II 
113TH CONGRESS 
2D SESSION 
H. R. 4302 
IN THE SENATE OF THE UNITED STATES 
MARCH 27, 2014 
Received 
AN ACT 
To amend the Social Security Act to extend Medicare pay-
ments to physicians and other provisions of the Medicare 
and Medicaid programs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Protecting Access to Medicare Act of 2014’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICARE EXTENDERS 
Sec. 101. Physician payment update. 
Sec. 102. Extension of work GPCI floor. 
Sec. 103. Extension of therapy cap exceptions process. 
Sec. 104. Extension of ambulance add-ons. 
Sec. 105. Extension of increased inpatient hospital payment adjustment for cer-
tain low-volume hospitals. 
Sec. 106. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 107. Extension for specialized Medicare Advantage plans for special needs 
individuals. 
Sec. 108. Extension of Medicare reasonable cost contracts. 
Sec. 109. Extension of funding for quality measure endorsement, input, and se-
lection. 
Sec. 110. Extension of funding outreach and assistance for low-income pro-
grams. 
Sec. 111. Extension of two-midnight rule. 
Sec. 112. Technical changes to Medicare LTCH amendments. 
TITLE II—OTHER HEALTH PROVISIONS 
Sec. 201. Extension of the qualifying individual (QI) program. 
Sec. 202. Temporary extension of transitional medical assistance (TMA). 
Sec. 203. Extension of Medicaid and CHIP express lane option. 
Sec. 204. Extension of special diabetes program for type I diabetes and for In-
dians. 
Sec. 205. Extension of abstinence education. 
Sec. 206. Extension of personal responsibility education program (PREP). 
Sec. 207. Extension of funding for family-to-family health information centers. 
Sec. 208. Extension of health workforce demonstration project for low-income 
individuals. 
Sec. 209. Extension of maternal, infant, and early childhood home visiting pro-
grams. 
Sec. 210. Pediatric quality measures. 
Sec. 211. Delay of effective date for Medicaid amendments relating to bene-
ficiary liability settlements. 
Sec. 212. Delay in transition from ICD–9 TO ICD–10 code sets. 
Sec. 213. Elimination of limitation on deductibles for employer-sponsored 
health plans. 
Sec. 214. GAO report on the Children’s Hospital Graduate Medical Education 
Program. 
Sec. 215. Skilled nursing facility value-based purchasing. 
Sec. 216. Improving Medicare policies for clinical diagnostic laboratory tests. 
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Sec. 217. Revisions under the Medicare ESRD prospective payment system. 
Sec. 218. Quality incentives for computed tomography diagnostic imaging and 
promoting evidence-based care. 
Sec. 219. Using funding from Transitional Fund for Sustainable Growth Rate 
(SGR) Reform. 
Sec. 220. Ensuring accurate valuation of services under the physician fee 
schedule. 
Sec. 221. Medicaid DSH. 
Sec. 222. Realignment of the Medicare sequester for fiscal year 2024. 
Sec. 223. Demonstration programs to improve community mental health serv-
ices. 
Sec. 224. Assisted outpatient treatment grant program for individuals with se-
rious mental illness. 
Sec. 225. Exclusion from PAYGO scorecards. 
TITLE I—MEDICARE EXTENDERS 
SEC. 101. PHYSICIAN PAYMENT UPDATE. 
Section 1848(d) of the Social Security Act (42 U.S.C. 
1395w–4(d)) is amended— 
(1) in paragraph (15)— 
(A) in the heading, by striking ‘‘JANUARY 
THROUGH MARCH OF’’; 
(B) in subparagraph (A), by striking ‘‘for 
the period beginning on January 1, 2014, and 
ending on March 31, 2014’’; and 
(C) in subparagraph (B)— 
(i) in the heading, by striking ‘‘RE-
MAINING PORTION OF 2014 AND’’; and 
(ii) by striking ‘‘the period beginning 
on April 1, 2014, and ending on December 
31, 2014, and for’’; and 
(2) by adding at the end the following new 
paragraph: 
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‘‘(16) UPDATE FOR JANUARY THROUGH MARCH 
OF 2015.— 
‘‘(A) IN GENERAL.—Subject to paragraphs 
(7)(B), 
(8)(B), 
(9)(B), 
(10)(B), 
(11)(B), 
(12)(B), (13)(B), (14)(B), and (15)(B), in lieu 
of the update to the single conversion factor es-
tablished in paragraph (1)(C) that would other-
wise apply for 2015 for the period beginning on 
January 1, 2015, and ending on March 31, 
2015, the update to the single conversion factor 
shall be 0.0 percent. 
‘‘(B) NO
EFFECT
ON
COMPUTATION
OF 
CONVERSION FACTOR FOR REMAINING PORTION 
OF 2015 AND SUBSEQUENT YEARS.—The con-
version factor under this subsection shall be 
computed under paragraph (1)(A) for the pe-
riod beginning on April 1, 2015, and ending on 
December 31, 2015, and for 2016 and subse-
quent years as if subparagraph (A) had never 
applied.’’. 
SEC. 102. EXTENSION OF WORK GPCI FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘April 
1, 2014’’ and inserting ‘‘April 1, 2015’’. 
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SEC. 103. EXTENSION OF THERAPY CAP EXCEPTIONS PROC-
ESS. 
Section 1833(g) of the Social Security Act (42 U.S.C. 
1395l(g)) is amended— 
(1) in paragraph (5)(A), in the first sentence, 
by striking ‘‘March 31, 2014’’ and inserting ‘‘March 
31, 2015’’; and 
(2) in paragraph (6)(A)— 
(A) by striking ‘‘March 31, 2014’’ and in-
serting ‘‘March 31, 2015’’; and 
(B) by striking ‘‘2012, 2013, or the first 
three months of 2014’’ and inserting ‘‘2012, 
2013, 2014, or the first three months of 2015’’. 
SEC. 104. 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 by striking ‘‘April 1, 2014’’ and inserting 
‘‘April 1, 2015’’ each place it appears. 
(b) SUPER RURAL GROUND AMBULANCE.—Section 
1834(l)(12)(A) of the Social Security Act (42 U.S.C. 
1395m(l)(12)(A)) is amended, in the first sentence, by 
striking ‘‘April 1, 2014’’ and inserting ‘‘April 1, 2015’’. 
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SEC. 105. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
Section 1886(d)(12) of the Social Security Act (42 
U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘in the portion of fiscal 
year 2014 beginning on April 1, 2014, fiscal year 
2015, and subsequent fiscal years’’ and inserting ‘‘in 
fiscal year 2015 (beginning on April 1, 2015), fiscal 
year 2016, and subsequent fiscal years’’; 
(2) in subparagraph (C)(i), by striking ‘‘fiscal 
years 2011, 2012, and 2013, and the portion of fis-
cal year 2014 before’’ and inserting ‘‘fiscal years 
2011 through 2014 and fiscal year 2015 (before 
April 1, 2015),’’ each place it appears; and 
(3) in subparagraph (D), by striking ‘‘fiscal 
years 2011, 2012, and 2013, and the portion of fis-
cal year 2014 before April 1, 2014,’’ and inserting 
‘‘fiscal years 2011 through 2014 and fiscal year 
2015 (before April 1, 2015),’’. 
SEC. 106. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
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SEC. 107. EXTENSION FOR SPECIALIZED MEDICARE ADVAN-
TAGE PLANS FOR SPECIAL NEEDS INDIVID-
UALS. 
Section 1859(f)(1) of the Social Security Act (42 
U.S.C. 1395w–28(f)(1)) is amended by striking ‘‘2016’’ 
and inserting ‘‘2017’’. 
SEC. 108. EXTENSION OF MEDICARE REASONABLE COST 
CONTRACTS. 
Section 1876(h)(5)(C)(ii) of the Social Security Act 
(42 U.S.C. 1395mm(h)(5)(C)(ii)) is amended, in the mat-
ter preceding subclause (I), by striking ‘‘January 1, 2015’’ 
and inserting ‘‘January 1, 2016’’. 
SEC. 109. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d) of the Social Security Act (42 U.S.C. 
1395aaa(d)) is amended— 
(1) by inserting ‘‘(1)’’ before ‘‘For purposes’’; 
and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) For purposes of carrying out this section and 
section 1890A (other than subsections (e) and (f)), the 
Secretary shall provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under section 1817 and 
the Federal Supplementary Medical Insurance Trust 
Fund under section 1841, in such proportion as the Sec-
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retary determines appropriate, to the Centers for Medicare 
& Medicaid Services Program Management Account of 
$5,000,000 for fiscal year 2014 and $15,000,000 for the 
first 6 months of fiscal year 2015. Amounts transferred 
under the preceding sentence shall remain available until 
expended.’’. 
SEC. 110. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH IN-
SURANCE PROGRAMS.—Subsection (a)(1)(B) of section 
119 of the Medicare Improvements for Patients and Pro-
viders Act of 2008 (42 U.S.C. 1395b–3 note), as amended 
by section 3306 of the Patient Protection and Affordable 
Care Act Public Law 111–148), section 610 of the Amer-
ican Taxpayer Relief Act of 2012 (Public Law 112–240), 
and section 1110 of the Pathway for SGR Reform Act 
of 2013 (Public Law 113–67), is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
(2) by striking clause (iv); and 
(3) by adding at the end the following new 
clauses: 
‘‘(iv) 
for 
fiscal 
year 
2014, 
of 
$7,500,000; and 
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‘‘(v) for the portion of fiscal year 
2015 
before 
April 
1, 
2015, 
of 
$3,750,000.’’. 
(b) ADDITIONAL FUNDING FOR AREA AGENCIES ON 
AGING.—Subsection (b)(1)(B) of such section 119, as so 
amended, is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
(2) by striking clause (iv); and 
(3) by inserting after clause (iii) the following 
new clauses: 
‘‘(iv) 
for 
fiscal 
year 
2014, 
of 
$7,500,000; and 
‘‘(v) for the portion of fiscal year 
2015 
before 
April 
1, 
2015, 
of 
$3,750,000.’’. 
(c) ADDITIONAL FUNDING
FOR AGING
AND DIS-
ABILITY RESOURCE CENTERS.—Subsection (c)(1)(B) of 
such section 119, as so amended, is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
(2) by striking clause (iv); and 
(3) by inserting after clause (iii) the following 
new clauses: 
‘‘(iv) 
for 
fiscal 
year 
2014, 
of 
$5,000,000; and 
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‘‘(v) for the portion of fiscal year 
2015 
before 
April 
1, 
2015, 
of 
$2,500,000.’’. 
(d) ADDITIONAL FUNDING
FOR CONTRACT WITH 
THE NATIONAL CENTER FOR BENEFITS AND OUTREACH 
ENROLLMENT.—Subsection (d)(2) of such section 119, as 
so amended, is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
(2) by striking clause (iv); and 
(3) by inserting after clause (iii) the following 
new clauses: 
‘‘(iv) 
for 
fiscal 
year 
2014, 
of 
$5,000,000; and 
‘‘(v) for the portion of fiscal year 
2015 
before 
April 
1, 
2015, 
of 
$2,500,000.’’. 
SEC. 111. EXTENSION OF TWO-MIDNIGHT RULE. 
(a) CONTINUATION OF CERTAIN MEDICAL REVIEW 
ACTIVITIES.—The Secretary of Health and Human Serv-
ices may continue medical review activities described in 
the notice entitled ‘‘Selecting Hospital Claims for Patient 
Status Reviews: Admissions On or After October 1, 
2013’’, posted on the Internet website of the Centers for 
Medicare & Medicaid Services, through the first 6 months 
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of fiscal year 2015 for such additional hospital claims as 
the Secretary determines appropriate. 
(b) LIMITATION.—The Secretary of Health and 
Human Services shall not conduct patient status reviews 
(as described in such notice) on a post-payment review 
basis through recovery audit contractors under section 
1893(h) of the Social Security Act (42 U.S.C. 
1395ddd(h)) for inpatient claims with dates of admission 
October 1, 2013, through March 31, 2015, unless there 
is evidence of systematic gaming, fraud, abuse, or delays 
in the provision of care by a provider of services (as de-
fined in section 1861(u) of such Act (42 U.S.C. 
1395x(u))). 
SEC. 112. TECHNICAL CHANGES TO MEDICARE LTCH 
AMENDMENTS. 
(a) IN GENERAL.—Subclauses (I) and (II) of section 
1886(m)(6)(C)(iv) of the Social Security Act (42 U.S.C. 
1395ww(m)(6)(C)(iv)) are each amended by striking ‘‘dis-
charges’’ and inserting ‘‘Medicare fee-for-service dis-
charges’’. 
(b) MMSEA CORRECTION.—Section 114(d) of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 
(42 U.S.C. 1395ww note), as amended by sections 3106(b) 
and 10312(b) of Public Law 111–148 and by section 
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1206(b)(2) of the Pathway for SGR Reform Act of 2013 
(division B of Public Law 113–67), is amended— 
(1) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘January 1, 2015,’’ 
and inserting ‘‘on the date of the enactment of para-
graph (7) of this subsection’’; 
(2) in paragraph (6), by striking ‘‘January 1, 
2015,’’ and inserting ‘‘on the date of the enactment 
of paragraph (7) of this subsection’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(7) ADDITIONAL
EXCEPTION
FOR
CERTAIN 
LONG-TERM
CARE
HOSPITALS.—The moratorium 
under paragraph (1)(A) shall not apply to a long- 
term care hospital that— 
‘‘(A) began its qualifying period for pay-
ment as a long-term care hospital under section 
412.23(e) of title 42, Code of Federal Regula-
tions, on or before the date of enactment of this 
paragraph; 
‘‘(B) has a binding written agreement as 
of the date of the enactment of this paragraph 
with an outside, unrelated party for the actual 
construction, renovation, lease, or demolition 
for a long-term care hospital, and has ex-
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