P.L. 109-432 SEC. 111.-Continued TITLE II-MEDICARE BENEFICIARY PROTECTIONS * * SEC. 202. PAYMENT FOR ADMINISTRATION OF PART D VACCINES. (a) [None Assigned] TRANSITION FOR 2007.-Notwithstanding any other provision of law, in the case of a vaccine that is a covered part D drug under section 1860D-2(e) of the Social Security Act (42 U.S.C. 1395w-102(e)) and that is administered during 2007, the administration of such vaccine shall be paid under part B of title XVIII of such Act as if it were the administration of a vaccine described in section 1861(s)(10)(B) of such Act (42 U.S.C. 1395w(s)(10)(B)). SEC. 203. [42 U.S.C. 1395w-102 note] OIG STUDY OF NEVER EVENTS. (a) STUDY. (1) IN GENERAL.-The Inspector General in the Department of Health and Human Services shall conduct a study on (A) incidences of never events for Medicare beneficiaries, including types of such events and payments by any party for such events; (B) the extent to which the Medicare program paid, denied payment, or recouped payment for services furnished in connection with such events and the extent to which beneficiaries paid for such services; and (C) the administrative processes of the Centers for Medicare & Medicaid Services to detect such events and to deny or (2) CONDUCT OF STUDY.-In conducting the study under paragraph (1), the Inspector General (A) shall audit a representative sample of claims and medical records of Medicare beneficiaries to identify never events and any payment (or recoupment) for services furnished in connection with such events; (B) may request access to such claims and records from any Medicare contractor; and (C) shall not release individually identifiable information or facilityspecific information. (b) REPORT.-Not later than 2 years after the date of the enactment of this Act, the Inspector General shall submit a report to Congress on the study conducted under this section. Such report shall include recommendations for such legislation and administrative action, such as a noncoverage policy or denial of payments, as the Inspector General determines appropriate, including— (1) recommendations on processes to identify never events and to deny or recoup payments for services furnished in connection with such events; and (2) a recommendation on a potential process (or processes) for public disclosure of never events which (A) will ensure protection of patient privacy; and (B) will permit the use of the disclosed information for a root cause analysis to inform the public and the medical community about safety issues involved. (c) FUNDING.-Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Inspector General of the Department of Health and Human Services $3,000,000 to carry out this section, to be available until January 1, 2010. (d) NEVER EVEnts Defined.-For purposes of this section, the term "never event" means an event that is listed and endorsed as a serious reportable event by the National Quality Forum as of November 16, 2006. Sec. 204. [42 U.S.C. 1395b-1 note] MEDICARE MEDICAL HOME DEMONSTRATION PROJECT. (a) IN GENERAL.-The Secretary of Health and Human Services (in this section referred to as the "Secretary”) shall establish under title XVIII of the Social P.L. 109-432 Sec. 204. Continued Security Act a medical home demonstration project (in this section referred to as the “project”) to redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations and under which (1) care management fees are paid to persons performing services as personal physicians; and (2) incentive payments are paid to physicians participating in practices that provide services as a medical home under subsection (d). For purposes of this subsection, the term "high-need population” means individuals with multiple chronic illnesses that require regular medical monitoring, advising, or treatment. (b) DETAILS.— (1) DURATION; SCOPE.-The project shall operate during a period of three years and shall include urban, rural, and underserved areas in a total of no more than 8 States. (2) ENCOURAGING PARTICIPATION OF SMALL PHYSICIAN PRACTICES.-The project shall be designed to include the participation of physicians in practices with fewer than three full-time equivalent physicians, as well as physicians in larger practices particularly in rural and underserved areas. (c) PERSONAL PHYSICIAN DEFINED. (1) IN GENERAL.-For purposes of this section, the term "personal physician" means a physician (as defined in section 1861(r)(1) of the Social Security Act (42 U.S.C. 1395x(r)(1)) who— (A) meets the requirements described in paragraph (2); and (B) performs the services described in paragraph (3). Nothing in this paragraph shall be construed as preventing such a physician from being a specialist or subspecialist for an individual requiring ongoing care for a specific chronic condition or multiple chronic conditions (such as severe asthma, complex diabetes, cardiovascular disease, rheumatologic disorder) or for an individual with a prolonged illness. (2) REQUIREMENTS.-The requirements described in this paragraph for a personal physician are as follows: (A) The physician is a board certified physician who provides first contact and continuous care for individuals under the physician's care. (B) The physician has the staff and resources to manage the comprehensive and coordinated health care of each such individual. (3) SERVICES PERFORMED.-A personal physician shall perform or provide for the performance of at least the following services: (A) Advocates for and provides ongoing support, oversight, and guidance to implement a plan of care that provides an integrated, coherent, cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient involved and other appropriate medical personnel or agencies (such as home health agencies). (B) Uses evidence-based medicine and clinical decision support tools to guide decision-making at the point-of-care based on patient-specific factors. (C) Uses health information technology, that may include remote monitoring and patient registries, to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services. (D) Encourages patients to engage in the management of their own health through education and support systems. (d) MEDICAL HOME DEFINED.-For purposes of this section, the term “medical home" means a physician practice that (1) is in charge of targeting beneficiaries for participation in the project; and (2) is responsible for (A) providing safe and secure technology to promote patient access to personal health information; (B) developing a health assessment tool for the individuals targeted; and P.L. 109-432 Sec. 204. Continued (C) providing training programs for personnel involved in the coordination of care. (e) PAYMENT MECHANISMS. (1) PERSONAL PHYSICIAN CARE MANAGEMENT FEE.-Under the project, the Secretary shall provide for payment under section 1848 of the Social Security Act (42 U.S.C. 1395w-4) of a care management fee to personal physicians providing care management under the project. Under such section and using the relative value scale update committee (RUC) process under such section, the Secretary shall develop a care management fee code for such payments and a value for such code. (2) MEDICAL HOME SHARING IN SAVINGS.-The Secretary shall provide for payment under the project of a medical home based on the payment methodology applied to physician group practices under section 1866A of the Social Security Act (42 U.S.C. 1395cc-1). Under such methodology, 80 percent of the reductions in expenditures under title XVIII of the Social Security Act resulting from participation of individuals that are attributable to the medical home (as reduced by the total care managements fees paid to the medical home under the project) shall be paid to the medical home. The amount of such reductions in expenditures shall be determined by using assumptions with respect to reductions in the occurrence of health complications, hospitalization rates, medical errors, and adverse drug reactions. (3) SOURCE.-Payments paid under the project shall be made from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t). (f) EVALUATIONS AND REPORTS.— (1) ANNUAL INTERIM EVALUATIONS AND REPORTS.-For each year of the project, the Secretary shall provide for an evaluation of the project and shall submit to Congress, by a date specified by the Secretary, a report on the project and on the evaluation of the project for each such year. (2)FINAL EVALUATION AND REPORT.-The Secretary shall provide for an evaluation of the project and shall submit to Congress, not later than one year after completion of the project, a report on the project and on the evaluation of the project. SEC. 302. EXTENSION AND EXPANSION OF RECOVERY AUDIT CONTRACTOR PROGRAM UNDER THE MEDICARE INTEGRITY PROGRAM. (b) [42 U.S.C. 1395 ddd note] ACCESS TO COORDINATION OF BENEFITS CONTRACTOR DATABASE.-The Secretary of Health and Human Services shall provide for access by recovery audit contractors conducting audit and recovery activities under section 1893(h) of the Social Security Act, as added by subsection (a), to the database of the Coordination of Benefits Contractor of the Centers for Medicare & Medicaid Services with respect to the audit and recovery periods described in paragraph (4) of such section 1893(h). SEC. 304. [None Assigned] IMPLEMENTATION FUNDING. For purposes of implementing the provisions of, and amendments made by, this title and titles I and II of this division, other than section 203, the Secretary of Health and Human Services shall provide for the transfer, in appropriate part from the P.L. 109-432 SEC. 304.-Continued TITLE IV-MEDICAID AND OTHER HEALTH PROVISIONS SEC. 401. [None Assigned] EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA) AND ABSTINENCE EDUCATION PROGRAM. Activities authorized by sections 510 and 1925 of the Social Security Act shall continue through June 30, 2007, in the manner authorized for fiscal year 2006, notwithstanding section 1902(e)(1)(A) of such Act, and out of any money in the Treasury of the United States not otherwise appropriated, there are hereby appropriated such sums as may be necessary for such purpose. Grants and payments may be made pursuant to this authority through the third quarter of fiscal year 2007 at the level provided for such activities through the third quarter of fiscal year 2006. [Internal References.-SSAct Title XVIII, §§1814(i), 1833, 1847B, 1848, 1860D-2, 1886, and 1893(b) have footnotes referring to P.L. 109-432.] P.L. 109-465, Approved December 22, 2006 (120 Stat. 3482) SECTION 1. [42 U.S.C. 1305 note ] SHORT TITLE. This Act may be cited as the "Social Security Trust Funds Restoration Act of 2006". SEC. 2. [None Assigned] DEFINITIONS. (1) CLERICAL ERROR.-The term "clerical error" means the bookkeeping errors at the Social Security Administration that resulted in the overpayment of amounts transferred from the Trust Funds to the general fund of the Treasury during the period commencing with 1999 and ending with 2005 as transfers, under the voluntary withholding program authorized by section 3402(p) of the Internal Revenue Code of 1986, of anticipated taxes on benefit payments under title II of the Social Security Act. (2) SECRETARY.-The term "Secretary" means the Secretary of the Treasury. (3) TRUST FUNDS.-The term "Trust Funds" means the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund. SEC. 3. [None Assigned] RESTORATION OF TRUST FUNDS. (a) APPROPRIATION.—There is hereby appropriated to each of the Trust Funds, out of any money in the Treasury not otherwise appropriated, an amount determined by the Secretary, in consultation with the Commissioner of Social Security, to be equal, to the extent practicable in the judgment of the Secretary, to the difference between-. (1) The sum of— (A) the amounts that the Secretary determines, in consultation with the Commissioner of Social Security, were overpaid from such Trust Fund to the general fund of the Treasury by reason of the clerical error, and (B) the amount that the Secretary determines, in consultation with the Commissioner of Social Security, to be equal, to the extent practicable in the judgment of the Secretary, to the interest income that would have been payable to such Trust Fund pursuant to section 201(d) of the Social Secu P.L. 109-482 SEC. 3. [None Assigned] RESTORATION OF TRUST FUNDS.-Continued rity Act on obligations issued under chapter 31 of title 31, United States Code, that was not paid by reason of the clerical error, and (2) The sum of (A) the amounts that are refunded to such Trust Fund as overpayments by reason of the clerical error to the extent not limited by periods of limitation under applicable provisions of the Internal Revenue Code of 1986, and (B) the interest that is paid to such Trust Fund on the overpayments resulting from the clerical error to the extent allowed under applicable provisions of such Code. (b) INVESTMENT.-The Secretary shall invest the amounts appropriated to each of the Trust Funds under subsection (a) in accordance with the currently applicable investment policy for such Trust Fund. SEC. 4. [None Assigned] TIMING. (a) ACTION BY THE SECRETARY.-The Secretary shall take such actions as are necessary to accomplish the restoration described in section 3 not later than 120 days after the date of the enactment of this Act. (b) ACTION BY THE COMMISSIONER.-The Commissioner of Social Security shall cooperate with the Secretary to the extent necessary to enable the Secretary to meet the requirements of subsection (a). SEC. 5.[None Assigned] CONGRESSIONAL NOTIFICATION. Not later than 30 days after the Secretary takes the last action necessary to accomplish the restoration described in section 3, the Secretary shall notify each House of the Congress in writing of the actions so taken. [Internal Reference.-SSAct Title II has a footnote referring to P.L. 109-465.] P.L. 109-482, Approved January 15, 2007 (120 Stat. 3675) National Institutes of Health Reform Act of 2006 SEC. 201. REDISTRIBUTION OF CERTAIN UNUSED SCHIP ALLOTMENTS FOR FISCAL 2004 AND 2005 TO REDUCE FUNDING SHORTFALLS FOR FISCAL YEAR 2007. * (c) REPORT TO CONGRESS.-Not later than April 30, 2007, the Secretary of Health and Human Services shall submit a report to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate regarding the amounts redistributed to States under section 2104 of the Social Security Act to reduce funding shortfalls for the State Children's Health Insurance Program (SCHIP) for fiscal year 2007. Such report shall include descriptions and analyses of― (1) the extent to which such redistributed amounts have reduced or eliminated such shortfalls on the basis of reports by States submitted to the Secretary as of April 1, 2007; and (2) the effect of the redistribution and limited availability of unexpended fiscal year 2005 allotments under such program on the States described in section 2104(h)(3)(B) of the Social Security Act (42 U.S.C. 1397dd(h)(3)(B)) on the basis of reports by States submitted to the Secretary as of such date. [Internal Reference.-SSAct §2104 has a footnote referring to P.L. 109-482.] |