Senator Mark Warner Value and Innovation Amendment Package

Value and Innovation Amendment Package
Improving Quality and Value through Delivery System Reform
 Sec. 3601. Quality Reporting for Psychiatric Hospitals. The section would create a pay-for-reporting program for Medicare inpatient psychiatric hospitals beginning 2014. A percentage of payment for these facilities would be tied to successful reporting of quality data, which would be available to the public after opportunity for a hospital or unit to review their performance.
 Sec. 3602. Pilot Testing Pay-for-Performance Program for Certain Medicare Providers. This section would direct the Secretary to begin pilot testing of value-based purchasing (pay-for-performance) programs for certain types of Medicare providers no later than January 1, 2016. These provider types include: inpatient psychiatric hospitals, long-term care hospitals, inpatient rehab facilities, acute prospective payment system-exempt cancer hospitals, and hospices. The Secretary would have authority, after 2018, to expand these pilots if the CMS Chief Actuary determines it would reduce Medicare program spending while maintaining or improving the quality of care.
 Sec. 3603. Plans for a Value-Based Purchasing Program for Ambulatory Surgical Centers. This section would direct the Secretary to develop a plan to create a value-based purchasing program for ambulatory surgical centers. The plan would be submitted to Congress no later than January 1, 2011.
 Sec. 3604. Revisions to National Pilot Program on Payment Bundling. This section would modify the new CMS pilot on Medicare bundled payments created by the Patient Protection and Affordable Care Act. It would expand the number of health conditions tested under the pilot and give the Secretary authority to expand the duration or scope of the pilot after January 1, 2016 if the CMS Chief Actuary determines it would reduce Medicare program spending while maintaining or improving the quality of care.
 Sec. 3605. Improvements to the Medicare Shared Savings Program. This section would give the Secretary greater flexibility in administering the Medicare Shared Savings Program. This program is created by the Patient Protection and Affordable Care Act to reward Accountable Care Organizations (ACO) that successfully coordinate care to lower costs and improve the quality of care.
 Sec. 3606. Incentives to Implement Activities to Reduce Disparities. This section would ensure that qualified health plans offered through new American Health Benefit
Exchanges include programs to reduce health disparities as part of required quality improvement activities.
 Sec. 3607. National Diabetes Prevention Program. This section would direct the Centers for Disease Control and Prevention (CDC) to establish a national diabetes prevention program that targets individuals at high risk of developing diabetes. It authorizes federal grants to entities developing community-based diabetes prevention models and other training and outreach activities.
 Sec. 3608. Selection of Efficiency Measures. This section would ensure that measures of efficiency are included under new quality measure development activities supported by this Act.
 Sec. 3609. Regional Testing of Payment and Service Delivery Models Under the Center for Medicare and Medicaid Innovation. This section would gives the new Center for Medicare and Medicaid Innovation (CMI) established under this Act explicit authority to target the testing of new payment and delivery models to more regions.
 Sec. 3610. Additional Improvements Under the Center for Medicare and Medicaid Innovation. This section gives CMI additional flexibility in selecting models to be tested and permits the Secretary to give preference to models that would align Medicare and Medicaid spending with other public sector or private sector payer quality improvement efforts.
 Sec. 3611. Improvements to the Physician Quality Reporting System. This section would modify the current Medicare Physician Quality Reporting Initiative (PQRI) to permit physicians who report quality data through a qualifying Maintenance of Certification (MOC) program to be eligible for an incentive payment for years 2011-2014. The Secretary also is permitted, starting in 2014, to include MOC participation as a component of the PQRI composite measure.
 Sec. 3612. Improvement in Part D Medication Therapy Management (MTM Programs).This section would require Medicare Part D prescription drug plans (PDPs) to offer a minimum set of medication therapy management services to certain targeted beneficiaries. It also would require PDPs to routinely assess at-risk individuals who are not enrolled in MTM services and automatically enroll them (permitting beneficiaries to opt-out if they choose).
 Sec. 3613. Evaluation of Telehealth Under the Center for Medicare and Medicaid Innovation. This section would permit CMI to evaluate, analyze and make recommendations about the effectiveness of telehealth behavioral health issues (such as post-traumatic stress disorder) and telestroke services in medically underserved areas and Indian Health Service facilities.
 Sec. 3614. Revisions to the Extension for the Rural Community Hospital Demonstration Program. This section would extend the Rural Community Hospital Demonstration Program for an additional five years, instead of one year as originally proposed by this Act. It would expand the number of hospitals eligible for the project from 15 to 30 and make 20 rural states eligible to participate, instead of the current 10. Another provision allows already participating hospitals to rebase Medicare reimbursements according to current health delivery costs.
Promoting Transparency and Competition
 Sec. 3621. Developing Methodology to Assess Health Plan Value. This section would require the Secretary to consult with relevant stakeholders to develop a methodology for measuring health plan value, which would include the cost, quality of care, efficiency, actuarial value of plans. The Secretary would submit a report to Congress concerning the proposed methodology within 18 months of enactment of this Act.
 Sec. 3622. Data Collection; Public Reporting. This section would modify the new data collection and reporting efforts created by this Act by requiring the Secretary to establish and implement an overall strategic framework for the public reporting of provider performance on reported quality measures.
 Sec. 3623. Modernizing Computer and Data Systems of the Centers for Medicare and Medicaid Services to Support Improvements in Care Delivery. This section would require the Secretary to develop a plan, within 9 months of enactment of this Act, to modernize the Centers for Medicare and Medicaid Services (CMS) computer and data systems.
 Sec. 3624. Expansion of the Scope of the Independent Medicare Advisory Board. This section would require the Independent Medicare Advisory Board (IMAB) created under this Act to produce an annual report starting in 2014 that includes national and regional information on the cost, utilization, quality, and other features of health care paid for by private payers and Medicare. IMAB also would be required to take the findings of these annual reports into account when preparing proposals to improve Medicare. IMAB also would, starting in 2015 and at least every two years after, submit recommendations to Congress and others on how to slow the growth in national health expenditures.
 Sec. 3625. Additional Priority for the National Health Care Workforce Commission. This section would require the National Health Care Workforce Commission created under this Act to also make recommendations to remove the barriers that health providers encounter to beginning or maintaining professional practice in primary care.
Promoting Accountability and Responsibility
 Sec. 3631. Health Care Fraud Enforcement. This section increases federal sentencing guidelines for all federal health care offenses that involve a loss greater than $1,000,000. This section amends the definition of “health care fraud offense” to include health care crimes that are codified outside of Title 18. This section clarifies the definition of “willfully” to prevent defendants from escaping punishment for violation of a federal health care fraud offense by arguing that they were not aware of the specific criminal provision that they are accused of violating. This section also provides that obstruction of criminal investigations involving administrative subpoenas under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 is treated in the same manner as obstruction of criminal investigations involving grand jury subpoenas. Finally, this section permits the Department of Justice to issue subpoenas in investigations pursuant to the Civil Rights of Institutionalized Persons Act.
 Sec. 3632. Development of Standards for Health Care Financial and Administrative Transactions. This section would require the Secretary, beginning no later than January 1, 2012, and every three years thereafter, to convene stakeholders to identify opportunities to create uniform standards for financial and administrative health care transactions, not already named under HIPAA, that would improve the operation of the health system and decrease administrative costs. Initially, this would include areas such as health claim edits, provider enrollment, and audits. Once the panel identifies new health care transactions that should be made uniform, the Secretary can develop standards for them. Health plans will need to comply with these new standards and associated business rules or face a financial penalty. In addition, this section convenes health information technology stakeholders to ensure a smooth transition takes place for providers as they move from one coding software to the next.

Harry Reid on Health Care

Dear Linda,

This evening at the UNLV campus, I addressed hundreds of Nevadans about our progress passing historic health insurance reform that will benefit Nevada's patients, seniors and small businesses.

I wanted to share my remarks with you.

Sincerely,

Harry Reid

Remarks at the Judy Bayley Theatre, University of Nevada, Las Vegas
Thursday, 5pm, January 7, 2010

After decades of waiting and years of suffering, in just a matter of weeks this health insurance reform bill will become law. We are closer than ever to making this dream a reality.

We've come this far and stand this close because of you. Don't let the political rhetoric and Washington photo-ops fool you - it's you who've made this possible.

Every day the people of Nevada have spoken to me in person, visited my office, written me letters, and called me on the phone - all to share their stories and help explain to America why doing nothing is not an option.

I've listened carefully to your stories - I've even shared many of them on the floor of the United States Senate - and I've thought about each and every one of them as we wrote this good bill.

Too many hardworking Nevadans don't need statistics to tell them that our state suffers more than almost any other from a broken health insurance system. And I'm here to tell you that when President Obama signs this bill into law, Nevada will benefit more than almost any other.

Nevada has the second highest rate of uninsured citizens in the nation. That often leads to bankruptcy and foreclosure, and as you know Nevada has the highest rate of foreclosures in the country. And in far too many cases, lack of health insurance leads to more sickness and even death - in fact, America is the only developed country in the world where dying for lack of health care is even possible.

That's what I mean when I say that doing nothing is not an option. And that's why I am proud of what this bill will do.

It will make health care affordable for half a million Nevadans who today have none, and lower premiums by as much as $1,600 for those who do.

It will stop greedy insurance companies from denying health care to the sick. That happens to thousands every day in Nevada and across the nation - but when this bill becomes law, that number will drop to zero.

It will ensure consumers like you have more choices, and ensure insurance companies face more competition.

For seniors, it will mean free annual check-ups. And it will close that loophole known as the "doughnut hole" so seniors can finally afford all of their prescription drugs - instead of having to decide which pills to split and which to skip.

This bill will also add years to the life of Medicare, which will add years to the life of our seniors. Let me be clear, if you're on Medicare, you won't see a single cut to the benefits you receive. In fact, our bill gives you more. I would never push a bill that would do anything less than strengthening this vital program.

It will make more Nevadans eligible for Medicaid, and I made sure it will do that in a way that protects our state's economy. It will give 24,000 small businesses in Nevada a tax credit to help them cover their employees and their families. And because more people will be able to go to the doctor, this bill will help bring more doctors to our state, and will support community health centers. As we do all this, we will slash our children's deficit in dramatic measure.

We may not completely cure this crisis today or tomorrow, but we must get started toward that end. That's what this bill does - it starts to trade a system that demands you pay more and get less for one in which you will pay less and get more.

You've no doubt heard a lot of myths and rumors about this bill. Some people say that we should solve the health care crisis by eliminating mandates and allowing insurance companies to get away with providing less care than they already are. Let me tell you, they are dead wrong.

I think it's too bad that some care more about politics or partisanship or polling than they do about the health of their neighbors. Because affording to live a healthy life isn't about politics, or partisanship, or polling.

It is about people.

It's about making sure no Nevadan has to choose between taking their mother to the doctor or sending their daughter to college.

It's about making sure no Nevadan has to hear a health insurance company tell them they are too risky to help.

It's about helping all Nevadans and all Americans - those fortunate enough to have health care, and those who do not.

It's about making the ability to afford a healthy life in America a right and not merely a privilege for the wealthy.

When health insurance reform becomes a reality - and we're closer than ever to that day: the uninsured will benefit - and so will the insured; seniors will benefit - and so will children; small business owners will benefit - and so will their employees; the healthy will benefit - and so will the sick.

And more than almost every other state in America, Nevada will benefit.

We're doing this because it is not a question of politics - it is a question of morality. It isn't about left and right - it's about right and wrong.

Health insurance reform is about saving lives, saving you money and saving Medicare. It's about human suffering. And given the chance to relieve this suffering, we must take it.