PUBLIC LAW 110–275—JULY 15, 2008 

MEDICARE IMPROVEMENTS FOR PATIENTS 

AND PROVIDERS ACT OF 2008 


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122 STAT. 2494 PUBLIC LAW 110–275—JULY 15, 2008 

Public Law 110–275 

110th Congress 

An Act 

To amend titles XVIII and XIX of the Social Security Act to extend expiring 

provisions under the Medicare Program, to improve beneficiary access to preventive 

and mental health services, to enhance low-income benefit programs, and to 

maintain access to care in rural areas, including pharmacy access, and for other 

purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Medicare 

Improvements for Patients and Providers Act of 2008’’. 

(b) TABLE OF CONTENTS.—The table of contents of this Act 

is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE 

Subtitle A—Beneficiary Improvements 

PART I—PREVENTION, MENTAL HEALTH, AND MARKETING

Sec. 101. Improvements to coverage of preventive services. 

Sec. 102. Elimination of discriminatory copayment rates for Medicare outpatient 

psychiatric services. 

Sec. 103. Prohibitions and limitations on certain sales and marketing activities 

under Medicare Advantage plans and prescription drug plans. 

Sec. 104. Improvements to the Medigap program. 

PART II—LOW-INCOME PROGRAMS

Sec. 111. Extension of qualifying individual (QI) program. 

Sec. 112. Application of full LIS subsidy assets test under Medicare Savings Program. 

Sec. 113. Eliminating barriers to enrollment. 

Sec. 114. Elimination of Medicare part D late enrollment penalties paid by subsidy 

eligible individuals. 

Sec. 115. Eliminating application of estate recovery. 

Sec. 116. Exemptions from income and resources for determination of eligibility for 

low-income subsidy. 

Sec. 117. Judicial review of decisions of the Commissioner of Social Security under 

the Medicare part D low-income subsidy program. 

Sec. 118. Translation of model form. 

Sec. 119. Medicare enrollment assistance. 

Subtitle B—Provisions Relating to Part A 

Sec. 121. Expansion and extension of the Medicare Rural Hospital Flexibility Program. 

Sec. 122. Rebasing for sole community hospitals. 

Sec. 123. Demonstration project on community health integration models in certain 

rural counties. 

Sec. 124. Extension of the reclassification of certain hospitals. 

Sec. 125. Revocation of unique deeming authority of the Joint Commission. 

42 USC 1305 

note. 

Medicare 

Improvements 

for Patients and 

Providers Act of 

2008. 

Intergovernmental 

relations. 

July 15, 2008 

[H.R. 6331] 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2495 

Subtitle C—Provisions Relating to Part B 

PART I—PHYSICIANS’ SERVICES

Sec. 131. Physician payment, efficiency, and quality improvements. 

Sec. 132. Incentives for electronic prescribing. 

Sec. 133. Expanding access to primary care services. 

Sec. 134. Extension of floor on Medicare work geographic adjustment under the 

Medicare physician fee schedule. 

Sec. 135. Imaging provisions. 

Sec. 136. Extension of treatment of certain physician pathology services under 

Medicare. 

Sec. 137. Accommodation of physicians ordered to active duty in the Armed Services. 

Sec. 138. Adjustment for Medicare mental health services. 

Sec. 139. Improvements for Medicare anesthesia teaching programs. 

PART II—OTHER PAYMENT AND COVERAGE IMPROVEMENTS

Sec. 141. Extension of exceptions process for Medicare therapy caps. 

Sec. 142. Extension of payment rule for brachytherapy and therapeutic radiopharmaceuticals. 

Sec. 143. Speech-language pathology services. 

Sec. 144. Payment and coverage improvements for patients with chronic obstructive 

pulmonary disease and other conditions. 

Sec. 145. Clinical laboratory tests. 

Sec. 146. Improved access to ambulance services. 

Sec. 147. Extension and expansion of the Medicare hold harmless provision under 

the prospective payment system for hospital outpatient department 

(HOPD) services for certain hospitals. 

Sec. 148. Clarification of payment for clinical laboratory tests furnished by critical 

access hospitals. 

Sec. 149. Adding certain entities as originating sites for payment of telehealth services. 

Sec. 150. MedPAC study and report on improving chronic care demonstration programs. 

Sec. 151. Increase of FQHC payment limits. 

Sec. 152. Kidney disease education and awareness provisions. 

Sec. 153. Renal dialysis provisions. 

Sec. 154. Delay in and reform of Medicare DMEPOS competitive acquisition program. 

Subtitle D—Provisions Relating to Part C 

Sec. 161. Phase-out of indirect medical education (IME). 

Sec. 162. Revisions to requirements for Medicare Advantage private fee-for-service 

plans. 

Sec. 163. Revisions to quality improvement programs. 

Sec. 164. Revisions relating to specialized Medicare Advantage plans for special 

needs individuals. 

Sec. 165. Limitation on out-of-pocket costs for dual eligibles and qualified medicare 

beneficiaries enrolled in a specialized Medicare Advantage plan for special needs individuals. 

Sec. 166. Adjustment to the Medicare Advantage stabilization fund. 

Sec. 167. Access to Medicare reasonable cost contract plans. 

Sec. 168. MedPAC study and report on quality measures. 

Sec. 169. MedPAC study and report on Medicare Advantage payments. 

Subtitle E—Provisions Relating to Part D 

PART I—IMPROVING PHARMACY ACCESS

Sec. 171. Prompt payment by prescription drug plans and MA–PD plans under part 

D. 

Sec. 172. Submission of claims by pharmacies located in or contracting with longterm care facilities. 

Sec. 173. Regular update of prescription drug pricing standard. 

PART II—OTHER PROVISIONS

Sec. 175. Inclusion of barbiturates and benzodiazepines as covered part D drugs. 

Sec. 176. Formulary requirements with respect to certain categories or classes of 

drugs. 

Subtitle F—Other Provisions 

Sec. 181. Use of part D data. 


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122 STAT. 2496 PUBLIC LAW 110–275—JULY 15, 2008 

Sec. 182. Revision of definition of medically accepted indication for drugs. 

Sec. 183. Contract with a consensus-based entity regarding performance measurement. 

Sec. 184. Cost-sharing for clinical trials. 

Sec. 185. Addressing health care disparities. 

Sec. 186. Demonstration to improve care to previously uninsured. 

Sec. 187. Office of the Inspector General report on compliance with and enforcement of national standards on culturally and linguistically appropriate 

services (CLAS) in Medicare. 

Sec. 188. Medicare Improvement Funding. 

Sec. 189. Inclusion of Medicare providers and suppliers in Federal Payment Levy 

and Administrative Offset Program. 

TITLE II—MEDICAID 

Sec. 201. Extension of transitional medical assistance (TMA) and abstinence education program. Sec. 202. Medicaid DSH extension. 

Sec. 203. Pharmacy reimbursement under Medicaid. 

Sec. 204. Review of administrative claim determinations. 

Sec. 205. County medicaid health insuring organizations. 

TITLE III—MISCELLANEOUS 

Sec. 301. Extension of TANF supplemental grants. 

Sec. 302. 70 percent federal matching for foster care and adoption assistance for 

the District of Columbia. 

Sec. 303. Extension of Special Diabetes Grant Programs. 

Sec. 304. IOM reports on best practices for conducting systematic reviews of clinical 

effectiveness research and for developing clinical protocols. 

TITLE I—MEDICARE 

Subtitle A—Beneficiary Improvements 

PART I—PREVENTION, MENTAL HEALTH, AND 

MARKETING 

SEC. 101. IMPROVEMENTS TO COVERAGE OF PREVENTIVE SERVICES. 

(a) COVERAGE OF ADDITIONAL PREVENTIVE SERVICES.— 

(1) COVERAGE.—Section 1861 of the Social Security Act 

(42 U.S.C. 1395x), as amended by section 114 of the Medicare, 

Medicaid, and SCHIP Extension Act of 2007 (Public Law 110– 

173), is amended— 

(A) in subsection (s)(2)— 

(i) in subparagraph (Z), by striking ‘‘and’’ after 

the semicolon at the end; 

(ii) in subparagraph (AA), by adding ‘‘and’’ after 

the semicolon at the end; and 

(iii) by adding at the end the following new 

subparagraph: 

‘‘(BB) additional preventive services (described in subsection (ddd)(1));’’; and 

(B) by adding at the end the following new subsection: 

‘‘Additional Preventive Services 

‘‘(ddd)(1) The term ‘additional preventive services’ means services not otherwise described in this title that identify medical conditions or risk factors and that the Secretary determines are— 

‘‘(A) reasonable and necessary for the prevention or early 

detection of an illness or disability; 

‘‘(B) recommended with a grade of A or B by the United 

States Preventive Services Task Force; and 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2497 

‘‘(C) appropriate for individuals entitled to benefits under 

part A or enrolled under part B. 

‘‘(2) In making determinations under paragraph (1) regarding 

the coverage of a new service, the Secretary shall use the process 

for making national coverage determinations (as defined in section 

1869(f)(1)(B)) under this title. As part of the use of such process, 

the Secretary may conduct an assessment of the relation between 

predicted outcomes and the expenditures for such service and may 

take into account the results of such assessment in making such 

determination.’’. 

(2) PAYMENT AND COINSURANCE FOR ADDITIONAL PREVEN- TIVE SERVICES.—Section 1833(a)(1) of the Social Security Act 

(42 U.S.C. 1395l(a)(1)) is amended— 

(A) by striking ‘‘and’’ before ‘‘(V)’’; and 

(B) by inserting before the semicolon at the end the 

following: ‘‘, and (W) with respect to additional preventive 

services (as defined in section 1861(ddd)(1)), the amount 

paid shall be (i) in the case of such services which are 

clinical diagnostic laboratory tests, the amount determined 

under subparagraph (D), and (ii) in the case of all other 

such services, 80 percent of the lesser of the actual charge 

for the service or the amount determined under a fee 

schedule established by the Secretary for purposes of this 

subparagraph’’. 

(3) CONFORMING AMENDMENT REGARDING COVERAGE.—Section 1862(a)(1)(A) of the Social Security Act (42 U.S.C. 

1395y(a)(1)(A)) is amended by inserting ‘‘or additional preventive services (as described in section 1861(ddd)(1))’’ after ‘‘succeeding subparagraph’’. 

(4) RULE OF CONSTRUCTION.—Nothing in the provisions 

of, or amendments made by, this subsection shall be construed 

to provide coverage under title XVIII of the Social Security 

Act of items and services for the treatment of a medical condition that is not otherwise covered under such title. 

(b) REVISIONS TO INITIAL PREVENTIVE PHYSICAL EXAMINA- TION.— 

(1) IN GENERAL.—Section 1861(ww) of the Social Security 

Act (42 U.S.C. 1395x(ww)) is amended— 

(A) in paragraph (1)— 

(i) by inserting ‘‘body mass index,’’ after ‘‘weight’’; 

(ii) by striking ‘‘, and an electrocardiogram’’; and 

(iii) by inserting ‘‘and end-of-life planning (as 

defined in paragraph (3)) upon the agreement with 

the individual’’ after ‘‘paragraph (2)’’; 

(B) in paragraph (2), by adding at the end the following 

new subparagraphs: 

‘‘(M) An electrocardiogram. 

‘‘(N) Additional preventive services (as defined in subsection 

(ddd)(1)).’’; and 

(C) by adding at the end the following new paragraph: 

‘‘(3) For purposes of paragraph (1), the term ‘end-of-life planning’ means verbal or written information regarding— 

‘‘(A) an individual’s ability to prepare an advance directive 

in the case that an injury or illness causes the individual 

to be unable to make health care decisions; and 

‘‘(B) whether or not the physician is willing to follow the 

individual’s wishes as expressed in an advance directive.’’. 

42 USC 1395l 

note. 


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122 STAT. 2498 PUBLIC LAW 110–275—JULY 15, 2008 

(2) WAIVER OF APPLICATION OF DEDUCTIBLE.—The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 

1395l(b)) is amended— 

(A) by striking ‘‘and’’ before ‘‘(8)’’; and 

(B) by inserting ‘‘, and (9) such deductible shall not 

apply with respect to an initial preventive physical examination (as defined in section 1861(ww))’’ before the period 

at the end. 

(3) EXTENSION OF ELIGIBILITY PERIOD FROM SIX MONTHS

TO ONE YEAR.—Section 1862(a)(1)(K) of the Social Security Act 

(42 U.S.C. 1395y(a)(1)(K)) is amended by striking ‘‘6 months’’ 

and inserting ‘‘1 year’’. 

(4) TECHNICAL CORRECTION.—Section 1862(a)(1)(K) of the 

Social Security Act (42 U.S.C. 1395y(a)(1)(K)) is amended by 

striking ‘‘not later’’ and inserting ‘‘more’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to services furnished on or after January 1, 2009. 

SEC. 102. ELIMINATION OF DISCRIMINATORY COPAYMENT RATES FOR 

MEDICARE OUTPATIENT PSYCHIATRIC SERVICES. 

Section 1833(c) of the Social Security Act (42 U.S.C. 1395l(c)) 

is amended to read as follows: 

‘‘(c)(1) Notwithstanding any other provision of this part, with 

respect to expenses incurred in a calendar year in connection with 

the treatment of mental, psychoneurotic, and personality disorders 

of an individual who is not an inpatient of a hospital at the time 

such expenses are incurred, there shall be considered as incurred 

expenses for purposes of subsections (a) and (b)— 

‘‘(A) for expenses incurred in years prior to 2010, only 

621⁄2 percent of such expenses; 

‘‘(B) for expenses incurred in 2010 or 2011, only 683⁄4

percent of such expenses; 

‘‘(C) for expenses incurred in 2012, only 75 percent of 

such expenses; 

‘‘(D) for expenses incurred in 2013, only 811⁄4 percent of 

such expenses; and 

‘‘(E) for expenses incurred in 2014 or any subsequent calendar year, 100 percent of such expenses. 

‘‘(2) For purposes of subparagraphs (A) through (D) of paragraph (1), the term ‘treatment’ does not include brief office visits 

(as defined by the Secretary) for the sole purpose of monitoring 

or changing drug prescriptions used in the treatment of such disorders or partial hospitalization services that are not directly provided by a physician.’’. 

SEC. 103. PROHIBITIONS AND LIMITATIONS ON CERTAIN SALES AND 

MARKETING ACTIVITIES UNDER MEDICARE ADVANTAGE 

PLANS AND PRESCRIPTION DRUG PLANS. 

(a) PROHIBITIONS.— 

(1) MEDICARE ADVANTAGE PROGRAM.— 

(A) IN GENERAL.—Section 1851 of the Social Security 

Act (42 U.S.C. 1395w–21) is amended— 

(i) in subsection (h)(4)— 

(I) in subparagraph (A)— 

(aa) by striking ‘‘cash or other monetary 

rebates’’ and inserting ‘‘, subject to subsection 

(j)(2)(C), cash, gifts, prizes, or other monetary 

rebates’’; and 

42 USC 1395l 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2499 

(bb) by striking ‘‘, and’’ at the end and 

inserting a semicolon; 

(II) in subparagraph (B), by striking the period 

at the end and inserting a semicolon; and 

(III) by adding at the end the following new 

subparagraph: 

‘‘(C) shall not permit a Medicare Advantage organization (or the agents, brokers, and other third parties representing such organization) to conduct the prohibited 

activities described in subsection (j)(1); and’’; and 

(ii) by adding at the end the following new subsection: 

‘‘(j) PROHIBITED ACTIVITIES DESCRIBED AND LIMITATIONS ON

THE CONDUCT OF CERTAIN OTHER ACTIVITIES.— 

‘‘(1) PROHIBITED ACTIVITIES DESCRIBED.—The following 

prohibited activities are described in this paragraph: 

‘‘(A) UNSOLICITED MEANS OF DIRECT CONTACT.—Any 

unsolicited means of direct contact of prospective enrollees, 

including soliciting door-to-door or any outbound telemarketing without the prospective enrollee initiating contact. 

‘‘(B) CROSS-SELLING.—The sale of other non-health 

related products (such as annuities and life insurance) 

during any sales or marketing activity or presentation conducted with respect to a Medicare Advantage plan. 

‘‘(C) MEALS.—The provision of meals of any sort, 

regardless of value, to prospective enrollees at promotional 

and sales activities. 

‘‘(D) SALES AND MARKETING IN HEALTH CARE SETTINGS

AND AT EDUCATIONAL EVENTS.—Sales and marketing activities for the enrollment of individuals in Medicare Advantage plans that are conducted— 

‘‘(i) in health care settings in areas where health 

care is delivered to individuals (such as physician 

offices and pharmacies), except in the case where such 

activities are conducted in common areas in health 

care settings; and 

‘‘(ii) at educational events.’’. 

(2) MEDICARE PRESCRIPTION DRUG PROGRAM.—Section 

1860D–4 of the Social Security Act (42 U.S.C. 1395w–104) 

is amended by adding at the end the following new subsection: 

‘‘(l) REQUIREMENTS WITH RESPECT TO SALES AND MARKETING

ACTIVITIES.—The following provisions shall apply to a PDP sponsor 

(and the agents, brokers, and other third parties representing such 

sponsor) in the same manner as such provisions apply to a Medicare 

Advantage organization (and the agents, brokers, and other third 

parties representing such organization): 

‘‘(1) The prohibition under section 1851(h)(4)(C) on conducting activities described in section 1851(j)(1).’’. 

(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply to plan years beginning on or after January 

1, 2009. 

(b) LIMITATIONS.— 

(1) MEDICARE ADVANTAGE PROGRAM.—Section 1851 of the 

Social Security Act (42 U.S.C. 1395w–21), as amended by subsection (a)(1), is amended— 

42 USC 

1395w–21 note. 

Applicability. 


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122 STAT. 2500 PUBLIC LAW 110–275—JULY 15, 2008 

(A) in subsection (h)(4), by adding at the end the following new subparagraph: 

‘‘(D) shall only permit a Medicare Advantage organization (and the agents, brokers, and other third parties representing such organization) to conduct the activities 

described in subsection (j)(2) in accordance with the limitations established under such subsection.’’; and 

(B) in subsection (j), by adding at the end the following 

new paragraph: 

‘‘(2) LIMITATIONS.—The Secretary shall establish limitations with respect to at least the following: 

‘‘(A) SCOPE OF MARKETING APPOINTMENTS.—The scope 

of any appointment with respect to the marketing of a 

Medicare Advantage plan. Such limitation shall require 

advance agreement with a prospective enrollee on the scope 

of the marketing appointment and documentation of such 

agreement by the Medicare Advantage organization. In 

the case where the marketing appointment is in person, 

such documentation shall be in writing. 

‘‘(B) CO-BRANDING.—The use of the name or logo of 

a co-branded network provider on Medicare Advantage plan 

membership and marketing materials. 

‘‘(C) LIMITATION OF GIFTS TO NOMINAL DOLLAR VALUE.— 

The offering of gifts and other promotional items other 

than those that are of nominal value (as determined by 

the Secretary) to prospective enrollees at promotional 

activities. 

‘‘(D) COMPENSATION.—The use of compensation other 

than as provided under guidelines established by the Secretary. Such guidelines shall ensure that the use of compensation creates incentives for agents and brokers to 

enroll individuals in the Medicare Advantage plan that 

is intended to best meet their health care needs. 

‘‘(E) REQUIRED TRAINING, ANNUAL RETRAINING, AND

TESTING OF AGENTS, BROKERS, AND OTHER THIRD PARTIES.— The use by a Medicare Advantage organization of any 

individual as an agent, broker, or other third party representing the organization that has not completed an initial 

training and testing program and does not complete an 

annual retraining and testing program.’’. 

(2) MEDICARE PRESCRIPTION DRUG PROGRAM.—Section 

1860D–4(l) of the Social Security Act, as added by subsection 

(a)(2), is amended by adding at the end the following new 

paragraph: 

‘‘(2) The requirement under section 1851(h)(4)(D) to conduct 

activities described in section 1851(j)(2) in accordance with 

the limitations established under such subsection.’’. 

(3) EFFECTIVE DATE.—The amendments made by this subsection shall take effect on a date specified by the Secretary 

(but in no case later than November 15, 2008). 

(c) REQUIRED INCLUSION OF PLAN TYPE IN PLAN NAME.— (1) MEDICARE ADVANTAGE PROGRAM.—Section 1851(h) of 

the Social Security Act (42 U.S.C. 1395w–21(h)) is amended 

by adding at the end following new paragraph: 

‘‘(6) REQUIRED INCLUSION OF PLAN TYPE IN PLAN NAME.— For plan years beginning on or after January 1, 2010, a Medicare Advantage organization must ensure that the name of 

Effective date. 

Deadline. 

42 USC 

1395w–21 note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2501 

each Medicare Advantage plan offered by the Medicare Advantage organization includes the plan type of the plan (using 

standard terminology developed by the Secretary).’’. 

(2) PRESCRIPTION DRUG PLANS.—Section 1860D–4(l) of the 

Social Security Act, as added by subsection (a)(2) and amended 

by subsection (b)(2), is amended by adding at the end the 

following new paragraph: 

‘‘(3) The inclusion of the plan type in the plan name under 

section 1851(h)(6).’’. 

(d) STRENGTHENING THE ABILITY OF STATES TO ACT IN

COLLABORATION WITH THE SECRETARY TO ADDRESS FRAUDULENT

OR INAPPROPRIATE MARKETING PRACTICES.— 

(1) MEDICARE ADVANTAGE PROGRAM.—Section 1851(h) of 

the Social Security Act (42 U.S.C. 1395w–21(h), as amended 

by subsection (c)(1), is amended by adding at the end the 

following new paragraph: 

‘‘(7) STRENGTHENING THE ABILITY OF STATES TO ACT IN

COLLABORATION WITH THE SECRETARY TO ADDRESS FRAUDULENT

OR INAPPROPRIATE MARKETING PRACTICES.— 

‘‘(A) APPOINTMENT OF AGENTS AND BROKERS.—Each 

Medicare Advantage organization shall— 

‘‘(i) only use agents and brokers who have been 

licensed under State law to sell Medicare Advantage 

plans offered by the Medicare Advantage organization; 

‘‘(ii) in the case where a State has a State appointment law, abide by such law; and 

‘‘(iii) report to the applicable State the termination 

of any such agent or broker, including the reasons 

for such termination (as required under applicable 

State law). 

‘‘(B) COMPLIANCE WITH STATE INFORMATION

REQUESTS.—Each Medicare Advantage organization shall 

comply in a timely manner with any request by a State 

for information regarding the performance of a licensed 

agent, broker, or other third party representing the Medicare Advantage organization as part of an investigation 

by the State into the conduct of the agent, broker, or 

other third party.’’. 

(2) PRESCRIPTION DRUG PLANS.—Section 1860D–4(l) of the 

Social Security Act, as amended by subsection (c)(2), is amended 

by adding at the end the following new paragraph: 

‘‘(4) The requirements regarding the appointment of agents 

and brokers and compliance with State information requests 

under subparagraphs (A) and (B), respectively, of section 

1851(h)(7).’’. 

(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply to plan years beginning on or after January 

1, 2009. 

SEC. 104. IMPROVEMENTS TO THE MEDIGAP PROGRAM. 

(a) IMPLEMENTATION OF NAIC RECOMMENDATIONS.— 

(1) IN GENERAL.—The Secretary of Health and Human 

Services (in this section referred to as the ‘‘Secretary’’) shall 

provide for implementation of the changes in the NAIC model 

law and regulations approved by the National Association of 

Insurance Commissioners in its Model #651 (‘‘Model Regulation 

42 USC 1395ss 

note. 

42 USC 

1395w–21 note. 

Reports. 


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122 STAT. 2502 PUBLIC LAW 110–275—JULY 15, 2008 

to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act’’) on March 11, 2007, as modified 

to reflect the changes made under this Act and the Genetic 

Information Nondiscrimination Act of 2008 (Public Law 110– 

233). 

(2) IMPLEMENTATION DATES.— (A) IN GENERAL.—The modifications to Model #651 

required under paragraph (1) shall be completed by the 

National Association of Insurance Commissioners not later 

than October 31, 2008. Except as provided in subparagraph 

(B), each State shall have 1 year from the date the National 

Association of Insurance Commissioners adopts the revised 

NAIC model law and regulations (as changed by Model 

#651, as so modified) to conform the regulatory program 

established by the State to such revised NAIC model law 

and regulations. 

(B) EXTENSION OF EFFECTIVE DATE FOR STATE LAW

AMENDMENT.—In the case of a State which the Secretary 

determines requires State legislation in order to conform 

the regulatory program established by the State to such 

revised NAIC model law and regulations, the State shall 

not be regarded as failing to comply with the requirements 

of this section solely on the basis of its failure to meet 

such requirements before the first day of the first calendar 

quarter beginning after the close of the first regular session 

of the State legislature that begins after the date of the 

enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative 

session, each year of the session is considered to be a 

separate regular session of the State legislature. 

(C) TRANSITION DATES.—No carrier may issue a new 

or revised medicare supplemental policy or certificate under 

section 1882 of the Social Security Act (42 U.S.C. 1395ss) 

that meets the requirements of such revised NAIC model 

law and regulations for coverage effective prior to June 

1, 2010. A carrier may continue to offer or issue a medicare 

supplemental policy under such section that meets the 

requirements of the NAIC model law and regulations and 

State law (as in effect prior to the adoption of such revised 

NAIC model law and regulations) prior to June 1, 2010. 

Nothing shall preclude carriers from marketing new or 

revised medicare supplemental policies or certificates that 

meet the requirements of such revised NAIC model law 

and regulations on or after the date on which the State 

conforms the regulatory program established by the State 

to such revised NAIC model law and regulations. 

(b) REQUIRED OFFERING OF A RANGE OF POLICIES.—Section 

1882(o) of the Social Security Act (42 U.S.C. 1395s(o)), as amended 

by section 104(b)(3) of the Genetic Information Nondiscrimination 

Act of 2008 (Public Law 110–233), is amended by adding at the 

end the following new paragraph: 

‘‘(5) In addition to the requirement under paragraph (2), 

the issuer of the policy must make available to the individual 

at least Medicare supplemental policies with benefit packages 

classified as ‘C’ or ‘F’.’’. 

(c) CLARIFICATION.—Any health insurance policy that provides 

reimbursement for expenses incurred for items and services for 

42 USC 

1395ss–1. 

42 USC 1395ss. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2503 

which payment may be made under title XVIII of the Social Security 

Act but which are not reimbursable by reason of the applicability 

of deductibles, coinsurance, copayments or other limitations imposed 

by a Medicare Advantage plan (including a Medicare Advantage 

private fee-for-service plan) under part C of such title shall comply 

with the requirements of section 1882(o) of the such Act (42 U.S.C. 

1395ss(o)). 

PART II—LOW-INCOME PROGRAMS 

SEC. 111. EXTENSION OF QUALIFYING INDIVIDUAL (QI) PROGRAM. 

(a) EXTENSION.—Section 1902(a)(10)(E)(iv) of the Social Security 

Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking ‘‘June 

2008’’ and inserting ‘‘December 2009’’. 

(b) EXTENDING TOTAL AMOUNT AVAILABLE FOR ALLOCATION.— Section 1933(g) of such Act (42 U.S.C. 1396u–3(g)) is amended— 

(1) in paragraph (2)— 

(A) by striking ‘‘and’’ at the end of subparagraph (H); 

(B) in subparagraph (I)— 

(i) by striking ‘‘June 30’’ and inserting ‘‘September 

30’’; (ii) by striking ‘‘$200,000,000’’ and inserting ‘‘$300,000,000’’; and 

(iii) by striking the period at the end and inserting 

a semicolon; and 

(C) by adding at the end the following new subparagraphs: 

‘‘(J) for the period that begins on October 1, 2008, 

and ends on December 31, 2008, the total allocation amount 

is $100,000,000; 

‘‘(K) for the period that begins on January 1, 2009, 

and ends on September 30, 2009, the total allocation 

amount is $350,000,000; and 

‘‘(L) for the period that begins on October 1, 2009, 

and ends on December 31, 2009, the total allocation amount 

is $150,000,000.’’; and 

(2) in paragraph (3), in the matter preceding subparagraph 

(A), by striking ‘‘or (H)’’ and inserting ‘‘(H), (J), or (L)’’. 

SEC. 112. APPLICATION OF FULL LIS SUBSIDY ASSETS TEST UNDER 

MEDICARE SAVINGS PROGRAM. 

Section 1905(p)(1)(C) of such Act (42 U.S.C. 1396d(p)(1)(C)) 

is amended by inserting before the period at the end the following: 

‘‘or, effective beginning with January 1, 2010, whose resources 

(as so determined) do not exceed the maximum resource level 

applied for the year under subparagraph (D) of section 1860D– 

14(a)(3) (determined without regard to the life insurance policy 

exclusion provided under subparagraph (G) of such section) 

applicable to an individual or to the individual and the individual’s 

spouse (as the case may be)’’. 

SEC. 113. ELIMINATING BARRIERS TO ENROLLMENT. 

(a) SSA ASSISTANCE WITH MEDICARE SAVINGS PROGRAM AND

LOW-INCOME SUBSIDY PROGRAM APPLICATIONS.—Section 1144 of 

such Act (42 U.S.C. 1320b–14) is amended by adding at the end 

the following new subsection: 

‘‘(c) ASSISTANCE WITH MEDICARE SAVINGS PROGRAM AND LOWINCOME SUBSIDY PROGRAM APPLICATIONS.— 


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122 STAT. 2504 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(1) DISTRIBUTION OF APPLICATIONS AND INFORMATION TO

INDIVIDUALS WHO ARE POTENTIALLY ELIGIBLE FOR LOW-INCOME

SUBSIDY PROGRAM.—For each individual who submits an 

application for low-income subsidies under section 1860D–14, 

requests an application for such subsidies, or is otherwise 

identified as an individual who is potentially eligible for such 

subsidies, the Commissioner shall do the following: 

‘‘(A) Provide information describing the low-income 

subsidy program under section 1860D–14 and the Medicare 

Savings Program (as defined in paragraph (7)). 

‘‘(B) Provide an application for enrollment under such 

low-income subsidy program (if not already received by 

the Commissioner). 

‘‘(C) In accordance with paragraph (3), transmit data 

from such an application for purposes of initiating an 

application for benefits under the Medicare Savings Program. 

‘‘(D) Provide information on how the individual may 

obtain assistance in completing such application and an 

application under the Medicare Savings Program, including 

information on how the individual may contact the State 

health insurance assistance program (SHIP). 

‘‘(E) Make the application described in subparagraph 

(B) and the information described in subparagraphs (A) 

and (D) available at local offices of the Social Security 

Administration. 

‘‘(2) TRAINING PERSONNEL IN EXPLAINING BENEFIT PROGRAMS

AND ASSISTING IN COMPLETING LIS APPLICATION.—The Commissioner shall provide training to those employees of the Social 

Security Administration who are involved in receiving applications for benefits described in paragraph (1)(B) in order that 

they may promote beneficiary understanding of the low-income 

subsidy program and the Medicare Savings Program in order 

to increase participation in these programs. Such employees 

shall provide assistance in completing an application described 

in paragraph (1)(B) upon request. 

‘‘(3) TRANSMITTAL OF DATA TO STATES.—Beginning on 

January 1, 2010, with the consent of an individual completing 

an application for benefits described in paragraph (1)(B), the 

Commissioner shall electronically transmit to the appropriate 

State Medicaid agency data from such application, as determined by the Commissioner, which transmittal shall initiate 

an application of the individual for benefits under the Medicare 

Savings Program with the State Medicaid agency. In order 

to ensure that such data transmittal provides effective assistance for purposes of State adjudication of applications for benefits under the Medicare Savings Program, the Commissioner 

shall consult with the Secretary, after the Secretary has consulted with the States, regarding the content, form, frequency, 

and manner in which data (on a uniform basis for all States) 

shall be transmitted under this subparagraph. 

‘‘(4) COORDINATION WITH OUTREACH.—The Commissioner 

shall coordinate outreach activities under this subsection in 

connection with the low-income subsidy program and the Medicare Savings Program. 

‘‘(5) REIMBURSEMENT OF SOCIAL SECURITY ADMINISTRATION

ADMINISTRATIVE COSTS.— Appropriation 

authorization. 

Effective date. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2505 

‘‘(A) INITIAL MEDICARE SAVINGS PROGRAM COSTS; ADDITIONAL LOW-INCOME SUBSIDY COSTS.— 

‘‘(i) INITIAL MEDICARE SAVINGS PROGRAM COSTS.— 

There are hereby appropriated to the Commissioner 

to carry out this subsection, out of any funds in the 

Treasury not otherwise appropriated, $24,100,000. The 

amount appropriated under ths clause shall be available on October 1, 2008, and shall remain available 

until expended. 

‘‘(ii) ADDITIONAL AMOUNT FOR LOW-INCOME SUBSIDY

ACTIVITIES.—There are hereby appropriated to the 

Commissioner, out of any funds in the Treasury not 

otherwise appropriated, $24,800,000 for fiscal year 

2009 to carry out low-income subsidy activities under 

section 1860D–14 and the Medicare Savings Program 

(in accordance with this subsection), to remain available until expended. Such funds shall be in addition 

to the Social Security Administration’s Limitation on 

Administrative Expenditure appropriations for such 

fiscal year. 

‘‘(B) SUBSEQUENT FUNDING UNDER AGREEMENTS.— 

‘‘(i) IN GENERAL.—Effective for fiscal years beginning on or after October 1, 2010, the Commissioner 

and the Secretary shall enter into an agreement which 

shall provide funding (subject to the amount appropriated under clause (ii)) to cover the administrative 

costs of the Commissioner’s activities under this subsection. Such agreement shall— 

‘‘(I) provide funds to the Commissioner for the 

full cost of the Social Security Administration’s 

work related to the Medicare Savings Program 

required under this section; 

‘‘(II) provide such funding quarterly in advance 

of the applicable quarter based on estimating 

methodology agreed to by the Commissioner and 

the Secretary; and 

‘‘(III) require an annual accounting and reconciliation of the actual costs incurred and funds 

provided under this subsection. 

‘‘(ii) APPROPRIATION.—There are hereby appropriated to the Secretary solely for the purpose of providing payments to the Commissioner pursuant to an 

agreement specified in clause (i) that is in effect, out 

of any funds in the Treasury not otherwise appropriated, not more than $3,000,000 for fiscal year 2011 

and each fiscal year thereafter. 

‘‘(C) LIMITATION.—In no case shall funds from the 

Social Security Administration’s Limitation on Administrative Expenses be used to carry out activities related to 

the Medicare Savings Program. For fiscal years beginning 

on or after October 1, 2010, no such activities shall be 

undertaken by the Social Security Administration unless 

the agreement specified in subparagraph (B) is in effect 

and full funding has been provided to the Commissioner 

as specified in such subparagraph. 

‘‘(6) GAO ANALYSIS AND REPORT.— 

Effective date. 

Effective date. 


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122 STAT. 2506 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(A) ANALYSIS.—The Comptroller General of the United 

States shall prepare an analysis of the impact of this 

subsection— 

‘‘(i) in increasing participation in the Medicare 

Savings Program, and 

‘‘(ii) on States and the Social Security Administration. 

‘‘(B) REPORT.—Not later than January 1, 2012, the 

Comptroller General shall submit to Congress, the Commissioner, and the Secretary a report on the analysis conducted 

under subparagraph (A). 

‘‘(7) MEDICARE SAVINGS PROGRAM DEFINED.—For purposes 

of this subsection, the term ‘Medicare Savings Program’ means 

the program of medical assistance for payment of the cost 

of medicare cost-sharing under the Medicaid program pursuant 

to sections 1902(a)(10)(E) and 1933.’’. 

(b) MEDICAID AGENCY CONSIDERATION OF DATA TRANSMITTAL.— 

(1) IN GENERAL.—Section 1935(a) of such Act (42 U.S.C. 

1396u–5(a)) is amended by adding at the end the following 

new paragraph: 

‘‘(4) CONSIDERATION OF DATA TRANSMITTED BY THE SOCIAL

SECURITY ADMINISTRATION FOR PURPOSES OF MEDICARE SAVINGS

PROGRAM.—The State shall accept data transmitted under section 1144(c)(3) and act on such data in the same manner 

and in accordance with the same deadlines as if the data 

constituted an initiation of an application for benefits under 

the Medicare Savings Program (as defined for purposes of such 

section) that had been submitted directly by the applicant. 

The date of the individual’s application for the low income 

subsidy program from which the data have been derived shall 

constitute the date of filing of such application for benefits 

under the Medicare Savings Program.’’. 

(2) CONFORMING AMENDMENTS.—Section 1935(a) of such 

Act (42 U.S.C. 1396u–5(a)) is amended in the subsection 

heading by striking ‘‘AND’’ and by inserting ‘‘, AND MEDICARE

COST-SHARING’’ after ‘‘ASSISTANCE’’. 

(c) EFFECTIVE DATE.—Except as otherwise provided, the amendments made by this section shall take effect on January 1, 2010. 

SEC. 114. ELIMINATION OF MEDICARE PART D LATE ENROLLMENT 

PENALTIES PAID BY SUBSIDY ELIGIBLE INDIVIDUALS. 

(a) WAIVER OF LATE ENROLLMENT PENALTY.— 

(1) IN GENERAL.—Section 1860D–13(b) of the Social Security Act (42 U.S.C. 1395w–113(b)) is amended by adding at 

the end the following new paragraph: 

‘‘(8) WAIVER OF PENALTY FOR SUBSIDY-ELIGIBLE INDIVIDUALS.—In no case shall a part D eligible individual who is 

determined to be a subsidy eligible individual (as defined in 

section 1860D–14(a)(3)) be subject to an increase in the monthly 

beneficiary premium established under subsection (a).’’. 

(2) CONFORMING AMENDMENT.—Section 1860D–14(a)(1)(A) 

of the Social Security Act (42 U.S.C. 1395w–114(a)(1)(A)) is 

amended by striking ‘‘equal to’’ and all that follows through 

the period and inserting ‘‘equal to 100 percent of the amount 

described in subsection (b)(1), but not to exceed the premium 

amount specified in subsection (b)(2)(B).’’. 

42 USC 

1320b–14 note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2507 

(b) EFFECTIVE DATE.—The amendments made by this section 

shall apply to subsidies for months beginning with January 2009. 

SEC. 115. ELIMINATING APPLICATION OF ESTATE RECOVERY. 

(a) IN GENERAL.—Section 1917(b)(1)(B)(ii) of the Social Security 

Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amended by inserting ‘‘(but 

not including medical assistance for medicare cost-sharing or for 

benefits described in section 1902(a)(10)(E))’’ before the period at 

the end. 

(b) EFFECTIVE DATE.—The amendment made by subsection (a) 

shall take effect as of January 1, 2010. 

SEC. 116. EXEMPTIONS FROM INCOME AND RESOURCES FOR DETERMINATION OF ELIGIBILITY FOR LOW-INCOME SUBSIDY. 

(a) IN GENERAL.—Section 1860D–14(a)(3) of the Social Security 

Act (42 U.S.C. 1395w–114(a)(3)) is amended— 

(1) in subparagraph (C)(i), by inserting ‘‘and except that 

support and maintenance furnished in kind shall not be counted 

as income’’ after ‘‘section 1902(r)(2)’’; 

(2) in subparagraph (D), in the matter before clause (i), 

by inserting ‘‘subject to the life insurance policy exclusion provided under subparagraph (G)’’ before ‘‘)’’; 

(3) in subparagraph (E)(i), in the matter before subclause 

(I), by inserting ‘‘subject to the life insurance policy exclusion 

provided under subparagraph (G)’’ before ‘‘)’’; and 

(4) by adding at the end the following new subparagraph: 

‘‘(G) LIFE INSURANCE POLICY EXCLUSION.—In determining the resources of an individual (and the eligible 

spouse of the individual, if any) under section 1613 for 

purposes of subparagraphs (D) and (E) no part of the 

value of any life insurance policy shall be taken into 

account.’’. 

(b) EFFECTIVE DATE.—The amendments made by this section 

shall take effect with respect to applications filed on or after 

January 1, 2010. 

SEC. 117. JUDICIAL REVIEW OF DECISIONS OF THE COMMISSIONER 

OF SOCIAL SECURITY UNDER THE MEDICARE PART D LOWINCOME SUBSIDY PROGRAM. 

(a) IN GENERAL.—Section 1860D–14(a)(3)(B)(iv) of the Social 

Security Act (42 U.S.C. 1395w–114(a)(3)(B)(iv)) is amended— 

(1) in subclause (I), by striking ‘‘and’’ at the end; 

(2) in subclause (II), by striking the period at the end 

and inserting ‘‘; and’’; and 

(3) by adding at the end the following new subclause: 

‘‘(III) judicial review of the final decision of 

the Commissioner made after a hearing shall be 

available to the same extent, and with the same 

limitations, as provided in subsections (g) and (h) 

of section 205.’’. 

(b) EFFECTIVE DATE.—The amendments made by subsection 

(a) shall take effect as if included in the enactment of section 

101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 

SEC. 118. TRANSLATION OF MODEL FORM. 

(a) IN GENERAL.—Section 1905(p)(5)(A) of the Social Security 

Act (42 U.S.C. 1396d(p)(5)(A)) is amended by adding at the end 

42 USC 

1395w–114 note. 

42 USC 

1395w–114 note. 

42 USC 1396p 

note. 

42 USC 

1395w–113 note. 


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122 STAT. 2508 PUBLIC LAW 110–275—JULY 15, 2008 

the following: ‘‘The Secretary shall provide for the translation of 

such application form into at least the 10 languages (other than 

English) that are most often used by individuals applying for hospital insurance benefits under section 226 or 226A and shall make 

the translated forms available to the States and to the Commissioner of Social Security.’’. 

(b) EFFECTIVE DATE.—The amendment made by subsection (a) 

shall take effect on January 1, 2010. 

SEC. 119. MEDICARE ENROLLMENT ASSISTANCE. 

(a) ADDITIONAL FUNDING FOR STATE HEALTH INSURANCE ASSISTANCE PROGRAMS.— 

(1) GRANTS.— 

(A) IN GENERAL.—The Secretary of Health and Human 

Services (in this section referred to as the ‘‘Secretary’’) 

shall use amounts made available under subparagraph (B) 

to make grants to States for State health insurance assistance programs receiving assistance under section 4360 of 

the Omnibus Budget Reconciliation Act of 1990. 

(B) 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 

$7,500,000 to the Centers for Medicare & Medicaid Services 

Program Management Account for fiscal year 2009, to 

remain available until expended. 

(2) AMOUNT OF GRANTS.—The amount of a grant to a State 

under this subsection from the total amount made available 

under paragraph (1) shall be equal to the sum of the amount 

allocated to the State under paragraph (3)(A) and the amount 

allocated to the State under subparagraph (3)(B). 

(3) ALLOCATION TO STATES.— 

(A) ALLOCATION BASED ON PERCENTAGE OF LOW-INCOME

BENEFICIARIES.—The amount allocated to a State under 

this subparagraph from 2⁄3 of the total amount made available under paragraph (1) shall be based on the number 

of individuals who meet the requirement under subsection 

(a)(3)(A)(ii) of section 1860D–14 of the Social Security Act 

(42 U.S.C. 1395w–114) but who have not enrolled to receive 

a subsidy under such section 1860D–14 relative to the 

total number of individuals who meet the requirement 

under such subsection (a)(3)(A)(ii) in each State, as estimated by the Secretary. 

(B) ALLOCATION BASED ON PERCENTAGE OF RURAL BENEFICIARIES.—The amount allocated to a State under this 

subparagraph from 1⁄3 of the total amount made available 

under paragraph (1) shall be based on the number of part 

D eligible individuals (as defined in section 1860D– 

1(a)(3)(A) of such Act (42 U.S.C. 1395w–101(a)(3)(A))) 

residing in a rural area relative to the total number of 

such individuals in each State, as estimated by the Secretary. 

42 USC 1395b–3 

note. 

42 USC 1396d 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2509 

(4) PORTION OF GRANT BASED ON PERCENTAGE OF LOWINCOME BENEFICIARIES TO BE USED TO PROVIDE OUTREACH TO

INDIVIDUALS WHO MAY BE SUBSIDY ELIGIBLE INDIVIDUALS OR

ELIGIBLE FOR THE MEDICARE SAVINGS PROGRAM.—Each grant 

awarded under this subsection with respect to amounts allocated under paragraph (3)(A) shall be used to provide outreach 

to individuals who may be subsidy eligible individuals (as 

defined in section 1860D–14(a)(3)(A) of the Social Security Act 

(42 U.S.C. 1395w–114(a)(3)(A)) or eligible for the Medicare 

Savings Program (as defined in subsection (f)). 

(b) ADDITIONAL FUNDING FOR AREA AGENCIES ON AGING.— 

(1) GRANTS.— 

(A) IN GENERAL.—The Secretary, acting through the 

Assistant Secretary for Aging, shall make grants 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 

Native American programs carried out under the Older 

Americans Act of 1965 (42 U.S.C. 3001 et seq.). 

(B) 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 

$7,500,000 to the Administration on Aging for fiscal year 

2009, to remain available until expended. 

(2) AMOUNT OF GRANT AND ALLOCATION TO STATES BASED

ON PERCENTAGE OF LOW-INCOME AND RURAL BENEFICIARIES.— 

The amount of a grant to a State under this subsection from 

the total amount made available under paragraph (1) shall 

be determined in the same manner as the amount of a grant 

to a State under subsection (a), from the total amount made 

available under paragraph (1) of such subsection, is determined 

under paragraph (2) and subparagraphs (A) and (B) of paragraph (3) of such subsection. 

(3) REQUIRED USE OF FUNDS.— 

(A) ALL FUNDS.—Subject to subparagraph (B), each 

grant awarded under this subsection shall be used to provide outreach to eligible Medicare beneficiaries regarding 

the benefits available under title XVIII of the Social Security Act. 

(B) OUTREACH TO INDIVIDUALS WHO MAY BE SUBSIDY

ELIGIBLE INDIVIDUALS OR ELIGIBLE FOR THE MEDICARE

SAVINGS PROGRAM.—Subsection (a)(4) shall apply to each 

grant awarded under this subsection in the same manner 

as it applies to a grant under subsection (a). 

(c) ADDITIONAL FUNDING FOR AGING AND DISABILITY RESOURCE

CENTERS.— 

(1) GRANTS.— 

(A) IN GENERAL.—The Secretary shall make grants 

to Aging and Disability Resource Centers under the Aging 

and Disability Resource Center grant program that are 

established centers under such program on the date of 

the enactment of this Act. 


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122 STAT. 2510 PUBLIC LAW 110–275—JULY 15, 2008 

(B) 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 Administration on Aging for fiscal year 

2009, to remain available until expended. 

(2) REQUIRED USE OF FUNDS.—Each grant awarded under 

this subsection shall be used to provide outreach to individuals 

regarding the benefits available under the Medicare prescription drug benefit under part D of title XVIII of the Social 

Security Act and under the Medicare Savings Program. 

(d) COORDINATION OF EFFORTS TO INFORM OLDER AMERICANS

ABOUT BENEFITS AVAILABLE UNDER FEDERAL AND STATE PROGRAMS.— 

(1) IN GENERAL.—The Secretary, acting through the Assistant Secretary for Aging, in cooperation with related Federal 

agency partners, shall make a grant to, or enter into a contract 

with, a qualified, experienced entity under which the entity 

shall— 

(A) maintain and update web-based decision support 

tools, and integrated, person-centered systems, designed 

to inform older individuals (as defined in section 102 of 

the Older Americans Act of 1965 (42 U.S.C. 3002)) about 

the full range of benefits for which the individuals may 

be eligible under Federal and State programs; 

(B) utilize cost-effective strategies to find older individuals with the greatest economic need (as defined in such 

section 102) and inform the individuals of the programs; 

(C) develop and maintain an information clearinghouse 

on best practices and the most cost-effective methods for 

finding older individuals with greatest economic need and 

informing the individuals of the programs; and 

(D) provide, in collaboration with related Federal 

agency partners administering the Federal programs, 

training and technical assistance on the most effective outreach, screening, and follow-up strategies for the Federal 

and State programs. 

(2) FUNDING.—For purposes of making a grant or entering 

into a contract under paragraph (1), 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 Administration on Aging for fiscal year 2009, to remain 

available until expended. 

(e) REPROGRAMMING FUNDS FROM MEDICARE, MEDICAID, AND

SCHIP EXTENSION ACT OF 2007.—The Secretary shall only use 

the $5,000,000 in funds allocated to make grants to States for 

Area Agencies on Aging and Aging Disability and Resource Centers 

for the period of fiscal years 2008 through 2009 under section 

118 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 

Internet. 

Grants. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2511 

(Public Law 110–173) for the sole purpose of providing outreach 

to individuals regarding the benefits available under the Medicare 

prescription drug benefit under part D of title XVIII of the Social 

Security Act. The Secretary shall republish the request for proposals 

issued on April 17, 2008, in order to comply with the preceding 

sentence. 

(f) MEDICARE SAVINGS PROGRAM DEFINED.—For purposes of 

this section, the term ‘‘Medicare Savings Program’’ means the program of medical assistance for payment of the cost of medicare 

cost-sharing under the Medicaid program pursuant to sections 

1902(a)(10)(E) and 1933 of the Social Security Act (42 U.S.C. 

1396a(a)(10)(E), 1396u–3). 

Subtitle B—Provisions Relating to Part A 

SEC. 121. EXPANSION AND EXTENSION OF THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM. 

(a) IN GENERAL.—Section 1820(g) of the Social Security Act 

(42 U.S.C. 1395i–4(g)) is amended by adding at the end the following 

new paragraph: 

‘‘(6) PROVIDING MENTAL HEALTH SERVICES AND OTHER

HEALTH SERVICES TO VETERANS AND OTHER RESIDENTS OF RURAL

AREAS.— 

‘‘(A) GRANTS TO STATES.—The Secretary may award 

grants to States that have submitted applications in accordance with subparagraph (B) for increasing the delivery 

of mental health services or other health care services 

deemed necessary to meet the needs of veterans of Operation Iraqi Freedom and Operation Enduring Freedom 

living in rural areas (as defined for purposes of section 

1886(d) and including areas that are rural census tracks, 

as defined by the Administrator of the Health Resources 

and Services Administration), including for the provision 

of crisis intervention services and the detection of posttraumatic stress disorder, traumatic brain injury, and other 

signature injuries of veterans of Operation Iraqi Freedom 

and Operation Enduring Freedom, and for referral of such 

veterans to medical facilities operated by the Department 

of Veterans Affairs, and for the delivery of such services 

to other residents of such rural areas. 

‘‘(B) APPLICATION.— 

‘‘(i) IN GENERAL.—An application is in accordance 

with this subparagraph if the State submits to the 

Secretary at such time and in such form as the Secretary may require an application containing the assurances described in subparagraphs (A)(ii) and (A)(iii) 

of subsection (b)(1). 

‘‘(ii) CONSIDERATION OF REGIONAL APPROACHES, 

NETWORKS, OR TECHNOLOGY.—The Secretary may, as 

appropriate in awarding grants to States under 

subparagraph (A), consider whether the application 

submitted by a State under this subparagraph includes 

1 or more proposals that utilize regional approaches, 

networks, health information technology, telehealth, 

or telemedicine to deliver services described in 

subparagraph (A) to individuals described in that 

Publication. 


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122 STAT. 2512 PUBLIC LAW 110–275—JULY 15, 2008 

subparagraph. For purposes of this clause, a network 

may, as the Secretary determines appropriate, include 

Federally qualified health centers (as defined in section 

1861(aa)(4)), rural health clinics (as defined in section 

1861(aa)(2)), home health agencies (as defined in section 1861(o)), community mental health centers (as 

defined in section 1861(ff)(3)(B)) and other providers 

of mental health services, pharmacists, local government, and other providers deemed necessary to meet 

the needs of veterans. 

‘‘(iii) COORDINATION AT LOCAL LEVEL.—The Secretary shall require, as appropriate, a State to demonstrate consultation with the hospital association of 

such State, rural hospitals located in such State, providers of mental health services, or other appropriate 

stakeholders for the provision of services under a grant 

awarded under this paragraph. 

‘‘(iv) SPECIAL CONSIDERATION OF CERTAIN APPLICATIONS.—In awarding grants to States under subparagraph (A), the Secretary shall give special consideration 

to applications submitted by States in which veterans 

make up a high percentage (as determined by the 

Secretary) of the total population of the State. Such 

consideration shall be given without regard to the 

number of veterans of Operation Iraqi Freedom and 

Operation Enduring Freedom living in the areas in 

which mental health services and other health care 

services would be delivered under the application. 

‘‘(C) COORDINATION WITH VA.—The Secretary shall, as 

appropriate, consult with the Director of the Office of Rural 

Health of the Department of Veterans Affairs in awarding 

and administering grants to States under subparagraph 

(A). 

‘‘(D) USE OF FUNDS.—A State awarded a grant under 

this paragraph may, as appropriate, use the funds to 

reimburse providers of services described in subparagraph 

(A) to individuals described in that subparagraph. 

‘‘(E) LIMITATION ON USE OF GRANT FUNDS FOR ADMINISTRATIVE EXPENSES.—A State awarded a grant under this 

paragraph may not expend more than 15 percent of the 

amount of the grant for administrative expenses. 

‘‘(F) INDEPENDENT EVALUATION AND FINAL REPORT.— 

The Secretary shall provide for an independent evaluation 

of the grants awarded under subparagraph (A). Not later 

than 1 year after the date on which the last grant is 

awarded to a State under such subparagraph, the Secretary 

shall submit a report to Congress on such evaluation. Such 

report shall include an assessment of the impact of such 

grants on increasing the delivery of mental health services 

and other health services to veterans of the United States 

Armed Forces living in rural areas (as so defined and 

including such areas that are rural census tracks), with 

particular emphasis on the impact of such grants on the 

delivery of such services to veterans of Operation Enduring 

Freedom and Operation Iraqi Freedom, and to other 

individuals living in such rural areas.’’. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2513 

(b) USE OF FUNDS FOR FEDERAL ADMINISTRATIVE EXPENSES.— Section 1820(g)(5) of the Social Security Act (42 U.S.C. 1395i– 

4(g)(5)) is amended— 

(1) by striking ‘‘beginning with fiscal year 2005’’ and 

inserting ‘‘for each of fiscal years 2005 through 2008’’; and 

(2) by inserting ‘‘and, of the total amount appropriated 

for grants under paragraphs (1), (2), and (6) for a fiscal year 

(beginning with fiscal year 2009)’’ after ‘‘2005)’’. 

(c) EXTENSION OF AUTHORIZATION FOR FLEX GRANTS.—Section 

1820(j) of the Social Security Act (42 U.S.C. 1395i–4(j)) is 

amended— 

(1) by striking ‘‘and for’’ and inserting ‘‘for’’; and 

(2) by inserting ‘‘, for making grants to all States under paragraphs (1) and (2) of subsection (g), $55,000,000 in each 

of fiscal years 2009 and 2010, and for making grants to all 

States under paragraph (6) of subsection (g), $50,000,000 in 

each of fiscal years 2009 and 2010, to remain available until 

expended’’ before the period at the end. 

(d) MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM.—Section 

1820(g)(1) of the Social Security Act (42 U.S.C. 1395i–4(g)(1)) is 

amended— 

(1) in subparagraph (B), by striking ‘‘and’’ at the end; 

(2) in subparagraph (C), by striking the period at the 

end and inserting ‘‘; and’’; and 

(3) by adding at the end the following new subparagraph: 

‘‘(D) providing support for critical access hospitals for 

quality improvement, quality reporting, performance 

improvements, and benchmarking.’’. 

(e) ASSISTANCE TO SMALL CRITICAL ACCESS HOSPITALS

TRANSITIONING TO SKILLED NURSING FACILITIES AND ASSISTED

LIVING FACILITIES.—Section 1820(g) of the Social Security Act (42 

U.S.C. 1395i–4(g)), as amended by subsection (a), is amended by 

adding at the end the following new paragraph: 

‘‘(7) CRITICAL ACCESS HOSPITALS TRANSITIONING TO SKILLED

NURSING FACILITIES AND ASSISTED LIVING FACILITIES.— ‘‘(A) GRANTS.—The Secretary may award grants to 

eligible critical access hospitals that have submitted 

applications in accordance with subparagraph (B) for 

assisting such hospitals in the transition to skilled nursing 

facilities and assisted living facilities. 

‘‘(B) APPLICATION.—An applicable critical access hospital seeking a grant under this paragraph shall submit 

an application to the Secretary on or before such date 

and in such form and manner as the Secretary specifies. 

‘‘(C) ADDITIONAL REQUIREMENTS.—The Secretary may 

not award a grant under this paragraph to an eligible 

critical access hospital unless— 

‘‘(i) local organizations or the State in which the 

hospital is located provides matching funds; and 

‘‘(ii) the hospital provides assurances that it will 

surrender critical access hospital status under this title 

within 180 days of receiving the grant. 

‘‘(D) AMOUNT OF GRANT.—A grant to an eligible critical 

access hospital under this paragraph may not exceed 

$1,000,000. 

‘‘(E) FUNDING.—There are appropriated from the Federal Hospital Insurance Trust Fund under section 1817 

Appropriation 

authorization. 


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122 STAT. 2514 PUBLIC LAW 110–275—JULY 15, 2008 

for making grants under this paragraph, $5,000,000 for 

fiscal year 2008. 

‘‘(F) ELIGIBLE CRITICAL ACCESS HOSPITAL DEFINED.— For purposes of this paragraph, the term ‘eligible critical 

access hospital’ means a critical access hospital that has 

an average daily acute census of less than 0.5 and an 

average daily swing bed census of greater than 10.0.’’. 

SEC. 122. REBASING FOR SOLE COMMUNITY HOSPITALS. 

(a) REBASING PERMITTED.—Section 1886(b)(3) of the Social 

Security Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at 

the end the following new subparagraph: 

‘‘(L)(i) For cost reporting periods beginning on or after January 

1, 2009, in the case of a sole community hospital there shall be 

substituted for the amount otherwise determined under subsection 

(d)(5)(D)(i) of this section, if such substitution results in a greater 

amount of payment under this section for the hospital, the subparagraph (L) rebased target amount. 

‘‘(ii) For purposes of this subparagraph, the term ‘subparagraph 

(L) rebased target amount’ has the meaning given the term ‘target 

amount’ in subparagraph (C), except that— 

‘‘(I) there shall be substituted for the base cost reporting 

period the 12-month cost reporting period beginning during 

fiscal year 2006; 

‘‘(II) any reference in subparagraph (C)(i) to the ‘first cost 

reporting period’ described in such subparagraph is deemed 

a reference to the first cost reporting period beginning on 

or after January 1, 2009; and 

‘‘(III) the applicable percentage increase shall only be 

applied under subparagraph (C)(iv) for discharges occurring 

on or after January 1, 2009.’’. 

(b) CONFORMING AMENDMENTS.—Section 1886(b)(3) of the Social 

Security Act (42 U.S.C. 1395ww(b)(3)) is amended— 

(1) in subparagraph (C), in the matter preceding clause 

(i), by striking ‘‘subparagraph (I)’’ and inserting ‘‘subparagraphs 

(I) and (L)’’; and 

(2) in subparagraph (I)(i), in the matter preceding subclause 

(I), by striking ‘‘For’’ and inserting ‘‘Subject to subparagraph 

(L), for’’. 

SEC. 123. DEMONSTRATION PROJECT ON COMMUNITY HEALTH 

INTEGRATION MODELS IN CERTAIN RURAL COUNTIES. 

(a) IN GENERAL.—The Secretary shall establish a demonstration 

project to allow eligible entities to develop and test new models 

for the delivery of health care services in eligible counties for 

the purpose of improving access to, and better integrating the 

delivery of, acute care, extended care, and other essential health 

care services to Medicare beneficiaries. 

(b) PURPOSE.—The purpose of the demonstration project under 

this section is to— 

(1) explore ways to increase access to, and improve the 

adequacy of, payments for acute care, extended care, and other 

essential health care services provided under the Medicare 

and Medicaid programs in eligible counties; and 

(2) evaluate regulatory challenges facing such providers 

and the communities they serve. 

(c) REQUIREMENTS.—The following requirements shall apply 

under the demonstration project: 

42 USC 1395i–4 

note. 

Applicability. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2515 

(1) Health care providers in eligible counties selected to 

participate in the demonstration project under subsection (d)(3) 

shall (when determined appropriate by the Secretary), instead 

of the payment rates otherwise applicable under the Medicare 

program, be reimbursed at a rate that covers at least the 

reasonable costs of the provider in furnishing acute care, 

extended care, and other essential health care services to Medicare beneficiaries. 

(2) Methods to coordinate the survey and certification 

process under the Medicare program and the Medicaid program 

across all health service categories included in the demonstration project shall be tested with the goal of assuring quality 

and safety while reducing administrative burdens, as appropriate, related to completing such survey and certification 

process. 

(3) Health care providers in eligible counties selected to 

participate in the demonstration project under subsection (d)(3) 

and the Secretary shall work with the State to explore ways 

to revise reimbursement policies under the Medicaid program 

to improve access to the range of health care services available 

in such eligible counties. 

(4) The Secretary shall identify regulatory requirements 

that may be revised appropriately to improve access to care 

in eligible counties. 

(5) Other essential health care services necessary to ensure 

access to the range of health care services in eligible counties 

selected to participate in the demonstration project under subsection (d)(3) shall be identified. Ways to ensure adequate 

funding for such services shall also be explored. 

(d) APPLICATION PROCESS.— 

(1) ELIGIBILITY.— 

(A) IN GENERAL.—Eligibility to participate in the demonstration project under this section shall be limited to 

eligible entities. 

(B) ELIGIBLE ENTITY DEFINED.—In this section, the 

term ‘‘eligible entity’’ means an entity that— 

(i) is a Rural Hospital Flexibility Program grantee 

under section 1820(g) of the Social Security Act (42 

U.S.C. 1395i–4(g)); and 

(ii) is located in a State in which at least 65 

percent of the counties in the State are counties that 

have 6 or less residents per square mile. 

(2) APPLICATION.— 

(A) IN GENERAL.—An eligible entity seeking to participate in the demonstration project under this section shall 

submit an application to the Secretary at such time, in 

such manner, and containing such information as the Secretary may require. 

(B) LIMITATION.—The Secretary shall select eligible 

entities located in not more than 4 States to participate 

in the demonstration project under this section. 

(3) SELECTION OF ELIGIBLE COUNTIES.—An eligible entity 

selected by the Secretary to participate in the demonstration 

project under this section shall select not more than 6 eligible 

counties in the State in which the entity is located in which 

to conduct the demonstration project. 


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122 STAT. 2516 PUBLIC LAW 110–275—JULY 15, 2008 

(4) ELIGIBLE COUNTY DEFINED.—In this section, the term 

‘‘eligible county’’ means a county that meets the following 

requirements: 

(A) The county has 6 or less residents per square 

mile. 

(B) As of the date of the enactment of this Act, a 

facility designated as a critical access hospital which meets 

the following requirements was located in the county: 

(i) As of the date of the enactment of this Act, 

the critical access hospital furnished 1 or more of the 

following: 

(I) Home health services. 

(II) Hospice care. 

(III) Rural health clinic services. 

(ii) As of the date of the enactment of this Act, 

the critical access hospital has an average daily 

inpatient census of 5 or less. 

(C) As of the date of the enactment of this Act, skilled 

nursing facility services were available in the county in— 

(i) a critical access hospital using swing beds; or 

(ii) a local nursing home. 

(e) ADMINISTRATION.— 

(1) IN GENERAL.—The demonstration project under this 

section shall be administered jointly by the Administrator of 

the Office of Rural Health Policy of the Health Resources and 

Services Administration and the Administrator of the Centers 

for Medicare & Medicaid Services, in accordance with paragraphs (2) and (3). 

(2) HRSA DUTIES.—In administering the demonstration 

project under this section, the Administrator of the Office of 

Rural Health Policy of the Health Resources and Services 

Administration shall— 

(A) award grants to the eligible entities selected to 

participate in the demonstration project; and 

(B) work with such entities to provide technical assistance related to the requirements under the project. 

(3) CMS DUTIES.—In administering the demonstration 

project under this section, the Administrator of the Centers 

for Medicare & Medicaid Services shall determine which provisions of titles XVIII and XIX of the Social Security Act (42 

U.S.C. 1395 et seq.; 1396 et seq.) the Secretary should waive 

under the waiver authority under subsection (i) that are relevant to the development of alternative reimbursement methodologies, which may include, as appropriate, covering at least 

the reasonable costs of the provider in furnishing acute care, 

extended care, and other essential health care services to Medicare beneficiaries and coordinating the survey and certification 

process under the Medicare and Medicaid programs, as appropriate, across all service categories included in the demonstration project. 

(f) DURATION.— (1) IN GENERAL.—The demonstration project under this 

section shall be conducted for a 3-year period beginning on 

October 1, 2009. 

(2) BEGINNING DATE OF DEMONSTRATION PROJECT.—The 

demonstration project under this section shall be considered 

to have begun in a State on the date on which the eligible 

Grants. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2517 

counties selected to participate in the demonstration project 

under subsection (d)(3) begin operations in accordance with 

the requirements under the demonstration project. 

(g) FUNDING.— (1) CMS.— 

(A) IN GENERAL.—The Secretary shall provide for the 

transfer, in appropriate part 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), of such 

sums as are necessary for the costs to the Centers for 

Medicare & Medicaid Services of carrying out its duties 

under the demonstration project under this section. 

(B) BUDGET NEUTRALITY.—In conducting the demonstration project under this section, the Secretary shall 

ensure that the aggregate payments made by the Secretary 

do not exceed the amount which the Secretary estimates 

would have been paid if the demonstration project under 

this section was not implemented. 

(2) HRSA.—There are authorized to be appropriated to 

the Office of Rural Health Policy of the Health Resources and 

Services Administration $800,000 for each of fiscal years 2010, 

2011, and 2012 for the purpose of carrying out the duties 

of such Office under the demonstration project under this section, to remain available for the duration of the demonstration 

project. 

(h) REPORT.— 

(1) INTERIM REPORT.—Not later than the date that is 2 

years after the date on which the demonstration project under 

this section is implemented, the Administrator of the Office 

of Rural Health Policy of the Health Resources and Services 

Administration, in coordination with the Administrator of the 

Centers for Medicare & Medicaid Services, shall submit a report 

to Congress on the status of the demonstration project that 

includes initial recommendations on ways to improve access 

to, and the availability of, health care services in eligible counties based on the findings of the demonstration project. 

(2) FINAL REPORT.—Not later than 1 year after the completion of the demonstration project, the Administrator of the 

Office of Rural Health Policy of the Health Resources and 

Services Administration, in coordination with the Administrator 

of the Centers for Medicare & Medicaid Services, shall submit 

a report to Congress on such project, together with recommendations for such legislation and administrative action 

as the Secretary determines appropriate. 

(i) WAIVER AUTHORITY.—The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 

1395 et seq.; 1396 et seq.) as may be necessary and appropriate 

for the purpose of carrying out the demonstration project under 

this section. 

(j) DEFINITIONS.—In this section: 

(1) EXTENDED CARE SERVICES.—The term ‘‘extended care 

services’’ means the following: 

(A) Home health services. 

(B) Covered skilled nursing facility services. 

(C) Hospice care. 

Appropriation 

authorization. 


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(2) COVERED SKILLED NURSING FACILITY SERVICES.—The 

term ‘‘covered skilled nursing facility services’’ has the meaning 

given such term in section 1888(e)(2)(A) of the Social Security 

Act (42 U.S.C. 1395yy(e)(2)(A)). 

(3) CRITICAL ACCESS HOSPITAL.—The term ‘‘critical access 

hospital’’ means a facility designated as a critical access hospital 

under section 1820(c) of such Act (42 U.S.C. 1395i–4(c)). 

(4) HOME HEALTH SERVICES.—The term ‘‘home health services’’ has the meaning given such term in section 1861(m) 

of such Act (42 U.S.C. 1395x(m)). 

(5) HOSPICE CARE.—The term ‘‘hospice care’’ has the 

meaning given such term in section 1861(dd) of such Act (42 

U.S.C. 1395x(dd)). 

(6) MEDICAID PROGRAM.—The term ‘‘Medicaid program’’ 

means the program under title XIX of such Act (42 U.S.C. 

1396 et seq.). 

(7) MEDICARE PROGRAM.—The term ‘‘Medicare program’’ 

means the program under title XVIII of such Act (42 U.S.C. 

1395 et seq.). 

(8) OTHER ESSENTIAL HEALTH CARE SERVICES.—The term 

‘‘other essential health care services’’ means the following: 

(A) Ambulance services (as described in section 

1861(s)(7) of the Social Security Act (42 U.S.C. 1395x(s)(7))). 

(B) Rural health clinic services. 

(C) Public health services (as defined by the Secretary). 

(D) Other health care services determined appropriate 

by the Secretary. 

(9) RURAL HEALTH CLINIC SERVICES.—The term ‘‘rural 

health clinic services’’ has the meaning given such term in 

section 1861(aa)(1) of such Act (42 U.S.C. 1395x(aa)(1)). 

(10) SECRETARY.—The term ‘‘Secretary’’ means the Secretary of Health and Human Services. 

SEC. 124. EXTENSION OF THE RECLASSIFICATION OF CERTAIN HOSPITALS. 

(a) IN GENERAL.—Subsection (a) of section 106 of division B 

of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395 

note), as amended by section 117 of the Medicare, Medicaid, and 

SCHIP Extension Act of 2007 (Public Law 110–173), is amended 

by striking ‘‘September 30, 2008’’ and inserting ‘‘September 30, 

2009’’. 

(b) SPECIAL EXCEPTION RECLASSIFICATIONS.—Section 117(a)(2) 

of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 

Law 110–173)) is amended by striking ‘‘September 30, 2008’’ and 

inserting ‘‘the last date of the extension of reclassifications under 

section 106(a) of the Medicare Improvement and Extension Act 

of 2006 (division B of Public Law 109–432)’’. 

(c) DISREGARDING SECTION 508 HOSPITAL RECLASSIFICATIONS

FOR PURPOSES OF GROUP RECLASSIFICATIONS.—Section 508(g) of 

the Medicare Prescription Drug, Improvement, and Modernization 

Act of 2003 (Public Law 108–173, 42 U.S.C. 1395ww note), as 

added by section 117(b) of the Medicare, Medicaid, and SCHIP 

Extension Act of 2008 (Public Law 110–173)), is amended by 

striking ‘‘during fiscal year 2008’’ and inserting ‘‘beginning on 

October 1, 2007, and ending on the last date of the extension 

42 USC 1395ww 

note. 

42 USC 1395ww 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2519 

of reclassifications under section 106(a) of the Medicare Improvement and Extension Act of 2006 (division B of Public Law 109– 

432)’’. 

SEC. 125. REVOCATION OF UNIQUE DEEMING AUTHORITY OF THE 

JOINT COMMISSION. 

(a) REVOCATION.—Section 1865 of the Social Security Act (42 

U.S.C. 1395bb) is amended— 

(1) by striking subsection (a); and 

(2) by redesignating subsections (b), (c), (d), and (e) as 

subsections (a), (b), (c), and (d), respectively. 

(b) CONFORMING AMENDMENTS.—(1) Section 1865 of the Social 

Security Act (42 U.S.C. 1395bb) is amended— 

(A) in subsection (a)(1), as redesignated by subsection (a)(2), 

by striking ‘‘In addition, if’’ and inserting ‘‘If’’; 

(B) in subsection (b), as so redesignated— 

(i) by striking ‘‘released to him by the Joint Commission 

on Accreditation of Hospitals,’’ and inserting ‘‘released to 

the Secretary by’’; and 

(ii) by striking the comma after ‘‘Association’’; 

(C) in subsection (c), as so redesignated, by striking ‘‘pursuant to subsection (a) or (b)(1)’’ and inserting ‘‘pursuant to subsection (a)(1)’’; and 

(D) in subsection (d), as so redesignated, by striking ‘‘pursuant to subsection (a) or (b)(1)’’ and inserting ‘‘pursuant to subsection (a)(1)’’. 

(2) Section 1861(e) of the Social Security Act (42 U.S.C. 

1395x(e)) is amended in the fourth sentence by striking ‘‘and (ii) 

is accredited by the Joint Commission on Accreditation of Hospitals, 

or is accredited by or approved by a program of the country in 

which such institution is located if the Secretary finds the accreditation or comparable approval standards of such program to be essentially equivalent to those of the Joint Commission on Accreditation 

of Hospitals’’ and inserting ‘‘and (ii) is accredited by a national 

accreditation body recognized by the Secretary under section 

1865(a), or is accredited by or approved by a program of the country 

in which such institution is located if the Secretary finds the accreditation or comparable approval standards of such program to be 

essentially equivalent to those of such a national accreditation 

body.’’. 

(3) Section 1864(c) of the Social Security Act (42 U.S.C. 

1395aa(c)) is amended by striking ‘‘pursuant to subsection (a) or 

(b)(1) of section 1865’’ and inserting ‘‘pursuant to section 1865(a)(1)’’. 

(4) Section 1875(b) of the Social Security Act (42 U.S.C. 

1395ll(b)) is amended by striking ‘‘the Joint Commission on Accreditation of Hospitals,’’ and inserting ‘‘national accreditation bodies 

under section 1865(a)’’. 

(5) Section 1834(a)(20)(B) of the Social Security Act (42 U.S.C. 

1395m(a)(20)(B)) is amended by striking ‘‘section 1865(b)’’ and 

inserting ‘‘section 1865(a)’’. 

(6) Section 1852(e)(4)(C) of the Social Security Act (42 U.S.C. 

1395w–22(e)(4)(C)) is amended by striking ‘‘section 1865(b)(2)’’ and 

inserting ‘‘section 1865(a)(2)’’. 

(c) AUTHORITY TO RECOGNIZE THE JOINT COMMISSION AS A

NATIONAL ACCREDITATION BODY.—The Secretary of Health and 

Human Services may recognize the Joint Commission as a national 

accreditation body under section 1865 of the Social Security Act 

42 USC 1395bb 

note. 


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122 STAT. 2520 PUBLIC LAW 110–275—JULY 15, 2008 

(42 U.S.C. 1395bb), as amended by this section, upon such terms 

and conditions, and upon submission of such information, as the 

Secretary may require. 

(d) EFFECTIVE DATE; TRANSITION RULE.—(1) Subject to paragraph (2), the amendments made by this section shall apply with 

respect to accreditations of hospitals granted on or after the date 

that is 24 months after the date of the enactment of this Act. 

(2) For purposes of title XVIII of the Social Security Act (42 

U.S.C. 1395 et seq.), the amendments made by this section shall 

not effect the accreditation of a hospital by the Joint Commission, 

or under accreditation or comparable approval standards found 

to be essentially equivalent to accreditation or approval standards 

of the Joint Commission, for the period of time applicable under 

such accreditation. 

Subtitle C—Provisions Relating to Part B 

PART I—PHYSICIANS’ SERVICES 

SEC. 131. PHYSICIAN PAYMENT, EFFICIENCY, AND QUALITY IMPROVEMENTS. 

(a) IN GENERAL.— 

(1) INCREASE IN UPDATE FOR THE SECOND HALF OF 2008

AND FOR 2009.— 

(A) FOR THE SECOND HALF OF 2008.—Section 1848(d)(8) 

of the Social Security Act (42 U.S.C. 1395w–4(d)(8)), as 

added by section 101 of the Medicare, Medicaid, and SCHIP 

Extension Act of 2007 (Public Law 110–173), is amended— 

(i) in the heading, by striking ‘‘A PORTION OF’’; 

(ii) in subparagraph (A), by striking ‘‘for the period 

beginning on January 1, 2008, and ending on June 

30, 2008,’’; and 

(iii) in subparagraph (B)— 

(I) in the heading, by striking ‘‘THE REMAINING

PORTION OF 2008 AND’’; and 

(II) by striking ‘‘for the period beginning on 

July 1, 2008, and ending on December 31, 2008, 

and’’. 

(B) FOR 2009.—Section 1848(d) of the Social Security 

Act (42 U.S.C. 1395w–4(d)), as amended by section 101 

of the Medicare, Medicaid, and SCHIP Extension Act of 

2007 (Public Law 110–173), is amended by adding at the 

end the following new paragraph: 

‘‘(9) UPDATE FOR 2009.— 

‘‘(A) IN GENERAL.—Subject to paragraphs (7)(B) and 

(8)(B), in lieu of the update to the single conversion factor 

established in paragraph (1)(C) that would otherwise apply 

for 2009, the update to the single conversion factor shall 

be 1.1 percent. 

‘‘(B) NO EFFECT ON COMPUTATION OF CONVERSION

FACTOR FOR 2010 AND SUBSEQUENT YEARS.—The conversion 

factor under this subsection shall be computed under paragraph (1)(A) for 2010 and subsequent years as if subparagraph (A) had never applied.’’. 

(3) REVISION OF THE PHYSICIAN ASSISTANCE AND QUALITY

INITIATIVE FUND.— 

Applicability. 

42 USC 1395bb 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2521 

(A) IN GENERAL.—Subject to subparagraph (B), section 

1848(l)(2) of the Social Security Act (42 U.S.C. 1395w– 

4(l)(2)), as amended by section 101(a)(2) of the Medicare, 

Medicaid, and SCHIP Extension Act of 2007 (Public Law 

110–173), is amended— 

(i) in subparagraph (A)— 

(I) by striking clause (i)(III); and 

(II) by striking clause (ii)(III); and 

(ii) in subparagraph (B)— 

(I) in clause (i), by adding ‘‘and’’ at the end; 

(II) in clause (ii), by striking ‘‘; and’’ and 

inserting a period; and 

(III) by striking clause (iii). 

(B) CONTINGENCY.—If there is enacted, before, on, or 

after the date of the enactment of this Act, a Supplemental 

Appropriations Act, 2008 that includes a provision 

amending section 1848(l) of the Social Security Act, the 

alternative amendment described in subparagraph (C)— 

(i) shall apply instead of the amendments made 

by subparagraph (A); and 

(ii) shall be executed after such provision in such 

Supplemental Appropriations Act. 

(C) ALTERNATIVE AMENDMENT DESCRIBED.—The alternative amendment described in this subparagraph is as 

follows: Section 1848(l)(2) of the Social Security Act (42 

U.S.C. 1395w–4(l)(2)), as amended by section 101(a)(2) of 

the Medicare, Medicaid, and SCHIP Extension Act of 2007 

(Public Law 110–173) and by the Supplemental Appropriations Act, 2008, is amended— 

(i) in subparagraph (A)— 

(I) by striking subclauses (III) and (IV) of 

clause (i); and 

(II) by striking subclauses (III) and (IV) of 

clause (ii); and 

(ii) in subparagraph (B)— 

(I) in clause (i), by adding ‘‘and’’ at the end; 

(II) in clause (ii), by striking the semicolon 

at the end and inserting a period; and 

(III) by striking clauses (iii) and (iv). 

(b) EXTENSION AND IMPROVEMENT OF THE QUALITY REPORTING

SYSTEM.— 

(1) SYSTEM.—Section 1848(k)(2) of the Social Security Act 

(42 U.S.C. 1395w–4(k)(2)), as amended by section 101(b)(1) 

of the Medicare, Medicaid, and SCHIP Extension Act of 2007 

(Public Law 110–173), is amended by adding at the end the 

following new subparagraphs: 

‘‘(C) FOR 2010 AND SUBSEQUENT YEARS.— 

‘‘(i) IN GENERAL.—Subject to clause (ii), for purposes of reporting data on quality measures for covered 

professional services furnished during 2010 and each 

subsequent year, subject to subsection (m)(3)(C), the 

quality measures (including electronic prescribing 

quality measures) specified under this paragraph shall 

be such measures selected by the Secretary from measures that have been endorsed by the entity with a 

contract with the Secretary under section 1890(a). 

Applicability. 


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‘‘(ii) EXCEPTION.—In the case of a specified area 

or medical topic determined appropriate by the Secretary for which a feasible and practical measure has 

not been endorsed by the entity with a contract under 

section 1890(a), the Secretary may specify a measure 

that is not so endorsed as long as due consideration 

is given to measures that have been endorsed or 

adopted by a consensus organization identified by the 

Secretary, such as the AQA alliance. 

‘‘(D) OPPORTUNITY TO PROVIDE INPUT ON MEASURES

FOR 2009 AND SUBSEQUENT YEARS.—For each quality 

measure (including an electronic prescribing quality 

measure) adopted by the Secretary under subparagraph 

(B) (with respect to 2009) or subparagraph (C), the Secretary shall ensure that eligible professionals have the 

opportunity to provide input during the development, 

endorsement, or selection of measures applicable to services 

they furnish.’’. 

(2) REDESIGNATION OF REPORTING SYSTEM.—Subsection (c) 

of section 101 of division B of the Tax Relief and Health 

Care Act of 2006 (42 U.S.C. 1395w–4 note), as amended by 

section 101(b)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is redesignated as 

subsection (m) of section 1848 of the Social Security Act. 

(3) INCENTIVE PAYMENTS UNDER REPORTING SYSTEM.—Section 1848(m) of the Social Security Act, as redesignated by 

paragraph (2), is amended— 

(A) by amending the heading to read as follows: 

‘‘INCENTIVE PAYMENTS FOR QUALITY REPORTING’’; 

(B) by striking paragraph (1) and inserting the following: 

‘‘(1) INCENTIVE PAYMENTS.— 

‘‘(A) IN GENERAL.—For 2007 through 2010, with respect 

to covered professional services furnished during a 

reporting period by an eligible professional, if— 

‘‘(i) there are any quality measures that have been 

established under the physician reporting system that 

are applicable to any such services furnished by such 

professional for such reporting period; and 

‘‘(ii) the eligible professional satisfactorily submits 

(as determined under this subsection) to the Secretary 

data on such quality measures in accordance with such 

reporting system for such reporting period, 

in addition to the amount otherwise paid under this part, 

there also shall be paid to the eligible professional (or 

to an employer or facility in the cases described in clause 

(A) of section 1842(b)(6)) or, in the case of a group practice 

under paragraph (3)(C), to the group practice, from the 

Federal Supplementary Medical Insurance Trust Fund 

established under section 1841 an amount equal to the 

applicable quality percent of the Secretary’s estimate (based 

on claims submitted not later than 2 months after the 

end of the reporting period) of the allowed charges under 

this part for all such covered professional services furnished 

by the eligible professional (or, in the case of a group 

practice under paragraph (3)(C), by the group practice) 

during the reporting period. 

Deadline. 

42 USC 1395w–4. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2523 

‘‘(B) APPLICABLE QUALITY PERCENT.—For purposes of 

subparagraph (A), the term ‘applicable quality percent’ 

means— 

‘‘(i) for 2007 and 2008, 1.5 percent; and 

‘‘(ii) for 2009 and 2010, 2.0 percent.’’; 

(C) by striking paragraph (3) and redesignating paragraph (2) as paragraph (3); 

(D) in paragraph (3), as so redesignated— 

(i) in the matter preceding subparagraph (A), by 

striking ‘‘For purposes’’ and inserting the following: 

‘‘(A) IN GENERAL.—For purposes’’; 

(ii) by redesignating subparagraphs (A) and (B) 

as clauses (i) and (ii), respectively, and moving the 

indentation of such clauses 2 ems to the right; 

(iii) in subparagraph (A), as added by clause (i), 

by adding at the end the following flush sentence: 

‘‘For years after 2008, quality measures for purposes of 

this subparagraph shall not include electronic prescribing 

quality measures.’’; and 

(iv) by adding at the end the following new subparagraphs: 

‘‘(C) SATISFACTORY REPORTING MEASURES FOR GROUP

PRACTICES.— 

‘‘(i) IN GENERAL.—By January 1, 2010, the Secretary shall establish and have in place a process under 

which eligible professionals in a group practice (as 

defined by the Secretary) shall be treated as satisfactorily submitting data on quality measures under 

subparagraph (A) and as meeting the requirement 

described in subparagraph (B)(ii) for covered professional services for a reporting period (or, for purposes 

of subsection (a)(5), for a reporting period for a year) 

if, in lieu of reporting measures under subsection 

(k)(2)(C), the group practice reports measures determined appropriate by the Secretary, such as measures 

that target high-cost chronic conditions and preventive 

care, in a form and manner, and at a time, specified 

by the Secretary. 

‘‘(ii) STATISTICAL SAMPLING MODEL.—The process 

under clause (i) shall provide for the use of a statistical 

sampling model to submit data on measures, such as 

the model used under the Physician Group Practice 

demonstration project under section 1866A. 

‘‘(iii) NO DOUBLE PAYMENTS.—Payments to a group 

practice under this subsection by reason of the process 

under clause (i) shall be in lieu of the payments that 

would otherwise be made under this subsection to 

eligible professionals in the group practice for satisfactorily submitting data on quality measures. 

‘‘(D) AUTHORITY TO REVISE SATISFACTORILY REPORTING

DATA.—For years after 2009, the Secretary, in consultation 

with stakeholders and experts, may revise the criteria 

under this subsection for satisfactorily submitting data on 

quality measures under subparagraph (A) and the criteria 

for submitting data on electronic prescribing quality measures under subparagraph (B)(ii).’’; 

(E) in paragraph (5)— 

Deadline. 


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(i) in subparagraph (C), by inserting ‘‘for 2007, 

2008, and 2009,’’ after ‘‘provision of law,’’; 

(ii) in subparagraph (D)— 

(I) in clause (i)— 

(aa) by inserting ‘‘for 2007 and 2008’’ after 

‘‘under this subsection’’; and 

(bb) by striking ‘‘paragraph (2)’’ and 

inserting ‘‘this subsection’’; 

(II) in clause (ii), by striking ‘‘shall’’ and 

inserting ‘‘may establish procedures to’’; and 

(III) in clause (iii)— 

(aa) by inserting ‘‘(or, in the case of a 

group practice under paragraph (3)(C), the 

group practice)’’ after ‘‘an eligible professional’’; 

(bb) by striking ‘‘bonus incentive payment’’ 

and inserting ‘‘incentive payment under this 

subsection’’; and 

(cc) by adding at the end the following 

new sentence: ‘‘If such payments for such 

period have already been made, the Secretary 

shall recoup such payments from the eligible 

professional (or the group practice).’’; 

(iii) in subparagraph (E)— 

(I) by striking ‘‘(I) IN GENERAL.—’’; 

(II) by striking clause (ii); 

(III) by redesignating subclauses (I) through 

(IV) as clauses (i) through (iv), respectively, and 

moving the indentation of such clauses 2 ems to 

the left; 

(IV) in clause (ii), as so redesignated, by 

striking ‘‘paragraph (2)’’ and inserting ‘‘this subsection’’; and 

(V) in clause (iv), as so redesignated— 

(aa) by striking ‘‘the bonus’’ and inserting 

‘‘any’’; and 

(bb) by inserting ‘‘and the payment adjustment under subsection (a)(5)(A)’’ before the 

period at the end; 

(iv) in subparagraph (F)— 

(I) by striking ‘‘2009, paragraph (3) shall not 

apply, and’’ and inserting ‘‘subsequent years,’’; and 

(II) by striking ‘‘paragraph (2)’’ and inserting 

‘‘this subsection’’; and 

(v) by adding at the end the following new subparagraph: 

‘‘(G) POSTING ON WEBSITE.—The Secretary shall post 

on the Internet website of the Centers for Medicare & 

Medicaid Services, in an easily understandable format, a 

list of the names of the following: 

‘‘(i) The eligible professionals (or, in the case of 

reporting under paragraph (3)(C), the group practices) 

who satisfactorily submitted data on quality measures 

under this subsection. 

‘‘(ii) The eligible professionals (or, in the case of 

reporting under paragraph (3)(C), the group practices) 

who are successful electronic prescribers.’’; and 


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(F) in paragraph (6), by striking subparagraph (C) 

and inserting the following: 

‘‘(C) REPORTING PERIOD.— 

‘‘(i) IN GENERAL.—Subject to clauses (ii) and (iii), 

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, 2009, 2010, and 2011, the entire 

year. 

‘‘(ii) AUTHORITY TO REVISE REPORTING PERIOD.— For years after 2009, the Secretary may revise the 

reporting period under clause (i) if the Secretary determines such revision is appropriate, produces valid 

results on measures reported, and is consistent with 

the goals of maximizing scientific validity and reducing 

administrative burden. If the Secretary revises such 

period pursuant to the preceding sentence, the term 

‘reporting period’ shall mean such revised period. 

‘‘(iii) REFERENCE.—Any reference in this subsection 

to a reporting period with respect to the application 

of subsection (a)(5) shall be deemed a reference to 

the reporting period under subparagraph (D)(iii) of 

such subsection.’’. 

(4) INCLUSION OF QUALIFIED AUDIOLOGISTS AS ELIGIBLE

PROFESSIONALS.— 

(A) IN GENERAL.—Section 1848(k)(3)(B) of the Social 

Security Act (42 U.S.C. 1395w–4(k)(3)(B)), is amended by 

adding at the end the following new clause: 

‘‘(iv) Beginning with 2009, a qualified audiologist 

(as defined in section 1861(ll)(3)(B)).’’. 

(B) NO CHANGE IN BILLING.—Nothing in the amendment made by subparagraph (A) shall be construed to 

change the way in which billing for audiology services 

(as defined in section 1861(ll)(2) of the Social Security 

Act (42 U.S.C. 1395x(ll)(2))) occurs under title XVIII of 

such Act as of July 1, 2008. 

(5) CONFORMING AMENDMENTS.—Section 1848(m) of the 

Social Security Act, as added and amended by paragraphs 

(2) and (3), is amended— 

(A) in paragraph (5)— 

(i) in subparagraph (A)— 

(I) by striking ‘‘section 1848(k) of the Social 

Security Act, as added by subsection (b),’’ and 

inserting ‘‘subsection (k)’’; and 

(II) by striking ‘‘such section’’ and inserting 

‘‘such subsection’’; 

(ii) in subparagraph (B), by striking ‘‘of the Social 

Security Act (42 U.S.C. 1395l)’’; 

(iii) in subparagraph (E), in the matter preceding 

clause (i), by striking ‘‘1869 or 1878 of the Social Security Act or otherwise’’ and inserting ‘‘1869, section 

1878, or otherwise’’; and 

(iv) in subparagraph (F)— 

(I) by striking ‘‘paragraph (2)(B) of section 

1848(k) of the Social Security Act (42 U.S.C. 

1395w–4(k))’’ and inserting ‘‘subsection (k)(2)(B)’’; 

and 

42 USC 1395w–4 

note. 


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(II) by striking ‘‘paragraph (4) of such section’’ 

and inserting ‘‘subsection (k)(4)’’; 

(B) in paragraph (6)— 

(i) in subparagraph (A), by striking ‘‘section 

1848(k)(3) of the Social Security Act, as added by subsection (b)’’ and inserting ‘‘subsection (k)(3)’’; and 

(ii) in subparagraph (B), by striking ‘‘section 

1848(k) of the Social Security Act, as added by subsection (b)’’ and inserting ‘‘subsection (k)’’; and 

(C) by striking paragraph (6)(D). 

(6) NO AFFECT ON INCENTIVE PAYMENTS FOR 2007 OR 2008.— Nothing in the amendments made by this subsection or section 

132 shall affect the operation of the provisions of section 

1848(m) of the Social Security Act, as redesignated and 

amended by such subsection and section, with respect to 2007 

or 2008. 

(c) PHYSICIAN FEEDBACK PROGRAM TO IMPROVE EFFICIENCY

AND CONTROL COSTS.— 

(1) IN GENERAL.—Section 1848 of the Social Security Act 

(42 U.S.C. 1395w–4), as amended by subsection (b), is amended 

by adding at the end the following new subsection: 

‘‘(n) PHYSICIAN FEEDBACK PROGRAM.— 

‘‘(1) ESTABLISHMENT.— 

‘‘(A) IN GENERAL.—The Secretary shall establish a 

Physician Feedback Program (in this subsection referred 

to as the ‘Program’) under which the Secretary shall use 

claims data under this title (and may use other data) 

to provide confidential reports to physicians (and, as determined appropriate by the Secretary, to groups of physicians) that measure the resources involved in furnishing 

care to individuals under this title. If determined appropriate by the Secretary, the Secretary may include information on the quality of care furnished to individuals under 

this title by the physician (or group of physicians) in such 

reports. 

‘‘(B) RESOURCE USE.—The resources described in 

subparagraph (A) may be measured— 

‘‘(i) on an episode basis; 

‘‘(ii) on a per capita basis; or 

‘‘(iii) on both an episode and a per capita basis. 

‘‘(2) IMPLEMENTATION.—The Secretary shall implement the 

Program by not later than January 1, 2009. 

‘‘(3) DATA FOR REPORTS.—To the extent practicable, reports 

under the Program shall be based on the most recent data 

available. 

‘‘(4) AUTHORITY TO FOCUS APPLICATION.—The Secretary may 

focus the application of the Program as appropriate, such as 

focusing the Program on— 

‘‘(A) physician specialties that account for a certain 

percentage of all spending for physicians’ services under 

this title; 

‘‘(B) physicians who treat conditions that have a high 

cost or a high volume, or both, under this title; 

‘‘(C) physicians who use a high amount of resources 

compared to other physicians; 

‘‘(D) physicians practicing in certain geographic areas; 

or 

Deadline. 

42 USC 1395w–4 

note. 


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‘‘(E) physicians who treat a minimum number of 

individuals under this title. 

‘‘(5) AUTHORITY TO EXCLUDE CERTAIN INFORMATION IF

INSUFFICIENT INFORMATION.—The Secretary may exclude certain information regarding a service from a report under the 

Program with respect to a physician (or group of physicians) 

if the Secretary determines that there is insufficient information relating to that service to provide a valid report on that 

service. 

‘‘(6) ADJUSTMENT OF DATA.—To the extent practicable, the 

Secretary shall make appropriate adjustments to the data used 

in preparing reports under the Program, such as adjustments 

to take into account variations in health status and other 

patient characteristics. 

‘‘(7) EDUCATION AND OUTREACH.—The Secretary shall provide for education and outreach activities to physicians on 

the operation of, and methodologies employed under, the Program. 

‘‘(8) DISCLOSURE EXEMPTION.—Reports under the Program 

shall be exempt from disclosure under section 552 of title 

5, United States Code.’’. 

(2) GAO STUDY AND REPORT ON THE PHYSICIAN FEEDBACK

PROGRAM.— 

(A) STUDY.—The Comptroller General of the United 

States shall conduct a study of the Physician Feedback 

Program conducted under section 1848(n) of the Social 

Security Act, as added by paragraph (1), including the 

implementation of the Program. 

(B) REPORT.—Not later than March 1, 2011, the Comptroller General of the United States shall submit a report 

to Congress containing the results of the study conducted 

under subparagraph (A), together with recommendations 

for such legislation and administrative action as the Comptroller General determines appropriate. 

(d) PLAN FOR TRANSITION TO VALUE-BASED PURCHASING PRO- GRAM FOR PHYSICIANS AND OTHER PRACTITIONERS.— 

(1) IN GENERAL.—The Secretary of Health and Human 

Services shall develop a plan to transition to a value-based 

purchasing program for payment under the Medicare program 

for covered professional services (as defined in section 

1848(k)(3)(A) of the Social Security Act (42 U.S.C. 1395w– 

4(k)(3)(A))). 

(2) REPORT.—Not later than May 1, 2010, the Secretary 

of Health and Human Services shall submit a report to Congress containing the plan developed under paragraph (1), 

together with recommendations for such legislation and 

administrative action as the Secretary determines appropriate. 

SEC. 132. INCENTIVES FOR ELECTRONIC PRESCRIBING. 

(a) INCENTIVE PAYMENTS.—Section 1848(m) of the Social Security Act, as added and amended by section 131(b), is amended— 

(1) by inserting after paragraph (1), the following new 

paragraph: 

‘‘(2) INCENTIVE PAYMENTS FOR ELECTRONIC PRESCRIBING.— 

‘‘(A) IN GENERAL.—For 2009 through 2013, with respect 

to covered professional services furnished during a 

reporting period by an eligible professional, if the eligible 

Deadline. 

42 USC 1395w–4. 


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professional is a successful electronic prescriber for such 

reporting period, in addition to the amount otherwise paid 

under this part, there also shall be paid to the eligible 

professional (or to an employer or facility in the cases 

described in clause (A) of section 1842(b)(6)) or, in the 

case of a group practice under paragraph (3)(C), to the 

group practice, from the Federal Supplementary Medical 

Insurance Trust Fund established under section 1841 an 

amount equal to the applicable electronic prescribing percent of the Secretary’s estimate (based on claims submitted 

not later than 2 months after the end of the reporting 

period) of the allowed charges under this part for all such 

covered professional services furnished by the eligible 

professional (or, in the case of a group practice under 

paragraph (3)(C), by the group practice) during the 

reporting period. 

‘‘(B) LIMITATION WITH RESPECT TO ELECTRONIC PRESCRIBING QUALITY MEASURES.—The provisions of this paragraph and subsection (a)(5) shall not apply to an eligible 

professional (or, in the case of a group practice under 

paragraph (3)(C), to the group practice) if, for the reporting 

period (or, for purposes of subsection (a)(5), for the 

reporting period for a year)— 

‘‘(i) the allowed charges under this part for all 

covered professional services furnished by the eligible 

professional (or group, as applicable) for the codes to 

which the electronic prescribing quality measure 

applies (as identified by the Secretary and published 

on the Internet website of the Centers for Medicare 

& Medicaid Services as of January 1, 2008, and as 

subsequently modified by the Secretary) are less than 

10 percent of the total of the allowed charges under 

this part for all such covered professional services furnished by the eligible professional (or the group, as 

applicable); or 

‘‘(ii) if determined appropriate by the Secretary, 

the eligible professional does not submit (including 

both electronically and nonelectronically) a sufficient 

number (as determined by the Secretary) of prescriptions under part D. 

If the Secretary makes the determination to apply clause 

(ii) for a period, then clause (i) shall not apply for such 

period. 

‘‘(C) APPLICABLE ELECTRONIC PRESCRIBING PERCENT.— 

For purposes of subparagraph (A), the term ‘applicable 

electronic prescribing percent’ means— 

‘‘(i) for 2009 and 2010, 2.0 percent; 

‘‘(ii) for 2011 and 2012, 1.0 percent; and 

‘‘(iii) for 2013, 0.5 percent.’’; 

(2) in paragraph (3), as redesignated by section 131(b)— 

(A) in the heading, by inserting ‘‘AND SUCCESSFUL ELEC- TRONIC PRESCRIBER’’ after ‘‘REPORTING’’; and 

(B) by inserting after subparagraph (A) the following 

new subparagraph: 

‘‘(B) SUCCESSFUL ELECTRONIC PRESCRIBER.— ‘‘(i) IN GENERAL.—For purposes of paragraph (2) 

and subsection (a)(5), an eligible professional shall be 


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treated as a successful electronic prescriber for a 

reporting period (or, for purposes of subsection (a)(5), 

for the reporting period for a year) if the eligible professional meets the requirement described in clause (ii), 

or, if the Secretary determines appropriate, the 

requirement described in clause (iii). If the Secretary 

makes the determination under the preceding sentence 

to apply the requirement described in clause (iii) for 

a period, then the requirement described in clause 

(ii) shall not apply for such period. 

‘‘(ii) REQUIREMENT FOR SUBMITTING DATA ON ELEC- TRONIC PRESCRIBING QUALITY MEASURES.—The requirement described in this clause is that, with respect 

to covered professional services furnished by an eligible 

professional during a reporting period (or, for purposes 

of subsection (a)(5), for the reporting period for a year), 

if there are any electronic prescribing quality measures 

that have been established under the physician 

reporting system and are applicable to any such services furnished by such professional for the period, such 

professional reported each such measure under such 

system in at least 50 percent of the cases in which 

such measure is reportable by such professional under 

such system. 

‘‘(iii) REQUIREMENT FOR ELECTRONICALLY PRESCRIBING UNDER PART D.—The requirement described 

in this clause is that the eligible professional electronically submitted a sufficient number (as determined 

by the Secretary) of prescriptions under part D during 

the reporting period (or, for purposes of subsection 

(a)(5), for the reporting period for a year). 

‘‘(iv) USE OF PART D DATA.—Notwithstanding sections 1860D-15(d)(2)(B) and 1860D-15(f)(2), the Secretary may use data regarding drug claims submitted 

for purposes of section 1860D-15 that are necessary 

for purposes of clause (iii), paragraph (2)(B)(ii), and 

paragraph (5)(G). 

‘‘(v) STANDARDS FOR ELECTRONIC PRESCRIBING.— 

To the extent practicable, in determining whether 

eligible professionals meet the requirements under 

clauses (ii) and (iii) for purposes of clause (i), the 

Secretary shall ensure that eligible professionals utilize 

electronic prescribing systems in compliance with 

standards established for such systems pursuant to 

the Part D Electronic Prescribing Program under section 1860D–4(e).’’; and 

(3) in paragraph (5)(E), by striking clause (iii) and inserting 

the following new clause: 

‘‘(iii) the determination of a successful electronic 

prescriber under paragraph (3), the limitation under 

paragraph (2)(B), and the exception under subsection 

(a)(5)(B); and’’. 

(b) INCENTIVE PAYMENT ADJUSTMENT.—Section 1848(a) of the 

Social Security Act (42 U.S.C. 1395w–4(a)) is amended by adding 

at the end the following new paragraph: 

‘‘(5) INCENTIVES FOR ELECTRONIC PRESCRIBING.— ‘‘(A) ADJUSTMENT.— 


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‘‘(i) IN GENERAL.—Subject to subparagraph (B) and 

subsection (m)(2)(B), with respect to covered professional services furnished by an eligible professional 

during 2012 or any subsequent year, if the eligible 

professional is not a successful electronic prescriber 

for the reporting period for the year (as determined 

under subsection (m)(3)(B)), the fee schedule amount 

for such services furnished by such professional during 

the year (including the fee schedule amount for purposes of determining a payment based on such amount) 

shall be equal to the applicable percent of the fee 

schedule amount that would otherwise apply to such 

services under this subsection (determined after 

application of paragraph (3) but without regard to this 

paragraph). 

‘‘(ii) APPLICABLE PERCENT.—For purposes of clause 

(i), the term ‘applicable percent’ means— 

‘‘(I) for 2012, 99 percent; 

‘‘(II) for 2013, 98.5 percent; and 

‘‘(III) for 2014 and each subsequent year, 98 

percent. 

‘‘(B) SIGNIFICANT HARDSHIP EXCEPTION.—The Secretary 

may, on a case-by-case basis, exempt an eligible professional from the application of the payment adjustment 

under subparagraph (A) if the Secretary determines, subject to annual renewal, that compliance with the requirement for being a successful electronic prescriber would 

result in a significant hardship, such as in the case of 

an eligible professional who practices in a rural area without sufficient Internet access. 

‘‘(C) APPLICATION.— 

‘‘(i) PHYSICIAN REPORTING SYSTEM RULES.—Paragraphs (5), (6), and (8) of subsection (k) shall apply 

for purposes of this paragraph in the same manner 

as they apply for purposes of such subsection. 

‘‘(ii) INCENTIVE PAYMENT VALIDATION RULES.— 

Clauses (ii) and (iii) of subsection (m)(5)(D) shall apply 

for purposes of this paragraph in a similar manner 

as they apply for purposes of such subsection. 

‘‘(D) DEFINITIONS.—For purposes of this paragraph: 

‘‘(i) ELIGIBLE PROFESSIONAL; COVERED PROFESSIONAL SERVICES.—The terms ‘eligible professional’ and 

‘covered professional services’ have the meanings given 

such terms in subsection (k)(3). 

‘‘(ii) PHYSICIAN REPORTING SYSTEM.—The term 

‘physician reporting system’ means the system established under subsection (k). 

‘‘(iii) REPORTING PERIOD.—The term ‘reporting 

period’ means, with respect to a year, a period specified 

by the Secretary.’’. 

(c) GAO REPORT ON ELECTRONIC PRESCRIBING.—Not later than 

September 1, 2012, the Comptroller General of the United States 

shall submit to Congress a report on the implementation of the 

incentives for electronic prescribing established under the provisions 

of, and amendments made by, this section. Such report shall include 

information regarding the following: 


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(1) The percentage of eligible professionals (as defined in 

section 1848(k)(3) of the Social Security Act (42 U.S.C. 1395w– 

4(k)(3)) that are using electronic prescribing systems, including 

a determination of whether less than 50 percent of eligible 

professionals are using electronic prescribing systems. 

(2) If less than 50 percent of eligible professionals are 

using electronic prescribing systems, recommendations for 

increasing the use of electronic prescribing systems by eligible 

professionals, such as changes to the incentive payment adjustments established under section 1848(a)(5) of such Act, as 

added by subsection (b). 

(3) The estimated savings to the Medicare program under 

title XVIII of such Act resulting from the use of electronic 

prescribing systems. 

(4) Reductions in avoidable medical errors resulting from 

the use of electronic prescribing systems. 

(5) The extent to which the privacy and security of the 

personal health information of Medicare beneficiaries is protected when such beneficiaries’ prescription drug data and 

usage information is used for purposes other than their direct 

clinical care, including— 

(A) whether information identifying the beneficiary is, 

and remains, removed from data regarding the beneficiary’s 

prescription drug utilization; and 

(B) the extent to which current law requires sufficient 

and appropriate oversight and audit capabilities to monitor 

the practice of prescription drug data mining. 

(6) Such other recommendations and administrative action 

as the Comptroller General determines to be appropriate. 

SEC. 133. EXPANDING ACCESS TO PRIMARY CARE SERVICES. 

(a) REVISIONS TO THE MEDICARE MEDICAL HOME DEMONSTRATION PROJECT.— 

(1) AUTHORITY TO EXPAND.—Section 204(b) of division B 

of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 

1395b–1 note) is amended— 

(A) in paragraph (1), by striking ‘‘The project’’ and 

inserting ‘‘Subject to paragraph (3), the project’’; and 

(B) by adding at the end the following new paragraph: 

‘‘(3) EXPANSION.—The Secretary may expand the duration 

and the scope of the project under paragraph (1), to an extent 

determined appropriate by the Secretary, if the Secretary determines that such expansion will result in any of the following 

conditions being met: 

‘‘(A) The expansion of the project is expected to improve 

the quality of patient care without increasing spending 

under the Medicare program (not taking into account 

amounts available under subsection (g)). 

‘‘(B) The expansion of the project is expected to reduce 

spending under the Medicare program (not taking into 

account amounts available under subsection (g)) without 

reducing the quality of patient care.’’. 

(2) FUNDING AND APPLICATION.—Section 204 of division 

B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 

1395b–1 note) is amended by adding at the end the following 

new subsections: 


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‘‘(g) FUNDING FROM SMI TRUST FUND.—There shall be available, from the Federal Supplementary Medical Insurance Trust 

Fund (under section 1841 of the Social Security Act (42 U.S.C. 

1395t)), the amount of $100,000,000 to carry out the project. 

‘‘(h) APPLICATION.—Chapter 35 of title 44, United States Code, 

shall not apply to the conduct of the project.’’. 

(b) APPLICATION OF BUDGET-NEUTRALITY ADJUSTOR TO CONVER- SION FACTOR.—Section 1848(c)(2)(B) of the Social Security Act (42 

U.S.C. 1395w–4(c)(2)(B)) is amended by adding at the end the 

following new clause: 

‘‘(vi) ALTERNATIVE APPLICATION OF BUDGET-NEU- TRALITY ADJUSTMENT.—Notwithstanding subsection 

(d)(9)(A), effective for fee schedules established beginning with 2009, with respect to the 5-year review of 

work relative value units used in fee schedules for 

2007 and 2008, in lieu of continuing to apply budgetneutrality adjustments required under clause (ii) for 

2007 and 2008 to work relative value units, the Secretary shall apply such budget-neutrality adjustments 

to the conversion factor otherwise determined for years 

beginning with 2009.’’. 

SEC. 134. EXTENSION OF FLOOR ON MEDICARE WORK GEOGRAPHIC 

ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE 

SCHEDULE. 

(a) IN GENERAL.—Section 1848(e)(1)(E) of the Social Security 

Act (42 U.S.C. 1395w–4(e)(1)(E)), as amended by section 103 of 

the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 

Law 110–173), is amended by striking ‘‘before July 1, 2008’’ and 

inserting ‘‘before January 1, 2010’’. 

(b) TREATMENT OF PHYSICIANS’ SERVICES FURNISHED IN CER- TAIN AREAS.—Section 1848(e)(1)(G) of the Social Security Act (42 

U.S.C. 1395w–4(e)(1)(G)) is amended by adding at the end the 

following new sentence: ‘‘For purposes of payment for services furnished in the State described in the preceding sentence on or 

after January 1, 2009, after calculating the work geographic index 

in subparagraph (A)(iii), the Secretary shall increase the work 

geographic index to 1.5 if such index would otherwise be less 

than 1.5’’. 

(c) TECHNICAL CORRECTION.—Section 602(1) of the Medicare 

Prescription Drug, Improvement, and Modernization Act of 2003 

(Public Law 108–173; 117 Stat. 2301) is amended to read as follows: 

‘‘(1) in subparagraph (A), by striking ‘subparagraphs (B), 

(C), and (E)’ and inserting ‘subparagraphs (B), (C), (E), and 

(G)’; and’’. 

SEC. 135. IMAGING PROVISIONS. 

(a) ACCREDITATION REQUIREMENT.— (1) ACCREDITATION REQUIREMENT.—Section 1834 of the 

Social Security Act (42 U.S.C. 1395m) is amended by inserting 

after subsection (d) the following new subsection: 

‘‘(e) ACCREDITATION REQUIREMENT FOR ADVANCED DIAGNOSTIC

IMAGING SERVICES.— 

‘‘(1) IN GENERAL.— 

‘‘(A) IN GENERAL.—Beginning with January 1, 2012, 

with respect to the technical component of advanced diagnostic imaging services for which payment is made under 

the fee schedule established under section 1848(b) and 

Effective date. 

42 USC 1395w–4. 


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that are furnished by a supplier, payment may only be 

made if such supplier is accredited by an accreditation 

organization designated by the Secretary under paragraph 

(2)(B)(i). 

‘‘(B) ADVANCED DIAGNOSTIC IMAGING SERVICES

DEFINED.—In this subsection, the term ‘advanced diagnostic 

imaging services’ includes— 

‘‘(i) diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including 

positron emission tomography); and 

‘‘(ii) such other diagnostic imaging services, 

including services described in section 1848(b)(4)(B) 

(excluding X-ray, ultrasound, and fluoroscopy), as 

specified by the Secretary in consultation with physician specialty organizations and other stakeholders. 

‘‘(C) SUPPLIER DEFINED.—In this subsection, the term 

‘supplier’ has the meaning given such term in section 

1861(d). 

‘‘(2) ACCREDITATION ORGANIZATIONS.— 

‘‘(A) FACTORS FOR DESIGNATION OF ACCREDITATION

ORGANIZATIONS.—The Secretary shall consider the following 

factors in designating accreditation organizations under 

subparagraph (B)(i) and in reviewing and modifying the 

list of accreditation organizations designated pursuant to 

subparagraph (C): 

‘‘(i) The ability of the organization to conduct 

timely reviews of accreditation applications. 

‘‘(ii) Whether the organization has established a 

process for the timely integration of new advanced 

diagnostic imaging services into the organization’s 

accreditation program. 

‘‘(iii) Whether the organization uses random site 

visits, site audits, or other strategies for ensuring 

accredited suppliers maintain adherence to the criteria 

described in paragraph (3). 

‘‘(iv) The ability of the organization to take into 

account the capacities of suppliers located in a rural 

area (as defined in section 1886(d)(2)(D)). 

‘‘(v) Whether the organization has established 

reasonable fees to be charged to suppliers applying 

for accreditation. 

‘‘(vi) Such other factors as the Secretary determines appropriate. 

‘‘(B) DESIGNATION.—Not later than January 1, 2010, 

the Secretary shall designate organizations to accredit suppliers furnishing the technical component of advanced diagnostic imaging services. The list of accreditation organizations so designated may be modified pursuant to subparagraph (C). 

‘‘(C) REVIEW AND MODIFICATION OF LIST OF ACCREDITATION ORGANIZATIONS.— 

‘‘(i) IN GENERAL.—The Secretary shall review the 

list of accreditation organizations designated under 

subparagraph (B) taking into account the factors under 

subparagraph (A). Taking into account the results of 

such review, the Secretary may, by regulation, modify 

Deadline. 


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the list of accreditation organizations designated under 

subparagraph (B). 

‘‘(ii) SPECIAL RULE FOR ACCREDITATIONS DONE

PRIOR TO REMOVAL FROM LIST OF DESIGNATED ACCREDITATION ORGANIZATIONS.—In the case where the Secretary removes an organization from the list of accreditation organizations designated under subparagraph 

(B), any supplier that is accredited by the organization 

during the period beginning on the date on which 

the organization is designated as an accreditation 

organization under subparagraph (B) and ending on 

the date on which the organization is removed from 

such list shall be considered to have been accredited 

by an organization designated by the Secretary under 

subparagraph (B) for the remaining period such 

accreditation is in effect. 

‘‘(3) CRITERIA FOR ACCREDITATION.—The Secretary shall 

establish procedures to ensure that the criteria used by an 

accreditation organization designated under paragraph (2)(B) 

to evaluate a supplier that furnishes the technical component 

of advanced diagnostic imaging services for the purpose of 

accreditation of such supplier is specific to each imaging 

modality. Such criteria shall include— 

‘‘(A) standards for qualifications of medical personnel 

who are not physicians and who furnish the technical 

component of advanced diagnostic imaging services; 

‘‘(B) standards for qualifications and responsibilities 

of medical directors and supervising physicians, including 

standards that recognize the considerations described in 

paragraph (4); 

‘‘(C) procedures to ensure that equipment used in furnishing the technical component of advanced diagnostic 

imaging services meets performance specifications; 

‘‘(D) standards that require the supplier have procedures in place to ensure the safety of persons who furnish 

the technical component of advanced diagnostic imaging 

services and individuals to whom such services are furnished; 

‘‘(E) standards that require the establishment and 

maintenance of a quality assurance and quality control 

program by the supplier that is adequate and appropriate 

to ensure the reliability, clarity, and accuracy of the technical quality of diagnostic images produced by such supplier; and 

‘‘(F) any other standards or procedures the Secretary 

determines appropriate. 

‘‘(4) RECOGNITION IN STANDARDS FOR THE EVALUATION OF

MEDICAL DIRECTORS AND SUPERVISING PHYSICIANS.—The standards described in paragraph (3)(B) shall recognize whether 

a medical director or supervising physician— 

‘‘(A) in a particular specialty receives training in 

advanced diagnostic imaging services in a residency program; 

‘‘(B) has attained, through experience, the necessary 

expertise to be a medical director or a supervising physician; 

Procedures. 


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‘‘(C) has completed any continuing medical education 

courses relating to such services; or 

‘‘(D) has met such other standards as the Secretary 

determines appropriate. 

‘‘(5) RULE FOR ACCREDITATIONS MADE PRIOR TO DESIGNATION.—In the case of a supplier that is accredited before 

January 1, 2010, by an accreditation organization designated 

by the Secretary under paragraph (2)(B) as of January 1, 2010, 

such supplier shall be considered to have been accredited by 

an organization designated by the Secretary under such paragraph as of January 1, 2012, for the remaining period such 

accreditation is in effect.’’. 

(2) CONFORMING AMENDMENTS.— 

(A) IN GENERAL.—Section 1862(a) of the Social Security 

Act (42 U.S.C. 1395y(a)) is amended— 

(i) in paragraph (21), by striking ‘‘or’’ at the end; 

(ii) in paragraph (22), by striking the period at 

the end and inserting ‘‘; or’’; and 

(iii) by inserting after paragraph (22) the following 

new paragraph: 

‘‘(23) which are the technical component of advanced diagnostic imaging services described in section 1834(e)(1)(B) for 

which payment is made under the fee schedule established 

under section 1848(b) and that are furnished by a supplier 

(as defined in section 1861(d)), if such supplier is not accredited 

by an accreditation organization designated by the Secretary 

under section 1834(e)(2)(B).’’. 

(B) EFFECTIVE DATE.—The amendments made by this 

paragraph shall apply to advanced diagnostic imaging services furnished on or after January 1, 2012. 

(b) DEMONSTRATION PROJECT TO ASSESS THE APPROPRIATE USE

OF IMAGING SERVICES.— 

(1) CONDUCT OF DEMONSTRATION PROJECT.— 

(A) IN GENERAL.—The Secretary of Health and Human 

Services (in this section referred to as the ‘‘Secretary’’) 

shall conduct a demonstration project using the models 

described in paragraph (2)(E) to collect data regarding 

physician compliance with appropriateness criteria selected 

under paragraph (2)(D) in order to determine the appropriateness of advanced diagnostic imaging services furnished to Medicare beneficiaries. 

(B) ADVANCED DIAGNOSTIC IMAGING SERVICES.—In this 

subsection, the term ‘‘advanced diagnostic imaging services’’ 

has the meaning given such term in section 1834(e)(1)(B) 

of the Social Security Act, as added by subsection (a). 

(C) AUTHORITY TO FOCUS DEMONSTRATION PROJECT.— 

The Secretary may focus the demonstration project with 

respect to certain advanced diagnostic imaging services, 

such as services that account for a large amount of expenditures under the Medicare program, services that have 

recently experienced a high rate of growth, or services 

for which appropriateness criteria exists. 

(2) IMPLEMENTATION AND DESIGN OF DEMONSTRATION

PROJECT.— 

(A) IMPLEMENTATION AND DURATION.— 

42 USC 1395m 

note. 

42 USC 1395y 

note. 


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(i) IMPLEMENTATION.—The Secretary shall implement the demonstration project under this subsection 

not later than January 1, 2010. 

(ii) DURATION.—The Secretary shall conduct the 

demonstration project under this subsection for a 2- 

year period. 

(B) APPLICATION AND SELECTION OF PARTICIPATING

PHYSICIANS.— 

(i) APPLICATION.—Each physician that desires to 

participate in the demonstration project under this 

subsection shall submit an application to the Secretary 

at such time, in such manner, and containing such 

information as the Secretary may require. 

(ii) SELECTION.—The Secretary shall select physicians to participate in the demonstration project under 

this subsection from among physicians submitting 

applications under clause (i). The Secretary shall 

ensure that the physicians selected— 

(I) represent a wide range of geographic areas, 

demographic characteristics (such as urban, rural, 

and suburban), and practice settings (such as private and academic practices); and 

(II) have the capability to submit data to the 

Secretary (or an entity under a subcontract with 

the Secretary) in an electronic format in accordance with standards established by the Secretary. 

(C) ADMINISTRATIVE COSTS AND INCENTIVES.—The Secretary shall— 

(i) reimburse physicians for reasonable administrative costs incurred in participating in the demonstration project under this subsection; and 

(ii) provide reasonable incentives to physicians to 

encourage participation in the demonstration project 

under this subsection. 

(D) USE OF APPROPRIATENESS CRITERIA.— 

(i) IN GENERAL.—The Secretary, in consultation 

with medical specialty societies and other stakeholders, 

shall select criteria with respect to the clinical appropriateness of advanced diagnostic imaging services for 

use in the demonstration project under this subsection. 

(ii) CRITERIA SELECTED.—Any criteria selected 

under clause (i) shall— 

(I) be developed or endorsed by a medical specialty society; and 

(II) be developed in adherence to appropriateness principles developed by a consensus organization, such as the AQA alliance. 

(E) MODELS FOR COLLECTING DATA REGARDING PHYSICIAN COMPLIANCE WITH SELECTED CRITERIA.—Subject to 

subparagraph (H), in carrying out the demonstration 

project under this subsection, the Secretary shall use each 

of the following models for collecting data regarding physician compliance with appropriateness criteria selected 

under subparagraph (D): 

(i) A model described in subparagraph (F). 

(ii) A model described in subparagraph (G). 


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(iii) Any other model that the Secretary determines 

to be useful in evaluating the use of appropriateness 

criteria for advanced diagnostic imaging services. 

(F) POINT OF SERVICE MODEL DESCRIBED.—A model 

described in this subparagraph is a model that— 

(i) uses an electronic or paper intake form that— 

(I) contains a certification by the physician 

furnishing the imaging service that the data on 

the intake form was confirmed with the Medicare 

beneficiary before the service was furnished; 

(II) contains standardized data elements for 

diagnosis, service ordered, service furnished, and 

such other information determined by the Secretary, in consultation with medical specialty societies and other stakeholders, to be germane to 

evaluating the effectiveness of the use of appropriateness criteria selected under subparagraph 

(D); and 

(III) is accessible to physicians participating 

in the demonstration project under this subsection 

in a format that allows for the electronic submission of such form; and 

(ii) provides for feedback reports in accordance 

with paragraph (3)(B). 

(G) POINT OF ORDER MODEL DESCRIBED.—A model 

described in this subparagraph is a model that— 

(i) uses a computerized order-entry system that 

requires the transmittal of relevant supporting 

information at the time of referral for advanced diagnostic imaging services and provides automated decision-support feedback to the referring physician 

regarding the appropriateness of furnishing such 

imaging services; and 

(ii) provides for feedback reports in accordance 

with paragraph (3)(B). 

(H) LIMITATION.—In no case may the Secretary use 

prior authorization— 

(i) as a model for collecting data regarding physician compliance with appropriateness criteria selected 

under subparagraph (D) under the demonstration 

project under this subsection; or 

(ii) under any model used for collecting such data 

under the demonstration project. 

(I) REQUIRED CONTRACTS AND PERFORMANCE STANDARDS FOR CERTAIN ENTITIES.— 

(i) IN GENERAL.—The Secretary shall enter into 

contracts with entities to carry out the model described 

in subparagraph (G). 

(ii) PERFORMANCE STANDARDS.—The Secretary 

shall establish and enforce performance standards for 

such entities under the contracts entered into under 

clause (i), including performance standards with 

respect to— 

(I) the satisfaction of Medicare beneficiaries 

who are furnished advanced diagnostic imaging 

services by a physician participating in the demonstration project; 

Certification. 


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(II) the satisfaction of physicians participating 

in the demonstration project; 

(III) if applicable, timelines for the provision 

of feedback reports under paragraph (3)(B); and 

(IV) any other areas determined appropriate 

by the Secretary. 

(3) COMPARISON OF UTILIZATION OF ADVANCED DIAGNOSTIC

IMAGING SERVICES AND FEEDBACK REPORTS.— (A) COMPARISON OF UTILIZATION OF ADVANCED DIAG- NOSTIC IMAGING SERVICES.—The Secretary shall consult 

with medical specialty societies and other stakeholders to 

develop mechanisms for comparing the utilization of 

advanced diagnostic imaging services by physicians participating in the demonstration project under this subsection 

against— 

(i) the appropriateness criteria selected under 

paragraph (2)(D); and 

(ii) to the extent feasible, the utilization of such 

services by physicians not participating in the demonstration project. 

(B) FEEDBACK REPORTS.—The Secretary shall, in consultation with medical specialty societies and other stakeholders, develop mechanisms to provide feedback reports 

to physicians participating in the demonstration project 

under this subsection. Such feedback reports shall 

include— 

(i) a profile of the rate of compliance by the physician with appropriateness criteria selected under paragraph (2)(D), including a comparison of— 

(I) the rate of compliance by the physician 

with such criteria; and 

(II) the rate of compliance by the physician’s 

peers (as defined by the Secretary) with such criteria; and 

(ii) to the extent feasible, a comparison of— 

(I) the rate of utilization of advanced diagnostic imaging services by the physician; and 

(II) the rate of utilization of such services by 

the physician’s peers (as defined by the Secretary) 

who are not participating in the demonstration 

project. 

(4) CONDUCT OF DEMONSTRATION PROJECT AND WAIVER.— 

(A) CONDUCT OF DEMONSTRATION PROJECT.—Chapter 

35 of title 44, United States Code, shall not apply to the 

conduct of the demonstration project under this subsection. 

(B) WAIVER.—The Secretary may waive such provisions 

of titles XI and XVIII of the Social Security Act (42 U.S.C. 

1301 et seq.; 1395 et seq.) as may be necessary to carry 

out the demonstration project under this subsection. 

(5) EVALUATION AND REPORT.— 

(A) EVALUATION.—The Secretary shall evaluate the 

demonstration project under this subsection to— 

(i) assess the timeliness and efficacy of the demonstration project; 

(ii) assess the performance of entities under a contract entered into under paragraph (2)(I)(i); 

(iii) analyze data— 


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(I) on the rates of appropriate, uncertain, and 

inappropriate advanced diagnostic imaging services furnished by physicians participating in the 

demonstration project; 

(II) on patterns and trends in the appropriateness and inappropriateness of such services furnished by such physicians; 

(III) on patterns and trends in national and 

regional variations of care with respect to the furnishing of such services; and 

(IV) on the correlation between the appropriateness of the services furnished and image 

results; and 

(iv) address— 

(I) the thresholds used under the demonstration project to identify acceptable and outlier levels 

of performance with respect to the appropriateness 

of advanced diagnostic imaging services furnished; 

(II) whether prospective use of appropriateness 

criteria could have an effect on the volume of such 

services furnished; 

(III) whether expansion of the use of appropriateness criteria with respect to such services 

to a broader population of Medicare beneficiaries 

would be advisable; 

(IV) whether, under such an expansion, physicians who demonstrate consistent compliance with 

such appropriateness criteria should be exempted 

from certain requirements; 

(V) the use of incident-specific versus practicespecific outlier information in formulating future 

recommendations with respect to the use of appropriateness criteria for such services under the 

Medicare program; and 

(VI) the potential for using methods (including 

financial incentives), in addition to those used 

under the models under the demonstration project, 

to ensure compliance with such criteria. 

(B) REPORT.—Not later than 1 year after the completion of the demonstration project under this subsection, 

the Secretary shall submit to Congress a report containing 

the results of the evaluation of the demonstration project 

conducted under subparagraph (A), together with recommendations for such legislation and administrative 

action as the Secretary determines appropriate. 

(6) FUNDING.—The Secretary shall provide for the transfer 

from the Federal Supplementary Medical Insurance Trust Fund 

established under section 1841 of the Social Security Act (42 

U.S.C. 1395t) of $10,000,000, for carrying out the demonstration 

project under this subsection (including costs associated with 

administering the demonstration project, reimbursing physicians for administrative costs and providing incentives to 

encourage participation under paragraph (2)(C), entering into 

contracts under paragraph (2)(I), and evaluating the demonstration project under paragraph (5)). 

(c) GAO STUDY AND REPORTS ON ACCREDITATION REQUIREMENT

FOR ADVANCED DIAGNOSTIC IMAGING SERVICES.— 


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122 STAT. 2540 PUBLIC LAW 110–275—JULY 15, 2008 

(1) STUDY.— 

(A) IN GENERAL.—The Comptroller General of the 

United States (in this subsection referred to as the ‘‘Comptroller General’’) shall conduct a study, by imaging 

modality, on— 

(i) the effect of the accreditation requirement under 

section 1834(e) of the Social Security Act, as added 

by subsection (a); and 

(ii) any other relevant questions involving access 

to, and the value of, advanced diagnostic imaging services for Medicare beneficiaries. 

(B) ISSUES.—The study conducted under subparagraph 

(A) shall examine the following: 

(i) The impact of such accreditation requirement 

on the number, type, and quality of imaging services 

furnished to Medicare beneficiaries. 

(ii) The cost of such accreditation requirement, 

including costs to facilities of compliance with such 

requirement and costs to the Secretary of administering such requirement. 

(iii) Access to imaging services by Medicare beneficiaries, especially in rural areas, before and after 

implementation of such accreditation requirement. 

(iv) Such other issues as the Secretary determines 

appropriate. 

(2) REPORTS.— 

(A) PRELIMINARY REPORT.—Not later than March 1, 

2013, the Comptroller General shall submit a preliminary 

report to Congress on the study conducted under paragraph 

(1). 

(B) FINAL REPORT.—Not later than March 1, 2014, 

the Comptroller General shall submit a final report to 

Congress on the study conducted under paragraph (1), 

together with recommendations for such legislation and 

administrative action as the Comptroller General determines appropriate. 

SEC. 136. EXTENSION OF TREATMENT OF CERTAIN PHYSICIAN 

PATHOLOGY 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), section 104 of 

division B of the Tax Relief and Health Care Act of 2006 (42 

U.S.C. 1395w–4 note), and section 104 of the Medicare, Medicaid, 

and SCHIP Extension Act of 2007 (Public Law 110–173), is amended 

by striking ‘‘2007, and the first 6 months of 2008’’ and inserting 

‘‘2007, 2008, and 2009’’. 

SEC. 137. ACCOMMODATION OF PHYSICIANS ORDERED TO 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 section 116 of the Medicare, 

Medicaid, and SCHIP Extension Act of 2007 (Public Law 110– 

173), is amended by striking ‘‘(before July 1, 2008)’’. 

42 USC 1395w–4 

note. 


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SEC. 138. ADJUSTMENT FOR MEDICARE MENTAL HEALTH SERVICES. 

(a) PAYMENT ADJUSTMENT.— 

(1) IN GENERAL.—For purposes of payment for services 

furnished under the physician fee schedule under section 1848 

of the Social Security Act (42 U.S.C. 1395w–4) during the 

period beginning on July 1, 2008, and ending on December 

31, 2009, the Secretary of Health and Human Services shall 

increase the fee schedule otherwise applicable for specified 

services by 5 percent. 

(2) NONAPPLICATION OF BUDGET-NEUTRALITY.—The budgetneutrality provision of section 1848(c)(2)(B)(ii) of the Social 

Security Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not apply 

to the adjustments described in paragraph (1). 

(b) DEFINITION OF SPECIFIED SERVICES.—In this section, the 

term ‘‘specified services’’ means procedure codes for services in 

the categories of the Health Care Common Procedure Coding 

System, established by the Secretary of Health and Human Services 

under section 1848(c)(5) of the Social Security Act (42 U.S.C. 1395w– 

4(c)(5)), as of July 1, 2007, and as subsequently modified by the 

Secretary, consisting of psychiatric therapeutic procedures furnished 

in office or other outpatient facility settings or in inpatient hospital, 

partial hospital, or residential care facility settings, but only with 

respect to such services in such categories that are in the subcategories of services which are— 

(1) insight oriented, behavior modifying, or supportive 

psychotherapy; or 

(2) interactive psychotherapy. 

(c) IMPLEMENTATION.—Notwithstanding any other provision of 

law, the Secretary may implement this section by program instruction or otherwise. 

SEC. 139. IMPROVEMENTS FOR MEDICARE ANESTHESIA TEACHING 

PROGRAMS. 

(a) SPECIAL PAYMENT RULE FOR TEACHING ANESTHESIOLOGISTS.—Section 1848(a) of the Social Security Act (42 U.S.C. 

1395w–4(a)), as amended by section 132(b), is amended— 

(1) in paragraph (4)(A), by inserting ‘‘except as provided 

in paragraph (5),’’ after ‘‘anesthesia cases,’’; and 

(2) by adding at the end the following new paragraph: 

‘‘(6) SPECIAL RULE FOR TEACHING ANESTHESIOLOGISTS.— 

With respect to physicians’ services furnished on or after 

January 1, 2010, in the case of teaching anesthesiologists 

involved in the training of physician residents in a single anesthesia case or two concurrent anesthesia cases, the fee schedule 

amount to be applied shall be 100 percent of the fee schedule 

amount otherwise applicable under this section if the anesthesia services were personally performed by the teaching 

anesthesiologist alone and paragraph (4) shall not apply if— 

‘‘(A) the teaching anesthesiologist is present during 

all critical or key portions of the anesthesia service or 

procedure involved; and 

‘‘(B) the teaching anesthesiologist (or another anesthesiologist with whom the teaching anesthesiologist has 

entered into an arrangement) is immediately available to 

furnish anesthesia services during the entire procedure.’’. 

(b) TREATMENT OF CERTIFIED REGISTERED NURSE ANES- THETISTS.—With respect to items and services furnished on or after Effective date. 

42 USC 1395l. 

Effective date. 

42 USC 1395w–4. 


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January 1, 2010, the Secretary of Health and Human Services 

shall make appropriate adjustments to payments under the Medicare program under title XVIII of the Social Security Act for 

teaching certified registered nurse anesthetists to implement a 

policy with respect to teaching certified registered nurse anesthetists that— 

(1) is consistent with the adjustments made by the special 

rule for teaching anesthesiologists under section 1848(a)(6) of 

the Social Security Act, as added by subsection (a); and 

(2) maintains the existing payment differences between 

teaching anesthesiologists and teaching certified registered 

nurse anesthetists. 

PART II—OTHER PAYMENT AND COVERAGE 

IMPROVEMENTS 

SEC. 141. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE 

THERAPY CAPS. 

Section 1833(g)(5) of the Social Security Act (42 U.S.C. 

1395l(g)(5)), as amended by section 105 of the Medicare, Medicaid, 

and SCHIP Extension Act of 2007 (Public Law 110–173), is amended 

by striking ‘‘June 30, 2008’’ and inserting ‘‘December 31, 2009’’. 

SEC. 142. EXTENSION OF PAYMENT RULE FOR BRACHYTHERAPY AND 

THERAPEUTIC RADIOPHARMACEUTICALS. 

Section 1833(t)(16)(C) of the Social Security Act (42 U.S.C. 

1395l(t)(16)(C)), as amended by section 106 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), 

is amended by striking ‘‘July 1, 2008’’ each place it appears and 

inserting ‘‘January 1, 2010’’. 

SEC. 143. SPEECH-LANGUAGE PATHOLOGY SERVICES. 

(a) IN GENERAL.—Section 1861(ll) of the Social Security Act 

(42 U.S.C. 1395x(ll)) is amended— 

(1) by redesignating paragraphs (2) and (3) as paragraphs 

(3) and (4), respectively; and 

(2) by inserting after paragraph (1) the following new paragraph: 

‘‘(2) The term ‘outpatient speech-language pathology services’ 

has the meaning given the term ‘outpatient physical therapy services’ in subsection (p), except that in applying such subsection— 

‘‘(A) ‘speech-language pathology’ shall be substituted for 

‘physical therapy’ each place it appears; and 

‘‘(B) ‘speech-language pathologist’ shall be substituted for 

‘physical therapist’ each place it appears.’’. 

(b) CONFORMING AMENDMENTS.— 

(1) Section 1832(a)(2)(C) of the Social Security Act (42 

U.S.C. 1395k(a)(2)(C)) is amended— 

(A) by striking ‘‘and outpatient’’ and inserting ‘‘, outpatient’’; and 

(B) by inserting before the semicolon at the end the 

following: ‘‘, and outpatient speech-language pathology 

services (other than services to which the second sentence 

of section 1861(p) applies through the application of section 

1861(ll)(2))’’. 

(2) Subparagraphs (A) and (B) of section 1833(a)(8) of the 

Social Security Act (42 U.S.C. 1395l(a)(8)) are each amended 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2543 

by striking ‘‘(which includes outpatient speech-language 

pathology services)’’ and inserting ‘‘, outpatient speech-language 

pathology services,’’. 

(3) Section 1833(g)(1) of the Social Security Act (42 U.S.C. 

1395l(g)(1)) is amended— 

(A) by inserting ‘‘and speech-language pathology services of the type described in such section through the 

application of section 1861(ll)(2)’’ after ‘‘1861(p)’’; and 

(B) by inserting ‘‘and speech-language pathology services’’ after ‘‘and physical therapy services’’. 

(4) The second sentence of section 1835(a) of the Social 

Security Act (42 U.S.C. 1395n(a)) is amended— 

(A) by striking ‘‘section 1861(g)’’ and inserting ‘‘subsection (g) or (ll)(2) of section 1861’’ each place it appears; 

and 

(B) by inserting ‘‘or outpatient speech-language 

pathology services, respectively’’ after ‘‘occupational 

therapy services’’. 

(5) Section 1861(p) of the Social Security Act (42 U.S.C. 

1395x(p)) is amended by striking the fourth sentence. 

(6) Section 1861(s)(2)(D) of the Social Security Act (42 

U.S.C. 1395x(s)(2)(D)) is amended by inserting ‘‘, outpatient 

speech-language pathology services,’’ after ‘‘physical therapy 

services’’. 

(7) Section 1862(a)(20) of the Social Security Act (42 U.S.C. 

1395y(a)(20)) is amended— 

(A) by striking ‘‘outpatient occupational therapy services or outpatient physical therapy services’’ and inserting 

‘‘outpatient physical therapy services, outpatient speechlanguage pathology services, or outpatient occupational 

therapy services’’; and 

(B) by striking ‘‘section 1861(g)’’ and inserting ‘‘subsection (g) or (ll)(2) of section 1861’’. 

(8) Section 1866(e)(1) of the Social Security Act (42 U.S.C. 

1395cc(e)(1)) is amended— 

(A) by striking ‘‘section 1861(g)’’ and inserting ‘‘subsection (g) or (ll)(2) of section 1861’’ the first two places 

it appears; 

(B) by striking ‘‘defined) or’’ and inserting ‘‘defined),’’; 

and 

(C) by inserting before the semicolon at the end the 

following: ‘‘, or (through the operation of section 1861(ll)(2)) 

with respect to the furnishing of outpatient speech-language pathology’’. 

(9) Section 1877(h)(6) of the Social Security Act (42 U.S.C. 

1395nn(h)(6)) is amended by adding at the end the following 

new subparagraph: 

‘‘(L) Outpatient speech-language pathology services.’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to services furnished on or after July 1, 2009. 

(d) CONSTRUCTION.—Nothing in this section shall be construed 

to affect existing regulations and policies of the Centers for Medicare 

& Medicaid Services that require physician oversight of care as 

a condition of payment for speech-language pathology services under 

part B of the Medicare program. 

42 USC 1395k 

note. 

42 USC 1395k 

note. 


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122 STAT. 2544 PUBLIC LAW 110–275—JULY 15, 2008 

SEC. 144. PAYMENT AND COVERAGE IMPROVEMENTS FOR PATIENTS 

WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND 

OTHER CONDITIONS. 

(a) COVERAGE OF PULMONARY AND CARDIAC REHABILITATION.— 

(1) IN GENERAL.—Section 1861 of the Social Security Act 

(42 U.S.C. 1395x), as amended by section 101(a), is amended— 

(A) in subsection (s)(2)— 

(i) in subparagraph (AA), by striking ‘‘and’’ at the 

end; 

(ii) by adding at the end the following new subparagraphs: 

‘‘(CC) items and services furnished under a cardiac 

rehabilitation program (as defined in subsection (eee)(1)) 

or under a pulmonary rehabilitation program (as defined 

in subsection (fff)(1)); and 

‘‘(DD) items and services furnished under an intensive 

cardiac rehabilitation program (as defined in subsection 

(eee)(4));’’; and 

(B) by adding at the end the following new subsections: 

‘‘Cardiac Rehabilitation Program; Intensive Cardiac Rehabilitation 

Program 

‘‘(eee)(1) The term ‘cardiac rehabilitation program’ means a 

physician-supervised program (as described in paragraph (2)) that 

furnishes the items and services described in paragraph (3). 

‘‘(2) A program described in this paragraph is a program under 

which— 

‘‘(A) items and services under the program are delivered— 

‘‘(i) in a physician’s office; 

‘‘(ii) in a hospital on an outpatient basis; or 

‘‘(iii) in other settings determined appropriate by the 

Secretary. 

‘‘(B) a physician is immediately available and accessible 

for medical consultation and medical emergencies at all times 

items and services are being furnished under the program, 

except that, in the case of items and services furnished under 

such a program in a hospital, such availability shall be presumed; and 

‘‘(C) individualized treatment is furnished under a written 

plan established, reviewed, and signed by a physician every 

30 days that describes— 

‘‘(i) the individual’s diagnosis; 

‘‘(ii) the type, amount, frequency, and duration of the 

items and services furnished under the plan; and 

‘‘(iii) the goals set for the individual under the plan. 

‘‘(3) The items and services described in this paragraph are— 

‘‘(A) physician-prescribed exercise; 

‘‘(B) cardiac risk factor modification, including education, 

counseling, and behavioral intervention (to the extent such 

education, counseling, and behavioral intervention is closely 

related to the individual’s care and treatment and is tailored 

to the individual’s needs); 

‘‘(C) psychosocial assessment; 

‘‘(D) outcomes assessment; and 

‘‘(E) such other items and services as the Secretary may 

determine, but only if such items and services are— 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2545 

‘‘(i) reasonable and necessary for the diagnosis or active 

treatment of the individual’s condition; 

‘‘(ii) reasonably expected to improve or maintain the 

individual’s condition and functional level; and 

‘‘(iii) furnished under such guidelines relating to the 

frequency and duration of such items and services as the 

Secretary shall establish, taking into account accepted 

norms of medical practice and the reasonable expectation 

of improvement of the individual. 

‘‘(4)(A) The term ‘intensive cardiac rehabilitation program’ 

means a physician-supervised program (as described in paragraph 

(2)) that furnishes the items and services described in paragraph 

(3) and has shown, in peer-reviewed published research, that it 

accomplished— 

‘‘(i) one or more of the following: 

‘‘(I) positively affected the progression of coronary heart 

disease; or 

‘‘(II) reduced the need for coronary bypass surgery; 

or 

‘‘(III) reduced the need for percutaneous coronary interventions; and 

‘‘(ii) a statistically significant reduction in 5 or more of 

the following measures from their level before receipt of cardiac 

rehabilitation services to their level after receipt of such services: 

‘‘(I) low density lipoprotein; 

‘‘(II) triglycerides; 

‘‘(III) body mass index; 

‘‘(IV) systolic blood pressure; 

‘‘(V) diastolic blood pressure; or 

‘‘(VI) the need for cholesterol, blood pressure, and 

diabetes medications. 

‘‘(B) To be eligible for an intensive cardiac rehabilitation program, an individual must have— 

‘‘(i) had an acute myocardial infarction within the preceding 

12 months; 

‘‘(ii) had coronary bypass surgery; 

‘‘(iii) stable angina pectoris; 

‘‘(iv) had heart valve repair or replacement; 

‘‘(v) had percutaneous transluminal coronary angioplasty 

(PTCA) or coronary stenting; or 

‘‘(vi) had a heart or heart-lung transplant. 

‘‘(C) An intensive cardiac rehabilitation program may be provided in a series of 72 one-hour sessions (as defined in section 

1848(b)(5)), up to 6 sessions per day, over a period of up to 18 

weeks. 

‘‘(5) The Secretary shall establish standards to ensure that 

a physician with expertise in the management of individuals with 

cardiac pathophysiology who is licensed to practice medicine in 

the State in which a cardiac rehabilitation program (or the intensive 

cardiac rehabilitation program, as the case may be) is offered— 

‘‘(A) is responsible for such program; and 

‘‘(B) in consultation with appropriate staff, is involved 

substantially in directing the progress of individual in the 

program. 

Standards. 


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122 STAT. 2546 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘Pulmonary Rehabilitation Program 

‘‘(fff)(1) The term ‘pulmonary rehabilitation program’ means 

a physician-supervised program (as described in subsection (eee)(2) 

with respect to a program under this subsection) that furnishes 

the items and services described in paragraph (2). 

‘‘(2) The items and services described in this paragraph are— 

‘‘(A) physician-prescribed exercise; 

‘‘(B) education or training (to the extent the education 

or training is closely and clearly related to the individual’s 

care and treatment and is tailored to such individual’s needs); 

‘‘(C) psychosocial assessment; 

‘‘(D) outcomes assessment; and 

‘‘(E) such other items and services as the Secretary may 

determine, but only if such items and services are— 

‘‘(i) reasonable and necessary for the diagnosis or active 

treatment of the individual’s condition; 

‘‘(ii) reasonably expected to improve or maintain the 

individual’s condition and functional level; and 

‘‘(iii) furnished under such guidelines relating to the 

frequency and duration of such items and services as the 

Secretary shall establish, taking into account accepted 

norms of medical practice and the reasonable expectation 

of improvement of the individual. 

‘‘(3) The Secretary shall establish standards to ensure that 

a physician with expertise in the management of individuals with 

respiratory pathophysiology who is licensed to practice medicine 

in the State in which a pulmonary rehabilitation program is 

offered— 

‘‘(A) is responsible for such program; and 

‘‘(B) in consultation with appropriate staff, is involved 

substantially in directing the progress of individual in the 

program.’’. 

(2) PAYMENT FOR INTENSIVE CARDIAC REHABILITATION PROGRAMS.— 

(A) INCLUSION IN PHYSICIAN FEE SCHEDULE.—Section 

1848(j)(3) of the Social Security Act (42 U.S.C. 1395w– 

4(j)(3)) is amended by inserting ‘‘(2)(DD),’’ after ‘‘(2)(AA),’’. 

(B) CONFORMING AMENDMENT.—Section 1848(b) of the 

Social Security Act (42 U.S.C. 1395w–4(b)) is amended 

by adding at the end the following new paragraph: 

‘‘(5) TREATMENT OF INTENSIVE CARDIAC REHABILITATION

PROGRAM.— 

‘‘(A) IN GENERAL.—In the case of an intensive cardiac 

rehabilitation program described in section 1861(eee)(4), 

the Secretary shall substitute the Medicare OPD fee 

schedule amount established under the prospective payment system for hospital outpatient department service 

under paragraph (3)(D) of section 1833(t) for cardiac 

rehabilitation (under HCPCS codes 93797 and 93798 for 

calendar year 2007, or any succeeding HCPCS codes for 

cardiac rehabilitation). 

‘‘(B) DEFINITION OF SESSION.—Each of the services 

described in subparagraphs (A) through (E) of section 

1861(eee)(3), when furnished for one hour, is a separate 

session of intensive cardiac rehabilitation. 

Standards. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2547 

‘‘(C) MULTIPLE SESSIONS PER DAY.—Payment may be 

made for up to 6 sessions per day of the series of 72 

one-hour sessions of intensive cardiac rehabilitation services described in section 1861(eee)(4)(B).’’. 

(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply to items and services furnished on or after 

January 1, 2010. 

(b) REPEAL OF TRANSFER OF OWNERSHIP OF OXYGEN EQUIPMENT.— 

(1) IN GENERAL.—Section 1834(a)(5)(F) of the Social Security Act (42 U.S.C. 1395m(a)(5)(F)) is amended— 

(A) in the heading, by striking ‘‘OWNERSHIP OF

EQUIPMENT’’ and inserting ‘‘RENTAL CAP’’; and 

(B) by striking clause (ii) and inserting the following: 

‘‘(ii) PAYMENTS AND RULES AFTER RENTAL CAP.— 

After the 36th continuous month during which payment is made for the equipment under this paragraph— 

‘‘(I) the supplier furnishing such equipment 

under this subsection shall continue to furnish 

the equipment during any period of medical need 

for the remainder of the reasonable useful lifetime 

of the equipment, as determined by the Secretary; 

‘‘(II) payments for oxygen shall continue to 

be made in the amount recognized for oxygen 

under paragraph (9) for the period of medical need; 

and 

‘‘(III) maintenance and servicing payments 

shall, if the Secretary determines such payments 

are reasonable and necessary, be made (for parts 

and labor not covered by the supplier’s or manufacturer’s warranty, as determined by the Secretary 

to be appropriate for the equipment), and such 

payments shall be in an amount determined to 

be appropriate by the Secretary.’’. 

(2) EFFECTIVE DATE.—The amendments made by paragraph 

(1) shall take effect on January 1, 2009. 

SEC. 145. CLINICAL LABORATORY TESTS. 

(a) REPEAL OF MEDICARE COMPETITIVE BIDDING DEMONSTRATION PROJECT FOR CLINICAL LABORATORY SERVICES.— 

(1) IN GENERAL.—Section 1847 of the Social Security Act 

(42 U.S.C. 1395w–3) is amended by striking subsection (e). 

(2) CONFORMING AMENDMENTS.—Section 1833(a)(1)(D) of 

the Social Security Act (42 U.S.C. 1395l(a)(1)(D)) is amended— 

(A) by inserting ‘‘or’’ before ‘‘(ii)’’; and 

(B) by striking ‘‘or (iii) on the basis’’ and all that 

follows before the comma at the end. 

(3) EFFECTIVE DATE.—The amendments made by this subsection shall take effect on the date of the enactment of this 

Act. 

(b) CLINICAL LABORATORY TEST FEE SCHEDULE UPDATE ADJUSTMENT.—Section 1833(h)(2)(A)(i) of the Social Security Act (42 U.S.C. 

1395l(h)(2)(A)(ii)) is amended by inserting ‘‘minus, for each of the 

years 2009 through 2013, 0.5 percentage points’’ after ‘‘city average)’’. 

42 USC 1395l. 

42 USC 1395m 

note. 

42 USC 1395w–4 

note. 


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122 STAT. 2548 PUBLIC LAW 110–275—JULY 15, 2008 

SEC. 146. IMPROVED ACCESS TO AMBULANCE SERVICES. 

(a) EXTENSION OF INCREASED MEDICARE PAYMENTS FOR GROUND

AMBULANCE SERVICES.—Section 1834(l)(13) of the Social Security 

Act (42 U.S.C. 1395m(l)(13)) is amended— 

(1) in subparagraph (A)— 

(A) in the matter preceding clause (i), by inserting 

‘‘and for such services furnished on or after July 1, 2008, 

and before January 1, 2010’’ after ‘‘2007,’’; 

(B) in clause (i), by inserting ‘‘(or 3 percent if such 

service is furnished on or after July 1, 2008, and before 

January 1, 2010)’’ after ‘‘2 percent’’; and 

(C) in clause (ii), by inserting ‘‘(or 2 percent if such 

service is furnished on or after July 1, 2008, and before 

January 1, 2010)’’ after ‘‘1 percent’’; and 

(2) in subparagraph (B)— 

(A) in the heading, by striking ‘‘2006’’ and inserting 

‘‘APPLICABLE PERIOD’’; and 

(B) by inserting ‘‘applicable’’ before ‘‘period’’. 

(b) AIR AMBULANCE PAYMENT IMPROVEMENTS.— 

(1) TREATMENT OF CERTAIN AREAS FOR PAYMENT FOR AIR

AMBULANCE SERVICES UNDER THE AMBULANCE FEE SCHEDULE.— 

Notwithstanding any other provision of law, for purposes of 

making payments under section 1834(l) of the Social Security 

Act (42 U.S.C. 1395m(l)) for air ambulance services furnished 

during the period beginning on July 1, 2008, and ending on 

December 31, 2009, any area that was designated as a rural 

area for purposes of making payments under such section for 

air ambulance services furnished on December 31, 2006, shall 

be treated as a rural area for purposes of making payments 

under such section for air ambulance services furnished during 

such period. 

(2) CLARIFICATION REGARDING SATISFACTION OF REQUIREMENT OF MEDICALLY NECESSARY.— 

(A) IN GENERAL.—Section 1834(l)(14)(B)(i) of the Social 

Security Act (42 U.S.C. 1395m(l)(14)(B)(i)) is amended by 

striking ‘‘reasonably determines or certifies’’ and inserting 

‘‘certifies or reasonably determines’’. 

(B) EFFECTIVE DATE.—The amendment made by 

subparagraph (A) shall apply to services furnished on or 

after the date of the enactment of this Act. 

SEC. 147. EXTENSION AND EXPANSION OF THE MEDICARE HOLD HARMLESS PROVISION UNDER THE PROSPECTIVE PAYMENT 

SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT 

(HOPD) SERVICES FOR CERTAIN HOSPITALS. 

Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 

1395l(t)(7)(D)(i)) is amended— 

(1) in subclause (II)— 

(A) in the first sentence, by striking ‘‘2009’’ and 

inserting ‘‘2010’’; and 

(B) by striking the second sentence and inserting the 

following new sentence: ‘‘For purposes of the preceding 

sentence, the applicable percentage shall be 95 percent 

with respect to covered OPD services furnished in 2006, 

90 percent with respect to such services furnished in 2007, 

and 85 percent with respect to such services furnished 

in 2008 or 2009.’’; and 

42 USC 1395m 

note. 

Time period. 

42 USC 1395m 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2549 

(2) by adding at the end the following new subclause: 

‘‘(III) In the case of a sole community hospital 

(as defined in section 1886(d)(5)(D)(iii)) that has not 

more than 100 beds, for covered OPD services furnished on or after January 1, 2009, and before January 

1, 2010, for which the PPS amount is less than the 

pre-BBA amount, the amount of payment under this 

subsection shall be increased by 85 percent of the 

amount of such difference.’’. 

SEC. 148. CLARIFICATION OF PAYMENT FOR CLINICAL LABORATORY 

TESTS FURNISHED BY CRITICAL ACCESS HOSPITALS. 

(a) IN GENERAL.—Section 1834(g)(4) of the Social Security Act 

(42 U.S.C. 1395m(g)(4)) is amended— 

(1) in the heading, by striking ‘‘NO BENEFICIARY COST- SHARING FOR’’ and inserting ‘‘TREATMENT OF’’; and 

(2) by adding at the end the following new sentence: ‘‘For 

purposes of the preceding sentence and section 1861(mm)(3), 

clinical diagnostic laboratory services furnished by a critical 

access hospital shall be treated as being furnished as part 

of outpatient critical access services without regard to whether 

the individual with respect to whom such services are furnished 

is physically present in the critical access hospital, or in a 

skilled nursing facility or a clinic (including a rural health 

clinic) that is operated by a critical access hospital, at the 

time the specimen is collected.’’. 

(b) EFFECTIVE DATE.—The amendments made by subsection 

(a) shall apply to services furnished on or after July 1, 2009. 

SEC. 149. ADDING CERTAIN ENTITIES AS ORIGINATING SITES FOR PAYMENT OF TELEHEALTH SERVICES. 

(a) IN GENERAL.—Section 1834(m)(4)(C)(ii) of the Social Security 

Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 

end the following new subclauses: 

‘‘(VI) A hospital-based or critical access hospital-based renal dialysis center (including satellites). 

‘‘(VII) A skilled nursing facility (as defined 

in section 1819(a)). 

‘‘(VIII) A community mental health center (as 

defined in section 1861(ff)(3)(B)).’’. 

(b) CONFORMING AMENDMENT.—Section 1888(e)(2)(A)(ii) of the 

Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by 

inserting ‘‘telehealth services furnished under section 

1834(m)(4)(C)(ii)(VII),’’ after ‘‘section 1861(s)(2),’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to services furnished on or after January 1, 2009. 

SEC. 150. MEDPAC STUDY AND REPORT ON IMPROVING CHRONIC CARE 

DEMONSTRATION PROGRAMS. 

(a) STUDY.—The Medicare Payment Advisory Commission (in 

this section referred to as the ‘‘Commission’’) shall conduct a study 

on the feasability and advisability of establishing a Medicare 

Chronic Care Practice Research Network that would serve as a 

standing network of providers testing new models of care coordination and other care approaches for chronically ill beneficiaries, 

including the initiation, operation, evaluation, and, if appropriate, 

42 USC 1395m 

note. 

42 USC 1395m 

note. 


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122 STAT. 2550 PUBLIC LAW 110–275—JULY 15, 2008 

expansion of such models to the broader Medicare patient population. In conducting such study, the Commission shall take into 

account the structure, implementation, and results of prior and 

existing care coordination and disease management demonstrations 

and pilots, including the Medicare Coordinated Care Demonstration 

Project under section 4016 of the Balanced Budget Act of 1997 

(42 U.S.C. 1395b–1 note) and the chronic care improvement programs under section 1807 of the Social Security Act (42 U.S.C. 

1395b–8), commonly known to as ‘‘Medicare Health Support’’. 

(b) REPORT.—Not later than June 15, 2009, the Commission 

shall submit to Congress a report containing the results of the 

study conducted under subsection (a). 

SEC. 151. INCREASE OF FQHC PAYMENT LIMITS. 

(a) IN GENERAL.—Section 1833 of the Social Security Act (42 

U.S.C. 1395l) is amended by adding at the end the following new 

subsection: 

‘‘(v) INCREASE OF FQHC PAYMENT LIMITS.—In the case of services furnished by Federally qualified health centers (as defined 

in section 1861(aa)(4)), the Secretary shall establish payment limits 

with respect to such services under this part for services furnished— 

‘‘(1) in 2010, at the limits otherwise established under 

this part for such year increased by $5; and 

‘‘(2) in a subsequent year, at the limits established under 

this subsection for the previous year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for 

such subsequent year.’’. 

(b) STUDY AND REPORT ON THE EFFECTS AND ADEQUACY OF

THE MEDICARE FEDERALLY QUALIFIED HEALTH CENTER PAYMENT

STRUCTURE.— 

(1) STUDY.—The Comptroller General of the United States 

shall conduct a study to determine whether the structure for 

payments for services furnished by Federally qualified health 

centers (as defined in section 1861(aa)(4) of the Social Security 

Act (42 U.S.C. 1395x(aa)(4)) under part B of title XVIII of 

the Social Security Act (42 U.S.C. 1395j et seq.) adequately 

reimburses Federally qualified health centers for the care furnished to Medicare beneficiaries. In conducting such study, 

the Comptroller General shall— 

(A) use the most current cost report data available; 

(B) examine the effects of the payment limits established with respect to such services under such part B 

on the ability of Federally qualified health centers to furnish care to Medicare beneficiaries; and 

(C) examine the cost of furnishing services covered 

under the Medicare program as of the date of the enactment 

of this Act that were not covered under such program 

as of the date on which the Secretary determined the 

payment rate for Federally qualified health centers in 1991. 

(2) REPORT.—Not later than 15 months after the date of 

the enactment of this Act, the Comptroller General of the 

United States shall submit to Congress a report on the study 

conducted under paragraph (1), together with recommendations 

for such legislation and administrative action the Comptroller 

General determines appropriate, taking into consideration the 

structure and adequacy of the prospective payment methodology 

used to make payments to Federally qualified health centers 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2551 

under the Medicaid program under title XIX of the Social 

Security Act (42 U.S.C. 1396 et seq.). 

SEC. 152. KIDNEY DISEASE EDUCATION AND AWARENESS PROVISIONS. 

(a) CHRONIC KIDNEY DISEASE INITIATIVES.—Part P of title III 

of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended 

by adding at the end the following new section: 

‘‘SEC. 399R. CHRONIC KIDNEY DISEASE INITIATIVES. 

‘‘(a) IN GENERAL.—The Secretary shall establish pilot projects 

to— 

‘‘(1) increase public and medical community awareness 

(particularly of those who treat patients with diabetes and 

hypertension) regarding chronic kidney disease, focusing on 

prevention; 

‘‘(2) increase screening for chronic kidney disease, focusing 

on Medicare beneficiaries at risk of chronic kidney disease; 

and 

‘‘(3) enhance surveillance systems to better assess the 

prevalence and incidence of chronic kidney disease. 

‘‘(b) SCOPE AND DURATION.— 

‘‘(1) SCOPE.—The Secretary shall select at least 3 States 

in which to conduct pilot projects under this section. 

‘‘(2) DURATION.—The pilot projects under this section shall 

be conducted for a period that is not longer than 5 years 

and shall begin on January 1, 2009. 

‘‘(c) EVALUATION AND REPORT.—The Comptroller General of 

the United States shall conduct an evaluation of the pilot projects 

conducted under this section. Not later than 12 months after the 

date on which the pilot projects are completed, the Comptroller 

General shall submit to Congress a report on the evaluation. 

‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 

to be appropriated such sums as may be necessary for the purpose 

of carrying out this section.’’. 

(b) MEDICARE COVERAGE OF KIDNEY DISEASE PATIENT EDU- CATION SERVICES.— 

(1) COVERAGE OF KIDNEY DISEASE EDUCATION SERVICES.— 

(A) COVERAGE.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 

144(a), is amended— 

(i) in subparagraph (CC), by striking ‘‘and’’ after 

the semicolon at the end; 

(ii) in subparagraph (DD), by adding ‘‘and’’ after 

the semicolon at the end; and 

(iii) by adding at the end the following new 

subparagraph: 

‘‘(EE) kidney disease education services (as defined in subsection (ggg));’’. 

(B) SERVICES DESCRIBED.—Section 1861 of the Social 

Security Act (42 U.S.C. 1395x), as amended by section 

144(a), is amended by adding at the end the following 

new subsection: 

‘‘Kidney Disease Education Services 

‘‘(ggg)(1) The term ‘kidney disease education services’ means 

educational services that are— 

42 USC 280g–6. 


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122 STAT. 2552 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(A) furnished to an individual with stage IV chronic kidney 

disease who, according to accepted clinical guidelines identified 

by the Secretary, will require dialysis or a kidney transplant; 

‘‘(B) furnished, upon the referral of the physician managing 

the individual’s kidney condition, by a qualified person (as 

defined in paragraph (2)); and 

‘‘(C) designed— 

‘‘(i) to provide comprehensive information (consistent 

with the standards set under paragraph (3)) regarding— 

‘‘(I) the management of comorbidities, including 

for purposes of delaying the need for dialysis; 

‘‘(II) the prevention of uremic complications; and 

‘‘(III) each option for renal replacement therapy 

(including hemodialysis and peritoneal dialysis at home 

and in-center as well as vascular access options and 

transplantation); 

‘‘(ii) to ensure that the individual has the opportunity 

to actively participate in the choice of therapy; and 

‘‘(iii) to be tailored to meet the needs of the individual 

involved. 

‘‘(2)(A) The term ‘qualified person’ means— 

‘‘(i) a physician (as defined in section 1861(r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist 

(as defined in section 1861(aa)(5)), who furnishes services for 

which payment may be made under the fee schedule established 

under section 1848; and 

‘‘(ii) a provider of services located in a rural area (as defined 

in section 1886(d)(2)(D)). 

‘‘(B) Such term does not include a provider of services (other 

than a provider of services described in subparagraph (A)(ii)) or 

a renal dialysis facility. 

‘‘(3) The Secretary shall set standards for the content of such 

information to be provided under paragraph (1)(C)(i) after consulting with physicians, other health professionals, health educators, professional organizations, accrediting organizations, kidney 

patient organizations, dialysis facilities, transplant centers, network 

organizations described in section 1881(c)(2), and other knowledgeable persons. To the extent possible the Secretary shall consult 

with persons or entities described in the previous sentence, other 

than a dialysis facility, that has not received industry funding 

from a drug or biological manufacturer or dialysis facility. 

‘‘(4) No individual shall be furnished more than 6 sessions 

of kidney disease education services under this title.’’. 

(C) PAYMENT UNDER THE PHYSICIAN FEE SCHEDULE.— 

Section 1848(j)(3) of the Social Security Act (42 U.S.C. 

1395w–4(j)(3)), as amended by section 144(b), is amended 

by inserting ‘‘(2)(EE),’’ after ‘‘(2)(DD),’’. 

(D) LIMITATION ON NUMBER OF SESSIONS.—Section 

1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) 

is amended— 

(i) in subparagraph (M), by striking ‘‘and’’ at the 

end; 

(ii) in subparagraph (N), by striking the semicolon 

at the end and inserting ‘‘, and’’; and 

(iii) by adding at the end the following new 

subparagraph: 

Standards. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2553 

‘‘(O) in the case of kidney disease education services (as 

defined in paragraph (1) of section 1861(ggg)), which are furnished in excess of the number of sessions covered under paragraph (4) of such section;’’. 

(2) EFFECTIVE DATE.—The amendments made by this subsection shall apply to services furnished on or after January 

1, 2010. 

SEC. 153. RENAL DIALYSIS PROVISIONS. 

(a) COMPOSITE RATE.— (1) UPDATE.—Section 1881(b)(12)(G) of the Social Security 

Act (42 U.S.C. 1395rr(b)(12)(G)) is amended— 

(A) in clause (i), by striking ‘‘and’’ at the end; 

(B) in clause (ii)— 

(i) by inserting ‘‘and before January 1, 2009,’’ after 

‘‘April 1, 2007,’’; and 

(ii) by striking the period at the end and inserting 

a semicolon; and 

(C) by adding at the end the following new clauses: 

‘‘(iii) furnished on or after January 1, 2009, and before 

January 1, 2010, by 1.0 percent above the amount of such 

composite rate component for such services furnished on 

December 31, 2008; and 

‘‘(iv) furnished on or after January 1, 2010, by 1.0 percent 

above the amount of such composite rate component for such 

services furnished on December 31, 2009.’’. 

(2) SITE NEUTRAL COMPOSITE RATE.—Section 1881(b)(12)(A) 

of the Social Security Act (42 U.S.C. 1395rr(b)(12)(A)) is 

amended by adding at the end the following new sentence: 

‘‘Under such system, the payment rate for dialysis services 

furnished on or after January 1, 2009, by providers of services 

shall be the same as the payment rate (computed without 

regard to this sentence) for such services furnished by renal 

dialysis facilities, and in applying the geographic index under 

subparagraph (D) to providers of services, the labor share shall 

be based on the labor share otherwise applied for renal dialysis 

facilities.’’. 

(b) DEVELOPMENT OF ESRD BUNDLED PAYMENT SYSTEM.— 

(1) IN GENERAL.—Section 1881(b) of the Social Security 

Act (42 U.S.C. 1395rr(b)) is amended by adding at the end 

the following new paragraph: 

‘‘(14)(A)(i) Subject to subparagraph (E), for services furnished 

on or after January 1, 2011, the Secretary shall implement a 

payment system under which a single payment is made under 

this title to a provider of services or a renal dialysis facility for 

renal dialysis services (as defined in subparagraph (B)) in lieu 

of any other payment (including a payment adjustment under paragraph (12)(B)(ii)) and for such services and items furnished pursuant to paragraph (4). 

‘‘(ii) In implementing the system under this paragraph the 

Secretary shall ensure that the estimated total amount of payments 

under this title for 2011 for renal dialysis services shall equal 

98 percent of the estimated total amount of payments for renal 

dialysis services, including payments under paragraph (12)(B)(ii), 

that would have been made under this title with respect to services 

furnished in 2011 if such system had not been implemented. In 

making the estimation under subclause (I), the Secretary shall 

Effective date. 

Effective date. 

Effective date. 

Time period. 

42 USC 1395w–4 

note. 


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122 STAT. 2554 PUBLIC LAW 110–275—JULY 15, 2008 

use per patient utilization data from 2007, 2008, or 2009, whichever 

has the lowest per patient utilization. 

‘‘(B) For purposes of this paragraph, the term ‘renal dialysis 

services’ includes— 

‘‘(i) items and services included in the composite rate for 

renal dialysis services as of December 31, 2010; 

‘‘(ii) erythropoiesis stimulating agents and any oral form 

of such agents that are furnished to individuals for the treatment of end stage renal disease; 

‘‘(iii) other drugs and biologicals that are furnished to 

individuals for the treatment of end stage renal disease and 

for which payment was (before the application of this paragraph) made separately under this title, and any oral equivalent 

form of such drug or biological; and 

‘‘(iv) diagnostic laboratory tests and other items and services not described in clause (i) that are furnished to individuals 

for the treatment of end stage renal disease. 

Such term does not include vaccines. 

‘‘(C) The system under this paragraph may provide for payment 

on the basis of services furnished during a week or month or 

such other appropriate unit of payment as the Secretary specifies. 

‘‘(D) Such system— 

‘‘(i) shall include a payment adjustment based on case 

mix that may take into account patient weight, body mass 

index, comorbidities, length of time on dialysis, age, race, ethnicity, and other appropriate factors; 

‘‘(ii) shall include a payment adjustment for high cost 

outliers due to unusual variations in the type or amount of 

medically necessary care, including variations in the amount 

of erythropoiesis stimulating agents necessary for anemia 

management; 

‘‘(iii) shall include a payment adjustment that reflects the 

extent to which costs incurred by low-volume facilities (as 

defined by the Secretary) in furnishing renal dialysis services 

exceed the costs incurred by other facilities in furnishing such 

services, and for payment for renal dialysis services furnished 

on or after January 1, 2011, and before January 1, 2014, 

such payment adjustment shall not be less than 10 percent; 

and 

‘‘(iv) may include such other payment adjustments as the 

Secretary determines appropriate, such as a payment adjustment— 

‘‘(I) for pediatric providers of services and renal dialysis 

facilities; 

‘‘(II) by a geographic index, such as the index referred 

to in paragraph (12)(D), as the Secretary determines to 

be appropriate; and 

‘‘(III) for providers of services or renal dialysis facilities 

located in rural areas. 

The Secretary shall take into consideration the unique treatment 

needs of children and young adults in establishing such system. 

‘‘(E)(i) The Secretary shall provide for a four-year phase-in 

(in equal increments) of the payment amount under the payment 

system under this paragraph, with such payment amount being 

fully implemented for renal dialysis services furnished on or after 

January 1, 2014. 

Effective date. 

Time period. 


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‘‘(ii) A provider of services or renal dialysis facility may make 

a one-time election to be excluded from the phase-in under clause 

(i) and be paid entirely based on the payment amount under the 

payment system under this paragraph. Such an election shall be 

made prior to January 1, 2011, in a form and manner specified 

by the Secretary, and is final and may not be rescinded. 

‘‘(iii) The Secretary shall make an adjustment to the payments 

under this paragraph for years during which the phase-in under 

clause (i) is applicable so that the estimated total amount of payments under this paragraph, including payments under this 

subparagraph, shall equal the estimated total amount of payments 

that would otherwise occur under this paragraph without such 

phase-in. 

‘‘(F)(i) Subject to clause (ii), beginning in 2012, the Secretary 

shall annually increase payment amounts established under this 

paragraph by an ESRD market basket percentage increase factor 

for a bundled payment system for renal dialysis services that 

reflects changes over time in the prices of an appropriate mix 

of goods and services included in renal dialysis services minus 

1.0 percentage point. 

‘‘(ii) For years during which a phase-in of the payment system 

pursuant to subparagraph (E) is applicable, the following rules 

shall apply to the portion of the payment under the system that 

is based on the payment of the composite rate that would otherwise 

apply if the system under this paragraph had not been enacted: 

‘‘(I) The update under clause (i) shall not apply. 

‘‘(II) The Secretary shall annually increase such composite 

rate by the ESRD market basket percentage increase factor 

described in clause (i) minus 1.0 percentage point. 

‘‘(G) There shall be no administrative or judicial review under 

section 1869, section 1878, or otherwise of the determination of 

payment amounts under subparagraph (A), the establishment of 

an appropriate unit of payment under subparagraph (C), the identification of renal dialysis services included in the bundled payment, 

the adjustments under subparagraph (D), the application of the 

phase-in under subparagraph (E), and the establishment of the 

market basket percentage increase factors under subparagraph (F). 

‘‘(H) Erythropoiesis stimulating agents and other drugs and 

biologicals shall be treated as prescribed and dispensed or administered and available only under part B if they are— 

‘‘(i) furnished to an individual for the treatment of end 

stage renal disease; and 

‘‘(ii) included in subparagraph (B) for purposes of payment 

under this paragraph.’’. 

(2) PROHIBITION OF UNBUNDLING.—Section 1862(a) of the 

Social Security Act (42 U.S.C. 1395y(a)), as amended by section 

135(a)(2), is amended— 

(A) in paragraph (22), by striking ‘‘or’’ at the end; 

(B) in paragraph (23), by striking the period at the 

end and inserting ‘‘; or’’; and 

(C) by inserting after paragraph (23) the following 

new paragraph: 

‘‘(24) where such expenses are for renal dialysis services 

(as defined in subparagraph (B) of section 1881(b)(14)) for which 

payment is made under such section unless such payment 

is made under such section to a provider of services or a 

renal dialysis facility for such services.’’. 

Effective date. 

Deadline. 


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(3) CONFORMING AMENDMENTS.—(A) Section 1881(b) of the 

Social Security Act (42 U.S.C. 1395rr(b)) is amended— 

(i) in paragraph (12)(A), by striking ‘‘In lieu of payment’’ and inserting ‘‘Subject to paragraph (14), in lieu 

of payment’’; 

(ii) in the second sentence of paragraph (12)(F)— 

(I) by inserting ‘‘or paragraph (14)’’ after ‘‘this paragraph’’; and 

(II) by inserting ‘‘or under the system under paragraph (14)’’ after ‘‘subparagraph (B)’’; and 

(iii) in paragraph (13)— 

(I) in subparagraph (A), in the matter preceding 

clause (i), by striking ‘‘The payment amounts’’ and 

inserting ‘‘Subject to paragraph (14), the payment 

amounts’’; and 

(II) in subparagraph (B)— 

(aa) in clause (i), by striking ‘‘(i)’’ after ‘‘(B)’’ 

and by inserting ‘‘, subject to paragraph (14)’’ 

before the period at the end; and 

(bb) by striking clause (ii). 

(B) Section 1861(s)(2)(F) of the Social Security Act (42 

U.S.C. 1395x(s)(2)(F)) is amended by inserting ‘‘, and, for items 

and services furnished on or after January 1, 2011, renal 

dialysis services (as defined in section 1881(b)(14)(B))’’ before 

the semicolon at the end. 

(C) Section 623(e) of the Medicare Prescription Drug, 

Improvement, and Modernization Act of 2003 (42 U.S.C. 1395rr 

note) is repealed. 

(4) RULE OF CONSTRUCTION.—Nothing in this subsection 

or the amendments made by this subsection shall be construed 

as authorizing or requiring the Secretary of Health and Human 

Services to make payments under the payment system implemented under paragraph (14)(A)(i) of section 1881(b) of the 

Social Security Act (42 U.S.C. 1395rr(b)), as added by paragraph 

(1), for any unrecovered amount for any bad debt attributable 

to deductible and coinsurance on items and services not 

included in the basic case-mix adjusted composite rate under 

paragraph (12) of such section as in effect before the date 

of the enactment of this Act. 

(c) QUALITY INCENTIVES IN THE END-STAGE RENAL DISEASE

PROGRAM.—Section 1881 of the Social Security Act (42 U.S.C. 

1395rr) is amended by adding at the end the following new subsection: 

‘‘(h) QUALITY INCENTIVES IN THE END-STAGE RENAL DISEASE

PROGRAM.— 

‘‘(1) QUALITY INCENTIVES.— 

‘‘(A) IN GENERAL.—With respect to renal dialysis services (as defined in subsection (b)(14)(B)) furnished on or 

after January 1, 2012, in the case of a provider of services 

or a renal dialysis facility that does not meet the requirement described in subparagraph (B) with respect to the 

year, payments otherwise made to such provider or facility 

under the system under subsection (b)(14) for such services 

shall be reduced by up to 2.0 percent, as determined appropriate by the Secretary. 

‘‘(B) REQUIREMENT.—The requirement described in this 

subparagraph is that the provider or facility meets (or 

Effective date. 

42 USC 1395rr 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2557 

exceeds) the total performance score under paragraph (3) 

with respect to performance standards established by the 

Secretary with respect to measures specified in paragraph 

(2). 

‘‘(C) NO EFFECT IN SUBSEQUENT YEARS.—The reduction 

under subparagraph (A) shall apply only with respect to 

the year involved, and the Secretary shall not take into 

account such reduction in computing the single payment 

amount under the system under paragraph (14) in a subsequent year. 

‘‘(2) MEASURES.— ‘‘(A) IN GENERAL.—The measures specified under this 

paragraph with respect to the year involved shall include— 

‘‘(i) measures on anemia management that reflect 

the labeling approved by the Food and Drug Administration for such management and measures on dialysis 

adequacy; 

‘‘(ii) to the extent feasible, such measure (or measures) of patient satisfaction as the Secretary shall 

specify; and 

‘‘(iii) such other measures as the Secretary specifies, including, to the extent feasible, measures on— 

‘‘(I) iron management; 

‘‘(II) bone mineral metabolism; and 

‘‘(III) vascular access, including for maximizing 

the placement of arterial venous fistula. 

‘‘(B) USE OF ENDORSED MEASURES.— 

‘‘(i) IN GENERAL.—Subject to clause (ii), any 

measure specified by the Secretary under subparagraph (A)(iii) must have been endorsed by the entity 

with a contract under section 1890(a). 

‘‘(ii) EXCEPTION.—In the case of a specified area 

or medical topic determined appropriate by the Secretary for which a feasible and practical measure has 

not been endorsed by the entity with a contract under 

section 1890(a), the Secretary may specify a measure 

that is not so endorsed as long as due consideration 

is given to measures that have been endorsed or 

adopted by a consensus organization identified by the 

Secretary. 

‘‘(C) UPDATING MEASURES.—The Secretary shall establish a process for updating the measures specified under 

subparagraph (A) in consultation with interested parties. 

‘‘(D) CONSIDERATION.—In specifying measures under 

subparagraph (A), the Secretary shall consider the availability of measures that address the unique treatment 

needs of children and young adults with kidney failure. 

‘‘(3) PERFORMANCE SCORES.— 

‘‘(A) TOTAL PERFORMANCE SCORE.— 

‘‘(i) IN GENERAL.—Subject to clause (ii), the Secretary shall develop a methodology for assessing the 

total performance of each provider of services and renal 

dialysis facility based on performance standards with 

respect to the measures selected under paragraph (2) 

for a performance period established under paragraph 

(4)(D) (in this subsection referred to as the ‘total 

performance score’). 


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122 STAT. 2558 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(ii) APPLICATION.—For providers of services and 

renal dialysis facilities that do not meet (or exceed) 

the total performance score established by the Secretary, the Secretary shall ensure that the application 

of the methodology developed under clause (i) results 

in an appropriate distribution of reductions in payment 

under paragraph (1) among providers and facilities 

achieving different levels of total performance scores, 

with providers and facilities achieving the lowest total 

performance scores receiving the largest reduction in 

payment under paragraph (1)(A). 

‘‘(iii) WEIGHTING OF MEASURES.—In calculating the 

total performance score, the Secretary shall weight 

the scores with respect to individual measures calculated under subparagraph (B) to reflect priorities 

for quality improvement, such as weighting scores to 

ensure that providers of services and renal dialysis 

facilities have strong incentives to meet or exceed 

anemia management and dialysis adequacy performance standards, as determined appropriate by the Secretary. 

‘‘(B) PERFORMANCE SCORE WITH RESPECT TO INDIVIDUAL

MEASURES.—The Secretary shall also calculate separate 

performance scores for each measure, including for dialysis 

adequacy and anemia management. 

‘‘(4) PERFORMANCE STANDARDS.— 

‘‘(A) ESTABLISHMENT.—Subject to subparagraph (E), 

the Secretary shall establish performance standards with 

respect to measures selected under paragraph (2) for a 

performance period with respect to a year (as established 

under subparagraph (D)). 

‘‘(B) ACHIEVEMENT AND IMPROVEMENT.—The performance standards established under subparagraph (A) shall 

include levels of achievement and improvement, as determined appropriate by the Secretary. 

‘‘(C) TIMING.—The Secretary shall establish the 

performance standards under subparagraph (A) prior to 

the beginning of the performance period for the year 

involved. 

‘‘(D) PERFORMANCE PERIOD.—The Secretary shall establish the performance period with respect to a year. Such 

performance period shall occur prior to the beginning of 

such year. 

‘‘(E) SPECIAL RULE.—The Secretary shall initially use 

as the performance standard for the measures specified 

under paragraph (2)(A)(i) for a provider of services or a 

renal dialysis facility the lesser of— 

‘‘(i) the performance of such provider or facility 

for such measures in the year selected by the Secretary 

under the second sentence of subsection (b)(14)(A)(ii); 

or 

‘‘(ii) a performance standard based on the national 

performance rates for such measures in a period determined by the Secretary. 

‘‘(5) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or 

otherwise of the following: 


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‘‘(A) The determination of the amount of the payment 

reduction under paragraph (1). 

‘‘(B) The establishment of the performance standards 

and the performance period under paragraph (4). 

‘‘(C) The specification of measures under paragraph 

(2). 

‘‘(D) The methodology developed under paragraph (3) 

that is used to calculate total performance scores and 

performance scores for individual measures. 

‘‘(6) PUBLIC REPORTING.— 

‘‘(A) IN GENERAL.—The Secretary shall establish procedures for making information regarding performance under 

this subsection available to the public, including— 

‘‘(i) the total performance score achieved by the 

provider of services or renal dialysis facility under 

paragraph (3) and appropriate comparisons of providers of services and renal dialysis facilities to the 

national average with respect to such scores; and 

‘‘(ii) the performance score achieved by the provider 

or facility with respect to individual measures. 

‘‘(B) OPPORTUNITY TO REVIEW.—The procedures established under subparagraph (A) shall ensure that a provider 

of services and a renal dialysis facility has the opportunity 

to review the information that is to be made public with 

respect to the provider or facility prior to such data being 

made public. 

‘‘(C) CERTIFICATES.— 

‘‘(i) IN GENERAL.—The Secretary shall provide certificates to providers of services and renal dialysis 

facilities who furnish renal dialysis services under this 

section to display in patient areas. The certificate shall 

indicate the total performance score achieved by the 

provider or facility under paragraph (3). 

‘‘(ii) DISPLAY.—Each facility or provider receiving 

a certificate under clause (i) shall prominently display 

the certificate at the provider or facility. 

‘‘(D) WEB-BASED LIST.—The Secretary shall establish 

a list of providers of services and renal dialysis facilities 

who furnish renal dialysis services under this section that 

indicates the total performance score and the performance 

score for individual measures achieved by the provider 

and facility under paragraph (3). Such information shall 

be posted on the Internet website of the Centers for Medicare & Medicaid Services in an easily understandable format.’’. 

(d) GAO REPORT ON ESRD BUNDLING SYSTEM AND QUALITY

INITIATIVE.—Not later than March 1, 2013, the Comptroller General 

of the United States shall submit to Congress a report on the 

implementation of the payment system under subsection (b)(14) 

of section 1881 of the Social Security Act (as added by subsection 

(b)) for renal dialysis services and related services (defined in 

subparagraph (B) of such subsection (b)(14)) and the quality initiative under subsection (h) of such section 1881 (as added by subsection (b)). Such report shall include the following information: 

(1) The changes in utilization rates for erythropoiesis 

stimulating agents. 

Procedures. 


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122 STAT. 2560 PUBLIC LAW 110–275—JULY 15, 2008 

(2) The mode of administering such agents, including 

information on the proportion of individuals receiving such 

agents intravenously as compared to subcutaneously. 

(3) An analysis of the payment adjustment under subparagraph (D)(iii) of such subsection (b)(14), including an examination of the extent to which costs incurred by rural, low-volume 

providers and facilities (as defined by the Secretary) in furnishing renal dialysis services exceed the costs incurred by 

other providers and facilities in furnishing such services, and 

a recommendation regarding the appropriateness of such 

adjustment. 

(4) The changes, if any, in utilization rates of drugs and 

biologicals that the Secretary identifies under subparagraph 

(B)(iii) of such subsection (b)(14), and any oral equivalent or 

oral substitutable forms of such drugs and biologicals or of 

drugs and biologicals described in clause (ii), that have occurred 

after implementation of the payment system under such subsection (b)(14). 

(5) Any other information or recommendations for legislative and administrative actions determined appropriate by the 

Comptroller General. 

SEC. 154. DELAY IN AND REFORM OF MEDICARE DMEPOS COMPETITIVE ACQUISITION PROGRAM. 

(a) TEMPORARY DELAY AND REFORM.— 

(1) IN GENERAL.—Section 1847(a)(1) of the Social Security 

Act (42 U.S.C. 1395w–3(a)(1)) is amended— 

(A) in paragraph (1)— 

(i) in subparagraph (B)(i), in the matter before 

subclause (I), by inserting ‘‘consistent with subparagraph (D)’’ after ‘‘in a manner’’; 

(ii) in subparagraph (B)(i)(II), by striking ‘‘80’’ and 

‘‘in 2009’’ and inserting ‘‘an additional 70’’ and ‘‘in 

2011’’, respectively; 

(iii) in subparagraph (B)(i)(III), by striking ‘‘after 

2009’’ and inserting ‘‘after 2011 (or, in the case of 

national mail order for items and services, after 2010)’’; 

and 

(iv) by adding at the end the following new subparagraphs: 

‘‘(D) CHANGES IN COMPETITIVE ACQUISITION PROGRAMS.— 

‘‘(i) ROUND 1 OF COMPETITIVE ACQUISITION PROGRAM.—Notwithstanding subparagraph (B)(i)(I) and in 

implementing the first round of the competitive 

acquisition programs under this section— 

‘‘(I) the contracts awarded under this section 

before the date of the enactment of this subparagraph are terminated, no payment shall be made 

under this title on or after the date of the enactment of this subparagraph based on such a contract, and, to the extent that any damages may 

be applicable as a result of the termination of 

such contracts, such damages shall be payable 

from the Federal Supplementary Medical Insurance Trust Fund under section 1841; 

Contracts. 


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‘‘(II) the Secretary shall conduct the competition for such round in a manner so that it occurs 

in 2009 with respect to the same items and services 

and the same areas, except as provided in subclauses (III) and (IV); 

‘‘(III) the Secretary shall exclude Puerto Rico 

so that such round of competition covers 9, instead 

of 10, of the largest metropolitan statistical areas; 

and 

‘‘(IV) there shall be excluded negative pressure 

wound therapy items and services. 

Nothing in subclause (I) shall be construed to provide 

an independent cause of action or right to administrative or judicial review with regard to the termination 

provided under such subclause. 

‘‘(ii) ROUND 2 OF COMPETITIVE ACQUISITION PROGRAM.—In implementing the second round of the 

competitive acquisition programs under this section 

described in subparagraph (B)(i)(II)— 

‘‘(I) the metropolitan statistical areas to be 

included shall be those metropolitan statistical 

areas selected by the Secretary for such round 

as of June 1, 2008; and 

‘‘(II) the Secretary may subdivide metropolitan 

statistical areas with populations (based upon the 

most recent data from the Census Bureau) of at 

least 8,000,000 into separate areas for competitive 

acquisition purposes. 

‘‘(iii) EXCLUSION OF CERTAIN AREAS IN SUBSEQUENT

ROUNDS OF COMPETITIVE ACQUISITION PROGRAMS.—In 

implementing subsequent rounds of the competitive 

acquisition programs under this section, including 

under subparagraph (B)(i)(III), for competitions occurring before 2015, the Secretary shall exempt from the 

competitive acquisition program (other than national 

mail order) the following: 

‘‘(I) Rural areas. 

‘‘(II) Metropolitan statistical areas not selected 

under round 1 or round 2 with a population of 

less than 250,000. 

‘‘(III) Areas with a low population density 

within a metropolitan statistical area that is otherwise selected, as determined for purposes of paragraph (3)(A). 

‘‘(E) VERIFICATION BY OIG.—The Inspector General of 

the Department of Health and Human Services shall, 

through post-award audit, survey, or otherwise, assess the 

process used by the Centers for Medicare & Medicaid Services to conduct competitive bidding and subsequent pricing 

determinations under this section that are the basis for 

pivotal bid amounts and single payment amounts for items 

and services in competitive bidding areas under rounds 

1 and 2 of the competitive acquisition programs under 

this section and may continue to verify such calculations 

for subsequent rounds of such programs. 

‘‘(F) SUPPLIER FEEDBACK ON MISSING FINANCIAL DOCU- MENTATION.— 

Puerto Rico. 


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122 STAT. 2562 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(i) IN GENERAL.—In the case of a bid where one 

or more covered documents in connection with such 

bid have been submitted not later than the covered 

document review date specified in clause (ii), the Secretary— 

‘‘(I) shall provide, by not later than 45 days 

(in the case of the first round of the competitive 

acquisition programs as described in subparagraph 

(B)(i)(I)) or 90 days (in the case of a subsequent 

round of such programs) after the covered document review date, for notice to the bidder of all 

such documents that are missing as of the covered 

document review date; and 

‘‘(II) may not reject the bid on the basis that 

any covered document is missing or has not been 

submitted on a timely basis, if all such missing 

documents identified in the notice provided to the 

bidder under subclause (I) are submitted to the 

Secretary not later than 10 business days after 

the date of such notice. 

‘‘(ii) COVERED DOCUMENT REVIEW DATE.—The covered document review date specified in this clause 

with respect to a competitive acquisition program is 

the later of— 

‘‘(I) the date that is 30 days before the final 

date specified by the Secretary for submission of 

bids under such program; or 

‘‘(II) the date that is 30 days after the first 

date specified by the Secretary for submission of 

bids under such program. 

‘‘(iii) LIMITATIONS OF PROCESS.—The process provided under this subparagraph— 

‘‘(I) applies only to the timely submission of 

covered documents; 

‘‘(II) does not apply to any determination as 

to the accuracy or completeness of covered documents submitted or whether such documents meet 

applicable requirements; 

‘‘(III) shall not prevent the Secretary from 

rejecting a bid based on any basis not described 

in clause (i)(II); and 

‘‘(IV) shall not be construed as permitting a 

bidder to change bidding amounts or to make other 

changes in a bid submission. 

‘‘(iv) COVERED DOCUMENT DEFINED.—In this 

subparagraph, the term ‘covered document’ means a 

financial, tax, or other document required to be submitted by a bidder as part of an original bid submission 

under a competitive acquisition program in order to 

meet required financial standards. Such term does not 

include other documents, such as the bid itself or 

accreditation documentation.’’; and 

(B) in paragraph (2)(A), by inserting before the period 

at the end the following: ‘‘and excluding certain complex 

rehabilitative power wheelchairs recognized by the Secretary as classified within group 3 or higher (and related 

Deadlines. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2563 

accessories when furnished in connection with such wheelchairs)’’. 

(2) BUDGET NEUTRAL OFFSET.— 

(A) IN GENERAL.—Section 1834(a)(14) of such Act (42 

U.S.C. 1395m(a)(14)) is amended— 

(i) by striking ‘‘and’’ at the end of subparagraphs 

(H) and (I); 

(ii) by redesignating subparagraph (J) as subparagraph (M); and 

(iii) by inserting after subparagraph (I) the following new subparagraphs: 

‘‘(J) for 2009— 

‘‘(i) in the case of items and services furnished 

in any geographic area, if such items or services were 

selected for competitive acquisition in any area under 

the competitive acquisition program under section 

1847(a)(1)(B)(i)(I) before July 1, 2008, including related 

accessories but only if furnished with such items and 

services selected for such competition and diabetic supplies but only if furnished through mail order, - 9.5 

percent; or 

‘‘(ii) in the case of other items and services, the 

percentage increase in the consumer price index for 

all urban consumers (U.S. urban average) for the 12- 

month period ending with June 2008; 

‘‘(K) for 2010, 2011, 2012, and 2013, the percentage 

increase in the consumer price index for all urban consumers (U.S. urban average) for the 12-month period 

ending with June of the previous year; 

‘‘(L) for 2014— 

‘‘(i) in the case of items and services described 

in subparagraph (J)(i) for which a payment adjustment 

has not been made under subsection (a)(1)(F)(ii) in 

any previous year, the percentage increase in the consumer price index for all urban consumers (U.S. urban 

average) for the 12-month period ending with June 

2013, plus 2.0 percentage points; or 

‘‘(ii) in the case of other items and services, the 

percentage increase in the consumer price index for 

all urban consumers (U.S. urban average) for the 12- 

month period ending with June 2013; and’’. 

(B) CONFORMING TREATMENT FOR CERTAIN ITEMS AND

SERVICES.—The second sentence of section 1842(s)(1) of 

such Act (42 U.S.C. 1395u(s)(1)) is amended by striking 

‘‘except that’’ and all that follows and inserting the following: ‘‘except that for items and services described in 

paragraph (2)(D)— 

‘‘(A) for 2009 section 1834(a)(14)(J)(i) shall apply under 

this paragraph instead of the percentage increase otherwise 

applicable; and 

‘‘(B) for 2014, if subparagraph (A) is applied to the items 

and services and there has not been a payment adjustment 

under paragraph (3)(B) for the items and services for any 

previous year, the percentage increase computed under section 

1834(a)(14)(L)(i) shall apply instead of the percentage increase 

otherwise applicable.’’. 

Applicability. 


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122 STAT. 2564 PUBLIC LAW 110–275—JULY 15, 2008 

(3) CONFORMING DELAY.—Subsections (a)(1)(F) and 

(h)(1)(H) of section 1834 of the Social Security Act (42 U.S.C. 

1395m) are each amended by striking ‘‘January 1, 2009’’ and 

inserting ‘‘January 1, 2011’’. 

(4) CONSIDERATIONS IN APPLICATION.—Section 1834 of such 

Act (42 U.S.C. 1395m) is amended— 

(A) in subsection (a)(1)— 

(i) in subparagraph (F), by inserting ‘‘subject to 

subparagraph (G),’’ before ‘‘that are included’’; and 

(ii) by adding at the end the following new 

subparagraph: 

‘‘(G) USE OF INFORMATION ON COMPETITIVE BID RATES.— 

The Secretary shall specify by regulation the methodology 

to be used in applying the provisions of subparagraph 

(F)(ii) and subsection (h)(1)(H)(ii). In promulgating such 

regulation, the Secretary shall consider the costs of items 

and services in areas in which such provisions would be 

applied compared to the payment rates for such items 

and services in competitive acquisition areas.’’; and 

(B) in subsection (h)(1)(H), by inserting ‘‘subject to 

subsection (a)(1)(G),’’ before ‘‘that are included’’. 

(b) QUALITY STANDARDS.— 

(1) APPLICATION OF ACCREDITATION REQUIREMENT.— 

(A) IN GENERAL.—Section 1834(a)(20) of the Social 

Security Act (42 U.S.C. 1395m(a)(20)) is amended— 

(i) in subparagraph (E), by inserting ‘‘including 

subparagraph (F),’’ after ‘‘under this paragraph,’’; and 

(ii) by adding at the end the following new 

subparagraph: 

‘‘(F) APPLICATION OF ACCREDITATION REQUIREMENT.— 

In implementing quality standards under this paragraph— 

‘‘(i) subject to clause (ii), the Secretary shall require 

suppliers furnishing items and services described in 

subparagraph (D) on or after October 1, 2009, directly 

or as a subcontractor for another entity, to have submitted to the Secretary evidence of accreditation by 

an accreditation organization designated under 

subparagraph (B) as meeting applicable quality standards; and 

‘‘(ii) in applying such standards and the accreditation requirement of clause (i) with respect to eligible 

professionals (as defined in section 1848(k)(3)(B)), and 

including such other persons, such as orthotists and 

prosthetists, as specified by the Secretary, furnishing 

such items and services— 

‘‘(I) such standards and accreditation requirement shall not apply to such professionals and 

persons unless the Secretary determines that the 

standards being applied are designed specifically 

to be applied to such professionals and persons; 

and 

‘‘(II) the Secretary may exempt such professionals and persons from such standards and 

requirement if the Secretary determines that 

licensing, accreditation, or other mandatory quality 

Effective date. 

Regulations. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2565 

requirements apply to such professionals and persons with respect to the furnishing of such items 

and services.’’. 

(B) CONSTRUCTION.—Section 1834(a)(20)(F)(ii) of the 

Social Security Act, as added by subparagraph (A), shall 

not be construed as preventing the Secretary of Health 

and Human Services from implementing the first round 

of competition under section 1847 of such Act on a timely 

basis. 

(2) DISCLOSURE OF SUBCONTRACTORS UNDER COMPETITIVE

ACQUISITION PROGRAM.—Section 1847(b)(3) of such Act (42 

U.S.C. 1395w–3(b)(3)) is amended by adding at the end the 

following new subparagraph: 

‘‘(C) DISCLOSURE OF SUBCONTRACTORS.— 

‘‘(i) INITIAL DISCLOSURE.—Not later than 10 days 

after the date a supplier enters into a contract with 

the Secretary under this section, such supplier shall 

disclose to the Secretary, in a form and manner specified by the Secretary, the information on— 

‘‘(I) each subcontracting relationship that such 

supplier has in furnishing items and services 

under the contract; and 

‘‘(II) whether each such subcontractor meets 

the requirement of section 1834(a)(20)(F)(i), if 

applicable to such subcontractor. 

‘‘(ii) SUBSEQUENT DISCLOSURE.—Not later than 10 

days after such a supplier subsequently enters into 

a subcontracting relationship described in clause (i)(II), 

such supplier shall disclose to the Secretary, in such 

form and manner, the information described in subclauses (I) and (II) of clause (i).’’. 

(3) COMPETITIVE ACQUISITION OMBUDSMAN.—Such section 

is further amended by adding at the end the following new 

subsection: 

‘‘(f) COMPETITIVE ACQUISITION OMBUDSMAN.—The Secretary 

shall provide for a competitive acquisition ombudsman within the 

Centers for Medicare & Medicaid Services in order to respond 

to complaints and inquiries made by suppliers and individuals 

relating to the application of the competitive acquisition program 

under this section. The ombudsman may be within the office of 

the Medicare Beneficiary Ombudsman appointed under section 

1808(c). The ombudsman shall submit to Congress an annual report 

on the activities under this subsection, which report shall be coordinated with the report provided under section 1808(c)(2)(C).’’. 

(c) CHANGE IN REPORTS AND DEADLINES.— 

(1) GAO REPORT.—Section 302(b)(3) of the Medicare 

Prescription Drug, Improvement, and Modernization Act of 

2003 (Public Law 108-173) is amended— 

(A) in subparagraph (A)— 

(i) by inserting ‘‘and as amended by section 2 of 

the Medicare DMEPOS Competitive Acquisition 

Reform Act of 2008’’ after ‘‘as amended by paragraph 

(1)’’; and 

(ii) by inserting before the period at the end the 

following: ‘‘and the topics specified in subparagraph 

(C)’’; 

42 USC 1395w–3 

note. 

Reports. 

Establishment. 

Deadline. 

42 USC 1395m 

note. 


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122 STAT. 2566 PUBLIC LAW 110–275—JULY 15, 2008 

(B) in subparagraph (B), by striking ‘‘Not later than 

January 1, 2009,’’ and inserting ‘‘Not later than 1 year 

after the first date that payments are made under section 

1847 of the Social Security Act,’’; and 

(C) by adding at the end the following new subparagraph: 

‘‘(C) TOPICS.—The topics specified in this subparagraph, for the study under subparagraph (A) concerning 

the competitive acquisition program, are the following: 

‘‘(i) Beneficiary access to items and services under 

the program, including the impact on such access of 

awarding contracts to bidders that— 

‘‘(I) did not have a physical presence in an 

area where they received a contract; or 

‘‘(II) had no previous experience providing the 

product category they were contracted to provide. 

‘‘(ii) Beneficiary satisfaction with the program and 

cost savings to beneficiaries under the program. 

‘‘(iii) Costs to suppliers of participating in the program and recommendations about ways to reduce those 

costs without compromising quality standards or 

savings to the Medicare program. 

‘‘(iv) Impact of the program on small business suppliers. 

‘‘(v) Analysis of the impact on utilization of different items and services paid within the same 

Healthcare Common Procedure Coding System 

(HCPCS) code. 

‘‘(vi) Costs to the Centers for Medicare & Medicaid 

Services, including payments made to contractors, for 

administering the program compared with administration of a fee schedule, in comparison with the relative 

savings of the program. 

‘‘(vii) Impact on access, Medicare spending, and 

beneficiary spending of any difference in treatment 

for diabetic testing supplies depending on how such 

supplies are furnished. 

‘‘(viii) Such other topics as the Comptroller General 

determines to be appropriate.’’. 

(2) DELAY IN OTHER DEADLINES.— 

(A) PROGRAM ADVISORY AND OVERSIGHT COMMITTEE.— 

Section 1847(c)(5) of the Social Security Act (42 U.S.C. 

1395w–3(c)(5)) is amended by striking ‘‘December 31, 2009’’ 

and inserting ‘‘December 31, 2011’’. 

(B) SECRETARIAL REPORT.—Section 1847(d) of such Act 

(42 U.S.C. 1395w–3(d)) is amended by striking ‘‘July 1, 

2009’’ and inserting ‘‘July 1, 2011’’. 

(C) IG REPORT.—Section 302(e) of the Medicare 

Prescription Drug, Improvement, and Modernization Act 

of 2003 (Public Law 108-173) is amended by striking ‘‘July 

1, 2009’’ and inserting ‘‘July 1, 2011’’. 

(3) EVALUATION OF CERTAIN CODE.—The Secretary of 

Health and Human Services shall evaluate the existing Health 

Care Common Procedure Coding System (HCPCS) codes for 

negative pressure wound therapy to ensure accurate reporting 

and billing for items and services under such codes. In carrying 

out such evaluation, the Secretary shall use an existing process, 

42 USC 1395m 

note. 

42 USC 1395w–3 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2567 

administered by the Durable Medical Equipment Medicare 

Administrative Contractors, for the consideration of coding 

changes and consider all relevant studies and information furnished pursuant to such process. 

(d) OTHER PROVISIONS.— (1) EXEMPTION FROM COMPETITIVE ACQUISITION FOR CER- TAIN OFF-THE-SHELF ORTHOTICS.—Section 1847(a) of the Social 

Security Act (42 U.S.C. 1395w–3(a)) is amended by adding 

at the end the following new paragraph: 

‘‘(7) EXEMPTION FROM COMPETITIVE ACQUISITION.—The programs under this section shall not apply to the following: 

‘‘(A) CERTAIN OFF-THE-SHELF ORTHOTICS.—Items and 

services described in paragraph (2)(C) if furnished— 

‘‘(i) by a physician or other practitioner (as defined 

by the Secretary) to the physician’s or practitioner’s 

own patients as part of the physician’s or practitioner’s 

professional service; or 

‘‘(ii) by a hospital to the hospital’s own patients 

during an admission or on the date of discharge. 

‘‘(B) CERTAIN DURABLE MEDICAL EQUIPMENT.—Those 

items and services described in paragraph (2)(A)— 

‘‘(i) that are furnished by a hospital to the hospital’s own patients during an admission or on the 

date of discharge; and 

‘‘(ii) to which such programs would not apply, as 

specified by the Secretary, if furnished by a physician 

to the physician’s own patients as part of the physician’s professional service.’’. 

(2) CORRECTION IN FACE-TO-FACE EXAMINATION REQUIREMENT.—Section 1834(a)(1)(E)(ii) of such Act (42 U.S.C. 

1395m(a)(1)(E)(ii)) is amended by striking ‘‘1861(r)(1)’’ and 

inserting ‘‘1861(r)’’. 

(3) SPECIAL RULE IN CASE OF NATIONAL MAIL-ORDER COMPETITION FOR DIABETIC TESTING STRIPS.—Section 1847(b) of such 

Act (42 U.S.C. 1395w–3(b)) is amended— 

(A) by redesignating paragraph (10) as paragraph (11); 

and 

(B) by inserting after paragraph (9) the following new 

paragraph: 

‘‘(10) SPECIAL RULE IN CASE OF COMPETITION FOR DIABETIC

TESTING STRIPS.— 

‘‘(A) IN GENERAL.—With respect to the competitive 

acquisition program for diabetic testing strips conducted 

after the first round of the competitive acquisition programs, if an entity does not demonstrate to the Secretary 

that its bid covers types of diabetic testing strip products 

that, in the aggregate and taking into account volume 

for the different products, cover 50 percent (or such higher 

percentage as the Secretary may specify) of all such types 

of products, the Secretary shall reject such bid. The volume 

for such types of products may be determined in accordance 

with such data (which may be market based data) as 

the Secretary recognizes. 

‘‘(B) STUDY OF TYPES OF TESTING STRIP PRODUCTS.— 

Before 2011, the Inspector General of the Department of 

Health and Human Services shall conduct a study to determine the types of diabetic testing strip products by volume 

Deadline. 


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122 STAT. 2568 PUBLIC LAW 110–275—JULY 15, 2008 

that could be used to make determinations pursuant to 

subparagraph (A) for the first competition under the 

competitive acquisition program described in such subparagraph and submit to the Secretary a report on the results 

of the study. The Inspector General shall also conduct 

such a study and submit such a report before the Secretary 

conducts a subsequent competitive acquistion program 

described in subparagraph (A).’’. 

(4) OTHER CONFORMING AMENDMENTS.—Section 1847(b)(11) 

of such Act, as redesignated by paragraph (3), is amended— 

(A) in subparagraph (C), by inserting ‘‘and the identification of areas under subsection (a)(1)(D)(iii)’’ after 

‘‘(a)(1)(A)’’; 

(B) in subparagraph (D), by inserting ‘‘and implementation of subsection (a)(1)(D)’’ after ‘‘(a)(1)(B)’’; 

(C) in subparagraph (E), by striking ‘‘or’’ at the end; 

(D) in subparagraph (F), by striking the period at 

the end and inserting ‘‘; or’’; and 

(E) by adding at the end the following new subparagraph: 

‘‘(G) the implementation of the special rule described 

in paragraph (10).’’. 

(5) FUNDING FOR IMPLEMENTATION.—In addition to funds 

otherwise available, for purposes of implementing the provisions of, and amendments made by, this section, other than 

the amendment made by subsection (c)(1) and other than section 1847(a)(1)(E) of the Social Security Act, the Secretary 

of Health and Human Services shall provide for the transfer 

from the Federal Supplementary Medical Insurance Trust Fund 

established under section 1841 of the Social Security Act (42 

U.S.C. 1395t) to the Centers for Medicare & Medicaid Services 

Program Management Account of $20,000,000 for fiscal year 

2008, and $25,000,000 for each of fiscal years 2009 through 

2012. Amounts transferred under this paragraph for a fiscal 

year shall be available until expended. 

(e) EFFECTIVE DATE.—The amendments made by this section 

shall take effect as of June 30, 2008. 

Subtitle D—Provisions Relating to Part C 

SEC. 161. PHASE-OUT OF INDIRECT MEDICAL EDUCATION (IME). 

(a) IN GENERAL.—Section 1853(k) of the Social Security Act 

(42 U.S.C. 1395w–23(k)) is amended— 

(1) in paragraph (1), in the matter preceding subparagraph 

(A), by striking ‘‘paragraph (2)’’ and inserting ‘‘paragraphs (2) 

and (4)’’; and 

(2) by adding at the end the following new paragraph: 

‘‘(4) PHASE-OUT OF THE INDIRECT COSTS OF MEDICAL EDUCATION FROM CAPITATION RATES.— 

‘‘(A) IN GENERAL.—After determining the applicable 

amount for an area for a year under paragraph (1) (beginning with 2010), the Secretary shall adjust such applicable 

amount to exclude from such applicable amount the phasein percentage (as defined in subparagraph (B)(i)) for the 

year of the Secretary’s estimate of the standardized costs 

for payments under section 1886(d)(5)(B) in the area for 

42 USC 1395m 

note. 

Reports. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2569 

the year. Any adjustment under the preceding sentence 

shall be made prior to the application of paragraph (2). 

‘‘(B) PERCENTAGES DEFINED.—For purposes of this 

paragraph: 

‘‘(i) PHASE-IN PERCENTAGE.—The term ‘phase-in 

percentage’ means, for an area for a year, the ratio 

(expressed as a percentage, but in no case greater 

than 100 percent) of— 

‘‘(I) the maximum cumulative adjustment 

percentage for the year (as defined in clause (ii)); 

to 

‘‘(II) the standardized IME cost percentage (as 

defined in clause (iii)) for the area and year. 

‘‘(ii) MAXIMUM CUMULATIVE ADJUSTMENT PERCENTAGE.—The term ‘maximum cumulative adjustment 

percentage’ means, for— 

‘‘(I) 2010, 0.60 percent; and 

‘‘(II) a subsequent year, the maximum cumulative adjustment percentage for the previous year 

increased by 0.60 percentage points. 

‘‘(iii) STANDARDIZED IME COST PERCENTAGE.—The 

term ‘standardized IME cost percentage’ means, for 

an area for a year, the per capita costs for payments 

under section 1886(d)(5)(B) (expressed as a percentage 

of the fee-for-service amount specified in subparagraph 

(C)) for the area and the year. 

‘‘(C) FEE-FOR-SERVICE AMOUNT.—The fee-for-service 

amount specified in this subparagraph for an area for 

a year is the amount specified under subsection (c)(1)(D) 

for the area and the year.’’. 

(b) EXCLUDING ADJUSTMENT FROM THE UPDATE.—Section 

1853(k)(1)(B)(i) of the Social Security Act (42 U.S.C. 1395w– 

23(k)(1)(B)(i)) is amended by striking ‘‘paragraph (2)’’ and inserting 

‘‘paragraphs (2) and (4)’’. 

(c) HOLD HARMLESS FOR PACE PROGRAM PAYMENTS.—Section 

1894(d) of the Social Security Act (42 U.S.C. 1395eee(d)) is amended 

by adding at the end the following new paragraph: 

‘‘(3) CAPITATION RATES DETERMINED WITHOUT REGARD TO

THE PHASE-OUT OF THE INDIRECT COSTS OF MEDICAL EDUCATION

FROM THE ANNUAL MEDICARE ADVANTAGE CAPITATION RATE.— 

Capitation amounts under this subsection shall be determined 

without regard to the application of section 1853(k)(4).’’. 

SEC. 162. REVISIONS TO REQUIREMENTS FOR MEDICARE ADVANTAGE 

PRIVATE FEE-FOR-SERVICE PLANS. 

(a) REQUIREMENTS TO ASSURE ACCESS TO NETWORK COVERAGE.— 

(1) INDIVIDUAL MARKET.—Section 1852(d) of the Social 

Security Act (42 U.S.C. 1395w–22(d)) is amended— 

(A) in paragraph (4), in the second sentence, by striking 

‘‘The Secretary’’ and inserting ‘‘Subject to paragraph (5), 

the Secretary’’; and 

(B) by adding at the end the following new paragraph: 

‘‘(5) REQUIREMENT OF CERTAIN NONEMPLOYER MEDICARE

ADVANTAGE PRIVATE FEE-FOR-SERVICE PLANS TO USE CONTRACTS

WITH PROVIDERS.— 


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122 STAT. 2570 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(A) IN GENERAL.—For plan year 2011 and subsequent 

plan years, in the case of a Medicare Advantage private 

fee-for-service plan not described in paragraph (1) or (2) 

of section 1857(i) operating in a network area (as defined 

in subparagraph (B)), the plan shall meet the access standards under paragraph (4) in that area only through 

entering into written contracts as provided for under 

subparagraph (B) of such paragraph and not, in whole 

or in part, through the establishment of payment rates 

meeting the requirements under subparagraph (A) of such 

paragraph. 

‘‘(B) NETWORK AREA DEFINED.—For purposes of 

subparagraph (A), the term ‘network area’ means, for a 

plan year, an area which the Secretary identifies (in the 

Secretary’s announcement of the proposed payment rates 

for the previous plan year under section 1853(b)(1)(B)) as 

having at least 2 network-based plans (as defined in 

subparagraph (C)) with enrollment under this part as of 

the first day of the year in which such announcement 

is made. 

‘‘(C) NETWORK-BASED PLAN DEFINED.— 

‘‘(i) IN GENERAL.—For purposes of subparagraph 

(B), the term ‘network-based plan’ means— 

‘‘(I) except as provided in clause (ii), a Medicare Advantage plan that is a coordinated care 

plan described in section 1851(a)(2)(A)(i); 

‘‘(II) a network-based MSA plan; and 

‘‘(III) a reasonable cost reimbursement plan 

under section 1876. 

‘‘(ii) EXCLUSION OF NON-NETWORK REGIONAL

PPOS.—The term ‘network-based plan’ shall not include 

an MA regional plan that, with respect to the area, 

meets access adequacy standards under this part 

substantially through the authority of section 

422.112(a)(1)(ii) of title 42, Code of Federal Regulations, rather than through written contracts.’’. 

(2) EMPLOYER PLANS.—Section 1852(d) of the Social Security Act (42 U.S.C. 1395w–22(d)), as amended by paragraph 

(1), is amended— 

(A) in paragraph (4), in the second sentence, by striking 

‘‘paragraph (5)’’ and inserting ‘‘paragraphs (5) and (6)’’; 

and 

(B) by adding at the end the following new paragraph: 

‘‘(6) REQUIREMENT OF ALL EMPLOYER MEDICARE ADVANTAGE

PRIVATE FEE-FOR-SERVICE PLANS TO USE CONTRACTS WITH PROVIDERS.—For plan year 2011 and subsequent plan years, in 

the case of a Medicare Advantage private fee-for-service plan 

that is described in paragraph (1) or (2) of section 1857(i), 

the plan shall meet the access standards under paragraph 

(4) only through entering into written contracts as provided 

for under subparagraph (B) of such paragraph and not, in 

whole or in part, through the establishment of payment rates 

meeting the requirements under subparagraph (A) of such paragraph.’’. 

(3) ACCESS REQUIREMENTS.— (A) IN GENERAL.—Section 1852(d)(4)(B) of the Social 

Security Act (42 U.S.C. 1395w–22(d)(4)(B)) is amended by 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2571 

striking ‘‘a sufficient number’’ through ‘‘terms of the plan’’ 

and inserting ‘‘a sufficient number and range of providers 

within such category to meet the access standards in subparagraphs (A) through (E) of paragraph (1)’’. 

(B) EFFECTIVE DATE.—The amendment made by 

subparagraph (A) shall apply to plan year 2010 and subsequent plan years. 

(b) CLARIFICATION REGARDING UTILIZATION.—Section 1859(b)(2) 

of the Social Security Act (42 U.S.C. 1395w–28(b)(2)) is amended 

by adding at the end the following flush sentence: 

‘‘Nothing in subparagraph (B) shall be construed to preclude 

a plan from varying rates for such a provider based on the 

specialty of the provider, the location of the provider, or other 

factors related to such provider that are not related to utilization, or to preclude a plan from increasing rates for such 

a provider based on increased utilization of specified preventive 

or screening services.’’. 

SEC. 163. REVISIONS TO QUALITY IMPROVEMENT PROGRAMS. 

(a) REQUIREMENT FOR MA PRIVATE FEE-FOR-SERVICE AND MSA 

PLANS TO HAVE A QUALITY IMPROVEMENT PROGRAM.—Section 

1852(e)(1) of the Social Security Act (42 U.S.C. 1395w–22(e)(1)) 

is amended by striking ‘‘(other than an MA private fee-for-service 

plan or an MSA plan)’’. 

(b) DATA COLLECTION REQUIREMENTS FOR MA REGIONAL PLANS, MA PRIVATE FEE-FOR-SERVICE PLANS, AND MSA PLANS.—Section 

1852(e)(3)(A) of the Social Security Act (42 U.S.C. 1395w– 

22(e)(3)(A)) is amended— 

(1) in clause (i), by adding at the end the following new 

sentence: ‘‘With respect to MA private fee-for-service plans and 

MSA plans, the requirements under the preceding sentence 

may not exceed the requirements under this subparagraph 

with respect to MA local plans that are preferred provider 

organization plans, except that, for plan year 2010, the limitation under clause (iii) shall not apply and such requirements 

shall apply only with respect to administrative claims data.’’ 

(2) by striking clause (ii); and 

(3) in clause (iii)— 

(A) in the heading— 

(i) by inserting ‘‘LOCAL’’ after ‘‘TO’’; and 

(ii) by inserting ‘‘AND MA REGIONAL PLANS’’ after ‘‘ORGANIZATIONS’’; and 

(B) by inserting ‘‘and to MA regional plans’’ after 

‘‘organization plans’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to plan years beginning on or after January 1, 2010. 

SEC. 164. REVISIONS RELATING TO SPECIALIZED MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS. 

(a) EXTENSION OF AUTHORITY TO RESTRICT ENROLLMENT.—Section 1859(f) of the Social Security Act (42 U.S.C. 1395w–28(f)), 

as amended by section 108(a) of the Medicare, Medicaid, and SCHIP 

Extension Act of 2007 (Public Law 110–173) is amended by striking 

‘‘2010’’ and inserting ‘‘2011’’. 

(b) MORATORIUM ON AUTHORITY TO DESIGNATE OTHER PLANS

AS SPECIALIZED MA PLANS.—During the period beginning on 

January 1, 2010, and ending on December 31, 2010, the Secretary 

of Health and Human Services may not exercise the authority 

Time period. 

42 USC 

1395w–21 note. 

42 USC 

1395w–22 note. 

42 USC 

1395w–22 note. 


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122 STAT. 2572 PUBLIC LAW 110–275—JULY 15, 2008 

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. 

(c) REQUIREMENTS FOR ENROLLMENT.— (1) IN GENERAL.—Section 1859 of the Social Security Act 

(42 U.S.C. 1395w–28) is amended— 

(A) in subsection (b)(6)(A), by inserting ‘‘and that, as 

of January 1, 2010, meets the applicable requirements 

of paragraph (2), (3), or (4) of subsection (f), as the case 

may be’’ before the period at the end; and 

(B) in subsection (f)— 

(i) by amending the heading to read as follows: 

‘‘REQUIREMENTS REGARDING ENROLLMENT IN SPECIAL- IZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS’’; 

(ii) by designating the sentence beginning ‘‘In the 

case of’’ as paragraph (1) with the heading ‘‘REQUIREMENTS FOR ENROLLMENT.—’’ and with appropriate 

indentation; and 

(iii) by adding at the end the following new paragraphs: 

‘‘(2) ADDITIONAL REQUIREMENTS FOR INSTITUTIONAL SNPS.— 

In the case of a specialized MA plan for special needs individuals described in subsection (b)(6)(B)(i), the applicable requirements described in this paragraph are as follows: 

‘‘(A) Each individual that enrolls in the plan on or 

after January 1, 2010, is a special needs individuals 

described in subsection (b)(6)(B)(i). In the case of an individual who is living in the community but requires an 

institutional level of care, such individual shall not be 

considered a special needs individual described in subsection (b)(6)(B)(i) unless the determination that the individual requires an institutional level of care was made— 

‘‘(i) using a State assessment tool of the State 

in which the individual resides; and 

‘‘(ii) by an entity other than the organization 

offering the plan. 

‘‘(B) The plan meets the requirements described in 

paragraph (5). 

‘‘(3) ADDITIONAL REQUIREMENTS FOR DUAL SNPS.—In the 

case of a specialized MA plan for special needs individuals 

described in subsection (b)(6)(B)(ii), the applicable requirements 

described in this paragraph are as follows: 

‘‘(A) Each individual that enrolls in the plan on or 

after January 1, 2010, is a special needs individuals 

described in subsection (b)(6)(B)(ii). 

‘‘(B) The plan meets the requirements described in 

paragraph (5). 

‘‘(C) The plan provides each prospective enrollee, prior 

to enrollment, with a comprehensive written statement 

(using standardized content and format established by the 

Secretary) that describes— 

‘‘(i) the benefits and cost-sharing protections that 

the individual is entitled to under the State Medicaid 

program under title XIX; and 

‘‘(ii) which of such benefits and cost-sharing protections are covered under the plan. 

Effective date. 

Effective date. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2573 

Such statement shall be included with any description of 

benefits offered by the plan. 

‘‘(D) The plan has a contract with the State Medicaid 

agency to provide benefits, or arrange for benefits to be 

provided, for which such individual is entitled to receive 

as medical assistance under title XIX. Such benefits may 

include long-term care services consistent with State policy. 

‘‘(4) ADDITIONAL REQUIREMENTS FOR SEVERE OR DISABLING

CHRONIC CONDITION SNPS.—In the case of a specialized MA 

plan for special needs individuals described in subsection 

(b)(6)(B)(iii), the applicable requirements described in this paragraph are as follows: 

‘‘(A) Each individual that enrolls in the plan on or 

after January 1, 2010, is a special needs individual 

described in subsection (b)(6)(B)(iii). 

‘‘(B) The plan meets the requirements described in 

paragraph (5).’’. 

(2) AUTHORITY TO OPERATE BUT NO SERVICE AREA EXPANSION FOR DUAL SNPS THAT DO NOT MEET CERTAIN REQUIREMENTS.—Notwithstanding subsection (f) of section 1859 of the 

Social Security Act (42 U.S.C. 1395w–28), during the period 

beginning on January 1, 2010, and ending on December 31, 

2010, in the case of a specialized Medicare Advantage plan 

for special needs individuals described in subsection (b)(6)(B)(ii) 

of such section, as amended by this section, that does not 

meet the requirement described in subsection (f)(3)(D) of such 

section, the Secretary of Health and Human Services— 

(A) shall permit such plan to be offered under part 

C of title XVIII of such Act; and 

(B) shall not permit an expansion of the service area 

of the plan under such part C. 

(3) RESOURCES FOR STATE MEDICAID AGENCIES.—The Secretary of Health and Human Services shall provide for the 

designation of appropriate staff and resources that can address 

State inquiries with respect to the coordination of State and 

Federal policies for specialized MA plans for special needs 

individuals described in section 1859(b)(6)(B)(ii) of the Social 

Security Act (42 U.S.C. 1395w–28(b)(6)(B)(ii)), as amended by 

this section. 

(4) NO REQUIREMENT FOR CONTRACT.—Nothing in the provisions of, or amendments made by, this subsection shall require 

a State to enter into a contract with a Medicare Advantage 

organization with respect to a specialized MA plan for special 

needs individuals described in section 1859(b)(6)(B)(ii) of the 

Social Security Act (42 U.S.C. 1395w–28(b)(6)(B)(ii)), as 

amended by this section. 

(d) CARE MANAGEMENT REQUIREMENTS FOR ALL SNPS.— 

(1) REQUIREMENTS.—Section 1859(f) of the Social Security 

Act (42 U.S.C. 1395w–28(f)), as amended by subsection (c)(1), 

is amended by adding at the end the following new paragraph: 

‘‘(5) CARE MANAGEMENT REQUIREMENTS FOR ALL SNPS.— 

The requirements described in this paragraph are that the 

organization offering a specialized MA plan for special needs 

individuals described in subsection (b)(6)(B)(i)— 

‘‘(A) have in place an evidenced-based model of care 

with appropriate networks of providers and specialists; and 

Time period. 

42 USC 

1395w–28 note. 

Effective date. 


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122 STAT. 2574 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(B) with respect to each individual enrolled in the 

plan— 

‘‘(i) conduct an initial assessment and an annual 

reassessment of the individual’s physical, psychosocial, 

and functional needs; 

‘‘(ii) develop a plan, in consultation with the individual as feasible, that identifies goals and objectives, 

including measurable outcomes as well as specific services and benefits to be provided; and 

‘‘(iii) use an interdisciplinary team in the management of care.’’. 

(2) REVIEW TO ENSURE COMPLIANCE WITH CARE MANAGEMENT REQUIREMENTS.—Section 1857(d) of the Social Security 

Act (42 U.S.C. 1395w–27(d)) is amended by adding at the 

end the following new paragraph: 

‘‘(6) REVIEW TO ENSURE COMPLIANCE WITH CARE MANAGEMENT REQUIREMENTS FOR SPECIALIZED MEDICARE ADVANTAGE

PLANS FOR SPECIAL NEEDS INDIVIDUALS.—In conjunction with 

the periodic audit of a specialized Medicare Advantage plan 

for special needs individuals under paragraph (1), the Secretary 

shall conduct a review to ensure that such organization offering 

the plan meets the requirements described in section 

1859(f)(5).’’. 

(e) CLARIFICATION OF THE DEFINITION OF A SEVERE OR DISABLING CHRONIC CONDITIONS SPECIALIZED NEEDS INDIVIDUAL.— 

(1) IN GENERAL.—Section 1859(b)(6)(B)(iii) of the Social 

Security Act (42 U.S.C. 1395w–28(b)(6)(B)(iii)) is amended by 

inserting ‘‘who have one or more comorbid and medically complex chronic conditions that are substantially disabling or life 

threatening, have a high risk of hospitalization or other significant adverse health outcomes, and require specialized delivery 

systems across domains of care’’ before the period at the end. 

(2) PANEL.—The Secretary of Health and Human Services 

shall convene a panel of clinical advisors to determine the 

conditions that meet the definition of severe and disabling 

chronic conditions under section 1859(b)(6)(B)(iii) of the Social 

Security Act (42 U.S.C. 1395w–28(b)(6)(B)(iii)), as amended by 

paragraph (1). The panel shall include the Director of the 

Agency for Healthcare Research and Quality (or the Director’s 

designee). 

(f) SPECIAL REQUIREMENTS REGARDING QUALITY REPORTING FOR

SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS.— 

(1) IN GENERAL.—Section 1852(e)(3)(A) of the Social Security Act (42 U.S.C. 1395w–22(e)(3)(A)), as amended by section 

163, is amended by inserting after clause (i) the following 

new clause: 

‘‘(ii) SPECIAL REQUIREMENTS FOR SPECIALIZED MA

PLANS FOR SPECIAL NEEDS INDIVIDUALS.—In addition 

to the data required to be collected, analyzed, and 

reported under clause (i) and notwithstanding the 

limitations under subparagraph (B), as part of the 

quality improvement program under paragraph (1), 

each MA organization offering a specialized Medicare 

Advantage plan for special needs individuals shall provide for the collection, analysis, and reporting of data 

that permits the measurement of health outcomes and 

Establishment. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2575 

other indices of quality with respect to the requirements described in paragraphs (2) through (5) of subsection (f). Such data may be based on claims data 

and shall be at the plan level.’’. 

(2) EFFECTIVE DATE.—The amendment made by paragraph 

(1) shall take effect on a date specified by the Secretary of 

Health and Human Services (but in no case later than January 

1, 2010), and shall apply to all specialized Medicare Advantage 

plans for special needs individuals regardless of when the plan 

first entered the Medicare Advantage program under part C 

of title XVIII of the Social Security Act. 

(g) EFFECTIVE DATE AND APPLICATION.—The amendments made 

by subsections (c)(1), (d), and (e)(1) shall apply to plan years beginning on or after January 1, 2010, and shall apply to all specialized 

Medicare Advantage plans for special needs individuals regardless 

of when the plan first entered the Medicare Advantage program 

under part C of title XVIII of the Social Security Act. 

(h) NO AFFECT ON MEDICAID BENEFITS FOR DUALS.—Nothing 

in the provisions of, or amendments made by, this section shall 

affect the benefits available under the Medicaid program under 

title XIX of the Social Security Act for special needs individuals 

described in section 1859(b)(6)(B)(ii) of such Act (42 U.S.C. 1395w– 

28(b)(6)(B)(ii)). 

SEC. 165. LIMITATION ON OUT-OF-POCKET COSTS FOR DUAL ELIGIBLES AND QUALIFIED MEDICARE BENEFICIARIES 

ENROLLED IN A SPECIALIZED MEDICARE ADVANTAGE 

PLAN FOR SPECIAL NEEDS INDIVIDUALS. 

(a) IN GENERAL.—Section 1852(a) of the Social Security Act 

(42 U.S.C. 1395w–22(a)) is amended by adding at the end the 

following new paragraph: 

‘‘(7) LIMITATION ON COST-SHARING FOR DUAL ELIGIBLES AND

QUALIFIED MEDICARE BENEFICIARIES.—In the case of an individual who is a full-benefit dual eligible individual (as defined 

in section 1935(c)(6)) or a qualified medicare beneficiary (as 

defined in section 1905(p)(1)) and who is enrolled in a specialized Medicare Advantage plan for special needs individuals 

described in section 1859(b)(6)(B)(ii), the plan may not impose 

cost-sharing that exceeds the amount of cost-sharing that would 

be permitted with respect to the individual under title XIX 

if the individual were not enrolled in such plan.’’. 

(b) EFFECTIVE DATE.—The amendment made by subsection (a) 

shall apply to plan years beginning on or after January 1, 2010. 

SEC. 166. ADJUSTMENT TO THE MEDICARE ADVANTAGE STABILIZATION FUND. 

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 110 of the Medicare, 

Medicaid, and SCHIP Extension Act of 2007 (Public Law 110– 

173), is amended— 

(1) by striking ‘‘2013’’ and inserting ‘‘2014’’; and 

(2) by striking ‘‘$1,790,000,000’’ and inserting ‘‘$1’’. 

SEC. 167. ACCESS TO MEDICARE REASONABLE COST CONTRACT PLANS. 

(a) EXTENSION OF REASONABLE COST CONTRACTS.—Section 

1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 

1395mm(h)(5)(C)(ii)), as amended by section 109 of the Medicare, 

Medicaid, and SCHIP Extension Act of 2007 (Public Law 110– 

42 USC 

1395w–22 note. 

42 USC 

1395w–28 note. 

42 USC 

1395w–27 note. 

42 USC 

1395w–22 note. 


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122 STAT. 2576 PUBLIC LAW 110–275—JULY 15, 2008 

173), is amended by striking ‘‘January 1, 2009’’ and inserting 

‘‘January 1, 2010’’ in the matter preceding subclause (I). 

(b) REQUIREMENT FOR AT LEAST TWO MEDICARE ADVANTAGE

ORGANIZATIONS TO BE OFFERING A PLAN IN AN AREA FOR THE

PROHIBITION TO BE APPLICABLE.—Subclauses (I) and (II) of section 

1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 

1395mm(h)(5)(C)(ii)) are each amended by inserting ‘‘, provided 

that all such plans are not offered by the same Medicare Advantage 

organization’’ after ‘‘clause (iii)’’. 

(c) REVISION OF REQUIREMENTS FOR A PLAN THAT ARE USED

TO DETERMINE IF PROHIBITION IS APPLICABLE.— 

(1) IN GENERAL.—Section 1876(h)(5)(C)(iii)(I) of the Social 

Security Act (42 U.S.C. 1395mm(h)(5)(C)(iii)(I)) is amended by 

inserting ‘‘that are not in another Metropolitan Statistical Area 

with a population of more than 250,000’’ after ‘‘such Metropolitan Statistical Area’’. 

(2) CLARIFICATION.—Section 1876(h)(5)(C)(iii)(I) of the 

Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(iii)(I)) is 

amended by adding at the end the following new sentence: 

‘‘If the service area includes a portion in more than 1 Metropolitan Statistical Area with a population of more than 250,000, 

the minimum enrollment determination under the preceding 

sentence shall be made with respect to each such Metropolitan 

Statistical Area (and such applicable contiguous counties to 

such Metropolitan Statistical Area).’’. 

(d) GAO STUDY AND REPORT.— 

(1) STUDY.—The Comptroller General of the United States 

shall conduct a study of the reasons (if any) why reasonable 

cost contracts under section 1876(h) of the Social Security Act 

(42 U.S.C. 1395mm(h)) are unable to become Medicare Advantage plans under part C of title XVIII of such Act. 

(2) REPORT.—Not later than December 31, 2009, the Comptroller General of the United States shall submit to Congress 

a report containing the results of the study conducted under 

paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General 

determines appropriate. 

SEC. 168. MEDPAC STUDY AND REPORT ON QUALITY MEASURES. 

(a) STUDY.—The Medicare Payment Advisory Commission shall 

conduct a study on how comparable measures of performance and 

patient experience can be collected and reported by 2011 for the 

Medicare Advantage program under part C of title XVIII of the 

Social Security Act and the original Medicare fee-for-service program under parts A and B of such title. Such study shall address 

technical issues, such as data requirements, in addition to issues 

relating to appropriate quality benchmarks that— 

(1) compare the quality of care Medicare beneficiaries 

receive across Medicare Advantage plans; and 

(2) compare the quality of care Medicare beneficiaries 

receive under Medicare Advantage plans and under the original 

Medicare fee-for-service program. 

(b) REPORT.—Not later than March 31, 2010, the Medicare 

Payment Advisory Commission shall submit to Congress a report 

containing the results of the study conducted under subsection 

(a), together with recommendations for such legislation and 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2577 

administrative action as the Medicare Payment Advisory Commission determines appropriate. 

SEC. 169. MEDPAC STUDY AND REPORT ON MEDICARE ADVANTAGE 

PAYMENTS. 

(a) STUDY.—The Medicare Payment Advisory Commission (in 

this section referred to as the ‘‘Commission’’) shall conduct a study 

of the following: 

(1) The correlation between— 

(A) the costs that Medicare Advantage organizations 

with respect to Medicare Advantage plans incur in providing coverage under the plan for items and services covered under the original Medicare fee-for-service program 

under parts A and B of title XVIII of the Social Security 

Act, as reflected in plan bids; and 

(B) county-level spending under such original Medicare 

fee-for-service program on a per capita basis, as calculated 

by the Chief Actuary of the Centers for Medicare & Medicaid Services. 

The study with respect to the issue described in the preceding 

sentence shall include differences in correlation statistics by 

plan type and geographic area. 

(2) Based on these results of the study with respect to 

the issue described in paragraph (1), and other data the 

Commission determines appropriate— 

(A) alternate approaches to payment with respect to 

a Medicare beneficiary enrolled in a Medicare Advantage 

plan other than through county-level payment area equivalents. 

(B) the accuracy and completeness of county-level estimates of per capita spending under such original Medicare 

fee-for-service program (including counties in Puerto Rico), 

as used to determine the annual Medicare Advantage capitation rate under section 1853 of the Social Security Act 

(42 U.S.C. 1395w–23), and whether such estimates 

include— 

(i) expenditures with respect to Medicare beneficiaries at facilities of the Department of Veterans 

Affairs; and 

(ii) all appropriate administrative expenses, 

including claims processing. 

(3) Ways to improve the accuracy and completeness of 

county-level estimates of per capita spending described in paragraph (2)(B). 

(b) REPORT.—Not later than March 31, 2010, the Commission 

shall submit to Congress a report containing the results of the 

study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Commission determines appropriate. 


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122 STAT. 2578 PUBLIC LAW 110–275—JULY 15, 2008 

Subtitle E—Provisions Relating to Part D 

PART I—IMPROVING PHARMACY ACCESS 

SEC. 171. PROMPT PAYMENT BY PRESCRIPTION DRUG PLANS AND 

MA–PD PLANS UNDER PART D. 

(a) PROMPT PAYMENT BY PRESCRIPTION DRUG PLANS.—Section 

1860D–12(b) of the Social Security Act (42 U.S.C. 1395w–112(b)) 

is amended by adding at the end the following new paragraph: 

‘‘(4) PROMPT PAYMENT OF CLEAN CLAIMS.— 

‘‘(A) PROMPT PAYMENT.— 

‘‘(i) IN GENERAL.—Each contract entered into with 

a PDP sponsor under this part with respect to a 

prescription drug plan offered by such sponsor shall 

provide that payment shall be issued, mailed, or otherwise transmitted with respect to all clean claims submitted by pharmacies (other than pharmacies that dispense drugs by mail order only or are located in, or 

contract with, a long-term care facility) under this 

part within the applicable number of calendar days 

after the date on which the claim is received. 

‘‘(ii) CLEAN CLAIM DEFINED.—In this paragraph, 

the term ‘clean claim’ means a claim that has no defect 

or impropriety (including any lack of any required 

substantiating documentation) or particular circumstance requiring special treatment that prevents 

timely payment from being made on the claim under 

this part. 

‘‘(iii) DATE OF RECEIPT OF CLAIM.—In this paragraph, a claim is considered to have been received— 

‘‘(I) with respect to claims submitted electronically, on the date on which the claim is transferred; 

and 

‘‘(II) with respect to claims submitted otherwise, on the 5th day after the postmark date of 

the claim or the date specified in the time stamp 

of the transmission. 

‘‘(B) APPLICABLE NUMBER OF CALENDAR DAYS

DEFINED.—In this paragraph, the term ‘applicable number 

of calendar days’ means— 

‘‘(i) with respect to claims submitted electronically, 

14 days; and 

‘‘(ii) with respect to claims submitted otherwise, 

30 days. 

‘‘(C) INTEREST PAYMENT.— 

‘‘(i) IN GENERAL.—Subject to clause (ii), if payment 

is not issued, mailed, or otherwise transmitted within 

the applicable number of calendar days (as defined 

in subparagraph (B)) after a clean claim is received, 

the PDP sponsor shall pay interest to the pharmacy 

that submitted the claim at a rate equal to the 

weighted average of interest on 3-month marketable 

Treasury securities determined for such period, 

increased by 0.1 percentage point for the period beginning on the day after the required payment date and 

ending on the date on which payment is made (as 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2579 

determined under subparagraph (D)(iv)). Interest 

amounts paid under this subparagraph shall not be 

counted against the administrative costs of a prescription drug plan or treated as allowable risk corridor 

costs under section 1860D–15(e). 

‘‘(ii) AUTHORITY NOT TO CHARGE INTEREST.—The 

Secretary may provide that a PDP sponsor is not 

charged interest under clause (i) in the case where 

there are exigent circumstances, including natural 

disasters and other unique and unexpected events, that 

prevent the timely processing of claims. 

‘‘(D) PROCEDURES INVOLVING CLAIMS.— 

‘‘(i) CLAIM DEEMED TO BE CLEAN.—A claim is 

deemed to be a clean claim if the PDP sponsor involved 

does not provide notice to the claimant of any deficiency 

in the claim— 

‘‘(I) with respect to claims submitted electronically, within 10 days after the date on which the 

claim is received; and 

‘‘(II) with respect to claims submitted otherwise, within 15 days after the date on which the 

claim is received. 

‘‘(ii) CLAIM DETERMINED TO NOT BE A CLEAN

CLAIM.— 

‘‘(I) IN GENERAL.—If a PDP sponsor determines 

that a submitted claim is not a clean claim, the 

PDP sponsor shall, not later than the end of the 

period described in clause (i), notify the claimant 

of such determination. Such notification shall 

specify all defects or improprieties in the claim 

and shall list all additional information or documents necessary for the proper processing and payment of the claim. 

‘‘(II) DETERMINATION AFTER SUBMISSION OF

ADDITIONAL INFORMATION.—A claim is deemed to 

be a clean claim under this paragraph if the PDP 

sponsor involved does not provide notice to the 

claimant of any defect or impropriety in the claim 

within 10 days of the date on which additional 

information is received under subclause (I). 

‘‘(iii) OBLIGATION TO PAY.—A claim submitted to 

a PDP sponsor that is not paid or contested by the 

sponsor within the applicable number of days (as 

defined in subparagraph (B)) after the date on which 

the claim is received shall be deemed to be a clean 

claim and shall be paid by the PDP sponsor in accordance with subparagraph (A). 

‘‘(iv) DATE OF PAYMENT OF CLAIM.—Payment of 

a clean claim under such subparagraph is considered 

to have been made on the date on which— 

‘‘(I) with respect to claims paid electronically, 

the payment is transferred; and 

‘‘(II) with respect to claims paid otherwise, 

the payment is submitted to the United States 

Postal Service or common carrier for delivery. 

Notice. 

Deadlines. 

Notice. 

Deadlines. 


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122 STAT. 2580 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(E) ELECTRONIC TRANSFER OF FUNDS.—A PDP sponsor 

shall pay all clean claims submitted electronically by electronic transfer of funds if the pharmacy so requests or 

has so requested previously. In the case where such payment is made electronically, remittance may be made by 

the PDP sponsor electronically as well. 

‘‘(F) PROTECTING THE RIGHTS OF CLAIMANTS.— ‘‘(i) IN GENERAL.—Nothing in this paragraph shall 

be construed to prohibit or limit a claim or action 

not covered by the subject matter of this section that 

any individual or organization has against a provider 

or a PDP sponsor. 

‘‘(ii) ANTI-RETALIATION.—Consistent with 

applicable Federal or State law, a PDP sponsor shall 

not retaliate against an individual or provider for exercising a right of action under this subparagraph. 

‘‘(G) RULE OF CONSTRUCTION.—A determination under 

this paragraph that a claim submitted by a pharmacy 

is a clean claim shall not be construed as a positive determination regarding eligibility for payment under this title, 

nor is it an indication of government approval of, or 

acquiescence regarding, the claim submitted. The determination shall not relieve any party of civil or criminal 

liability with respect to the claim, nor does it offer a defense 

to any administrative, civil, or criminal action with respect 

to the claim.’’. 

(b) PROMPT PAYMENT BY MA–PD PLANS.—Section 1857(f) of 

the Social Security Act (42 U.S.C. 1395w–27) is amended by adding 

at the end the following new paragraph: 

‘‘(3) INCORPORATION OF CERTAIN PRESCRIPTION DRUG PLAN

CONTRACT REQUIREMENTS.—The following provisions shall apply 

to contracts with a Medicare Advantage organization offering 

an MA–PD plan in the same manner as they apply to contracts 

with a PDP sponsor offering a prescription drug plan under 

part D: 

‘‘(A) PROMPT PAYMENT.—Section 1860D–12(b)(4).’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to plan years beginning on or after January 1, 2010. 

SEC. 172. SUBMISSION OF CLAIMS BY PHARMACIES LOCATED IN OR 

CONTRACTING WITH LONG-TERM CARE FACILITIES. 

(a) SUBMISSION OF CLAIMS BY PHARMACIES LOCATED IN OR

CONTRACTING WITH LONG-TERM CARE FACILITIES.— 

(1) SUBMISSION OF CLAIMS TO PRESCRIPTION DRUG PLANS.— 

Section 1860D–12(b) of the Social Security Act (42 U.S.C. 

1395w–112(b)), as amended by section 171(a), is amended by 

adding at the end the following new paragraph: 

‘‘(5) SUBMISSION OF CLAIMS BY PHARMACIES LOCATED IN

OR CONTRACTING WITH LONG-TERM CARE FACILITIES.—Each contract entered into with a PDP sponsor under this part with 

respect to a prescription drug plan offered by such sponsor 

shall provide that a pharmacy located in, or having a contract 

with, a long-term care facility shall have not less than 30 

days (but not more than 90 days) to submit claims to the 

sponsor for reimbursement under the plan.’’. 

(2) SUBMISSION OF CLAIMS TO MA–PD PLANS.—Section 

1857(f)(3) of the Social Security Act, as added by section 171(b), 

Deadline. 

42 USC 

1395w–27 note. 

Applicability. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2581 

is amended by adding at the end the following new subparagraph: 

‘‘(B) SUBMISSION OF CLAIMS BY PHARMACIES LOCATED

IN OR CONTRACTING WITH LONG-TERM CARE FACILITIES.— Section 1860D–12(b)(5).’’. 

(b) EFFECTIVE DATE.—The amendments made by this section 

shall apply to plan years beginning on or after January 1, 2010. 

SEC. 173. REGULAR UPDATE OF PRESCRIPTION DRUG PRICING 

STANDARD. 

(a) REQUIREMENT FOR PRESCRIPTION DRUG PLANS.—Section 

1860D–12(b) of the Social Security Act (42 U.S.C. 1395w–112(b)), 

as amended by section 172(a)(1), is amended by adding at the 

end the following new paragraph: 

‘‘(6) REGULAR UPDATE OF PRESCRIPTION DRUG PRICING

STANDARD.—If the PDP sponsor of a prescription drug plan 

uses a standard for reimbursement of pharmacies based on 

the cost of a drug, each contract entered into with such sponsor 

under this part with respect to the plan shall provide that 

the sponsor shall update such standard not less frequently 

than once every 7 days, beginning with an initial update on 

January 1 of each year, to accurately reflect the market price 

of acquiring the drug.’’. 

(b) REQUIREMENT FOR MA–PD PLANS.—Section 1857(f)(3) of 

the Social Security Act, as amended by section 172(a)(2), is amended 

by adding at the end the following new subparagraph: 

‘‘(C) REGULAR UPDATE OF PRESCRIPTION DRUG PRICING

STANDARD.—Section 1860D–12(b)(6).’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to plan years beginning on or after January 1, 2009. 

PART II—OTHER PROVISIONS 

SEC. 175. INCLUSION OF BARBITURATES AND BENZODIAZEPINES AS 

COVERED PART D DRUGS. 

(a) IN GENERAL.—Section 1860D–2(e)(2)(A) of the Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is amended by inserting 

after ‘‘agents),’’ the following ‘‘other than subparagraph (I) of such 

section (relating to barbiturates) if the barbiturate is used in the 

treatment of epilepsy, cancer, or a chronic mental health disorder, 

and other than subparagraph (J) of such section (relating to 

benzodiazepines),’’. 

(b) EFFECTIVE DATE.—The amendments made by subsection 

(a) shall apply to prescriptions dispensed on or after January 1, 

2013. 

SEC. 176. FORMULARY REQUIREMENTS WITH RESPECT TO CERTAIN 

CATEGORIES OR CLASSES OF DRUGS. 

Section 1860D–4(b)(3) of the Social Security Act (42 U.S.C. 

1395w–104(b)(3)) is amended— 

(1) in subparagraph (C)(i), by striking ‘‘The formulary’’ 

and inserting ‘‘Subject to subparagraph (G), the formulary’’; 

and 

(2) by inserting after subparagraph (F) the following new 

subparagraph: 

‘‘(G) REQUIRED INCLUSION OF DRUGS IN CERTAIN CAT- EGORIES AND CLASSES.— 

42 USC 

1395w–102 note. 

42 USC 

1395w–27 note. 

42 USC 

1395w–27 note. 


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122 STAT. 2582 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(i) IDENTIFICATION OF DRUGS IN CERTAIN CAT- EGORIES AND CLASSES.—Beginning with plan year 

2010, the Secretary shall identify, as appropriate, categories and classes of drugs for which both of the 

following criteria are met: 

‘‘(I) Restricted access to drugs in the category 

or class would have major or life threatening clinical consequences for individuals who have a disease or disorder treated by the drugs in such category or class. 

‘‘(II) There is significant clinical need for such 

individuals to have access to multiple drugs within 

a category or class due to unique chemical actions 

and pharmacological effects of the drugs within 

the category or class, such as drugs used in the 

treatment of cancer. 

‘‘(ii) FORMULARY REQUIREMENTS.—Subject to clause 

(iii), PDP sponsors offering prescription drug plans 

shall be required to include all covered part D drugs 

in the categories and classes identified by the Secretary 

under clause (i). 

‘‘(iii) EXCEPTIONS.—The Secretary may establish 

exceptions that permits a PDP sponsor of a prescription 

drug plan to exclude from its formulary a particular 

covered part D drug in a category or class that is 

otherwise required to be included in the formulary 

under clause (ii) (or to otherwise limit access to such 

a drug, including through prior authorization or utilization management). Any exceptions established under 

the preceding sentence shall be provided under a 

process that— 

‘‘(I) ensures that any exception to such requirement is based upon scientific evidence and medical 

standards of practice (and, in the case of 

antiretroviral medications, is consistent with the 

Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV1-Infected Adults and Adolescents); and 

‘‘(II) includes a public notice and comment 

period.’’. 

Subtitle F—Other Provisions 

SEC. 181. USE OF PART D DATA. 

Section 1860D–12(b)(3)(D) of the Social Security Act (42 U.S.C. 

1395w–112(b)(3)(D)) is amended by adding at the end the following 

sentence: ‘‘Notwithstanding any other provision of law, information 

provided to the Secretary under the application of section 1857(e)(1) 

to contracts under this section under the preceding sentence— 

‘‘(i) may be used for the purposes of carrying out 

this part, improving public health through research 

on the utilization, safety, effectiveness, quality, and 

efficiency of health care services (as the Secretary 

determines appropriate); and 

‘‘(ii) shall be made available to Congressional support agencies (in accordance with their obligations to 

Effective date. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2583 

support Congress as set out in their authorizing statutes) for the purposes of conducting Congressional 

oversight, monitoring, making recommendations, and 

analysis of the program under this title.’’. 

SEC. 182. REVISION OF DEFINITION OF MEDICALLY ACCEPTED INDICATION FOR DRUGS. 

(a) REVISION OF DEFINITION FOR PART D DRUGS.— 

(1) IN GENERAL.—Section 1860D–2(e)(1) of the Social Security Act (42 U.S.C. 1395w–102(e)(1)) is amended, in the matter 

following subparagraph (B)— 

(A) by striking ‘‘(as defined in section 1927(k)(6))’’ and 

inserting ‘‘(as defined in paragraph (4))’’; and 

(B) by adding at the end the following new paragraph: 

‘‘(4) MEDICALLY ACCEPTED INDICATION DEFINED.— 

‘‘(A) IN GENERAL.—For purposes of paragraph (1), the 

term ‘medically accepted indication’ has the meaning given 

that term— 

‘‘(i) in the case of a covered part D drug used 

in an anticancer chemotherapeutic regimen, in section 

1861(t)(2)(B), except that in applying such section— 

‘‘(I) ‘prescription drug plan or MA–PD plan’ 

shall be substituted for ‘carrier’ each place it 

appears; and 

‘‘(II) subject to subparagraph (B), the compendia described in section 1927(g)(1)(B)(i)(III) 

shall be included in the list of compendia described 

in clause (ii)(I) section 1861(t)(2)(B); and 

‘‘(ii) in the case of any other covered part D drug, 

in section 1927(k)(6). 

‘‘(B) CONFLICT OF INTEREST.—On and after January 

1, 2010, subparagraph (A)(i)(II) shall not apply unless the 

compendia described in section 1927(g)(1)(B)(i)(III) meets 

the requirement in the third sentence of section 

1861(t)(2)(B). 

‘‘(C) UPDATE.—For purposes of applying subparagraph 

(A)(ii), the Secretary shall revise the list of compendia 

described in section 1927(g)(1)(B)(i) as is appropriate for 

identifying medically accepted indications for drugs. Any 

such revision shall be done in a manner consistent with 

the process for revising compendia under section 

1861(t)(2)(B).’’. 

(2) EFFECTIVE DATE.—The amendments made by this subsection shall apply to plan years beginning on or after January 

1, 2009. 

(b) CONFLICTS OF INTEREST.—Section 1861(t)(2)(B) of the Social 

Security Act (42 U.S.C. 1395x(t)(2)(B)) is amended by adding at 

the end the following new sentence: ‘‘On and after January 1, 

2010, no compendia may be included on the list of compendia 

under this subparagraph unless the compendia has a publicly transparent process for evaluating therapies and for identifying potential 

conflicts of interests.’’. 

SEC. 183. CONTRACT WITH A CONSENSUS-BASED ENTITY REGARDING 

PERFORMANCE MEASUREMENT. 

(a) CONTRACT.— 

Effective date. 

42 USC 

1395w–102 note. 

Effective date. 


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122 STAT. 2584 PUBLIC LAW 110–275—JULY 15, 2008 

(1) IN GENERAL.—Part E of title XVIII of the Social Security 

Act (42 U.S.C. 1395x et seq.) is amended by inserting after 

section 1889 the following new section: 

‘‘CONTRACT WITH A CONSENSUS-BASED ENTITY REGARDING

PERFORMANCE MEASUREMENT

‘‘SEC. 1890. (a) CONTRACT.— ‘‘(1) IN GENERAL.—For purposes of activities conducted 

under this Act, the Secretary shall identify and have in effect 

a contract with a consensus-based entity, such as the National 

Quality Forum, that meets the requirements described in subsection (c). Such contract shall provide that the entity will 

perform the duties described in subsection (b). 

‘‘(2) TIMING FOR FIRST CONTRACT.—As soon as practicable 

after the date of the enactment of this subsection, the Secretary 

shall enter into the first contract under paragraph (1). 

‘‘(3) PERIOD OF CONTRACT.—A contract under paragraph 

(1) shall be for a period of 4 years (except as may be renewed 

after a subsequent bidding process). 

‘‘(4) COMPETITIVE PROCEDURES.—Competitive procedures 

(as defined in section 4(5) of the Office of Federal Procurement 

Policy Act (41 U.S.C. 403(5))) shall be used to enter into a 

contract under paragraph (1). 

‘‘(b) DUTIES.—The duties described in this subsection are the 

following: 

‘‘(1) PRIORITY SETTING PROCESS.—The entity shall synthesize evidence and convene key stakeholders to make recommendations, with respect to activities conducted under this 

Act, on an integrated national strategy and priorities for health 

care performance measurement in all applicable settings. In 

making such recommendations, the entity shall— 

‘‘(A) ensure that priority is given to measures— 

‘‘(i) that address the health care provided to 

patients with prevalent, high-cost chronic diseases; 

‘‘(ii) with the greatest potential for improving the 

quality, efficiency, and patient-centeredness of health 

care; and 

‘‘(iii) that may be implemented rapidly due to 

existing evidence, standards of care, or other reasons; 

and 

‘‘(B) take into account measures that— 

‘‘(i) may assist consumers and patients in making 

informed health care decisions; 

‘‘(ii) address health disparities across groups and 

areas; and 

‘‘(iii) address the continuum of care a patient 

receives, including services furnished by multiple 

health care providers or practitioners and across multiple settings. 

‘‘(2) ENDORSEMENT OF MEASURES.—The entity shall provide 

for the endorsement of standardized health care performance 

measures. The endorsement process under the preceding sentence shall consider whether a measure— 

‘‘(A) is evidence-based, reliable, valid, verifiable, relevant to enhanced health outcomes, actionable at the caregiver level, feasible to collect and report, and responsive 

to variations in patient characteristics, such as health 

42 USC 1395aaa. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2585 

status, language capabilities, race or ethnicity, and income 

level; and 

‘‘(B) is consistent across types of health care providers, 

including hospitals and physicians. 

‘‘(3) MAINTENANCE OF MEASURES.—The entity shall establish and implement a process to ensure that measures endorsed 

under paragraph (2) are updated (or retired if obsolete) as 

new evidence is developed. 

‘‘(4) PROMOTION OF THE DEVELOPMENT OF ELECTRONIC

HEALTH RECORDS.—The entity shall promote the development 

and use of electronic health records that contain the 

functionality for automated collection, aggregation, and transmission of performance measurement information. 

‘‘(5) ANNUAL REPORT TO CONGRESS AND THE SECRETARY; 

SECRETARIAL PUBLICATION AND COMMENT.— 

‘‘(A) ANNUAL REPORT.—By not later than March 1 of 

each year (beginning with 2009), the entity shall submit 

to Congress and the Secretary a report containing a description of— 

‘‘(i) the implementation of quality measurement 

initiatives under this Act and the coordination of such 

initiatives with quality initiatives implemented by 

other payers; 

‘‘(ii) the recommendations made under paragraph 

(1); and 

‘‘(iii) the performance by the entity of the duties 

required under the contract entered into with the Secretary under subsection (a). 

‘‘(B) SECRETARIAL REVIEW AND PUBLICATION OF ANNUAL

REPORT.—Not later than 6 months after receiving a report 

under subparagraph (A) for a year, the Secretary shall— 

‘‘(i) review such report; and 

‘‘(ii) publish such report in the Federal Register, 

together with any comments of the Secretary on such 

report. 

‘‘(c) REQUIREMENTS DESCRIBED.—The requirements described 

in this subsection are the following: 

‘‘(1) PRIVATE NONPROFIT.—The entity is a private nonprofit 

entity governed by a board. 

‘‘(2) BOARD MEMBERSHIP.—The members of the board of 

the entity include— 

‘‘(A) representatives of health plans and health care 

providers and practitioners or representatives of groups 

representing such health plans and health care providers 

and practitioners; 

‘‘(B) health care consumers or representatives of groups 

representing health care consumers; and 

‘‘(C) representatives of purchasers and employers or 

representatives of groups representing purchasers or 

employers. 

‘‘(3) ENTITY MEMBERSHIP.—The membership of the entity 

includes persons who have experience with— 

‘‘(A) urban health care issues; 

‘‘(B) safety net health care issues; 

‘‘(C) rural and frontier health care issues; and 

‘‘(D) health care quality and safety issues. 


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122 STAT. 2586 PUBLIC LAW 110–275—JULY 15, 2008 

‘‘(4) OPEN AND TRANSPARENT.—With respect to matters 

related to the contract with the Secretary under subsection 

(a), the entity conducts its business in an open and transparent 

manner and provides the opportunity for public comment on 

its activities. 

‘‘(5) VOLUNTARY CONSENSUS STANDARDS SETTING ORGANIZATION.—The entity operates as a voluntary consensus standards 

setting organization as defined for purposes of section 12(d) 

of the National Technology Transfer and Advancement Act 

of 1995 (Public Law 104–113) and Office of Management and 

Budget Revised Circular A–119 (published in the Federal Register on February 10, 1998). 

‘‘(6) EXPERIENCE.—The entity has at least 4 years of experience in establishing national consensus standards. 

‘‘(7) MEMBERSHIP FEES.—If the entity requires a membership fee for participation in the functions of the entity, such 

fees shall be reasonable and adjusted based on the capacity 

of the potential member to pay the fee. In no case shall membership fees pose a barrier to the participation of individuals 

or groups with low or nominal resources to participate in the 

functions of the entity. 

‘‘(d) FUNDING.—For purposes of carrying out this section, the 

Secretary shall provide for the transfer, from the Federal Hospital 

Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in 

such proportion as the Secretary determines appropriate), of 

$10,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2009 through 

2012.’’. 

(2) SENSE OF THE SENATE.—It is the Sense of the Senate 

that the selection by the Secretary of Health and Human Services of an entity to contract with under section 1890(a) of 

the Social Security Act, as added by paragraph (1), should 

not be construed as diminishing the significant contributions 

of the Boards of Medicine, the quality alliances, and other 

clinical and technical experts to efforts to measure and improve 

the quality of health care services. 

(b) GAO STUDY AND REPORTS ON THE PERFORMANCE AND COSTS

OF THE CONSENSUS-BASED ENTITY UNDER THE CONTRACT.— 

(1) IN GENERAL.—The Comptroller General of the United 

States shall conduct a study on— 

(A) the performance of the entity with a contract with 

the Secretary of Health and Human Services under section 

1890(a) of the Social Security Act, as added by subsection 

(a), of its duties under such contract; and 

(B) the costs incurred by such entity in performing 

such duties. 

(2) REPORTS.—Not later than 18 months and 36 months 

after the effective date of the first contract entered into under 

such section 1890(a), the Comptroller General of the United 

States shall submit to Congress a report containing the results 

of the study conducted under paragraph (1), together with 

recommendations for such legislation and administrative action 

as the Comptroller General determines appropriate. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2587 

SEC. 184. COST-SHARING FOR CLINICAL TRIALS. 

Section 1833 of the Social Security Act (42 U.S.C. 1395l), as 

amended by section 151(a), is amended by adding at the end the 

following new subsection: 

‘‘(w) METHODS OF PAYMENT.—The Secretary may develop alternative methods of payment for items and services provided under 

clinical trials and comparative effectiveness studies sponsored or 

supported by an agency of the Department of Health and Human 

Services, as determined by the Secretary, to those that would otherwise apply under this section, to the extent such alternative 

methods are necessary to preserve the scientific validity of such 

trials or studies, such as in the case where masking the identity 

of interventions from patients and investigators is necessary to 

comply with the particular trial or study design.’’. 

SEC. 185. ADDRESSING HEALTH CARE DISPARITIES. 

Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 

is amended by inserting after section 1808 the following new section: 

‘‘ADDRESSING HEALTH CARE DISPARITIES

‘‘SEC. 1809. (a) EVALUATING DATA COLLECTION APPROACHES.— 

The Secretary shall evaluate approaches for the collection of data 

under this title, to be performed in conjunction with existing quality 

reporting requirements and programs under this title, that allow 

for the ongoing, accurate, and timely collection and evaluation 

of data on disparities in health care services and performance 

on the basis of race, ethnicity, and gender. In conducting such 

evaluation, the Secretary shall consider the following objectives: 

‘‘(1) Protecting patient privacy. 

‘‘(2) Minimizing the administrative burdens of data collection and reporting on providers and health plans participating 

under this title. 

‘‘(3) Improving Medicare program data on race, ethnicity, 

and gender. 

‘‘(b) REPORTS TO CONGRESS.— 

‘‘(1) REPORT ON EVALUATION.—Not later than 18 months 

after the date of the enactment of this section, the Secretary 

shall submit to Congress a report on the evaluation conducted 

under subsection (a). Such report shall, taking into consideration the results of such evaluation— 

‘‘(A) identify approaches (including defining methodologies) for identifying and collecting and evaluating data 

on health care disparities on the basis of race, ethnicity, 

and gender for the original Medicare fee-for-service program under parts A and B, the Medicare Advantage program under part C, and the Medicare prescription drug 

program under part D; and 

‘‘(B) include recommendations on the most effective 

strategies and approaches to reporting HEDIS quality 

measures as required under section 1852(e)(3) and other 

nationally recognized quality performance measures, as 

appropriate, on the basis of race, ethnicity, and gender. 

‘‘(2) REPORTS ON DATA ANALYSES.—Not later than 4 years 

after the date of the enactment of this section, and 4 years 

thereafter, the Secretary shall submit to Congress a report 

that includes recommendations for improving the identification 

42 USC 

1395b–10. 


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122 STAT. 2588 PUBLIC LAW 110–275—JULY 15, 2008 

of health care disparities for Medicare beneficiaries based on 

analyses of the data collected under subsection (c). 

‘‘(c) IMPLEMENTING EFFECTIVE APPROACHES.—Not later than 

24 months after the date of the enactment of this section, the 

Secretary shall implement the approaches identified in the report 

submitted under subsection (b)(1) for the ongoing, accurate, and 

timely collection and evaluation of data on health care disparities 

on the basis of race, ethnicity, and gender.’’. 

SEC. 186. DEMONSTRATION TO IMPROVE CARE TO PREVIOUSLY UNINSURED. 

(a) ESTABLISHMENT.—Within one year after the date of the 

enactment of this Act, the Secretary (in this section referred to 

as the ‘‘Secretary’’) shall establish a demonstration project to determine the greatest needs and most effective methods of outreach 

to medicare beneficiaries who were previously uninsured. 

(b) SCOPE.—The demonstration shall be in no fewer than 10 

sites, and shall include state health insurance assistance programs, 

community health centers, community-based organizations, community health workers, and other service providers under parts A, 

B, and C of title XVIII of the Social Security Act. Grantees that 

are plans operating under part C shall document that enrollees 

who were previously uninsured receive the ‘‘Welcome to Medicare’’ 

physical exam. 

(c) DURATION.—The Secretary shall conduct the demonstration 

project for a period of 2 years. 

(d) REPORT AND EVALUATION.—The Secretary shall conduct an 

evaluation of the demonstration and not later than 1 year after 

the completion of the project shall submit to Congress a report 

including the following: 

(1) An analysis of the effectiveness of outreach activities 

targeting beneficiaries who were previously uninsured, such 

as revising outreach and enrollment materials (including the 

potential for use of video information), providing one-on-one 

counseling, working with community health workers, and 

amending the Medicare and You handbook. 

(2) The effect of such outreach on beneficiary access to 

care, utilization of services, efficiency and cost-effectiveness 

of health care delivery, patient satisfaction, and select health 

outcomes. 

SEC. 187. OFFICE OF THE INSPECTOR GENERAL REPORT ON COMPLIANCE WITH AND ENFORCEMENT OF NATIONAL STANDARDS ON CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN MEDICARE. 

(a) REPORT.—Not later than two years after the date of the 

enactment of this Act, the Inspector General of the Department 

of Health and Human Services shall prepare and publish a report 

on— 

(1) the extent to which Medicare providers and plans are 

complying with the Office for Civil Rights’ Guidance to Federal 

Financial Assistance Recipients Regarding Title VI Prohibition 

Against National Origin Discrimination Affecting Limited 

English Proficient Persons and the Office of Minority Health’s 

Culturally and Linguistically Appropriate Services Standards 

in health care; and 

(2) a description of the costs associated with or savings 

related to the provision of language services. 

42 USC 1395cc 

note. 

Deadline. 

42 USC 1395b–4 

note. 

Deadline. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2589 

Such report shall include recommendations on improving compliance with CLAS Standards and recommendations on improving 

enforcement of CLAS Standards. 

(b) IMPLEMENTATION.—Not later than one year after the date 

of publication of the report under subsection (a), the Department 

of Health and Human Services shall implement changes responsive 

to any deficiencies identified in the report. 

SEC. 188. MEDICARE IMPROVEMENT FUNDING. 

(a) MEDICARE IMPROVEMENT FUND.— (1) IN GENERAL.—Subject to paragraph (2), title XVIII of 

the Social Security Act (42 U.S.C. 1395 et seq.) is amended 

by adding at the end the following new section: 

‘‘MEDICARE IMPROVEMENT FUND

‘‘SEC. 1898. (a) ESTABLISHMENT.— ‘‘The Secretary shall establish under this title a Medicare 

Improvement Fund (in this section referred to as the ‘Fund’) 

which shall be available to the Secretary to make improvements 

under the original fee-for-service program under parts A and 

B for individuals entitled to, or enrolled for, benefits under 

part A or enrolled under part B. 

‘‘(b) FUNDING.— ‘‘(1) IN GENERAL.—There shall be available to the Fund, 

for expenditures from the Fund for services furnished during 

fiscal years 2014 through 2017, $19,900,000,000. 

‘‘(2) PAYMENT FROM TRUST FUNDS.—The amount specified 

under paragraph (1) shall be available to the Fund, as expenditures are made from the Fund, from the Federal Hospital 

Insurance Trust Fund and the Federal Supplementary Medical 

Insurance Trust Fund in such proportion as the Secretary 

determines appropriate. 

‘‘(3) FUNDING LIMITATION.—Amounts in the Fund shall be 

available in advance of appropriations but only if the total 

amount obligated from the Fund does not exceed the amount 

available to the Fund under paragraph (1). The Secretary may 

obligate funds from the Fund only if the Secretary determines 

(and the Chief Actuary of the Centers for Medicare & Medicaid 

Services and the appropriate budget officer certify) that there 

are available in the Fund sufficient amounts to cover all such 

obligations incurred consistent with the previous sentence.’’. 

(2) CONTINGENCY.— 

(A) IN GENERAL.—If there is enacted, before, on, or 

after the date of the enactment of this Act, a Supplemental 

Appropriations Act, 2008 that includes a provision providing for a Medicare Improvement Fund under a section 

1898 of the Social Security Act, the alternative amendment 

described in subparagraph (B)— 

(i) shall apply instead of the amendment made 

by paragraph (1); and 

(ii) shall be executed after such provision in such 

Supplemental Appropriations Act. 

(B) ALTERNATIVE AMENDMENT DESCRIBED.—The alternative amendment described in this subparagraph is as 

follows: Section 1898(b)(1) of the Social Security Act, as 

added by the Supplemental Appropriations Act, 2008, is 

amended by inserting before the period at the end the 

42 USC 1395iii. 

Applicability. 

Certification. 

Deadline. 


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122 STAT. 2590 PUBLIC LAW 110–275—JULY 15, 2008 

following: ‘‘ and, in addition for services furnished during 

fiscal years 2014 through 2017, $19,900,000,000’’. 

(b) IMPLEMENTATION.—For purposes of carrying out the provisions of, and amendments made by, this title, in addition to any 

other amounts provided in such provisions and amendments, the 

Secretary of Health and Human Services 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 $140,000,000 to the Centers for Medicare 

& Medicaid Services Program Management Account for the period 

of fiscal years 2009 through 2013. 

SEC. 189. INCLUSION OF MEDICARE PROVIDERS AND SUPPLIERS IN 

FEDERAL PAYMENT LEVY AND ADMINISTRATIVE OFFSET 

PROGRAM. 

(a) IN GENERAL.—Section 1874 of the Social Security Act (42 

U.S.C. 1395kk) is amended by adding at the end the following 

new subsection: 

‘‘(d) INCLUSION OF MEDICARE PROVIDER AND SUPPLIER PAYMENTS IN FEDERAL PAYMENT LEVY PROGRAM.— 

‘‘(1) IN GENERAL.—The Centers for Medicare & Medicaid 

Services shall take all necessary steps to participate in the 

Federal Payment Levy Program under section 6331(h) of the 

Internal Revenue Code of 1986 as soon as possible and shall 

ensure that— 

‘‘(A) at least 50 percent of all payments under parts 

A and B are processed through such program beginning 

within 1 year after the date of the enactment of this section; 

‘‘(B) at least 75 percent of all payments under parts 

A and B are processed through such program beginning 

within 2 years after such date; and 

‘‘(C) all payments under parts A and B are processed 

through such program beginning not later than September 

30, 2011. 

‘‘(2) ASSISTANCE.—The Financial Management Service and 

the Internal Revenue Service shall provide assistance to the 

Centers for Medicare & Medicaid Services to ensure that all 

payments described in paragraph (1) are included in the Federal 

Payment Levy Program by the deadlines specified in that subsection.’’. 

(b) APPLICATION OF ADMINISTRATIVE OFFSET PROVISIONS TO

MEDICARE PROVIDER OR SUPPLIER PAYMENTS.—Section 3716 of title 

31, United States Code, is amended— 

(1) by inserting ‘‘the Department of Health and Human 

Services,’’ after ‘‘United States Postal Service,’’ in subsection 

(c)(1)(A); and 

(2) by adding at the end of subsection (c)(3) the following 

new subparagraph: 

‘‘(D) This section shall apply to payments made after 

the date which is 90 days after the enactment of this 

subparagraph (or such earlier date as designated by the 

Secretary of Health and Human Services) with respect 

to claims or debts, and to amounts payable, under title 

XVIII of the Social Security Act.’’. 

Applicability. 

Effective date. 

Deadline. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2591 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall take effect on the date of the enactment of this Act. 

TITLE II—MEDICAID 

SEC. 201. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA) 

AND 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), section 2 of 

the TMA, Abstinence, Education, and QI Programs Extension Act 

of 2007 (Public Law 110–90, 121 Stat. 984), and section 202 of 

the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 

Law 110–173) is amended— 

(1) by striking ‘‘June 30, 2008’’ and inserting ‘‘June 30, 

2009’’; 

(2) by striking ‘‘the third quarter of fiscal year 2008’’ and 

inserting ‘‘the third quarter of fiscal year 2009’’; and 

(3) by striking ‘‘the third quarter of fiscal year 2007’’ and 

inserting ‘‘the third quarter of fiscal year 2008’’. 

SEC. 202. MEDICAID DSH EXTENSION. 

Section 1923(f)(6) of the Social Security Act (42 U.S.C. 1396r– 

4(f)(6)) is amended— 

(1) in the heading, by striking ‘‘FISCAL YEAR 2007 AND PORTIONS OF FISCAL YEAR 2008’’ and inserting ‘‘FISCAL YEARS 2007

THROUGH 2009 AND THE FIRST CALENDAR QUARTER OF FISCAL

YEAR 2010’’; and 

(2) in subparagraph (A)— 

(A) in clause (i)— 

(i) in the second sentence— 

(I) by striking ‘‘fiscal year 2008 for the period 

ending on June 30, 2008’’ and inserting ‘‘fiscal 

years 2008 and 2009’’; and 

(II) by striking ‘‘3⁄4 of’’; and 

(ii) by adding at the end the following new sentences: ‘‘Only with respect to fiscal year 2010 for the 

period ending on December 31, 2009, the DSH allotment for Tennessee for such portion of the fiscal year, 

notwithstanding such table or terms, shall be 1⁄4 of 

the amount specified in the first sentence for fiscal 

year 2007.’’; 

(B) in clause (ii), by striking ‘‘or for a period in fiscal 

year 2008’’ and inserting ‘‘, 2008, 2009, or for a period 

in fiscal year 2010’’; 

(C) in clause (iv)— 

(i) in the heading, by striking ‘‘FISCAL YEAR 2007

AND FISCAL YEAR 2008’’ and inserting ‘‘FISCAL YEARS

2007 THROUGH 2009 AND THE FIRST CALENDAR QUARTER

OF FISCAL YEAR 2010’’; 

(ii) in subclause (I), by striking ‘‘or for a period 

in fiscal year 2008’’ and inserting ‘‘, 2008, 2009, or 

for a period in fiscal year 2010’’; and 

(iii) in subclause (II), by striking ‘‘or for a period 

in fiscal year 2008’’ and inserting ‘‘, 2008, 2009, or 

for a period in fiscal year 2010’’; and 

31 USC 3176 

note. 


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122 STAT. 2592 PUBLIC LAW 110–275—JULY 15, 2008 

(3) in subparagraph (B)(i)— 

(A) in the first sentence, by striking ‘‘fiscal year 2007’’ 

and inserting ‘‘each of fiscal years 2007 through 2009’’; 

and 

(B) by striking the second sentence and inserting the 

following: ‘‘Only with respect to fiscal year 2010 for the 

period ending on December 31, 2009, the DSH allotment 

for Hawaii for such portion of the fiscal year, notwithstanding the table set forth in paragraph (2), shall be 

$2,500,000.’’. 

SEC. 203. PHARMACY REIMBURSEMENT UNDER MEDICAID. 

(a) DELAY IN APPLICATION OF NEW PAYMENT LIMIT FOR MUL- TIPLE SOURCE DRUGS UNDER MEDICAID.—Notwithstanding paragraphs (4) and (5) of subsection (e) of section 1927 of the Social 

Security Act (42 U.S.C. 1396r–8) or part 447 of title 42, Code 

of Federal Regulations, as published on July 17, 2007 (72 Federal 

Register 39142)— 

(1) the specific upper limit under section 447.332 of title 

42, Code of Federal Regulations (as in effect on December 

31, 2006) applicable to payments made by a State for multiple 

source drugs under a State Medicaid plan shall continue to 

apply through September 30, 2009, for purposes of the availability of Federal financial participation for such payments; 

and 

(2) the Secretary of Health and Human Services shall 

not, prior to October 1, 2009, finalize, implement, enforce, or 

otherwise 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 the specific upper limit 

established under section 447.514(b) of title 42, Code of Federal 

Regulations as published on July 17, 2007 (72 Federal Register 

39142). 

(b) TEMPORARY SUSPENSION OF UPDATED PUBLICLY AVAILABLE

AMP DATA.—Notwithstanding clause (v) of section 1927(b)(3)(D) 

of the Social Security Act (42 U.S.C. 1396r–8(b)(3)(D)), the Secretary 

of Health and Human Services shall not, prior to October 1, 2009, 

make publicly available any AMP disclosed to the Secretary. 

(c) DEFINITIONS.—In this subsection: 

(1) The term ‘‘multiple source drug’’ has the meaning given 

that term in section 1927(k)(7)(A)(i) of the Social Security Act 

(42 U.S.C. 1396r–8(k)(7)(A)(i)). 

(2) The term ‘‘AMP’’ has the meaning given ‘‘average manufacturer price’’ in section 1927(k)(1) of the Social Security Act 

(42 U.S.C. 1396r–8(k)(1)) and ‘‘AMP’’ in section 447.504(a) of 

title 42, Code of Federal Regulations as published on July 

17, 2007 (72 Federal Register 39142). 

SEC. 204. REVIEW OF ADMINISTRATIVE CLAIM DETERMINATIONS. 

(a) IN GENERAL.—Section 1116 of the Social Security Act (42 

U.S.C. 1316) is amended by adding at the end the following new 

subsection: 

‘‘(e)(1) Whenever the Secretary determines that any item or 

class of items on account of which Federal financial participation 

is claimed under title XIX shall be disallowed for such participation, 

the State shall be entitled to and upon request shall receive a 

Time periods. 

42 USC 1396r–8 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2593 

reconsideration of the disallowance, provided that such request 

is made during the 60-day period that begins on the date the 

State receives notice of the disallowance. 

‘‘(2)(A) A State may appeal a disallowance of a claim for federal 

financial participation under title XIX by the Secretary, or an 

unfavorable reconsideration of a disallowance, during the 60-day 

period that begins on the date the State receives notice of the 

disallowance or of the unfavorable reconsideration, in whole or 

in part, to the Departmental Appeals Board, established in the 

Department of Health and Human Services (in this paragraph 

referred to as the ‘Board’), by filing a notice of appeal with the 

Board. 

‘‘(B) The Board shall consider a State’s appeal of a disallowance 

of such a claim (or of an unfavorable reconsideration of a disallowance) on the basis of such documentation as the State may submit 

and as the Board may require to support the final decision of 

the Board. In deciding whether to uphold a disallowance of such 

a claim or any portion thereof, the Board shall be bound by all 

applicable laws and regulations and shall conduct a thorough review 

of the issues, taking into account all relevant evidence. The Board’s 

decision of an appeal under subparagraph (A) shall be the final 

decision of the Secretary and shall be subject to reconsideration 

by the Board only upon motion of either party filed during the 

60-day period that begins on the date of the Board’s decision or 

to judicial review in accordance with subparagraph (C). 

‘‘(C) A State may obtain judicial review of a decision of the 

Board by filing an action in any United States District Court 

located within the appealing State (or, if several States jointly 

appeal the disallowance of claims for Federal financial participation 

under section 1903, in any United States District Court that is 

located within any State that is a party to the appeal) or the 

United States District Court for the District of Columbia. Such 

an action may only be filed— 

‘‘(i) if no motion for reconsideration was filed within the 

60-day period specified in subparagraph (B), during such 60- 

day period; or 

‘‘(ii) if such a motion was filed within such period, during 

the 60-day period that begins on the date of the Board’s decision 

on such motion.’’. 

(b) CONFORMING AMENDMENT.—Section 1116(d) of such Act (42 

U.S.C. 1316(d)) is amended by striking ‘‘or XIX,’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

take effect on the date of the enactment of this Act and apply 

to any disallowance of a claim for Federal financial participation 

under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 

made on or after such date or during the 60-day period prior 

to such date. 

SEC. 205. COUNTY MEDICAID HEALTH INSURING ORGANIZATIONS. 

(a) IN GENERAL.—Section 9517(c)(3) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. 1396b note), 

as added by section 4734 of the Omnibus Budget Reconciliation 

Act of 1990 and as amended by section 704 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, 

is amended— 

42 USC 1316 

note. 


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122 STAT. 2594 PUBLIC LAW 110–275—JULY 15, 2008 

(1) in subparagraph (A), by inserting ‘‘, in the case of 

any health insuring organization described in such subparagraph that is operated by a public entity established by Ventura 

County, and in the case of any health insuring organization 

described in such subparagraph that is operated by a public 

entity established by Merced County’’ after ‘‘described in 

subparagraph (B)’’; and 

(2) in subparagraph (C), by striking ‘‘14 percent’’ and 

inserting ‘‘16 percent’’. 

(b) EFFECTIVE DATE.—The amendments made by subsection 

(a) shall take effect on the date of the enactment of this Act. 

TITLE III—MISCELLANEOUS 

SEC. 301. EXTENSION OF TANF SUPPLEMENTAL GRANTS. 

(a) EXTENSION THROUGH FISCAL YEAR 2009.—Section 7101(a) 

of the Deficit Reduction Act of 2005 (Public Law 109–171; 120 

Stat. 135) is amended by striking ‘‘fiscal year 2008’’ and inserting 

‘‘fiscal year 2009’’. 

(b) CONFORMING AMENDMENT.—Section 403(a)(3)(H)(ii) of the 

Social Security Act (42 U.S.C. 603(a)(3)(H)(ii)) is amended to read 

as follows: 

‘‘(ii) subparagraph (G) shall be applied as if ‘fiscal 

year 2009’ were substituted for ‘fiscal year 2001’; and’’. 

SEC. 302. 70 PERCENT FEDERAL MATCHING FOR FOSTER CARE AND 

ADOPTION ASSISTANCE FOR THE DISTRICT OF COLUMBIA. 

(a) IN GENERAL.—Section 474(a) of the Social Security Act 

(42 U.S.C. 674(a)) is amended in each of paragraphs (1) and (2) 

by striking ‘‘(as defined in section 1905(b) of this Act)’’ and inserting 

‘‘(which shall be as defined in section 1905(b), in the case of a 

State other than the District of Columbia, or 70 percent, in the 

case of the District of Columbia)’’. 

(b) EFFECTIVE DATE.—The amendment made by subsection (a) 

shall take effect on October 1, 2008, and shall apply to calendar 

quarters beginning on or after that date. 

SEC. 303. EXTENSION OF SPECIAL DIABETES GRANT PROGRAMS. 

(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)) is amended by striking ‘‘2009’’ and inserting ‘‘2011’’. 

(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 ‘‘2009’’ and inserting ‘‘2011’’. 

(c) REPORT ON GRANT PROGRAMS.—Section 4923(b) of the Balanced Budget Act of 1997 (42 U.S.C. 1254c–2 note), as amended 

by section 931(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, and section 1(c) of Public 

Law 107–360, is amended— 

(1) in paragraph (1), by striking ‘‘and’’ at the end; 

(2) in paragraph (2)— 

(A) by striking ‘‘a final report’’ and inserting ‘‘a second 

interim report’’; and 

(B) by striking the period at the end and inserting 

‘‘; and’’; and 

(3) by adding at the end the following new paragraph: 

42 USC 254c–2 

note. 

42 USC 674 note. 

42 USC 1396b 

note. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2595 

‘‘(3) a report on such evaluation not later than January 

1, 2011.’’. 

SEC. 304. IOM REPORTS ON BEST PRACTICES FOR CONDUCTING 

SYSTEMATIC REVIEWS OF CLINICAL EFFECTIVENESS 

RESEARCH AND FOR DEVELOPING CLINICAL PROTOCOLS. 

(a) SYSTEMATIC REVIEWS OF CLINICAL EFFECTIVENESS

RESEARCH.— 

(1) STUDY.—Not later than 60 days after the date of the 

enactment of this Act, the Secretary of Health and Human 

Services shall enter into a contract with the Institute of Medicine of the National Academies (in this section referred to 

as the ‘‘Institute’’) under which the Institute shall conduct 

a study to identify the methodological standards for conducting 

systematic reviews of clinical effectiveness research on health 

and health care in order to ensure that organizations conducting 

such reviews have information on methods that are objective, 

scientifically valid, and consistent. 

(2) REPORT.—Not later than 18 months after the effective 

date of the contract under paragraph (1), the Institute, as 

part of such contract, shall submit to the Secretary of Health 

and Human Services and the appropriate committees of jurisdiction of Congress a report containing the results of the study 

conducted under paragraph (1), together with recommendations 

for such legislation and administrative action as the Institute 

determines appropriate. 

(3) PARTICIPATION.—The contract under paragraph (1) shall 

require that stakeholders with expertise in conducting clinical 

effectiveness research participate on the panel responsible for 

conducting the study under paragraph (1) and preparing the 

report under paragraph (2). 

(b) CLINICAL PROTOCOLS.— 

(1) STUDY.—Not later than 60 days after the date of the 

enactment of this Act, the Secretary of Health and Human 

Services shall enter into a contract with the Institute of Medicine of the National Academies (in this section referred to 

as the ‘‘Institute’’) under which the Institute shall conduct 

a study on the best methods used in developing clinical practice 

guidelines in order to ensure that organizations developing 

such guidelines have information on approaches that are objective, scientifically valid, and consistent. 

(2) REPORT.—Not later than 18 months after the effective 

date of the contract under paragraph (1), the Institute, as 

part of such contract, shall submit to the Secretary of Health 

and Human Services and the appropriate committees of jurisdiction of Congress a report containing the results of the study 

conducted under paragraph (1), together with recommendations 

for such legislation and administrative action as the Institute 

determines appropriate. 

(3) PARTICIPATION.—The contract under paragraph (1) shall 

require that stakeholders with expertise in making clinical 

recommendations participate on the panel responsible for conducting the study under paragraph (1) and preparing the report 

under paragraph (2). 

Contracts. 

Contracts. 

Deadline. 


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122 STAT. 2596 PUBLIC LAW 110–275—JULY 15, 2008 

(c) FUNDING.—Out of any funds in the Treasury not otherwise 

appropriated, there are appropriated for the period of fiscal years 

2009 and 2010, $3,000,000 to carry out this section. 

Nancy Pelosi 

Speaker of the House of Representatives. 

Robert C. Byrd 

President of the Senate pro tempore. 

IN THE HOUSE OF REPRESENTATIVES, U.S. 

July 15, 2008. 

The House of Representatives having proceeded to reconsider the bill (H.R. 6331) 

entitled ‘An Act to amend titles XVIII and XIX of the Social Security Act to extend 

expiring provisions under the Medicare Program, to improve beneficiary access to 

preventive and mental health services, to enhance low-income benefit programs, and 

to maintain access to care in rural areas, including pharmacy access, and for other 

purposes’’, returned by the President of the United States with his objections, to the 

House of Representatives, in which it originated, it was 

Resolved, That the said bill pass, two-thirds of the House of Representatives 

agreeing to pass the same. 

Lorraine C. Miller 

Clerk. 

By 

Robert F. Reeves 

Deputy Clerk. 

I certify that this Act originated in the House of Representatives. 

Lorraine C. Miller 

Clerk. 


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PUBLIC LAW 110–275—JULY 15, 2008 122 STAT. 2597 

LEGISLATIVE HISTORY—H.R. 6331: 

CONGRESSIONAL RECORD, Vol. 154 (2008): 

June 24, considered and passed House. 

July 9, considered and passed Senate. 

WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 44 (2008): 

July 15, Presidential veto message. 

CONGRESSIONAL RECORD, Vol. 154 (2008): 

July 15, House and Senate overrode veto. 

Æ 

IN THE SENATE OF THE UNITED STATES, 

July 15, 2008. 

The Senate having proceeded to reconsider the bill (H.R. 6331) entitled ‘‘An Act 

to amend titles XVIII and XIX of the Social Security Act to extend expiring provisions under the Medicare Program, to improve beneficiary access to preventive and 

mental health services, to enhance low-income benefit programs, and to maintain 

access to care in rural areas, including pharmacy access, and for other purposes’’, 

returned by the President of the United States with his objections, to the House of 

Representatives, in which it originated, and passed by the House of Representatives 

on reconsideration of the same, it was 

Resolved, That the said bill pass, two-thirds of the Senators present having voted 

in the affirmative. 

Nancy Erickson 

Secretary. 


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