Vote to adopt an amendment to S Amdt 2786 to HR 3590 that issues various amendments to the bill, including, but not limited to, the following highlights.
Specifies that health care coverage, premium rates, and any participation in health and wellness programs shall not be affected by an individual's lawful ownership, use, or storage of firearms or ammunition, nor shall such data be collected on individuals (Sec. 10101).
Specifies that individuals enrolled in a group health plan or other health plan can choose any participating primary care provider who is available to accept such individual, including pediatricians (Sec. 10101).
Prohibits health insurers that provide emergency care coverage from requiring prior authorization or increased cost sharing when an enrollee has an emergency medical condition (Sec. 10101).
Prohibits health insurers from requiring a woman to get pre-approval or a physician referral for obstetric or gynecological care (Sec. 10101).
Prohibits health insurers from discriminating against an enrollee for participating in an approved clinical trial for the treatment of cancer or other life-threatening condition (Sec. 10103).
Requires health plans seeking certification as a qualified plan under the Health Care Exchange use "plain language" to describe the plan, and that such providers submit the following to the Exchange, the Secretary of Health and Human Services, and to the state's insurance commissioner (Sec. 10104):
Policies and practices for claims payments;
Data on enrollment, disenrollment, the number of claims that were denied, and rating practices;
Information on cost sharing and payments made for any out-of-network coverage;
Information on the rights of enrollees; and
Other information deemed appropriate by the Secretary.
Requires employers who elect to provide minimal health coverage to offer health care vouchers that can be used to pay for Exchange-eligible health care plans to employees that meet the following requirements (Sec. 10108):
Required contribution for minimum coverage exceeds 8 percent of the employee's household income but does not exceed 9.8 percent;
Household income does not exceed 400 percent of the federal poverty line for the taxable year; and
The employee elects not to be covered under the employer's health plan.
Requires health care vouchers to be equal to the monthly cost of the employer-sponsored plan that would have been paid by the employer if the employee were covered, and specifies that any amount in excess of the premium shall be paid to the employee and that vouchers are not included in the employee's gross income for the taxable year (Sec. 10108).
Establishes a program that allows for increased federal medical assistance payments to states that offer long-term home-based or community health care services in place of nursing facilities (Sec. 10202).
Appropriates $57.62 billion for the State Children's Health Insurance Program (SCHIP) as follows (Sec. 10203):
$15.36 billion for the period of October 1, 2012 through March 31, 2013 (increased from $11.71 billion);
$17.41 billion for fiscal year 2012-2013;
$19.15 billion for fiscal year 2013-2014; and
$5.7 billion for fiscal year 2014-2015.
Establishes the Pregnancy Assistance Fund for the purpose of funding state programs that assist pregnant and parenting teens in high schools and colleges, and appropriates $25 million per annum for fiscal years 2010 through 2019 (Secs. 10212-10214).
Repeals an amendment to the Sustainable Growth Rate Formula used to adjust Medicare rates of payment to physicians, including a requirement that rates be reduced if Medicare expenditures exceeded specific targets set by the Balanced Budget Act of 1997, by establishing a standard 0.5 percent rate for 2010 (Sec. 10310).
Exempts the state of Nebraska from the federal compensation guidelines for the expansion of Medicaid, and instead the state will be compensated for 100 percent of the costs beginning in 2014 and each subsequent year thereafter (Sec. 10201).
Expands Medicare eligibility to individuals who are exposed to environmental health hazards are eligible for Medicare, including, but not limited to, individuals with conditions related to asbestos exposure, and specifies that such individual must have been present in the contaminated area for at least 6 months and must file a claim within 10 years of being diagnosed (Sec. 10323).
Extends the Rural Community Hospital Demonstration Program, which provides inpatient care services for Medicare beneficiaries, for 5 years from the expiration date (Sec. 10313).
Requires the Secretary of Health and Human Services to develop a method for measuring "health plan value", including but not limited to the following elements (Sec. 10329):
The overall cost to enrollees;
The quality of the care provided;
How efficient the plan is in providing care;
The relative risk of the plan's enrollees compared to other plans; and
The actuarial value or other measure of benefits.
Requires the Secretary to establish the Physician Compare Internet website no later than January 1, 2011, which provides physician performance information on physicians enrolled in the Medicare, and requires the Secretary of Health and Human Services to also make available on the website information on the following (Sec. 10331):
Patient health outcomes and the functional status of patients;
Measures collected under the Physician Quality Reporting Initiative;
Continuity and coordination of care and care transitions;
Patient experience and patient, caregiver, and family engagement;
Safety, effectiveness, and timeliness of care;
Information on measurements collected; and
Other information deemed appropriate by the Secretary.
Authorizes the Secretary of Health and Human Services to award demonstration grants to states that develop, implement, and evaluate alternatives to current health care tort litigation policy, and appropriates $50 million for this purpose (Sec. 10607).
Authorizes states to enact laws prohibiting abortion coverage in qualified health plans offered through an Exchange in the state, and specifies that states may also repeal such laws (Sec. 10104).
Specifies that plans may choose whether or not to cover abortion services, and requires the separation of funds for abortion services for which federal funding is prohibited so that a subsidy eligible individual will make a separate premium payment that will go to an account that will be used solely for covering such abortion services (Sec. 10104).
Prohibits health plans from discriminating against providers based on unwillingness to cover, pay for, or refer for abortions (Sec. 10104).
Specifies that nothing in this act shall preempt state or federal abortion laws (Sec. 10104).
NOTE: THIS IS AN AMENDMENT TO A SUBSTITUTE AMENDMENT. A SUBSTITUTE AMENDMENT REPLACES THE ENTIRE TEXT OF A PIECE OF LEGISLATION WITH A NEW TEXT.