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                  Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print



                                             One Hundred Eleventh Congress
                                                        of the
                                               United States of America
                                                           AT T H E S E C O N D S E S S I O N

                                                Begun and held at the City of Washington on Tuesday,
                                                   the fifth day of January, two thousand and ten




                                                                            An Act
                                                     Entitled The Patient Protection and Affordable Care Act.

                                          Be it enacted by the Senate and House of Representatives of
                                      the United States of America in Congress assembled,
                                      SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
                                           (a) SHORT TITLE.--This Act may be cited as the ``Patient Protec-
                                      tion and Affordable Care Act''.
                                           Note: This print is of the Patient Protection and Affordable
                                      Care Act (``PPACA''; Public Law 111148) consolidating the amend-
                                      ments made by title X of the Act and the Health Care and Education
                                      Reconciliation Act of 2010 (``HCERA''; Public Law 111152). The
                                      text of the Indian Health Care Improvement Reauthorization and
                                      Extension Act of 2009 (S. 1790), as enacted (in amended form)
                                      by section 10221 of PPACA, is shown in a separate, accompanying
                                      document. This document has been prepared by the House Office
                                      of the Legislative Counsel (HOLC) for the use of its attorneys and
                                      its clients; it is not an official document of the House of Representa-
                                      tives or its committees and may not be cited as ``the law''. HOLC
                                      welcomes any corrections or suggestions to this document; these
                                      should be emailed to edward.grossman@mail.house.gov.
                                           (b) TABLE OF CONTENTS.--The table of contents of this Act
                                      is as follows:
                                      Sec. 1. Short title; table of contents.
                                         TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
                                       Subtitle A--Immediate Improvements in Health Care Coverage for All Americans
                                      Sec. 1001. Amendments to the Public Health Service Act.
                                      Sec. 1002. Health insurance consumer information.
                                      Sec. 1003. Ensuring that consumers get value for their dollars.
                                      Sec. 1004. Effective dates.
                                               Subtitle B--Immediate Actions to Preserve and Expand Coverage
                                      Sec. 1101. Immediate access to insurance for uninsured individuals with a pre-
                                                 existing condition.
                                      Sec. 1102. Reinsurance for early retirees.
                                      Sec. 1103. Immediate information that allows consumers to identify affordable cov-
                                                 erage options.
                                      Sec. 1104. Administrative simplification.
                                      Sec. 1105. Effective date.
                                                Subtitle C--Quality Health Insurance Coverage for All Americans
                                                      PART 1--HEALTH INSURANCE MARKET REFORMS
                                      Sec. 1201. Amendment to the Public Health Service Act.
                                                                  PART 2--OTHER PROVISIONS
                                      Sec. 1251. Preservation of right to maintain existing coverage.

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                                     Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print--2
                                      Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and
                                                 group health plans.
                                      Sec. 1253. Annual report on self-insured plans.
                                      Sec. 1254. Study of large group market.
                                      Sec. 1255. Effective dates.
                                                      Subtitle D--Available Coverage Choices for All Americans
                                                        PART 1--ESTABLISHMENT OF QUALIFIED HEALTH PLANS
                                      Sec.   1301.   Qualified health plan defined.
                                      Sec.   1302.   Essential health benefits requirements.
                                      Sec.   1303.   Special rules.
                                      Sec.   1304.   Related definitions.
                                         PART 2--CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH
                                                                      BENEFIT EXCHANGES
                                      Sec. 1311. Affordable choices of health benefit plans.
                                      Sec. 1312. Consumer choice.
                                      Sec. 1313. Financial integrity.
                                                     PART 3--STATE FLEXIBILITY RELATING TO EXCHANGES
                                      Sec. 1321. State flexibility in operation and enforcement of Exchanges and related
                                                 requirements.
                                      Sec. 1322. Federal program to assist establishment and operation of nonprofit,
                                                 member-run health insurance issuers.
                                      Sec. 1323. Community health insurance option stricken.
                                      Sec. 1323. Funding for the territories.
                                      Sec. 1324. Level playing field.
                                              PART 4--STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS
                                      Sec. 1331. State flexibility to establish basic health programs for low-income indi-
                                                 viduals not eligible for Medicaid.
                                      Sec. 1332. Waiver for State innovation.
                                      Sec. 1333. Provisions relating to offering of plans in more than one State.
                                      Sec. 1334. Multi-State plans.
                                                         PART 5--REINSURANCE AND RISK ADJUSTMENT
                                      Sec. 1341. Transitional reinsurance program for individual market in each State.
                                      Sec. 1342. Establishment of risk corridors for plans in individual and small group
                                                 markets.
                                      Sec. 1343. Risk adjustment.
                                                      Subtitle E--Affordable Coverage Choices for All Americans
                                                 PART I--PREMIUM TAX CREDITS      AND   COST-SHARING REDUCTIONS
                                              SUBPART A--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
                                      Sec. 1401. Refundable tax credit providing premium assistance for coverage under
                                                 a qualified health plan.
                                      Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans.
                                                           SUBPART B--ELIGIBILITY DETERMINATIONS
                                      Sec. 1411. Procedures for determining eligibility for Exchange participation, pre-
                                                 mium tax credits and reduced cost-sharing, and individual responsibility
                                                 exemptions.
                                      Sec. 1412. Advance determination and payment of premium tax credits and cost-
                                                 sharing reductions.
                                      Sec. 1413. Streamlining of procedures for enrollment through an exchange and
                                                 State Medicaid, CHIP, and health subsidy programs.
                                      Sec. 1414. Disclosures to carry out eligibility requirements for certain programs.
                                      Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded for
                                                 Federal and Federally-assisted programs.
                                      Sec. 1416. Study of geographic variation in application of FPL.
                                                             PART II--SMALL BUSINESS TAX CREDIT
                                      Sec. 1421. Credit for employee health insurance expenses of small businesses.
                                                          Subtitle F--Shared Responsibility for Health Care
                                                            PART I--INDIVIDUAL RESPONSIBILITY
                                      Sec. 1501. Requirement to maintain minimum essential coverage.

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                                     Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print--3
                                      Sec. 1502. Reporting of health insurance coverage.
                                                                 PART II--EMPLOYER RESPONSIBILITIES
                                      Sec.   1511.   Automatic enrollment for employees of large employers.
                                      Sec.   1512.   Employer requirement to inform employees of coverage options.
                                      Sec.   1513.   Shared responsibility for employers.
                                      Sec.   1514.   Reporting of employer health insurance coverage.
                                      Sec.   1515.   Offering of Exchange-participating qualified health plans through cafe-
                                                     teria plans.
                                                              Subtitle G--Miscellaneous Provisions
                                      Sec.   1551.
                                                 Definitions.
                                      Sec.   1552.
                                                 Transparency in government.
                                      Sec.   1553.
                                                 Prohibition against discrimination on assisted suicide.
                                      Sec.   1554.
                                                 Access to therapies.
                                      Sec.   1555.
                                                 Freedom not to participate in Federal health insurance programs.
                                      Sec.   1556.
                                                 Equity for certain eligible survivors.
                                      Sec.   1557.
                                                 Nondiscrimination.
                                      Sec.   1558.
                                                 Protections for employees.
                                      Sec.   1559.
                                                 Oversight.
                                      Sec.   1560.
                                                 Rules of construction.
                                      Sec.   1561.
                                                 Health information technology enrollment standards and protocols.
                                      Sec.   1562.
                                                 GAO study regarding the rate of denial of coverage and enrollment by
                                                  health insurance issuers and group health plans.
                                      Sec. 1563. Small business procurement.
                                      Sec. 1563 [sic]. Conforming amendments.
                                      Sec. 1563 [sic]. Sense of the Senate promoting fiscal responsibility.
                                                             TITLE II--ROLE OF PUBLIC PROGRAMS
                                                           Subtitle A--Improved Access to Medicaid
                                      Sec. 2001. Medicaid coverage for the lowest income populations.
                                      Sec. 2002. Income eligibility for nonelderly determined using modified gross in-
                                                 come.
                                      Sec. 2003. Requirement to offer premium assistance for employer-sponsored insur-
                                                 ance.
                                      Sec. 2004. Medicaid coverage for former foster care children.
                                      Sec. 2005. Payments to territories.
                                      Sec. 2006. Special adjustment to FMAP determination for certain States recovering
                                                 from a major disaster.
                                      Sec. 2007. Medicaid Improvement Fund rescission.
                                          Subtitle B--Enhanced Support for the Children's Health Insurance Program
                                      Sec. 2101. Additional federal financial participation for CHIP.
                                      Sec. 2102. Technical corrections.
                                                  Subtitle C--Medicaid and CHIP Enrollment Simplification
                                      Sec. 2201. Enrollment Simplification and coordination with State Health Insurance
                                                 Exchanges.
                                      Sec. 2202. Permitting hospitals to make presumptive eligibility determinations for
                                                 all Medicaid eligible populations.
                                                            Subtitle D--Improvements to Medicaid Services
                                      Sec.   2301.   Coverage for freestanding birth center services.
                                      Sec.   2302.   Concurrent care for children.
                                      Sec.   2303.   State eligibility option for family planning services.
                                      Sec.   2304.   Clarification of definition of medical assistance.
                                        Subtitle E--New Options for States to Provide Long-Term Services and Supports
                                      Sec. 2401. Community First Choice Option.
                                      Sec. 2402. Removal of barriers to providing home and community-based services.
                                      Sec. 2403. Money Follows the Person Rebalancing Demonstration.
                                      Sec. 2404. Protection for recipients of home and community-based services against
                                                  spousal impoverishment.
                                      Sec. 2405. Funding to expand State Aging and Disability Resource Centers.
                                      Sec. 2406. Sense of the Senate regarding long-term care.
                                                       Subtitle F--Medicaid Prescription Drug Coverage
                                      Sec. 2501. Prescription drug rebates.
                                      Sec. 2502. Elimination of exclusion of coverage of certain drugs.

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                                     Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print--4
                                      Sec. 2503. Providing adequate pharmacy reimbursement.
                                            Subtitle G--Medicaid Disproportionate Share Hospital (DSH) Payments
                                      Sec. 2551. Disproportionate share hospital payments.
                                              Subtitle H--Improved Coordination for Dual Eligible Beneficiaries
                                      Sec. 2601. 5-year period for demonstration projects.
                                      Sec. 2602. Providing Federal coverage and payment coordination for dual eligible
                                                 beneficiaries.
                                            Subtitle I--Improving the Quality of Medicaid for Patients and Providers
                                      Sec. 2701. Adult health quality measures.
                                      Sec. 2702. Payment Adjustment for Health Care-Acquired Conditions.
                                      Sec. 2703. State option to provide health homes for enrollees with chronic condi-
                                                  tions.
                                      Sec. 2704. Demonstration project to evaluate integrated care around a hospitaliza-
                                                  tion.
                                      Sec. 2705. Medicaid Global Payment System Demonstration Project.
                                      Sec. 2706. Pediatric Accountable Care Organization Demonstration Project.
                                      Sec. 2707. Medicaid emergency psychiatric demonstration project.
                                           Subtitle II--Improvements to the Medicaid and CHIP Payment and Access
                                                                   Commission (MACPAC)
                                      Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries.
                                              Subtitle III--Protections for American Indians and Alaska Natives
                                      Sec. 2901. Special rules relating to Indians.
                                      Sec. 2902. Elimination of sunset for reimbursement for all medicare part B services
                                                 furnished by certain indian hospitals and clinics.
                                                           Subtitle IV--Maternal and Child Health Services
                                      Sec.   2951.   Maternal, infant, and early childhood home visiting programs.
                                      Sec.   2952.   Support, education, and research for postpartum depression.
                                      Sec.   2953.   Personal responsibility education.
                                      Sec.   2954.   Restoration of funding for abstinence education.
                                      Sec.   2955.   Inclusion of information about the importance of having a health care
                                                     power of attorney in transition planning for children aging out of foster
                                                     care and independent living programs.
                                       TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
                                                     Subtitle A--Transforming the Health Care Delivery System
                                      PART 1--LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM
                                      Sec. 3001. Hospital Value-Based purchasing program.
                                      Sec. 3002. Improvements to the physician quality reporting system.
                                      Sec. 3003. Improvements to the physician feedback program.
                                      Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation
                                                 hospitals, and hospice programs.
                                      Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.
                                      Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities
                                                 and home health agencies.
                                      Sec. 3007. Value-based payment modifier under the physician fee schedule.
                                      Sec. 3008. Payment adjustment for conditions acquired in hospitals.
                                                 PART 2--NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
                                      Sec.   3011. National strategy.
                                      Sec.   3012. Interagency Working Group on Health Care Quality.
                                      Sec.   3013. Quality measure development.
                                      Sec.   3014. Quality measurement.
                                      Sec.   3015. Data collection; public reporting.
                                             PART 3--ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
                                      Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within
                                                 CMS.
                                      Sec. 3022. Medicare shared savings program.
                                      Sec. 3023. National pilot program on payment bundling.
                                      Sec. 3024. Independence at home demonstration program.
                                      Sec. 3025. Hospital readmissions reduction program.
                                      Sec. 3026. Community-Based Care Transitions Program.

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                                     Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print--5
                                      Sec. 3027. Extension of gainsharing demonstration.
                                                   Subtitle B--Improving Medicare for Patients and Providers
                                       PART I--ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES
                                      Sec. 3101. Increase in the physician payment updaterepealed.
                                      Sec. 3102. Extension of the work geographic index floor and revisions to the prac-
                                                 tice expense geographic adjustment under the Medicare physician fee
                                                 schedule.
                                      Sec. 3103. Extension of exceptions process for Medicare therapy caps.
                                      Sec. 3104. Extension of payment for technical component of certain physician pa-
                                                 thology services.
                                      Sec. 3105. Extension of ambulance add-ons.
                                      Sec. 3106. Extension of certain payment rules for long-term care hospital services
                                                 and of moratorium on the establishment of certain hospitals and facili-
                                                 ties.
                                      Sec. 3107. Extension of physician fee schedule mental health add-on.
                                      Sec. 3108. Permitting physician assistants to order post-Hospital extended care
                                                 services.
                                      Sec. 3109. Exemption of certain pharmacies from accreditation requirements.
                                      Sec. 3110. Part B special enrollment period for disabled TRICARE beneficiaries.
                                      Sec. 3111. Payment for bone density tests.
                                      Sec. 3112. Revision to the Medicare Improvement Fund.
                                      Sec. 3113. Treatment of certain complex diagnostic laboratory tests.
                                      Sec. 3114. Improved access for certified nurse-midwife services.
                                                                 PART II--RURAL PROTECTIONS
                                      Sec. 3121. Extension of outpatient hold harmless provision.
                                      Sec. 3122. Extension of Medicare reasonable costs payments for certain clinical di-
                                                 agnostic laboratory tests furnished to hospital patients in certain rural
                                                 areas.
                                      Sec. 3123. Extension of the Rural Community Hospital Demonstration Program.
                                      Sec. 3124. Extension of the Medicare-dependent hospital (MDH) program.
                                      Sec. 3125. Temporary improvements to the Medicare inpatient hospital payment
                                                 adjustment for low-volume hospitals.
                                      Sec. 3126. Improvements to the demonstration project on community health inte-
                                                 gration models in certain rural counties.
                                      Sec. 3127. MedPAC study on adequacy of Medicare payments for health care pro-
                                                 viders serving in rural areas.
                                      Sec. 3128. Technical correction related to critical access hospital services.
                                      Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.
                                                           PART III--IMPROVING PAYMENT ACCURACY
                                      Sec. 3131. Payment adjustments for home health care.
                                      Sec. 3132. Hospice reform.
                                      Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) pay-
                                                 ments.
                                      Sec. 3134. Misvalued codes under the physician fee schedule.
                                      Sec. 3135. Modification of equipment utilization factor for advanced imaging serv-
                                                 ices.
                                      Sec. 3136. Revision of payment for power-driven wheelchairs.
                                      Sec. 3137. Hospital wage index improvement.
                                      Sec. 3138. Treatment of certain cancer hospitals.
                                      Sec. 3139. Payment for biosimilar biological products.
                                      Sec. 3140. Medicare hospice concurrent care demonstration program.
                                      Sec. 3141. Application of budget neutrality on a national basis in the calculation of
                                                 the Medicare hospital wage index floor.
                                      Sec. 3142. HHS study on urban Medicare-dependent hospitals.
                                      Sec. 3143. Protecting home health benefits.
                                                           Subtitle C--Provisions Relating to Part C
                                      Sec. 3201. Medicare Advantage paymentrepealed & replaced.
                                      Sec. 3202. Benefit protection and simplification.
                                      Sec. 3203. Application of coding intensity adjustment during MA payment transi-
                                                  tionrepealed and replaced.
                                      Sec. 3204. Simplification of annual beneficiary election periods.
                                      Sec. 3205. Extension for specialized MA plans for special needs individuals.
                                      Sec. 3206. Extension of reasonable cost contracts.
                                      Sec. 3207. Technical correction to MA private fee-for-service plans.
                                      Sec. 3208. Making senior housing facility demonstration permanent.
                                      Sec. 3209. Authority to deny plan bids.

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