152 
transfer to the Graduate Medical Education Trust Fund 
under section 9512 all funds made available, appropriated, 
or transferred to the trust fund under this section on or 
after October 1, 2014.’’. 
SEC. 314. REPORT ON TRANSITIONING PAYMENTS UNDER 
MEDICARE FOR DISPROPORTIONATE SHARE 
HOSPITALS INTO A GRANT PROGRAM. 
Not later than December 31, 2017, the Secretary of 
Health and Human Services shall submit to Congress a 
report containing recommendations on the extent to 
which— 
(1) adjustments in payments under section 
1886(d)(5)(F) of the Social Security Act for inpa-
tient hospital services furnished by disproportionate 
share hospitals should be terminated; and 
(2) instead of such adjustments described in 
paragraph (1) there should be established a grant 
program (separate from the Medicare programs 
under title XVIII of the Social Security Act) to pro-
vide disproportionate care hospitals funding for pro-
viding such services. 
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153 
SEC. 315. ONE-YEAR FREEZE FOR PHYSICIAN PAYMENT UP-
DATE; SENSE OF CONGRESS RELATING TO 
THE SUSTAINABLE GROWTH RATE (SGR). 
(a) ONE-YEAR FREEZE FOR 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: 
‘‘(14) UPDATE FOR 2013.— 
‘‘(A) IN GENERAL.—Subject to paragraphs 
(7)(B), 
(8)(B), 
(9)(B), 
(10)(B), 
(11)(B), 
(12)(B), and (13)(B), in lieu of the update to 
the single conversion factor established in para-
graph (1)(C) that would otherwise apply for 
2013, the update to the single conversion factor 
shall be zero percent. 
‘‘(B) NO
EFFECT
ON
COMPUTATION
OF 
CONVERSION
FACTOR
FOR
2014
AND
SUBSE-
QUENT
YEARS.—The conversion factor under 
this subsection shall be computed under para-
graph (1)(A) for 2014 and subsequent years as 
if subparagraph (A) had never applied.’’. 
(b) SENSE OF CONGRESS RELATING TO THE SUS-
TAINABLE GROWTH RATE (SGR).—It is the Sense of Con-
gress that the sustainable growth rate (SGR) formula 
under the Medicare physician fee schedule under section 
1848 of the Social Security Act (42 U.S.C. 1395w–4(d) 
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154 
is fundamentally flawed and that replacing such formula 
with a payment system that protects the access of seniors 
to high-quality physician care should be an urgent pri-
ority. 
SEC. 316. IMPROVEMENTS TO MSA PLANS; PERMITTING OF-
FERING OF CATASTROPHIC PLAN WITH HIGH 
DEDUCTIBLE AND CONTRIBUTION TO MSA, 
HSA, OR HIRA. 
(a) MSA PLAN MAY CHOOSE TO NOT APPLY DE-
DUCTIBLE
TO
PREVENTIVE
SERVICES.—Section 
1859(b)(3) of the Social Security Act is amended— 
(1) in subparagraph (A), by inserting ‘‘, subject 
to subparagraph (C)’’ after ‘‘plan that’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) DEDUCTIBLE
NOT
APPLICABLE
TO 
PREVENTIVE
SERVICES.—With respect to ex-
penses incurred during the first plan year be-
ginning on or after the date of the enactment 
of this subparagraph or a subsequent plan year, 
a Medicare Advantage organization offering an 
MSA plan may waive application of the deduct-
ible under this paragraph with respect to pre-
ventive care (within the meaning of section 
1871) under such plan and such waiver shall 
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155 
not affect the plan satisfying the definition 
under subparagraph (A).’’. 
(b) MA AND MSA PLANS ALLOWED TO MAKE MEDI-
CARE
ADVANTAGE
MSA 
CONTRIBUTIONS.—Section 
138(b)(2) of the Internal Revenue Code of 1986 is amend-
ed— 
(1) in subparagraph (A), by striking at the end 
‘‘or’’; 
(2) in subparagraph (B), by adding at the end 
‘‘or’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) a contribution made by a Medicare 
Advantage plan or MSA plan under part C of 
title XVIII of the Social Security Act pursuant 
to subparagraph (B) or (D) of section 
1851(a)(2) of such Act,’’. 
(c) MA PLANS OFFERED MAY INCLUDE CATA-
STROPHIC PLAN WITH HIGH DEDUCTIBLE AND MSA, 
HSA, OR HIRA CONTRIBUTION.—Section 1851(a)(2) of 
the Social Security Act (42 U.S.C. 1395w–21(a)(2)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(D) COMBINATION
CATASTROPHIC
HIGH 
DEDUCTIBLE PLAN WITH MSA, HSA, OR HIRA 
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CONTRIBUTION.—A plan offering catastrophic 
coverage with a high deductible feature (as de-
scribed in section 1882(p)(11)(B)), and a con-
tribution by such plan into a Medicare Advan-
tage medical savings account (MSA) (as defined 
in section 138(b)(2) of the Internal Revenue 
Code of 1986), a health savings account (as de-
fined in section 223(d) of the Internal Revenue 
Code of 1986), or a health individual retirement 
account established under section 503(b) of the 
Save and Strengthen Medicare Act of 2012.’’. 
SEC. 317. EXTENSION FOR SPECIALIZED MA PLANS FOR 
SPECIAL NEEDS INDIVIDUALS. 
(a) NO PERIOD LIMITATION APPLIED
FOR RE-
STRICTED ENROLLMENTS.—Section 1859(f)(1) of the So-
cial Security Act (42 U.S.C. 1395w–28(f)(1)) is amended 
by striking ‘‘and for periods before January 1, 2014’’. 
(b) PERIOD FOR MEETING APPLICABLE REQUIRE-
MENTS EXTENDED.—Section 1859(b)(6)(A) of the Social 
Security Act (42 U.S.C. 1395w–28(b)(6)(A)) is amended 
by striking ‘‘, as of January 1, 2010,’’. 
(c) EXTENSION OF AUTHORITY TO OPERATE BUT 
NO SERVICE AREA EXPANSION
FOR DUAL SPECIAL 
NEEDS PLANS THAT DO NOT MEET CERTAIN REQUIRE-
MENTS.—Section 164(c)(2) of the Medicare Improvements 
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