Summary of the Amendment to the Amendment in the Nature of a Substitute

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Would (1) reduce the growth rate of the Part D spending threshold for catastrophic benefits between 2014 and 2019, providing additional benefits for seniors with high drug costs; (2) add a transitional phase up period for the coding intensity adjustment for Medicare Advantage plans; (3) strike a provision that would have deposited funds collected from Medicare Advantage plans for failing to meet the medical loss ratio into the CMS Program Management Account; (4) insert a new section 1108 that accelerates phase-in of Medicare physician practice expense adjustment for areas with below average practice expense payment rates. In 2010, national blend would be increased from ¼ to ½. Inserts a new Section 1109 that provides an additional payment under the  Medicare inpatient prospective payment systems to hospitals located in counties in the bottom quartile of counties as ranked by risk adjusted spending per Medicare enrollee; (5) clarify the timing for the election period for territories to choose to establish Exchanges; (6) clarify new requirements for community mental health centers to be eligible to participate in the Medicare partial hospitalization benefit; (7) strike section 1303 of the legislation (CMS-IRS Data Match to Identify Fraudulent Providers); (8) delete a provision providing for transfers of amounts collected from the supplementary medical insurance trust fund; (9) modify the pharmaceutical industry annual fee schedule; (10) modify the excise tax on importers and manufacturers of medical devices by lowering the rate to 2.3 percent and by eliminating the exclusion for Class I medical devices (except if such devices are of a type which is purchased by the general public at retail and for individual use.); (11) strike section 1411 of the legislation (No Impact on Social Security Trust Funds); (12) amend section 1501 to incorporate the funds into the Trade Act and strikes the provision in section 1501 that expands the focus of programs to individuals eligible for unemployment insurance; (13) move the $13.5 billion in additional Pell funding for fiscal year 2011 into section 401 of the Higher Education Act; (14) strike section 2102 of the legislation (Student Financial Assistance); (15) strike section 2213 of the legislation (Agreements with State-Owned Banks).