1.Short title; table of contents
(a)This Act may be cited as the Medicare and Medicaid Extenders Act of 2010
.
(b)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.
<enum>I</enum><header>Extensions</header>
<section id="H6DB333DF36404FD1903BED8D1459D26A"><enum>101.</enum><header>Physician payment update</header><text display-inline="no-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H51DCDBA89A0549CC95375A45CFB282C1" style="OLC">
<paragraph id="HA9374164FEE7430BAF3E0795FC074BB6"><enum>(12)</enum><header>Update for 2011</header>
<subparagraph id="H781BFF2A808D48B1B63D3067CB906446"><enum>(A)</enum><header>In general</header><text>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.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H50AC5A9C3510409EAF03A6C1DBA803F8"><enum>(B)</enum><header>No effect on computation of conversion factor for 2012 and subsequent years</header><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section commented="no" id="H2FD9E95E881742F28F02CC061EB51C38"><enum>102.</enum><header>Extension of MMA section 508 reclassifications</header>
<subsection commented="no" id="H1C99F3724A1F48949AA1C7215B9008D1"><enum>(a)</enum><header>Extension</header>
<paragraph commented="no" id="H5B2DB5AAE3A4450EA9D2E40607ABABFF"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 <quote>September 30, 2010</quote> and inserting <quote>September 30, 2011</quote>.</text></paragraph>
<paragraph id="H423BB1EA41BB44B0A6D9D5F1EE7DE59E"><enum>(2)</enum><header>Special rule for fiscal year 2011</header>
<subparagraph id="H58A878E1FA6C45199C230C7EAE923593"><enum>(A)</enum><header>In general</header><text>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.</text></subparagraph>
<subparagraph commented="no" id="HD2A7707CE52640EC8F608B623C52ED3C"><enum>(B)</enum><header>Exception</header><text>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.</text></subparagraph></paragraph>
<paragraph commented="no" id="H27363F0F434F48A48A924BB33D70DCD7"><enum>(3)</enum><header>Adjustment for certain hospitals in fiscal year 2011</header>
<subparagraph commented="no" id="H9A2077E8A4B241DE841882E65C83A57C"><enum>(A)</enum><header>In general</header><text>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—</text>
<clause commented="no" id="H51AE5B728D3E4153BD23B67632D40ABE"><enum>(i)</enum><text>a reclassification of its wage index for purposes of such section was extended pursuant to the amendment made by paragraph (1); and</text></clause>
<clause commented="no" id="H7C1106597C984348A8069DDE1D73011F"><enum>(ii)</enum><text>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);</text></clause><continuation-text commented="no" continuation-text-level="subparagraph">the Secretary shall pay such hospital an additional payment that reflects the difference between the wage index for such periods.</continuation-text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H357615EE85364D5EBE08CDA2D55721E9"><enum>(B)</enum><header>Timeframe for payments</header><text>The Secretary shall make payments required under subparagraph (A) by not later than December 31, 2011.</text></subparagraph></paragraph></subsection>
<subsection id="H63DAD503E5064D5B9E7E9862EC593CC5"><enum>(b)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline">Section 117(a)(3) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173) is amended by inserting <quote>in fiscal years 2008 and 2009</quote> after “For purposes of implementation of this subsection”.</text></subsection></section>
<section display-inline="no-display-inline" id="HFEA58BB77FDC4E6DA537C41B5EE78323" section-type="subsequent-section"><enum>103.</enum><header>Extension of Medicare work geographic adjustment floor</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)) is amended by striking <quote>before January 1, 2011</quote> and inserting <quote>before January 1, 2012</quote>.</text></section>
<section display-inline="no-display-inline" id="H2E1A7E49C899466F94166DD2716DD284" section-type="subsequent-section"><enum>104.</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>and ending on</quote> and all that follows through <quote>2010</quote> and inserting <quote>and ending on December 31, 2011</quote>.</text></section>
<section commented="no" id="HAD6A1BE3116F4E03B9C98A0E7A69EB34"><enum>105.</enum><header>Extension of payment for technical component of certain physician pathology services</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), 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 <quote>and 2010</quote> and inserting <quote>2010, and 2011</quote>.</text></section>
<section id="H4227782D51684EFCBB38707D47958B7C"><enum>106.</enum><header>Extension of ambulance add-ons</header>
<subsection id="H5290EEF807F34D929928F0F5566CF490"><enum>(a)</enum><header>Ground ambulance</header><text display-inline="yes-display-inline">Section 1834(l)(13)(A) of the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended—</text>
<paragraph id="HEB12A9E46D6C47EF93499AE8CF02B0F4"><enum>(1)</enum><text>in the matter preceding clause (i), by striking <quote>2011</quote> and inserting <quote>2012,</quote>; and</text></paragraph>
<paragraph id="H735A4023DC6A47C594DFD41D8CE977C0"><enum>(2)</enum><text>in each of clauses (i) and (ii), by striking <quote>January 1, 2011</quote> and inserting <quote>January 1, 2012</quote> each place it appears.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H7E2DB71663EE4B93B4C48C3548AC8B30"><enum>(b)</enum><header>Air Ambulance</header><text display-inline="yes-display-inline">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 <quote>December 31, 2010</quote> and inserting <quote>December 31, 2011</quote>.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HA8325D72880E46DD8A7D872BCDDDF2EE"><enum>(c)</enum><header>Super rural ambulance</header><text display-inline="yes-display-inline">Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking <quote>2011</quote> and inserting <quote>2012</quote>.</text></subsection></section>
<section display-inline="no-display-inline" id="H600BC936EBB64947A600B74E3FE40C17" section-type="subsequent-section"><enum>107.</enum><header>Extension of physician fee schedule mental health add-on payment</header><text display-inline="no-display-inline">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 <quote>December 31, 2010</quote> and inserting <quote>December 31, 2011</quote>.</text></section>
<section id="HFFD2FB65590942F1833B3BE62967C8A4"><enum>108.</enum><header>Extension of outpatient hold harmless provision</header><text display-inline="no-display-inline">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—</text>
<paragraph id="HD432BA373389459DBBA1CF741B4FF87F"><enum>(1)</enum><text>in subclause (II)—</text>
<subparagraph id="H14934F552D5640CC900DE3F3C9D799BD"><enum>(A)</enum><text display-inline="yes-display-inline">in the first sentence, by striking <quote>2011</quote> and inserting <quote>2012</quote>; and</text></subparagraph>
<subparagraph id="H3DB0154919CB487E8EF2A7B108B2BFD2"><enum>(B)</enum><text>in the second sentence, by striking <quote>or 2010</quote> and inserting <quote>2010, or 2011</quote>; and</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HDE293E2D0A434B96B3406605D1BB542F"><enum>(2)</enum><text>in subclause (III), by striking <quote>January 1, 2011</quote> and inserting <quote>January 1, 2012</quote>.</text></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="H21A90B6911FA4CF98E4331AC5BB93D9C"><enum>109.</enum><header display-inline="yes-display-inline">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), 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 <quote>the 1-year period beginning on July 1, 2010</quote> and inserting <quote>the 2-year period beginning on July 1, 2010</quote>.</text></section>
<section id="HC8094A09C7784DC29081AFB7A9271B56"><enum>110.</enum><header>Extension of the qualifying individual (QI) program</header>
<subsection id="HDA7FA683FF3B4B38B1E98BA77DF58D5D"><enum>(a)</enum><header>Extension</header><text display-inline="yes-display-inline">Section 1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking <quote>December 2010</quote> and inserting <quote>December 2011</quote>.</text></subsection>
<subsection id="H9BFB046CD04846078C859774DAA0D3EA"><enum>(b)</enum><header>Extending total amount available for allocation</header><text>Section 1933(g) of such Act (42 U.S.C. 1396u-3(g)) is amended—</text>
<paragraph id="H7BC58533A24640C8B9BB39CE3A53146F"><enum>(1)</enum><text>in paragraph (2)—</text>
<subparagraph id="H8A12DC4A7E1349A89496C0F947A04F00"><enum>(A)</enum><text>by striking <quote>and</quote> at the end of subparagraph (M);</text></subparagraph>
<subparagraph id="HBA43F00B4A0243E9BD772D5AB1D3964A"><enum>(B)</enum><text>in subparagraph (N), by striking the period at the end and inserting a semicolon; and</text></subparagraph>
<subparagraph id="H7EB9B55DA2F842B5988EF10A158444C5"><enum>(C)</enum><text>by adding at the end the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="HC6372A6D68AE45999F670095959B2BD5" style="OLC">
<subparagraph id="H28C5B3BBFCE44BE59A5C0ADC8D33FD38"><enum>(O)</enum><text>for the period that begins on January 1, 2011, and ends on September 30, 2011, the total allocation amount is $720,000,000; and</text></subparagraph>
<subparagraph id="H1F379CB45D7244DA861A9A91BA62A66D"><enum>(P)</enum><text>for the period that begins on October 1, 2011, and ends on December 31, 2011, the total allocation amount is $280,000,000.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="H1E11F7B232DE4858A9C03757A3934B00"><enum>(2)</enum><text>in paragraph (3), in the matter preceding subparagraph (A), by striking <quote>or (N)</quote> and inserting <quote>(N), or (P)</quote>.</text></paragraph></subsection></section>
<section commented="no" display-inline="no-display-inline" id="HF5871A297B574D698E16C5C1D0D42BD8" section-type="subsequent-section"><enum>111.</enum><header>Extension of Transitional Medical Assistance (TMA)</header><text display-inline="no-display-inline">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 <quote>December 31, 2010</quote> and inserting <quote>December 31, 2011</quote>.</text></section>
<section id="H581DF903AE1F4FDCA56ABB3E633A0C69"><enum>112.</enum><header>Special diabetes programs</header>
<paragraph id="HB9097CD6E9334AF58E569FD899CBDD24"><enum>(1)</enum><header>Special diabetes programs for type i diabetes</header><text>Section 330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c–2(b)(2)(C)) is amended by striking <quote>2011</quote> and inserting <quote>2013</quote>.</text></paragraph>
<paragraph id="H3FFE8C1A406A452696FCBED65430B313"><enum>(2)</enum><header>Special diabetes programs for indians</header><text>Section 330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 254c–3(c)(2)(C)) is amended by striking <quote>2011</quote> and inserting <quote>2013</quote>.</text></paragraph></section>
<enum>II</enum><header>Other provisions</header>
<section display-inline="no-display-inline" id="H7BAC7BF9E5F946B987DCD4097E68C9DD"><enum>201.</enum><header>Clarification of effective date of part B special enrollment period for disabled TRICARE beneficiaries</header><text display-inline="no-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H123864CE7051465D81F7C3118A8C18FE" style="OLC">
<paragraph id="H92A3CC5BE9054B9D97535F69C708AFD3"><enum>(2)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendment made by paragraph (1) shall apply to elections made on and after the date of the enactment of this Act.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section commented="no" id="H14A1571E379147178E8F9DFC132FBBA2"><enum>202.</enum><header>Repeal of delay of RUG–IV</header><text display-inline="no-display-inline">Effective as if included in the enactment of Public Law 111–148, section 10325 of such Act is repealed.</text></section>
<section id="H8EBE3B79C7BB4BE8AB110785931F916F" section-type="subsequent-section"><enum>203.</enum><header>Clarification for affiliated hospitals for distribution of additional residency positions</header><text display-inline="no-display-inline">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:</text>
<quoted-block display-inline="no-display-inline" id="H3355F690CC904895B21D72D408FD2E8F" style="OLC">
<subparagraph id="H3E41F3093D6D40848D2952D85DF6AD46"><enum>(I)</enum><header>Affiliation</header><text display-inline="yes-display-inline">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.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="HB34D2110FEE044E1A512E3529EF09F0F"><enum>204.</enum><header>Continued inclusion of orphan drugs in definition of covered outpatient drugs with respect to children’s hospitals under the 340B drug discount program</header>
<subsection id="H9AB24309847C424A8261993E69049FD6"><enum>(a)</enum><header>Definition of covered outpatient drug</header>
<paragraph id="HDBA225D0A95A4B47966D8006EB632021"><enum>(1)</enum><header>Amendment</header><text>Subsection (e) of section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended by striking <quote>covered entities described in subparagraph (M)</quote> and inserting <quote>covered entities described in subparagraph (M) (other than a children’s hospital described in subparagraph (M))</quote>.</text></paragraph>
<paragraph id="H6AA13648AFC748F78C416F0169E7E9B5"><enum>(2)</enum><header>Effective date</header><text>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).</text></paragraph></subsection>
<subsection id="HD9984099AB9D4A16AF5B9B865E6B8CFA"><enum>(b)</enum><header>Technical amendment</header><text>Subparagraph (B) of section 1927(a)(5) of the Social Security Act (42 U.S.C. 1396r–8(a)(5)) is amended by striking <quote>and a children’s hospital</quote> and all that follows through the end of the subparagraph and inserting a period.</text></subsection></section>
<section id="H25FA55D45898474FABE76DC1898DE3B2" section-type="subsequent-section"><enum>205.</enum><header>Medicaid and CHIP technical corrections</header>
<subsection id="H3B15042431384C2090A8E0E006EE71D2"><enum>(a)</enum><header>Repeal of exclusion of certain individuals and entities from Medicaid</header><text display-inline="yes-display-inline">Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended by striking paragraph (78).</text></subsection>
<subsection id="HB64C20731F0A41D5A3F9634390C60544"><enum>(b)</enum><header>Income level for certain children under Medicaid</header><text>Section 1902(l)(2)(C) of the Social Security Act (42 U.S.C. 1396a(l)(2)(C)) is amended by striking <quote>133 percent</quote> and inserting <quote>100 percent (or, beginning January 1, 2014, 133 percent)</quote>.</text></subsection>
<subsection id="HFE032E7361124E4D89FD61E788CD2B3A"><enum>(c)</enum><header>Calculation and publication of payment error rate measurement for certain years</header><text display-inline="yes-display-inline">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.’’.</text></subsection>
<subsection id="H5DA6E882AC3042B2B8CEB883A398E7E8"><enum>(d)</enum><header>Corrections to exceptions to exclusion of children of certain employees</header><text>Section 2110(b)(6) of the Social Security Act (42 U.S.C. 1397jj(b)(6)) is amended—</text>
<paragraph id="HD8EE9DB4D59D494498F6AC3833488175"><enum>(1)</enum><text>in subparagraph (B)—</text>
<subparagraph id="H570F84A517FE4513A88D6236CB8E41CA"><enum>(A)</enum><text>by striking <quote><header-in-text level="subparagraph" style="OLC">per person</header-in-text></quote> in the heading; and</text></subparagraph>
<subparagraph id="H8DBB89605911498F9AD46451D7C6DBE3"><enum>(B)</enum><text>by striking <quote>each employee</quote> and inserting <quote>employees</quote>; and</text></subparagraph></paragraph>
<paragraph commented="no" id="H983CCDD4F8784B14980D965043CC6355"><enum>(2)</enum><text>in subparagraph (C), by striking <quote>, on a case-by-case basis,</quote>.</text></paragraph></subsection>
<subsection id="H29E0762A1C5444EC9CA55A6B4636E56F"><enum>(e)</enum><header>Electronic health records</header><text>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—</text>
<paragraph id="H5E821968A4244EF1BD431CA7F51270C3"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (3)(E), by striking <quote>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)</quote> and inserting <quote>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)</quote>; and</text></paragraph>
<paragraph id="HD433E75AB151481DB3D8F69875F3DE3E"><enum>(2)</enum><text>in paragraph (6)(B), by inserting before the period the following: <quote>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</quote>.</text></paragraph></subsection>
<subsection id="H099CB90A08B7455F9AD5A4E79FC68144"><enum>(f)</enum><header>Corrections of designations</header>
<paragraph display-inline="no-display-inline" id="H05746482F34646CB8614BBB637A7E161"><enum>(1)</enum><text>Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—</text>
<subparagraph id="HFC394A615C894DF29272EA4E8D7A8F44"><enum>(A)</enum><text>in subsection (a)(10), in the matter following subparagraph (G), by striking <quote>and</quote> before <quote>(XVI) the medical</quote> and by striking <quote>(XVI) if</quote> and inserting <quote>(XVII) if</quote>;</text></subparagraph>
<subparagraph id="H5D91BFE0CCE0420B94B1709F21E8700C"><enum>(B)</enum><text>in subsection (a)(23), by striking <quote>(ii)</quote> and inserting <quote>(kk)</quote>;</text></subparagraph>
<subparagraph id="HF9E0209753854753AE0883276E39413C"><enum>(C)</enum><text>in subsection (a)(77), by striking <quote>(ii)</quote> and inserting <quote>(kk)</quote>;</text></subparagraph>
<subparagraph id="HB0949262849149A4A92B7BDE05F8883F"><enum>(D)</enum><text>in subsection (ii)(2), as added by section 2303(a)(2) of Public Law 111–148, by striking <quote>(XV)</quote> and inserting <quote>(XVI)</quote>; and</text></subparagraph>
<subparagraph id="H8B92CE01A7DC4F3082390DBF224F91A3"><enum>(E)</enum><text>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.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H6EFFE2C556BD40C39CB0EEE518E0E352"><enum>(2)</enum><text display-inline="yes-display-inline">Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H47BA6A9116D44071B8D0C66C94464E99"><enum>(A)</enum><text>in subparagraph (D), as added by section 6401(c) of Public Law 111–148, by striking <quote>(ii)</quote> and inserting <quote>(kk)</quote>; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H61B3C6F9E950447E9D5C5E1C1C0FB865"><enum>(B)</enum><text display-inline="yes-display-inline">by redesignating the subparagraph (N) of that section added by 2101(e) of Public Law 111–148 as subparagraph (O).</text></subparagraph></paragraph></subsection></section>
<section display-inline="no-display-inline" id="H50E64D826B5A4884A202F43026289080" section-type="subsequent-section"><enum>206.</enum><header>Funding for claims reprocessing</header><text display-inline="no-display-inline">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.</text></section>
<section id="H9EFCFD8FF4D94093BC28B05AC1639CD8"><enum>207.</enum><header>Revision to the Medicare Improvement Fund</header><text display-inline="no-display-inline">Section 1898(b)(1)(B) of the Social Security Act (42 U.S.C. 1395iii(b)(1)(B)) is amended by striking <quote>$550,000,000</quote> and inserting <quote>$275,000,000</quote>.</text></section>
<section id="H34E0A4A1FA09418093E6E9B89279D27C"><enum>208.</enum><header>Limitations on aggregate amount recovered on reconciliation of the health insurance tax credit and the advance of that credit</header>
<subsection id="HBE8E8B7F67B4477E9E996EF7DA597D24"><enum>(a)</enum><header>In general</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H8752928926B147839431C693D62F1EBB" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="HA1171F41FF8B4961A905096293084CF4"><enum>(B)</enum><header display-inline="yes-display-inline">Limitation on increase</header>
<clause commented="no" display-inline="no-display-inline" id="H7F3328336CC84EBE9A89DF6754CFDFC0"><enum>(i)</enum><header>In general</header><text>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):</text>
<table align-to-level="section" blank-lines-before="1" colsep="1" frame="topbot" line-rules="hor-ver" rowsep="0" rule-weights="4.4.4.0.0.0" table-template-name="Generic: 2 text, 1st longer" table-type="">
<tgroup cols="2" grid-typeface="1.1" no-carding="1" rowsep="0" thead-tbody-ldg-size="10.10.12"><colspec coldef="txt" colname="column1" colwidth="217pts" min-data-value="200" rowsep="0"/><colspec coldef="txt-no-ldr" colname="column2" colwidth="108pts" min-data-value="100"/><thead>
<row><entry align="center" colname="column1" morerows="0" namest="column1" rowsep="1">If the household income (expressed as a percent of poverty line) is:</entry><entry align="center" colname="column2" morerows="0" namest="column2" rowsep="1">The applicable dollar amount is:</entry></row></thead>
<tbody>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">Less than 200%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$600</entry></row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">At least 200% but less than 250%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$1,000</entry></row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">At least 250% but less than 300%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$1,500</entry></row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">At least 300% but less than 350%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$2,000</entry></row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">At least 350% but less than 400%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$2,500</entry></row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">At least 400% but less than 450%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$3,000</entry></row>
<row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">At least 450% but less than 500%</entry><entry align="left" colname="column2" leader-modify="clr-ldr" rowsep="0">$3,500</entry></row></tbody></tgroup></table></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H2939AD628DEB479698995DB3A7114F4A"><enum>(b)</enum><header>Conforming amendment</header><text>Section 36B(f)(2)(B)(ii) of such Code is amended by inserting <quote>in the table contained</quote> after <quote>each of the dollar amounts</quote>.</text></subsection>
<subsection id="H26075F491E4A4D8B94767D3564B446F2"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to taxable years beginning after December 31, 2013.</text></subsection></section>
<section commented="no" display-inline="no-display-inline" id="HA76AA8669C7B4EE3917F7F4C66BA3DC8" section-type="subsequent-section"><enum>209.</enum><header display-inline="yes-display-inline">Determination of budgetary effects</header>
<subsection commented="no" display-inline="no-display-inline" id="HD42F9403141E400999942DB3FFDE3E62"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">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 <quote>Budgetary Effects of PAYGO Legislation</quote> 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.</text></subsection>
<subsection commented="no" id="HF3336D3BDE5D4E30A4DFDF13E116EF9A"><enum>(b)</enum><header>Emergency Designation for Congressional Enforcement</header><text>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.</text></subsection></section>
Speaker of the House of Representatives.Vice President of the United States and President of the Senate.