† HR 4994 EAS 
SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MEN-
TAL HEALTH ADD-ON PAYMENT. 
Section 138(a)(1) of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110–275), 
as amended by section 3107 of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is amended by 
striking ‘‘December 31, 2010’’ and inserting ‘‘December 31, 
2011’’. 
SEC. 108. EXTENSION OF OUTPATIENT HOLD HARMLESS 
PROVISION. 
Section 1833(t)(7)(D)(i) of the Social Security Act (42 
U.S.C. 1395l(t)(7)(D)(i)), as amended by section 3121(a) 
of the Patient Protection and Affordable Care Act (Public 
Law 111–148), is amended— 
(1) in subclause (II)— 
(A) in the first sentence, by striking 
‘‘2011’’and inserting ‘‘2012’’; and 
(B) in the second sentence, by striking ‘‘or 
2010’’ and inserting ‘‘2010, or 2011’’; and 
(2) in subclause (III), by striking ‘‘January 1, 
2011’’ and inserting ‘‘January 1, 2012’’.
† HR 4994 EAS 
SEC. 109. EXTENSION OF MEDICARE REASONABLE COSTS 
PAYMENTS FOR CERTAIN CLINICAL DIAG-
NOSTIC LABORATORY TESTS FURNISHED TO 
HOSPITAL 
PATIENTS 
IN 
CERTAIN 
RURAL 
AREAS. 
Section 416(b) of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (42 U.S.C. 
1395l–4), as amended by section 105 of division B of the 
Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395l 
note), section 107 of the Medicare, Medicaid, and SCHIP 
Extension Act of 2007 (42 U.S.C. 1395l note), and section 
3122 of the Patient Protection and Affordable Care Act 
(Public Law 111–148), is amended by striking ‘‘the 1-year 
period beginning on July 1, 2010’’ and inserting ‘‘the 2- 
year period beginning on July 1, 2010’’. 
SEC. 110. 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 2010’’ and inserting ‘‘De-
cember 2011’’. 
(b) EXTENDING TOTAL AMOUNT AVAILABLE FOR AL-
LOCATION.—Section 1933(g) of such Act (42 U.S.C. 1396u- 
3(g)) is amended— 
(1) in paragraph (2)—
† HR 4994 EAS 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (M); 
(B) in subparagraph (N), by striking the 
period at the end and inserting a semicolon; and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(O) for the period that begins on January 
1, 2011, and ends on September 30, 2011, the 
total allocation amount is $720,000,000; and 
‘‘(P) for the period that begins on October 
1, 2011, and ends on December 31, 2011, the 
total allocation amount is $280,000,000.’’; and 
(2) in paragraph (3), in the matter preceding 
subparagraph (A), by striking ‘‘or (N)’’ and inserting 
‘‘(N), or (P)’’. 
SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSIST-
ANCE (TMA). 
Sections 1902(e)(1)(B) and 1925(f) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)) are each 
amended by striking ‘‘December 31, 2010’’ and inserting 
‘‘December 31, 2011’’. 
SEC. 112. SPECIAL DIABETES PROGRAMS. 
(1) SPECIAL DIABETES PROGRAMS FOR TYPE I 
DIABETES.—Section 330B(b)(2)(C) of the Public
† HR 4994 EAS 
Health Service Act (42 U.S.C. 254c–2(b)(2)(C)) is 
amended by striking ‘‘2011’’ and inserting ‘‘2013’’. 
(2) SPECIAL
DIABETES
PROGRAMS
FOR
INDI-
ANS.—Section 330C(c)(2)(C) of the Public Health 
Service Act (42 U.S.C. 254c–3(c)(2)(C)) is amended 
by striking ‘‘2011’’ and inserting ‘‘2013’’. 
TITLE II—OTHER PROVISIONS 
SEC. 201. CLARIFICATION OF EFFECTIVE DATE OF PART B 
SPECIAL ENROLLMENT PERIOD FOR DIS-
ABLED TRICARE BENEFICIARIES. 
Effective as if included in the enactment of Public Law 
111–148, section 3110(a)(2) of such Act is amended to read 
as follows: 
‘‘(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to elections made on 
and after the date of the enactment of this Act.’’. 
SEC. 202. REPEAL OF DELAY OF RUG–IV. 
Effective as if included in the enactment of Public Law 
111–148, section 10325 of such Act is repealed. 
SEC. 203. CLARIFICATION FOR AFFILIATED HOSPITALS FOR 
DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS. 
Effective as if included in the enactment of section 
5503(a) of Public Law 111–148, section 1886(h)(8) of the 
Social Security Act (42 U.S.C. 1395ww(h)(8)), as added
† HR 4994 EAS 
by such section 5503(a), is amended by adding at the end 
the following new subparagraph: 
‘‘(I) AFFILIATION.—The provisions of this 
paragraph shall be applied to hospitals which 
are members of the same affiliated group (as de-
fined 
by 
the 
Secretary 
under 
paragraph 
(4)(H)(ii)) and the reference resident level for 
each such hospital shall be the reference resident 
level with respect to the cost reporting period 
that results in the smallest difference between the 
reference resident level and the otherwise appli-
cable resident limit.’’. 
SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN 
DEFINITION 
OF 
COVERED 
OUTPATIENT 
DRUGS WITH RESPECT TO CHILDREN’S HOS-
PITALS UNDER THE 340B DRUG DISCOUNT 
PROGRAM. 
(a) DEFINITION OF COVERED OUTPATIENT DRUG.— 
(1) AMENDMENT.—Subsection (e) of section 
340B of the Public Health Service Act (42 U.S.C. 
256b) is amended by striking ‘‘covered entities de-
scribed in subparagraph (M)’’ and inserting ‘‘covered 
entities described in subparagraph (M) (other than a 
children’s hospital described in subparagraph (M))’’.
† HR 4994 EAS 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect as if included in the 
enactment of section 2302 of the Health Care and 
Education Reconciliation Act of 2010 (Public Law 
111–152). 
(b) TECHNICAL AMENDMENT.—Subparagraph (B) of 
section 1927(a)(5) of the Social Security Act (42 U.S.C. 
1396r–8(a)(5)) is amended by striking ‘‘and a children’s 
hospital’’ and all that follows through the end of the sub-
paragraph and inserting a period. 
SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS. 
(a) REPEAL OF EXCLUSION OF CERTAIN INDIVIDUALS 
AND ENTITIES FROM MEDICAID.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)) is amended by 
striking paragraph (78). 
(b) INCOME LEVEL FOR CERTAIN CHILDREN UNDER 
MEDICAID.—Section 1902(l)(2)(C) of the Social Security 
Act (42 U.S.C. 1396a(l)(2)(C)) is amended by striking ‘‘133 
percent’’ and inserting ‘‘100 percent (or, beginning Janu-
ary 1, 2014, 133 percent)’’. 
(c) CALCULATION
AND PUBLICATION
OF PAYMENT 
ERROR RATE MEASUREMENT FOR CERTAIN YEARS.—Sec-
tion 601(b) of the Children’s Health Insurance Program Re-
authorization Act of 2009 (Public Law 111–3) is amended 
by adding at the end the following: ‘‘The Secretary is not