In the Senate of the United States, 

December 8, 2010. 

Resolved, That the bill from the House of Representatives (H.R. 4994) entitled ‘‘An Act to amend the Internal 

Revenue Code of 1986 to reduce taxpayer burdens and enhance taxpayer protections, and for other purposes.’’, do pass 

with the following 

AMENDMENTS: 

Strike all after the enacting clause and insert the 

following: 

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Medicare and Medicaid Extenders Act of 2010’’. 

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

5 Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—EXTENSIONS 

Sec. 101. Physician payment update. 

Sec. 102. Extension of MMA section 508 reclassifications. 

Sec. 103. Extension of Medicare work geographic adjustment floor. 

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

Sec. 105. Extension of payment for technical component of certain physician pathology services. 
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Sec. 106. Extension of ambulance add-ons. 

Sec. 107. Extension of physician fee schedule mental health add-on payment. 

Sec. 108. Extension of outpatient hold harmless provision. 

Sec. 109. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain 

rural areas. 

Sec. 110. Extension of the qualifying individual (QI) program. 

Sec. 111. Extension of Transitional Medical Assistance (TMA). 

Sec. 112. Special diabetes programs. 

TITLE II—OTHER PROVISIONS 

Sec. 201. Clarification of effective date of part B special enrollment period for 

disabled TRICARE beneficiaries. 

Sec. 202. Repeal of delay of RUG–IV. 

Sec. 203. Clarification for affiliated hospitals for distribution of additional residency positions. 

Sec. 204. Continued inclusion of orphan drugs in definition of covered outpatient 

drugs with respect to children’s hospitals under the 340B drug 

discount program. 

Sec. 205. Medicaid and CHIP technical corrections. 

Sec. 206. Funding for claims reprocessing. 

Sec. 207. Revision to the Medicare Improvement Fund. 

Sec. 208. Limitations on aggregate amount recovered on reconciliation of the 

health insurance tax credit and the advance of that credit. 

Sec. 209. Determination of budgetary effects. 

1 TITLE I—EXTENSIONS 

2 SEC. 101. PHYSICIAN PAYMENT UPDATE. 

3 Section 1848(d) of the Social Security Act (42 U.S.C. 

4 1395w–4(d)) is amended by adding at the end the following 

5 new paragraph: 

6 ‘‘(12) UPDATE FOR 2011.— 

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

8 (7)(B), (8)(B), (9)(B), (10)(B), and (11)(B), in 

9 lieu of the update to the single conversion factor 

10 established in paragraph (1)(C) that would oth11 erwise apply for 2011, the update to the single 

12 conversion factor shall be 0 percent. 
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1 ‘‘(B) NO EFFECT ON COMPUTATION OF CON2 VERSION FACTOR FOR 2012 AND SUBSEQUENT

3 YEARS.—The conversion factor under this sub4 section shall be computed under paragraph 

5 (1)(A) for 2012 and subsequent years as if sub6 paragraph (A) had never applied.’’. 

7 SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICA8 TIONS. 

9 (a) EXTENSION.— 

10 (1) IN GENERAL.—Section 106(a) of division B 

11 of the Tax Relief and Health Care Act of 2006 (42 

12 U.S.C. 1395 note), as amended by section 117 of the 

13 Medicare, Medicaid, and SCHIP Extension Act of 

14 2007 (Public Law 110–173), section 124 of the Medi15 care Improvements for Patients and Providers Act of 

16 2008 (Public Law 110–275), and sections 3137(a) 

17 and 10317 of the Patient Protection and Affordable 

18 Care Act (Public Law 111–148), is amended by strik19 ing ‘‘September 30, 2010’’ and inserting ‘‘September 

20 30, 2011’’. 

21 (2) SPECIAL RULE FOR FISCAL YEAR 2011.— 

22 (A) IN GENERAL.—Subject to subparagraph 

23 (B), for purposes of implementation of the 

24 amendment made by paragraph (1), including 

25 (notwithstanding paragraph (3) of section 
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1 117(a) of the Medicare, Medicaid, and SCHIP 

2 Extension Act of 2007 (Public Law 110–173), as 

3 amended by section 124(b) of the Medicare Im4 provements for Patients and Providers Act of 

5 2008 (Public Law 110–275)) for purposes of the 

6 implementation of paragraph (2) of such section 

7 117(a), during fiscal year 2011, the Secretary of 

8 Health and Human Services shall use the hos9 pital wage index that was promulgated by the 

10 Secretary of Health and Human Services in the 

11 Federal Register on August 16, 2010 (75 Fed. 

12 Reg. 50042), and any subsequent corrections. 

13 (B) EXCEPTION.—Beginning on April 1, 

14 2011, in determining the wage index applicable 

15 to hospitals that qualify for wage index reclassi16 fication, the Secretary shall include the average 

17 hourly wage data of hospitals whose reclassifica18 tion was extended pursuant to the amendment 

19 made by paragraph (1) only if including such 

20 data results in a higher applicable reclassified 

21 wage index. Any revision to hospital wage in22 dexes made as a result of this subparagraph shall 

23 not be effected in a budget neutral manner. 

24 (3) ADJUSTMENT FOR CERTAIN HOSPITALS IN

25 FISCAL YEAR 2011.— 
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1 (A) IN GENERAL.—In the case of a sub2 section (d) hospital (as defined in subsection 

3 (d)(1)(B) of section 1886 of the Social Security 

4 Act (42 U.S.C. 1395ww)) with respect to 

5 which— 

6 (i) a reclassification of its wage index 

7 for purposes of such section was extended 

8 pursuant to the amendment made by para9 graph (1); and 

10 (ii) the wage index applicable for such 

11 hospital for the period beginning on October 

12 1, 2010, and ending on March 31, 2011, 

13 was lower than for the period beginning on 

14 April 1, 2011, and ending on September 30, 

15 2011, by reason of the application of para16 graph (2)(B); 

17 the Secretary shall pay such hospital an addi18 tional payment that reflects the difference be19 tween the wage index for such periods. 

20 (B) TIMEFRAME FOR PAYMENTS.—The Sec21 retary shall make payments required under sub22 paragraph (A) by not later than December 31, 

23 2011. 

24 (b) CONFORMING AMENDMENT.—Section 117(a)(3) of 

25 the Medicare, Medicaid, and SCHIP Extension Act of 2007 
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1 (Public Law 110–173) is amended by inserting ‘‘in fiscal 

2 years 2008 and 2009’’ after ‘‘For purposes of implementa3 tion of this subsection’’. 

4 SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC 

5 ADJUSTMENT FLOOR. 

6 Section 1848(e)(1)(E) of the Social Security Act (42 

7 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘before 

8 January 1, 2011’’ and inserting ‘‘before January 1, 2012’’. 

9 SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDI10 CARE THERAPY CAPS. 

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

12 U.S.C. 1395l(g)(5)) is amended by striking ‘‘and ending 

13 on’’ and all that follows through ‘‘2010’’ and inserting ‘‘and 

14 ending on December 31, 2011’’. 

15 SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COM16 PONENT OF CERTAIN PHYSICIAN PATHOLOGY 

17 SERVICES. 

18 Section 542(c) of the Medicare, Medicaid, and SCHIP 

19 Benefits Improvement and Protection Act of 2000 (as en20 acted into law by section 1(a)(6) of Public Law 106–554), 

21 as amended by section 732 of the Medicare Prescription 

22 Drug, Improvement, and Modernization Act of 2003 (42 

23 U.S.C. 1395w–4 note), section 104 of division B of the Tax 

24 Relief and Health Care Act of 2006 (42 U.S.C. 1395w–4 

25 note), section 104 of the Medicare, Medicaid, and SCHIP 
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1 Extension Act of 2007 (Public Law 110–173), section 136 

2 of the Medicare Improvements for Patients and Providers 

3 Act of 2008 (Public Law 110–275), and section 3104 of the 

4 Patient Protection and Affordable Care Act (Public Law 

5 111–148) is amended by striking ‘‘and 2010’’ and inserting 

6 ‘‘2010, and 2011’’. 

7 SEC. 106. EXTENSION OF AMBULANCE ADD-ONS. 

8 (a) GROUND AMBULANCE.—Section 1834(l)(13)(A) of 

9 the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is 

10 amended— 

11 (1) in the matter preceding clause (i), by strik12 ing ‘‘2011’’ and inserting ‘‘2012,’’; and 

13 (2) in each of clauses (i) and (ii), by striking 

14 ‘‘January 1, 2011’’ and inserting ‘‘January 1, 2012’’ 

15 each place it appears. 

16 (b) AIR AMBULANCE.—Section 146(b)(1) of the Medi17 care Improvements for Patients and Providers Act of 2008 

18 (Public Law 110–275), as amended by sections 3105(b) and 

19 10311(b) of Public Law 111–148, is amended by striking 

20 ‘‘December 31, 2010’’ and inserting ‘‘December 31, 2011’’. 

21 (c) SUPER RURAL AMBULANCE.—Section 

22 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 

23 1395m(l)(12)(A)) is amended by striking ‘‘2011’’ and in24 serting ‘‘2012’’. 
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1 SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MEN2 TAL HEALTH ADD-ON PAYMENT. 

3 Section 138(a)(1) of the Medicare Improvements for 

4 Patients and Providers Act of 2008 (Public Law 110–275), 

5 as amended by section 3107 of the Patient Protection and 

6 Affordable Care Act (Public Law 111–148), is amended by 

7 striking ‘‘December 31, 2010’’ and inserting ‘‘December 31, 

8 2011’’. 

9 SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS 

10 PROVISION. 

11 Section 1833(t)(7)(D)(i) of the Social Security Act (42 

12 U.S.C. 1395l(t)(7)(D)(i)), as amended by section 3121(a) 

13 of the Patient Protection and Affordable Care Act (Public 

14 Law 111–148), is amended— 

15 (1) in subclause (II)— 

16 (A) in the first sentence, by striking 

17 ‘‘2011’’and inserting ‘‘2012’’; and 

18 (B) in the second sentence, by striking ‘‘or 

19 2010’’ and inserting ‘‘2010, or 2011’’; and 

20 (2) in subclause (III), by striking ‘‘January 1, 

21 2011’’ and inserting ‘‘January 1, 2012’’. 
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1 SEC. 109. EXTENSION OF MEDICARE REASONABLE COSTS 

2 PAYMENTS FOR CERTAIN CLINICAL DIAG3 NOSTIC LABORATORY TESTS FURNISHED TO 

4 HOSPITAL PATIENTS IN CERTAIN RURAL 

5 AREAS. 

6 Section 416(b) of the Medicare Prescription Drug, Im7 provement, and Modernization Act of 2003 (42 U.S.C. 

8 1395l–4), as amended by section 105 of division B of the 

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

10 note), section 107 of the Medicare, Medicaid, and SCHIP 

11 Extension Act of 2007 (42 U.S.C. 1395l note), and section 

12 3122 of the Patient Protection and Affordable Care Act 

13 (Public Law 111–148), is amended by striking ‘‘the 1-year 

14 period beginning on July 1, 2010’’ and inserting ‘‘the 2- 

15 year period beginning on July 1, 2010’’. 

16 SEC. 110. EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) 

17 PROGRAM. 

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

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

20 amended by striking ‘‘December 2010’’ and inserting ‘‘De21 cember 2011’’. 

22 (b) EXTENDING TOTAL AMOUNT AVAILABLE FOR AL23 LOCATION.—Section 1933(g) of such Act (42 U.S.C. 1396u24 3(g)) is amended— 

25 (1) in paragraph (2)— 
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1 (A) by striking ‘‘and’’ at the end of sub2 paragraph (M); 

3 (B) in subparagraph (N), by striking the 

4 period at the end and inserting a semicolon; and 

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

6 subparagraphs: 

7 ‘‘(O) for the period that begins on January 

8 1, 2011, and ends on September 30, 2011, the 

9 total allocation amount is $720,000,000; and 

10 ‘‘(P) for the period that begins on October 

11 1, 2011, and ends on December 31, 2011, the 

12 total allocation amount is $280,000,000.’’; and 

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

14 subparagraph (A), by striking ‘‘or (N)’’ and inserting 

15 ‘‘(N), or (P)’’. 

16 SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSIST17 ANCE (TMA). 

18 Sections 1902(e)(1)(B) and 1925(f) of the Social Secu19 rity Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)) are each 

20 amended by striking ‘‘December 31, 2010’’ and inserting 

21 ‘‘December 31, 2011’’. 

22 SEC. 112. SPECIAL DIABETES PROGRAMS. 

23 (1) SPECIAL DIABETES PROGRAMS FOR TYPE I

24 DIABETES.—Section 330B(b)(2)(C) of the Public 
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1 Health Service Act (42 U.S.C. 254c–2(b)(2)(C)) is 

2 amended by striking ‘‘2011’’ and inserting ‘‘2013’’. 

3 (2) SPECIAL DIABETES PROGRAMS FOR INDI4 ANS.—Section 330C(c)(2)(C) of the Public Health 

5 Service Act (42 U.S.C. 254c–3(c)(2)(C)) is amended 

6 by striking ‘‘2011’’ and inserting ‘‘2013’’. 

7 TITLE II—OTHER PROVISIONS 

8 SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B 

9 SPECIAL ENROLLMENT PERIOD FOR DIS10 ABLED TRICARE BENEFICIARIES. 

11 Effective as if included in the enactment of Public Law 

12 111–148, section 3110(a)(2) of such Act is amended to read 

13 as follows: 

14 ‘‘(2) EFFECTIVE DATE.—The amendment made 

15 by paragraph (1) shall apply to elections made on 

16 and after the date of the enactment of this Act.’’. 

17 SEC. 202. REPEAL OF DELAY OF RUG–IV. 

18 Effective as if included in the enactment of Public Law 

19 111–148, section 10325 of such Act is repealed. 

20 SEC. 203. CLARIFICATION FOR AFFILIATED HOSPITALS FOR 

21 DISTRIBUTION OF ADDITIONAL RESIDENCY 

22 POSITIONS. 

23 Effective as if included in the enactment of section 

24 5503(a) of Public Law 111–148, section 1886(h)(8) of the 

25 Social Security Act (42 U.S.C. 1395ww(h)(8)), as added 
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1 by such section 5503(a), is amended by adding at the end 

2 the following new subparagraph: 

3 ‘‘(I) AFFILIATION.—The provisions of this 

4 paragraph shall be applied to hospitals which 

5 are members of the same affiliated group (as de6 fined by the Secretary under paragraph 

7 (4)(H)(ii)) and the reference resident level for 

8 each such hospital shall be the reference resident 

9 level with respect to the cost reporting period 

10 that results in the smallest difference between the 

11 reference resident level and the otherwise appli12 cable resident limit.’’. 

13 SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN 

14 DEFINITION OF COVERED OUTPATIENT 

15 DRUGS WITH RESPECT TO CHILDREN’S HOS16 PITALS UNDER THE 340B DRUG DISCOUNT 

17 PROGRAM. 

18 (a) DEFINITION OF COVERED OUTPATIENT DRUG.— 

19 (1) AMENDMENT.—Subsection (e) of section 

20 340B of the Public Health Service Act (42 U.S.C. 

21 256b) is amended by striking ‘‘covered entities de22 scribed in subparagraph (M)’’ and inserting ‘‘covered 

23 entities described in subparagraph (M) (other than a 

24 children’s hospital described in subparagraph (M))’’. 
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1 (2) EFFECTIVE DATE.—The amendment made by 

2 paragraph (1) shall take effect as if included in the 

3 enactment of section 2302 of the Health Care and 

4 Education Reconciliation Act of 2010 (Public Law 

5 111–152). 

6 (b) TECHNICAL AMENDMENT.—Subparagraph (B) of 

7 section 1927(a)(5) of the Social Security Act (42 U.S.C. 

8 1396r–8(a)(5)) is amended by striking ‘‘and a children’s 

9 hospital’’ and all that follows through the end of the sub10 paragraph and inserting a period. 

11 SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS. 

12 (a) REPEAL OF EXCLUSION OF CERTAIN INDIVIDUALS

13 AND ENTITIES FROM MEDICAID.—Section 1902(a) of the 

14 Social Security Act (42 U.S.C. 1396a(a)) is amended by 

15 striking paragraph (78). 

16 (b) INCOME LEVEL FOR CERTAIN CHILDREN UNDER

17 MEDICAID.—Section 1902(l)(2)(C) of the Social Security 

18 Act (42 U.S.C. 1396a(l)(2)(C)) is amended by striking ‘‘133 

19 percent’’ and inserting ‘‘100 percent (or, beginning Janu20 ary 1, 2014, 133 percent)’’. 

21 (c) CALCULATION AND PUBLICATION OF PAYMENT

22 ERROR RATE MEASUREMENT FOR CERTAIN YEARS.—Sec23 tion 601(b) of the Children’s Health Insurance Program Re24 authorization Act of 2009 (Public Law 111–3) is amended 

25 by adding at the end the following: ‘‘The Secretary is not 
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1 required under this subsection to calculate or publish a na2 tional or a State-specific error rate for fiscal year 2009 or 

3 fiscal year 2010.’’. 

4 (d) CORRECTIONS TO EXCEPTIONS TO EXCLUSION OF

5 CHILDREN OF CERTAIN EMPLOYEES.—Section 2110(b)(6) 

6 of the Social Security Act (42 U.S.C. 1397jj(b)(6)) is 

7 amended— 

8 (1) in subparagraph (B)— 

9 (A) by striking ‘‘PER PERSON’’ in the head10 ing; and 

11 (B) by striking ‘‘each employee’’ and insert12 ing ‘‘employees’’; and 

13 (2) in subparagraph (C), by striking ‘‘, on a 

14 case-by-case basis,’’. 

15 (e) ELECTRONIC HEALTH RECORDS.—Effective as if 

16 included in the enactment of section 4201(a)(2) of the 

17 American Recovery and Reinvestment Act of 2009 (Public 

18 Law 111–5), section 1903(t) of the Social Security Act (42 

19 U.S.C. 1396b(t)) is amended— 

20 (1) in paragraph (3)(E), by striking ‘‘reduced by 

21 any payment that is made to such Medicaid provider 

22 from any other source (other than under this sub23 section or by a State or local government)’’ and in24 serting ‘‘reduced by the average payment the Sec25 retary estimates will be made to such Medicaid pro-
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1 viders (determined on a percentage or other basis for 

2 such classes or types of providers as the Secretary 

3 may specify) from other sources (other than under 

4 this subsection, or by the Federal government or a 

5 State or local government)’’; and 

6 (2) in paragraph (6)(B), by inserting before the 

7 period the following: ‘‘and shall be determined to have 

8 met such responsibility to the extent that the payment 

9 to the Medicaid provider is not in excess of 85 percent 

10 of the net average allowable cost’’. 

11 (f) CORRECTIONS OF DESIGNATIONS.— 

12 (1) Section 1902 of the Social Security Act (42 

13 U.S.C. 1396a) is amended— 

14 (A) in subsection (a)(10), in the matter fol15 lowing subparagraph (G), by striking ‘‘and’’ be16 fore ‘‘(XVI) the medical’’ and by striking ‘‘(XVI) 

17 if’’ and inserting ‘‘(XVII) if’’; 

18 (B) in subsection (a)(23), by striking ‘‘(ii)’’ 

19 and inserting ‘‘(kk)’’; 

20 (C) in subsection (a)(77), by striking ‘‘(ii)’’ 

21 and inserting ‘‘(kk)’’; 

22 (D) in subsection (ii)(2), as added by sec23 tion 2303(a)(2) of Public Law 111–148, by strik24 ing ‘‘(XV)’’ and inserting ‘‘(XVI)’’; and 
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1 (E) by redesignating subsection (ii), as 

2 added by section 6401(b)(1)(B) of Public Law 

3 111–148, as subsection (kk) and transferring 

4 such subsection so as to appear after subsection 

5 (jj) of that section. 

6 (2) Section 2107(e)(1) of the Social Security Act 

7 (42 U.S.C. 1397gg(e)(1)) is amended— 

8 (A) in subparagraph (D), as added by sec9 tion 6401(c) of Public Law 111–148, by striking 

10 ‘‘(ii)’’ and inserting ‘‘(kk)’’; and 

11 (B) by redesignating the subparagraph (N) 

12 of that section added by 2101(e) of Public Law 

13 111–148 as subparagraph (O). 

14 SEC. 206. FUNDING FOR CLAIMS REPROCESSING. 

15 For purposes of carrying out the provisions of, and 

16 amendments made by, this Act that relate to title XVIII 

17 of the Social Security Act, and other provisions of, or relat18 ing to, such title that ensure appropriate payment of 

19 claims, there are appropriated to the Secretary of Health 

20 and Human Services for the Centers for Medicare & Med21 icaid Services Program Management Account, from 

22 amounts in the general fund of the Treasury not otherwise 

23 appropriated, $200,000,000. Amounts appropriated under 

24 the preceding sentence shall be in addition to any other 

25 funds available for such purposes, shall remain available 
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1 until expended, and shall not be used to implement changes 

2 to title XVIII of the Social Security Act made by Public 

3 Laws 111-148 and 111-152. 

4 SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT 

5 FUND. 

6 Section 1898(b)(1)(B) of the Social Security Act (42 

7 U.S.C. 1395iii(b)(1)(B)) is amended by striking 

8 ‘‘$550,000,000’’ and inserting ‘‘$275,000,000’’. 

9 SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOV10 ERED ON RECONCILIATION OF THE HEALTH 

11 INSURANCE TAX CREDIT AND THE ADVANCE 

12 OF THAT CREDIT. 

13 (a) IN GENERAL.—So much of section 36B(f)(2)(B) of 

14 the Internal Revenue Code of 1986 as precedes clause (ii) 

15 thereof is amended to read as follows: 

16 ‘‘(B) LIMITATION ON INCREASE.— 

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

18 taxpayer whose household income is less 

19 than 500 percent of the poverty line for the 

20 size of the family involved for the taxable 

21 year, the amount of the increase under sub22 paragraph (A) shall in no event exceed the 

23 applicable dollar amount determined in ac24 cordance with the following table (one-half 

25 of such amount in the case of a taxpayer 
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1 whose tax is determined under section 1(c) 

2 for the taxable year): 

‘‘If the household income (expressed as a percent of 

poverty line) is: 

The applicable dollar 

amount is: 

Less than 200% .............................................................. $600 

At least 200% but less than 250% ............................... $1,000 

At least 250% but less than 300% ............................... $1,500 

At least 300% but less than 350% ............................... $2,000 

At least 350% but less than 400% ............................... $2,500 

At least 400% but less than 450% ............................... $3,000 

At least 450% but less than 500% ............................... $3,500’’. 

3 (b) CONFORMING AMENDMENT.—Section 

4 36B(f)(2)(B)(ii) of such Code is amended by inserting ‘‘in 

5 the table contained’’ after ‘‘each of the dollar amounts’’. 

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

7 section shall apply to taxable years beginning after Decem8 ber 31, 2013. 

9 SEC. 209. DETERMINATION OF BUDGETARY EFFECTS. 

10 (a) IN GENERAL.—The budgetary effects of this Act, 

11 for the purpose of complying with the Statutory Pay-As12 You-Go Act of 2010, shall be determined by reference to the 

13 latest statement titled ‘‘Budgetary Effects of PAYGO Legis14 lation’’ for this Act, submitted for printing in the Congres15 sional Record by the Chairman of the Senate Budget Com16 mittee, provided that such statement has been submitted 

17 prior to the vote on passage. 

18 (b) EMERGENCY DESIGNATION FOR CONGRESSIONAL

19 ENFORCEMENT.—In the House of Representatives, this Act, 
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1 with the exception of section 101, is designated as an emer2 gency for purposes of pay-as-you-go principles. 

Amend the title so as to read: ‘‘An Act to extend 

certain expiring provisions of the Medicare and Medicaid 

programs, and for other purposes.’’. 

Attest: 

Secretary. 
111TH CONGRESS 

2D SESSION H.R. 4994 

AMENDMENTS