H. R. 4994—4 
SEC. 107. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL 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’’. 
SEC. 109. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS 
FOR CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS 
FURNISHED TO HOSPITAL PATIENTS IN CERTAIN RURAL 
AREAS. 
Section 416(b) of the Medicare Prescription Drug, Improvement, 
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 ‘‘December 2011’’. 
(b) EXTENDING TOTAL AMOUNT AVAILABLE FOR ALLOCATION.— 
Section 1933(g) of such Act (42 U.S.C. 1396u-3(g)) is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘and’’ at the end of subparagraph (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 subpara-
graphs: 
‘‘(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)’’.
H. R. 4994—5 
SEC. 111. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA). 
Sections 1902(e)(1)(B) and 1925(f) of the Social Security 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 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
INDIANS.—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 DISABLED TRICARE BENE-
FICIARIES. 
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 DISTRIBU-
TION 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 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 defined 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 applicable resident limit.’’. 
SEC. 204. CONTINUED INCLUSION OF ORPHAN DRUGS IN DEFINITION 
OF COVERED OUTPATIENT DRUGS WITH RESPECT TO 
CHILDREN’S HOSPITALS 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 described in subparagraph (M)’’ and 
inserting ‘‘covered entities described in subparagraph (M) (other 
than a children’s hospital described in subparagraph (M))’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall take effect as if included in the enactment of section
H. R. 4994—6 
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 subparagraph and inserting a period. 
SEC. 205. MEDICAID AND CHIP TECHNICAL CORRECTIONS. 
(a) REPEAL OF EXCLUSION OF CERTAIN INDIVIDUALS AND ENTI-
TIES 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 January 1, 2014, 133 percent)’’. 
(c) CALCULATION AND PUBLICATION OF PAYMENT ERROR RATE 
MEASUREMENT FOR CERTAIN YEARS.—Section 601(b) of the Chil-
dren’s Health Insurance Program Reauthorization Act of 2009 
(Public Law 111–3) is amended by adding at the end the following: 
‘‘The Secretary is not required under this subsection to calculate 
or publish a national or a State-specific error rate for fiscal year 
2009 or fiscal year 2010.’’. 
(d) CORRECTIONS TO EXCEPTIONS TO EXCLUSION OF CHILDREN 
OF CERTAIN EMPLOYEES.—Section 2110(b)(6) of the Social Security 
Act (42 U.S.C. 1397jj(b)(6)) is amended— 
(1) in subparagraph (B)— 
(A) by striking ‘‘PER PERSON’’ in the heading; and 
(B) 
by 
striking 
‘‘each 
employee’’ 
and 
inserting 
‘‘employees’’; and 
(2) in subparagraph (C), by striking ‘‘, on a case-by-case 
basis,’’. 
(e) ELECTRONIC HEALTH RECORDS.—Effective as if included in 
the enactment of section 4201(a)(2) of the American Recovery and 
Reinvestment Act of 2009 (Public Law 111–5), section 1903(t) of 
the Social Security Act (42 U.S.C. 1396b(t)) is amended— 
(1) in paragraph (3)(E), by striking ‘‘reduced by any pay-
ment that is made to such Medicaid provider from any other 
source (other than under this subsection or by a State or 
local government)’’ and inserting ‘‘reduced by the average pay-
ment the Secretary estimates will be made to such Medicaid 
providers (determined on a percentage or other basis for such 
classes or types of providers as the Secretary may specify) 
from other sources (other than under this subsection, or by 
the Federal government or a State or local government)’’; and 
(2) in paragraph (6)(B), by inserting before the period the 
following: ‘‘and shall be determined to have met such responsi-
bility to the extent that the payment to the Medicaid provider 
is not in excess of 85 percent of the net average allowable 
cost’’. 
(f) CORRECTIONS OF DESIGNATIONS.— 
(1) Section 1902 of the Social Security Act (42 U.S.C. 1396a) 
is amended— 
(A) in subsection (a)(10), in the matter following 
subparagraph (G), by striking ‘‘and’’ before ‘‘(XVI) the med-
ical’’ and by striking ‘‘(XVI) if’’ and inserting ‘‘(XVII) if’’; 
(B) in subsection (a)(23), by striking ‘‘(ii)’’ and inserting 
‘‘(kk)’’;
H. R. 4994—7 
(C) in subsection (a)(77), by striking ‘‘(ii)’’ and inserting 
‘‘(kk)’’; 
(D) in subsection (ii)(2), as added by section 2303(a)(2) 
of Public Law 111–148, by striking ‘‘(XV)’’ and inserting 
‘‘(XVI)’’; and 
(E) by redesignating subsection (ii), as added by section 
6401(b)(1)(B) of Public Law 111–148, as subsection (kk) 
and transferring such subsection so as to appear after 
subsection (jj) of that section. 
(2) Section 2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended— 
(A) in subparagraph (D), as added by section 6401(c) 
of Public Law 111–148, by striking ‘‘(ii)’’ and inserting 
‘‘(kk)’’; and 
(B) by redesignating the subparagraph (N) of that sec-
tion added by 2101(e) of Public Law 111–148 as subpara-
graph (O). 
SEC. 206. FUNDING FOR CLAIMS REPROCESSING. 
For purposes of carrying out the provisions of, and amendments 
made by, this Act that relate to title XVIII of the Social Security 
Act, and other provisions of, or relating to, such title that ensure 
appropriate payment of claims, there are appropriated to the Sec-
retary of Health and Human Services for the Centers for Medicare 
& Medicaid Services Program Management Account, from amounts 
in the general fund of the Treasury not otherwise appropriated, 
$200,000,000. Amounts appropriated under the preceding sentence 
shall be in addition to any other funds available for such purposes, 
shall remain available until expended, and shall not be used to 
implement changes to title XVIII of the Social Security Act made 
by Public Laws 111-148 and 111-152. 
SEC. 207. REVISION TO THE MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1)(B) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)(B)) is amended by striking ‘‘$550,000,000’’ and 
inserting ‘‘$275,000,000’’. 
SEC. 208. LIMITATIONS ON AGGREGATE AMOUNT RECOVERED ON REC-
ONCILIATION OF THE HEALTH INSURANCE TAX CREDIT 
AND THE ADVANCE OF THAT CREDIT. 
(a) IN GENERAL.—So much of section 36B(f)(2)(B) of the Internal 
Revenue Code of 1986 as precedes clause (ii) thereof is amended 
to read as follows: 
‘‘(B) LIMITATION ON INCREASE.— 
‘‘(i) IN GENERAL.—In the case of a taxpayer whose 
household income is less than 500 percent of the pov-
erty line for the size of the family involved for the 
taxable year, the amount of the increase under 
subparagraph (A) shall in no event exceed the 
applicable dollar amount determined in accordance 
with the following table (one-half of such amount in 
the case of a taxpayer whose tax is determined under 
section 1(c) for the taxable year):
H. R. 4994—8 
‘‘If the household income (expressed as a 
percent of poverty line) is: 
The applicable dollar 
amount is: 
Less than 200% ..............................................
$600 
At least 200% but less than 250% ...............
$1,000 
At least 250% but less than 300% ...............
$1,500 
At least 300% but less than 350% ...............
$2,000 
At least 350% but less than 400% ...............
$2,500 
At least 400% but less than 450% ...............
$3,000 
At least 450% but less than 500% ...............
$3,500’’. 
(b) CONFORMING AMENDMENT.—Section 36B(f)(2)(B)(ii) of such 
Code is amended by inserting ‘‘in the table contained’’ after ‘‘each 
of the dollar amounts’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to taxable years beginning after December 31, 2013. 
SEC. 209. DETERMINATION OF BUDGETARY EFFECTS. 
(a) IN GENERAL.—The budgetary effects of this Act, for the 
purpose of complying with the Statutory Pay-As-You-Go Act of 
2010, shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this Act, sub-
mitted for printing in the Congressional Record by the Chairman 
of the Senate Budget Committee, provided that such statement 
has been submitted prior to the vote on passage. 
(b) EMERGENCY DESIGNATION FOR CONGRESSIONAL ENFORCE-
MENT.—In the House of Representatives, this Act, with the excep-
tion of section 101, is designated as an emergency for purposes 
of pay-as-you-go principles. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.