Affordable Care Act - Detailed breakdown

Requires states to test and develop 'rap back' systems to immediately notify employers if a current employee is convicted of a crime after their initial background check.

Authorizes the Secretary to suspend Medicare and Medicaid payments to a provider or supplier pending an investigation of a credible allegation of fraud.

Establishes new civil monetary penalties for making false statements or delaying inspections related to Federal health care programs.

Authorizes grants to establish stationary and mobile forensic centers to develop expertise and provide services related to elder abuse, neglect, and exploitation.

Requires owners, operators, employees, and contractors of federally funded long-term care facilities to report any reasonable suspicion of a crime against a resident to law enforcement.

Prohibits long-term care facilities from retaliating against employees who report suspected crimes, with penalties including fines up to $200,000 and exclusion from federal programs.

Increases penalties for federal health care fraud offenses based on the dollar amount of the loss and clarifies that specific intent to violate the law is not required for conviction.

Mandates that each state's Health Benefit Exchange must include a Small Business Health Options Program (SHOP) to assist small employers in providing health coverage to their employees.

Prohibits subjecting private health insurance plans to federal or state laws if a public option, CO-OP, or nationwide plan is not subject to the same law.

Authorizes regulations for interstate compacts, allowing qualified health plans to be sold across state lines within the compact, subject primarily to the laws of the originating state.

Establishes a separate appeals process for employers who may be liable for a tax penalty because an employee received a premium tax credit, allowing them to present information for review.

Creates a tax credit for eligible small employers with fewer than 25 full-time equivalent employees to help cover the cost of providing health insurance to their workers.

Imposes a penalty on large employers (50 or more full-time employees) that do not offer affordable health coverage if at least one employee receives a premium tax credit through an exchange.

Prohibits false marketing of MEWAs, requires registration with the Department of Labor, and allows federal orders against financially hazardous plans to combat fraud.

Specifies that for tax purposes, the CLASS program will be treated in the same manner as a qualified long-term care insurance contract.

Limits the tax deduction for remuneration paid by certain health insurance providers to any individual to $500,000 per year.

Creates a new type of simplified cafeteria plan for employers with 100 or fewer employees, which is deemed to meet nondiscrimination requirements if certain contribution and eligibility rules are met.

Imposes a $600 penalty per employee on large employers that require a waiting period of more than 60 days for enrollment in their health plan.

Prohibits the waiver of federal procurement requirements relating to small businesses for any contract awarded under the authority of this Act.

Increases the annual fee on medical device manufacturers and importers to $3,000,000,000 after 2017.

Establishes a fee structure for health insurance providers based on their net premiums written, with exemptions for certain nonprofit and mutual insurance entities.

Creates a state allotment program to fund education for adolescents on both abstinence and contraception for pregnancy and STI prevention, along with other adulthood preparation subjects.

Amends the Social Security Act to authorize funding for abstinence education programs for fiscal years 2010 through 2014.

Authorizes a demonstration program to award grants for developing and implementing academic curricula that integrate quality improvement and patient safety into clinical education.

Authorizes grants and contracts to health professions schools and other entities to develop programs to educate and train health care professionals in pain care.

Establishes a competitive grant program for State partnerships to plan and implement comprehensive health care workforce development strategies at state and local levels.

Increases the annual and aggregate loan limits for students in the nursing student loan program and provides for future cost-of-attendance adjustments.

Establishes a loan repayment program for pediatric medical, surgical, and mental health specialists who agree to work full-time for at least two years in a shortage area.

Authorizes grants to educational institutions to provide new training opportunities for direct care workers employed in long-term care settings like nursing homes and assisted living facilities.

Expands geriatric education programs, creating a fellowship for faculty, training for caregivers, and establishing career incentive awards for health professionals specializing in geriatrics.

Authorizes grants to support the recruitment and education of students in social work, psychology, and child and adolescent mental health programs.

Establishes a loan repayment program for individuals who agree to serve as full-time faculty at an accredited school of nursing for at least four years.

Authorizes activities to address workforce shortages in state and local health departments by expanding fellowship programs in epidemiology, laboratory science, and informatics.

Establishes a new educational track to train health professionals with an emphasis on public health and emergency response, requiring a service obligation in the Public Health Service Commissioned Corps.

Increases the loan repayment limit for certain health professions faculty and reauthorizes appropriations for scholarships and educational assistance for individuals from disadvantaged backgrounds.

Reorganizes the Area Health Education Centers (AHEC) program to focus on recruiting diverse students, providing community-based training, and addressing workforce needs in underserved areas.

Expands the use of nursing workforce diversity grants to include stipends for diploma or associate degree nurses entering bridge or degree completion programs and for accelerated nursing programs.

Authorizes grants for projects to train low-income individuals for healthcare jobs and to develop certification programs for personal or home care aides.

Establishes a demonstration project to provide Medicare payments to up to five hospitals for the costs of clinical training for advanced practice nurses, aiming to increase their numbers.

Establishes the Cures Acceleration Network within the NIH to award grants and contracts to accelerate the development of 'high need cures' for diseases and conditions.

Creates a demonstration grant program to train family nurse practitioners for careers as primary care providers in Federally Qualified Health Centers and nurse-managed health clinics.

Creates a grant program for medical schools to establish rural-focused training programs to encourage graduates to practice in underserved rural areas.

Mandates that the only health plans the federal government may make available to Members of Congress and their staff must be plans created under or offered through a Health Benefit Exchange.

Subjects Health Benefit Exchanges to financial accounting, reporting, audits, and investigations by the Secretary of HHS and the GAO to ensure financial integrity and protect against fraud and abuse.

If a state fails to establish a required Health Benefit Exchange by January 1, 2014, the Secretary of Health and Human Services is required to establish and operate such an exchange within the state.

States are permitted to enact laws to prohibit health insurance exchanges within their borders from offering the community health insurance option.

Permits states to apply for waivers from key ACA requirements starting in 2017 to implement alternative health coverage plans, provided they meet affordability and coverage standards.

Directs the Secretary of Health and Human Services to establish a program to determine eligibility for Exchange participation, premium tax credits, cost-sharing reductions, and individual responsibility exemptions.

Requires the creation of a single, streamlined application system for residents to apply for and enroll in various state health subsidy programs, including the Exchange, Medicaid, and CHIP.

Amends the Internal Revenue Code to allow the IRS to disclose taxpayer return information to HHS to verify eligibility for premium tax credits, cost-sharing reductions, Medicaid, and CHIP.

Prohibits employers from discharging or discriminating against an employee because they received a health insurance tax credit or subsidy, or reported violations of the law.

Expresses the non-binding sense of the Senate that savings from the Act related to Social Security and the CLASS program should be reserved for those programs and not spent on other purposes.

Expands the duties of the Medicaid and CHIP Payment and Access Commission (MACPAC) to review policies affecting all Medicaid beneficiaries, consult with states, and coordinate with MedPAC.

Directs the Government Accountability Office and the Secretary of Health and Human Services to study the impact of the value-based purchasing program and report their findings to Congress.

Establishes an interagency working group, chaired by the Secretary of Health and Human Services, to collaborate on and coordinate federal efforts to improve health care quality.

Reduces the amount available in the Medicare Improvement Fund from $22,290,000,000 to $0.

Directs the Secretary to develop and maintain a widely known and easy-to-use complaint system for Medicare Advantage and prescription drug plans, with annual reports to Congress.

Directs the Inspector General to study Part D formularies' inclusion of drugs for dual eligibles and to compare drug prices between Medicare Part D and Medicaid, reporting findings to Congress.

Mandates the Secretary of Health and Human Services to implement the Board's proposals unless Congress enacts superseding legislation through an expedited process.

Establishes a procedure for Congress to enact a joint resolution by August 15, 2017, to discontinue the board and its automatic implementation process.

Requires the Comptroller General to study and report to Congress on the effects of the Independent Medicare Advisory Board's recommendations on beneficiary access, affordability, and quality of care.

Establishes a 15-member commission to serve as a national resource, coordinate with federal departments, evaluate training activities, and make recommendations on health care workforce priorities.

Establishes a National Center for Health Workforce Analysis to develop information, evaluate programs, and publish performance measures related to the health care workforce.

Establishes a Ready Reserve Corps within the Public Health Service to provide additional personnel for routine public health duties and emergency response missions.

Requires the Secretary of Health and Human Services to establish a new methodology for designating Medically Underserved Populations and Health Professions Shortage Areas through a negotiated rulemaking process.

Creates a commission to oversee the establishment of a key national indicators system, contracting with the National Academy of Sciences to develop and maintain it.

Mandates the Comptroller General to conduct a study on the CMS Five-Star Quality Rating System for nursing homes to analyze its implementation, problems, and potential improvements.

Requires participating states to monitor compliance, provide an independent appeals process for employees, and designate a single state agency to oversee the background check process.

Mandates the Inspector General of the Department of Health and Human Services to evaluate the program's effectiveness, costs, and impact, and submit a report to Congress.

Terminates the Federal Coordinating Council for Comparative Effectiveness Research, which was established under the American Recovery and Reinvestment Act of 2009.

Requires CMS to create an Integrated Data Repository, combining claims data from Medicare, Medicaid, VA, and DoD to identify potential fraud, waste, and abuse.

Eliminates duplication by merging the Healthcare Integrity and Protection Data Bank (HIPDB) with the National Practitioner Data Bank (NPDB).

Prohibits state Medicaid programs from making payments for items or services to any financial institution or entity located outside of the United States.

Establishes a federal council to coordinate elder justice activities across government agencies and an advisory board to create strategic plans and provide recommendations.

Mandates that any savings to the federal government resulting from the enactment of the subtitle on biosimilars must be used for deficit reduction.

Directs the Secretary to improve program integrity by verifying manufacturer ceiling prices, establishing refund procedures for overcharges, and creating an administrative dispute resolution process.

Requires the Comptroller General to submit a report to Congress examining the 340B program's effectiveness and providing recommendations for improvement.

Establishes a trust fund in the U.S. Treasury, the CLASS Independence Fund, to hold all premiums collected and pay program benefits and administrative costs.

Creates a council of up to 15 members, appointed by the President, to advise the Secretary of Health and Human Services on the administration and policies of the CLASS program.

Requires employers to report the aggregate cost of applicable employer-sponsored health coverage on an employee's Form W-2.

Requires the Secretary of Health and Human Services to study the feasibility of adjusting the Federal Poverty Level for different geographic areas to reflect local variations in the cost of living.

Directs the Government Accountability Office to study the incidence of denials of medical coverage and enrollment applications by health insurance plans and report the findings to the public.

Requires the Secretary of Health and Human Services to seek input on standardizing more financial and administrative activities to improve efficiency and reduce administrative costs in health care.

Prohibits states that require local governments to contribute to Medicaid costs from increasing those contribution percentages in order to receive enhanced federal funding.

Requires the Secretary of HHS to establish a public notice and comment process at both the state and federal levels for applications and renewals of Medicaid and CHIP demonstration projects.

Directs the Government Accountability Office (GAO) to study whether new health quality guidelines and standards could establish new legal causes of action or claims.

Renames the board to the Independent Payment Advisory Board and expands its scope to include submitting advisory reports and recommendations to slow national health expenditure growth.

Directs the Secretary of HHS to develop a plan to modernize the computer and data systems of the Centers for Medicare & Medicaid Services to support improvements in care delivery.

Establishes a task force to assess and develop a strategy to improve health care access for federal beneficiaries in Alaska.

Authorizes demonstration grants to states for developing and evaluating alternatives to current medical tort litigation for resolving health care injury disputes.

Prohibits health insurance plans from establishing lifetime limits on the dollar value of benefits and places restrictions on unreasonable annual limits.

Prevents health insurance plans from rescinding coverage once an enrollee is covered, except in cases of fraud or intentional misrepresentation of a material fact.

Requires health plans to cover certain preventive services, such as specific screenings and immunizations, without imposing any cost-sharing requirements on the patient.

Requires health plans that offer dependent coverage to continue making it available for adult children until they turn 26 years of age.

Directs the Secretary to develop standards for a uniform summary of benefits and coverage explanation to help consumers understand and compare health insurance plans.

Requires health insurance issuers to submit reports on spending and provide annual rebates to consumers if the portion of premium revenue spent on non-clinical costs exceeds a certain percentage.

Mandates that health plans implement an effective internal and external appeals process for coverage determinations and claims, ensuring consumer protections.

Establishes a temporary high-risk health insurance pool program to provide immediate coverage for uninsured individuals with a preexisting condition until January 1, 2014.

Creates a temporary reinsurance program to reimburse participating employment-based health plans for a portion of the cost of providing coverage to retirees aged 55 and older not yet eligible for Medicare.

Amends the Health Insurance Portability and Accountability Act (HIPAA) to establish uniform standards and operating rules for electronic health care transactions to reduce administrative burdens.

Prohibits group health plans and health insurance issuers from imposing any preexisting condition exclusions for coverage.

Limits how health insurance premiums can be set. Rates may only vary based on family size, rating area, age (within a 3:1 ratio), and tobacco use (within a 1.5:1 ratio).

Requires health insurance issuers in the individual and group markets to accept every employer and individual that applies for coverage and to renew coverage at the option of the plan sponsor or individual.

Prevents group health plans and insurers from establishing eligibility rules based on health status, medical condition, claims experience, medical history, genetic information, or other health-related factors.

Establishes standards for employer wellness programs, limiting financial rewards to 30% of the cost of employee-only coverage, with provisions to increase this to 50%.

Prohibits group health plans and health insurance issuers from applying a waiting period for coverage that exceeds 90 days.

Allows individuals and groups to keep their existing health plans (grandfathered plans) that were in place when the law was enacted, exempting them from certain new requirements.

Requires qualified health plans to provide a package of essential health benefits, including at least 10 specified categories such as emergency services, maternity care, and prescription drugs.

Sets annual limits on out-of-pocket costs for health plans. For small group plans, deductibles are capped at $2,000 for individuals and $4,000 for families, indexed for future years.

Prohibits federal funds, such as premium tax credits, from being used for abortions, except in cases of rape, incest, or to save the life of the mother, and requires segregation of funds for such coverage.

Requires each state to establish a health insurance marketplace, known as an Exchange, by January 1, 2014, to facilitate the purchase of qualified health plans for individuals and small businesses.

Authorizes the Secretary of Health and Human Services to award grants to states for activities related to establishing American Health Benefit Exchanges. No new grants can be awarded after January 1, 2015.

Requires each Health Benefit Exchange to establish a Navigator program that awards grants to entities to conduct public education and provide fair, impartial assistance with enrollment in health plans.

Requires health insurance issuers to consider all enrollees within the individual market as a single risk pool, and likewise for the small group market, to prevent discrimination based on health status.

Establishes a program to provide loans and grants to foster the creation of qualified nonprofit, member-run health insurance issuers to offer health plans in the individual and small group markets.

The Secretary of Health and Human Services will establish a public health insurance option to be offered through state exchanges, promoting competition and affordable coverage.

Allows states to establish a basic health program for low-income individuals (133-200% of poverty line) not eligible for Medicaid, in lieu of offering them coverage through an exchange.

Establishes a temporary reinsurance program from 2014-2016, funded by contributions from health insurers, to stabilize premiums in the individual market by covering high-risk individuals.

Creates a temporary risk corridor program for 2014-2016 where the federal government shares in the gains or losses of qualified health plans if their costs are significantly different than premiums.

Requires states to implement a risk adjustment program that transfers funds from plans with lower-risk enrollees to plans with higher-risk enrollees in the individual and small group markets.

Establishes a new refundable tax credit to provide premium assistance for eligible taxpayers with household incomes between 100% and 400% of the federal poverty line to purchase health insurance through an Exchange.

Requires health plan issuers to reduce cost-sharing, such as deductibles and co-pays, for eligible individuals with household incomes between 100% and 400% of the poverty line who enroll in a silver-level plan.

Eliminates all cost-sharing requirements for Native Americans with household incomes up to 300% of the poverty line who are enrolled in any qualified health plan through an Exchange.

Establishes a program for making advance payments of premium tax credits and cost-sharing reductions directly to insurance issuers to lower the monthly premiums paid by eligible individuals.

Requires most individuals to obtain and maintain minimum essential health coverage for themselves and their dependents each month beginning after 2013, or pay a penalty.

Requires employers with more than 200 full-time employees to automatically enroll new full-time employees in a health benefits plan, with an opportunity for the employee to opt out.

Requires employers to provide written notice to employees about the existence of Health Insurance Exchanges and their potential eligibility for tax credits if they purchase a plan through an Exchange.

Directs the Secretary of HHS to develop interoperable and secure standards to facilitate enrollment in federal and state health and human services programs, and authorizes grants for implementation.

Expands Medicaid eligibility beginning in 2014 to individuals under age 65 with incomes at or below 133% of the poverty line, with the federal government providing enhanced funding for this new population.

Requires states to maintain their Medicaid eligibility standards until their state's health insurance exchange is fully operational, and through September 30, 2019, for children.

Requires states to use Modified Adjusted Gross Income (MAGI) to determine Medicaid eligibility for most non-elderly individuals, eliminating asset tests for these populations, effective January 1, 2014.

Increases the cap on federal Medicaid payments to U.S. territories by 30% and raises their federal matching rate (FMAP) to 55%, effective January 1, 2011.

Provides a temporary adjustment to the Federal Medical Assistance Percentage (FMAP) for states that have experienced a major disaster and subsequently face a significant drop in their federal matching rate.

Increases the enhanced Federal Medical Assistance Percentage (FMAP) for the Children's Health Insurance Program (CHIP) by 23 percentage points from October 1, 2013, to September 30, 2019.

Prohibits states from making eligibility standards for the Children's Health Insurance Program (CHIP) more restrictive than those in effect on the date of enactment, until September 30, 2019.

Requires states to establish streamlined online systems for Medicaid and CHIP applications and to coordinate with State Health Insurance Exchanges for seamless enrollment and eligibility screening.

Allows any participating hospital to make presumptive (temporary) eligibility determinations for all Medicaid-eligible populations, effective January 1, 2014.

Requires state Medicaid plans to cover services provided at freestanding birth centers, which are non-hospital facilities licensed for prenatal, delivery, and postpartum care.

Allows children in Medicaid or CHIP to receive both hospice care and curative treatment for a terminal illness simultaneously.

Creates a new state option to provide Medicaid coverage limited to family planning services for certain low-income individuals who are not pregnant.

Increases the minimum rebate percentages drug manufacturers must pay to Medicaid and extends these rebate requirements to drugs dispensed through Medicaid managed care organizations.

Requires state Medicaid programs to cover certain drugs they were previously allowed to exclude, such as smoking cessation agents, barbiturates, and benzodiazepines, starting January 1, 2014.

Revises the calculation for the Federal upper reimbursement limit for multiple source drugs and redefines the average manufacturer price (AMP) to exclude certain discounts and fees.

Reduces a state's Disproportionate Share Hospital (DSH) allotment once its uninsured population decreases by at least 45% from 2009 levels, with the reduction percentage varying by state.

Establishes a Federal Coordinated Health Care Office within CMS to integrate Medicare and Medicaid benefits and extends demonstration projects for dual eligibles to 5-year periods.

Requires the Secretary of HHS to establish a core set of health quality measures for adults on Medicaid and creates a Medicaid Quality Measurement Program to improve and test these measures.

Prohibits federal Medicaid payments to states for costs associated with specified health care-acquired conditions, effective July 1, 2011, to improve patient safety.

Allows states to create 'health homes' to coordinate care for Medicaid enrollees with chronic conditions, offering a 90% federal match for the first 8 quarters to encourage adoption.

Establishes several demonstration projects, including ones for bundled payments around hospitalization, global payments for safety-net hospitals, and pediatric Accountable Care Organizations.

Creates a 3-year demonstration project allowing states to receive Medicaid payment for services provided in certain institutions for mental diseases to stabilize emergency conditions for adults.

Establishes Indian Health Service programs as the payer of last resort and makes permanent the reimbursement for all Medicare Part B services furnished by certain Indian hospitals and clinics.

Encourages research on postpartum conditions and authorizes grants for projects providing essential services to individuals with or at risk for postpartum depression and their families.

Establishes a program starting in fiscal year 2013 to provide incentive payments to hospitals based on their performance on quality measures, funded by reducing base operating payments to all hospitals.

Establishes demonstration programs to test value-based purchasing methods for critical access hospitals and other hospitals that are otherwise excluded from the main program.

Extends the Physician Quality Reporting System through 2014, offering incentive payments for reporting, and introduces payment penalties for non-reporting beginning in 2015.

Requires the Secretary of HHS to develop a plan by January 1, 2012, to integrate physician quality reporting with reporting requirements for the meaningful use of electronic health records.

Expands the Physician Feedback Program to provide confidential reports to physicians on their resource use and quality of care, comparing them to their peers.

Requires long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs to submit quality data starting in fiscal year 2014 or face a 2 percentage point reduction in payments.

Requires certain cancer hospitals to submit quality data to the Secretary of HHS for fiscal year 2014 and subsequent years.

Directs the Secretary of HHS to develop and report to Congress a plan to implement value-based purchasing programs for skilled nursing facilities and home health agencies.

Establishes a payment modifier to adjust physician payments under the Medicare fee schedule based on the quality and cost of care provided, with implementation beginning in 2015.

Reduces Medicare payments by 1% for hospitals in the top quartile for hospital-acquired conditions, starting in fiscal year 2015, to incentivize better patient safety.

Directs the Secretary of Health and Human Services to establish a national strategy to improve health care delivery, patient outcomes, and population health through a transparent, collaborative process.

Authorizes the Secretary of Health and Human Services to award grants and contracts to develop, improve, and expand quality measures for use in federal health programs.

Requires a pre-rulemaking process where multi-stakeholder groups provide input to the Secretary on the selection of quality measures for Medicare and other health programs.

Directs the Secretary of Health and Human Services to collect data on quality and resource use and make performance information publicly available on standardized websites.

Creates the Center for Medicare and Medicaid Innovation within CMS to test innovative payment and service delivery models aimed at reducing costs while preserving or enhancing quality of care.

Establishes a program to encourage providers to form Accountable Care Organizations (ACOs) to coordinate care for Medicare beneficiaries and share in any savings they achieve.

Establishes a pilot program to test bundled payments for episodes of care around a hospitalization to improve coordination, quality, and efficiency of Medicare services.

Creates a demonstration program to test a payment incentive and service delivery model using home-based primary care teams to reduce costs and improve outcomes for high-need beneficiaries.

Reduces Medicare payments to hospitals with excess readmission rates for certain conditions, beginning on or after October 1, 2012.

Establishes a 5-year program providing funding to eligible entities that furnish improved care transition services to high-risk Medicare beneficiaries to reduce hospital readmissions.

Allows physician assistants to order post-hospital extended care services for Medicare beneficiaries, effective for services furnished on or after January 1, 2011.

Exempts certain pharmacies from durable medical equipment accreditation if their Medicare billings are less than 5% of total sales and they meet other criteria.

Creates a one-time, 12-month special enrollment period for Medicare Part B for disabled TRICARE beneficiaries who did not enroll during their initial enrollment period.

Increases the Medicare payment rate for services furnished by certified nurse-midwives to 100 percent of the physician fee schedule amount, effective January 1, 2011.

Extends through 2010 a provision that protects small rural hospitals from payment reductions under the outpatient prospective payment system.

Extends the Rural Community Hospital Demonstration Program for one year, expands it to 20 states, and increases the maximum number of participating hospitals to 30.

Extends the special payment methodology for Medicare-Dependent Hospitals (MDHs) for one year, through fiscal year 2012.

Temporarily modifies the criteria for low-volume hospital payment adjustments for fiscal years 2011 and 2012, expanding eligibility and implementing a sliding scale for payment increases.

Directs the Medicare Payment Advisory Commission to study the adequacy of Medicare payments for health care providers in rural areas and report to Congress by January 1, 2011.

Rebases home health prospective payment amounts starting in 2013, imposes a 10% cap on outlier payments for individual agencies, and extends the 3% rural add-on payment through 2015.

Requires collection of new data to reform hospice payment rates by 2013 and mandates a face-to-face encounter with a physician or nurse practitioner to recertify eligibility after 180 days.

Restructures Medicare DSH payments starting in FY2015, paying 25% of the old amount and distributing the rest based on hospitals' share of uncompensated care, adjusted for changes in the uninsured rate.

Requires the Secretary to establish a process to identify, review, and adjust relative values for potentially misvalued services under the Medicare physician fee schedule.

Reduces Medicare payments for advanced imaging by increasing the presumed equipment utilization rate in phases to 75% and increasing the payment reduction for multiple procedures from 25% to 50%.

Requires the Secretary of Health and Human Services to develop and report to Congress a plan to reform the Medicare hospital wage index system by December 31, 2011.

Establishes a 3-year, 15-site demonstration program to allow Medicare beneficiaries to receive both hospice care and curative treatment services concurrently.

Transitions Medicare Advantage (MA) payment benchmarks to be based on the weighted average of competitive bids from plans in an area, phasing in from 2012 to 2015.

Increases the required rebate for Medicare Advantage plans from 75 percent to 100 percent of the savings for plan years beginning on or after January 1, 2014.

Requires the Chief Actuary of CMS to establish actuarial guidelines and bidding rules to ensure accurate bids and fair competition among MA plans, effective for bids submitted on or after January 1, 2012.

Establishes performance bonuses for MA plans starting in 2014, rewarding plans for care coordination programs and high-quality performance based on a star rating system.

Prohibits Medicare Advantage plans from charging higher cost-sharing than original Medicare for certain services, including chemotherapy, renal dialysis, and skilled nursing care, effective 2011.

Requires that for 2012 and later, MA plan rebates and performance bonuses must be used first to reduce cost-sharing, then for preventive benefits, and finally for other extra benefits.

Requires the Secretary to analyze and incorporate coding intensity adjustments into Medicare Advantage risk scores for 2011 through 2013, with authority to continue for subsequent years.

Changes the annual Medicare Advantage and Part D election period to run from October 15 to December 7 each year, starting with the period for 2012.

Extends the authority for Specialized MA Plans for Special Needs Individuals (SNPs) through 2014 and requires them to be approved by the National Committee for Quality Assurance (NCQA) starting in 2012.

Makes permanent a demonstration project allowing certain Medicare Advantage plans to limit their service area to a specific senior housing facility, such as a continuing care retirement community.

Grants the Secretary of Health and Human Services the authority to reject bids from Medicare Advantage and Part D plans, particularly if they propose significant cost-sharing increases or benefit cuts.

Directs a review and revision of standards for Medicare Supplemental (Medigap) plans C and F to include nominal cost-sharing to encourage appropriate use of physician services, effective by 2015.

Establishes a program requiring drug manufacturers to provide a 50% discount on applicable drugs for beneficiaries in the Part D coverage gap as a condition for their drugs to be covered under Part D.

Modifies the calculation of the low-income benchmark premium for Medicare Part D to disregard reductions from beneficiary rebates or bonus payments, effective January 1, 2011.

Allows prescription drug plans to waive small (de minimis) monthly premiums for low-income subsidy eligible individuals and authorizes the Secretary to auto-enroll these individuals into such plans.

Requires the Secretary to provide reassigned low-income beneficiaries with information on formulary differences and their rights to appeal coverage decisions within 30 days of reassignment.

Requires Medicare Part D plans to include all drugs in certain protected classes, such as anticonvulsants, antidepressants, and antiretrovirals, unless the Secretary establishes exceptions.

Increases the monthly Medicare Part D premium for individuals whose modified adjusted gross income exceeds a certain threshold, similar to the income-related adjustment for Part B.

Eliminates cost-sharing for full-benefit dual eligible individuals receiving home and community-based services, treating them as institutionalized individuals for cost-sharing purposes.

Requires prescription drug plans to use specific dispensing techniques, like weekly or daily doses, for residents of long-term care facilities to reduce waste from 30-day fills.

Requires all Medicare Part D plans to use a single, uniform exceptions and appeals process, including a model form and access via a toll-free number and website.

Specifies that costs paid by AIDS Drug Assistance Programs, the Indian Health Service, and State Pharmaceutical Assistance Programs count toward a beneficiary's annual out-of-pocket threshold.

Increases the initial coverage limit for Medicare Part D by $500 for the 2010 plan year only, providing immediate relief to beneficiaries approaching the coverage gap.

Reduces annual Medicare payment increases for various providers, including hospitals and nursing facilities, by applying a productivity adjustment and other specific percentage point reductions for fiscal years 2010-2019.

Freezes the income thresholds used to determine higher Medicare Part B premiums at 2010 levels for the period from January 1, 2011, through December 31, 2019.

Creates an independent board to propose recommendations for reducing the per capita growth rate in Medicare spending if projections exceed a target rate.

Prohibits the Independent Medicare Advisory Board from recommending rationing health care, raising beneficiary premiums, increasing cost-sharing, or restricting benefits or eligibility.

Directs the Agency for Healthcare Research and Quality to conduct and support research on innovative strategies for improving the quality, safety, and value of health care delivery.

Authorizes the Agency for Healthcare Research and Quality to award grants and contracts to help health care providers implement best practices for quality improvement.

Establishes a grant program for community-based interdisciplinary health teams to support primary care practices and patient-centered medical homes.

Creates a grant program for licensed pharmacists to provide medication management services to individuals with chronic diseases to improve care quality and reduce costs.

Authorizes competitive grants for pilot projects to design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems.

Establishes grant programs for trauma centers to defray uncompensated care costs, support core missions, and provide emergency relief to ensure service availability.

Establishes a program to facilitate shared decision-making between patients and clinicians, including the development, certification, and use of patient decision aids.

Requires the Secretary of HHS to determine if adding standardized quantitative summaries of drug benefits and risks to promotional materials would improve health care decision-making.

Establishes and codifies Offices of Women's Health within the HHS, CDC, AHRQ, HRSA, and FDA to coordinate and promote women's health issues.

Ensures that no provision in the Act will reduce guaranteed Medicare benefits and directs that any savings generated will extend the solvency of Medicare trust funds and benefit beneficiaries.

Prohibits this Act from resulting in the reduction or elimination of any benefits guaranteed by law to participants in Medicare Advantage plans.

Establishes a council chaired by the Surgeon General to coordinate federal prevention and public health efforts and develop a national strategy.

Establishes a dedicated fund to provide for expanded and sustained national investment in prevention and public health programs.

Formalizes the duties of the independent Preventive Services Task Force and establishes a new Community Preventive Services Task Force to develop recommendations.

Directs the Secretary of Health and Human Services to implement a national public-private partnership for an outreach and education campaign on preventive health.

Establishes grant programs to support the establishment (facilities and equipment) and operation of school-based health centers.

Establishes a 5-year national public education campaign on oral healthcare prevention and authorizes grants for dental caries disease management.

Provides Medicare coverage for an annual wellness visit, including a personalized prevention plan, without cost-sharing for beneficiaries, effective January 1, 2011.

Eliminates cost-sharing (coinsurance and deductibles) for highly-rated preventive services for Medicare beneficiaries, effective January 1, 2011.

Authorizes the Secretary to modify or eliminate Medicare coverage for preventive services that are not recommended by the U.S. Preventive Services Task Force.

Increases the federal matching rate by one percentage point for states that cover recommended preventive services for adults in Medicaid without cost-sharing.

Requires state Medicaid programs to cover comprehensive tobacco cessation services, including counseling and pharmacotherapy, for pregnant women without cost-sharing.

Establishes a grant program for states to provide incentives to Medicaid beneficiaries who participate in programs to prevent or manage chronic diseases.

Awards competitive grants to state and local agencies and community organizations for evidence-based health activities to reduce chronic disease rates and address health disparities.

Creates a pilot program for public health interventions for individuals aged 55-64 and requires an evaluation of community-based prevention and wellness programs for Medicare beneficiaries.

Directs the Architectural and Transportation Barriers Compliance Board to establish standards ensuring medical diagnostic equipment is accessible to individuals with disabilities.

Allows states to purchase adult vaccines at federally negotiated prices and establishes a demonstration program to improve immunization coverage for high-risk populations.

Requires restaurants and similar retail food establishments with 20 or more locations to disclose calorie information on menus and menu boards for standard menu items.

Requires federally supported health programs to collect and report data on race, ethnicity, sex, primary language, and disability status to analyze and monitor health disparities.

Directs the CDC to provide technical assistance, tools, and resources to employers for evaluating and improving their workplace wellness programs.

Establishes a grant program for health departments to improve surveillance and response to infectious diseases by strengthening epidemiology and laboratory capacity.

Directs the Secretary of Health and Human Services to convene a conference to address pain as a public health problem, identify barriers to care, and establish an agenda for action.

Establishes a committee to coordinate pain research efforts within HHS and other Federal agencies, identify research gaps, and make recommendations to improve care and avoid duplication.

Establishes a loan repayment program for public health professionals who agree to serve in federal, state, local, or tribal public health agencies. Participants can receive up to $35,000 per year.

Expands an existing loan forgiveness program to include allied health professionals who work full-time in public health agencies or in medically underserved areas.

Authorizes grants to fund the operational costs of nurse-managed health clinics that provide primary care or wellness services to underserved or vulnerable populations.

Authorizes grants to establish demonstration programs for training and employing alternative dental health care providers to increase access to dental services in underserved communities.

Authorizes grants to enhance the nursing workforce by creating career ladder programs and improving patient care delivery systems to increase nurse retention.

Authorizes the CDC to award grants to support community health workers in educating and providing outreach to medically underserved communities to promote positive health behaviors and outcomes.

Establishes a program to support primary care providers through Health Extension Agents, helping them incorporate preventive medicine, chronic disease management, and evidence-based practices.

Establishes a 10% Medicare bonus payment for primary care services and for major surgical procedures performed by general surgeons in health professional shortage areas, from 2011 to 2016.

Expands Medicare coverage at FQHCs to include preventive services and directs the Secretary of HHS to implement a prospective payment system for FQHCs by October 2014.

Reduces residency limits for hospitals with unused positions and redistributes them to qualifying hospitals, prioritizing those in underserved areas and rural locations.

Allows hospitals to count resident training time in non-hospital settings towards Medicare graduate medical education payments, provided the hospital covers the resident's stipend and benefits.

Establishes a process to transfer medical residency positions from closed hospitals to other hospitals, prioritizing those in the same geographic area to prevent a net loss of training slots.

Authorizes grants for demonstration projects to provide coordinated primary and specialty care services in community-based mental and behavioral health settings for adults with mental illnesses.

Limits the 'whole hospital' and 'rural provider' exceptions to the physician self-referral prohibition, restricting the expansion of existing physician-owned hospitals and preventing new ones from being established.

Requires manufacturers of drugs, devices, and medical supplies to publicly report payments and other transfers of value made to physicians and teaching hospitals.

Requires physicians referring patients for certain imaging services (MRI, CT, PET) within their own practice to inform patients in writing that they may obtain the service elsewhere and provide a list of alternative suppliers.

Requires drug manufacturers and authorized distributors to annually report to the Secretary of HHS on the identity and quantity of drug samples requested and distributed.

Requires PBMs serving Medicare Part D and exchange plans to report information on drug rebates, discounts, price concessions, and payment differentials to the Secretary of HHS.

Requires nursing homes to disclose detailed information about their owners, operators, and other parties with financial or managerial control, which will be made publicly available.

Requires skilled nursing and nursing facilities to establish effective compliance and ethics programs to prevent violations and promote quality of care, with regulations to be developed by the Secretary of HHS.

Mandates the inclusion of more detailed information on the Nursing Home Compare website, such as staffing data, inspection reports, complaint information, and records of criminal violations.

Directs the Secretary of HHS to develop a standardized complaint form for residents or their representatives to file complaints with state agencies and long-term care ombudsman programs.

Requires facilities to electronically submit direct care staffing information based on payroll and other auditable data, including staff category, resident census, turnover, and hours of care per resident.

Allows for a reduction of up to 50% in civil money penalties for facilities that self-report and promptly correct a deficiency, with prohibitions on reductions for repeat or severe deficiencies.

Requires facility administrators to provide a 60-day written notification of an impending closure to the Secretary, state ombudsman, and residents, and include a plan for relocating residents.

Requires that training for nurse aides in skilled nursing and nursing facilities include dementia management and patient abuse prevention training.

Establishes a nationwide program for states to conduct background checks on prospective employees of long-term care facilities who have direct patient access.

Mandates that background checks include state and national criminal history, abuse registries, and a fingerprint check using the FBI's Integrated Automated Fingerprint Identification System.

Creates a nonprofit corporation, the Patient-Centered Outcomes Research Institute, to conduct and support research comparing the effectiveness of medical treatments.

Establishes a trust fund in the U.S. Treasury, funded by appropriations and fees on health plans, to support the Institute's research activities.

Imposes fees on specified health insurance policies and self-insured health plans to finance the Patient-Centered Outcomes Research Trust Fund.

Prohibits using research findings to deny Medicare coverage or to devalue life based on age, disability, or terminal illness in coverage determinations.

Requires the Agency for Healthcare Research and Quality (AHRQ) to broadly disseminate research findings from the Institute to physicians, patients, payers, and policymakers.

Establishes a risk-based screening process for providers, including licensure checks, background checks, and site visits, to prevent fraud, waste, and abuse.

Requires providers and suppliers to report and return any identified overpayments within 60 days. Failure to do so can result in penalties under the False Claims Act.

Reduces the maximum period for submitting Medicare claims from up to three years to one calendar year after the date of service.

Requires physicians to have a face-to-face encounter with a patient before certifying eligibility for home health services or ordering durable medical equipment.

Requires physicians and other eligible professionals who order durable medical equipment or home health services to be enrolled in Medicare.

Allows the Secretary to revoke a physician's or supplier's enrollment for failing to maintain and provide documentation for referrals to programs at high risk of waste and abuse.

Requires HHS to establish a protocol for healthcare providers to self-disclose potential violations of self-referral laws, with potential for reduced penalties.

Expands Round 2 of the Durable Medical Equipment competitive bidding program to 91 metropolitan areas and requires nationwide application of competitive prices by 2016.

Expands the RAC program to identify and recoup overpayments in Medicaid and Medicare Parts C and D, requiring states to establish programs by December 31, 2010.

Requires state Medicaid programs to terminate participation of any provider who has been terminated from Medicare or another state's Medicaid plan.

Requires state Medicaid programs to incorporate the National Correct Coding Initiative to control improper coding and prevent inappropriate payments.

Creates grant programs and incentives to train, recruit, and retain direct care employees in long-term care settings, and to improve management practices.

Authorizes grants to help long-term care facilities purchase, lease, and implement certified Electronic Health Record (EHR) technology to improve patient safety and reduce medication errors.

Directs the Secretary of Health and Human Services to conduct a study on the feasibility and establishment of a national nurse aide registry to improve background checks and data collection.

Expresses that states should be encouraged to test alternatives to the existing civil litigation system for medical malpractice claims to improve patient safety and dispute resolution.

Establishes an abbreviated licensure pathway for biological products demonstrated to be highly similar (biosimilar) or substitutable (interchangeable) with an existing FDA-approved biologic.

Grants a 12-year market exclusivity period to original biological products and provides exclusivity for the first interchangeable biosimilar product.

Creates a structured process for biosimilar applicants and original manufacturers to exchange patent information and resolve potential infringement claims before the biosimilar product is marketed.

Extends market exclusivity periods by 6 months for biological products if the manufacturer conducts pediatric studies as requested by the Secretary of Health and Human Services.

Expands the types of healthcare facilities eligible for the 340B drug discount program, including certain children's, cancer, critical access, and rural hospitals.

Imposes a 40% excise tax on the value of employer-sponsored health coverage that exceeds certain annual thresholds, often called the 'Cadillac Tax'.

Limits tax-free distributions from HSAs, Archer MSAs, and FSAs for over-the-counter medicines to only prescribed drugs or insulin.

Increases the additional tax on distributions from Health Savings Accounts (HSAs) and Archer MSAs not used for qualified medical expenses to 20%.

Limits employee salary reduction contributions to a health flexible spending arrangement (FSA) to $2,500 per taxable year.

Requires tax-exempt hospitals to conduct community health needs assessments, establish financial assistance policies, and limit charges for eligible individuals to maintain their status.

Increases the threshold for the itemized deduction for medical expenses from 7.5% to 10% of adjusted gross income, with a temporary exception for seniors.

Imposes an additional Medicare tax on wages and self-employment income for individuals earning over $200,000 ($250,000 for joint filers).

Imposes a 5% excise tax on elective cosmetic medical procedures that are not necessary to ameliorate a deformity or disease.

Amends the Internal Revenue Code to exclude the value of qualified health care benefits provided by Indian tribal governments from an individual's gross income, making these benefits non-taxable.

Establishes a tax credit or grant for up to 50% of qualified investments in projects to develop new therapies, diagnose diseases, or improve therapeutic delivery for small businesses with up to 250 employees.

Prohibits group health plans and insurers from establishing lifetime or annual dollar limits on essential health benefits for any participant or beneficiary.

Requires health insurers to provide annual rebates to consumers if they do not spend at least 80-85% of premium revenues on medical care and quality improvement activities.

Establishes several patient protections, including coverage for emergency services without prior authorization, direct access to OB/GYN care, and the ability to choose any available primary care provider.

Requires health plans to cover routine patient costs for individuals participating in approved clinical trials for cancer or other life-threatening diseases.

Specifies that any reference to a qualified health plan is deemed to include plans offered through the CO-OP program and multi-State plans, unless otherwise specified.

Requires qualified health plans to pay Federally-Qualified Health Centers an amount no less than the rate the center would have received under Medicaid for the same item or service.

Allows states to prohibit abortion coverage in exchange plans, prohibits using federal subsidies for certain abortions, and requires plans covering them to collect separate, segregated payments from enrollees.

Requires health plans on the exchange to publicly disclose information on claims payment, financial data, enrollment, denied claims, and cost-sharing in plain language.

Directs the Office of Personnel Management to contract with private insurers to offer at least two multi-state qualified health plans on each state's health insurance exchange.

Creates a program requiring employers to provide vouchers to eligible employees to purchase a plan on an exchange if the employee's share of the premium for employer coverage is deemed unaffordable.

Clarifies and modifies Medicaid eligibility criteria for individuals under age 26 who were formerly in foster care, ensuring their continued access to health coverage.

Provides an increased Federal Medical Assistance Percentage (FMAP) to certain states that expanded Medicaid but do not receive other enhanced federal payments for newly eligible individuals.

Creates a program offering enhanced federal Medicaid matching funds to states that increase spending on non-institutional, home, and community-based long-term care services.

Extends federal funding for the Children's Health Insurance Program (CHIP) through fiscal year 2015 and makes various technical and programmatic adjustments.

Reauthorizes and amends the Indian Health Care Improvement Act, addressing various aspects of health services for American Indians and Alaska Natives.

Directs the Secretary of HHS to develop a plan to implement a value-based purchasing program for ambulatory surgical centers under Medicare.

Requires the Secretary of HHS to develop and periodically update provider-level outcome measures for hospitals and physicians for prevalent acute and chronic conditions and preventive care.

Enhances the Center for Medicare and Medicaid Innovation by allowing geographically limited tests and focusing on models that reduce costs while preserving or enhancing care quality.

Authorizes the Secretary of HHS to use alternative payment models, such as partial capitation, for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program.

Extends the demonstration program for five years, expands it to 20 states, and increases the maximum number of participating hospitals to 30.

Establishes a quality reporting program for psychiatric hospitals and units, reducing payments by 2 percentage points for facilities that fail to submit required quality data.

Grants Medicare eligibility to individuals diagnosed with certain conditions after being exposed to environmental health hazards in areas with a public health emergency declaration.

Establishes a minimum wage index floor of 1.00 for hospitals, hospital outpatient departments, and physician services in states where at least 50% of counties are sparsely populated.

Requires the Secretary of HHS to conduct pilot programs by 2016 to test value-based purchasing for psychiatric hospitals, long-term care hospitals, rehabilitation hospitals, and others.

Provides an additional 0.5% incentive payment from 2011-2014 for eligible professionals who submit quality data through a Maintenance of Certification Program.

Enhances Medicare Part D MTM programs by requiring annual comprehensive medication reviews and automatic enrollment for targeted beneficiaries, with an option to opt-out.

Requires the Secretary of HHS to develop a 'Physician Compare' website to publicly report on the performance of Medicare physicians, including quality and patient experience measures.

Requires the Secretary of HHS to make standardized Medicare claims data available to qualified public and private entities to evaluate the performance of healthcare providers.

Authorizes a grant program to support community-based collaborative care networks that provide comprehensive, coordinated health care services for low-income populations.

Elevates the Office of Minority Health within HHS and establishes similar offices in six other HHS agencies to improve minority health and eliminate racial and ethnic health disparities.

Directs the Government Accountability Office to study and report on Medicare beneficiary access to high-quality dialysis services, focusing on the impact of new payment systems for oral drugs.

Eliminates Medicare coinsurance and deductibles for preventive services that receive a grade of A or B from the U.S. Preventive Services Task Force.

Establishes programs to improve diabetes care, including a biennial national diabetes report card, improved vital statistics collection, and a study on diabetes medical education.

Creates a grant program for small businesses (fewer than 100 employees) to establish comprehensive workplace wellness programs.

Establishes a grant program to create a network of national centers of excellence for depression to improve treatment, conduct research, and disseminate findings.

Authorizes the CDC to establish a national surveillance system for congenital heart disease and the NIH to expand and coordinate research on the condition.

Establishes a national education campaign through the CDC to increase breast health awareness among young women, educate health professionals, and support prevention research.

Directs the CDC to establish a national program to prevent diabetes in high-risk adults, including grants for community-based programs.

Requires the Secretary of HHS to develop and implement a prospective payment system for services provided by Federally Qualified Health Centers under Medicare, beginning October 1, 2014.

Establishes the Community Health Center Fund to provide increased and sustained funding for community health centers and the National Health Service Corps.

Extends Federal Tort Claims Act medical malpractice liability protection to officers, governing board members, employees, and contractors of free clinics.

Treats longshore workers as employees in high-risk professions for the purposes of the excise tax on high-cost health plans and modifies which benefits are exempt.

Limits employee salary reduction contributions to a health flexible spending arrangement to $2,500 per year, with adjustments for inflation.

Changes the standard for what charitable hospitals can charge certain patients from "the lowest amounts charged" to "the amounts generally billed."

Increases the additional Hospital Insurance (Medicare) tax on high-income taxpayers from 0.5 percent to 0.9 percent.

Imposes a 10 percent excise tax on indoor tanning services, paid by the consumer.

Excludes from gross income any student loan repayment or forgiveness received by health professionals under state programs for working in underserved areas.

Premium tax credits and cost-sharing reduction payments for health insurance will not be counted as income or resources when determining eligibility for other federal or federally-assisted programs.

Amends the Black Lung Benefits Act to ease the requirements for certain survivors of coal miners to claim benefits, applying to claims filed after January 1, 2005.

Prohibits discrimination based on race, color, national origin, sex, age, or disability in any health program or activity receiving federal financial assistance.

Expands Medicaid eligibility to individuals under age 25 who were in foster care for more than six months, effective January 1, 2019.

Establishes a new Medicaid state plan option for home and community-based attendant services, offering a 6 percentage point increase in the federal matching rate to participating states.

Extends the Money Follows the Person program, which helps individuals transition from institutions to community-based settings, through fiscal year 2016 and reduces the required institutional residency period.

Extends spousal impoverishment protections to spouses of individuals receiving Medicaid home and community-based services for a five-year period starting January 1, 2014.

Establishes a grant program for states to deliver services through early childhood home visitation programs to improve outcomes for at-risk families.

Requires states to include information about designating a health care power of attorney in transition planning for children aging out of foster care.

Extends the eligibility period for low-income assistance for an individual whose spouse dies by one year beyond its original expiration date.

Amends the Fair Labor Standards Act to require employers with 50 or more employees to provide reasonable break time and a private place for nursing mothers to express breast milk.

Amends the Social Security Act to add a new subtitle dedicated to 'Elder Justice', establishing a framework for preventing, detecting, and prosecuting elder abuse, neglect, and exploitation.

Authorizes formula grants to states and funding for demonstration programs to enhance adult protective services for investigating reports of elder abuse, neglect, and exploitation.

Creates a national voluntary insurance program, the Community Living Assistance Services and Supports (CLASS) program, to help individuals with functional limitations live independently.

Establishes automatic enrollment for working individuals aged 18 and over, with an option to opt-out. Premiums are set to ensure the program's 75-year solvency, with no taxpayer funds used for benefits.

Provides a daily cash benefit, averaging at least $50, to eligible beneficiaries after a 5-year vesting period. Eligibility is triggered by significant functional or cognitive limitations.

Requires states to ensure an adequate supply of personal care attendants and establishes a Personal Care Attendants Workforce Advisory Panel to advise on workforce issues.

Establishes a competitive grant program for states to support pregnant and parenting teens and women, including services at high schools and colleges and for victims of violence.

Increases the adoption tax credit to $13,170, makes the credit refundable, and provides for future inflation adjustments.

Prohibits wellness programs from collecting information on lawful firearm ownership and bars insurers from increasing premiums or denying coverage based on it.