‘‘(iv) 
COVERED
DOCUMENT
DE-
FINED.—In this subparagraph, the term 
‘covered document’ means a financial, tax, 
or other document required to be sub-
mitted by a bidder as part of an original 
bid submission under a competitive acqui-
sition program in order to meet required 
financial standards. Such term does not in-
clude other documents, such as the bid 
itself or accreditation documentation.’’; 
and 
(B) in paragraph (2)(A), by inserting be-
fore the period at the end the following: ‘‘and 
excluding certain complex rehabilitative power 
wheelchairs recognized by the Secretary as clas-
sified within group 3 or higher (and related ac-
cessories when furnished in connection with 
such wheelchairs)’’. 
(2) BUDGET NEUTRAL OFFSET.— 
(A) IN GENERAL.—Section 1834(a)(14) of 
such Act (42 U.S.C. 1395m(a)(14)) is amend-
ed— 
(i) by striking ‘‘and’’ at the end of 
subparagraphs (H) and (I); 
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(ii) by redesignating subparagraph (J) 
as subparagraph (M); and 
(iii) by inserting after subparagraph 
(I) the following new subparagraphs: 
‘‘(J) for 2009— 
‘‘(i) in the case of items and services 
furnished in any geographic area, if such 
items or services were selected for competi-
tive acquisition in any area under the com-
petitive acquisition program under section 
1847(a)(1)(B)(i)(I) before July 1, 2008, 
including diabetic supplies but only if fur-
nished through mail order, - 9.5 percent; 
or 
‘‘(ii) in the case of other items and 
services, the percentage increase in the 
consumer price index for all urban con-
sumers (U.S. urban average) for the 12- 
month period ending with June 2008; 
‘‘(K) for 2010, 2011, 2012, and 2013, the 
percentage increase in the consumer price index 
for all urban consumers (U.S. urban average) 
for the 12-month period ending with June of 
the previous year; 
‘‘(L) for 2014— 
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‘‘(i) in the case of items and services 
described in subparagraph (J)(i) for which 
a payment adjustment has not been made 
under subsection (a)(1)(F)(ii) in any pre-
vious year, the percentage increase in the 
consumer price index for all urban con-
sumers (U.S. urban average) for the 12- 
month period ending with June 2013, plus 
2.0 percentage points; or 
‘‘(ii) in the case of other items and 
services, the percentage increase in the 
consumer price index for all urban con-
sumers (U.S. urban average) for the 12- 
month period ending with June 2013; 
and’’. 
(B) CONFORMING TREATMENT FOR CER-
TAIN ITEMS AND SERVICES.—The second sen-
tence of section 1842(s)(1) of such Act (42 
U.S.C. 1395u(s)(1)) is amended by striking 
‘‘except that’’ and all that follows and inserting 
the following: ‘‘except that for items and serv-
ices described in paragraph (2)(D)— 
‘‘(A) for 2009 section 1834(a)(14)(J)(i) shall 
apply under this paragraph instead of the percent-
age increase otherwise applicable; and 
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‘‘(B) for 2014, if subparagraph (A) applied to 
the items and services and there has not been a pay-
ment adjustment under subsection (h)(1)(H) for the 
items and services for any previous year, the per-
centage 
increase 
computed 
under 
section 
1834(a)(14)(L)(i) shall apply instead of the percent-
age increase otherwise applicable.’’. 
(3) 
CONFORMING
DELAY.—Subsections 
(a)(1)(F) and (h)(1)(H) of section 1834 of the So-
cial Security Act (42 U.S.C. 1395m) are each 
amended by striking ‘‘January 1, 2009’’ and insert-
ing ‘‘January 1, 2011’’. 
(4) CONSIDERATIONS
IN
APPLICATION.—Sec-
tion 1834 of such Act (42 U.S.C. 1395m) is amend-
ed— 
(A) in subsection (a)(1)— 
(i) in subparagraph (F), by inserting 
‘‘subject to subparagraph (G),’’ before 
‘‘that are included’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(G) USE OF INFORMATION ON COMPETI-
TIVE BID RATES.—The Secretary shall specify 
by regulation the methodology to be used in ap-
plying the provisions of subparagraph (F)(ii) 
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and subsection (h)(1)(H)(ii). In promulgating 
such regulation, the Secretary shall consider the 
costs of items and services in areas in which 
such provisions would be applied compared to 
the payment rates for such items and services 
in competitive acquisition areas.’’; and 
(B) in subsection (h)(1)(H), by inserting 
‘‘subject to subsection (a)(1)(G),’’ before ‘‘that 
are included’’. 
(b) QUALITY STANDARDS.— 
(1) APPLICATION OF ACCREDITATION REQUIRE-
MENT.— 
(A) IN GENERAL.—Section 1834(a)(20) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(a)(20)) is amended— 
(i) in subparagraph (E), by inserting 
‘‘including 
subparagraph 
(F),’’ 
after 
‘‘under this paragraph,’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(F) APPLICATION OF ACCREDITATION RE-
QUIREMENT.—In implementing quality stand-
ards under this paragraph— 
‘‘(i) subject to clause (ii), the Sec-
retary shall require suppliers furnishing 
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items and services described in subpara-
graph (D) on or after October 1, 2009, di-
rectly or as a subcontractor for another en-
tity, to have submitted to the Secretary 
evidence of accreditation by an accredita-
tion organization designated under sub-
paragraph (B) as meeting applicable qual-
ity standards; and 
‘‘(ii) in applying such standards and 
the accreditation requirement of clause (i) 
with respect to eligible professionals (as 
defined in section 1848(k)(3)(B)), and in-
cluding such other persons, such as 
orthotists and prosthetists, as specified by 
the Secretary, furnishing such items and 
services— 
‘‘(I) such standards and accredi-
tation requirement shall not apply to 
such professionals and persons unless 
the Secretary determines that the 
standards being applied are designed 
specifically to be applied to such pro-
fessionals and persons; and 
‘‘(II) the Secretary may exempt 
such professionals and persons from 
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