Browse the sections of Title VI

Effective March 23, 2011, requires that community mental health centers (CMHCs) that provide Medicare partial hospitalization services provide at least 40% of its services to non-Medicare covered beneficiaries.  Further delineates that such services are those other than the services provided in an individual’s home or in an inpatient or residential setting.

As modified by sections 10601(a)(1) and 1106(1) of HCERA, revises the standing Medicare physician self-referral prohibition such that only hospitals with a Medicare provider agreement in effect on December 31, 2010 and that meet specified requirements (e.g., pertaining to a limitation on expansion of facility capacity, preventing conflicts of interest, etc.) by September 23, 2011 may qualify for the rural...

Effective March 31, 2013, and on the 90th day of each CY thereafter, requires drug, device, biological, or medical supply manufactures that provide payment or other transfer of value to a physician and/or teaching hospital to submit (in electronic form) mandated information to HHS, including the name of the covered recipient; the amount of the payment or other transfer of...

For purposes of the Medicare in-office ancillary exception, effective January 1, 2010, requires the referring physician to disclose to the beneficiary in writing and at the time of the referral for certain imaging services (MRI, CT, and PET), as well as other health services as designated by HHS, that the beneficiary may obtain such services from a physician other than...

Effective not later than April 1, 2012 (and annually thereafter), requires prescription drug manufacturers and authorized distributors of record (ADR) to report to the Secretary of HHS on information pertaining to the distribution of drug samples and the requesting practitioner, as well as other information determined appropriate by HHS.

Specifies that a health benefits plan or PBM that manages prescription drug coverage under a contract with a PDP or MA-PD under Medicare Part D or with a QHP under the Exchange provide stipulated information to the Secretary of HHS.  Specifically, such information must include: the generic dispensing rate (by pharmacy type); the aggregate amount, and the type of rebates,...

Stipulates that nursing facilities (NFs) under Medicaid and skilled nursing facilities (SNFs) under Medicare must disclose ownership (including direct or indirect interests if the interest is equal to or exceeds 5% of the entity’s total property or assets) and additional information to HHS and other  entities.  Provides for a special rule in cases where the information has already been reported...

Effective March 23, 2013, requires SNFs and NFs (under Medicare and Medicaid, respectively) to have in operation a compliance and ethics program to prevent and detect criminal, civil, and administrative violations and to promote quality of care.  Directs the Secretary of HHS to promulgate regulations by March 23, 2012 to this effect, which may include a model compliance program, and...

Stipulates a number of additions to the Nursing Home Compare website, including: staffing data; links to state Internet websites with information regarding state survey and certification programs; standardized complaint forms; summary information on the number, type, severity, and outcome of substantiated complaints; and the number of adjudicated instances of criminal violations by a facility or the employees of a facility. ...

Effective March 23, 2012, requires SNFs to separately delineate via a modified cost report form (to be developed by HHS in consultation with private sector accountants by March 23, 2011) the expenditures for wages and benefits for direct care staff.  By September 30, 2012, requires the Secretary of HHS to – in consultation with MedPAC, MACPAC, and the OIG –...

Effective March 23, 2011, directs the Secretary of HHS to develop a standardized complaint form for use by a resident (or a person acting on the resident’s behalf) in filing a complaint with a state survey and certification agency and a state long-term care ombudsman program. Requires states to establish a complaint resolution process.

Effective March 23, 2012, directs the Secretary of HHS, following consultation with state long-term care ombudsman programs and others, to require facilities to electronically submit direct care staffing information based on payroll and other verifiable and auditable data in a prescribed uniform format.

Directs the GAO to, not later than March 23, 2012, submit a report to Congress on CMS’ Five-Star Quality Rating System for nursing homes. The study is to assess: how such system is being implemented; any problems associated with such system or its implementation; and how such system could be improved.

Effective March 23, 2011, authorizes the Secretary of HHS to reduce civil monetary penalties (CMPs) by up to 50% for SNFs and NFs (under Medicare and Medicaid, respectively) in the case where a facility self-reports and promptly corrects a deficiency for which a penalty was imposed not later than 10 calendar days after the date of such imposition. Delineates certain circumstances...

Not later than March 23, 2011, directs the Secretary of HHS, in consultation with the OIG, to conduct a 2-year demonstration project to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains of SNFs and NFs.  Delineates requirements relative to the implementation of recommendations (i.e., within 10 days after receipt of finding) by participating...

Effective March 23, 2011, directs nursing home facility administrators to provide written notification regarding an impending closure to the Secretary of HHS, the state long-term care ombudsman, residents of the facility, and the legal representatives of such residents or other responsible parties at least 60 days prior to the date of such closure.  Stipulates sanctions (via CMPs and otherwise) in...

Directs the Secretary of HHS to conduct 2 demonstration projects – 1 for the development of best practices in SNFs and NFs that are involved in the culture change movement and 1 for the development of best practices in SNFs and NFs for the use of information technology to improve resident care.  Requires the Secretary of HHS to submit a...

Effective March 23, 2011, requires SNFs and NFs to provide as part of initial and, if the Secretary of HHS deems appropriate, ongoing training, dementia management training and patient abuse training.

Directs the Secretary of HHS to establish a nationwide program to identify efficient, effective, and economical procedures for long-term care facilities or providers to conduct background checks on prospective direct patient access employees (“nationwide program”).  Stipulates that, subject to certain modifications, such program is to be implemented in accordance with similar terms and conditions as the pilot program authorized at...

As revised by section 10602 of the Senate Manager's Amendment. Establishes a private, nonprofit entity, the Patient-Centered Outcomes Research Institute (PCORI), overseen by a Comptroller General-appointed Board of Governors on which the Directors of the NIH and AHRQ are to reside.  The purpose of PCORI is to assist patients, clinicians, purchasers, and policymakers in making informed health decisions through the advancement of...

Amended by section 10603 of the Senate Manager's Amendment and section 1304 of HCERA. Directs the Secretary of HHS to, not later than September 23, 2010, establish procedures for conducting provider and supplier screenings (according to the risk of fraud, waste, and abuse for each provider/supplier category) under Medicare, Medicaid, and CHIP.  Such screening is to include a licensure check,...

Amended by section 1303 of HCERA. Directs CMS to include in the Integrated Data Repository (IDR) claims and payment data for sharing and data-matching purposes from Medicare, Medicaid, and CHIP, as well as health-related programs administered by the VA and DoD, SSA, and the IHS.  Authorizes the DOJ and OIG to access HHS claims and payment data within the IDR...

Directs the Secretary of HHS to develop a national health care fraud and abuse data collection program for the reporting of certain final adverse actions (not including settlements in which no findings of liability have been made) against providers, practitioners, and suppliers.  Requires that such information be provided to the National Practitioner Data Bank (NPDB) at which point such information...

Effective for services furnished on or after January 1, 2010, clarifies the maximum period for submission of Medicare claims to be not more than 12 months.

Revised by sections 10603 and 10604 of the Senate Manager's Amendment. Effective July 1, 2010, requires physicians who order DME items or home health services be enrolled in the Medicare program. Authorizes the Secretary of HHS to extend this requirement to all other categories of Medicare items or services, including Part D-covered drugs.

Effective January 1, 2010, authorizes the Secretary of HHS to revoke a physician or supplier’s enrollment for up to a year for failure to maintain and provide (upon request) written orders or requests for payment or referrals of DME, home health services, and other items and services.

Revised by section 10605 of the Senate Manager's Amendment. Effective January 1, 2010, requires physicians (or other authorized practitioners) have a face-to-face encounter (including through use of telehealth, subject to certain requirements) prior to issuing a certification or re-certification for home health services and DME under Medicare or Medicaid.  Authorizes the Secretary to apply the face-to-face encounter requirement to other...

Effective after January 1, 2010, with some exceptions, increases the amount of applicable civil monetary penalties (CMPs) for false statements or delaying inspections – up to $50,000 for each false record or statement and $15,000 for each day of failure.  Delineates changes to MA and Part D plans to ensure timely inspections relating to contracts with MA organizations.

Directs the Secretary of HHS to, in cooperation with the OIG, establish by September 23, 2010, a protocol – the self-referral disclosure protocol (SRDP) – to enable health care providers and suppliers to disclose an actual or potential violation of Medicare physician self-referral law.  Such information on how to disclose via the SRDP is required to be publicly posted on...

Directs the Secretary of HHS to expand Round 2 of the DMEPOS Competitive Bidding program to include 91 MSAs (up from 70) – i.e., via the inclusion of the next 21 largest MSAs by total population. Requires the Secretary to either extend the competitive bidding program or apply payment adjustments using competitively bid rates to all other parts of the...

Requires the expansion of the RAC program to Medicaid (with applicable regulations to be promulgated by HHS) and Medicare Parts C and D (with special requirements delineated) by December 31, 2010. Calls for CMS to submit an annual report to Congress concerning the effectiveness of the RAC program under Medicaid and Medicare including recommendations for expanding or improving the program.

Stipulates that states must terminate the participation of any individual or entity (subject to some permissible exclusions) under Medicaid and CHIP if the participation of such individual or entity is terminated under Medicare or other state plan.

Requires states to exclude from Medicaid participation any individual or entity if such individual or entity owns, controls, or manages an entity that: has unpaid overpayments; is suspended, excluded, or terminated from participation; or is affiliated with an individual or entity that has been suspended, excluded, or terminated from participation.

Requires that any agent, clearinghouse, or other alternate payee that submits Medicaid claims on behalf of a health care provider register with the state and the Secretary of HHS in a form and manner specified by the Secretary.

Effective January 1, 2010, directs states and Medicaid managed care organizations (MCOs) to submit data elements determined to be necessary by the Secretary of HHS for program integrity, program oversight, and administration at a frequency determined by the Secretary.

Bars states from making any Medicaid payments to any financial institution or entity located outside of the United States.

Effective March 23, 2010, extends the period for collection of Medicaid overpayments from 60 days to 1 year.  Specifies that, in cases whereby a state is unable to recover a debt (which represents an overpayment due to fraud) absent a final administrative or judicial determination, a state would not be required to remit the federal portion of such overpayment until...

Effective October 1, 2010, requires states to incorporate compatible methodologies of the National Correct Coding Initiative (NCCI) used in the Medicare program within their respective Medicaid programs to curb improper coding and payments.  Requires the Secretary of HHS to provide guidance to the states by September 1, 2010 to comply with this requirement and to submit a report to Congress...

Stipulates applicable criminal penalties for an agent of a multiple employer welfare arrangement (MEWA) who knowingly makes a false statement or representation in the marketing or sale of such plan or arrangement.  Makes a conforming amendment to ERISA.

Makes a clarifying definition with respect to ERISA.

Authorizes the Secretary of DOL to, for the purpose of identifying, preventing, or prosecuting fraud and abuse, establish or issue an order against MEWAs regardless of whether the state law is otherwise preempted.  Makes a conforming change to ERISA.

Authorizes the Secretary of DOL to issue a cease and desist (ex parte) order under if it appears that the alleged conduct of a MEWA is fraudulent, or creates an immediate danger to the public safety or welfare, or is causing or can be reasonably expected to cause significant, imminent, and irreparable public injury.  Also authorizes the Secretary to issue...

Amends ERISA to require that MEWAs register with the Secretary of DOL prior to operating in a state.

Amends ERISA to authorize the Secretary of DOL to promulgate a regulation that allows for confidential communications between or among, certain public entities or their agents, consultants, or employees in fraud and abuse investigations.

Specifies Subtitle H (sections 6701-6703) to be titled, the ‘‘Elder Justice Act of 2009’’.

With certain exceptions, aligns the terms used in Subtitle H with those defined in section 2011 of the Social Security Act (SSA).

Delineates a number of initiatives, including via the provision of grants, to enhance the care and support provided to seniors, including those focused on preventing abuse and neglect in long-term care facilities.  Also establishes a within the Office of the Secretary an Elder Justice Coordinating Council (“Council”), comprised of heads of federal agencies and others, as well as an Advisory...

Expresses the sense of the Senate regarding the opportunity at-hand to address medical malpractice issues by encouraging state alternatives to the existing civil litigation system.  Calls upon Congress to authorize a state demonstration program to test such approaches.

Delineates a number of requirements relative to federal health care fraud sentencing guidelines as well as enhances subpoena authority under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  

Authorizes the Secretary of HHS to award 5-year demonstration grants to states for the development, implementation, and evaluation of alternatives to current tort litigation for resolving disputes over injuries allegedly caused by health care providers or health care organizations.  Specifies an annual report and an evaluation to begin no later than 18 months following the date of implementation.  Calls for independent...

Effective March 23, 2010, extends medical malpractice coverage to an officer, governing board member, employee, or contractor of a free clinic.

Makes a number of revisions to Abbreviated New Drug Application (ANDA) labeling requirements to ensure that ANDAs with outdated labeling can be approved if the reference listed drug (RLD) was changed within 60 days of the event that cleared the way for generic competition and the generic sponsor agrees to submit a revised label within 60 days.