[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2499 Enrolled Bill (ENR)]
:\SENENR\s2499--enr.xml [file 1 of 1]
S.2499
One Hundred Tenth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Thursday,
the fourth day of January, two thousand and seven
An Act
To amend titles XVIII, XIX, and XXI of the Social Security Act to extend
provisions under the Medicare, Medicaid, and SCHIP programs, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(a) In General.--This Act may be cited as the ``Medicare, Medicaid,
and SCHIP Extension Act of 2007''.
(b) Table of Contents.--The table of contents of this Act is as
follows:

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TITLE I

-MEDICARE

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a768cdbfcb1b036a0ffedf9f839d67ebc505b270867539b8f75ec508a76aa593

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

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for special needs individuals to restrict enrollment.

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extension or renewal of Medicare reasonable cost contract
plans.

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Programs, Area Agencies on Aging, and Aging and Disability
Resource Centers.

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TITLE II

-MEDICAID AND SCHIP

PHYSICIAN QUALITY REPORTING SYSTEM.
(a) Increase in Physician Payment Update.--
(1) In general.--Section 1848(d) of the Social Security Act (42
U.S.C. 1395w-4(d)) is amended--
(A) in paragraph (4)(B), by striking ``and paragraphs (5)
and (6)'' and inserting ``and the succeeding paragraphs of this
subsection''; and
(B) by adding at the end the following new paragraph:
``(8) Update for a portion of 2008.--
``(A) In general.--Subject to paragraph (7)(B), in lieu of
the update to the single conversion factor established in
paragraph (1)(C) that would otherwise apply for 2008, for the
period beginning on January 1, 2008, and ending on June 30,
2008, the update to the single conversion factor shall be 0.5
percent.
``(B) No effect on computation of conversion factor for the
remaining portion of 2008 and 2009.--The conversion factor
under this subsection shall be computed under paragraph (1)(A)
for the period beginning on July 1, 2008, and ending on
December 31, 2008, and for 2009 and subsequent years as if
subparagraph (A) had never applied.''.
(2) Revision of the physician assistance and quality initiative
fund.--
(A) Revision.--Section 1848(l)(2) of the Social Security
Act (42 U.S.C. 1395w-4(l)(2)) is amended--
(i) by striking subparagraph (A) and inserting the
following:
``(A) Amount available.--
``(i) In general.--Subject to clause (ii), there shall
be available to the Fund the following amounts:
``(I) For expenditures during 2008, an amount equal
to $150,500,000.
``(II) For expenditures during 2009, an amount
equal to $24,500,000.
``(III) For expenditures during 2013, an amount
equal to $4,960,000,000.
``(ii) Limitations on expenditures.--
``(I) 2008.--The amount available for expenditures
during 2008 shall be reduced as provided by
subparagraph (A) of section 225(c)(1) and section 524
of the Departments of Labor, Health and Human Services,
and Education, and Related Agencies Appropriations Act,
2008 (division G of the Consolidated Appropriations
Act, 2008).
``(II) 2009.--The amount available for expenditures
during 2009 shall be reduced as provided by
subparagraph (B) of such section 225(c)(1).
``(III) 2013.--The amount available for
expenditures during 2013 shall only be available for an
adjustment to the update of the conversion factor under
subsection (d) for that year.''; and
(ii) in subparagraph (B), by striking ``entire amount
specified in the first sentence of subparagraph (A)'' and
all that follows and inserting the following: ``entire
amount available for expenditures, after application of
subparagraph (A)(ii), during--
``(i) 2008 for payment with respect to physicians'
services furnished during 2008;
``(ii) 2009 for payment with respect to physicians'
services furnished during 2009; and
``(iii) 2013 for payment with respect to physicians'
services furnished during 2013.''.
(B) Effective date.--
(i) In general.--Subject to clause (ii), the amendments
made by subparagraph (A) shall take effect on the date of
the enactment of this Act.
(ii) Special rule for coordination with consolidated
appropriations act, 2008.--If the date of the enactment of
the Consolidated Appropriations Act, 2008, occurs on or
after the date described in clause (i), the amendments made
by subparagraph (A) shall be deemed to be made on the day
after the effective date of sections 225(c)(1) and 524 of
the Departments of Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act, 2008
(division G of the Consolidated Appropriations Act, 2008).
(C) Transfer of funds to part b trust fund.--Amounts that
would have been available to the Physician Assistance and
Quality Initiative Fund under section 1848(l)(2) of the Social
Security Act (42 U.S.C. 1395w-4(l)(2)) for payment with respect
to physicians' services furnished prior to January 1, 2013, but
for the amendments made by subparagraph (A), shall be deposited
into, and made available for expenditures from, the Federal
Supplementary Medical Insurance Trust Fund under section 1841
of such Act (42 U.S.C. 1395t).
(b) Extension of the Physician Quality Reporting System.--
(1) System.--Section 1848(k)(2)(B) of the Social Security Act
(42 U.S.C. 1395w-4(k)(2)(B)) is amended--
(A) in the heading, by inserting ``and 2009'' after
``2008'';
(B) in clause (i), by inserting ``and 2009'' after
``2008''; and
(C) in each of clauses (ii) and (iii)--
(i) by striking ``, 2007'' and inserting ``of each of
2007 and 2008''; and
(ii) by inserting ``or 2009, as applicable'' after
``2008''.
(2) Reporting.--Section 101(c) of division B of the Tax Relief
and Health Care Act of 2006 (42 U.S.C. 1395w-4 note) is amended--
(A) in the heading, by inserting ``and 2008'' after
``2007'';
(B) in paragraph (5), by adding at the end the following:
``(F) Extension.--For 2008 and 2009, paragraph (3) shall
not apply, and the Secretary shall establish alternative
criteria for satisfactorily reporting under paragraph (2) and
alternative reporting periods under paragraph (6)(C) for
reporting groups of measures under paragraph (2)(B) of section
1848(k) of the Social Security Act (42 U.S.C. 1395w-4(k)) and
for reporting using the method specified in paragraph (4) of
such section.''; and
(C) in paragraph (6), by striking subparagraph (C) and
inserting the following new subparagraph:
``(C) Reporting period.--The term `reporting period'
means--
``(i) for 2007, the period beginning on July 1, 2007,
and ending on December 31, 2007; and
``(ii) for 2008, all of 2008.''.
(c) Implementation.--For purposes of carrying out the provisions
of, and amendments made by subsections (a) and (b), in addition to any
amounts otherwise provided in this title, there are appropriated to the
Centers for Medicare & Medicaid Services Program Management Account,
out of any money in the Treasury not otherwise appropriated,
$25,000,000 for the period of fiscal years 2008 and 2009.

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PHYSICIAN SCARCITY AREAS.
Section 1833(u) of the Social Security Act (42 U.S.C. 1395l(u)) is
amended--
(1) in paragraph (1), by striking ``before January 1, 2008''
and inserting ``before July 1, 2008''; and
(2) in paragraph (4)--
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following new
subparagraph:
``(D) Special rule.--With respect to physicians' services
furnished on or after January 1, 2008, and before July 1, 2008,
for purposes of this subsection, the Secretary shall use the
primary care scarcity counties and the specialty care scarcity
counties (as identified under the preceding provisions of this
paragraph) that the Secretary was using under this subsection
with respect to physicians' services furnished on December 31,
2007.''.

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THE MEDICARE PHYSICIAN FEE SCHEDULE.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)), as amended by section 102 of division B of the Tax Relief
and Health Care Act of 2006, is amended by striking ``before January 1,
2008'' and inserting ``before July 1, 2008''.

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SERVICES UNDER MEDICARE.
Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 (as enacted into law by section
1(a)(6) of Public Law 106-554), as amended by section 732 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(42 U.S.C. 1395w-4 note) and section 104 of division B of the Tax
Relief and Health Care Act of 2006 (42 U.S.C. 1395w-4 note), is amended
by striking ``and 2007'' and inserting ``2007, and the first 6 months
of 2008''.

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CAPS.
Section 1833(g)(5) of the Social Security Act (42 U.S.C.
1395l(g)(5)) is amended by striking ``December 31, 2007'' and inserting
``June 30, 2008''.

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THERAPEUTIC RADIOPHARMACEUTICALS.
(a) Extension of Payment Rule for Brachytherapy.--Section
1833(t)(16)(C) of the Social Security Act (42 U.S.C. 1395l(t)(16)(C)),
as amended by section 107(a) of division B of the Tax Relief and Health
Care Act of 2006, is amended by striking ``January 1, 2008'' and
inserting ``July 1, 2008''.
(b) Payment for Therapeutic Radiopharmaceuticals.--Section
1833(t)(16)(C) of the Social Security Act (42 U.S.C. 1395l(t)(16)(C)),
as amended by subsection (a), is amended--
(1) in the heading, by inserting ``and therapeutic
radiopharmaceuticals'' before ``at charges'';
(2) in the first sentence--
(A) by inserting ``and for therapeutic radiopharmaceuticals
furnished on or after January 1, 2008, and before July 1,
2008,'' after ``July 1, 2008,'';
(B) by inserting ``or therapeutic radiopharmaceutical''
after ``the device''; and
(C) by inserting ``or therapeutic radiopharmaceutical''
after ``each device''; and
(3) in the second sentence, by inserting ``or therapeutic
radiopharmaceuticals'' after ``such devices''.

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CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS FURNISHED TO
HOSPITAL PATIENTS IN CERTAIN RURAL AREAS.
Section 416(b) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (42 U.S.C. 1395l-4), as amended by section
105 of division B of the Tax Relief and Health Care Act of 2006 (42
U.S.C. 1395l note), is amended by striking ``the 3-year period
beginning on July 1, 2004'' and inserting ``the period beginning on
July 1, 2004, and ending on June 30, 2008''.

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PLANS FOR SPECIAL NEEDS INDIVIDUALS TO RESTRICT ENROLLMENT.
(a) Extension of Authority To Restrict Enrollment.--Section 1859(f)
of the Social Security Act (42 U.S.C. 1395w-28(f)) is amended by
striking ``2009'' and inserting ``2010''.
(b) Moratorium.--
(1) Authority to designate other plans as specialized ma
plans.--During the period beginning on January 1, 2008, and ending
on December 31, 2009, the Secretary of Health and Human Services
shall not exercise the authority provided under section 231(d) of
the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (42 U.S.C. 1395w-21 note) to designate other plans as
specialized MA plans for special needs individuals under part C of
title XVIII of the Social Security Act. The preceding sentence
shall not apply to plans designated as specialized MA plans for
special needs individuals under such authority prior to January 1,
2008.
(2) Enrollment in new plans.--During the period beginning on
January 1, 2008, and ending on December 31, 2009, the Secretary of
Health and Human Services shall not permit enrollment of any
individual residing in an area in a specialized Medicare Advantage
plan for special needs individuals under part C of title XVIII of
the Social Security Act to take effect unless that specialized
Medicare Advantage plan for special needs individuals was available
for enrollment for individuals residing in that area on January 1,
2008.

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EXTENSION OR RENEWAL OF MEDICARE REASONABLE COST CONTRACT PLANS.
Section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C.
1395mm(h)(5)(C)(ii)), in the matter preceding subclause (I), is amended
by striking ``January 1, 2008'' and inserting ``January 1, 2009''.

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Section 1858(e)(2)(A)(i) of the Social Security Act (42 U.S.C.
1395w-27a(e)(2)(A)(i)), as amended by section 3 of Public Law 110-48,
is amended by striking ``the Fund'' and all that follows and inserting
``the Fund during 2013, $1,790,000,000.''

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(a) In General.--Section 1862(b) of the Social Security Act (42
U.S.C. 1395y(b)) is amended by adding at the end the following new
paragraphs:
``(7) Required submission of information by group health
plans.--
``(A) Requirement.--On and after the first day of the first
calendar quarter beginning after the date that is 1 year after
the date of the enactment of this paragraph, an entity serving
as an insurer or third party administrator for a group health
plan, as defined in paragraph (1)(A)(v), and, in the case of a
group health plan that is self-insured and self-administered, a
plan administrator or fiduciary, shall--
``(i) secure from the plan sponsor and plan
participants such information as the Secretary shall
specify for the purpose of identifying situations where the
group health plan is or has been a primary plan to the
program under this title; and
``(ii) submit such information to the Secretary in a
form and manner (including frequency) specified by the
Secretary.
``(B) Enforcement.--
``(i) In general.--An entity, a plan administrator, or
a fiduciary described in subparagraph (A) that fails to
comply with the requirements under such subparagraph shall
be subject to a civil money penalty of $1,000 for each day
of noncompliance for each individual for which the
information under such subparagraph should have been
submitted. The provisions of subsections (e) and (k) of
section 1128A shall apply to a civil money penalty under
the previous sentence in the same manner as such provisions
apply to a penalty or proceeding under section 1128A(a). A
civil money penalty under this clause shall be in addition
to any other penalties prescribed by law and in addition to
any Medicare secondary payer claim under this title with
respect to an individual.
``(ii) Deposit of amounts collected.--Any amounts
collected pursuant to clause (i) shall be deposited in the
Federal Hospital Insurance Trust Fund under section 1817.
``(C) Sharing of information.--Notwithstanding any other
provision of law, under terms and conditions established by the
Secretary, the Secretary--
``(i) shall share information on entitlement under Part
A and enrollment under Part B under this title with
entities, plan administrators, and fiduciaries described in
subparagraph (A);
``(ii) may share the entitlement and enrollment
information described in clause (i) with entities and
persons not described in such clause; and
``(iii) may share information collected under this
paragraph as necessary for purposes of the proper
coordination of benefits.
``(D) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.
``(8) Required submission of information by or on behalf of
liability insurance (including self-insurance), no fault insurance,
and workers' compensation laws and plans.--
``(A) Requirement.--On and after the first day of the first
calendar quarter beginning after the date that is 18 months
after the date of the enactment of this paragraph, an
applicable plan shall--
``(i) determine whether a claimant (including an
individual whose claim is unresolved) is entitled to
benefits under the program under this title on any basis;
and
``(ii) if the claimant is determined to be so entitled,
submit the information described in subparagraph (B) with
respect to the claimant to the Secretary in a form and
manner (including frequency) specified by the Secretary.
``(B) Required information.--The information described in
this subparagraph is--
``(i) the identity of the claimant for which the
determination under subparagraph (A) was made; and
``(ii) such other information as the Secretary shall
specify in order to enable the Secretary to make an
appropriate determination concerning coordination of
benefits, including any applicable recovery claim.
``(C) Timing.--Information shall be submitted under
subparagraph (A)(ii) within a time specified by the Secretary
after the claim is resolved through a settlement, judgment,
award, or other payment (regardless of whether or not there is
a determination or admission of liability).
``(D) Claimant.--For purposes of subparagraph (A), the term
`claimant' includes--
``(i) an individual filing a claim directly against the
applicable plan; and
``(ii) an individual filing a claim against an
individual or entity insured or covered by the applicable
plan.
``(E) Enforcement.--
``(i) In general.--An applicable plan that fails to
comply with the requirements under subparagraph (A) with
respect to any claimant shall be subject to a civil money
penalty of $1,000 for each day of noncompliance with
respect to each claimant. The provisions of subsections (e)
and (k) of section 1128A shall apply to a civil money
penalty under the previous sentence in the same manner as
such provisions apply to a penalty or proceeding under
section 1128A(a). A civil money penalty under this clause
shall be in addition to any other penalties prescribed by
law and in addition to any Medicare secondary payer claim
under this title with respect to an individual.
``(ii) Deposit of amounts collected.--Any amounts
collected pursuant to clause (i) shall be deposited in the
Federal Hospital Insurance Trust Fund.
``(F) Applicable plan.--In this paragraph, the term
`applicable plan' means the following laws, plans, or other
arrangements, including the fiduciary or administrator for such
law, plan, or arrangement:
``(i) Liability insurance (including self-insurance).
``(ii) No fault insurance.
``(iii) Workers' compensation laws or plans.
``(G) Sharing of information.--The Secretary may share
information collected under this paragraph as necessary for
purposes of the proper coordination of benefits.
``(H) Implementation.--Notwithstanding any other provision
of law, the Secretary may implement this paragraph by program
instruction or otherwise.''.
(b) Rule of Construction.--Nothing in the amendments made by this
section shall be construed to limit the authority of the Secretary of
Health and Human Services to collect information to carry out Medicare
secondary payer provisions under title XVIII of the Social Security
Act, including under parts C and D of such title.
(c) Implementation.--For purposes of implementing paragraphs (7)
and (8) of section 1862(b) of the Social Security Act, as added by
subsection (a), to ensure appropriate payments under title XVIII of
such Act, the Secretary of Health and Human Services shall provide for
the transfer, from the Federal Hospital Insurance Trust Fund
established under section 1817 of the Social Security Act (42 U.S.C.
1395i) and the Federal Supplementary Medical Insurance Trust Fund
established under section 1841 of such Act (42 U.S.C. 1395t), in such
proportions as the Secretary determines appropriate, of $35,000,000 to
the Centers for Medicare & Medicaid Services Program Management Account
for the period of fiscal years 2008, 2009, and 2010.

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(a) Application of Alternative Volume Weighting in Computation of
ASP.--Section 1847A(b) of the Social Security Act (42 U.S.C. 1395w-
3a(b)) is amended--
(1) in paragraph (1)(A), by inserting ``for a multiple source
drug furnished before April 1, 2008, or 106 percent of the amount
determined under paragraph (6) for a multiple source drug furnished
on or after April 1, 2008'' after ``paragraph (3)'';
(2) in each of subparagraphs (A) and (B) of paragraph (4), by
inserting ``for single source drugs and biologicals furnished
before April 1, 2008, and using the methodology applied under
paragraph (6) for single source drugs and biologicals furnished on
or after April 1, 2008,'' after ``paragraph (3)''; and
(3) by adding at the end the following new paragraph:
``(6) Use of volume-weighted average sales prices in
calculation of average sales price.--
``(A) In general.--For all drug products included within
the same multiple source drug billing and payment code, the
amount specified in this paragraph is the volume-weighted
average of the average sales prices reported under section
1927(b)(3)(A)(iii) determined by--
``(i) computing the sum of the products (for each
National Drug Code assigned to such drug products) of--
``(I) the manufacturer's average sales price (as
defined in subsection (c)), determined by the Secretary
without dividing such price by the total number of
billing units for the National Drug Code for the
billing and payment code; and
``(II) the total number of units specified under
paragraph (2) sold; and
``(ii) dividing the sum determined under clause (i) by
the sum of the products (for each National Drug Code
assigned to such drug products) of--
``(I) the total number of units specified under
paragraph (2) sold; and
``(II) the total number of billing units for the
National Drug Code for the billing and payment code.
``(B) Billing unit defined.--For purposes of this
subsection, the term `billing unit' means the identifiable
quantity associated with a billing and payment code, as
established by the Secretary.''.
(b) Treatment of Certain Drugs.--Section 1847A(b) of the Social
Security Act (42 U.S.C. 1395w-3a(b)), as amended by subsection (a), is
amended--
(1) in paragraph (1), by inserting ``paragraph (7) and'' after
``Subject to''; and
(2) by adding at the end the following new paragraph:
``(7) Special rule.--Beginning with April 1, 2008, the payment
amount for--
``(A) each single source drug or biological described in
section 1842(o)(1)(G) that is treated as a multiple source drug
because of the application of subsection (c)(6)(C)(ii) is the
lower of--
``(i) the payment amount that would be determined for
such drug or biological applying such subsection; or
``(ii) the payment amount that would have been
determined for such drug or biological if such subsection
were not applied; and
``(B) a multiple source drug described in section
1842(o)(1)(G) (excluding a drug or biological that is treated
as a multiple source drug because of the application of such
subsection) is the lower of--
``(i) the payment amount that would be determined for
such drug or biological taking into account the application
of such subsection; or
``(ii) the payment amount that would have been
determined for such drug or biological if such subsection
were not applied.''.

daf0e534ade91c524289ca2b1b4883ab8bc86ad3f34ca635e157ef9d8df9b324

Section 1833(h) of the Social Security Act (42 U.S.C. 1395l(h)) is
amended by adding at the end the following new paragraph:
``(9) Notwithstanding any other provision in this part, in the case
of any diagnostic laboratory test for HbA1c that is labeled by the Food
and Drug Administration for home use and is furnished on or after April
1, 2008, the payment rate for such test shall be the payment rate
established under this part for a glycated hemoglobin test (identified
as of October 1, 2007, by HCPCS code 83036 (and any succeeding
codes)).''.

1bfe6200385986b8b8e3ffa28ea2d938a91d34ff265b72ee47aaf3393979b8d5

(a) Definition of Long-Term Care Hospital.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
``Long-Term Care Hospital
``(ccc) The term `long-term care hospital' means a hospital which--
``(1) is primarily engaged in providing inpatient services, by
or under the supervision of a physician, to Medicare beneficiaries
whose medically complex conditions require a long hospital stay and
programs of care provided by a long-term care hospital;
``(2) has an average inpatient length of stay (as determined by
the Secretary) of greater than 25 days, or meets the requirements
of clause (II) of section 1886(d)(1)(B)(iv);
``(3) satisfies the requirements of subsection (e); and
``(4) meets the following facility criteria:
``(A) the institution has a patient review process,
documented in the patient medical record, that screens patients
prior to admission for appropriateness of admission to a long-
term care hospital, validates within 48 hours of admission that
patients meet admission criteria for long-term care hospitals,
regularly evaluates patients throughout their stay for
continuation of care in a long-term care hospital, and assesses
the available discharge options when patients no longer meet
such continued stay criteria;
``(B) the institution has active physician involvement with
patients during their treatment through an organized medical
staff, physician-directed treatment with physician on-site
availability on a daily basis to review patient progress, and
consulting physicians on call and capable of being at the
patient's side within a moderate period of time, as determined
by the Secretary; and
``(C) the institution has interdisciplinary team treatment
for patients, requiring interdisciplinary teams of health care
professionals, including physicians, to prepare and carry out
an individualized treatment plan for each patient.''.
(b) Study and Report on Long-Term Care Hospital Facility and
Patient Criteria.--
(1) In general.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct a
study on the establishment of national long-term care hospital
facility and patient criteria for purposes of determining medical
necessity, appropriateness of admission, and continued stay at, and
discharge from, long-term care hospitals.
(2) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report on the study conducted under paragraph (1), together with
recommendations for such legislation and administrative actions,
including timelines for implementation of patient criteria or other
actions, as the Secretary determines appropriate.
(3) Considerations.--In conducting the study and preparing the
report under this subsection, the Secretary shall consider--
(A) recommendations contained in a report to Congress by
the Medicare Payment Advisory Commission in June 2004 for long-
term care hospital-specific facility and patient criteria to
ensure that patients admitted to long-term care hospitals are
medically complex and appropriate to receive long-term care
hospital services; and
(B) ongoing work by the Secretary to evaluate and determine
the feasibility of such recommendations.
(c) Payment for Long-Term Care Hospital Services.--
(1) No application of 25 percent patient threshold payment
adjustment to freestanding and grandfathered ltchs.--The Secretary
shall not apply, for cost reporting periods beginning on or after
the date of the enactment of this Act for a 3-year period--
(A) section 412.536 of title 42, Code of Federal
Regulations, or any similar provision, to freestanding long-
term care hospitals; and
(B) such section or section 412.534 of title 42, Code of
Federal Regulations, or any similar provisions, to a long-term
care hospital identified by the amendment made by section
4417(a) of the Balanced Budget Act of 1997 (Public Law 105-33).
(2) Payment for hospitals-within-hospitals.--
(A) In general.--Payment to an applicable long-term care
hospital or satellite facility which is located in a rural area
or which is co-located with an urban single or MSA dominant
hospital under paragraphs (d)(1), (e)(1), and (e)(4) of section
412.534 of title 42, Code of Federal Regulations, shall not be
subject to any payment adjustment under such section if no more
than 75 percent of the hospital's Medicare discharges (other
than discharges described in paragraph (d)(2) or (e)(3) of such
section) are admitted from a co-located hospital.
(B) Co-located long-term care hospitals and satellite
facilities.--
(i) In general.--Payment to an applicable long-term
care hospital or satellite facility which is co-located
with another hospital shall not be subject to any payment
adjustment under section 412.534 of title 42, Code of
Federal Regulations, if no more than 50 percent of the
hospital's Medicare discharges (other than discharges
described in paragraph (c)(3) of such section) are admitted
from a co-located hospital.
(ii) Applicable long-term care hospital or satellite
facility defined.--In this paragraph, the term ``applicable
long-term care hospital or satellite facility'' means a
hospital or satellite facility that is subject to the
transition rules under section 412.534(g) of title 42, Code
of Federal Regulations.
(C) Effective date.--Subparagraphs (A) and (B) shall apply
to cost reporting periods beginning on or after the date of the
enactment of this Act for a 3-year period.
(3) No application of very short-stay outlier policy.--The
Secretary shall not apply, for the 3-year period beginning on the
date of the enactment of this Act, the amendments finalized on May
11, 2007 (72 Federal Register 26904, 26992) made to the short-stay
outlier payment provision for long-term care hospitals contained in
section 412.529(c)(3)(i) of title 42, Code of Federal Regulations,
or any similar provision.
(4) No application of one-time adjustment to standard amount.--
The Secretary shall not, for the 3-year period beginning on the
date of the enactment of this Act, make the one-time prospective
adjustment to long-term care hospital prospective payment rates
provided for in section 412.523(d)(3) of title 42, Code of Federal
Regulations, or any similar provision.
(d) Moratorium on the Establishment of Long-Term Care Hospitals,
Long-Term Care Satellite Facilities and on the Increase of Long-Term
Care Hospital Beds in Existing Long-Term Care Hospitals or Satellite
Facilities.--
(1) In general.--During the 3-year period beginning on the date
of the enactment of this Act, the Secretary shall impose a
moratorium for purposes of the Medicare program under title XVIII
of the Social Security Act--
(A) subject to paragraph (2), on the establishment and
classification of a long-term care hospital or satellite
facility, other than an existing long-term care hospital or
facility; and
(B) subject to paragraph (3), on an increase of long-term
care hospital beds in existing long-term care hospitals or
satellite facilities.
(2) Exception for certain long-term care hospitals.--The
moratorium under paragraph (1)(A) shall not apply to a long-term
care hospital that as of the date of the enactment of this Act--
(A) began its qualifying period for payment as a long-term
care hospital under section 412.23(e) of title 42, Code of
Federal Regulations, on or before the date of the enactment of
this Act;
(B) has a binding written agreement with an outside,
unrelated party for the actual construction, renovation, lease,
or demolition for a long-term care hospital, and has expended,
before the date of the enactment of this Act, at least 10
percent of the estimated cost of the project (or, if less,
$2,500,000); or
(C) has obtained an approved certificate of need in a State
where one is required on or before the date of the enactment of
this Act.
(3) Exception for bed increases during moratorium.--
(A) In general.--Subject to subparagraph (B), the
moratorium under paragraph (1)(B) shall not apply to an
increase in beds in an existing hospital or satellite facility
if the hospital or facility--
(i) is located in a State where there is only one other
long-term care hospital; and
(ii) requests an increase in beds following the closure
or the decrease in the number of beds of another long-term
care hospital in the State.
(B) No effect on certain limitation.--The exception under
subparagraph (A) shall not effect the limitation on increasing
beds under sections 412.22(h)(3) and 412.22(f) of title 42,
Code of Federal Regulations.
(4) Existing hospital or satellite facility defined.--For
purposes of this subsection, the term ``existing'' means, with
respect to a hospital or satellite facility, a hospital or
satellite facility that received payment under the provisions of
subpart O of part 412 of title 42, Code of Federal Regulations, as
of the date of the enactment of this Act.
(5) Judicial review.--There shall be no administrative or
judicial review under section 1869 of the Social Security Act (42
U.S.C. 1395ff), section 1878 of such Act (42 U.S.C. 1395oo), or
otherwise, of the application of this subsection by the Secretary.
(e) Long-Term Care Hospital Payment Update.--
(1) In general.--Section 1886 of the Social Security Act (42
U.S.C. 1395ww) is amended by adding at the end the following new
subsection:
``(m) Prospective Payment for Long-Term Care Hospitals.--
``(1) Reference to establishment and implementation of
system.--For provisions related to the establishment and
implementation of a prospective payment system for payments under
this title for inpatient hospital services furnished by a long-term
care hospital described in subsection (d)(1)(B)(iv), see section
123 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 and section 307(b) of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000.
``(2) Update for rate year 2008.--In implementing the system
described in paragraph (1) for discharges occurring during the rate
year ending in 2008 for a hospital, the base rate for such
discharges for the hospital shall be the same as the base rate for
discharges for the hospital occurring during the rate year ending
in 2007.''.
(2) Delayed effective date.--Subsection (m)(2) of section 1886
of the Social Security Act, as added by paragraph (1), shall not
apply to discharges occurring on or after July 1, 2007, and before
April 1, 2008.
(f) Expanded Review of Medical Necessity.--
(1) In general.--The Secretary of Health and Human Services
shall provide, under contracts with one or more appropriate fiscal
intermediaries or medicare administrative contractors under section
1874A(a)(4)(G) of the Social Security Act (42 U.S.C. 1395kk-
1(a)(4)(G)), for reviews of the medical necessity of admissions to
long-term care hospitals (described in section 1886(d)(1)(B)(iv) of
such Act) and continued stay at such hospitals, of individuals
entitled to, or enrolled for, benefits under part A of title XVIII
of such Act consistent with this subsection. Such reviews shall be
made for discharges occurring on or after October 1, 2007.
(2) Review methodology.--The medical necessity reviews under
paragraph (1) shall be conducted on an annual basis in accordance
with rules specified by the Secretary. Such reviews shall--
(A) provide for a statistically valid and representative
sample of admissions of such individuals sufficient to provide
results at a 95 percent confidence interval; and
(B) guarantee that at least 75 percent of overpayments
received by long-term care hospitals for medically unnecessary
admissions and continued stays of individuals in long-term care
hospitals will be identified and recovered and that related
days of care will not be counted toward the length of stay
requirement contained in section 1886(d)(1)(B)(iv) of the
Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(iv)).
(3) Continuation of reviews.--Under contracts under this
subsection, the Secretary shall establish an error rate with
respect to such reviews that could require further review of the
medical necessity of admissions and continued stay in the hospital
involved and other actions as determined by the Secretary.
(4) Termination of required reviews.--
(A) In general.--Subject to subparagraph (B), the previous
provisions of this subsection shall cease to apply for
discharges occurring on or after October 1, 2010.
(B) Continuation.--As of the date specified in subparagraph
(A), the Secretary shall determine whether to continue to
guarantee, through continued medical review and sampling under
this paragraph, recovery of at least 75 percent of overpayments
received by long-term care hospitals due to medically
unnecessary admissions and continued stays.
(5) Funding.--The costs to fiscal intermediaries or medicare
administrative contractors conducting the medical necessity reviews
under paragraph (1) shall be funded from the aggregate overpayments
recouped by the Secretary of Health and Human Services from long-
term care hospitals due to medically unnecessary admissions and
continued stays. The Secretary may use an amount not in excess of
40 percent of the overpayments recouped under this paragraph to
compensate the fiscal intermediaries or Medicare administrative
contractors for the costs of services performed.
(g) Implementation.--For purposes of carrying out the provisions
of, and amendments made by, this title, in addition to any amounts
otherwise provided in this title, there are appropriated to the Centers
for Medicare & Medicaid Services Program Management Account, out of any
money in the Treasury not otherwise appropriated, $35,000,000 for the
period of fiscal years 2008 and 2009.

e2d2708e6569c4b5a9a4c0ec47fb50e02bbe472203a2245847f75d505db9898b

SERVICES.
(a) Payment Update.--
(1) In general.--Section 1886(j)(3)(C) of the Social Security
Act (42 U.S.C. 1395ww(j)(3)(C)) is amended by adding at the end the
following: ``The increase factor to be applied under this
subparagraph for each of fiscal years 2008 and 2009 shall be 0
percent.''.
(2) Delayed effective date.--The amendment made by paragraph
(1) shall not apply to payment units occurring before April 1,
2008.
(b) Inpatient Rehabilitation Facility Classification Criteria.--
(1) In general.--Section 5005 of the Deficit Reduction Act of
2005 (Public Law 109-171; 42 U.S.C. 1395ww note) is amended--
(A) in subsection (a), by striking ``apply the applicable
percent specified in subsection (b)'' and inserting ``require a
compliance rate that is no greater than the 60 percent
compliance rate that became effective for cost reporting
periods beginning on or after July 1, 2006,''; and
(B) by amending subsection (b) to read as follows:
``(b) Continued Use of Comorbidities.--For cost reporting periods
beginning on or after July 1, 2007, the Secretary shall include
patients with comorbidities as described in section 412.23(b)(2)(i) of
title 42, Code of Federal Regulations (as in effect as of January 1,
2007), in the inpatient population that counts toward the percent
specified in subsection (a).''.
(2) Effective date.--The amendment made by paragraph (1)(A)
shall apply for cost reporting periods beginning on or after July
1, 2007.
(c) Recommendations for Classifying Inpatient Rehabilitation
Hospitals and Units.--
(1) Report to congress.--Not later than 18 months after the
date of the enactment of this Act, the Secretary of Health and
Human Services, in consultation with physicians (including
geriatricians and physiatrists), administrators of inpatient
rehabilitation, acute care hospitals, skilled nursing facilities,
and other settings providing rehabilitation services, Medicare
beneficiaries, trade organizations representing inpatient
rehabilitation hospitals and units and skilled nursing facilities,
and the Medicare Payment Advisory Commission, shall submit to the
Committee on Ways and Means of the House of Representatives and the
Committee on Finance of the Senate a report that includes the
following:
(A) An analysis of Medicare beneficiaries' access to
medically necessary rehabilitation services, including the
potential effect of the 75 percent rule (as defined in
paragraph (2)) on access to care.
(B) An analysis of alternatives or refinements to the 75
percent rule policy for determining criteria for inpatient
rehabilitation hospital and unit designation under the Medicare
program, including alternative criteria which would consider a
patient's functional status, diagnosis, co-morbidities, and
other relevant factors.
(C) An analysis of the conditions for which individuals are
commonly admitted to inpatient rehabilitation hospitals that
are not included as a condition described in section
412.23(b)(2)(iii) of title 42, Code of Federal Regulations, to
determine the appropriate setting of care, and any variation in
patient outcomes and costs, across settings of care, for
treatment of such conditions.
(2) 75 percent rule defined.--For purposes of this subsection,
the term ``75 percent rule'' means the requirement of section
412.23(b)(2) of title 42, Code of Federal Regulations, that 75
percent of the patients of a rehabilitation hospital or converted
rehabilitation unit are in 1 or more of 13 listed treatment
categories.

653bb6c7355aed298e43dc5bbbcec6fc86cc572fe5f5b82c7e3cbbfc12b29272

ACTIVE DUTY IN THE ARMED SERVICES.
Section 1842(b)(6)(D)(iii) of the Social Security Act (42 U.S.C.
1395u(b)(6)(D)(iii)), as amended by Public Law 110-54 (121 Stat. 551)
is amended by striking ``January 1, 2008'' and inserting ``July 1,
2008''.

b605675fe1d09aa09d22998cce24a71c44f3ef7800dd07f68543637b77dcd742

(a) Extending Certain Medicare Hospital Wage Index
Reclassifications Through Fiscal Year 2008.--
(1) In general.--Section 106(a) of division B of the Tax Relief
and Health Care Act of 2006 (42 U.S.C. 1395 note) is amended by
striking ``September 30, 2007'' and inserting ``September 30,
2008''.
(2) Special exception reclassifications.--The Secretary of
Health and Human Services shall extend for discharges occurring
through September 30, 2008, the special exception reclassifications
made under the authority of section 1886(d)(5)(I)(i) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and contained in the
final rule promulgated by the Secretary in the Federal Register on
August 11, 2004 (69 Fed. Reg. 49105, 49107).
(3) Use of particular wage index.--For purposes of
implementation of this subsection, the Secretary shall use the
hospital wage index that was promulgated by the Secretary in the
Federal Register on October 10, 2007 (72 Fed. Reg. 57634), and any
subsequent corrections.
(b) Disregarding Section 508 Hospital Reclassifications for
Purposes of Group Reclassifications.--Section 508 of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public
Law 108-173, 42 U.S.C. 1395ww note) is amended by adding at the end the
following new subsection:
``(g) Disregarding Hospital Reclassifications for Purposes of Group
Reclassifications.--For purposes of the reclassification of a group of
hospitals in a geographic area under section 1886(d) of the Social
Security Act for purposes of discharges occurring during fiscal year
2008, a hospital reclassified under this section (including any such
reclassification which is extended under section 106(a) of the Medicare
Improvements and Extension Act of 2006) shall not be taken into account
and shall not prevent the other hospitals in such area from continuing
such a group for such purpose.''.
(c) Correction of Application of Wage Index During Tax Relief and
Health Care Act Extension.--In the case of a subsection (d) hospital
(as defined for purposes of section 1886 of the Social Security Act (42
U.S.C. 1395ww)) with respect to which--
(1) a reclassification of its wage index for purposes of such
section was extended for the period beginning on April 1, 2007, and
ending on September 30, 2007, pursuant to subsection (a) of section
106 of division B of the Tax Relief and Health Care Act of 2006 (42
U.S.C. 1395 note); and
(2) the wage index applicable for such hospital during such
period was lower than the wage index applicable for such hospital
during the period beginning on October 1, 2006, and ending on March
31, 2007,
the Secretary shall apply the higher wage index that was applicable for
such hospital during the period beginning on October 1, 2006, and
ending on March 31, 2007, for the entire fiscal year 2007. If the
Secretary determines that the application of the preceding sentence to
a hospital will result in a hospital being owed additional
reimbursement, the Secretary shall make such payments within 90 days
after the settlement of the applicable cost report.

06d232801be1211e2c5810bfb86d5bbf6dc94fa934af80f6da126ebf685ac371

PROGRAMS, AREA AGENCIES ON AGING, AND AGING AND DISABILITY
RESOURCE CENTERS.
(a) State Health Insurance Assistance Programs.--
(1) In general.--The Secretary of Health and Human Services
shall use amounts made available under paragraph (2) to make grants
to States for State health insurance assistance programs receiving
assistance under section 4360 of the Omnibus Budget Reconciliation
Act of 1990.
(2) Funding.--For purposes of making grants under this
subsection, the Secretary shall provide for the transfer, from the
Federal Hospital Insurance Trust Fund under section 1817 of the
Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary determines
under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of
$15,000,000 to the Centers for Medicare & Medicaid Services Program
Management Account for fiscal year 2008.
(b) Area Agencies on Aging and Aging and Disability Resource
Centers.--
(1) In general.--The Secretary of Health and Human Services
shall use amounts made available under paragraph (2) to make
grants--
(A) to States for area agencies on aging (as defined in
section 102 of the Older Americans Act of 1965 (42 U.S.C.
3002)); and
(B) to Aging and Disability Resource Centers under the
Aging and Disability Resource Center grant program.
(2) Funding.--For purposes of making grants under this
subsection, the Secretary shall provide for the transfer, from the
Federal Hospital Insurance Trust Fund under section 1817 of the
Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary determines
under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of
$5,000,000 to the Centers for Medicare & Medicaid Services Program
Management Account for the period of fiscal years 2008 through
2009.

935256cd5d37586ad777807d52fd8d55dc2fc840b10fa8d1cabf6b23b706a70c

(a) Through the Second Quarter of Fiscal Year 2009.--
(1) In general.--Section 2104 of the Social Security Act (42
U.S.C. 1397dd) is amended--
(A) in subsection (a)--
(i) by striking ``and'' at the end of paragraph (9);
(ii) by striking the period at the end of paragraph
(10) and inserting ``; and''; and
(iii) by adding at the end the following new paragraph:
``(11) for each of fiscal years 2008 and 2009,
$5,000,000,000.''; and
(B) in subsection (c)(4)(B), by striking ``for fiscal year
2007'' and inserting ``for each of fiscal years 2007 through
2009''.
(2) Availability of extended funding.--Funds made available
from any allotment made from funds appropriated under subsection
(a)(11) or (c)(4)(B) of section 2104 of the Social Security Act (42
U.S.C. 1397dd) for fiscal year 2008 or 2009 shall not be available
for child health assistance for items and services furnished after
March 31, 2009, or, if earlier, the date of the enactment of an Act
that provides funding for fiscal years 2008 and 2009, and for one
or more subsequent fiscal years for the State Children's Health
Insurance Program under title XXI of the Social Security Act.
(3) End of funding under continuing resolution.--Section
136(a)(2) of Public Law 110-92 is amended by striking ``after the
termination date'' and all that follows and inserting ``after the
date of the enactment of the Medicare, Medicaid, and SCHIP
Extension Act of 2007.''.
(4) Clarification of application of funding under continuing
resolution.--Section 107 of Public Law 110-92 shall apply with
respect to expenditures made pursuant to section 136(a)(1) of such
Public Law.
(b) Extension of Treatment of Qualifying States; Rules on
Redistribution of Unspent Fiscal Year 2005 Allotments Made Permanent.--
(1) In general.--Section 2105(g)(1)(A) of the Social Security
Act (42 U.S.C. 1397ee(g)(1)(A)), as amended by subsection (d) of
section 136 of Public Law 110-92, is amended by striking ``or
2008'' and inserting ``2008, or 2009''.
(2) Applicability.--The amendment made by paragraph (1) shall
be in effect through March 31, 2009.
(3) Certain rules made permanent.--Subsection (e) of section
136 of Public Law 110-92 is repealed.
(c) Additional Allotments To Eliminate Remaining Funding Shortfalls
Through March 31, 2009.--
(1) In general.--Section 2104 of the Social Security Act (42
U.S.C. 1397dd) is amended by adding at the end the following new
subsections:
``(j) Additional Allotments To Eliminate Funding Shortfalls for
Fiscal Year 2008.--
``(1) Appropriation; allotment authority.--For the purpose of
providing additional allotments described in subparagraphs (A) and
(B) of paragraph (3), there is appropriated, out of any money in
the Treasury not otherwise appropriated, such sums as may be
necessary, not to exceed $1,600,000,000 for fiscal year 2008.
``(2) Shortfall states described.--For purposes of paragraph
(3), a shortfall State described in this paragraph is a State with
a State child health plan approved under this title for which the
Secretary estimates, on the basis of the most recent data available
to the Secretary as of November 30, 2007, that the Federal share
amount of the projected expenditures under such plan for such State
for fiscal year 2008 will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2006 and 2007 that will not be expended by the end
of fiscal year 2007;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2008 in accordance with subsection
(i); and
``(C) the amount of the State's allotment for fiscal year
2008.
``(3) Allotments.--In addition to the allotments provided under
subsections (b) and (c), subject to paragraph (4), of the amount
available for the additional allotments under paragraph (1) for
fiscal year 2008, the Secretary shall allot--
``(A) to each shortfall State described in paragraph (2)
not described in subparagraph (B), such amount as the Secretary
determines will eliminate the estimated shortfall described in
such paragraph for the State; and
``(B) to each commonwealth or territory described in
subsection (c)(3), an amount equal to the percentage specified
in subsection (c)(2) for the commonwealth or territory
multiplied by 1.05 percent of the sum of the amounts determined
for each shortfall State under subparagraph (A).
``(4) Proration rule.--If the amounts available for additional
allotments under paragraph (1) are less than the total of the
amounts determined under subparagraphs (A) and (B) of paragraph
(3), the amounts computed under such subparagraphs shall be reduced
proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust the
estimates and determinations made to carry out this subsection as
necessary on the basis of the amounts reported by States not later
than November 30, 2008, on CMS Form 64 or CMS Form 21, as the case
may be, and as approved by the Secretary.
``(6) One-year availability; no redistribution of unexpended
additional allotments.--Notwithstanding subsections (e) and (f),
amounts allotted to a State pursuant to this subsection for fiscal
year 2008, subject to paragraph (5), shall only remain available
for expenditure by the State through September 30, 2008. Any
amounts of such allotments that remain unexpended as of such date
shall not be subject to redistribution under subsection (f).
``(k) Redistribution of Unused Fiscal Year 2006 Allotments to
States With Estimated Funding Shortfalls During the First 2 Quarters of
Fiscal Year 2009.--
``(1) In general.--Notwithstanding subsection (f) and subject
to paragraphs (3) and (4), with respect to months beginning during
the first 2 quarters of fiscal year 2009, the Secretary shall
provide for a redistribution under such subsection from the
allotments for fiscal year 2006 under subsection (b) that are not
expended by the end of fiscal year 2008, to a fiscal year 2009
shortfall State described in paragraph (2), such amount as the
Secretary determines will eliminate the estimated shortfall
described in such paragraph for such State for the month.
``(2) Fiscal year 2009 shortfall state described.--A fiscal
year 2009 shortfall State described in this paragraph is a State
with a State child health plan approved under this title for which
the Secretary estimates, on a monthly basis using the most recent
data available to the Secretary as of such month, that the Federal
share amount of the projected expenditures under such plan for such
State for the first 2 quarters of fiscal year 2009 will exceed the
sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2007 and 2008 that was not expended by the end of
fiscal year 2008; and
``(B) the amount of the State's allotment for fiscal year
2009.
``(3) Funds redistributed in the order in which states realize
funding shortfalls.--The Secretary shall redistribute the amounts
available for redistribution under paragraph (1) to fiscal year
2009 shortfall States described in paragraph (2) in the order in
which such States realize monthly funding shortfalls under this
title for fiscal year 2009. The Secretary shall only make
redistributions under this subsection to the extent that there are
unexpended fiscal year 2006 allotments under subsection (b)
available for such redistributions.
``(4) Proration rule.--If the amounts available for
redistribution under paragraph (1) are less than the total amounts
of the estimated shortfalls determined for the month under that
paragraph, the amount computed under such paragraph for each fiscal
year 2009 shortfall State for the month shall be reduced
proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust the
estimates and determinations made to carry out this subsection as
necessary on the basis of the amounts reported by States not later
than May 31, 2009, on CMS Form 64 or CMS Form 21, as the case may
be, and as approved by the Secretary.
``(6) Availability; no further redistribution.--Notwithstanding
subsections (e) and (f), amounts redistributed to a State pursuant
to this subsection for the first 2 quarters of fiscal year 2009
shall only remain available for expenditure by the State through
March 31, 2009, and any amounts of such redistributions that remain
unexpended as of such date, shall not be subject to redistribution
under subsection (f).
``(l) Additional Allotments To Eliminate Funding Shortfalls for the
First 2 Quarters of Fiscal Year 2009.--
``(1) Appropriation; allotment authority.--For the purpose of
providing additional allotments described in subparagraphs (A) and
(B) of paragraph (3), there is appropriated, out of any money in
the Treasury not otherwise appropriated, such sums as may be
necessary, not to exceed $275,000,000 for the first 2 quarters of
fiscal year 2009.
``(2) Shortfall states described.--For purposes of paragraph
(3), a shortfall State described in this paragraph is a State with
a State child health plan approved under this title for which the
Secretary estimates, on the basis of the most recent data available
to the Secretary, that the Federal share amount of the projected
expenditures under such plan for such State for the first 2
quarters of fiscal year 2009 will exceed the sum of--
``(A) the amount of the State's allotments for each of
fiscal years 2007 and 2008 that will not be expended by the end
of fiscal year 2008;
``(B) the amount, if any, that is to be redistributed to
the State during fiscal year 2009 in accordance with subsection
(k); and
``(C) the amount of the State's allotment for fiscal year
2009.
``(3) Allotments.--In addition to the allotments provided under
subsections (b) and (c), subject to paragraph (4), of the amount
available for the additional allotments under paragraph (1) for the
first 2 quarters of fiscal year 2009, the Secretary shall allot--
``(A) to each shortfall State described in paragraph (2)
not described in subparagraph (B) such amount as the Secretary
determines will eliminate the estimated shortfall described in
such paragraph for the State; and
``(B) to each commonwealth or territory described in
subsection (c)(3), an amount equal to the percentage specified
in subsection (c)(2) for the commonwealth or territory
multiplied by 1.05 percent of the sum of the amounts determined
for each shortfall State under subparagraph (A).
``(4) Proration rule.--If the amounts available for additional
allotments under paragraph (1) are less than the total of the
amounts determined under subparagraphs (A) and (B) of paragraph
(3), the amounts computed under such subparagraphs shall be reduced
proportionally.
``(5) Retrospective adjustment.--The Secretary may adjust the
estimates and determinations made to carry out this subsection as
necessary on the basis of the amounts reported by States not later
than May 31, 2009, on CMS Form 64 or CMS Form 21, as the case may
be, and as approved by the Secretary.
``(6) Availability; no redistribution of unexpended additional
allotments.--Notwithstanding subsections (e) and (f), amounts
allotted to a State pursuant to this subsection for fiscal year
2009, subject to paragraph (5), shall only remain available for
expenditure by the State through March 31, 2009. Any amounts of
such allotments that remain unexpended as of such date shall not be
subject to redistribution under subsection (f).''.

49145561fcd5aad773fd66a19238f9322e9ae482805a9194ae57df66ec147f68

ABSTINENCE EDUCATION PROGRAM.
Section 401 of division B of the Tax Relief and Health Care Act of
2006 (Public Law 109-432, 120 Stat. 2994), as amended by section 1 of
Public Law 110-48 (121 Stat. 244) and section 2 of the TMA, Abstinence,
Education, and QI Programs Extension Act of 2007 (Public Law 110-90,
121 Stat. 984), is amended--
(1) by striking ``December 31, 2007'' and inserting ``June 30,
2008''; and
(2) by striking ``first quarter'' and inserting ``third
quarter'' each place it appears.

31153415f98c7768a8a14c28dd6b5ea8ae1dc4972714917f74034045aac61af0

(a) Extension.--Section 1902(a)(10)(E)(iv) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking ``December
2007'' and inserting ``June 2008''.
(b) Extending Total Amount Available for Allocation.--Section
1933(g)(2) of the Social Security Act (42 U.S.C. 1396u-3(g)(2)) is
amended--
(1) in subparagraph (G), by striking ``and'' at the end;
(2) in subparagraph (H), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(I) for the period that begins on January 1, 2008, and
ends on June 30, 2008, the total allocation amount is
$200,000,000.''.

81384df4934b2259ab97c5519f540c955f5f3d5acd19426825e700ae74d12fe1

Section 1923(f)(6) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)) is amended--
(1) in the heading, by inserting ``and portions of fiscal year
2008'' after ``fiscal year 2007''; and
(2) in subparagraph (A)--
(A) in clause (i), by adding at the end (after and below
subclause (II)) the following:
``Only with respect to fiscal year 2008 for the period
ending on June 30, 2008, the DSH allotment for Tennessee
for such portion of the fiscal year, notwithstanding such
table or terms, shall be \3/4\ of the amount specified in
the previous sentence for fiscal year 2007.'';
(B) in clause (ii)--
(i) by inserting ``or for a period in fiscal year 2008
described in clause (i)'' after ``fiscal year 2007''; and
(ii) by inserting ``or period'' after ``such fiscal
year''; and
(C) in clause (iv)--
(i) in the heading, by inserting ``and fiscal year
2008'' after ``fiscal year 2007'';
(ii) in subclause (I)--
(I) by inserting ``or for a period in fiscal year
2008 described in clause (i)'' after ``fiscal year
2007''; and
(II) by inserting ``or period'' after ``for such
fiscal year''; and
(iii) in subclause (II)--
(I) by inserting ``or for a period in fiscal year
2008 described in clause (i)'' after ``fiscal year
2007''; and
(II) by inserting ``or period'' after ``such fiscal
year'' each place it appears; and
(3) in subparagraph (B)(i), by adding at the end the following:
``Only with respect to fiscal year 2008 for the period ending on
June 30, 2008, the DSH allotment for Hawaii for such portion of the
fiscal year, notwithstanding the table set forth in paragraph (2),
shall be $7,500,000.''.

bdc7c22141e6f84c7fabe5206a5a83224517b58945f74a63ec7d5941ed9d7988

Section 2109(b)(2) of the Social Security Act (42 U.S.C.
1397ii(b)(2)) is amended by inserting before the period at the end the
following ``(except that only with respect to fiscal year 2008, there
are appropriated $20,000,000 for the purpose of carrying out this
subsection, to remain available until expended)''.

c651bc553fca5541a59672e483b645308af62a988b4893bfaabcbb56bcfa359d

Notwithstanding any other provision of law, the Secretary of Health
and Human Services shall not, prior to June 30, 2008, take any action
(through promulgation of regulation, issuance of regulatory guidance,
use of Federal payment audit procedures, or other administrative
action, policy, or practice, including a Medical Assistance Manual
transmittal or letter to State Medicaid directors) to impose any
restrictions relating to coverage or payment under title XIX of the
Social Security Act for rehabilitation services or school-based
administration and school-based transportation if such restrictions are
more restrictive in any aspect than those applied to such areas as of
July 1, 2007.

3b225b01f5b7fa68cda005744bbfecc9ad5fc37f4bd68d1bc5eca8b9b82a2db1

Section 1805(a) of the Social Security Act (42 U.S.C. 1395b-6(a))
is amended by inserting ``as an agency of Congress'' after
``established''.

13e88e6d12b3f7c94519907ccbcd72342878776bf3b894bfa085e1f2331f9985

TITLE III

-MISCELLANEOUS

INDIANS.
(a) Special Diabetes Programs for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2008'' and inserting ``2009''.
(b) Special Diabetes Programs for Indians.--Section 330C(c)(2)(C)
of the Public Health Service Act (42 U.S.C. 254c-3(c)(2)(C)) is amended
by striking ``2008'' and inserting ``2009''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

2ad21006e3982b6ab0a553e8d42d2975737dfea83330b61f961452b6bcd2d553

Medicare, Medicaid, and SCHIP Extension Act of 2007 — S. 2499

Other Sections

TITLE I

TITLE II

TITLE III

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