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<bill bill-stage="Considered-and-Passed-Senate" dms-id="A1" public-private="public">
	<form>
		<distribution-code display="yes">II</distribution-code>
		<congress>110th CONGRESS</congress>
		<session>1st Session</session>
		<legis-num>S. 2499</legis-num>
		<current-chamber>IN THE SENATE OF THE UNITED STATES</current-chamber>
		<action>
			<action-date date="20071218">December 18, 2007</action-date>
			<action-desc><sponsor name-id="S127">Mr. Baucus</sponsor> (for himself
			 and <cosponsor name-id="S153">Mr. Grassley</cosponsor>) introduced the
			 following bill; which was read twice, considered, read the third time, and
			 passed</action-desc>
		</action>
		<legis-type>A BILL</legis-type>
		<official-title>To amend titles XVIII, XIX, and XXI of the Social
		  Security Act to extend provisions under the Medicare, Medicaid, and SCHIP
		  programs, and for other purposes.</official-title>
	</form>
	<legis-body>
		<section id="S1" section-type="section-one"><enum>1.</enum><header>Short
			 title; table of contents</header>
			<subsection id="id5EF2F9C483264FFC89B21FA5C4C97A22"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">This Act may be cited
			 as the <quote><short-title>Medicare, Medicaid, and SCHIP
			 Extension Act of 2007</short-title></quote>.</text>
			</subsection><subsection id="idFD720DD066C1454AADFA3BE0A93AF049"><enum>(b)</enum><header>Table of
			 contents</header><text>The table of contents of this Act is as follows:</text>
				<toc>
					<toc-entry idref="S1" level="section">Sec. 1. Short title; table of
				contents.</toc-entry>
					<toc-entry idref="id5DA05C3BE8B44363AFF7A330FDC2DBE9" level="title">TITLE I—Medicare</toc-entry>
					<toc-entry idref="H0BD1C61FECC54F2CBF2D0300354D2323" level="section">Sec. 101. Increase in physician payment update; extension of
				the physician quality reporting system.</toc-entry>
					<toc-entry idref="HA9B31C9F1B9E41AD8C930600008CD58F" level="section">Sec. 102. Extension of Medicare incentive payment program for
				physician scarcity areas.</toc-entry>
					<toc-entry idref="H7C6BF9A6A0954ACFA38C097EE3AD5E5D" level="section">Sec. 103. Extension of floor on work geographic adjustment
				under the Medicare physician fee schedule.</toc-entry>
					<toc-entry idref="IDB4F6FB08B8FB4763AF28883C6819D5F2" level="section">Sec. 104. Extension of treatment of certain physician pathology
				services under Medicare.</toc-entry>
					<toc-entry idref="id5E445FF0FB9247DB8B1B318ACE6DE9D5" level="section">Sec. 105. Extension of exceptions process for Medicare therapy
				caps.</toc-entry>
					<toc-entry idref="idD31A9507CD944285B702653BAF1D7057" level="section">Sec. 106. Extension of payment rule for brachytherapy;
				extension to therapeutic radiopharmaceuticals.</toc-entry>
					<toc-entry idref="id9E8FB1807F134B7AAC2E03BBBFE100B1" level="section">Sec. 107. Extension of Medicare reasonable costs payments for
				certain clinical diagnostic laboratory tests furnished to hospital patients in
				certain rural areas.</toc-entry>
					<toc-entry idref="id58FFAF432C8E42419B0F86D00FBC3141" level="section">Sec. 108. Extension of authority of specialized Medicare
				Advantage plans for special needs individuals to restrict
				enrollment.</toc-entry>
					<toc-entry idref="idBEFCD4ADBCDF4DFCBC9837A69265B77C" level="section">Sec. 109. Extension of deadline for application of limitation
				on extension or renewal of Medicare reasonable cost contract plans.</toc-entry>
					<toc-entry idref="HA6BE9C2E325B4BF0A64034D17768DDB8" level="section">Sec. 110. Adjustment to the Medicare Advantage stabilization
				fund.</toc-entry>
					<toc-entry idref="H5CE6D9B4B09F45BD8091CC777FEBB97" level="section">Sec. 111. Medicare secondary payor.</toc-entry>
					<toc-entry idref="H96D2E3DC4A914D72A048FD3BABFEABDE" level="section">Sec. 112. Payment for part B drugs.</toc-entry>
					<toc-entry idref="H8D3D680BE81D46158276BE3D56D33E1C" level="section">Sec. 113. Payment rate for certain diagnostic laboratory
				tests.</toc-entry>
					<toc-entry idref="H602663D9710C4444BD064808A21BFCB" level="section">Sec. 114. Long-term care hospitals.</toc-entry>
					<toc-entry idref="HCB928EAB5E7941EEAAF065316364AA1E" level="section">Sec. 115. Payment for inpatient rehabilitation facility (IRF)
				services.</toc-entry>
					<toc-entry idref="H81CEF34DA978412996712F389B380465" level="section">Sec. 116. Extension of accommodation of physicians ordered to
				active duty in the Armed Services.</toc-entry>
					<toc-entry idref="H0B0550F964294956A8A58550F28C16F" level="section">Sec. 117. Treatment of certain hospitals.</toc-entry>
					<toc-entry idref="idD50A6D5D1CF54775BF79942B33013F1D" level="section">Sec. 118. Additional Funding for State Health Insurance
				Assistance Programs, Area Agencies on Aging, and Aging and Disability Resource
				Centers.</toc-entry>
					<toc-entry idref="id6C7184B6049C4A1EBE83927118204214" level="title">TITLE II—Medicaid and SCHIP</toc-entry>
					<toc-entry idref="H32C280AEFA5A416F8FCCC4D842C3C542" level="section">Sec. 201. Extending SCHIP funding through March 31,
				2009.</toc-entry>
					<toc-entry idref="H4308253E655749828F119CCDC65EC8FE" level="section">Sec. 202. Extension of transitional medical assistance (TMA)
				and abstinence education program.</toc-entry>
					<toc-entry idref="H8C90C2499662434E84948B6959E24942" level="section">Sec. 203. Extension of qualifying individual (QI)
				program.</toc-entry>
					<toc-entry idref="HC8808302347C" level="section">Sec. 204. Medicaid
				DSH extension.</toc-entry>
					<toc-entry idref="HB999D96FC99F421C8033239500FB1373" level="section">Sec. 205. Improving data collection.</toc-entry>
					<toc-entry idref="HCEAF4191D3A64C0EAC9E445B010047D2" level="section">Sec. 206. Moratorium on certain payment
				restrictions.</toc-entry>
					<toc-entry idref="id314BA201933142E9900066D7B1C2130F" level="title">TITLE III—Miscellaneous</toc-entry>
					<toc-entry idref="id3197D6A88EFC4DA8AB0E74160B1CCAB8" level="section">Sec. 301. Medicare Payment Advisory Commission
				status.</toc-entry>
					<toc-entry idref="IDE81560453319427CB39FA6E5A9EE8DC1" level="section">Sec. 302. Special Diabetes Programs for Type I Diabetes and
				Indians.</toc-entry>
				</toc>
			</subsection></section><title id="id5DA05C3BE8B44363AFF7A330FDC2DBE9"><enum>I</enum><header>Medicare</header>
			<section id="H0BD1C61FECC54F2CBF2D0300354D2323"><enum>101.</enum><header>Increase in
			 physician payment update; extension of the physician quality reporting
			 system</header>
				<subsection id="id6FB45011F3A24604884BD094FD7F46E9"><enum>(a)</enum><header>Increase in
			 physician payment update</header>
					<paragraph id="id535229D2B73A40C78CB68A01ABC4CCD4"><enum>(1)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Section 1848(d) of
			 the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395w–4(d)) is amended—</text>
						<subparagraph id="id57F2012D64E843E4835F597BD802F286"><enum>(A)</enum><text>in paragraph
			 (4)(B), by striking <quote>and paragraphs (5) and (6)</quote> and inserting
			 <quote>and the succeeding paragraphs of this subsection</quote>; and</text>
						</subparagraph><subparagraph id="id3D0905B0C5E9450C8493A97865437C02"><enum>(B)</enum><text display-inline="yes-display-inline">by adding at the end the following new
			 paragraph:</text>
							<quoted-block display-inline="no-display-inline" id="H83F46070F12349FBAC7941F91428D1DB" style="OLC">
								<paragraph id="HE5E9EDB745A34D268D85A1AD6D9800C4"><enum>(8)</enum><header>Update for a
				portion of 2008</header>
									<subparagraph id="idD45C1183B94D4469B6F14243CDF849CB"><enum>(A)</enum><header>In
				general</header><text>Subject to paragraph (7)(B), in lieu of the update to the
				single conversion factor established in paragraph (1)(C) that would otherwise
				apply for 2008, for the period beginning on January 1, 2008, and ending on June
				30, 2008, the update to the single conversion factor shall be 0.5
				percent.</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ID33530AAF5F3C43C8AF955EBD0E6BC0C9"><enum>(B)</enum><header>No effect on
				computation of conversion factor for the remaining portion of 2008 and
				2009</header><text>The conversion factor under this subsection shall be
				computed under paragraph (1)(A) for the period beginning on July 1, 2008, and
				ending on December 31, 2008, and for 2009 and subsequent years as if
				subparagraph (A) had never
				applied.</text>
									</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H3532325F3B1742AB00B31AC6CEC042F"><enum>(2)</enum><header>Revision of the
			 Physician Assistance and Quality Initiative Fund</header>
						<subparagraph commented="no" display-inline="no-display-inline" id="id99009DC9264E499DAE2C966295F1E2AE"><enum>(A)</enum><header>Revision</header><text display-inline="yes-display-inline">Section 1848(l)(2) of the Social Security
			 Act (42 U.S.C. 1395w–4(l)(2)) is amended—</text>
							<clause commented="no" display-inline="no-display-inline" id="id2C4D0371608849B1A7AD574A95DAFBAC"><enum>(i)</enum><text display-inline="yes-display-inline">by striking subparagraph (A) and inserting
			 the following:</text>
								<quoted-block display-inline="no-display-inline" id="idA2239984FAF9418C8AF79753BCFCE6C6" style="OLC">
									<subparagraph commented="no" display-inline="no-display-inline" id="id0B9B399E350E4C5D8EF1E2A8E7218F7D"><enum>(A)</enum><header>Amount
				available</header>
										<clause commented="no" display-inline="no-display-inline" id="id9035002959854879AA56003DE3D9E429"><enum>(i)</enum><header>In
				general</header><text display-inline="yes-display-inline">Subject to clause
				(ii), there shall be available to the Fund the following amounts:</text>
											<subclause commented="no" display-inline="no-display-inline" id="id005B6932887D46DBB92BABDD34267770"><enum>(I)</enum><text display-inline="yes-display-inline">For expenditures during 2008, an amount
				equal to $150,500,000.</text>
											</subclause><subclause commented="no" display-inline="no-display-inline" id="id1F253A85FB504F8B9D0FE81BAB5B3D00"><enum>(II)</enum><text display-inline="yes-display-inline">For expenditures during 2009, an amount
				equal to $24,500,000.</text>
											</subclause><subclause commented="no" display-inline="no-display-inline" id="id96B79A6666874B42BE25AD9DFECD6C9B"><enum>(III)</enum><text display-inline="yes-display-inline">For expenditures during 2013, an amount
				equal to $4,960,000,000.</text>
											</subclause></clause><clause commented="no" display-inline="no-display-inline" id="idCE43358E6B204A559F9811046CF4B7AF"><enum>(ii)</enum><header>Limitations on
				expenditures</header>
											<subclause commented="no" display-inline="no-display-inline" id="idFAA25694700147ADB94CC4E65DE0C47B"><enum>(I)</enum><header>2008</header><text display-inline="yes-display-inline">The amount available for expenditures
				during 2008 shall be reduced as provided by subparagraph (A) of section
				225(c)(1) and section 524 of the Departments of Labor, Health and Human
				Services, and Education, and Related Agencies Appropriations Act, 2008
				(division G of the Consolidated Appropriations Act, 2008).</text>
											</subclause><subclause commented="no" display-inline="no-display-inline" id="idEC1330E466D04C748843191378B6A248"><enum>(II)</enum><header>2009</header><text display-inline="yes-display-inline">The amount available for expenditures
				during 2009 shall be reduced as provided by subparagraph (B) of such section
				225(c)(1).</text>
											</subclause><subclause commented="no" display-inline="no-display-inline" id="idE71885B0250741F39596D6285C147CE6"><enum>(III)</enum><header>2013</header><text display-inline="yes-display-inline">The amount available for expenditures
				during 2013 shall only be available for an adjustment to the update of the
				conversion factor under subsection (d) for that
				year.</text>
											</subclause></clause></subparagraph><after-quoted-block>;
				and</after-quoted-block></quoted-block>
							</clause><clause commented="no" display-inline="no-display-inline" id="idE7E21923CFE04A8C87F5211CC42B3511"><enum>(ii)</enum><text>in subparagraph
			 (B), by striking <quote>entire amount specified in the first sentence of
			 subparagraph (A)</quote> and all that follows and inserting the following:
			 “entire amount available for expenditures, after application of subparagraph
			 (A)(ii), during—</text>
								<quoted-block display-inline="no-display-inline" id="idF0F057F33ABB4F3897145BCB3D9211C8" style="OLC">
									<clause commented="no" display-inline="no-display-inline" id="id2BBC0B1D72614F34879E092B5857B0C2"><enum>(i)</enum><text>2008 for payment
				with respect to physicians' services furnished during 2008;</text>
									</clause><clause commented="no" display-inline="no-display-inline" id="id3CFA8DF85A2E48A19D1AC9910A90018B"><enum>(ii)</enum><text>2009 for payment
				with respect to physicians' services furnished during 2009; and</text>
									</clause><clause commented="no" display-inline="no-display-inline" id="idE0C3198AAD9543D796831D9866631782"><enum>(iii)</enum><text>2013 for
				payment with respect to physicians' services furnished during
				2013.</text>
									</clause><after-quoted-block>.</after-quoted-block></quoted-block>
							</clause></subparagraph><subparagraph id="idCBF6F846067E45BFA62BE3EECC5C490E"><enum>(B)</enum><header>Effective
			 Date</header>
							<clause id="id2D5CE03867E34419BB0A1133B267B111"><enum>(i)</enum><header>In
			 general</header><text>Subject to clause (ii), the amendments made by
			 subparagraph (A) shall take effect on the date of the enactment of this
			 Act.</text>
							</clause><clause id="idFBCCAF2887194F10ADB00C36C7555A5E"><enum>(ii)</enum><header>Special rule
			 for coordination with Consolidated Appropriations Act, 2008</header><text>If
			 the date of the enactment of the Consolidated Appropriations Act, 2008, occurs
			 on or after the date described in clause (i), the amendments made by
			 subparagraph (A) shall be deemed to be made on the day after the effective date
			 of sections 225(c)(1) and 524 of the Departments of Labor, Health and Human
			 Services, and Education, and Related Agencies Appropriations Act, 2008
			 (division G of the Consolidated Appropriations Act, 2008).</text>
							</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF9338752BB5945BABED675A740FCABD"><enum>(C)</enum><header>Transfer of funds
			 to part B trust fund</header><text>Amounts that would have been available to
			 the Physician Assistance and Quality Initiative Fund under section 1848(l)(2)
			 of the Social Security Act (42 U.S.C. 1395w–4(l)(2)) for payment with respect
			 to physicians' services furnished prior to January 1, 2013, but for the
			 amendments made by subparagraph (A), shall be deposited into, and made
			 available for expenditures from, the Federal Supplementary Medical Insurance
			 Trust Fund under section 1841 of such Act (42 U.S.C. 1395t).</text>
						</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id3703D12BA86C4890B17E14CA7D09F51E"><enum>(b)</enum><header>Extension of
			 the physician quality reporting system</header>
					<paragraph commented="no" display-inline="no-display-inline" id="idBE54AC3FDC8F47E4874B2F8C038D674A"><enum>(1)</enum><header>System</header><text>Section
			 1848(k)(2)(B) of the Social Security Act (42 U.S.C. 1395w–4(k)(2)(B)) is
			 amended—</text>
						<subparagraph commented="no" display-inline="no-display-inline" id="idDC9335730F4D4950AF4489F2D8C4039E"><enum>(A)</enum><text>in the heading,
			 by inserting <quote><header-in-text level="subparagraph" style="OLC">and
			 2009</header-in-text></quote> after <quote><header-in-text level="subparagraph" style="OLC">2008</header-in-text></quote>;</text>
						</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id95C2F2F311C94BF797029234BD81E488"><enum>(B)</enum><text>in clause (i), by
			 inserting <quote>and 2009</quote> after <quote>2008</quote>; and</text>
						</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4CBBEAF3FF23481088BA8C1502262B89"><enum>(C)</enum><text>in each of
			 clauses (ii) and (iii)—</text>
							<clause commented="no" display-inline="no-display-inline" id="idAE265718D85D4323BD37FE712645AFEA"><enum>(i)</enum><text>by striking
			 <quote>, 2007</quote> and inserting <quote>of each of 2007 and 2008</quote>;
			 and</text>
							</clause><clause commented="no" display-inline="no-display-inline" id="id0815594A46984D23B0078D16ACF15D87"><enum>(ii)</enum><text>by inserting
			 <quote>or 2009, as applicable</quote> after <quote>2008</quote>.</text>
							</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3C49EB75A373478386746D244030B61F"><enum>(2)</enum><header>Reporting</header><text>Section
			 101(c) of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C.
			 1395w–4 note) is amended—</text>
						<subparagraph commented="no" display-inline="no-display-inline" id="id63132E6653BF453C878AA58B91A650E1"><enum>(A)</enum><text>in the heading,
			 by inserting <quote><header-in-text level="subsection" style="OLC">and
			 2008</header-in-text></quote> after <quote><header-in-text level="subsection" style="OLC">2007</header-in-text></quote>;</text>
						</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idD373446121C84BDF9D896AF724F755E8"><enum>(B)</enum><text>in paragraph (5),
			 by adding at the end the following:</text>
							<quoted-block display-inline="no-display-inline" id="idCBA63E9FAC1545B58100D44D90F90C8D" style="OLC">
								<subparagraph commented="no" display-inline="no-display-inline" id="idC0312AC167924EA5B5508D1AA4AD0220"><enum>(F)</enum><header>Extension</header><text>For
				2008 and 2009, paragraph (3) shall not apply, and the Secretary shall establish
				alternative criteria for satisfactorily reporting under paragraph (2) and
				alternative reporting periods under paragraph (6)(C) for reporting groups of
				measures under paragraph (2)(B) of section 1848(k) of the Social Security Act
				(42 U.S.C. 1395w–4(k)) and for reporting using the method specified in
				paragraph (4) of such section.</text>
								</subparagraph><after-quoted-block>;
				and</after-quoted-block></quoted-block>
						</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id61217048E30848C8A6C7DCA3DB291A39"><enum>(C)</enum><text>in paragraph (6),
			 by striking subparagraph (C) and inserting the following new
			 subparagraph:</text>
							<quoted-block display-inline="no-display-inline" id="id14C7D483B7B843FBBD12D5FC36722E37" style="OLC">
								<subparagraph commented="no" display-inline="no-display-inline" id="id9DACC20096184A7AB7BAFE212DF99F91"><enum>(C)</enum><header>Reporting
				period</header><text>The term <quote>reporting period</quote> means—</text>
									<clause commented="no" display-inline="no-display-inline" id="idFE5CBA6B53734893AE429E8C62766369"><enum>(i)</enum><text>for 2007, the
				period beginning on July 1, 2007, and ending on December 31, 2007; and</text>
									</clause><clause commented="no" display-inline="no-display-inline" id="id6A117F69E3D84C68AC20CDD0E6E026C6"><enum>(ii)</enum><text>for 2008, all of
				2008.</text>
									</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph></subsection><subsection display-inline="no-display-inline" id="id09B781E077EA49E6AACE5112BAB06903"><enum>(c)</enum><header>Implementation</header><text display-inline="yes-display-inline">For purposes of carrying out the provisions
			 of, and amendments made by subsections (a) and (b), in addition to any amounts
			 otherwise provided in this title, there are appropriated to the Centers for
			 Medicare &amp; Medicaid Services Program Management Account, out of any money
			 in the Treasury not otherwise appropriated, $25,000,000 for the period of
			 fiscal years 2008 and 2009.</text>
				</subsection></section><section id="HA9B31C9F1B9E41AD8C930600008CD58F" section-type="subsequent-section"><enum>102.</enum><header>Extension of
			 Medicare incentive payment program for physician scarcity areas</header><text display-inline="no-display-inline">Section 1833(u) of the Social Security Act
			 (42 U.S.C. 1395l(u)) is amended—</text>
				<paragraph id="idBC23D2BFF2B047059A0922618DE041A5"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1), by striking <quote>before
			 January 1, 2008</quote> and inserting <quote>before July 1, 2008</quote>;
			 and</text>
				</paragraph><paragraph id="id1FD1D9B22C7447FD8A475464F59887C4"><enum>(2)</enum><text>in paragraph
			 (4)—</text>
					<subparagraph id="idB8237649EF074F5588911850FDEC4754"><enum>(A)</enum><text>by redesignating
			 subparagraph (D) as subparagraph (E); and</text>
					</subparagraph><subparagraph id="idE0986B8CF1684F3C8CE82293C38328FE"><enum>(B)</enum><text>by inserting
			 after subparagraph (C) the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="id375E3EEE74924D2FABDC0FCED844CA0B" style="OLC">
							<subparagraph id="id5D52EC10BAB64CDCACD9E8ED73573233"><enum>(D)</enum><header>Special
				rule</header><text>With respect to physicians' services furnished on or after
				January 1, 2008, and before July 1, 2008, for purposes of this subsection, the
				Secretary shall use the primary care scarcity counties and the specialty care
				scarcity counties (as identified under the preceding provisions of this
				paragraph) that the Secretary was using under this subsection with respect to
				physicians' services furnished on December 31,
				2007.</text>
							</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</subparagraph></paragraph></section><section id="H7C6BF9A6A0954ACFA38C097EE3AD5E5D"><enum>103.</enum><header>Extension of
			 floor on work geographic adjustment under the Medicare physician fee
			 schedule</header><text display-inline="no-display-inline">Section 1848(e)(1)(E)
			 of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)), as amended by section
			 102 of division B of the Tax Relief and Health Care Act of 2006, is amended by
			 striking <quote>before January 1, 2008</quote> and inserting <quote>before July
			 1, 2008</quote>.</text>
			</section><section commented="no" display-inline="no-display-inline" id="IDB4F6FB08B8FB4763AF28883C6819D5F2" section-type="subsequent-section"><enum>104.</enum><header>Extension of
			 treatment of certain physician pathology services under Medicare</header><text display-inline="no-display-inline">Section 542(c) of the Medicare, Medicaid,
			 and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law
			 by section 1(a)(6) of Public Law 106–554), as amended by section 732 of the
			 Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42
			 U.S.C. 1395w–4 note) and section 104 of division B of the Tax Relief and Health
			 Care Act of 2006 (42 U.S.C. 1395w–4 note), is amended by striking <quote>and
			 2007</quote> and inserting <quote>2007, and the first 6 months of
			 2008</quote>.</text>
			</section><section commented="no" id="id5E445FF0FB9247DB8B1B318ACE6DE9D5"><enum>105.</enum><header>Extension of
			 exceptions process for Medicare therapy caps</header><text display-inline="no-display-inline">Section 1833(g)(5) of the Social Security
			 Act (42 U.S.C. 1395l(g)(5)) is amended by striking <quote>December 31,
			 2007</quote> and inserting <quote>June 30, 2008</quote>.</text>
			</section><section id="idD31A9507CD944285B702653BAF1D7057"><enum>106.</enum><header>Extension of
			 payment rule for brachytherapy; extension to therapeutic
			 radiopharmaceuticals</header>
				<subsection id="id169094046E9F4038AE37E7031F90D86F"><enum>(a)</enum><header>Extension of
			 payment rule for brachytherapy</header><text display-inline="yes-display-inline">Section 1833(t)(16)(C) of the Social
			 Security Act (42 U.S.C. 1395l(t)(16)(C)), as amended by section 107(a) of
			 division B of the Tax Relief and Health Care Act of 2006, is amended by
			 striking <quote>January 1, 2008</quote> and inserting <quote>July 1,
			 2008</quote>.</text>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="id52B704BD66344444818D9FD4192C6368"><enum>(b)</enum><header>Payment for
			 therapeutic radiopharmaceuticals</header><text>Section 1833(t)(16)(C) of the
			 Social Security Act (42 U.S.C. 1395l(t)(16)(C)), as amended by subsection (a),
			 is amended—</text>
					<paragraph id="id119717C71C1A4A0EB05E63F355210D4E"><enum>(1)</enum><text>in the heading,
			 by inserting <quote><header-in-text level="subparagraph" style="OLC">and
			 therapeutic radiopharmaceuticals</header-in-text></quote> before
			 <quote><header-in-text level="subparagraph" style="OLC">at
			 charges</header-in-text></quote>;</text>
					</paragraph><paragraph id="id976D233C87D64DD590EF76ED9510DDE5"><enum>(2)</enum><text>in the first
			 sentence—</text>
						<subparagraph id="idCB8876D7D4DD4455A8B635E8D7E9DB13"><enum>(A)</enum><text>by inserting
			 <quote>and for therapeutic radiopharmaceuticals furnished on or after January
			 1, 2008, and before July 1, 2008,</quote> after <quote>July 1,
			 2008,</quote>;</text>
						</subparagraph><subparagraph id="idE584FFBD6B91457789E259338C45FBE0"><enum>(B)</enum><text>by inserting
			 <quote>or therapeutic radiopharmaceutical</quote> after <quote>the
			 device</quote>; and</text>
						</subparagraph><subparagraph id="id871FA41FE57B43709A3B8BD565585DE4"><enum>(C)</enum><text>by inserting
			 <quote>or therapeutic radiopharmaceutical</quote> after <quote>each
			 device</quote>; and</text>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idA48E2A6AEEEF40C5ABF303B491BE7B56"><enum>(3)</enum><text>in the second
			 sentence, by inserting <quote>or therapeutic radiopharmaceuticals</quote> after
			 <quote>such devices</quote>.</text>
					</paragraph></subsection></section><section id="id9E8FB1807F134B7AAC2E03BBBFE100B1"><enum>107.</enum><header>Extension of
			 Medicare reasonable costs payments for certain clinical diagnostic laboratory
			 tests furnished to hospital patients in certain rural areas</header><text display-inline="no-display-inline">Section 416(b) of the Medicare Prescription
			 Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l–4), as
			 amended by section 105 of division B of the Tax Relief and Health Care Act of
			 2006 (42 U.S.C. 1395l note), is amended by striking <quote>the 3-year period
			 beginning on July 1, 2004</quote> and inserting <quote>the period beginning on
			 July 1, 2004, and ending on June 30, 2008</quote>.</text>
			</section><section id="id58FFAF432C8E42419B0F86D00FBC3141"><enum>108.</enum><header>Extension of
			 authority of specialized Medicare Advantage plans for special needs individuals
			 to restrict enrollment</header>
				<subsection id="H1E9334E2A1B440EE9156A5A94081E973"><enum>(a)</enum><header>Extension of
			 authority To restrict enrollment</header><text>Section 1859(f) of the Social
			 Security Act (42 U.S.C. 1395w–28(f)) is amended by striking <quote>2009</quote>
			 and inserting <quote>2010</quote>.</text>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="H6EE59BF450034B69009818AEB2590024"><enum>(b)</enum><header>Moratorium</header>
					<paragraph commented="no" display-inline="no-display-inline" id="id5D125EF21F8D46818AD6924D435EED97"><enum>(1)</enum><header>Authority To
			 designate other plans as specialized MA plans</header><text>During the period
			 beginning on January 1, 2008, and ending on December 31, 2009, the Secretary of
			 Health and Human Services shall not exercise the authority provided under
			 section 231(d) of the Medicare Prescription Drug, Improvement, and
			 Modernization Act of 2003 (42 U.S.C. 1395w–21 note) to designate other plans as
			 specialized MA plans for special needs individuals under part C of title XVIII
			 of the Social Security Act. The preceding sentence shall not apply to plans
			 designated as specialized MA plans for special needs individuals under such
			 authority prior to January 1, 2008.</text>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id295EC2584F60455199EF2CFDAEC81E34"><enum>(2)</enum><header>Enrollment in
			 new plans</header><text>During the period beginning on January 1, 2008, and
			 ending on December 31, 2009, the Secretary of Health and Human Services shall
			 not permit enrollment of any individual residing in an area in a specialized
			 Medicare Advantage plan for special needs individuals under part C of title
			 XVIII of the Social Security Act to take effect unless that specialized
			 Medicare Advantage plan for special needs individuals was available for
			 enrollment for individuals residing in that area on January 1, 2008.</text>
					</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="idBEFCD4ADBCDF4DFCBC9837A69265B77C" section-type="subsequent-section"><enum>109.</enum><header>Extension of
			 deadline for application of limitation on extension or renewal of Medicare
			 reasonable cost contract plans</header><text display-inline="no-display-inline">Section 1876(h)(5)(C)(ii) of the Social
			 Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)), in the matter preceding subclause
			 (I), is amended by striking <quote>January 1, 2008</quote> and inserting
			 <quote>January 1, 2009</quote>.</text>
			</section><section id="HA6BE9C2E325B4BF0A64034D17768DDB8"><enum>110.</enum><header>Adjustment to
			 the Medicare Advantage stabilization fund</header><text display-inline="no-display-inline">Section 1858(e)(2)(A)(i) of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395w–27a(e)(2)(A)(i)), as amended by section 3 of Public Law 110–48, is
			 amended by striking <quote>the Fund</quote> and all that follows and inserting
			 <quote>the Fund during 2013, $1,790,000,000.</quote></text>
			</section><section commented="no" display-inline="no-display-inline" id="H5CE6D9B4B09F45BD8091CC777FEBB97" section-type="subsequent-section"><enum>111.</enum><header>Medicare secondary
			 payor</header>
				<subsection commented="no" id="H346674005AAD4EC6B468CF70CEB9CE1F"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Section 1862(b) of
			 the Social Security Act (42 U.S.C. 1395y(b)) is amended by adding at the end
			 the following new paragraphs:</text>
					<quoted-block display-inline="no-display-inline" id="H40863B4401EF4ED49FA805B4FA409F65" style="OLC">
						<paragraph commented="no" id="H110126B3647B4CFAA1B82CB446E779A5"><enum>(7)</enum><header>Required
				submission of information by group health plans</header>
							<subparagraph commented="no" id="HB114CFD4F645426AA5940037486975A1"><enum>(A)</enum><header>Requirement</header><text>On
				and after the first day of the first calendar quarter beginning after the date
				that is 1 year after the date of the enactment of this paragraph, an entity
				serving as an insurer or third party administrator for a group health plan, as
				defined in paragraph (1)(A)(v), and, in the case of a group health plan that is
				self-insured and self-administered, a plan administrator or fiduciary,
				shall—</text>
								<clause commented="no" id="HDA3047280BF64E08B82B4773EE048460"><enum>(i)</enum><text>secure from the
				plan sponsor and plan participants such information as the Secretary shall
				specify for the purpose of identifying situations where the group health plan
				is or has been a primary plan to the program under this title; and</text>
								</clause><clause commented="no" id="H22CACB6F61FB4D40BAD6D509051776E0"><enum>(ii)</enum><text>submit such
				information to the Secretary in a form and manner (including frequency)
				specified by the Secretary.</text>
								</clause></subparagraph><subparagraph commented="no" id="HB46D0773AFAF49E2A24700E8FF4FCDE4"><enum>(B)</enum><header>Enforcement</header>
								<clause commented="no" id="H7F279FD4E0CC44310000879200630000"><enum>(i)</enum><header>In
				general</header><text>An entity, a plan administrator, or a fiduciary described
				in subparagraph (A) that fails to comply with the requirements under such
				subparagraph shall be subject to a civil money penalty of $1,000 for each day
				of noncompliance for each individual for which the information under such
				subparagraph should have been submitted. The provisions of subsections (e) and
				(k) of section 1128A shall apply to a civil money penalty under the previous
				sentence in the same manner as such provisions apply to a penalty or proceeding
				under section 1128A(a). A civil money penalty under this clause shall be in
				addition to any other penalties prescribed by law and in addition to any
				Medicare secondary payer claim under this title with respect to an
				individual.</text>
								</clause><clause commented="no" id="H8444C60FFC744722B023BBC33500AA38"><enum>(ii)</enum><header>Deposit of
				amounts collected</header><text>Any amounts collected pursuant to clause (i)
				shall be deposited in the Federal Hospital Insurance Trust Fund under section
				1817.</text>
								</clause></subparagraph><subparagraph commented="no" id="H3D38B32CA3244A8EBFEE1C954906BCE"><enum>(C)</enum><header>Sharing of
				information</header><text>Notwithstanding any other provision of law, under
				terms and conditions established by the Secretary, the Secretary—</text>
								<clause commented="no" id="H65B0775472184E098D3603ADA705DE84"><enum>(i)</enum><text>shall share
				information on entitlement under Part A and enrollment under Part B under this
				title with entities, plan administrators, and fiduciaries described in
				subparagraph (A);</text>
								</clause><clause id="HF932C75E028844829EE218C9916C21D1"><enum>(ii)</enum><text>may share the
				entitlement and enrollment information described in clause (i) with entities
				and persons not described in such clause; and</text>
								</clause><clause commented="no" id="H565DF921CEF543629B058545EDC9984E"><enum>(iii)</enum><text>may share
				information collected under this paragraph as necessary for purposes of the
				proper coordination of benefits.</text>
								</clause></subparagraph><subparagraph id="H57C1F019B9E14508A45D73F196EFFE5"><enum>(D)</enum><header>Implementation</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law,
				the Secretary may implement this paragraph by program instruction or
				otherwise.</text>
							</subparagraph></paragraph><paragraph commented="no" id="H44444961C24B4C77A57200C4FCB95E8"><enum>(8)</enum><header>Required
				submission of information by or on behalf of liability insurance (including
				self-insurance), no fault insurance, and workers’ compensation laws and
				plans</header>
							<subparagraph commented="no" id="H8D48C6003CD44892A45BD22C35CF7657"><enum>(A)</enum><header>Requirement</header><text>On
				and after the first day of the first calendar quarter beginning after the date
				that is 18 months after the date of the enactment of this paragraph, an
				applicable plan shall—</text>
								<clause id="H8B4F9478CC2941728972DC9A057B86C"><enum>(i)</enum><text>determine whether a
				claimant (including an individual whose claim is unresolved) is entitled to
				benefits under the program under this title on any basis; and</text>
								</clause><clause id="H292C27072BC84154B69301B37500922F"><enum>(ii)</enum><text>if the claimant
				is determined to be so entitled, submit the information described in
				subparagraph (B) with respect to the claimant to the Secretary in a form and
				manner (including frequency) specified by the Secretary.</text>
								</clause></subparagraph><subparagraph id="H2C0F469A625846A8A7732259A4003EB"><enum>(B)</enum><header>Required
				information</header><text>The information described in this subparagraph
				is—</text>
								<clause id="HFB77ED4DF33E4F6B843E12B64033E7BD"><enum>(i)</enum><text>the identity of
				the claimant for which the determination under subparagraph (A) was made;
				and</text>
								</clause><clause id="HF51DF7A5151745F5A6952150CB4F2B2F"><enum>(ii)</enum><text>such other
				information as the Secretary shall specify in order to enable the Secretary to
				make an appropriate determination concerning coordination of benefits,
				including any applicable recovery claim.</text>
								</clause></subparagraph><subparagraph id="HA5F7C86AB841413D9C5EB79B33DD5D2F"><enum>(C)</enum><header>Timing</header><text>Information
				shall be submitted under subparagraph (A)(ii) within a time specified by the
				Secretary after the claim is resolved through a settlement, judgment, award, or
				other payment (regardless of whether or not there is a determination or
				admission of liability).</text>
							</subparagraph><subparagraph id="HCB8FB40473324E019FBE1FB76FD27500"><enum>(D)</enum><header>Claimant</header><text>For
				purposes of subparagraph (A), the term <quote>claimant</quote> includes—</text>
								<clause id="HEB355C098656429D8E938DC867AEEE5"><enum>(i)</enum><text>an
				individual filing a claim directly against the applicable plan; and</text>
								</clause><clause id="HFD7BEC88E38249AA00B1043736DFF44B"><enum>(ii)</enum><text>an individual
				filing a claim against an individual or entity insured or covered by the
				applicable plan.</text>
								</clause></subparagraph><subparagraph commented="no" id="H62909EEFC8C84599B70515E146BF5D3"><enum>(E)</enum><header>Enforcement</header>
								<clause commented="no" id="H7033350608604FBC9922681B4200BE33"><enum>(i)</enum><header>In
				general</header><text>An applicable plan that fails to comply with the
				requirements under subparagraph (A) with respect to any claimant shall be
				subject to a civil money penalty of $1,000 for each day of noncompliance with
				respect to each claimant. The provisions of subsections (e) and (k) of section
				1128A shall apply to a civil money penalty under the previous sentence in the
				same manner as such provisions apply to a penalty or proceeding under section
				1128A(a). A civil money penalty under this clause shall be in addition to any
				other penalties prescribed by law and in addition to any Medicare secondary
				payer claim under this title with respect to an individual.</text>
								</clause><clause commented="no" id="HD8F3136B51714E0888A0BFB1BA075F03"><enum>(ii)</enum><header>Deposit of
				amounts collected</header><text>Any amounts collected pursuant to clause (i)
				shall be deposited in the Federal Hospital Insurance Trust Fund.</text>
								</clause></subparagraph><subparagraph commented="no" id="H838FA55790324709B974B85B5BBFE702"><enum>(F)</enum><header>Applicable
				plan</header><text>In this paragraph, the term <quote>applicable plan</quote>
				means the following laws, plans, or other arrangements, including the fiduciary
				or administrator for such law, plan, or arrangement:</text>
								<clause commented="no" id="H954EDDAB832545C79FFDC0CCAA271E5C"><enum>(i)</enum><text>Liability
				insurance (including self-insurance).</text>
								</clause><clause commented="no" id="HEDDF9A9096A94EA4BB2B562F38AAC158"><enum>(ii)</enum><text>No fault
				insurance.</text>
								</clause><clause commented="no" id="H9B37218C59E54802BB06DDB57D51A622"><enum>(iii)</enum><text>Workers’
				compensation laws or plans.</text>
								</clause></subparagraph><subparagraph commented="no" id="HD88D91EC717A4631ADEFED3200C84F09"><enum>(G)</enum><header>Sharing of
				information</header><text>The Secretary may share information collected under
				this paragraph as necessary for purposes of the proper coordination of
				benefits.</text>
							</subparagraph><subparagraph id="H9FF7131AECF2441FA63D69F73FD0FF2D"><enum>(H)</enum><header>Implementation</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law,
				the Secretary may implement this paragraph by program instruction or
				otherwise.</text>
							</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection commented="no" id="H7CDAB11277F643ED00D2D6EEAC9E5F94"><enum>(b)</enum><header>Rule of
			 construction</header><text>Nothing in the amendments made by this section shall
			 be construed to limit the authority of the Secretary of Health and Human
			 Services to collect information to carry out Medicare secondary payer
			 provisions under title XVIII of the Social Security Act, including under parts
			 C and D of such title.</text>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="H470C0A03962E4C29807000F1837DF649"><enum>(c)</enum><header>Implementation</header><text display-inline="yes-display-inline">For purposes of implementing paragraphs (7)
			 and (8) of section 1862(b) of the Social Security Act, as added by subsection
			 (a), to ensure appropriate payments under title XVIII of such Act, the
			 Secretary of Health and Human Services shall provide for the transfer, from the
			 Federal Hospital Insurance Trust Fund established under section 1817 of the
			 Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical
			 Insurance Trust Fund established under section 1841 of such Act (42 U.S.C.
			 1395t), in such proportions as the Secretary determines appropriate, of
			 $35,000,000 to the Centers for Medicare &amp; Medicaid Services Program
			 Management Account for the period of fiscal years 2008, 2009, and 2010.</text>
				</subsection></section><section display-inline="no-display-inline" id="H96D2E3DC4A914D72A048FD3BABFEABDE" section-type="subsequent-section"><enum>112.</enum><header>Payment for part B
			 drugs</header>
				<subsection id="H7BEE2077E47C4E5C89E8A4517CC80027"><enum>(a)</enum><header>Application of
			 alternative volume weighting in computation of ASP</header><text>Section
			 1847A(b) of the Social Security Act (42 U.S.C. 1395w–3a(b)) is amended—</text>
					<paragraph id="HEAF1BD51FDD942269FE5A2F4D2708409"><enum>(1)</enum><text>in paragraph
			 (1)(A), by inserting <quote>for a multiple source drug furnished before April
			 1, 2008, or 106 percent of the amount determined under paragraph (6) for a
			 multiple source drug furnished on or after April 1, 2008</quote> after
			 <quote>paragraph (3)</quote>;</text>
					</paragraph><paragraph id="H514D9E4762274A39A080CFF7595EE31"><enum>(2)</enum><text>in
			 each of subparagraphs (A) and (B) of paragraph (4), by inserting <quote>for
			 single source drugs and biologicals furnished before April 1, 2008, and using
			 the methodology applied under paragraph (6) for single source drugs and
			 biologicals furnished on or after April 1, 2008,</quote> after <quote>paragraph
			 (3)</quote>; and</text>
					</paragraph><paragraph id="HE5681A5A746A4CE4A95F225D15C81900"><enum>(3)</enum><text>by adding at the
			 end the following new paragraph:</text>
						<quoted-block display-inline="no-display-inline" id="HC186DE0C709E4A5F810066AD00964726" style="OLC">
							<paragraph id="H956A46E524EC4CCE97BF290747F3944B"><enum>(6)</enum><header>Use of
				volume-weighted average sales prices in calculation of average sales
				price</header>
								<subparagraph id="H8FA3918D4026453A9217CDC4B0DB7675"><enum>(A)</enum><header>In
				general</header><text>For all drug products included within the same multiple
				source drug billing and payment code, the amount specified in this paragraph is
				the volume-weighted average of the average sales prices reported under section
				1927(b)(3)(A)(iii) determined by—</text>
									<clause id="H704799B6DC884FC6ADC662ADFAC585B1"><enum>(i)</enum><text>computing the sum
				of the products (for each National Drug Code assigned to such drug products)
				of—</text>
										<subclause id="H3A3E1626F83246A0AD9335512F40C96C"><enum>(I)</enum><text>the manufacturer's
				average sales price (as defined in subsection (c)), determined by the Secretary
				without dividing such price by the total number of billing units for the
				National Drug Code for the billing and payment code; and</text>
										</subclause><subclause id="H01A094F6DEF545F6AEF09E5F0400F1C9"><enum>(II)</enum><text>the total number
				of units specified under paragraph (2) sold; and</text>
										</subclause></clause><clause id="HF2891285DCFD45708226C219C90067B9"><enum>(ii)</enum><text>dividing the sum
				determined under clause (i) by the sum of the products (for each National Drug
				Code assigned to such drug products) of—</text>
										<subclause id="H2793410973AE4611AE6EAD560EE05AB"><enum>(I)</enum><text>the total number of
				units specified under paragraph (2) sold; and</text>
										</subclause><subclause id="H8E98E34567464B5D00CCF7D355FECFDE"><enum>(II)</enum><text>the total number
				of billing units for the National Drug Code for the billing and payment
				code.</text>
										</subclause></clause></subparagraph><subparagraph id="H01FA6835615D41FB993EF824C7FAB12"><enum>(B)</enum><header>Billing unit
				defined</header><text>For purposes of this subsection, the term <term>billing
				unit</term> means the identifiable quantity associated with a billing and
				payment code, as established by the
				Secretary.</text>
								</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection id="H49209AE176F748B38E20DB34F921D248"><enum>(b)</enum><header>Treatment of
			 certain drugs</header><text display-inline="yes-display-inline">Section
			 1847A(b) of the Social Security Act (42 U.S.C. 1395w–3a(b)), as amended by
			 subsection (a), is amended—</text>
					<paragraph id="HADB831E9A41245AFB900D4EC56986735"><enum>(1)</enum><text>in paragraph (1),
			 by inserting <quote>paragraph (7) and</quote> after <quote>Subject to</quote>;
			 and</text>
					</paragraph><paragraph id="H26F53C873605476595DCB1C972E5B98"><enum>(2)</enum><text>by
			 adding at the end the following new paragraph:</text>
						<quoted-block display-inline="no-display-inline" id="H555E6BBD8CFB4D378863ECB2EB3DF136" style="OLC">
							<paragraph id="H10EF654FB76A4CEB8EF7B46BE05887B2"><enum>(7)</enum><header>Special
				rule</header><text>Beginning with April 1, 2008, the payment amount for—</text>
								<subparagraph id="H43D156913CDA481DBF14DF835D8DE283"><enum>(A)</enum><text>each single source
				drug or biological described in section 1842(o)(1)(G) that is treated as a
				multiple source drug because of the application of subsection (c)(6)(C)(ii) is
				the lower of—</text>
									<clause id="H532C3E5D8B69449DBB5691ED809E00C9"><enum>(i)</enum><text>the payment amount
				that would be determined for such drug or biological applying such subsection;
				or</text>
									</clause><clause id="HC4DA12036CC1433797C1009638D01877"><enum>(ii)</enum><text>the payment
				amount that would have been determined for such drug or biological if such
				subsection were not applied; and</text>
									</clause></subparagraph><subparagraph display-inline="no-display-inline" id="HFDD5BBC5FF50472E9261DEEC28DAC399"><enum>(B)</enum><text>a multiple source
				drug described in section 1842(o)(1)(G) (excluding a drug or biological that is
				treated as a multiple source drug because of the application of such
				subsection) is the lower of—</text>
									<clause id="H819DC59BB109436EA13171BBB7CF4300"><enum>(i)</enum><text>the payment amount
				that would be determined for such drug or biological taking into account the
				application of such subsection; or</text>
									</clause><clause id="HE3360A67D9084AF185C54494109CADF"><enum>(ii)</enum><text>the payment amount
				that would have been determined for such drug or biological if such subsection
				were not
				applied.</text>
									</clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection></section><section display-inline="no-display-inline" id="H8D3D680BE81D46158276BE3D56D33E1C" section-type="subsequent-section"><enum>113.</enum><header>Payment rate for
			 certain diagnostic laboratory tests</header><text display-inline="no-display-inline">Section 1833(h) of the Social Security Act
			 (42 U.S.C. 1395l(h)) is amended by adding at the end the following new
			 paragraph:</text>
				<quoted-block display-inline="no-display-inline" id="H0459BCEF301A42C295DACABEE4C2526E" style="OLC">
					<paragraph id="H59EB98DB59324E9DAE1F4E04DD8BB1BB" indent="up1"><enum>(9)</enum><text>Notwithstanding any other provision
				in this part, in the case of any diagnostic laboratory test for HbA1c that is
				labeled by the Food and Drug Administration for home use and is furnished on or
				after April 1, 2008, the payment rate for such test shall be the payment rate
				established under this part for a glycated hemoglobin test (identified as of
				October 1, 2007, by HCPCS code 83036 (and any succeeding
				codes)).</text>
					</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section commented="no" display-inline="no-display-inline" id="H602663D9710C4444BD064808A21BFCB" section-type="subsequent-section"><enum>114.</enum><header>Long-term care
			 hospitals</header>
				<subsection commented="no" id="HA79FE95091D94246B3B7A17D00309EDB"><enum>(a)</enum><header>Definition of
			 long-term care hospital</header><text display-inline="yes-display-inline">Section 1861 of the Social Security Act (42
			 U.S.C. 1395x) is amended by adding at the end the following new
			 subsection:</text>
					<quoted-block display-inline="no-display-inline" id="H0D320F82F37A4FC48F88D27633006D71" other-style="archaic" style="other">
						<subsection commented="no" id="HFA5507D0C8E04077AE8CF102A232D68F"><enum>(ccc)</enum><header>Long-Term Care Hospital</header><text>The term
				<term>long-term care hospital</term> means a hospital which—</text>
							<paragraph commented="no" id="HCA349227A0C741588B32514C1700E7A"><enum>(1)</enum><text>is primarily
				engaged in providing inpatient services, by or under the supervision of a
				physician, to Medicare beneficiaries whose medically complex conditions require
				a long hospital stay and programs of care provided by a long-term care
				hospital;</text>
							</paragraph><paragraph commented="no" id="H04013FCEB3F14875A78796773291D9D0"><enum>(2)</enum><text>has an average
				inpatient length of stay (as determined by the Secretary) of greater than 25
				days, or meets the requirements of clause (II) of section
				1886(d)(1)(B)(iv);</text>
							</paragraph><paragraph commented="no" id="H5B2706FC0B724C3EA2DF7DE7849B142B"><enum>(3)</enum><text>satisfies the
				requirements of subsection (e); and</text>
							</paragraph><paragraph commented="no" id="HA1FD081C4CBF4B9D9316037895EA71D"><enum>(4)</enum><text>meets the following
				facility criteria:</text>
								<subparagraph commented="no" id="H614B23A83B7D48E892812BEE46A79507"><enum>(A)</enum><text display-inline="yes-display-inline">the institution has a patient review
				process, documented in the patient medical record, that screens patients prior
				to admission for appropriateness of admission to a long-term care hospital,
				validates within 48 hours of admission that patients meet admission criteria
				for long-term care hospitals, regularly evaluates patients throughout their
				stay for continuation of care in a long-term care hospital, and assesses the
				available discharge options when patients no longer meet such continued stay
				criteria;</text>
								</subparagraph><subparagraph commented="no" id="HF560BA43E1C14EAC9FFA7859C6F136E6"><enum>(B)</enum><text>the institution
				has active physician involvement with patients during their treatment through
				an organized medical staff, physician-directed treatment with physician on-site
				availability on a daily basis to review patient progress, and consulting
				physicians on call and capable of being at the patient’s side within a moderate
				period of time, as determined by the Secretary; and</text>
								</subparagraph><subparagraph commented="no" id="H6C2B99CB04144B54B9340422DA57BB98"><enum>(C)</enum><text>the institution
				has interdisciplinary team treatment for patients, requiring interdisciplinary
				teams of health care professionals, including physicians, to prepare and carry
				out an individualized treatment plan for each
				patient.</text>
								</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection commented="no" display-inline="no-display-inline" id="HF32F0269E0A64F5AB2F94C935F8ECC3B"><enum>(b)</enum><header>Study and report
			 on long-term care hospital facility and patient criteria</header>
					<paragraph commented="no" display-inline="no-display-inline" id="H036DA4B8EFE24BB9A9EA4F248D588661"><enum>(1)</enum><header>In
			 general</header><text>The Secretary of Health and Human Services (in this
			 section referred to as the <quote>Secretary</quote>) shall conduct a study on
			 the establishment of national long-term care hospital facility and patient
			 criteria for purposes of determining medical necessity, appropriateness of
			 admission, and continued stay at, and discharge from, long-term care
			 hospitals.</text>
					</paragraph><paragraph commented="no" id="H512ABAEF37AD485DBB3C7D66BA93AF4F"><enum>(2)</enum><header>Report</header><text>Not
			 later than 18 months after the date of the enactment of this Act, the Secretary
			 shall submit to Congress a report on the study conducted under paragraph (1),
			 together with recommendations for such legislation and administrative actions,
			 including timelines for implementation of patient criteria or other actions, as
			 the Secretary determines appropriate.</text>
					</paragraph><paragraph commented="no" id="H9765C3E9A71A45448E380102F6DD1C3B"><enum>(3)</enum><header>Considerations</header><text>In
			 conducting the study and preparing the report under this subsection, the
			 Secretary shall consider—</text>
						<subparagraph commented="no" id="HB79F3541F9764562B4BFB6D3AF56C524"><enum>(A)</enum><text>recommendations
			 contained in a report to Congress by the Medicare Payment Advisory Commission
			 in June 2004 for long-term care hospital-specific facility and patient criteria
			 to ensure that patients admitted to long-term care hospitals are medically
			 complex and appropriate to receive long-term care hospital services; and</text>
						</subparagraph><subparagraph commented="no" id="HA4D33F4659AC45C5831134070063A477"><enum>(B)</enum><text>ongoing work by
			 the Secretary to evaluate and determine the feasibility of such
			 recommendations.</text>
						</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H6B477569F6344046B8E831EB6FEDE5D"><enum>(c)</enum><header>Payment for
			 long-term care hospital services</header>
					<paragraph commented="no" id="H14D4B7635BB5468AB3C13B3F37D06C3B"><enum>(1)</enum><header>No application
			 of <enum-in-header>25</enum-in-header> percent patient threshold payment
			 adjustment to freestanding and grandfathered LTCHS</header><text>The Secretary
			 shall not apply, for cost reporting periods beginning on or after the date of
			 the enactment of this Act for a 3-year period—</text>
						<subparagraph commented="no" id="id64B88B142A7D444F9050F95C61FE587F"><enum>(A)</enum><text>section 412.536
			 of title 42, Code of Federal Regulations, or any similar provision, to
			 freestanding long-term care hospitals; and</text>
						</subparagraph><subparagraph commented="no" id="id72EE6739D4FC4EC3AC6E063D793BE82E"><enum>(B)</enum><text>such section or
			 section 412.534 of title 42, Code of Federal Regulations, or any similar
			 provisions, to a long-term care hospital identified by the amendment made by
			 section 4417(a) of the Balanced Budget Act of 1997 (Public Law 105–33).</text>
						</subparagraph></paragraph><paragraph commented="no" id="H05FD9B7C27B84A3B98EF95AE619037F2"><enum>(2)</enum><header>Payment for
			 hospitals-within-hospitals</header>
						<subparagraph commented="no" id="HAFBCC5D7C3DB43529F4772F9F73FC5F6"><enum>(A)</enum><header>In
			 general</header><text>Payment to an applicable long-term care hospital or
			 satellite facility which is located in a rural area or which is co-located with
			 an urban single or MSA dominant hospital under paragraphs (d)(1), (e)(1), and
			 (e)(4) of section 412.534 of title 42, Code of Federal Regulations, shall not
			 be subject to any payment adjustment under such section if no more than 75
			 percent of the hospital’s Medicare discharges (other than discharges described
			 in paragraph (d)(2) or (e)(3) of such section) are admitted from a co-located
			 hospital.</text>
						</subparagraph><subparagraph commented="no" id="H8F6BF489EAD94438B84F863B77CEE161"><enum>(B)</enum><header>Co-located
			 long-term care hospitals and satellite facilities</header>
							<clause commented="no" id="HC17DE4A28D3F4813A4A90520E100D1AB"><enum>(i)</enum><header>In
			 general</header><text>Payment to an applicable long-term care hospital or
			 satellite facility which is co-located with another hospital shall not be
			 subject to any payment adjustment under section 412.534 of title 42, Code of
			 Federal Regulations, if no more than 50 percent of the hospital’s Medicare
			 discharges (other than discharges described in paragraph (c)(3) of such
			 section) are admitted from a co-located hospital.</text>
							</clause><clause commented="no" id="H0A93015504B34D4FB44D65501C95BB91"><enum>(ii)</enum><header>Applicable
			 long-term care hospital or satellite facility defined</header><text>In this
			 paragraph, the term <term>applicable long-term care hospital or satellite
			 facility</term> means a hospital or satellite facility that is subject to the
			 transition rules under section 412.534(g) of title 42, Code of Federal
			 Regulations.</text>
							</clause></subparagraph><subparagraph commented="no" id="H33F79B5742DE4634914592A53CCB003B"><enum>(C)</enum><header>Effective
			 date</header><text>Subparagraphs (A) and (B) shall apply to cost reporting
			 periods beginning on or after the date of the enactment of this Act for a
			 3-year period.</text>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF96E5D45B8834D4AAD713C1096890099"><enum>(3)</enum><header>No application
			 of very short-stay outlier policy</header><text>The Secretary shall not apply,
			 for the 3-year period beginning on the date of the enactment of this Act, the
			 amendments finalized on May 11, 2007 (72 Federal Register 26904, 26992) made to
			 the short-stay outlier payment provision for long-term care hospitals contained
			 in section 412.529(c)(3)(i) of title 42, Code of Federal Regulations, or any
			 similar provision.</text>
					</paragraph><paragraph commented="no" id="H5FBE81B7D53944DFABA30024158D3807"><enum>(4)</enum><header>No application
			 of one-time adjustment to standard amount</header><text>The Secretary shall
			 not, for the 3-year period beginning on the date of the enactment of this Act,
			 make the one-time prospective adjustment to long-term care hospital prospective
			 payment rates provided for in section 412.523(d)(3) of title 42, Code of
			 Federal Regulations, or any similar provision.</text>
					</paragraph></subsection><subsection commented="no" id="H72AB97378FF449C9BA16A17C7CA6E35F"><enum>(d)</enum><header>Moratorium on
			 the establishment of long-term care hospitals, long-term care satellite
			 facilities and on the increase of long-term care hospital beds in existing
			 long-term care hospitals or satellite facilities</header>
					<paragraph commented="no" id="H9F48ECD06FD44A33A6DAB5CE9CC85010"><enum>(1)</enum><header>In
			 general</header><text display-inline="yes-display-inline">During the 3-year
			 period beginning on the date of the enactment of this Act, the Secretary shall
			 impose a moratorium for purposes of the Medicare program under title XVIII of
			 the Social Security Act—</text>
						<subparagraph commented="no" id="H0DFA3698482D43E187945BBFA6B57143"><enum>(A)</enum><text>subject to
			 paragraph (2), on the establishment and classification of a long-term care
			 hospital or satellite facility, other than an existing long-term care hospital
			 or facility; and</text>
						</subparagraph><subparagraph commented="no" id="H032065B0CDEC4C6C80BCD32D6F0526F4"><enum>(B)</enum><text>subject to
			 paragraph (3), on an increase of long-term care hospital beds in existing
			 long-term care hospitals or satellite facilities.</text>
						</subparagraph></paragraph><paragraph commented="no" id="HCA79A27E3B2B4FDC95C2E155D98702C7"><enum>(2)</enum><header>Exception for
			 Certain Long-Term Care Hospitals</header><text display-inline="yes-display-inline">The moratorium under paragraph (1)(A) shall
			 not apply to a long-term care hospital that as of the date of the enactment of
			 this Act—</text>
						<subparagraph commented="no" id="HEDB6DBE3C054403999A3E804AE0617D5"><enum>(A)</enum><text>began its
			 qualifying period for payment as a long-term care hospital under section
			 412.23(e) of title 42, Code of Federal Regulations, on or before the date of
			 the enactment of this Act;</text>
						</subparagraph><subparagraph commented="no" id="H89E8C0BA0BE54D51B232426D5E7658C3"><enum>(B)</enum><text>has a binding
			 written agreement with an outside, unrelated party for the actual construction,
			 renovation, lease, or demolition for a long-term care hospital, and has
			 expended, before the date of the enactment of this Act, at least 10 percent of
			 the estimated cost of the project (or, if less, $2,500,000); or</text>
						</subparagraph><subparagraph commented="no" id="H4A3079DC4A00489E9D2BF66EB31FEFBD"><enum>(C)</enum><text>has obtained an
			 approved certificate of need in a State where one is required on or before the
			 date of the enactment of this Act.</text>
						</subparagraph></paragraph><paragraph commented="no" id="H9C5C3537D96041E29840B05127F1400"><enum>(3)</enum><header>Exception for bed
			 increases during moratorium</header>
						<subparagraph commented="no" id="id288FBA64F32D472685AFEA56223C6511"><enum>(A)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Subject to
			 subparagraph (B), the moratorium under paragraph (1)(B) shall not apply to an
			 increase in beds in an existing hospital or satellite facility if the hospital
			 or facility—</text>
							<clause commented="no" id="H3E5FA520756B49ACB2DABC6C43F8B72E"><enum>(i)</enum><text>is located in a
			 State where there is only one other long-term care hospital; and</text>
							</clause><clause commented="no" id="HC76340D3A513473188762CBD6CD6BBA"><enum>(ii)</enum><text display-inline="yes-display-inline">requests an increase in beds following the
			 closure or the decrease in the number of beds of another long-term care
			 hospital in the State.</text>
							</clause></subparagraph><subparagraph commented="no" id="id2AC831F091554FDE82390210C579897F"><enum>(B)</enum><header>No effect on
			 certain limitation</header><text>The exception under subparagraph (A) shall not
			 effect the limitation on increasing beds under sections 412.22(h)(3) and
			 412.22(f) of title 42, Code of Federal Regulations.</text>
						</subparagraph></paragraph><paragraph commented="no" id="HBC3A915585D746D28D8E94032E920011"><enum>(4)</enum><header>Existing
			 hospital or satellite facility defined</header><text>For purposes of this
			 subsection, the term <quote>existing</quote> means, with respect to a hospital
			 or satellite facility, a hospital or satellite facility that received payment
			 under the provisions of subpart O of part 412 of title 42, Code of Federal
			 Regulations, as of the date of the enactment of this Act.</text>
					</paragraph><paragraph commented="no" id="idEBB781AE49A84A4785B0FA11CD7CA363"><enum>(5)</enum><header>Judicial
			 review</header><text>There shall be no administrative or judicial review under
			 section 1869 of the Social Security Act (42 U.S.C. 1395ff), section 1878 of
			 such Act (42 U.S.C. 1395oo), or otherwise, of the application of this
			 subsection by the Secretary.</text>
					</paragraph></subsection><subsection commented="no" id="HE3EE8C9E8A7F435185F38700E597C36"><enum>(e)</enum><header>Long-term care
			 hospital payment update</header>
					<paragraph commented="no" id="H345071E4078048538BD8996CE34E3BAB"><enum>(1)</enum><header>In
			 general</header><text>Section 1886 of the <act-name parsable-cite="SSA">Social
			 Security Act</act-name> (42 U.S.C. 1395ww) is amended by adding at the end the
			 following new subsection:</text>
						<quoted-block act-name="Social" id="HA51DD8A937604B4191632E0845FE478" style="OLC">
							<subsection commented="no" id="H57B7A24F4BDC4D4FB9D1668F8F556D7E"><enum>(m)</enum><header>Prospective
				payment for long-term care hospitals</header>
								<paragraph commented="no" id="H40526E59CF13449CA7F2C1B32712521F"><enum>(1)</enum><header>Reference to
				establishment and implementation of system</header><text>For provisions related
				to the establishment and implementation of a prospective payment system for
				payments under this title for inpatient hospital services furnished by a
				long-term care hospital described in subsection (d)(1)(B)(iv), see section 123
				of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 and
				section 307(b) of the Medicare, Medicaid, and SCHIP Benefits Improvement and
				Protection Act of 2000.</text>
								</paragraph><paragraph commented="no" id="H84C82E8C86F24D9AA953B0B990D3D119"><enum>(2)</enum><header>Update for rate
				year 2008</header><text>In implementing the system described in paragraph (1)
				for discharges occurring during the rate year ending in 2008 for a hospital,
				the base rate for such discharges for the hospital shall be the same as the
				base rate for discharges for the hospital occurring during the rate year ending
				in
				2007.</text>
								</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H9C5CCFB069B54FF8B845A3BF7DB95B53"><enum>(2)</enum><header>Delayed
			 effective date</header><text>Subsection (m)(2) of section 1886 of the Social
			 Security Act, as added by paragraph (1), shall not apply to discharges
			 occurring on or after July 1, 2007, and before April 1, 2008.</text>
					</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H38A40FCD51424BACAE007B1C78AC9247"><enum>(f)</enum><header>Expanded review
			 of medical necessity</header>
					<paragraph commented="no" id="H8C1CC2A9601A4416BBAB536FBE922D02"><enum>(1)</enum><header>In
			 general</header><text display-inline="yes-display-inline">The Secretary of
			 Health and Human Services shall provide, under contracts with one or more
			 appropriate fiscal intermediaries or medicare administrative contractors under
			 section 1874A(a)(4)(G) of the Social Security Act (42 U.S.C.
			 1395kk–1(a)(4)(G)), for reviews of the medical necessity of admissions to
			 long-term care hospitals (described in section 1886(d)(1)(B)(iv) of such Act)
			 and continued stay at such hospitals, of individuals entitled to, or enrolled
			 for, benefits under part A of title XVIII of such Act consistent with this
			 subsection. Such reviews shall be made for discharges occurring on or after
			 October 1, 2007.</text>
					</paragraph><paragraph commented="no" id="H34C2FBFE9CD945BFB87DC44585B1D063"><enum>(2)</enum><header>Review
			 methodology</header><text>The medical necessity reviews under paragraph (1)
			 shall be conducted on an annual basis in accordance with rules specified by the
			 Secretary. Such reviews shall—</text>
						<subparagraph commented="no" id="HDB0EBD56C0B341828CCA504611B3D4F3"><enum>(A)</enum><text display-inline="yes-display-inline">provide for a statistically valid and
			 representative sample of admissions of such individuals sufficient to provide
			 results at a 95 percent confidence interval; and</text>
						</subparagraph><subparagraph commented="no" id="H7B012C54D0B043828E1700B500B3B062"><enum>(B)</enum><text>guarantee that at
			 least 75 percent of overpayments received by long-term care hospitals for
			 medically unnecessary admissions and continued stays of individuals in
			 long-term care hospitals will be identified and recovered and that related days
			 of care will not be counted toward the length of stay requirement contained in
			 section 1886(d)(1)(B)(iv) of the Social Security Act (42 U.S.C.
			 1395ww(d)(1)(B)(iv)).</text>
						</subparagraph></paragraph><paragraph commented="no" id="HEACECFAC34AE4BED92A500A71CFAC03F"><enum>(3)</enum><header>Continuation of
			 reviews</header><text>Under contracts under this subsection, the Secretary
			 shall establish an error rate with respect to such reviews that could require
			 further review of the medical necessity of admissions and continued stay in the
			 hospital involved and other actions as determined by the Secretary.</text>
					</paragraph><paragraph commented="no" id="HB2340057DFAE4E4A00C148965CA0FE36"><enum>(4)</enum><header>Termination of
			 required reviews</header>
						<subparagraph commented="no" id="HCF3EA967B1754C9DB596F4879F3D795F"><enum>(A)</enum><header>In
			 general</header><text>Subject to subparagraph (B), the previous provisions of
			 this subsection shall cease to apply for discharges occurring on or after
			 October 1, 2010.</text>
						</subparagraph><subparagraph commented="no" id="H62FA1E7E58D949749FF711CD46030058"><enum>(B)</enum><header>Continuation</header><text>As
			 of the date specified in subparagraph (A), the Secretary shall determine
			 whether to continue to guarantee, through continued medical review and sampling
			 under this paragraph, recovery of at least 75 percent of overpayments received
			 by long-term care hospitals due to medically unnecessary admissions and
			 continued stays.</text>
						</subparagraph></paragraph><paragraph commented="no" id="H7B3835A6D4F54DBE9434D395CDE9699F"><enum>(5)</enum><header>Funding</header><text display-inline="yes-display-inline">The costs to fiscal intermediaries or
			 medicare administrative contractors conducting the medical necessity reviews
			 under paragraph (1) shall be funded from the aggregate overpayments recouped by
			 the Secretary of Health and Human Services from long-term care hospitals due to
			 medically unnecessary admissions and continued stays. The Secretary may use an
			 amount not in excess of 40 percent of the overpayments recouped under this
			 paragraph to compensate the fiscal intermediaries or Medicare administrative
			 contractors for the costs of services performed.</text>
					</paragraph></subsection><subsection display-inline="no-display-inline" id="idAA47C31FEFB94A99932643FDC0A1214B"><enum>(g)</enum><header>Implementation</header><text display-inline="yes-display-inline">For purposes of carrying out the provisions
			 of, and amendments made by, this title, in addition to any amounts otherwise
			 provided in this title, there are appropriated to the Centers for Medicare
			 &amp; Medicaid Services Program Management Account, out of any money in the
			 Treasury not otherwise appropriated, $35,000,000 for the period of fiscal years
			 2008 and 2009.</text>
				</subsection></section><section commented="no" id="HCB928EAB5E7941EEAAF065316364AA1E"><enum>115.</enum><header>Payment for
			 inpatient rehabilitation facility (IRF) services</header>
				<subsection commented="no" id="H21E290C7BC91462EBEA9459FE0AC8F73"><enum>(a)</enum><header>Payment
			 update</header>
					<paragraph commented="no" id="HADE2230E75314A2FA3B003774773D78"><enum>(1)</enum><header>In
			 general</header><text>Section 1886(j)(3)(C) of the Social Security Act (42
			 U.S.C. 1395ww(j)(3)(C)) is amended by adding at the end the following:
			 <quote>The increase factor to be applied under this subparagraph for each of
			 fiscal years 2008 and 2009 shall be 0 percent.</quote>.</text>
					</paragraph><paragraph commented="no" id="HD4589C7847FF4BB2886D00C0DFFC2E15"><enum>(2)</enum><header>Delayed
			 effective date</header><text>The amendment made by paragraph (1) shall not
			 apply to payment units occurring before April 1, 2008.</text>
					</paragraph></subsection><subsection commented="no" id="H1AE57FE3459D43E3BD3D2F137D1343F7"><enum>(b)</enum><header>Inpatient
			 rehabilitation facility classification criteria</header>
					<paragraph commented="no" id="H7B1981F6A9F142C48B2DE2118EEA8D1D"><enum>(1)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Section 5005 of the
			 Deficit Reduction Act of 2005 (Public Law 109–171; 42 U.S.C. 1395ww note) is
			 amended—</text>
						<subparagraph commented="no" id="HF9DDC8CFD0D74493A75668A844A9FA3"><enum>(A)</enum><text>in subsection (a),
			 by striking <quote>apply the applicable percent specified in subsection
			 (b)</quote> and inserting <quote>require a compliance rate that is no greater
			 than the 60 percent compliance rate that became effective for cost reporting
			 periods beginning on or after July 1, 2006,</quote>; and</text>
						</subparagraph><subparagraph commented="no" id="H3120481BABC3468DAD2BD84AC2B4E4B"><enum>(B)</enum><text>by amending
			 subsection (b) to read as follows:</text>
							<quoted-block id="H47405E4AB5FD42D68BBA2D9D9E951731" style="OLC">
								<subsection commented="no" id="H178331B0537C45B1BC66AA0093947C08"><enum>(b)</enum><header>Continued Use of
				Comorbidities</header><text>For cost reporting periods beginning on or after
				July 1, 2007, the Secretary shall include patients with comorbidities as
				described in section 412.23(b)(2)(i) of title 42, Code of Federal Regulations
				(as in effect as of January 1, 2007), in the inpatient population that counts
				toward the percent specified in subsection
				(a).</text>
								</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph commented="no" id="H3E3F0C577A4A41D6A520CB35B3021FE9"><enum>(2)</enum><header>Effective
			 date</header><text>The amendment made by paragraph (1)(A) shall apply for cost
			 reporting periods beginning on or after July 1, 2007.</text>
					</paragraph></subsection><subsection commented="no" id="H233CB833E7894166A629318093CD1F3F"><enum>(c)</enum><header>Recommendations
			 for classifying inpatient rehabilitation hospitals and units</header>
					<paragraph commented="no" id="HF57B47A58C7B4D4A89BED0052851BDDD"><enum>(1)</enum><header>Report to
			 congress</header><text>Not later than 18 months after the date of the enactment
			 of this Act, the Secretary of Health and Human Services, in consultation with
			 physicians (including geriatricians and physiatrists), administrators of
			 inpatient rehabilitation, acute care hospitals, skilled nursing facilities, and
			 other settings providing rehabilitation services, Medicare beneficiaries, trade
			 organizations representing inpatient rehabilitation hospitals and units and
			 skilled nursing facilities, and the Medicare Payment Advisory Commission, shall
			 submit to the Committee on Ways and Means of the House of Representatives and
			 the Committee on Finance of the Senate a report that includes the
			 following:</text>
						<subparagraph commented="no" id="HD2DE0DE480DA4534BCE49734F45F7E9"><enum>(A)</enum><text>An analysis of
			 Medicare beneficiaries’ access to medically necessary rehabilitation services,
			 including the potential effect of the 75 percent rule (as defined in paragraph
			 (2)) on access to care.</text>
						</subparagraph><subparagraph commented="no" id="H8FF75635CE8F46AEB91849F800003159"><enum>(B)</enum><text display-inline="yes-display-inline">An analysis of alternatives or refinements
			 to the 75 percent rule policy for determining criteria for inpatient
			 rehabilitation hospital and unit designation under the Medicare program,
			 including alternative criteria which would consider a patient’s functional
			 status, diagnosis, co-morbidities, and other relevant factors.</text>
						</subparagraph><subparagraph commented="no" id="H0E9B3724C88546DDADE8393FF4E872F8"><enum>(C)</enum><text>An analysis of the
			 conditions for which individuals are commonly admitted to inpatient
			 rehabilitation hospitals that are not included as a condition described in
			 section 412.23(b)(2)(iii) of title 42, Code of Federal Regulations, to
			 determine the appropriate setting of care, and any variation in patient
			 outcomes and costs, across settings of care, for treatment of such
			 conditions.</text>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H50766491273D487FA200C04FCA693567"><enum>(2)</enum><header>75 percent rule
			 defined</header><text>For purposes of this subsection, the term <term>75
			 percent rule</term> means the requirement of section 412.23(b)(2) of title 42,
			 Code of Federal Regulations, that 75 percent of the patients of a
			 rehabilitation hospital or converted rehabilitation unit are in 1 or more of 13
			 listed treatment categories.</text>
					</paragraph></subsection></section><section display-inline="no-display-inline" id="H81CEF34DA978412996712F389B380465" section-type="subsequent-section"><enum>116.</enum><header>Extension of
			 accommodation of physicians ordered to active duty in the Armed
			 Services</header><text display-inline="no-display-inline">Section
			 1842(b)(6)(D)(iii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(b)(6)(D)(iii)</external-xref>), as
			 amended by Public Law 110–54 (121 Stat. 551) is amended by striking
			 <quote>January 1, 2008</quote> and inserting <quote>July 1,
			 2008</quote>.</text>
			</section><section display-inline="no-display-inline" id="H0B0550F964294956A8A58550F28C16F" section-type="subsequent-section"><enum>117.</enum><header>Treatment of certain
			 hospitals</header>
				<subsection id="H1520D931B09A4444A4E056DA165FFAFE"><enum>(a)</enum><header>Extending
			 certain Medicare hospital wage index reclassifications through fiscal year
			 2008</header>
					<paragraph id="HFE1C47316B8D4A4CB4FD25C49C1C8F53"><enum>(1)</enum><header>In
			 general</header><text>Section 106(a) of division B of the Tax Relief and Health
			 Care Act of 2006 (42 U.S.C. 1395 note) is amended by striking <quote>September
			 30, 2007</quote> and inserting <quote>September 30, 2008</quote>.</text>
					</paragraph><paragraph commented="no" id="H6A08E24392FB4A2E8DD3D1DDFA6CA4D9"><enum>(2)</enum><header>Special
			 exception reclassifications</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services
			 shall extend for discharges occurring through September 30, 2008, the special
			 exception reclassifications made under the authority of section
			 1886(d)(5)(I)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and
			 contained in the final rule promulgated by the Secretary in the Federal
			 Register on August 11, 2004 (69 Fed. Reg. 49105, 49107).</text>
					</paragraph><paragraph commented="no" id="H3D54641ED1DD4E2F9900781BD611E4C7"><enum>(3)</enum><header>Use of
			 particular wage index</header><text display-inline="yes-display-inline">For
			 purposes of implementation of this subsection, the Secretary shall use the
			 hospital wage index that was promulgated by the Secretary in the Federal
			 Register on October 10, 2007 (72 Fed. Reg. 57634), and any subsequent
			 corrections.</text>
					</paragraph></subsection><subsection id="H339A578150594D2F938D2544A1730157"><enum>(b)</enum><header>Disregarding
			 section 508 hospital reclassifications for purposes of group
			 reclassifications</header><text>Section 508 of the Medicare Prescription Drug,
			 Improvement, and Modernization Act of 2003 (Public Law 108–173, 42 U.S.C.
			 1395ww note) is amended by adding at the end the following new
			 subsection:</text>
					<quoted-block display-inline="no-display-inline" id="H413F2E4CBA914F0CB844398438FF51DC" style="OLC">
						<subsection commented="no" id="H80161AFC5F79443A8648F89D7FA1C970"><enum>(g)</enum><header>Disregarding
				hospital reclassifications for purposes of group
				reclassifications</header><text>For purposes of the reclassification of a group
				of hospitals in a geographic area under section 1886(d) of the Social Security
				Act for purposes of discharges occurring during fiscal year 2008, a hospital
				reclassified under this section (including any such reclassification which is
				extended under section 106(a) of the Medicare Improvements and Extension Act of
				2006) shall not be taken into account and shall not prevent the other hospitals
				in such area from continuing such a group for such
				purpose.</text>
						</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H0296C4CB11E24006BF8170320004A619"><enum>(c)</enum><header>Correction of
			 application of wage index during Tax Relief and Health Care Act
			 extension</header><text>In the case of a subsection (d) hospital (as defined
			 for purposes of section 1886 of the <act-name parsable-cite="SSA">Social
			 Security Act</act-name> (42 U.S.C. 1395ww)) with respect to which—</text>
					<paragraph id="H4A1F14E1B08F4E49BEBAC63773431840"><enum>(1)</enum><text>a
			 reclassification of its wage index for purposes of such section was extended
			 for the period beginning on April 1, 2007, and ending on September 30, 2007,
			 pursuant to subsection (a) of section 106 of division B of the Tax Relief and
			 Health Care Act of 2006 (42 U.S.C. 1395 note); and</text>
					</paragraph><paragraph id="H0039BD6496E9437889DC8EC07980264"><enum>(2)</enum><text>the wage index
			 applicable for such hospital during such period was lower than the wage index
			 applicable for such hospital during the period beginning on October 1, 2006,
			 and ending on March 31, 2007,</text>
					</paragraph><continuation-text commented="no" continuation-text-level="subsection">the Secretary shall apply the higher
			 wage index that was applicable for such hospital during the period beginning on
			 October 1, 2006, and ending on March 31, 2007, for the entire fiscal year 2007.
			 If the Secretary determines that the application of the preceding sentence to a
			 hospital will result in a hospital being owed additional reimbursement, the
			 Secretary shall make such payments within 90 days after the settlement of the
			 applicable cost report.</continuation-text></subsection></section><section id="idD50A6D5D1CF54775BF79942B33013F1D"><enum>118.</enum><header>Additional
			 Funding for State Health Insurance Assistance Programs, Area Agencies on Aging,
			 and Aging and Disability Resource Centers</header>
				<subsection id="idBF5B5344C4CF459ABCDFDA3596DDB626"><enum>(a)</enum><header>State Health
			 Insurance Assistance Programs</header>
					<paragraph id="idE4A22B5057264B088C3C47401527F036"><enum>(1)</enum><header>In
			 general</header><text>The Secretary of Health and Human Services shall use
			 amounts made available under paragraph (2) to make grants to States for State
			 health insurance assistance programs receiving assistance under section 4360 of
			 the Omnibus Budget Reconciliation Act of 1990.</text>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF0FCE4DACF37422F82463972D8618581"><enum>(2)</enum><header display-inline="yes-display-inline">Funding</header><text display-inline="yes-display-inline">For purposes of making grants under this
			 subsection, the Secretary shall provide for the transfer, from the Federal
			 Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42
			 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under
			 section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the
			 Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w–23(f)),
			 of $15,000,000 to the Centers for Medicare &amp; Medicaid Services Program
			 Management Account for fiscal year 2008.</text>
					</paragraph></subsection><subsection id="id934FCD8E6D6F42348FBB6178E1800B3E"><enum>(b)</enum><header>Area Agencies
			 on Aging and Aging and Disability Resource Centers</header>
					<paragraph id="idECCA30F4130040ABB86EB3B8601E562E"><enum>(1)</enum><header>In
			 general</header><text>The Secretary of Health and Human Services shall use
			 amounts made available under paragraph (2) to make grants—</text>
						<subparagraph id="id0A38EA7AC1F4459D82C8FD9224304143"><enum>(A)</enum><text>to States for
			 area agencies on aging (as defined in section 102 of the Older Americans Act of
			 1965 (42 U.S.C. 3002)); and</text>
						</subparagraph><subparagraph id="id208A5285673A4439B0786D099D89DEC9"><enum>(B)</enum><text>to Aging and
			 Disability Resource Centers under the Aging and Disability Resource Center
			 grant program.</text>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8F5BC6B1548A4F0396ACC86A643816C1"><enum>(2)</enum><header display-inline="yes-display-inline">Funding</header><text display-inline="yes-display-inline">For purposes of making grants under this
			 subsection, the Secretary shall provide for the transfer, from the Federal
			 Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42
			 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under
			 section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the
			 Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w–23(f)),
			 of $5,000,000 to the Centers for Medicare &amp; Medicaid Services Program
			 Management Account for the period of fiscal years 2008 through 2009.</text>
					</paragraph></subsection></section></title><title id="id6C7184B6049C4A1EBE83927118204214"><enum>II</enum><header>Medicaid and
			 SCHIP</header>
			<section id="H32C280AEFA5A416F8FCCC4D842C3C542" section-type="subsequent-section"><enum>201.</enum><header>Extending SCHIP
			 funding through March 31, 2009</header>
				<subsection id="HC2131501C1964DA4B8AC339DEE678651"><enum>(a)</enum><header>Through the
			 second quarter of fiscal year 2009</header>
					<paragraph id="H069E4DF445EF4AF18143B32EC8CC5DFF"><enum>(1)</enum><header>In
			 general</header><text>Section 2104 of the Social Security Act (42 U.S.C.
			 1397dd) is amended—</text>
						<subparagraph id="H51503342AF174218AFE68E4637F8F41C"><enum>(A)</enum><text>in subsection
			 (a)—</text>
							<clause id="HCFF0DB2B9821411D9B00B097593BFF8D"><enum>(i)</enum><text>by
			 striking <quote>and</quote> at the end of paragraph (9);</text>
							</clause><clause id="H7BEFE44DCF3346318DD657C72D786D92"><enum>(ii)</enum><text>by
			 striking the period at the end of paragraph (10) and inserting <quote>;
			 and</quote>; and</text>
							</clause><clause id="HAEEEB4DDD0E6457B96700075764C1BEF"><enum>(iii)</enum><text>by
			 adding at the end the following new paragraph:</text>
								<quoted-block display-inline="no-display-inline" id="HFDE1C429AD1E423700DE2D7E8EAEF63F" style="OLC">
									<paragraph id="H23E311AC4885428496FBA8FD9BA8B51"><enum>(11)</enum><text display-inline="yes-display-inline">for each of fiscal years 2008 and 2009,
				$5,000,000,000.</text>
									</paragraph><after-quoted-block>;
				and</after-quoted-block></quoted-block>
							</clause></subparagraph><subparagraph id="HD3A36F714C2E4842A793ED65BD2F0136"><enum>(B)</enum><text>in subsection
			 (c)(4)(B), by striking <quote>for fiscal year 2007</quote> and inserting
			 <quote>for each of fiscal years 2007 through 2009</quote>.</text>
						</subparagraph></paragraph><paragraph id="H8C428F1AE92E43AC8D1D00A35C628C1F"><enum>(2)</enum><header>Availability of
			 extended funding</header><text>Funds made available from any allotment made
			 from funds appropriated under subsection (a)(11) or (c)(4)(B) of section 2104
			 of the Social Security Act (42 U.S.C. 1397dd) for fiscal year 2008 or 2009
			 shall not be available for child health assistance for items and services
			 furnished after March 31, 2009, or, if earlier, the date of the enactment of an
			 Act that provides funding for fiscal years 2008 and 2009, and for one or more
			 subsequent fiscal years for the State Children's Health Insurance Program under
			 title XXI of the Social Security Act.</text>
					</paragraph><paragraph id="H3AF3837A0A7F416D94D5F5CAC9522DE9"><enum>(3)</enum><header>End of funding
			 under continuing resolution</header><text display-inline="yes-display-inline">Section 136(a)(2) of Public Law 110-92 is
			 amended by striking <quote>after the termination date</quote> and all that
			 follows and inserting <quote>after the date of the enactment of the
			 <short-title>Medicare, Medicaid, and SCHIP Extension Act
			 of 2007</short-title>.</quote>.</text>
					</paragraph><paragraph id="H978F934BA6A347F2B816A85357867157"><enum>(4)</enum><header>Clarification of
			 application of funding under continuing resolution</header><text>Section 107 of
			 Public Law 110–92 shall apply with respect to expenditures made pursuant to
			 section 136(a)(1) of such Public Law.</text>
					</paragraph></subsection><subsection id="H62173388096247A0A8CCDF1BD662B00"><enum>(b)</enum><header>Extension of
			 treatment of qualifying States; rules on redistribution of unspent fiscal year
			 2005 allotments made permanent</header>
					<paragraph id="H2256D2BFC46C4239925E3F837E09007D"><enum>(1)</enum><header>In
			 general</header><text>Section 2105(g)(1)(A) of the Social Security Act (42
			 U.S.C. 1397ee(g)(1)(A)), as amended by subsection (d) of section 136 of Public
			 Law 110–92, is amended by striking <quote>or 2008</quote> and inserting
			 <quote>2008, or 2009</quote>.</text>
					</paragraph><paragraph id="HF6CA8106F05141AE863336BF2E9B7196"><enum>(2)</enum><header>Applicability</header><text>The
			 amendment made by paragraph (1) shall be in effect through March 31,
			 2009.</text>
					</paragraph><paragraph id="HB20E66B1C86643E59690E01E57D752E2"><enum>(3)</enum><header>Certain rules
			 made permanent</header><text>Subsection (e) of section 136 of Public Law 110–92
			 is repealed.</text>
					</paragraph></subsection><subsection id="HBDA823183247462BBC90EC49A6BA00E9"><enum>(c)</enum><header>Additional
			 allotments To eliminate remaining funding shortfalls through March 31,
			 2009</header>
					<paragraph id="H6D8A1393A67D455EA3CF956ADFD9FC6"><enum>(1)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Section 2104 of the
			 Social Security Act (42 U.S.C. 1397dd) is amended by adding at the end the
			 following new subsections:</text>
						<quoted-block display-inline="no-display-inline" id="H59422DBAF44C49EBB19858C0E14BD000" style="OLC">
							<subsection id="H32C1C61434E64EC79CE76CD9C200D360"><enum>(j)</enum><header>Additional
				allotments To eliminate funding shortfalls for fiscal year 2008</header>
								<paragraph id="HC99ADF4928CA45C0A9A30002C85F605E"><enum>(1)</enum><header>Appropriation;
				allotment authority</header><text display-inline="yes-display-inline">For the
				purpose of providing additional allotments described in subparagraphs (A) and
				(B) of paragraph (3), there is appropriated, out of any money in the Treasury
				not otherwise appropriated, such sums as may be necessary, not to exceed
				$1,600,000,000 for fiscal year 2008.</text>
								</paragraph><paragraph id="HFF53FC0CBD0F4899A1C25093E969E508"><enum>(2)</enum><header>Shortfall states
				described</header><text display-inline="yes-display-inline">For purposes of
				paragraph (3), a shortfall State described in this paragraph is a State with a
				State child health plan approved under this title for which the Secretary
				estimates, on the basis of the most recent data available to the Secretary as
				of November 30, 2007, that the Federal share amount of the projected
				expenditures under such plan for such State for fiscal year 2008 will exceed
				the sum of—</text>
									<subparagraph id="HA09D108B8A564960A8178D4C49AB2327"><enum>(A)</enum><text>the amount of the
				State's allotments for each of fiscal years 2006 and 2007 that will not be
				expended by the end of fiscal year 2007;</text>
									</subparagraph><subparagraph id="H44999489AA67466490676200CD00027B"><enum>(B)</enum><text>the amount, if
				any, that is to be redistributed to the State during fiscal year 2008 in
				accordance with subsection (i); and</text>
									</subparagraph><subparagraph id="H5859B7D89EF64C60B780DEBC50804054"><enum>(C)</enum><text>the amount of the
				State's allotment for fiscal year 2008.</text>
									</subparagraph></paragraph><paragraph id="H646D0EE398854E7782EF8BE5E153FD3E"><enum>(3)</enum><header>Allotments</header><text display-inline="yes-display-inline">In addition to the allotments provided
				under subsections (b) and (c), subject to paragraph (4), of the amount
				available for the additional allotments under paragraph (1) for fiscal year
				2008, the Secretary shall allot—</text>
									<subparagraph id="H42D831F1789E47688B3753516D823692"><enum>(A)</enum><text>to each shortfall
				State described in paragraph (2) not described in subparagraph (B), such amount
				as the Secretary determines will eliminate the estimated shortfall described in
				such paragraph for the State; and</text>
									</subparagraph><subparagraph id="H0967BBD36DA044D080FDCBBD8B1353DE"><enum>(B)</enum><text>to each
				commonwealth or territory described in subsection (c)(3), an amount equal to
				the percentage specified in subsection (c)(2) for the commonwealth or territory
				multiplied by 1.05 percent of the sum of the amounts determined for each
				shortfall State under subparagraph (A).</text>
									</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H0814B79E832541FE93ABE3E02D71B022"><enum>(4)</enum><header display-inline="yes-display-inline">Proration
				rule</header><text display-inline="yes-display-inline">If the amounts available
				for additional allotments under paragraph (1) are less than the total of the
				amounts determined under subparagraphs (A) and (B) of paragraph (3), the
				amounts computed under such subparagraphs shall be reduced
				proportionally.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBDB30DBB6E2A4ABBA28BB76DAE79A610"><enum>(5)</enum><header>Retrospective
				adjustment</header><text display-inline="yes-display-inline">The Secretary may
				adjust the estimates and determinations made to carry out this subsection as
				necessary on the basis of the amounts reported by States not later than
				November 30, 2008, on CMS Form 64 or CMS Form 21, as the case may be, and as
				approved by the Secretary.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H20B7A134D1AF4A3ABC26F861CD2EE363"><enum>(6)</enum><header>One-year
				availability; no redistribution of unexpended additional
				allotments</header><text display-inline="yes-display-inline">Notwithstanding
				subsections (e) and (f), amounts allotted to a State pursuant to this
				subsection for fiscal year 2008, subject to paragraph (5), shall only remain
				available for expenditure by the State through September 30, 2008. Any amounts
				of such allotments that remain unexpended as of such date shall not be subject
				to redistribution under subsection (f).</text>
								</paragraph></subsection><subsection id="H88A8591FE2AD4483A961A2FAEC74293"><enum>(k)</enum><header>Redistribution of
				unused fiscal year 2006 allotments to States with estimated funding shortfalls
				during the first 2 quarters of fiscal year 2009</header>
								<paragraph commented="no" display-inline="no-display-inline" id="HCC6D1D4047BF43D280A294F05E7EF9EA"><enum>(1)</enum><header>In
				general</header><text>Notwithstanding subsection (f) and subject to paragraphs
				(3) and (4), with respect to months beginning during the first 2 quarters of
				fiscal year 2009, the Secretary shall provide for a redistribution under such
				subsection from the allotments for fiscal year 2006 under subsection (b) that
				are not expended by the end of fiscal year 2008, to a fiscal year 2009
				shortfall State described in paragraph (2), such amount as the Secretary
				determines will eliminate the estimated shortfall described in such paragraph
				for such State for the month.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H2E08F5E60E814F81A7DD7B9D741BBAD7"><enum>(2)</enum><header>Fiscal year 2009
				shortfall State described</header><text>A fiscal year 2009 shortfall State
				described in this paragraph is a State with a State child health plan approved
				under this title for which the Secretary estimates, on a monthly basis using
				the most recent data available to the Secretary as of such month, that the
				Federal share amount of the projected expenditures under such plan for such
				State for the first 2 quarters of fiscal year 2009 will exceed the sum
				of—</text>
									<subparagraph commented="no" display-inline="no-display-inline" id="HEDFEE1E7FD6340C3A755F584507503A5"><enum>(A)</enum><text>the amount of the
				State's allotments for each of fiscal years 2007 and 2008 that was not expended
				by the end of fiscal year 2008; and</text>
									</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H960C6CC19CAF44E9A3756E33004DFC3F"><enum>(B)</enum><text>the amount of the
				State's allotment for fiscal year 2009.</text>
									</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H8C17CD97C79541DF9465D1B2CB975E72"><enum>(3)</enum><header display-inline="yes-display-inline">Funds redistributed in the order in which
				States realize funding shortfalls</header><text display-inline="yes-display-inline">The Secretary shall redistribute the
				amounts available for redistribution under paragraph (1) to fiscal year 2009
				shortfall States described in paragraph (2) in the order in which such States
				realize monthly funding shortfalls under this title for fiscal year 2009. The
				Secretary shall only make redistributions under this subsection to the extent
				that there are unexpended fiscal year 2006 allotments under subsection (b)
				available for such redistributions.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H9C030037541C46E4BD16C54E4D37B654"><enum>(4)</enum><header>Proration
				rule</header><text>If the amounts available for redistribution under paragraph
				(1) are less than the total amounts of the estimated shortfalls determined for
				the month under that paragraph, the amount computed under such paragraph for
				each fiscal year 2009 shortfall State for the month shall be reduced
				proportionally.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H11ECE81081C7434297D98B2600A2C3C4"><enum>(5)</enum><header display-inline="yes-display-inline">Retrospective adjustment</header><text>The
				Secretary may adjust the estimates and determinations made to carry out this
				subsection as necessary on the basis of the amounts reported by States not
				later than May 31, 2009, on CMS Form 64 or CMS Form 21, as the case may be, and
				as approved by the Secretary.</text>
								</paragraph><paragraph id="H85EDE32A21674626BC3921D7CB464B"><enum>(6)</enum><header>Availability; no
				further redistribution</header><text>Notwithstanding subsections (e) and (f),
				amounts redistributed to a State pursuant to this subsection for the first 2
				quarters of fiscal year 2009 shall only remain available for expenditure by the
				State through March 31, 2009, and any amounts of such redistributions that
				remain unexpended as of such date, shall not be subject to redistribution under
				subsection (f).</text>
								</paragraph></subsection><subsection id="H2FE21ABE60A0487EB110BFBEDD7D703D"><enum>(l)</enum><header>Additional
				allotments To eliminate funding shortfalls for the first 2 quarters of fiscal
				year 2009</header>
								<paragraph id="H2F2923C22A3F4DA28E221753CF045B5"><enum>(1)</enum><header>Appropriation;
				allotment authority</header><text display-inline="yes-display-inline">For the
				purpose of providing additional allotments described in subparagraphs (A) and
				(B) of paragraph (3), there is appropriated, out of any money in the Treasury
				not otherwise appropriated, such sums as may be necessary, not to exceed
				$275,000,000 for the first 2 quarters of fiscal year 2009.</text>
								</paragraph><paragraph id="HF16157E91E734172A53DE138596C723C"><enum>(2)</enum><header>Shortfall states
				described</header><text display-inline="yes-display-inline">For purposes of
				paragraph (3), a shortfall State described in this paragraph is a State with a
				State child health plan approved under this title for which the Secretary
				estimates, on the basis of the most recent data available to the Secretary,
				that the Federal share amount of the projected expenditures under such plan for
				such State for the first 2 quarters of fiscal year 2009 will exceed the sum
				of—</text>
									<subparagraph id="HF6F719A8BDC3407387B95C3EBA9FA11B"><enum>(A)</enum><text>the amount of the
				State's allotments for each of fiscal years 2007 and 2008 that will not be
				expended by the end of fiscal year 2008;</text>
									</subparagraph><subparagraph id="H0F5EE733F9D1464FA1D2C2B4FB36C3B8"><enum>(B)</enum><text>the amount, if
				any, that is to be redistributed to the State during fiscal year 2009 in
				accordance with subsection (k); and</text>
									</subparagraph><subparagraph id="H162010CF117A4A8B831CCD02DDCD90B1"><enum>(C)</enum><text>the amount of the
				State's allotment for fiscal year 2009.</text>
									</subparagraph></paragraph><paragraph id="HF2EB0E3301934ABF87C9EF606C835EE9"><enum>(3)</enum><header>Allotments</header><text display-inline="yes-display-inline">In addition to the allotments provided
				under subsections (b) and (c), subject to paragraph (4), of the amount
				available for the additional allotments under paragraph (1) for the first 2
				quarters of fiscal year 2009, the Secretary shall allot—</text>
									<subparagraph id="H432CB11C01AD4E58B8186FFECE09339B"><enum>(A)</enum><text>to each shortfall
				State described in paragraph (2) not described in subparagraph (B) such amount
				as the Secretary determines will eliminate the estimated shortfall described in
				such paragraph for the State; and</text>
									</subparagraph><subparagraph id="H18351225E6C847B79F5C34D5ECCB359E"><enum>(B)</enum><text>to each
				commonwealth or territory described in subsection (c)(3), an amount equal to
				the percentage specified in subsection (c)(2) for the commonwealth or territory
				multiplied by 1.05 percent of the sum of the amounts determined for each
				shortfall State under subparagraph (A).</text>
									</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H02B18B5FCD5748BA85C6B9077761A753"><enum>(4)</enum><header display-inline="yes-display-inline">Proration
				rule</header><text display-inline="yes-display-inline">If the amounts available
				for additional allotments under paragraph (1) are less than the total of the
				amounts determined under subparagraphs (A) and (B) of paragraph (3), the
				amounts computed under such subparagraphs shall be reduced
				proportionally.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H80F3A3546CF84ED993C94747222F9B3D"><enum>(5)</enum><header>Retrospective
				adjustment</header><text display-inline="yes-display-inline">The Secretary may
				adjust the estimates and determinations made to carry out this subsection as
				necessary on the basis of the amounts reported by States not later than May 31,
				2009, on CMS Form 64 or CMS Form 21, as the case may be, and as approved by the
				Secretary.</text>
								</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1F6C9F6C75074A498312068E4184A525"><enum>(6)</enum><header>Availability; no
				redistribution of unexpended additional allotments</header><text display-inline="yes-display-inline">Notwithstanding
				subsections (e) and (f), amounts allotted to a State pursuant to this
				subsection for fiscal year 2009, subject to paragraph (5), shall only remain
				available for expenditure by the State through March 31, 2009. Any amounts of
				such allotments that remain unexpended as of such date shall not be subject to
				redistribution under subsection
				(f).</text>
								</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection></section><section id="H4308253E655749828F119CCDC65EC8FE"><enum>202.</enum><header>Extension of
			 transitional medical assistance (TMA) and abstinence education
			 program</header><text display-inline="no-display-inline">Section 401 of
			 division B of the Tax Relief and Health Care Act of 2006 (<external-xref legal-doc="public-law" parsable-cite="pl/109/432">Public Law
			 109–432</external-xref>, 120 Stat. 2994), as amended by section 1 of Public Law
			 110–48 (121 Stat. 244) and section 2 of the TMA, Abstinence, Education, and QI
			 Programs Extension Act of 2007 (Public Law 110–90, 121 Stat. 984), is
			 amended—</text>
				<paragraph commented="no" display-inline="no-display-inline" id="H4DAA39614CBC4D7CB4B4E2F6375B3043"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>December 31,
			 2007</quote> and inserting <quote>June 30, 2008</quote>; and</text>
				</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id503476BE4E1F44D8B26F15B05FEADA51"><enum>(2)</enum><text>by striking
			 <quote>first quarter</quote> and inserting <quote>third quarter</quote> each
			 place it appears.</text>
				</paragraph></section><section id="H8C90C2499662434E84948B6959E24942"><enum>203.</enum><header>Extension of
			 qualifying individual (QI) program</header>
				<subsection id="id6321B670F2DE4C16853FDE49B19C0405"><enum>(a)</enum><header>Extension</header><text>Section
			 1902(a)(10)(E)(iv) of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42
			 U.S.C. 1396a(a)(10)(E)(iv)</external-xref>) is amended by striking
			 <quote>December 2007</quote> and inserting <quote>June 2008</quote>.</text>
				</subsection><subsection id="H7BDAAA8F33C04F0687CB87190074399F"><enum>(b)</enum><header>Extending Total
			 Amount Available for Allocation</header><text>Section 1933(g)(2) of the Social
			 Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-3">42
			 U.S.C. 1396u–3(g)</external-xref>(2)) is amended—</text>
					<paragraph id="HDECEAAECDE254FC88DB1768BE564009F"><enum>(1)</enum><text>in subparagraph
			 (G), by striking <quote>and</quote> at the end;</text>
					</paragraph><paragraph id="HA089363A5FF944A282353FBD398D2DD8"><enum>(2)</enum><text>in subparagraph
			 (H), by striking the period at the end and inserting <quote>; and</quote>;
			 and</text>
					</paragraph><paragraph id="H46223AE7572049B2A33800444D72CC07"><enum>(3)</enum><text>by adding at the
			 end the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="idE402F084AD724881A373FCB4F4F214C4" style="OLC">
							<subparagraph id="HA1F0D593A6FD4860BA7FED46CB29E795"><enum>(I)</enum><text>for the period
				that begins on January 1, 2008, and ends on June 30, 2008, the total allocation
				amount is
				$200,000,000.</text>
							</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection></section><section id="HC8808302347C" section-type="subsequent-section"><enum>204.</enum><header>Medicaid DSH
			 extension</header><text display-inline="no-display-inline">Section 1923(f)(6)
			 of the Social Security Act (42 U.S.C. 1396r–4(f)(6)) is amended—</text>
				<paragraph id="H81B8C1A2127248D8B04EE680B58F00B6"><enum>(1)</enum><text>in the heading, by
			 inserting <quote><header-in-text level="paragraph" style="OLC">and portions of
			 fiscal year 2008</header-in-text></quote> after <quote><header-in-text level="paragraph" style="OLC">fiscal year 2007</header-in-text></quote>;
			 and</text>
				</paragraph><paragraph commented="no" id="HD329B314E1104785893EA18E41E9664B"><enum>(2)</enum><text>in subparagraph
			 (A)—</text>
					<subparagraph commented="no" id="H26F9055821D64C7387D9B00732EF2A1"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (i), by adding at the end (after
			 and below subclause (II)) the following:</text>
						<quoted-block display-inline="no-display-inline" id="H795D769BEAA44B94A9C651AEA0C6DF2" style="OLC">
							<quoted-block-continuation-text commented="no" quoted-block-continuation-text-level="clause">Only with respect to fiscal year 2008
				for the period ending on June 30, 2008, the DSH allotment for Tennessee for
				such portion of the fiscal year, notwithstanding such table or terms, shall be
				¾ of the amount specified in the previous sentence for fiscal year
				2007.</quoted-block-continuation-text><after-quoted-block>; </after-quoted-block></quoted-block>
					</subparagraph><subparagraph commented="no" id="H55D729C36A684FFDAE3347155BA3CAEA"><enum>(B)</enum><text>in clause
			 (ii)—</text>
						<clause commented="no" id="H985BA2475FA04C308D67000019D6E452"><enum>(i)</enum><text>by inserting
			 <quote>or for a period in fiscal year 2008 described in clause (i)</quote>
			 after <quote>fiscal year 2007</quote>; and</text>
						</clause><clause commented="no" id="H8278750D42424C1798C83C6B8B006951"><enum>(ii)</enum><text>by inserting
			 <quote>or period</quote> after <quote>such fiscal year</quote>; and</text>
						</clause></subparagraph><subparagraph commented="no" id="H4CBCBB72DEF94AA094F0C9F790719895"><enum>(C)</enum><text>in clause
			 (iv)—</text>
						<clause commented="no" id="H51C7B4EB70A54B6300A85E513F78EFFB"><enum>(i)</enum><text>in the heading, by
			 inserting <quote><header-in-text level="clause" style="OLC">and fiscal year
			 2008</header-in-text></quote> after <quote><header-in-text level="clause" style="OLC">fiscal year 2007</header-in-text></quote>;</text>
						</clause><clause commented="no" id="H88BBA4A4AE84473594637D5CAD78C931"><enum>(ii)</enum><text>in subclause
			 (I)—</text>
							<subclause commented="no" id="id35A766BD3DFE4368B6F67A00CAA928A3"><enum>(I)</enum><text>by inserting
			 <quote>or for a period in fiscal year 2008 described in clause (i)</quote>
			 after <quote>fiscal year 2007</quote>; and</text>
							</subclause><subclause commented="no" id="H74811300C82543499653C7D2004E94F7"><enum>(II)</enum><text display-inline="yes-display-inline">by inserting <quote>or period</quote> after
			 <quote>for such fiscal year</quote>; and</text>
							</subclause></clause><clause commented="no" id="H51E3B4FEADE843DC82C387CD24A42CB8"><enum>(iii)</enum><text display-inline="yes-display-inline">in subclause (II)—</text>
							<subclause commented="no" id="id5D318BD82E194E178EFF169EF9FB2EE2"><enum>(I)</enum><text display-inline="yes-display-inline">by inserting <quote>or for a period in
			 fiscal year 2008 described in clause (i)</quote> after <quote>fiscal year
			 2007</quote>; and</text>
							</subclause><subclause commented="no" id="H6142F097F4724370A0FBA811A7E6E5E9"><enum>(II)</enum><text>by inserting
			 <quote>or period</quote> after <quote>such fiscal year</quote> each place it
			 appears; and</text>
							</subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF27A046BF53B4D9B8877616F26B84FC1"><enum>(3)</enum><text>in subparagraph
			 (B)(i), by adding at the end the following: <quote>Only with respect to fiscal
			 year 2008 for the period ending on June 30, 2008, the DSH allotment for Hawaii
			 for such portion of the fiscal year, notwithstanding the table set forth in
			 paragraph (2), shall be $7,500,000. </quote>.</text>
				</paragraph></section><section display-inline="no-display-inline" id="HB999D96FC99F421C8033239500FB1373" section-type="subsequent-section"><enum>205.</enum><header>Improving data
			 collection</header><text display-inline="no-display-inline">Section 2109(b)(2)
			 of the Social Security Act (42 U.S.C. 1397ii(b)(2)) is amended by inserting
			 before the period at the end the following <quote>(except that only with
			 respect to fiscal year 2008, there are appropriated $20,000,000 for the purpose
			 of carrying out this subsection, to remain available until
			 expended)</quote>.</text>
			</section><section display-inline="no-display-inline" id="HCEAF4191D3A64C0EAC9E445B010047D2" section-type="subsequent-section"><enum>206.</enum><header>Moratorium on
			 certain payment restrictions</header><text display-inline="no-display-inline">Notwithstanding any other provision of law,
			 the Secretary of Health and Human Services shall not, prior to June 30, 2008,
			 take any action (through promulgation of regulation, issuance of regulatory
			 guidance, use of Federal payment audit procedures, or other administrative
			 action, policy, or practice, including a Medical Assistance Manual transmittal
			 or letter to State Medicaid directors) to impose any restrictions relating to
			 coverage or payment under title XIX of the Social Security Act for
			 rehabilitation services or school-based administration and school-based
			 transportation if such restrictions are more restrictive in any aspect than
			 those applied to such areas as of July 1, 2007.</text>
			</section></title><title id="id314BA201933142E9900066D7B1C2130F"><enum>III</enum><header>Miscellaneous</header>
			<section commented="no" display-inline="no-display-inline" id="id3197D6A88EFC4DA8AB0E74160B1CCAB8" section-type="subsequent-section"><enum>301.</enum><header display-inline="yes-display-inline">Medicare Payment Advisory Commission
			 status</header><text display-inline="no-display-inline">Section 1805(a) of the
			 Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-6">42 U.S.C. 1395b–6(a)</external-xref>) is amended
			 by inserting <quote>as an agency of Congress</quote> after
			 <quote>established</quote>.</text>
			</section><section id="IDE81560453319427CB39FA6E5A9EE8DC1"><enum>302.</enum><header>Special
			 Diabetes Programs for Type I Diabetes and Indians</header>
				<subsection id="ID33F3E9F19F25409DB1CD4E0712A7D026"><enum>(a)</enum><header>Special
			 Diabetes Programs for Type I Diabetes</header><text>Section 330B(b)(2)(C) of
			 the <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42
			 U.S.C. 254c–2(b)(2)(C)) is amended by striking <quote>2008</quote> and
			 inserting <quote>2009</quote>.</text>
				</subsection><subsection id="ID5D81F36726F34E848C25F1E32B8782E7"><enum>(b)</enum><header>Special
			 Diabetes Programs for Indians</header><text>Section 330C(c)(2)(C) of the
			 <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
			 254c–3(c)(2)(C)) is amended by striking <quote>2008</quote> and inserting
			 <quote>2009</quote>.</text>
				</subsection></section></title></legis-body>
</bill>
