The second half of the notes of what every section of the Health Care Bill does.

1501—modifies regulations regarding resident physicians at hospitals. If there are fewer residents than that hospital’s reference level, then the remaining slots are taken away and redistributed to other facilities. If a hospital is expanding and requires more residents, it can apply and get slots redistributed from other facilities. I guess this reduces payments to hospitals with fewer residents and enables other hospitals to expand their programs and get more federal money for them. Dictates special treatment for certain hospitals over others (rural areas, training critical or low-availability specialists, etc.)
1502—allows clinic and home-visit time to count toward resident training. Patient care activities in “A non-provider setting”. Calls for a science project that reimburses teaching hospitals for teaching costs; a teaching health center will contract with teaching hospitals to train residents, and the residents in training will not count against the hospital’s allotted residents.
1503—counts residents’ time spent in researching specific patient care issues or attending training or seminars geared to addressing a particular patient’s needs as time spent towards full-time equivalency.
1504—if a hospital closes, all the residency positions authorized for that hospital are redistributed to other hospitals in the same State.
1505—Lists the training objectives of residency programs and dictates the terms for a study on the ability of hospitals’ programs to meet those objectives; Report to Congress on how to improve training programs, develop curricula, and regulate the accreditation process of those programs.

1601—appropriates $100 million a year to fight waste, fraud, and abuse. I’m not kidding. There are no additional provisions or details—just an extra 100 million a year to fight waste, fraud, and abuse.

1611—Increases fines for making false claims or giving false information or omitting info in reports to medicare.--$50k per false statement or omission.
1612—Does the same for others submitting false info in support of a fraudulent claim
1613—fines for delaying inspection by the govt. $15k/day for delaying an audit or inspection of a care provider or their records
1614—empowers govt to inspect hospice care providers, punish/sanction for inadequate care, and terminate their accreditation.
1615—penalties for health services providers that file claims for individuals that are excluded from participation in a federal health care program. This is just a racket to siphon money off of service providers that don’t keep up with their records.
1616—Augmented penalties against Medicare Advantage or Medicare Part D service providers that provide false information.
1617—augmented penalties for service providers that violate marketing regulations
1618—enhanced penalties for getting in the way or otherwise obstructing examinations or audits of any program or provider that gets any money at all from any Federal health care program
1619—detailed procedures for dealing with claims filed by or inadvertently paid to people excluded from federal programs. These include those convicted of felony drug charges, health care system crimes, patient abuse, etc.
1620—Inspector general of Medicare can exclude from participation the owners and officers of entities/facilities convicted of anything that would exclude them as detailed in 1619.
1621—protocol for service providers to report themselves for violations they commit.

1631—authorizes secretary to apply special unfavorable treatment to programs or providers if there is high levels or suspicion of fraudulent activity. Can be additional screening, increased oversight, moratorium on enrollment.
1632—requirements to report associations (within last 10 years) with service provider or supplier that either has unpaid debt to federal program or has been excluded from participation in it.
1633—establishes a payment modifier within applicable fee schedules that apply to certain procedures, tests, or devices that the secretary determines are likely targets for fraud or abuse.
1634—demands reports from supplier/providers, whatever the secretary deems necessary
1635—any supplier or provider that wants to play with federal programs has to have in place a waste and abuse prevention program; the program is up to the provider but has to be approved by the secretary
1636—maximum period for submitting claims to federal health programs is reduced from 36 months to 12 months.
1637—only physicians that are accredited and enrolled in medicare program can order durable medical equipment or home health services under federal funding.
1638—physicians have to maintain and provide upon request documentation for any and all referrals or orders for durable medical equipment or home health services or anything else the secretary deems susceptible to fraud and abuse. Physician can be disenrolled/suspended.
1639—physican can’t order any of the above mentioned things unless he has a face-to-face with the patient within the previous 6 months.
1640—power to subpoena people for waste/fraud/abuse investigations extended beyond office of secretary of social security to include the secretary of health and human services.
1641—over-payments under federal health programs must be repaid to govt within 60 days of over payment.
1642—hardship waivers are available to beneficiaries of Medicare Part A and Part B. This section makes them available to beneficiaries of any federal health program
1643—renal dialysis facilities have to provide ownership and association and compensation arrangement information.
1644—billing agents, clearinghouses, or other 3rd party payees have to be registered under Medicare
1645—administrative changes for the previous increases in fines for false claims, extends the statute of limitations for prosecuting false claims from 6 years to 10 years.
1646—requires all medicare payments to be processed through direct deposit or electronic fund transfer using insured depository institutions. No more bags of cash to anonymous “doctors”.
1647—established the office of Inspector General for the Health Choices Administration Yea!!! More bureaucrats!!!!!

1651—mandates disclosure and sharing among various federal and state agencies of various elements of information required to detect and reduce waste, fraud, and abuse.
1652—aligning and eliminating redundancy within two existing health databases.
1653—guarantees that the Health Insurance Portability and Accountability Act of 1996 applies to all information and provisions of this bill.

1701—expansion of eligibility for Medicaid. Under age 65, household income under 150% of federal poverty level. Gradual expansion downward (age 18, age 5, birth). Matching federal funds for state Medicaid payments for newborns
1702—states must use National Health Insurance Exchange. Must enroll people referred to them by the exchange, no questions asked.
1703—States are not allowed to restrict CHIP or Medicaid eligibility standards beyond the point they were restricted as of 16 June 2009. Ever.
1704—cuts Medicaid DSH payments to states, incrementally, through 2019. DSH (disproportionate shared hospital) payments are payments directly to hospitals. This provision slashes that by $1.5 billion in 2017, $2.5 billion in 2018, and $6 billion in 2019. These cuts will be considered “overpayment” to the states and come out of the states’ claim authorizations. The cuts are not evenly spread—they are focused on states that have lower % of uninsured, lower proportion of Medicaid-dependent patients, and probably tend to vote republican.
1705—expands “outstationing”—filing of Medicaid claims and processing them at locations other than the place of care.

1711—mandates/expands Medicaid coverage of preventive services as directed for health insurers and for Medicare.
1712—ADDS tobacco cessation materials to the list of “drugs” covered by Medicaid
1713—Adds home nurse visitation (newborn, well-baby) to Medicaid coverage.
1714—Allows state Medicaid programs the option of covering Family Planning Services through state Medicaid—thus making abortions partially federally funded. Pg 1048-1049

1721—Medicaid pay-per-service payouts increased. 80% in 2010, 90% in 2011, 100% in 2012. Also, 1.25% bonus paid for primary care services. This replaces lower increases previously determined in other legislation.
1722—Medicaid home-care pilot program. 5 years, deals with special categories of patients, including fragile children and high-risk pregnant women. Pays for administrative costs of the program (instead of the state). $1.235 billion over 5 years.
1723—Medicaid payments for language services.
1724—States can opt to cover Free-Standing Birth Centers and have Medicaid pay help pay
1725—Expansion of coverage of vaccines for children—more health centers
1726—Mandates Medicaid coverage of podiatrists and optomotrists
1727—“ “ therapeutic foster care
1728—Mandates states submit new plans to ensure adequate payment for services. If secretary doesn’t like the plan, the state has to try again.
1729—If a juvenile delinquent is eligible for Medicaid before incarceration, he will get it again after incarceration (if still under age 18). The state is responsible for enrolling youths before release.
1730—develop measures to quantify state of maternity and adult care under state Medicaid programs. Maintain and Report these metrics to Congress annually. Appropriates $40 million for the 5 years 2010-2014. Creates pilot program that tests out, under Medicaid, the same kind of care models under Medicare for this bill

1731—States can opt to have Medicaid cover low-income HIV positive individuals. This coverage would be exempt from funding limitations currently placed on US territories. This coverage does not add to amounts expended for other coverage.
1732—transitional Medicaid assistance was set to expire in 2010—this extends it to 2012.
1733—CHIP programs have to cover children in increments of 12 continuous months
1734—infants/toddlers, children whose families have recently lost coverage or cannot afford employer-based coverage will not be subject to standard CHIP waiting periods
1735—coverage for adult day care
1736—exceptions and exemptions for the Marshall Islands, Micronesia, and Palau
1737—Medicaid coverage of non-emergency transportation to site of medically necessary services.
1738—states can make it easier for certain people to qualify for Medicaid prescription coverage—patient has high costs of prescriptions and has exhausted their own coverage—states can disregard certain percentages of their income in order to make them “eligible” for coverage
1739—provisions to confirm adequacy and staffing of Community Living Assistance Services. $7 million per year 2011-2013.

1741—polishing of Medicaid payments procedures for pharmaceuticals. Including demanding reimbursements from companies in the case of recalls. Dictates pricing and timeliness of payments.
1742—rebates to the govt for payments for drugs that are only re-formulations existing drugs. Reduces the govt payment to states for prescription reimbursement
1743—expands Medicaid prescription coverage to enrollees of managed care organizations
1744—medicaid payment now eligible for graduate medical education programs as specified in the bill.
1745--$6 billion of supplemental payments for nursing facilities, 2010-2012.
1746—mandates states report to the govt Medicaid expenditures and rates.
1747—calls for studies on federal payments to state Medicaid programs, in order to make recommendations about adjusting or eliminating payment floors or ceilings
1748—extends a budgeting gimmick about to expire through the end of FY 2010
1749—Extends temporary increase in federal medical assistance that was in last year’s American Recovery and Re-investment Act through 2011

1751—attempts to cut waste/fraud by prohibiting Medicaid reimbursement for treatment of conditions that can be filed under multiple Medicaid codes (and has already been filed for that code) or conditions that are related to or resultant from health care treatment.
1752—any entity trying to contract to provide Medicaid services must have in place and agree to provide self-evaluations and internal reviews of the integrity oftheir processes
1753—suppliers and providers of Medicaid equipment and services must have a federal compliance program in place
1754—Gives the govt more time to adjust payments to states downward in order to compensate for earlier overpayments.
1755—application to Medicaid managed care organizations of the 85% medical loss ratio found earlier in the Bill.
1756—if a provider or physician or facility is terminated from eligibility under medicare, state care plans, child care plans, etc., they are also terminated from Medicaid.
1757—State Medicaid programs must exclude from participation in providing services anybody that owns, manages, or controls any entity that has been terminated from program, has uncorrected overpayments, or is affiliated with another entity that is also in violation.
1758—additional data has to be reported and shared to help detect waste, fraud, and abuse
1759—similar to a provision for medicare—billing agents, clearinghouses, and alternate payees have to be registered under Medicaid and adhere to standards
1760—Medicaid can’t be used to reimburse legal fees due to litigation of states, providers, physicians, facilities, etc.
1761—The secretary has to establish uniform coding standards and all State Medicaid agencies have to use them

1771—provides massive increases in Medicaid funding to US territories, incrementally each year from 2011 to 2019. Massive amounts of money. Also mandates “parity” among all 50 states by 2020; dictates development of a list of actions that states must take between now and 2020 to ensure parity in Medicaid financing. Note that parity is not equality—states with higher per capita incomes will not be treated equally.

1781—clerical adjustments to previous legislation for clarification purposes.
1782—extends cost-sharing financing gimmick with Medicare from 2010 through 2012 (this has already been extended several times). Also removes several funding restrictions for dual-eligible (Medicaid and medicare) individuals, covering 100% of costs.
1783—States are required to require hospitals and clinics to report costs of services provided. The report is to the state as well as to customers, and must be available in an easy format, preferably online.
1784—Secretary must report to Congress on the shortfall between Medicaid payments and the actual costs of providing care in nursing facilities. Must make recommendations for adjustments. Same thing is required for Pediatrics. Appropriates $11.8 million additional for implementation of the provisions of this bill that impact Medicaid or CHIP.
1785—Secretary HHS must issue guidance on best ways to inform Medicaid eligibles of their eligibility.
1786—states that THIS BILL does not change any CURRENT prohibitions of applying Medicaid or CHIP financing to illegal aliens.
1787—Science project to come up with a model in which mental health institutions get paid to provide care for free. The care would be fore “stabilization” of emergency conditions only. (e.g. suicide watch). The project is run by states who apply to have their costs recouped by Dept. HHS. Project lasts 3 years. Appropriates $75 million for the project. States and Dept HHS have to report to Congress and come up with plan to implement any system-wide changes.
1788—Funding limitations and by-number appropriations in the Social Security Act for certain Medicaid services are deleted and replaced with, in effect, “use as much money as you need”.
1789—Places additional administrative requirements on Medicaid brokers.
1790—Says it’s not a state’s fault if their state provisions are not in line with the new and improved Medicaid if this bill gets passed—gives them special leeway until they can legislate state programs into compliance.

1801—Sharing of taxpayer return information to Social Security Administration to more easily identify people ineligible for Medicaid/medicare prescription drug coverage.
THIS ONE IS CRITICAL*******
1802—Changes US Tax Code to create a new Comparative Effectiveness Research” trust fund. Appropriates $300 million over 3 years to start it out, after which it is fed by fees on health insurance and self-insured plans, and additional funds proportional to the number of people enrolled in Medicaid/medicare. The fees are generated using a “fair share per capita amount” that is levied against private health insurance plans. Note—the fee is leveraged against the Provider of the insurance plan. The fair share per capita amount is basically a factor, established by the secretary of HHS, that is multiplied by the number of people covered by a certain plan and the total amount is charged to the plan provider (which of course is passed on in higher premiums). Coincidentally, this fee does not apply to the government option plan. The spread of this amount will be calculated so that revenues to the trust fund ever year after 2012 will be $375 million. 2.6% of the fund and its revenues will be available every year to pay for the studies, programs, research, administrative requirements, and hookers of the bureaucrats researching “comparative effectiveness” of federal health care programs.

1901--This measure deletes an entire subsection of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The subsection deleted is the one that contained all the limitations on funding and the provisions to limit cost that were contingent on a trigger. The trigger is therefore deleted and the cost and expenditure controls eliminated.
1902—The comparative cost adjustment program of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is repealed. This was a 6-year study that was supposed to start next year and was geared to check the feasibility of making drug cost-related adjustments to Medicaid/medicare premiums.
1903—Extends the Gainsharing Project established by the Deficit Reduction Act of 2005. This project seeks to reduce costs and improve care by improving coordination between hospitals and physicians. Was supposed to expire this year. Extends through next year and throws another $1.6 million at it.
1904—Provides for grants to states to pay for home visits of families with young children. Provides money for training outreach individuals and sets criteria for households and neighborhoods to focus on (low-income, high incidence of abuse). The scary thing is I see nothing that says that a state has to make the program optional for the families—it only says that it is optional for the state to conduct the program and apply for the grants. Appropriates $50 million for 2010, $100 million for 2011, $150 million for 2012, $200 million for 2013, and $250 million for 2014. ($650 million total)
1905—special treatment mandated for people that are eligible for both Medicaid and medicare, in order to ensure maximum coverage. Also seeks to increase the efficiency of processing dual claims and inter-agency coordination (another study!)
1906—Dept. HHS conducts a study on the diseases and conditions that are most cost intensive for federal programs. Study will include recommendations on directions of research to reduce these costs.
1907—creates new bureaucracy within the Medicaid/Medicare office – the Center for Medicaid and Medicare Innovation – to test innovative service delivery and payment models. Prohibits administrative or judicial review of any of the models or techniques the office tries out on guinea pig regions. Appropriates $350 million in 2010, $440 million in 2011, and $550 million in 2012. Increases administrative budget of the Center for Medicaid/Medicare Services by $25 million per year.
1908—Bill does not impact the requirement for hospitals to provide emergency care.
1909—Disregards portions of patients’ income when considering for participation in clinical trials.


2002—Creates a new Federal fund—the Public Health Investment Fund (PHIF). The fund is created depositing $4.6 billion in 2011, $5.6 billion in 2012, $6.9 billion in 2013, $7.8 billion in 2014, and $9 billion in 2015 (total $33.9 billion). Lists specific purposes already legislated within the Public Health Service Act that the money can be used for. The purposes are dictated below.
2003—This funding must be counted as new expenditures for purposes of deficit calculation.
2101—Use 1 of the PHIF: increased funding for community health centers.
2201—Augments the National Health Service Corps with funds from PHIF. Rules for certification of corps workforce and their obligated service in return for loans to finish medical certifications. Increases loan repayment amount for Service Corps members to $50k
2202—Specifies money to be made available from the PHIF for the Service Corps.

2211—Establishes new loan repayment program for dentists and primary care providers in certain high-need areas of the country. Doctors agree to 2 years of full-time indentured servitude in exchange for student loan repayments.
2212—Financial need considerations for participation in program.
2213—Special grants to medical schools or health training centers to incentivize training in family practice, pediatrics, and other primary care providers. Preference is to be given for training/educational institutions with a record of training individuals from “disadvantaged backgrounds”.
2214—Awards and grants for training medical residents in “community-based” settings. Preference is to be given for training/educational institutions with a record of training individuals from “disadvantaged backgrounds”.
2215—Awards and grants for training various kinds of dentists. Preference is to be given for training/educational institutions with a record of training individuals from “disadvantaged backgrounds”.
2216—directives to allocate funds from the PHIF to pay for all this crap.
2217—Conduct a study on the effectiveness of loans and scholarships on incentivizing doctors to pursue particular specialties, on the retention of such care providers, and on encouraging those care providers to serve in “underprivileged areas”.

2221—Augments funding for nurse-managed health care centers and nurse training. Increases student loan amounts; directives to allocate funds from the PHIF to pay for all this crap

2231—Establishes the Public Health Workforce Corps. Empowers Secretary to place and appoint Corps members in positions of responsibility where the Secretary thinks they are needed. Establishes a scholarship program for anyone enrolled in a health-related scholarship program. The applicant must serve in the health workforce corps 1 year per academic year covered by the scholarship (max 4 years). The Scholarship pays all educational expenses plus a monthly stipend of $1300. Also sets up a loan repayment program for students in health-related career fields. Loan repayment is maxed at $35k per year for 2 years (2 years obligated service).
2232—public health workforce training and enhancement program—grants, awards, fellowships, etc. for individuals seeking training and institutes providing the training. Preference is to be given for training/educational institutions with a record of training individuals from “disadvantaged backgrounds” or who end up serving in “underprivileged areas”.
2233—bureaucratic crap adjusting wording to reflect proposed changes.
2234—Special grants for institutes providing graduate medical residents training in preventive medicine specialties.
2235—directives to allocate funds from the PHIF to pay for all this crap.

2241—Ups federal scholarship amounts from $20k to $35k for students from disadvantaged backgrounds.
2242-- bureaucratic crap adjusting wording to reflect proposed changes.
2243—Bureaucratic rewording of existing legislation on diversity and cultural competency programs.

2251—cultural and linguistic competency training program for health professionals. Offers grants and awards to institutions that improve or establish training programs for linguistic competency to treat non-english speakers.
2252—provides for grants and awards to institutions that develop health professional training programs that promote delivery of health care across multiple disciplines and multiple settings (hospital, clinic, home, community, etc.)

2261—Secretary HHS establishes an Advisory Committee for Health Workforce Evaluation and Assessment. The committee will submit recommendations regarding the supply, diversity, and geographic distribution of the health workforce, the retention and expansion/contraction, etc. The committee consists of 15 people, one of which must be a representative or organized labor.

2271—mandates periodic “health workforce assessment” by Dept. HHS.

2281—Specifies appropriations from the PHIF to pay for lots of new programs—Diversity training (about $105 million per year), interdisciplinary training programs (about $100 million per year), and extending authorizations that have expired or are expiring soon through 2015.

2301—Creates the Prevention and Wellness Trust, using a total of about $15.5 billion from the PHIF. Secretary HHS must report a national strategy to promote wellness. Massive amounts of new spending on Prevention and wellness research ($1.25 billion over 5 years), delivery of community preventive and wellness services ($5.26 billion), and core public health infrastructure ($1.75 billion). Secretary will establish Task Force on Clinical Preventive Services to track effectiveness, evaluate studies and research and metrics, and otherwise waste space and money. Task force is 30 people. The task force will create the Clinical Prevention Stakeholder Board made up of even more people. Secretary will establish the Task Force on Community Preventive Services made up of 30 other appointees. The task force will create the Community Prevention Stakeholder Board made up of even more people. Sound redundant? I thought so, too. Authorizes the Dept. HHS to award grants to institutes that conduct research or projects in response to the recommendations of these task forces. No room for graft or corruption there, it there? Allows for awards and grants for institutions that conduct research or test projects on promoting healthy lifestyles (no tobacco, fighting obesity, etc.). Allows for awards and grants to entities that organize communities (community organizers?) into “Health Empowerment Zones” characterized by partnerships between the community, local government, and local health care facilities. Allows for grants and awards to address “core health infrastructure”, including health workforce training and competence, laboratory facilities, health information systems, financing, etc. Grants and awards focused on addressing “health disparities”—population-sp