548 
AMDT. NO. 98 
‘‘Subpart J—Build America Bonds 
‘‘Sec. 54AA. Build America bonds. 
‘‘SEC. 54AA. BUILD AMERICA BONDS. 
‘‘(a) IN GENERAL.—If a taxpayer holds a build 
America bond on one or more interest payment dates of 
the bond during any taxable year, there shall be allowed 
as a credit against the tax imposed by this chapter for 
the taxable year an amount equal to the sum of the credits 
determined under subsection (b) with respect to such 
dates. 
‘‘(b) AMOUNT OF CREDIT.—The amount of the credit 
determined under this subsection with respect to any in-
terest payment date for a build America bond is 35 per-
cent of the amount of interest payable by the issuer with 
respect to such date. 
‘‘(c) LIMITATION BASED ON AMOUNT OF TAX.— 
‘‘(1) IN GENERAL.—The credit allowed under 
subsection (a) for any taxable year shall not exceed 
the excess of— 
‘‘(A) the sum of the regular tax liability 
(as defined in section 26(b)) plus the tax im-
posed by section 55, over 
‘‘(B) the sum of the credits allowable 
under this part (other than subpart C and this 
subpart). 
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AMDT. NO. 98 
‘‘(2) CARRYOVER OF UNUSED CREDIT.—If the 
credit allowable under subsection (a) exceeds the 
limitation imposed by paragraph (1) for such taxable 
year, such excess shall be carried to the succeeding 
taxable year and added to the credit allowable under 
subsection (a) for such taxable year (determined be-
fore the application of paragraph (1) for such suc-
ceeding taxable year). 
‘‘(d) BUILD AMERICA BOND.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘build America bond’ means any obli-
gation (other than a private activity bond) if— 
‘‘(A) the interest on such obligation would 
(but for this section) be excludable from gross 
income under section 103, 
‘‘(B) such obligation is issued before Janu-
ary 1, 2012, and 
‘‘(C) the issuer makes an irrevocable elec-
tion to have this section apply. 
‘‘(2) APPLICABLE RULES.—For purposes of ap-
plying paragraph (1)— 
‘‘(A) a build America bond shall not be 
treated as federally guaranteed by reason of the 
credit allowed under subsection (a) or section 
6431, 
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AMDT. NO. 98 
‘‘(B) the yield on a build America bond 
shall be determined without regard to the credit 
allowed under subsection (a), and 
‘‘(C) a bond shall not be treated as a build 
America bond if the issue price has more than 
a de minimis amount (determined under rules 
similar to the rules of section 1273(a)(3)) of 
premium over the stated principal amount of 
the bond. 
‘‘(e) INTEREST PAYMENT DATE.—For purposes of 
this section, the term ‘interest payment date’ means any 
date on which the holder of record of the build America 
bond is entitled to a payment of interest under such bond. 
‘‘(f) SPECIAL RULES.— 
‘‘(1) INTEREST ON BUILD AMERICA BONDS IN-
CLUDIBLE IN GROSS INCOME FOR FEDERAL INCOME 
TAX PURPOSES.—For purposes of this title, interest 
on any build America bond shall be includible in 
gross income. 
‘‘(2) APPLICATION OF CERTAIN RULES.—Rules 
similar to the rules of subsections (f), (g), (h), and 
(i) of section 54A shall apply for purposes of the 
credit allowed under subsection (a). 
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AMDT. NO. 98 
‘‘(g) SPECIAL RULE FOR QUALIFIED BONDS ISSUED 
BEFORE 2011.—In the case of a qualified bond issued be-
fore January 1, 2011— 
‘‘(1) ISSUER
ALLOWED
REFUNDABLE
CRED-
IT.—In lieu of any credit allowed under this section 
with respect to such bond, the issuer of such bond 
shall be allowed a credit as provided in section 6431. 
‘‘(2) QUALIFIED BOND.—For purposes of this 
subsection, the term ‘qualified bond’ means any 
build America bond issued as part of an issue if— 
‘‘(A) 100 percent of the available project 
proceeds (as defined in section 54A) of such 
issue are to be used for capital expenditures, 
and 
‘‘(B) the issuer makes an irrevocable elec-
tion to have this subsection apply. 
‘‘(h) REGULATIONS.—The Secretary may prescribe 
such regulations and other guidance as may be necessary 
or appropriate to carry out this section and section 
6431.’’. 
(b) CREDIT FOR QUALIFIED BONDS ISSUED BEFORE 
2011.—Subchapter B of chapter 65 is amended by adding 
at the end the following new section: 
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AMDT. NO. 98 
‘‘SEC. 6431. CREDIT FOR QUALIFIED BONDS ALLOWED TO 
ISSUER. 
‘‘(a) IN GENERAL.—In the case of a qualified bond 
issued before January 1, 2011, the issuer of such bond 
shall be allowed a credit with respect to each interest pay-
ment under such bond which shall be payable by the Sec-
retary as provided in subsection (b). 
‘‘(b) PAYMENT OF CREDIT.—The Secretary shall pay 
(contemporaneously with each interest payment date 
under such bond) to the issuer of such bond (or to any 
person who makes such interest payments on behalf of the 
issuer) 35 percent of the interest payable under such bond 
on such date. 
‘‘(c) APPLICATION OF ARBITRAGE RULES.—For pur-
poses of section 148, the yield on a qualified bond shall 
be reduced by the credit allowed under this section. 
‘‘(d) INTEREST PAYMENT DATE.—For purposes of 
this subsection, the term ‘interest payment date’ means 
each date on which interest is payable by the issuer under 
the terms of the bond. 
‘‘(e) QUALIFIED BOND.—For purposes of this sub-
section, the term ‘qualified bond’ has the meaning given 
such term in section 54AA(g).’’. 
(c) CONFORMING AMENDMENTS.— 
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553 
AMDT. NO. 98 
(1) Section 1324(b)(2) of title 31, United 
States Code, is amended by striking ‘‘or 6428’’ and 
inserting ‘‘6428, or 6431,’’. 
(2) Section 54A(c)(1)(B) is amended by strik-
ing ‘‘subpart C’’ and inserting ‘‘subparts C and J’’. 
(3) 
Sections 
54(c)(2), 
1397E(c)(2), 
and 
1400N(l)(3)(B) are each amended by striking ‘‘and 
I’’ and inserting ‘‘, I, and J’’. 
(4) Section 6401(b)(1) is amended by striking 
‘‘and I’’ and inserting ‘‘I, and J’’. 
(5) The table of subparts for part IV of sub-
chapter A of chapter 1 is amended by adding at the 
end the following new item: 
‘‘Subpart J. Build America bonds.’’. 
(6) The table of section for subchapter B of 
chapter 65 is amended by adding at the end the fol-
lowing new item: 
‘‘Sec. 6431. Credit for qualified bonds allowed to issuer.’’. 
(d) TRANSITIONAL
COORDINATION
WITH
STATE 
LAW.—Except as otherwise provided by a State after the 
date of the enactment of this Act, the interest on any build 
America bond (as defined in section 54AA of the Internal 
Revenue Code of 1986, as added by this section) and the 
amount of any credit determined under such section with 
respect to such bond shall be treated for purposes of the 
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554 
AMDT. NO. 98 
income tax laws of such State as being exempt from Fed-
eral income tax. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to obligations issued after the date 
of the enactment of this Act. 
Subtitle G—Economic Recovery 
Payments to Certain Individuals 
SEC. 1601. ECONOMIC RECOVERY PAYMENT TO RECIPIENTS 
OF SOCIAL SECURITY, SUPPLEMENTAL SECU-
RITY INCOME, RAILROAD RETIREMENT BENE-
FITS, AND VETERANS DISABILITY COMPENSA-
TION OR PENSION BENEFITS. 
(a) AUTHORITY TO MAKE PAYMENTS.— 
(1) ELIGIBILITY.— 
(A) IN GENERAL.—Subject to paragraph 
(5)(B), the Secretary of the Treasury shall 
make a $300 payment to each individual who, 
for any month during the 3-month period end-
ing with the month which ends prior to the 
month that includes the date of the enactment 
of this Act, is entitled to a benefit payment de-
scribed in clause (i), (ii), or (iii) of subpara-
graph (B) or is eligible for a SSI cash benefit 
described in subparagraph (C). 
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555 
AMDT. NO. 98 
(B) BENEFIT PAYMENT DESCRIBED.—For 
purposes of subparagraph (A): 
(i) TITLE II BENEFIT.—A benefit pay-
ment described in this clause is a monthly 
insurance benefit payable (without regard 
to sections 202(j)(1) and 223(b) of the So-
cial Security Act (42 U.S.C. 402(j)(1), 
423(b)) under— 
(I) section 202(a) of such Act 
(42 U.S.C. 402(a)); 
(II) section 202(b) of such Act 
(42 U.S.C. 402(b)); 
(III) section 202(c) of such Act 
(42 U.S.C. 402(c)); 
(IV) section 202(d)(1)(B)(ii) of 
such 
Act 
(42 
U.S.C. 
402(d)(1)(B)(ii)); 
(V) section 202(e) of such Act 
(42 U.S.C. 402(e)); 
(VI) section 202(f) of such Act 
(42 U.S.C. 402(f)); 
(VII) section 202(g) of such Act 
(42 U.S.C. 402(g)); 
(VIII) section 202(h) of such Act 
(42 U.S.C. 402(h)); 
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556 
AMDT. NO. 98 
(IX) section 223(a) of such Act 
(42 U.S.C. 423(a)); 
(X) section 227 of such Act (42 
U.S.C. 427); or 
(XI) section 228 of such Act (42 
U.S.C. 428). 
(ii) RAILROAD
RETIREMENT
BEN-
EFIT.—A benefit payment described in this 
clause is a monthly annuity or pension 
payment payable (without regard to section 
5(a)(ii) of the Railroad Retirement Act of 
1974 (45 U.S.C. 231d(a)(ii)) under— 
(I) section 2(a)(1) of such Act 
(45 U.S.C. 231a(a)(1)); 
(II) section 2(c) of such Act (45 
U.S.C. 231a(c)); 
(III) section 2(d)(1)(i) of such 
Act (45 U.S.C. 231a(d)(1)(i)); 
(IV) section 2(d)(1)(ii) of such 
Act (45 U.S.C. 231a(d)(1)(ii)); 
(V) section 2(d)(1)(iii)(C) of such 
Act to an adult disabled child (45 
U.S.C. 231a(d)(1)(iii)(C)); 
(VI) section 2(d)(1)(iv) of such 
Act (45 U.S.C. 231a(d)(1)(iv)); 
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557 
AMDT. NO. 98 
(VII) section 2(d)(1)(v) of such 
Act (45 U.S.C. 231a(d)(1)(v)); or 
(VIII) section 7(b)(2) of such Act 
(45 U.S.C. 231f(b)(2)) with respect to 
any of the benefit payments described 
in clause (i) of this subparagraph. 
(iii) VETERANS BENEFIT.—A benefit 
payment described in this clause is a com-
pensation or pension payment payable 
under— 
(I) section 1110, 1117, 1121, 
1131, 1141, or 1151 of title 38, 
United States Code; 
(II) section 1310, 1312, 1313, 
1315, 1316, or 1318 of title 38, 
United States Code; 
(III) section 1513, 1521, 1533, 
1536, 1537, 1541, 1542, or 1562 of 
title 38, United States Code; or 
(IV) section 1805, 1815, or 1821 
of title 38, United States Code, 
to a veteran, surviving spouse, child, or 
parent as described in paragraph (2), (3), 
(4)(A)(ii), or (5) of section 101, title 38, 
United States Code, who received that ben-
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558 
AMDT. NO. 98 
efit during any month within the 3 month 
period ending with the month which ends 
prior to the month that includes the date 
of the enactment of this Act. 
(C) SSI CASH
BENEFIT
DESCRIBED.—A 
SSI cash benefit described in this subparagraph 
is a cash benefit payable under section 1611 
(other than under subsection (e)(1)(B) of such 
section) or 1619(a) of the Social Security Act 
(42 U.S.C. 1382, 1382h). 
(2) REQUIREMENT.—A payment shall be made 
under paragraph (1) only to individuals who reside 
in 1 of the 50 States, the District of Columbia, 
Puerto Rico, Guam, the United States Virgin Is-
lands, American Samoa, or the Northern Mariana 
Islands. For purposes of the preceding sentence, the 
determination of the individual’s residence shall be 
based on the current address of record under a pro-
gram specified in paragraph (1). 
(3) NO
DOUBLE
PAYMENTS.—An individual 
shall be paid only 1 payment under this section, re-
gardless of whether the individual is entitled to, or 
eligible for, more than 1 benefit or cash payment de-
scribed in paragraph (1). 
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560 
AMDT. NO. 98 
tion 1611 (42 U.S.C. 1382) or section 1129A 
of such Act (42 U.S.C. 1320a-8a); or 
(D) in the case of any individual whose 
date of death occurs before the date on which 
the individual is certified under subsection (b) 
to receive a payment under this section. 
(5) TIMING AND MANNER OF PAYMENTS.— 
(A) IN GENERAL.—The Secretary of the 
Treasury shall commence making payments 
under this section at the earliest practicable 
date but in no event later than 120 days after 
the date of enactment of this Act. The Sec-
retary of the Treasury may make any payment 
electronically to an individual in such manner 
as if such payment was a benefit payment or 
cash benefit to such individual under the appli-
cable program described in subparagraph (B) 
or (C) of paragraph (1). 
(B) DEADLINE.—No payments shall be 
made under this section after December 31, 
2010, regardless of any determinations of enti-
tlement to, or eligibility for, such payments 
made after such date. 
(b) IDENTIFICATION OF RECIPIENTS.—The Commis-
sioner of Social Security, the Railroad Retirement Board, 
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561 
AMDT. NO. 98 
and the Secretary of Veterans Affairs shall certify the in-
dividuals entitled to receive payments under this section 
and provide the Secretary of the Treasury with the infor-
mation needed to disburse such payments. A certification 
of an individual shall be unaffected by any subsequent de-
termination or redetermination of the individual’s entitle-
ment to, or eligibility for, a benefit specified in subpara-
graph (B) or (C) of subsection (a)(1). 
(c) TREATMENT OF PAYMENTS.— 
(1) PAYMENT TO BE DISREGARDED FOR PUR-
POSES OF ALL FEDERAL AND FEDERALLY ASSISTED 
PROGRAMS.—A payment under subsection (a) shall 
not be regarded as income and shall not be regarded 
as a resource for the month of receipt and the fol-
lowing 9 months, for purposes of determining the 
eligibility of the recipient (or the recipient’s spouse 
or family) for benefits or assistance, or the amount 
or extent of benefits or assistance, under any Fed-
eral program or under any State or local program fi-
nanced in whole or in part with Federal funds. 
(2) PAYMENT NOT CONSIDERED INCOME FOR 
PURPOSES OF TAXATION.—A payment under sub-
section (a) shall not be considered as gross income 
for purposes of the Internal Revenue Code of 1986. 
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562 
AMDT. NO. 98 
(3) PAYMENTS
PROTECTED
FROM
ASSIGN-
MENT.—The 
provisions 
of 
sections 
207 
and 
1631(d)(1) of the Social Security Act (42 U.S.C. 
407, 1383(d)(1)), section 14(a) of the Railroad Re-
tirement Act of 1974 (45 U.S.C. 231m(a)), and sec-
tion 5301 of title 38, United States Code, shall 
apply to any payment made under subsection (a) as 
if such payment was a benefit payment or cash ben-
efit to such individual under the applicable program 
described in subparagraph (B) or (C) of subsection 
(a)(1). 
(4) PAYMENTS SUBJECT TO OFFSET.—Notwith-
standing paragraph (3), for purposes of section 
3716 of title 31, United States Code, any payment 
made under this section shall not be considered a 
benefit payment or cash benefit made under the ap-
plicable program described in subparagraph (B) or 
(C) of subsection (a)(1) and all amounts paid shall 
be subject to offset to collect delinquent debts. 
(d) PAYMENT TO REPRESENTATIVE PAYEES AND FI-
DUCIARIES.— 
(1) IN GENERAL.—In any case in which an in-
dividual who is entitled to a payment under sub-
section (a) and whose benefit payment or cash ben-
efit described in paragraph (1) of that subsection is 
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563 
AMDT. NO. 98 
paid to a representative payee or fiduciary, the pay-
ment under subsection (a) shall be made to the indi-
vidual’s representative payee or fiduciary and the en-
tire payment shall be used only for the benefit of the 
individual who is entitled to the payment. 
(2) APPLICABILITY.— 
(A) PAYMENT ON THE BASIS OF A TITLE 
II OR SSI BENEFIT.—Section 1129(a)(3) of the 
Social Security Act (42 U.S.C. 1320a–8(a)(3)) 
shall apply to any payment made on the basis 
of an entitlement to a benefit specified in para-
graph (1)(B)(i) or (1)(C) of subsection (a) in 
the same manner as such section applies to a 
payment under title II or XVI of such Act. 
(B) PAYMENT ON THE BASIS OF A RAIL-
ROAD
RETIREMENT
BENEFIT.—Section 13 of 
the Railroad Retirement Act (45 U.S.C. 231l) 
shall apply to any payment made on the basis 
of an entitlement to a benefit specified in para-
graph (1)(B)(ii) of subsection (a) in the same 
manner as such section applies to a payment 
under such Act. 
(C) PAYMENT ON THE BASIS OF A VET-
ERANS
BENEFIT.—Sections 5502, 6106, and 
6108 of title 38, United States Code, shall 
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AMDT. NO. 98 
apply to any payment made on the basis of an 
entitlement to a benefit specified in paragraph 
(1)(B)(iii) of subsection (a) in the same manner 
as those sections apply to a payment under that 
title. 
(e) APPROPRIATION.—Out of any sums in the Treas-
ury of the United States not otherwise appropriated, the 
following sums are appropriated for the period of fiscal 
years 2009 and 2010 to carry out this section: 
(1) For the Secretary of the Treasury— 
(A) such sums as may be necessary to 
make payments under this section; and 
(B) $57,000,000 for administrative costs 
incurred in carrying out this section and section 
36A of the Internal Revenue Code of 1986 (as 
added by this Act). 
(2) For the Commissioner of Social Security, 
$90,000,000 for the Social Security Administration’s 
Limitation on Administrative Expenses for costs in-
curred in carrying out this section. 
(3) For the Railroad Retirement Board, 
$1,000,000 for administrative costs incurred in car-
rying out this section. 
(4) For the Secretary of Veterans Affairs, 
$100,000 for the Information Systems Technology 
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565 
AMDT. NO. 98 
account and $7,100,000 for the General Operating 
Expenses account for administrative costs incurred 
in carrying out this section. 
Subtitle H—Trade Adjustment 
Assistance 
SEC. 1701. TEMPORARY EXTENSION OF TRADE ADJUST-
MENT ASSISTANCE PROGRAM. 
(a) ASSISTANCE FOR WORKERS.— 
(1) IN GENERAL.—Section 245(a) of the Trade 
Act of 1974 (19 U.S.C. 2317(a)) is amended by 
striking ‘‘December 31, 2007’’ and inserting ‘‘De-
cember 31, 2010’’. 
(2) ALTERNATIVE TRADE ADJUSTMENT ASSIST-
ANCE.—Section 246(b)(1) of the Trade Act of 1974 
(19 U.S.C. 2318(b)(1)) is amended by striking ‘‘5 
years’’ and inserting ‘‘7 years’’. 
(b) ASSISTANCE FOR FIRMS.—Section 256(b) of the 
Trade Act of 1974 (19 U.S.C. 2346(b)) is amended by 
striking ‘‘2007, and $4,000,000 for the 3-month period 
beginning on October 1, 2007,’’ and inserting ‘‘December 
31, 2010’’. 
(c) ASSISTANCE FOR FARMERS.—Section 298(a) of 
the Trade Act of 1974 (19 U.S.C. 2401g(a)) is amended 
by striking ‘‘through 2007’’ and all that follows through 
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AMDT. NO. 98 
the end period and inserting ‘‘through December 31, 2010 
to carry out the purposes of this chapter.’’. 
(d) EXTENSION OF TERMINATION DATES.—Section 
285 of the Trade Act of 1974 (19 U.S.C. 2271 note) is 
amended by striking ‘‘December 31, 2007’’ each place it 
appears and inserting ‘‘December 31, 2010’’. 
(e) SENSE OF THE SENATE REGARDING ADJUST-
MENT ASSISTANCE FOR COMMUNITIES.—It is the sense 
of the Senate that title II of the Trade Act of 1974 (19 
U.S.C. 2271 et seq.) should be amended to assist any com-
munity impacted by trade with economic adjustment 
through— 
(1) the coordination of efforts by State and 
local governments and economic organizations; 
(2) the coordination of Federal, State, and local 
resources; 
(3) the creation of community-based develop-
ment strategies; and 
(4) the development and provision of training 
programs. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall be effective as of January 1, 2008. 
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567 
AMDT. NO. 98 
Subtitle I—Prohibition on Collec-
tion of Certain Payments Made 
Under the Continued Dumping 
and Subsidy Offset Act of 2000 
SEC. 1801. PROHIBITION ON COLLECTION OF CERTAIN PAY-
MENTS MADE UNDER THE CONTINUED DUMP-
ING AND SUBSIDY OFFSET ACT OF 2000. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, neither the Secretary of Homeland Security 
nor any other person may— 
(1) require repayment of, or attempt in any 
other way to recoup, any payments described in sub-
section (b); or 
(2) offset any past, current, or future distribu-
tions of antidumping or countervailing duties as-
sessed with respect to imports from countries that 
are not parties to the North American Free Trade 
Agreement in an attempt to recoup any payments 
described in subsection (b). 
(b) PAYMENTS DESCRIBED.—Payments described in 
this subsection are payments of antidumping or counter-
vailing duties made pursuant to the Continued Dumping 
and Subsidy Offset Act of 2000 (section 754 of the Tariff 
Act of 1930 (19 U.S.C. 1675c; repealed by subtitle F of 
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AMDT. NO. 98 
title VII of the Deficit Reduction Act of 2005 (Public Law 
109–171; 120 Stat. 154))) that were— 
(1) assessed and paid on imports of goods from 
countries that are parties to the North American 
Free Trade Agreement; and 
(2) distributed on or after January 1, 2001, 
and before January 1, 2006. 
(c) PAYMENT
OF FUNDS COLLECTED
OR WITH-
HELD.—Not later than the date that is 60 days after the 
date of the enactment of this Act, the Secretary of Home-
land Security shall— 
(1) refund any repayments, or any other 
recoupment, of payments described in subsection (b); 
and 
(2) fully distribute any antidumping or counter-
vailing duties that the U.S. Customs and Border 
Protection is withholding as an offset as described in 
subsection (a)(2). 
(d) LIMITATION.—Nothing in this section shall be 
construed to prevent the Secretary of Homeland Security, 
or any other person, from requiring repayment of, or at-
tempting to otherwise recoup, any payments described in 
subsection (b) as a result of— 
(1) a finding of false statements or other mis-
conduct by a recipient of such a payment; or 
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AMDT. NO. 98 
(2) the reliquidation of an entry with respect to 
which such a payment was made. 
Subtitle J—Other Provisions 
SEC. 1901. APPLICATION OF CERTAIN LABOR STANDARDS 
TO PROJECTS FINANCED WITH CERTAIN TAX- 
FAVORED BONDS. 
Subchapter IV of chapter 31 of the title 40, United 
States Code, shall apply to projects financed with the pro-
ceeds of— 
(1) any new clean renewable energy bond (as 
defined in section 54C of the Internal Revenue Code 
of 1986) issued after the date of the enactment of 
this Act, 
(2) any qualified energy conservation bond (as 
defined in section 54D of the Internal Revenue Code 
of 1986) issued after the date of the enactment of 
this Act, 
(3) any qualified zone academy bond (as de-
fined in section 54E of the Internal Revenue Code 
of 1986) issued after the date of the enactment of 
this Act, 
(4) any qualified school construction bond (as 
defined in section 54F of the Internal Revenue Code 
of 1986), and 
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AMDT. NO. 98 
(5) any recovery zone economic development 
bond (as defined in section 1400U–2 of the Internal 
Revenue Code of 1986). 
SEC. 1902. INCREASE IN PUBLIC DEBT LIMIT. 
Subsection (b) of section 3101 of title 31, United 
States Code, is amended by striking out the dollar limita-
tion 
contained 
in 
such 
subsection 
and 
inserting 
‘‘$12,140,000,000,000’’. 
TITLE II—ASSISTANCE FOR UN-
EMPLOYED 
WORKERS 
AND 
STRUGGLING FAMILIES 
SEC. 2000. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This title may be cited as the 
‘‘Assistance for Unemployed Workers and Struggling 
Families Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this title is as follows: 
TITLE II—ASSISTANCE FOR UNEMPLOYED WORKERS AND 
STRUGGLING FAMILIES 
Sec. 2000. Short title; table of contents. 
Subtitle A—Unemployment Insurance 
Sec. 2001. Extension of emergency unemployment compensation program. 
Sec. 2002. Increase in unemployment compensation benefits. 
Sec. 2003. Unemployment compensation modernization. 
Sec. 2004. Temporary assistance for States with advances. 
Subtitle B—Assistance for Vulnerable Individuals 
Sec. 2101. Emergency fund for TANF program. 
Sec. 2102. Extension of TANF supplemental grants. 
Sec. 2103. Clarification of authority of states to use tanf funds carried over 
from prior years to provide tanf benefits and services. 
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AMDT. NO. 98 
Sec. 2104. Temporary reinstatement of authority to provide Federal matching 
payments for State spending of child support incentive pay-
ments. 
Subtitle A—Unemployment 
Insurance 
SEC. 2001. EXTENSION OF EMERGENCY UNEMPLOYMENT 
COMPENSATION PROGRAM. 
(a) IN GENERAL.—Section 4007 of the Supplemental 
Appropriations Act, 2008 (Public Law 110-252; 26 U.S.C. 
3304 note), as amended by section 4 of the Unemployment 
Compensation Extension Act of 2008 (Public Law 110- 
449; 122 Stat. 5015), is amended— 
(1) by striking ‘‘March 31, 2009’’ each place it 
appears and inserting ‘‘December 31, 2009’’; 
(2) in the heading for subsection (b)(2), by 
striking ‘‘MARCH 31, 2009’’ and inserting ‘‘DECEM-
BER 31, 2009’’; and 
(3) in subsection (b)(3), by striking ‘‘August 
27, 2009’’ and inserting ‘‘May 31, 2010’’. 
(b) FINANCING PROVISIONS.—Section 4004 of such 
Act is amended by adding at the end the following: 
‘‘(e) TRANSFER OF FUNDS.—Notwithstanding any 
other provision of law, the Secretary of the Treasury shall 
transfer from the general fund of the Treasury (from 
funds not otherwise appropriated)— 
‘‘(1) to the extended unemployment compensa-
tion account (as established by section 905 of the 
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AMDT. NO. 98 
Social Security Act) such sums as the Secretary of 
Labor estimates to be necessary to make payments 
to States under this title by reason of the amend-
ments made by section 2001(a) of the Assistance for 
Unemployed Workers and Struggling Families Act; 
and 
‘‘(2) to the employment security administration 
account (as established by section 901 of the Social 
Security Act) such sums as the Secretary of Labor 
estimates to be necessary for purposes of assisting 
States in meeting administrative costs by reason of 
the amendments referred to in paragraph (1). 
There are appropriated from the general fund of the 
Treasury, without fiscal year limitation, the sums referred 
to in the preceding sentence and such sums shall not be 
required to be repaid.’’. 
SEC. 2002. INCREASE IN UNEMPLOYMENT COMPENSATION 
BENEFITS. 
(a) FEDERAL-STATE
AGREEMENTS.—Any State 
which desires to do so may enter into and participate in 
an agreement under this section with the Secretary of 
Labor (hereinafter in this section referred to as the ‘‘Sec-
retary’’). Any State which is a party to an agreement 
under this section may, upon providing 30 days’ written 
notice to the Secretary, terminate such agreement. 
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AMDT. NO. 98 
(b) PROVISIONS OF AGREEMENT.— 
(1) ADDITIONAL COMPENSATION.—Any agree-
ment under this section shall provide that the State 
agency of the State will make payments of regular 
compensation to individuals in amounts and to the 
extent that they would be determined if the State 
law of the State were applied, with respect to any 
week for which the individual is (disregarding this 
section) otherwise entitled under the State law to re-
ceive regular compensation, as if such State law had 
been modified in a manner such that the amount of 
regular compensation (including dependents’ allow-
ances) payable for any week shall be equal to the 
amount determined under the State law (before the 
application of this paragraph) plus an additional 
$25. 
(2) ALLOWABLE METHODS OF PAYMENT.—Any 
additional compensation provided for in accordance 
with paragraph (1) shall be payable either— 
(A) as an amount which is paid at the 
same time and in the same manner as any reg-
ular compensation otherwise payable for the 
week involved; or 
(B) at the option of the State, by pay-
ments which are made separately from, but on 
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AMDT. NO. 98 
the same weekly basis as, any regular com-
pensation otherwise payable. 
(c) NONREDUCTION RULE.—An agreement under 
this section shall not apply (or shall cease to apply) with 
respect to a State upon a determination by the Secretary 
that the method governing the computation of regular 
compensation under the State law of that State has been 
modified in a manner such that— 
(1) the average weekly benefit amount of reg-
ular compensation which will be payable during the 
period of the agreement (determined disregarding 
any additional amounts attributable to the modifica-
tion described in subsection (b)(1)) will be less than 
(2) the average weekly benefit amount of reg-
ular compensation which would otherwise have been 
payable during such period under the State law, as 
in effect on December 31, 2008. 
(d) PAYMENTS TO STATES.— 
(1) IN GENERAL.— 
(A) FULL REIMBURSEMENT.—There shall 
be paid to each State which has entered into an 
agreement under this section an amount equal 
to 100 percent of— 
(i) the total amount of additional 
compensation (as described in subsection 
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AMDT. NO. 98 
(b)(1)) paid to individuals by the State 
pursuant to such agreement; and 
(ii) any additional administrative ex-
penses incurred by the State by reason of 
such agreement (as determined by the Sec-
retary). 
(B) TERMS OF PAYMENTS.—Sums payable 
to any State by reason of such State’s having 
an agreement under this section shall be pay-
able, either in advance or by way of reimburse-
ment (as determined by the Secretary), in such 
amounts as the Secretary estimates the State 
will be entitled to receive under this section for 
each calendar month, reduced or increased, as 
the case may be, by any amount by which the 
Secretary finds that his estimates for any prior 
calendar month were greater or less than the 
amounts which should have been paid to the 
State. Such estimates may be made on the 
basis of such statistical, sampling, or other 
method as may be agreed upon by the Secretary 
and the State agency of the State involved. 
(2) 
CERTIFICATIONS.—The 
Secretary 
shall 
from time to time certify to the Secretary of the 
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AMDT. NO. 98 
Treasury for payment to each State the sums pay-
able to such State under this section. 
(3) APPROPRIATION.—There are appropriated 
from the general fund of the Treasury, without fiscal 
year limitation, such sums as may be necessary for 
purposes of this subsection. 
(e) APPLICABILITY.— 
(1) IN GENERAL.—An agreement entered into 
under this section shall apply to weeks of unemploy-
ment— 
(A) beginning after the date on which such 
agreement is entered into; and 
(B) ending before January 1, 2010. 
(2) TRANSITION RULE FOR INDIVIDUALS RE-
MAINING ENTITLED TO REGULAR COMPENSATION AS 
OF JANUARY 1, 2010.—In the case of any individual 
who, as of the date specified in paragraph (1)(B), 
has not yet exhausted all rights to regular com-
pensation under the State law of a State with re-
spect to a benefit year that began before such date, 
additional compensation (as described in subsection 
(b)(1)) shall continue to be payable to such indi-
vidual for any week beginning on or after such date 
for which the individual is otherwise eligible for reg-
ular compensation with respect to such benefit year. 
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AMDT. NO. 98 
(3) TERMINATION.—Notwithstanding any other 
provision of this subsection, no additional compensa-
tion (as described in subsection (b)(1)) shall be pay-
able for any week beginning after June 30, 2010. 
(f) FRAUD AND OVERPAYMENTS.—The provisions of 
section 4005 of the Supplemental Appropriations Act, 
2008 (Public Law 110–252; 122 Stat. 2356) shall apply 
with respect to additional compensation (as described in 
subsection (b)(1)) to the same extent and in the same 
manner as in the case of emergency unemployment com-
pensation. 
(g) APPLICATION TO OTHER UNEMPLOYMENT BENE-
FITS.— 
(1) IN GENERAL.—Each agreement under this 
section shall include provisions to provide that the 
purposes of the preceding provisions of this section 
shall be applied with respect to unemployment bene-
fits described in subsection (i)(3) to the same extent 
and in the same manner as if those benefits were 
regular compensation. 
(2) ELIGIBILITY AND TERMINATION RULES.— 
Additional compensation (as described in subsection 
(b)(1))— 
(A) shall not be payable, pursuant to this 
subsection, with respect to any unemployment 
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578 
AMDT. NO. 98 
benefits described in subsection (i)(3) for any 
week beginning on or after the date specified in 
subsection (e)(1)(B), except in the case of an 
individual who was eligible to receive additional 
compensation (as so described) in connection 
with any regular compensation or any unem-
ployment benefits described in subsection (i)(3) 
for any period of unemployment ending before 
such date; and 
(B) shall in no event be payable for any 
week beginning after the date specified in sub-
section (e)(3). 
(h) DISREGARD OF ADDITIONAL COMPENSATION FOR 
PURPOSES OF MEDICAID AND SCHIP.—A State that en-
ters into an agreement under this section shall disregard 
the monthly equivalent of $25 per week for any individual 
who receives additional compensation under subsection 
(b)(1) in considering the amount of income of the indi-
vidual for any purposes under the Medicaid program 
under title XIX of the Social Security Act and the State 
Children’s Health Insurance Program under title XXI of 
such Act. 
(i) DEFINITIONS.—For purposes of this section— 
(1) the terms ‘‘compensation’’, ‘‘regular com-
pensation’’, ‘‘benefit year’’, ‘‘State’’, ‘‘State agency’’, 
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AMDT. NO. 98 
‘‘State law’’, and ‘‘week’’ have the respective mean-
ings given such terms under section 205 of the Fed-
eral-State Extended Unemployment Compensation 
Act of 1970 (26 U.S.C. 3304 note); 
(2) the term ‘‘emergency unemployment com-
pensation’’ means emergency unemployment com-
pensation under title IV of the Supplemental Appro-
priations Act, 2008 (Public Law 110–252; 122 Stat. 
2353); and 
(3) any reference to unemployment benefits de-
scribed in this paragraph shall be considered to refer 
to— 
(A) extended compensation (as defined by 
section 205 of the Federal-State Extended Un-
employment Compensation Act of 1970); and 
(B) unemployment compensation (as de-
fined by section 85(b) of the Internal Revenue 
Code of 1986) provided under any program ad-
ministered by a State under an agreement with 
the Secretary. 
SEC. 2003. UNEMPLOYMENT COMPENSATION MODERNIZA-
TION. 
(a) IN GENERAL.—Section 903 of the Social Security 
Act (42 U.S.C. 1103) is amended by adding at the end 
the following: 
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AMDT. NO. 98 
‘‘Special Transfers for Modernization 
‘‘(f)(1)(A) In addition to any other amounts, the Sec-
retary of Labor shall provide for the making of unemploy-
ment compensation modernization incentive payments 
(hereinafter ‘incentive payments’) to the accounts of the 
States in the Unemployment Trust Fund, by transfer from 
amounts reserved for that purpose in the Federal unem-
ployment account, in accordance with succeeding provi-
sions of this subsection. 
‘‘(B) The maximum incentive payment allowable 
under this subsection with respect to any State shall, as 
determined by the Secretary of Labor, be equal to the 
amount obtained by multiplying $7,000,000,000 by the 
same ratio as would apply under subsection (a)(2)(B) for 
purposes of determining such State’s share of any excess 
amount (as described in subsection (a)(1)) that would 
have been subject to transfer to State accounts, as of Oc-
tober 1, 2008, under the provisions of subsection (a). 
‘‘(C) Of the maximum incentive payment determined 
under subparagraph (B) with respect to a State— 
‘‘(i) one-third shall be transferred to the ac-
count of such State upon a certification under para-
graph (4)(B) that the State law of such State meets 
the requirements of paragraph (2); and 
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AMDT. NO. 98 
‘‘(ii) the remainder shall be transferred to the 
account of such State upon a certification under 
paragraph (4)(B) that the State law of such State 
meets the requirements of paragraph (3). 
‘‘(2) The State law of a State meets the requirements 
of this paragraph if such State law— 
‘‘(A) uses a base period that includes the most 
recently completed calendar quarter before the start 
of the benefit year for purposes of determining eligi-
bility for unemployment compensation; or 
‘‘(B) provides that, in the case of an individual 
who would not otherwise be eligible for unemploy-
ment compensation under the State law because of 
the use of a base period that does not include the 
most recently completed calendar quarter before the 
start of the benefit year, eligibility shall be deter-
mined using a base period that includes such cal-
endar quarter. 
‘‘(3) The State law of a State meets the requirements 
of this paragraph if such State law includes provisions to 
carry out at least 2 of the following subparagraphs: 
‘‘(A) An individual shall not be denied regular 
unemployment compensation under any State law 
provisions relating to availability for work, active 
search for work, or refusal to accept work, solely be-
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AMDT. NO. 98 
cause such individual is seeking only part-time (and 
not full-time) work, except that the State law provi-
sions carrying out this subparagraph may exclude an 
individual if a majority of the weeks of work in such 
individual’s base period do not include part-time 
work. 
‘‘(B) An individual shall not be disqualified 
from regular unemployment compensation for sepa-
rating from employment if that separation is for any 
compelling family reason. For purposes of this sub-
paragraph, the term ‘compelling family reason’ 
means the following: 
‘‘(i) Domestic violence, verified by such 
reasonable and confidential documentation as 
the State law may require, which causes the in-
dividual reasonably to believe that such individ-
ual’s continued employment would jeopardize 
the safety of the individual or of any member 
of the individual’s immediate family (as defined 
by the Secretary of Labor). 
‘‘(ii) The illness or disability of a member 
of the individual’s immediate family (as defined 
by the Secretary of Labor). 
‘‘(iii) The need for the individual to accom-
pany such individual’s spouse— 
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AMDT. NO. 98 
‘‘(I) to a place from which it is im-
practical for such individual to commute; 
and 
‘‘(II) due to a change in location of 
the spouse’s employment. 
‘‘(C) Weekly unemployment compensation is 
payable under this subparagraph to any individual 
who is unemployed (as determined under the State 
unemployment compensation law), has exhausted all 
rights to regular unemployment compensation under 
the State law, and is enrolled and making satisfac-
tory progress in a State-approved training program 
or in a job training program authorized under the 
Workforce Investment Act of 1998. Such programs 
shall prepare individuals who have been separated 
from a declining occupation, or who have been invol-
untarily and indefinitely separated from employment 
as a result of a permanent reduction of operations 
at the individual’s place of employment, for entry 
into a high-demand occupation. The amount of un-
employment compensation payable under this sub-
paragraph to an individual for a week of unemploy-
ment shall be equal to the individual’s average week-
ly benefit amount (including dependents’ allowances) 
for the most recent benefit year, and the total 
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AMDT. NO. 98 
amount of unemployment compensation payable 
under this subparagraph to any individual shall be 
equal to at least 26 times the individual’s average 
weekly benefit amount (including dependents’ allow-
ances) for the most recent benefit year. 
‘‘(D) Dependents’ allowances are provided, in 
the case of any individual who is entitled to receive 
regular unemployment compensation and who has 
any dependents (as defined by State law), in an 
amount equal to at least $15 per dependent per 
week, subject to any aggregate limitation on such al-
lowances which the State law may establish (but 
which aggregate limitation on the total allowance for 
dependents paid to an individual may not be less 
than $50 for each week of unemployment or 50 per-
cent of the individual’s weekly benefit amount for 
the benefit year, whichever is less). 
‘‘(4)(A) Any State seeking an incentive payment 
under this subsection shall submit an application therefor 
at such time, in such manner, and complete with such in-
formation as the Secretary of Labor may within 60 days 
after the date of the enactment of this subsection prescribe 
(whether by regulation or otherwise), including informa-
tion relating to compliance with the requirements of para-
graph (2) or (3), as well as how the State intends to use 
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AMDT. NO. 98 
the incentive payment to improve or strengthen the State’s 
unemployment compensation program. The Secretary of 
Labor shall, within 30 days after receiving a complete ap-
plication, notify the State agency of the State of the Sec-
retary’s findings with respect to the requirements of para-
graph (2) or (3) (or both). 
‘‘(B)(i) If the Secretary of Labor finds that the State 
law provisions (disregarding any State law provisions 
which are not then currently in effect as permanent law 
or which are subject to discontinuation) meet the require-
ments of paragraph (2) or (3), as the case may be, the 
Secretary of Labor shall thereupon make a certification 
to that effect to the Secretary of the Treasury, together 
with a certification as to the amount of the incentive pay-
ment to be transferred to the State account pursuant to 
that finding. The Secretary of the Treasury shall make 
the appropriate transfer within 7 days after receiving such 
certification. 
‘‘(ii) For purposes of clause (i), State law provisions 
which are to take effect within 12 months after the date 
of their certification under this subparagraph shall be con-
sidered to be in effect as of the date of such certification. 
‘‘(C)(i) No certification of compliance with the re-
quirements of paragraph (2) or (3) may be made with re-
spect to any State whose State law is not otherwise eligible 
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586 
AMDT. NO. 98 
for certification under section 303 or approvable under 
section 3304 of the Federal Unemployment Tax Act. 
‘‘(ii) No certification of compliance with the require-
ments of paragraph (3) may be made with respect to any 
State whose State law is not in compliance with the re-
quirements of paragraph (2). 
‘‘(iii) No application under subparagraph (A) may be 
considered if submitted before the date of the enactment 
of this subsection or after the latest date necessary (as 
specified by the Secretary of Labor) to ensure that all in-
centive payments under this subsection are made before 
October 1, 2010. In the case of a State in which the first 
day of the first regularly scheduled session of the State 
legislature beginning after the date of enactment of this 
subsection begins after December 31, 2010, the preceding 
sentence shall be applied by substituting ‘October 1, 2011’ 
for ‘October 1, 2010’ . 
‘‘(5)(A) Except as provided in subparagraph (B), any 
amount transferred to the account of a State under this 
subsection may be used by such State only in the payment 
of cash benefits to individuals with respect to their unem-
ployment (including for dependents’ allowances and for 
unemployment compensation under paragraph (3)(C)), ex-
clusive of expenses of administration. 
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AMDT. NO. 98 
‘‘(B) A State may, subject to the same conditions as 
set forth in subsection (c)(2) (excluding subparagraph (B) 
thereof, and deeming the reference to ‘subsections (a) and 
(b)’ in subparagraph (D) thereof to include this sub-
section), use any amount transferred to the account of 
such State under this subsection for the administration 
of its unemployment compensation law and public employ-
ment offices. 
‘‘(6) Out of any money in the Federal unemployment 
account not otherwise appropriated, the Secretary of the 
Treasury shall reserve $7,000,000,000 for incentive pay-
ments under this subsection. Any amount so reserved shall 
not be taken into account for purposes of any determina-
tion under section 902, 910, or 1203 of the amount in 
the Federal unemployment account as of any given time. 
Any amount so reserved for which the Secretary of the 
Treasury has not received a certification under paragraph 
(4)(B) by the deadline described in paragraph (4)(C)(iii) 
shall, upon the close of fiscal year 2011, become unre-
stricted as to use as part of the Federal unemployment 
account. 
‘‘(7) For purposes of this subsection, the terms ‘ben-
efit year’, ‘base period’, and ‘week’ have the respective 
meanings given such terms under section 205 of the Fed-
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AMDT. NO. 98 
eral-State Extended Unemployment Compensation Act of 
1970 (26 U.S.C. 3304 note). 
‘‘Special Transfer in Fiscal Year 2009 for Administration 
‘‘(g)(1) In addition to any other amounts, the Sec-
retary of the Treasury shall transfer from the employment 
security administration account to the account of each 
State in the Unemployment Trust Fund, within 30 days 
after the date of the enactment of this subsection, the 
amount determined with respect to such State under para-
graph (2). 
‘‘(2) The amount to be transferred under this sub-
section to a State account shall (as determined by the Sec-
retary of Labor and certified by such Secretary to the Sec-
retary of the Treasury) be equal to the amount obtained 
by multiplying $500,000,000 by the same ratio as deter-
mined under subsection (f)(1)(B) with respect to such 
State. 
‘‘(3) Any amount transferred to the account of a 
State as a result of the enactment of this subsection may 
be used by the State agency of such State only in the pay-
ment of expenses incurred by it for— 
‘‘(A) the administration of the provisions of its 
State law carrying out the purposes of subsection 
(f)(2) or any subparagraph of subsection (f)(3); 
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AMDT. NO. 98 
‘‘(B) improved outreach to individuals who 
might be eligible for regular unemployment com-
pensation by virtue of any provisions of the State 
law which are described in subparagraph (A); 
‘‘(C) the improvement of unemployment benefit 
and unemployment tax operations, including re-
sponding to increased demand for unemployment 
compensation; and 
‘‘(D) staff-assisted reemployment services for 
unemployment compensation claimants.’’. 
(b) REGULATIONS.—The Secretary of Labor may 
prescribe any regulations, operating instructions, or other 
guidance necessary to carry out the amendment made by 
subsection (a). 
SEC. 2004. TEMPORARY ASSISTANCE FOR STATES WITH AD-
VANCES. 
Section 1202(b) of the Social Security Act (42 U.S.C. 
1322(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(10)(A) With respect to the period beginning on the 
date of enactment of this paragraph and ending on De-
cember 31, 2010— 
‘‘(i) any interest payment otherwise due from a 
State under this subsection during such period shall 
be deemed to have been made by the State; and 
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AMDT. NO. 98 
‘‘(ii) no interest shall accrue on any advance or 
advances made under section 1201 to a State during 
such period. 
‘‘(B) The provisions of subparagraph (A) shall have 
no effect on the requirement for interest payments under 
this subsection after the period described in such subpara-
graph or on the accrual of interest under this subsection 
after such period.’’. 
Subtitle B—Assistance for 
Vulnerable Individuals 
SEC. 2101. EMERGENCY FUND FOR TANF PROGRAM. 
(a) TEMPORARY FUND.— 
(1) IN GENERAL.—Section 403 of the Social 
Security Act (42 U.S.C. 603) is amended by adding 
at the end the following: 
‘‘(c) EMERGENCY FUND.— 
‘‘(1) ESTABLISHMENT.—There is established in 
the Treasury of the United States a fund which 
shall be known as the ‘Emergency Contingency 
Fund for State Temporary Assistance for Needy 
Families Programs’ (in this subsection referred to as 
the ‘Emergency Fund’). 
‘‘(2) DEPOSITS INTO FUND.— 
‘‘(A) IN GENERAL.—Out of any money in 
the Treasury of the United States not otherwise 
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AMDT. NO. 98 
appropriated, there are appropriated for fiscal 
year 2009, $3,000,000,000 for payment to the 
Emergency Fund. 
‘‘(B) AVAILABILITY AND USE OF FUNDS.— 
The amounts appropriated to the Emergency 
Fund under subparagraph (A) shall remain 
available through fiscal year 2010 and shall be 
used to make grants to States in each of fiscal 
years 2009 and 2010 in accordance with the re-
quirements of paragraph (3). 
‘‘(C) LIMITATION.—In no case may the 
Secretary make a grant from the Emergency 
Fund for a fiscal year after fiscal year 2010. 
‘‘(3) GRANTS.— 
‘‘(A) GRANT RELATED TO CASELOAD IN-
CREASES.— 
‘‘(i) IN GENERAL.—For each calendar 
quarter in fiscal year 2009 or 2010, the 
Secretary shall make a grant from the 
Emergency Fund to each State that— 
‘‘(I) requests a grant under this 
subparagraph for the quarter; and 
‘‘(II) meets the requirement of 
clause (ii) for the quarter. 
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‘‘(ii) CASELOAD INCREASE REQUIRE-
MENT.—A State meets the requirement of 
this clause for a quarter if the average 
monthly assistance caseload of the State 
for the quarter exceeds the average month-
ly assistance caseload of the State for the 
corresponding quarter in the emergency 
fund base year of the State. 
‘‘(iii) AMOUNT OF GRANT.—Subject to 
paragraph (5), the amount of the grant to 
be made to a State under this subpara-
graph for a quarter shall be 80 percent of 
the amount (if any) by which the total ex-
penditures of the State for basic assistance 
(as defined by the Secretary) in the quar-
ter, whether under the State program 
funded under this part or as qualified 
State expenditures, exceeds the total ex-
penditures of the State for such assistance 
for the corresponding quarter in the emer-
gency fund base year of the State. 
‘‘(B) GRANT RELATED TO INCREASED EX-
PENDITURES
FOR
NON-RECURRENT
SHORT 
TERM BENEFITS.— 
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AMDT. NO. 98 
‘‘(i) IN GENERAL.—For each calendar 
quarter in fiscal year 2009 or 2010, the 
Secretary shall make a grant from the 
Emergency Fund to each State that— 
‘‘(I) requests a grant under this 
subparagraph for the quarter; and 
‘‘(II) meets the requirement of 
clause (ii) for the quarter. 
‘‘(ii) NON-RECURRENT
SHORT
TERM 
EXPENDITURE
REQUIREMENT.—A State 
meets the requirement of this clause for a 
quarter if the total expenditures of the 
State for non-recurrent short term benefits 
in the quarter, whether under the State 
program funded under this part or as 
qualified State expenditures, exceeds the 
total such expenditures of the State for 
non-recurrent short term benefits in the 
corresponding quarter in the emergency 
fund base year of the State. 
‘‘(iii) AMOUNT OF GRANT.—Subject to 
paragraph (5), the amount of the grant to 
be made to a State under this subpara-
graph for a quarter shall be an amount 
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AMDT. NO. 98 
equal to 80 percent of the excess described 
in clause (ii). 
‘‘(C) GRANT RELATED TO INCREASED EX-
PENDITURES FOR SUBSIDIZED EMPLOYMENT.— 
‘‘(i) IN GENERAL.—For each calendar 
quarter in fiscal year 2009 or 2010, the 
Secretary shall make a grant from the 
Emergency Fund to each State that— 
‘‘(I) requests a grant under this 
subparagraph for the quarter; and 
‘‘(II) meets the requirement of 
clause (ii) for the quarter. 
‘‘(ii) SUBSIDIZED
EMPLOYMENT
EX-
PENDITURE
REQUIREMENT.—A 
State 
meets the requirement of this clause for a 
quarter if the total expenditures of the 
State for subsidized employment in the 
quarter, whether under the State program 
funded under this part or as qualified 
State expenditures, exceeds the total of 
such expenditures of the State in the cor-
responding quarter in the emergency fund 
base year of the State. 
‘‘(iii) AMOUNT OF GRANT.—Subject to 
paragraph (5), the amount of the grant to 
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AMDT. NO. 98 
be made to a State under this subpara-
graph for a quarter shall be an amount 
equal to 80 percent of the excess described 
in clause (ii). 
‘‘(4) AUTHORITY TO MAKE NECESSARY ADJUST-
MENTS TO DATA AND COLLECT NEEDED DATA.—In 
determining the size of the caseload of a State and 
the expenditures of a State for basic assistance, non- 
recurrent short-term benefits, and subsidized em-
ployment, during any period for which the State re-
quests funds under this subsection, and during the 
emergency fund base year of the State, the Sec-
retary may make appropriate adjustments to the 
data to ensure that the data reflect expenditures 
under the State program funded under this part and 
qualified State expenditures. The Secretary may de-
velop a mechanism for collecting expenditure data, 
including procedures which allow States to make 
reasonable estimates, and may set deadlines for 
making revisions to the data. 
‘‘(5) LIMITATION.—The total amount payable 
to a single State under subsection (b) and this sub-
section for a fiscal year shall not exceed 25 percent 
of the State family assistance grant. 
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AMDT. NO. 98 
‘‘(6) LIMITATIONS ON USE OF FUNDS.—A State 
to which an amount is paid under this subsection 
may use the amount only as authorized by section 
404. 
‘‘(7) TIMING OF IMPLEMENTATION.—The Sec-
retary shall implement this subsection as quickly as 
reasonably possible, pursuant to appropriate guid-
ance to States. 
‘‘(8) DEFINITIONS.—In this subsection: 
‘‘(A) 
AVERAGE
MONTHLY
ASSISTANCE 
CASELOAD
DEFINED.—The 
term 
‘average 
monthly assistance caseload’ means, with re-
spect to a State and a quarter, the number of 
families receiving assistance during the quarter 
under the State program funded under this 
part or as qualified State expenditures, subject 
to adjustment under paragraph (4). 
‘‘(B) EMERGENCY FUND BASE YEAR.— 
‘‘(i) IN GENERAL.—The term ‘emer-
gency fund base year’ means, with respect 
to a State and a category described in 
clause (ii), whichever of fiscal year 2007 or 
2008 is the fiscal year in which the 
amount described by the category with re-
spect to the State is the lesser. 
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AMDT. NO. 98 
‘‘(ii) CATEGORIES
DESCRIBED.—The 
categories described in this clause are the 
following: 
‘‘(I) The average monthly assist-
ance caseload of the State. 
‘‘(II) The total expenditures of 
the State for non-recurrent short term 
benefits, whether under the State pro-
gram funded under this part or as 
qualified State expenditures. 
‘‘(III) The total expenditures of 
the State for subsidized employment, 
whether under the State program 
funded under this part or as qualified 
State expenditures. 
‘‘(C) QUALIFIED STATE EXPENDITURES.— 
The term ‘qualified State expenditures’ has the 
meaning given the term in section 409(a)(7).’’. 
(2) REPEAL.—Effective October 1, 2010, sub-
section (c) of section 403 of the Social Security Act 
(42 U.S.C. 603) (as added by paragraph (1)) is re-
pealed. 
(b) TEMPORARY MODIFICATION OF CASELOAD RE-
DUCTION CREDIT.—Section 407(b)(3)(A)(i) of such Act 
(42 U.S.C. 607(b)(3)(A)(i)) is amended by inserting ‘‘(or 
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AMDT. NO. 98 
if the immediately preceding fiscal year is fiscal year 2008, 
2009, or 2010, then, at State option, during the emer-
gency fund base year of the State with respect to the aver-
age monthly assistance caseload of the State (within the 
meaning of section 403(c)(8)(B), except that, if a State 
elects such option for fiscal year 2008, the emergency fund 
base year of the State with respect to such caseload shall 
be fiscal year 2007))’’ before ‘‘under the State’’. 
(c) DISREGARD FROM LIMITATION ON TOTAL PAY-
MENTS TO TERRITORIES.—Section 1108(a)(2) of the So-
cial Security Act (42 U.S.C. 1308(a)(2)) is amended by 
inserting ‘‘403(c)(3),’’ after ‘‘403(a)(5),’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. 
SEC. 2102. EXTENSION OF TANF SUPPLEMENTAL GRANTS. 
(a) EXTENSION THROUGH FISCAL YEAR 2010.—Sec-
tion 7101(a) of the Deficit Reduction Act of 2005 (Public 
Law 109–171; 120 Stat. 135), as amended by section 
301(a) of the Medicare Improvements for Patients and 
Providers Act of 2008 (Public Law 110–275), is amended 
by striking ‘‘fiscal year 2009’’ and inserting ‘‘fiscal year 
2010’’. 
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AMDT. NO. 98 
(b) 
CONFORMING
AMENDMENT.—Section 
403(a)(3)(H)(ii) of the Social Security Act (42 U.S.C. 
603(a)(3)(H)(ii)) is amended to read as follows: 
‘‘(ii) subparagraph (G) shall be ap-
plied as if ‘fiscal year 2010’ were sub-
stituted for ‘fiscal year 2001’; and’’. 
SEC. 2103. CLARIFICATION OF AUTHORITY OF STATES TO 
USE TANF FUNDS CARRIED OVER FROM 
PRIOR YEARS TO PROVIDE TANF BENEFITS 
AND SERVICES. 
Section 404(e) of the Social Security Act (42 U.S.C. 
604(e)) is amended to read as follows: 
‘‘(e) 
AUTHORITY
TO
CARRY
OVER
CERTAIN 
AMOUNTS FOR BENEFITS OR SERVICES OR FOR FUTURE 
CONTINGENCIES.—A State or tribe may use a grant made 
to the State or tribe under this part for any fiscal year 
to provide, without fiscal year limitation, any benefit or 
service that may be provided under the State or tribal pro-
gram funded under this part.’’. 
SEC. 2104. TEMPORARY REINSTATEMENT OF AUTHORITY 
TO PROVIDE FEDERAL MATCHING PAYMENTS 
FOR STATE SPENDING OF CHILD SUPPORT 
INCENTIVE PAYMENTS. 
During the period that begins on October 1, 2008, 
and ends on December 31, 2010, section 455(a)(1) of the 
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AMDT. NO. 98 
Social Security Act (42 U.S.C. 655(a)(1)) shall be applied 
without regard to the amendment made by section 
7309(a) of the Deficit Reduction Act of 2005 (Public Law 
109–171, 120 Stat. 147). 
TITLE III—HEALTH INSURANCE 
ASSISTANCE 
SEC. 3000. TABLE OF CONTENTS OF TITLE. 
The table of contents for this title is as follows: 
TITLE III—HEALTH INSURANCE ASSISTANCE 
Sec. 3000. Table of contents of title. 
Subtitle A—Premium Subsidies for COBRA Continuation Coverage for 
Unemployed Workers 
Sec. 3001. Premium assistance for COBRA benefits. 
Subtitle B—Transitional Medical Assistance (TMA) 
Sec. 3101. Extension of transitional medical assistance (TMA). 
Subtitle C—Extension of the Qualified Individual (QI) Program 
Sec. 3201. Extension of the qualifying individual (QI) program. 
Subtitle D—Other Provisions 
Sec. 3301. Premiums and cost sharing protections under Medicaid, eligibility 
determinations under Medicaid and CHIP, and protection of 
certain Indian property from Medicaid estate recovery. 
Sec. 3302. Rules applicable under Medicaid and CHIP to managed care entities 
with respect to Indian enrollees and Indian health care pro-
viders and Indian managed care entities. 
Sec. 3303. Consultation on Medicaid, CHIP, and other health care programs 
funded under the Social Security Act involving Indian Health 
Programs and Urban Indian Organizations. 
Sec. 3304. Application of prompt pay requirements to nursing facilities. 
Sec. 3305. Period of application; sunset. 
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AMDT. NO. 98 
Subtitle A—Premium Subsidies for 
COBRA Continuation Coverage 
for Unemployed Workers 
SEC. 3001. PREMIUM ASSISTANCE FOR COBRA BENEFITS. 
(a) TABLE OF CONTENTS OF SUBTITLE.—The table 
of contents of this subtitle is as follows: 
Sec. 3001. Premium assistance for COBRA benefits. 
(b) PREMIUM ASSISTANCE FOR COBRA CONTINU-
ATION COVERAGE
FOR UNEMPLOYED WORKERS
AND 
THEIR FAMILIES.— 
(1) PROVISION OF PREMIUM ASSISTANCE.— 
(A) 
REDUCTION
OF
PREMIUMS
PAY-
ABLE.—In the case of any premium for a 
month of coverage beginning after the date of 
the enactment of the Act for COBRA continu-
ation coverage with respect to any assistance el-
igible individual, such individual shall be treated 
for purposes of any COBRA continuation provi-
sion as having paid the amount of such pre-
mium if such individual pays 35 percent of the 
amount of such premium (as determined with-
out regard to this subsection). 
(B) PLAN ENROLLMENT OPTION.— 
(i) IN
GENERAL.—Notwithstanding 
the COBRA continuation provisions, an as-
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602 
AMDT. NO. 98 
sistance eligible individual may, not later 
than 90 days after the date of notice of the 
plan enrollment option described in this 
subparagraph, elect to enroll in coverage 
under a plan offered by the employer in-
volved, or the employee organization in-
volved (including, for this purpose, a joint 
board of trustees of a multiemployer trust 
affiliated with one or more multiemployer 
plans), that is different than coverage 
under the plan in which such individual 
was enrolled at the time the qualifying 
event occurred, and such coverage shall be 
treated as COBRA continuation coverage 
for purposes of the applicable COBRA con-
tinuation coverage provision. 
(ii) REQUIREMENTS.—An assistance 
eligible individual may elect to enroll in 
different coverage as described in clause (i) 
only if— 
(I) the employer involved has 
made a determination that such em-
ployer will permit assistance eligible 
individuals to enroll in different cov-
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AMDT. NO. 98 
erage as provided for this subpara-
graph; 
(II) the premium for such dif-
ferent coverage does not exceed the 
premium for coverage in which the in-
dividual was enrolled at the time the 
qualifying event occurred; 
(III) the different coverage in 
which the individual elects to enroll is 
coverage that is also offered to the ac-
tive employees of the employer at the 
time at which such election is made; 
and 
(IV) the different coverage is 
not— 
(aa) coverage that provides 
only dental, vision, counseling, or 
referral services (or a combina-
tion of such services); 
(bb) a health flexible spend-
ing account or health reimburse-
ment arrangement; or 
(cc) coverage that provides 
coverage for services or treat-
ments furnished in an on-site 
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AMDT. NO. 98 
medical facility maintained by 
the employer and that consists 
primarily of first-aid services, 
prevention and wellness care, or 
similar care (or a combination of 
such care). 
(C) PREMIUM REIMBURSEMENT.—For pro-
visions providing the balance of such premium, 
see section 6432 of the Internal Revenue Code 
of 1986, as added by paragraph (12). 
(2) LIMITATION OF PERIOD OF PREMIUM AS-
SISTANCE.— 
(A) IN GENERAL.—Paragraph (1)(A) shall 
not apply with respect to any assistance eligible 
individual for months of coverage beginning on 
or after the earlier of— 
(i) the first date that such individual 
is eligible for coverage under any other 
group health plan (other than coverage 
consisting of only dental, vision, coun-
seling, or referral services (or a combina-
tion thereof), coverage under a health re-
imbursement arrangement or a health 
flexible spending arrangement, or coverage 
of treatment that is furnished in an on-site 
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AMDT. NO. 98 
medical facility maintained by the em-
ployer and that consists primarily of first- 
aid services, prevention and wellness care, 
or similar care (or a combination thereof)) 
or is eligible for benefits under title XVIII 
of the Social Security Act; or 
(ii) the earliest of— 
(I) the date which is 9 months 
after the first day of first month that 
paragraph (1)(A) applies with respect 
to such individual, 
(II) the date following the expira-
tion of the maximum period of con-
tinuation coverage required under the 
applicable COBRA continuation cov-
erage provision, or 
(III) the date following the expi-
ration of the period of continuation 
coverage allowed under paragraph 
(4)(B)(ii). 
(B) TIMING
OF
ELIGIBILITY
FOR
ADDI-
TIONAL COVERAGE.—For purposes of subpara-
graph (A)(i), an individual shall not be treated 
as eligible for coverage under a group health 
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AMDT. NO. 98 
plan before the first date on which such indi-
vidual could be covered under such plan. 
(C) 
NOTIFICATION
REQUIREMENT.—An 
assistance eligible individual shall notify in writ-
ing the group health plan with respect to which 
paragraph (1)(A) applies if such paragraph 
ceases to apply by reason of subparagraph 
(A)(i). Such notice shall be provided to the 
group health plan in such time and manner as 
may be specified by the Secretary of Labor. 
(3) ASSISTANCE
ELIGIBLE
INDIVIDUAL.—For 
purposes of this section, the term ‘‘assistance eligible 
individual’’ means any qualified beneficiary if— 
(A) at any time during the period that be-
gins with September 1, 2008, and ends with 
December 31, 2009, such qualified beneficiary 
is eligible for COBRA continuation coverage, 
(B) such qualified beneficiary elects such 
coverage, and 
(C) the qualifying event with respect to the 
COBRA continuation coverage consists of the 
involuntary termination of the covered employ-
ee’s employment and occurred during such pe-
riod. 
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AMDT. NO. 98 
(4) EXTENSION OF ELECTION PERIOD AND EF-
FECT ON COVERAGE.— 
(A) IN
GENERAL.—Notwithstanding sec-
tion 605(a) of the Employee Retirement Income 
Security Act of 1974, section 4980B(f)(5)(A) of 
the Internal Revenue Code of 1986, section 
2205(a) of the Public Health Service Act, and 
section 8905a(c)(2) of title 5, United States 
Code, in the case of an individual who is a 
qualified beneficiary described in paragraph 
(3)(A) as of the date of the enactment of this 
Act and has not made the election referred to 
in paragraph (3)(B) as of such date, such indi-
vidual may elect the COBRA continuation cov-
erage under the COBRA continuation coverage 
provisions containing such sections during the 
60-day period commencing with the date on 
which the notification required under paragraph 
(7)(C) is provided to such individual. 
(B) COMMENCEMENT
OF
COVERAGE; NO 
REACH-BACK.—Any COBRA continuation cov-
erage elected by a qualified beneficiary during 
an extended election period under subparagraph 
(A)— 
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AMDT. NO. 98 
(i) shall commence on the date of the 
enactment of this Act, and 
(ii) shall not extend beyond the period 
of COBRA continuation coverage that 
would have been required under the appli-
cable COBRA continuation coverage provi-
sion if the coverage had been elected as re-
quired under such provision. 
(C) PREEXISTING CONDITIONS.—With re-
spect to a qualified beneficiary who elects 
COBRA continuation coverage pursuant to sub-
paragraph (A), the period— 
(i) beginning on the date of the quali-
fying event, and 
(ii) ending with the day before the 
date of the enactment of this Act, 
shall be disregarded for purposes of deter-
mining the 63-day periods referred to in section 
701)(2) of the Employee Retirement Income 
Security Act of 1974, section 9801(c)(2) of the 
Internal Revenue Code of 1986, and section 
2701(c)(2) of the Public Health Service Act. 
(5) EXPEDITED REVIEW OF DENIALS OF PRE-
MIUM ASSISTANCE.—In any case in which an indi-
vidual requests treatment as an assistance eligible 
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AMDT. NO. 98 
individual and is denied such treatment by the group 
health plan by reason of such individual’s ineligi-
bility for COBRA continuation coverage, the Sec-
retary of Labor (or the Secretary of Health and 
Human services in connection with COBRA continu-
ation coverage which is provided other than pursu-
ant to part 6 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974), in con-
sultation with the Secretary of the Treasury, shall 
provide for expedited review of such denial. An indi-
vidual shall be entitled to such review upon applica-
tion to such Secretary in such form and manner as 
shall be provided by such Secretary. Such Secretary 
shall make a determination regarding such individ-
ual’s eligibility within 10 business days after receipt 
of such individual’s application for review under this 
paragraph. 
(6) DISREGARD OF SUBSIDIES FOR PURPOSES 
OF
FEDERAL
AND
STATE
PROGRAMS.—Notwith-
standing any other provision of law, any premium 
reduction with respect to an assistance eligible indi-
vidual under this subsection shall not be considered 
income or resources in determining eligibility for, or 
the amount of assistance or benefits provided under, 
any other public benefit provided under Federal law 
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AMDT. NO. 98 
or the law of any State or political subdivision there-
of. 
(7) NOTICES TO INDIVIDUALS.— 
(A) GENERAL NOTICE.— 
(i) IN GENERAL.—In the case of no-
tices provided under section 606(4) of the 
Employee Retirement Income Security Act 
of 1974 (29 U.S.C. 1166(4)), section 
4980B(f)(6)(D) of the Internal Revenue 
Code of 1986, section 2206(4) of the Pub-
lic Health Service Act (42 U.S.C. 300bb- 
6(4)), or section 8905a(f)(2)(A) of title 5, 
United States Code, with respect to indi-
viduals who, during the period described in 
paragraph (3)(A), become entitled to elect 
COBRA continuation coverage, such no-
tices shall include an additional notifica-
tion to the recipient of— 
(I) the availability of premium 
reduction with respect to such cov-
erage under this subsection; and 
(II) the option to enroll in dif-
ferent coverage if an employer that 
permits assistance eligible individuals 
to elect enrollment in different cov-
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AMDT. NO. 98 
erage (as described in paragraph 
(1)(B)). 
(ii) ALTERNATIVE
NOTICE.—In the 
case of COBRA continuation coverage to 
which the notice provision under such sec-
tions does not apply, the Secretary of 
Labor, in consultation with the Secretary 
of the Treasury and the Secretary of 
Health and Human Services, shall, in co-
ordination with administrators of the 
group health plans (or other entities) that 
provide or administer the COBRA continu-
ation coverage involved, provide rules re-
quiring the provision of such notice. 
(iii) FORM.—The requirement of the 
additional notification under this subpara-
graph may be met by amendment of exist-
ing notice forms or by inclusion of a sepa-
rate document with the notice otherwise 
required. 
(B) SPECIFIC REQUIREMENTS.—Each ad-
ditional notification under subparagraph (A) 
shall include— 
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AMDT. NO. 98 
(i) the forms necessary for estab-
lishing eligibility for premium reduction 
under this subsection, 
(ii) the name, address, and telephone 
number necessary to contact the plan ad-
ministrator and any other person main-
taining relevant information in connection 
with such premium reduction, 
(iii) a description of the extended elec-
tion period provided for in paragraph 
(4)(A), 
(iv) a description of the obligation of 
the qualified beneficiary under paragraph 
(2)(C) to notify the plan providing continu-
ation coverage of eligibility for subsequent 
coverage under another group health plan 
or eligibility for benefits under title XVIII 
of the Social Security Act and the penalty 
provided for failure to so notify the plan, 
(v) a description, displayed in a 
prominent manner, of the qualified bene-
ficiary’s right to a reduced premium and 
any conditions on entitlement to the re-
duced premium; and 
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AMDT. NO. 98 
(vi) a description of the option of the 
qualified beneficiary to enroll in different 
coverage if the employer permits such ben-
eficiary to elect to enroll in such different 
coverage under paragraph (1)(B). 
(C) NOTICE
RELATING
TO
RETROACTIVE 
COVERAGE.—In the case of an individual de-
scribed in paragraph (3)(A) who has elected 
COBRA continuation coverage as of the date of 
enactment of this Act or an individual described 
in paragraph (4)(A), the administrator of the 
group health plan (or other person) involved 
shall provide (within 60 days after the date of 
enactment of this Act) for the additional notifi-
cation required to be provided under subpara-
graph (A). 
(D) MODEL NOTICES.—Not later than 30 
days after the date of enactment of this Act, 
the Secretary of the Labor, in consultation with 
the Secretary of the Treasury and the Secretary 
of Health and Human Services, shall prescribe 
models for the additional notification required 
under this paragraph. 
(8) SAFEGUARDS.—The Secretary of the Treas-
ury shall provide such rules, procedures, regulations, 
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AMDT. NO. 98 
and other guidance as may be necessary and appro-
priate to prevent fraud and abuse under this sub-
section. 
(9) OUTREACH.—The Secretary of Labor, in 
consultation with the Secretary of the Treasury and 
the Secretary of Health and Human Services, shall 
provide outreach consisting of public education and 
enrollment assistance relating to premium reduction 
provided under this subsection. Such outreach shall 
target employers, group health plan administrators, 
public assistance programs, States, insurers, and 
other entities as determined appropriate by such 
Secretaries. Such outreach shall include an initial 
focus on those individuals electing continuation cov-
erage who are referred to in paragraph (7)(C). In-
formation on such premium reduction, including en-
rollment, shall also be made available on website of 
the Departments of Labor, Treasury, and Health 
and Human Services. 
(10) DEFINITIONS.—For purposes of this sub-
section— 
(A) ADMINISTRATOR.—The term ‘‘admin-
istrator’’ has the meaning given such term in 
section 3(16) of the Employee Retirement In-
come Security Act of 1974 
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AMDT. NO. 98 
(B) COBRA CONTINUATION COVERAGE.— 
The term ‘‘COBRA continuation coverage’’ 
means continuation coverage provided pursuant 
to part 6 of subtitle B of title I of the Em-
ployee Retirement Income Security Act of 1974 
(other than under section 609), title XXII of 
the Public Health Service Act, section 4980B of 
the Internal Revenue Code of 1986 (other than 
subsection (f)(1) of such section insofar as it 
relates to pediatric vaccines), or section 8905a 
of title 5, United States Code, or under a State 
program that provides continuation coverage 
comparable to such continuation coverage. Such 
term does not include coverage under a health 
flexible spending arrangement. 
(C) COBRA CONTINUATION PROVISION.— 
The term ‘‘COBRA continuation provision’’ 
means the provisions of law described in sub-
paragraph (B). 
(D) 
COVERED
EMPLOYEE.—The 
term 
‘‘covered employee’’ has the meaning given such 
term in section 607(2) of the Employee Retire-
ment Income Security Act of 1974. 
(E) QUALIFIED BENEFICIARY.—The term 
‘‘qualified beneficiary’’ has the meaning given 
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AMDT. NO. 98 
such term in section 607(3) of the Employee 
Retirement Income Security Act of 1974. 
(F) GROUP
HEALTH
PLAN.—The term 
‘‘group health plan’’ has the meaning given 
such term in section 607(1) of the Employee 
Retirement Income Security Act of 1974. 
(G) STATE.—The term ‘‘State’’ includes 
the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, Amer-
ican Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
(11) REPORTS.— 
(A) INTERIM REPORT.—The Secretary of 
the Treasury shall submit an interim report to 
the Committee on Education and Labor, the 
Committee on Ways and Means, and the Com-
mittee on Energy and Commerce of the House 
of Representatives and the Committee on 
Health, Education, Labor, and Pensions and 
the Committee on Finance of the Senate re-
garding the premium reduction provided under 
this subsection that includes— 
(i) the number of individuals provided 
such assistance as of the date of the re-
port; and 
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AMDT. NO. 98 
(ii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with such 
assistance as of the date of the report. 
(B) FINAL
REPORT.—As soon as prac-
ticable after the last period of COBRA continu-
ation coverage for which premium reduction is 
provided under this section, the Secretary of the 
Treasury shall submit a final report to each 
Committee referred to in subparagraph (A) that 
includes— 
(i) the number of individuals provided 
premium reduction under this section; 
(ii) 
the 
average 
dollar 
amount 
(monthly and annually) of premium reduc-
tions provided to such individuals; and 
(iii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with pre-
mium reduction under this section. 
(12) COBRA PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 65 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following 
new section: 
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AMDT. NO. 98 
‘‘SEC. 6432. COBRA PREMIUM ASSISTANCE. 
‘‘(a) IN GENERAL.—The person to whom premiums 
are payable under COBRA continuation coverage shall be 
reimbursed for the amount of premiums not paid by plan 
beneficiaries by reason of section 3001(b) of the American 
Recovery and Reinvestment Act of 2009. Such amount 
shall be treated as a credit against the requirement of such 
person to make deposits of payroll taxes and the liability 
of such person for payroll taxes. To the extent that such 
amount exceeds the amount of such taxes, the Secretary 
shall pay to such person the amount of such excess. No 
payment may be made under this subsection to a person 
with respect to any assistance eligible individual until after 
such person has received the reduced premium from such 
individual required under section 3001(a)(1)(A) of such 
Act. 
‘‘(b) PAYROLL TAXES.—For purposes of this section, 
the term ‘payroll taxes’ means— 
‘‘(1) amounts required to be deducted and with-
held for the payroll period under section 3401 (relat-
ing to wage withholding), 
‘‘(2) amounts required to be deducted for the 
payroll period under section 3102 (relating to FICA 
employee taxes), and 
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AMDT. NO. 98 
‘‘(3) amounts of the taxes imposed for the pay-
roll period under section 3111 (relating to FICA em-
ployer taxes). 
‘‘(c) TREATMENT OF CREDIT.—Except as otherwise 
provided by the Secretary, the credit described in sub-
section (a) shall be applied as though the employer had 
paid to the Secretary, on the day that the qualified bene-
ficiary’s premium payment is received, an amount equal 
to such credit. 
‘‘(d) TREATMENT OF PAYMENT.—For purposes of 
section 1324(b)(2) of title 31, United States Code, any 
payment under this subsection shall be treated in the same 
manner as a refund of the credit under section 35. 
‘‘(e) REPORTING.— 
‘‘(1) IN GENERAL.—Each person entitled to re-
imbursement under subsection (a) for any period 
shall submit such reports as the Secretary may re-
quire, including— 
‘‘(A) an attestation of involuntary termi-
nation of employment for each covered em-
ployee on the basis of whose termination entitle-
ment to reimbursement is claimed under sub-
section (a), and 
‘‘(B) a report of the amount of payroll 
taxes offset under subsection (a) for the report-
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AMDT. NO. 98 
ing period and the estimated offsets of such 
taxes for the subsequent reporting period in 
connection with reimbursements under sub-
section (a). 
‘‘(2) TIMING
OF
REPORTS
RELATING
TO 
AMOUNT
OF
PAYROLL
TAXES.—Reports required 
under paragraph (1)(B) shall be submitted at the 
same time as deposits of taxes imposed by chapters 
21, 22, and 24 or at such time as is specified by the 
Secretary. 
‘‘(f) REGULATIONS.—The Secretary may issue such 
regulations or other guidance as may be necessary or ap-
propriate to carry out this section, including the require-
ment to report information or the establishment of other 
methods for verifying the correct amounts of payments 
and credits under this section, and the application of this 
section to group health plans which are multiemployer 
plans.’’. 
(B) SOCIAL SECURITY TRUST FUNDS HELD 
HARMLESS.—In determining any amount trans-
ferred or appropriated to any fund under the 
Social Security Act, section 6432 of the Inter-
nal Revenue Code of 1986 shall not be taken 
into account. 
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AMDT. NO. 98 
(C) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 65 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new item: 
‘‘Sec. 6432. COBRA premium assistance.’’. 
(D) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to pre-
miums to which subsection (a)(1)(A) applies. 
(E) SPECIAL RULE.— 
(i) IN GENERAL.—In the case of an 
assistance eligible individual who pays the 
full premium amount required for COBRA 
continuation coverage for any month dur-
ing the 60-day period beginning on the 
first day of the first month after the date 
of enactment of this Act, the person to 
whom such payment is made shall— 
(I) make a reimbursement pay-
ment to such individual for the 
amount of such premium paid in ex-
cess of the amount required to be paid 
under subsection (b)(1)(A); or 
(II) provide credit to the indi-
vidual for such amount in a manner 
that reduces one or more subsequent 
premium payments that the individual 
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AMDT. NO. 98 
is required to pay under such sub-
section for the coverage involved. 
(ii) 
REIMBURSING
EMPLOYER.—A 
person to which clause (i) applies shall be 
reimbursed as provided for in section 6432 
of the Internal Revenue Code of 1986 for 
any payment made, or credit provided, to 
the employee under such clause. 
(iii) PAYMENT OR CREDITS.—Unless 
it is reasonable to believe that the credit 
for the excess payment in clause (i)(II) will 
be used by the assistance eligible individual 
within 180 days of the date on which the 
person receives from the individual the 
payment of the full premium amount, a 
person to which clause (i) applies shall 
make the payment required under such 
clause to the individual within 60 days of 
such payment of the full premium amount. 
If, as of any day within the 180-day pe-
riod, it is no longer reasonable to believe 
that the credit will be used during that pe-
riod, payment equal to the remainder of 
the credit outstanding shall be made to the 
individual within 60 days of such day. 
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AMDT. NO. 98 
(13) PENALTY
FOR
FAILURE
TO
NOTIFY 
HEALTH PLAN OF CESSATION OF ELIGIBILITY FOR 
PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—Part I of subchapter B 
of chapter 68 of the Internal Revenue Code of 
1986 is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 6720C. PENALTY FOR FAILURE TO NOTIFY HEALTH 
PLAN OF CESSATION OF ELIGIBILITY FOR 
COBRA PREMIUM ASSISTANCE. 
‘‘(a) IN GENERAL.—Any person required to notify a 
group health plan under section 3001(a)(2)(C) of the 
American Recovery and Reinvestment Act of 2009 who 
fails to make such a notification at such time and in such 
manner as the Secretary of Labor may require shall pay 
a penalty of 110 percent of the premium reduction pro-
vided under such section after termination of eligibility 
under such subsection. 
‘‘(b) REASONABLE CAUSE EXCEPTION.—No penalty 
shall be imposed under subsection (a) with respect to any 
failure if it is shown that such failure is due to reasonable 
cause and not to willful neglect.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections of part I of subchapter B of chapter 68 
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AMDT. NO. 98 
of such Code is amended by adding at the end 
the following new item: 
‘‘Sec. 6720C. Penalty for failure to notify health plan of cessation of eligibility 
for COBRA premium assistance.’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to failures 
occurring after the date of the enactment of 
this Act. 
(14) COORDINATION WITH HCTC.— 
(A) IN GENERAL.—Subsection (g) of sec-
tion 35 of the Internal Revenue Code of 1986 
is amended by redesignating paragraph (9) as 
paragraph (10) and inserting after paragraph 
(8) the following new paragraph: 
‘‘(9) COBRA PREMIUM
ASSISTANCE.—In the 
case of an assistance eligible individual who receives 
premium reduction for COBRA continuation cov-
erage under section 3001(a) of the American Recov-
ery and Reinvestment Act of 2009 for any month 
during the taxable year, such individual shall not be 
treated as an eligible individual, a certified indi-
vidual, or a qualifying family member for purposes 
of this section or section 7527 with respect to such 
month.’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply to tax-
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AMDT. NO. 98 
able years ending after the date of the enact-
ment of this Act. 
(15) EXCLUSION OF COBRA PREMIUM ASSIST-
ANCE FROM GROSS INCOME.— 
(A) IN GENERAL.—Part III of subchapter 
B of chapter 1 of the Internal Revenue Code of 
1986 is amended by inserting after section 
139B the following new section: 
‘‘SEC. 139C. COBRA PREMIUM ASSISTANCE. 
‘‘In the case of an assistance eligible individual (as 
defined in section 3001 of the American Recovery and Re-
investment Act of 2009), gross income does not include 
any premium reduction provided under subsection (a) of 
such section.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for part III of subchapter B of chapter 
1 of such Code is amended by inserting after 
the item relating to section 139B the following 
new item: 
‘‘Sec. 139C. COBRA premium assistance.’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to taxable 
years ending after the date of the enactment of 
this Act. 
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AMDT. NO. 98 
Subtitle B—Transitional Medical 
Assistance (TMA) 
SEC. 3101. EXTENSION OF TRANSITIONAL MEDICAL ASSIST-
ANCE (TMA). 
(a) 18-MONTH EXTENSION.— 
(1) IN GENERAL.—Sections 1902(e)(1)(B) and 
1925(f) of the Social Security Act (42 U.S.C. 
1396a(e)(1)(B), 1396r–6(f)) are each amended by 
striking ‘‘September 30, 2003’’ and inserting ‘‘De-
cember 31, 2010’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on July 1, 2009. 
(b) STATE OPTION OF INITIAL 12-MONTH ELIGI-
BILITY.—Section 1925 of the Social Security Act (42 
U.S.C. 1396r–6) is amended— 
(1) in subsection (a)(1), by inserting ‘‘but sub-
ject to paragraph (5)’’ after ‘‘Notwithstanding any 
other provision of this title’’; 
(2) by adding at the end of subsection (a) the 
following: 
‘‘(5) OPTION OF 12-MONTH INITIAL ELIGIBILITY 
PERIOD.—A State may elect to treat any reference 
in this subsection to a 6-month period (or 6 months) 
as a reference to a 12-month period (or 12 months). 
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AMDT. NO. 98 
In the case of such an election, subsection (b) shall 
not apply.’’; and 
(3) in subsection (b)(1), by inserting ‘‘but sub-
ject to subsection (a)(5)’’ after ‘‘Notwithstanding 
any other provision of this title’’. 
(c) REMOVAL OF REQUIREMENT FOR PREVIOUS RE-
CEIPT OF MEDICAL ASSISTANCE.—Section 1925(a)(1) of 
such Act (42 U.S.C. 1396r–6(a)(1)), as amended by sub-
section (b)(1), is further amended— 
(1) by inserting ‘‘subparagraph (B) and’’ before 
‘‘paragraph (5)’’; 
(2) by redesignating the matter after ‘‘RE-
QUIREMENT.—’’ as a subparagraph (A) with the 
heading ‘‘IN GENERAL.—’’ and with the same inden-
tation as subparagraph (B) (as added by paragraph 
(3)); and 
(3) by adding at the end the following: 
‘‘(B) STATE OPTION TO WAIVE REQUIRE-
MENT
FOR
MONTHS
BEFORE
RECEIPT
OF 
MEDICAL ASSISTANCE.—A State may, at its op-
tion, elect also to apply subparagraph (A) in 
the case of a family that was receiving such aid 
for fewer than three months or that had applied 
for and was eligible for such aid for fewer than 
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AMDT. NO. 98 
3 months during the 6 immediately preceding 
months described in such subparagraph.’’. 
(d) CMS REPORT ON ENROLLMENT AND PARTICIPA-
TION RATES UNDER TMA.—Section 1925 of such Act (42 
U.S.C. 1396r–6), as amended by this section, is further 
amended by adding at the end the following new sub-
section: 
‘‘(g) COLLECTION AND REPORTING OF PARTICIPA-
TION INFORMATION.— 
‘‘(1) COLLECTION
OF
INFORMATION
FROM 
STATES.—Each State shall collect and submit to the 
Secretary (and make publicly available), in a format 
specified by the Secretary, information on average 
monthly enrollment and average monthly participa-
tion rates for adults and children under this section 
and of the number and percentage of children who 
become ineligible for medical assistance under this 
section whose medical assistance is continued under 
another eligibility category or who are enrolled under 
the State’s child health plan under title XXI. Such 
information shall be submitted at the same time and 
frequency in which other enrollment information 
under this title is submitted to the Secretary. 
‘‘(2) ANNUAL REPORTS TO CONGRESS.—Using 
the information submitted under paragraph (1), the 
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AMDT. NO. 98 
Secretary shall submit to Congress annual reports 
concerning enrollment and participation rates de-
scribed in such paragraph.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
subsections (b) through (d) shall take effect on July 1, 
2009. 
Subtitle C—Extension of the 
Qualified Individual (QI) Program 
SEC. 3201. EXTENSION OF THE QUALIFYING INDIVIDUAL 
(QI) PROGRAM. 
(a) EXTENSION.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is 
amended by striking ‘‘December 2009’’ and inserting ‘‘De-
cember 2010’’. 
(b) EXTENDING TOTAL AMOUNT AVAILABLE FOR 
ALLOCATION.—Section 1933(g) of such Act (42 U.S.C. 
1396u–3(g)) is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (K); 
(B) in subparagraph (L), by striking the 
period at the end and inserting a semicolon; 
and 
(C) by adding at the end the following new 
subparagraphs: 
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AMDT. NO. 98 
‘‘(M) for the period that begins on Janu-
ary 1, 2010, and ends on September 30, 2010, 
the total allocation amount is $412,500,000; 
and 
‘‘(N) for the period that begins on October 
1, 2010, and ends on December 31, 2010, the 
total allocation amount is $150,000,000.’’; and 
(2) in paragraph (3), in the matter preceding 
subparagraph (A), by striking ‘‘or (L)’’ and insert-
ing ‘‘(L), or (N)’’. 
Subtitle D—Other Provisions 
SEC. 3301. PREMIUMS AND COST SHARING PROTECTIONS 
UNDER MEDICAID, ELIGIBILITY DETERMINA-
TIONS UNDER MEDICAID AND CHIP, AND 
PROTECTION OF CERTAIN INDIAN PROPERTY 
FROM MEDICAID ESTATE RECOVERY. 
(a) PREMIUMS
AND COST SHARING PROTECTION 
UNDER MEDICAID.— 
(1) IN GENERAL.—Section 1916 of the Social 
Security Act (42 U.S.C. 1396o) is amended— 
(A) in subsection (a), in the matter pre-
ceding paragraph (1), by striking ‘‘and (i)’’ and 
inserting ‘‘, (i), and (j)’’; and 
(B) by adding at the end the following new 
subsection: 
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AMDT. NO. 98 
‘‘(j) NO PREMIUMS OR COST SHARING FOR INDIANS 
FURNISHED ITEMS OR SERVICES DIRECTLY BY INDIAN 
HEALTH PROGRAMS OR THROUGH REFERRAL UNDER 
CONTRACT HEALTH SERVICES.— 
‘‘(1) NO COST SHARING FOR ITEMS OR SERV-
ICES
FURNISHED
TO
INDIANS
THROUGH
INDIAN 
HEALTH PROGRAMS.— 
‘‘(A) IN
GENERAL.—No enrollment fee, 
premium, or similar charge, and no deduction, 
copayment, cost sharing, or similar charge shall 
be imposed against an Indian who is furnished 
an item or service directly by the Indian Health 
Service, an Indian Tribe, Tribal Organization, 
or Urban Indian Organization or through refer-
ral under contract health services for which 
payment may be made under this title. 
‘‘(B) NO REDUCTION IN AMOUNT OF PAY-
MENT TO INDIAN HEALTH PROVIDERS.—Pay-
ment due under this title to the Indian Health 
Service, an Indian Tribe, Tribal Organization, 
or Urban Indian Organization, or a health care 
provider through referral under contract health 
services for the furnishing of an item or service 
to an Indian who is eligible for assistance under 
such title, may not be reduced by the amount 
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AMDT. NO. 98 
of any enrollment fee, premium, or similar 
charge, or any deduction, copayment, cost shar-
ing, or similar charge that would be due from 
the Indian but for the operation of subpara-
graph (A). 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed as restricting the 
application of any other limitations on the imposi-
tion of premiums or cost sharing that may apply to 
an individual receiving medical assistance under this 
title who is an Indian.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1916A(b)(3) of such Act (42 U.S.C. 1396o–1(b)(3)) 
is amended— 
(A) in subparagraph (A), by adding at the 
end the following new clause: 
‘‘(vi) An Indian who is furnished an 
item or service directly by the Indian 
Health Service, an Indian Tribe, Tribal 
Organization or Urban Indian Organiza-
tion or through referral under contract 
health services.’’; and 
(B) in subparagraph (B), by adding at the 
end the following new clause: 
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AMDT. NO. 98 
‘‘(ix) Items and services furnished to 
an Indian directly by the Indian Health 
Service, an Indian Tribe, Tribal Organiza-
tion or Urban Indian Organization or 
through referral under contract health 
services.’’. 
(b) TREATMENT OF CERTAIN PROPERTY FROM RE-
SOURCES FOR MEDICAID AND CHIP ELIGIBILITY.— 
(1) MEDICAID.—Section 1902 of the Social Se-
curity Act (42 U.S.C. 1396a) is amended by adding 
at the end the following new subsection: 
‘‘(dd) Notwithstanding any other requirement of this 
title or any other provision of Federal or State law, a State 
shall disregard the following property from resources for 
purposes of determining the eligibility of an individual who 
is an Indian for medical assistance under this title: 
‘‘(1) Property, including real property and im-
provements, that is held in trust, subject to Federal 
restrictions, or otherwise under the supervision of 
the Secretary of the Interior, located on a reserva-
tion, including any federally recognized Indian 
Tribe’s reservation, pueblo, or colony, including 
former reservations in Oklahoma, Alaska Native re-
gions established by the Alaska Native Claims Set-
tlement Act, and Indian allotments on or near a res-
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AMDT. NO. 98 
ervation as designated and approved by the Bureau 
of Indian Affairs of the Department of the Interior. 
‘‘(2) For any federally recognized Tribe not de-
scribed in paragraph (1), property located within the 
most recent boundaries of a prior Federal reserva-
tion. 
‘‘(3) Ownership interests in rents, leases, royal-
ties, or usage rights related to natural resources (in-
cluding extraction of natural resources or harvesting 
of timber, other plants and plant products, animals, 
fish, and shellfish) resulting from the exercise of fed-
erally protected rights. 
‘‘(4) Ownership interests in or usage rights to 
items not covered by paragraphs (1) through (3) 
that have unique religious, spiritual, traditional, or 
cultural significance or rights that support subsist-
ence or a traditional lifestyle according to applicable 
tribal law or custom.’’. 
(2) APPLICATION TO CHIP.—Section 2107(e)(1) 
of such Act (42 U.S.C. 1397gg(e)(1)) is amended— 
(A) by redesignating subparagraphs (B) 
through (E), as subparagraphs (C) through 
(F), respectively; and 
(B) by inserting after subparagraph (A), 
the following new subparagraph: 
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AMDT. NO. 98 
‘‘(B) Section 1902(dd) (relating to dis-
regard of certain property for purposes of mak-
ing eligibility determinations).’’. 
(c) CONTINUATION OF CURRENT LAW PROTECTIONS 
OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE 
RECOVERY.—Section 1917(b)(3) of the Social Security 
Act (42 U.S.C. 1396p(b)(3)) is amended— 
(1) by inserting ‘‘(A)’’ after ‘‘(3)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) The standards specified by the Sec-
retary under subparagraph (A) shall require 
that the procedures established by the State 
agency under subparagraph (A) exempt income, 
resources, and property that are exempt from 
the application of this subsection as of April 1, 
2003, under manual instructions issued to carry 
out this subsection (as in effect on such date) 
because of the Federal responsibility for Indian 
Tribes and Alaska Native Villages. Nothing in 
this subparagraph shall be construed as pre-
venting the Secretary from providing additional 
estate recovery exemptions under this title for 
Indians.’’. 
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AMDT. NO. 98 
SEC. 3302. RULES APPLICABLE UNDER MEDICAID AND CHIP 
TO MANAGED CARE ENTITIES WITH RESPECT 
TO INDIAN ENROLLEES AND INDIAN HEALTH 
CARE PROVIDERS AND INDIAN MANAGED 
CARE ENTITIES. 
(a) IN GENERAL.—Section 1932 of the Social Secu-
rity Act (42 U.S.C. 1396u–2) is amended by adding at 
the end the following new subsection: 
‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN-
ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND IN-
DIAN MANAGED CARE ENTITIES.— 
‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN 
HEALTH CARE PROVIDER AS PRIMARY CARE PRO-
VIDER.—In the case of a non-Indian Medicaid man-
aged care entity that— 
‘‘(A) has an Indian enrolled with the enti-
ty; and 
‘‘(B) has an Indian health care provider 
that is participating as a primary care provider 
within the network of the entity, 
insofar as the Indian is otherwise eligible to receive 
services from such Indian health care provider and 
the Indian health care provider has the capacity to 
provide primary care services to such Indian, the 
contract with the entity under section 1903(m) or 
under section 1905(t)(3) shall require, as a condi-
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AMDT. NO. 98 
tion of receiving payment under such contract, that 
the Indian shall be allowed to choose such Indian 
health care provider as the Indian’s primary care 
provider under the entity. 
‘‘(2) ASSURANCE
OF
PAYMENT
TO
INDIAN 
HEALTH CARE PROVIDERS FOR PROVISION OF COV-
ERED
SERVICES.—Each contract with a managed 
care entity under section 1903(m) or under section 
1905(t)(3) shall require any such entity, as a condi-
tion of receiving payment under such contract, to 
satisfy the following requirements: 
‘‘(A) DEMONSTRATION OF ACCESS TO IN-
DIAN HEALTH CARE PROVIDERS AND APPLICA-
TION
OF
ALTERNATIVE
PAYMENT
ARRANGE-
MENTS.—Subject to subparagraph (C), to— 
‘‘(i) demonstrate that the number of 
Indian health care providers that are par-
ticipating providers with respect to such 
entity are sufficient to ensure timely access 
to covered Medicaid managed care services 
for those Indian enrollees who are eligible 
to receive services from such providers; and 
‘‘(ii) agree to pay Indian health care 
providers, whether such providers are par-
ticipating or nonparticipating providers 
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AMDT. NO. 98 
with respect to the entity, for covered Med-
icaid managed care services provided to 
those Indian enrollees who are eligible to 
receive services from such providers at a 
rate equal to the rate negotiated between 
such entity and the provider involved or, if 
such a rate has not been negotiated, at a 
rate that is not less than the level and 
amount of payment which the entity would 
make for the services if the services were 
furnished by a participating provider which 
is not an Indian health care provider. 
‘‘(B) PROMPT
PAYMENT.—To agree to 
make prompt payment (consistent with rule for 
prompt payment of providers under section 
1932(f)) to Indian health care providers that 
are participating providers with respect to such 
entity or, in the case of an entity to which sub-
paragraph (A)(ii) or (C) applies, that the entity 
is required to pay in accordance with that sub-
paragraph. 
‘‘(C) APPLICATION OF SPECIAL PAYMENT 
REQUIREMENTS
FOR
FEDERALLY-QUALIFIED 
HEALTH
CENTERS
AND
FOR
SERVICES
PRO-
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AMDT. NO. 98 
VIDED BY CERTAIN INDIAN HEALTH CARE PRO-
VIDERS.— 
‘‘(i) FEDERALLY-QUALIFIED HEALTH 
CENTERS.— 
‘‘(I) MANAGED
CARE
ENTITY 
PAYMENT
REQUIREMENT.—To agree 
to pay any Indian health care provider 
that is a federally-qualified health 
center under this title but not a par-
ticipating provider with respect to the 
entity, for the provision of covered 
Medicaid managed care services by 
such provider to an Indian enrollee of 
the entity at a rate equal to the 
amount of payment that the entity 
would pay a federally-qualified health 
center that is a participating provider 
with respect to the entity but is not 
an Indian health care provider for 
such services. 
‘‘(II) CONTINUED
APPLICATION 
OF
STATE
REQUIREMENT
TO
MAKE 
SUPPLEMENTAL
PAYMENT.—Nothing 
in subclause (I) or subparagraph (A) 
or (B) shall be construed as waiving 
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AMDT. NO. 98 
the application of section 1902(bb)(5) 
regarding the State plan requirement 
to make any supplemental payment 
due under such section to a federally- 
qualified health center for services 
furnished by such center to an en-
rollee of a managed care entity (re-
gardless of whether the federally- 
qualified health center is or is not a 
participating provider with the entity). 
‘‘(ii) PAYMENT RATE FOR SERVICES 
PROVIDED
BY
CERTAIN
INDIAN
HEALTH 
CARE PROVIDERS.—If the amount paid by 
a managed care entity to an Indian health 
care provider that is not a federally-quali-
fied health center for services provided by 
the provider to an Indian enrollee with the 
managed care entity is less than the rate 
that applies to the provision of such serv-
ices by the provider under the State plan, 
the plan shall provide for payment to the 
Indian health care provider, whether the 
provider is a participating or nonpartici-
pating provider with respect to the entity, 
of the difference between such applicable 
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AMDT. NO. 98 
rate and the amount paid by the managed 
care entity to the provider for such serv-
ices. 
‘‘(D) CONSTRUCTION.—Nothing in this 
paragraph shall be construed as waiving the ap-
plication of section 1902(a)(30)(A) (relating to 
application of standards to assure that pay-
ments are consistent with efficiency, economy, 
and quality of care). 
‘‘(3) SPECIAL RULE FOR ENROLLMENT FOR IN-
DIAN MANAGED CARE ENTITIES.—Regarding the ap-
plication of a Medicaid managed care program to In-
dian Medicaid managed care entities, an Indian 
Medicaid managed care entity may restrict enroll-
ment under such program to Indians and to mem-
bers of specific Tribes in the same manner as Indian 
Health Programs may restrict the delivery of serv-
ices to such Indians and tribal members. 
‘‘(4) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) INDIAN HEALTH CARE PROVIDER.— 
The term ‘Indian health care provider’ means 
an Indian Health Program or an Urban Indian 
Organization. 
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AMDT. NO. 98 
‘‘(B) INDIAN
MEDICAID
MANAGED
CARE 
ENTITY.—The term ‘Indian Medicaid managed 
care entity’ means a managed care entity that 
is controlled (within the meaning of the last 
sentence of section 1903(m)(1)(C)) by the In-
dian Health Service, a Tribe, Tribal Organiza-
tion, or Urban Indian Organization, or a con-
sortium, which may be composed of 1 or more 
Tribes, Tribal Organizations, or Urban Indian 
Organizations, and which also may include the 
Service. 
‘‘(C) NON-INDIAN
MEDICAID
MANAGED 
CARE ENTITY.—The term ‘non-Indian Medicaid 
managed care entity’ means a managed care en-
tity that is not an Indian Medicaid managed 
care entity. 
‘‘(D) COVERED MEDICAID MANAGED CARE 
SERVICES.—The term ‘covered Medicaid man-
aged care services’ means, with respect to an 
individual enrolled with a managed care entity, 
items and services for which benefits are avail-
able with respect to the individual under the 
contract between the entity and the State in-
volved. 
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AMDT. NO. 98 
‘‘(E) MEDICAID
MANAGED
CARE
PRO-
GRAM.—The term ‘Medicaid managed care pro-
gram’ 
means 
a 
program 
under 
sections 
1903(m), 1905(t), and 1932 and includes a 
managed care program operating under a waiv-
er under section 1915(b) or 1115 or other-
wise.’’. 
(b) APPLICATION
TO CHIP.—Subject to section 
l013(d), section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(1)) is amended by adding at the end the following 
new subparagraph: 
‘‘(E) Subsections (a)(2)(C) and (h) of sec-
tion 1932.’’. 
SEC. 3303. CONSULTATION ON MEDICAID, CHIP, AND 
OTHER HEALTH CARE PROGRAMS FUNDED 
UNDER THE SOCIAL SECURITY ACT INVOLV-
ING INDIAN HEALTH PROGRAMS AND URBAN 
INDIAN ORGANIZATIONS. 
(a) CONSULTATION WITH TRIBAL TECHNICAL ADVI-
SORY GROUP (TTAG).—The Secretary of Health and 
Human Services shall maintain within the Centers for 
Medicaid & Medicare Services (CMS) a Tribal Technical 
Advisory Group (TTAG), which was first established in 
accordance with requirements of the charter dated Sep-
tember 30, 2003, and the Secretary of Health and Human 
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AMDT. NO. 98 
Services shall include in such Group a representative of 
a national urban Indian health organization and a rep-
resentative of the Indian Health Service. The inclusion of 
a representative of a national urban Indian health organi-
zation in such Group shall not affect the nonapplication 
of the Federal Advisory Committee Act (5 U.S.C. App.) 
to such Group. 
(b) SOLICITATION OF ADVICE UNDER MEDICAID AND 
CHIP.— 
(1) MEDICAID
STATE
PLAN
AMENDMENT.— 
Subject to subsection (d), section 1902(a) of the So-
cial Security Act (42 U.S.C. 1396a(a)) is amend-
ed— 
(A) in paragraph (70), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (71), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (71), the 
following new paragraph: 
‘‘(72) in the case of any State in which 1 or 
more Indian Health Programs or Urban Indian Or-
ganizations furnishes health care services, provide 
for a process under which the State seeks advice on 
a regular, ongoing basis from designees of such In-
dian Health Programs and Urban Indian Organiza-
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AMDT. NO. 98 
tions on matters relating to the application of this 
title that are likely to have a direct effect on such 
Indian Health Programs and Urban Indian Organi-
zations and that— 
‘‘(A) shall include solicitation of advice 
prior to submission of any plan amendments, 
waiver requests, and proposals for demonstra-
tion projects likely to have a direct effect on In-
dians, Indian Health Programs, or Urban In-
dian Organizations; and 
‘‘(B) may include appointment of an advi-
sory committee and of a designee of such In-
dian Health Programs and Urban Indian Orga-
nizations to the medical care advisory com-
mittee advising the State on its State plan 
under this title.’’. 
(2) APPLICATION
TO
CHIP.—Subject to sub-
section (d), section 2107(e)(1) of such Act (42 
U.S.C. 1397gg(e)(1)), as amended by section 
3302(b)(2), is amended— 
(A) by redesignating subparagraphs (B) 
through (E) as subparagraphs (C) through (F), 
respectively; and 
(B) by inserting after subparagraph (A), 
the following new subparagraph: 
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AMDT. NO. 98 
‘‘(B) Section 1902(a)(72) (relating to re-
quiring certain States to seek advice from des-
ignees of Indian Health Programs and Urban 
Indian Organizations).’’. 
(c) RULE
OF
CONSTRUCTION.—Nothing in the 
amendments made by this section shall be construed as 
superseding existing advisory committees, working groups, 
guidance, or other advisory procedures established by the 
Secretary of Health and Human Services or by any State 
with respect to the provision of health care to Indians. 
(d) CONTINGENCY RULE.—If the Children’s Health 
Insurance Program Reauthorization Act of 2009 (in this 
subsection referred to as ‘‘CHIPRA’’) has been enacted 
as of the date of enactment of this Act, the following shall 
apply: 
(1) Subparagraph (I) of section 2107(e) of the 
Social Security Act (as redesignated by CHIPRA) is 
redesignated as subparagraph (K) and the subpara-
graph (E) added to section 2107(e) of the Social Se-
curity Act by section 3302(b) is redesignated as sub-
paragraph (J). 
(2) Subparagraphs (D) through (H) of section 
2107(e) of the Social Security Act (as added and re-
designated by CHIPRA) are redesignated as sub-
paragraphs (E) through (I), respectively and the 
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AMDT. NO. 98 
subparagraph (B) of section 2107(e) of the Social 
Security Act added by subsection (b)(2) of this sec-
tion is redesignated as subparagraph (D) and 
amended by striking ‘‘1902(a)(72)’’ and inserting 
‘‘1902(a)(73)’’. 
(3) Section 1902(a) of the Social Security Act 
(as amended by CHIPRA) is amended by striking 
‘‘and’’ at the end of paragraph (71), by striking the 
period at the end of the paragraph (72) added by 
CHIPRA and inserting ‘‘; and’’ and by redesignated 
the paragraph (72) added to such section by sub-
section (b)(1) of this section as paragraph (73). 
SEC. 3304. APPLICATION OF PROMPT PAY REQUIREMENTS 
TO NURSING FACILITIES. 
Section 1902(a)(37)(A) of the Social Security Act 
(42 U.S.C. 1396a(a)(37)(A)) is amended by inserting ‘‘, 
or by nursing facilities,’’ after ‘‘health facilities’’ 
SEC. 3305. PERIOD OF APPLICATION; SUNSET. 
This subtitle and the amendments made by this sub-
title shall be in effect only during the period that begins 
on April 1, 2009, and ends on December 31, 2010. On 
and after January 1, 2011, the Social Security Act shall 
be applied as if this subtitle and the amendments made 
by this subtitle had not been enacted. 
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AMDT. NO. 98 
TITLE IV—HEALTH 
INFORMATION TECHNOLOGY 
SEC. 4001. SHORT TITLE; TABLE OF CONTENTS OF TITLE. 
(a) SHORT TITLE.—This title may be cited as the 
‘‘Medicare and Medicaid Health Information Technology 
for Economic and Clinical Health Act’’ or the ‘‘M- 
HITECH Act’’. 
(b) TABLE OF CONTENTS OF TITLE.—The table of 
contents for this title is as follows: 
TITLE IV—HEALTH INFORMATION TECHNOLOGY 
Sec. 4001. Short title; table of contents of title. 
Subtitle A—Medicare Program 
Sec. 4201. Incentives for eligible professionals. 
Sec. 4202. Incentives for hospitals. 
Sec. 4203. Premium hold harmless and implementation funding. 
Sec. 4204. Non-application of phased-out indirect medical education (IME) ad-
justment factor for fiscal year 2009. 
Sec. 4205. Study on application of EHR payment incentives for providers not 
receiving other incentive payments. 
Sec. 4206. Study on availability of open source health information technology 
systems. 
Subtitle B—Medicaid Funding 
Sec. 4211. Medicaid provider EHR adoption and operation payments; imple-
mentation funding. 
Subtitle A—Medicare Program 
SEC. 4201. INCENTIVES FOR ELIGIBLE PROFESSIONALS. 
(a) INCENTIVE PAYMENTS.—Section 1848 of the So-
cial Security Act (42 U.S.C. 1395w–4) is amended by add-
ing at the end the following new subsection: 
‘‘(o) INCENTIVES FOR ADOPTION AND MEANINGFUL 
USE OF CERTIFIED EHR TECHNOLOGY.— 
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AMDT. NO. 98 
‘‘(1) INCENTIVE PAYMENTS.— 
‘‘(A) IN GENERAL.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii) and the succeeding subparagraphs of 
this paragraph, with respect to covered 
professional services furnished by an eligi-
ble professional during a payment year (as 
defined in subparagraph (E)), if the eligi-
ble professional is a meaningful EHR user 
(as determined under paragraph (2)) for 
the reporting period with respect to such 
year, in addition to the amount otherwise 
paid under this part, there also shall be 
paid to the eligible professional (or to an 
employer or facility in the cases described 
in clause (A) of section 1842(b)(6)), from 
the Federal Supplementary Medical Insur-
ance Trust Fund established under section 
1841 an amount equal to 75 percent of the 
Secretary’s estimate (based on claims sub-
mitted not later than 2 months after the 
end of the payment year) of the allowed 
charges under this part for all such cov-
ered professional services furnished by the 
eligible professional during such year. 
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AMDT. NO. 98 
‘‘(ii) NO INCENTIVE PAYMENTS WITH 
RESPECT TO YEARS AFTER 2015.—No in-
centive payments may be made under this 
subsection with respect to a year after 
2015. 
‘‘(B) LIMITATIONS
ON
AMOUNTS
OF
IN-
CENTIVE PAYMENTS.— 
‘‘(i) IN GENERAL.—In no case shall 
the amount of the incentive payment pro-
vided under this paragraph for an eligible 
professional for a payment year exceed the 
applicable amount specified under this sub-
paragraph with respect to such eligible 
professional and such year. 
‘‘(ii) AMOUNT.—Subject to clauses 
(iii) through (v), the applicable amount 
specified in this subparagraph for an eligi-
ble professional is as follows: 
‘‘(I) For the first payment year 
for such professional, $15,000 (or, if 
the first payment year for such eligi-
ble professional is 2011 or 2012, 
$18,000). 
‘‘(II) For the second payment 
year for such professional, $12,000. 
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AMDT. NO. 98 
‘‘(III) For the third payment 
year for such professional, $8,000. 
‘‘(IV) For the fourth payment 
year for such professional, $4,000. 
‘‘(V) For the fifth payment year 
for such professional, $2,000. 
‘‘(VI) For any succeeding pay-
ment year for such professional, $0. 
‘‘(iii) PHASE
DOWN
FOR
ELIGIBLE 
PROFESSIONALS FIRST ADOPTING EHR IN 
2014.—If the first payment year for an eli-
gible professional is 2014, then the amount 
specified in this subparagraph for a pay-
ment year for such professional is the 
same as the amount specified in clause (ii) 
for such payment year for an eligible pro-
fessional whose first payment year is 2013. 
‘‘(iv) INCREASE FOR CERTAIN RURAL 
ELIGIBLE PROFESSIONALS.—In the case of 
an eligible professional who predominantly 
furnishes services under this part in a 
rural area that is designated by the Sec-
retary (under section 332(a)(1)(A) of the 
Public Health Service Act) as a health pro-
fessional shortage area, the amount that 
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would otherwise apply for a payment year 
for such professional under subclauses (I) 
through (V) of clause (ii) shall be in-
creased by 25 percent. In implementing 
the preceding sentence, the Secretary may, 
as determined appropriate, apply provi-
sions of subsections (m) and (u) of section 
1833 in a similar manner as such provi-
sions apply under such subsection. 
‘‘(v) NO
INCENTIVE
PAYMENT
IF 
FIRST ADOPTING AFTER 2014.—If the first 
payment year for an eligible professional is 
after 2014 then the applicable amount 
specified in this subparagraph for such 
professional for such year and any subse-
quent year shall be $0. 
‘‘(C) NON-APPLICATION
TO
HOSPITAL- 
BASED ELIGIBLE PROFESSIONALS.— 
‘‘(i) IN GENERAL.—No incentive pay-
ment may be made under this paragraph 
in the case of a hospital-based eligible pro-
fessional. 
‘‘(ii) HOSPITAL-BASED ELIGIBLE PRO-
FESSIONAL.—For purposes of clause (i), 
the term ‘hospital-based eligible profes-
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sional’ means, with respect to covered pro-
fessional services furnished by an eligible 
professional during the reporting period for 
a payment year, an eligible professional, 
such as a pathologist, anesthesiologist, or 
emergency physician, who furnishes sub-
stantially all of such services in a hospital 
setting (whether inpatient or outpatient) 
and through the use of the facilities and 
equipment, including qualified electronic 
health records, of the hospital. 
‘‘(D) PAYMENT.— 
‘‘(i) FORM OF PAYMENT.—The pay-
ment under this paragraph may be in the 
form of a single consolidated payment or 
in the form of such periodic installments 
as the Secretary may specify. 
‘‘(ii) COORDINATION OF APPLICATION 
OF
LIMITATION
FOR
PROFESSIONALS
IN 
DIFFERENT PRACTICES.—In the case of an 
eligible professional furnishing covered pro-
fessional services in more than one practice 
(as specified by the Secretary), the Sec-
retary shall establish rules to coordinate 
the incentive payments, including the ap-
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plication of the limitation on amounts of 
such incentive payments under this para-
graph, among such practices. 
‘‘(iii) 
COORDINATION
WITH
MED-
ICAID.—The Secretary shall seek, to the 
maximum extent practicable, to avoid du-
plicative requirements from Federal and 
State Governments to demonstrate mean-
ingful use of certified EHR technology 
under this title and title XIX. In doing so, 
the Secretary may deem satisfaction of 
State requirements for such meaningful 
use for a payment year under title XIX to 
be sufficient to qualify as meaningful use 
under this subsection and subsection (a)(7) 
and vice versa. The Secretary may also ad-
just the reporting periods under such title 
and such subsections in order to carry out 
this clause. 
‘‘(E) PAYMENT YEAR DEFINED.— 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, the term ‘payment year’ 
means a year beginning with 2011. 
‘‘(ii) FIRST, SECOND, ETC. PAYMENT 
YEAR.—The term ‘first payment year’ 
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AMDT. NO. 98 
means, with respect to covered professional 
services furnished by an eligible profes-
sional, the first year for which an incentive 
payment is made for such services under 
this subsection. The terms ‘second pay-
ment year’, ‘third payment year’, ‘fourth 
payment year’, and ‘fifth payment year’ 
mean, with respect to covered professional 
services furnished by such eligible profes-
sional, each successive year immediately 
following the first payment year for such 
professional. 
‘‘(2) MEANINGFUL EHR USER.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), an eligible professional shall be 
treated as a meaningful EHR user for a report-
ing period for a payment year (or, for purposes 
of subsection (a)(7), for a reporting period 
under such subsection for a year) if each of the 
following requirements is met: 
‘‘(i) MEANINGFUL USE OF CERTIFIED 
EHR
TECHNOLOGY.—The eligible profes-
sional demonstrates to the satisfaction of 
the Secretary, in accordance with subpara-
graph (C)(i), that during such period the 
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professional is using certified EHR tech-
nology in a meaningful manner, which 
shall include the use of electronic pre-
scribing as determined to be appropriate 
by the Secretary. 
‘‘(ii) INFORMATION EXCHANGE.—The 
eligible professional demonstrates to the 
satisfaction of the Secretary, in accordance 
with subparagraph (C)(i), that during such 
period such certified EHR technology is 
connected in a manner that provides, in 
accordance with law and standards appli-
cable to the exchange of information, for 
the electronic exchange of health informa-
tion to improve the quality of health care, 
such as promoting care coordination. 
‘‘(iii) 
REPORTING
ON
MEASURES 
USING
EHR.—Subject to subparagraph 
(B)(ii) and using such certified EHR tech-
nology, the eligible professional submits in-
formation for such period, in a form and 
manner specified by the Secretary, on such 
clinical quality measures and such other 
measures as selected by the Secretary 
under subparagraph (B)(i). 
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AMDT. NO. 98 
‘‘(ii) MEDICARE
SHARE.—The Medi-
care share as specified in subparagraph 
(D) for the hospital for a period selected 
by the Secretary with respect to such pay-
ment year. 
‘‘(iii) 
TRANSITION
FACTOR.—The 
transition factor specified in subparagraph 
(E) for the hospital for the payment year. 
‘‘(B) BASE
AMOUNT.—The base amount 
specified in this subparagraph is $2,000,000. 
‘‘(C) DISCHARGE RELATED AMOUNT.—The 
discharge related amount specified in this sub-
paragraph for a 12-month period selected by 
the Secretary shall be determined as the sum of 
the amount, based upon total discharges (re-
gardless of any source of payment) for the pe-
riod, for each discharge up to the 23,000th dis-
charge as follows: 
‘‘(i) For the 1,150th through the 
9,200nd discharge, $200. 
‘‘(ii) For the 9,201st through the 
13,800th discharge, 50 percent of the 
amount specified in clause (i). 
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