    [United States Statutes at Large, Volume 124, 111th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    Public Law 111-309
    111th Congress

    An Act

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

    Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <>
    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short <> Title.--This Act may be cited
    as the ``Medicare and Medicaid Extenders Act of 2010''.

    (b) Table of Contents.--The table of contents of this Act is as
    follows:

    Sec. 1. Short title; table of contents.

    TITLE I--EXTENSIONS

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

    TITLE II--OTHER PROVISIONS

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

    TITLE I--EXTENSIONS

    SEC. 101. PHYSICIAN PAYMENT UPDATE.

    Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) is
    amended by adding at the end the following new paragraph:

    [[Page 3286]]

    ``(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

    [[Page 3287]]

    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''.

    [[Page 3288]]

    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 3289]]

    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

    [[Page 3290]]

    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)'';

    [[Page 3291]]

    (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):

    [[Page 3292]]

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

    (b) Conforming Amendment.--Section 36B(f)(2)(B)(ii) of such Code
    is <> amended by inserting ``in the table contained''
    after ``each of the dollar amounts''.

    (c) Effective <> Date.--The amendments made
    by this section shall apply to taxable years beginning after December
    31, 2013.
    SEC. 209. DETERMINATION OF BUDGETARY EFFECTS.

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

    Approved December 15, 2010.

    LEGISLATIVE HISTORY--H.R. 4994:
    ---------------------------------------------------------------------------

    CONGRESSIONAL RECORD, Vol. 156 (2010):
    Apr. 14, considered and passed House.
    Dec. 8, considered and passed Senate, amended.
    Dec. 9, House concurred in Senate amendments.