[Congressional Record Volume 153, Number 194 (Tuesday, December 18, 2007)]
[Senate]
[Pages S15834-S15843]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE, MEDICAID, AND SCHIP EXTENSION ACT OF 2007
Mr. DURBIN. Mr. President, I ask unanimous consent that the Senate
proceed to immediate consideration S. 2499, introduced earlier today.
The PRESIDING OFFICER. The clerk will report the bill by title.
The assistant legislative clerk read as follows:
A bill (S. 2499) 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.
There being no objection, the Senate proceeded to consider the bill.
Mr. GRASSLEY. Mr. President, as we approach the end of 2007, one
cannot help but look ahead and see that there are many challenges that
await us in the second session of the 110th Congress, specially in
addressing issues relating to health care. In 2008, we will need to
take a serious look at many issues in the Medicare Program. Among them
will be continuing to work on developing a solution for Medicare's
flawed physician reimbursement system. As usual, I look forward to
working with my partner on the Senate Finance Committee, chairman,
Senator Max Baucus, in our usual bipartisan way to address this and
many other issues.
However, before we could adjourn this first session and go home to
enjoy the holidays with our families, there was still urgent work to
finish. That was the purpose of this exercise. In the legislation we
considered today, there were several provisions that rise to the level
of ``must do's.'' These included ensuring that physicians do not
receive a drastic cut in their Medicare reimbursement and extending a
number of expiring provisions including the State Children's Health
Insurance Program.
Ensuring health care access to my constituents is a top priority of
mine and the possibility of a negative update for physicians was of
great concern to me as well as to doctors and patients in Iowa and
elsewhere. When discussions began to solve this problem I was in favor
of a 2-year update. I know that several of my colleagues were as well.
But in continuing negotiations with the House and Senate colleagues it
became apparent that a 2-year fix was not possible.
I wanted to do more. I know Senator Baucus wanted to do more. We were
unable to reach consensus even on the Republican side either and,
therefore, the Finance Committee was unable to move ahead with the
legislation that Senator Baucus and I had been developing.
Unfortunately, for a variety of complex reasons, we are now here with a
much more limited package. This is a disappointment for many of us. So
the purpose of moving forward with a 6-month package now is to provide
the opportunity for the Finance Committee to address these priorities
next year.
One of my first priorities has been to ensure access to rural
hospital services. Since hospitals are often not only the sole provider
of health care in rural areas, but also significant employers and
purchasers in the community, it is especially important that they are
able to keep their doors open. One group of hospitals that I am
especially concerned about are ``tweener'' hospitals, which are too
large to be critical access hospitals, but too small to be financially
viable under the Medicare hospital prospective payment systems. The
struggles these facilities face in Iowa are real and serious. I am very
disappointed we were not able to help these hospitals in this package.
I look forward to working with Senator Baucus and other Members to
include ``tweener'' hospital improvements in next year's package.
Second, we must address the problem of specialty hospitals. I have
been an outspoken advocate against these facilities for several years
now. My primary concern with these facilities is the inherent conflict
of interest that exists when physicians have an ownership interest in
the facilities to which they refer patients. The best interest of the
patient should always be the deciding factor when a referral for
treatment is made, not the financial self-interest of the doctor who is
treating the patient. I strongly support a competitive marketplace and
free market forces, but not at the expense of decreasing access to
health care for the poor and uninsured or decreasing the quality of
care for and safety of patients. I have been and remain concerned about
the ability of community hospitals to provide care to all patients. I
also look forward to working with Senator Baucus on addressing this
issue in our package next year.
There are a number of other important issues that need to be
addressed as well. We need to take on the reforms of the Medicare
Quality Improvement Organization Program, we need to inject some
sunshine into the payments that drug companies make to doctors, and we
also need to make sure that Medicare is part of the solution when it
comes to greater use of electronic prescribing and electronic health
records.
In the meantime, we have this package with the following provisions
that extend a number of Medicare, Medicaid and SCHIP provisions.
This legislation prevents the 10.1 percent cut to physician payment
that would have occurred as of January 1, 2008, and instead gives a 6-
month 0.5 percent update for physicians through June 30, 2008. In
effect, this provides a 10.5 percent increase in physician fees from
what they would otherwise have received beginning in January under
current law. While this is not what many of us had in mind when we
began this process, providing an update through next June will allow
more time and the opportunity for a bill to fully go through the
legislative process beginning with a committee markup next year.
This legislation also continues to provide additional payment
incentives for physicians and other health care practitioners who
report quality measures in the Physician Quality Reporting System. We
must ensure that health care providers can afford to continue to
practice medicine. We must also ensure that beneficiaries have access
to physicians and other health care providers. And we must provide
incentives for quality improvement.
[[Page S15835]]
We also accommodate physicians ordered to active duty in the Armed
Services by extending for 6-months a provision that permits them to
engage in substitute billing arrangements for longer than the 60 days
allowed under current law when they are ordered to active duty.
Our legislation also revises the Physician Assistance and Quality
Initiative Fund, which is intended to help stabilize physician payments
and promote physician quality initiatives.
This new fund will be available in 2008 to help minimize fluctuations
in physician payments and promote physician quality initiatives.
The physician payment changes will be offset, in part, by an
adjustment to the Medicare Advantage stabilization fund. Our
legislation does not repeal the stabilization fund but rather preserves
the fund for future years. We use the $1.5 billion available in 2012,
while preserving the fund in 2013. Given the continued strong
participation by plans in the program right now, the legislation
preserves the fund so that Congress can add more funds in future years
if they are needed.
The legislation extends Medicare private plan cost contracts through
2009, which, without this legislation, are due to expire at the end of
2008. These are longstanding plans that provide health care to Medicare
beneficiaries in many communities but have been unable to convert to
Medicare Advantage plans. In addition, the legislation includes a 1-
year extension to Medicare Advantage special needs plans through 2009.
At the same time, the legislation puts a moratorium on new special
needs plans. When Congress enacted the Medicare Modernization Act in
2003, it created a category of plans intended to provide specialized
care models for certain populations, including Medicare beneficiaries
who are also eligible for Medicaid, those who are chronically and
severely ill or disabled, and those who are institutionalized (for
example, in nursing homes). While these plans have proliferated, it is
unclear how well they are meeting their mission of specialized care.
The legislation freezes the program at the plans currently approved so
that Congress and CMS can monitor the plans' performance and determine
if any changes are needed.
In addition to reforming the manner in which Medicare pays for
physician services, this legislation will extend several expiring
provisions enacted in the Medicare Modernization Act to help ensure
that beneficiaries will continue to have access to needed medical
services. This includes provisions applicable to rural payments to
physicians, extending the 1.0 floor on the work geographic adjustment,
continuing direct payments to independent laboratories for physician
pathology services, and continuing Medicare reasonable cost payments
for lab tests in small rural hospitals.
Our legislation also provides a 6-month extension of the therapy cap
exceptions process that was included in the Tax Relief and Health Care
Act last year to ensure that beneficiaries receive the physical,
occupational, and speech language therapy services they need. It also
extends the existing payment methodology for brachytherapy services and
extends it to therapeutic radiopharmaceuticals through June 30, 2008.
As in previous legislation that Congress has passed, this legislation
will continue to improve accountability in the Medicare Program. There
are situations when Medicare is not the primary payer for a
beneficiary's health care, but it is currently difficult to identify
these situations. This legislation will improve the Secretary's ability
to identify beneficiaries for whom Medicare is the secondary payer by
requiring group health plans and liability insurers to submit data to
the Secretary.
The legislation will ensure beneficiary access to long-term care
hospitals. These facilities will receive regulatory relief for 3-years.
In order to ensure patients are receiving appropriate levels of care at
long-term care hospitals, facility and medical review requirements will
be established, and the Secretary will be required to conduct a study
on long-term care hospital facility and patient criteria. Also, there
will be a limited moratorium on the development of new long-term care
facilities and a freeze to the annual long-term care hospital payment
update for one quarter in rate year 2008.
The legislation will also ensure beneficiary access to inpatient
rehabilitation facility services by addressing the 75-percent rule.
This rule has been criticized as too blunt an instrument for ensuring
that appropriate patients receive care at these facilities. Under
current law, a percentage of Medicare patients must have at least 1 of
13 listed medical conditions in order to be classified as an inpatient
rehabilitation facility. This percentage or compliance threshold is
currently at 65 percent. This legislation would permanently freeze the
compliance threshold at 60 percent and allow comorbid conditions to
count permanently toward this threshold. The Secretary will be required
to study beneficiary access to inpatient rehabilitation services and
care at inpatient rehabilitation facilities and to make recommendations
for alternatives to the 75-percent rule. In addition, there will be a
freeze to the annual inpatient rehabilitation facility payment update
from April 1, 2008 through fiscal year 2009.
This legislation will also continue to promote more accurate hospital
payments. One aspect of Medicare hospital payments that has been
subject to much criticism is the area wage index. Many say that the
current method of calculating the wage index does not reflect a
hospital's actual labor costs and is instead arbitrary in nature so
that similarly situated hospitals can receive significantly different
wage index values. Since the enactment of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, hospitals have been
able to obtain relief from this unfair situation temporarily.
The legislation also provides more accurate payment for Part B drugs.
It implements recommendations of HHS Office of Inspector General and
requires CMS to adjust its average sales price, ASP, calculation to use
volume-weighted ASPs based on actual sales volume. It also establishes
appropriate reimbursement rates for generic albuterol and for glycated
hemoglobin diabetes laboratory tests.
In the Medicaid arena, the legislation extends the provision of
disproportionate share hospital payments to Tennessee and Hawaii for
the first three-quarters of the current fiscal year. These payments
were authorized for these States for the first time in last year's Tax
Relief and Health Care Act and this is an extension of that policy.
The legislation also delays implementation of recently released
regulations on school-based services and rehabilitation services in
Medicaid so that the Finance Committee can appropriately review those
regulations.
And finally, the legislation also includes an extension of the State
Children's Health Insurance Program, SCHIP, through March 31, 2009.
This provision makes additional funding available so that States do not
have to scale back SCHIP. This SCHIP extension will ensure that no
State has to cut back their program due to insufficient Federal
funding.
I remain hopeful that when the 110th Congress reconvenes next year,
there will be a renewed effort to reauthorize and improve SCHIP.
The bill we considered today addressed the things Congress needed to
do before going home for the holidays. I am pleased we were able to act
quickly and unanimously to pass the bill. I know many of my colleagues
wanted to do more. I know some of my colleagues are disappointed
because their individual priorities could not be included. It is
unfortunate. I do hope we can do more when we come back next year.
Next year is an election year. The caucuses in my home state of Iowa
are but days away. We have important business to conclude in Medicare
and Medicaid and SCHIP. We have a Democratic Congress that has to work
with a slim majority in the Senate and a Republican President. At times
this year, I am not sure my colleagues on the other side of the aisle
fully grasped the consequences of that reality. It certainly shows when
you consider what we could have done this year and what was ultimately
accomplished. I sincerely hope we do a better job of being bipartisan
albeit in a political year.
Let me be clear that I stand ready to roll up my sleeves and get back
to work come January. I am committed to moving ahead with the broader
Medicare package when we return here next year. To make law, that
package
[[Page S15836]]
will have to be one that the President will sign. It will require
bipartisan cooperation and hard work. I am ready to get the job done.
There are many problems that need to be addressed, and we can address
the myriad issues that we left on the table. We can review and act on
the proposed Medicaid regulations that have so many people vexed. We
can pass a SCHIP reauthorization that can become law. We have learned
the pathway to failure this year. I stand ready to join any of my
colleagues who want to join me on the path not taken in 2007 to a more
productive 2008.
As we move to the end of the first session of the 110th Congress, I
want to extend my grateful appreciation to my health staff and others
for the work they have done in 2007. My staff director on the Finance
Committee, Kolan Davis, has been with me for many, many years and
provides me invaluable counsel. My chief health policy counsel, Mark
Hayes, accomplishes more every day than any other hundred people on the
Hill combined and for his tireless work ethic, I am truly thankful. My
Medicare Part A counsel, Mike Park, labored through the last several
weeks though he was sick as a dog because it is that important. My
Medicare Part B counsel, Sue Walden, ably deciphered the multiple
variations we considered for providing an update to the physicians. The
newest member of my team, Kristin Bass, who handles Medicare Parts C
and D, helped us reach thoughtful compromises on numerous challenging
issues. My Medicaid staffer, Rodney Whitlock, deftly handles the most
controversial of issues day in and day out. I particularly want to pay
tribute to my SCHIP staffer, Becky Shipp. We may have not accomplished
what we hoped to do with SCHIP this year, but we wouldn't have been
remotely close without Becky's expertise and effort. My team benefits
from the able assistance of Sean McGuire and Shaun Freiman going above
and beyond the call of duty to make sure the little things get done. I
also want to thank Senator McConnell's point person on health care, Meg
Hauck, for working with us throughout the year. The Finance Committee
benefits from that strong working relationship.
We work as hard as we possibly can to achieve bipartisan consensus in
the Finance Committee and so I also want to pay tribute to Senator
Baucus' staff: staff director Russ Sullivan, Michelle Easton, Neleen
Eisinger, Billy Wynne, Shawn Bishop, David Schwartz, and Catherine
Dratz.
We benefit greatly from the Congressional support staff as well. Tom
Bradley, Tim Gronniger, Shinobu Suzuki, Jeanne De Sa, Eric Rollins and
all of the hard-working scoring gurus at CBO. Jim Fransen, John
Goetcheus, Kelly Malone, and Ruth Ernst at Senate Legislative Counsel.
Jennifer O'Sullivan, Rich Rimkunas, Chris Peterson, April Grady, Elicia
Herz, Sybil Tyson, Mark Hamelburg, Erin Taylor and all the folks at
CRS. Mark Miller and all of his staff at MedPAC. They make us look a
lot more intelligent and effective than we actually are some days.
Finally, I want to thank some folks at CMS. Liz Hall, Erin Clapton,
Ira Burney, Richard Strauss are people who help make sure we get things
right even when we aren't in complete agreement.
In closing, I want to thank all those folks for their hard work in
2007 in service to the people of Iowa, Montana, and all of America.
Thank you.
Mr. HATCH. Mr. President, I rise in support of this package and want
to commend my colleagues on a job well done.
To be fair, it would have been my preference to do a broader bill and
resolve the myriad of Medicare-, Medicaid- and CHIP-related issues we
have been discussing for many months now. Given that this has proven
impossible, my overriding concern is that we move ahead with flawed
correction to the physician reimbursement formula, as this bill does.
Indeed, while most of us would have preferred to have a longer term
physician fix, this bill is a reasonable compromise. Physicians will be
able to practice medicine without having their Medicare reimbursement
rates significantly reduced. And that means that Medicare beneficiaries
will continue to have access to quality health care.
I also am pleased about other provisions in this legislation,
particularly those related to policy on long-term care hospitals and
inpatient rehabilitation facilities, IRFs. With regard to long-term
care hospitals, Senator Conrad and I introduced legislation, S. 1958,
Medicare Long-Term Care Hospital Patient Safety and Improvement Act of
2007. I am proud that the long-term care hospital provisions in today's
Medicare legislation are based on the legislative language from the
Conrad-Hatch bill. The legislation before us provides regulatory relief
to allow continued access to current long-term care hospital services;
requires new facility and medical reviews to ensure that patients are
receiving appropriate care; and authorizes a study by the Secretary of
Health and Human Services, HHS, on long-term care hospitals and patient
criteria. This legislative language reflects compromises that were made
between the various trade groups for long-term care hospitals and
finding policy solutions which generate savings for Medicare.
As a proud cosponsor of S. 543, Preserving Patient Access to
Inpatient Rehabilitation Hospitals Act of 2007, I am also pleased that
the Medicare bill eliminates the 75 percent rule implemented by the
Centers for Medicare and Medicaid Services, CMS, for rehabilitation
hospitals. Instead, this legislation permanently freezes the inpatient
rehabilitation services compliance threshold at 60 percent and allows
comorbid conditions to count toward this threshold. Finally, it
requires the Secretary of HHS to study beneficiary access to inpatient
rehabilitation services and care at IRFs and make recommendations on
how to classify inpatient rehabilitation facility hospitals and units.
Additionally, the legislation before the Senate extends the State
Children's Health Insurance Program, CHIP, through March 31, 2009. Let
me make one point perfectly clear on this provision I--am not going to
give up on reauthorizing the CHIP program for an additional 5 years. I
am still committed to that goal and intend to work with my colleagues
early next year. I will not rest until this program is reauthorized and
all eligible, low-income children are covered by the CHIP program.
On balance, while this bill is not what any of us would have liked,
it does address many of the immediate concerns of Medicare patients,
their physician and other health care providers. I strongly support
this bipartisan legislation and urge my colleagues to support this
bill.
Mr. AKAKA. Mr. President, I support the Medicare, Medicaid, SCHIP
Extension Act of 2007. I appreciate the hard work and leadership of
Senators Baucus and Grassley in putting together this important
legislation that will improve Medicare reimbursements, extend the State
Children's Health Insurance Program, and extend other important
Medicare and Medicaid policies.
In addition, this legislation includes a provision that extends
Medicaid disproportionate share hospital, DSH, allotments for Hawaii
and Tennessee for another 6 months. Medicaid DSH resources help support
hospitals that care for significant numbers of Medicaid and uninsured
patients.
Hawaii and Tennessee are the only two States that do not have
permanent DSH allotments. The Balanced Budget Act of 1997 created
specific DSH allotments for each State based on their actual DSH
expenditures for fiscal year 1995. In 1994, Hawaii implemented the
QUEST demonstration program that was designed to reduce the number of
uninsured and improve access to health care. The prior Medicaid DSH
program was incorporated into QUEST. As a result of the demonstration
program, Hawaii did not have DSH expenditures in 1995 and was not
provided a DSH allotment.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 made further changes to the DSH program, which included the
establishment of a floor for DSH allotments. However, States without
allotments were again left out.
The Medicare Prescription Drug, Improvement, and Modernization Act of
2003 made additional changes in the DSH program. This included an
increase in DSH allotments for low DSH States. Again, States without
allotments were left out.
[[Page S15837]]
In the Tax Relief and Health Care Act of 2006, DSH allotments were
finally provided for Hawaii and Tennessee for 2007. The act included a
$10 million Medicaid DSH allotment for Hawaii for 2007. The Medicare,
Medicaid, and SCHIP Extension Act of 2007 will extend the DSH
allotments for Hawaii and Tennessee for an additional 6 months.
This extension authorizes the submission by the State of Hawaii of a
State plan amendment covering a DSH payment methodology to hospitals
which is consistent with the requirements of existing law relating to
DSH payments. The purpose of providing a DSH allotment for Hawaii is to
provide additional funding to the State of Hawaii to permit a greater
contribution toward the uncompensated costs of hospitals that are
providing indigent care. It is not meant to alter existing arrangements
between the State of Hawaii and the Centers for Medicare and Medicaid
Services, CMS, or to reduce in any way the level of Federal funding for
Hawaii's QUEST program.
I look forward to continuing to work with Senators Alexander, Corker,
and Inouye to permanently restore allotments for Hawaii and Tennessee.
I thank the chairman and ranking member of the Finance Committee for
all of their efforts on this legislation and for their support on this
issue of great importance.
Mr. DURBIN. Mr. President, I ask unanimous consent that the bill be
read a third time and passed, the motion to reconsider be laid upon the
table, and that any statements relating to the bill be printed in the
Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The bill (S. 2499) was ordered to be engrossed for a third reading,
was read the third time, and passed, as follows:
S. 2499
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) In General.--This Act may be cited as the ``Medicare,
Medicaid, and SCHIP Extension Act of 2007''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE
Sec. 101. Increase in physician payment update; extension of the
physician quality reporting system.
Sec. 102. Extension of Medicare incentive payment program for physician
scarcity areas.
Sec. 103. Extension of floor on work geographic adjustment under the
Medicare physician fee schedule.
Sec. 104. Extension of treatment of certain physician pathology
services under Medicare.
Sec. 105. Extension of exceptions process for Medicare therapy caps.
Sec. 106. Extension of payment rule for brachytherapy; extension to
therapeutic radiopharmaceuticals.
Sec. 107. Extension of Medicare reasonable costs payments for certain
clinical diagnostic laboratory tests furnished to
hospital patients in certain rural areas.
Sec. 108. Extension of authority of specialized Medicare Advantage
plans for special needs individuals to restrict
enrollment.
Sec. 109. Extension of deadline for application of limitation on
extension or renewal of Medicare reasonable cost contract
plans.
Sec. 110. Adjustment to the Medicare Advantage stabilization fund.
Sec. 111. Medicare secondary payor.
Sec. 112. Payment for part B drugs.
Sec. 113. Payment rate for certain diagnostic laboratory tests.
Sec. 114. Long-term care hospitals.
Sec. 115. Payment for inpatient rehabilitation facility (IRF) services.
Sec. 116. Extension of accommodation of physicians ordered to active
duty in the Armed Services.
Sec. 117. Treatment of certain hospitals.
Sec. 118. Additional Funding for State Health Insurance Assistance
Programs, Area Agencies on Aging, and Aging and
Disability Resource Centers.
TITLE II--MEDICAID AND SCHIP
Sec. 201. Extending SCHIP funding through March 31, 2009.
Sec. 202. Extension of transitional medical assistance (TMA) and
abstinence education program.
Sec. 203. Extension of qualifying individual (QI) program.
Sec. 204. Medicaid DSH extension.
Sec. 205. Improving data collection.
Sec. 206. Moratorium on certain payment restrictions.
TITLE III--MISCELLANEOUS
Sec. 301. Medicare Payment Advisory Commission status.
Sec. 302. Special Diabetes Programs for Type I Diabetes and Indians.
TITLE I--MEDICARE
SEC. 101. INCREASE IN PHYSICIAN PAYMENT UPDATE; EXTENSION OF
THE PHYSICIAN QUALITY REPORTING SYSTEM.
(a) Increase in Physician Payment Update.--
(1) In general.--Section 1848(d) of the Social Security Act
(42 U.S.C. 1395w-4(d)) is amended--
(A) in paragraph (4)(B), by striking ``and paragraphs (5)
and (6)'' and inserting ``and the succeeding paragraphs of
this subsection''; and
(B) by adding at the end the following new paragraph:
``(8) Update for a portion of 2008.--
``(A) In general.--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.
``(B) No effect on computation of conversion factor for the
remaining portion of 2008 and 2009.--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.''.
(2) Revision of the physician assistance and quality
initiative fund.--
(A) Revision.--Section 1848(l)(2) of the Social Security
Act (42 U.S.C. 1395w-4(l)(2)) is amended--
(i) by striking subparagraph (A) and inserting the
following:
``(A) Amount available.--
``(i) In general.--Subject to clause (ii), there shall be
available to the Fund the following amounts:
``(I) For expenditures during 2008, an amount equal to
$150,500,000.
``(II) For expenditures during 2009, an amount equal to
$24,500,000.
``(III) For expenditures during 2013, an amount equal to
$4,960,000,000.
``(ii) Limitations on expenditures.--
``(I) 2008.--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).
``(II) 2009.--The amount available for expenditures during
2009 shall be reduced as provided by subparagraph (B) of such
section 225(c)(1).
``(III) 2013.--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.''; and
(ii) in subparagraph (B), by striking ``entire amount
specified in the first sentence of subparagraph (A)'' and all
that follows and inserting the following: ``entire amount
available for expenditures, after application of subparagraph
(A)(ii), during--
``(i) 2008 for payment with respect to physicians' services
furnished during 2008;
``(ii) 2009 for payment with respect to physicians'
services furnished during 2009; and
``(iii) 2013 for payment with respect to physicians'
services furnished during 2013.''.
(B) Effective date.--
(i) In general.--Subject to clause (ii), the amendments
made by subparagraph (A) shall take effect on the date of the
enactment of this Act.
(ii) Special rule for coordination with consolidated
appropriations act, 2008.--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).
(C) Transfer of funds to part b trust fund.--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).
(b) Extension of the Physician Quality Reporting System.--
(1) System.--Section 1848(k)(2)(B) of the Social Security
Act (42 U.S.C. 1395w-4(k)(2)(B)) is amended--
(A) in the heading, by inserting ``and 2009'' after
``2008'';
(B) in clause (i), by inserting ``and 2009'' after
``2008''; and
(C) in each of clauses (ii) and (iii)--
(i) by striking ``, 2007'' and inserting ``of each of 2007
and 2008''; and
(ii) by inserting ``or 2009, as applicable'' after
``2008''.
(2) Reporting.--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--
[[Page S15838]]
(A) in the heading, by inserting ``and 2008'' after
``2007'';
(B) in paragraph (5), by adding at the end the following:
``(F) Extension.--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.''; and
(C) in paragraph (6), by striking subparagraph (C) and
inserting the following new subparagraph:
``(C) Reporting period.--The term `reporting period'
means--
``(i) for 2007, the period beginning on July 1, 2007, and
ending on December 31, 2007; and
``(ii) for 2008, all of 2008.''.
(c) Implementation.--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 &
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.
SEC. 102. EXTENSION OF MEDICARE INCENTIVE PAYMENT PROGRAM FOR
PHYSICIAN SCARCITY AREAS.
Section 1833(u) of the Social Security Act (42 U.S.C.
1395l(u)) is amended--
(1) in paragraph (1), by striking ``before January 1,
2008'' and inserting ``before July 1, 2008''; and
(2) in paragraph (4)--
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following new
subparagraph:
``(D) Special rule.--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.''.
SEC. 103. EXTENSION OF FLOOR ON WORK GEOGRAPHIC ADJUSTMENT
UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.
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 ``before January 1, 2008'' and inserting ``before
July 1, 2008''.
SEC. 104. EXTENSION OF TREATMENT OF CERTAIN PHYSICIAN
PATHOLOGY SERVICES UNDER MEDICARE.
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 ``and 2007'' and inserting ``2007, and the first
6 months of 2008''.
SEC. 105. 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 ``December 31, 2007'' and
inserting ``June 30, 2008''.
SEC. 106. EXTENSION OF PAYMENT RULE FOR BRACHYTHERAPY;
EXTENSION TO THERAPEUTIC RADIOPHARMACEUTICALS.
(a) Extension of Payment Rule for Brachytherapy.--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 ``January 1, 2008'' and inserting ``July 1, 2008''.
(b) Payment for Therapeutic Radiopharmaceuticals.--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--
(1) in the heading, by inserting ``and therapeutic
radiopharmaceuticals'' before ``at charges'';
(2) in the first sentence--
(A) by inserting ``and for therapeutic radiopharmaceuticals
furnished on or after January 1, 2008, and before July 1,
2008,'' after ``July 1, 2008,'';
(B) by inserting ``or therapeutic radiopharmaceutical''
after ``the device''; and
(C) by inserting ``or therapeutic radiopharmaceutical''
after ``each device''; and
(3) in the second sentence, by inserting ``or therapeutic
radiopharmaceuticals'' after ``such devices''.
SEC. 107. 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), is
amended by striking ``the 3-year period beginning on July 1,
2004'' and inserting ``the period beginning on July 1, 2004,
and ending on June 30, 2008''.
SEC. 108. EXTENSION OF AUTHORITY OF SPECIALIZED MEDICARE
ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS
TO RESTRICT ENROLLMENT.
(a) Extension of Authority To Restrict Enrollment.--Section
1859(f) of the Social Security Act (42 U.S.C. 1395w-28(f)) is
amended by striking ``2009'' and inserting ``2010''.
(b) Moratorium.--
(1) Authority to designate other plans as specialized ma
plans.--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.
(2) Enrollment in new plans.--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.
SEC. 109. EXTENSION OF DEADLINE FOR APPLICATION OF LIMITATION
ON EXTENSION OR RENEWAL OF MEDICARE REASONABLE
COST CONTRACT PLANS.
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 ``January 1, 2008'' and
inserting ``January 1, 2009''.
SEC. 110. ADJUSTMENT TO THE MEDICARE ADVANTAGE STABILIZATION
FUND.
Section 1858(e)(2)(A)(i) of the Social Security Act (42
U.S.C. 1395w-27a(e)(2)(A)(i)), as amended by section 3 of
Public Law 110-48, is amended by striking ``the Fund'' and
all that follows and inserting ``the Fund during 2013,
$1,790,000,000.''
SEC. 111. MEDICARE SECONDARY PAYOR.
(a) In General.--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:
``(7) Required submission of information by group health
plans.--
``(A) Requirement.--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--
``(i) 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
``(ii) submit such information to the Secretary in a form
and manner (including frequency) specified by the Secretary.
``(B) Enforcement.--
``(i) In general.--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.
``(ii) Deposit of amounts collected.--Any amounts collected
pursuant to clause (i) shall be deposited in the Federal
Hospital Insurance Trust Fund under section 1817.
``(C) Sharing of information.--Notwithstanding any other
provision of law, under terms and conditions established by
the Secretary, the Secretary--
``(i) 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);
``(ii) may share the entitlement and enrollment information
described in clause (i) with entities and persons not
described in such clause; and
``(iii) may share information collected under this
paragraph as necessary for purposes of the proper
coordination of benefits.
``(D) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.
[[Page S15839]]
``(8) Required submission of information by or on behalf of
liability insurance (including self-insurance), no fault
insurance, and workers' compensation laws and plans.--
``(A) Requirement.--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--
``(i) 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
``(ii) 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.
``(B) Required information.--The information described in
this subparagraph is--
``(i) the identity of the claimant for which the
determination under subparagraph (A) was made; and
``(ii) 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.
``(C) Timing.--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).
``(D) Claimant.--For purposes of subparagraph (A), the term
`claimant' includes--
``(i) an individual filing a claim directly against the
applicable plan; and
``(ii) an individual filing a claim against an individual
or entity insured or covered by the applicable plan.
``(E) Enforcement.--
``(i) In general.--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.
``(ii) Deposit of amounts collected.--Any amounts collected
pursuant to clause (i) shall be deposited in the Federal
Hospital Insurance Trust Fund.
``(F) Applicable plan.--In this paragraph, the term
`applicable plan' means the following laws, plans, or other
arrangements, including the fiduciary or administrator for
such law, plan, or arrangement:
``(i) Liability insurance (including self-insurance).
``(ii) No fault insurance.
``(iii) Workers' compensation laws or plans.
``(G) Sharing of information.--The Secretary may share
information collected under this paragraph as necessary for
purposes of the proper coordination of benefits.
``(H) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.''.
(b) Rule of Construction.--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.
(c) Implementation.--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 & Medicaid Services Program Management Account for
the period of fiscal years 2008, 2009, and 2010.
SEC. 112. PAYMENT FOR PART B DRUGS.
(a) Application of Alternative Volume Weighting in
Computation of ASP.--Section 1847A(b) of the Social Security
Act (42 U.S.C. 1395w-3a(b)) is amended--
(1) in paragraph (1)(A), by inserting ``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'' after
``paragraph (3)'';
(2) in each of subparagraphs (A) and (B) of paragraph (4),
by inserting ``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,'' after
``paragraph (3)''; and
(3) by adding at the end the following new paragraph:
``(6) Use of volume-weighted average sales prices in
calculation of average sales price.--
``(A) In general.--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--
``(i) computing the sum of the products (for each National
Drug Code assigned to such drug products) of--
``(I) 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
``(II) the total number of units specified under paragraph
(2) sold; and
``(ii) dividing the sum determined under clause (i) by the
sum of the products (for each National Drug Code assigned to
such drug products) of--
``(I) the total number of units specified under paragraph
(2) sold; and
``(II) the total number of billing units for the National
Drug Code for the billing and payment code.
``(B) Billing unit defined.--For purposes of this
subsection, the term `billing unit' means the identifiable
quantity associated with a billing and payment code, as
established by the Secretary.''.
(b) Treatment of Certain Drugs.--Section 1847A(b) of the
Social Security Act (42 U.S.C. 1395w-3a(b)), as amended by
subsection (a), is amended--
(1) in paragraph (1), by inserting ``paragraph (7) and''
after ``Subject to''; and
(2) by adding at the end the following new paragraph:
``(7) Special rule.--Beginning with April 1, 2008, the
payment amount for--
``(A) 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--
``(i) the payment amount that would be determined for such
drug or biological applying such subsection; or
``(ii) the payment amount that would have been determined
for such drug or biological if such subsection were not
applied; and
``(B) 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--
``(i) the payment amount that would be determined for such
drug or biological taking into account the application of
such subsection; or
``(ii) the payment amount that would have been determined
for such drug or biological if such subsection were not
applied.''.
SEC. 113. PAYMENT RATE FOR CERTAIN DIAGNOSTIC LABORATORY
TESTS.
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:
``(9) 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)).''.
SEC. 114. LONG-TERM CARE HOSPITALS.
(a) Definition of Long-Term Care Hospital.--Section 1861 of
the Social Security Act (42 U.S.C. 1395x) is amended by
adding at the end the following new subsection:
``Long-Term Care Hospital
``(ccc) The term `long-term care hospital' means a hospital
which--
``(1) 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;
``(2) 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);
``(3) satisfies the requirements of subsection (e); and
``(4) meets the following facility criteria:
``(A) 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;
``(B) 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
``(C) 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.''.
(b) Study and Report on Long-Term Care Hospital Facility
and Patient Criteria.--
[[Page S15840]]
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') 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.
(2) Report.--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.
(3) Considerations.--In conducting the study and preparing
the report under this subsection, the Secretary shall
consider--
(A) 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
(B) ongoing work by the Secretary to evaluate and determine
the feasibility of such recommendations.
(c) Payment for Long-Term Care Hospital Services.--
(1) No application of 25 percent patient threshold payment
adjustment to freestanding and grandfathered ltchs.--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--
(A) section 412.536 of title 42, Code of Federal
Regulations, or any similar provision, to freestanding long-
term care hospitals; and
(B) 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).
(2) Payment for hospitals-within-hospitals.--
(A) In general.--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.
(B) Co-located long-term care hospitals and satellite
facilities.--
(i) In general.--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.
(ii) Applicable long-term care hospital or satellite
facility defined.--In this paragraph, the term ``applicable
long-term care hospital or satellite facility'' 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.
(C) Effective date.--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.
(3) No application of very short-stay outlier policy.--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.
(4) No application of one-time adjustment to standard
amount.--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.
(d) 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.--
(1) In general.--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--
(A) 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
(B) subject to paragraph (3), on an increase of long-term
care hospital beds in existing long-term care hospitals or
satellite facilities.
(2) Exception for certain long-term care hospitals.--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--
(A) 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;
(B) 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
(C) 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.
(3) Exception for bed increases during moratorium.--
(A) In general.--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--
(i) is located in a State where there is only one other
long-term care hospital; and
(ii) 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.
(B) No effect on certain limitation.--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.
(4) Existing hospital or satellite facility defined.--For
purposes of this subsection, the term ``existing'' 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.
(5) Judicial review.--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.
(e) Long-Term Care Hospital Payment Update.--
(1) In general.--Section 1886 of the Social Security Act
(42 U.S.C. 1395ww) is amended by adding at the end the
following new subsection:
``(m) Prospective Payment for Long-Term Care Hospitals.--
``(1) Reference to establishment and implementation of
system.--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.
``(2) Update for rate year 2008.--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.''.
(2) Delayed effective date.--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.
(f) Expanded Review of Medical Necessity.--
(1) In general.--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.
(2) Review methodology.--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--
(A) provide for a statistically valid and representative
sample of admissions of such individuals sufficient to
provide results at a 95 percent confidence interval; and
(B) 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)).
(3) Continuation of reviews.--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.
(4) Termination of required reviews.--
(A) In general.--Subject to subparagraph (B), the previous
provisions of this subsection shall cease to apply for
discharges occurring on or after October 1, 2010.
[[Page S15841]]
(B) Continuation.--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.
(5) Funding.--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.
(g) Implementation.--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 & 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.
SEC. 115. PAYMENT FOR INPATIENT REHABILITATION FACILITY (IRF)
SERVICES.
(a) Payment Update.--
(1) In general.--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: ``The increase factor to be applied
under this subparagraph for each of fiscal years 2008 and
2009 shall be 0 percent.''.
(2) Delayed effective date.--The amendment made by
paragraph (1) shall not apply to payment units occurring
before April 1, 2008.
(b) Inpatient Rehabilitation Facility Classification
Criteria.--
(1) In general.--Section 5005 of the Deficit Reduction Act
of 2005 (Public Law 109-171; 42 U.S.C. 1395ww note) is
amended--
(A) in subsection (a), by striking ``apply the applicable
percent specified in subsection (b)'' and inserting ``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,''; and
(B) by amending subsection (b) to read as follows:
``(b) Continued Use of Comorbidities.--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).''.
(2) Effective date.--The amendment made by paragraph (1)(A)
shall apply for cost reporting periods beginning on or after
July 1, 2007.
(c) Recommendations for Classifying Inpatient
Rehabilitation Hospitals and Units.--
(1) Report to congress.--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:
(A) 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.
(B) 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.
(C) 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.
(2) 75 percent rule defined.--For purposes of this
subsection, the term ``75 percent rule'' 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.
SEC. 116. EXTENSION OF ACCOMMODATION OF PHYSICIANS ORDERED TO
ACTIVE DUTY IN THE ARMED SERVICES.
Section 1842(b)(6)(D)(iii) of the Social Security Act (42
U.S.C. 1395u(b)(6)(D)(iii)), as amended by Public Law 110-54
(121 Stat. 551) is amended by striking ``January 1, 2008''
and inserting ``July 1, 2008''.
SEC. 117. TREATMENT OF CERTAIN HOSPITALS.
(a) Extending Certain Medicare Hospital Wage Index
Reclassifications Through Fiscal Year 2008.--
(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) is
amended by striking ``September 30, 2007'' and inserting
``September 30, 2008''.
(2) Special exception reclassifications.--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).
(3) Use of particular wage index.--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.
(b) Disregarding Section 508 Hospital Reclassifications for
Purposes of Group Reclassifications.--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:
``(g) Disregarding Hospital Reclassifications for Purposes
of Group Reclassifications.--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.''.
(c) Correction of Application of Wage Index During Tax
Relief and Health Care Act Extension.--In the case of a
subsection (d) hospital (as defined for purposes of section
1886 of the Social Security Act (42 U.S.C. 1395ww)) with
respect to which--
(1) 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
(2) 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,
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.
SEC. 118. ADDITIONAL FUNDING FOR STATE HEALTH INSURANCE
ASSISTANCE PROGRAMS, AREA AGENCIES ON AGING,
AND AGING AND DISABILITY RESOURCE CENTERS.
(a) State Health Insurance Assistance Programs.--
(1) In general.--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.
(2) Funding.--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 & Medicaid Services Program Management
Account for fiscal year 2008.
(b) Area Agencies on Aging and Aging and Disability
Resource Centers.--
(1) In general.--The Secretary of Health and Human Services
shall use amounts made available under paragraph (2) to make
grants--
(A) 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
(B) to Aging and Disability Resource Centers under the
Aging and Disability Resource Center grant program.
(2) Funding.--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 & Medicaid Services Program Management
Account for the period of fiscal years 2008 through 2009.
[[Page S15842]]
TITLE II--MEDICAID AND SCHIP
SEC. 201. EXTENDING SCHIP FUNDING THROUGH MARCH 31, 2009.
(a) Through the Second Quarter of Fiscal Year 2009.--
(1) In general.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd) is amended--
(A) in subsection (a)--
(i) by striking ``and'' at the end of paragraph (9);
(ii) by striking the period at the end of paragraph (10)
and inserting ``; and''; and
(iii) by adding at the end the following new paragraph:
``(11) for each of fiscal years 2008 and 2009,
$5,000,000,000.''; and
(B) in subsection (c)(4)(B), by striking ``for fiscal year
2007'' and inserting ``for each of fiscal years 2007 through
2009''.
(2) Availability of extended funding.--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.
(3) End of funding under continuing resolution.--Section
136(a)(2) of Public Law 110-92 is amended by striking ``after
the termination date'' and all that follows and inserting
``after the date of the enactment of the Medicare, Medicaid,
and SCHIP Extension Act of 2007.''.
(4) Clarification of application of funding under
continuing resolution.--Section 107 of Public Law 110-92
shall apply with respect to expenditures made pursuant to
section 136(a)(1) of such Public Law.
(b) Extension of Treatment of Qualifying States; Rules on
Redistribution of Unspent Fiscal Year 2005 Allotments Made
Permanent.--
(1) In general.--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 ``or 2008'' and inserting ``2008, or
2009''.
(2) Applicability.--The amendment made by paragraph (1)
shall be in effect through March 31, 2009.
(3) Certain rules made permanent.--Subsection (e) of
section 136 of Public Law 110-92 is repealed.
(c) Additional Allotments To Eliminate Remaining Funding
Shortfalls Through March 31, 2009.--
(1) In general.--Section 2104 of the Social Security Act
(42 U.S.C. 1397dd) is amended by adding at the end the
following new subsections:
``(j) Additional Allotments To Eliminate Funding Shortfalls
for Fiscal Year 2008.--
``(1) Appropriation; allotment authority.--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.
``(2) Shortfall states described.--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--
``(A) 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;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2008 in accordance with
subsection (i); and
``(C) the amount of the State's allotment for fiscal year
2008.
``(3) Allotments.--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--
``(A) 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
``(B) 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).
``(4) Proration rule.--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.
``(5) Retrospective adjustment.--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.
``(6) One-year availability; no redistribution of
unexpended additional allotments.--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).
``(k) Redistribution of Unused Fiscal Year 2006 Allotments
to States With Estimated Funding Shortfalls During the First
2 Quarters of Fiscal Year 2009.--
``(1) In general.--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.
``(2) Fiscal year 2009 shortfall state described.--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--
``(A) 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
``(B) the amount of the State's allotment for fiscal year
2009.
``(3) Funds redistributed in the order in which states
realize funding shortfalls.--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.
``(4) Proration rule.--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.
``(5) Retrospective adjustment.--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.
``(6) Availability; no further redistribution.--
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).
``(l) Additional Allotments To Eliminate Funding Shortfalls
for the First 2 Quarters of Fiscal Year 2009.--
``(1) Appropriation; allotment authority.--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.
``(2) Shortfall states described.--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--
``(A) 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;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2009 in accordance with
subsection (k); and
``(C) the amount of the State's allotment for fiscal year
2009.
``(3) Allotments.--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--
``(A) 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
``(B) 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
[[Page S15843]]
the amounts determined for each shortfall State under
subparagraph (A).
``(4) Proration rule.--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.
``(5) Retrospective adjustment.--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.
``(6) Availability; no redistribution of unexpended
additional allotments.--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).''.
SEC. 202. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA)
AND ABSTINENCE EDUCATION PROGRAM.
Section 401 of division B of the Tax Relief and Health Care
Act of 2006 (Public Law 109-432, 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--
(1) by striking ``December 31, 2007'' and inserting ``June
30, 2008''; and
(2) by striking ``first quarter'' and inserting ``third
quarter'' each place it appears.
SEC. 203. EXTENSION OF 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 2007'' and inserting ``June 2008''.
(b) Extending Total Amount Available for Allocation.--
Section 1933(g)(2) of the Social Security Act (42 U.S.C.
1396u-3(g)(2)) is amended--
(1) in subparagraph (G), by striking ``and'' at the end;
(2) in subparagraph (H), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(I) for the period that begins on January 1, 2008, and
ends on June 30, 2008, the total allocation amount is
$200,000,000.''.
SEC. 204. MEDICAID DSH EXTENSION.
Section 1923(f)(6) of the Social Security Act (42 U.S.C.
1396r-4(f)(6)) is amended--
(1) in the heading, by inserting ``and portions of fiscal
year 2008'' after ``fiscal year 2007''; and
(2) in subparagraph (A)--
(A) in clause (i), by adding at the end (after and below
subclause (II)) the following:
``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 \3/4\ of the amount specified in the previous
sentence for fiscal year 2007.'';
(B) in clause (ii)--
(i) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(ii) by inserting ``or period'' after ``such fiscal year'';
and
(C) in clause (iv)--
(i) in the heading, by inserting ``and fiscal year 2008''
after ``fiscal year 2007'';
(ii) in subclause (I)--
(I) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(II) by inserting ``or period'' after ``for such fiscal
year''; and
(iii) in subclause (II)--
(I) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(II) by inserting ``or period'' after ``such fiscal year''
each place it appears; and
(3) in subparagraph (B)(i), by adding at the end the
following: ``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.''.
SEC. 205. IMPROVING DATA COLLECTION.
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 ``(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)''.
SEC. 206. MORATORIUM ON CERTAIN PAYMENT RESTRICTIONS.
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.
TITLE III--MISCELLANEOUS
SEC. 301. MEDICARE PAYMENT ADVISORY COMMISSION STATUS.
Section 1805(a) of the Social Security Act (42 U.S.C.
1395b-6(a)) is amended by inserting ``as an agency of
Congress'' after ``established''.
SEC. 302. SPECIAL DIABETES PROGRAMS FOR TYPE I DIABETES AND
INDIANS.
(a) 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 ``2008'' and
inserting ``2009''.
(b) 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 ``2008'' and
inserting ``2009''.
____________________