[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4994 Enrolled Bill (ENR)]

        H.R.4994

                      One Hundred Eleventh Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

          Begun and held at the City of Washington on Tuesday,
             the fifth day of January, two thousand and ten


                                 An Act


 
   To extend certain expiring provisions of the Medicare and Medicaid 
                    programs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
    (a) Short Title.--This Act may be cited as the ``Medicare and 
Medicaid Extenders Act of 2010''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

                           TITLE I--EXTENSIONS

Sec. 101. Physician payment update.
Sec. 102. Extension of MMA section 508 reclassifications.
Sec. 103. Extension of Medicare work geographic adjustment floor.
Sec. 104. Extension of exceptions process for Medicare therapy caps.
Sec. 105. Extension of payment for technical component of certain 
          physician pathology services.
Sec. 106. Extension of ambulance add-ons.
Sec. 107. Extension of physician fee schedule mental health add-on 
          payment.
Sec. 108. Extension of outpatient hold harmless provision.
Sec. 109. Extension of Medicare reasonable costs payments for certain 
          clinical diagnostic laboratory tests furnished to hospital 
          patients in certain rural areas.
Sec. 110. Extension of the qualifying individual (QI) program.
Sec. 111. Extension of Transitional Medical Assistance (TMA).
Sec. 112. Special diabetes programs.

                       TITLE II--OTHER PROVISIONS

Sec. 201. Clarification of effective date of part B special enrollment 
          period for disabled TRICARE beneficiaries.
Sec. 202. Repeal of delay of RUG-IV.
Sec. 203. Clarification for affiliated hospitals for distribution of 
          additional residency positions.
Sec. 204. Continued inclusion of orphan drugs in definition of covered 
          outpatient drugs with respect to children's hospitals under 
          the 340B drug discount program.
Sec. 205. Medicaid and CHIP technical corrections.
Sec. 206. Funding for claims reprocessing.
Sec. 207. Revision to the Medicare Improvement Fund.
Sec. 208. Limitations on aggregate amount recovered on reconciliation of 
          the health insurance tax credit and the advance of that 
          credit.
Sec. 209. Determination of budgetary effects.

                          TITLE I--EXTENSIONS

    SEC. 101. PHYSICIAN PAYMENT UPDATE.
    Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) 
is amended by adding at the end the following new paragraph:
        ``(12) Update for 2011.--
            ``(A) In general.--Subject to paragraphs (7)(B), (8)(B), 
        (9)(B), (10)(B), and (11)(B), in lieu of the update to the 
        single conversion factor established in paragraph (1)(C) that 
        would otherwise apply for 2011, the update to the single 
        conversion factor shall be 0 percent.
            ``(B) No effect on computation of conversion factor for 
        2012 and subsequent years.--The conversion factor under this 
        subsection shall be computed under paragraph (1)(A) for 2012 
        and subsequent years as if subparagraph (A) had never 
        applied.''.
    SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICATIONS.
    (a) Extension.--
        (1) In general.--Section 106(a) of division B of the Tax Relief 
    and Health Care Act of 2006 (42 U.S.C. 1395 note), as amended by 
    section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 
    2007 (Public Law 110-173), section 124 of the Medicare Improvements 
    for Patients and Providers Act of 2008 (Public Law 110-275), and 
    sections 3137(a) and 10317 of the Patient Protection and Affordable 
    Care Act (Public Law 111-148), is amended by striking ``September 
    30, 2010'' and inserting ``September 30, 2011''.
        (2) Special rule for fiscal year 2011.--
            (A) In general.--Subject to subparagraph (B), for purposes 
        of implementation of the amendment made by paragraph (1), 
        including (notwithstanding paragraph (3) of section 117(a) of 
        the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
        Law 110-173), as amended by section 124(b) of the Medicare 
        Improvements for Patients and Providers Act of 2008 (Public Law 
        110-275)) for purposes of the implementation of paragraph (2) 
        of such section 117(a), during fiscal year 2011, the Secretary 
        of Health and Human Services shall use the hospital wage index 
        that was promulgated by the Secretary of Health and Human 
        Services in the Federal Register on August 16, 2010 (75 Fed. 
        Reg. 50042), and any subsequent corrections.
            (B) Exception.--Beginning on April 1, 2011, in determining 
        the wage index applicable to hospitals that qualify for wage 
        index reclassification, the Secretary shall include the average 
        hourly wage data of hospitals whose reclassification was 
        extended pursuant to the amendment made by paragraph (1) only 
        if including such data results in a higher applicable 
        reclassified wage index. Any revision to hospital wage indexes 
        made as a result of this subparagraph shall not be effected in 
        a budget neutral manner.
        (3) Adjustment for certain hospitals in fiscal year 2011.--
            (A) In general.--In the case of a subsection (d) hospital 
        (as defined in subsection (d)(1)(B) of section 1886 of the 
        Social Security Act (42 U.S.C. 1395ww)) with respect to which--
                (i) a reclassification of its wage index for purposes 
            of such section was extended pursuant to the amendment made 
            by paragraph (1); and
                (ii) the wage index applicable for such hospital for 
            the period beginning on October 1, 2010, and ending on 
            March 31, 2011, was lower than for the period beginning on 
            April 1, 2011, and ending on September 30, 2011, by reason 
            of the application of paragraph (2)(B);
        the Secretary shall pay such hospital an additional payment 
        that reflects the difference between the wage index for such 
        periods.
            (B) Timeframe for payments.--The Secretary shall make 
        payments required under subparagraph (A) by not later than 
        December 31, 2011.
    (b) Conforming Amendment.--Section 117(a)(3) of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) is 
amended by inserting ``in fiscal years 2008 and 2009'' after ``For 
purposes of implementation of this subsection''.
    SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC ADJUSTMENT FLOOR.
    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``before January 1, 2011'' and 
inserting ``before January 1, 2012''.
    SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY 
      CAPS.
    Section 1833(g)(5) of the Social Security Act (42 U.S.C. 
1395l(g)(5)) is amended by striking ``and ending on'' and all that 
follows through ``2010'' and inserting ``and ending on December 31, 
2011''.
    SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF CERTAIN 
      PHYSICIAN PATHOLOGY SERVICES.
    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), section 104 of division B of the Tax Relief 
and Health Care Act of 2006 (42 U.S.C. 1395w-4 note), section 104 of 
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 
110-173), section 136 of the Medicare Improvements for Patients and 
Providers Act of 2008 (Public Law 110-275), and section 3104 of the 
Patient Protection and Affordable Care Act (Public Law 111-148) is 
amended by striking ``and 2010'' and inserting ``2010, and 2011''.
    SEC. 106. EXTENSION OF AMBULANCE ADD-ONS.
    (a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social 
Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended--
        (1) in the matter preceding clause (i), by striking ``2011'' 
    and inserting ``2012,''; and
        (2) in each of clauses (i) and (ii), by striking ``January 1, 
    2011'' and inserting ``January 1, 2012'' each place it appears.
    (b) Air Ambulance.--Section 146(b)(1) of the Medicare Improvements 
for Patients and Providers Act of 2008 (Public Law 110-275), as amended 
by sections 3105(b) and 10311(b) of Public Law 111-148, is amended by 
striking ``December 31, 2010'' and inserting ``December 31, 2011''.
    (c) Super Rural Ambulance.--Section 1834(l)(12)(A) of the Social 
Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking 
``2011'' and inserting ``2012''.
    SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL HEALTH ADD-ON 
      PAYMENT.
    Section 138(a)(1) of the Medicare Improvements for Patients and 
Providers Act of 2008 (Public Law 110-275), as amended by section 3107 
of the Patient Protection and Affordable Care Act (Public Law 111-148), 
is amended by striking ``December 31, 2010'' and inserting ``December 
31, 2011''.
    SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS PROVISION.
    Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 
1395l(t)(7)(D)(i)), as amended by section 3121(a) of the Patient 
Protection and Affordable Care Act (Public Law 111-148), is amended--
        (1) in subclause (II)--
            (A) in the first sentence, by striking ``2011'' and 
        inserting ``2012''; and
            (B) in the second sentence, by striking ``or 2010'' and 
        inserting ``2010, or 2011''; and
        (2) in subclause (III), by striking ``January 1, 2011'' and 
    inserting ``January 1, 2012''.
    SEC. 109. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS FOR 
      CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS FURNISHED TO 
      HOSPITAL PATIENTS IN CERTAIN RURAL AREAS.
    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), section 107 of the Medicare, Medicaid, and SCHIP 
Extension Act of 2007 (42 U.S.C. 1395l note), and section 3122 of the 
Patient Protection and Affordable Care Act (Public Law 111-148), is 
amended by striking ``the 1-year period beginning on July 1, 2010'' and 
inserting ``the 2-year period beginning on July 1, 2010''.
    SEC. 110. EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) PROGRAM.
    (a) Extension.--Section 1902(a)(10)(E)(iv) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking ``December 
2010'' and inserting ``December 2011''.
    (b) Extending Total Amount Available for Allocation.--Section 
1933(g) of such Act (42 U.S.C. 1396u-3(g)) is amended--
        (1) in paragraph (2)--
            (A) by striking ``and'' at the end of subparagraph (M);
            (B) in subparagraph (N), by striking the period at the end 
        and inserting a semicolon; and
            (C) by adding at the end the following new subparagraphs:
            ``(O) for the period that begins on January 1, 2011, and 
        ends on September 30, 2011, the total allocation amount is 
        $720,000,000; and
            ``(P) for the period that begins on October 1, 2011, and 
        ends on December 31, 2011, the total allocation amount is 
        $280,000,000.''; and
        (2) in paragraph (3), in the matter preceding subparagraph (A), 
    by striking ``or (N)'' and inserting ``(N), or (P)''.
    SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA).
    Sections 1902(e)(1)(B) and 1925(f) of the Social Security Act (42 
U.S.C. 1396a(e)(1)(B), 1396r-6(f)) are each amended by striking 
``December 31, 2010'' and inserting ``December 31, 2011''.
    SEC. 112. SPECIAL DIABETES PROGRAMS.
        (1) Special diabetes programs for type i diabetes.--Section 
    330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
    2(b)(2)(C)) is amended by striking ``2011'' and inserting ``2013''.
        (2) Special diabetes programs for indians.--Section 
    330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
    3(c)(2)(C)) is amended by striking ``2011'' and inserting ``2013''.

                       TITLE II--OTHER PROVISIONS

    SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B SPECIAL 
      ENROLLMENT PERIOD FOR DISABLED TRICARE BENEFICIARIES.
    Effective as if included in the enactment of Public Law 111-148, 
section 3110(a)(2) of such Act is amended to read as follows:
        ``(2) Effective date.--The amendment made by paragraph (1) 
    shall apply to elections made on and after the date of the 
    enactment of this Act.''.
    SEC. 202. REPEAL OF DELAY OF RUG-IV.
    Effective as if included in the enactment of Public Law 111-148, 
section 10325 of such Act is repealed.
    SEC. 203. CLARIFICATION FOR AFFILIATED HOSPITALS FOR DISTRIBUTION 
      OF ADDITIONAL RESIDENCY POSITIONS.
    Effective as if included in the enactment of section 5503(a) of 
Public Law 111-148, section 1886(h)(8) of the Social Security Act (42 
U.S.C. 1395ww(h)(8)), as added by such section 5503(a), is amended by 
adding at the end the following new subparagraph:
            ``(I) Affiliation.--The provisions of this paragraph shall 
        be applied to hospitals which are members of the same 
        affiliated group (as defined by the Secretary under paragraph 
        (4)(H)(ii)) and the reference resident level for each such 
        hospital shall be the reference resident level with respect to 
        the cost reporting period that results in the smallest 
        difference between the reference resident level and the 
        otherwise applicable resident limit.''.
    SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN DEFINITION OF 
      COVERED OUTPATIENT DRUGS WITH RESPECT TO CHILDREN'S HOSPITALS 
      UNDER THE 340B DRUG DISCOUNT PROGRAM.
    (a) Definition of Covered Outpatient Drug.--
        (1) Amendment.--Subsection (e) of section 340B of the Public 
    Health Service Act (42 U.S.C. 256b) is amended by striking 
    ``covered entities described in subparagraph (M)'' and inserting 
    ``covered entities described in subparagraph (M) (other than a 
    children's hospital described in subparagraph (M))''.
        (2) Effective date.--The amendment made by paragraph (1) shall 
    take effect as if included in the enactment of section 2302 of the 
    Health Care and Education Reconciliation Act of 2010 (Public Law 
    111-152).
    (b) Technical Amendment.--Subparagraph (B) of section 1927(a)(5) of 
the Social Security Act (42 U.S.C. 1396r-8(a)(5)) is amended by 
striking ``and a children's hospital'' and all that follows through the 
end of the subparagraph and inserting a period.
    SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS.
    (a) Repeal of Exclusion of Certain Individuals and Entities From 
Medicaid.--Section 1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended by striking paragraph (78).
    (b) Income Level for Certain Children Under Medicaid.--Section 
1902(l)(2)(C) of the Social Security Act (42 U.S.C. 1396a(l)(2)(C)) is 
amended by striking ``133 percent'' and inserting ``100 percent (or, 
beginning January 1, 2014, 133 percent)''.
    (c) Calculation and Publication of Payment Error Rate Measurement 
for Certain Years.--Section 601(b) of the Children's Health Insurance 
Program Reauthorization Act of 2009 (Public Law 111-3) is amended by 
adding at the end the following: ``The Secretary is not required under 
this subsection to calculate or publish a national or a State-specific 
error rate for fiscal year 2009 or fiscal year 2010.''.
    (d) Corrections to Exceptions to Exclusion of Children of Certain 
Employees.--Section 2110(b)(6) of the Social Security Act (42 U.S.C. 
1397jj(b)(6)) is amended--
        (1) in subparagraph (B)--
            (A) by striking ``per person'' in the heading; and
            (B) by striking ``each employee'' and inserting 
        ``employees''; and
        (2) in subparagraph (C), by striking ``, on a case-by-case 
    basis,''.
    (e) Electronic Health Records.--Effective as if included in the 
enactment of section 4201(a)(2) of the American Recovery and 
Reinvestment Act of 2009 (Public Law 111-5), section 1903(t) of the 
Social Security Act (42 U.S.C. 1396b(t)) is amended--
        (1) in paragraph (3)(E), by striking ``reduced by any payment 
    that is made to such Medicaid provider from any other source (other 
    than under this subsection or by a State or local government)'' and 
    inserting ``reduced by the average payment the Secretary estimates 
    will be made to such Medicaid providers (determined on a percentage 
    or other basis for such classes or types of providers as the 
    Secretary may specify) from other sources (other than under this 
    subsection, or by the Federal government or a State or local 
    government)''; and
        (2) in paragraph (6)(B), by inserting before the period the 
    following: ``and shall be determined to have met such 
    responsibility to the extent that the payment to the Medicaid 
    provider is not in excess of 85 percent of the net average 
    allowable cost''.
    (f) Corrections of Designations.--
        (1) Section 1902 of the Social Security Act (42 U.S.C. 1396a) 
    is amended--
            (A) in subsection (a)(10), in the matter following 
        subparagraph (G), by striking ``and'' before ``(XVI) the 
        medical'' and by striking ``(XVI) if'' and inserting ``(XVII) 
        if'';
            (B) in subsection (a)(23), by striking ``(ii)'' and 
        inserting ``(kk)'';
            (C) in subsection (a)(77), by striking ``(ii)'' and 
        inserting ``(kk)'';
            (D) in subsection (ii)(2), as added by section 2303(a)(2) 
        of Public Law 111-148, by striking ``(XV)'' and inserting 
        ``(XVI)''; and
            (E) by redesignating subsection (ii), as added by section 
        6401(b)(1)(B) of Public Law 111-148, as subsection (kk) and 
        transferring such subsection so as to appear after subsection 
        (jj) of that section.
        (2) Section 2107(e)(1) of the Social Security Act (42 U.S.C. 
    1397gg(e)(1)) is amended--
            (A) in subparagraph (D), as added by section 6401(c) of 
        Public Law 111-148, by striking ``(ii)'' and inserting 
        ``(kk)''; and
            (B) by redesignating the subparagraph (N) of that section 
        added by 2101(e) of Public Law 111-148 as subparagraph (O).
    SEC. 206. FUNDING FOR CLAIMS REPROCESSING.
    For purposes of carrying out the provisions of, and amendments made 
by, this Act that relate to title XVIII of the Social Security Act, and 
other provisions of, or relating to, such title that ensure appropriate 
payment of claims, there are appropriated to the Secretary of Health 
and Human Services for the Centers for Medicare & Medicaid Services 
Program Management Account, from amounts in the general fund of the 
Treasury not otherwise appropriated, $200,000,000. Amounts appropriated 
under the preceding sentence shall be in addition to any other funds 
available for such purposes, shall remain available until expended, and 
shall not be used to implement changes to title XVIII of the Social 
Security Act made by Public Laws 111-148 and 111-152.
    SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT FUND.
    Section 1898(b)(1)(B) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)(B)) is amended by striking ``$550,000,000'' and inserting 
``$275,000,000''.
    SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOVERED ON 
      RECONCILIATION OF THE HEALTH INSURANCE TAX CREDIT AND THE ADVANCE 
      OF THAT CREDIT.
    (a) In General.--So much of section 36B(f)(2)(B) of the Internal 
Revenue Code of 1986 as precedes clause (ii) thereof is amended to read 
as follows:
            ``(B) Limitation on increase.--
                ``(i) In general.--In the case of a taxpayer whose 
            household income is less than 500 percent of the poverty 
            line for the size of the family involved for the taxable 
            year, the amount of the increase under subparagraph (A) 
            shall in no event exceed the applicable dollar amount 
            determined in accordance with the following table (one-half 
            of such amount in the case of a taxpayer whose tax is 
            determined under section 1(c) for the taxable year):


----------------------------------------------------------------------------------------------------------------
    ``If the household income (expressed as a percent of
                     poverty line) is:                                 The applicable dollar amount is:
----------------------------------------------------------------------------------------------------------------
Less than 200%.............................................  $600
At least 200% but less than 250%...........................  $1,000
At least 250% but less than 300%...........................  $1,500
At least 300% but less than 350%...........................  $2,000
At least 350% but less than 400%...........................  $2,500
At least 400% but less than 450%...........................  $3,000
At least 450% but less than 500%...........................  $3,500''.
----------------------------------------------------------------------------------------------------------------


''.    (b) Conforming Amendment.--Section 36B(f)(2)(B)(ii) of such Code 
is amended by inserting ``in the table contained'' after ``each of the 
dollar amounts''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2013.
    SEC. 209. DETERMINATION OF BUDGETARY EFFECTS.
    (a) In General.--The budgetary effects of this Act, for the purpose 
of complying with the Statutory Pay-As-You-Go Act of 2010, shall be 
determined by reference to the latest statement titled ``Budgetary 
Effects of PAYGO Legislation'' for this Act, submitted for printing in 
the Congressional Record by the Chairman of the Senate Budget 
Committee, provided that such statement has been submitted prior to the 
vote on passage.
    (b) Emergency Designation for Congressional Enforcement.--In the 
House of Representatives, this Act, with the exception of section 101, 
is designated as an emergency for purposes of pay-as-you-go principles.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.