[Congressional Record (Bound Edition), Volume 156 (2010), Part 13]
[Senate]
[Pages 19158-19160]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    TAXPAYER ASSISTANCE ACT OF 2010

  Mr. BENNET. Mr. President, I ask unanimous consent that the Finance 
Committee be discharged from H.R. 4994, the Taxpayer Assistance Act of 
2010, and that the Senate then proceed to its immediate consideration.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will state the bill by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 4994) to amend the Internal Revenue Code of 
     1986 to reduce taxpayer burdens, enhance taxpayer protection, 
     and for other purposes.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. BENNET. Mr. President, there is a substitute amendment at the 
desk, and I ask that the amendment be considered and agreed to; that 
the bill, as amended, be read the third time; and that after the 
reading of the Budget Committee pay-go letter, the bill, as amended, be 
passed; and that the title amendment, which is at the desk, be 
considered and agreed to; further, that any statements relating to the 
measure be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 4742), in the nature of a substitute, was agreed 
to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The amendment (No. 4743) was agreed to, as follows:

       Amend the title so as to read: ``An Act to extend certain 
     expiring provisions of the Medicare and Medicaid programs, 
     and for other purposes.''.

  The PRESIDING OFFICER. The clerk will read the pay-go letter.
  The assistant legislative clerk read as follows:

       Mr. Conrad: This is the Statement of Budgetary Effects of 
     PAYGO Legislation for H.R. 4994, as amended.

       Total Budgetary Effects of H.R. 4994 for the 5-year 
     Statutory PAYGO Scorecard: net increase in the deficit of 
     $2.278 billion.
       Total Budgetary Effects of H.R. 4994 for the 10-year 
     Statutory PAYGO Scorecard: net decrease in the deficit of 
     $17.276 billion.

       Also submitted for the Record as part of this statement is 
     a table prepared by the Congressional Budget Office, which 
     provides additional information on the budgetary effects of 
     this Act, as follows:

   ESTIMATE OF THE STATUTORY PAY-AS-YOU-GO EFFECTS FOR H.R. 4994, AN ACT TO EXTEND CERTAIN EXPIRING PROVISIONS OF THE MEDICARE AND MEDICAID PROGRAMS, AND FOR OTHER PURPOSES (AS INTRODUCED ON
                                                                DECEMBER 7, 2010--ERN10381; ASSUMED ENACTMENT LATE DECEMBER 2010)
                                                                            [By fiscal year, in millions of dollars]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 2011       2012       2013       2014       2015       2016       2017       2018       2019       2020    2011-2015  2011-2020
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                      Net Increase or Decrease (-) in the On-Budget Deficit
 
Total On-Budget Changes.....................................     12,035      7,038        299       -742     -1,849     -2,893     -3,626     -4,037     -4,336     -4,662    -16,782     -2,772
Less:
    Current-Policy Adjustment for Medicare Payment to             9,624      4,881          0          0          0          0          0          0          0          0     14,505     14,505
     Physicians\1\..........................................
                                                             -----------------------------------------------------------------------------------------------------------------------------------
Statutory Pay-As-You-Go Impact..............................      2,412      2,157        299       -742     -1,849     -2,893     -3,626     -4,037     -4,336     -4,662      2,278    -17,276
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: Components may not sum to totals because of rounding. This legislation would freeze Medicare's payment rates for physicians' services at the current level through the end of December
  2011 and extend many other expiring provisions in Medicare. Additionally, the legislation would limit the aggregate amount recovered from reconciliation of income used for determining
  eligibility for tax credits provided through health insurance exchanges.
\1\Section 7(c) of the Statutory Pay-As-You-Go Act of 2010 provides for current-policy adjustments related to Medicare payments to physicians.
Sources: Congressional Budget Office, Staff of the Joint Committee on Taxation.

  The amendments were ordered to be engrossed and the bill to be read a 
third time.
  The bill (H.R. 4994), as amended, was read the third time and passed, 
as follows:

                               H.R. 4994

       Resolved, That the bill from the House of Representatives 
     (H.R. 4994) entitled ``An Act to amend the Internal Revenue 
     Code of 1986 to reduce taxpayer burdens and enhance taxpayer 
     protections, and for other purposes.'', do pass with the 
     following amendments:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     and Medicaid Extenders Act of 2010''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                          TITLE I--EXTENSIONS

Sec. 101. Physician payment update.
Sec. 102. Extension of MMA section 508 reclassifications.
Sec. 103. Extension of Medicare work geographic adjustment floor.

[[Page 19159]]

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

                       TITLE II--OTHER PROVISIONS

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

                          TITLE I--EXTENSIONS

     SEC. 101. PHYSICIAN PAYMENT UPDATE.

       Section 1848(d) of the Social Security Act (42 U.S.C. 
     1395w-4(d)) is amended by adding at the end the following new 
     paragraph:
       ``(12) Update for 2011.--
       ``(A) In general.--Subject to paragraphs (7)(B), (8)(B), 
     (9)(B), (10)(B), and (11)(B), in lieu of the update to the 
     single conversion factor established in paragraph (1)(C) that 
     would otherwise apply for 2011, the update to the single 
     conversion factor shall be 0 percent.
       ``(B) No effect on computation of conversion factor for 
     2012 and subsequent years.--The conversion factor under this 
     subsection shall be computed under paragraph (1)(A) for 2012 
     and subsequent years as if subparagraph (A) had never 
     applied.''.

     SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICATIONS.

       (a) Extension.--
       (1) In general.--Section 106(a) of division B of the Tax 
     Relief and Health Care Act of 2006 (42 U.S.C. 1395 note), as 
     amended by section 117 of the Medicare, Medicaid, and SCHIP 
     Extension Act of 2007 (Public Law 110-173), section 124 of 
     the Medicare Improvements for Patients and Providers Act of 
     2008 (Public Law 110-275), and sections 3137(a) and 10317 of 
     the Patient Protection and Affordable Care Act (Public Law 
     111-148), is amended by striking ``September 30, 2010'' and 
     inserting ``September 30, 2011''.
       (2) Special rule for fiscal year 2011.--
       (A) In general.--Subject to subparagraph (B), for purposes 
     of implementation of the amendment made by paragraph (1), 
     including (notwithstanding paragraph (3) of section 117(a) of 
     the Medicare, Medicaid, and SCHIP Extension Act of 2007 
     (Public Law 110-173), as amended by section 124(b) of the 
     Medicare Improvements for Patients and Providers Act of 2008 
     (Public Law 110-275)) for purposes of the implementation of 
     paragraph (2) of such section 117(a), during fiscal year 
     2011, the Secretary of Health and Human Services shall use 
     the hospital wage index that was promulgated by the Secretary 
     of Health and Human Services in the Federal Register on 
     August 16, 2010 (75 Fed. Reg. 50042), and any subsequent 
     corrections.
       (B) Exception.--Beginning on April 1, 2011, in determining 
     the wage index applicable to hospitals that qualify for wage 
     index reclassification, the Secretary shall include the 
     average hourly wage data of hospitals whose reclassification 
     was extended pursuant to the amendment made by paragraph (1) 
     only if including such data results in a higher applicable 
     reclassified wage index. Any revision to hospital wage 
     indexes made as a result of this subparagraph shall not be 
     effected in a budget neutral manner.
       (3) Adjustment for certain hospitals in fiscal year 2011.--
       (A) In general.--In the case of a subsection (d) hospital 
     (as defined in subsection (d)(1)(B) of section 1886 of the 
     Social Security Act (42 U.S.C. 1395ww)) with respect to 
     which--
       (i) a reclassification of its wage index for purposes of 
     such section was extended pursuant to the amendment made by 
     paragraph (1); and
       (ii) the wage index applicable for such hospital for the 
     period beginning on October 1, 2010, and ending on March 31, 
     2011, was lower than for the period beginning on April 1, 
     2011, and ending on September 30, 2011, by reason of the 
     application of paragraph (2)(B);

     the Secretary shall pay such hospital an additional payment 
     that reflects the difference between the wage index for such 
     periods.
       (B) Timeframe for payments.--The Secretary shall make 
     payments required under subparagraph (A) by not later than 
     December 31, 2011.
       (b) Conforming Amendment.--Section 117(a)(3) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173) is amended by inserting ``in fiscal years 2008 
     and 2009'' after ``For purposes of implementation of this 
     subsection''.

     SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC ADJUSTMENT 
                   FLOOR.

       Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 
     1395w-4(e)(1)(E)) is amended by striking ``before January 1, 
     2011'' and inserting ``before January 1, 2012''.

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

       Section 1833(g)(5) of the Social Security Act (42 U.S.C. 
     1395l(g)(5)) is amended by striking ``and ending on'' and all 
     that follows through ``2010'' and inserting ``and ending on 
     December 31, 2011''.

     SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF 
                   CERTAIN PHYSICIAN PATHOLOGY SERVICES.

       Section 542(c) of the Medicare, Medicaid, and SCHIP 
     Benefits Improvement and Protection Act of 2000 (as enacted 
     into law by section 1(a)(6) of Public Law 106-554), as 
     amended by section 732 of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w-4 
     note), section 104 of division B of the Tax Relief and Health 
     Care Act of 2006 (42 U.S.C. 1395w-4 note), section 104 of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), section 136 of the Medicare Improvements for 
     Patients and Providers Act of 2008 (Public Law 110-275), and 
     section 3104 of the Patient Protection and Affordable Care 
     Act (Public Law 111-148) is amended by striking ``and 2010'' 
     and inserting ``2010, and 2011''.

     SEC. 106. EXTENSION OF AMBULANCE ADD-ONS.

       (a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social 
     Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended--
       (1) in the matter preceding clause (i), by striking 
     ``2011'' and inserting ``2012,''; and
       (2) in each of clauses (i) and (ii), by striking ``January 
     1, 2011'' and inserting ``January 1, 2012'' each place it 
     appears.
       (b) Air Ambulance.--Section 146(b)(1) of the Medicare 
     Improvements for Patients and Providers Act of 2008 (Public 
     Law 110-275), as amended by sections 3105(b) and 10311(b) of 
     Public Law 111-148, is amended by striking ``December 31, 
     2010'' and inserting ``December 31, 2011''.
       (c) Super Rural Ambulance.--Section 1834(l)(12)(A) of the 
     Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by 
     striking ``2011'' and inserting ``2012''.

     SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL HEALTH 
                   ADD-ON PAYMENT.

       Section 138(a)(1) of the Medicare Improvements for Patients 
     and Providers Act of 2008 (Public Law 110-275), as amended by 
     section 3107 of the Patient Protection and Affordable Care 
     Act (Public Law 111-148), is amended by striking ``December 
     31, 2010'' and inserting ``December 31, 2011''.

     SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS PROVISION.

       Section 1833(t)(7)(D)(i) of the Social Security Act (42 
     U.S.C. 1395l(t)(7)(D)(i)), as amended by section 3121(a) of 
     the Patient Protection and Affordable Care Act (Public Law 
     111-148), is amended--
       (1) in subclause (II)--
       (A) in the first sentence, by striking ``2011''and 
     inserting ``2012''; and
       (B) in the second sentence, by striking ``or 2010'' and 
     inserting ``2010, or 2011''; and
       (2) in subclause (III), by striking ``January 1, 2011'' and 
     inserting ``January 1, 2012''.

     SEC. 109. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS FOR 
                   CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS 
                   FURNISHED TO HOSPITAL PATIENTS IN CERTAIN RURAL 
                   AREAS.

       Section 416(b) of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l-
     4), as amended by section 105 of division B of the Tax Relief 
     and Health Care Act of 2006 (42 U.S.C. 1395l note), section 
     107 of the Medicare, Medicaid, and SCHIP Extension Act of 
     2007 (42 U.S.C. 1395l note), and section 3122 of the Patient 
     Protection and Affordable Care Act (Public Law 111-148), is 
     amended by striking ``the 1-year period beginning on July 1, 
     2010'' and inserting ``the 2-year period beginning on July 1, 
     2010''.

     SEC. 110. EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) 
                   PROGRAM.

       (a) Extension.--Section 1902(a)(10)(E)(iv) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by 
     striking ``December 2010'' and inserting ``December 2011''.
       (b) Extending Total Amount Available for Allocation.--
     Section 1933(g) of such Act (42 U.S.C. 1396u-3(g)) is 
     amended--
       (1) in paragraph (2)--
       (A) by striking ``and'' at the end of subparagraph (M);
       (B) in subparagraph (N), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding at the end the following new subparagraphs:
       ``(O) for the period that begins on January 1, 2011, and 
     ends on September 30, 2011, the total allocation amount is 
     $720,000,000; and
       ``(P) for the period that begins on October 1, 2011, and 
     ends on December 31, 2011, the total allocation amount is 
     $280,000,000.''; and
       (2) in paragraph (3), in the matter preceding subparagraph 
     (A), by striking ``or (N)'' and inserting ``(N), or (P)''.

[[Page 19160]]



     SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA).

       Sections 1902(e)(1)(B) and 1925(f) of the Social Security 
     Act (42 U.S.C. 1396a(e)(1)(B), 1396r-6(f)) are each amended 
     by striking ``December 31, 2010'' and inserting ``December 
     31, 2011''.

     SEC. 112. SPECIAL DIABETES PROGRAMS.

       (1) Special diabetes programs for type i diabetes.--Section 
     330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 
     254c-2(b)(2)(C)) is amended by striking ``2011'' and 
     inserting ``2013''.
       (2) Special diabetes programs for indians.--Section 
     330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 
     254c-3(c)(2)(C)) is amended by striking ``2011'' and 
     inserting ``2013''.

                       TITLE II--OTHER PROVISIONS

     SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B SPECIAL 
                   ENROLLMENT PERIOD FOR DISABLED TRICARE 
                   BENEFICIARIES.

       Effective as if included in the enactment of Public Law 
     111-148, section 3110(a)(2) of such Act is amended to read as 
     follows:
       ``(2) Effective date.--The amendment made by paragraph (1) 
     shall apply to elections made on and after the date of the 
     enactment of this Act.''.

     SEC. 202. REPEAL OF DELAY OF RUG-IV.

       Effective as if included in the enactment of Public Law 
     111-148, section 10325 of such Act is repealed.

     SEC. 203. CLARIFICATION FOR AFFILIATED HOSPITALS FOR 
                   DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.

       Effective as if included in the enactment of section 
     5503(a) of Public Law 111-148, section 1886(h)(8) of the 
     Social Security Act (42 U.S.C. 1395ww(h)(8)), as added by 
     such section 5503(a), is amended by adding at the end the 
     following new subparagraph:
       ``(I) Affiliation.--The provisions of this paragraph shall 
     be applied to hospitals which are members of the same 
     affiliated group (as defined by the Secretary under paragraph 
     (4)(H)(ii)) and the reference resident level for each such 
     hospital shall be the reference resident level with respect 
     to the cost reporting period that results in the smallest 
     difference between the reference resident level and the 
     otherwise applicable resident limit.''.

     SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN DEFINITION 
                   OF COVERED OUTPATIENT DRUGS WITH RESPECT TO 
                   CHILDREN'S HOSPITALS UNDER THE 340B DRUG 
                   DISCOUNT PROGRAM.

       (a) Definition of Covered Outpatient Drug.--
       (1) Amendment.--Subsection (e) of section 340B of the 
     Public Health Service Act (42 U.S.C. 256b) is amended by 
     striking ``covered entities described in subparagraph (M)'' 
     and inserting ``covered entities described in subparagraph 
     (M) (other than a children's hospital described in 
     subparagraph (M))''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect as if included in the enactment of section 
     2302 of the Health Care and Education Reconciliation Act of 
     2010 (Public Law 111-152).
       (b) Technical Amendment.--Subparagraph (B) of section 
     1927(a)(5) of the Social Security Act (42 U.S.C. 1396r-
     8(a)(5)) is amended by striking ``and a children's hospital'' 
     and all that follows through the end of the subparagraph and 
     inserting a period.

     SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS.

       (a) Repeal of Exclusion of Certain Individuals and Entities 
     From Medicaid.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a(a)) is amended by striking paragraph (78).
       (b) Income Level for Certain Children Under Medicaid.--
     Section 1902(l)(2)(C) of the Social Security Act (42 U.S.C. 
     1396a(l)(2)(C)) is amended by striking ``133 percent'' and 
     inserting ``100 percent (or, beginning January 1, 2014, 133 
     percent)''.
       (c) Calculation and Publication of Payment Error Rate 
     Measurement for Certain Years.--Section 601(b) of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009 (Public Law 111-3) is amended by adding at the end the 
     following: ``The Secretary is not required under this 
     subsection to calculate or publish a national or a State-
     specific error rate for fiscal year 2009 or fiscal year 
     2010.''.
       (d) Corrections to Exceptions to Exclusion of Children of 
     Certain Employees.--Section 2110(b)(6) of the Social Security 
     Act (42 U.S.C. 1397jj(b)(6)) is amended--
       (1) in subparagraph (B)--
       (A) by striking ``per person'' in the heading; and
       (B) by striking ``each employee'' and inserting 
     ``employees''; and
       (2) in subparagraph (C), by striking ``, on a case-by-case 
     basis,''.
       (e) Electronic Health Records.--Effective as if included in 
     the enactment of section 4201(a)(2) of the American Recovery 
     and Reinvestment Act of 2009 (Public Law 111-5), section 
     1903(t) of the Social Security Act (42 U.S.C. 1396b(t)) is 
     amended--
       (1) in paragraph (3)(E), by striking ``reduced by any 
     payment that is made to such Medicaid provider from any other 
     source (other than under this subsection or by a State or 
     local government)'' and inserting ``reduced by the average 
     payment the Secretary estimates will be made to such Medicaid 
     providers (determined on a percentage or other basis for such 
     classes or types of providers as the Secretary may specify) 
     from other sources (other than under this subsection, or by 
     the Federal government or a State or local government)''; and
       (2) in paragraph (6)(B), by inserting before the period the 
     following: ``and shall be determined to have met such 
     responsibility to the extent that the payment to the Medicaid 
     provider is not in excess of 85 percent of the net average 
     allowable cost''.
       (f) Corrections of Designations.--
       (1) Section 1902 of the Social Security Act (42 U.S.C. 
     1396a) is amended--
       (A) in subsection (a)(10), in the matter following 
     subparagraph (G), by striking ``and'' before ``(XVI) the 
     medical'' and by striking ``(XVI) if'' and inserting ``(XVII) 
     if'';
       (B) in subsection (a)(23), by striking ``(ii)'' and 
     inserting ``(kk)'';
       (C) in subsection (a)(77), by striking ``(ii)'' and 
     inserting ``(kk)'';
       (D) in subsection (ii)(2), as added by section 2303(a)(2) 
     of Public Law 111-148, by striking ``(XV)'' and inserting 
     ``(XVI)''; and
       (E) by redesignating subsection (ii), as added by section 
     6401(b)(1)(B) of Public Law 111-148, as subsection (kk) and 
     transferring such subsection so as to appear after subsection 
     (jj) of that section.
       (2) Section 2107(e)(1) of the Social Security Act (42 
     U.S.C. 1397gg(e)(1)) is amended--
       (A) in subparagraph (D), as added by section 6401(c) of 
     Public Law 111-148, by striking ``(ii)'' and inserting 
     ``(kk)''; and
       (B) by redesignating the subparagraph (N) of that section 
     added by 2101(e) of Public Law 111-148 as subparagraph (O).

     SEC. 206. FUNDING FOR CLAIMS REPROCESSING.

       For purposes of carrying out the provisions of, and 
     amendments made by, this Act that relate to title XVIII of 
     the Social Security Act, and other provisions of, or relating 
     to, such title that ensure appropriate payment of claims, 
     there are appropriated to the Secretary of Health and Human 
     Services for the Centers for Medicare & Medicaid Services 
     Program Management Account, from amounts in the general fund 
     of the Treasury not otherwise appropriated, $200,000,000. 
     Amounts appropriated under the preceding sentence shall be in 
     addition to any other funds available for such purposes, 
     shall remain available until expended, and shall not be used 
     to implement changes to title XVIII of the Social Security 
     Act made by Public Laws 111-148 and 111-152.

     SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1)(B) of the Social Security Act (42 U.S.C. 
     1395iii(b)(1)(B)) is amended by striking ``$550,000,000'' and 
     inserting ``$275,000,000''.

     SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOVERED ON 
                   RECONCILIATION OF THE HEALTH INSURANCE TAX 
                   CREDIT AND THE ADVANCE OF THAT CREDIT.

       (a) In General.--So much of section 36B(f)(2)(B) of the 
     Internal Revenue Code of 1986 as precedes clause (ii) thereof 
     is amended to read as follows:
       ``(B) Limitation on increase.--
       ``(i) In general.--In the case of a taxpayer whose 
     household income is less than 500 percent of the poverty line 
     for the size of the family involved for the taxable year, the 
     amount of the increase under subparagraph (A) shall in no 
     event exceed the applicable dollar amount determined in 
     accordance with the following table (one-half of such amount 
     in the case of a taxpayer whose tax is determined under 
     section 1(c) for the taxable year):


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

       (b) Conforming Amendment.--Section 36B(f)(2)(B)(ii) of such 
     Code is amended by inserting ``in the table contained'' after 
     ``each of the dollar amounts''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2013.

     SEC. 209. DETERMINATION OF BUDGETARY EFFECTS.

       (a) In General.--The budgetary effects of this Act, for the 
     purpose of complying with the Statutory Pay-As-You-Go Act of 
     2010, shall be determined by reference to the latest 
     statement titled ``Budgetary Effects of PAYGO Legislation'' 
     for this Act, submitted for printing in the Congressional 
     Record by the Chairman of the Senate Budget Committee, 
     provided that such statement has been submitted prior to the 
     vote on passage.
       (b) Emergency Designation for Congressional Enforcement.--
     In the House of Representatives, this Act, with the exception 
     of section 101, is designated as an emergency for purposes of 
     pay-as-you-go principles.

         Amend the title so as to read: ``An Act to extend certain 
     expiring provisions of the Medicare and Medicaid programs, 
     and for other purposes.''.

  The PRESIDING OFFICER. The Senator from Tennessee is recognized.

                          ____________________