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Patient Protection and Affordable Care Act

Amendments will be posted as they are filed.
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Amendment 2790: Protecting the Children’s Health Insurance Program
The amendment would continue full funding for the Children’s Health Insurance Program (CHIP) through 2019, ensure affordable coverage and high quality benefits for children and make it easier for families to enroll in the program. It would also:

  • Require a report in 2016 that will compare coverage and benefits for low income children under CHIP to the health care Exchange created in the reform bill;
  • Increase federal matching funding for states that implement best practices for enrolling children;
  • Protect children and families by ensuring, through 2013, that states may not reduce eligibility levels in place on October 1, 2009; will also require, beginning in 2014, that all states must cover children in families up to 250% of poverty;
  • Streamline and simplify the CHIP application process to ensure families know about and can take advantage of coverage;
  • Continue $50 million annual enrollment grants through 2019 to improve outreach to families about CHIP services and enroll children;
  • Prevent eligibility errors by improving the eligibility screening process; and
  • Dedicate any savings to be shared 50/50 between deficit reduction and a new fund for vulnerable children and families.

Amendment 2924 – Medical Schools
This amendment would create a program of grants to support newly accredited allopathic and osteopathic medical schools to increase the nation’s number of physicians. These grants will be used to create scholarships, develop academic research programs and residencies, recruit and retain faculty, and build infrastructure. Medical schools receiving this funding will submit annual reports to the Secretary, describing how funds have been used and to what benefit. The same schools will also submit annual reports to Congress to evaluate the effectiveness of the grants provided, including how use of funding has increased the number of physicians, resulted in greater access to healthcare for ordinary citizens, increased focus on communications skills of medical students, and enabled the creation of cost-conscious healthcare models.

Amendment 2928 – Direct Care Workers
The Casey-Kohl amendment would add direct care workers as a high priority occupation for the research and reporting done by the National Health Care Workforce Commission established by the Patient Protection and Affordable Care Act. This amendment would ensure that as part of its charge, the Commission review the current and projected workforce needs of direct care workers and provide comprehensive recommendations to Congress and the Administration on how best to align direct care workforce resources with our national needs.

Amendment 2929 – Autism National Training Initiative
This amendment with Senator Durbin and Senator Menendez would create a national training initiative on autism, which would award grants to provide interdisciplinary training, continuing education, technical assistance and information to improve the provision of services rendered to children and adults with autism and their families. The amendment would provide grants to establish up to 4 new University Centers for Excellence in Developmental Disabilities Education, Research and Service at institutions of higher education. These centers would increase the capacity of interdisciplinary training programs to provide training and continuing education, technical assistance and information dissemination to providers.

Amendment 2970 – Tom Lantos Pulmonary Hypertension Act of 2009
Pulmonary hypertension is a simplified name for a complex health problem–continuous high blood pressure in the pulmonary artery in the lungs, resulting in an enlarged heart which can also lose its ability to pump. It is currently very difficult to diagnose and is frequently misdiagnosed. Without diagnosis and treatment, 50% of PH patients die within 2.8 years of diagnosis. The sooner a PH patient receives effective treatment, the better their prognosis. Several treatments are available, but patients see an average of three physicians before a fourth physician makes an accurate diagnosis—often losing a precious year, or more.
This amendment:

  • Calls for the expansion and intensification of PH-related research activities within the National Heart Lung and Blood institute. Recommendations include:
    • Clinical research for the development and evaluation of new treatments for pulmonary hypertension, including the establishment of a "Pulmonary Hypertension Clinical Research Network."
    • Support for the training of new clinicians and investigators with expertise in the pulmonary hypertension field.
    • Information and education programs for the general public.
  • Increases public and professional awareness of pulmonary hypertension:
    • Calls on the Centers for Disease Control to disseminate information on pulmonary hypertension to the public.
    • Disseminates information to healthcare providers for the purpose of ensuring that providers remain informed about PH, its presenting symptoms, and current treatment options.

Amendment 2971 – Medical Education Models
This amendment would allow for the testing of methods to change education models and the practice of community based care through the CMS Innovation Center to determine the most effective means to impact care delivery to improve both the quality and the cost effectiveness of care. Knowledge from this process will be used to broaden skill sets and learning objectives in the medical school curriculum to encourage the development of physicians who modify practice based on evidence and scientific information and who are skilled at working as part of interdisciplinary teams.

Amendment 2972 – Stroke Therapy Services
This amendment would add testing of stroke therapy models in both urban and rural areas to the list of priorities in the CMS Innovation Center. This addition will allow experts to study if individuals living in a Metropolitan Statistical Area are being disadvantaged by the current Medicare payment policy. Currently the use of telemedicine for stroke therapy is limited to non Metropolitan Statistical Area counties.

Amendment 3033 – Medicare Advantage Accreditation
The Centers for Medicare and Medicaid Services has deemed several accrediting organizations for durable medical equipment (DME) suppliers.  However, many Medicare Advantage plans are telling DME suppliers they can only be accredited by certain accrediting organizations, and not select from the complete CMS list of approved accrediting organizations.  This limits provider choice and could impact quality.   This amendment would require plans to accept all accrediting organizations that were approved by CMS, protecting provider choice and helping to ensure quality. 

Amendment 3064 – Conscience Protection
This amendment provides conscience protection to health care providers, facilities, plans and organizations, protecting them against discrimination if they choose not to provide, pay for, provide coverage of, or refer for abortions.

Amendment 3098 – Support for Pregnant and Parenting Teens and Young Women
Many teens and women who face an unplanned pregnancy do so with little or no support.  The Pregnant and Parenting Teens and Women Amendment offers teens and young women the support they need to finish their educations and provide for their children.

This support is especially important for teens: 

  • Only 40% of mothers who have a child before age 18 ever graduate from high school, compared to about 75% of women who delay child bearing until age 20 or 21.
  • Less than 2% of mothers who have children before age 18 have a college degree by age 30, compared to 9% of women who wait until age 20 or 21 to have children and compared to 25% of women overall age 25 or older.
    • This can have a dramatic impact on a mother’s ability to provide for her child.  Women who complete college earn, on average, $17,000 more per year than women who only have a high school degree.
  • Parenthood is the leading cause of dropping out of school for teenage girls.
  • Furthermore, the children of teen mothers are more likely than the children of older mothers to drop out of high school.

This amendment includes:

  • Funding for colleges  to provide pregnancy and parenting resources located on campus or within the local community and improve such resources, including:
    • The inclusion of maternity coverage and the availability of riders for additional family members in student health care
    • Family housing
    • Child care
    • Flexible or alternative academic scheduling to allow students to stay in school
    • Education to improve parenting skills
    • Maternity and baby clothing, baby food, baby furniture, and similar items
    • Post-partum counseling and support groups
  • Funding for programs that help pregnant or parenting teens stay in or complete high school and prepare for college or vocational education by providing resources and assistance.
  • Assistance to States in providing intervention services, accompaniment, and supportive social services for pregnant victims of domestic violence, sexual violence, or stalking.
  • Additional resources for public awareness and outreach so that pregnant and parenting teens and women are aware of services available to them.

Amendment 3115 - Community-Integrated Nursing Care Homes
This amendment would test the financial and operational aspects required to further de-institutionalize long-term care by breaking down large nursing homes into small 10-person nursing homes offering the highest levels of care integrated into residents’ familiar neighborhoods and communities.

Amendment 3164 – Religious Conscience Exemption Clarification
This amendment clarifies the religious conscience exemption. Beginning in 2014, most individuals will be required to maintain "minimum essential health coverage" or pay a penalty; exceptions to this requirement are made for religious objectors and a few other categories of individuals. Under the religious conscience exception, one must certify that he or she is a member of a recognized religious sect described in the Internal Revenue Code Section 1402(g)(1) and is an adherent of established teachings of the sect. Under current law, the language in the Patient Protection and Affordable Care Act applies only to self-employed individuals or employees working for employers who qualify for the exemption. This amendment broadens the exemption to include employers of an individual who qualifies for the religious exemption.

Amendment 3168 – Nurse Home Visitation
This amendment will make it easier for practitioners and states to seek reimbursement for nurse home visitation services by providing a state option under Medicaid for all the services provided during a nurse home visit. Nurse home visitation is a highly successful program that reduces infant mortality, injury among toddlers and language delays; reduces child abuse and neglect in the first 15 years of life; and leads to fewer children entering the criminal justice system in the first 15 years of life.

Amendment 3184 – Adoption Tax Credit
Families hoping to adopt a child face many hurdles, and one of the biggest is the cost. Domestic adoptions can cost up to $15,000, and international adoptions can easily reach $20,000-$30,000. In 2001, Congress created tax credits to help families offset the high cost of adoption; these provisions expire after December 31, 2010. The Adoption Tax Credit Amendment extends the existing credit through December 31, 2014; increases it from $10,000 to $15,000; and makes it refundable. Raising the limit will help families cover more of the cost of adoption, and making the credit refundable will make adoption more affordable for lower- and middle-income families.

Amendment 3234 – Continuing Care Hospital
This amendment would create a second pilot program under the bundling section of the bill to test the Continuing Care Hospital. This model is a post-acute entity that would offer the services currently provided in inpatient rehabilitation hospitals and units, long-term care hospitals, and hospital-based skilled nursing facilities, and coordinate other needed post-acute care services within the bundled time period.

Amendment 3235 – Medicare Advantage
This amendment would provide transitional benefits to a select number of counties that have exceptionally high Medicare Advantage penetration levels, in states that have an especially high percentage of older citizens. In these areas a large number of beneficiaries have come to rely on the benefits Medicare Advantage plans provide. Accordingly, this amendment aims to smooth the transition to competitive bidding in these areas by providing them access to transitional benefits.

Amendment 3246 – Covered Drugs Under Medicare Part D
This amendment would add disposable medical devices that reduce the side effects associated with the treatment of cancer to the list of covered drugs under the Medicare Part D program.