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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

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(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

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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

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(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

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(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

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(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

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(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

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(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

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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

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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

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(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

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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

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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

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(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

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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

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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 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

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Act, with the exception of section 101, is designated as1

an emergency for purposes of pay-as-you-go principles.2

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