‘‘(2) TAXPAYER
TO
WHOM
SUBSECTION
AP-
PLIES.—This subsection shall apply to any taxpayer 
who is engaged in the trade or business of providing 
medical care other than as an employee and who 
used the cash receipts and disbursements method of 
accounting. 
‘‘(3) QUALIFIED
MEDICAL
CARE
DEBT.—For 
purposes of this subsection, the term ‘qualified med-
ical care debt’ means any debt for medical care pro-
vided by the taxpayer to a low-income individual who 
is a citizen or legal resident of the United States. 
‘‘(4) 
DETERMINATION
OF
CHARGE.—The 
amount of the taxpayer’s charge which may be taken 
into account— 
‘‘(A) shall not exceed the amount of the 
charge that would be recognized for purposes of 
title XVIII of the Social Security Act, and 
‘‘(B) shall not include any amount for 
which the taxpayer is not entitled to reimburse-
ment from the low-income individual. 
‘‘(5) LOW-INCOME INDIVIDUAL.—For purposes 
of this subsection, the term ‘low-income individual’ 
means an individual who, at the time the medical 
care attributable to the debt is provided, has an an-
nual household income below 135 percent of the pov-
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erty line (as defined in section 673 of the Commu-
nity Services Block Grant Act (42 U.S.C. 9902)) ap-
plicable to the size of the family involved, and is a 
citizen or legal resident of the United States. 
‘‘(6) MEDICAL
CARE.—For purposes of this 
subsection, the term ‘medical care’ has the meaning 
given to such term by section 213(d). 
‘‘(7) REGULATIONS.—The Secretary shall pre-
scribe such regulations as may be necessary or ap-
propriate to carry out this section, including regula-
tions providing for methods of establishing that an 
individual is a low-income individual for purposes of 
this section.’’ 
(2) EFFECTIVE DATE.—The amendment made 
by this section shall apply to taxable years beginning 
after the date of the enactment of this Act. 
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TITLE III—PROMOTING AFFORD-
ABLE PRESCRIPTION DRUGS 
BY DEFINING OBJECTIVES IN 
NEGOTIATION 
OF 
TRADE 
AGREEMENTS 
SEC. 301. PROMOTING AFFORDABLE PRESCRIPTION DRUGS 
BY DEFINING OBJECTIVES IN NEGOTIATION 
OF TRADE AGREEMENTS. 
(a) IN GENERAL.—Section 2102(a) of the Bipartisan 
Trade Promotion Authority Act of 2002 (19 U.S.C. 
3802(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(8); 
(2) by striking the period at the end of para-
graph (9) and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(10) to avoid negotiating trade agreements 
that could restrict, or be interpreted to restrict, the 
access of consumers in the United States to pharma-
ceutical imports from countries with a pharma-
ceutical infrastructure that is equivalent, or supe-
rior, to that of the United States— 
‘‘(A) by or through the use and develop-
ment of the doctrine of international patent ex-
haustion, as interpreted or applied by United 
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States courts on the date of enactment of this 
Act; or 
‘‘(B) by making it a violation for the 
United States to enact legislation permitting 
pharmaceutical imports without the consent of 
patent owners when the products involved have 
been sold outside the United States.’’. 
(b) CERTAIN PROHIBITIONS.—Notwithstanding any 
other provision of law, the United States Trade Represent-
ative— 
(1) may not enter into a bilateral or multilat-
eral trade agreement that, with respect to the impor-
tation of pharmaceutical products without the con-
sent of the patent owners, includes provisions that 
are the same or similar to the provisions of— 
(A) paragraph 2 of Article 16.7 of the 
United States-Singapore Free Trade Agree-
ment; 
(B) paragraph 4 of Article 17.9 of the 
United States-Australia Free Trade Agreement; 
or 
(C) paragraph 4 of Article 15.9 of the 
United States-Morocco Free Trade Agreement; 
and 
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(2) may not, with respect to the importation of 
pharmaceutical products without the consent of the 
patent owners, negotiate an agreement or under-
standing with respect to any of the provisions re-
ferred to in paragraph (1). 
TITLE IV—ENCOURAGING 
PREVENTATIVE CARE 
SEC. 401. ENCOURAGING PREVENTATIVE CARE. 
(a) MOBILE MAMMOGRAPHY PROMOTION.— 
(1) REFUNDS.—Section 6427 of the Internal 
Revenue Code of 1986 (relating to fuels not used for 
taxable purposes) is amended by inserting after sub-
section (f) the following new subsection: 
‘‘(g) FUELS USED IN MOBILE MAMMOGRAPHY VEHI-
CLES.—Except as provided in subsection (k), if any fuel 
on which tax was imposed by section 4041 or 4081 is used 
in any highway vehicle designed exclusively to provide mo-
bile mammography services to patients within such vehi-
cle, the Secretary shall pay (without interest) to the ulti-
mate purchaser of such fuel an amount equal to the aggre-
gate amount of the tax imposed on such fuel.’’. 
(2) EXEMPTION
FROM
RETAIL
TAX.—Section 
4041 of such Code is amended by adding at the end 
the following new subsection: 
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‘‘(n) FUELS USED IN MOBILE MAMMOGRAPHY VEHI-
CLES.—No tax shall be imposed under this section on any 
liquid sold for use in, or used in, any highway vehicle de-
signed exclusively to provide mobile mammography serv-
ices to patients within such vehicle.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section shall take effect on the date of the 
enactment of this Act. 
(b) MEDICARE LUNG CANCER EARLY DETECTION.— 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended— 
(1) in subsection (b)(1)(B), by striking ‘‘sub-
section 
(c)(1)(A)’’ 
and 
inserting 
‘‘subsections 
(c)(1)(A) and (n)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(n) PAYMENT FOR CHEST RADIOGRAPHY SERVICES 
THAT USE COMPUTER AIDED DETECTION TECHNOLOGY 
FOR THE EARLY DETECTION OF LUNG CANCER.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this part, with respect to chest radiog-
raphy services (identified as of September 1, 2006, 
by HCPCS codes 71010, 71020, 71021, 71022, and 
71030, and as subsequently modified by the Sec-
retary) furnished on or after January 1, 2010, that 
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use Computer Aided Detection technology for the 
early detection of lung cancer (as defined in para-
graph (4)), the amount of payment shall be equal 
to— 
‘‘(A) with respect to the technical compo-
nent of such services— 
‘‘(i) the amount of payment under the 
fee schedule established under section 
1848 for such component for the year that 
would otherwise apply; plus 
‘‘(ii) the amount described in para-
graph (2); and 
‘‘(B) with respect to the professional com-
ponent of such services— 
‘‘(i) the amount of payment under the 
fee schedule established under section 
1848 for such component for the year that 
would otherwise apply; plus 
‘‘(ii) the amount described in para-
graph (3). 
‘‘(2) AMOUNT
DESCRIBED
FOR
TECHNICAL 
COMPONENT.—The amount described in this para-
graph for services furnished— 
‘‘(A) during 2010 is $12; or 
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‘‘(B) during a subsequent year is the 
amount established under this paragraph for 
the preceding year, increased by the update de-
termined under section 1848(d) for the year. 
‘‘(3) AMOUNT DESCRIBED FOR PROFESSIONAL 
COMPONENT.—The amount described in this para-
graph for services furnished— 
‘‘(A) during 2010 is $4; and 
‘‘(B) during a subsequent year is the 
amount established under this paragraph for 
the preceding year increased by the update de-
termined under section 1848(d) for the year. 
‘‘(4) COMPUTER
AIDED
DETECTION
TECH-
NOLOGY FOR THE EARLY DETECTION OF LUNG CAN-
CER DEFINED.—In this subsection, the term ‘Com-
puter Aided Detection technology for the early detec-
tion of lung cancer’ means a computer software 
technology which allows for the production of a dig-
ital chest x-ray image or the conversion of a chest 
x-ray into a digital image to be subsequently ana-
lyzed for early lung cancer nodules and which the 
Food and Drug Administration has granted approval 
or clearance. 
‘‘(5) NEW CODES.—The Secretary shall estab-
lish new codes for chest radiography services de-
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scribed in paragraph (1) in order to implement this 
subsection.’’. 
(c) VETERANS TRAVEL TAX RELIEF.— 
(1) IN GENERAL.—Part VII of subchapter B of 
chapter I of the Internal Revenue Code of 1986 (re-
lating to additional itemized deductions for individ-
uals) is amended by redesignating section 224 as 
section 225, and by inserting after section 223 the 
following new section: 
‘‘SEC. 224. TRAVEL EXPENSES OF VETERANS FOR HEALTH 
CARE AT MEDICAL CENTERS OF THE DE-
PARTMENT OF VETERANS AFFAIRS. 
‘‘(a) ALLOWANCE OF DEDUCTION.—In the case of an 
individual, there shall be allowed as a deduction the quali-
fied travel expenses for the taxable year. 
‘‘(b) LIMITATIONS.— 
‘‘(1) DOLLAR
LIMITATION.—The amount al-
lowed as a deduction under subsection (a) for a tax-
able year shall not exceed $400. 
‘‘(2) LIMITATION BASED ON ADJUSTED GROSS 
INCOME.—The amount allowable as a deduction 
under subsection (a) shall be reduced (but not below 
zero) by an amount which bears the same ratio to 
the amount so allowable (determined without regard 
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to this paragraph but with regard to paragraph (1)) 
as— 
‘‘(A) the amount (if any) by which the tax-
payer’s adjusted gross income exceeds $75,000 
($150,000 in the case of a joint return), bears 
to 
‘‘(B) $10,000 ($20,000 in the case of a 
joint return). 
‘‘(3) ADJUSTMENTS
FOR
INFLATION.—In the 
case of a taxable year beginning after 2009, each of 
the dollar amounts in paragraph (2) shall be in-
creased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year in which the taxable year begins, deter-
mined by substituting ‘calendar year 2008’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $100, such amount shall 
be rounded to the nearest multiple of $100. 
‘‘(c) QUALIFIED TRAVEL EXPENSES.—For purposes 
of this section— 
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‘‘(1) IN GENERAL.—The term ‘qualified travel 
expenses’ means amounts paid for travel expenses of 
a veteran and a family member of the veteran to a 
medical center of the Department of Veterans Af-
fairs for— 
‘‘(A) treatment relating to a service-con-
nected disability, or 
‘‘(B) examination conducted by the Sec-
retary of Veterans Affairs relating to a claim 
for disability compensation or pension under 
the laws administered by the Secretary of Vet-
erans Affairs. 
‘‘(2) REIMBURSEMENTS
BY
DEPARTMENT
OF 
VETERANS AFFAIRS.—The term ‘qualified travel ex-
penses’ does not include any travel expense which is 
reimbursed by the Department of Veterans Affairs 
or any other insurance plan. 
‘‘(3) LIMITATION.—Travel expenses incurred by 
a veteran shall not be taken into account under 
paragraph (1) unless— 
‘‘(A) the principal place of abode of the 
veteran is more than 25 miles from the medical 
center in which the treatment is provided or ex-
amination conducted, and 
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