† HR 4994 EAS 
Sec. 106. Extension of ambulance add-ons. 
Sec. 107. Extension of physician fee schedule mental health add-on payment. 
Sec. 108. Extension of outpatient hold harmless provision. 
Sec. 109. Extension of Medicare reasonable costs payments for certain clinical di-
agnostic laboratory tests furnished to hospital patients in certain 
rural areas. 
Sec. 110. Extension of the qualifying individual (QI) program. 
Sec. 111. Extension of Transitional Medical Assistance (TMA). 
Sec. 112. Special diabetes programs. 
TITLE II—OTHER PROVISIONS 
Sec. 201. Clarification of effective date of part B special enrollment period for 
disabled TRICARE beneficiaries. 
Sec. 202. Repeal of delay of RUG–IV. 
Sec. 203. Clarification for affiliated hospitals for distribution of additional resi-
dency positions. 
Sec. 204. Continued inclusion of orphan drugs in definition of covered outpatient 
drugs with respect to children’s hospitals under the 340B drug 
discount program. 
Sec. 205. Medicaid and CHIP technical corrections. 
Sec. 206. Funding for claims reprocessing. 
Sec. 207. Revision to the Medicare Improvement Fund. 
Sec. 208. Limitations on aggregate amount recovered on reconciliation of the 
health insurance tax credit and the advance of that credit. 
Sec. 209. Determination of budgetary effects. 
TITLE I—EXTENSIONS 
SEC. 101. PHYSICIAN PAYMENT UPDATE. 
Section 1848(d) of the Social Security Act (42 U.S.C. 
1395w–4(d)) is amended by adding at the end the following 
new paragraph: 
‘‘(12) UPDATE FOR 2011.— 
‘‘(A) IN GENERAL.—Subject to paragraphs 
(7)(B), (8)(B), (9)(B), (10)(B), and (11)(B), in 
lieu of the update to the single conversion factor 
established in paragraph (1)(C) that would oth-
erwise apply for 2011, the update to the single 
conversion factor shall be 0 percent.
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‘‘(B) NO EFFECT ON COMPUTATION OF CON-
VERSION
FACTOR
FOR
2012
AND
SUBSEQUENT 
YEARS.—The conversion factor under this sub-
section shall be computed under paragraph 
(1)(A) for 2012 and subsequent years as if sub-
paragraph (A) had never applied.’’. 
SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICA-
TIONS. 
(a) EXTENSION.— 
(1) IN GENERAL.—Section 106(a) of division B 
of the Tax Relief and Health Care Act of 2006 (42 
U.S.C. 1395 note), as amended by section 117 of the 
Medicare, Medicaid, and SCHIP Extension Act of 
2007 (Public Law 110–173), section 124 of the Medi-
care Improvements for Patients and Providers Act of 
2008 (Public Law 110–275), and sections 3137(a) 
and 10317 of the Patient Protection and Affordable 
Care Act (Public Law 111–148), is amended by strik-
ing ‘‘September 30, 2010’’ and inserting ‘‘September 
30, 2011’’. 
(2) SPECIAL RULE FOR FISCAL YEAR 2011.— 
(A) IN GENERAL.—Subject to subparagraph 
(B), for purposes of implementation of the 
amendment made by paragraph (1), including 
(notwithstanding 
paragraph 
(3) 
of 
section
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117(a) of the Medicare, Medicaid, and SCHIP 
Extension Act of 2007 (Public Law 110–173), as 
amended by section 124(b) of the Medicare Im-
provements for Patients and Providers Act of 
2008 (Public Law 110–275)) for purposes of the 
implementation of paragraph (2) of such section 
117(a), during fiscal year 2011, the Secretary of 
Health and Human Services shall use the hos-
pital wage index that was promulgated by the 
Secretary of Health and Human Services in the 
Federal Register on August 16, 2010 (75 Fed. 
Reg. 50042), and any subsequent corrections. 
(B) EXCEPTION.—Beginning on April 1, 
2011, in determining the wage index applicable 
to hospitals that qualify for wage index reclassi-
fication, the Secretary shall include the average 
hourly wage data of hospitals whose reclassifica-
tion was extended pursuant to the amendment 
made by paragraph (1) only if including such 
data results in a higher applicable reclassified 
wage index. Any revision to hospital wage in-
dexes made as a result of this subparagraph shall 
not be effected in a budget neutral manner. 
(3) ADJUSTMENT
FOR
CERTAIN
HOSPITALS
IN 
FISCAL YEAR 2011.—
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(A) IN GENERAL.—In the case of a sub-
section (d) hospital (as defined in subsection 
(d)(1)(B) of section 1886 of the Social Security 
Act (42 U.S.C. 1395ww)) with respect to 
which— 
(i) a reclassification of its wage index 
for purposes of such section was extended 
pursuant to the amendment made by para-
graph (1); and 
(ii) the wage index applicable for such 
hospital for the period beginning on October 
1, 2010, and ending on March 31, 2011, 
was lower than for the period beginning on 
April 1, 2011, and ending on September 30, 
2011, by reason of the application of para-
graph (2)(B); 
the Secretary shall pay such hospital an addi-
tional payment that reflects the difference be-
tween the wage index for such periods. 
(B) TIMEFRAME FOR PAYMENTS.—The Sec-
retary shall make payments required under sub-
paragraph (A) by not later than December 31, 
2011. 
(b) CONFORMING AMENDMENT.—Section 117(a)(3) of 
the Medicare, Medicaid, and SCHIP Extension Act of 2007
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(Public Law 110–173) is amended by inserting ‘‘in fiscal 
years 2008 and 2009’’ after ‘‘For purposes of implementa-
tion of this subsection’’. 
SEC. 103. EXTENSION OF MEDICARE WORK GEOGRAPHIC 
ADJUSTMENT FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘before 
January 1, 2011’’ and inserting ‘‘before January 1, 2012’’. 
SEC. 104. EXTENSION OF EXCEPTIONS PROCESS FOR MEDI-
CARE THERAPY CAPS. 
Section 1833(g)(5) of the Social Security Act (42 
U.S.C. 1395l(g)(5)) is amended by striking ‘‘and ending 
on’’ and all that follows through ‘‘2010’’ and inserting ‘‘and 
ending on December 31, 2011’’. 
SEC. 105. EXTENSION OF PAYMENT FOR TECHNICAL COM-
PONENT OF CERTAIN PHYSICIAN PATHOLOGY 
SERVICES. 
Section 542(c) of the Medicare, Medicaid, and SCHIP 
Benefits Improvement and Protection Act of 2000 (as en-
acted into law by section 1(a)(6) of Public Law 106–554), 
as amended by section 732 of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (42 
U.S.C. 1395w–4 note), section 104 of division B of the Tax 
Relief and Health Care Act of 2006 (42 U.S.C. 1395w–4 
note), section 104 of the Medicare, Medicaid, and SCHIP
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Extension Act of 2007 (Public Law 110–173), section 136 
of the Medicare Improvements for Patients and Providers 
Act of 2008 (Public Law 110–275), and section 3104 of the 
Patient Protection and Affordable Care Act (Public Law 
111–148) is amended by striking ‘‘and 2010’’ and inserting 
‘‘2010, and 2011’’. 
SEC. 106. EXTENSION OF AMBULANCE ADD-ONS. 
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) of 
the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is 
amended— 
(1) in the matter preceding clause (i), by strik-
ing ‘‘2011’’ and inserting ‘‘2012,’’; and 
(2) in each of clauses (i) and (ii), by striking 
‘‘January 1, 2011’’ and inserting ‘‘January 1, 2012’’ 
each place it appears. 
(b) AIR AMBULANCE.—Section 146(b)(1) of the Medi-
care Improvements for Patients and Providers Act of 2008 
(Public Law 110–275), as amended by sections 3105(b) and 
10311(b) of Public Law 111–148, is amended by striking 
‘‘December 31, 2010’’ and inserting ‘‘December 31, 2011’’. 
(c) 
SUPER
RURAL
AMBULANCE.—Section 
1834(l)(12)(A) of the Social Security Act (42 U.S.C. 
1395m(l)(12)(A)) is amended by striking ‘‘2011’’ and in-
serting ‘‘2012’’.