H. R. 4994 
One Hundred Eleventh Congress 
of the 
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Tuesday, 
the fifth day of January, two thousand and ten 
An Act 
To extend certain expiring provisions of the Medicare and Medicaid programs, 
and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Medicare 
and Medicaid Extenders Act of 2010’’. 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—EXTENSIONS 
Sec. 101. Physician payment update. 
Sec. 102. Extension of MMA section 508 reclassifications. 
Sec. 103. Extension of Medicare work geographic adjustment floor. 
Sec. 104. Extension of exceptions process for Medicare therapy caps. 
Sec. 105. Extension of payment for technical component of certain physician pathol-
ogy services. 
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 diag-
nostic 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 dis-
abled TRICARE beneficiaries. 
Sec. 202. Repeal of delay of RUG–IV. 
Sec. 203. Clarification for affiliated hospitals for distribution of additional residency 
positions. 
Sec. 204. Continued inclusion of orphan drugs in definition of covered outpatient 
drugs with respect to children’s hospitals under the 340B drug discount 
program. 
Sec. 205. Medicaid and CHIP technical corrections. 
Sec. 206. Funding for claims reprocessing. 
Sec. 207. Revision to the Medicare Improvement Fund. 
Sec. 208. Limitations on aggregate amount recovered on reconciliation of the health 
insurance tax credit and the advance of that credit. 
Sec. 209. Determination of budgetary effects. 
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:
H. R. 4994—2 
‘‘(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 otherwise apply for 2011, the update to the 
single conversion factor shall be 0 percent. 
‘‘(B) NO
EFFECT
ON
COMPUTATION
OF
CONVERSION 
FACTOR FOR 2012 AND SUBSEQUENT YEARS.—The conversion 
factor under this subsection shall be computed under para-
graph (1)(A) for 2012 and subsequent years as if subpara-
graph (A) had never applied.’’. 
SEC. 102. EXTENSION OF MMA SECTION 508 RECLASSIFICATIONS. 
(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 Medicare 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 striking ‘‘September 30, 2010’’ 
and inserting ‘‘September 30, 2011’’. 
(2) SPECIAL RULE FOR FISCAL YEAR 2011.— 
(A) IN GENERAL.—Subject to subparagraph (B), for pur-
poses of implementation of the amendment made by para-
graph (1), including (notwithstanding paragraph (3) of sec-
tion 117(a) of the Medicare, Medicaid, and SCHIP Exten-
sion Act of 2007 (Public Law 110–173), as amended by 
section 124(b) of the Medicare Improvements for Patients 
and Providers Act of 2008 (Public Law 110–275)) for pur-
poses 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 hospital 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 deter-
mining the wage index applicable to hospitals that qualify 
for wage index reclassification, the Secretary shall include 
the average hourly wage data of hospitals whose reclassi-
fication 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 indexes made as a result of this subpara-
graph shall not be effected in a budget neutral manner. 
(3) ADJUSTMENT FOR CERTAIN HOSPITALS IN FISCAL YEAR 
2011.— 
(A) IN GENERAL.—In the case of a subsection (d) hos-
pital (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 amend-
ment made by paragraph (1); and 
(ii) the wage index applicable for such hospital 
for the period beginning on October 1, 2010, and ending
H. R. 4994—3 
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 paragraph 
(2)(B); 
the Secretary shall pay such hospital an additional pay-
ment that reflects the difference between the wage index 
for such periods. 
(B) TIMEFRAME FOR PAYMENTS.—The Secretary shall 
make payments required under subparagraph (A) by not 
later than December 31, 2011. 
(b) CONFORMING AMENDMENT.—Section 117(a)(3) of the Medi-
care, Medicaid, and SCHIP Extension Act of 2007 (Public Law 
110–173) is amended by inserting ‘‘in fiscal years 2008 and 2009’’ 
after ‘‘For purposes of implementation 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 MEDICARE 
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 COMPONENT OF 
CERTAIN PHYSICIAN PATHOLOGY SERVICES. 
Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (as enacted into law by 
section 1(a)(6) of Public Law 106–554), as amended by section 
732 of the Medicare Prescription Drug, Improvement, and Mod-
ernization 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 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 Protec-
tion 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 striking ‘‘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 Medicare 
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 inserting ‘‘2012’’.