[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4994 Enrolled Bill (ENR)]
H.R.4994
One Hundred Eleventh Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Tuesday,
the fifth day of January, two thousand and ten
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,

be3e2083b35f4b8a25bcd1a501064f5d41b93dec1ca09d5baea47a7b833a1580

(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:

27e05fa78161e77ff51f844369e279a7f54734c5573ca1d3f6f8babe4e27f783

2b46728aa84cafc3db9783a6236a01147764d7bd26d5a5beec1d873cc804e8c8

TITLE I

-EXTENSIONS

d3e542cab321f29326677d9b792a599cdbe556c54a643d4c409a88ecdd1077c4

clinical diagnostic laboratory tests furnished to hospital
patients in certain rural areas.

5e9e848a83754d767d8cad0347385e9ad5473ab1372af0adfffa90db69f3998a

period for disabled TRICARE beneficiaries.

bed7758a8be40ca773b1afd7169c1f5e820682265e698d86b01dc23021085272

TITLE II

-OTHER PROVISIONS

50064649e0312cc9c0f60e8201350a546f10c51b8132348f3147be9ba60a9bdc

outpatient drugs with respect to children's hospitals under
the 340B drug discount program.

00fec7f026a5fdca4e7501ae6bfa59dd4b42db1933fef7151669d542e1a3a95b

the health insurance tax credit and the advance of that
credit.

7f1b2c07d4ad7fbc68585d0b33ac69febbf5744ada44561af09a9d1aee6dd176

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.''.

b2ba7bc6b1d7ea282ac75bbebfcfe3d0a639c3419658bc7789db120745b5db8e

(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''.

e1d0ffd888b51792873fc481e78da56f0b5f3effd102f9810456dc35eaf951d8

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''.

15b25774746266856db1f532e90bdff01405d60cd6f2ad1080e44b8d3066790a

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''.

94beec5f6899f0c175d3bfecd6c9d9ad98d1cc244fc455cf5ae5be33bf261258

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''.

535b5d4f03da16d1a889991494356cc23738a07e7d4b8da506f6aaa4dd252f5a

(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''.

735033ae4034cedc5c91bcf9205235a36b30e96a19264a14744101ac9ef7015b

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''.

8d4957191eedd4bd4afd7ce8eacc0ee936beea67f99f7931b17b4e19c5e7bf2f

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''.

ad93e43597da187f67c0a9e324650e6c6965d484986c2bc0cb9a65bf33d7d746

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''.

50979b315a3b928d621e46aae5ef441757d23afbfaec6adcc6222ffe698383a7

(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)''.

b75126f640bbe67cf22c68dc1cbfd67a36c23d767cef1173c4ce093cafe00af3

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''.

a95017c84cf254bcba2873d8eeedf0052945a1d8632a6fabda7fc862355fb5fd

(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''.

77c9029686cc6535e2afda56b4564bfe09155e314bc5e7d0e6a2fe0dd22695cc

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.''.

a65fdfd211daa1dff2e5fb67cfacd0116b3ef05a4cad11aa0c67e4ef28eb4416

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

c53d73751952c9d68e92400b7c258ebfed834e95e75c123ad7b9e76395aae899

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.''.

a19ded6d96087e2765c8b84bf14c11443812433b8969738ef999d90157604d80

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.

5bdb4c75ecfecde3f28931056b03a41b0a1e1425defe6d1958f9f906c6c023ef

(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).

5f077e83bfbe8ec035000712cbeae65d6cb07310a47526dcadcd54b18f77c239

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.

71e53527d980cfb3a1db91f05692f59c23cb0332777533fd0ed9f165beadb8ec

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''.

ab1aea006122e4b645e4dbd3b246d3cfdc440bfdcadee56f2181bbc18db20df8

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 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.

715ed30dacd14dcfba723fdfe038d787018efc6a6963a5b7712d529ce275559c

(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.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

5d9d6c4c973772ced88ccbb99ab51e12de6364d57b46c403402a3aaec1908b0d

Medicare and Medicaid Extenders Act of 2010 — HR. 4994

Other Sections

TITLE I

TITLE II

Want the full experience?