HR 3162 PCS
TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS 
Subtitle A—Improvements in Benefits 
Sec. 201. Coverage and waiver of cost-sharing for preventive services. 
Sec. 202. Waiver of deductible for colorectal cancer screening tests regardless 
of coding, subsequent diagnosis, or ancillary tissue removal. 
Sec. 203. Parity for mental health coinsurance. 
Subtitle B—Improving, Clarifying, and Simplifying Financial Assistance for 
Low Income Medicare Beneficiaries 
Sec. 211. Improving assets tests for Medicare Savings Program and low-income 
subsidy program. 
Sec. 212. Making QI program permanent and expanding eligibility. 
Sec. 213. Eliminating barriers to enrollment. 
Sec. 214. Eliminating application of estate recovery. 
Sec. 215. Elimination of part D cost-sharing for certain non-institutionalized 
full-benefit dual eligible individuals. 
Sec. 216. Exemptions from income and resources for determination of eligibility 
for low-income subsidy. 
Sec. 217. Cost-sharing protections for low-income subsidy-eligible individuals. 
Sec. 218. Intelligent assignment in enrollment. 
Subtitle C—Part D Beneficiary Improvements 
Sec. 221. Including costs incurred by AIDS drug assistance programs and In-
dian Health Service in providing prescription drugs toward the 
annual out of pocket threshold under Part D. 
Sec. 222. Permitting mid-year changes in enrollment for formulary changes ad-
versely impact an enrollee. 
Sec. 223. Removal of exclusion of benzodiazepines from required coverage 
under the Medicare prescription drug program. 
Sec. 224. Permitting updating drug compendia under part D using part B up-
date process. 
Sec. 225. Codification of special protections for six protected drug classifica-
tions. 
Sec. 226. Elimination of Medicare part D late enrollment penalties paid by low- 
income subsidy-eligible individuals. 
Sec. 227. Special enrollment period for subsidy eligible individuals. 
Subtitle D—Reducing Health Disparities 
Sec. 231. Medicare data on race, ethnicity, and primary language. 
Sec. 232. Ensuring effective communication in Medicare. 
Sec. 233. Demonstration to promote access for Medicare beneficiaries with lim-
ited English proficiency by providing reimbursement for cul-
turally and linguistically appropriate services. 
Sec. 234. Demonstration to improve care to previously uninsured. 
Sec. 235. Office of the Inspector General report on compliance with and en-
forcement of national standards on culturally and linguistically 
appropriate services (CLAS) in medicare. 
Sec. 236. IOM report on impact of language access services. 
Sec. 237. Definitions. 
TITLE III—PHYSICIANS’ SERVICE PAYMENT REFORM 
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Sec. 301. Establishment of separate target growth rates for service categories. 
Sec. 302. Improving accuracy of relative values under the Medicare physician 
fee schedule. 
Sec. 303. Feedback mechanism on practice patterns. 
Sec. 304. Payments for efficient areas. 
Sec. 305. Recommendations on refining the physician fee schedule. 
Sec. 306. Improved and expanded medical home demonstration project. 
Sec. 307. Repeal of Physician Assistance and Quality Initiative Fund. 
Sec. 308. Adjustment to Medicare payment localities. 
Sec. 309. Payment for imaging services. 
Sec. 310. Reducing frequency of meetings of the Practicing Physicians Advisory 
Council. 
TITLE IV—MEDICARE ADVANTAGE REFORMS 
Subtitle A—Payment Reform 
Sec. 401. Equalizing payments between Medicare Advantage plans and fee-for- 
service Medicare. 
Subtitle B—Beneficiary Protections 
Sec. 411. NAIC development of marketing, advertising, and related protections. 
Sec. 412. Limitation on out-of-pocket costs for individual health services. 
Sec. 413. MA plan enrollment modifications. 
Sec. 414. Information for beneficiaries on MA plan administrative costs. 
Subtitle C—Quality and Other Provisions 
Sec. 421. Requiring all MA plans to meet equal standards. 
Sec. 422. Development of new quality reporting measures on racial disparities. 
Sec. 423. Strengthening audit authority. 
Sec. 424. Improving risk adjustment for MA payments. 
Sec. 425. Eliminating special treatment of private fee-for-service plans. 
Sec. 426. Renaming of Medicare Advantage program. 
Subtitle D—Extension of Authorities 
Sec. 431. Extension and revision of authority for special needs plans (SNPs). 
Sec. 432. Extension and revision of authority for Medicare reasonable cost con-
tracts. 
TITLE V—PROVISIONS RELATING TO MEDICARE PART A 
Sec. 501. Inpatient hospital payment updates. 
Sec. 502. Payment for inpatient rehabilitation facility (IRF) services. 
Sec. 503. Long-term care hospitals. 
Sec. 504. Increasing the DSH adjustment cap. 
Sec. 505. PPS-exempt cancer hospitals. 
Sec. 506. Skilled nursing facility payment update. 
Sec. 507. Revocation of unique deeming authority of the Joint Commission for 
the Accreditation of Healthcare Organizations. 
Sec. 508. Treatment of Medicare hospital reclassifications. 
Sec. 509. Medicare critical access hospital designations. 
TITLE VI—OTHER PROVISIONS RELATING TO MEDICARE PART B 
Subtitle A—Payment and Coverage Improvements 
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Sec. 601. Payment for therapy services. 
Sec. 602. Medicare separate definition of outpatient speech-language pathology 
services. 
Sec. 603. Increased reimbursement rate for certified nurse-midwives. 
Sec. 604. Adjustment in outpatient hospital fee schedule increase factor. 
Sec. 605. Exception to 60-day limit on Medicare substitute billing arrange-
ments in case of physicians ordered to active duty in the 
Armed Forces. 
Sec. 606. Excluding clinical social worker services from coverage under the 
medicare skilled nursing facility prospective payment system 
and consolidated payment. 
Sec. 607. Coverage of marriage and family therapist services and mental health 
counselor services. 
Sec. 608. Rental and purchase of power-driven wheelchairs. 
Sec. 609. Rental and purchase of oxygen equipment. 
Sec. 610. Adjustment for Medicare mental health services. 
Sec. 611. Extension of brachytherapy special rule. 
Sec. 612. Payment for part B drugs. 
Subtitle B—Extension of Medicare Rural Access Protections 
Sec. 621. 2-year extension of floor on medicare work geographic adjustment. 
Sec. 622. 2-year extension of special treatment of certain physician pathology 
services under Medicare. 
Sec. 623. 2-year extension of medicare reasonable costs payments for certain 
clinical diagnostic laboratory tests furnished to hospital pa-
tients in certain rural areas. 
Sec. 624. 2-year extension of Medicare incentive payment program for physi-
cian scarcity areas. 
Sec. 625. 2-year extension of medicare increase payments for ground ambu-
lance services in rural areas. 
Sec. 626. Extending hold harmless for small rural hospitals under the HOPD 
prospective payment system. 
Subtitle C—End Stage Renal Disease Program 
Sec. 631. Chronic kidney disease demonstration projects. 
Sec. 632. Medicare coverage of kidney disease patient education services. 
Sec. 633. Required training for patient care dialysis technicians. 
Sec. 634. MedPAC report on treatment modalities for patients with kidney fail-
ure. 
Sec. 635. Adjustment for erythropoietin stimulating agents (ESAs). 
Sec. 636. Site neutral composite rate. 
Sec. 637. Development of ESRD bundling system and quality incentive pay-
ments. 
Sec. 638. MedPAC report on ESRD bundling system. 
Sec. 639. OIG study and report on erythropoietin. 
Subtitle D—Miscellaneous 
Sec. 651. Limitation on exception to the prohibition on certain physician refer-
rals for hospitals. 
TITLE VII—PROVISIONS RELATING TO MEDICARE PARTS A AND 
B 
Sec. 701. Home health payment update for 2008. 
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