Summary: Children's Health and Medicare Protection (CHAMP) Act of 2007 - Title I: Children's Health Insurance Program - (Sec. 100) States that it is the purpose of this title to provide dependable and stable funding for children's health insurance under titles XXI (Children's Health Insurance Program) (CHIP) (also known as SCHIP) and XIX (Medicaid) of the Social Security Act (SSA) in order to enroll all six million uninsured children who are eligible, but not enrolled, for coverage today. Subtitle A: Funding - (Sec. 101) Prescribes formulae for new base CHIP allotments for states and territories beginning with FY2008. (Sec. 102) Makes CHIP allotments for FY2008 and each following fiscal year available for two years only (currently three years). (Sec. 103) Provides for redistribution of unused allotments to address state funding shortfalls. (Sec. 104) Increases from 20% to 30% the percentage of any CHIP allotment that a state may use for Medicaid payments after FY2007. Subtitle B: Improving Enrollment and Retention of Eligible Children - (Sec. 111) Directs the Secretary of Health and Human Services (HHS) to make performance bonus payments to states to offset the additional Medicaid and CHIP child enrollment costs resulting from enrollment and retention efforts. (Sec. 112) Gives states the option to provide that, in determining a child's Medicaid eligibility, it may rely on a finding made within a reasonable period from an Express Lane agency. Requires the state to use its regular procedures to determine Medicaid eligibility, however, if the Express Lane finding is negative. Authorizes a federal or state agency or private entity possessing sources of data potentially pertinent to Medicaid eligibility determinations to convey such data to the state agency administering the state Medicaid plan, subject to specified requirements. (Sec. 113)Applies Medicaid outreach procedures to all children and pregnant women. (Sec. 114) Requires payments to states to cover translation or interpretation services in connection with the enrollment and retention under Medicaid of children of families for whom English is not the primary language. Provides for the use of community health workers for outreach activities. Subtitle C: Coverage - (Sec. 121) Requires the child health assistance provided to a targeted low-income child to cover dental services, federally-qualified health center (FQHC) services, and rural health clinic (RHC) services. (Sec. 122) Revises the definition of both CHIP and Medicaid: (1) Secretary-approved coverage, relating to child health assistance to a targeted low-income child, to require the health benefits coverage to be at least equivalent to the coverage in a benchmark benefit package; and (2) state employee benchmark coverage to be that selected most frequently by employees seeking dependent coverage in either of the previous two plan years. (Sec. 123) Establishes a 30-day premium grace period for state child health plans. Subtitle D: Populations - (Sec. 131) Provides for optional coverage of older children, up to age 25, under Medicaid and CHIP. (Sec. 132) Provides for optional coverage of legal immigrants under Medicaid and CHIP. (Sec. 133) Gives states the option to expand or add coverage of targeted low-income pregnant women under CHIP. (Sec. 134) Prohibits the Secretary, through exercise of waiver authority, from providing for federal financial participation to a state for CHIP health care services for individuals who are not targeted low-income children or pregnant women, unless the Secretary determines that no eligible targeted low-income child in the state would be denied such coverage because of such eligibility. Subtitle E: Access - (Sec. 141) Amends SSA title XIX (Medicaid) to establish as an agency of Congress the Children's Access, Payment, and Equality Commission to review federal and state payment policies of the Medicaid and CHIP programs and make pertinent recommendations to Congress. (Sec. 142) Directs the Comptroller General to develop, and report to Congress on, a model process for the coordination of Medicaid and CHIP enrollment, retention, and coverage of children who, because of migration of families, emergency evacuations, educational needs, or otherwise, frequently change their state of residency or otherwise are temporarily located outside of the state of their residency. (Sec. 143) Gives states the option to require children to present satisfactory documentary evidence of proof of U.S. citizenship or nationality for Medicaid eligibility purposes. (Sec. 144) Directs the Secretary to develop a program to deliver oral health educational materials that inform new parents about risks for, and prevention of, early childhood caries and the need for a dental visit within their newborn's first year of life. Prohibits a state from preventing an FQHC from contracting with private practice dental providers in the provision of FQHC services. (Sec. 145) Prohibits the Secretary from approving any new health opportunity account demonstration programs. Subtitle F: Quality and Program Integrity - (Sec. 151) Requires the Secretary to establish a child health care quality measurement program to develop and implement pediatric quality measures for children's health care, as well as overall program performance measures, that may be used by public and private health care purchasers. (Sec. 152) Requires any state child health plan to apply to CHIP coverage, state agencies, enrollment brokers, and managed care entities and organizations certain managed care quality safeguards that apply to such coverage and entities under Medicaid. (Sec. 153) Directs the Secretary to conduct an independent subsequent evaluation of 10 states with approved child health plans. (Sec. 154) Grants access to CHIP records for Inspector General and General Accounting Office audits and evaluation. Title II: Medicare Beneficiary Improvements - Subtitle A: Improvements in Benefits - (Sec. 202) Amends SSA title XVIII (Medicare) to provide coverage of, and waiver of cost-sharing for, specified preventive services. Eliminates coinsurance in outpatient hospital settings and waives application of any deductible for all preventive services, as well as medical nutrition therapy services. (Sec. 202) Revises requirements for payments from the Federal Supplementary Medical Insurance Trust Fund. Waives the deductible for colorectal cancer screening tests regardless of coding, subsequent diagnosis, or ancillary tissue removal. (Sec. 203) Eliminates the 62 1/2% limitation on payments for outpatient treatment of mental disorders (thus requiring parity of payments for mental health coinsurance). Subtitle B: Improving, Clarifying, and Simplifying Financial Assistance for Low Income Medicare Beneficiaries - (Sec. 211) Provides that, beginning in 2009, the maximum resources level shall be the same for both part D low-income subsidy (LIS) groups. Sets such level in 2009 at $17,000 for an individual and $34,000 for a couple, and in subsequent years at the previous year's level increased by $1,000 for an individual and $2,000 for a couple. Applies such maximum resource levels also to eligibility determination for Medicare Savings programs. (Sec. 212) Revises requirements for the program under which individuals qualifying for Medicare (QIs) also qualify for Medicaid. Repeals the termination date for the QI program to make the program permanent. Eliminates the funding limitation, thereby expanding eligibility to all persons meeting the income and resource criteria. Provides a 100% federal medical assistance percentage (FMAP) for payments under the QI program. Sets the resources standard for the QI program at 150% of the federal poverty level. (Sec. 213) Requires that persons applying for the part D LIS program be permitted to qualify on the basis of self-certification of income and resources without the need to provide additional documentation. Requires that a subsidy eligible individual (or particular class, such as a full or partial subsidy individual) be deemed to continue to be eligible without the need for any annual or periodic application (automatic reenrollment), unless and until the individual notifies a responsible federal or state official that the eligibility conditions have changed so that the individual is no longer subsidy eligible. Requires the Secretary to take all reasonable steps to encourage states to provide, under the Medicare Savings Program (MSP), for such administrative verification of income and automatic reenrollment. Directs the Commissioner of Social Security to provide Medicare part A benefit applicants information describing the MSP and the LIS program (LISP), applications for LISP for medical assistance for Medicare cost-sharing, as well as information on how to obtain assistance in completing such applications. Requires the Commissioner to: (1) make such application forms available at local Social Security Administration (SS Admin) offices; and (2) provide training to SS Admin employees in assisting applicants in completing an MSP application. Requires the state Medicaid agency to accept MSP applications and act on them in the same manner, and subject to the same deadlines, as if they had been submitted directly by the applicant. Requires the Secretary to translate the Model Form used for MSP applications into at least 10 languages that are most often used by persons applying for Social Security or Medicare part A benefits. Amends the Internal Revenue Code to provide for the disclosure of tax return information to SS Admin officers and employees for purposes of providing low-income subsidies under Medicare. (Sec. 214) Prohibits any estate recovery of Medicaid correctly paid for Medicare cost-sharing or related benefits on behalf of an individual who was 55 years of age or older when the individual received such medical assistance. (Sec. 215) Eliminates part D cost-sharing for certain non-institutionalized full-benefit dual eligible mentally retarded individuals. (Sec. 216) Excludes from calculation of income and resources for LIS eligibility the value of any life insurance policy or any balance in a pension or retirement plan. (Sec. 217) Limits the aggregate cost-sharing per year for LIS-eligible individuals to 2.5% of income. (Sec. 218) Prohibits the automatic enrollment of a part D eligible individual in a prescription drug plan unless the plan meets specified formulary, pharmacy network, quality, and low cost requirements. Subtitle C: Part D Beneficiary Improvements - (Sec. 221) Revises requirements for the annual out-of-pocket threshold that part D beneficiaries must meet for any costs incurred by AIDS drug assistance programs and the Indian Health Service. (Sec. 222) Permits a special enrollment period in the case of an individual enrolled in a prescription drug plan (PDP) or Medicare Advantage-Prescription Drug (MA-PD) plan who has been prescribed a covered part D drug while so enrolled, if the formulary of the plan is materially changed (in midyear, and other than because of a Food and Drug Administration recall or withdrawal) in a way to reduce the drug coverage (or increase the cost-sharing). (Sec. 223) Repeals the exclusion of benzodiazepines from required part D drug coverage (thus extending coverage to such drugs). (Sec. 224) Authorizes the Secretary to apply to part D the same process for updating drug compendia as used under Medicare part B. (Sec. 225) Requires PDP formularies to include all or substantially all covered part D drugs in the therapeutic classes: (1) anticonvulsants; (2) antineoplastics; (3) antiretrovirals; (4) antidepressants; (5) antipsychotics; and (6) immunosuppressants. (Sec. 226) Eliminates part D late enrollment penalties for LIS-eligible individuals. (Sec. 227) Creates a special enrollment period for LIS-eligible individuals, together with automatic enrollment for those who fail to enroll in a PDP or MA-PD plan during such period. Subtitle D: Reducing Health Disparities - (Sec. 231) Directs the Secretary to: (1) collect data on the race, ethnicity, and primary language of each Medicare benefits applicant and recipient; (2) analyze and report on such data annually to the Director of the Office for Civil Rights and specified congressional committees; and (3) ensure that the provision of assistance to an applicant or recipient of assistance is not denied or otherwise adversely affected because of the failure of the applicant or recipient to provide race, ethnicity, and primary language data. (Sec. 232) Directs the Secretary to study and report to the appropriate congressional committees on ways that Medicare should develop payment systems for language services using the results of Sec. 233 demonstration programs to improve effective communication between Medicare service providers and Medicare beneficiaries who are limited English proficient. (Sec. 233) Directs the Secretary, acting through the Centers for Medicare & Medicaid Services, to award 24 three-year grants to eligible Medicare service providers to conduct such demonstration programs. (Sec. 234) Directs the Secretary to establish a demonstration project to determine the greatest needs and most effective methods of outreach to Medicare beneficiaries who were previously uninsured. (Sec. 235) Directs the Inspector General of the Department of Health and Human Services to report on: (1) the extent to which Medicare providers and plans are complying with the Office for Civil Rights' Guidance to Federal Financial Assistance Recipients Regarding the Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, and the Office of Minority Health's Culturally and Linguistically Appropriate Service Standards in health care; and (2) a description of the costs associated with or savings related to the provision of language services. Directs the Department of Health and Human Services to implement changes responsive to any deficiencies identified in the report. (Sec. 236) Requires the Secretary to seek to arrange with the Institute of Medicine to report on the impact of language access services on the health and health care of limited English proficient populations. Title III: Physicians' Service Payment Reform - (Sec. 301) Amends SSA title XVIII (Medicare) to require establishment of: (1) separate target growth rates for service categories; (2) separate conversion factors for each service category; and (3) updates for such conversion factors. (Sec. 302) Directs the Secretary to: (1) establish an expert panel to identify misvalued physicians' services; and (2) conduct a five-year review of physicians' services in conjunction with the five-year review by the American Medical Association/Specialty Society Relative Value Update Committee (RUC), particularly for services that have experienced substantial changes in length of stay, site of service, volume, practice expense, or other factors that may indicate changes in physician work. Gives the Secretary the authority to reduce the work component for services with accelerated growth without using the RUC process. (Sec. 303) Requires the Secretary to develop a mechanism to measure resource use on a per capita and an episode basis in order to provide confidential feedback to physicians in the Medicare program on how their practice patterns compare to physicians generally, both in the same locality as well as nationally. (Sec. 304) Creates incentive payments under the Medicare program for participating physicians practicing in an efficient area. (Sec. 305) Directs the Comptroller General to analyze and report to Congress on: (1) codes paid under the Medicare physician fee schedule to determine whether the codes for procedures that are commonly furnished together should be combined; and (2) those procedures under the same schedule for which no global payment methodology is applied but for which a "bundled" payment methodology would be appropriate. (Sec. 306) Directs the Secretary to establish: (1) an expanded medical home demonstration project; and (2) a process for selection of a qualified standard setting and certification organization to establish standards for medical practices to qualify as medical homes or as HIT-enhanced medical homes. Requires the Secretary to provide for payment to the personal physician of each participating beneficiary of a monthly medical home care management fee. (Sec. 307) Repeals the Physician Assistance and Quality Initiative Fund. (Sec. 308) Requires the Secretary to revise the fee schedule areas for California for services furnished on or after January 1, 2008 using a specified proposed county-based geographic adjustment factor. (Sec. 309) Requires diagnostic imaging services to be furnished at an accredited facility in order to be covered by the part B physicians' services fee schedule. Provides for the adjustment in practice expenses to reflect a higher presumed utilization of such imaging services. Requires the Secretary to adjust the number of practice expense relative value units for imaging services to reflect a 75%, rather than a 50%, presumed rate of utilization. Directs the Secretary to increase from 25% to 50% the reduction in expenditures ("discount") attributable to the multiple procedure payment reduction applicable to the technical component for single-session imaging involving consecutive body parts under a specified final rule published by the Secretary in the Federal Register. Directs the Secretary, in computing the practice expense component for imaging services, to change the interest rate assumption for capital purchases of imaging devices to reflect the prevailing rate in the market, but in no case higher than 11%. Prohibits the Secretary from accepting or paying a claim for imaging unless it is made separately for each component of such services. (Thus disallows global billing.) (Sec. 310) Reduces the frequency of meetings of the Practicing Physicians Advisory Council from once each quarter to once a year. Title IV: Medicare Advantage Reforms - Subtitle A: Payment Reform - (Sec. 401) Revises requirements for Medicare Advantage (MA) rates for monthly capitation payments to the MA plans, currently set by a process based on county level benchmarks and MA plan bids. Requires phase-out of payments to MA plans in excess of 100% of the average Fee-for-Service (FFS) costs in each county over four years to 100% of the FFS cost in the county in 2011. Prescribes a formula for blended county benchmarks and FFS to accomplish this goal. Excludes indirect medical education (IME) costs from the calculation of the 100% FFS for an MA plan in a county area. Provides that, if a MA plan bid exceeds 106% of the county FFS amount for 2009 or 103% of the FFS amount in 2010, then that MA plan may not enroll any new enrollees for that year during the annual, coordinated election period or during the year (if the enrollment becomes effective during the year). Requires FFS rates to be rebased annually beginning in 2009. Repeals the regional Preferred Provider Organization (PPO) stabilization fund. Subtitle B: Beneficiary Protections - (Sec. 411) Requests the National Association of Insurance Commissioners (NAIC) to develop and submit to the Secretary model regulations regarding Medicare plan marketing, enrollment, broker and agent training and certification, agent and broker commissions, and market conduct by plans, agents and brokers. Prescribes general guidelines for such regulations. Declares that any contract with an MA organization shall require it to meet all marketing and enrollment standards adopted pursuant to such NAIC model regulations, subject to specified sanctions. Doubles the civil monetary penalties that may be imposed on an MA organization that violates its contract. Requires the Secretary to: (1) disclose on the HHS public website all market and advertising contract violations and imposed sanctions; and (2) develop standard definitions of benefits and formats for use in marketing materials. Specifies funding to support Medicare part C and part D (Voluntary Prescription Drug Benefit Program) counseling and assistance provided by State Health Insurance Assistance Programs (SHIPs). (Sec. 412) Requires Medicare part C (private) plans to offer benefits under the original Medicare FFS program option with cost-sharing requirements no greater than those imposed under the traditional Medicare program. States that nothing shall be construed as prohibiting Medicare part C plans from using flat co-payments or per diem rates in lieu of part A or part B cost-sharing amounts, as long as they do not exceed the level of cost-sharing under traditional Medicare. Prohibits Medicare part C plans from imposing cost-sharing for dual-eligible individuals or qualified Medicare beneficiaries enrolled in a Medicare part C plan that exceeds the cost-sharing amounts permitted under the Medicare and Medicaid statutes. (Sec. 413) Authorizes continuous open enrollment in Medicare part C plans for full benefit dual-eligible individuals and qualified Medicare beneficiaries (QMBs). Changes the continuous open enrollment period to allow institutionalized, dual-eligible individuals and QMBs to disenroll from MA plans and return to traditional Medicare at any time. Authorizes special election periods for specified low-income Medicare beneficiaries and beneficiaries enrolled in Medicare part C plans in which enrollment has been suspended for not meeting the terms of their contracts. Requires the Secretary to take into account the health or well-being of the individual when determining the exceptional conditions in which individuals may be allowed to take advantage of a special election period. Increases from one year to two years the length of time certain categories of individuals who leave Medicare part C plans have to enroll in a Medigap plan. Prohibits the Secretary from enrolling Medicaid-eligible individuals (automatically) as dual-eligibles or QMBs in a Medicare part C plan without the individual's affirmative enrollment application. (Sec. 414) Directs the Secretary to publish for each Medicare part C plan: (1) its medical loss ratio in the previous year: (2) the per enrollee payment to the plan, as adjusted to reflect a risk score of 1.0; and (3) the average risk score (as so based). Prescribes requirements for preparation of the data necessary for such information, including standardized data elements and definitions. Requires a contract with a Medicare part C organization to provide the Secretary with the right to audit and inspect any pertinent book or record. Provides that, beginning in 2010, if an MA plan fails to have a medical loss ratio of at least .85, it will be subject to the following sanctions: (1) reduction of the blended benchmark amount; (2) no new enrollees for a specified period of time; and (3) termination of the plan contract if the plan fails to have such a medical loss for five consecutive contract years. Directs the Secretary to publish monthly the actual enrollment in each Medicare part C plan by contract and county. Requires the Medicare Payment Advisory Commission (MEDPAC) to study and report to Congress on the need and feasibility of providing for different minimum medical loss ratios for different types of Medicare part C plans. Subtitle C: Quality and Other Provisions - (Sec. 421) Requires any Medicare Advantage organization offering a private fee-for-service plan or an MSA plan for contract year 2009 to submit to the Secretary the same information on the same performance measures for which such information must be submitted for Medicare part C plans that are PPO plans for that year. Requires any such Medicare Advantage organization for contract year 2010 to submit to the Secretary the same performance measure information for which such information must be submitted for coordinated Medicare part C plans for that year. Requires employer-sponsored Medicare part C plans to have 90% of the Medicare beneficiaries enrolled in the plan reside in a county in which the organization offers a Medicare part C local plan. (Sec. 422) Requires the Secretary to develop quality measures for Medicare part C plans that measure disparities in the amount and quality of health services provided to racial and ethnic minorities. Requires the Secretary to provide for Medicare part C organizations to submit data that permits analysis of such disparities, together with biennial reports to Congress on how quality assurance programs measure and report on them. (Sec. 423) Requires Medicare Advantage plan audits to cover plan information submitted for risk adjustment purposes. Authorizes the Secretary to take actions, including pursuit of financial recoveries, necessary to address deficiencies identified in an audit or other activities. Applies such authority of the Secretary to PDPs under Medicare part D. (Sec. 424) Directs the Secretary to report to Congress on the adequacy of the Medicare Advantage risk adjustment system. (Sec. 425) Eliminates the providers' ability to bill enrollees in private fee-for-service plans more than the Medicare fee schedule amount. Repeals the exemption of private FFA plans from the Secretary's authority to review and negotiate Medicare Advantage plan bid amounts. (Thus authorizes the Secretary to review and negotiate the bid amounts for private FFS plans in the same manner as with other Medicare part C plans.) (Sec. 426) Renames the Medicare Advantage program as the Medicare part C program. Subtitle D: Extension of Authorities - (Sec. 431) Extends the authority to limit enrollment in special needs plans to only special needs beneficiaries for periods before January 1, 2012. Redefines a special needs plan to require that it to meet either of the following conditions: (1) at least 90% of enrollees are institutionalized as determined under regulation in effect as of July 1, 2007; or (2) at least 90% of enrollees are also entitled to Medicaid and are full-benefit dual eligible individuals for Medicare and Medicaid or qualified Medicare beneficiaries. Requires special needs plans to meet additional requirements for enrollment. Requires special needs plans for institutionalized individuals to: (1) have an agreement with the state regarding cooperation on the coordination of care for such individuals; (2) have contracts with long-term care facilities and other area providers sufficient to provide proper care; and (3) report to the Secretary on additional quality measures. Requires special needs plans for dual eligible individuals to have agreements with the state Medicaid agency regarding cooperation on the coordination of the financing of care for such individuals, certain payment requirements, and capitation payments. Limits out-of-pocket costs for part A and part B services charged to enrollees to maximum Medicaid out-of-pocket costs. Requires the Secretary to develop new quality measures appropriate to meeting the needs of special needs plan beneficiaries who are institutionalized or are dually eligible individuals. (Sec. 432) Extends for three additional years the length of time a cost-based plan may continue operating in an area where either two local or two regional Medicare Advantage plans had entered. Applies certain Medicare Advantage requirements to reasonable cost contract extended or renewed after enactment of this Act. Title V: Provisions Relating to Medicare Part A - (Sec. 501) Amends SSA title XVIII (Medicare part A (Hospital Insurance Benefits for Aged and Disabled)) to set the following inpatient hospital payment updates for acute hospitals and for other hospitals: (1) for acute hospitals, for FY2007, the market basket percentage increase for hospitals in all areas, and for FY2008, the market basket percentage increase minus .25 percentage points for hospitals in all areas; and (2) for other hospitals, for FY2003-FY2007, the market basket percentage increase, and for FY2008, the market basket percentage increase minus .25 percentage point. (Sec. 502) Sets the payment update factor for FY2008 at 1% for payments for inpatient rehabilitation facility (IRF) services. Amends the Deficit Reduction Act of 2005 to require the IRF compliance rate to remain at a maximum of 60% for cost reporting periods beginning on or after July 1, 2006. Requires the Secretary to continue to consider comorbidities as qualifying conditions. Creates a special payment rule for patients in IRFs admitted for three applicable medical conditions: (1) unilateral knee replacement; (2) unilateral hip replacement; and (3) unilateral hip fracture. Directs the Secretary to examine and report to Congress on: (1) Medicare beneficiaries' access to medically necessary rehabilitation services; (2) alternatives or refinements to the 75% rule policy for determining exclusion criteria for IRF designation; and (3) any condition for which individuals are commonly admitted to IRFs to determine the appropriate setting of care, and any variation in patient outcomes and costs, across settings of care, for treatment of such conditions. (Sec. 503) Creates cross-references to the Medicare, Medicaid, and CHIP Balanced Budget Refinement Act of 1999 and the Medicare, Medicaid and CHIP Benefits Improvement and Protection Act of 2000 for the prospective payment of long-term care hospitals (LTCHs). Makes the LTCH base rate for rate year 2008 the same as the one used for discharges in the previous rate year. Defines LTCH and establishes new patient criteria for prospective payment to LTCHs. Requires the Secretary to approve distinct part rehabilitation units in certain LTCHs if rehabilitation services are not included within one of the major diagnostic categories. Directs the Secretary to contract with one or more appropriate fiscal intermediaries or Medicare administrative contractors to review the medical necessity of long term care admissions and continued stays for individuals entitled to benefits under Medicare part A. Directs the Secretary to impose a four-year moratorium, with certain exceptions, on certification of new LTCHs (and satellite facilities) and new LTCH and satellite facility beds. Creates a separate classification for a certain long-stay cancer hospital. (Sec. 504) Raises the disproportionate share hospital (DSH) adjustment cap for small urban hospitals and rural hospitals to 16% for discharges occurring in FY2008 and to 18% for discharges in FY2009. Makes the adjustment cap for discharges on or after October 1, 2009, revert to 12%. (Sec. 505) Authorizes the Secretary to compute the target amount for the hospital's 12-month cost reporting period beginning during FY2008 in the case of certain cancer hospitals exempt from the inpatient prospective payment system (IPPS) that: (1) received payment for inpatient hospital services furnished during cost reporting periods beginning before October 1, 1999; and (2) request a rebasing. Establishes three additional IPPS-exempt cancer hospitals for cost reporting periods beginning after January 1, 2006. Directs MEDPAC to evaluate and report to the Secretary and Congress on: (1) measures of payment adequacy and Medicare margins for PPS-exempt cancer hospitals; (2) the margins of a PPS-exempt cancer hospital and another hospital with which it was previously affiliated as separate entities, as well as their margins when affiliated; and (3) payment adequacy for cancer discharges under the Medicare IPPS. (Sec. 506) Eliminates the skilled nursing facility market basket update for FY2008. (Sec. 507) Revokes the deeming authority granted to the Joint Commission of Healthcare Organizations to accredit hospitals for participation in Medicare. (Sec. 508) Amends the Medicare Improvements and Extension Act of 2006 (MIEA) and Section 508 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MPDIMA) to extend through FY2009 the geographic reclassification of certain hospitals otherwise unable to qualify for administrative reclassification to areas with higher wage index values. (Sec. 509) Amends MPDIMA to enable Minnesota to designate one hospital in Cass County as a necessary provider of health care on or after January 1, 2006. Designates a hospital located in Butler County, Alabama, as a critical access hospital. Title VI: Other Provisions Relating to Medicare part B - Subtitle A: Payment and Coverage Improvements - (Sec. 601) Amends SSA title XVIII (Medicare part B (Supplementary Medical Insurance Benefits for Aged and Disabled)), as amended by MIEA, to extend through calendar 2009 the process for exceptions from beneficiary payment limits for Medicare part B outpatient physical therapy services. Directs the Secretary to study and report to Congress on refined and alternative payment systems to the Medicare payment cap for physical therapy, speech-language pathology, and occupational therapy services. (Sec. 602) Establishes a separate definition for outpatient speech language pathology services to permit speech language pathologists practicing independently to bill part B, subject to the same conditions applicable to physical and occupational therapists in independent practice. (Sec. 603) Removes the limitation on the fee schedule amount for a service furnished by a certified nurse midwife to 65% of the fee amount for a physician. (Sec. 604) Sets the outpatient hospital fee schedule increase factor for services furnished in 2008 as the market basket increase reduced by .25 percentage points. (Sec. 605) Creates an exception to the 60-day limit on Medicare reciprocal billing arrangements in the case of physicians ordered to active duty in the armed forces. (Sec. 606) Excludes clinical social worker services from the skilled nursing facility PPS. (Sec. 607) Includes marriage and family therapist services and mental health counselor services within the definition of medical and other heath services covered under Medicare part B. Excludes such services, however, from the skilled nursing facility PPS. (Sec. 608) Eliminates the option to purchase a power-driven wheelchair with a lump sum payment at the time a purchase agreement has been entered into. (Does not, however, eliminate the lump-sum purchase option for a replacement wheelchair.) (Sec. 609) Decreases from 36 continuous months to 18 continuous months the length of time Medicare will make rental payments for oxygen equipment before transferring title to the beneficiary. Maintains the 36-month rule, however, for oxygen generating portable equipment (concentrators or transfilling systems). Directs the Secretary to study and report to Congress on the service component and equipment component of the provision of oxygen to Medicare beneficiaries. (Sec. 610) Increases by 5% the part B payment for applicable mental health services. (Sec. 611) Extends cost reimbursement for brachytherapy services until January 1, 2009. (Sec. 612) Requires the Secretary to use a specified formula to assure consistent volume-weighting in the computation of the average sales price (ASP) payable for drugs and biologicals furnished on or after July 1, 2008. Modifies the Competitive Acquisition Program (CAP), permitting continuous open enrollment and vendor delivery of drugs to the site of administration. Requires the Secretary to: (1) conduct an outreach and education program on the CAP; and (2) provide for the rebidding of CAP contracts only for periods on or after the expiration of the contract in effect on the date of enactment of this Act. Establishes a special rule for the payment calculation for inhalation drugs furnished through items of DME. Subtitle B: Extension of Medicare Rural Access Protections - (Sec. 621) Extends the floor on Medicare work geographic adjustment through December 31, 2009. (Sec. 622) Amends the Medicare, Medicaid, and CHIP Benefits Improvement and Protection Act of 2000, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and other specified law, to extend through December 31, 2009, the special treatment of certain physician pathology services under Medicare. (Sec. 623) Extends until July 1, 2009, reasonable cost reimbursement for certain clinical diagnostic laboratory services provided by qualified rural hospitals. (Sec. 624) Extends through December 31, 2009, the Medicare incentive payment program for physician scarcity areas. (Sec. 625) Reinstates the ground ambulance bonus payments for rural areas for the period beginning on January 1, 2008, and ending on December 31, 2009. (Sec. 626) Extends a specified hold harmless for small rural hospitals under the hospital outpatient department PPS, by maintaining through calendar year 2009 the calendar year 2007 payment of 90% of the difference between PPS payments and payments that would have been made under the prior reimbursement system. Subtitle C: End Stage Renal Disease Program - (Sec. 631) Directs the Secretary, acting through the Director of the National Institutes of Health, to establish demonstration projects to: (1) increase public and medical community awareness about the factors that lead to chronic kidney disease, how to prevent it, how to diagnose it, and how to treat it; (2) increase screening and use of prevention techniques for chronic kidney disease for Medicare beneficiaries and the general public; and (3) enhance surveillance systems and expand research to better assess the prevalence and incidence of chronic kidney disease. (Sec. 632) Extends Medicare coverage to kidney disease patient education services. Requires the Comptroller General to report to Congress on the chronic kidney disease Medicare program. (Sec. 633) Requires training for patient care dialysis technicians. (Sec. 634) Requires MEDPAC to report to the Secretary and Congress on the barriers that exist to increasing the number of individuals with end-stage renal disease who elect to receive home dialysis services under Medicare. (Sec. 635) Sets the payment amounts for erythropoietin and darbepoetin alfa furnished during 2008 or 2009 to an individual with end stage renal disease (ESRD) by a large dialysis facility. (Sec. 636) Makes the payment for providers of dialysis services furnished by hospital-based facilities the same as the rate for services furnished by renal dialysis facilities that are not hospital-based (site neutral composite rate), with an exception for the application of the labor share of the geographic index to hospital-based facilitates. (Sec. 637) Requires the Secretary to implement a bundled ESRD payment system under which a single payment is made for Medicare renal dialysis services. Requires quality incentive payments for ESRD services meeting certain performance standards that are furnished during specified periods during 2008 through 2011. (Sec. 638) Directs MEDPAC to report to Congress on the implementation of the ESRD bundling payment system. (Sec. 639) Requires the Inspector General of the Department of Health and Human Services to study and report to Congress on dosing guidelines, standards, protocols, and alogorithims for erythropoietin stimulating agents (ESAS) recommended or used by providers of services and renal dialysis facilities. Subtitle D: Miscellaneous - (Sec. 651) Prescribes new requirements for hospitals to qualify for the hospital exception to the general prohibition against physician referral (self-referral) of Medicare patients for certain services to facilities in which they (or their immediate family members) have financial interests. Title VII: Provisions Relating to Medicare Parts A and B - (Sec. 701) Eliminates the market basket update for home health payments for 2008. (Sec. 702) Amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as amended by the Deficit Reduction Act of 2005, to extend through calendar 2009 the temporary Medicare payment increase for home health services furnished in a rural area. (Sec. 703) Amends SSA title XVIII to extend from 30 to 42 months the coordination period for ESRD Medicare Secondary Payer requirements under which any third-party group health plan coverage beneficiaries receive through their employer or their spouse's employer is the primary payer. Applies this extended coordination period, however, only to those individuals who receive group coverage through a large group health plan (one offered by an employer that normally employed at least 100 employees on a typical business day during the preceding calendar year) (Sec. 704) Directs the Secretary to develop a plan to implement, beginning in FY2010, a policy to reduce or eliminate payments under Medicare for never events. Defines "never event" as an event involving the delivery of (or failure to deliver) physicians' services, inpatient or outpatient hospital services, or facility services furnished in an ambulatory surgical facility in which there is an error in medical care that: (1) is clearly identifiable, usually preventable, and serious in consequences to patients; and (2) indicates a deficiency in the safety and process controls of the services furnished with respect to the physician, hospital, or ambulatory surgical center involved. (Sec. 705) Provides for redistribution of residency slots (including those for osteopaths and allopaths) if one or more hospitals with approved medical residency training programs, located within the same metropolitan division of the core-based statistical area as of January 1, 2001, closes. Requires the Secretary, in the event of such a closure, to increase by no more than 10 the otherwise applicable resident limit for each hospital within the same metropolitan division that meets specified criteria. Prescribes an adjustment for any hospital with a dual accredited osteopathic and allopathic family practice program that had its resident limit reduced under certain residency redistribution requirements using a cost report subsequently revised between September 1 and 15, 2006. Title VIII: Medicaid - Subtitle A: Protecting Existing Coverage - (Sec. 801) Amends SSA title XIX (Medicaid) to extend through FY2009 certain requirements for state provision of transitional medical assistance to recipient families who lose their Medicaid eligibility for certain reasons. Authorizes a state to opt to: (1) substitute a 12-month, in lieu of the current six-month, initial eligibility period for extended transitional Medicaid; and (2) waive the minimum three-month receipt of medical assistance requirement for eligibility for transitional Medicaid. Requires each state to collect and submit to the Secretary information on: (1) average monthly enrollment and average monthly transitional Medicaid participation rates for adults and children; and (2) the number and percentage of children who become ineligible for transitional Medicaid whose medical assistance is continued under another eligibility category or who are enrolled under the state's child health plan under title XXI (State Children's Health Insurance Program) (SCHIP). (Sec. 802) Authorizes state Medicaid plans to: (1) cover a specified categorically needy group, whose medical assistance shall be limited to family planning services and supplies, including medical diagnosis or treatment services; and (2) provide for such assistance during a presumptive eligibility period. (Sec. 803) Prohibits the Secretary, between November 3, 2005, and March 1, 2009, from denying federal financial participation in any adult day health services approved under a state Medicaid plan. (Sec. 804) Revises requirements for treatment of the income and resources of certain institutionalized spouses by redefining "institutionalized spouse" to specify one who is receiving medical assistance for home and community-based services. (Sec. 805) Amends the Consolidated Omnibus Budget Reconciliation Act of 1959 to exempt Medicaid health insuring organizations operated by public entities in Ventura and Merced Counties, California, from the requirement that they be Medicaid managed care organizations meeting certain criteria. Declares that such exemption shall not apply with respect to any period for which the number of Medicaid beneficiaries enrolled with such health insuring organizations exceeds 16% (currently 14%) of the number of such beneficiaries in California. Subtitle B: Payments - (Sec. 811) Increases Medicaid payments to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for FY2009-FY2012. Removes the federal matching payments for improving data reporting systems from the over-all limit on payments to such territories for any territory. (Sec. 812) Increases from 15.1% to 20.1% after December 31, 2007, the minimum Medicaid drug rebate percentage drug manufacturers must agree to for covered outpatient drugs. Revises the definition of "best price," for the calculation of a rebate, to include cash discounts, free goods that are contingent on any purchase requirement, volume discounts, and rebates (as under current law), plus discounts and other price concessions to pharmaceutical benefit managers (PBMs). (Sec. 813) Requires the disregard of any significantly disproportionate employer pension contribution (whose aggregate allocation exceeds 25% of the total increase in personal income in the state) in calculating the state's per capita income for purposes of computing its federal medical assistance percentage (FMAP) for a fiscal year. (Sec. 814) Places a one-year moratorium on any federal action, policy, or practice to restrict Medicaid coverage or payment for rehabilitation services, or school-based administration, transportation, or medical services, if such restrictions are more restrictive in any aspect than those applied to such coverage or payment as of July 1, 2007. (Sec. 815) Deems the DSH allotments for Tennessee for each fiscal year beginning with FY2008 to be $30,000. Permits the Secretary to impose a limitation on the total amount of payments made to hospitals under the TennCare Section 1115 waiver only to the extent that it is necessary to ensure that a hospital does not receive payment in excess of certain amounts or as necessary to ensure that the waiver remains budget neutral. (Sec. 816) Addresses construction of certain requirements for reduction in state medical assistance expenditures for federal Medicaid payment purposes by the amount of specified donations and taxes. States that nothing in such requirements shall be construed as prohibiting a state's use of funds as the nonfederal share of Medicaid expenditures where they are transferred from or certified by a publicly-owned regional medical center located in another state, as long as the Secretary determines that the use of funds is proper and in the interest of the Medicaid program. Subtitle C: Miscellaneous - (Sec. 821) Amends SSA title XXI (SCHIP) to direct the Secretary to establish a demonstration project under which up to 10 states may provide under the state child health plan for a five-year period for child health assistance in relation to family coverage for children who would be targeted low-income children but for coverage as beneficiaries under a group health plan as the children of participants by virtue of a qualifying employer's contributions. (Sec. 822) Requires a transfer of certain FY2009 SCHIP funds for diabetes grants. Title IX: Miscellaneous - (Sec. 901) Establishes MEDPAC as an agency of Congress. (Sec. 902) Repeals subtitle A of title XVIII of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MPDIMA), which requires the board of trustees of the Hospital Insurance and Supplemental Medical Insurance trust funds to determine annually for Congress whether or not general revenue financing will exceed 45% of total Medicare outlays within the next seven years. (Sec. 903) Repeals the Comparative Cost Adjustment (CCA) program, as added by the Medicare Prescription, Drug, Improvement, and Modernization Act of 2003. (Sec. 904) Directs the Secretary to establish within the Agency of Health Care Research and Quality a Center for Comparative Effectiveness Research. Requires the Center to conduct, support, and synthesize research with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which disease, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically. Directs the Secretary to establish: (1) an independent Comparative Effectiveness Research Commission to oversee and evaluate the Center's activities; and (2) a Coordinating Council for Health Services Research. Amends the Internal Revenue Code to establish in the Treasury a Health Care Comparative Effectiveness Research Trust Fund, to be financed in part by fair share per capita fees. Imposes on each specified health insurance policy for each policy year a fee, payable by the policy issuer, which shall be equal to the fair share per capita amount multiplied by the average number of lives covered under the policy. Imposes a similar fee on self-insured plans. (Sec. 905) Directs the Secretary to report to Congress: (1) a plan to develop and implement a health information technology (health IT system) for all health care providers under Medicare; and (2) an analysis of the impact, feasibility, and costs associated with the use of health information technology in medically undeserved communities (Sec. 906) Directs the Secretary to designate and arrange with a single organization meeting specified requirements (such as the National Quality Forum) for advice and recommendations to the Secretary on \the key elements and priorities of a national system for establishing health care measures. (Sec. 907) Directs the Secretary to provide for implementation of the changes in the NAIC model law and regulations (for improvements to the Medigap program) recommended by the National Association of Insurance Commissioners (NAIC) in its Model #651 on March 11, 2007, as modified to reflect the changes made under this Act. Requires issuers of Medicare supplemental (Medigap) policies to offer, in addition to the core package, at least benefit packages classified as "C" or "F." (Sec. 908) Directs the Secretary, in order to implement the first nine titles of this Act, to provide for the transfer of $40 million from the Federal Supplementary Health and Human Services Trust Fund to the Centers for Medicare & Medicaid Services Program Management Account for FY2008. Title X: Revenues - (Sec. 1001) Amends the Internal Revenue Code to increase the excise taxes on: (1) cigars; (2) cigarettes; (3) cigarette papers; (4) cigarette tubes; (5) smokeless tobacco; (6) pipe tobacco; and (7) roll-your-own tobacco. Imposes a floor stocks tax on certain domestic or imported cigarettes, including those located in a foreign trade zone, except cigarettes in vending machines. Allows a credit of $500 against such increased excise taxes. (Sec. 1002) Exempts from federal excise tax any liquid fuel sold for use in any ambulances providing transportation for emergency medical services. Entitles the ultimate purchaser of such fuel to a rebate of any excise taxes paid.

act title children sec states purpose title provide dependable stable funding children health insurance titles chip known schip xix medicaid social security act ssa order enroll million uninsured children eligible enrolled coverage today subtitle funding sec prescribes formulae new base chip allotments states territories beginning fy2008 sec makes chip allotments fy2008 following fiscal year available years currently years sec provides redistribution unused allotments address state funding shortfalls sec increases percentage chip allotment state use medicaid payments fy2007 subtitle sec directs secretary health_and_human_services hhs performance bonus payments states offset additional medicaid chip child enrollment costs resulting enrollment retention efforts sec gives states option provide determining child medicaid eligibility rely finding reasonable period agency requires state use regular procedures determine medicaid eligibility finding negative authorizes federal state agency private entity possessing sources data potentially pertinent medicaid eligibility determinations convey data state agency administering state medicaid plan subject specified requirements sec medicaid outreach procedures children pregnant women sec requires payments states cover translation interpretation services connection enrollment retention medicaid children families english primary language provides use community health workers outreach activities subtitle coverage sec requires child health assistance provided targeted low income child cover dental services federally qualified health center fqhc services rural health clinic services sec revises definition chip medicaid secretary approved coverage relating child health assistance targeted low income child require health benefits coverage equivalent coverage benchmark benefit package state employee benchmark coverage selected frequently employees seeking dependent coverage previous plan years sec establishes day premium grace period state child health plans subtitle populations sec provides optional coverage older children age medicaid chip sec provides optional coverage legal immigrants medicaid chip sec gives states option expand add coverage targeted low income pregnant women chip sec prohibits secretary exercise waiver authority providing federal financial participation state chip health care services individuals targeted low income children pregnant women secretary determines eligible targeted low income child state denied coverage eligibility subtitle access sec amends ssa title xix medicaid establish agency review federal state payment policies medicaid chip programs pertinent recommendations congress sec directs comptroller general develop report congress model process coordination medicaid chip enrollment retention coverage children migration families emergency educational needs frequently change state residency temporarily located outside state residency sec gives states option require children present satisfactory documentary evidence proof citizenship nationality medicaid eligibility purposes sec directs secretary develop program deliver oral health educational materials inform new parents risks prevention early childhood caries need dental visit newborn year life prohibits state preventing fqhc contracting private practice dental providers provision fqhc services sec prohibits secretary approving new health opportunity account demonstration programs subtitle quality program integrity sec requires secretary establish child health care quality measurement program develop implement pediatric quality measures children health care overall program performance measures public private health care purchasers sec requires state child health plan apply chip coverage state agencies enrollment brokers managed care entities organizations certain managed care quality safeguards apply coverage entities medicaid sec directs secretary conduct independent subsequent evaluation states approved child health plans sec grants access chip records inspector_general audits evaluation title improvements benefits sec amends ssa title xviii medicare provide coverage waiver cost sharing specified preventive services eliminates coinsurance outpatient hospital settings waives application deductible preventive services medical nutrition therapy services sec revises requirements payments federal_supplementary_medical_insurance_trust_fund waives deductible colorectal cancer screening tests regardless coding subsequent diagnosis ancillary tissue removal sec eliminates limitation payments outpatient treatment mental disorders requiring parity payments mental health coinsurance subtitle improving clarifying low income medicare beneficiaries sec provides beginning maximum resources level shall low income subsidy lis groups sets level individual couple subsequent years previous year level increased individual couple applies maximum resource levels eligibility determination programs sec revises requirements program individuals qualifying medicare qualify medicaid repeals termination date program program permanent eliminates funding limitation expanding eligibility persons meeting income resource criteria provides federal medical assistance percentage fmap payments program sets resources standard program federal poverty level sec requires persons applying lis program permitted qualify basis self certification income resources need provide additional documentation requires subsidy eligible individual particular class partial subsidy individual deemed continue eligible need annual periodic application automatic individual notifies responsible federal state official eligibility conditions changed individual longer subsidy eligible requires secretary reasonable steps encourage states provide medicare_savings_program administrative verification income automatic directs commissioner social_security provide medicare benefit applicants information describing lis program applications medical assistance medicare cost sharing information obtain assistance completing applications requires commissioner application forms available local social_security_administration offices provide training employees assisting applicants completing application requires state medicaid agency accept applications act manner subject deadlines submitted directly applicant requires secretary translate model form applications languages persons applying social_security medicare benefits amends internal revenue code provide disclosure tax return information officers employees purposes providing low income subsidies medicare sec prohibits estate recovery medicaid correctly paid medicare cost sharing related benefits behalf individual years age older individual received medical assistance sec eliminates cost sharing certain non institutionalized benefit dual eligible mentally retarded individuals sec excludes calculation income resources lis eligibility value life insurance policy balance pension retirement plan sec limits aggregate cost sharing year lis eligible individuals income sec prohibits automatic enrollment eligible individual prescription drug plan plan meets specified formulary pharmacy network quality low cost requirements subtitle beneficiary improvements sec revises requirements annual pocket threshold beneficiaries meet costs incurred aids drug assistance programs indian_health_service sec permits special enrollment period case individual enrolled prescription drug plan pdp ma-pd plan prescribed covered drug enrolled formulary plan materially changed food_and_drug_administration recall withdrawal way reduce drug coverage increase cost sharing sec repeals exclusion benzodiazepines required drug coverage extending coverage drugs sec authorizes secretary apply process updating drug medicare sec requires pdp formularies include substantially covered drugs therapeutic classes antidepressants sec eliminates late enrollment penalties lis eligible individuals sec creates special enrollment period lis eligible individuals automatic enrollment fail enroll pdp ma-pd plan period subtitle reducing health disparities sec directs secretary collect data race ethnicity primary language medicare benefits applicant recipient analyze report data annually director specified congressional committees ensure provision assistance applicant recipient assistance denied adversely affected failure applicant recipient provide race ethnicity primary language data sec directs secretary study report appropriate congressional committees ways medicare develop payment systems language services results sec demonstration programs improve effective communication medicare service providers medicare beneficiaries limited english proficient sec directs secretary acting award year grants eligible medicare service providers conduct demonstration programs sec directs secretary establish demonstration project determine greatest needs effective methods outreach medicare beneficiaries previously uninsured sec directs inspector general department_of_health_and_human_services report extent medicare providers plans complying office_of_minority_health culturally health care description costs associated savings related provision language services directs department_of_health_and_human_services implement changes responsive deficiencies identified report sec requires secretary seek arrange institute_of_medicine report impact language access services health health care limited english proficient populations title iii physicians service payment reform sec amends ssa title xviii medicare require establishment separate target growth rates service categories separate conversion factors service category updates conversion factors sec directs secretary establish expert panel identify misvalued physicians services conduct year review physicians services conjunction year review ruc particularly services experienced substantial changes length stay site service volume practice expense factors indicate changes physician work gives secretary authority reduce work component services accelerated growth ruc process sec requires secretary develop mechanism measure resource use capita episode basis order provide confidential feedback physicians medicare program practice patterns compare physicians generally locality nationally sec creates incentive payments medicare program participating physicians practicing efficient area sec directs comptroller general analyze report congress codes paid medicare physician fee schedule determine codes procedures commonly furnished combined procedures schedule global payment methodology applied bundled payment methodology appropriate sec directs secretary establish expanded medical home demonstration project process selection qualified standard setting certification organization establish standards medical practices qualify medical homes hit enhanced medical homes requires secretary provide payment personal physician participating beneficiary monthly medical home care management fee sec repeals quality initiative fund sec requires secretary revise fee schedule areas california services furnished january specified proposed county based geographic adjustment factor sec requires diagnostic imaging services furnished accredited facility order covered physicians services fee schedule provides adjustment practice expenses reflect higher presumed utilization imaging services requires secretary adjust number practice expense relative value units imaging services reflect presumed rate utilization directs secretary increase reduction expenditures discount attributable multiple procedure payment reduction applicable technical component single session imaging involving consecutive body parts specified final rule published secretary federal_register directs secretary computing practice expense component imaging services change interest rate assumption capital purchases imaging devices reflect prevailing rate market case higher prohibits secretary accepting paying claim imaging separately component services disallows global billing sec reduces frequency meetings quarter year title medicare advantage reforms subtitle payment reform sec revises requirements medicare_advantage rates monthly capitation payments plans currently set process based county level benchmarks plan bids requires phase payments plans excess average fee service ffs costs county years ffs cost county prescribes formula blended county benchmarks ffs accomplish goal excludes indirect medical education ime costs calculation ffs plan county area provides plan bid exceeds county ffs ffs plan enroll new enrollees year annual coordinated election period year enrollment effective year requires ffs rates annually beginning repeals regional stabilization fund subtitle beneficiary protections sec requests national_association_of_insurance_commissioners naic develop submit secretary model regulations medicare plan marketing enrollment broker agent training certification agent broker commissions market conduct plans agents brokers prescribes general guidelines regulations declares contract organization shall require meet marketing enrollment standards adopted pursuant naic model regulations subject specified sanctions doubles civil monetary penalties imposed organization violates contract requires secretary disclose hhs public website market advertising contract violations imposed sanctions develop standard definitions benefits formats use marketing materials specifies funding support medicare voluntary prescription drug benefit program counseling assistance provided ships sec requires medicare private plans offer benefits original medicare ffs program option cost sharing requirements greater imposed traditional medicare program states shall construed prohibiting medicare plans flat payments diem rates lieu cost sharing amounts long exceed level cost sharing traditional medicare prohibits medicare plans imposing cost sharing dual eligible individuals qualified medicare beneficiaries enrolled medicare plan exceeds cost sharing amounts permitted medicare medicaid statutes sec authorizes continuous open enrollment medicare plans benefit dual eligible individuals qualified medicare beneficiaries qmbs changes continuous open enrollment period allow institutionalized dual eligible individuals qmbs plans return traditional medicare time authorizes special election periods specified low income medicare beneficiaries beneficiaries enrolled medicare plans enrollment suspended meeting terms contracts requires secretary account health individual determining exceptional conditions individuals allowed advantage special election period increases year years length time certain categories individuals leave medicare plans enroll medigap plan prohibits secretary enrolling medicaid eligible individuals automatically dual eligibles qmbs medicare plan individual affirmative enrollment application sec directs secretary publish medicare plan medical loss ratio previous year enrollee payment plan adjusted reflect risk score average risk score based prescribes requirements preparation data necessary information including standardized data elements definitions requires contract medicare organization provide secretary right audit inspect pertinent book record provides beginning plan fails medical loss ratio subject following sanctions reduction blended benchmark new enrollees specified period time termination plan contract plan fails medical loss consecutive contract years directs secretary publish monthly actual enrollment medicare plan contract county requires medicare_payment_advisory_commission medpac study report congress need feasibility providing different minimum medical loss ratios different types medicare plans subtitle quality provisions sec requires medicare_advantage organization offering private fee service plan msa plan contract year submit secretary information performance measures information submitted medicare plans plans year requires medicare_advantage organization contract year submit secretary performance measure information information submitted coordinated medicare plans year requires employer sponsored medicare plans medicare beneficiaries enrolled plan reside county organization offers medicare local plan sec requires secretary develop quality measures medicare plans measure disparities quality health services provided racial ethnic minorities requires secretary provide medicare organizations submit data permits analysis disparities biennial reports congress quality assurance programs measure report sec requires medicare advantage plan audits cover plan information submitted risk adjustment purposes authorizes secretary actions including pursuit financial recoveries necessary address deficiencies identified audit activities applies authority secretary pdps medicare sec directs secretary report congress adequacy medicare_advantage risk adjustment system sec eliminates providers ability bill enrollees private fee service plans medicare fee schedule repeals exemption private plans secretary authority review negotiate medicare_advantage plan bid amounts authorizes secretary review negotiate bid amounts private ffs plans manner medicare plans sec renames medicare_advantage program medicare program subtitle extension authorities sec extends authority limit enrollment special needs plans special needs beneficiaries periods january redefines special needs plan require meet following conditions enrollees institutionalized determined regulation effect july enrollees entitled medicaid benefit dual eligible individuals medicare medicaid qualified medicare beneficiaries requires special needs plans meet additional requirements enrollment requires special needs plans institutionalized individuals agreement state cooperation coordination care individuals contracts long term care facilities area providers sufficient provide proper care report secretary additional quality measures requires special needs plans dual eligible individuals agreements state medicaid agency cooperation coordination financing care individuals certain payment requirements capitation payments limits pocket costs services charged enrollees maximum medicaid pocket costs requires secretary develop new quality measures appropriate meeting needs special needs plan beneficiaries institutionalized dually eligible individuals sec extends additional years length time cost based plan continue operating area local regional medicare_advantage plans entered applies certain medicare_advantage requirements reasonable cost contract extended renewed enactment act title provisions relating medicare sec amends ssa title xviii medicare hospital insurance benefits aged disabled set following inpatient hospital payment updates acute hospitals hospitals acute hospitals fy2007 market basket percentage increase hospitals areas fy2008 market basket percentage increase minus percentage points hospitals areas hospitals fy2003 fy2007 market basket percentage increase fy2008 market basket percentage increase minus percentage point sec sets payment update factor fy2008 payments inpatient rehabilitation facility services amends deficit reduction act require compliance rate remain maximum cost reporting periods beginning july requires secretary continue consider qualifying conditions creates special payment rule patients admitted applicable medical conditions unilateral replacement unilateral replacement unilateral fracture directs secretary examine report congress medicare beneficiaries access medically necessary rehabilitation services alternatives rule policy determining exclusion criteria designation condition individuals commonly admitted determine appropriate setting care variation patient outcomes costs settings care treatment conditions sec creates cross references medicare medicaid medicare medicaid chip benefits improvement protection act prospective payment long term care hospitals ltchs makes ltch base rate rate year discharges previous rate year defines ltch establishes new patient criteria prospective payment ltchs requires secretary approve distinct rehabilitation units certain ltchs rehabilitation services included major diagnostic categories directs secretary contract appropriate fiscal intermediaries medicare administrative contractors review medical necessity long term care admissions continued stays individuals entitled benefits medicare directs secretary impose year moratorium certain exceptions certification new ltchs satellite facilities new ltch satellite facility beds creates separate classification certain long stay cancer hospital sec raises disproportionate share hospital dsh adjustment cap small urban hospitals rural hospitals discharges occurring fy2008 discharges fy2009 makes adjustment cap discharges october revert sec authorizes secretary compute target hospital month cost reporting period beginning fy2008 case certain cancer hospitals exempt inpatient prospective payment system ipps received payment inpatient hospital services furnished cost reporting periods beginning october request rebasing establishes additional ipps exempt cancer hospitals cost reporting periods beginning january directs medpac evaluate report secretary congress measures payment adequacy medicare margins pps exempt cancer hospitals margins pps exempt cancer hospital hospital previously affiliated separate entities margins affiliated payment adequacy cancer discharges sec eliminates skilled nursing facility market basket update fy2008 sec revokes deeming authority granted accredit hospitals participation medicare sec amends section medicare prescription drug improvement modernization act extend fy2009 geographic reclassification certain hospitals unable qualify administrative reclassification areas higher wage index values sec enable minnesota designate hospital necessary provider health care january designates hospital located alabama critical access hospital title provisions relating medicare subtitle payment coverage improvements sec amends ssa title xviii medicare supplementary medical insurance benefits aged disabled amended extend calendar process exceptions beneficiary payment limits medicare outpatient physical therapy services directs secretary study report congress refined alternative payment systems medicare payment cap physical therapy speech language pathology occupational therapy services sec establishes separate definition outpatient speech language pathology services permit speech language pathologists practicing independently bill subject conditions applicable physical occupational therapists independent practice sec removes limitation fee schedule service furnished certified nurse midwife fee physician sec sets outpatient hospital fee schedule increase factor services furnished market basket increase reduced percentage points sec creates exception day limit medicare reciprocal billing arrangements case physicians ordered active duty armed forces sec excludes clinical social worker services skilled nursing facility pps sec includes marriage family therapist services mental health counselor services definition medical heath services covered medicare excludes services skilled nursing facility pps sec eliminates option purchase power driven wheelchair lump sum payment time purchase agreement entered eliminate lump sum purchase option replacement wheelchair sec decreases continuous months continuous months length time medicare rental payments oxygen equipment transferring title beneficiary maintains month rule oxygen generating portable equipment systems directs secretary study report congress service component equipment component provision oxygen medicare beneficiaries sec increases payment applicable mental health services sec extends cost reimbursement services january sec requires secretary use specified formula assure consistent volume computation average sales price payable drugs biologicals furnished july modifies cap permitting continuous open enrollment vendor delivery drugs site administration requires secretary conduct outreach education program cap provide cap contracts periods expiration contract effect date enactment act establishes special rule payment calculation inhalation drugs furnished items dme subtitle extension sec extends floor medicare work geographic adjustment december sec amends medicare medicaid chip benefits improvement protection act amended medicare_prescription_drug improvement modernization act specified law extend december special treatment certain physician pathology services medicare sec extends july reasonable cost reimbursement certain clinical diagnostic laboratory services provided qualified rural hospitals sec extends december medicare incentive payment program physician scarcity areas sec reinstates ground ambulance bonus payments rural areas period beginning january ending december sec extends specified hold harmless small rural hospitals hospital outpatient department pps maintaining calendar year calendar year payment difference pps payments payments prior reimbursement system subtitle end stage renal disease program sec directs secretary acting director national_institutes_of_health establish demonstration projects increase public medical community awareness factors lead chronic kidney disease prevent diagnose treat increase screening use prevention techniques chronic kidney disease medicare beneficiaries general public enhance surveillance systems expand research better assess prevalence incidence chronic kidney disease sec extends medicare coverage kidney disease patient education services requires comptroller general report congress chronic kidney disease medicare program sec requires training patient care dialysis technicians sec requires medpac report secretary congress barriers exist increasing number individuals end stage renal disease elect receive home dialysis services medicare sec sets payment amounts furnished individual end stage renal disease esrd large dialysis facility sec makes payment providers dialysis services furnished hospital based facilities rate services furnished renal dialysis facilities hospital based site neutral composite rate exception application labor share geographic index hospital based facilitates sec requires secretary implement bundled esrd payment system single payment medicare renal dialysis services requires quality incentive payments esrd services meeting certain performance standards furnished specified periods sec directs medpac report congress implementation esrd bundling payment system sec requires inspector general department_of_health_and_human_services study report congress dosing guidelines standards protocols agents recommended providers services renal dialysis facilities subtitle miscellaneous sec prescribes new requirements hospitals qualify hospital exception general prohibition physician referral self referral medicare patients certain services facilities immediate family members financial interests title vii provisions relating medicare parts sec eliminates market basket update home health payments sec amends medicare_prescription_drug improvement modernization act amended deficit reduction act extend calendar temporary medicare payment increase home health services furnished rural area sec amends ssa title xviii extend months coordination period esrd medicare requirements party group health plan coverage beneficiaries receive employer spouse employer primary payer applies extended coordination period individuals receive group coverage large group health plan offered employer normally employed employees typical business day preceding calendar year sec directs secretary develop plan implement beginning fy2010 policy reduce eliminate payments medicare events defines event event involving delivery failure deliver physicians services inpatient outpatient hospital services facility services furnished ambulatory surgical facility error medical care clearly identifiable usually preventable consequences patients indicates deficiency safety process controls services furnished respect physician hospital ambulatory surgical center involved sec provides redistribution residency slots including hospitals approved medical residency training programs located metropolitan division core based statistical area january closes requires secretary event closure increase applicable resident limit hospital metropolitan division meets specified criteria prescribes adjustment hospital dual accredited osteopathic allopathic family practice program resident limit reduced certain residency redistribution requirements cost report subsequently revised september title viii protecting existing coverage sec amends ssa title xix medicaid extend fy2009 certain requirements state provision transitional medical assistance recipient families lose medicaid eligibility certain reasons authorizes state opt substitute month lieu current month initial eligibility period extended transitional medicaid waive minimum month receipt medical assistance requirement eligibility transitional medicaid requires state collect submit secretary information average monthly enrollment average monthly transitional medicaid participation rates adults children number percentage children ineligible transitional medicaid medical assistance continued eligibility category enrolled state child health plan title schip sec authorizes state medicaid plans cover specified categorically needy group medical assistance shall limited family planning services supplies including medical diagnosis treatment services provide assistance presumptive eligibility period sec prohibits secretary november march denying federal financial participation adult day health services approved state medicaid plan sec revises requirements treatment income resources certain institutionalized spouses redefining institutionalized spouse specify receiving medical assistance home community based services sec amends consolidated_omnibus_budget_reconciliation_act exempt medicaid health insuring organizations operated public entities ventura california requirement medicaid managed care organizations meeting certain criteria declares exemption shall apply respect period number medicaid beneficiaries enrolled health insuring organizations exceeds currently number beneficiaries california subtitle payments sec increases medicaid payments puerto_rico virgin_islands guam northern_mariana islands american_samoa fy2009 fy2012 removes federal matching payments improving data reporting systems limit payments territories territory sec increases december minimum medicaid drug rebate percentage drug manufacturers agree covered outpatient drugs revises definition best price calculation rebate include cash discounts free goods contingent purchase requirement volume discounts rebates current law plus discounts price concessions pharmaceutical benefit managers sec requires disregard significantly disproportionate employer pension contribution aggregate allocation exceeds total increase personal income state calculating state capita income purposes computing federal medical assistance percentage fmap fiscal year sec places year moratorium federal action policy practice restrict medicaid coverage payment rehabilitation services school based administration transportation medical services restrictions restrictive aspect applied coverage payment july sec deems dsh allotments tennessee fiscal year beginning fy2008 permits secretary impose limitation total payments hospitals section waiver extent necessary ensure hospital receive payment excess certain amounts necessary ensure waiver remains budget neutral sec addresses construction certain requirements reduction state medical assistance expenditures federal medicaid payment purposes specified donations taxes states requirements shall construed prohibiting state use funds nonfederal share medicaid expenditures transferred certified publicly owned regional medical center located state long secretary determines use funds proper interest medicaid program subtitle miscellaneous sec amends ssa title direct secretary establish demonstration project states provide state child health plan year period child health assistance relation family coverage children targeted low income children coverage beneficiaries group health plan children participants virtue qualifying employer contributions sec requires transfer certain funds diabetes grants title miscellaneous sec establishes medpac agency congress sec repeals subtitle title xviii medicare prescription drug improvement modernization act requires board trustees trust funds determine annually congress general revenue financing exceed total medicare outlays seven years sec repeals comparative cost adjustment program added modernization act sec directs secretary establish requires center conduct support synthesize research respect outcomes effectiveness appropriateness health care services procedures order identify manner disease disorders health conditions effectively appropriately prevented diagnosed treated managed clinically directs secretary establish independent oversee evaluate center activities coordinating council health services research amends internal revenue code establish treasury health care comparative effectiveness research trust fund financed fair share capita fees imposes specified health insurance policy policy year fee payable policy issuer shall equal fair share capita multiplied average number lives covered policy imposes similar fee self insured plans sec directs secretary report congress plan develop implement health information technology health system health care providers medicare analysis impact feasibility costs associated use health information technology medically communities sec directs secretary designate arrange single organization meeting specified requirements advice recommendations secretary key elements priorities national system establishing health care measures sec directs secretary provide implementation changes naic model law regulations improvements medigap program recommended national_association_of_insurance_commissioners naic model march modified reflect changes act requires issuers medicare supplemental medigap policies offer addition core package benefit packages classified sec directs secretary order implement titles act provide transfer million centers fy2008 title revenues sec amends internal revenue code increase excise taxes cigars cigarettes cigarette papers cigarette tubes smokeless tobacco pipe tobacco roll tobacco imposes floor stocks tax certain domestic imported cigarettes including located foreign trade zone cigarettes vending machines allows credit increased excise taxes sec exempts federal excise tax liquid fuel sold use providing transportation emergency medical services entitles ultimate purchaser fuel rebate excise taxes paid


Summary: Healthy Americans Act - Requires each adult individual to have the opportunity to purchase a Healthy Americans Private Insurance Plan (HAPI). Makes individuals who are not enrolled in another specified health plan and who are not opposed to coverage for religious reasons responsible for enrolling themselves and their dependent children in a HAPI plan offered through their state of residence. Sets forth penalties for failure to enroll. Establishes standardized coverage and state options for HAPI plans. Requires the Secretary of Health and Human Services to promulgate guidelines concerning the benefits, items, and services to be covered. Sets forth requirements for setting premiums. Requires the Secretary to establish the Healthy America Advisory Committee to provide annual recommendations concerning modifications to the benefits, items, and services required. Requires the Secretary to establish Chronic Care Education Centers. Requires states to establish or designate a state Health Help Agency to carry out the administration of HAPI plans and to promote prevention and wellness for residents. Amends the Internal Revenue Code to require employers and individuals to each make shared responsibility payments for HAPI plan premiums. Sets forth requirements for health insurance issuers offering a HAPI plan. Establishes the Healthy Americans Public Health Trust Fund for the payment of premium subsidies. Terminates federal health benefits coverage, including coverage provided under the Federal Employees Health Benefits (FEHB) program and the State Children's Health Insurance program (SCHIP). Enhanced Health Care Value for All Act of 2007 - Provides for a Comparative Effectiveness Advisory Board and a Health Care Comparative Effectiveness Research Trust Fund.

healthy americans act requires adult individual opportunity purchase healthy americans private insurance plan makes individuals enrolled specified health plan opposed coverage religious reasons responsible enrolling dependent children plan offered state residence sets forth penalties failure enroll establishes standardized coverage state options plans requires secretary health_and_human_services promulgate guidelines concerning benefits items services covered sets forth requirements setting premiums requires secretary establish provide annual recommendations concerning modifications benefits items services required requires secretary establish requires states establish designate state carry administration plans promote prevention wellness residents amends internal revenue code require employers individuals shared responsibility payments plan premiums sets forth requirements health insurance issuers offering plan establishes payment premium subsidies terminates federal health benefits coverage including coverage provided federal_employees_health benefits fehb program program schip act provides comparative effectiveness advisory board


Summary: Wounded Warriors Expansion of Care Act of 2007 - Entitles any recovering member and any former member with a severe injury or illness to medical and dental care in any military medical facility or through any civilian health care provider authorized by the Secretary of Defense to provide health and mental health services, including services for traumatic brain injury and post-traumatic stress disorder. Authorizes such medical and dental care for three years beginning on the date: (1) of enactment of this Act, for those whose injury or illness was incurred on or after October 7, 2001, and before the enactment of this Act; and (2) on which the injury or illness is incurred, for those whose injury or illness occurs on or after the enactment of this Act. Authorizes the Secretary to waive any limitation on the provision of such care if considered appropriate to assure the maximum feasible recovery and rehabilitation of the member or former member. Prohibits the Secretary from providing such medical and dental care after December 31, 2012, if the Secretary has not provided such care to such member or former member before that date. Entitles members with a severe injury or illness to rehabilitation and vocational benefits from the Secretary of Veterans Affairs. Authorizes the Secretary of the military department concerned to reimburse recovering members and former members with a severe injury or illness for certain expenses incurred in connection with the receipt of required medical care.

wounded warriors expansion care act entitles recovering member member severe injury illness medical dental care military medical facility civilian health care provider authorized secretary defense provide health mental health services including services traumatic brain injury post traumatic stress disorder authorizes medical dental care years beginning date enactment act injury illness incurred october enactment act injury illness incurred injury illness occurs enactment act authorizes secretary waive limitation provision care considered appropriate assure maximum feasible recovery rehabilitation member member prohibits secretary providing medical dental care december secretary provided care member member date entitles members severe injury illness rehabilitation vocational benefits secretary veterans_affairs authorizes secretary military department concerned reimburse recovering members members severe injury illness certain expenses incurred connection receipt required medical care


Summary: HSA Improvement and Expansion Act of 2007 - Amends Internal Revenue Code provisions relating to health savings accounts (HSAs) to: (1) allow HSAs to incorporate flexible spending and health reimbursement arrangements; (2) increase the annual HSA contribution limitation; (3) permit the use of HSAs to purchase health insurance; (4) allow the payment of certain medical expenses incurred before the establishment of an HSA; (5) allow veterans eligible for service-connected disability benefits to establish an HSA; and (6) allow spouses to make increased catch-up contributions to a single HSA.

2007_-_amends_internal_revenue code provisions relating health savings accounts hsas allow hsas incorporate flexible spending health reimbursement arrangements increase annual hsa contribution limitation permit use hsas purchase health insurance allow payment certain medical expenses incurred establishment hsa allow veterans eligible service connected disability benefits establish hsa allow spouses increased catch contributions single hsa


Summary: Flexible Health Savings Act of 2007 - Amends the Internal Revenue Code to allow up to $500 of unused health benefits in a plan or other arrangement that provides for a health flexible spending arrangement to be carried forward to the next plan year or be contributed to a health savings account or a qualified retirement plan, without affecting the status of such plan or arrangement as a tax-exempt employee benefit cafeteria plan.

amends internal revenue code allow unused health benefits plan arrangement provides health flexible spending arrangement carried forward plan year contributed health savings account qualified retirement plan affecting status plan arrangement tax exempt employee benefit cafeteria plan


Summary: Early Treatment for HIV Act of 2007 - Amends title XIX (Medicaid) of the Social Security Act to give states the option of providing Medicaid coverage for certain low-income HIV-infected individuals. Provides states taking advantage of this option with an enhanced federal Medicaid match.

early treatment hiv act amends title xix medicaid social security act states option providing medicaid coverage certain low income hiv infected individuals provides states taking advantage option enhanced federal medicaid match


Summary: Comprehensive Health Care Reform Act of 2007- Amends the Internal Revenue Code to: (1) revise the tax credit for the health insurance costs of a taxpayer, the taxpayer's spouse, and dependents to increase the amount of, and expand eligibility criteria for, such credit; (2) permit up to $500 of unused health benefits under a health flexible spending arrangement to be carried over to a succeeding plan year or paid directly to an employee as compensation; (3) revise the tax deduction for payments to a health savings account to eliminate the requirement for coverage under a high deductible health plan; and (4) repeal the 7.5% threshold limitation on the tax deduction of medical and dental expenses.

comprehensive health care reform act amends_the_internal_revenue_code revise tax credit health insurance costs taxpayer taxpayer spouse dependents increase expand eligibility criteria credit permit unused health benefits health flexible spending arrangement carried succeeding plan year paid directly employee compensation revise tax deduction payments health savings account eliminate requirement coverage high deductible health plan repeal threshold limitation tax deduction medical dental expenses


Summary: Health Insurance Tax Relief Act of 2007 - Amends the Internal Revenue Code to: (1) allow individual taxpayers a refundable tax credit for health insurance costs paid for the benefit of the taxpayer, the taxpayer's spouse, and dependents; (2) require business taxpayers who receive payments for certain employee health insurance coverage to file informational returns; and (3) direct the Secretary of the Treasury to make advance payments of health insurance tax credit amounts to health insurance providers.

amends internal revenue code allow individual taxpayers refundable tax credit health insurance costs paid benefit taxpayer taxpayer spouse dependents require business taxpayers receive payments certain employee health insurance coverage file informational returns direct secretary treasury advance payments health insurance tax credit amounts health insurance providers


Summary: Affordable Health Care for Americans Act of 2007 - Amends the Internal Revenue Code to allow a tax deduction from gross income for the health insurance costs of an individual taxpayer, the taxpayer's spouse, and dependents (available whether or not a taxpayer itemizes deductions).

affordable health care americans act amends internal revenue code allow tax deduction gross income health insurance costs individual taxpayer taxpayer spouse dependents available taxpayer itemizes deductions


Summary: Public and Teaching Hospital Preservation Act - Amends the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 to extend by one year the moratorium on: (1) implementation of a rule relating to the federal-state financial partnership under titles XIX (Medicaid) and XXI (State Children's Health Insurance Program) (SCHIP) of the Social Security Act; and (2) finalization of a Medicaid rule regarding the treatment of graduate medical education (GME).

public teaching hospital preservation act amends katrina_recovery iraq_accountability_appropriations_act extend year moratorium implementation rule relating federal state financial partnership titles xix medicaid schip social security act finalization medicaid rule treatment graduate medical education gme