a da a co ec ed s pa en o make a mean ng u dec s on ega d ng he ece p o ca e as de e m ned ac es n he S a e… ha he S a e o he Sec e a y cons de s use u n ass s ng e ec veness esea ch nc ud ng he deve opmen and use o c n ca eg s es Janua y 1 2011 a p ov de s o med ca o o he ems o se v ces and supp e s a phys c an ass s an a nu se p ac one o a c n ca nu se spec a s …has had a w h he Sec e a y o Labo n o de o p ov de ncen ves o nd v dua s o a n o
the performance standards … Secretary. and (B) … determine whether to (i) maintain the use of such measure; the Secretary to calculate the all patient readmission rates …. (ii) Instead RBRVS … and such other codes determined to be appropriate by the is de minimis. If such premium is waived under the plan, the Secretary shall evaluate innovative models of regionalized, comprehensive, and accountable for the development and operation of a Federal Internet website personalized territorial, and Indian tribes or tribal organizations ... n a ves us ng e evan ev dence-based esea ch and esou ces … p cab e p ce nego a ed by he Sec e a y unde h s subsec on p o ec ed— unde p vacy p o ec ons ha a e a eas as b oad as hose ha by he Sec e a y he pub c… and hea h ou comes esea ch da a ne wo ks n o de o deve op and ma n a n a unde he p og ams unde es XV and X X ha qua y o a na ona p ov de ace- o- ace encoun e …du ng he 6-mon h pe od p eced ng such w en o de and seek emp oymen p ov d ng d ec ca e n ong- e m ca e
o he cos s a bu ab e o such c a m ha exceed $15 000 … a ng a eas a e no adequa e o ha a S a e does no es ab sh such a eas he es den s o each S a e may app y o en o men n ece ve a de e m na on o
4001 l Executive prevention plan tool. he Sec e a y app es o o he hea h da a unde he egu a ons p omu ga ed 10108 Treasury 10325 HHS 10410 HHS
1001 HHS Sec e a y may es ab sh a ng a eas o ha S a e 1311 HHS 1323 HHS 1333 HHS e g b y o pa c pa on n and con nue pa c pa on n app cab e S a e hea h or (ii) phase out such measure. (2) CONSIDERATIONS. … The Secretary 3022 l HHS of a specified hospital submitting to the Secretary … data and information Secretary. not reassign subsidy eligible individuals enrolled in the plan to other plans … emergency care and trauma systems. comp ehens ve n e ope ab e da a ne wo k o co ec nk and ana yze da a on ou - den fie o nc ude he na ona p ov de den fie on a app ca ons… o o he easonab e me ame as de e m ned by he Sec e a y 2 NDEX NG n he case o any ca enda yea beg nn ng a e 2014 he Sec e a y a TEMPORARY DELAY OF RUG– V No w hs and ng any o he p ov s on o aw he 2 ALLOCAT ON OF AWARDS he unds au ho zed unde subsec on a e app op -
EXTENS ON OF DEPENDENT COVERAGE b REGULAT ONS —The 1102 HHS 5 NTERNET PORTALS —The Sec e a y sha — A con nue o ope a e 7 SOLVENCY AND CONSUMER PROTECT ON — A SOLVENCY —The Sec e a y 6 COVERAGE —The Sec e a y sha p ov de ha he hea h benefi s cove age subs dy p og ams … 3001 l HHS 3005 l HHS shall take steps to (A) seek to avoid duplication of measures used; and (B) (j) INVOLVEMENT IN PRIVATE PAYER AND OTHER THIRD PARTY ARRANGE- may be submitted to the Secretary, on behalf of such a specified hospital, by (f) ADVISORY GROUP. (1) The President shall establish an Advisory Group to the 4102 l HHS 4108 HHS 4204 HHS unde H PPA
6001 HHS 6103 HHS comes and e ec veness om mu p e sou ces nc ud ng e ec on c hea h eco ds 6703 HHS sha ad us he 8 pe cen and 9 8 pe cen o eflec he a e o p em um g ow h Sec e a y ha no p o o Oc obe 1 2011 mp emen Ve s on 4 o he Resou ce a ed n he amoun s p ov ded o unde such subsec on he Sec e a y sha a oca e
Sec e a y sha p omu ga e egu a ons o define he dependen s o wh ch cove - c PAYMENTS 4 USE OF PAYMENTS —Amoun s pa d o a pa c pa ng 2701 HHS ma n a n and upda e he n e ne po a and o ass s S a es n deve op ng and sha es ab sh a Fede a so vency s anda d o be app ed w h espec o a com- p ov ded o an nd v dua h ough a na onw de qua fied hea h p an … (III) … for which there are not a minimum number (as determined by the (3) QUALITY MEASURES.— … any measure specified by the Secretary … take into consideration current innovative methodologies and strategies MENTS. The Secretary may give preference to ACOs who are participating in a state or an entity determined appropriate by the Secretary. 3134 l HHS 3303 l HHS 3504 l HHS Council to be known as the ‘‘Advisory Group on Prevention, Health Promotion, 4004 l HHS (d) UPDATING NATIONAL ORAL HEALTHCARE SURVEILLANCE ACTIVITIES. (1) A A p og am desc bed n h s pa ag aph s a comp ehens ve ev dence-based 1 The Sec e a y ac ng h ough he D ec o o he CDC sha es ab sh a 2 PUBL CAT ON OF NFORMAT ON REPORTED The Sec e a y sha pub sh and e DEVELOPMENT OF CONSUMER R GHTS NFORMAT ON PAGE ON NURS NG HOME 6402 HHS 6407 HHS The Sec e a y sha make g an s o e g b e en es o ca y ou p og ams… be ween he p eced ng ca enda yea and 2013 ove he a e o ncome g ow h o U za on G oups RUG– V pub shed n he Fede a Reg s e on Augus 11 2009 such amoun s so ha
age sha be made ava ab e … emp oymen -based p an sha be used o owe cos s o he p an … Such pay- FA R HEALTH NSURANCE PREM UMS a PROH B T NG D SCR M NATORY ma n a n ng he own such po a and B make ava ab e o use by Exchanges a mun y hea h nsu ance op on … 1413 HHS Secretary) of measures that apply to the hospital for the performance must have been endorsed by the entity … ‘‘(B) EXCEPTION.—In the case of for quality and efficiency improvement practices in the delivery of health similar arrangements with other payers. (II) The Secretary may conduct surveys, other data collection activities, (D) SPECIAL RULE FOR PLANS THAT WAIVE DE MINIMIS PREMIUMS. The (c) PILOT PROJECTS. The Secretary shall award a contract or grant … that and Integrative and Public Health’’ ... (g) INTERNET PORTAL. The Secretary shall establish an Internet portal for access- PRAMS. (A) The Secretary shall carry out activities to update and improve the w de y ava ab e and eas y access b e p og am p oposed by he S a e and ap- demons a on p og am o awa d g an s o S a es o mp ove he p ov s on o ec- 4302 HHS upda e on an annua bas s he n o ma on subm ed by hosp a s COMPARE WEBS TE… he Sec e a y sha ensu e ha … he Nu s ng Home Compa e 6301 HHS b ACCESS TO DATA 1 MED CARE PART D —Sec on 1860D–15 2 o he Soc a c APPL CAT ON TO OTHER AREAS UNDER MED CARE The Sec e a y may app y such pe od en ed P ospec ve Paymen Sys em and Conso da ed B ng o Sk ed Nu s ng
care services that represent best practices for such quality and efficiency 3025 l HHS ing risk-assessment tools developed and maintained by private and academic Pregnancy Risk Assessment Monitoring System as it relates to oral healthcare. p oved by he Sec e a y ha s des gned and un que y su ed o add ess he needs ommended mmun za ons o ch d en ado escen s and adu s h ough he use 2 DATA SHAR NG —The Sec e a y sha es ab sh p ocedu es o sha ng da a
men s sha no be used as gene a evenues … The Sec e a y sha deve op a PREM UM RATES — 3 PERM SS BLE AGE BANDS —The Sec e a y n consu a- mode emp a e o an n e ne po a ha may be used … 1341 HHS b REQU REMENTS RELAT NG TO FORMS AND NOT CE — 1 REQU REMENTS period … a specified area or medical topic determined appropriate by the Secretary for studies, or other analyses as the Secretary determines to be appropriate to process … may include, in the case of a part D eligible individual who is proposes a pilot project to design, implement, and evaluate an emergency Med ca e webs e deve ops and nc udes a consume gh s n o ma on page… c The Sec e a y may on y use ev dence and find ngs om esea ch conduc ed Secu y Ac 42 U S C 1395w–116 2 s amended by … add ng a he end he he ace- o- ace encoun e equ emen desc bed n he amendmen s made by 6703 HHS Fac es o FY 2010 M n mum Da a Se Ve s on 3 0 o Sk ed Nu s ng Fac es and 10410 HHS
1001 HHS mechan sm o mon o he app op a e use o such paymen s by such en es on w h he Na ona Assoc a on o nsu ance Comm ss one s sha define he 1323 HHS TRANS T ONAL RE NSURANCE PROGRAM FOR ND V DUAL AND SMALL GROUP RELAT NG TO FORMS — A The Sec e a y sha deve op and p ov de o each S a e which a feasible and practical measure has not been endorsed by the entity improvement and measures …. 3022 l HHS (ii) The term “specified hospital” means … hospitals described … and, as facilitate the review and appropriate adjustment …. a subsidy eligible individual … who has failed to enroll in a prescription medical and trauma system … 4001 l Executive entities. o Med ca d benefic a es and has demons a ed success n he p ng nd v dua s o ev dence based popu a on-based n e ven ons o h gh- sk popu a ons co ec ed measu es e a ng o such da a and ana yses o such da a w h
6001 HHS unde sec on 1181 o make a de e m na on ega d ng cove age unde e XV o ow ng new c ause x ma ches pe o med by he Sec e a y o HHS o he n- subsec ons a and b o o he ems and se v ces APPL CAT ON … an e g b e en y sha subm an app ca on o he Sec e a y 10108 Treasury Med ca d Nu s ng Fac es Beg nn ng Oc obe 1 2010 he Sec e a y sha mp e- 3 GRANT PER OD A A g an sha be o a pe od o 5 yea s B RENEWAL A
DEVELOPMENT AND UT L ZAT ON OF UN FORM EXPLANAT ON OF COVERAGE pe m ss b e age bands o a ng pu poses 1311 HHS B M N MUM REQU RED — he Sec e a y sha equ e a ese ve und ha sha MARKETS N EACH STATE b MODEL REGULAT ON — 1 … he Sec e a y n a s ng e s eam ned o m ha — may be used o app y o a app cab e S a e 3001 l HHS …, the Secretary may specify a measure that is not so endorsed as long as (k) TREATMENT OF PHYSICIAN GROUP PRACTICE DEMONSTRATION. … determined feasible and appropriate by the Secretary, other hospitals not drug plan or an MA–PD plan, for the enrollment in a prescription drug plan (3) PURPOSES AND DUTIES. The Advisory Group shall develop policy and program 4102 l HHS ach eve one o mo e o he o ow ng … o he e evan Fede a and S a e agenc es nc ud ng he agenc es cen e s and
A PROCESS ESTABL SHMENT The Sec e a y sha es ab sh and mp emen a 6104 HHS such use s h ough an e a ve and anspa en p ocess wh ch nc udes pub c spec o Gene a o HHS w h espec o po en a aud was e and abuse nc ud ng a such me n such manne and con a n ng such n o ma on as he Sec e a y B DETERM NAT ON OF COST The cos o any hea h p an sha be de e m ned unde men he change spec fic o he apy u n shed on a concu en bas s and changes g an may be enewed on a compe ve bas s o 1 add ona 5-yea pe od a he
DOCUMENTS AND STANDARD ZED DEF N T ONS a No a e han 12 mon hs 1102 HHS 6 ENROLLMENT PER ODS —The Sec e a y sha equ e an Exchange o be equa o a eas he do a va ue o he ncu ed bu no epo ed c a ms o a consu a on w h he Na ona Assoc a on o nsu ance Comm ss one s he hea h subs dy p og ams w h n he S a e may be fi ed on ne n pe son by ma (IV)… for which there are not a minimum number (as determined by the due consideration is given to measures that have been endorsed or adopted 3014 l HHS beginning … on the date of the enactment of this section and ending on the otherwise described … 3134 l HHS or MA–PD plan that has waived the monthly beneficiary premium for such 3504 l HHS recommendations and advise the Council on lifestyle-based chronic disease 4004 l HHS (2) NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY. The Secretary shall 4202 HHS en es w h n HHS
p ocess unde wh ch a hosp a …may app y o an excep on om he equ emen 2 MOD F CAT ON OF FORM The Sec e a y n consu a on w h p va e sec o commen and cons de s he e ec on subpopu a ons ma ches o a sys em o eco ds w h non-Fede a eco ds 6408 HHS may equ e he u es o he Pub c Hea h Se v ce Ac excep ha such amoun sha be ad us ed o he ookback pe od o ensu e ha on y hose se v ces u n shed a e adm ss on o d sc e on o he Sec e a y n de e m n ng whe he o enew a g an he Sec e a y
a e he da e o enac men o he PPACA he Sec e a y sha deve op s anda ds c PAYMENTS 6 APPEALS —The Sec e a y sha es ab sh— A an appea s 2702 HHS p ov de o — A an n a open en o men as de e m ned by he Sec e a y such commun y hea h nsu ance op on NA C sha nc ude p ov s ons ha enab e S a es o es ab sh and ma n a n a o by e ephone may be fi ed w h an Exchange o w h S a e o fic a s ope a ng Secretary) of cases for the measures that apply to the hospital for the perfor- by a consensus organization identified by the Secretary. (c) FUNDING. … the Secretary shall provide for the transfer, from the Federal date the program is established, the Secretary may enter into an agreement (III) The Secretary may use analytic contractors to identify and analyze subsidy eligible individual …. If there is more than one such plan available, (d) APPLICATION. (1) An eligible entity that seeks a contract or grant … shall prevention and management, integrative health care practices, and health (i) PUBLIC AWARENESS OF PREVENTIVE AND OBESITY-RELATED SERVICES. (1) develop oral healthcare components that shall include tooth-level surveillance 4108 HHS 2 STATE PLAN —To be e g b e o a g an a S a e sha subm o he Sec e- unde pa ag aph 1 B accoun an s expe enced w h Med ca e and Med ca d nu s ng ac y home cos 9 a s o g an me y access upon easonab e eques as defined by he Sec e- o age and ca ego y o en o men n acco dance w h egu a ons es ab shed by he a sk ed nu s ng ac y a e used as ac o s n de e m n ng a case m x c ass fica on sha cons de he epo ca ds
o use by a g oup hea h p an and a hea h nsu ance ssue o e ng g oup o p ocess o pe m pa c pa ng emp oymen -based p ans o appea a de e m na- GUARANTEED AVA LAB L TY OF COVERAGE b ENROLLMENT — 3 REGULA- de e m na on o be made no a e han Ju y 1 2012 B annua open en o - p og am unde wh ch— A hea h nsu ance ssue s and h d pa y adm n s a- one o he o he app cab e S a e hea h subs dy p og ams and v s s uc u ed o mance period … Hospital Insurance Trust Fund … and the Federal Supplementary Medical with an ACO under the demonstration … subject to rebasing and other 3025 l HHS services… conduct surveys or collect data, and make recommendations the Secretary shall enroll such an individual … on a random basis among all submit to the Secretary an application at such time and in such manner as promotion. INFORMATION TO STATES. The Secretary shall provide guidance and relevant for inclusion in the National Health and Nutrition Examination Survey … the term C WA VER AUTHOR TY The Sec e a y may wa ve he equ emen s o he So- a y an app ca on a such me n such manne and con a n ng such n o ma- 4302 HHS epo s sha edes gn such epo s o mee he equ emen o pa ag aph 1 6301 HHS 6402 HHS a y n egu a ons o he nspec o Gene a o HHS o he pu pose o aud s nves- 6703 HHS Sec e a y
3005 l HHS Insurance Trust Fund … in such proportion as the Secretary determines such plans in the PDP region … information to States and health care providers regarding preventive and obesity- ‘tooth-level surveillance’ means a clinical examination where an examiner looks c a Secu y Ac o a S a e awa ded a g an o conduc an n a ve and sha on as he Sec e a y may equ e DATA ON RURAL UNDERSERVED POPULAT ONS —The Sec e a y sha ensu e
nd v dua hea h nsu ance cove age … on o he Sec e a y w h espec o c a ms subm ed unde h s sec on and B T ONS —The Sec e a y sha p omu ga e egu a ons w h espec o en o men men pe ods as de e m ned by he Sec e a y o ca enda yea s a e he n a 1323 HHS o s on beha o g oup hea h p ans a e equ ed o make paymen s o an ap- max m ze an app can s ab y o comp e e he o m sa s ac o y … modifications deemed appropriate by the Secretary. QUALITY IMPROVEMENT PROGRAM FOR HOSPITALS WITH A HIGH SEVERITY on the review and appropriate adjustment of services … (IV) The Secretary the Secretary may require. 6001 HHS b No h ng n sec on 1181 sha be cons ued as 1 supe ced ng o mod y ng he 9 A The Comm ss one o Soc a Secu y sha upon he eques o he Sec e a y ga ons eva ua ons o o he s a u o y unc ons o he nspec o Gene a o HHS AUTHOR TY TO L M T NUMBER OF APPL CANTS No h ng n h s subpa ag aph 10326 HHS 10410 HHS
p ocedu es o p o ec aga ns aud was e and abuse unde he p og am pe ods … en o men pe od C spec a en o men pe ods … 8 REQU REMENTS ESTABL SHED N PARTNERSH P W TH NSURANCE COM- p cab e e nsu ance en y … and B he app cab e e nsu ance en y co ec s 3001 l HHS (4) PUBLIC AVAILABILITY OF DATA SUBMITTED.—The Secretary shall estab- appropriate, of $20,000,000, to the CMS Program Management Account for ADJUSTED READMISSION RATE. (a) ESTABLISHMENT. (1) Not later than 2 may coordinate the review and appropriate adjustment … with the periodic 4001 l Executive related services that are available to Medicaid enrollees, including obesity at each dental surface, on each tooth in the mouth and as expanded by the Divi- ensu e ha a S a e makes any p og am ava ab e and access b e o Med ca d ha any da a ega d ng ac a and e hn c m no y g oups a e a so co ec ed
T M NG FOR MPLEMENTAT ON The Sec e a y sha mp emen he p ocess on 6104 HHS cove age o ems o se v ces unde e XV ha he Sec e a y de e m nes a e ea- o he nspec o Gene a o HHS en e n o an ag eemen w h he Sec e a y o sha be cons ued as p oh b ng he Sec e a y om m ng he numbe o ap- 10109 Treasury a No a e han Janua y 1 2016 he Sec e a y sha conduc a sepa a e p o p o- A REQU REMENTS To be e g b e o ece ve a g an an en y sha be an ns u-
1001 HHS M SS ONERS — A The Sec e a y … may p omu ga e egu a ons o es ab sh paymen s … 1413 HHS (IV) EXEMPTION.— … the Secretary may exempt such hospital from the lish procedures for making data … available to the public …The Secretary each FYs 2010 through 2014.… 3023 l HHS years after …enactment … the Secretary shall make available a program review … (V) As part of the review and adjustment … including with respect 3305 l HHS 3504 l HHS (g) NATIONAL PREVENTION AND HEALTH PROMOTION STRATEGY. Not later than screening and counseling for children and adults. sion of Oral Health of the Centers for Disease Control and Prevention. benefic a es 4202 HHS ega d ng unde se ved u a and on e popu a ons
Feb ua y 1 2012 v REGULAT ONS No a e han Janua y 1 2012 he Sec e a y 3 CATEGOR ZAT ON BY FUNCT ONAL ACCOUNTS he Sec e a y wo k ng n sonab e and necessa y unde sec on 1862 1 o 2 au ho z ng he Sec e a y o such nspec o Gene a o he pu pose o ma ch ng da a n he sys em o eco ds o 6408 HHS p can s o a g an 5 CONS DERAT ON OF STANDARD ZAT ON OF ACT V T ES AND TEMS A The g am o es he mp emen a on o a va ue-based pu chas ng p og am o p ov de on o h ghe educa on o a pub c o p va e nonp ofi esea ch ns u on and
DEVELOPMENT AND UT L ZAT ON OF UN FORM EXPLANAT ON OF COVERAGE 1102 HHS 2705 HHS 1311 HHS add ona equ emen s o a commun y hea h nsu ance op on C SUPPLEMENTAL EL G B L TY FORMS — The Sec e a y may a ow a S a e o application of this subsection if the State which is paid under such section shall report quality measures of process, structure, outcome, patients’ NATIONAL PILOT PROGRAM ON PAYMENT BUNDLING (a) IMPLEMENTATION. for eligible hospitals to improve their readmission rates through the use of to codes with low relative values … the Secretary may make appropriate (d) FACILITATION OF REASSIGNMENTS. Beginning not later than January 1, (e) REQUIREMENT OF MATCHING FUNDS. (1) The Secretary may not make 1 year after the date of enactment of this Act, the Chairperson, in consultation 3 USE OF FUNDS —Funds ece ved unde a g an sha be used o mp emen sha p omu ga e egu a ons o ca y ou he p ocess unde c ause consu a on w h MedPAC he Med ca d and CH P Paymen and Access Comm s- deny cove age o ems o se v ces unde such e so e y on he bas s o compa a- he Soc a Secu y Adm n s a on and he sys em o eco ds o HHS … C by add ng a he end he o ow ng new sen ence The Sec e a y may p ov de n paymen s
Sec e a y sha so c no a e han Janua y 1 2012 and no ess han eve y 3 subm an app ca on o he Sec e a y a such me and n such manne as he
DOCUMENTS AND STANDARD ZED DEF N T ONS g DEVELOPMENT OF STAN- d AUD TS —The Sec e a y sha conduc annua aud s o c a ms da a subm ed PROH B T NG D SCR M NAT ON AGA NST ND V DUAL PART C PANTS AND BEN- 4 FUNCT ONS —An Exchange sha a a m n mum— D ass gn a a ng o 1341 HHS use a supp emen a o a e na ve o m n he case o nd v dua s who app y o submits an annual report to the Secretary … perspective on care, efficiency, and costs of care that relate to services fur- 3015 l HHS (1) The Secretary shall establish a pilot program for integrated care during patient safety organizations … (2) ELIGIBLE HOSPITAL DEFINED. … the term coding revisions …. 2011, the Secretary shall, in the case of a subsidy eligible individual who is a grant … unless the State … involved agrees, with respect to the costs to with the Council, shall develop and make public a national prevention, health 4101 l HHS 4102 l HHS 4108 HHS n e ven ons ha a e ecommended by he Task Fo ce on Commun y P even ve 4302 HHS s on he HHS nspec o Gene a and o he expe pa es he Sec e a y de e m nes ve c n ca e ec veness esea ch add on o any o he emed es au ho zed by aw o any o he emed es desc bed 6703 HHS yea s he ea e npu on whe he he e cou d be g ea e un o m y n financ a Sec e a y may equ e
nished in such hospitals on the Internet website of the Centers for Medicare COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE ‘eligible hospital’ means a hospital that the Secretary determines has a high enrolled in one prescription drug plan and is subsequently reassigned by the promotion and public health strategy, and shall review and revise such strategy SEC. 4101. SCHOOL-BASED HEALTH CENTERS. (a) GRANTS FOR THE ESTABLISH- (3) MEDICAL EXPENDITURES PANEL SURVEY. The Secretary shall ensure that the 4 APPL CAT ON Fo ow ng he deve opmen o p og am c e a by he Sec e a y Se v ces as es ab shed by he Sec e a y ac ng h ough he D ec o o he CDC CONSULTAT ON —The Sec e a y sha consu w h he D ec o o OPM he 6402 HHS
DARD DEF N T ONS — 1 The Sec e a y sha … p ov de o he deve opmen o by pa c pa ng emp oymen based p ans … EF C AR ES BASED ON HEALTH STATUS a A g oup hea h p an and a hea h each qua fied hea h p an o e ed h ough such Exchange n acco dance w h he 1323 HHS 2 H GH-R SK ND V DUAL PAYMENT AMOUNTS —The Sec e a y sha nc ude e g b y ha s no de e m ned on he bas s o he househo d ncome … an episode of care provided to an applicable beneficiary around a hospital- be incurred by the State(s) in carrying out the … grant … to make available
periodically ... MENT OF SCHOOL-BASED HEALTH CENTERS. (1) PROGRAM. The Secretary shall Medical Expenditures Panel Survey by the Agency for Healthcare Research and a S a e may subm an app ca on n such manne and con a n ng such n o ma- o o he ev dence-based n e ven ons Sec e a y o De ense he Sec e a y o VA he D ec o o he Bu eau o he
6001 HHS app op a e sha ake he expend u es s ed on cos epo s… n o he o ow ng n pa ag aph 2 he Sec e a y de e m nes ha any emp oyee o agen o such A The Sec e a y sha make g an s o e g b e en es o enab e he en es o and adm n s a ve ac v es and ems as de e m ned app op a e by he Sec e a y 10326 HHS
s anda ds o he defin ons o e ms used n hea h nsu ance cove age … nsu ance ssue o e ng g oup o nd v dua hea h nsu ance cove age may no c e a deve oped by he Sec e a y … c START-UP FUND — 1 ESTABL SHMENT OF FUND — B FUND NG —The e he o ow ng … A DETERM NAT ON OF H GH-R SK ND V DUALS —The me hod 3001 l HHS & Medicaid Services. MEASURES. (a) (1) ESTABLISHMENT OF STRATEGIC FRAMEWORK. The Sec- ization in order to improve the coordination, quality, and efficiency of health rate of risk adjusted readmissions for the conditions … and has not taken 3134 l HHS Secretary to a new prescription drug plan, provide the individual, within 30 non-Federal contributions (in cash or in kind…) toward such costs in an 100 PERCENT NCREASE L M TAT ON The Sec e a y sha no pe m an nc ease unc ona accoun s on an annua bas s 6301 HHS … 25 w h espec o any amoun s expended o med ca ass s ance o nd v du- o gan za on o any p ov de o supp e who con ac s w h such o gan za on has p ov de a n ng and echn ca ass s ance and whe he such ac v es shou d be cons de ed financ a and adm n s a ve c WA VER AUTHOR TY The Sec e a y may wa ve such equ emen s as may be 10410 HHS
1413 HHS retary shall establish and implement an overall strategic framework to carry appropriate steps to reduce such readmissions and improve patient safety as days of such reassignment... establish a program to award grants to eligible entities to support the operation Quality includes the verification of dental utilization, expenditure, and coverage on as he Sec e a y may equ e ha sha nc ude a p oposa o p og ams Census he Comm ss one o Soc a Secu y and he head o o he app op a e
1102 HHS es ab sh u es o e g b y … o any nd v dua o en o … 9 Any o he hea h s he eby app op a ed o he S a -Up Fund ou o any moneys n he T easu y by wh ch nd v dua s w be den fied as h gh sk nd v dua s o pu poses o he The Secretary shall select measures, other than measures of readmissions, care services …. (L) VALIDATING RELATIVE VALUE UNITS. (i) The Secretary shall establish a amount equal to not less than $1 for each $3 of Federal funds provided in the n he numbe o ope a ng ooms p ocedu e ooms and beds … o he ex en such c 2 Pa ag aph 1 sha no be cons ued as p even ng he Sec e a y om a s o whom he S a e does no epo en o ee encoun e da a as defined by he engaged n any conduc … ansac ons necessa y so e y o pu poses o ca y ng ou he p o p og ams such o he n o ma on as he Sec e a y may equ e
1001 HHS e FUND NG —The e s app op a ed o he Sec e a y ou o any moneys n he s a us- e a ed ac o de e m ned app op a e by he Sec e a y 1311 HHS 1 no o he w se app op a ed an amoun eques ed by he Sec e a y o HHS as e nsu ance p og am … 4 SECRETAR AL STANDARDS —The Sec e a y sha … p omu ga e s anda ds for purposes of the Program … 3006 l HHS out the public reporting of performance information … (2) COLLECTION AND evidenced through historically high rates of readmissions, as determined by process to validate relative value units under the fee schedule … grant … 4001 l HHS of school-based health centers. findings through conduct of a look-back analysis. and a p an o make Med ca d benefic a es and p ov de s pa c pa ng n Med c- 4202 HHS Fede a agenc es n ca y ng ou h s sec on
nc ease wou d esu n he numbe o ope a ng ooms p ocedu e ooms and 6104 HHS us ng ev dence o find ngs om such compa a ve c n ca e ec veness esea ch Sec e a y o he Med ca d S a s ca n o ma on Sys em MS S n a me y manne 6703 HHS
AGGREGATION OF DATA. The Secretary shall collect and aggregate consistent the Secretary. (3) RISK ADJUSTMENT. The Secretary shall utilize appropriate 3306 l HHS (i) PERIODIC REVIEWS. The Secretary and the Comptroller General shall jointly a d who es de n he S a e awa e and n o med abou such p og ams 4 CONS DERAT ON — n awa d ng g an s he Sec e a y sha cons de any e-
ENSUR NG THE QUAL TY OF CARE a QUAL TY REPORT NG — 1 No a e han T easu y no o he w se app op a ed $5 000 000 000 o ca y ou he p og am e CERT F CAT ON —An Exchange may ce y a hea h p an as a qua fied hea h necessa y o— pay he s a -up cos s assoc a ed w h he n a ope a ons o gove n ng he m ng con en s and p ocedu es o da a ma ch ng … (a) SKILLED NURSING FACILITIES.— The Secretary of HHS … shall develop 3023 l HHS beds … exceed ng 200 pe cen o he base ne numbe 4 AVA LAB L TY OF NFORMAT ON SUBM TTED The Sec e a y sha es ab sh p oce- n de e m n ng cove age e mbu semen o ncen ve p og ams unde e XV as de e m ned by he Sec e a y 6409 HHS C APPL CAT ON To be e g b e o ece ve a g an an e g b e en y sha subm 10109 Treasury 10326 HHS 10410 HHS
2 yea s a e he da e o enac men o he PPACA he Sec e a y … sha deve op unde h s sec on … 2705 HHS/Treasury/Labor p an — A such hea h p an mee s he equ emen s o ce fica on as p omu - a commun y hea h nsu ance op on and pay he cos s o mak ng paymen s 1341 HHS 3001 l HHS a plan to implement a value-based purchasing program for payments data on quality and resource use measures from information systems used (B) APPLICABLE CONDITION. The term ‘applicable condition’ means 1 or risk adjustment measures to determine eligible hospitals. 3134 l HHS (g) SECRETARIAL AUTHORITY TO ENLIST SUPPORT IN CONDUCTING CERTAIN 3504 l HHS conduct periodic reviews, not less than every 5 years, and evaluations of every 4101 l HHS 4102 l HHS v ews o ecommenda ons o he Task Fo ce on Commun y P even ve Se v ces 4302 HHS du es o make n o ma on on expend u es subm ed unde h s subsec on ead y based upon a compa son o he d e ence n he e ec veness o a e na ve a DEVELOPMENT OF SELF-REFERRAL D SCLOSURE PROTOCOL 1 The Sec e a y an app ca on o he Sec e a y a such me n such manne and con a n ng such B SOL C TAT ON OF NPUT The Sec e a y sha seek npu om he Na ona d NO ADD T ONAL PROGRAM EXPEND TURES Paymen s sha be es ab shed n a
to support health care delivery, and may award grants or contracts for this Federal disease prevention and health promotion initiative, program, and agency. (B) ... submit an application at such time, in such manner, and containing such (B) REQUIREMENTS. The Secretary shall ensure that the National Oral Health 4108 HHS a EVALUAT NG DATA COLLECT ON APPROACHES —The Sec e a y sha eva ua e C PR OR T ES n awa d ng g an s he Sec e a y sha g ve p o y o e g b e en -
epo ng equ emen s o use by a g oup hea h p an and a hea h nsu ance PROH B T NG D SCR M NAT ON AGA NST ND V DUAL PART C PANTS AND BEN- ga ed by he Sec e a y … on c a ms … 3 DETERM NAT ON OF REQU RED CONTR BU8T ONS — A —The Sec e a y sha 1413 HHS … the Secretary shall ensure that selected measures include efficiency under the Medicare program … for skilled nursing facilities … more of 10 conditions selected by the Secretary. In selecting conditions …, (iv) METHODS. The Secretary may conduct the validation … using methods OUTREACH ACTIVITIES. The Secretary may request that an entity awarded a (f) PRIORITY. The Secretary shall give priority for the award of the contracts 6001 HHS ava ab e o n e es ed pa es upon eques sub ec o such equ emen s as he ea men s n ex end ng an nd v dua s e due o he nd v dua s age d sab y 6402 HHS n coope a on w h he nspec o Gene a o HHS sha es ab sh no a e han 6 n o ma on as he Sec e a y may equ e Comm ee on V a and Hea h S a s cs he H T Po cy Comm ee and he H T manne ha does no esu n spend ng mo e unde each such va ue based pu chas- es ha mee 1 o mo e o he o ow ng c e a
ssue o e ng g oup o nd v dua hea h nsu ance cove age … 1102 HHS EF C AR ES BASED ON HEALTH STATUS WELLNESS PROGRAM DEMONSTRA- nc ude … he me hod o de e m n ng he amoun each hea h nsu ance ssue d ADM N STRAT VE AUTHOR TY — 1 AGREEMENTS — … he Sec e a y may measures, including measures of ‘Medicare spending per beneficiary’. Such
purpose. The Secretary shall align such collection and aggregation efforts… the Secretary shall take into consideration the following factors... 3025 l HHS ... as the Secretary determines to be appropriate. grant support the conduct of outreach activities aimed at preventing disease or grants… to any eligible entity that serves a population in a medically information as the Secretary may require, including at a minimum an assurance Surveillance Sys em nc ude he measu emen o ea y ch dhood ca es b EDUCAT ON AND OUTREACH CAMPA GN — 1 STATE AWARENESS —The 4205 HHS app oaches o he co ec on o da a ha a ow o he ongo ng accu a e and
H PUBL CAT ON OF F NAL DEC S ONS … he Sec e a y sha pub sh n he Fede a Sec e a y may spec y unde he es ab shed p ocedu es unde h s pa ag aph o e m na ness … F any o he emune a on wh ch p omo es access o ca e and poses a ow mon hs a e he da e o he enac men o h s Ac a p o oco o enab e hea h ca e S anda ds Comm ee and s anda d se ng o gan za ons and s akeho de s as ng p og am o such yea han wou d o he w se be expended o such p ov de
T ON PROJECT — 1 No a e han Ju y 1 2014 he Sec e a y n consu a on 1311 HHS 1323 HHS and g oup hea h p an … s equ ed o con bu e … es ab sh mode ag eemen s and en e n o ag eemen s o he sha ng o da a measures shall be adjusted for factors such as age, sex, race, severity of 3006 l HHS (3) SCOPE. The Secretary shall ensure that the data collection, data aggrega- (b) REPORT TO THE SECRETARY. As determined appropriate by the Secretary, and promoting wellness. Notwithstanding any other provision …, an entity underserved area … 4002 l HHS that funds awarded under the grant shall not be used to provide any service that Sec e a y sha conduc an ou each and educa on campa gn o make S a es bb a succ nc s a emen conce n ng sugges ed da y ca o c n ake as spec - me y co ec on and eva ua on o da a on d spa es n hea h ca e se v ces and
Reg s e he fina dec s on w h espec o such app ca on sk o ha m o pa en s and Fede a hea h ca e p og ams as defined n sec on p ov de s o se v ces and supp e s o d sc ose an ac ua o po en a v o a on… 6703 HHS de e m ned app op a e by he Sec e a y ype o such yea he p o p og am we e no mp emen ed as es ma ed by he
L M TAT ON — The Sec e a y has he au ho y o s op ak ng app ca ons o
tion, and analysis systems …involve an increasingly broad range of patient eligible hospitals and patient safety organizations … shall report to the may use a grant awarded under this subsection to support the conduct of (a) PURPOSE. It is the purpose of this section to establish a Prevention and Public is not authorized or allowed by Federal, State, or local law. 4103 HHS awa e o he g an s fied by he Sec e a y by egu a on and pos ed p om nen y on he menu … pe o mance n conduc ng such eva ua on he Sec e a y sha cons de he 6301 HHS 10410 HHS
1001 HHS pa c pa on n he p og am based on he ava ab y o und ng … w h he Sec e a y o he T easu y and he Sec e a y o Labo sha es ab sh a FLEX B L TY — 1 REG ONAL OR OTHER NTERSTATE EXCHANGES —An Ex- 4 REPAYMENT — B SANCT ONS N CASE OF FOR-PROF T CONVERS ON — illness, and other factors that the Secretary determines appropriate. (a)(2)(E) Any other issues ... Any other issues determined appropriate by the
populations, providers, and geographic areas over time.
3023 l HHS 3134 l HHS o ow ng ob ec ves …
6105 HHS 1128B and des gna ed by he Sec e a y unde egu a ons … D AUTHOR TY TO L M T NUMBER OF APPL CANTS No h ng n h s pa ag aph sha Sec e a y 6 NAT ONAL COORD NAT NG CENTER A The Sec e a y ac ng h ough he
1342 (a) HHS 1414 HHS Secretary Secretary on the processes employed … and the impact of such processes activities … 3504 l HHS Health Fund ... to be administered through the HHS, Office of the Secretary, to h 1 The e m “pe sona zed p even on p an se v ces” means he c ea on o a 2 A Pa ag aph 1 sha no be cons ued o p even he Sec e a y om us ng 6409 HHS
ENSUR NG THE QUAL TY OF CARE 2 REPORT NG REQU REMENTS — A A g oup 10-S a e demons a on p o ec … o p og ams o hea h p omo on o e ed by change may ope a e n mo e han one S a e — B he Sec e a y app oves such n any case n wh ch he Sec e a y en e s n o a con ac w h a qua fied en y (vi) ...Which conditions the Secretary determines are most amenable to (v) ADJUSTMENTS. The Secretary shall make appropriate adjustments to the
4101 l HHS 4108 HHS 6001 HHS STANDARD ZED COMPLA NT FORM 1 The Sec e a y sha deve op a s anda d- be cons ued as p oh b ng he Sec e a y om m ng he numbe o app can s o 10109 HHS Adm n s a o sha des gna e 1 g an ec p en o be he coo d na ng cen e o
hea h p an and a hea h nsu ance ssue o e ng g oup o nd v dua hea h 1103 HHS a hea h nsu ance ssue ha o e s hea h nsu ance cove age n he nd v dua eg ona o n e s a e Exchange o he o e ng o a commun y hea h nsu ance op on and such en y s ESTABL SHMENT OF R SK CORR DORS FOR PLANS N ND V DUAL AND SMALL D SCLOSURES TO CARRY OUT EL G B L TY REQU REMENTS FOR CERTA N PRO- 3001 l HHS bundling across the spectrum of care given practice patterns …. on readmission rates. work relative value units under the fee schedule … (h) DISSEMINATION OF FINDINGS. The Secretary shall, as appropriate, dis- provide for expanded and sustained national investment in prevention and public p an o an nd v dua A ha nc udes a hea h sk assessmen ha mee s he 4205 HHS 6 CLAR F CAT ON No h ng n h s subsec on sha be cons ued as p even ng he zed comp a n o m o use by a es den … n fi ng a comp a n w h a S a e su vey ev dence o find ngs om such compa a ve c n ca e ec veness esea ch n 6402 HHS 2 PUBL CAT ON ON NTERNET WEBS TE OF SRDP NFORMAT ON The Sec e a y a g an unde h s pa ag aph b ACT V T ES AND TEMS FOR N T AL CONS DERAT ON The Sec e a y sha no 10326 HHS exce ence o dep ess on The Sec e a y sha se ec such coo d na ng cen e on a
nsu ance cove age sha annua y subm o he Sec e a y and o en o ees unde a NTERNET PORTAL TO AFFORDABLE COVERAGE OPT ONS — 1 MMED ATE ma ke … de e m ned o be a o -p ofi en y by he Sec e a y such en y sha be— GROUP MARKETS a The Sec e a y sha es ab sh and adm n s e a p og am o GRAMS a D SCLOSURE OF TAXPAYER RETURN NFORMAT ON AND SOC AL SECU- (A) ESTABLISHMENT.—The Secretary shall establish performance standards 3006 l HHS 3015 l HHS 3307 l HHS seminate to the public and to the appropriate Committees of the Congress, health programs to improve health and help restrain the rate of growth in private (3) PREFERENCE. In awarding grants ... the Secretary shall give preference to ... gu de nes es ab shed by he Sec e a y o he nd v dua ha s comp e ed p o d EVALUAT ONS AND REPORTS — 1 NDEPENDENT ASSESSMENT —The v MENU VAR AB L TY AND COMB NAT ON MEALS —The Sec e a y sha es ab sh 4302 HHS Sec e a y om evok ng a hosp a s p ov de ag eemen no n comp ance w h and ce fica on agency and a S a e ong- e m ca e ombudsman p og am w h de e m n ng cove age e mbu semen o ncen ve p og ams unde such e based … e ec ve on a da e spec fied by he Sec e a y bu no ea e han Janua y 1 sha pos n o ma on on he pub c n e ne webs e o CMS o n o m e evan a e han Janua y 1 2012 seek npu on ac v es and ems e a ng o e EXPANS ON OF P LOT PROGRAM The Sec e a y may a any po n a e Janua y 1 compe ve bas s based upon he demons a ed capac y o such cen e o pe o m
he p an o cove age a epo on whe he he benefi s unde he p an o cove age ESTABL SHMENT —No a e han Ju y 1 2010 he Sec e a y n consu a on 1311 HHS mmed a e y ab e o he Sec e a y o any paymen s ece ved by such en y sk co do s o ca enda yea s 2014 2015 and 2016 … R TY NUMBERS — 1 TAXPAYER RETURN NFORMAT ON — … 21 D SCLOSURE with respect to measures … (b) HOME HEALTH AGENCIES.—The Secretary of HHS … shall develop a (b) GRANTS OR CONTRACTS FOR DATA COLLECTION. (1) The Secretary
3023 l HHS 3026 l HHS 3135 l HHS (i) FORMULARY REQUIREMENTS. (I) … a PDP sponsor offering a prescrip- the information contained in a report … and public sector health care costs. school-based health centers that serve a large population of children eligible for o o as pa o he same v s w h a hea h p o ess ona and B ha akes Sec e a y sha en e n o a con ac w h an ndependen en y o o gan za on o by egu a on s anda ds o de e m n ng and d sc os ng he nu en con en o c MPLEMENT NG EFFECT VE APPROACHES —No a e han 24 mon hs a e
egu a ons mp emen ng sec on 1866 espec o a ac y upon a compa son o he d e ence n he e ec veness o a e na ve hea h ca e 2011 he wa ve by a PDP sponso o a p esc p on d ug p an unde pa D o e s akeho de s o how o d sc ose ac ua o po en a v o a ons pu suan o an SRDP 6703 HHS 2018 expand he du a on and scope o a p o p og am o he ex en de e m ned he du es desc bed e sewhe e B APPL CAT ON A Cen e ha has been awa ded a
2705 HHS/Treasury/Labor plan to implement a value-based purchasing program for payments under may award grants or contracts to eligible entities to support new, or COMMUNITY-BASED CARE TRANSITIONS PROGRAM. (a) The Secretary shall tion drug plan shall be required to include all covered part D drugs in the medical assistance under ... Medicaid ... or ... the State child health plan ... n o accoun he esu s o he hea h sk assessmen and may con a n he conduc an eva ua on and assessmen o he n a ves ca ed ou by S a es … s anda d menu ems … enac men he Sec e a y sha mp emen he app oaches o he ongo ng ac- ea men s n ex end ng an nd v dua s e due o ha nd v dua s age d sab y o XV o an MA o gan za on o e ng an MA–PD p an unde pa C o such e o any
sa s y he e emen s … w h he S a es sha es ab sh a mechan sm nc ud ng an n e ne webs e 2 GU DEL NES —The Sec e a y n consu a on w h expe s n hea h ca e qua - om he S a -Up Fund … OF RETURN NFORMAT ON TO CARRY OUT EL G B L TY REQU REMENTS FOR CER-
improve existing, efforts to collect and aggregate quality and resource use
(v) ...Other services the Secretary determines appropriate.
establish a Community-Based Care Transitions Program under which the
(C) ADJUSTMENT IN IMAGING UTILIZATION RATE … the Secretary shall use a
categories and classes identified by the Secretary … (II) EXCEPTIONS. The 4002 l HHS e emen s desc bed … cu a e and me y co ec on and eva ua on o da a on hea h ca e d spa es … e m na ness
4 ACCOUNTAB L TY MEASURES The Sec e a y sha deve op accoun ab y mea- 10109 HHS app op a e by he Sec e a y 1 he Sec e a y de e m nes ha such expans on s g an may app y o des gna on as he coo d na ng cen e by subm ng an app -
h ough wh ch a es den o any S a e may den y a o dab e hea h nsu ance PROH B T NG D SCR M NAT ON AGA NST ND V DUAL PART C PANTS AND BENEF - y and s akeho de s sha deve op gu de nes conce n ng he ma e s … 1343 HHS TA N PROGRAMS — A The Sec e a y upon w en eques om he Sec e a y o 3001 l HHS the Medicare program … for home health agencies … 75 percent assumption instead of the utilization rates otherwise established 3504 l HHS 6001 HHS 6106 HHS copaymen o he fi s fi o a cove ed pa D d ug… 6409 HHS su es o ensu e ha he ac v es conduc ed us ng unds made ava ab e benefi 3 Whe he s anda d zed o ms cou d app y o financ a aud s equ ed by hea h expec ed o A educe spend ng w hou educ ng he qua y o ca e o B mp ove ca on o he Sec e a y a such me n such manne and con a n ng such n o ma on
1001 HHS cove age op ons n ha S a e C AR ES BASED ON HEALTH STATUS WELLNESS PROGRAM DEMONSTRAT ON 1323 HHS R SK ADJUSTMENT b CR TER A AND METHODS —The Sec e a y n consu a on HHS sha d sc ose … e u n n o ma on o any axpaye whose ncome s e evan (C) TIMING.—The Secretary shall establish and announce the performance
measures ….
3023 l HHS Secretary provides funding to … furnish improved care transition services to in such final rule … Secretary may establish exceptions that permit a PDP sponsor offering a (d) AUTHORITY. … beginning on the date of enactment of the PPACA, the (c) USE OF FUND. The Secretary shall transfer amounts in the Fund to accounts 4101 l HHS 4108 HHS 4205 HHS b ENFORCEMENT 1 ENSUR NG COMPL ANCE The Sec e a y o HHS sha es ab sh g SUBM SS ON OF STAFF NG NFORMAT ON BASED ON PAYROLL DATA N A UN - b REDUCT ON N AMOUNTS OWED The Sec e a y s au ho zed o educe he nd v dua s who p ov de d ec ca e and nc ease he s ab y o he ong- e m ca e p ans Fede a and S a e agenc es and o he e evan en es as de e m ned ap- he qua y o ca e and educe spend ng 2 he Ch e Ac ua y o CMS ce fies ha as he Sec e a y may equ e
ENSUR NG THE QUAL TY OF CARE C REGULAT ONS —No a e han 2 yea s PROJECT 2 EXPANS ON OF DEMONSTRAT ON PROJECT — he Sec e a y … 1311 HHS e AUTHOR TY TO CONTRACT TERMS OF CONTRACT — 1 AUTHOR TY A —The w h S a es sha es ab sh c e a and me hods o be used n ca y ng ou he n de e m n ng any p em um ax c ed … o any cos -sha ng educ on … standards not later than 60 days prior to the beginning of the performance 3006 l HHS (ii) ESTABLISHMENT OF PERIOD BY THE SECRETARY. The Secretary, as
high-risk Medicare beneficiaries. prescription drug plan to exclude from its formulary a particular covered part Secretary shall transfer authority in administering grants and related authori- within the HHS to increase funding, over FY 2008 level, for programs authorized (4) LIMITATION ON USE OF FUNDS. An eligible entity shall use … only for expen- 4103 HHS 2 STATE REPORT NG —A S a e awa ded a g an o ca y ou n a ves sha sub- v ADD T ONAL NFORMAT ON — he Sec e a y de e m nes ha a nu en 4303 HHS po c es and p ocedu es o ensu e comp ance w h he equ emen s … 2 AUD TS FORM FORMAT a e consu ng w h … pa es he Sec e a y deems app op - 6301 HHS 6402 HHS amoun due and ow ng o a v o a ons unde sec on 1877 o he Soc a Secu y wo k o ce p op a e by he Sec e a y such expans on wou d educe p og am spend ng and 3 he Sec e a y de e m nes
1103 HHS n consu a on w h he Sec e a y o he T easu y and he Sec e a y o Labo (b)(2)(E) Any other issues determined appropriate by the Secretary. 3015 l HHS 3135 l HHS D drug in a category or class that is otherwise required to be included in the ties under such parts from the Administrator of the Health Resources and by the Public Health Service Act … ditures for facilities, … equipment, or similar expenditures, as specified by the G Any o he e emen de e m ned app op a e by he Sec e a y m epo s o he Sec e a y on a sem -annua bas s … Such epo sha nc ude shou d be d sc osed o he pu pose o p ov d ng n o ma on o ass s consume s n o de o expand he u za on o ev dence-based p even on and hea h a e he Sec e a y sha equ e a ac y o e ec on ca y subm o he Sec e a y a The Sec e a y sha p ov de o he ans e om he Fede a Hosp a nsu ance 4 The p ov s ons o subsec ons d and e o sec on 205 sha app y w h espec Ac o an amoun ess han ha spec fied n subsec on g o such sec on… he ha such expans on wou d no deny o m he cove age o benefi s o Med -
a e he da e o enac men o he PPACA he Sec e a y sha p omu ga e egu a- h QUAL TY MPROVEMENT — 1 ENHANC NG PAT ENT SAFETY —Beg nn ng on Sec e a y may en e n o a con ac o con ac s w h one o mo e qua fied en - sk ad us men ac v es … period for the fiscal year involved.
(D) agree to report, as determined by the Secretary, measures on quality
appropriate, may establish a period … for an episode of care under the pilot
3026 l HHS formulary … Secretary ... n o ma on as spec fied by he Sec e a y ega d ng p omo on app oaches n he wo kp ace he D ec o sha 1 p ov de emp oye s
… he Sec e a y sha conduc aud s o de e m ne hosp a s v o a e he equ e- 10410 HHS
ons ha p ov de c e a o de e m n ng whe he a e mbu semen s uc u e s b ENHANC NG COMPARAT VE PURCHAS NG OPT ONS — 1 No a e han de e m nes ha he demons a on p o ec … s e ec ve such Sec e a es may Janua y 1 2015 a qua fied hea h p an may con ac w h— B a hea h ca e es o he pu pose o pe o m ng adm n s a ve unc ons … The Sec e a y sha 1414 HHS program. (D) ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SES- Services Administration to the Assistant Secretary for Preparedness and n ma n a n ng hea hy d e a y p ac ces he Sec e a y may equ e by egu a on men s e e ed o n pa ag aph 1 d ec ca e s a fing n o ma on…acco d ng o spec fica ons es ab shed by he T us Fund… n p opo on as es ma ed by he Sec e a y o he o a expend u es o h s sec on o he same ex en as hey a e app cab e w h espec o e The Sec e a y may cons de he o ow ng ac o s… 6703 HHS 10109 HHS ca e benefic a es 7 MATCH NG FUNDS The Sec e a y may no awa d a g an o con ac o an en y
desc bed 60 days a e he da e o enac men o h s Ac he Sec e a y sha deve op a beg nn ng on Ju y 1 2017 expand such demons a on p o ec o nc ude ad- p ov de on y such p ov de mp emen s such mechan sms o mp ove hea h have he same au ho y w h espec o a commun y hea h nsu ance op on … 1401 Treasury … such o he n o ma on as s p esc bed by he Sec e a y by egu a on as 3001 l HHS 3006 l HHS and resource use to the public in accordance with the public reporting (1) ELIGIBLE ENTITY. The term ‘‘eligible entity’’ means the following: (A) A … SION IMAGING INVOLVING CONSECUTIVE BODY PARTS. For services furnished Response. 4003 l HHS 4103 HHS d sc osu e o such nu en n he w en o m nc ud ng sma med um and a ge emp oye s as de e m ned by he D ec o Sec e a y… du ng such fisca yea ha a e made unde e XV om he espec ve us und Sec e a y may de ega e he au ho y g an ed by sec on 205 d as made app cab e 5 DEF N T ONS The e m commun y-based ong- e m ca e has he mean ng c CD COD NG CROSSWALKS 1 CD–9 TO CD–10 CROSSWALK The Sec e a y sha un ess he en y ag ees ha w make ava ab e d ec y o h ough con bu ons
s anda d zed o ma o be used o he p esen a on o n o ma on e a ng o he d ona pa c pa ng S a es ca e qua y as he Sec e a y may by egu a on equ e REFUNDABLE TAX CRED T PROV D NG PREM UM ASS STANCE FOR COVERAGE m gh nd ca e whe he he axpaye s e g b e o such c ed o educ on … (D) CONSIDERATIONS IN ESTABLISHING STANDARDS.— In establishing (b)(3) CONSULTATION.—In developing the plan, the Secretary shall— (A)
process ….
3023 l HHS hospital … identified by the Secretary as having a high readmission rate …. on or after July 1, 2010, the Secretary shall increase the reduction in pay- 3307 l HHS (a) PREVENTIVE SERVICES TASK FORCE. (1) ESTABLISHMENT AND PURPOSE. 4101 l HHS 3 A hea h p o ess ona s A a phys c an B a p ac one desc bed e se- 4201 HHS w h echn ca ass s ance consu a on oo s and o he esou ces … 2 bu d
6002 HHS o he Pa en -Cen e ed Ou comes Resea ch T us Fund… o h s sec on o he nspec o Gene a o HHS… 6409 HHS g ven such e m by he Sec e a y ask he CD–9–CM Coo d na on and Ma n enance Comm ee o convene a mee ng 10327 HHS om o he pub c o p va e en es non-Fede a con bu ons owa d he ac v es
(ii) IDENTIFICATION OF DRUGS IN CERTAIN CATEGORIES AND CLASSES. (I) … The Director shall convene an independent Preventive Services Task Force to be (B) CRITERIA. The Secretary shall prescribe criteria for determining the specific whe e o C a med ca p o ess ona nc ud ng a hea h educa o eg s e ed COMMUN TY TRANSFORMAT ON GRANTS a The Sec e a y ac ng h ough he 4205 HHS eva ua on capac y among wo kp ace s a by a n ng emp oye s on how o
1001 HHS cove age op ons … 1323 HHS UNDER A QUAL F ED HEALTH PLAN SEC 36B REFUNDABLE CRED T FOR COVER- performance standards with respect to measures under this paragraph, the consult with relevant affected parties; and (B) consider experience with such (3) DEADLINE FOR IMPLEMENTATION. The Secretary shall establish the pilot ments attributable to the multiple procedure payment reduction applicable to 3504 l HHS a TRANSPARENCY REPORTS 1 PAYMENTS OR OTHER TRANSFERS OF VALUE A 6106 HHS … 4 Such o he ac o s as he Sec e a y cons de s app op a e no a e han Janua y 1 2011 o ece ve npu om app op a e s akeho de s bb an a e na ve o m and manne de e m ned app op a e by he Sec e a y o be ca ed ou unde he g an o con ac n an amoun equa o $1 o each $5 o
STANDARD HOSP TAL CHARGES —Each hosp a ope a ng w h n he U S 2705 HHS/Treasury/Labor 1311 HHS 2 QUAL F ED ENT TY —To be qua fied o be se ec ed by he Sec e a y o o e AGE UNDER A QUAL F ED HEALTH PLAN NDEX NG — n he case o axab e 1414 HHS demonstrations that the Secretary determines are relevant to the value- 3015 l HHS 3026 l HHS the technical component for imaging …from 25 percent to 50 percent … the Secretary shall identify, as appropriate, categories and classes of drugs (a) EMERGENCY MEDICAL RESEARCH. The Secretary shall support Federal composed of individuals with appropriate expertise. shortages of personal health services for medically underserved children and d e an o nu on p o ess ona o a eam o med ca p o ess ona s as de e - D ec o o he CDC sha awa d compe ve g an s … cc … such o he ood ha s pa o a cus oma y ma ke es appea ng on eva ua e emp oye -based we ness p og ams …
No h ng n h s subsec on sha be cons ued as p even ng he Sec e a y om 6301 HHS 6402 HHS
Secretary shall take into account appropriate factors …
(c) CONSISTENT DATA AGGREGATION. The Secretary may award grants or
program not later than January 1, 2013.
(2) HIGH-RISK MEDICARE BENEFICIARY. The term ‘‘high risk Medicare benefi- for which the Secretary determines are of clinical concern. (II) CRITERIA. adolescents ... that shall … and other factors as determined appropriate by the m ned app op a e by he Sec e a y unde he supe v s on o a phys c an he menu o ess han 90 days unde e ms and cond ons es ab shed by he
On Ma ch 31 2013 and on he 90 h day o each ca enda yea beg nn ng he ea e
C REQU REMENTS… he Sec e a y o HHS sha d s bu e 80 pe cen o he
6703 HHS ega d ng he c osswa k be ween he N n h and Ten h Rev s ons o he n e na ona Fede a unds
sha o each yea es ab sh and upda e and make pub c n acco dance w h 1103 HHS PROH B T NG D SCR M NAT ON AGA NST ND V DUAL PART C PANTS AND BENEF - h QUAL TY MPROVEMENT 2 EXCEPT ONS —The Sec e a y may es ab sh a commun y hea h nsu ance op on an en y sha … and G mee such o he yea s beg nn ng n any ca enda yea a e 2014 he Sec e a y sha ad us he B NFORMAT ON TO EXCHANGE AND STATE AGENC ES —The Sec e a y o HHS based purchasing program … programs administered by NIH, the Agency for Healthcare Research and
4303 HHS any app cab e manu ac u e ha p ov des a paymen o o he ans e o va ue o equ ng subm ss on o such n o ma on w h espec o spec fic ca ego es such g SURETY BOND REQU REMENTS 1 DURABLE MED CAL EQU PMENT Sec on 6410 HHS B EL G BLE ENT TY The e m e g b e en y means he o ow ng… A commu- C ass fica on o D seases pos ed on he CMS webs e and make ecommenda ons 10327 HHS
gu de nes deve oped by he Sec e a y a s o he hosp a s s anda d cha ges b ENHANC NG COMPARAT VE PURCHAS NG OPT ONS 2 USE OF FORMAT —The C AR ES BASED ON HEALTH STATUS WELLNESS PROGRAM DEMONSTRAT ON easonab e excep ons … equ emen s as he Sec e a y may mpose n a and fina app cab e pe cen ages … may d sc ose … any ncons s ency be ween he n o ma on p ov ded by he 3001 l HHS
contracts … only to entities that enable summary data that can be inte-
3023 l HHS ciary’’ means a Medicare beneficiary who has attained a minimum hierarchi- 3137 l HHS The Secretary shall use criteria established by the Secretary in making any Quality, the Health Resources and Services Administration, the CDC, and 4003 l HHS Secretary. 4201 HHS Sec e a y a cove ed ec p en o o an en y o nd v dua a he eques o o des gna ed on as nu s ng s a be o e o he ca ego es o ce fied emp oyees O fice o Commun ca on and Know edge T ans e o AHRQ… and 20 pe cen o 1834 a 16 B o he Soc a Secu y Ac 42 U S C 1395m a 16 B s amended … he Sec e a y sha nc ude he nex 21 a ges me opo an s a s ca a eas n y-based ong- e m ca e en y as defined by he Sec e a y abou app op a e ev s ons o such c osswa k 2 REV S ON OF CROSSWALK Fo A Ma n enance o Ce fica on p og am subm s o he Sec e a y on beha o he 10410 HHS
o ems and se v ces p ov ded by he hosp a … Sec e a y sha u ze he o ma deve oped unde pa ag aph 1 n comp ng PROJECT 3 REQU REMENTS — A MA NTENANCE OF COVERAGE —The Sec e- Exchange o S a e agency o he Sec e a y and he n o ma on p ov ded o he (5) HOSPITAL PERFORMANCE SCORE.— … the Secretary shall develop a 3006 l HHS grated and compared across multiple sources. The Secretary shall provide
(b) DEVELOPMENTAL PHASE. (1) DETERMINATION OF PATIENT ASSESSMENT
cal condition category score, as determined by the Secretary … (B) EXCEPTION. Beginning on April 1, 2010, in determining the wage index
determination under subclause (I). (iii) IMPLEMENTATION. The Secretary shall other agencies involved in improving the emergency care system to expand (2) DUTIES. The duties of the Task Force shall include (A) the development of 4103 HHS 2 subm o he D ec o an app ca on a such me n such a manne and a … he D ec o sha conduc a na ona wo ks e hea h po c es and p og ams
beha o a cove ed ec p en sha subm o he Sec e a y n such e ec on c o m he Sec e a y o ca y ou he desc bed ac v es n such sec on 937 by nse ng ha he Sec e a y de e m nes s commensu a e w h he vo ume o by o a popu a on a e hose se ec ed unde subc ause o such ound… pu poses o he c osswa k 1 he Sec e a y sha make app op a e ev s ons and e g b e p o ess ona n o ma on n a o m and manne spec fied by he Sec e a y D o he n o ma on as he Sec e a y may equ e
n o ma on conce n ng cove age op ons on he n e ne webs e … a y n consu a on w h he Sec e a y o he T easu y and he Sec e a y o Labo
1311 HHS 1323 HHS 1401 Treasury/HHS Sec e a y … (f) AMBULATORY SURGICAL CENTERS.—The Secretary shall develop a plan
standards for the protection of the security and privacy of patient data.
applicable to hospitals that qualify for wage index reclassification, the Secre-
establish the criteria … and any exceptions … through the promulgation of and accelerate research in emergency medical care systems and emergency additional topic areas for new recommendations and interventions ... (B) at least 4101 l HHS 4 A The Sec e a y no a e han 1 yea a e enac men o h s subsec on con a n ng such n o ma on as he D ec o may equ e nc ud ng a desc p on 4205 HHS su vey o assess emp oye -based hea h po c es and p og ams
as he Sec e a y sha equ e he o ow ng n o ma on w h espec o he p eced- 6111 HHS he b ng o he supp e …Sec on 1861 o 7 C o he Soc a Secu y Ac 42 pos any such ev sed c osswa k on he CMS webs e 3 USE OF REV SED CROSS- ha he e g b e p o ess ona has success u y me he equ emen s eques ed
sha no app ove he pa c pa on o a S a e n he demons a on p o ec unde
methodology for assessing the total performance of each hospital based INSTRUMENT. The Secretary shall determine which patient assessment in-
3026 l HHS a regulation which includes a public notice and comment period. once during every 5-year period, review interventions and update recommen- (b) AUTHORITY TO AWARD GRANTS. The Secretary shall award grants for the sha es ab sh pub c y ava ab e gu de nes o hea h sk assessmen s Such o he p og am o be ca ed ou unde he g an 6401 HHS 6703 HHS
1001 HHS h QUAL TY MPROVEMENT 3 ADJUSTMENT —The Sec e a y may by egu a on 3 TERM —A con ac p ov ded o … sha be o a e m o a eas 5 yea s bu a S a e equ es a qua fied hea h p an … o cove benefi s n add on o he on performance standards … Using such methodology, the Secretary shall to implement a value-based purchasing program for payments under the strument … shall be used under the pilot program to evaluate the applicable tary shall include the average hourly wage data of hospitals … medicine … An au ho zed o fic a o any es au an o s m a e a ood es ab shmen o ng ca enda yea REDUCT ON OF C V L MONEY PENALT ES N CERTA N C RCUMSTANCES… he U S C 1395x o 7 C s amended by nse ng ha he Sec e a y de e m nes s 6410 HHS 1 GRANTS AUTHOR ZED The Sec e a y s au ho zed o make g an s o ong- e m WALK Any ev sed c osswa k sha be ea ed as a code se o wh ch a s anda d by he Sec e a y on he su vey o pa en expe ence w h ca e and as he 10410 HHS
DEF N T ONS —The Sec e a y n consu a on w h he Na ona Assoc a on o 1103 HHS h s sec on un ess he Sec e a es de e m ne ha he S a e s p o ec s des gned
ad us he numbe o beds … no mo e han 10 yea s as de e m ned by he Sec e a y A he end o each such essen a hea h benefi s equ ed o be p ov ded by he p an he po on o he 1414 HHS provide for an assessment … for each hospital for each performance period. Medicare program … 3015 l HHS condition of an applicable beneficiary for purposes of determining the most (D) Any other chronic disease or risk factor as determined by the Secretary. dations related to existing topic areas ... (C) improved integration with Federal costs of the operation of school-based health centers (“SBHCs”). gu de nes sha be deve oped n consu a on w h e evan g oups and en es and vend ng mach ne ope a o no sub ec o he equ emen s o h s c ause may 4303 HHS Sec e a y may educe he amoun o he pena y mposed by no mo e han 50 2 PROV DER SCREEN NG A PROCEDURES… he Sec e a y n consu a on w h commensu a e w h he vo ume o he b ng o he home hea h agency be o e n he case o cove ed ems u n shed on o a e Janua y 1 2016 he Sec e- has been adop ed by he Sec e a y 4 SUBSEQUENT CROSSWALKS Fo subse- Sec e a y may equ e on he me hods measu es and da a used unde he Ma n e-
3308 l SSA ca e ac es o he pu pose o ass s ng such en es e ESTABL SHMENT OF STANDARDS REPORT CARDS AND RECOMMENDAT ONS
nsu ance Comm ss ons sha es ab sh un o m defin ons o he ac v es c AUTHOR TY TO CONTRACT —The Sec e a y may ca y ou h s sec on h ough
n a manne ha — w no esu n any dec ease n cove age and w no e m he Sec e a y sha conduc a compe ve b dd ng p ocess o he pu poses p em um o he p an p ope y a ocab e unde u es p esc bed by he Sec e a y x The Sec e a y o HHS and he Exchanges … a e au ho zed o co ec and (d) MATCHING FUNDS. The Secretary may not award a grant or contract …
clinically appropriate site for the provision of post-acute care … 3137 l HHS 3504 l HHS Government health objectives and related target setting for health improvement; sha p ov de ha a hea h sk assessmen 4201 HHS e ec o be sub ec o he equ emen s o such c ause by eg s e ng b annua y The Sec e a y sha eva ua e a p og ams unded h ough he CDC be o e
6002 HHS pe cen he HHS nspec o Gene a sha es ab sh p ocedu es unde wh ch sc een ng s he sem co on a he end a y sha con nue o make such ad us men s desc bed n c ause quen ev s ons o he n e na ona C ass fica on o D seases ha a e adop ed by he nance o Ce fica on P og am and he qua fied Ma n enance o Ce fica on P og am TH RD PARTY REV EW 1 ESTABL SHMENT OF STANDARDS The Sec e a y ac ng
epo ed … con ac s en e ed n o w h qua fied en es
nc ease he cos o he Fede a Gove nmen …
1311 HHS o enew ng ex s ng con ac s o se ec ng new qua fied en es … o HHS … use he names and soc a secu y accoun numbe s o nd v dua s as equ ed o 3001 l HHS 3006 l HHS to an entity unless the entity agrees that it will make available … non- 3026 l HHS (3) ADJUSTMENT FOR CERTAIN HOSPITALS IN FISCAL YEAR 2010. (A) In
(D) DETERMINATION BY COMMISSIONER OF SOCIAL SECURITY. The Commis- (b) PEDIATRIC EMERGENCY MEDICAL RESEARCH. The Secretary shall support (D) the enhanced dissemination of recommendations; (E) the provision of techni- 4101 l HHS v o he ac o s as de e m ned by he Sec e a y he name and add ess o such es au an o s m a e a ood es ab shmen o conduc ng such an eva ua on o p va e y unded p og ams un ess an en y w h
… V any o he o m o paymen o o he ans e o va ue as defined by he conduc ed w h espec o p ov de s o med ca o o he ems o se v ces and sup- Sec e a y as a s anda d code se he Sec e a y sha a e consu a on w h he p ac ce assessmen
Federal contributions toward the activities to be carried out under the grant sioner of Social Security shall make any determination necessary to carry out cal assistance to those health care professionals, agencies and organizations (c) APPLICATIONS. To be eligible to receive a grant ... an entity shall (1) be an 4103 HHS vend ng mach ne ope a o w h he Sec e a y as spec fied by he Sec e a y by a p va e y unded we ness p og am eques s such an eva ua on p e s unde he p og am unde h s e he Med ca d p og am unde e X X and 6402 HHS 6703 HHS h ough he Adm n s a o sha es ab sh pe o mance s anda ds o A each Cen e
h QUAL TY MPROVEMENT 4 STANDARDS — A The Sec e a y sha es ab sh adm n s e he p ov s ons o and he amendmen s made by … (B) APPLICATION.— ‘‘(i) APPROPRIATE DISTRIBUTION.—The Secretary shall (f)(2)(E) Any other issues determined appropriate by the Secretary. 3023 l HHS (B) EXPANSION. The Secretary may expand the duration and the scope of the case of a … hospital … with respect to which (i) a reclassification of Federal programs administered by NIH, the Agency for Healthcare Research Sec e a y 6111 HHS 6411 HHS 3 APPL CAT ON A … a ong- e m ca e ac y sha subm an app ca on o he
app op a e s akeho de s pos on he CMS webs e a c osswa k be ween he p ev ous and B he ne wo k o Cen e s as a who e 2 REPORT CARDS The Sec e a y ac ng
1001 HHS 1104 HHS 2705 HHS s anda ds o nav ga o s nc ud ng p ov s ons o ensu e ha any p va e o pub c 1323 HHS 1401 HHS ensure that the application of the methodology … results in an appropriate
or contract in an amount equal to $1 for each $5 of Federal funds provided
(2) DEVELOPMENT OF QUALITY MEASURES FOR AN EPISODE OF CARE the program, to the extent determined appropriate by the Secretary, if the its wage index … was extended … and (ii) the wage index applicable for
the income-related increase in the base beneficiary premium … and Quality, the Health Resources and Services Administration, the CDC, and that request help in implementing ... recommendations; and (F) the submission of SBHC ... and (2) submit to the Secretary an application at such time, in such V h ough any o he means he Sec e a y de e m nes app op a e o max - 4201 HHS egu a on V COLLECT ON OF C V L MONEY PENALT ES — n he case o a c v money pen- he CH P p og am unde e XX n REQU REMENT OF A SURETY BOND FOR CERTA N PROV DERS OF SERV CES AND … es ab sh a p og am unde wh ch he S a e con ac s cons s en w h S a e and subsequen ve s on 10327 HHS h ough he Adm n s a o sha A o each Cen e no a e han 3 yea s a e he
PROH B T NG D SCR M NAT ON AGA NST ND V DUAL PART C PANTS AND BEN- under the grant or contract. yearly reports to Congress and related agencies … manner, and containing … (D) such other information as the Secretary may m ze access b y and ease o use by benefic a es wh e ensu ng he p vacy o 4304 HHS Sec e a y a such me n such manne and con a n ng such n o ma on as he
The Sec e a y sha awa d g an s o S a es o enab e such S a es … o es ab sh ADM N STRAT VE S MPL F CAT ON 4 REQU REMENTS FOR F NANC AL AND en y ha s se ec ed as a nav ga o s qua fied and censed app op a e o 4 L M TAT ON —A con ac may no be enewed un ess he Sec e a y de e - E SPEC AL RULE FOR PED ATR C DENTAL COVERAGE — … he po on o he 1414 HHS distribution of value-based incentive payments … 3006 l HHS AND FOR POST-ACUTE CARE. (A) The Secretary … shall develop quality Secretary determines (and the Chief Actuary of CMS … certifies) that such such hospital for the period beginning on October 1, 2009, and ending on other agencies to coordinate and expand research in pediatric emergency d TRA N NG — 1 The D ec o sha deve op a p og am o p ov de a n ng 6002 HHS a y mposed unde h s c ause he Sec e a y sha ssue egu a ons… SUPPL ERS 1 The Sec e a y may equ e a p ov de o se v ces o supp e o aw and n he same manne as he Sec e a y en e s n o con ac s w h ecove y Sec e a y may equ e B No h ng n h s subsec on sha be cons ued as p oh b - The e m “Ma n enance o Ce fica on P og am” means a con nuous assessmen da e on wh ch such cen e o exce ence s es ab shed and annua y he ea e ssue
expand o p ov de suppo … ADM N STRAT VE TRANSACT ONS — A The s anda ds and assoc a ed ope a -
EF C AR ES BASED ON HEALTH STATUS WELLNESS PROGRAM DEMONSTRA-
engage n he nav ga o and o avo d confl c s o n e es … m nes ha he con ac ng adm n s a o has me pe o mance equ emen s p em um o he p an desc bed n such sec on ha unde egu a ons p e- b HEALTH NSURANCE CRED T AMOUNT 2 he agg ega e amoun o none ec- (f)(3) CONSULTATION.— … (1) the Secretary shall— (A) consult with relevant measures for use in the pilot program (i) for episodes of care; and (ii) for expansion would reduce spending under this title without reducing quality. March 31, 2010, was lower than for the period beginning on April 1, 2010, 3308 l SSA medical care systems and pediatric emergency medicine … require. such benefic a es on e ec ve s a eg es o he p even on and con o o ch on c d sease and 4205 HHS a … he Sec e a y ac ng h ough he D ec o o he CDC sha es ab sh an
… XV any o he na u e o he paymen o o he ans e o va ue as defined by he 6401 HHS p ov de he Sec e a y on a con nu ng bas s w h a su e y bond n a o m spec fied aud con ac o s unde sec on 1893 h sub ec o such excep ons o equ emen s 10201 HHS p og am such as qua fied Ame can Boa d o Med ca Spec a es Ma n enance o a epo ca d o he coo d na ng cen e o a e he pe o mance o such Cen e and
T ON PROJECT 3 REQU REMENTS — B OTHER REQU REMENTS —S a es ha 3015 l HHS (IV) Any other information the Commissioner of Social Security determines 4003 l HHS Ep dem o ogy and Labo a o y Capac y G an P og am o awa d g an s o S a e ng he Sec e a y om m ng he numbe o app can s o a g an unde h s
es ab shed by he Sec e a y … sc bed by he Sec e a y s p ope y a ocab e o ped a c den a benefi s … ve con bu ons wh ch he emp oye wou d have made du ng he axab e yea and ending on September 30, 2010 … the Secretary shall pay such hospital he nk be ween phys ca emo ona and soc a we -be ng 2 COMMUN TY REG STRAT ON —W h n 120 days o enac men he Sec e a y sha pub sh 6111 HHS B LEVEL OF SCREEN NG The Sec e a y sha de e m ne he eve o sc een ng by he Sec e a y n an amoun no ess han $50 000 ha he Sec e a y de e - B A S a e desc bed n h s subpa ag aph s a S a e ha s an expans on S a e Ce fica on p og am o an equ va en p og am as de e m ned by he Sec e a y ha
ng u es adop ed by he Sec e a y sha — … enab e de e m na on o an
pa c pa e n he demons a on p o ec unde h s subsec on — v sha ensu e 3001 l HHS affected parties; and (B) consider experience with such demonstrations
PUBLIC REPORTING OF PERFORMANCE INFORMATION. (a) DEVELOPMENT OF
post-acute care.
necessary to carry out the income-related increase in the base beneficiary (3) ROLE OF AGENCY. The Agency shall provide ongoing administrative, research, 4101 l HHS 4103 HHS hea h depa men s as we as oca hea h depa men s and ba u sd c ons
Sec e a y as he Sec e a y may equ e… subsec on B no a e han 3 yea s a e he da e on wh ch he fi s g an s awa ded unde
1001 HHS nd v dua s e g b y and financ a espons b y … be comp ehens ve … 1311 HHS sha be ea ed as a p em um payab e o a qua fied hea h p an unde he a angemen each emp oyee aken n o accoun unde pa ag aph 1 … The methodology developed shall provide for the assignment of weights that the Secretary determines are relevant to the value-based purchasing 3026 l HHS an additional payment that reflects the difference between the wage index 3504 l HHS TRANSFORMAT ON PLAN —The D ec o sha p ov de app op a e eedback and a no ce n he Fede a Reg s e spec y ng he e ms and cond ons o mp e- … cc may p ov de o he co ec on o such c v money pena y and he p ace- conduc ed unde h s pa ag aph acco d ng o he sk o aud was e and abuse as m nes s commensu a e w h he vo ume o he b ng o he p ov de o se v ces desc bed e sewhe e he Sec e a y de e m nes w no ece ve any paymen s advances qua y and he e ong ea n ng and se -assessmen o boa d ce fied spe- subsec on b 1 and annua y he ea e ssue a epo ca d o Cong ess o a e he
and demons a e o he sa s ac on o he Sec e a y ha he d scoun s o o he PERFORMANCE WEBSITES. The Secretary shall make available to the public, premium … and technical support for the operations of the Task Force, including coordinating (d) PREFERENCES AND CONSIDERATION. In reviewing applications: (1) The Sec- B No a e han 1 yea enac men he Sec e a y sha es ab sh s anda ds echn ca ass s ance o g an ees o es ab sh commun y ans o ma on p ans 3 men a on pend ng p omu ga on o egu a ons ha mee such c e a as he D ec o de e m nes app op a e Academ c cen- de e m ned by he Sec e a y Such sc een ng sha nc ude a censu e check… o supp e The Sec e a y may wa ve he equ emen o a bond… 2 A p ov de o
CR TER A —A S a e ha ece ves a g an unde h s sec on sha comp y w h p ov de o me y acknow edgmen esponse and s a us epo ng … and
ewa ds p ov ded unde he p o ec eflec he expec ed eve o pa c pa on n 5 FA R AND MPART AL NFORMAT ON AND SERV CES —The Sec e a y n co - 1323 HHS had en o ed n a qua fied hea h p an wh ch had a p em um equa o he ave age for categories of measures as the Secretary determines appropriate. program …
through standardized Internet websites, performance information summariz- 3023 l HHS (2) APPLICATION; PARTICIPATION. (A) (i) APPLICATION. An eligible entity for such periods. (B) TIMEFRAME FOR PAYMENTS. The Secretary shall make (c) IMPACT RESEARCH. The Secretary shall support research to determine
and supporting the dissemination of the recommendations of the Task Force, en- e s ha ass s S a e and e g b e oca and ba hea h depa men s may a so be 6002 HHS men o such amoun s co ec ed n an esc ow accoun unde he d ec on o he 6411 HHS 6703 HHS on he bas s o an nc eased FMAP o expend u es o med ca ass s ance o new y c a y phys c ans by ocus ng on he compe enc es o pa en ca e med ca know edge pe o mance o he ne wo k o cen e s o exce ence as a who e
c e a es ab shed by he Sec e a y o ca y ng ou ac v es unde such g an v desc be a da a e emen s … n unamb guous e ms equ e ha such da a 6 REVOCAT ON —A con ac awa ded sha be evoked by he Sec e a y … The 1401 HHS/Treasury p em um as de e m ned by he Sec e a y o HHS … seeking to participate in the program shall submit an application to the payments required … not later than December 31, 2010. the estimated economic impact of, and savings that result from, the imple- retary may give preference to applicants who demonstrate an ability to serve the o n e ac ve e ephon c o web-based p og ams used o u n sh hea h sk EVALUAT ON —The D ec o sha p ov de a e a u e ev ew and amewo k o Sec e a y… and may as he Sec e a y de e m nes app op a e based on he sk o aud se v ces o supp e desc bed n h s pa ag aph s a p ov de o se v ces o supp e e g b e nd v dua s and has no been app oved by he Sec e a y o d ve a p ac ce-based ea n ng n e pe sona and commun ca on sk s and p o ess ona sm
abo a on w h S a es sha deve op s anda ds o ensu e ha n o ma on made (C) COORDINATION WITH QUALITY MEASURE DEVELOPMENT AND ENDORSE- … v Any o he ca ego es o n o ma on ega d ng he paymen o o he ans e … p ov de assu ances sa s ac o y o he Sec e a y… 4 PART C PAT ON N STATE HEALTH EXCHANGES A ong- e m ca e ac y ha
e emen s be equ ed o cond oned upon se va ues n o he fie ds and p oh b
he we ness p og am nvo ved and he an c pa ed e ec he p og am w have
Sec e a y may evoke such con ac he Sec e a y de e m nes ha such ad- 3 SECRETAR AL AUTHOR TY —The Sec e a y o HHS n consu a on w h he 3007 l HHS
ing data on quality measures. Secretary at such time, in such manner, and containing such information as 3308 l SSA mentation of coordinated emergency care systems. suring adequate staff resources, and assistance to those organizations request- following: … (2) The Secretary may give consideration to whether an applicant assessmen s The Sec e a y may u ze any hea h sk assessmen o he he eva ua on o p og ams conduc ed as pa o he g an p og am n add on 4205 HHS e g b e o und ng as he D ec o de e m nes app op a e was e and abuse desc bed n he p eced ng sen ence nc ude …and V such he Sec e a y de e m nes app op a e… po on o he DSH a o men o a S a e o he cos s o p ov d ng med ca ass s ance o 10410 HHS
on u za on o med ca c a m cos s ava ab e by nav ga o s s a accu a e and mpa a 3001 l HHS MENT PROCEDURES. The Secretary shall ensure that the development of
(B) AGREEMENTS. In the case where the monthly benefit payments of an ing it for implementation of ... recommendations. has received a grant under ... the PPACA. PPACA as pa o he equ emen o deve op a pe sona zed p even on p an o wo k ng w h academ c ns u ons o o he en es w h expe se n ou come
o va ue he Sec e a y de e m nes app op a e
o he sc een ng as he Sec e a y de e m nes app op a e ece ves a g an unde h s subsec on sha whe e ava ab e pa c pa e n ac v es
1001 HHS/Treasury/Labor add ona cond ons … m n s a o has engaged n aud decep on was e abuse o powe neg gence Sec e a y sha p esc be u es se ng o h he me hods by wh ch ca cu a ons o 1414 HHS/Labor (6) CALCULATION OF VALUE-BASED INCENTIVE PAYMENTS.— In the case of (p) ESTABLISHMENT OF VALUE-BASED PAYMENT MODIFIER.— The Secretary quality measures … is … consistent with the measures …. the Secretary may require. 3137 l HHS x REGULAT ONS — PROPOSED REGULAT ON —No a e han 1 yea a e 6111 HHS 6411 HHS conduc ed by a S a e o a qua fied S a e-des gna ed en y… o coo d na e ca e and
o he hea h benefi s cove age unde a wa ve ha s n e ec on Ju y 2009 10328 HHS 3 RECOMMENDAT ONS Based upon he epo ca ds he Sec e a y sha no
m smanagemen o axpaye do a s o g oss m smanagemen … am y s ze and househo d ncome a e made … C HOURS OF SERV CE —The Sec e a y n consu a on w h he Sec e a y o 3015 l HHS (3) CONSULTATION. In developing the plan … the Secretary shall consult with individual that are withheld … are insufficient … the Commissioner of Social 3505 l HHS eva ua on enac men he Sec e a y sha p omu ga e p oposed egu a ons o ca y ou h s 4305 HHS 6402 HHS C REQU RED NTERVENT ONS Fo p an yea s beg nn ng on o a e he da e ha s
DATA COLLECT ON — … an o fice o hea h nsu ance consume ass s ance o
2706 HHS 1311 HHS a hospital that the Secretary determines meets (or exceeds) the performance shall establish a payment modifier that provides for differential payment to a
(c) CONSULTATION. (1) … the Secretary shall consult with the entity with Security shall enter into agreements with the Secretary, the Director of OPM, 4003 l HHS 4101 l HHS 4103 HHS a NST TUTE OF MED C NE CONFERENCE ON PA N — 1 CONVEN NG —No 6002 HHS … ac y mp ovemen n a ves app oved by he Sec e a y nc ud ng o n
6401 HHS … V such p og am s ca ed ou n acco dance w h such equ emen s as he o o he pu poses de e m ned app op a e by he Sec e a y a e han Sep embe 30 2015 A make ecommenda ons o he Cen e s ega d ng
ombudsman p og am sha be equ ed o co ec and epo da a o he Sec e a y 1104 HHS k CONFL CT —An Exchange may no es ab sh u es ha confl c w h o p even Labo sha p esc be such egu a ons u es and gu dance as may be necessa y standards … the Secretary shall increase the base operating DRG payment physician or a group of physicians under the fee schedule … 3023 l HHS 3026 l HHS relevant affected parties. (a) The Secretary shall establish 3 programs to award grants to qualified c ause CONTENTS — n p omu ga ng egu a ons he Sec e a y sha — aa
2 PHYS C AN OWNERSH P…sha subm o he Sec e a y n such e ec on c o m a n ng o ac y s a and su veyo s echn ca ass s ance o ac es mp emen - o SUSPENS ON OF PAYMENTS PEND NG NVEST GAT ON OF CRED BLE AL-
Sec e a y sha spec y … 10201 HHS 2 yea s a e he da e o he enac men o PPACA p esc p on d ug p an sponso s mp ovemen s such cen e s sha make and B make ecommenda ons o Cong ess
… The Sec e a y sha u ze such da a o den y a eas whe e mo e en o ce- B REDUCT ON OF CLER CAL BURDEN — n adop ng s anda ds and ope a ng
NON-D SCR M NAT ON N HEALTH CARE a PROV DERS — … No h ng n h s
1323 HHS 1401 HHS o de e m ne he hou s o se v ce o an emp oyee … a contract … and other entities, as appropriate, to determine the type of (3) SELECTION. In selecting eligible entities to participate, the Secretary shall and the Railroad Retirement Board as necessary in order to allow other public, nonprofit IHS, Indian tribal, and urban Indian trauma centers. (4) COORDINATION WITH COMMUNITY PREVENTIVE SERVICES TASK FORCE. The (e) WAIVER OF REQUIREMENTS. The Secretary may (1) under appropriate C No a e han 18 mon hs a e enac men he Sec e a y sha deve op 4202 HHS cons de s anda d za on o ec pes and me hods o p epa a on easonab e va a- a e han 1 yea a e unds a e app op a ed he Sec e a y sha seek o en e
ng qua y assu ance p og ams he appo n men o empo a y managemen fi ms C APPL CAT ON FEES NST TUT ONAL PROV DERS… he Sec e a y sha mpose LEGAT ONS OF FRAUD 1 The Sec e a y may suspend paymen s o a p ov de CERTA N HOSP TAL PAYMENTS The Sec e a y may no mpose a m a on on he sha o e med ca on he apy managemen se v ces o a ge ed benefic a es ha o expand ng he Cen e s o se ve nd v dua s w h o he ypes o men a d so de s
sec on sha be cons ued as p even ng a g oup hea h p an a hea h nsu ance he app ca on o egu a ons p omu ga ed by he Sec e a y … amount … information that is useful to stakeholders and the format that best facilitates (c)(1)(B) EXPANSION. The Secretary may, at any point after January 1, 2016, agencies to collect the amount described … Task Force shall take appropriate steps to coordinate its work with the Commu- circumstances, waive the application of all or part of the requirements ... with and make ava ab e o he pub c a hea h sk assessmen mode Any hea h a HEALTHY AG NG L V NG WELL — 1 The Sec e a y ac ng h ough he D ec- on n se v ng s ze and o mu a on o menu ems … and o he ac o s as he n o an ag eemen w h OM o convene a Con e ence on Pa n as he Sec e a y sha equ e he o ow ng n o ma on ega d ng any owne sh p o
a ee on each ns u ona p ov de o med ca o o he ems o se v ces o supp e o se v ces o supp e pend ng an nves ga on o a c ed b e a ega on o aud 6703 HHS
men ac on s necessa y and sha sha e such n o ma on u es o he ansac ons e e ed o unde pa ag aph 1 he Sec e a y sha
ssue o he Sec e a y om es ab sh ng va y ng e mbu semen a es based on
7 FEE FOR ADM N STRAT ON A —The Sec e a y sha pay he con ac ng ad- g REGULAT ONS —The Sec e a y sha p esc be such egu a ons as may be 3007 l HHS use of the reports and of performance reporting Internet websites. expand the duration and scope of the pilot program, to the extent determined give priority to eligible entities that... 3138 l HHS nity Preventive Services Task Force and the Advisory Committee on Immunization nves men n e es … D Any o he n o ma on ega d ng he owne sh p o nves - and o he ac v es app oved by he Sec e a y 6411 HHS 5 ACCOUNTAB L TY MEASURES The Sec e a y sha deve op accoun ab y mea-
o a amoun o paymen s made o hosp a s unde he QUEST sec on 1115 Demon- nc ude a a m n mum he o ow ng o nc ease adhe ence o p esc p on med ca-
1414 HHS 3505 l HHS respect to an SBHC for not to exceed 2 years; and (2) upon a showing of good sk assessmen ha mee s he gu de nes and s app oved by he Sec e a y o o he CDC sha awa d g an s o S a e o oca hea h depa men s and nd an Sec e a y de e m nes and REPORT NG —The Sec e a y sha subm o he such as a hosp a o sk ed nu s ng ac y w h espec o wh ch sc een ng s aga ns he p ov de o se v ces o supp e un ess he Sec e a y de e m nes he e s a on P o ec excep o he ex en ha such m a on s necessa y o ensu e ha a ons o o he goa s deemed necessa y by he Sec e a y An annua comp ehens ve
seek o educe he numbe and comp ex y o o ms … and da a en y equ ed
qua y o pe o mance measu es 1312 (e) HHS m n s a o a ee o he managemen adm n s a on and de ve y o he benefi s necessa y … wh ch p ov de o — 1 he coo d na on o he c ed a owed … 3001 l HHS (B) MEASURES.— (i) The Secretary shall establish appropriate measures appropriate by the Secretary, if (i) the Secretary determines that such expan- (18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS. (A) STUDY.
3309 l HHS Practices, including the examination of how each task force’s recommendations cause, waive the requirement that the SBHC provide all required comprehensive may be used o mee he equ emen … bes o ca y ou 5-yea p o p og ams … Comm ee on Hea h Educa on Labo and Pens ons o he Sena e and he Com- 4305 HHS men n e es he Sec e a y de e m nes app op a e
conduc ed unde h s pa ag aph… s good cause no o suspend such paymen s 2 The Sec e a y sha consu w h 2 COORD NAT ON REGULAT ONS A The Sec e a y ac ng h ough he Adm n- su es o ensu e ha he ac v es conduc ed us ng unds made ava ab e unde h s 10410 HHS
1001 HHS by pa en s and p ov de s CONSUMER CHO CE e ENROLLMENT THROUGH AGENTS OR BROKERS — The unde h s sec on and 2 he app ca on … whe e he fi ng s a us o he axpaye o a axab e g APPL CAT ON OF SECT ON FOR CALENDAR YEARS 2011 2012 AND 2013 2 (C) VALUE-BASED INCENTIVE PAYMENT PERCENTAGE.—The Secretary shall of the quality of care furnished by a physician or group of physicians to sion is expected to (I) reduce spending … (iii) the Secretary determines that 3026 l HHS The Secretary shall conduct a study to determine if, under the system… (b) MINIMUM QUALIFICATIONS OF TRAUMA CENTERS. (1) PARTICIPATION 6112 HHS s a o o CMS sha coo d na e he expans on o he Recove y Aud Con ac o subsec on he p mp ove pa en sa e y and educe adve se even s and hea h ca e
hosp a does no ece ve paymen s o as necessa y o ensu e ha such paymen s med ca on ev ew u n shed pe son- o-pe son o us ng e ehea h echno og es as 4 TH RD PARTY REV EW No a e han 3 yea s a e he da e on wh ch he fi s g an
yea s d e en om such s a us used o de e m n ng he advance paymen o AMOUNT OF CRED T —The amoun o he c ed de e m ned unde subsec on b 3015 l HHS (d) IMPLEMENTATION. Notwithstanding any other provision of law, the Secre- costs incurred by hospitals … with respect to ambulatory payment … ELIMINATION OF COST SHARING FOR CERTAIN DUAL ELIGIBLE INDIVIDUALS. IN TRAUMA CARE SYSTEM OPERATING UNDER CERTAIN PROFESSIONAL
interact at the nexus of clinic and community. primary health services for a designated period of time to be determined by the m ee on Ene gy and Comme ce o he House o Rep esen a ves a qua e y epo 1 The D ec o o N H s encou aged o con nue and expand h ough he Pa n he nspec o Gene a o HHS n de e m n ng whe he he e s a c ed b e a ega on o do no n he agg ega e n any yea exceed he amoun ha he Sec e a y de e m nes defined by he Sec e a y by a censed pha mac s o o he qua fied p ov de
N T AL PREM UM REV EW PROCESS —The Sec e a y … sha es ab sh a
1301 HHS Sec e a y sha es ab sh p ocedu es unde wh ch a S a e may a ow agen s o specify a value-based incentive payment percentage for a hospital for a individuals enrolled, such as measures that reflect health outcomes. Such
(d) COORDINATION. Where appropriate, the Secretary shall coordinate the
such expansion would not deny or limit the coverage or provision of benefits
… the Social Security Act is amended by inserting ‘‘or, effective on a date Secretary. 4103 HHS 4202 HHS ha desc bes he Sec e a y s p og ess owa d p omu ga ng fina egu a ons Conso um an agg ess ve p og am o bas c and c n ca esea ch on he causes 6002 HHS a ESTABL SHMENT 1 The Sec e a y…sha conduc a demons a on p o ec o
6401 HHS aud 3 The Sec e a y sha p omu ga e egu a ons o ca y ou … p og am o Med ca d w h S a es… B The Sec e a y sha p omu ga e egu a- comp ca ons esu ng om med ca on e o s
s equa o he FMAP componen a bu ab e o DSH paymen ad us men s o such
s awa ded and annua y he ea e he Sec e a y sha a ange o an ndependen
p ocess o he annua ev ew beg nn ng w h he 2010 p an yea … o 1104 HHS b oke s— 1 o en o nd v dua s n any qua fied hea h p ans … and 2 o 1323 HHS he c ed sha be de e m ned— C by subs u ng o he ave age p em um … he amoun fiscal year. measures shall be risk adjusted as determined appropriate by the Secretary.
manner in which data are presented through Internet websites … and for
under this title for individuals. tary may implement the provisions … by program instruction or otherwise. exceed those costs incurred by other hospitals furnishing services … (as
specified by the Secretary (but in no case earlier than January 1, 2012), who
GUIDELINES. … the Secretary may not award a grant to a trauma center
4003 l HHS o and po en a ea men s o pa n c PROCEDURES FOR SUBM SS ON OF NFORMAT ON AND PUBL C AVA LAB L TY — deve op es and mp emen an ndependen mon o p og am o ove see n e s a e ons o ca y ou h s subsec on and he amendmen s made by h s subsec on h d pa y o conduc an eva ua on o he ne wo k o Cen e s o ensu e ha such
un easonab e nc eases n p em ums o hea h nsu ance cove age g OPERAT NG RULES — 1 The Sec e a y sha adop a s ng e se o ope a ng
QUAL F ED HEALTH PLAN DEF NED a QUAL F ED HEALTH PLAN — 1 The e m
ass s nd v dua s n app y ng o p em um ax c ed s and cos -sha ng educ ons B REQU REMENT FOR H GH QUAL TY ADM N STRAT ON —The Sec e a y may he Sec e a y o HHS de e m nes s he ave age p em um o he sma g oup (ii) The Secretary shall seek endorsement of the measures established by the determined appropriate by the Secretary). In conducting the study … the … unless … is a participant in a trauma system that substantially complies D The Sec e a y may coo d na e w h commun y-based … o ensu e ha B subm o he Sec e a y an app ca on a such me n such manne and
1 A ESTABL SHMENT he Sec e a y sha es ab sh p ocedu es o app cab e and a ge n as a e cha ns o sk ed nu s ng ac es and nu s ng ac es HARDSH P EXCEPT ON WA VER FOR CERTA N MED CA D PROV DERS The Sec e-
nc ud ng w h espec o cond ons o Fede a financ a pa c pa on as spec fied 6703 HHS
yea ha s eflec ed n he budge neu a y p ov s on o he QUEST Demons a on 10328 HHS cen e s a e mee ng he goa s
u es o each ansac on e e ed o unde subsec on a 1 w h he goa o
qua fied hea h p an means a hea h p an ha — C s o e ed by a hea h
nc ease he ee … based on he ex en o wh ch he con ac ng adm n s a o n 1402 HHS ma ke n he S a e n wh ch he emp oye s o e ng hea h nsu ance cove age entity …
public reporting of other quality measures by the Secretary ….
3023 l HHS 3026 l HHS Secretary shall take into consideration the cost of drugs and biological …. would be such an institutionalized individual or couple, if the full-benefit dual with section 1213. COMMUNITY PREVENTIVE SERVICES TASK FORCE. (a) ESTABLISHMENT AND 4101 l HHS hea h sk assessmen s a e access b e o benefic a es and p ov de app op - con a n ng such n o ma on as he Sec e a y may equ e nc ud ng a desc p on 4206 HHS a y may on a case by- case bas s exemp a p ov de o med ca o o he ems o 6402 HHS P o ec The Sec e a y n consu a on w h e evan s akeho de s sha deve op a s anda d zed
nsu ance ssue ha — v comp es w h he egu a ons deve oped by he o p ans so d h ough an Exchange … 3001 l HHS (B) AUTHORIZATION OF ADJUSTMENT. Insofar as the Secretary determines eligible individual were not receiving services under a home and community- PURPOSE. The Director of the CDC shall convene an independent Community 2) CONSTRUCTION. The Secretary may award grants ... to pay the costs associ- a e suppo o he comp e on o hea h sk assessmen s by benefic a es o he p og am o be ca ed ou unde he g an s DEMONSTRAT ON PROGRAM FOR ND V DUAL ZED WELLNESS PLANS — 1 4305 HHS manu ac u e s and app cab e g oup pu chas ng o gan za ons o subm n o ma-
se v ces o supp e om he mpos on o an app ca on ee unde h s subpa a- C by any nd v dua o en y o whom he S a e has a ed o suspend paymen s
by he Sec e a y 1 STANDARDS AND COMPAT B L TY The Sec e a y sha adop e ec on c s anda ds
o ma o he ac on p an and summa y
1001 HHS c ea ng as much un o m y n he mp emen a on o he e ec on c s anda ds as he de e m na on o he Sec e a y mee s pe o mance equ emen s es ab shed REDUCED COST-SHAR NG FOR ND V DUALS ENROLL NG N QUAL F ED HEALTH o o such a ea w h n he S a e as s spec fied by he Sec e a y
(7) FUNDING FOR VALUE-BASED INCENTIVE PAYMENTS.— ‘‘(A) AMOUNT.— 3021 l HHS (B) REQUIREMENTS. The Secretary shall develop requirements for entities to (e) WAIVER AUTHORITY. The Secretary may waive such requirements … as
based waiver authorized for a State under section 1115 or subsection (c) or Preventive Services Task Force ... Such Task Force shall review the scientific on o he Sec e a y unde subsec on a and o he Sec e a y o make such 6112 HHS o he exchange o c n ca da a by ong- e m ca e ac es… 10410 HHS
poss b e …
Sec e a y …
by he Sec e a y … PLANS B COORD NAT ON W TH ACTUAR AL VALUE L M TS — The Sec e a y 3007 l HHS may be necessary to carry out the program. … that costs incurred by hospitals … exceed those costs incurred by other 3505 l HHS ated with expanding and modernizing existing buildings for use as an SBHC, The Sec e a y sha es ab sh a p o p og am o es he mpac o p ov d ng a - 1 ESTABL SHMENT —The Sec e a y sha es ab sh no a e han 1 yea a e g aph he Sec e a y de e m nes ha he mpos on o he app ca on ee wou d unde he p an du ng any pe od when he e s pend ng an nves ga on o a c ed-
6411 HHS 10201 HHS
JUST F CAT ON AND D SCLOSURE — … equ e hea h nsu ance ssue s o 1313 HHS The total amount available for value based incentive payments … shall be (a) CENTER FOR MEDICARE AND MEDICAID INNOVATION ESTABLISHED. (1)
participate in the pilot program … Such requirements shall ensure that ap- (d) of section 1915 or under a State plan amendment under subsection (i) of evidence related to the effectiveness, appropriateness, and cost-effectiveness of including the purchase of trailers or manufactured buildings to install on the 4103 HHS 4202 HHS sk popu a ons who u ze commun y hea h cen e s 2 AGREEMENTS —The enac men and as necessa y ma n a n a comm ee o be known as he
n o ma on subm ed ava ab e o he pub c 2 SELECT ON The Sec e a y sha se ec cha ns o sk ed nu s ng ac es and
esu n a ha dsh p… o he ee wou d mpede benefic a y access o ca e b e a ega on o aud aga ns he nd v dua o en y as de e m ned by he S a e n
2 ALLOCAT ON OF FUNDS AUTHOR ZED O he amoun app op a ed o a fisca
subm o he Sec e a y and he e evan S a e a us fica on o an un easonab e F NANC AL NTEGR TY a ACCOUNT NG FOR EXPEND TURES — 2 NVEST - sha ensu e he educ on unde h s pa ag aph sha no esu n an nc ease 1414 HHS equal to the total amount of reduced payments for all hospitals for such fiscal (3) COSTS.— … costs shall be evaluated, to the extent practicable, based on plicable beneficiaries have an adequate choice of providers of services and hospitals … the Secretary shall provide for an appropriate adjustment … to (4) TRAUMA CENTERS IN 1115 WAIVER STATES. … the Secretary may award nu s ng ac es… om among hose cha ns ha subm an app ca on o he 9 SPEC AL RULES RELAT NG TO PARTS C AND D The Sec e a y sha en e n o 6703 HHS
d 1 An app ca on o enewa o any expe men a p o o demons a on p o ec 10328 HHS yea he Sec e a y sha de e m ne he a oca on o each Cen e bu n no case may
1104 HHS 1302 HHS 1323 HHS n he p an s sha e o he o a a owed cos s o benefi s p ov ded unde he p an REGULAT ONS —The Sec e a y sha p esc be such egu a ons as may be There is created within the CMS a Center for Medicare and Medicaid Innova-
3102 l HHS reflect those higher costs effective … on or after January 1, 2011. such section or services provided through enrollment in a medicaid managed
a substantial uncompensated care grant to a trauma center under subsec-
community preventive interventions for the purpose of developing recommenda- school property. E The Sec e a y sha es ab sh p ocedu es o make benefic a es and p ov de s any o he measu es deemed app op a e by he Sec e a y Sec e a y sha en e n o ag eemen s w h no mo e han 10 unded commun y n e agency Pa n Resea ch Coo d na ng Comm ee … acco dance w h egu a ons p omu ga ed by he Sec e a y… unde aken n a S a e ha wou d esu n an mpac on e g b y en o men ben- Fo ow-up n e ven ons as wa an ed based on he find ngs o he annua
p em um nc ease p o o he mp emen a on o he nc ease … The Sec e a y
ESSENT AL HEALTH BENEF TS REQU REMENTS a ESSENT AL HEALTH BENEF TS GAT ONS —The Sec e a y n coo d na on w h he nspec o Gene a o he year, as estimated by the Secretary. a composite of appropriate measures of costs established by the Secretary
tion (“CMI”) to carry out the duties described in this section. The purpose of
suppliers under the pilot program. care organization with a contract under section 1903(m) or under section tions, to be published in the Guide to Community Preventive Services ... awa e o he equ emen ha a benefic a y comp e e a hea h sk assessmen hea h cen e s o conduc ac v es unde he p o p og am 6002 HHS Sec e a y a such me n such manne and con a n ng such n o ma on as he
6401 HHS con ac s unde pa ag aph 1 o equ e ecove y aud con ac o s o… D e- 2 ELECTRON C SUBM SS ON OF DATA TO THE SECRETARY A No a e han 10 efi s cos -sha ng o financ ng sha be cons de ed by he Sec e a y n acco dance
he a oca on be mo e han $5 000 000 excep ha he Sec e a y may a oca e no
sha ensu e he pub c d sc osu e o n o ma on on such nc eases and us fica- 4 MPLEMENTAT ON — A The Sec e a y sha adop ope a ng u es … o - Depa men o HHS may nves ga e he a a s o an Exchange may exam ne 8 L M TAT ON — … he Sec e a y sha nego a e he e mbu semen a es … above … necessa y o ca y ou he p ov s ons o h s sec on … … and other factors determined appropriate by the Secretary. (iv) ANALYSIS. The Secretary shall analyze current methods of establishing tion (a)(1) if the trauma center qualifies for funds under a Low Income Pool or … v con a ns any o he n o ma on he Sec e a y de e m nes wou d be he p u o Sec e a y may equ e v ew es ma es subm ed by p esc p on d ug p ans by p va e p ans w h espec med ca on ev ew o he a ge ed med ca on en o men and wh ch may be p ov ded mo e han $10 000 000 o he coo d na ng cen e
PACKAGE — he e m essen a hea h benefi s package means w h espec the CMI is to test innovative payment and service delivery models to reduce 1932’’ after ‘‘1902(q)(1)(B))’’. 4101 l HHS 4305 HHS 6402 HHS yea s a e he da e o enac men o he E de Jus ce Ac o 2009 he Sec e a y
ons o a hea h nsu ance ssue s ow ng cons de a on o he ope a ng u es deve oped by he non-p ofi en y he p ope es and eco ds o an Exchange and may equ e pe od c epo s n 3001 l HHS 3023 l HHS practice expense geographic adjustments …and evaluate data that fairly 3140 l HHS Safety Net Care Pool established through a waiver … p o o o a he same me as ece v ng pe sona zed p even on p an se v ces 4202 HHS he ave age consume …
USE OF FUNDS Amoun s co ec ed as a esu o he mpos on o a ee unde
o he en o men o h gh cos benefic a es as defined by he Sec e a y and o
w h he egu a ons equ ed o be p omu ga ed pe son- o-pe son o us ng e ehea h echno og es as defined by he Sec e a y
o any hea h p an cove age ha — 1 p ov des o he essen a hea h benefi s
1402 HHS 5001 HHS program expenditures … while preserving or enhancing the quality of care (a) ESTABLISHMENT. (1) The Secretary of HHS ... shall establish a Medicare 4003 l HHS (2) WAIVER. The Secretary may waive all or part of the matching requirement 4 P LOT PROGRAM EVALUAT ON —The Sec e a y sha conduc an annua 4301 HHS 2 MEMBERSH P — A The Comm ee sha be composed o he o ow ng vo ng h s subpa ag aph sha be used by he Sec e a y o p og am n eg y e o s … 4 he en y ag ees o p ov de he Sec e a y and he nspec o Gene a o HHS sha have p ocedu es n p ace o accep he op ona e ec on c subm ss on o
desc bed n pa ag aph 2 and he ecommenda on subm ed by he Na ona e a on o ac v es unde aken by an Exchange … 1331 HHS (B) ADJUSTMENT TO PAYMENTS.— The Secretary shall reduce the base op- 3007 l HHS furnished … In selecting such models, the Secretary shall give preference (3) PAYMENT METHODOLOGY. (A) (i) ESTABLISHMENT OF PAYMENT METH- and reliably establishes distinctions in the costs of operating a medical
3310 l HHS (c) ROLE OF AGENCY. The Director shall provide ongoing administrative, research, 6112 HHS compa e such es ma es w h he numbe s o such benefic a es ac ua y en o ed c n ca da a by ong- e m ca e ac es pu suan o he s anda ds adop ed unde 10411 HHS
1001 HHS Comm ee on V a and Hea h S a s cs … and hav ng ensu ed consu a on w h
defined by he Sec e a y …
STATE FLEX B L TY TO ESTABL SH BAS C HEALTH PROGRAMS FOR LOW- NCOME 2 ADD T ONAL REDUCT ON FOR LOWER NCOME NSUREDS —The Sec e a y REQU REMENT TO MA NTA N M N MUM ESSENT AL COVERAGE e EXEMP- erating DRG payment amount … for a hospital for each discharge in a fiscal (4) IMPLEMENTATION.— (A) PUBLICATION OF MEASURES, DATES OF IMPLE- ODS. The Secretary shall develop payment methods for the pilot program practice in the different fee schedule areas. Hospice Concurrent Care demonstration program at participating hospice 3505 l HHS ... for any fiscal year for the SBHC if the Secretary determines that applying the 4103 HHS eva ua on o he e ec veness o he p o p og am a The Sec e a y ac ng h ough he D ec o o he CDC sha p ov de und ng membe s No mo e han 7 vo ng Fede a ep esen a ves appo n by he Sec-
6002 HHS 3 DURAT ON The Sec e a y sha conduc he demons a on p o ec unde h s
nc ud ng o cove he cos s o conduc ng sc een ng unde h s pa ag aph and o w h such pe o mance s a s cs…as he Sec e a y o he nspec o Gene a may
by such p ans pa ag aph 1
10201 HHS 10328 HHS a The Sec e a y ac ng h ough he D ec o o CDC may 1 enhance and expand
to models that also improve the coordination, quality, and efficiency of health programs under which Medicare beneficiaries are furnished … hospice care (3) REDUCING WASTEFUL DISPENSING OF OUTPATIENT PRESCRIPTION and technical support for the operations of the Task Force … matching requirement to the SBHC would result in serious hardship or an inability F To he ex en p ac cab e he Sec e a y sha encou age he use o n eg a on o esea ch n he a ea o pub c hea h se v ces and sys ems e a y … B ADD T ONAL MEMBERS —The Comm ee sha nc ude add ona ca y ou h s subsec on and sec on 1128J eques … 2 No a e han 180 days a e he da e o enac men he Sec e a y sha
MON TOR NG BY SECRETARY OF PREM UM NCREASES — A Beg nn ng w h p ov de s 1313 HHS ND V DUALS NOT EL G BLE FOR MED CA D a ESTABL SHMENT OF PROGRAM — sha es ab sh p ocedu es unde wh ch he ssue o a qua fied hea h p an o T ONS — … ND V DUALS WHO CANNOT AFFORD COVERAGE — D NDEX- year (beginning with fiscal year 2013) by an amount … The Secretary shall MENTATION, PERFORMANCE PERIOD.—Not later than January 1, 2012, the for entities participating in the pilot program. Such payment methods may (c) ADDITIONAL REQUIREMENTS. The Secretary may not award a grant to a 2 CONSULTAT ON… he Sec e a y sha consu w h he nspec o Gene a o he sec on o a 2-yea pe od b RULE OF CONSTRUCT ON No h ng n h s sec on sha m he au ho y o he n as uc u e o ack he ep dem o ogy o congen a hea d sease and o o gan ze
1302 HHS/Labor wh ch h s sec on app es sha u he educe cos sha ng unde he p an … NG — n he case o p an yea s beg nn ng n any ca enda yea a e 2014 h s
care services ….
3102 l HHS and any other items … from funds otherwise paid … DRUGS IN LONG-TERM CARE FACILITIES. The Secretary shall require PDP
trauma center …unless …it (1) submits to the Secretary a plan satisfac- to carry out the purposes ... w h and coo d na on o H T and may expe men w h he use o pe sona zed 4202 HHS vo ng membe s appo n ed by he Sec e a y as o ows … C NONVOT NG MEM- p omu ga e egu a ons e a ng o app ca ons o and enewa s o a demons a on Sec e a y o mod y o b oaden equ emen s o a med ca on he apy managemen
p an yea s beg nn ng n 2014 he Sec e a y n con unc on w h he S a es …
ESSENT AL HEALTH BENEF TS REQU REMENTS b ESSENT AL HEALTH BEN- F NANC AL NTEGR TY a ACCOUNT NG FOR EXPEND TURES 3 AUD TS —An 1 The Sec e a y sha es ab sh a bas c hea h p og am mee ng he equ emen s make such reductions for all hospitals in the fiscal year involved, regardless Secretary shall publish the following: … (i) INITIAL IMPLEMENTATION.— … include bundled payments and bids from entities for episodes of care. The sponsors of prescription drug plans to utilize specific, uniform dispensing 4003 l HHS echno ogy o a d n he deve opmen o se -managemen sk s and manage- 4302 HHS BERS —The Comm ee sha nc ude such nonvo ng membe s as he Sec e a y Depa men o HHS a ec ed ndus y consume s consume advoca es and o he
6401 HHS 6402 HHS 6502 HHS 6703 HHS p o ec ha p ov de o A a p ocess o pub c no ce and commen a he S a e eve
such n o ma on n o a na ona y- ep esen a ve popu a on-based su ve ance
sha mon o p em um nc eases o hea h nsu ance cove age o e ed h ough 1104 HHS Exchange sha be sub ec o annua aud s by he Sec e a y o h s sec on unde wh ch a S a e may en e n o con ac s o o e 1 o mo e sha be app ed by subs u ng o 8 pe cen he pe cen age he Sec e a y o of whether or not the hospital has been determined by the Secretary to have the Secretary shall begin implementing the payment modifier … for the physi-
3021 l HHS Secretary shall make payments … for services …. (v) REVISION FOR 2012 AND SUBSEQUENT YEARS. … the Secretary shall, techniques, as determined by the Secretary, in consultation with … any
tory to the Secretary that demonstrates a continued commitment to serving b EVALUAT ON AND PLAN FOR COMMUN TY-BASED PREVENT ON AND WELL- n e es ed pa es n o de o ensu e ha he n o ma on made ava ab e o he 6112 HHS A has unpa d ove paymen s as defined by he Sec e a y unde h s e du ng a SECRETAR AL RESPONS B L T ES 1 The Sec e a y sha ensu e ha HHS A
p og am o o s udy new mode s o med ca on he apy managemen sys em ha comp es da a conce n ng ac ua occu ences o congen a hea d sease
an Exchange and ou s de o an Exchange C EXPED TED RULEMAK NG —The Sec e a y sha p omu ga e an n e m fina
EF TS — 2 L M TAT ON — A The Sec e a y sha ensu e ha he scope o he
s anda d hea h p ans p ov d ng a eas he essen a hea h benefi s … o e g b e 1402 HHS HHS de e m nes eflec s he excess o he a e o p em um g ow h be ween earned a value-based incentive payment … cian fee schedule … (ii) INITIAL PERFORMANCE PERIOD.— (I) The Secretary not later than January 1, 2012, make appropriate adjustments … to ensure 3140 l HHS trauma patients regardless of their ability to pay … (d) COORDINATION WITH PREVENTIVE SERVICES TASK FORCE. The Task Force 4101 l HHS men o and adhe ence o p ov de ecommenda ons n o de o mp ove he NESS PROGRAMS FOR MED CARE BENEF C AR ES — 1 The Sec e a y sha a DATA COLLECT ON — 1 The Sec e a y sha ensu e ha by no a e han 2 de e m nes o be app op a e
pub c unde such pa ag aph s p esen ed n he app op a e ove a con ex 4 MPLEMENTAT ON The Sec e a y sha mp emen he demons a on p o ec
E EXPED TED RULEMAK NG The Sec e a y may p omu ga e an n e m fina u e o EVALUAT ONS AND ANNUAL REPORT 1 EVALUAT ONS The Sec e a y sha
such pe od de e m ned by he Sec e a y o he S a e agency o be de nquen
nc ud ng pub c hea ngs su fic en o ensu e a mean ng u eve o pub c npu B o 2 awa d a g an o one e g b e en y o unde ake he desc bed ac v es
essen a hea h benefi s s equa o he scope o benefi s p ov ded unde a yp ca (2) DEADLINE. The Secretary shall ensure that the CMI is carrying out the other stakeholders the Secretary determines appropriate ... when dispensing shall take appropriate steps to coordinate work with the U.S. Preventive Services (i) EVALUATION. The Secretary shall develop and implement a plan for evaluating hea h s a us o benefic a es yea s a e enac men any ede a y conduc ed o suppo ed hea h ca e o ca y ou h s pa ag aph conduc eva ua ons o e g b e en es wh ch he Sec e a y con ac s w h unde he p ov des und ng au ho zed by h s pa … B co ec s and d ssem na es da a equ emen s e a ng o he goa s o he p og am o be mp emen ed o enewed
u e app y ng any s anda d o ope a ng u e ecommended by he Na ona Com- 1313 HHS nd v dua s n eu o o e ng such nd v dua s cove age h ough an Exchange 3 METHODS FOR REDUC NG COST-SHAR NG — B CAP TATED PAYMENTS — he p eced ng ca enda yea and 2013 ove he a e o ncome g ow h o such shall specify an initial performance period for application of the payment modi- 3023 l HHS accurate geographic adjustments across fee schedule areas … (3) SITES. The Secretary shall select not more than 15 hospice programs
covered part D drugs to enrollees who reside in a long-term care facility in
conduc an eva ua on o commun y-based p even on and we ness p og ams unde h s sec on no a e han 1 yea a e he da e o he enac men o h s Ac annua y… C deve ops and d ssem na es n o ma on on bes p ac ces… D con- 10329 HHS
1001 HHS m ee on V a and Hea h S a s cs … The Sec e a y sha accep and cons de
emp oye p an as de e m ned by he Sec e a y …
The Sec e a y may es ab sh a cap a ed paymen sys em o ca y ou he pay- pe od fier … with respect to 2015. (II) PROVISION OF INFORMATION DURING INITIAL
duties … by not later than January 1, 2011. at which the demonstration program … Such hospice programs shall be 3505 l HHS Task Force and the Advisory Committee on Immunization Practices ... SBHCs and monitoring quality performance under the awards made ... and deve op a p an o p omo ng hea hy es y es and ch on c d sease se - pub c hea h p og am ac v y o su vey … co ec s and epo s o he ex en 4305 HHS P og am no ess equen y han eve y 3 yea s he expec ed S a e and Fede a cos s and cove age p o ec ons and he a DEVELOPMENT The Sec e a y n consu a on w h e evan s akeho de s nc ud ng 10411 HHS
F NANC AL NTEGR TY a ACCOUNT NG FOR EXPEND TURES 4 PATTERN OF 3001 l HHS (ii) NO ADDITIONAL PROGRAM EXPENDITURES. Payments … for appli-
located in urban and rural areas.
order to reduce waste associated with 30-day fills.
4103 HHS managemen o Med ca e benefic a es p ac cab e a The Sec e a y may make awa ds o g an s coope a ve ag eemen s and 6002 HHS 6401 HHS 6503 HHS duc s esea ch e a ed o he p ov s on o adu p o ec ve se v ces … E p ov des spec fic p ans o he S a e o ensu e ha he demons a on p o ec w be n comp -
GRANTS N SUPPORT OF PROCESS — 1 PREM UM REV EW GRANTS DUR NG pub c commen s on any n e m fina u e …
1302 HHS ABUSE — he Sec e a y de e m nes ha an Exchange o a S a e has engaged n 1331 HHS men o cos -sha ng educ ons unde h s sec on … (10) PUBLIC REPORTING.— ‘‘(A) HOSPITAL SPECIFIC INFORMATION.— The PERFORMANCE PERIOD.—During the initial performance period, the Secretary
3021 l HHS cable items and services … for applicable beneficiaries for a year shall 3109 l HHS (2) CONSIDERATIONS IN MAKING GRANTS. … (a) SUBSTANTIAL UNCOMPEN-
4004 l HHS 4 CONSULTAT ON The Sec e a y sha consu w h he nspec o Gene a o he 6112 HHS 79 p ov de ha any agen c ea nghouse o o he a e na e payee as defined by echn ca ass s ance o S a es and o he en es hea h nsu ance ssue s hea h ca e consume s emp oye s hea h ca e p ov de s e PAT ENT PR VACY The Sec e a y sha ensu e ha he Congen a Hea D sease
2010 THROUGH 2014 —The Sec e a y sha ca y ou a p og am o awa d g an s 2 CERT F CAT ONS AS TO BENEF T COVERAGE AND COSTS —Such p og am 5001 HHS shall … provide information to physicians and groups of physicians about be established in a manner that does not result in spending more for such (B) ... by inserting ‘‘, except that the Secretary shall not require a pharmacy SATED CARE AWARDS. (1) The Secretary shall establish an award basis for 4102 l HHS H The Sec e a y sha ssue gu dance ha den fies e emen s ha a e con ac s o hea h p o ess ons schoo s hosp ces and o he pub c and p va e 3 PROV S ONAL PER OD OF ENHANCED OVERS GHT FOR NEW PROV DERS OF 6402 HHS ance w h e X X o XX C a p ocess o p ov d ng pub c no ce and commen a e and o he en es de e m ned app op a e by he Sec e a y sha deve op a me hodo - Su ve ance Sys em s ma n a ned n a manne ha comp es w h he egu a ons
ESSENT AL HEALTH BENEF TS REQU REMENTS b ESSENT AL HEALTH BENEF TS se ous m sconduc … he Sec e a y may esc nd om paymen s o he w se due Secretary shall make information available to the public regarding the perfor- (3) CONSULTATION. …the CMI shall consult representatives of relevant Fed- 3140 l HHS 3311 l HHS EDUCATION AND OUTREACH CAMPAIGN REGARDING PREVENTIVE BENEFITS. (a) (a) ESTABLISHMENT. The Secretary, acting through the Director of the CDC and equ ed o be p ov ded o a benefic a y as pa o he fi s v s o pe sona zed 4202 HHS 4302 HHS en es o he deve opmen and mp emen a on o p og ams o p ov de educa- Depa men o HHS on he mp emen a on o h s sec on b REQU REMENTS The Sec e a y sha eva ua e cha ns se ec ed o pa c pa e
SERV CES AND SUPPL ERS A The Sec e a y sha es ab sh p ocedu es…wh ch D The en y ag ees o p ov de he Sec e a y and he nspec o Gene a o HHS w h
he Sec e a y ha subm s c a ms on beha o a hea h ca e p ov de mus eg s e he app ca on s ece ved by he Sec e a y ha s su fic en o ensu e a mean ng u
o S a es … A n ev ew ng and app op a e unde S a e aw app ov ng p e- 1104 HHS 3 NOT CE AND HEAR NG — n defin ng he essen a hea h benefi s … he o such S a e nvo ved unde h s o any o he Ac adm n s e ed by he Sec e a y sha p ov de ha a S a e may no es ab sh a bas c hea h p og am unde h s 1402 HHS B SPEC AL RULES — … The Sec e a y sha p esc be u es o he co ec on mance of individual hospitals under the Program … the quality of care (iii) APPLICATION.—The Secretary shall apply the payment
eral agencies, and clinical and analytical experts with expertise in medicine
entity for such beneficiaries than would otherwise be expended … were not to have submitted to the Secretary such evidence of accreditation prior to (a) The Secretary shall develop and maintain a complaint system, that is
each eligible trauma center for grants …
The Secretary shall provide for the planning and implementation of a national on and a n ng o hea h ca e p o ess ona s n pa n ca e n he demons a on p o ec unde h s sec on based on c e a se ec ed by he w h he S a e and he Sec e a y n a o m and manne spec fied by he Sec e a y 6703 HHS eve o pub c npu D a p ocess o he subm ss on o he Sec e a y o pe od c
ogy o measu e hea h p an va ue Such me hodo ogy sha ake n o cons de a on o H PPA
m um nc eases o hea h nsu ance cove age and B n p ov d ng n o ma on h COMPL ANCE — 1 HEALTH PLAN CERT F CAT ON — A EL G B L TY FOR A sec on un ess he S a e es ab shes o he sa s ac on o he Sec e a y and he 5 SPEC AL RULE FOR PED ATR C DENTAL PLANS — an nd v dua en o s n o he pena y mposed by h s sec on n cases whe e con nuous pe ods nc ude modifier … (I) … with respect to specific physicians and groups of physicians implemented, as estimated by the Secretary. January 1, 2011’’ before the semicolon at the end. (b) INDEPENDENT EVALUATION AND REPORTS. (1) INDEPENDENT EVALUA- in consultation with professional oral health organizations, shall, subject to p even on p an se v ces and es ab shes a yea y schedu e o app op a e A The Sec e a y sha eva ua e commun y p even on and we ness p og ams D any o he demog aph c da a as deemed app op a e by he Sec e a y new p ov de s o med ca o o he ems o se v ces and supp e s as he Sec e a y such pe o mance s a s cs nc ud ng he numbe and amoun o ove paymen s whe e app cab e— 1 he ove a cos o en o ees unde he p an 2 he qua y o
Sec e a y sha p ov de no ce and an oppo un y o pub c commen an amoun … and health care management. The CMI shall use open door forums or other widely known and easy to use, to collect and maintain information on MA– public–private partnership for a prevention and health promotion outreach and the availability of appropriations, establish a 5-year national, public education p ov s on o such e emen s he ea e ega d ng hea h d spa es 6002 HHS Sec e a y
de e m nes app op a e…wou d be sub ec o enhanced ove s gh … B MPLE- ecove ed he numbe o aud e e a s and he e u n on nves men o such 1 ESTABL SHMENT The e s es ab shed an adu p o ec ve se v ces g an p og am epo s by he S a e conce n ng mp emen a on and E a p ocess o he pe od c
and ecommenda ons o he Sec e a y … HEALTH PLAN HEALTH CLA M STATUS ELECTRON C FUNDS TRANSFERS HEALTH Sec e a y ce fies ha — A n he case o an e g b e nd v dua en o ed n a bo h a qua fied hea h p an and a p an desc bed n sec on 1311 d 2 B mon hs n mo e han 1 axab e yea
3001 l HHS the Secretary determines appropriate … TION. The Secretary shall provide for the conduct of an independent evalua-
PD plan and prescription drug plan complaints that are received … by the 3505 l HHS nc ud ng hose ha educe he sk o d sease d sab y and n u y by mak-
e 1 APPL CABLE GROUP PURCHAS NG ORGAN ZAT ON The e m app cab e g oup 6504 HHS unde wh ch he Sec e a y sha annua y awa d g an s o S a es n he amoun s
he ca e p ov ded o unde he p an 3 he e fic ency o he p an n p ov d ng ca e 10411 HHS
CARE PAYMENT AND REM TTANCE ADV CE —No a e han Decembe 31 2013 a s anda d hea h p an o e ed h ough he p og am he S a e p ov des … o any p an yea subsec on a sha no app y o ha po on o any educ on
mechanisms to seek input from interested parties.
3023 l HHS 3109 l HHS tion of the demonstration program … (c) EMERGENCY AWARDS. In awarding grants … the Secretary shall (1) give
education campaign to raise public awareness of health improvement across the campaign ... ng hea hy es y e cho ces nc ud ng exe c se d e and se -managemen o 4305 HHS MENTAT ON The Sec e a y may es ab sh by p og am ns uc on o o he w se he ac v es by he en y as he Sec e a y o he nspec o Gene a may eques eva ua on by he Sec e a y 4 he e a ve sk o he p an s en o ees as compa ed o o he p ans 5 he ac ua a
1302 HHS 1313 HHS (11) IMPLEMENTATION.— ‘‘(A) APPEALS.—The Secretary shall establish Secretary … through the date on which the complaint is resolved. life span ... 4105 HHS 4302 HHS c EVALUAT ON OF PROGRAMS —The Sec e a y sha … p ov de o he eva u- pu chas ng o gan za on means a g oup pu chas ng o gan za on as defined by he 6112 HHS p ocedu es unde h s pa ag aph a Sec on 1903 1 F o he Soc a Secu y Ac 42 U S C 1396b 1 F s ca cu a ed unde pa ag aph 2 2 subm o he Sec e a y an app ca on a such me n such manne and
1001 HHS hea h p an sha fi e a s a emen w h he Sec e a y n such o m as he Sec e a y n cos -sha ng unde subsec on c ha unde egu a ons p esc bed by he 5001 HHS a process by which hospitals may appeal the calculation of a hospital’s 3007 l HHS (B) INCLUSION OF CERTAIN SERVICES. A payment methodology tested under (II) the Secretary may apply to such pharmacies an alternative accreditation preference to … ch on c d seases
Sec e a y ha pu chases a anges o o nego a es he pu chase o a cove ed c RESPONS B L T ES An ndependen mon o ha en e s n o a con ac w h he amended by nse ng a e necessa y he o ow ng and nc ud ng o da a
va ue o o he compa a ve measu e o he benefi s cove ed unde he p an and 6 con a n ng such n o ma on as he Sec e a y may equ e
ESSENT AL HEALTH BENEF TS REQU REMENTS b ESSENT AL HEALTH BENEF TS F NANC AL NTEGR TY a ACCOUNT NG FOR EXPEND TURES 5 PROTECT ONS 3021 l HHS 3140 l HHS 4102 l HHS n AUTHOR TY TO MOD FY OR EL M NATE COVERAGE OF CERTA N PREVENT VE 2 COLLECT ON STANDARDS — n co ec ng da a he Sec e a y o des gnee a on o p og ams mp emen ed … n o de o de e m ne he e ec o such 6402 HHS 10202 Treasury o he ac o s de e m ned e evan by he Sec e a y
ALLOCAT ON —The Sec e a y sha es ab sh a o mu a o de e m n ng he may equ e ce y ng ha he da a and n o ma on sys ems o such p an a e n AGA NST FRAUD AND ABUSE — … he Sec e a y sha p ov de o he e fic en 1331 HHS Sec e a y s p ope y a ocab e o ped a c den a benefi s … 5 HARDSH PS —Any app cab e nd v dua who o any mon h s de e m ned performance assessment with respect to the performance standards … (C) BUDGET NEUTRALITY.—The payment modifier established under this the pilot program shall include payment for the furnishing of applicable requirement established by the Secretary if the Secretary determines such 3311 l HHS 4004 l HHS d ug dev ce b o og ca o med ca supp y Sec e a y o pa c pa e n he conduc o he demons a on p o ec unde h s sec- subm ed o he Sec e a y on o a e Janua y 1 2010 da a e emen s om 6703 HHS
amoun o any g an o a S a e comp ance w h any app cab e s anda ds … and assoc a ed ope a ng u es … 4 REQU RED ELEMENTS FOR CONS DERAT ON — n defin ng he essen a hea h
and non-d sc m na o y adm n s a on o Exchange ac v es and mp emen d TRANSFER OF FUNDS TO STATES 1 — he Sec e a y de e m nes ha a by he Sec e a y o HHS unde sec on 1311 d 4 H o have su e ed a ha dsh p The Secretary shall ensure that such process provides for resolution of such subsection shall be implemented in a budget neutral manner. (5) TESTING WITHIN CERTAIN GEOGRAPHIC AREAS. For purposes of testing
services and other appropriate services, such as care coordination, medica- alternative accreditation requirement is more appropriate for such pharma- (c) BUDGET NEUTRALITY. With respect to the 3-year period of the demonstra- 3505 l HHS (b) REQUIREMENTS. In establishing the campaign, the Secretary shall (1) ensure SERV CES E ec ve Janua y 1 2010 he Sec e a y de e m nes app op - 4202 HHS sha p og ams on know edge and p ac ce o pa n ca e
on sha …
6401 HHS 4 EVALUAT ONS The Sec e a y sha conduc eva ua ons o e g b e en es
he au oma ed da a sys em ha he Sec e a y de e m nes o be necessa y o
b BALANC NG NCENT VE PAYMENT STATE A ba anc ng ncen ve paymen S a e s
10413 HHS
payment and service delivery models … the Secretary may elect to limit (b) MODEL ELECTRONIC COMPLAINT FORM. The Secretary shall develop a (b) CONSULTATION. In coordinating the campaign ... the Secretary shall consult B GUARANTEED M N MUM PAYMENT AMOUNT … he Sec e a y sha nc ease a S a e 1 n wh ch ess han 50 pe cen o he o a expend u es unde he S a e
o e ec on c unds ans e s e g b y o a hea h p an hea h c a m s a us and benefi s he Sec e a y sha — A ensu e ha such essen a hea h benefi s
any measu e o p ocedu e ha — A he Sec e a y de e m nes s app op a e S a e e ec ng he app ca on o h s sec on mee s he equ emen s o he p o- 1402 HHS/Treasury w h espec o he capab y o ob a n cove age unde a qua fied hea h p an appeals in a timely manner. tion reconciliation, discharge planning, transitional care services, and other cies. tion program … the Secretary shall ensure that the aggregate expenditures
model electronic complaint form to be used for reporting plan complaints … (a) MAINTENANCE OF FINANCIAL SUPPORT. The Secretary may require a that activities are targeted towards specific populations such as children, a e he Sec e a y may 1 mod y A he cove age o any p even ve se v ce o EV DENCE REV EW —The Sec e a y sha ev ew ava ab e ev dence e a u e
6003 HHS
4 90-DAY PER OD OF ENHANCED OVERS GHT FOR N T AL CLA MS OF DME SUP- wh ch he Sec e a y con ac s w h unde he P og am no ess equen y han
p og am n eg y p og am ove s gh and adm n s a on a such equency as such de e m ned amoun so ha he o a amoun pa d unde h s subsec on o he
10330 HHS a PUBL C EDUCAT ON CAMPA GN 1 The Sec e a y ac ng h ough he D ec o
1101 HHS hea h ca e paymen and em ance adv ce espec ve y eflec an app op a e ba ance among he ca ego es desc bed … B no
g am he Sec e a y sha ans e o he S a e o each fisca yea … e RULES FOR ND V DUALS NOT LAWFULLY PRESENT — 3 SECRETAR AL AU- 3007 l HHS testing of a model to certain geographic areas.
patient-centered activities as determined appropriate by the Secretary. … for such period shall not exceed the aggregate expenditures that would trauma center receiving a grant …to maintain access to trauma services at
with the IOM to provide ongoing advice on evidence-based scientific information pregnant women, ... (2) utilize science-based strategies to convey oral health he ex en ha such mod fica on s cons s en w h he ecommenda ons o he bes p ac ces and esou ces ha a e e evan o p og ams ha p omo e hea hy 4302 HHS 4402 HHS PL ERS As added by sec on 1304 o HCERA … he Sec e a y de e m nes ha eve y 3 yea s Med ca d p og am o a fisca yea o ong- e m se v ces and suppo s as defined by a The Sec e a y sha deve op a p an and de a ed budge o he esou ces needed
make cove age dec s ons de e m ne e mbu semen a es es ab sh ncen ve o educe aud and abuse … and B he Sec e a y has au ho y o mp emen for policy, program development, and evaluation. prevention messages … U S P even ve Se v ces Task Fo ce and B he se v ces nc uded n he n a To de e m ne whe he ex s ng Fede a hea h and we ness n a ves a e e ec- a Sec on 1877 b 2 o he Soc a Secu y Ac 42 U S C 1395nn b 2 s amended 6112 HHS he e s a s gn fican sk o audu en ac v y… he Sec e a y sha no w hs and ng
he Sec e a y sha de e m ne S a e o he yea s equa o 0 75 pe cen o he amoun so app op a ed he Sec e a y a e o non- ns u ona y based ong- e m se v ces and suppo s o CDC sha conduc a na ona ev dence-based educa on campa gn o nc ease
No a e han 90 days a e he da e o enac men o h s Ac he Sec e a y sha unde h s e o any o he Ac THOR TY —The Sec e a y n consu a on w h he Sec e a y o he T easu y sha 5001 HHS 3001 l HHS (5) SYSTEMS-BASED CARE.—The Secretary shall … apply the payment 3109 l HHS have been expended … if the demonstration program … had not been
3312 l HHS comparable levels to the prior year during the grant period. es y es and educe sk ac o s o he Med ca e popu a on The Sec e a y may 3 DATA MANAGEMENT — n co ec ng da a he Sec e a y ac ng h ough he
by add ng… Such equ emen s sha w h espec o magne c esonance e COST OF APPO NTMENT…The cha n sha pay such po on o he Sec e a y n
o mp emen such p an o mode n ze he compu e and da a sys ems o CMS awa eness o young women s know edge ega d ng
1104 HHS p og ams o des gn benefi s … C ake n o accoun he hea h ca e needs o
1331 HHS p esc be u es se ng o h he me hods by wh ch ca cu a ons o am y s ze and M N MUM ESSENT AL COVERAGE — … E OTHER COVERAGE —Such o he modifier … in a manner that promotes systems-based care. 3021 l HHS 3023 l HHS implemented. p even ve phys ca exam na on and 2 p ov de ha no paymen sha be de e m ne he scope o he ev dence ev ew and such ssues o be cons de ed Na ona Coo d na o o H T sha — A deve op na ona s anda ds o he man- ve n ach ev ng he s a ed goa s he Sec e a y o HHS sha — sec ons 1816 c 1842 c and 1869 a 2 w hho d paymen unde such e w h 6403 HHS 2 ha subm s an app ca on and mee s he cond ons and 3 ha s se ec ed by
es ab sh a empo a y h gh sk hea h nsu ance poo p og am … d ve se segmen s o he popu a on … D ensu e ha hea h benefi s es ab shed (12) PROMULGATION OF REGULATIONS.—The Secretary shall promulgate (b) TESTING OF MODELS (PHASE I). (1) The CMI shall test payment and
(ii) PHARMACIES DESCRIBED. A pharmacy … meets each of the following (i) ...use a single, uniform exceptions and appeals process (including, to the 4004 l HHS 4102 l HHS made unde h s e o a p even ve se v ce ha has no ece ved a g ade o mag ng compu ed omog aphy pos on em ss on omog aphy and any o he an amoun and n acco dance w h p ocedu es es ab shed by he Sec e a y espec o du ab e med ca equ pmen u n shed by such supp e … 6504 HHS 6703 HHS he Sec e a y o pa c pa e n he S a e ba anc ng ncen ve paymen p og am
2 DOCUMENTAT ON OF COMPL ANCE —A hea h p an sha p ov de he Sec e- 1321 HHS 3 AMOUNT OF PAYMENT — A SECRETAR AL DETERM NAT ON — The amoun househo d ncome … hea h benefi s cove age such as a S a e hea h benefi s sk poo as he Sec- regulations to carry out the Program … used to determine the amount of (C) BUNDLED PAYMENTS. (i) A bundled payment under the pilot program criteria: (I) The total billings by the pharmacy … are less than 5 percent of extent the Secretary determines feasible, a single, uniform model form for 3505 l HHS agemen o da a co ec ed and B deve op n e ope ab y and secu y sys ems
des gna ed hea h se v ces spec fied unde subsec on h 6 D ha he Sec e a y
a The Sec e a y sha ma n a n a na ona hea h ca e aud and abuse da a co -
b MANAGED CARE ORGAN ZAT ONS 1 Sec on 1903 m 2 A x o he Soc a C PRO RATA REDUCT ONS The Sec e a y sha make such p o a a educ ons o
10330 HHS 10413 HHS
as essen a no be sub ec o den a o nd v dua s aga ns he w shes … E service delivery models … to determine the effect … program expenditures (c) MEDIA CAMPAIGN. (1) Not later than 1 year after the date of enactment of A B C o by such Task Fo ce
1101 HHS a y n such o m as he Sec e a y may equ e w h adequa e documen a on o de e m ned o any fisca yea s he amoun he Sec e a y de e m nes s equa o e a y o HHS n coo d na on w h he Sec e a y ecogn zes o pu poses o h s value-based incentive payments … 3007 l HHS shall (I) be comprehensive, covering the costs of applicable services and total pharmacy sales, as determined based on the average total pharmacy 3141 l HHS (b) TRAUMA CARE REGISTRY. The Secretary may require the trauma center (c) PLANNING AND IMPLEMENTATION. Not later than 2 years after the date of 4202 HHS o da a managemen
de e m nes app op a e… 6112 HHS
ec on p og am unde h s sec on o he epo ng o ce a n fina adve se ac ons
Secu y Ac 42 U S C 1396b m 2 A x s amended by nse ng and o he b CONS DERAT ONS n deve op ng he p an he Sec e a y sha cons de how such 3 MED A CAMPA GN n conduc ng he educa on campa gn he Sec e a y sha
p ov de ha a qua fied hea h p an sha no be ea ed as p ov d ng cove age o STATE FLEX B L TY N OPERAT ON AND ENFORCEMENT OF EXCHANGES AND RE- …and the quality of care …. use under such process) with respect to the determination of prescription this Act, the Secretary, acting through the Director of the CDC, shall establish and enactment of this section, the Secretary shall begin implementing the 5-year 6401 HHS no nc ud ng se emen s n wh ch no find ngs o ab y have been made aga ns he amoun s desc bed n subpa ag aph A as a e necessa y o comp y w h he 10202 HHS
ADM N STRAT ON — 1 The Sec e a y may ca y ou he p og am unde h s comp ance w h he s anda ds and ope a ng u es … A hea h p an sha no be
he essen a hea h benefi s LATEDREQU REMENTS a ESTABL SHMENT OF STANDARDS — 1 The Sec e a y 85 pe cen o he p em um ax c ed s … ha wou d have been p ov ded o he 1411 HHS/Treasury subsec on (6) CONSIDERATION OF SPECIAL CIRCUMSTANCES OF CERTAIN PROVID- other appropriate services furnished to an individual during an episode of sales for the previous 3 calendar years, 3 fiscal years, or other yearly period In the case of discharges occurring on or after October 1, 2010 … the Sec-
drug coverage for an enrollee under the plan … receiving a grant … to provide data to a national and centralized registry NDEPENDENT EVALUAT ON OF EV DENCE-BASED COMMUN TY PREVENT ON
WA VER AUTHOR TY The Sec e a y may wa ve such equ emen s o es XV p ov s on o such da a o he S a e a a equency and eve o de a o be spec fied equ emen s o subpa ag aph B
mode n zed compu e sys em cou d awa d g an s o en es o es ab sh na ona mu med a campa gns o en ed o young
cons de ed o have p ov ded adequa e documen a on and sha no be ce - fisca yea o e g b e nd v dua s en o ed n s anda d hea h p ans … PROCEDURES FOR DETERM N NG EL G B L TY FOR EXCHANGE PART C PAT ON ERS.— … the Secretary shall … take into account the special circum- care (as determined by the Secretary); and (II) be made to the entity which is specified by the Secretary … (III) The pharmacy submits to the Secretary an retary … shall administer … in the same manner as … through a uniform, of trauma cases, in accordance with guidelines developed by the American
implement a national science-based media campaign on health promotion and campaign … 4107 HHS AND WELLNESS PROGRAMS — The Adm n s a o o CMS n consu a on w h 4302 HHS 5 NCREASED D SCLOSURE REQU REMENTS A D SCLOSURE A p ov de o med - hea h ca e p ov de s supp e s o p ac one s as equ ed by subsec on b w h c COND T ONS The cond ons a e he o ow ng 1 APPL CAT ON The S a e sub-
sec on d ec y o h ough con ac s o e g b e en es sha … ssue egu a ons se ng s anda ds … o— A he es ab shmen and 3001 l HHS 3021 l HHS disease prevention. B by any o he hea h ca e p o ess ona who s ega y au ho zed o u n sh 6004 HHS and X X o he Soc a Secu y Ac ca o o he ems o se v ces o supp e …sha d sc ose n a o m and manne and access as se o h n subsec on d and sha u n sh he n o ma on co ec ed
by he Sec e a y a e pa en s m s an app ca on o he Sec e a y ha nc udes n add on o such o he n o ma on women ha may nc ude adve s ng h ough e ev s on ad o p n med a b boa ds
fied as be ng n comp ance w h such s anda ds un ess he hea h p an— A ope a on o Exchanges nc ud ng SHOP Exchanges B he o e ng o qua fied PREM UM TAX CRED TS AND REDUCED COST-SHAR NG AND ND V DUAL RE- 1502 HHS stances of physicians or groups of physicians in rural areas and other participating in the pilot program. attestation, in a form and manner, and at a time, specified by the Secretary, national adjustment to the area wage index …
3401 l HHS College of Surgeons, and as the Secretary may otherwise require. he Ass s an Sec e a y o Ag ng sha o he ex en eas b e and p ac cab e c DATA REPORT NG AND D SSEM NAT ON — 1 The Sec e a y sha make he
6703 HHS 10331 HHS pos e s a o ms o ex s ng and espec a y eme g ng soc a ne wo k ng med a o he
demons a es o he Sec e a y ha he p an conduc s he e ec on c ansac ons 1302 HHS (2) AMENDMENTS FOR REPORTING OF HOSPITAL QUALITY INFORMATION.— (2) SELECTION OF MODELS TO BE TESTED. (A) The Secretary shall select 4102 l HHS such se v ces unde S a e aw … o he S a e n wh ch he se v ces a e u n shed conduc an eva ua on o ex s ng commun y p even on and we ness p og ams ana yses ava ab e o … o he en es as de e m ned app op a e by he
a No a e han Ap 1 o each yea beg nn ng w h 2012 each manu ac u e and a such me as de e m ned by he Sec e a y any cu en o p ev ous a fi a on d - unde h s sec on o he Na ona P ac one Da a Bank … as he Sec e a y sha equ e
1101 HHS ESSENT AL HEALTH BENEF TS REQU REMENTS b ESSENT AL HEALTH BENEF TS hea h p ans h ough such Exchanges C he es ab shmen o he e nsu ance 1331 HHS SPONS B L TY EXEMPT ONS a ESTABL SHMENT OF PROGRAM —The Sec e a y REPORT NG OF HEALTH NSURANCE COVERAGE a Eve y pe son who p ov des … The Secretary may require hospitals to submit data on measures that are underserved communities.
models to be tested from models where the Secretary determines that there
that the pharmacy meets the criteria described … (IV) The pharmacy agrees
(II) The productivity adjustment … with respect to a percentage, factor, or 4004 l HHS and s au ho zed o ece ve paymen o o he se v ces unde h s e o s au ho zed d s bu o o eco d o an app cab e d ug sha subm o he Sec e a y 6112 HHS ec y o nd ec y w h a p ov de o med ca o o he ems o se v ces o supp e 6506 HHS c STATE DEMONSTRAT ON PROGRAMS 1 ESTABL SHMENT The Sec e a y sha
a 1 DEVELOPMENT No a e han Janua y 1 2011 he Sec e a y sha deve op a n e ne med a and any o he med um de e m ned app op a e by he Sec e a y
spec fied n pa ag aph 1 n a manne ha u y comp es w h he egu a ons and sk ad us men p og ams unde pa V and D such o he equ emen s as SPEC F C REQU REMENTS —The Sec e a y sha make he de e m na on on sha es ab sh a p og am o de e m n ng— 1 whe he an nd v dua … who s m n mum essen a cove age o an nd v dua du ng a ca enda yea sha a such not used for the determination of value-based incentive payments … 3023 l HHS to submit materials as requested by the Secretary, or during the course of 3201 l HHS 3505 l HHS RESEARCH-BASED DENTAL CARIES DISEASE MANAGEMENT. (a) The Secretary, ha a e sponso ed by he Adm n s a on on Ag ng o assess he ex en o wh ch Sec e a y
n a o m and manne spec fied by he Sec e a y he o ow ng n o ma on w h b CORRECT VE ACT ON —The Sec e a y sha p omu ga e egu a ons ha equ e Phys c an Compa e webs e w h n o ma on on phys c ans en o ed n Med ca e
EL G BLE ENT T ES —To be e g b e o a con ac … an en y sha … B subm
o he Sec e a y and B p ov des documen a on show ng ha he p an has 4 REQU RED ELEMENTS FOR CONS DERAT ON H pe od ca y upda e he es-
3007 l HHS is evidence that the model addresses a defined population for which there an audit conducted on a random sample of pharmacies selected annually, to (C) PERIODIC RANKING. … (i) in 1 of the 50 States or the District
update for a fiscal year, year, cost reporting period, or other annual period, is (3) EVALUATION. The Secretary shall ensure that the campaign ... is subject to an acting through the Director of the CDC, shall award demonstration grants to des gna ed by he Sec e a y o h s pu pose Med ca e benefic a es who pa c pa e n such p og ams 1 EVALUAT ON The Sec e a y n consu a on w h he nspec o Gene a o he ha has unco ec ed deb has been o s sub ec o a paymen suspens on unde a 6403 HHS awa d g an s o S a es o he pu poses o conduc ng demons a on p og ams n 10202 HHS and o he e g b e p o ess ona s who pa c pa e n he Phys c an Qua y Repo ng
o he Sec e a y an app ca on a such me n such manne and con a n ng such sen a hea h benefi s o add ess any gaps n access o cove age o changes n he Sec e a y de e m nes app op a e … a pe en o ee bas s and sha ake n o accoun a e evan ac o s necessa y o o be cove ed n he nd v dua ma ke by a qua fied hea h p an o e ed h ough me as he Sec e a y may p esc be make a e u n …
are deficits in care leading to poor clinical outcomes or potentially avoid-
(D) PAYMENT FOR POST-ACUTE CARE SERVICES AFTER THE EPISODE OF a productivity adjustment equal to the 10-year moving average of changes in (a) APPLICATION. The Secretary may not award a grant to a trauma center …
independent evaluation every 2 years and shall report every 2 years to Congress espec o he p eced ng yea … Depa men o HHS sha eva ua e he demons a on p o ec conduc ed unde h s Fede a hea h ca e p og am… S a es o co ec Fede a y den fied c a ms ove paymen s… acco dance w h pa ag aph 2 6 DATA COLLECT ON The S a e ag ees o co ec om p ov de s he o ow ng da a 10413 HHS
n o ma on as he Sec e a y may equ e …
comp e ed end- o-end es ng o such ansac ons w h he pa ne s such as
he ev dence base he Sec e a y den fies n he ev ew de e m ne he va ue o he p em um ax c ed s and cos -sha ng educ ons … an Exchange o who s c a m ng a p em um ax c ed o educed cos -sha ng
3001 l HHS (7) APPLICATION.— … On or after January 1, 2017, the Secretary may CARE. The Secretary shall establish procedures, in the case where an ap- verify that the pharmacy meets the criteria … Materials submitted … shall of Columbia, the Secretary shall rank such area in each year … based upon
annual economy-wide private nonfarm business multi-factor productivity (as unless such center submits an application for the grant to the Secretary and eligible entities to demonstrate the effectiveness of research-based dental caries 4302 HHS sec on
2 FEES FOR D SCLOSURE The Sec e a y may es ab sh o app ove easonab e ees n a ve 4 ADV SORY COMM TTEE A ESTABL SHMENT No a e han 60 days a e he
hosp a s and phys c ans
1321 HHS mee s he equ emen s … 1502 HHS apply this subsection to eligible professionals as the Secretary determines
able expenditures. The Secretary shall focus on models expected to reduce
plicable beneficiary requires continued post-acute care services after the last include a certification by an accountant … or the submission of tax returns the level of the amount … for such areas; or (ii) in a territory, the Secretary the application is in such form, is made in such manner, and contains such
on the effectiveness of such campaigns towards meeting science-based metrics. disease management activities. 4107 HHS 4202 HHS 2 REPORT NG OF DATA —The Sec e a y sha epo da a and ana yses o he d sc osu e o n o ma on unde h s sec on The amoun o such a ee may A SERV CES DATA Se v ces da a om p ov de s o non- ns u ona y-based ong-
(VIII) … the Secretary shall provide for such risk adjustment as the Secretary program costs … while preserving or enhancing the quality of care received projected by the Secretary for the 10-year period ending with the applicable 2 Such e m s m ed o A se v ces ecommended w h espec o p egnan 6004 HHS 6401 HHS no exceed he cos s o p ocess ng he eques s o d sc osu e and o p ov d ng such 6507 HHS 6703 HHS e m se v ces and suppo s on a pe -benefic a y bas s and n acco dance w h such da e o he enac men o h s sec on he Sec e a y ac ng h ough he D ec o o
1101 Treasury STATE FLEX B L TY N OPERAT ON AND ENFORCEMENT OF EXCHANGES AND RE- 1331 HHS b FORM AND MANNER OF RETURN — 1 A e u n s desc bed n h s subsec- appropriate. day of the episode of care, under which payment for such services shall be filed … as requested by the Secretary. shall rank such areas in each such year based upon the level of the amount agreements, assurances, and information as the Secretary determines to be 4 FUND NG — The Sec e a y sha p ov de o he ans e om he Fede a h ough— A pub c pos ngs on webs es o HHS and B any o he epo ng
6113 HHS 10331 HHS CDDDC sha es ab sh an adv so y comm ee o ass s n c ea ng and conduc -
1104 HHS 1302 HHS 1411 HHS on such e u n— A s n such o m as he Sec e a y may p esc be …
determines to be appropriate to maintain incentives for hospitals to treat by individuals receiving benefits …
made. … for such area relative to quartile rankings ….
fiscal year, year, cost reporting period, or other annual period).
necessary to carry out this part. 4004 l HHS 4102 l HHS women n “T ea ng Tobacco Use and Dependence 2008 Upda e A C n ca Hosp a nsu ance T us Fund and he Fede a Supp emen a Med ca nsu ance o d ssem na on mechan sms de e m ned app op a e by he Sec e a y
… B any o he ca ego y o n o ma on de e m ned app op a e by he Sec e a y 5 B AUTHOR TY TO DENY ENROLLMENT he Sec e a y de e m nes ha such n o ma on Such ees sha be ava ab e o he Sec e a y o cove such cos s … v e ec ve o c a ms fi ed on o a e Oc obe 1 2010 nco po a e compa - 3 APPL CAT ON … a S a e sha subm an app ca on o he Sec e a y a such s anda d zed cod ng p ocedu es as he S a e sha es ab sh n consu a on w h he
2 PLAN No a e han Janua y 1 2013 and w h espec o epo ng pe ods ha
REQU REMENTS — A qua fied h gh sk poo mee s he equ emen s o h s ESSENT AL HEALTH BENEF TS REQU REMENTS c REQU REMENTS RELAT NG TO LATEDREQU REMENTS b STATE ACT ON —Each S a e ha e ec s a such me B CORRECT ONS —The Sec e a y sha ad us he paymen o any fisca yea o patients with severe illnesses or conditions. … h NOT F CAT ON OF FAC L TY CLOSURE 1 A n he case o a ac y whe e b e me hodo og es o he Na ona Co ec Cod ng n a ve adm n s e ed by he me n such manne and con a n ng such n o ma on as he Sec e a y may Sec e a y B QUAL TY DATA Qua y da a on a se ec ed se o co e qua y measu es ng he educa on campa gns B MEMBERSH P The Sec e a y ac ng h ough
4 CERT F CAT ON BY OUTS DE ENT TY —The Sec e a y may des gna e ndepen- 3109 l HHS (d) WEBSITE. The Secretary … shall maintain or enter into a contract to maintain (2) ... submit to the Secretary an application at such time, in such manner, and P ac ce Gu de ne ” pub shed by he Pub c Hea h Se v ce n May 2008 o any T us Fund n such p opo on as he Sec e a y de e m nes app op a e o p ev ous a fi a on poses an undue sk o aud was e o abuse he Sec e a y may
pa ag aph such poo — B p ov des hea h nsu ance cove age — … he Sec- COST-SHAR NG — 4 PREM UM ADJUSTMENT PERCENTAGE — … he p em um and n such manne as he Sec e a y may p esc be o app y he equ emen s eflec any e o … b NFORMAT ON REQU RED TO BE PROV DED BY APPL CANTS — 2 C T ZEN- 3007 l HHS 3021 l HHS 3401 l HHS 6005 HHS he Sec e a y e m na es he ac y s pa c pa on unde h s e no a e han he Sec e a y…and such o he me hodo og es o ha n a ve…as he Sec e a y equ e ag eed upon by he Sec e a y and he S a e ha a e nked o popu a on-spec fic ou -
beg n no ea e han Janua y 1 2012 he Sec e a y sha a so mp emen a p an o he D ec o o CDC sha appo n o he adv so y comm ee such membe s as
den ou s de en es o ce y ha a hea h p an has comp ed w h he equ e- … 1 he es ab shed ede a s anda ds o 2 a S a e aw o egu a on ha he SH P OR MM GRAT ON STATUS —The o ow ng n o ma on sha be p ov ded 1502 HHS (8) DEFINITIONS.—For purposes of this subsection: (A) COSTS.—The term 3023 l HHS (b) ADMINISTRATION. Notwithstanding any other provision of law, the Sec- 3201 l HHS 3505 l HHS a website to provide science-based information on guidelines for nutrition, regu- containing such information as the Secretary may require. subsequen mod fica on o such Gu de ne and B such o he se v ces ha he $50 000 000 o he CMS P og am Managemen Accoun … 4302 HHS deny such app ca on 6403 HHS mak ng pub c y ava ab e h ough Phys c an Compa e n o ma on on Med ca e deemed necessa y o p ope y adv se he Sec e a y and sha nc ude o gan za ons
e a y may mod y such m necessa y o ensu e he poo mee s he ac ua a
men s unde h s subsec on p ov ded ha he ce fica on s anda ds emp oyed ad us men pe cen age o any ca enda yea s he pe cen age any by wh ch
w h espec o eve y en o ee B … he en o ee s soc a secu y numbe
3001 l HHS (C) ADDITIONAL FACTORS FOR CONSIDERATION. In selecting models for test- retary may implement the amendments made … by program instruction or (o) APPLICABLE PERCENTAGE QUALITY INCREASES. (1) … Subject to the
(ii) ADJUSTMENT. For FY 2012 and each subsequent fiscal year, after lar exercise, obesity reduction, smoking cessation, and specific chronic disease Sec e a y ecogn zes o be e ec ve o cessa on o obacco use by p egnan 3 AVA LAB L TY OF DATA —The Sec e a y may make da a ava ab e o
a PROV S ON OF NFORMAT ON 2 a qua fied hea h benefi s p an o e ed da e ha he Sec e a y de e m nes app op a e … APPROPR ATE COORD NAT ON n mp emen ng h s sec on he Sec e a y sha
den fies … comes measu es and access b e o p ov de s C OUTCOMES MEASURES Ou comes
phys c an pe o mance ha p ov des compa ab e n o ma on o he pub c on qua y
va ue m unde c ause he ave age pe cap a p em um o hea h nsu ance cove age n he U S o he Sec e a y de e m nes mp emen s he s anda ds w h n he S a e 1331 HHS 2 NFORMAT ON RELAT NG TO EMPLOYER-PROV DED COVERAGE — … C he (IX)(aa) … each measure specified by the Secretary under this clause shall ‘costs’ means expenditures per individual as determined appropriate by the
ing…, the CMI may consider the following additional factors...
(4) QUALITY MEASURES. (A) The Secretary shall establish quality measures determining the percentage described … , the Secretary shall reduce such (b) LIMITATION ON DURATION OF SUPPORT. The period during which a
prevention. women h ough an exchange…sha p ov de he n o ma on desc bed n subsec on b 6401 HHS 6703 HHS measu es da a on a se ec ed se o co e popu a on-spec fic ou comes measu es and nd v dua s w h expe se n b eas cance d sease p even on ea y de ec on
by such en es a e n acco dance w h any s anda ds o ope a ng u es ssued
SECRETAR AL OVERS GHT —The Sec e a y sha each yea conduc a ev ew app cab e and such den y ng n o ma on w h espec o he en o ee s mm - hea h nsu ance cove age s a qua fied hea h p an n he sma g oup ma ke o - Secretary. … (B) PERFORMANCE PERIOD.—The term “performance period” (including quality measures of process, outcome, and structure) related to otherwise. succeeding paragraphs, in the case of a qualifying plan … beginning with trauma center receives payments under a grant … shall be for 3 fiscal years, 4102 l HHS 4204 HHS add ona esea ch ana yses and d ssem na on o o he Fede a agenc es non- p ov de o he max mum app op a e coo d na on w h pa B o he Hea h Ca e
6507 HHS and pa en expe ence measu es d agnos s pub c hea h soc a ma ke ng gene c sc een ng and counse ng ea -
by he Sec e a y p eced ng ca enda yea as es ma ed by he Sec e a y no a e han Oc obe 1
g a on s a us as he Sec e a y a e consu a on w h he Sec e a y o Home and
be endorsed by the entity with a contract …
2012, the applicable percentage … shall be increased on a plan or contract
percentage by the productivity adjustment … The application … may result
(d) USE OF INFORMATION. The Secretary shall utilize information generated from AUTHOR TY TO PURCHASE RECOMMENDED VACC NES FOR ADULTS — 1 The gove nmen a en es and he pub c n acco dance w h any Fede a agency s
o he Sec e a y and n he case o a PBM o he p an w h wh ch he PBM s un- 6113 HHS A … he Sec e a y may make any necessa y ad us men s o paymen s o he ap- Qua y mp ovemen Ac o 1986 … 4 STATE REPORTS Each S a e ha ece ves unds unde h s subsec on sha ag eed upon by he Sec e a y and he S a e ha a e access b e o p ov de s
1101 HHS o such p eced ng ca enda yea exceeds such ave age pe cap a p em um o 1321 HHS o each S a e p og am o ensu e comp ance nc ud ng ensu ng ha he S a e e ed h ough an Exchange such o he n o ma on as he Sec e a y may equ e means a period specified by the Secretary.
3021 l HHS
care provided by entities participating in the pilot program. Quality measures in such percentage being less than 0.0 for a fiscal year, and may result in except that the Secretary may waive such requirement for a center and
4004 l HHS 4108 HHS de con ac w h a such mes and n such o m and manne as he Sec e a y B CONT NUAT ON OF PAYMENTS UNT L RES DENTS RELOCATED The Sec e a y p cab e p ov de o se v ces o supp e unde he p og am unde h s e n o de 4 Fo pu poses o pa ag aph 1 B v he Sec e a y sha … A den y hose subm o he Sec e a y a epo a such me n such manne and con a n ng such
men ehab a on pa a ve ca e and su v vo sh p n young women
REQU REMENTS — A qua fied h gh sk poo mee s he equ emen s o h s 2013 as de e m ned by he Sec e a y c FA LURE TO ESTABL SH EXCHANGE OR MPLEMENT REQU REMENTS — 1 p og am mee s … Secu y de e m nes app op a e o adm n s a on o he c ed …
3001 l HHS … shall include … the following: (ix) ...Other measures, including measures 3110 l HHS/DoD/SSA level, as determined by the Secretary.
payment rates … for a fiscal year being less than such payment rates for the authorize such center to receive such payments for 1 additional fiscal year. grantees ... in planning and implementing the public education campaign ... Sec e a y may nego a e and en e n o con ac s w h manu ac u e s o vacc nes da a use ag eemen s
sha spec y may as he Sec e a y de e m nes app op a e con nue o make paymen s unde me hodo og es o he Na ona Co ec Cod ng n a ve adm n s e ed by he Sec e- n o ma on as he Sec e a y may equ e… 10202 HHS 10331 HHS
pa ag aph such poo — D mee s any o he equ emen s de e m ned app op -
1104 HHS — A a S a e s no an e ec ng S a e b o B he Sec e a y de e m nes … ha 3007 l HHS (3) BUDGET NEUTRALITY. (A) INITIAL PERIOD. The Secretary shall not require, of patient outcomes, determined appropriate by the Secretary. (5) The Secretary shall ensure that the materials relating to coverage preceding fiscal year.
(e) DISSEMINATION OF INFORMATION THROUGH PROVIDERS. The Secretary, act- a N T AT VES 1 ESTABL SHMENT A The Sec e a y sha awa d g an s o o he pu chase and de ve y o vacc nes o adu s o sa s y any pas -due ob ga ons desc bed n subpa ag aph B o an ob ga ed 6403 HHS a y … den y hose me hodo og es o such n a ve … No y S a es … G o he n o ma on as de e m ned app op a e by he Sec e a y 10413 HHS
(bb) In the case of a specified area or medical topic determined appropriate as a condition for testing a model …, that the designof such model ensure ing through the CDC, shall develop and implement a plan for the dissemination S a es o ca y ou n a ves o p ov de ncen ves o Med ca d benefic a es h s e w h espec o es den s o a ac y ha has subm ed a no fica on p ov de o se v ces o supp e DEF N T ONS 1 LONG-TERM SERV CES AND SUPPORTS DEF NED The e m ong-
a e by he Sec e a y
5 COMPL ANCE W TH REV SED STANDARDS AND OPERAT NG RULES — A
1302 HHS an e ec ng S a e— w no have any equ ed Exchange ope a ona by Janu- 1332 HHS 1411 HHS/Treasury/DHS/SSA 1512 HHS (9) COORDINATION WITH OTHER VALUE-BASED PURCHASING REFORMS.— … provided … prior to the individual’s initial enrollment period contain 3021 l HHS 3505 l HHS 6005 HHS
A L CENS NG OR CERT F CAT ON ACT ONS The S a e mus have n e ec a sys em b HEALTH CARE PROFESS ONAL EDUCAT ON CAMPA GN The Sec e a y ac ng
A hea h p an … sha fi e a s a emen w h he Sec e a y n such o m as he a y 1 2014 o has no aken he ac ons he Sec e a y de e m nes necessa y 4 METHODS — A The Sec e a y n consu a on w h he Sec e a y o he EMPLOYER REQU REMENT TO NFORM EMPLOYEES OF COVERAGE OPT ONS …
by the Secretary for which a feasible and practical measure has not been
The Secretary shall coordinate the value-based payment modifier … with
that such model is budget neutral initially with respect expenditures ….
3023 l HHS information concerning the impact of not enrolling … (6) The Secretary of (ii) APPLICATION OF INCREASES TO LOW ENROLLMENT PLANS. (I) 2012. (g) SUBSTANTIAL UNCOMPENSATED CARE AWARD DISTRIBUTION AND PRO-
of health promotion and disease prevention information consistent with national who success u y pa c pa e n he p og am and upon comp e on o epo ng he o ow ng n o ma on w h espec o o ma p oceed ngs as 6703 HHS e m se v ces and suppo s has he mean ng g ven ha e m by Sec e a y and may
10331 HHS h ough he D ec o o CDC and n consu a on w h he Adm n s a o o he Hea h
Sec e a y may equ e ce y ng ha he da a and n o ma on sys ems o such ESSENT AL HEALTH BENEF TS REQU REMENTS d LEVELS OF COVERAGE — 2 WA VER FOR STATE NNOVAT ON a APPL CAT ON — 1 A S a e may app y o he
T easu y he Sec e a y o Home and Secu y and he Comm ss one o Soc a
endorsed by the entity … the Secretary may specify a measure that is not
Defense shall collaborate with the Secretary of HHS and the Commissioner For 2012, the term ‘qualifying plan’ includes a MA plan that the Secretary
3401 l HHS priorities, to health care providers who participate in Federal programs … demons a e changes n hea h sk and ou comes nc ud ng he adop on and c CONF DENT AL TY n o ma on…sha no be d sc osed…excep ha he Sec- 6114 HHS 6401 HHS defined by he Sec e a y n egu a ons conc uded aga ns a hea h ca e p ac one 6603 HHS a GRANTS TO SUPPORT THE LONG-TERM CARE OMBUDSMAN PROGRAM 1 The nc ude any o he o ow ng
1101 HHS ACTUAR AL VALUE — A Unde egu a ons ssued by he Sec e a y he eve o o mp emen — he o he equ emen s se o h n he s anda ds o he Sec e a y o he wa ve o a o any equ emen s … Such app ca on sha — a— n acco dance w h egu a ons p omu ga ed by he Sec e a y an emp oye so endorsed … or adopted by a consensus organization identified by the the Physician Feedback Program and, as the Secretary determines appropri- (B) REPORTING ON QUALITY MEASURES. (i) A entity shall submit data to (ii) PRODUCTIVITY AND OTHER ADJUSTMENT. After establishing the increase PORTIONAL SHARE. … of the amount appropriated for substantial uncom- e a y may d sc ose he n o ma on n a o m wh ch does no d sc ose he den y The Sec e a y sha eques he Na ona Assoc a on o nsu ance Comm ss one s o b OTHER REQU RED CONS DERAT ONS n deve op ng and mp emen ng he p an Resou ces and Se v ces Adm n s a on sha conduc an educa on campa gn among
p an a e n comp ance w h any app cab e ev sed s anda ds and assoc a ed equ emen s and amendmen s made e sewhe e he Sec e a y sha … es ab sh Secu y sha p ov de ha ve fica ons and de e m na ons unde h s subsec- o wh ch h s Ac app es sha p ov de o each emp oyee a he me o h ng … ate, other similar provisions of this title. 3021 l HHS the Secretary on quality measures … during each year of the pilot program of Social Security to provide for the accurate identification of individuals … determines is not able to have a quality rating … because of low enroll- pensated care grants for a fiscal year, the Secretary shall (1) make available
ma n enance o hea hy behav o s a The Sec e a y sha conduc 2 demons a on p o ec s 1 o he deve opmen o OBL GATED PROV DER OF SERV CES OR SUPPL ER The e m ob ga ed p ov de o en y by a S a e cens ng o ce fica on agency … Sec e a y sha make g an s o e g b e en es w h e evan expe se and expe -