[Congressional Record Volume 154, Number 112 (Wednesday, July 9, 2008)]
[Senate]
[Pages S6505-S6509]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. MURKOWSKI (for herself and Mr. Stevens):
  S. 3234. A bill to amend the Internal Revenue Code of 1986 to provide 
a temporary income tax credit for commercial fishermen to offset high 
fuel costs; to the Committee on Finance.
  Ms. MURKOWSKI. Mr. President, I rise to introduce a bill that will 
help commercial fishermen in Alaska and all over the United States 
offset high fuel prices by providing a temporary income tax credit for 
excessive fuel costs. I am pleased to have Mr. Stevens join me in 
introducing this important legislation.
  Diesel fuel prices in Alaska and across the Nation have increased 
more than 50 percent over the past year. Some fishermen are reporting 
that they are now spending up to 70 percent of their income for fuel. 
This is having a devastating impact on this industry as fishermen do 
not have the option of passing the cost of fuel onto clients or 
customers, turning to alternative modes of transportation to do their 
jobs, or selling their product for a higher price. They can't simply 
increase the price of fish to offset higher fuel costs. Fish prices, in 
most cases, are set by the seafood processing sector and are tied to 
prices in the global seafood market in which Alaskan and American 
seafood compete.
  All around the world, fishermen are responding to this crisis. They 
are

[[Page S6506]]

blockading harbors in Ireland and France, protesting at the European 
Union headquarters in Belgium, rioting in Italy and Spain, burning 
fishing boats in Thailand, and striking in Japan.
  Fishermen all over the United States are staying tied to the dock, 
unable to make enough money from their catch to pay for the fuel. In 
Gloucester and Biloxi, Key West and Honolulu, Point Judith and Kodiak, 
fishermen simply can't afford to go fishing. And some U.S. vessels are 
running all the way from the Gulf of Mexico and California to Mexico to 
buy fuel. Even the Federal Government is cancelling fishery stock 
assessment surveys due to the high cost of fuel. As you can see, 
fishermen are getting hit from all sides right now.
  When fishermen can't go fishing, they can't make their boat and 
permit payments. Many are simply going out of business. Fishermen are 
not the only ones who are concerned about the high price of fuel. The 
seafood processing sector also is facing higher costs for energy and 
many other inputs and is worried about the industry's ability to 
maintain a steady supply of fish. When fishermen don't leave the dock, 
the processors don't get their fish and a major seafood supply shortage 
could occur in the near future.
  Some people might say that if fish stocks were healthier or fewer 
boats were fishing, that the industry could better deal with the 
increased price of fuel. But even in Alaska, where we have abundant, 
sustainably managed fish stocks that supply over 50 percent of the 
seafood in the United States, we are still suffering. The price of fuel 
has increased from an average of $1.80 per gallon in 2004 to $2.80 last 
year and diesel is now $4.50 on average.
  In Alaska, we have already limited the number of vessels in most 
fisheries, so they are not over capitalized. We also have established 
many limited access privilege programs such as limited entry, 
individual fishing quotas, and coops, where fishermen can make choices 
to harvest in the most efficient and economic way. So, even though we 
have tried to make the fisheries much more economical, we still are 
being severely impacted by these high fuel prices. We are much more 
able to withstand these high fuel prices than regions and fisheries 
that have not limited the number of vessels or slowed the race for 
fish. But, many fisheries in Alaska, including our salmon fisheries, 
where over 150 million fish likely will be caught in a 2\1/2\ month 
season, fishermen must catch the fish while they are available. In 
other parts of the country, where fishermen are still racing for fish 
and have not limited the number of vessels participating, things must 
be far worse.
  In order to provide temporary relief to the commercial fishermen 
across the country, I am introducing this legislation. If we allow the 
fishermen in this country to stay tied to the dock, or go out of 
business, we may lose a large portion of the industry. Since over 80 
percent of the seafood Americans eat is imported, we simply can't 
afford for this to happen. We must try to assist this industry weather 
this storm. I believe this legislation will help us do that.
                                 ______
                                 
      By Mr. McCONNELL (for himself, Mr. Grassley, and Mr. Kyl):
  S. 3236. A bill to amend titles XVIII and XIX of the Social Security 
Act to extend provisions under Medicare and Medicaid programs, and for 
other purposes; read the first time.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the text 
of the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                S. 3236

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     and Medicaid Extension Act of 2008''.
       (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. Extension of physician payment update.
Sec. 102. Extension of floor on Medicare work geographic adjustment 
              under the Medicare physician fee schedule.
Sec. 103. Extension of treatment of certain physician pathology 
              services under Medicare.
Sec. 104. Extension of exceptions process for Medicare therapy caps.
Sec. 105. Extension of payment rule for brachytherapy and therapeutic 
              radiopharmaceuticals.
Sec. 106. Extension of accommodation of physicians ordered to active 
              duty in the Armed Services.
Sec. 107. Delay in and reform of Medicare DMEPOS competitive 
              acquisition program.

                           TITLE II--MEDICAID

Sec. 201. Extension of qualifying individual (QI) program.
Sec. 202. Extension of transitional medical assistance (TMA) and 
              abstinence education program.
Sec. 203. Medicaid DSH extension.

                         TITLE III--CONTINGENCY

Sec. 301. Contingency.

                           TITLE I--MEDICARE

     SEC. 101. EXTENSION OF PHYSICIAN PAYMENT UPDATE.

       (a) In General.--Section 1848(d)(8) of the Social Security 
     Act (42 U.S.C. 1395w-4(d)(8)), as added by section 101 of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), is amended--
       (1) in subparagraph (A), by striking ``June 30, 2008'' and 
     inserting ``July 31, 2008''; and
       (2) in subparagraph (B), by striking ``July 1, 2008'' and 
     inserting ``August 1, 2008''.
       (b) Revision of the Physician Assistance and Quality 
     Initiative Fund.--Section 1848(l)(2)(A)(i) of the Social 
     Security Act (42 U.S.C. 1395w-4(l)(2)(A)(i)), as amended by 
     section 101(a)(2) of the Medicare, Medicaid, and SCHIP 
     Extension Act of 2007 (Public Law 110-173) and by section 
     7002(c) of the Supplemental Appropriations Act, 2008, is 
     amended--
       (1) in subclause (III), by inserting `` reduced by 
     $600,000,000'' before the period at the end; and
       (2) in subclause (IV), by inserting `` increased by 
     $220,000,000'' before the period at the end.
       (c) Implementation.--For purposes of carrying out the 
     provisions of, and amendments made by, this title, in 
     addition to any amounts otherwise provided in such provisions 
     and amendments, there are appropriated to the Centers for 
     Medicare & Medicaid Services Program Management Account, out 
     of any money in the Treasury not otherwise appropriated, 
     $20,000,000.

     SEC. 102. EXTENSION OF FLOOR ON MEDICARE WORK GEOGRAPHIC 
                   ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE 
                   SCHEDULE.

       (a) In General.--Section 1848(e)(1)(E) of the Social 
     Security Act (42 U.S.C. 1395w-4(e)(1)(E)), as amended by 
     section 103 of the Medicare, Medicaid, and SCHIP Extension 
     Act of 2007 (Public Law 110-173), is amended by striking 
     ``before July 1, 2008'' and inserting ``before August 1, 
     2008''.
       (b) Technical Correction.--Section 602(1) of the Medicare 
     Prescription Drug, Improvement, and Modernization Act of 2003 
     (Public Law 108-173; 117 Stat. 2301) is amended to read as 
     follows:
       ``(1) in subparagraph (A), by striking `subparagraphs (B), 
     (C), and (E)' and inserting `subparagraphs (B), (C), (E), and 
     (G)'; and''.

     SEC. 103. 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), section 104 of division B of the Tax Relief and Health 
     Care Act of 2006 (42 U.S.C. 1395w-4 note), and section 104 of 
     the Medicare, Medicaid, and SCHIP Extension Act of 2007 
     (Public Law 110-173), is amended by striking ``the first 6 
     months of 2008'' and inserting ``the first 7 months of 
     2008''.

     SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE 
                   THERAPY CAPS.

       Section 1833(g)(5) of the Social Security Act (42 U.S.C. 
     1395l(g)(5)), as amended by section 105 of the Medicare, 
     Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-
     173), is amended by striking ``June 30, 2008'' and inserting 
     ``July 31, 2008''.

     SEC. 105. EXTENSION OF PAYMENT RULE FOR BRACHYTHERAPY AND 
                   THERAPEUTIC RADIOPHARMACEUTICALS.

       Section 1833(t)(16)(C) of the Social Security Act (42 
     U.S.C. 1395l(t)(16)(C)), as amended by section 106 of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), is amended by striking ``July 1, 2008'' each 
     place it appears and inserting ``August 1, 2008''.

     SEC. 106. 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 section 116 of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), is amended by striking ``July 1, 2008'' and 
     inserting ``August 1, 2008''.

     SEC. 107. DELAY IN AND REFORM OF MEDICARE DMEPOS COMPETITIVE 
                   ACQUISITION PROGRAM.

       (a) Temporary Delay and Reform.--
       (1) In general.--Section 1847(a) of the Social Security Act 
     (42 U.S.C. 1395w-3(a)) is amended--
       (A) in paragraph (1)--

[[Page S6507]]

       (i) in subparagraph (B)(i), in the matter before subclause 
     (I), by inserting ``consistent with subparagraph (D)'' after 
     ``in a manner'';
       (ii) in subparagraph (B)(i)(II), by striking ``80'' and 
     ``in 2009'' and inserting ``an additional 70'' and ``in 
     2011'', respectively;
       (iii) in subparagraph (B)(i)(III), by striking ``after 
     2009'' and inserting ``after 2011 (or, in the case of 
     national mail order for items and services, after 2010)''; 
     and
       (iv) by adding at the end the following new subparagraphs:
       ``(D) Changes in competitive acquisition programs.--
       ``(i) Round 1 of competitive acquisition program.--
     Notwithstanding subparagraph (B)(i)(I) and in implementing 
     the first round of the competitive acquisition programs under 
     this section--

       ``(I) the contracts awarded under this section before the 
     date of the enactment of this subparagraph are terminated, no 
     payment shall be made under this title on or after the date 
     of the enactment of this subparagraph based on such a 
     contract, and, to the extent that any damages may be 
     applicable as a result of the termination of such contracts, 
     such damages shall be payable from the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841;
       ``(II) the Secretary shall conduct the competition for such 
     round in a manner so that it occurs in 2009 with respect to 
     the same items and services and the same areas, except as 
     provided in subclauses (III) and (IV);
       ``(III) the Secretary shall exclude Puerto Rico so that 
     such round of competition covers 9, instead of 10, of the 
     largest metropolitan statistical areas; and
       ``(IV) there shall be excluded negative pressure wound 
     therapy items and services.

     Nothing in subclause (I) shall be construed to provide an 
     independent cause of action or right to administrative or 
     judicial review with regard to the termination provided under 
     such subclause.
       ``(ii) Round 2 of competitive acquisition program.--In 
     implementing the second round of the competitive acquisition 
     programs under this section described in subparagraph 
     (B)(i)(II)--

       ``(I) the metropolitan statistical areas to be included 
     shall be those metropolitan statistical areas selected by the 
     Secretary for such round as of June 1, 2008; and
       ``(II) the Secretary may subdivide metropolitan statistical 
     areas with populations (based upon the most recent data from 
     the Census Bureau) of at least 8,000,000 into separate areas 
     for competitive acquisition purposes.

       ``(iii) Exclusion of certain areas in subsequent rounds of 
     competitive acquisition programs.--In implementing subsequent 
     rounds of the competitive acquisition programs under this 
     section, including under subparagraph (B)(i)(III), for 
     competitions occurring before 2015, the Secretary shall 
     exempt from the competitive acquisition program (other than 
     national mail order) the following:

       ``(I) Rural areas.
       ``(II) Metropolitan statistical areas not selected under 
     round 1 or round 2 with a population of less than 250,000.
       ``(III) Areas with a low population density within a 
     metropolitan statistical area that is otherwise selected, as 
     determined for purposes of paragraph (3)(A).

       ``(E) Verification by oig.--The Inspector General of the 
     Department of Health and Human Services shall, through post-
     award audit, survey, or otherwise, assess the process used by 
     the Centers for Medicare & Medicaid Services to conduct 
     competitive bidding and subsequent pricing determinations 
     under this section that are the basis for pivotal bid amounts 
     and single payment amounts for items and services in 
     competitive bidding areas under rounds 1 and 2 of the 
     competitive acquisition programs under this section and may 
     continue to verify such calculations for subsequent rounds of 
     such programs.
       ``(F) Supplier feedback on missing financial 
     documentation.--
       ``(i) In general.--In the case of a bid where one or more 
     covered documents in connection with such bid have been 
     submitted not later than the covered document review date 
     specified in clause (ii), the Secretary--

       ``(I) shall provide, by not later than 45 days (in the case 
     of the first round of the competitive acquisition programs as 
     described in subparagraph (B)(i)(I)) or 90 days (in the case 
     of a subsequent round of such programs) after the covered 
     document review date, for notice to the bidder of all such 
     documents that are missing as of the covered document review 
     date; and
       ``(II) may not reject the bid on the basis that any covered 
     document is missing or has not been submitted on a timely 
     basis, if all such missing documents identified in the notice 
     provided to the bidder under subclause (I) are submitted to 
     the Secretary not later than 10 business days after the date 
     of such notice.

       ``(ii) Covered document review date.--The covered document 
     review date specified in this clause with respect to a 
     competitive acquisition program is the later of--

       ``(I) the date that is 30 days before the final date 
     specified by the Secretary for submission of bids under such 
     program; or
       ``(II) the date that is 30 days after the first date 
     specified by the Secretary for submission of bids under such 
     program.

       ``(iii) Limitations of process.--The process provided under 
     this subparagraph--

       ``(I) applies only to the timely submission of covered 
     documents;
       ``(II) does not apply to any determination as to the 
     accuracy or completeness of covered documents submitted or 
     whether such documents meet applicable requirements;
       ``(III) shall not prevent the Secretary from rejecting a 
     bid based on any basis not described in clause (i)(II); and
       ``(IV) shall not be construed as permitting a bidder to 
     change bidding amounts or to make other changes in a bid 
     submission.

       ``(iv) Covered document defined.--In this subparagraph, the 
     term `covered document' means a financial, tax, or other 
     document required to be submitted by a bidder as part of an 
     original bid submission under a competitive acquisition 
     program in order to meet required financial standards. Such 
     term does not include other documents, such as the bid itself 
     or accreditation documentation.''; and
       (B) in paragraph (2)(A), by inserting before the period at 
     the end the following: ``and excluding certain complex 
     rehabilitative power wheelchairs recognized by the Secretary 
     as classified within group 3 or higher (and related 
     accessories when furnished in connection with such 
     wheelchairs)''.
       (2) Budget neutral offset.--
       (A) In general.--Section 1834(a)(14) of such Act (42 U.S.C. 
     1395m(a)(14)) is amended--
       (i) by striking ``and'' at the end of subparagraphs (H) and 
     (I);
       (ii) by redesignating subparagraph (J) as subparagraph (M); 
     and
       (iii) by inserting after subparagraph (I) the following new 
     subparagraphs:
       ``(J) for 2009--
       ``(i) in the case of items and services furnished in any 
     geographic area, if such items or services were selected for 
     competitive acquisition in any area under the competitive 
     acquisition program under section 1847(a)(1)(B)(i)(I) before 
     July 1, 2008, including related accessories but only if 
     furnished with such items and services selected for such 
     competition and diabetic supplies but only if furnished 
     through mail order, -9.5 percent; or
       ``(ii) in the case of other items and services, the 
     percentage increase in the consumer price index for all urban 
     consumers (U.S. urban average) for the 12-month period ending 
     with June 2008;
       ``(K) for 2010, 2011, 2012, and 2013, the percentage 
     increase in the consumer price index for all urban consumers 
     (U.S. urban average) for the 12-month period ending with June 
     of the previous year;
       ``(L) for 2014--
       ``(i) in the case of items and services described in 
     subparagraph (J)(i) for which a payment adjustment has not 
     been made under subsection (a)(1)(F)(ii) in any previous 
     year, the percentage increase in the consumer price index for 
     all urban consumers (U.S. urban average) for the 12-month 
     period ending with June 2013, plus 2.0 percentage points; or
       ``(ii) in the case of other items and services, the 
     percentage increase in the consumer price index for all urban 
     consumers (U.S. urban average) for the 12-month period ending 
     with June 2013; and''.
       (B) Conforming treatment for certain items and services.--
     The second sentence of section 1842(s)(1) of such Act (42 
     U.S.C. 1395u(s)(1)) is amended by striking ``except that'' 
     and all that follows and inserting the following: ``except 
     that for items and services described in paragraph (2)(D)--
       ``(A) for 2009 section 1834(a)(14)(J)(i) shall apply under 
     this paragraph instead of the percentage increase otherwise 
     applicable; and
       ``(B) for 2014, if subparagraph (A) is applied to the items 
     and services and there has not been a payment adjustment 
     under paragraph (3)(B) for the items and services for any 
     previous year, the percentage increase computed under section 
     1834(a)(14)(L)(i) shall apply instead of the percentage 
     increase otherwise applicable.''.
       (3) Conforming delay.--Subsections (a)(1)(F) and (h)(1)(H) 
     of section 1834 of the Social Security Act (42 U.S.C. 1395m) 
     are each amended by striking ``January 1, 2009'' and 
     inserting ``January 1, 2011''.
       (4) Considerations in application.--Section 1834 of such 
     Act (42 U.S.C. 1395m) is amended--
       (A) in subsection (a)(1)--
       (i) in subparagraph (F), by inserting ``subject to 
     subparagraph (G),'' before ``that are included''; and
       (ii) by adding at the end the following new subparagraph:
       ``(G) Use of information on competitive bid rates.--The 
     Secretary shall specify by regulation the methodology to be 
     used in applying the provisions of subparagraph (F)(ii) and 
     subsection (h)(1)(H)(ii). In promulgating such regulation, 
     the Secretary shall consider the costs of items and services 
     in areas in which such provisions would be applied compared 
     to the payment rates for such items and services in 
     competitive acquisition areas.''; and
       (B) in subsection (h)(1)(H), by inserting ``subject to 
     subsection (a)(1)(G),'' before ``that are included''.
       (b) Quality Standards.--
       (1) Application of accreditation requirement.--
       (A) In general.--Section 1834(a)(20) of the Social Security 
     Act (42 U.S.C. 1395m(a)(20)) is amended--
       (i) in subparagraph (E), by inserting ``including 
     subparagraph (F),'' after ``under this paragraph,''; and
       (ii) by adding at the end the following new subparagraph:

[[Page S6508]]

       ``(F) Application of accreditation requirement.--In 
     implementing quality standards under this paragraph--
       ``(i) subject to clause (ii), the Secretary shall require 
     suppliers furnishing items and services described in 
     subparagraph (D) on or after October 1, 2009, directly or as 
     a subcontractor for another entity, to have submitted to the 
     Secretary evidence of accreditation by an accreditation 
     organization designated under subparagraph (B) as meeting 
     applicable quality standards; and
       ``(ii) in applying such standards and the accreditation 
     requirement of clause (i) with respect to eligible 
     professionals (as defined in section 1848(k)(3)(B)), and 
     including such other persons, such as orthotists and 
     prosthetists, as specified by the Secretary, furnishing such 
     items and services--

       ``(I) such standards and accreditation requirement shall 
     not apply to such professionals and persons unless the 
     Secretary determines that the standards being applied are 
     designed specifically to be applied to such professionals and 
     persons; and
       ``(II) the Secretary may exempt such professionals and 
     persons from such standards and requirement if the Secretary 
     determines that licensing, accreditation, or other mandatory 
     quality requirements apply to such professionals and persons 
     with respect to the furnishing of such items and services.''.

       (B) Construction.--Section 1834(a)(20)(F)(ii) of the Social 
     Security Act, as added by subparagraph (A), shall not be 
     construed as preventing the Secretary of Health and Human 
     Services from implementing the first round of competition 
     under section 1847 of such Act on a timely basis.
       (2) Disclosure of subcontractors under competitive 
     acquisition program.--Section 1847(b)(3) of such Act (42 
     U.S.C. 1395w-3(b)(3)) is amended by adding at the end the 
     following new subparagraph:
       ``(C) Disclosure of subcontractors.--
       ``(i) Initial disclosure.--Not later than 10 days after the 
     date a supplier enters into a contract with the Secretary 
     under this section, such supplier shall disclose to the 
     Secretary, in a form and manner specified by the Secretary, 
     the information on--

       ``(I) each subcontracting relationship that such supplier 
     has in furnishing items and services under the contract; and
       ``(II) whether each such subcontractor meets the 
     requirement of section 1834(a)(20)(F)(i), if applicable to 
     such subcontractor.

       ``(ii) Subsequent disclosure.--Not later than 10 days after 
     such a supplier subsequently enters into a subcontracting 
     relationship described in clause (i)(II), such supplier shall 
     disclose to the Secretary, in such form and manner, the 
     information described in subclauses (I) and (II) of clause 
     (i).''.
       (3) Competitive acquisition ombudsman.--Section 1847 of 
     such Act (42 U.S.C. 1395w-3) is amended by adding at the end 
     the following new subsection:
       ``(f) Competitive Acquisition Ombudsman.--The Secretary 
     shall provide for a competitive acquisition ombudsman within 
     the Centers for Medicare & Medicaid Services in order to 
     respond to complaints and inquiries made by suppliers and 
     individuals relating to the application of the competitive 
     acquisition program under this section. The ombudsman may be 
     within the office of the Medicare Beneficiary Ombudsman 
     appointed under section 1808(c). The ombudsman shall submit 
     to Congress an annual report on the activities under this 
     subsection, which report shall be coordinated with the report 
     provided under section 1808(c)(2)(C).''.
       (c) Change in Reports and Deadlines.--
       (1) GAO report.--Section 302(b)(3) of the Medicare 
     Prescription Drug, Improvement, and Modernization Act of 2003 
     (Public Law 108-173) is amended--
       (A) in subparagraph (A)--
       (i) by inserting ``and as amended by section 2 of the 
     Medicare DMEPOS Competitive Acquisition Reform Act of 2008'' 
     after ``as amended by paragraph (1)''; and
       (ii) by inserting before the period at the end the 
     following: ``and the topics specified in subparagraph (C)'';
       (B) in subparagraph (B), by striking ``Not later than 
     January 1, 2009,'' and inserting ``Not later than 1 year 
     after the first date that payments are made under section 
     1847 of the Social Security Act,''; and
       (C) by adding at the end the following new subparagraph:
       ``(C) Topics.--The topics specified in this subparagraph, 
     for the study under subparagraph (A) concerning the 
     competitive acquisition program, are the following:
       ``(i) Beneficiary access to items and services under the 
     program, including the impact on such access of awarding 
     contracts to bidders that--

       ``(I) did not have a physical presence in an area where 
     they received a contract; or
       ``(II) had no previous experience providing the product 
     category they were contracted to provide.

       ``(ii) Beneficiary satisfaction with the program and cost 
     savings to beneficiaries under the program.
       ``(iii) Costs to suppliers of participating in the program 
     and recommendations about ways to reduce those costs without 
     compromising quality standards or savings to the Medicare 
     program.
       ``(iv) Impact of the program on small business suppliers.
       ``(v) Analysis of the impact on utilization of different 
     items and services paid within the same Healthcare Common 
     Procedure Coding System (HCPCS) code.
       ``(vi) Costs to the Centers for Medicare & Medicaid 
     Services, including payments made to contractors, for 
     administering the program compared with administration of a 
     fee schedule, in comparison with the relative savings of the 
     program.
       ``(vii) Impact on access, Medicare spending, and 
     beneficiary spending of any difference in treatment for 
     diabetic testing supplies depending on how such supplies are 
     furnished.
       ``(viii) Such other topics as the Comptroller General 
     determines to be appropriate.''.
       (2) Delay in other deadlines.--
       (A) Program advisory and oversight committee.--Section 
     1847(c)(5) of the Social Security Act (42 U.S.C. 1395w-
     3(c)(5)) is amended by striking ``December 31, 2009'' and 
     inserting ``December 31, 2011''.
       (B) Secretarial report.--Section 1847(d) of such Act (42 
     U.S.C. 1395w-3(d)) is amended by striking ``July 1, 2009'' 
     and inserting ``July 1, 2011''.
       (C) IG report.--Section 302(e) of the Medicare Prescription 
     Drug, Improvement, and Modernization Act of 2003 (Public Law 
     108-173) is amended by striking ``July 1, 2009'' and 
     inserting ``July 1, 2011''.
       (3) Evaluation of certain code.--The Secretary of Health 
     and Human Services shall evaluate the existing Health Care 
     Common Procedure Coding System (HCPCS) codes for negative 
     pressure wound therapy to ensure accurate reporting and 
     billing for items and services under such codes. In carrying 
     out such evaluation, the Secretary shall use an existing 
     process, administered by the Durable Medical Equipment 
     Medicare Administrative Contractors, for the consideration of 
     coding changes and consider all relevant studies and 
     information furnished pursuant to such process.
       (d) Other Provisions.--
       (1) Exemption from competitive acquisition for certain off-
     the-shelf orthotics.--Section 1847(a) of the Social Security 
     Act (42 U.S.C. 1395w-3(a)) is amended by adding at the end 
     the following new paragraph:
       ``(7) Exemption from competitive acquisition.--The programs 
     under this section shall not apply to the following:
       ``(A) Certain off-the-shelf orthotics.--Items and services 
     described in paragraph (2)(C) if furnished--
       ``(i) by a physician or other practitioner (as defined by 
     the Secretary) to the physician's or practitioner's own 
     patients as part of the physician's or practitioner's 
     professional service; or
       ``(ii) by a hospital to the hospital's own patients during 
     an admission or on the date of discharge.
       ``(B) Certain durable medical equipment.--Those items and 
     services described in paragraph (2)(A)--
       ``(i) that are furnished by a hospital to the hospital's 
     own patients during an admission or on the date of discharge; 
     and
       ``(ii) to which such programs would not apply, as specified 
     by the Secretary, if furnished by a physician to the 
     physician's own patients as part of the physician's 
     professional service.''.
       (2) Correction in face-to-face examination requirement.--
     Section 1834(a)(1)(E)(ii) of such Act (42 U.S.C. 
     1395m(a)(1)(E)(ii)) is amended by striking ``1861(r)(1)'' and 
     inserting ``1861(r)''.
       (3) Special rule in case of national mail-order competition 
     for diabetic testing strips.--Section 1847(b) of such Act (42 
     U.S.C. 1395w-3(b)) is amended--
       (A) by redesignating paragraph (10) as paragraph (11); and
       (B) by inserting after paragraph (9) the following new 
     paragraph:
       ``(10) Special rule in case of competition for diabetic 
     testing strips.--
       ``(A) In general.--With respect to the competitive 
     acquisition program for diabetic testing strips conducted 
     after the first round of the competitive acquisition 
     programs, if an entity does not demonstrate to the Secretary 
     that its bid covers types of diabetic testing strip products 
     that, in the aggregate and taking into account volume for the 
     different products, cover 50 percent (or such higher 
     percentage as the Secretary may specify) of all such types of 
     products, the Secretary shall reject such bid. The volume for 
     such types of products may be determined in accordance with 
     such data (which may be market based data) as the Secretary 
     recognizes.
       ``(B) Study of types of testing strip products.--Before 
     2011, the Inspector General of the Department of Health and 
     Human Services shall conduct a study to determine the types 
     of diabetic testing strip products by volume that could be 
     used to make determinations pursuant to subparagraph (A) for 
     the first competition under the competitive acquisition 
     program described in such subparagraph and submit to the 
     Secretary a report on the results of the study. The Inspector 
     General shall also conduct such a study and submit such a 
     report before the Secretary conducts a subsequent competitive 
     acquisition program described in subparagraph (A).''.
       (4) Other conforming amendments.--Section 1847(b)(11) of 
     such Act, as redesignated by paragraph (3), is amended--
       (A) in subparagraph (C), by inserting ``and the 
     identification of areas under subsection (a)(1)(D)(iii)'' 
     after ``(a)(1)(A)'';
       (B) in subparagraph (D), by inserting ``and implementation 
     of subsection (a)(1)(D)'' after ``(a)(1)(B)'';

[[Page S6509]]

       (C) in subparagraph (E), by striking ``or'' at the end;
       (D) in subparagraph (F), by striking the period at the end 
     and inserting ``; or''; and
       (E) by adding at the end the following new subparagraph:
       ``(G) the implementation of the special rule described in 
     paragraph (10).''.
       (5) Funding for implementation.--In addition to funds 
     otherwise available, for purposes of implementing the 
     provisions of, and amendments made by, this section, other 
     than the amendment made by subsection (c)(1) and other than 
     section 1847(a)(1)(E) of the Social Security Act, the 
     Secretary of Health and Human Services shall provide for the 
     transfer from the Federal Supplementary Medical Insurance 
     Trust Fund established under section 1841 of the Social 
     Security Act (42 U.S.C. 1395t) to the Centers for Medicare & 
     Medicaid Services Program Management Account of $20,000,000 
     for fiscal year 2008, and $25,000,000 for each of fiscal 
     years 2009 through 2012. Amounts transferred under this 
     paragraph for a fiscal year shall be available until 
     expended.
       (e) Effective Date.--The amendments made by this section 
     shall take effect as of June 30, 2008.

                           TITLE II--MEDICAID

     SEC. 201. 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 ``June'' and inserting ``July''.
       (b) Extending Total Amount Available for Allocation.--
     Section 1933(g)(2)(I) of the Social Security Act (42 U.S.C. 
     1396u-3(g)(2)(I)) is amended--
       (1) by striking ``June 30'' and inserting ``July 31'';
       (2) by striking ``$200,000,000'' and inserting 
     ``$250,000,000''.

     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), section 2 
     of the TMA, Abstinence, Education, and QI Programs Extension 
     Act of 2007 (Public Law 110-90, 121 Stat. 984), and section 
     202 of the Medicare, Medicaid, and SCHIP Extension Act of 
     2007 (Public Law 110-173), is amended--
       (1) by striking ``June 30'' and inserting ``July 31'';
       (2) by striking ``the third quarter of fiscal year 2008'' 
     and inserting ``July 31, 2008''; and
       (3) by striking ``the third quarter of fiscal year 2007'' 
     and inserting ``July 31, 2007''.

     SEC. 203. MEDICAID DSH EXTENSION.

       Section 1923(f)(6) of the Social Security Act (42 U.S.C. 
     1396r-4(f)(6)) is amended--
       (1) in subparagraph (A)(i), in the second sentence--
       (A) by striking ``June 30'' and inserting ``July 31''; and
       (B) by striking ``\3/4\'' and inserting ``\5/6\''; and
       (2) in subparagraph (B)(i)--
       (A) in the first sentence, by striking ``June 30'' and 
     inserting ``July 31''; and
       (B) by striking ``$7,500,000'' and inserting 
     ``$8,333,333''.

                         TITLE III--CONTINGENCY

     SEC. 301. CONTINGENCY.

       If a bill entitled the ``Medicare Improvements for Patients 
     and Providers Act of 2008'' is enacted, before, on, or after 
     the date of enactment of this Act, except for sections 
     101(c), the provisions of, and amendments made by, this Act 
     are repealed and any Act amended by such amendments shall be 
     administered as if such provisions and amendments had not 
     been enacted.

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