S.1679 - Affordable Health Choices Act111th Congress (2009-2010)
|Sponsor:||Sen. Harkin, Tom [D-IA] (Introduced 09/17/2009)|
|Committees:||Senate - Health, Education, Labor, and Pensions|
|Latest Action:||09/17/2009 Placed on Senate Legislative Calendar under General Orders. Calendar No. 161. (All Actions)|
|Notes:||For further action, see H.R.3590, which became Public Law 111-148 on 3/23/2010.|
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Summary: S.1679 — 111th Congress (2009-2010)All Bill Information (Except Text)
Reported to Senate without amendment (09/17/2009)
(This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.)
Affordable Health Choices Act - Title I: Quality, Affordable Health Care for All Americans - Subtitle A: Effective Coverage for All Americans - Part I: Provisions Applicable to the Individual and Group Markets - (Sec. 101) Amends the Public Health Service Act to set forth provisions governing health insurance plans and issuers, including to: (1) prohibit preexisting condition exclusions; (2) limit premium variances; (3) provide for guaranteed coverage of every employer and individual and automatic renewal of coverage; (4) require reports on premium revenues expended; (5) prohibit eligibility rules based on specified health-status related factors; (6) require a reimbursement structure that provides quality incentives; (7) limit cost-sharing for preventive care; (8) require coverage of a dependent child until 26 years of age; and (9) prohibit lifetime or annual limits on benefits.
Part II: Provision Applicable to the Group Market - (Sec. 121) Prohibits a group health plan from establishing eligibility rules based on a full-time employee's salary.
Part III: Other Provisions - (Sec. 131) Provides that nothing in this Act shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled prior to the date of enactment of this Act. Allows family members of individuals currently enrolled in a plan to enroll in such plan or coverage if such enrollment was permitted under the terms of the plan. Allows new employees and their families to enroll in a group health plan that provides coverage on the date of enactment of this Act.
States that nothing in this Act shall apply to: (1) a group health plan or health insurance coverage in which an individual was enrolled on the date of enactment of this Act, regardless of whether the individual renews such coverage after such date of enactment; (2) an existing group health plan that enrolls new employees under this section; and (3) health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before the date of enactment of this Act, until the date on which the last of the collective bargaining agreements relating to the coverage terminates.
(Sec. 134) Declares that savings to the federal government generated as a result of the enactment of this subtitle shall be used for deficit reduction.
(Sec. 135) Makes this subtitle effective for plan years beginning on or after one year after enactment of this Act. Sets forth provisions which shall only become effective when a state or the Secretary of Health and Human Services (HHS) establishes an American Health Benefit Gateway.
Subtitle B: Available Coverage for All Americans - (Sec. 141) Expresses the sense of the Senate that Congress should establish a means for all Americans to enjoy affordable choices in health benefit plans in the same manner that Members of Congress have such choices through the federal employees health benefits program.
(Sec. 142) Requires the Secretary to award grants to states for the establishment of an American Health Benefit Gateway to: (1) facilitate the purchase of health insurance coverage and related insurance products at an affordable price by qualified individuals and employers; and (2) reduce the cost of health care. Requires a Gateway to make qualified health plans available.
Requires the Secretary to establish essential health care benefits eligible for premium credits, which must include hospitalization, prescription drugs, and preventive and wellness services.
Establishes a temporary advisory commission to be known as the National Independent Commission on Essential Health Care Benefits.
Authorizes states to establish a Gateway or request the Secretary operate a Gateway in the state.
Requires the Secretary to establish a community health insurance option to offer, through each Gateway, health care coverage that includes essential health benefits and provides value, choice, competition, and stability of affordable, high quality coverage throughout the United States.
Directs the Secretary to award grants to enable participating states to establish, expand, or provide support for offices of health insurance consumer assistance.
(Sec. 143) Requires all Members of Congress and congressional staff to enroll in a federal health insurance program: (1) created under this Act; or (2) offered through a Gateway.
Subtitle C: Affordable Coverage for All Americans - (Sec. 151) Requires the Secretary to: (1) establish at least two tiers of cost-sharing for eligible low-income individuals; (2) pay a premium credit to the Gateway for enrolled eligible individuals; and (3) make a payment to qualified small employers for health insurance costs of their employees.
(Sec. 152) Amends the Internal Revenue Code to require the Secretary of the Treasury to provide a mechanism for each taxpayer to indicate whether such taxpayer authorizes the disclosure of return information to determine eligibility for premium credits.
Subtitle D: Shared Responsibility for Health Care - (Sec. 161) Imposes a surtax on each individual who does not have health insurance coverage.
(Sec. 162) Amends the Fair Labor Standards Act of 1938 to require an employer to provide to each employee at the time of hiring written notice of the existence of an American Health Benefit Gateway.
(Sec. 163) Requires employers to make payments to the HHS Secretary for each employee who is not offered qualifying coverage or for whom the employer is not contributing at least 60% of the monthly premiums for such coverage. Exempts small employers.
Subtitle E: Improving Access to Health Care Services - (Sec. 171) Reauthorizes appropriations for health centers to serve medically underserved populations.
(Sec. 172) Revises provisions related to community health centers, including to allow such centers to offer services at other locations.
(Sec. 173) Requires the Secretary to establish through a negotiated rulemaking process a methodology and criteria for designation of medically underserved populations and health professions shortage areas.
(Sec. 174) Amends the Black Lung Benefits Act, with respect to claims filed on or after the effective date of the Black Lung Benefits Amendments of 1981, to eliminate exceptions to: (1) the applicability of certain provisions regarding rebuttable presumptions; and (2) the prohibition against requiring eligible survivors of a miner determined to be eligible for black lung benefits to file a new claim or to refile or otherwise revalidate the miner's claim.
(Sec. 175) Reauthorizes appropriations for FY2010-FY2014 for the expansion and improvement of emergency medical services for children who need treatment for trauma or critical care.
(Sec. 176) Requires the Secretary, acting through the Administrator of the Substance Abuse and Mental Health Services Administration, to award grants to establish demonstration projects for the provision of coordinated and integrated services to individuals with mental illnesses who have co-occurring primary care conditions and chronic diseases through the co-location of primary and specialty care services in community-based mental and behavioral health settings.
Subtitle F: Making Health Care More Affordable for Retirees - (Sec. 181) Requires the Secretary to establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for a portion of the cost of providing health benefits to retirees whose primary residences are located in any state that is not a participating state or an establishing state until such state becomes such a state. (Defines an "establishing state" as one that has taken actions to establish a Gateway and a "participating state" as one in which a requested Gateway is established by the Secretary.)
Subtitle G: Improving the Use of Health Information Technology for Enrollment; Miscellaneous Provisions - (Sec. 185) Requires the Secretary to: (1) develop interoperable and secure standards and protocols that facilitate enrollment of individuals in federal and state health and human services programs; and (2) award grants to develop and adapt technology systems to implement such standards and protocols.
(Sec. 186) Declares that nothing in this title shall be construed to modify or limit the application of the exemption from preemption of state laws for the Hawaii's Prepaid Health Care Act.
(Sec. 187) Establishes a Commission on Key National Indicators to: (1) conduct comprehensive oversight of a newly established key national indicators system; and (2) make recommendations on how to improve such system. Directs the National Academy of Sciences to enable the establishment of such system by creating its own institutional capability or by partnering with an independent private nonprofit organization.
(Sec. 188) Requires the Comptroller General to conduct a study on preventable diseases in Medicare beneficiaries.
(Sec. 189) Requires the Secretary to publish on the HHS website a list of authorities provided to the Secretary under this Act.
(Sec. 189A) Declares that nothing in this Act shall be carried out in a manner that threatens the solvency of Medicare or Social Security programs.
(Sec. 189B) Prohibits the federal government, any state or local government or health care provider that receives federal financial assistance under this Act, or any health plan created under this Act from discriminating against an individual or institutional health care entity on the basis that such individual or entity does not provide a health care item or service furnished for the purpose of causing, or assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.
(Sec. 189C) Prohibits the Secretary from promulgating any regulation that: (1) creates an unreasonable barrier to the ability of individuals to obtain appropriate medical care; (2) impedes timely access to health care services; (3) interferes with communications regarding a full range of treatment options between the patient and the health care provider; (4) restricts the ability of health care providers to provide full disclosure of all relevant information to patients making health care decisions; (5) violates the principle of informed consent and the ethical standards of health care professionals; or (6) limits the availability of health care treatment for the full duration of a patient's medical needs.
(Sec. 189D) Declares that no individual, company, business, nonprofit entity, or health insurer offering group or individual health insurance coverage shall be required to participate in any federal health insurance program created by or expanded under this Act. Prohibits any penalty from being imposed upon any such insurer for choosing not to participate in any such program.
Subtitle H: CLASS Act - Community Living Assistance Services and Supports Act or the CLASS Act - (Sec. 191) Establishes a national, voluntary disability insurance program to purchase community living assistance services and supports (CLASS program) under which: (1) all employees are automatically enrolled, but are allowed to waive enrollment; (2) payroll deductions pay monthly premiums; and (3) benefits are provided to purchase non-medical services and supports that the beneficiary needs to maintain independence.
Requires the Secretary to establish a Personal Care Attendants Workforce Advisory Panel.
Title II: Improving the Quality and Efficiency of Health Care - Subtitle A: National Strategy to Improve Health Care Quality - (Sec. 201) Requires the Secretary to establish a national strategy to improve the delivery of health care services, patient health outcomes, and population health.
(Sec. 202) Directs the President to convene the Interagency Working Group on Health Care Quality.
(Sec. 203) Requires the Director of the Agency for Healthcare Research and Quality (AHRQ) to award grants for the development, improvement, or expansion of health care quality measures.
(Sec. 204) Requires the Secretary to implement a system for reporting on quality measures.
(Sec. 205) Directs the Secretary to support the collection and aggregation of quality and resource use measures from information systems used to support health care delivery.
Subtitle B: Health Care Quality Improvements - (Sec. 211) Establishes the Patient Safety Research Center within AHRQ.
(Sec. 212) Requires the Secretary to award grants for community-based interdisciplinary, interprofessional health teams to support primary care practices.
(Sec. 213) Directs the Secretary to award grants for the implementation of medication management services provided by licensed pharmacists to improve the quality of care and reduce overall cost in the treatment of chronic diseases.
(Sec. 214) Requires the Secretary to award contracts or grants for pilot projects to design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency medical and trauma systems.
Directs the Secretary to support emergency medicine research.
(Sec. 215) Requires the Secretary to establish programs to: (1) award grants for trauma centers; (2) reduce hospital readmissions; and (3) award grants or contracts to develop patient decision aids.
(Sec. 218) Requires the Secretary, acting through the Commissioner of Food and Drugs (FDA), to determine whether the addition of quantitative summaries of the benefits and risks of prescription drugs in a standardized format to the promotional labeling or print advertising of such drugs would improve health care decisionmaking by clinicians, patients, and consumers.
(Sec. 219) Requires the Secretary to establish the Center for Health Outcomes Research and Evaluation.
(Sec. 220) Authorizes the Secretary to award grants to develop and implement academic curricula that integrate quality improvement and patient safety in the clinical education of health professionals.
(Sec. 221) Establishes Offices of Women's Health within the Department of Health and Human Services (HHS) and its agencies.
(Sec. 222) Requires the Secretary to adopt standards, implementation specifications, and operating rules for the electronic exchange and use of health information for purposes of financial and administrative transactions.
(Sec. 223) Requires patient navigators to have minimum core proficiencies.
(Sec. 224) Authorizes appropriations for this subtitle.
Subtitle C: Civil and Criminal Penalties for Acts Involving Federal Health Care Programs; Exception to Limitation on Certain Physician Referrals - (Sec. 231) Amends titles XI (General Provisions, Peer Review, and Administrative Simplification) and XVIII (Medicare) of the Social Security Act (SSA) to create safe harbors from civil and criminal penalties in current anti-kickback laws for providing certain health information technology and training services.
Title III: Improving the Health of the American People - Subtitle A: Modernizing Disease Prevention and Public Health Systems - (Sec. 301) Establishes the National Prevention, Health Promotion and Public Health Council.
(Sec. 302) Establishes a Prevention and Public Health Fund to provide for expanded and sustained national investment in prevention and public health programs. Authorizes and appropriates money to such Fund.
(Sec. 303) Amends the Public Health Service Act to require (currently, allows) the Director of AHRQ to convene the Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community.
Requires the Director of the Centers for Disease Control and Prevention (CDC) to convene an independent Community Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations for individuals and organizations delivering population-based services and other policy makers.
(Sec. 304) Requires the Secretary to provide for the planning and implementation of a national public-private partnership for an outreach and education campaign to raise public awareness of health improvement across the life span.
Subtitle B: Increasing Access to Clinical Preventive Services - (Sec. 311) Requires the Secretary to: (1) award an annual grant to each state for the establishment of a Right Choices Program to provide health risk appraisals and care plans to uninsured individuals; and (2) award demonstration grants to demonstrate the effectiveness of research-based dental caries disease management activities.
(Sec. 312) Requires the Secretary to award grants for the cost of operation of school-based health clinics.
(Sec. 313) Requires the Secretary, acting through the Director of CDC, to carry out oral health activities, including: (1) establishing a public education campaign focused on oral health care prevention and education; and (2) awarding grants for the development of school-based dental sealant programs.
Subtitle C: Creating Healthier Communities - (Sec. 321) Requires the Secretary, acting through the Director of CDC, to award grants for community preventive health activities.
(Sec. 322) Requires the Secretary, acting through the Director of CDC, to award grants for public health community interventions, screenings, and clinical referrals for individuals between the ages of 55 and 64.
(Sec. 323) Amends the Rehabilitation Act of 1973 to require the Architectural and Transportation Barriers Compliance Board to promulgate standards setting forth the minimum technical criteria for medical diagnostic equipment used in medical settings to ensure that such equipment is accessible to, and usable by, individuals with accessibility needs.
(Sec. 324) Requires Secretary, acting through the Director of CDC, to establish a demonstration program to award grants to states for immunizations for children, adolescents, and adults.
(Sec. 325) Amends the Federal Food, Drug, and Cosmetic Act to require the labeling of a food item offered for sale in a retail food establishment that is part of a chain with 20 or more locations under the same name to disclose on the menu and menu board: (1) the number of calories contained in the standard menu item; (2) the suggested daily caloric intake; and (3) the availability on the premises and upon request of specified additional nutrient information. Requires self-service facilities to place adjacent to each food offered a sign that lists calories per displayed food item or per serving. Requires vending machine operators who operate 20 or more vending machines to provide a sign disclosing the number of calories contained in each article of food.
(Sec. 326) Permits a group health plan to offer incentives to an individual who voluntarily participates in a wellness program that is reasonably-designed to promote health or prevent disease.
(Sec. 327) Requires the Secretary to establish a pilot program to test the impact of providing an individualized wellness plan to at-risk populations who utilize community health centers.
(Sec. 328) Requires employers to provide a reasonable break time and a suitable place, other than a bathroom, for an employee to express breast milk for her nursing child. Excludes an employer with fewer than 50 employees if such requirements would impose an undue hardship.
Subtitle D: Support for Prevention and Public Health Innovation - (Sec. 331) Requires the Secretary, acting through the Director of CDC, to provide funding for research in the area of public health services and systems.
(Sec. 332) Requires the Secretary to ensure that any federally conducted or supported health care or public health program, activity, or survey collects and reports specified demographic data regarding health disparities.
(Sec. 333) Requires the Secretary, acting through the Director of CDC, to establish a program at the National Center of Environmental Health to foster advances and provide technical support in the field of health impact assessments.
(Sec. 334) Requires the Director of CDC to conduct educational campaigns on employer-based wellness programs.
(Sec. 335) Requires the Secretary, acting through the Director of CDC, to establish an Epidemiology and Laboratory Capacity Grant Program.
(Sec. 336) Requires the Secretary, acting through the Director of CDC, to establish and implement a media campaign on health promotion and disease prevention.
Subtitle E: Advancing Research and Treatment for Pain Care Management - (Sec. 341) Requires the Secretary to seek to enter into an agreement with the Institute of Medicine to convene a Conference on Pain.
(Sec. 342) Requires the Secretary to establish the Interagency Pain Research Coordinating Committee to coordinate all efforts within federal agencies that relate to pain research.
(Sec. 343) Authorizes the Secretary to provide training to health care professionals in pain care.
(Sec. 344) Requires the Secretary to establish a national pain care education outreach and awareness campaign.
Subtitle F: Coordinated Environmental Public Health Network - (Sec. 351) Requires the Secretary to establish and operate a Coordinated Environmental Public Health Network.
Subtitle G: Miscellaneous Provisions - (Sec. 362) Requires the Secretary to evaluate programs to determine whether existing federal health and wellness initiatives are effective.
Title IV: Health Care Workforce - Subtitle A: Purpose and Definitions - (Sec. 401) Declares that the purpose of this title is to improve access to, and the delivery of, health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity, and rural populations.
Subtitle B: Innovations in the Health Care Workforce - (Sec. 411) Establishes a National Health Care Workforce Commission to: (1) review current and projected health care workforce supply and demand; and (2) make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies.
(Sec. 412) Establishes a health care workforce development grant program.
(Sec 413) Requires the Secretary to establish the National Center for Health Workforce Analysis.
Subtitle C: Increasing the Supply of the Health Care Workforce - (Sec. 421) Revises student loan provisions related to the length of service requirement for the primary health care loan repayment program.
(Sec. 422) Increases the maximum amount of loans made by schools of nursing to students.
(Sec. 423) Requires the Secretary to establish a pediatric specialty loan repayment program.
(Sec. 424) Directs the Secretary to establish the Public Health Workforce Loan Repayment Program to assure an adequate supply of public health professionals to eliminate critical public health workforce shortages in federal, state, local, and tribal public health agencies.
(Sec. 425) Amends the Higher Education Act of 1965 to expand student loan forgiveness to include allied health professionals employed in public health agencies.
(Sec. 426) Includes public health workforce loan repayment programs as permitted activities under a grant program to increase the number of individuals in the public health workforce.
Authorizes the Secretary to provide for scholarships for mid-career professionals in the public health and allied health workforce to receive additional training.
(Sec. 427) Authorizes appropriations for the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program.
(Sec. 428) Requires the Secretary to awards grants for operation of nurse-managed health clinics.
(Sec. 429) Eliminates the cap on the number of commissioned officers in the Public Health Service Regular Corps.
(Sec. 430) Revises the Regular Corps and the Reserve Corps (renamed the Ready Reserve Corps) in the Public Health Service. Sets forth the uses of the Ready Reserve Corps.
Subtitle D: Enhancing Health Care Workforce Education and Training - (Sec. 431) Sets forth provisions providing for health care professional training programs.
(Sec 432) Requires the Secretary to award grants for new training opportunities for direct care workers who are employed in long-term care settings.
(Sec. 433) Sets forth provisions providing for dentistry professional training programs.
(Sec. 434) Authorizes the Secretary to award grants for demonstration programs to establish training programs for alternative dental health care providers in order to increase access to dental health services in rural and other underserved communities.
(Sec. 435) Requires the Secretary to award grants or contracts to entities that operate a geriatric education center to offer short-term, intensive courses that focus on geriatrics, chronic care management, and long-term care.
Expands geriatric faculty fellowship programs to make dentists eligible.
Reauthorizes and revises the geriatric education programs to allow grant funds to be used for the establishment of traineeships for individuals who are preparing for advanced education nursing degrees in areas that specialize in the care of elderly populations.
(Sec. 436) Authorizes the Secretary to award grants to institutions of higher education to support the recruitment of students for, and education and clinical experience of the students in, social work programs, psychology programs, child and adolescent mental health, and training of paraprofessional child and adolescent mental health workers.
(Sec. 437) Requires the Secretary to support model curricula for cultural competency, prevention, and public health proficiency and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs.
(Sec. 438) Revises requirements for nurse-midwifery programs to be eligible for advanced education nursing grants, including requiring accreditation of such programs.
(Sec. 439) Authorizes the Secretary to award grants to, and enter into contracts with, entities to enhance the nursing workforce by initiating and maintaining nurse retention programs.
(Sec. 440) Makes nurse faculty at an accredited school of nursing eligible for the nursing education loan repayment program.
(Sec. 441) Revises the nurse faculty loan repayment program, including to increase the amount of such loans.
Authorizes the Secretary, acting through the Administrator of Health Resources and Services Administration, to enter into an agreement for the repayment of education loans in exchange for service as a member of a faculty at an accredited school of nursing.
(Sec. 442) Authorizes appropriations for carrying out nursing workforce programs.
(Sec. 443) Requires the Director of CDC to award grants to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.
(Sec. 444) Authorizes area health education centers to use grant funds to establish a youth public health program to expose and recruit high school students into health careers, with a focus on careers in public health.
(Sec. 445) Authorizes the Secretary to carry out activities to address documented workforce shortages in state and local health departments in the critical areas of applied public health epidemiology and public health laboratory science and informatics.
(Sec. 446) Authorizes the establishment of the United States Public Health Sciences Track, which is authorized to award advanced degrees in public health, epidemiology, and emergency preparedness and response.
Directs the Surgeon General to develop: (1) an integrated longitudinal plan for health professions continuing education; and (2) faculty development programs and curricula in decentralized venues of health care to balance urban, tertiary, and inpatient venues.
Subtitle E: Supporting the Existing Health Care Workforce - (Sec. 451) Revises the allocation of funds to assist schools in supporting programs of excellence in health professions education for underrepresented minority individuals and schools designated as centers of excellence.
(Sec. 452) Authorizes appropriations for: (1) scholarships for disadvantaged students attending health professions or nursing schools; (2) loan repayment for health professions faculty; and (3) grants to health professions schools to assist individuals from disadvantaged backgrounds.
(Sec. 453) Requires the Secretary to: (1) award grants to eligible entities to initiate health care workforce education programs or to continue such programs; and (2) make grants to, and enter into contracts with, eligible entities to improve health care, increase retention, increase representation of minority faculty members, enhance the practice environment, and provide information dissemination and educational support to reduce professional isolation through the timely dissemination of research findings using relevant resources.
(Sec. 454) Makes revisions to the grant program to increase nursing education opportunities for individuals from disadvantaged backgrounds, including to provide: (1) stipends for diploma or associate degree nurses to enter a bridge or degree completion program; (2) student scholarships or stipends for accelerated nursing degree programs; and (3) advanced education preparation.
(Sec. 455) Requires the Secretary, acting through the Director AHRQ, to establish a Primary Care Extension Program to provide support and assistance to educate primary care providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services, and evidence-based and evidence-informed therapies and techniques.
(Sec. 456) Amends the Higher Education Act of 1965 with respect to the meaning of economic hardship under the Federal Family Education Loan or Perkins Loan and related loan insurance programs. Considers borrowers under such programs to be suffering economic hardship if they are working full time, have a federal educational debt burden equal to at least 20% of their adjusted gross income, and the difference between their adjusted gross income minus such debt burden is less than 220% of the greater of: (1) the annual earnings of an minimum wage earner; or (2) 150% of the poverty line applicable to their family size.
Subtitle F: General Provisions - (Sec. 461) Requires the Secretary to report to the appropriate congressional committees on activities carried out under this title.
Title V: Preventing Fraud and Abuse - Subtitle A: Establishment of New Health and Human Services and Department of Justice Health Care Fraud Positions - (Sec. 501 ) Requires: (1) the Secretary to appoint a Senior Advisor for Health Care Fraud; and (2) the Attorney General to appoint a Senior Counsel for Health Care Fraud Enforcement. Requires the Senior Advisor and the Senior Counsel to annually report to the appropriate congressional committees regarding the detection and prevention of health care fraud, waste, and abuse involving public health insurance and private health insurance coverage.
(Sec. 504) Requires the President to establish a commission to review federal health care programs and private health insurance to eliminate fraud, waste, and abuse and to more effectively align public and private sector efforts to combat fraud, waste, and abuse.
Subtitle B: Health Care Program Integrity Coordinating Council - (Sec. 511) Establishes the Health Care Program Integrity Coordinating Council.
Subtitle C: False Statements and Representations - (Sec. 521) Prohibits a person from making a false statement or false representation of fact in connection with a multiple employer welfare arrangement (MEWA) concerning the financial condition or solvency of, benefits provided by, or regulatory status of such plan or arrangement.
Subtitle D: Federal Health Care Offense - (Sec. 531) Expands the definition of "federal health care offense" to include specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA).
Subtitle E: Uniformity in Fraud and Abuse Reporting - (Sec. 541) Requires the Secretary to request the National Association of Insurance Commissioners to develop a model uniform report form for private health insurance issuers seeking to refer suspected fraud and abuse to state insurance departments or other responsible state agencies for investigation.
Subtitle F: Applicability of State Law to Combat Fraud and Abuse - (Sec. 551) Amends ERISA to direct the Secretary of Labor to adopt regulatory standards and/or issue orders to subject MEWAs to state law relating to fraud and abuse.
Subtitle G: Enabling the Department of Labor to Issue Administrative Summary Cease and Desist Orders and Summary Seizures Orders Against Plans That Are in Financially Hazardous Condition - (Sec. 561) Authorizes the Secretary of Labor to: (1) issue cease-and-desist orders to shut down temporarily the operations of MEWAs conducting fraudulent activities or posing a serious threat to the public until hearings can be completed; and (2) seize a plan's assets if it appears that the plan is in a financially hazardous condition.
Subtitle H: Requiring Multiple Employer Welfare Arrangement (MEWA) Plans to File a Registration Form With the Department of Labor Prior to Enrolling Anyone in the Plan - (Sec. 571) Amends ERISA to require (currently, permits) MEWA Plans that are not group health plans to register with the Department of Labor before operating in a state.
Subtitle I: Permitting Evidentiary Privilege and Confidential Communications - (Sec. 581) Authorizes the Secretary of Labor to promulgate a regulation providing an evidentiary privilege that allows confidential communication among specified federal and state officials relating to investigation of fraud and abuse.
Title VI: Improving Access to Innovative Medical Therapies - Subtitle A: Biologics Price Competition and Innovation - Biologics Price Competition and Innovation Act of 2009 - (Sec. 602) Amends the Public Health Service Act to allow a person to submit an application for licensure of a biological product based on its similarity to a licensed biological product (the reference product).
Prohibits the HHS Secretary from determining that a second or subsequent biological product is interchangeable with a reference product for any condition of use for specified periods based on the marketing of, and the presence or status of litigation involving, the first biosimilar biological product deemed interchangeable with the same reference product.
Prohibits the Secretary from making approval of an application under this Act effective until 12 years after the date on which the reference product was first licensed.
(Sec. 603) Requires the Secretary of the Treasury to determine the amount of savings to the federal government as a result of the enactment of this subtitle and requires such savings to be used for deficit reduction.
Subtitle B: More Affordable Medicines for Children and Underserved Communities - (Sec. 611) Expands the 340B drug discount program (a program limiting the cost of covered outpatient drugs to certain federal grantees) to: (1) allow participation as a covered entity by certain children's hospitals, freestanding cancer hospitals, critical access hospitals, rural referral centers, and sole community hospitals; and (2) include drugs used in connection with an inpatient or outpatient service by enrolled hospitals (currently, only outpatient drugs are covered under the program).
Requires the HHS Secretary to establish reasonable exceptions to the prohibition on enrolled hospitals obtaining covered outpatient drugs through a group purchasing organization or other group purchasing arrangement, including: (1) for drugs unavailable through the program; and (2) to facilitate generic substitution when a generic covered drug is available at a lower price. Allows such hospitals to purchase covered drugs for inpatients through any such arrangement.
Requires a hospital enrolled in the 340B drug discount program to issue a credit to a state Medicaid program for inpatient covered drugs provided to Medicaid recipients.
(Sec. 612) Requires the Secretary to: (1) provide for improvements in compliance by manufacturers and covered entities with the requirements of the 340B drug discount program; and (2) establish and implement an administrative process for resolving claims by covered entities and manufacturers of violations of such requirements.
Requires manufacturers to offer each covered entity covered drugs for purchase at or below the applicable ceiling price if such a drug is made available to any other purchaser at any price.
(Sec. 613) Requires the Comptroller General to report to Congress on whether those individuals served by the covered entities under the 340B drug discount program are receiving optimal health care services.