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[111th Congress Public Law 309]
[From the U.S. Government Printing Office]

[[Page 124 STAT. 3285]]

Public Law 111-309
111th Congress

                                 An Act

 
   To extend certain expiring provisions of the Medicare and Medicaid 
    programs, and for other purposes. <<NOTE: Dec. 15, 2010 -  [H.R. 
                                4994]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Medicare and 
Medicaid Extenders Act of 2010.>> 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short <<NOTE: 42 USC 1305 note.>> Title.--This Act may be cited 
as the ``Medicare and Medicaid Extenders Act of 2010''.

    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

                           TITLE I--EXTENSIONS

Sec. 101. Physician payment update.
Sec. 102. Extension of MMA section 508 reclassifications.
Sec. 103. Extension of Medicare work geographic adjustment floor.
Sec. 104. Extension of exceptions process for Medicare therapy caps.
Sec. 105. Extension of payment for technical component of certain 
           physician pathology services.
Sec. 106. Extension of ambulance add-ons.
Sec. 107. Extension of physician fee schedule mental health add-on 
           payment.
Sec. 108. Extension of outpatient hold harmless provision.
Sec. 109. Extension of Medicare reasonable costs payments for certain 
           clinical diagnostic laboratory tests furnished to hospital 
           patients in certain rural areas.
Sec. 110. Extension of the qualifying individual (QI) program.
Sec. 111. Extension of Transitional Medical Assistance (TMA).
Sec. 112. Special diabetes programs.

                       TITLE II--OTHER PROVISIONS

Sec. 201. Clarification of effective date of part B special enrollment 
           period for disabled TRICARE beneficiaries.
Sec. 202. Repeal of delay of RUG-IV.
Sec. 203. Clarification for affiliated hospitals for distribution of 
           additional residency positions.
Sec. 204. Continued inclusion of orphan drugs in definition of covered 
           outpatient drugs with respect to children's hospitals under 
           the 340B drug discount program.
Sec. 205. Medicaid and CHIP technical corrections.
Sec. 206. Funding for claims reprocessing.
Sec. 207. Revision to the Medicare Improvement Fund.
Sec. 208. Limitations on aggregate amount recovered on reconciliation of 
           the health insurance tax credit and the advance of that 
           credit.
Sec. 209. Determination of budgetary effects.

                           TITLE I--EXTENSIONS

SEC. 101. PHYSICIAN PAYMENT UPDATE.

    Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) is 
amended by adding at the end the following new paragraph:

[[Page 124 STAT. 3286]]

            ``(12) Update for 2011.--
                    ``(A) In general.--Subject to paragraphs (7)(B), 
                (8)(B), (9)(B), (10)(B), and (11)(B), in lieu of the 
                update to the single conversion factor established in 
                paragraph (1)(C) that would otherwise apply for 2011, 
                the update to the single conversion factor shall be 0 
                percent.
                    ``(B) No effect on computation of conversion factor 
                for 2012 and subsequent years.--The conversion factor 
                under this subsection shall be computed under paragraph 
                (1)(A) for 2012 and subsequent years as if subparagraph 
                (A) had never applied.''.
SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICATIONS.

    (a) Extension.--
            (1) In general.--Section 106(a) of division B of the Tax 
        Relief and Health Care Act of 2006 <<NOTE: 42 USC 1395ww 
        note.>> (42 U.S.C. 1395 note), as amended by section 117 of the 
        Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 
        110-173), section 124 of the Medicare Improvements for Patients 
        and Providers Act of 2008 (Public Law 110-275), and sections 
        3137(a) and 10317 of the Patient Protection and Affordable Care 
        Act (Public Law 111-148), is amended by striking ``September 30, 
        2010'' and inserting ``September 30, 2011''.
            (2) Special <<NOTE: 42 USC 1395ww note.>> rule for fiscal 
        year 2011.--
                    (A) In general.--Subject to subparagraph (B), for 
                purposes of implementation of the amendment made by 
                paragraph (1), including (notwithstanding paragraph (3) 
                of section 117(a) of the Medicare, Medicaid, and SCHIP 
                Extension Act of 2007 (Public Law 110-173), as amended 
                by section 124(b) of the Medicare Improvements for 
                Patients and Providers Act of 2008 (Public Law 110-275)) 
                for purposes of the implementation of paragraph (2) of 
                such section 117(a), during fiscal year 2011, the 
                Secretary of Health and Human Services shall use the 
                hospital wage index that was promulgated by the 
                Secretary of Health and Human Services in the Federal 
                Register on August 16, 2010 (75 Fed. Reg. 50042), and 
                any subsequent corrections.
                    (B) Exception.--Beginning <<NOTE: Effective 
                date.>> on April 1, 2011, in determining the wage index 
                applicable to hospitals that qualify for wage index 
                reclassification, the Secretary shall include the 
                average hourly wage data of hospitals whose 
                reclassification was extended pursuant to the amendment 
                made by paragraph (1) only if including such data 
                results in a higher applicable reclassified wage index. 
                Any revision to hospital wage indexes made as a result 
                of this subparagraph shall not be effected in a budget 
                neutral manner.
            (3) Adjustment <<NOTE: 42 USC 1395ww note.>> for certain 
        hospitals in fiscal year 2011.--
                    (A) In <<NOTE: Payments.>> general.--In the case of 
                a subsection (d) hospital (as defined in subsection 
                (d)(1)(B) of section 1886 of the Social Security Act (42 
                U.S.C. 1395ww)) with respect to which--
                          (i) a reclassification of its wage index for 
                      purposes of such section was extended pursuant to 
                      the amendment made by paragraph (1); and
                          (ii) the <<NOTE: Time periods.>> wage index 
                      applicable for such hospital for the period 
                      beginning on October 1, 2010, and ending

[[Page 124 STAT. 3287]]

                      on March 31, 2011, was lower than for the period 
                      beginning on April 1, 2011, and ending on 
                      September 30, 2011, by reason of the application 
                      of paragraph (2)(B);
                the Secretary shall pay such hospital an additional 
                payment that reflects the difference between the wage 
                index for such periods.
                    (B) Timeframe for payments.--The Secretary shall 
                make payments required under subparagraph (A) by not 
                later than December 31, 2011.

    (b) Conforming Amendment.--Section 117(a)(3) of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-
173) <<NOTE: 42 USC 1395ww note.>> is amended by inserting ``in fiscal 
years 2008 and 2009'' after ``For purposes of implementation of this 
subsection''.
SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC ADJUSTMENT FLOOR.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``before January 1, 2011'' and 
inserting ``before January 1, 2012''.
SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY 
                        CAPS.

    Section 1833(g)(5) of the Social Security Act (42 U.S.C. 
1395l(g)(5)) is amended by striking ``and ending on'' and all that 
follows through ``2010'' and inserting ``and ending on December 31, 
2011''.
SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF CERTAIN 
                        PHYSICIAN PATHOLOGY SERVICES.

    Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (as enacted into law by section 
1(a)(6) of Public Law 106-554), as amended by section 732 of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(42 U.S.C. 1395w-4 note), section 104 of division B of the Tax Relief 
and Health Care Act of 2006 (42 U.S.C. 1395w-4 note), section 104 of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-
173), section 136 of the Medicare Improvements for Patients and 
Providers Act of 2008 (Public Law 110-275), and section 3104 of the 
Patient Protection and Affordable Care Act (Public Law 111-148) is 
amended by striking ``and 2010'' and inserting ``2010, and 2011''.
SEC. 106. EXTENSION OF AMBULANCE ADD-ONS.

    (a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social Security 
Act (42 U.S.C. 1395m(l)(13)(A)) is amended--
            (1) in the matter preceding clause (i), by striking ``2011'' 
        and inserting ``2012,''; and
            (2) in each of clauses (i) and (ii), by striking ``January 
        1, 2011'' and inserting ``January 1, 2012'' each place it 
        appears.

    (b) Air Ambulance.--Section 146(b)(1) of the Medicare Improvements 
for Patients and Providers Act of 2008 (Public Law 110-275), as amended 
by sections 3105(b) and 10311(b) of Public Law 111-148, <<NOTE: 42 USC 
1395m note.>> is amended by striking ``December 31, 2010'' and inserting 
``December 31, 2011''.

    (c) Super Rural Ambulance.--Section 1834(l)(12)(A) of the Social 
Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking ``2011'' 
and inserting ``2012''.

[[Page 124 STAT. 3288]]

SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL HEALTH ADD-ON 
                        PAYMENT.

    Section 138(a)(1) of the Medicare Improvements for Patients and 
Providers Act of 2008 (Public Law 110-275), as amended by section 3107 
of the Patient Protection and Affordable Care Act (Public Law 111-
148), <<NOTE: 42 USC 1395w-4 note.>> is amended by striking ``December 
31, 2010'' and inserting ``December 31, 2011''.
SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS PROVISION.

    Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 
1395l(t)(7)(D)(i)), as amended by section 3121(a) of the Patient 
Protection and Affordable Care Act (Public Law 111-148), is amended--
            (1) in subclause (II)--
                    (A) in the first sentence, by striking ``2011'' and 
                inserting ``2012''; and
                    (B) in the second sentence, by striking ``or 2010'' 
                and inserting ``2010, or 2011''; and
            (2) in subclause (III), by striking ``January 1, 2011'' and 
        inserting ``January 1, 2012''.
SEC. 109. EXTENSION <<NOTE: 42 USC 1395l note.>> OF MEDICARE 
                        REASONABLE COSTS PAYMENTS FOR CERTAIN 
                        CLINICAL DIAGNOSTIC LABORATORY TESTS 
                        FURNISHED TO HOSPITAL PATIENTS IN CERTAIN 
                        RURAL AREAS.

    Section 416(b) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (42 U.S.C. 1395l-4), as amended by section 105 
of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 
1395l note), section 107 of the Medicare, Medicaid, and SCHIP Extension 
Act of 2007 (42 U.S.C. 1395l note), and section 3122 of the Patient 
Protection and Affordable Care Act (Public Law 111-148), is amended by 
striking ``the 1-year period beginning on July 1, 2010'' and inserting 
``the 2-year period beginning on July 1, 2010''.
SEC. 110. EXTENSION OF THE 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 ``December 
2010'' and inserting ``December 2011''.
    (b) Extending Total Amount Available for Allocation.--Section 
1933(g) of such Act (42 U.S.C. 1396u-3(g)) is amended--
            (1) in paragraph (2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (M);
                    (B) in subparagraph (N), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following new 
                subparagraphs:
                    ``(O) for <<NOTE: Time period.>> the period that 
                begins on January 1, 2011, and ends on September 30, 
                2011, the total allocation amount is $720,000,000; and
                    ``(P) for <<NOTE: Time period.>> the period that 
                begins on October 1, 2011, and ends on December 31, 
                2011, the total allocation amount is $280,000,000.''; 
                and
            (2) in paragraph (3), in the matter preceding subparagraph 
        (A), by striking ``or (N)'' and inserting ``(N), or (P)''.

[[Page 124 STAT. 3289]]

SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA).

    Sections 1902(e)(1)(B) and 1925(f) of the Social Security Act (42 
U.S.C. 1396a(e)(1)(B), 1396r-6(f)) are each amended by striking 
``December 31, 2010'' and inserting ``December 31, 2011''.
SEC. 112. SPECIAL DIABETES PROGRAMS.
            (1) Special diabetes programs for type i diabetes.--Section 
        330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
        2(b)(2)(C)) is amended by striking ``2011'' and inserting 
        ``2013''.
            (2) Special diabetes programs for indians.--Section 
        330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
        3(c)(2)(C)) is amended by striking ``2011'' and inserting 
        ``2013''.

                       TITLE II--OTHER PROVISIONS

SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B SPECIAL 
                        ENROLLMENT PERIOD FOR DISABLED TRICARE 
                        BENEFICIARIES.

    Effective as if included in the enactment of Public Law 111-148, 
section 3110(a)(2) of such Act <<NOTE: 42 USC 1395p note.>> is amended 
to read as follows:
            ``(2) Effective date.--The amendment made by paragraph (1) 
        shall apply to elections made on and after the date of the 
        enactment of this Act.''.
SEC. 202. REPEAL OF DELAY OF RUG-IV.

    Effective as if included in the enactment of Public Law 111-148, 
section 10325 of such Act <<NOTE: Ante, p. 960.>>  is repealed.
SEC. 203. CLARIFICATION <<NOTE: 42 USC 1395ww note.>> FOR 
                        AFFILIATED HOSPITALS FOR DISTRIBUTION OF 
                        ADDITIONAL RESIDENCY POSITIONS.

    Effective as if included in the enactment of section 5503(a) of 
Public Law 111-148, section 1886(h)(8) of the Social Security Act (42 
U.S.C. 1395ww(h)(8)), as added by such section 5503(a), is amended by 
adding at the end the following new subparagraph:
                    ``(I) Affiliation.--
                The <<NOTE: Applicability.>> provisions of this 
                paragraph shall be applied to hospitals which are 
                members of the same affiliated group (as defined by the 
                Secretary under paragraph (4)(H)(ii)) and the reference 
                resident level for each such hospital shall be the 
                reference resident level with respect to the cost 
                reporting period that results in the smallest difference 
                between the reference resident level and the otherwise 
                applicable resident limit.''.
SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN DEFINITION OF 
                        COVERED OUTPATIENT DRUGS WITH RESPECT TO 
                        CHILDREN'S HOSPITALS UNDER THE 340B DRUG 
                        DISCOUNT PROGRAM.

    (a) Definition of Covered Outpatient Drug.--
            (1) Amendment.--Subsection (e) of section 340B of the Public 
        Health Service Act (42 U.S.C. 256b) is amended by striking 
        ``covered entities described in subparagraph (M)'' and inserting 
        ``covered entities described in subparagraph (M) (other than a 
        children's hospital described in subparagraph (M))''.
            (2) Effective <<NOTE: 42 USC 256b note.>>  date.--The 
        amendment made by paragraph (1) shall take effect as if included 
        in the enactment of section

[[Page 124 STAT. 3290]]

        2302 of the Health Care and Education Reconciliation Act of 2010 
        (Public Law 111-152).

    (b) Technical Amendment.--Subparagraph (B) of section 1927(a)(5) of 
the Social Security Act (42 U.S.C. 1396r-8(a)(5)) is amended by striking 
``and a children's hospital'' and all that follows through the end of 
the subparagraph and inserting a period.
SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS.

    (a) Repeal of Exclusion of Certain Individuals and Entities From 
Medicaid.--Section 1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended by striking paragraph (78).
    (b) Income Level for Certain Children Under Medicaid.--Section 
1902(l)(2)(C) of the Social Security Act (42 U.S.C. 1396a(l)(2)(C)) is 
amended by striking ``133 percent'' and inserting ``100 percent (or, 
beginning January 1, 2014, 133 percent)''.
    (c) Calculation and Publication of Payment Error Rate Measurement 
for Certain Years.--Section 601(b) of the Children's Health Insurance 
Program Reauthorization Act of 2009 (Public Law 111-3) <<NOTE: Ante, p. 
96.>>  is amended by adding at the end the following: ``The Secretary is 
not required under this subsection to calculate or publish a national or 
a State-specific error rate for fiscal year 2009 or fiscal year 2010.''.

    (d) Corrections to Exceptions to Exclusion of Children of Certain 
Employees.--Section 2110(b)(6) of the Social Security Act (42 U.S.C. 
1397jj(b)(6)) is amended--
            (1) in subparagraph (B)--
                    (A) by striking ``per person'' in the heading; and
                    (B) by striking ``each employee'' and inserting 
                ``employees''; and
            (2) in subparagraph (C), by striking ``, on a case-by-case 
        basis,''.

    (e) Electronic <<NOTE: 42 USC 1396b note.>> Health Records.--
Effective as if included in the enactment of section 4201(a)(2) of the 
American Recovery and Reinvestment Act of 2009 (Public Law 111-5), 
section 1903(t) of the Social Security Act (42 U.S.C. 1396b(t)) is 
amended--
            (1) in paragraph (3)(E), by striking ``reduced by any 
        payment that is made to such Medicaid provider from any other 
        source (other than under this subsection or by a State or local 
        government)'' and inserting ``reduced by the average payment the 
        Secretary estimates will be made to such Medicaid providers 
        (determined on a percentage or other basis for such classes or 
        types of providers as the Secretary may specify) from other 
        sources (other than under this subsection, or by the Federal 
        government or a State or local government)''; and
            (2) in paragraph (6)(B), by inserting before the period the 
        following: ``and shall be determined to have met such 
        responsibility to the extent that the payment to the Medicaid 
        provider is not in excess of 85 percent of the net average 
        allowable cost''.

    (f) Corrections of Designations.--
            (1) Section 1902 of the Social Security Act (42 U.S.C. 
        1396a) is amended--
                    (A) in subsection (a)(10), in the matter following 
                subparagraph (G), by striking ``and'' before ``(XVI) the 
                medical'' and by striking ``(XVI) if'' and inserting 
                ``(XVII) if'';
                    (B) in subsection (a)(23), by striking ``(ii)'' and 
                inserting ``(kk)'';

[[Page 124 STAT. 3291]]

                    (C) in subsection (a)(77), by striking ``(ii)'' and 
                inserting ``(kk)'';
                    (D) in subsection (ii)(2), as added by section 
                2303(a)(2) of Public Law 111-148, by striking ``(XV)'' 
                and inserting ``(XVI)''; and
                    (E) by redesignating subsection (ii), as added by 
                section 6401(b)(1)(B) of Public Law 111-148, as 
                subsection (kk) and transferring such subsection so as 
                to appear after subsection (jj) of that section.
            (2) Section 2107(e)(1) of the Social Security Act (42 U.S.C. 
        1397gg(e)(1)) is amended--
                    (A) in subparagraph (D), as added by section 6401(c) 
                of Public Law 111-148, by striking ``(ii)'' and 
                inserting ``(kk)''; and
                    (B) by redesignating the subparagraph (N) of that 
                section added by 2101(e) of Public Law 111-148 as 
                subparagraph (O).
SEC. 206. FUNDING FOR CLAIMS REPROCESSING.

    For purposes of carrying out the provisions of, and amendments made 
by, this Act that relate to title XVIII of the Social Security Act, and 
other provisions of, or relating to, such title that ensure appropriate 
payment of claims, there are appropriated to the Secretary of Health and 
Human Services for the Centers for Medicare & Medicaid Services Program 
Management Account, from amounts in the general fund of the Treasury not 
otherwise appropriated, $200,000,000. Amounts appropriated under the 
preceding sentence shall be in addition to any other funds available for 
such purposes, shall remain available until expended, and shall not be 
used to implement changes to title XVIII of the Social Security Act made 
by Public Laws 111-148 and 111-152.
SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT FUND.

    Section 1898(b)(1)(B) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)(B)) is amended by striking ``$550,000,000'' and inserting 
``$275,000,000''.
SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOVERED ON 
                        RECONCILIATION OF THE HEALTH INSURANCE TAX 
                        CREDIT AND THE ADVANCE OF THAT CREDIT.

    (a) In General.--So much of section 36B(f)(2)(B) of the Internal 
Revenue Code of 1986 <<NOTE: 26 USC 36B.>> as precedes clause (ii) 
thereof is amended to read as follows:
                    ``(B) Limitation on increase.--
                          ``(i) In general.--In the case of a taxpayer 
                      whose household income is less than 500 percent of 
                      the poverty line for the size of the family 
                      involved for the taxable year, the amount of the 
                      increase under subparagraph (A) shall in no event 
                      exceed the applicable dollar amount determined in 
                      accordance with the following table (one-half of 
                      such amount in the case of a taxpayer whose tax is 
                      determined under section 1(c) for the taxable 
                      year):

[[Page 124 STAT. 3292]]

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    ``If the household income (expressed as a percent of
                     poverty line) is:                                 The applicable dollar amount is:
----------------------------------------------------------------------------------------------------------------
Less than 200%.............................................  $600
At least 200% but less than 250%...........................  $1,000
At least 250% but less than 300%...........................  $1,500
At least 300% but less than 350%...........................  $2,000
At least 350% but less than 400%...........................  $2,500
At least 400% but less than 450%...........................  $3,000
At least 450% but less than 500%...........................  $3,500''.
----------------------------------------------------------------------------------------------------------------

    (b) Conforming Amendment.--Section 36B(f)(2)(B)(ii) of such Code 
is <<NOTE: 26 USC 36B.>> amended by inserting ``in the table contained'' 
after ``each of the dollar amounts''.

    (c) Effective <<NOTE: 26 USC 36B note.>> Date.--The amendments made 
by this section shall apply to taxable years beginning after December 
31, 2013.
SEC. 209. DETERMINATION OF BUDGETARY EFFECTS.

    (a) In General.--The budgetary effects of this Act, for the purpose 
of complying with the Statutory Pay-As-You-Go Act of 2010, shall be 
determined by reference to the latest statement titled ``Budgetary 
Effects of PAYGO Legislation'' for this Act, submitted for printing in 
the Congressional Record by the Chairman of the Senate Budget Committee, 
provided that such statement has been submitted prior to the vote on 
passage.
    (b) Emergency Designation for Congressional Enforcement.--In the 
House of Representatives, this Act, with the exception of section 101, 
is designated as an emergency for purposes of pay-as-you-go principles.

    Approved December 15, 2010.

LEGISLATIVE HISTORY--H.R. 4994:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 156 (2010):
            Apr. 14, considered and passed House.
            Dec. 8, considered and passed Senate, amended.
            Dec. 9, House concurred in Senate amendments.

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