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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3961 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 252
111th CONGRESS
  2d Session
                                H. R. 3961

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           November 20, 2009

                                Received

                           December 24, 2009

                          Read the first time

                            January 20, 2010

            Read the second time and placed on the calendar

_______________________________________________________________________

                                 AN ACT

 
To amend title XVIII of the Social Security Act to reform the Medicare 
  SGR payment system for physicians and to reinstitute and update the 
Pay-As-You-Go requirement of budget neutrality on new tax and mandatory 
   spending legislation, enforced by the threat of annual, automatic 
                             sequestration.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

       DIVISION A--MEDICARE PHYSICIAN PAYMENT REFORM ACT OF 2009

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This division may be cited as the ``Medicare 
Physician Payment Reform Act of 2009''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

       DIVISION A--MEDICARE PHYSICIAN PAYMENT REFORM ACT OF 2009

Sec. 1. Short title; table of contents.
Sec. 2. Medicare sustainable growth rate reform.
            DIVISION B--STATUTORY PAY-AS-YOU-GO ACT OF 2009

Sec. 101. Short Title.
Sec. 102. Purpose.
Sec. 103. Definitions.
Sec. 104. PAYGO estimates and PAYGO scorecards.
Sec. 105. Annual report and sequestration order.
Sec. 106. Calculating a sequestration.
Sec. 107. Current policy adjustment to the CBO estimates.
Sec. 108. Application of BBEDCA.
Sec. 109. Technical corrections.
Sec. 110. Conforming amendments.
Sec. 111. Exempt programs and activities.

SEC. 2. MEDICARE SUSTAINABLE GROWTH RATE REFORM.

    (a) Transitional Update for 2010.--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:
            ``(10) Update for 2010.--The update to the single 
        conversion factor established in paragraph (1)(C) for 2010 
        shall be the percentage increase in the MEI (as defined in 
        section 1842(i)(3)) for that year.''.
    (b) Rebasing SGR Using 2009; Limitation on Cumulative Adjustment 
Period.--Section 1848(d)(4) of such Act (42 U.S.C. 1395w-4(d)(4)) is 
amended--
            (1) in subparagraph (B), by striking ``subparagraph (D)'' 
        and inserting ``subparagraphs (D) and (G)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(G) Rebasing using 2009 for future update 
                adjustments.--In determining the update adjustment 
                factor under subparagraph (B) for 2011 and subsequent 
                years--
                            ``(i) the allowed expenditures for 2009 
                        shall be equal to the amount of the actual 
                        expenditures for physicians' services during 
                        2009; and
                            ``(ii) the reference in subparagraph 
                        (B)(ii)(I) to `April 1, 1996' shall be treated 
                        as a reference to `January 1, 2009 (or, if 
                        later, the first day of the fifth year before 
                        the year involved)'.''.
    (c) Limitation on Physicians' Services Included in Target Growth 
Rate Computation to Services Covered Under Physician Fee Schedule.--
Effective for services furnished on or after January 1, 2009, section 
1848(f)(4)(A) of such Act is amended by striking ``(such as clinical'' 
and all that follows through ``in a physician's office'' and inserting 
``for which payment under this part is made under the fee schedule 
under this section, for services for practitioners described in section 
1842(b)(18)(C) on a basis related to such fee schedule, or for services 
described in section 1861(p) (other than such services when furnished 
in the facility of a provider of services)''.
    (d) Establishment of Separate Target Growth Rates for Categories of 
Services.--
            (1) Establishment of service categories.--Subsection (j) of 
        section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is 
        amended by adding at the end the following new paragraph:
            ``(5) Service categories.--For services furnished on or 
        after January 1, 2009, each of the following categories of 
        physicians' services (as defined in paragraph (3)) shall be 
        treated as a separate `service category':
                    ``(A) Evaluation and management services that are 
                procedure codes (for services covered under this title) 
                for--
                            ``(i) services in the category designated 
                        Evaluation and Management in the Health Care 
                        Common Procedure Coding System (established by 
                        the Secretary under subsection (c)(5) as of 
                        December 31, 2009, and as subsequently modified 
                        by the Secretary); and
                            ``(ii) preventive services (as defined in 
                        section 1861(iii)) for which payment is made 
                        under this section.
                    ``(B) All other services not described in 
                subparagraph (A).
        Service categories established under this paragraph shall apply 
        without regard to the specialty of the physician furnishing the 
        service.''.
            (2) Establishment of separate conversion factors for each 
        service category.--Subsection (d)(1) of section 1848 of the 
        Social Security Act (42 U.S.C. 1395w-4) is amended--
                    (A) in subparagraph (A)--
                            (i) by designating the sentence beginning 
                        ``The conversion factor'' as clause (i) with 
                        the heading ``Application of single conversion 
                        factor.--'' and with appropriate indentation;
                            (ii) by striking ``The conversion factor'' 
                        and inserting ``Subject to clause (ii), the 
                        conversion factor''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) Application of multiple conversion 
                        factors beginning with 2011.--
                                    ``(I) In general.--In applying 
                                clause (i) for years beginning with 
                                2011, separate conversion factors shall 
                                be established for each service 
                                category of physicians' services (as 
                                defined in subsection (j)(5)) and any 
                                reference in this section to a 
                                conversion factor for such years shall 
                                be deemed to be a reference to the 
                                conversion factor for each of such 
                                categories.
                                    ``(II) Initial conversion 
                                factors.--Such factors for 2011 shall 
                                be based upon the single conversion 
                                factor for the previous year multiplied 
                                by the update established under 
                                paragraph (11) for such category for 
                                2011.
                                    ``(III) Updating of conversion 
                                factors.--Such factor for a service 
                                category for a subsequent year shall be 
                                based upon the conversion factor for 
                                such category for the previous year and 
                                adjusted by the update established for 
                                such category under paragraph (11) for 
                                the year involved.''; and
                    (B) in subparagraph (D), by striking ``other 
                physicians' services'' and inserting ``for physicians' 
                services described in the service category described in 
                subsection (j)(5)(B)''.
            (3) Establishing updates for conversion factors for service 
        categories.--Section 1848(d) of the Social Security Act (42 
        U.S.C. 1395w-4(d)), as amended by subsection (a), is amended--
                    (A) in paragraph (4)(C)(iii), by striking ``The 
                allowed'' and inserting ``Subject to paragraph (11)(B), 
                the allowed''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(11) Updates for service categories beginning with 
        2011.--
                    ``(A) In general.--In applying paragraph (4) for a 
                year beginning with 2011, the following rules apply:
                            ``(i) Application of separate update 
                        adjustments for each service category.--
                        Pursuant to paragraph (1)(A)(ii)(I), the update 
                        shall be made to the conversion factor for each 
                        service category (as defined in subsection 
                        (j)(5)) based upon an update adjustment factor 
                        for the respective category and year and the 
                        update adjustment factor shall be computed, for 
                        a year, separately for each service category.
                            ``(ii) Computation of allowed and actual 
                        expenditures based on service categories.--In 
                        computing the prior year adjustment component 
                        and the cumulative adjustment component under 
                        clauses (i) and (ii) of paragraph (4)(B), the 
                        following rules apply:
                                    ``(I) Application based on service 
                                categories.--The allowed expenditures 
                                and actual expenditures shall be the 
                                allowed and actual expenditures for the 
                                service category, as determined under 
                                subparagraph (B).
                                    ``(II) Application of category 
                                specific target growth rate.--The 
                                growth rate applied under clause 
                                (ii)(II) of such paragraph shall be the 
                                target growth rate for the service 
                                category involved under subsection 
                                (f)(5).
                    ``(B) Determination of allowed expenditures.--In 
                applying paragraph (4) for a year beginning with 2010, 
                notwithstanding subparagraph (C)(iii) of such 
                paragraph, the allowed expenditures for a service 
                category for a year is an amount computed by the 
                Secretary as follows:
                            ``(i) For 2010.--For 2010:
                                    ``(I) Total 2009 actual 
                                expenditures for all services included 
                                in sgr computation for each service 
                                category.--Compute total actual 
                                expenditures for physicians' services 
                                (as defined in subsection (f)(4)(A)) 
                                for 2009 for each service category.
                                    ``(II) Increase by growth rate to 
                                obtain 2010 allowed expenditures for 
                                service category.--Compute allowed 
                                expenditures for the service category 
                                for 2010 by increasing the allowed 
                                expenditures for the service category 
                                for 2009 computed under subclause (I) 
                                by the target growth rate for such 
                                service category under subsection (f) 
                                for 2010.
                            ``(ii) For subsequent years.--For a 
                        subsequent year, take the amount of allowed 
                        expenditures for such category for the 
                        preceding year (under clause (i) or this 
                        clause) and increase it by the target growth 
                        rate determined under subsection (f) for such 
                        category and year.''.
            (4) Application of separate target growth rates for each 
        category.--
                    (A) In general.--Section 1848(f) of the Social 
                Security Act (42 U.S.C. 1395w-4(f)) is amended by 
                adding at the end the following new paragraph:
            ``(5) Application of separate target growth rates for each 
        service category beginning with 2010.--The target growth rate 
        for a year beginning with 2010 shall be computed and applied 
        separately under this subsection for each service category (as 
        defined in subsection (j)(5)) and shall be computed using the 
        same method for computing the target growth rate except that 
        the factor described in paragraph (2)(C) for--
                    ``(A) the service category described in subsection 
                (j)(5)(A) shall be increased by 0.02; and
                    ``(B) the service category described in subsection 
                (j)(5)(B) shall be increased by 0.01.''.
                    (B) Use of target growth rates.--Section 1848 of 
                such Act is further amended--
                            (i) in subsection (d)--
                                    (I) in paragraph (1)(E)(ii), by 
                                inserting ``or target'' after 
                                ``sustainable''; and
                                    (II) in paragraph (4)(B)(ii)(II), 
                                by inserting ``or target'' after 
                                ``sustainable'';
                            (ii) in the heading of subsection (f), by 
                        inserting ``and Target Growth Rate'' after 
                        ``Sustainable Growth Rate'';
                            (iii) in subsection (f)(1)--
                                    (I) by striking ``and'' at the end 
                                of subparagraph (A);
                                    (II) in subparagraph (B), by 
                                inserting ``before 2010'' after ``each 
                                succeeding year'' and by striking the 
                                period at the end and inserting ``; 
                                and''; and
                                    (III) by adding at the end the 
                                following new subparagraph:
                    ``(C) November 1 of each succeeding year the target 
                growth rate for such succeeding year and each of the 2 
                preceding years.''; and
                            (iv) in subsection (f)(2), in the matter 
                        before subparagraph (A), by inserting after 
                        ``beginning with 2000'' the following: ``and 
                        ending with 2009''.
    (e) Application to Health Care Group Demonstration Program and 
Successor Accountable Care Organization Pilot Program.--In applying the 
target growth rate under subsections (d) and (f) of section 1848 of the 
Social Security Act to services furnished by a practitioner to 
beneficiaries who are attributable to a health care group under the 
demonstration program provided under section 1886A of such Act (or to 
an accountable care organization under a pilot program that is a 
succcessor to such demonstration program under a section of such Act), 
the Secretary of Health and Human Services shall develop, not later 
than January 1, 2012, for application beginning with 2012, a method 
that--
            (1) allows each such group or organization to have its own 
        expenditure targets and updates for such practitioners, with 
        respect to beneficiaries who are attributable to that group or 
        organization, that are consistent with the methodologies 
        described in such subsection (f); and
            (2) provides that the target growth rate applicable to 
        other physicians shall not apply to such physicians to the 
        extent that the physicians' services are furnished through the 
        group or organization.
In applying paragraph (1), the Secretary of Health and Human Services 
may apply the difference in the update under such paragraph on a claim-
by-claim or lump sum basis and such a payment shall be taken into 
account under the demonstration or pilot program.

            DIVISION B--STATUTORY PAY-AS-YOU-GO ACT OF 2009

SEC. 101. SHORT TITLE.

    This division may be cited as the ``Statutory Pay-As-You-Go Act of 
2009''.

SEC. 102. PURPOSE.

    The purpose of this division is to reestablish a statutory 
procedure to enforce a rule of budget neutrality on new revenue and 
direct spending legislation.

SEC. 103. DEFINITIONS.

    As used in this division--
            (1) The term ``BBEDCA'' means the Balanced Budget and 
        Emergency Deficit Control Act of 1985.
            (2) The definitions set forth in section 3 of the 
        Congressional Budget and Impoundment Control Act of 1974 and in 
        section 250 of BBEDCA shall apply to this division, except to 
        the extent that they are specifically modified as follows:
                    (A) The term ``outyear'' means a fiscal year that 
                occurs one or more years after the budget year.
                    (B) In section 250(c)(8)(C), the reference to the 
                food stamp program shall be deemed to be a reference to 
                the Supplemental Nutrition Assistance Program.
            (3) The term ``AMT'' means the Alternative Minimum Tax for 
        individuals under sections 55-59 of the Internal Revenue Code 
        of 1986, the term ``EGTRRA'' means the Economic Growth and Tax 
        Relief Reconciliation Act of 2001 (Public Law 107-16), and the 
        term ``JGTRRA'' means the Jobs and Growth Tax Relief and 
        Reconciliation Act of 2003 (Public Law 108-27).
            (4)(A) The term ``budgetary effects'' means the amounts by 
        which PAYGO legislation changes direct spending or revenues 
        relative to the baseline and shall be determined on the basis 
        of estimates included by reference in the PAYGO Act or prepared 
        under section 104(d)(3), as applicable. Budgetary effects that 
        increase direct spending or decrease revenues are termed 
        ``costs'' and budgetary effects that increase revenues or 
        decrease direct spending are termed ``savings''.
            (B) For purposes of these definitions, off-budget effects 
        shall be counted as budgetary effects unless such changes flow 
        directly from amendments to title II of the Social Security Act 
        and related provisions of the Internal Revenue Code of 1986 and 
        debt service effects shall not be counted as budgetary effects.
            (C) Solely for purposes of recording entries on a PAYGO 
        scorecard, provisions in appropriations Acts are also 
        considered to be budgetary effects for purposes of this 
        division if such provisions make outyear modifications to 
        substantive law, except that provisions for which the outlay 
        effects net to zero over a period consisting of the current 
        year, the budget year, and the 4 subsequent years shall not be 
        considered budgetary effects. For purposes of this paragraph, 
        the term, ``modifications to substantive law'' refers to 
        changes to or restrictions on entitlement law or other 
        mandatory spending contained in appropriations Acts, 
        notwithstanding section 250(c)(8) of BBEDCA. Provisions in 
        appropriations Acts that are neither outyear modifications to 
        substantive law nor changes in revenues have no budgetary 
        effects for purposes of this division.
            (D) If a provision is designated as an emergency 
        requirement under this division and is also designated as an 
        emergency requirement under the applicable rules of the House 
        of Representatives, CBO shall not include the cost of such a 
        provision in its estimate of the PAYGO legislation's budgetary 
        effects.
            (5) The term ``debit'' refers to the net total amount, when 
        positive, by which costs recorded on the PAYGO scorecards for a 
        fiscal year exceed savings recorded on those scorecards for 
        that year.
            (6) The term ``entitlement law'' refers to a section of law 
        which provides entitlement authority.
            (7) The term ``PAYGO legislation'' or a ``PAYGO Act'' 
        refers to a bill or joint resolution that affects direct 
        spending or revenue relative to the baseline. The budgetary 
        effects of changes in revenues and outyear modifications to 
        substantive law included in appropriation Acts as defined in 
        paragraph (4) shall be treated as if they were contained in 
        PAYGO legislation.
            (8) The term ``timing shift'' refers to a delay of the date 
        on which direct spending would otherwise occur from the ninth 
        outyear to the tenth outyear or an acceleration of the date on 
        which revenues would otherwise occur from the tenth outyear to 
        the ninth outyear.

SEC. 104. PAYGO ESTIMATES AND PAYGO SCORECARDS.

    (a) Paygo Estimates.--(1) A PAYGO Act shall include by reference an 
estimate of its budgetary effects as determined under section 308(a)(3) 
of the Congressional Budget Act of 1974, if timely submitted for 
printing in the Congressional Record by the chairs of the Committees on 
the Budget of the House of Representatives and the Senate, as 
applicable, before the vote on the PAYGO legislation. The Clerk of the 
House or the Secretary of the Senate, as applicable, shall also 
incorporate by reference such estimate printed in the relevant portion 
of the Congressional Record under section 308(a)(3) of the 
Congressional Budget Act of 1974 into the enrollment of a PAYGO Act. 
Budgetary effects that are not so included shall be determined under 
section 104(d)(3).
    (2)(A) Section 308(a) of the Congressional Budget Act of 1974 is 
amended by adding at the end the following new paragraph:
            ``(3) CBO paygo estimates.--Before a vote in either House 
        on a PAYGO Act that, if determined in the affirmative, would 
        clear such Act for enrollment, the chairs of the Committees on 
        the Budget of the House and Senate, as applicable, shall 
        request from the Director of the Congressional Budget Office an 
        estimate of the budgetary effects of such Act under the 
        Statutory Pay-As-You-Go Act of 2009. If such an estimate is 
        timely provided, the chairs of the Committees on the Budget of 
        the House of Representatives and the Senate shall post such 
        estimate on their respective committee websites and cause it to 
        be printed in the Congressional Record under the heading `PAYGO 
        ESTIMATE'. For purposes of this section, the Director of the 
        Congressional Budget Office shall not count timing shifts in 
        his estimates of the budgetary effects of PAYGO legislation (as 
        defined in section 103 of the Statutory Pay-As-You-Go Act of 
        2009).''.
    (B) The side heading of section 308(a) of the Congressional Budget 
Act of 1974 is amended by striking ``Reports on''.
    (b) Section 308 of the Congressional Budget Act of 1974 is amended 
by adding at the end the following new subsection:
    ``(d) Scorekeeping Guidelines.--The Director of the Congressional 
Budget Office shall provide estimates under this section in accordance 
with the scorekeeping guidelines determined under section 252(d)(5) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. Upon 
agreement, the chairs of the Committees on the Budget of the House of 
Representatives and the Senate shall submit updates to such guidelines 
for printing in the Congressional Record.''.
    (c) Current Policy Adjustments for Certain Legislation.--For 
purposes of calculating budgetary effects under this division, CBO 
shall adjust its estimates as described below for any provision of 
legislation designated as meeting the criteria in subsection (b), (c), 
or (d) of section 107 and which the chairman of the Committee on the 
Budget of the House of Representatives or the Senate, as applicable, 
designates as meeting those criteria. A single piece of legislation may 
contain provisions designated as meeting criteria in more than one of 
the subsections listed above. For appropriately designated provisions, 
CBO shall exclude from its estimates for purposes of this division any 
costs of a provision to the extent that those costs, when combined with 
all other excluded costs of any other previously designated provisions 
of enacted legislation under the same subsection of section 107, do not 
exceed the maximum applicable current policy adjustment defined under 
the applicable subsection of section 107 for the applicable 10-year 
period, using the most recent baseline estimates supplied by the 
Congressional Budget Office consistent with section 257 of the Balanced 
Budget and Emergency Deficit Control Act of 1985 used in considering a 
concurrent resolution on the budget; or, after the beginning of a new 
calendar year and before consideration of a concurrent resolution on 
the budget, using the most recent baseline estimates supplied by the 
Congressional Budget Office consistent with section 257 of the Balanced 
Budget and Emergency Deficit Control Act of 1985. CBO estimates of 
legislation containing a current policy designation under this 
subsection shall include a separate presentation of costs excluded from 
the calculation of budgetary effects for the legislation, as well as an 
updated total of all excluded costs of provisions within the same 
subsection of section 107.
    (d) OMB Paygo Scorecards.--
            (1) In general.--OMB shall maintain and make publicly 
        available a continuously updated document containing two PAYGO 
        scorecards displaying the budgetary effects of PAYGO 
        legislation as determined under section 308 of the 
        Congressional Budget Act of 1974, applying the look-back 
        requirement in subsection (e) and the averaging requirement in 
        subsection (f), and a separate addendum displaying the 
        estimates of the costs of provisions designated in statute as 
        emergency requirements.
            (2) Estimates in legislation.--Except as provided in 
        paragraph (3), in making the calculations for the PAYGO 
        scorecards, OMB shall use the budgetary effects included by 
        reference in the applicable legislation.
            (3) OMB estimates.--If legislation does not contain the 
        estimate of budgetary effects under paragraph (2), then OMB 
        shall score the budgetary effects of that legislation upon its 
        enactment, based on the approaches to scorekeeping set forth in 
        this division.
            (4) 5-year scorecard.--The first scorecard shall display 
        the budgetary effects of PAYGO legislation in each year over 
        the 5-year period beginning in the budget year.
            (5) 10-year scorecard.--The second scorecard shall display 
        the budgetary effects of PAYGO legislation in each year over 
        the 10-year period beginning in the budget year.
    (e) Look-back to Capture Current-year Effects.--For purposes of 
this section, OMB shall treat the budgetary effects of PAYGO 
legislation enacted during a session of Congress that occur during the 
current year as though they occurred in the budget year.
    (f) Averaging Used to Measure Compliance Over 5-year and 10-year 
Periods.--OMB shall cumulate the budgetary effects of a PAYGO Act over 
the budget year (which includes any look-back effects under subsection 
(e)) and--
            (1) for purposes of the 5-year scorecard referred to in 
        subsection (d)(4), the four subsequent outyears, divide that 
        cumulative total by five, and enter the quotient in the budget-
        year column and in each subsequent column of the 5-year PAYGO 
        scorecard; and
            (2) for purposes of the 10-year scorecard referred to in 
        subsection (d)(5), the nine subsequent outyears, divide that 
        cumulative total by ten, and enter the quotient in the budget-
        year column and in each subsequent column of the 10-year PAYGO 
        scorecard.

SEC. 105. ANNUAL REPORT AND SEQUESTRATION ORDER.

    (a) Annual Report.--Not later than 14 days (excluding weekends and 
holidays) after Congress adjourns to end a session, OMB shall make 
publicly available and cause to be printed in the Federal Register an 
annual PAYGO report. The report shall include an up-to-date document 
containing the PAYGO scorecards, a description of any current policy 
adjustments made under section 104(c), information about emergency 
legislation (if any) designated under section 103(4)(D), information 
about any sequestration if required by subsection (b), and other data 
and explanations that enhance public understanding of this division and 
actions taken under it.
    (b) Sequestration Order.--If the annual report issued at the end of 
a session of Congress under subsection (a) shows a debit on either 
PAYGO scorecard for the budget year, OMB shall prepare and the 
President shall issue and include in that report a sequestration order 
that, upon issuance, shall reduce budgetary resources of direct 
spending programs by enough to offset that debit as prescribed in 
section 106. If there is a debit on both scorecards, the order shall 
fully offset the larger of the two debits. OMB shall include that order 
in the annual report and transmit it to the House of Representatives 
and the Senate. If the President issues a sequestration order, the 
annual report shall contain, for each budget account to be sequestered, 
estimates of the baseline level of budgetary resources subject to 
sequestration, the amount of budgetary resources to be sequestered, and 
the outlay reductions that will occur in the budget year and the 
subsequent fiscal year because of that sequestration.

SEC. 106. CALCULATING A SEQUESTRATION.

    (a) Reducing Nonexempt Budgetary Resources by a Uniform 
Percentage.--OMB shall calculate the uniform percentage by which the 
budgetary resources of nonexempt direct spending programs are to be 
sequestered such that the outlay savings resulting from that 
sequestration, as calculated under subsection (b), shall offset the 
budget-year debit, if any on the applicable PAYGO scorecard. If the 
uniform percentage calculated under the prior sentence exceeds 4 
percent, the Medicare programs described in section 256(d) of BBEDCA 
shall be reduced by 4 percent and the uniform percentage by which the 
budgetary resources of all other nonexempt direct spending programs are 
to be sequestered shall be increased, as necessary, so that the 
sequestration of Medicare and of all other nonexempt direct spending 
programs together produce the required outlay savings.
    (b) Outlay Savings.--In determining the amount by which a 
sequestration offsets a budget-year debit, OMB shall count--
            (1) the amount by which the sequestration in a crop year of 
        crop support payments, pursuant to section 256(j) of BBEDCA, 
        reduces outlays in the budget year and the subsequent fiscal 
        year;
            (2) the amount by which the sequestration of Medicare 
        payments in the 12-month period following the sequestration 
        order, pursuant to section 256(d) of BBEDCA, reduces outlays in 
        the budget year and the subsequent fiscal year; and
            (3) the amount by which the sequestration in the budget 
        year of the budgetary resources of other nonexempt mandatory 
        programs reduces outlays in the budget year and in the 
        subsequent fiscal year.

SEC. 107. CURRENT POLICY ADJUSTMENT TO THE CBO ESTIMATES.

    (a) Purpose.--The purpose of this section is to provide for 
adjustments of estimates of budgetary effects of PAYGO legislation for 
legislation affecting four areas of the budget--
            (1) payments made under section 1848 of the Social Security 
        Act (titled Payment for Physicians' Services);
            (2) the Estate and Gift Tax under subtitle B of the 
        Internal Revenue Code of 1986;
            (3) the AMT; and
            (4) provisions of EGTRRA or JGTRRA that amended the 
        Internal Revenue Code of 1986 (or provisions in later statutes 
        further amending the amendments made by EGTRRA or JGTRRA), 
        other than--
                    (A) the provisions of those two Acts that were made 
                permanent by the Pension Protection Act of 2006 (Public 
                Law 109-280);
                    (B) amendments to the estate and gift tax referred 
                to in paragraph (2);
                    (C) the AMT referred to in paragraph (3);
                    (D) the 35 percent bracket and that portion of the 
                33 percent bracket that applies to taxable income 
                greater than $200,000 for an individual and $250,000 
                for a couple; and
                    (E) provisions in those two Acts relating to taxes 
                rates on capital gains and dividends.
    (b) Medicare Payments to Physicians.--
            (1) Criteria.--Legislation that includes provisions 
        amending or superseding the system of payments under section 
        1848 of the Social Security Act shall trigger the current 
        policy adjustment required by this division.
            (2) Adjustment.--The amount of the maximum current policy 
        adjustment shall be the difference between--
                    (A) estimated net outlays attributable to the 
                payments made to physicians under that section of the 
                Social Security Act (as scheduled on July 15, 2009, to 
                be in effect); and
                    (B) what those net outlays would have been if the 
                nominal payment rates and related parameters in effect 
                for 2009 had been in effect thereafter without change.
    (c) Estate and Gift Tax.--
            (1) Criteria.--Legislation that includes provisions 
        amending the Estate and Gift Tax under subtitle B of the 
        Internal Revenue Code of 1986 shall trigger the current policy 
        adjustment required by this division.
            (2) Adjustment.--The amount of the maximum current policy 
        adjustment shall be the difference between--
                    (A) total revenues projected to be collected under 
                the Internal Revenue Code of 1986 (as scheduled on July 
                15, 2009, to be in effect); and
                    (B) what those revenue collections would have been 
                if, on the date of enactment of the legislation meeting 
                the criteria in paragraph (1), estate and gift tax law 
                had instead been amended so that the tax rates, nominal 
                exemption amounts, and related parameters in effect for 
                tax year 2009 had remained in effect thereafter without 
                change.
    (d) Permanent Extension of Middle-Class Tax Cuts and AMT Relief.--
            (1) Criteria.--Legislation that includes provisions 
        extending middle-class tax cuts or AMT relief shall trigger the 
        current policy adjustment required by this division if those 
        provisions extend one or more of the following provisions--
                    (A) AMT relief for calendar year 2010 and 
                subsequent years in such a manner that the number of 
                AMT taxpayers is not estimated to exceed the number of 
                AMT taxpayers in tax year 2008 in any year through the 
                tenth year after enactment;
                    (B) the 10 percent bracket as in effect for tax 
                year 2010, as provided for under section 101(a) of the 
                Economic Growth and Tax Relief Reconciliation Act of 
                2001 and any later amendments through July 15, 2009;
                    (C) the child tax credit as in effect for tax year 
                2010, as provided for under section 201 of the Economic 
                Growth and Tax Relief Reconciliation Act and any later 
                amendments through July 15, 2009;
                    (D) tax benefits for married couples as in effect 
                for tax year 2010, as provided for under title III of 
                the Economic Growth and Tax Relief Reconciliation Act 
                and any later amendments through July 15, 2009;
                    (E) the adoption credit as in effect in tax year 
                2010, as provided for under section 202 of the Economic 
                Growth and Tax Relief Reconciliation Act of 2001 and 
                any later amendments through July 15, 2009;
                    (F) the dependent care credit as in effect in tax 
                year 2010, as provided for under section 204 of the 
                Economic Growth and Tax Relief Reconciliation Act of 
                2001 and any later amendments through July 15, 2009;
                    (G) the employer-provided child care credit as in 
                effect in tax year 2010, as provided for under section 
                205 of the Economic Growth and Tax Relief 
                Reconciliation Act of 2001 and any later amendments 
                through July 15, 2009;
                    (H) the education tax benefits as in effect in tax 
                year 2010, as provided for under title IV of the 
                Economic Growth and Tax Relief Reconciliation Act of 
                2001 and any later amendments through July 15, 2009;
                    (I) the 25 and 28 percent brackets as in effect for 
                tax year 2010, as provided for under section 101(a) of 
                the Economic Growth and Tax Relief Reconciliation Act 
                of 2001 and any later amendments through July 15, 2009; 
                and
                    (J) the 33 percent brackets as in effect for tax 
                year 2010, as provided for under section 101(a) of the 
                Economic Growth and Tax Relief Reconciliation Act of 
                2001 and any later amendment affecting taxpayers with 
                taxable income of $200,000 or less for individuals and 
                $250,000 or less for couples in calendar year 2010 and 
                increased in each subsequent year by an amount equal to 
                the cost of living adjustment determined under section 
                1(f)(3) of the Internal Revenue Code of 1986 for the 
                calendar year in which the taxable year begins, 
                determined by substituting ``calendar year 2008'' for 
                ``calendar year 1992'' in subparagraph (B) thereof.
            (2) Adjustment.--The amount of the maximum current policy 
        adjustment shall be the difference between what total revenues 
        would have been under the Internal Revenue Code of 1986 (as 
        scheduled on July 15, 2009, to be in effect) and what revenues 
        would be if legislation--
                    (A) permanently extending the AMT exemption and 
                brackets in effect in tax year 2009 but increased in 
                tax year 2010 and each subsequent tax year as indicated 
                under subsection (d)(2)(B), along with any additional 
                amount necessary to prevent the number of taxpayers who 
                must pay AMT from increasing; and
                    (B) permanently extending the provisions identified 
                in paragraph (1),
        were enacted on the same day as the legislation referred to in 
        paragraph (1).

SEC. 108. APPLICATION OF BBEDCA.

    For purposes of this division--
            (1) notwithstanding section 275 of BBEDCA, the provisions 
        of sections 255, 256, 257, and 274 of BBEDCA, as amended by 
        this division, shall apply to the provisions of this division;
            (2) references in sections 255, 256, 257, and 274 to ``this 
        part'' or ``this title'' shall be interpreted as applying to 
        this division;
            (3) references in sections 255, 256, 257, and 274 of BBEDCA 
        to ``section 254'' shall be interpreted as referencing section 
        105 of this division;
            (4) the reference in section 256(b) of BBEDCA to ``section 
        252 or 253'' shall be interpreted as referencing section 105 of 
        this division;
            (5) the reference in section 256(d)(1) of BBEDCA to 
        ``section 252 or 253'' shall be interpreted as referencing 
        section 106 of this division;
            (6) the reference in section 256(d)(4) of BBEDCA to 
        ``section 252 or 253'' shall be interpreted as referencing 
        section 105 of this division;
            (7) section 256(k) of BBEDCA shall apply to a 
        sequestration, if any, under this division; and
            (8) references in section 257(e) of BBEDCA to ``section 
        251, 252, or 253'' shall be interpreted as referencing section 
        104 of this division.

SEC. 109. TECHNICAL CORRECTIONS.

    (a) Section 250(c)(18) of BBEDCA is amended by striking ``the 
expenses the Federal deposit insurance agencies'' and inserting ``the 
expenses of the Federal deposit insurance agencies''.
    (b) Section 256(k)(1) of BBEDCA is amended by striking ``in 
paragraph (5)'' and inserting ``in paragraph (6)''.

SEC. 110. CONFORMING AMENDMENTS.

    (a) Section 256(a) of BBEDCA is repealed.
    (b) Section 256(b) of BBEDCA is amended by striking ``origination 
fees under sections 438(c)(2) and 455(c) of that Act shall each be 
increased by 0.50 percentage point.'' and inserting in lieu thereof 
``origination fees under sections 438(c)(2) and (6) and 455(c) and loan 
processing and issuance fees under section 428(f)(1)(A)(ii) of that Act 
shall each be increased by the uniform percentage specified in that 
sequestration order, and, for student loans originated during the 
period of the sequestration, special allowance payments under section 
438(b) of that Act accruing during the period of the sequestration 
shall be reduced by the uniform percentage specified in that 
sequestration order.''.
    (c) Section 256(c) of BBEDCA is repealed.
    (d) Section 256(d) of BBEDCA is amended--
            (1) by redesignating paragraphs (2), (3), and (4) as 
        paragraphs (3), (5), and (6);
            (2) by amending paragraph (1) to read as follows:
            ``(1) Calculation of reduction in payment amounts.--To 
        achieve the total percentage reduction in those programs 
        required by section 252 or 253, subject to paragraph (2), and 
        notwithstanding section 710 of the Social Security Act, OMB 
        shall determine, and the applicable Presidential order under 
        section 254 shall implement, the percentage reduction that 
        shall apply, with respect to the health insurance programs 
        under title XVIII of the Social Security Act--
                    ``(A) in the case of parts A and B of such title, 
                to individual payments for services furnished during 
                the one-year period beginning on the first day of the 
                first month beginning after the date the order is 
                issued (or, if later, the date specified in paragraph 
                (4)); and
                    ``(B) in the case of parts C and D, to monthly 
                payments under contracts under such parts for the same 
                one-year period;
        such that the reduction made in payments under that order shall 
        achieve the required total percentage reduction in those 
        payments for that period.'';
            (3) by inserting after paragraph (1) the following:
            ``(2) Uniform reduction rate; maximum permissible 
        reduction.--Reductions in payments for programs and activities 
        under such title XVIII pursuant to a sequestration order under 
        section 254 shall be at a uniform rate, which shall not exceed 
        4 percent, across all such programs and activities subject to 
        such order.'';
            (4) by inserting after paragraph (3), as redesignated, the 
        following:
            ``(4) Timing of subsequent sequestration order.--A 
        sequestration order required by section 252 or 253 with respect 
        to programs under such title XVIII shall not take effect until 
        the first month beginning after the end of the effective period 
        of any prior sequestration order with respect to such programs, 
        as determined in accordance with paragraph (1).'';
            (5) in paragraph (6), as redesignated, to read as follows:
            ``(6) Sequestration disregarded in computing payment 
        amounts.--The Secretary of Health and Human Services shall not 
        take into account any reductions in payment amounts which have 
        been or may be effected under this part, for purposes of 
        computing any adjustments to payment rates under such title 
        XVIII, specifically including--
                    ``(A) the part C growth percentage under section 
                1853(c)(6);
                    ``(B) the part D annual growth rate under section 
                1860D-2(b)(6); and
                    ``(C) application of risk corridors to part D 
                payment rates under section 1860D-15(e).''; and
            (6) by adding after paragraph (6), as redesignated, the 
        following:
            ``(7) Exemptions from sequestration.--In addition to the 
        programs and activities specified in section 255, the following 
        shall be exempt from sequestration under this part:
                    ``(A) Part d low-income subsidies.--Premium and 
                cost-sharing subsidies under section 1860D-14 of the 
                Social Security Act.
                    ``(B) Part d catastrophic subsidy.--Payments under 
                section 1860D-15(b) and (e)(2)(B) of the Social 
                Security Act.
                    ``(C) Qualified individual (qi) premiums.--Payments 
                to States for coverage of Medicare cost-sharing for 
                certain low-income Medicare beneficiaries under section 
                1933 of the Social Security Act.''.

SEC. 111. EXEMPT PROGRAMS AND ACTIVITIES.

    (a) Designations.--Section 255 of BBEDCA is amended by 
redesignating subsection (i) as (j) and striking ``1998'' and inserting 
in lieu thereof ``2010''.
    (b) Social Security, Veterans Programs, Net Interest, and Tax 
Credits.--Subsections (a) through (d) of section 255 of BBEDCA are 
amended to read as follows:
    ``(a) Social Security Benefits and Tier I Railroad Retirement 
Benefits.--Benefits payable under the old-age, survivors, and 
disability insurance program established under title II of the Social 
Security Act (42 U.S.C. 401 et seq.), and benefits payable under 
section 231b(a), 231b(f)(2), 231c(a), and 231c(f) of title 45, United 
States Code, shall be exempt from reduction under any order issued 
under this part.
    ``(b) Veterans Programs.--The following program shall be exempt 
from reduction under any order issued under this part--
            ``All programs administered by the Department of Veterans 
        Affairs.
            ``Special Benefits for Certain World War II Veterans (28-
        0401-0-1-701).
    ``(c) Net Interest.--No reduction of payments for net interest (all 
of major functional category 900) shall be made under any order issued 
under this part.
    ``(d) Refundable Income Tax Credits.--Payments to individuals made 
pursuant to provisions of the Internal Revenue Code of 1986 
establishing refundable tax credits shall be exempt from reduction 
under any order issued under this part.''.
    (c) Other Programs and Activities, Low-income Programs, and 
Economic Recovery Programs.--Subsections (g) and (h) of section 255 of 
BBEDCA are amended to read as follows:
    ``(g) Other Programs and Activities.--
            ``(1)(A) The following budget accounts and activities shall 
        be exempt from reduction under any order issued under this 
        part:
                    ``Activities resulting from private donations, 
                bequests, or voluntary contributions to the Government.
                    ``Activities financed by voluntary payments to the 
                Government for goods or services to be provided for 
                such payments.
                    ``Administration of Territories, Northern Mariana 
                Islands Covenant grants (14-0412-0-1-808).
                    ``Advances to the Unemployment Trust Fund and Other 
                Funds (16-0327-0-1-600).
                    ``Black Lung Disability Trust Fund Refinancing (16-
                0329-0-1-601).
                    ``Bonneville Power Administration Fund and 
                borrowing authority established pursuant to section 13 
                of Public Law 93-454 (1974), as amended (89-4045-0-3-
                271).
                    ``Claims, Judgments, and Relief Acts (20-1895-0-1-
                808).
                    ``Compact of Free Association (14-0415-0-1-808).
                    ``Compensation of the President (11-0209-01-1-802).
                    ``Comptroller of the Currency, Assessment Funds 
                (20-8413-0-8-373).
                    ``Continuing Fund, Southeastern Power 
                Administration (89-5653-0-2-271).
                    ``Continuing Fund, Southwestern Power 
                Administration (89-5649-0-2-271).
                    ``Dual Benefits Payments Account (60-0111-0-1-601).
                    ``Emergency Fund, Western Area Power Administration 
                (89-5069-0-2-271).
                    ``Exchange Stabilization Fund (20-4444-0-3-155).
                    ``Federal Deposit Insurance Corporation, Deposit 
                Insurance Fund (51-4596-4-4-373).
                    ``Federal Deposit Insurance Corporation, FSLIC 
                Resolution Fund (51-4065-0-3-373).
                    ``Federal Deposit Insurance Corporation, 
                Noninterest Bearing Transaction Account Guarantee (51-
                4458-0-3-373).
                    ``Federal Deposit Insurance Corporation, Senior 
                Unsecured Debt Guarantee (51-4457-0-3-373).
                    ``Federal Housing Finance Agency, Administrative 
                Expenses (95-5532-0-2-371).
                    ``Federal Payment to the District of Columbia 
                Judicial Retirement and Survivors Annuity Fund (20-
                1713-0-1-752).
                    ``Federal Payment to the District of Columbia 
                Pension Fund (20-1714-0-1-601).
                    ``Federal Payments to the Railroad Retirement 
                Accounts (60-0113-0-1-601).
                    ``Federal Reserve Bank Reimbursement Fund (20-1884-
                0-1-803).
                    ``Financial Agent Services (20-1802-0-1-803).
                    ``Foreign Military Sales Trust Fund (11-8242-0-7-
                155).
                    ``Hazardous Waste Management, Conservation Reserve 
                Program (12-4336-0-3-999).
                    ``Host Nation Support Fund for Relocation (97-8337-
                0-7-051).
                    ``Internal Revenue Collections for Puerto Rico (20-
                5737-0-2-806).
                    ``Intragovernmental funds, including those from 
                which the outlays are derived primarily from resources 
                paid in from other government accounts, except to the 
                extent such funds are augmented by direct 
                appropriations for the fiscal year during which an 
                order is in effect.
                    ``Medical Facilities Guarantee and Loan Fund (75-
                9931-0-3-551).
                    ``National Credit Union Administration, Central 
                Liquidity Facility (25-4470-0-3-373).
                    ``National Credit Union Administration, Corporate 
                Credit Union Share Guarantee Program (25-4476-0-3-376).
                    ``National Credit Union Administration, Credit 
                Union Homeowners Affordability Relief Program (25-4473-
                0-3-371).
                    ``National Credit Union Administration, Credit 
                Union Share Insurance Fund (25-4468-0-3-373).
                    ``National Credit Union Administration, Credit 
                Union System Investment Program (25-4474-0-3-376).
                    ``National Credit Union Administration, Operating 
                fund (25-4056-0-3-373).
                    ``National Credit Union Administration, Share 
                Insurance Fund Corporate Debt Guarantee Program (25-
                4469-0-3-376).
                    ``National Credit Union Administration, U.S. 
                Central Federal Credit Union Capital Program (25-4475-
                0-3-376).
                    ``Office of Thrift Supervision (20-4108-0-3-373).
                    ``Panama Canal Commission Compensation Fund (16-
                5155-0-2-602).
                    ``Payment of Vietnam and USS Pueblo prisoner-of-war 
                claims within the Salaries and Expenses, Foreign Claims 
                Settlement account (15-0100-0-1-153).
                    ``Payment to Civil Service Retirement and 
                Disability Fund (24-0200-0-1-805).
                    ``Payment to Department of Defense Medicare-
                Eligible Retiree Health Care Fund (97-0850-0-1-054).
                    ``Payment to Judiciary Trust Funds (10-0941-0-1-
                752).
                    ``Payment to Military Retirement Fund (97-0040-0-1-
                054).
                    ``Payment to the Foreign Service Retirement and 
                Disability Fund (19-0540-0-1-153).
                    ``Payments to Copyright Owners (03-5175-0-2-376).
                    ``Payments to Health Care Trust Funds (75-0580-0-1-
                571).
                    ``Payment to Radiation Exposure Compensation Trust 
                Fund (15-0333-0-1-054).
                    ``Payments to Social Security Trust Funds (28-0404-
                0-1-651).
                    ``Payments to the United States Territories, Fiscal 
                Assistance (14-0418-0-1-806).
                    ``Payments to trust funds from excise taxes or 
                other receipts properly creditable to such trust funds.
                    ``Payments to widows and heirs of deceased Members 
                of Congress (00-0215-0-1-801).
                    ``Postal Service Fund (18-4020-0-3-372).
                    ``Radiation Exposure Compensation Trust Fund (15-
                8116-0-1-054).
                    ``Reimbursement to Federal Reserve Banks (20-0562-
                0-1-803).
                    ``Salaries of Article III judges.
                    ``Soldiers and Airmen's Home, payment of claims 
                (84-8930-0-7-705).
                    ``Tennessee Valley Authority Fund, except nonpower 
                programs and activities (64-4110-0-3-999).
                    ``Tribal and Indian trust accounts within the 
                Department of the Interior which fund prior legal 
                obligations of the Government or which are established 
                pursuant to Acts of Congress regarding Federal 
                management of tribal real property or other fiduciary 
                responsibilities, including but not limited to Tribal 
                Special Fund (14-5265-0-2-452), Tribal Trust Fund (14-
                8030-0-7-452), White Earth Settlement (14-2204-0-1-
                452), and Indian Water Rights and Habitat Acquisition 
                (14-5505-0-2-303).
                    ``United Mine Workers of America 1992 Benefit Plan 
                (95-8260-0-7-551).
                    ``United Mine Workers of America 1993 Benefit Plan 
                (95-8535-0-7-551).
                    ``United Mine Workers of America Combined Benefit 
                Fund (95-8295-0-7-551).
                    ``United States Enrichment Corporation Fund (95-
                4054-0-3-271).
                    ``Universal Service Fund (27-5183-0-2-376).
                    ``Vaccine Injury Compensation (75-0320-0-1-551).
                    ``Vaccine Injury Compensation Program Trust Fund 
                (20-8175-0-7-551).
            ``(B) The following Federal retirement and disability 
        accounts and activities shall be exempt from reduction under 
        any order issued under this part:
                    ``Black Lung Disability Trust Fund (20-8144-0-7-
                601).
                    ``Central Intelligence Agency Retirement and 
                Disability System Fund (56-3400-0-1-054).
                    ``Civil Service Retirement and Disability Fund (24-
                8135-0-7-602).
                    ``Comptrollers general retirement system (05-0107-
                0-1-801).
                    ``Contributions to U.S. Park Police annuity 
                benefits, Other Permanent Appropriations (14-9924-0-2-
                303).
                    ``Court of Appeals for Veterans Claims Retirement 
                Fund (95-8290-0-7-705).
                    ``Department of Defense Medicare-Eligible Retiree 
                Health Care Fund (97-5472-0-2-551).
                    ``District of Columbia Federal Pension Fund (20-
                5511-0-2-601).
                    ``District of Columbia Judicial Retirement and 
                Survivors Annuity Fund (20-8212-0-7-602).
                    ``Energy Employees Occupational Illness 
                Compensation Fund (16-1523-0-1-053).
                    ``Foreign National Employees Separation Pay (97-
                8165-0-7-051).
                    ``Foreign Service National Defined Contributions 
                Retirement Fund (19-5497-0-2-602).
                    ``Foreign Service National Separation Liability 
                Trust Fund (19-8340-0-7-602).
                    ``Foreign Service Retirement and Disability 
                Fund(19-8186-0-7-602).
                    ``Government Payment for Annuitants, Employees 
                Health Benefits (24-0206-0-1-551).
                    ``Government Payment for Annuitants, Employee Life 
                Insurance (24-0500-0-1-602).
                    ``Judicial Officers' Retirement Fund (10-8122-0-7-
                602).
                    ``Judicial Survivors' Annuities Fund (10-8110-0-7-
                602).
                    ``Military Retirement Fund (97-8097-0-7-602).
                    ``National Railroad Retirement Investment Trust 
                (60-8118-0-7-601).
                    ``National Oceanic and Atmospheric Administration 
                retirement (13-1450-0-1-306).
                    ``Pensions for former Presidents (47-0105-0-1-802).
                    ``Postal Service Retiree Health Benefits Fund (24-
                5391-0-2-551).
                    ``Public Safety Officer Benefits (15-0403-0-1-754).
                    ``Rail Industry Pension Fund (60-8011-0-7-601).
                    ``Retired Pay, Coast Guard (70-0602-0-1-403).
                    ``Retirement Pay and Medical Benefits for 
                Commissioned Officers, Public Health Service (75-0379-
                0-1-551).
                    ``Special Benefits for Disabled Coal Miners (16-
                0169-0-1-601).
                    ``Special Benefits, Federal Employees' Compensation 
                Act (16-1521-0-1-600).
                    ``Special Workers Compensation Expenses (16-9971-0-
                7-601).
                    ``Tax Court Judges Survivors Annuity Fund (23-8115-
                0-7-602).
                    ``United States Court of Federal Claims Judges' 
                Retirement Fund (10-8124-0-7-602).
                    ``United States Secret Service, DC Annuity (70-
                0400-0-1-751).
                    ``Voluntary Separation Incentive Fund (97-8335-0-7-
                051).
            ``(2) Prior legal obligations of the Government in the 
        following budget accounts and activities shall be exempt from 
        any order issued under this part:
                    ``Biomass Energy Development (20-0114-0-1-271).
                    ``Check Forgery Insurance Fund (20-4109-0-3-803).
                    ``Credit liquidating accounts.
                    ``Credit reestimates.
                    ``Employees Life Insurance Fund (24-8424-0-8-602).
                    ``Federal Aviation Insurance Revolving Fund (69-
                4120-0-3-402).
                    ``Federal Crop Insurance Corporation Fund (12-4085-
                0-3-351).
                    ``Federal Emergency Management Agency, National 
                Flood Insurance Fund (58-4236-0-3-453).
                    ``Federal Home Loan Mortgage Corporation (Freddie 
                Mac).
                    ``Federal National Mortgage Corporation (Fannie 
                Mae).
                    ``Geothermal resources development fund (89-0206-0-
                1-271).
                    ``Low-Rent Public Housing--Loans and Other Expenses 
                (86-4098-0-3-604).
                    ``Maritime Administration, War Risk Insurance 
                Revolving Fund (69-4302-0-3-403).
                    ``Natural Resource Damage Assessment Fund (14-1618-
                0-1-302).
                    ``Overseas Private Investment Corporation, 
                Noncredit Account (71-4184-0-3-151).
                    ``Pension Benefit Guaranty Corporation Fund (16-
                4204-0-3-601).
                    ``San Joaquin Restoration Fund (14-5537-0-2-301).
                    ``Servicemembers' Group Life Insurance Fund (36-
                4009-0-3-701).
                    ``Terrorism Insurance Program (20-0123-0-1-376).
    ``(h) Low-income Programs.--The following programs shall be exempt 
from reduction under any order issued under this part:
            ``Academic Competitiveness/Smart Grant Program (91-0205-0-
        1-502).
            ``Child Care Entitlement to States (75-1550-0-1-609).
            ``Child Enrollment Contingency Fund (75-5551-0-2-551).
            ``Child Nutrition Programs (with the exception of special 
        milk programs) (12-3539-0-1-605).
            ``Children's Health Insurance Fund (75-0515-0-1-551).
            ``Commodity Supplemental Food Program (12-3507-0-1-605).
            ``Contingency Fund (75-1522-0-1-609).
            ``Family Support Programs (75-1501-0-1-609).
            ``Federal Pell Grants under section 401 Title IV of the 
        Higher Education Act.
            ``Grants to States for Medicaid (75-0512-0-1-551).
            ``Payments for Foster Care and Permanency (75-1545-0-1-
        609).
            ``Supplemental Nutrition Assistance Program (12-3505-0-1-
        605).
            ``Supplemental Security Income Program (28-0406-0-1-609).
            ``Temporary Assistance for Needy Families (75-1552-0-1-
        609).''.
    (d) Economic Recovery Programs.--Section 255 of BBEDCA is amended 
by adding the following after subsection (h):
    ``(i) Economic Recovery Programs.--The following programs shall be 
exempt from reduction under any order issued under this part:
            ``All programs enacted in, or increases in programs 
        provided by, the American Recovery and Reinvestment Act of 
        2009.
            ``Exchange Stabilization Fund-Money Market Mutual Fund 
        Guaranty Facility (20-4274-0-3-376).
            ``Financial Stabilization Reserve (20-0131-4-1-376).
            ``GSE Mortgage-Backed Securities Purchase Program Account 
        (20-0126-0-1-371).
            ``GSE Preferred Stock Purchase Agreements (20-0125-0-1-
        371).
            ``Office of Financial Stability (20-0128-0-1-376).
            ``Special Inspector General for the Troubled Asset Relief 
        Program (20-0133-0-1-376).
            ``Troubled Asset Relief Program Account (20-0132-0-1-376).
            ``Troubled Asset Relief Program Equity Purchase Program 
        (20-0134-0-1-376).
            ``Troubled Asset Relief Program, Home Affordable 
        Modification Program (20-0136-0-1-604).''.

            Passed the House of Representatives November 19, 2009.

            Attest:

                                            LORRAINE C. MILLER,

                                                                 Clerk.
                                                       Calendar No. 252

111th CONGRESS

  2d Session

                               H. R. 3961

_______________________________________________________________________

                                 AN ACT

To amend title XVIII of the Social Security Act to reform the Medicare 
  SGR payment system for physicians and to reinstitute and update the 
Pay-As-You-Go requirement of budget neutrality on new tax and mandatory 
   spending legislation, enforced by the threat of annual, automatic 
                             sequestration.

_______________________________________________________________________

                            January 20, 2010

            Read the second time and placed on the calendar
```