The Affordable Care Act

The full text of the Patient Protection and Affordable Care Act, also known as Obamacare.
About Jack Berlin

About edocr
Sec HEALTH HEALTH insur Coverage Care HEALTH Care
The full text of the Patient Protection and Affordable Care Act, also known as Obamacare.
About Jack Berlin

About edocr
Sec HEALTH HEALTH insur Coverage Care HEALTH Care
<p>124 STAT. 119 
PUBLIC LAW 111–148—MAR. 23, 2010 
Public Law 111–148 
111th Congress 
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’’. 
(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. 
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS 
‘‘SUBPART II—IMPROVING COVERAGE 
‘‘Sec. 2711. No lifetime or annual limits. 
‘‘Sec. 2712. Prohibition on rescissions. 
‘‘Sec. 2713. Coverage of preventive health services. 
‘‘Sec. 2714. Extension of dependent coverage. 
‘‘Sec. 2715. Development and utilization of uniform explanation of coverage 
documents and standardized definitions. 
‘‘Sec. 2716. Prohibition of discrimination based on salary. 
‘‘Sec. 2717. Ensuring the quality of care. 
‘‘Sec. 2718. Bringing down the cost of health care coverage. 
‘‘Sec. 2719. Appeals process. 
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 I—HEALTH INSURANCE MARKET REFORMS 
Sec. 1201. Amendment to the Public Health Service Act. 
‘‘SUBPART I—GENERAL REFORM 
‘‘Sec. 2704. Prohibition of preexisting condition exclusions or other discrimina-
tion based on health status. 
‘‘Sec. 2701. Fair health insurance premiums. 
‘‘Sec. 2702. Guaranteed availability of coverage. 
42 USC 18001 
note. 
Patient 
Protection and 
Affordable Care 
Act. 
Mar. 23, 2010 
[H.R. 3590] 
VerDate Nov 24 2008 10:54 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00001 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 120 
PUBLIC LAW 111–148—MAR. 23, 2010 
‘‘Sec. 2703. Guaranteed renewability of coverage. 
‘‘Sec. 2705. Prohibiting discrimination against individual participants and 
beneficiaries based on health status. 
‘‘Sec. 2706. Non-discrimination in health care. 
‘‘Sec. 2707. Comprehensive health insurance coverage. 
‘‘Sec. 2708. Prohibition on excessive waiting periods. 
PART II—OTHER PROVISIONS 
Sec. 1251. Preservation of right to maintain existing coverage. 
Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and 
group health plans. 
Sec. 1253. Effective dates. 
Subtitle D—Available Coverage Choices for All Americans 
PART I—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 II—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 III—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. 
Sec. 1324. Level playing field. 
PART IV—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. 
PART V—REINSURANCE AND RISK ADJUSTMENT 
Sec. 1341. Transitional reinsurance program for individual and small group mar-
kets 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. 
PART II—SMALL BUSINESS TAX CREDIT 
Sec. 1421. Credit for employee health insurance expenses of small businesses. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00002 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 121 
PUBLIC LAW 111–148—MAR. 23, 2010 
Subtitle F—Shared Responsibility for Health Care 
PART I—INDIVIDUAL RESPONSIBILITY 
Sec. 1501. Requirement to maintain minimum essential coverage. 
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. Conforming amendments. 
Sec. 1563. 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. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00003 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 122 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 2502. Elimination of exclusion of coverage of certain drugs. 
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 J—Improvements to the Medicaid and CHIP Payment and Access 
Commission (MACPAC) 
Sec. 2801. MACPAC assessment of policies affecting all Medicaid beneficiaries. 
Subtitle K—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 L—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 I—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 II—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 III—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. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00004 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 123 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 3026. Community-Based Care Transitions Program. 
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 update. 
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 payment. 
Sec. 3202. Benefit protection and simplification. 
Sec. 3203. Application of coding intensity adjustment during MA payment transi-
tion. 
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. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00005 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 124 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 3209. Authority to deny plan bids. 
Sec. 3210. Development of new standards for certain Medigap plans. 
Subtitle D—Medicare Part D Improvements for Prescription Drug Plans and MA– 
PD Plans 
Sec. 3301. Medicare coverage gap discount program. 
Sec. 3302. Improvement in determination of Medicare part D low-income bench-
mark premium. 
Sec. 3303. Voluntary de minimis policy for subsidy eligible individuals under pre-
scription drug plans and MA–PD plans. 
Sec. 3304. Special rule for widows and widowers regarding eligibility for low-in-
come assistance. 
Sec. 3305. Improved information for subsidy eligible individuals reassigned to pre-
scription drug plans and MA–PD plans. 
Sec. 3306. Funding outreach and assistance for low-income programs. 
Sec. 3307. Improving formulary requirements for prescription drug plans and MA– 
PD plans with respect to certain categories or classes of drugs. 
Sec. 3308. Reducing part D premium subsidy for high-income beneficiaries. 
Sec. 3309. Elimination of cost sharing for certain dual eligible individuals. 
Sec. 3310. Reducing wasteful dispensing of outpatient prescription drugs in long- 
term care facilities under prescription drug plans and MA–PD plans. 
Sec. 3311. Improved Medicare prescription drug plan and MA–PD plan complaint 
system. 
Sec. 3312. Uniform exceptions and appeals process for prescription drug plans and 
MA–PD plans. 
Sec. 3313. Office of the Inspector General studies and reports. 
Sec. 3314. Including costs incurred by AIDS drug assistance programs and Indian 
Health Service in providing prescription drugs toward the annual out- 
of-pocket threshold under part D. 
Sec. 3315. Immediate reduction in coverage gap in 2010. 
Subtitle E—Ensuring Medicare Sustainability 
Sec. 3401. Revision of certain market basket updates and incorporation of produc-
tivity improvements into market basket updates that do not already in-
corporate such improvements. 
Sec. 3402. Temporary adjustment to the calculation of part B premiums. 
Sec. 3403. Independent Medicare Advisory Board. 
Subtitle F—Health Care Quality Improvements 
Sec. 3501. Health care delivery system research; Quality improvement technical as-
sistance. 
Sec. 3502. Establishing community health teams to support the patient-centered 
medical home. 
Sec. 3503. Medication management services in treatment of chronic disease. 
Sec. 3504. Design and implementation of regionalized systems for emergency care. 
Sec. 3505. Trauma care centers and service availability. 
Sec. 3506. Program to facilitate shared decisionmaking. 
Sec. 3507. Presentation of prescription drug benefit and risk information. 
Sec. 3508. Demonstration program to integrate quality improvement and patient 
safety training into clinical education of health professionals. 
Sec. 3509. Improving women’s health. 
Sec. 3510. Patient navigator program. 
Sec. 3511. Authorization of appropriations. 
Subtitle G—Protecting and Improving Guaranteed Medicare Benefits 
Sec. 3601. Protecting and improving guaranteed Medicare benefits. 
Sec. 3602. No cuts in guaranteed benefits. 
TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC 
HEALTH 
Subtitle A—Modernizing Disease Prevention and Public Health Systems 
Sec. 4001. National Prevention, Health Promotion and Public Health Council. 
Sec. 4002. Prevention and Public Health Fund. 
Sec. 4003. Clinical and community preventive services. 
Sec. 4004. Education and outreach campaign regarding preventive benefits. 
Subtitle B—Increasing Access to Clinical Preventive Services 
Sec. 4101. School-based health centers. 
Sec. 4102. Oral healthcare prevention activities. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00006 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 125 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 4103. Medicare coverage of annual wellness visit providing a personalized pre-
vention plan. 
Sec. 4104. Removal of barriers to preventive services in Medicare. 
Sec. 4105. Evidence-based coverage of preventive services in Medicare. 
Sec. 4106. Improving access to preventive services for eligible adults in Medicaid. 
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant 
women in Medicaid. 
Sec. 4108. Incentives for prevention of chronic diseases in medicaid. 
Subtitle C—Creating Healthier Communities 
Sec. 4201. Community transformation grants. 
Sec. 4202. Healthy aging, living well; evaluation of community-based prevention 
and wellness programs for Medicare beneficiaries. 
Sec. 4203. Removing barriers and improving access to wellness for individuals with 
disabilities. 
Sec. 4204. Immunizations. 
Sec. 4205. Nutrition labeling of standard menu items at chain restaurants. 
Sec. 4206. Demonstration project concerning individualized wellness plan. 
Sec. 4207. Reasonable break time for nursing mothers. 
Subtitle D—Support for Prevention and Public Health Innovation 
Sec. 4301. Research on optimizing the delivery of public health services. 
Sec. 4302. Understanding health disparities: data collection and analysis. 
Sec. 4303. CDC and employer-based wellness programs. 
Sec. 4304. Epidemiology-Laboratory Capacity Grants. 
Sec. 4305. Advancing research and treatment for pain care management. 
Sec. 4306. Funding for Childhood Obesity Demonstration Project. 
Subtitle E—Miscellaneous Provisions 
Sec. 4401. Sense of the Senate concerning CBO scoring. 
Sec. 4402. Effectiveness of Federal health and wellness initiatives. 
TITLE V—HEALTH CARE WORKFORCE 
Subtitle A—Purpose and Definitions 
Sec. 5001. Purpose. 
Sec. 5002. Definitions. 
Subtitle B—Innovations in the Health Care Workforce 
Sec. 5101. National health care workforce commission. 
Sec. 5102. State health care workforce development grants. 
Sec. 5103. Health care workforce assessment. 
Subtitle C—Increasing the Supply of the Health Care Workforce 
Sec. 5201. Federally supported student loan funds. 
Sec. 5202. Nursing student loan program. 
Sec. 5203. Health care workforce loan repayment programs. 
Sec. 5204. Public health workforce recruitment and retention programs. 
Sec. 5205. Allied health workforce recruitment and retention programs. 
Sec. 5206. Grants for State and local programs. 
Sec. 5207. Funding for National Health Service Corps. 
Sec. 5208. Nurse-managed health clinics. 
Sec. 5209. Elimination of cap on commissioned corps. 
Sec. 5210. Establishing a Ready Reserve Corps. 
Subtitle D—Enhancing Health Care Workforce Education and Training 
Sec. 5301. Training in family medicine, general internal medicine, general pediat-
rics, and physician assistantship. 
Sec. 5302. Training opportunities for direct care workers. 
Sec. 5303. Training in general, pediatric, and public health dentistry. 
Sec. 5304. Alternative dental health care providers demonstration project. 
Sec. 5305. Geriatric education and training; career awards; comprehensive geriatric 
education. 
Sec. 5306. Mental and behavioral health education and training grants. 
Sec. 5307. Cultural competency, prevention, and public health and individuals with 
disabilities training. 
Sec. 5308. Advanced nursing education grants. 
Sec. 5309. Nurse education, practice, and retention grants. 
Sec. 5310. Loan repayment and scholarship program. 
Sec. 5311. Nurse faculty loan program. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00007 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 126 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 5312. Authorization of appropriations for parts B through D of title VIII. 
Sec. 5313. Grants to promote the community health workforce. 
Sec. 5314. Fellowship training in public health. 
Sec. 5315. United States Public Health Sciences Track. 
Subtitle E—Supporting the Existing Health Care Workforce 
Sec. 5401. Centers of excellence. 
Sec. 5402. Health care professionals training for diversity. 
Sec. 5403. Interdisciplinary, community-based linkages. 
Sec. 5404. Workforce diversity grants. 
Sec. 5405. Primary care extension program. 
Subtitle F—Strengthening Primary Care and Other Workforce Improvements 
Sec. 5501. Expanding access to primary care services and general surgery services. 
Sec. 5502. Medicare Federally qualified health center improvements. 
Sec. 5503. Distribution of additional residency positions. 
Sec. 5504. Counting resident time in nonprovider settings. 
Sec. 5505. Rules for counting resident time for didactic and scholarly activities and 
other activities. 
Sec. 5506. Preservation of resident cap positions from closed hospitals. 
Sec. 5507. Demonstration projects To address health professions workforce needs; 
extension of family-to-family health information centers. 
Sec. 5508. Increasing teaching capacity. 
Sec. 5509. Graduate nurse education demonstration. 
Subtitle G—Improving Access to Health Care Services 
Sec. 5601. Spending for Federally Qualified Health Centers (FQHCs). 
Sec. 5602. Negotiated rulemaking for development of methodology and criteria for 
designating medically underserved populations and health professions 
shortage areas. 
Sec. 5603. Reauthorization of the Wakefield Emergency Medical Services for Chil-
dren Program. 
Sec. 5604. Co-locating primary and specialty care in community-based mental 
health settings. 
Sec. 5605. Key National indicators. 
Subtitle H—General Provisions 
Sec. 5701. Reports. 
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY 
Subtitle A—Physician Ownership and Other Transparency 
Sec. 6001. Limitation on Medicare exception to the prohibition on certain physician 
referrals for hospitals. 
Sec. 6002. Transparency reports and reporting of physician ownership or invest-
ment interests. 
Sec. 6003. Disclosure requirements for in-office ancillary services exception to the 
prohibition on physician self-referral for certain imaging services. 
Sec. 6004. Prescription drug sample transparency. 
Sec. 6005. Pharmacy benefit managers transparency requirements. 
Subtitle B—Nursing Home Transparency and Improvement 
PART I—IMPROVING TRANSPARENCY OF INFORMATION 
Sec. 6101. Required disclosure of ownership and additional disclosable parties in-
formation. 
Sec. 6102. Accountability requirements for skilled nursing facilities and nursing fa-
cilities. 
Sec. 6103. Nursing home compare Medicare website. 
Sec. 6104. Reporting of expenditures. 
Sec. 6105. Standardized complaint form. 
Sec. 6106. Ensuring staffing accountability. 
Sec. 6107. GAO study and report on Five-Star Quality Rating System. 
PART II—TARGETING ENFORCEMENT 
Sec. 6111. Civil money penalties. 
Sec. 6112. National independent monitor demonstration project. 
Sec. 6113. Notification of facility closure. 
Sec. 6114. National demonstration projects on culture change and use of informa-
tion technology in nursing homes. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00008 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 127 
PUBLIC LAW 111–148—MAR. 23, 2010 
PART III—IMPROVING STAFF TRAINING 
Sec. 6121. Dementia and abuse prevention training. 
Subtitle C—Nationwide Program for National and State Background Checks on 
Direct Patient Access Employees of Long-term Care Facilities and Providers 
Sec. 6201. Nationwide program for National and State background checks on direct 
patient access employees of long-term care facilities and providers. 
Subtitle D—Patient-Centered Outcomes Research 
Sec. 6301. Patient-Centered Outcomes Research. 
Sec. 6302. Federal coordinating council for comparative effectiveness research. 
Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions 
Sec. 6401. Provider screening and other enrollment requirements under Medicare, 
Medicaid, and CHIP. 
Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions. 
Sec. 6403. Elimination of duplication between the Healthcare Integrity and Protec-
tion Data Bank and the National Practitioner Data Bank. 
Sec. 6404. Maximum period for submission of Medicare claims reduced to not more 
than 12 months. 
Sec. 6405. Physicians who order items or services required to be Medicare enrolled 
physicians or eligible professionals. 
Sec. 6406. Requirement for physicians to provide documentation on referrals to pro-
grams at high risk of waste and abuse. 
Sec. 6407. Face to face encounter with patient required before physicians may cer-
tify eligibility for home health services or durable medical equipment 
under Medicare. 
Sec. 6408. Enhanced penalties. 
Sec. 6409. Medicare self-referral disclosure protocol. 
Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics, 
orthotics, and supplies competitive acquisition program. 
Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program. 
Subtitle F—Additional Medicaid Program Integrity Provisions 
Sec. 6501. Termination of provider participation under Medicaid if terminated 
under Medicare or other State plan. 
Sec. 6502. Medicaid exclusion from participation relating to certain ownership, con-
trol, and management affiliations. 
Sec. 6503. Billing agents, clearinghouses, or other alternate payees required to reg-
ister under Medicaid. 
Sec. 6504. Requirement to report expanded set of data elements under MMIS to de-
tect fraud and abuse. 
Sec. 6505. Prohibition on payments to institutions or entities located outside of the 
United States. 
Sec. 6506. Overpayments. 
Sec. 6507. Mandatory State use of national correct coding initiative. 
Sec. 6508. General effective date. 
Subtitle G—Additional Program Integrity Provisions 
Sec. 6601. Prohibition on false statements and representations. 
Sec. 6602. Clarifying definition. 
Sec. 6603. Development of model uniform report form. 
Sec. 6604. Applicability of State law to combat fraud and abuse. 
Sec. 6605. Enabling the Department of Labor to issue administrative summary 
cease and desist orders and summary seizures orders against plans that 
are in financially hazardous condition. 
Sec. 6606. MEWA plan registration with Department of Labor. 
Sec. 6607. Permitting evidentiary privilege and confidential communications. 
Subtitle H—Elder Justice Act 
Sec. 6701. Short title of subtitle. 
Sec. 6702. Definitions. 
Sec. 6703. Elder Justice. 
Subtitle I—Sense of the Senate Regarding Medical Malpractice 
Sec. 6801. Sense of the Senate regarding medical malpractice. 
TITLE VII—IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES 
Subtitle A—Biologics Price Competition and Innovation 
Sec. 7001. Short title. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00009 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 128 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 7002. Approval pathway for biosimilar biological products. 
Sec. 7003. Savings. 
Subtitle B—More Affordable Medicines for Children and Underserved Communities 
Sec. 7101. Expanded participation in 340B program. 
Sec. 7102. Improvements to 340B program integrity. 
Sec. 7103. GAO study to make recommendations on improving the 340B program. 
TITLE VIII—CLASS ACT 
Sec. 8001. Short title of title. 
Sec. 8002. Establishment of national voluntary insurance program for purchasing 
community living assistance services and support. 
TITLE IX—REVENUE PROVISIONS 
Subtitle A—Revenue Offset Provisions 
Sec. 9001. Excise tax on high cost employer-sponsored health coverage. 
Sec. 9002. Inclusion of cost of employer-sponsored health coverage on W–2. 
Sec. 9003. Distributions for medicine qualified only if for prescribed drug or insulin. 
Sec. 9004. Increase in additional tax on distributions from HSAs and Archer MSAs 
not used for qualified medical expenses. 
Sec. 9005. Limitation on health flexible spending arrangements under cafeteria 
plans. 
Sec. 9006. Expansion of information reporting requirements. 
Sec. 9007. Additional requirements for charitable hospitals. 
Sec. 9008. Imposition of annual fee on branded prescription pharmaceutical manu-
facturers and importers. 
Sec. 9009. Imposition of annual fee on medical device manufacturers and import-
ers. 
Sec. 9010. Imposition of annual fee on health insurance providers. 
Sec. 9011. Study and report of effect on veterans health care. 
Sec. 9012. Elimination of deduction for expenses allocable to Medicare Part D sub-
sidy. 
Sec. 9013. Modification of itemized deduction for medical expenses. 
Sec. 9014. Limitation on excessive remuneration paid by certain health insurance 
providers. 
Sec. 9015. Additional hospital insurance tax on high-income taxpayers. 
Sec. 9016. Modification of section 833 treatment of certain health organizations. 
Sec. 9017. Excise tax on elective cosmetic medical procedures. 
Subtitle B—Other Provisions 
Sec. 9021. Exclusion of health benefits provided by Indian tribal governments. 
Sec. 9022. Establishment of simple cafeteria plans for small businesses. 
Sec. 9023. Qualifying therapeutic discovery project credit. 
TITLE X—STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR 
ALL AMERICANS 
Subtitle A—Provisions Relating to Title I 
Sec. 10101. Amendments to subtitle A. 
Sec. 10102. Amendments to subtitle B. 
Sec. 10103. Amendments to subtitle C. 
Sec. 10104. Amendments to subtitle D. 
Sec. 10105. Amendments to subtitle E. 
Sec. 10106. Amendments to subtitle F. 
Sec. 10107. Amendments to subtitle G. 
Sec. 10108. Free choice vouchers. 
Sec. 10109. Development of standards for financial and administrative trans-
actions. 
Subtitle B—Provisions Relating to Title II 
PART I—MEDICAID AND CHIP 
Sec. 10201. Amendments to the Social Security Act and title II of this Act. 
Sec. 10202. Incentives for States to offer home and community-based services as a 
long-term care alternative to nursing homes. 
Sec. 10203. Extension of funding for CHIP through fiscal year 2015 and other 
CHIP-related provisions. 
PART II—SUPPORT FOR PREGNANT AND PARENTING TEENS AND WOMEN 
Sec. 10211. Definitions. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00010 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 129 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 10212. Establishment of pregnancy assistance fund. 
Sec. 10213. Permissible uses of Fund. 
Sec. 10214. Appropriations. 
PART III—INDIAN HEALTH CARE IMPROVEMENT 
Sec. 10221. Indian health care improvement. 
Subtitle C—Provisions Relating to Title III 
Sec. 10301. Plans for a Value-Based purchasing program for ambulatory surgical 
centers. 
Sec. 10302. Revision to national strategy for quality improvement in health care. 
Sec. 10303. Development of outcome measures. 
Sec. 10304. Selection of efficiency measures. 
Sec. 10305. Data collection; public reporting. 
Sec. 10306. Improvements under the Center for Medicare and Medicaid Innovation. 
Sec. 10307. Improvements to the Medicare shared savings program. 
Sec. 10308. Revisions to national pilot program on payment bundling. 
Sec. 10309. Revisions to hospital readmissions reduction program. 
Sec. 10310. Repeal of physician payment update. 
Sec. 10311. Revisions to extension of ambulance add-ons. 
Sec. 10312. Certain payment rules for long-term care hospital services and morato-
rium on the establishment of certain hospitals and facilities. 
Sec. 10313. Revisions to the extension for the rural community hospital demonstra-
tion program. 
Sec. 10314. Adjustment to low-volume hospital provision. 
Sec. 10315. Revisions to home health care provisions. 
Sec. 10316. Medicare DSH. 
Sec. 10317. Revisions to extension of section 508 hospital provisions. 
Sec. 10318. Revisions to transitional extra benefits under Medicare Advantage. 
Sec. 10319. Revisions to market basket adjustments. 
Sec. 10320. Expansion of the scope of, and additional improvements to, the Inde-
pendent Medicare Advisory Board. 
Sec. 10321. Revision to community health teams. 
Sec. 10322. Quality reporting for psychiatric hospitals. 
Sec. 10323. Medicare coverage for individuals exposed to environmental health haz-
ards. 
Sec. 10324. Protections for frontier States. 
Sec. 10325. Revision to skilled nursing facility prospective payment system. 
Sec. 10326. Pilot testing pay-for-performance programs for certain Medicare pro-
viders. 
Sec. 10327. Improvements to the physician quality reporting system. 
Sec. 10328. Improvement in part D medication therapy management (MTM) pro-
grams. 
Sec. 10329. Developing methodology to assess health plan value. 
Sec. 10330. Modernizing computer and data systems of the Centers for Medicare & 
Medicaid services to support improvements in care delivery. 
Sec. 10331. Public reporting of performance information. 
Sec. 10332. Availability of medicare data for performance measurement. 
Sec. 10333. Community-based collaborative care networks. 
Sec. 10334. Minority health. 
Sec. 10335. Technical correction to the hospital value-based purchasing program. 
Sec. 10336. GAO study and report on Medicare beneficiary access to high-quality 
dialysis services. 
Subtitle D—Provisions Relating to Title IV 
Sec. 10401. Amendments to subtitle A. 
Sec. 10402. Amendments to subtitle B. 
Sec. 10403. Amendments to subtitle C. 
Sec. 10404. Amendments to subtitle D. 
Sec. 10405. Amendments to subtitle E. 
Sec. 10406. Amendment relating to waiving coinsurance for preventive services. 
Sec. 10407. Better diabetes care. 
Sec. 10408. Grants for small businesses to provide comprehensive workplace 
wellness programs. 
Sec. 10409. Cures Acceleration Network. 
Sec. 10410. Centers of Excellence for Depression. 
Sec. 10411. Programs relating to congenital heart disease. 
Sec. 10412. Automated Defibrillation in Adam’s Memory Act. 
Sec. 10413. Young women’s breast health awareness and support of young women 
diagnosed with breast cancer. 
Subtitle E—Provisions Relating to Title V 
Sec. 10501. Amendments to the Public Health Service Act, the Social Security Act, 
and title V of this Act. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00011 Fmt 6580 Sfmt 6582 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 130 
PUBLIC LAW 111–148—MAR. 23, 2010 
Sec. 10502. Infrastructure to Expand Access to Care. 
Sec. 10503. Community Health Centers and the National Health Service Corps 
Fund. 
Sec. 10504. Demonstration project to provide access to affordable care. 
Subtitle F—Provisions Relating to Title VI 
Sec. 10601. Revisions to limitation on medicare exception to the prohibition on cer-
tain physician referrals for hospitals. 
Sec. 10602. Clarifications to patient-centered outcomes research. 
Sec. 10603. Striking provisions relating to individual provider application fees. 
Sec. 10604. Technical correction to section 6405. 
Sec. 10605. Certain other providers permitted to conduct face to face encounter for 
home health services. 
Sec. 10606. Health care fraud enforcement. 
Sec. 10607. State demonstration programs to evaluate alternatives to current med-
ical tort litigation. 
Sec. 10608. Extension of medical malpractice coverage to free clinics. 
Sec. 10609. Labeling changes. 
Subtitle G—Provisions Relating to Title VIII 
Sec. 10801. Provisions relating to title VIII. 
Subtitle H—Provisions Relating to Title IX 
Sec. 10901. Modifications to excise tax on high cost employer-sponsored health cov-
erage. 
Sec. 10902. Inflation adjustment of limitation on health flexible spending arrange-
ments under cafeteria plans. 
Sec. 10903. Modification of limitation on charges by charitable hospitals. 
Sec. 10904. Modification of annual fee on medical device manufacturers and im-
porters. 
Sec. 10905. Modification of annual fee on health insurance providers. 
Sec. 10906. Modifications to additional hospital insurance tax on high-income tax-
payers. 
Sec. 10907. Excise tax on indoor tanning services in lieu of elective cosmetic med-
ical procedures. 
Sec. 10908. Exclusion for assistance provided to participants in State student loan 
repayment programs for certain health professionals. 
Sec. 10909. Expansion of adoption credit and adoption assistance programs. 
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. 
Part A of title XXVII of the Public Health Service Act (42 
U.S.C. 300gg et seq.) is amended— 
(1) by striking the part heading and inserting the following: 
‘‘PART A—INDIVIDUAL AND GROUP MARKET 
REFORMS’’; 
(2) by redesignating sections 2704 through 2707 as sections 
2725 through 2728, respectively; 
(3) by redesignating sections 2711 through 2713 as sections 
2731 through 2733, respectively; 
(4) by redesignating sections 2721 through 2723 as sections 
2735 through 2737, respectively; and 
(5) by inserting after section 2702, the following: 
42 USC 
300gg–21— 
300gg–23. 
42 USC 
300gg–11— 
300gg–13, 
300gg–9. 
42 USC 
300gg–4— 
300gg–7, 
300gg–25— 
300gg–28. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00012 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 131 
PUBLIC LAW 111–148—MAR. 23, 2010 
‘‘Subpart II—Improving Coverage 
‘‘SEC. 2711. NO LIFETIME OR ANNUAL LIMITS. 
‘‘(a) IN GENERAL.—A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may 
not establish— 
‘‘(1) lifetime limits on the dollar value of benefits for any 
participant or beneficiary; or 
‘‘(2) unreasonable annual limits (within the meaning of 
section 223 of the Internal Revenue Code of 1986) on the 
dollar value of benefits for any participant or beneficiary. 
‘‘(b) PER BENEFICIARY LIMITS.—Subsection (a) shall not be con-
strued to prevent a group health plan or health insurance coverage 
that is not required to provide essential health benefits under 
section 1302(b) of the Patient Protection and Affordable Care Act 
from placing annual or lifetime per beneficiary limits on specific 
covered benefits to the extent that such limits are otherwise per-
mitted under Federal or State law. 
‘‘SEC. 2712. PROHIBITION ON RESCISSIONS. 
‘‘A group health plan and a health insurance issuer offering 
group or individual health insurance coverage shall not rescind 
such plan or coverage with respect to an enrollee once the enrollee 
is covered under such plan or coverage involved, except that this 
section shall not apply to a covered individual who has performed 
an act or practice that constitutes fraud or makes an intentional 
misrepresentation of material fact as prohibited by the terms of 
the plan or coverage. Such plan or coverage may not be cancelled 
except with prior notice to the enrollee, and only as permitted 
under section 2702(c) or 2742(b). 
‘‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES. 
‘‘(a) IN GENERAL.—A group health plan and a health insurance 
issuer offering group or individual health insurance coverage shall, 
at a minimum provide coverage for and shall not impose any 
cost sharing requirements for— 
‘‘(1) evidence-based items or services that have in effect 
a rating of ‘A’ or ‘B’ in the current recommendations of the 
United States Preventive Services Task Force; 
‘‘(2) immunizations that have in effect a recommendation 
from the Advisory Committee on Immunization Practices of 
the Centers for Disease Control and Prevention with respect 
to the individual involved; and 
‘‘(3) with respect to infants, children, and adolescents, evi-
dence-informed preventive care and screenings provided for 
in the comprehensive guidelines supported by the Health 
Resources and Services Administration. 
‘‘(4) with respect to women, such additional preventive 
care and screenings not described in paragraph (1) as provided 
for in comprehensive guidelines supported by the Health 
Resources and Services Administration for purposes of this 
paragraph. 
‘‘(5) for the purposes of this Act, and for the purposes 
of any other provision of law, the current recommendations 
of the United States Preventive Service Task Force regarding 
breast cancer screening, mammography, and prevention shall 
42 USC 
300gg–13. 
42 USC 
300gg–12. 
42 USC 
300gg–11. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00013 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 132 
PUBLIC LAW 111–148—MAR. 23, 2010 
be considered the most current other than those issued in 
or around November 2009. 
Nothing in this subsection shall be construed to prohibit a plan 
or issuer from providing coverage for services in addition to those 
recommended by United States Preventive Services Task Force 
or to deny coverage for services that are not recommended by 
such Task Force. 
‘‘(b) INTERVAL.— 
‘‘(1) IN GENERAL.—The Secretary shall establish a minimum 
interval between the date on which a recommendation described 
in subsection (a)(1) or (a)(2) or a guideline under subsection 
(a)(3) is issued and the plan year with respect to which the 
requirement described in subsection (a) is effective with respect 
to the service described in such recommendation or guideline. 
‘‘(2) MINIMUM.—The interval described in paragraph (1) 
shall not be less than 1 year. 
‘‘(c) VALUE-BASED INSURANCE DESIGN.—The Secretary may 
develop guidelines to permit a group health plan and a health 
insurance issuer offering group or individual health insurance cov-
erage to utilize value-based insurance designs. 
‘‘SEC. 2714. EXTENSION OF DEPENDENT COVERAGE. 
‘‘(a) IN GENERAL.—A group health plan and a health insurance 
issuer offering group or individual health insurance coverage that 
provides dependent coverage of children shall continue to make 
such coverage available for an adult child (who is not married) 
until the child turns 26 years of age. Nothing in this section shall 
require a health plan or a health insurance issuer described in 
the preceding sentence to make coverage available for a child of 
a child receiving dependent coverage. 
‘‘(b) REGULATIONS.—The Secretary shall promulgate regulations 
to define the dependents to which coverage shall be made available 
under subsection (a). 
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this section shall 
be construed to modify the definition of ‘dependent’ as used in 
the Internal Revenue Code of 1986 with respect to the tax treatment 
of the cost of coverage. 
‘‘SEC. 2715. DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLA-
NATION OF COVERAGE DOCUMENTS AND STANDARDIZED 
DEFINITIONS. 
‘‘(a) IN GENERAL.—Not later than 12 months after the date 
of enactment of the Patient Protection and Affordable Care Act, 
the Secretary shall develop standards for use by a group health 
plan and a health insurance issuer offering group or individual 
health insurance coverage, in compiling and providing to enrollees 
a summary of benefits and coverage explanation that accurately 
describes the benefits and coverage under the applicable plan or 
coverage. In developing such standards, the Secretary shall consult 
with the National Association of Insurance Commissioners (referred 
to in this section as the ‘NAIC’), a working group composed of 
representatives of health insurance-related consumer advocacy 
organizations, health insurance issuers, health care professionals, 
patient advocates including those representing individuals with lim-
ited English proficiency, and other qualified individuals. 
‘‘(b) REQUIREMENTS.—The standards for the summary of bene-
fits and coverage developed under subsection (a) shall provide for 
the following: 
Deadline. 
42 USC 
300gg–15. 
42 USC 
300gg–14. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00014 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 133 
PUBLIC LAW 111–148—MAR. 23, 2010 
‘‘(1) APPEARANCE.—The standards shall ensure that the 
summary of benefits and coverage is presented in a uniform 
format that does not exceed 4 pages in length and does not 
include print smaller than 12-point font. 
‘‘(2) LANGUAGE.—The standards shall ensure that the sum-
mary is presented in a culturally and linguistically appropriate 
manner and utilizes terminology understandable by the average 
plan enrollee. 
‘‘(3) CONTENTS.—The standards shall ensure that the sum-
mary of benefits and coverage includes— 
‘‘(A) uniform definitions of standard insurance terms 
and medical terms (consistent with subsection (g)) so that 
consumers may compare health insurance coverage and 
understand the terms of coverage (or exception to such 
coverage); 
‘‘(B) a description of the coverage, including cost 
sharing for— 
‘‘(i) each of the categories of the essential health 
benefits described in subparagraphs (A) through (J) 
of section 1302(b)(1) of the Patient Protection and 
Affordable Care Act; and 
‘‘(ii) other benefits, as identified by the Secretary; 
‘‘(C) the exceptions, reductions, and limitations on cov-
erage; 
‘‘(D) the cost-sharing provisions, including deductible, 
coinsurance, and co-payment obligations; 
‘‘(E) the renewability and continuation of coverage 
provisions; 
‘‘(F) a coverage facts label that includes examples to 
illustrate common benefits scenarios, including pregnancy 
and serious or chronic medical conditions and related cost 
sharing, such scenarios to be based on recognized clinical 
practice guidelines; 
‘‘(G) a statement of whether the plan or coverage— 
‘‘(i) provides minimum essential coverage (as 
defined under section 5000A(f) of the Internal Revenue 
Code 1986); and 
‘‘(ii) ensures that the plan or coverage share of 
the total allowed costs of benefits provided under the 
plan or coverage is not less than 60 percent of such 
costs; 
‘‘(H) a statement that the outline is a summary of 
the policy or certificate and that the coverage document 
itself should be consulted to determine the governing 
contractual provisions; and 
‘‘(I) a contact number for the consumer to call with 
additional questions and an Internet web address where 
a copy of the actual individual coverage policy or group 
certificate of coverage can be reviewed and obtained. 
‘‘(c) PERIODIC REVIEW AND UPDATING.—The Secretary shall 
periodically review and update, as appropriate, the standards devel-
oped under this section. 
‘‘(d) REQUIREMENT TO PROVIDE.— 
‘‘(1) IN GENERAL.—Not later than 24 months after the date 
of enactment of the Patient Protection and Affordable Care 
Act, each entity described in paragraph (3) shall provide, prior 
Deadline. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00015 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 134 
PUBLIC LAW 111–148—MAR. 23, 2010 
to any enrollment restriction, a summary of benefits and cov-
erage explanation pursuant to the standards developed by 
the Secretary under subsection (a) to— 
‘‘(A) an applicant at the time of application; 
‘‘(B) an enrollee prior to the time of enrollment or 
reenrollment, as applicable; and 
‘‘(C) a policyholder or certificate holder at the time 
of issuance of the policy or delivery of the certificate. 
‘‘(2) COMPLIANCE.—An entity described in paragraph (3) 
is deemed to be in compliance with this section if the summary 
of benefits and coverage described in subsection (a) is provided 
in paper or electronic form. 
‘‘(3) ENTITIES IN GENERAL.—An entity described in this 
paragraph is— 
‘‘(A) a health insurance issuer (including a group health 
plan that is not a self-insured plan) offering health insur-
ance coverage within the United States; or 
‘‘(B) in the case of a self-insured group health plan, 
the plan sponsor or designated administrator of the plan 
(as such terms are defined in section 3(16) of the Employee 
Retirement Income Security Act of 1974). 
‘‘(4) NOTICE OF MODIFICATIONS.—If a group health plan 
or health insurance issuer makes any material modification 
in any of the terms of the plan or coverage involved (as defined 
for purposes of section 102 of the Employee Retirement Income 
Security Act of 1974) that is not reflected in the most recently 
provided summary of benefits and coverage, the plan or issuer 
shall provide notice of such modification to enrollees not later 
than 60 days prior to the date on which such modification 
will become effective. 
‘‘(e) PREEMPTION.—The standards developed under subsection 
(a) shall preempt any related State standards that require a sum-
mary of benefits and coverage that provides less information to 
consumers than that required to be provided under this section, 
as determined by the Secretary. 
‘‘(f) FAILURE TO PROVIDE.—An entity described in subsection 
(d)(3) that willfully fails to provide the information required under 
this section shall be subject to a fine of not more than $1,000 
for each such failure. Such failure with respect to each enrollee 
shall constitute a separate offense for purposes of this subsection. 
‘‘(g) DEVELOPMENT OF STANDARD DEFINITIONS.— 
‘‘(1) IN GENERAL.—The Secretary shall, by regulation, pro-
vide for the development of standards for the definitions of 
terms used in health insurance coverage, including the insur-
ance-related terms described in paragraph (2) and the medical 
terms described in paragraph (3). 
‘‘(2) INSURANCE-RELATED TERMS.—The insurance-related 
terms described in this paragraph are premium, deductible, 
co-insurance, co-payment, out-of-pocket limit, preferred pro-
vider, non-preferred provider, out-of-network co-payments, UCR 
(usual, customary and reasonable) fees, excluded services, griev-
ance and appeals, and such other terms as the Secretary deter-
mines are important to define so that consumers may compare 
health insurance coverage and understand the terms of their 
coverage. 
Regulations. 
Fine. 
Deadline. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00016 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 135 
PUBLIC LAW 111–148—MAR. 23, 2010 
‘‘(3) MEDICAL TERMS.—The medical terms described in this 
paragraph are hospitalization, hospital outpatient care, emer-
gency room care, physician services, prescription drug coverage, 
durable medical equipment, home health care, skilled nursing 
care, rehabilitation services, hospice services, emergency med-
ical transportation, and such other terms as the Secretary 
determines are important to define so that consumers may 
compare the medical benefits offered by health insurance and 
understand the extent of those medical benefits (or exceptions 
to those benefits). 
‘‘SEC. 2716. PROHIBITION OF DISCRIMINATION BASED ON SALARY. 
‘‘(a) IN GENERAL.—The plan sponsor of a group health plan 
(other than a self-insured plan) may not establish rules relating 
to the health insurance coverage eligibility (including continued 
eligibility) of any full-time employee under the terms of the plan 
that are based on the total hourly or annual salary of the employee 
or otherwise establish eligibility rules that have the effect of 
discriminating in favor of higher wage employees. 
‘‘(b) LIMITATION.—Subsection (a) shall not be construed to pro-
hibit a plan sponsor from establishing contribution requirements 
for enrollment in the plan or coverage that provide for the payment 
by employees with lower hourly or annual compensation of a lower 
dollar or percentage contribution than the payment required of 
similarly situated employees with a higher hourly or annual com-
pensation. 
‘‘SEC. 2717. ENSURING THE QUALITY OF CARE. 
‘‘(a) QUALITY REPORTING.— 
‘‘(1) IN GENERAL.—Not later than 2 years after the date 
of enactment of the Patient Protection and Affordable Care 
Act, the Secretary, in consultation with experts in health care 
quality and stakeholders, shall develop reporting requirements 
for use by a group health plan, and a health insurance issuer 
offering group or individual health insurance coverage, with 
respect to plan or coverage benefits and health care provider 
reimbursement structures that— 
‘‘(A) improve health outcomes through the implementa-
tion of activities such as quality reporting, effective case 
management, care coordination, chronic disease manage-
ment, and medication and care compliance initiatives, 
including through the use of the medical homes model 
as defined for purposes of section 3602 of the Patient 
Protection and Affordable Care Act, for treatment or serv-
ices under the plan or coverage; 
‘‘(B) implement activities to prevent hospital readmis-
sions through a comprehensive program for hospital dis-
charge that includes patient-centered education and coun-
seling, comprehensive discharge planning, and post dis-
charge reinforcement by an appropriate health care profes-
sional; 
‘‘(C) implement activities to improve patient safety and 
reduce medical errors through the appropriate use of best 
clinical practices, evidence based medicine, and health 
information technology under the plan or coverage; and 
‘‘(D) implement wellness and health promotion activi-
ties. 
‘‘(2) REPORTING REQUIREMENTS.— 
42 USC 
300gg–17. 
42 USC 
300gg–16. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00017 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 136 
PUBLIC LAW 111–148—MAR. 23, 2010 
‘‘(A) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage shall annually submit to the Secretary, and 
to enrollees under the plan or coverage, a report on whether 
the benefits under the plan or coverage satisfy the elements 
described in subparagraphs (A) through (D) of paragraph 
(1). 
‘‘(B) TIMING OF REPORTS.—A report under subpara-
graph (A) shall be made available to an enrollee under 
the plan or coverage during each open enrollment period. 
‘‘(C) AVAILABILITY OF REPORTS.—The Secretary shall 
make reports submitted under subparagraph (A) available 
to the public through an Internet website. 
‘‘(D) PENALTIES.—In developing the reporting require-
ments under paragraph (1), the Secretary may develop 
and impose appropriate penalties for non-compliance with 
such requirements. 
‘‘(E) EXCEPTIONS.—In developing the reporting require-
ments under paragraph (1), the Secretary may provide 
for exceptions to such requirements for group health plans 
and health insurance issuers that substantially meet the 
goals of this section. 
‘‘(b) WELLNESS AND PREVENTION PROGRAMS.—For purposes of 
subsection (a)(1)(D), wellness and health promotion activities may 
include personalized wellness and prevention services, which are 
coordinated, maintained or delivered by a health care provider, 
a wellness and prevention plan manager, or a health, wellness 
or prevention services organization that conducts health risk assess-
ments or offers ongoing face-to-face, telephonic or web-based inter-
vention efforts for each of the program’s participants, and which 
may include the following wellness and prevention efforts: 
‘‘(1) Smoking cessation. 
‘‘(2) Weight management. 
‘‘(3) Stress management. 
‘‘(4) Physical fitness. 
‘‘(5) Nutrition. 
‘‘(6) Heart disease prevention. 
‘‘(7) Healthy lifestyle support. 
‘‘(8) Diabetes prevention. 
‘‘(c) REGULATIONS.—Not later than 2 years after the date of 
enactment of the Patient Protection and Affordable Care Act, the 
Secretary shall promulgate regulations that provide criteria for 
determining whether a reimbursement structure is described in 
subsection (a). 
‘‘(d) STUDY AND REPORT.—Not later than 180 days after the 
date on which regulations are promulgated under subsection (c), 
the Government Accountability Office shall review such regulations 
and conduct a study and submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives a report 
regarding the impact the activities under this section have had 
on the quality and cost of health care. 
‘‘SEC. 2718. BRINGING DOWN THE COST OF HEALTH CARE COVERAGE. 
‘‘(a) CLEAR ACCOUNTING FOR COSTS.—A health insurance issuer 
offering group or individual health insurance coverage shall, with 
Reports. 
42 USC 
300gg–18. 
Deadline. 
VerDate Nov 24 2008 06:35 Apr 30, 2010 Jkt 089139 PO 00148 Frm 00018 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148
dk
ra
us
e 
on
 G
SD
DP
C2
9P
RO
D 
wi
th
 P
UB
LI
C 
LA
W
S
124 STAT. 137 
PUBLIC LAW 111–148—MAR. 23, 2010 
respect to each plan year, submit to the Secretary a report con-
cerning the percentage of total premium revenue that such coverage 
expends— 
‘‘(1) on reimbursement for clinical services provided to 
enrollees under such coverage; 
‘‘(2) for activities that improve health care quality; and 
‘‘(3) on all other non-claims costs, including an explanation 
of the nature of such costs, and excluding State taxes and 
licensing or regulatory fees. 
The Secretary shall make reports received under this section avail-
able to the public on the Internet website of the Department of 
Health and Human Services. 
‘‘(b) ENSURING THAT CONSUMERS RECEIVE VALUE FOR THEIR 
PREMIUM PAYMENTS.— 
‘‘(1) REQUIREMENT TO PROVIDE VALUE FOR PREMIUM PAY-
MENTS.—A health insurance issuer offering group or individual 
health insurance coverage shall, with respect to each plan 
year, provide an annual rebate to each enrollee under such 
coverage, on a pro rata basis, in an amount that is equal 
to the amount by which premium revenue expended by the 
issuer on activities described in subsection (a)(3) exceeds— 
‘‘(A) with respect to a health insurance issuer offering 
coverage in the group market, 20 percent, or such lower 
percentage as a State may by regulation determine; or 
‘‘(B) with respect to a health insurance issuer offering 
coverage in the individual market, 25 percent, or such 
lower percentage as a State may by regulation determine, 
except that such percentage shall be adjusted to the extent 
the Secretary determines that the application of such 
percentage with a State may destabilize the existing indi-
vidual market in such State. 
‘‘(2) CONSIDERATION IN SETTING PERCENTAGES.—In deter-
mining the percentages under paragraph (1), a State shall 
seek to ensure adequate participation by health insurance 
issuers, competition in the health insurance market in the 
State, and value for consumers so that premiums are used 
for clinical services and quality improvements. 
‘‘(3) TERMINATION.—The provisions of this subsection shall 
have no force or effect after December 31, 2013. 
‘‘(c) STANDARD HOSPITAL CHARGES.—Each hospital operating 
within the United States shall for each year establish (and update) 
and make public (in accordance with guidelines developed by the 
Secretary) a list of the hospital’s standard charges for items and 
services provided by the hospital, including for diagnosis-related 
gro</p>