II 

Calendar No. 874 

110TH CONGRESS 

2D SESSION S. 3236 

To amend titles XVIII and XIX of the Social Security Act to extend provisions under the Medicare and Medicaid programs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 9, 2008 

Mr. MCCONNELL (for himself, Mr. GRASSLEY, and Mr. KYL) introduced the 

following bill; which was read the first time 

JULY 11, 2008 

Read the second time and placed on the calendar 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to extend provisions under the Medicare and Medicaid 

programs, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Medicare and Medicaid Extension Act of 2008’’. 

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

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE 

Sec. 101. Extension of physician payment update. 

Sec. 102. Extension of floor on Medicare work geographic adjustment under 

the Medicare physician fee schedule. 

Sec. 103. Extension of treatment of certain physician pathology services under 

Medicare. 

Sec. 104. Extension of exceptions process for Medicare therapy caps. 

Sec. 105. Extension of payment rule for brachytherapy and therapeutic radiopharmaceuticals. 

Sec. 106. Extension of accommodation of physicians ordered to active duty in 

the Armed Services. 

Sec. 107. Delay in and reform of Medicare DMEPOS competitive acquisition 

program. 

TITLE II—MEDICAID 

Sec. 201. Extension of qualifying individual (QI) program. 

Sec. 202. Extension of transitional medical assistance (TMA) and abstinence 

education program. 

Sec. 203. Medicaid DSH extension. 

TITLE III—CONTINGENCY 

Sec. 301. Contingency. 

1 TITLE I—MEDICARE 

2 SEC. 101. EXTENSION OF PHYSICIAN PAYMENT UPDATE. 

3 (a) IN GENERAL.—Section 1848(d)(8) of the Social 

4 Security Act (42 U.S.C. 1395w–4(d)(8)), as added by sec5 tion 101 of the Medicare, Medicaid, and SCHIP Extension 

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

7 (1) in subparagraph (A), by striking ‘‘June 30, 

8 2008’’ and inserting ‘‘July 31, 2008’’; and 

9 (2) in subparagraph (B), by striking ‘‘July 1, 

10 2008’’ and inserting ‘‘August 1, 2008’’. 

11 (b) REVISION OF THE PHYSICIAN ASSISTANCE AND

12 QUALITY INITIATIVE FUND.—Section 1848(l)(2)(A)(i) of 

13 the Social Security Act (42 U.S.C. 1395w–4(l)(2)(A)(i)), 


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1 as amended by section 101(a)(2) of the Medicare, Med2 icaid, and SCHIP Extension Act of 2007 (Public Law 

3 110–173) and by section 7002(c) of the Supplemental Ap4 propriations Act, 2008, is amended— 

5 (1) in subclause (III), by inserting ‘‘ reduced by 

6 $600,000,000’’ before the period at the end; and 

7 (2) in subclause (IV), by inserting ‘‘ increased 

8 by $220,000,000’’ before the period at the end. 

9 (c) IMPLEMENTATION.—For purposes of carrying out 

10 the provisions of, and amendments made by, this title, in 

11 addition to any amounts otherwise provided in such provi12 sions and amendments, there are appropriated to the Cen13 ters for Medicare & Medicaid Services Program Manage14 ment Account, out of any money in the Treasury not oth15 erwise appropriated, $20,000,000. 

16 SEC. 102. EXTENSION OF FLOOR ON MEDICARE WORK GEO17 GRAPHIC ADJUSTMENT UNDER THE MEDI18 CARE PHYSICIAN FEE SCHEDULE. 

19 (a) IN GENERAL.—Section 1848(e)(1)(E) of the So20 cial Security Act (42 U.S.C. 1395w–4(e)(1)(E)), as 

21 amended by section 103 of the Medicare, Medicaid, and 

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

23 amended by striking ‘‘before July 1, 2008’’ and inserting 

24 ‘‘before August 1, 2008’’. 


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1 (b) TECHNICAL CORRECTION.—Section 602(1) of the 

2 Medicare Prescription Drug, Improvement, and Mod3 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

4 2301) is amended to read as follows: 

5 ‘‘(1) in subparagraph (A), by striking ‘subpara6 graphs (B), (C), and (E)’ and inserting ‘subpara7 graphs (B), (C), (E), and (G)’; and’’. 

8 SEC. 103. EXTENSION OF TREATMENT OF CERTAIN PHYSI9 CIAN PATHOLOGY SERVICES UNDER MEDI10 CARE. 

11 Section 542(c) of the Medicare, Medicaid, and 

12 SCHIP Benefits Improvement and Protection Act of 2000 

13 (as enacted into law by section 1(a)(6) of Public Law 106– 

14 554), as amended by section 732 of the Medicare Prescrip15 tion Drug, Improvement, and Modernization Act of 2003 

16 (42 U.S.C. 1395w–4 note), section 104 of division B of 

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

18 1395w–4 note), and section 104 of the Medicare, Med19 icaid, and SCHIP Extension Act of 2007 (Public Law 

20 110–173), is amended by striking ‘‘the first 6 months of 

21 2008’’ and inserting ‘‘the first 7 months of 2008’’. 

22 SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDI23 CARE THERAPY CAPS. 

24 Section 1833(g)(5) of the Social Security Act (42 

25 U.S.C. 1395l(g)(5)), as amended by section 105 of the 


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1 Medicare, Medicaid, and SCHIP Extension Act of 2007 

2 (Public Law 110–173), is amended by striking ‘‘June 30, 

3 2008’’ and inserting ‘‘July 31, 2008’’. 

4 SEC. 105. EXTENSION OF PAYMENT RULE FOR 

5 BRACHYTHERAPY AND THERAPEUTIC RADIO6 PHARMACEUTICALS. 

7 Section 1833(t)(16)(C) of the Social Security Act (42 

8 U.S.C. 1395l(t)(16)(C)), as amended by section 106 of the 

9 Medicare, Medicaid, and SCHIP Extension Act of 2007 

10 (Public Law 110–173), is amended by striking ‘‘July 1, 

11 2008’’ each place it appears and inserting ‘‘August 1, 

12 2008’’. 

13 SEC. 106. EXTENSION OF ACCOMMODATION OF PHYSICIANS 

14 ORDERED TO ACTIVE DUTY IN THE ARMED 

15 SERVICES. 

16 Section 1842(b)(6)(D)(iii) of the Social Security Act 

17 (42 U.S.C. 1395u(b)(6)(D)(iii)), as amended by section 

18 116 of the Medicare, Medicaid, and SCHIP Extension Act 

19 of 2007 (Public Law 110–173), is amended by striking 

20 ‘‘July 1, 2008’’ and inserting ‘‘August 1, 2008’’. 

21 SEC. 107. DELAY IN AND REFORM OF MEDICARE DMEPOS 

22 COMPETITIVE ACQUISITION PROGRAM. 

23 (a) TEMPORARY DELAY AND REFORM.— 


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1 (1) IN GENERAL.—Section 1847(a) of the So2 cial Security Act (42 U.S.C. 1395w–3(a)) is amend3 ed— 

4 (A) in paragraph (1)— 

5 (i) in subparagraph (B)(i), in the 

6 matter before subclause (I), by inserting 

7 ‘‘consistent with subparagraph (D)’’ after 

8 ‘‘in a manner’’; 

9 (ii) in subparagraph (B)(i)(II), by 

10 striking ‘‘80’’ and ‘‘in 2009’’ and inserting 

11 ‘‘an additional 70’’ and ‘‘in 2011’’, respec12 tively; 

13 (iii) in subparagraph (B)(i)(III), by 

14 striking ‘‘after 2009’’ and inserting ‘‘after 

15 2011 (or, in the case of national mail order 

16 for items and services, after 2010)’’; and 

17 (iv) by adding at the end the following 

18 new subparagraphs: 

19 ‘‘(D) CHANGES IN COMPETITIVE ACQUISI20 TION PROGRAMS.— 

21 ‘‘(i) ROUND 1 OF COMPETITIVE AC22 QUISITION PROGRAM.—Notwithstanding 

23 subparagraph (B)(i)(I) and in imple24 menting the first round of the competitive 

25 acquisition programs under this section— 


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1 ‘‘(I) the contracts awarded under 

2 this section before the date of the en3 actment of this subparagraph are ter4 minated, no payment shall be made 

5 under this title on or after the date of 

6 the enactment of this subparagraph 

7 based on such a contract, and, to the 

8 extent that any damages may be ap9 plicable as a result of the termination 

10 of such contracts, such damages shall 

11 be payable from the Federal Supple12 mentary Medical Insurance Trust 

13 Fund under section 1841; 

14 ‘‘(II) the Secretary shall conduct 

15 the competition for such round in a 

16 manner so that it occurs in 2009 with 

17 respect to the same items and services 

18 and the same areas, except as pro19 vided in subclauses (III) and (IV); 

20 ‘‘(III) the Secretary shall exclude 

21 Puerto Rico so that such round of 

22 competition covers 9, instead of 10, of 

23 the largest metropolitan statistical 

24 areas; and 


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1 ‘‘(IV) there shall be excluded 

2 negative pressure wound therapy 

3 items and services. 

4 Nothing in subclause (I) shall be construed 

5 to provide an independent cause of action 

6 or right to administrative or judicial review 

7 with regard to the termination provided 

8 under such subclause. 

9 ‘‘(ii) ROUND 2 OF COMPETITIVE AC10 QUISITION PROGRAM.—In implementing 

11 the second round of the competitive acqui12 sition programs under this section de13 scribed in subparagraph (B)(i)(II)— 

14 ‘‘(I) the metropolitan statistical 

15 areas to be included shall be those 

16 metropolitan statistical areas selected 

17 by the Secretary for such round as of 

18 June 1, 2008; and 

19 ‘‘(II) the Secretary may sub20 divide metropolitan statistical areas 

21 with populations (based upon the 

22 most recent data from the Census Bu23 reau) of at least 8,000,000 into sepa24 rate areas for competitive acquisition 

25 purposes. 


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1 ‘‘(iii) EXCLUSION OF CERTAIN AREAS

2 IN SUBSEQUENT ROUNDS OF COMPETITIVE

3 ACQUISITION PROGRAMS.—In imple4 menting subsequent rounds of the competi5 tive acquisition programs under this sec6 tion, including under subparagraph 

7 (B)(i)(III), for competitions occurring be8 fore 2015, the Secretary shall exempt from 

9 the competitive acquisition program (other 

10 than national mail order) the following: 

11 ‘‘(I) Rural areas. 

12 ‘‘(II) Metropolitan statistical 

13 areas not selected under round 1 or 

14 round 2 with a population of less than 

15 250,000. 

16 ‘‘(III) Areas with a low popu17 lation density within a metropolitan 

18 statistical area that is otherwise se19 lected, as determined for purposes of 

20 paragraph (3)(A). 

21 ‘‘(E) VERIFICATION BY OIG.—The Inspec22 tor General of the Department of Health and 

23 Human Services shall, through post-award 

24 audit, survey, or otherwise, assess the process 

25 used by the Centers for Medicare & Medicaid 


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1 Services to conduct competitive bidding and 

2 subsequent pricing determinations under this 

3 section that are the basis for pivotal bid 

4 amounts and single payment amounts for items 

5 and services in competitive bidding areas under 

6 rounds 1 and 2 of the competitive acquisition 

7 programs under this section and may continue 

8 to verify such calculations for subsequent 

9 rounds of such programs. 

10 ‘‘(F) SUPPLIER FEEDBACK ON MISSING FI11 NANCIAL DOCUMENTATION.— 

12 ‘‘(i) IN GENERAL.—In the case of a 

13 bid where one or more covered documents 

14 in connection with such bid have been sub15 mitted not later than the covered document 

16 review date specified in clause (ii), the Sec17 retary— 

18 ‘‘(I) shall provide, by not later 

19 than 45 days (in the case of the first 

20 round of the competitive acquisition 

21 programs as described in subpara22 graph (B)(i)(I)) or 90 days (in the 

23 case of a subsequent round of such 

24 programs) after the covered document 

25 review date, for notice to the bidder of 


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1 all such documents that are missing 

2 as of the covered document review 

3 date; and 

4 ‘‘(II) may not reject the bid on 

5 the basis that any covered document 

6 is missing or has not been submitted 

7 on a timely basis, if all such missing 

8 documents identified in the notice pro9 vided to the bidder under subclause 

10 (I) are submitted to the Secretary not 

11 later than 10 business days after the 

12 date of such notice. 

13 ‘‘(ii) COVERED DOCUMENT REVIEW

14 DATE.—The covered document review date 

15 specified in this clause with respect to a 

16 competitive acquisition program is the 

17 later of— 

18 ‘‘(I) the date that is 30 days be19 fore the final date specified by the 

20 Secretary for submission of bids 

21 under such program; or 

22 ‘‘(II) the date that is 30 days 

23 after the first date specified by the 

24 Secretary for submission of bids 

25 under such program. 


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1 ‘‘(iii) LIMITATIONS OF PROCESS.— 

2 The process provided under this subpara3 graph— 

4 ‘‘(I) applies only to the timely 

5 submission of covered documents; 

6 ‘‘(II) does not apply to any deter7 mination as to the accuracy or com8 pleteness of covered documents sub9 mitted or whether such documents 

10 meet applicable requirements; 

11 ‘‘(III) shall not prevent the Sec12 retary from rejecting a bid based on 

13 any basis not described in clause 

14 (i)(II); and 

15 ‘‘(IV) shall not be construed as 

16 permitting a bidder to change bidding 

17 amounts or to make other changes in 

18 a bid submission. 

19 ‘‘(iv) COVERED DOCUMENT DE20 FINED.—In this subparagraph, the term 

21 ‘covered document’ means a financial, tax, 

22 or other document required to be sub23 mitted by a bidder as part of an original 

24 bid submission under a competitive acqui25 sition program in order to meet required 


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1 financial standards. Such term does not in2 clude other documents, such as the bid 

3 itself or accreditation documentation.’’; 

4 and 

5 (B) in paragraph (2)(A), by inserting be6 fore the period at the end the following: ‘‘and 

7 excluding certain complex rehabilitative power 

8 wheelchairs recognized by the Secretary as clas9 sified within group 3 or higher (and related ac10 cessories when furnished in connection with 

11 such wheelchairs)’’. 

12 (2) BUDGET NEUTRAL OFFSET.— 

13 (A) IN GENERAL.—Section 1834(a)(14) of 

14 such Act (42 U.S.C. 1395m(a)(14)) is amend15 ed— 

16 (i) by striking ‘‘and’’ at the end of 

17 subparagraphs (H) and (I); 

18 (ii) by redesignating subparagraph (J) 

19 as subparagraph (M); and 

20 (iii) by inserting after subparagraph 

21 (I) the following new subparagraphs: 

22 ‘‘(J) for 2009— 

23 ‘‘(i) in the case of items and services 

24 furnished in any geographic area, if such 

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1 tive acquisition in any area under the com2 petitive acquisition program under section 

3 1847(a)(1)(B)(i)(I) before July 1, 2008, 

4 including related accessories but only if 

5 furnished with such items and services se6 lected for such competition and diabetic 

7 supplies but only if furnished through mail 

8 order, - 9.5 percent; or 

9 ‘‘(ii) in the case of other items and 

10 services, the percentage increase in the 

11 consumer price index for all urban con12 sumers (U.S. urban average) for the 12- 

13 month period ending with June 2008; 

14 ‘‘(K) for 2010, 2011, 2012, and 2013, the 

15 percentage increase in the consumer price index 

16 for all urban consumers (U.S. urban average) 

17 for the 12-month period ending with June of 

18 the previous year; 

19 ‘‘(L) for 2014— 

20 ‘‘(i) in the case of items and services 

21 described in subparagraph (J)(i) for which 

22 a payment adjustment has not been made 

23 under subsection (a)(1)(F)(ii) in any pre24 vious year, the percentage increase in the 

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1 sumers (U.S. urban average) for the 12- 

2 month period ending with June 2013, plus 

3 2.0 percentage points; or 

4 ‘‘(ii) in the case of other items and 

5 services, the percentage increase in the 

6 consumer price index for all urban con7 sumers (U.S. urban average) for the 12- 

8 month period ending with June 2013; 

9 and’’. 

10 (B) CONFORMING TREATMENT FOR CER11 TAIN ITEMS AND SERVICES.—The second sen12 tence of section 1842(s)(1) of such Act (42 

13 U.S.C. 1395u(s)(1)) is amended by striking 

14 ‘‘except that’’ and all that follows and inserting 

15 the following: ‘‘except that for items and serv16 ices described in paragraph (2)(D)— 

17 ‘‘(A) for 2009 section 1834(a)(14)(J)(i) shall 

18 apply under this paragraph instead of the percent19 age increase otherwise applicable; and 

20 ‘‘(B) for 2014, if subparagraph (A) is applied 

21 to the items and services and there has not been a 

22 payment adjustment under paragraph (3)(B) for the 

23 items and services for any previous year, the per24 centage increase computed under section 


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1 1834(a)(14)(L)(i) shall apply instead of the percent2 age increase otherwise applicable.’’. 

3 (3) CONFORMING DELAY.—Subsections 

4 (a)(1)(F) and (h)(1)(H) of section 1834 of the So5 cial Security Act (42 U.S.C. 1395m) are each 

6 amended by striking ‘‘January 1, 2009’’ and insert7 ing ‘‘January 1, 2011’’. 

8 (4) CONSIDERATIONS IN APPLICATION.—Sec9 tion 1834 of such Act (42 U.S.C. 1395m) is amend10 ed— 

11 (A) in subsection (a)(1)— 

12 (i) in subparagraph (F), by inserting 

13 ‘‘subject to subparagraph (G),’’ before 

14 ‘‘that are included’’; and 

15 (ii) by adding at the end the following 

16 new subparagraph: 

17 ‘‘(G) USE OF INFORMATION ON COMPETI18 TIVE BID RATES.—The Secretary shall specify 

19 by regulation the methodology to be used in ap20 plying the provisions of subparagraph (F)(ii) 

21 and subsection (h)(1)(H)(ii). In promulgating 

22 such regulation, the Secretary shall consider the 

23 costs of items and services in areas in which 

24 such provisions would be applied compared to 


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1 the payment rates for such items and services 

2 in competitive acquisition areas.’’; and 

3 (B) in subsection (h)(1)(H), by inserting 

4 ‘‘subject to subsection (a)(1)(G),’’ before ‘‘that 

5 are included’’. 

6 (b) QUALITY STANDARDS.— 

7 (1) APPLICATION OF ACCREDITATION REQUIRE8 MENT.— 

9 (A) IN GENERAL.—Section 1834(a)(20) of 

10 the Social Security Act (42 U.S.C. 

11 1395m(a)(20)) is amended— 

12 (i) in subparagraph (E), by inserting 

13 ‘‘including subparagraph (F),’’ after 

14 ‘‘under this paragraph,’’; and 

15 (ii) by adding at the end the following 

16 new subparagraph: 

17 ‘‘(F) APPLICATION OF ACCREDITATION RE18 QUIREMENT.—In implementing quality stand19 ards under this paragraph— 

20 ‘‘(i) subject to clause (ii), the Sec21 retary shall require suppliers furnishing 

22 items and services described in subpara23 graph (D) on or after October 1, 2009, di24 rectly or as a subcontractor for another en25 tity, to have submitted to the Secretary 


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1 evidence of accreditation by an accredita2 tion organization designated under sub3 paragraph (B) as meeting applicable qual4 ity standards; and 

5 ‘‘(ii) in applying such standards and 

6 the accreditation requirement of clause (i) 

7 with respect to eligible professionals (as 

8 defined in section 1848(k)(3)(B)), and in9 cluding such other persons, such as 

10 orthotists and prosthetists, as specified by 

11 the Secretary, furnishing such items and 

12 services— 

13 ‘‘(I) such standards and accredi14 tation requirement shall not apply to 

15 such professionals and persons unless 

16 the Secretary determines that the 

17 standards being applied are designed 

18 specifically to be applied to such pro19 fessionals and persons; and 

20 ‘‘(II) the Secretary may exempt 

21 such professionals and persons from 

22 such standards and requirement if the 

23 Secretary determines that licensing, 

24 accreditation, or other mandatory 

25 quality requirements apply to such 


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1 professionals and persons with respect 

2 to the furnishing of such items and 

3 services.’’. 

4 (B) CONSTRUCTION.—Section 

5 1834(a)(20)(F)(ii) of the Social Security Act, 

6 as added by subparagraph (A), shall not be con7 strued as preventing the Secretary of Health 

8 and Human Services from implementing the 

9 first round of competition under section 1847 

10 of such Act on a timely basis. 

11 (2) DISCLOSURE OF SUBCONTRACTORS UNDER

12 COMPETITIVE ACQUISITION PROGRAM.—Section 

13 1847(b)(3) of such Act (42 U.S.C. 1395w–3(b)(3)) 

14 is amended by adding at the end the following new 

15 subparagraph: 

16 ‘‘(C) DISCLOSURE OF SUBCONTRAC17 TORS.— 

18 ‘‘(i) INITIAL DISCLOSURE.—Not later 

19 than 10 days after the date a supplier en20 ters into a contract with the Secretary 

21 under this section, such supplier shall dis22 close to the Secretary, in a form and man23 ner specified by the Secretary, the infor24 mation on— 


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1 ‘‘(I) each subcontracting relation2 ship that such supplier has in fur3 nishing items and services under the 

4 contract; and 

5 ‘‘(II) whether each such subcon6 tractor meets the requirement of sec7 tion 1834(a)(20)(F)(i), if applicable 

8 to such subcontractor. 

9 ‘‘(ii) SUBSEQUENT DISCLOSURE.—Not 

10 later than 10 days after such a supplier 

11 subsequently enters into a subcontracting 

12 relationship described in clause (i)(II), 

13 such supplier shall disclose to the Sec14 retary, in such form and manner, the in15 formation described in subclauses (I) and 

16 (II) of clause (i).’’. 

17 (3) COMPETITIVE ACQUISITION OMBUDSMAN.— 

18 Section 1847 of such Act (42 U.S.C. 1395w–3) is 

19 amended by adding at the end the following new 

20 subsection: 

21 ‘‘(f) COMPETITIVE ACQUISITION OMBUDSMAN.—The 

22 Secretary shall provide for a competitive acquisition om23 budsman within the Centers for Medicare & Medicaid 

24 Services in order to respond to complaints and inquiries 

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1 tion of the competitive acquisition program under this sec2 tion. The ombudsman may be within the office of the 

3 Medicare Beneficiary Ombudsman appointed under sec4 tion 1808(c). The ombudsman shall submit to Congress 

5 an annual report on the activities under this subsection, 

6 which report shall be coordinated with the report provided 

7 under section 1808(c)(2)(C).’’. 

8 (c) CHANGE IN REPORTS AND DEADLINES.— 

9 (1) GAO REPORT.—Section 302(b)(3) of the 

10 Medicare Prescription Drug, Improvement, and 

11 Modernization Act of 2003 (Public Law 108-173) is 

12 amended— 

13 (A) in subparagraph (A)— 

14 (i) by inserting ‘‘and as amended by 

15 section 2 of the Medicare DMEPOS Com16 petitive Acquisition Reform Act of 2008’’ 

17 after ‘‘as amended by paragraph (1)’’; and 

18 (ii) by inserting before the period at 

19 the end the following: ‘‘and the topics spec20 ified in subparagraph (C)’’; 

21 (B) in subparagraph (B), by striking ‘‘Not 

22 later than January 1, 2009,’’ and inserting 

23 ‘‘Not later than 1 year after the first date that 

24 payments are made under section 1847 of the 

25 Social Security Act,’’; and 


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1 (C) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(C) TOPICS.—The topics specified in this 

4 subparagraph, for the study under subpara5 graph (A) concerning the competitive acquisi6 tion program, are the following: 

7 ‘‘(i) Beneficiary access to items and 

8 services under the program, including the 

9 impact on such access of awarding con10 tracts to bidders that— 

11 ‘‘(I) did not have a physical pres12 ence in an area where they received a 

13 contract; or 

14 ‘‘(II) had no previous experience 

15 providing the product category they 

16 were contracted to provide. 

17 ‘‘(ii) Beneficiary satisfaction with the 

18 program and cost savings to beneficiaries 

19 under the program. 

20 ‘‘(iii) Costs to suppliers of partici21 pating in the program and recommenda22 tions about ways to reduce those costs 

23 without compromising quality standards or 

24 savings to the Medicare program. 


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1 ‘‘(iv) Impact of the program on small 

2 business suppliers. 

3 ‘‘(v) Analysis of the impact on utiliza4 tion of different items and services paid 

5 within the same Healthcare Common Pro6 cedure Coding System (HCPCS) code. 

7 ‘‘(vi) Costs to the Centers for Medi8 care & Medicaid Services, including pay9 ments made to contractors, for admin10 istering the program compared with ad11 ministration of a fee schedule, in compari12 son with the relative savings of the pro13 gram. 

14 ‘‘(vii) Impact on access, Medicare 

15 spending, and beneficiary spending of any 

16 difference in treatment for diabetic testing 

17 supplies depending on how such supplies 

18 are furnished. 

19 ‘‘(viii) Such other topics as the Comp20 troller General determines to be appro21 priate.’’. 

22 (2) DELAY IN OTHER DEADLINES.— 

23 (A) PROGRAM ADVISORY AND OVERSIGHT

24 COMMITTEE.—Section 1847(c)(5) of the Social 

25 Security Act (42 U.S.C. 1395w–3(c)(5)) is 


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1 amended by striking ‘‘December 31, 2009’’ and 

2 inserting ‘‘December 31, 2011’’. 

3 (B) SECRETARIAL REPORT.—Section 

4 1847(d) of such Act (42 U.S.C. 1395w–3(d)) is 

5 amended by striking ‘‘July 1, 2009’’ and insert6 ing ‘‘July 1, 2011’’. 

7 (C) IG REPORT.—Section 302(e) of the 

8 Medicare Prescription Drug, Improvement, and 

9 Modernization Act of 2003 (Public Law 108- 

10 173) is amended by striking ‘‘July 1, 2009’’ 

11 and inserting ‘‘July 1, 2011’’. 

12 (3) EVALUATION OF CERTAIN CODE.—The Sec13 retary of Health and Human Services shall evaluate 

14 the existing Health Care Common Procedure Coding 

15 System (HCPCS) codes for negative pressure wound 

16 therapy to ensure accurate reporting and billing for 

17 items and services under such codes. In carrying out 

18 such evaluation, the Secretary shall use an existing 

19 process, administered by the Durable Medical Equip20 ment Medicare Administrative Contractors, for the 

21 consideration of coding changes and consider all rel22 evant studies and information furnished pursuant to 

23 such process. 

24 (d) OTHER PROVISIONS.— 


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1 (1) EXEMPTION FROM COMPETITIVE ACQUISI2 TION FOR CERTAIN OFF-THE-SHELF ORTHOTICS.— 

3 Section 1847(a) of the Social Security Act (42 

4 U.S.C. 1395w–3(a)) is amended by adding at the 

5 end the following new paragraph: 

6 ‘‘(7) EXEMPTION FROM COMPETITIVE ACQUISI7 TION.—The programs under this section shall not 

8 apply to the following: 

9 ‘‘(A) CERTAIN OFF-THE-SHELF

10 ORTHOTICS.—Items and services described in 

11 paragraph (2)(C) if furnished— 

12 ‘‘(i) by a physician or other practi13 tioner (as defined by the Secretary) to the 

14 physician’s or practitioner’s own patients 

15 as part of the physician’s or practitioner’s 

16 professional service; or 

17 ‘‘(ii) by a hospital to the hospital’s 

18 own patients during an admission or on 

19 the date of discharge. 

20 ‘‘(B) CERTAIN DURABLE MEDICAL EQUIP21 MENT.—Those items and services described in 

22 paragraph (2)(A)— 

23 ‘‘(i) that are furnished by a hospital 

24 to the hospital’s own patients during an 

25 admission or on the date of discharge; and 


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1 ‘‘(ii) to which such programs would 

2 not apply, as specified by the Secretary, if 

3 furnished by a physician to the physician’s 

4 own patients as part of the physician’s 

5 professional service.’’. 

6 (2) CORRECTION IN FACE-TO-FACE EXAMINA7 TION REQUIREMENT.—Section 1834(a)(1)(E)(ii) of 

8 such Act (42 U.S.C. 1395m(a)(1)(E)(ii)) is amended 

9 by striking ‘‘1861(r)(1)’’ and inserting ‘‘1861(r)’’. 

10 (3) SPECIAL RULE IN CASE OF NATIONAL MAIL11 ORDER COMPETITION FOR DIABETIC TESTING

12 STRIPS.—Section 1847(b) of such Act (42 U.S.C. 

13 1395w–3(b)) is amended— 

14 (A) by redesignating paragraph (10) as 

15 paragraph (11); and 

16 (B) by inserting after paragraph (9) the 

17 following new paragraph: 

18 ‘‘(10) SPECIAL RULE IN CASE OF COMPETITION

19 FOR DIABETIC TESTING STRIPS.— 

20 ‘‘(A) IN GENERAL.—With respect to the 

21 competitive acquisition program for diabetic 

22 testing strips conducted after the first round of 

23 the competitive acquisition programs, if an enti24 ty does not demonstrate to the Secretary that 

25 its bid covers types of diabetic testing strip 


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1 products that, in the aggregate and taking into 

2 account volume for the different products, cover 

3 50 percent (or such higher percentage as the 

4 Secretary may specify) of all such types of 

5 products, the Secretary shall reject such bid. 

6 The volume for such types of products may be 

7 determined in accordance with such data (which 

8 may be market based data) as the Secretary 

9 recognizes. 

10 ‘‘(B) STUDY OF TYPES OF TESTING STRIP

11 PRODUCTS.—Before 2011, the Inspector Gen12 eral of the Department of Health and Human 

13 Services shall conduct a study to determine the 

14 types of diabetic testing strip products by vol15 ume that could be used to make determinations 

16 pursuant to subparagraph (A) for the first com17 petition under the competitive acquisition pro18 gram described in such subparagraph and sub19 mit to the Secretary a report on the results of 

20 the study. The Inspector General shall also con21 duct such a study and submit such a report be22 fore the Secretary conducts a subsequent com23 petitive acquisition program described in sub24 paragraph (A).’’. 


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1 (4) OTHER CONFORMING AMENDMENTS.—Sec2 tion 1847(b)(11) of such Act, as redesignated by 

3 paragraph (3), is amended— 

4 (A) in subparagraph (C), by inserting ‘‘and 

5 the identification of areas under subsection 

6 (a)(1)(D)(iii)’’ after ‘‘(a)(1)(A)’’; 

7 (B) in subparagraph (D), by inserting 

8 ‘‘and implementation of subsection (a)(1)(D)’’ 

9 after ‘‘(a)(1)(B)’’; 

10 (C) in subparagraph (E), by striking ‘‘or’’ 

11 at the end; 

12 (D) in subparagraph (F), by striking the 

13 period at the end and inserting ‘‘; or’’; and 

14 (E) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(G) the implementation of the special rule 

17 described in paragraph (10).’’. 

18 (5) FUNDING FOR IMPLEMENTATION.—In addi19 tion to funds otherwise available, for purposes of im20 plementing the provisions of, and amendments made 

21 by, this section, other than the amendment made by 

22 subsection (c)(1) and other than section 

23 1847(a)(1)(E) of the Social Security Act, the Sec24 retary of Health and Human Services shall provide 

25 for the transfer from the Federal Supplementary 


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1 Medical Insurance Trust Fund established under 

2 section 1841 of the Social Security Act (42 U.S.C. 

3 1395t) to the Centers for Medicare & Medicaid Serv4 ices Program Management Account of $20,000,000 

5 for fiscal year 2008, and $25,000,000 for each of 

6 fiscal years 2009 through 2012. Amounts trans7 ferred under this paragraph for a fiscal year shall be 

8 available until expended. 

9 (e) EFFECTIVE DATE.—The amendments made by 

10 this section shall take effect as of June 30, 2008. 

11 TITLE II—MEDICAID 

12 SEC. 201. EXTENSION OF QUALIFYING INDIVIDUAL (QI) 

13 PROGRAM. 

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

15 Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is 

16 amended by striking ‘‘June’’ and inserting ‘‘July’’. 

17 (b) EXTENDING TOTAL AMOUNT AVAILABLE FOR

18 ALLOCATION.—Section 1933(g)(2)(I) of the Social Secu19 rity Act (42 U.S.C. 1396u–3(g)(2)(I)) is amended— 

20 (1) by striking ‘‘June 30’’ and inserting ‘‘July 

21 31’’; 

22 (2) by striking ‘‘$200,000,000’’ and inserting 

23 ‘‘$250,000,000’’. 


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1 SEC. 202. EXTENSION OF TRANSITIONAL MEDICAL ASSIST2 ANCE (TMA) AND ABSTINENCE EDUCATION 

3 PROGRAM. 

4 Section 401 of division B of the Tax Relief and 

5 Health Care Act of 2006 (Public Law 109–432, 120 Stat. 

6 2994), as amended by section 1 of Public Law 110–48 

7 (121 Stat. 244), section 2 of the TMA, Abstinence, Edu8 cation, and QI Programs Extension Act of 2007 (Public 

9 Law 110–90, 121 Stat. 984), and section 202 of the Medi10 care, Medicaid, and SCHIP Extension Act of 2007 (Public 

11 Law 110–173), is amended— 

12 (1) by striking ‘‘June 30’’ and inserting ‘‘July 

13 31’’; 

14 (2) by striking ‘‘the third quarter of fiscal year 

15 2008’’ and inserting ‘‘July 31, 2008’’; and 

16 (3) by striking ‘‘the third quarter of fiscal year 

17 2007’’ and inserting ‘‘July 31, 2007’’. 

18 SEC. 203. MEDICAID DSH EXTENSION. 

19 Section 1923(f)(6) of the Social Security Act (42 

20 U.S.C. 1396r–4(f)(6)) is amended— 

21 (1) in subparagraph (A)(i), in the second sen22 tence— 

23 (A) by striking ‘‘June 30’’ and inserting 

24 ‘‘July 31’’; and 

(B) by striking ‘‘3⁄4’’ and inserting ‘‘5 25 ⁄6’’; 

26 and 


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1 (2) in subparagraph (B)(i)— 

2 (A) in the first sentence, by striking ‘‘June 

3 30’’ and inserting ‘‘July 31’’; and 

4 (B) by striking ‘‘$7,500,000’’ and insert5 ing ‘‘$8,333,333’’. 

6 TITLE III—CONTINGENCY 

7 SEC. 301. CONTINGENCY. 

8 If a bill entitled the ‘‘Medicare Improvements for Pa9 tients and Providers Act of 2008’’ is enacted, before, on, 

10 or after the date of enactment of this Act, except for sec11 tions 101(c), the provisions of, and amendments made by, 

12 this Act are repealed and any Act amended by such 

13 amendments shall be administered as if such provisions 

14 and amendments had not been enacted. 


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Calendar No. 874 

110TH CONGRESS 

2D SESSION S. 3236 

A BILL 

To amend titles XVIII and XIX of the Social Secuand Medicaid programs, and for other purposes. rity Act to extend provisions under the Medicare 

JULY 11, 2008 

Read the second time and placed on the calendar 


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