Download - ERN10381
-
8/8/2019 ERN10381
1/19
-
8/8/2019 ERN10381
2/19
2
ERN10381 S.L.C.
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 cer-tain 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 IIOTHER PROVISIONS
Sec. 201. Clarification of effective date of part B special enrollment period for
disabled TRICARE beneficiaries.
Sec. 202. Repeal of delay of RUGIV.
Sec. 203. Clarification for affiliated hospitals for distribution of additional resi-
dency positions.
Sec. 204. Continued inclusion of orphan drugs in definition of covered out-
patient drugs with respect to childrens 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 IEXTENSIONS1
SEC. 101. PHYSICIAN PAYMENT UPDATE.2
Section 1848(d) of the Social Security Act (42 U.S.C.3
1395w4(d)) is amended by adding at the end the fol-4
lowing new paragraph:5
(12) UPDATE FOR 2011.6
(A) IN GENERAL.Subject to paragraphs7
(7)(B), (8)(B), (9)(B), (10)(B), and (11)(B), in8
lieu of the update to the single conversion fac-9
tor established in paragraph (1)(C) that would10
otherwise apply for 2011, the update to the sin-11
gle conversion factor shall be 0 percent.12
-
8/8/2019 ERN10381
3/19
3
ERN10381 S.L.C.
(B) NO EFFECT ON COMPUTATION OF1
CONVERSION FACTOR FOR 2012 AND SUBSE-2
QUENT YEARS.The conversion factor under3
this subsection shall be computed under para-4
graph (1)(A) for 2012 and subsequent years as5
if subparagraph (A) had never applied..6
SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICA-7
TIONS.8
(a) EXTENSION.9
(1) IN GENERAL.Section 106(a) of division B10
of the Tax Relief and Health Care Act of 2006 (4211
U.S.C. 1395 note), as amended by section 117 of12
the Medicare, Medicaid, and SCHIP Extension Act13
of 2007 (Public Law 110173), section 124 of the14
Medicare Improvements for Patients and Providers15
Act of 2008 (Public Law 110275), and sections16
3137(a) and 10317 of the Patient Protection and17
Affordable Care Act (Public Law 111148), is18
amended by striking September 30, 2010 and in-19
serting September 30, 2011.20
(2) SPECIAL RULE FOR FISCAL YEAR 2011.21
(A) IN GENERAL.Subject to subpara-22
graph (B), for purposes of implementation of23
the amendment made by paragraph (1), includ-24
ing (notwithstanding paragraph (3) of section25
-
8/8/2019 ERN10381
4/19
4
ERN10381 S.L.C.
117(a) of the Medicare, Medicaid, and SCHIP1
Extension Act of 2007 (Public Law 110173),2
as amended by section 124(b) of the Medicare3
Improvements for Patients and Providers Act of4
2008 (Public Law 110275)) for purposes of5
the implementation of paragraph (2) of such6
section 117(a), during fiscal year 2011, the7
Secretary of Health and Human Services shall8
use the hospital wage index that was promul-9
gated by the Secretary of Health and Human10
Services in the Federal Register on August 16,11
2010 (75 Fed. Reg. 50042), and any subse-12
quent corrections.13
(B) EXCEPTION.Beginning on April 1,14
2011, in determining the wage index applicable15
to hospitals that qualify for wage index reclassi-16
fication, the Secretary shall include the average17
hourly wage data of hospitals whose reclassi-18
fication was extended pursuant to the amend-19
ment made by paragraph (1) only if including20
such data results in a higher applicable reclassi-21
fied wage index. Any revision to hospital wage22
indexes made as a result of this subparagraph23
shall not be effected in a budget neutral man-24
ner.25
-
8/8/2019 ERN10381
5/19
5
ERN10381 S.L.C.
(3) ADJUSTMENT FOR CERTAIN HOSPITALS IN1
FISCAL YEAR 2011.2
(A) IN GENERAL.In the case of a sub-3
section (d) hospital (as defined in subsection4
(d)(1)(B) of section 1886 of the Social Security5
Act (42 U.S.C. 1395ww)) with respect to6
which7
(i) a reclassification of its wage index8
for purposes of such section was extended9
pursuant to the amendment made by para-10
graph (1); and11
(ii) the wage index applicable for such12
hospital for the period beginning on Octo-13
ber 1, 2010, and ending on March 31,14
2011, was lower than for the period begin-15
ning on April 1, 2011, and ending on Sep-16
tember 30, 2011, by reason of the applica-17
tion of paragraph (2)(B);18
the Secretary shall pay such hospital an addi-19
tional payment that reflects the difference be-20
tween the wage index for such periods.21
(B) TIMEFRAME FOR PAYMENTS.The22
Secretary shall make payments required under23
subparagraph (A) by not later than December24
31, 2011.25
-
8/8/2019 ERN10381
6/19
6
ERN10381 S.L.C.
(b) CONFORMING AMENDMENT.Section 117(a)(3)1
of the Medicare, Medicaid, and SCHIP Extension Act of2
2007 (Public Law 110173) is amended by inserting in3
fiscal years 2008 and 2009 after For purposes of imple-4
mentation of this subsection.5
SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC6
ADJUSTMENT FLOOR.7
Section 1848(e)(1)(E) of the Social Security Act (428
U.S.C. 1395w4(e)(1)(E)) is amended by striking before9
January 1, 2011 and inserting before January 1,10
2012.11
SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDI-12
CARE THERAPY CAPS.13
Section 1833(g)(5) of the Social Security Act (4214
U.S.C. 1395l(g)(5)) is amended by striking and ending15
on and all that follows through 2010 and inserting16
and ending on December 31, 2011.17
SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COM-18
PONENT OF CERTAIN PHYSICIAN PATHOL-19
OGY SERVICES.20
Section 542(c) of the Medicare, Medicaid, and21
SCHIP Benefits Improvement and Protection Act of 200022
(as enacted into law by section 1(a)(6) of Public Law 10623
554), as amended by section 732 of the Medicare Prescrip-24
tion Drug, Improvement, and Modernization Act of 200325
-
8/8/2019 ERN10381
7/19
7
ERN10381 S.L.C.
(42 U.S.C. 1395w4 note), section 104 of division B of1
the Tax Relief and Health Care Act of 2006 (42 U.S.C.2
1395w4 note), section 104 of the Medicare, Medicaid,3
and SCHIP Extension Act of 2007 (Public Law 1104
173), section 136 of the Medicare Improvements for Pa-5
tients and Providers Act of 2008 (Public Law 110275),6
and section 3104 of the Patient Protection and Affordable7
Care Act (Public Law 111148) is amended by striking8
and 2010 and inserting 2010, and 2011.9
SEC. 106. EXTENSION OF AMBULANCE ADD-ONS.10
(a) GROUND AMBULANCE.Section 1834(l)(13)(A)11
of the Social Security Act (42 U.S.C. 1395m(l)(13)(A))12
is amended13
(1) in the matter preceding clause (i), by strik-14
ing 2011 and inserting 2012,; and15
(2) in each of clauses (i) and (ii), by striking16
January 1, 2011 and inserting January 1,17
2012 each place it appears.18
(b) AIR AMBULANCE.Section 146(b)(1) of the19
Medicare Improvements for Patients and Providers Act of20
2008 (Public Law 110275), as amended by sections21
3105(b) and 10311(b) of Public Law 111148, is amend-22
ed by striking December 31, 2010 and inserting De-23
cember 31, 2011.24
-
8/8/2019 ERN10381
8/19
8
ERN10381 S.L.C.
(c) SUPER RURAL AMBULANCE.Section1
1834(l)(12)(A) of the Social Security Act (42 U.S.C.2
1395m(l)(12)(A)) is amended by striking 2011 and in-3
serting 2012.4
SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MEN-5
TAL HEALTH ADD-ON PAYMENT.6
Section 138(a)(1) of the Medicare Improvements for7
Patients and Providers Act of 2008 (Public Law 1108
275), as amended by section 3107 of the Patient Protec-9
tion and Affordable Care Act (Public Law 111148), is10
amended by striking December 31, 2010 and inserting11
December 31, 2011.12
SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS13
PROVISION.14
Section 1833(t)(7)(D)(i) of the Social Security Act15
(42 U.S.C. 1395l(t)(7)(D)(i)), as amended by section16
3121(a) of the Patient Protection and Affordable Care Act17
(Public Law 111148), is amended18
(1) in subclause (II)19
(A) in the first sentence, by striking20
2011and inserting 2012; and21
(B) in the second sentence, by striking or22
2010 and inserting 2010, or 2011; and23
(2) in subclause (III), by striking January 1,24
2011 and inserting January 1, 2012.25
-
8/8/2019 ERN10381
9/19
-
8/8/2019 ERN10381
10/19
10
ERN10381 S.L.C.
(A) by striking and at the end of sub-1
paragraph (M);2
(B) in subparagraph (N), by striking the3
period at the end and inserting a semicolon;4
and5
(C) by adding at the end the following new6
subparagraphs:7
(O) for the period that begins on January8
1, 2011, and ends on September 30, 2011, the9
total allocation amount is $720,000,000; and10
(P) for the period that begins on October11
1, 2011, and ends on December 31, 2011, the12
total allocation amount is $280,000,000.; and13
(2) in paragraph (3), in the matter preceding14
subparagraph (A), by striking or (N) and insert-15
ing (N), or (P).16
SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSIST-17
ANCE (TMA).18
Sections 1902(e)(1)(B) and 1925(f) of the Social Se-19
curity Act (42 U.S.C. 1396a(e)(1)(B), 1396r6(f)) are20
each amended by striking December 31, 2010 and in-21
serting December 31, 2011.22
SEC. 112. SPECIAL DIABETES PROGRAMS.23
(1) SPECIAL DIABETES PROGRAMS FOR TYPE I24
DIABETES.Section 330B(b)(2)(C) of the Public25
-
8/8/2019 ERN10381
11/19
11
ERN10381 S.L.C.
Health Service Act (42 U.S.C. 254c2(b)(2)(C)) is1
amended by striking 2011 and inserting 2013.2
(2) SPECIAL DIABETES PROGRAMS FOR INDI-3
ANS.Section 330C(c)(2)(C) of the Public Health4
Service Act (42 U.S.C. 254c3(c)(2)(C)) is amended5
by striking 2011 and inserting 2013.6
TITLE IIOTHER PROVISIONS7
SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B8
SPECIAL ENROLLMENT PERIOD FOR DIS-9
ABLED TRICARE BENEFICIARIES.10
Effective as if included in the enactment of Public11
Law 111148, section 3110(a)(2) of such Act is amended12
to read as follows:13
(2) EFFECTIVE DATE.The amendment made14
by paragraph (1) shall apply to elections made on15
and after the date of the enactment of this Act..16
SEC. 202. REPEAL OF DELAY OF RUGIV.17
Effective as if included in the enactment of Public18
Law 111148, section 10325 of such Act is repealed.19
SEC. 203. CLARIFICATION FOR AFFILIATED HOSPITALS FOR20
DISTRIBUTION OF ADDITIONAL RESIDENCY21
POSITIONS.22
Effective as if included in the enactment of section23
5503(a) of Public Law 111148, section 1886(h)(8) of the24
Social Security Act (42 U.S.C. 1395ww(h)(8)), as added25
-
8/8/2019 ERN10381
12/19
12
ERN10381 S.L.C.
by such section 5503(a), is amended by adding at the end1
the following new subparagraph:2
(I) AFFILIATION.The provisions of this3
paragraph shall be applied to hospitals which4
are members of the same affiliated group (as5
defined by the Secretary under paragraph6
(4)(H)(ii)) and the reference resident level for7
each such hospital shall be the reference resi-8
dent level with respect to the cost reporting pe-9
riod that results in the smallest difference be-10
tween the reference resident level and the other-11
wise applicable resident limit..12
SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN13
DEFINITION OF COVERED OUTPATIENT14
DRUGS WITH RESPECT TO CHILDRENS HOS-15
PITALS UNDER THE 340B DRUG DISCOUNT16
PROGRAM.17
(a) DEFINITION OF COVERED OUTPATIENT DRUG.18
(1) AMENDMENT.Subsection (e) of section19
340B of the Public Health Service Act (42 U.S.C.20
256b) is amended by striking covered entities de-21
scribed in subparagraph (M) and inserting cov-22
ered entities described in subparagraph (M) (other23
than a childrens hospital described in subparagraph24
(M)).25
-
8/8/2019 ERN10381
13/19
13
ERN10381 S.L.C.
(2) EFFECTIVE DATE.The amendment made1
by paragraph (1) shall take effect as if included in2
the enactment of section 2302 of the Health Care3
and Education Reconciliation Act of 2010 (Public4
Law 111152).5
(b) TECHNICALAMENDMENT.Subparagraph (B) of6
section 1927(a)(5) of the Social Security Act (42 U.S.C.7
1396r8(a)(5)) is amended by striking and a childrens8
hospital and all that follows through the end of the sub-9
paragraph and inserting a period.10
SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS.11
(a) REPEAL OF E XCLUSION OF CERTAIN INDIVID-12
UALS AND ENTITIES FROM MEDICAID.Section 1902(a)13
of the Social Security Act (42 U.S.C. 1396a(a)) is amend-14
ed by striking paragraph (78).15
(b) INCOME LEVEL FOR CERTAIN CHILDREN UNDER16
MEDICAID.Section 1902(l)(2)(C) of the Social Security17
Act (42 U.S.C. 1396a(l)(2)(C)) is amended by striking18
133 percent and inserting 100 percent (or, beginning19
January 1, 2014, 133 percent).20
(c) C ALCULATION AND PUBLICATION OF PAYMENT21
ERROR RATE MEASUREMENT FOR CERTAIN YEARS.22
Section 601(b) of the Childrens Health Insurance Pro-23
gram Reauthorization Act of 2009 (Public Law 1113)24
is amended by adding at the end the following: The Sec-25
-
8/8/2019 ERN10381
14/19
14
ERN10381 S.L.C.
retary is not required under this subsection to calculate1
or publish a national or a State-specific error rate for fis-2
cal year 2009 or fiscal year 2010..3
(d) CORRECTIONS TO E XCEPTIONS TO EXCLUSION4
OF CHILDREN OF CERTAIN EMPLOYEES.Section5
2110(b)(6) of the Social Security Act (42 U.S.C.6
1397jj(b)(6)) is amended7
(1) in subparagraph (B)8
(A) by striking PER PERSON in the9
heading; and10
(B) by striking each employee and in-11
serting employees; and12
(2) in subparagraph (C), by striking , on a13
case-by-case basis,.14
(e) ELECTRONIC HEALTH RECORDS.Effective as if15
included in the enactment of section 4201(a)(2) of the16
American Recovery and Reinvestment Act of 2009 (Public17
Law 1115), section 1903(t) of the Social Security Act18
(42 U.S.C. 1396b(t)) is amended19
(1) in paragraph (3)(E), by striking reduced20
by any payment that is made to such Medicaid pro-21
vider from any other source (other than under this22
subsection or by a State or local government) and23
inserting reduced by the average payment the Sec-24
retary estimates will be made to such Medicaid pro-25
-
8/8/2019 ERN10381
15/19
15
ERN10381 S.L.C.
viders (determined on a percentage or other basis1
for such classes or types of providers as the Sec-2
retary may specify) from other sources (other than3
under this subsection, or by the Federal government4
or a State or local government); and5
(2) in paragraph (6)(B), by inserting before the6
period the following: and shall be determined to7
have met such responsibility to the extent that the8
payment to the Medicaid provider is not in excess of9
85 percent of the net average allowable cost.10
(f) CORRECTIONS OF DESIGNATIONS.11
(1) Section 1902 of the Social Security Act (4212
U.S.C. 1396a) is amended13
(A) in subsection (a)(10), in the matter14
following subparagraph (G), by striking and15
before (XVI) the medical and by striking16
(XVI) if and inserting (XVII) if;17
(B) in subsection (a)(23), by striking18
(ii) and inserting (kk);19
(C) in subsection (a)(77), by striking (ii)20
and inserting (kk);21
(D) in subsection (ii)(2), as added by sec-22
tion 2303(a)(2) of Public Law 111148, by23
striking (XV) and inserting (XVI); and24
-
8/8/2019 ERN10381
16/19
16
ERN10381 S.L.C.
(E) by redesignating subsection (ii), as1
added by section 6401(b)(1)(B) of Public Law2
111148, as subsection (kk) and transferring3
such subsection so as to appear after subsection4
(jj) of that section.5
(2) Section 2107(e)(1) of the Social Security6
Act (42 U.S.C. 1397gg(e)(1)) is amended7
(A) in subparagraph (D), as added by sec-8
tion 6401(c) of Public Law 111148, by strik-9
ing (ii) and inserting (kk); and10
(B) by redesignating the subparagraph (N)11
of that section added by 2101(e) of Public Law12
111148 as subparagraph (O).13
SEC. 206. FUNDING FOR CLAIMS REPROCESSING.14
For purposes of carrying out the provisions of, and15
amendments made by, this Act that relate to title XVIII16
of the Social Security Act, and other provisions of, or re-17
lating to, such title that ensure appropriate payment of18
claims, there are appropriated to the Secretary of Health19
and Human Services for the Centers for Medicare & Med-20
icaid Services Program Management Account, from21
amounts in the general fund of the Treasury not otherwise22
appropriated, $200,000,000. Amounts appropriated under23
the preceding sentence shall be in addition to any other24
funds available for such purposes, shall remain available25
-
8/8/2019 ERN10381
17/19
17
ERN10381 S.L.C.
until expended, and shall not be used to implement1
changes to title XVIII of the Social Security Act made2
by Public Laws 111-148 and 111-152.3
SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT4
FUND.5
Section 1898(b)(1)(B) of the Social Security Act (426
U.S.C. 1395iii(b)(1)(B)) is amended by striking7
$550,000,000 and inserting $275,000,000.8
SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOV-9
ERED ON RECONCILIATION OF THE HEALTH10
INSURANCE TAX CREDIT AND THE ADVANCE11
OF THAT CREDIT.12
(a) IN GENERAL.So much of section 36B(f)(2)(B)13
of the Internal Revenue Code of 1986 as precedes clause14
(ii) thereof is amended to read as follows:15
(B) LIMITATION ON INCREASE.16
(i) IN GENERAL.In the case of a17
taxpayer whose household income is less18
than 500 percent of the poverty line for19
the size of the family involved for the tax-20
able year, the amount of the increase21
under subparagraph (A) shall in no event22
exceed the applicable dollar amount deter-23
mined in accordance with the following24
table (one-half of such amount in the case25
-
8/8/2019 ERN10381
18/19
18
ERN10381 S.L.C.
of a taxpayer whose tax is determined1
under section 1(c) for the taxable year):2
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.Section3
36B(f)(2)(B)(ii) of such Code is amended by inserting in4
the table contained after each of the dollar amounts.5
(c) EFFECTIVE DATE.The amendments made by6
this section shall apply to taxable years beginning after7
December 31, 2013.8
SEC. 209. DETERMINATION OF BUDGETARY EFFECTS.9
(a) IN GENERAL.The budgetary effects of this Act,10
for the purpose of complying with the Statutory Pay-As-11
You-Go Act of 2010, shall be determined by reference to12
the latest statement titled Budgetary Effects of PAYGO13
Legislation for this Act, submitted for printing in the14
Congressional Record by the Chairman of the Senate15
Budget Committee, provided that such statement has been16
submitted prior to the vote on passage.17
(b) EMERGENCY DESIGNATION FOR CONGRESSIONAL18
ENFORCEMENT.In the House of Representatives, this19
-
8/8/2019 ERN10381
19/19
19
ERN10381 S.L.C.
Act, with the exception of section 101, is designated as1
an emergency for purposes of pay-as-you-go principles.2