Baucus Bill Revisions

- In the paragraph beginning ―Contributions collected ‖ , strike ―sold in the state exchangesin the second sentence.

- For clarification, the penalty would apply to individuals accessing the exchange as well as at the exchange and federal entity level.   The penalty may also include a penalty applicable to someone who applies on behalf of an individual and supplies false information or documentation.

- At the end of the first sentence in the first paragraph, insert ―in order to meet minimum creditable coverage ‖ .

- Under ―Employer Offer of Health Insurance Coverage ‖ , strike ―employerin the second paragraph, at the end of the fourth sentence

- Insert ―fulltimein the sentence at the top of the page before both references to ―employees ‖ .

ï'· Develop standard definitions for common insurance terms including premium, deductible, co-insurance, co-payment, out-of-pocket limit, preferred provider, non-preferred provider, out-of-network co-payments, UCR (usual, customary and reasonable) fees, excluded services, grievance and appeals, and such other terms as the Secretary determines.

ï'· Develop standard definitions for medical terms including hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing care, rehabilitation services, hospice services, emergency medical transportation, and such other terms as the Secretary determines.

ï'· Develop several scenarios (for example, Breast Cancer) which include information that must be provided by every insurance carrier offering coverage in the individual and small group markets in describing their plans to consumers.  This label should include information regarding at minimum estimated out-of-pocket cost-sharing and significant exclusions or benefit limits for such scenarios.

ï'· Develop standards for an annual personalized statement that summarizes an individuals' use of health care services and claims paid in the previous year.

Insert ―The Chairman's Mark would clarify the original intent of Congress that the term ―medical assistanceas used in various sections of the Social Security Act encompasses both payment for services provided and the services themselves.  The Chairman's Mark would amend section 1905(a) of the Social Security Act by inserting ―or the care and services themselves, or bothbefore ―(if provided in or after) ‖ .

- Strike the provision ―Make Prescription Drugs a Mandatory Benefit ‖ .

Insert ―no less thanbefore ―175 percent ‖ .

Strike the word ―pointboth times it appears in the paragraph beginning ―Each year thereafter ‖ .

- Strike ―screeningin the second sentence of the first paragraph and replace with ―assessment ‖ .

- Insert at the end of the last line of the description of the Chairman's Mark ―for any indication or population ‖ .

- Strike ―Secretaryin the third line of the Chairman's Description of the Mark and replace with ―Each participating site ‖ . 

To amend Title III, Subtitle A, on page 76, to add ―and in addition would include healthcare-associated infections, as measured by the prevention metrics and targets established in the Department of Health and Human Services HHS Action Plan to Prevent Healthcare-Associated Infections or any successor planto line 4 after ―patient perception of care ‖ .

- Strike ―2015and replace with ―2014 ‖ .

Insert new section entitled, ―Technical Correction related to Critical Access Hospitals (CAHs) ‖ , which clarifies that CAHs are eligible to receive 101 percent of reasonable costs for providing outpatient services regardless of  billing method and for providing qualifying ambulance services. 

- Strike ―2010and replace with ―2011 ‖ .

Add after ―margins;in ―(5) ‖ :  ―or payment updates; 

- First sentence of first full paragraph, after ―Patient-Centered Outcomes Research Institute ‖ , add ―which will be tax exempt for Federal tax purposes.

- Strike ―2009in the sixth full paragraph and replace with ―2010 ‖ .

Regular Income Tax .  For regular income tax purposes, individuals are allowed an itemized deduction for unreimbursed medical expenses, but only to the extent that such expenses exceed 7.5 percent of adjusted gross income ("AGI"). 1  

Alternative Minimum Tax .   For purposes of the alternative minimum tax ("AMT"), medical expenses are deductible only to the extent that they exceed 10 percent of AGI.

Add a provision to provide an exclusion from gross income for the value of specified Indian tribe health benefits.  The exclusion applies to the value of:  (1) health services or benefits provided or purchased by the Indian Health Service ("IHS"), either directly or indirectly, through a grant to or a contract or compact with an Indian tribe or tribal organization or through programs of third parties funded by the IHS; 2 (2) medical care services (in the form of provided or purchased medical care services, accident or health insurance or an arrangement having the same effect, or amounts paid directly or indirectly, to reimburse the member for expenses incurred for medical care) provided by an Indian tribe or tribal organization to a member of an Indian tribe, including the member's spouse or dependents; 3 (3) accident or health plan coverage (or an arrangement having the same effect) provided by an Indian tribe or tribal organization for medical care to a member of an Indian tribe and the member's spouse or dependents; and (4) any other medical care provided by an Indian tribe that supplements, replaces, or substitutes for the programs and services provided by the Federal government to Indian tribes or Indians.

3   The terms "accident or health insurance" and "accident or health plan" have the same meaning as when used in sections 104 and 106.  The term "medical care" is the same as the definition under section 213.  For purposes of the provision, dependents are determined under section 152, but without regard to subsections (b)(1), (b)(2), and (d)(1)(B).  Section 152(b)(1) generally provides that if an individual is a dependent of another taxpayer during a taxable year such individual is treated as having no dependents for such taxable year.  Section 152(b)(2) provides that a married individual filing a joint return with his or her spouse is not treated as a dependent of a taxpayer.  Section 152(d)(1)(B) provides that a "qualifying relative" (i.e., a relative that qualifies as a dependent) does not include a person whose gross income for the calendar year in which the taxable year begins equals or exceeds the exempt amount (as defined under section 151).

The provision provides that the threshold amount ($8,000 for individual coverage and $21,000 for family coverage for 2013) is indexed to the Consumer Price Index for Urban Consumers (―CPI-U ‖ ), as determined by the Department of Labor beginning in 2014, plus one percent.