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(II) by inserting ‘‘or otherwise ap-
plied for such year’’ after ‘‘applied 
under subsection (a)’’; and 
(ii) in subparagraph (B)— 
(I) by inserting ‘‘(i)’’ after ‘‘(B)’’; 
(II) by striking ‘‘or decrease’’; 
(III) by striking the period at the 
end and inserting ‘‘; and’’; and 
(IV) by adding at the end the fol-
lowing: 
‘‘(ii) make an additional adjustment to the 
standardized 
amounts 
under 
such 
section 
1886(d) based upon the Secretary’s estimates for 
discharges occurring only during fiscal years 
2014, 2015, 2016, and 2017 to fully offset 
$11,000,000,000 (which represents the amount of 
the increase in aggregate payments from fiscal 
years 2008 through 2013 for which an adjust-
ment was not previously applied).’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (A), by inserting 
before the semicolon the following: ‘‘or af-
fecting the Secretary’s authority under such 
paragraph to apply a prospective adjust-
ment to offset aggregate additional pay-
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† HR 8 EAS 
ments related to documentation and coding 
improvements made with respect to dis-
charges during fiscal year 2010’’; and 
(ii) in subparagraph (B), by striking 
‘‘and 2012’’ and inserting ‘‘2012, 2014, 
2015, 2016, and 2017’’. 
SEC. 632. REVISIONS TO THE MEDICARE ESRD BUNDLED 
PAYMENT SYSTEM TO REFLECT FINDINGS IN 
THE GAO REPORT. 
(a) ADJUSTMENT TO ESRD BUNDLED PAYMENT RATE 
TO ACCOUNT FOR CHANGES IN THE UTILIZATION OF CER-
TAIN DRUGS AND BIOLOGICALS.—Section 1881(b)(14) of 
the Social Security Act (42 U.S.C. 1395rr(b)(14)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(I) For services furnished on or after January 1, 
2014, the Secretary shall, by comparing per patient utiliza-
tion data from 2007 with such data from 2012, make reduc-
tions to the single payment that would otherwise apply 
under this paragraph for renal dialysis services to reflect 
the Secretary’s estimate of the change in the utilization of 
drugs and biologicals described in clauses (ii), (iii), and 
(iv) of subparagraph (B) (other than oral-only ESRD-re-
lated drugs, as such term is used in the final rule promul-
gated by the Secretary in the Federal Register on August
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† HR 8 EAS 
12, 2010 (75 Fed. Reg. 49030)). In making reductions 
under the preceding sentence, the Secretary shall take into 
account the most recently available data on average sales 
prices and changes in prices for drugs and biological re-
flected in the ESRD market basket percentage increase fac-
tor under subparagraph (F).’’. 
(b) TWO-YEAR DELAY OF IMPLEMENTATION OF ORAL- 
ONLY ESRD-RELATED DRUGS IN THE ESRD PROSPEC-
TIVE PAYMENT SYSTEM; MONITORING.— 
(1) DELAY.—The Secretary of Health and 
Human Services may not implement the policy under 
section 413.174(f)(6) of title 42, Code of Federal Reg-
ulations (relating to oral-only ESRD-related drugs in 
the ESRD prospective payment system), prior to 
January 1, 2016. 
(2) MONITORING.—With respect to the imple-
mentation of oral-only ESRD-related drugs in the 
ESRD prospective payment system under subsection 
(b)(14) of section 1881 of the Social Security Act (42 
U.S.C. 1395rr(b)(14)), the Secretary of Health and 
Human Services shall monitor the bone and mineral 
metabolism of individuals with end stage renal dis-
ease.
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† HR 8 EAS 
(c) ANALYSIS
OF
CASE
MIX
PAYMENT
ADJUST-
MENTS.—By not later than January 1, 2016, the Secretary 
of Health and Human Services shall— 
(1) conduct an analysis of the case mix payment 
adjustments 
being 
used 
under 
section 
1881(b)(14)(D)(i) of the Social Security Act (42 
U.S.C. 1395rr(b)(14)(D)(i)); and 
(2) make appropriate revisions to such case mix 
payment adjustments. 
(d) UPDATED GAO REPORT.—Not later than Decem-
ber 31, 2015, the Comptroller General of the United States 
shall submit to Congress a report that updates the report 
submitted to Congress under section 10336 of the Patient 
Protection and Affordable Care Act (Public Law 111–148; 
124 Stat. 974). The updated report shall include an anal-
ysis of how the Secretary of Health and Human Services 
has addressed points raised in the report submitted under 
such section 10336 with respect to the Secretary’s prepara-
tions to implement payment for oral-only ESRD-related 
drugs in the bundled prospective payment system under sec-
tion 1881(b)(14) of the Social Security Act (42 U.S.C. 
1395rr(b)(14)).
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SEC. 633. TREATMENT OF MULTIPLE SERVICE PAYMENT 
POLICIES FOR THERAPY SERVICES. 
(a) SERVICES FURNISHED BY PHYSICIANS AND CER-
TAIN OTHER PROVIDERS.—Section 1848(b)(7) of the Social 
Security Act (42 U.S.C. 1395w–4(b)(7)) is amended— 
(1) by striking ‘‘2011,’’ and inserting ‘‘2011, and 
before April 1, 2013,’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘In the case of such services furnished on or 
after April 1, 2013, and for which payment is made 
under such fee schedules, instead of the 25 percent 
multiple procedure payment reduction specified in 
such final rule, the reduction percentage shall be 50 
percent.’’. 
(b) SERVICES FURNISHED BY OTHER PROVIDERS.— 
Section 1834(k) of the Social Security Act (42 U.S.C. 
1395m(k)) is amended by adding at the end the following 
new paragraph: 
‘‘(7) ADJUSTMENT IN DISCOUNT FOR CERTAIN 
MULTIPLE THERAPY SERVICES.—In the case of ther-
apy services furnished on or after April 1, 2013, and 
for which payment is made under this subsection pur-
suant to the applicable fee schedule amount (as de-
fined in paragraph (3)), instead of the 25 percent 
multiple procedure payment reduction specified in the 
final rule published by the Secretary in the Federal
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† HR 8 EAS 
Register on November 29, 2010, the reduction percent-
age shall be 50 percent.’’. 
SEC. 634. PAYMENT FOR CERTAIN RADIOLOGY SERVICES 
FURNISHED UNDER THE MEDICARE HOS-
PITAL OUTPATIENT DEPARTMENT PROSPEC-
TIVE PAYMENT SYSTEM. 
Section 1833(t)(16) of the Social Security Act (42 
U.S.C. 1395l(t)(16)) is amended by adding at the end the 
following new subparagraph: 
‘‘(D) SPECIAL PAYMENT RULE.— 
‘‘(i) IN GENERAL.—In the case of cov-
ered OPD services furnished on or after 
April 1, 2013, in a hospital described in 
clause (ii), if— 
‘‘(I) the payment rate that would 
otherwise apply under this subsection 
for stereotactic radiosurgery, complete 
course of treatment of cranial lesion(s) 
consisting of 1 session that is multi- 
source Cobalt 60 based (identified as of 
January 1, 2013, by HCPCS code 
77371 (and any succeeding code) and 
reimbursed as of such date under APC 
0127 (and any succeeding classifica-
tion group)); exceeds
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† HR 8 EAS 
‘‘(iii) NOT
BUDGET
NEUTRAL.—In 
making any budget neutrality adjustments 
under this subsection for 2013 (with respect 
to covered OPD services furnished on or 
after April 1, 2013, and before January 1, 
2014) or a subsequent year, the Secretary 
shall not take into account the reduced ex-
penditures that result from the application 
of this subparagraph.’’. 
SEC. 635. ADJUSTMENT OF EQUIPMENT UTILIZATION RATE 
FOR ADVANCED IMAGING SERVICES. 
Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4) is amended— 
(1) in subsection (b)(4)(C)— 
(A) by striking ‘‘and subsequent years’’ and 
inserting ‘‘, 2012, and 2013’’; and 
(B) by adding at the end the following new 
sentence: ‘‘With respect to fee schedules estab-
lished for 2014 and subsequent years, in such 
methodology, the Secretary shall use a 90 percent 
utilization rate.’’; and 
(2) in subsection (c)(2)(B)(v)(III), by striking 
‘‘change in the utilization rate applicable to 2011, as 
described in’’ and inserting ‘‘changes in the utiliza-
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† HR 8 EAS 
tion rate applicable to 2011 and 2014, as described 
in the first and second sentence, respectively, of’’. 
SEC. 636. MEDICARE PAYMENT OF COMPETITIVE PRICES 
FOR DIABETIC SUPPLIES AND ELIMINATION 
OF OVERPAYMENT FOR DIABETIC SUPPLIES. 
(a) APPLICATION OF COMPETITIVE BIDDING PRICES 
FOR DIABETIC SUPPLIES.—Section 1834(a)(1) of the Social 
Security Act (42 U.S.C. 1395m(a)(1)) is amended— 
(1) in subparagraph (F), in the matter preceding 
clause (i), by striking ‘‘subparagraph (G)’’ and in-
serting ‘‘subparagraphs (G) and (H)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(H) DIABETIC SUPPLIES.— 
‘‘(i) IN
GENERAL.—On or after the 
date described in clause (ii), the payment 
amount under this part for diabetic sup-
plies, including testing strips, that are non- 
mail order items (as defined by the Sec-
retary) shall be equal to the single payment 
amounts established under the national 
mail order competition for diabetic supplies 
under section 1847. 
‘‘(ii) DATE DESCRIBED.—The date de-
scribed in this clause is the date of the im-
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† HR 8 EAS 
plementation of the single payment amounts 
under the national mail order competition 
for diabetic supplies under section 1847.’’. 
(b) OVERPAYMENT ELIMINATION FOR DIABETIC SUP-
PLIES.—Section 1834(a) of the Social Security Act (42 
U.S.C. 1395m(a)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(22) SPECIAL
PAYMENT
RULE
FOR
DIABETIC 
SUPPLIES.—Notwithstanding the preceding provisions 
of this subsection, for purposes of determining the 
payment amount under this subsection for diabetic 
supplies furnished on or after the first day of the cal-
endar quarter during 2013 that is at least 30 days 
after the date of the enactment of this paragraph and 
before the date described in paragraph (1)(H)(ii), the 
Secretary shall recalculate and apply the covered item 
update under paragraph (14) as if subparagraph 
(J)(i) of such paragraph was amended by striking 
‘but only if furnished through mail order’.’’. 
SEC. 637. MEDICARE PAYMENT ADJUSTMENT FOR NON- 
EMERGENCY AMBULANCE TRANSPORTS FOR 
ESRD BENEFICIARIES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended by adding at the end the following 
new paragraph:
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† HR 8 EAS 
‘‘(15) PAYMENT
ADJUSTMENT
FOR
NON-EMER-
GENCY
AMBULANCE
TRANSPORTS
FOR
ESRD
BENE-
FICIARIES.—The fee schedule amount otherwise appli-
cable under the preceding provisions of this subsection 
shall be reduced by 10 percent for ambulance services 
furnished on or after October 1, 2013, consisting of 
non-emergency basic life support services involving 
transport of an individual with end-stage renal dis-
ease for renal dialysis services (as described in section 
1881(b)(14)(B)) furnished other than on an emer-
gency basis by a provider of services or a renal dialy-
sis facility.’’. 
SEC. 638. REMOVING OBSTACLES TO COLLECTION OF OVER-
PAYMENTS. 
(a) IN GENERAL.—The last sentence of subsections (b) 
and (c) of section 1870 of the Social Security Act (42 U.S.C. 
1395gg) are each amended— 
(1) by striking ‘‘third year’’ and inserting ‘‘fifth 
year’’; and 
(2) by striking ‘‘three-year’’ and inserting ‘‘five- 
year’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall take effect on the date of the enactment 
of this Act.
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† HR 8 EAS 
SEC. 639. MEDICARE ADVANTAGE CODING INTENSITY AD-
JUSTMENT. 
Section 1853(a)(1)(C)(ii)(III) of the Social Security 
Act (42 U.S.C. 1395w–23(a)(1)(C)(ii)(III)) is amended— 
(1) by striking ‘‘1.3 percentage points’’ and in-
serting ‘‘1.5 percentage points’’; and 
(2) by striking ‘‘5.7 percent’’ and inserting ‘‘5.9 
percent’’. 
SEC. 640. ELIMINATION OF ALL FUNDING FOR THE MEDI-
CARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)) is amended by striking subpara-
graphs (A), (B), and (C) and inserting the following new 
subparagraphs: 
‘‘(A) fiscal year 2014, $0; and 
‘‘(B) fiscal year 2015, $0.’’. 
SEC. 641. REBASING OF STATE DSH ALLOTMENTS. 
Section 1923(f)(8) of the Social Security Act (42 
U.S.C. 1396r–4(f)(8)) is amended to read as follows: 
‘‘(8) SPECIAL RULES FOR CALCULATING DSH AL-
LOTMENTS FOR CERTAIN FISCAL YEARS.— 
‘‘(A) FISCAL YEAR 2021.—Only with respect 
to fiscal year 2021, the DSH allotment for a 
State, in lieu of the amount determined under 
paragraph (3) for the State for that year, shall 
be equal to the DSH allotment for the State as
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† HR 8 EAS 
reduced under paragraph (7) for fiscal year 
2020, increased, subject to subparagraphs (B) 
and (C) of paragraph (3), and paragraph (5), by 
the percentage change in the consumer price 
index for all urban consumers (all items; U.S. 
city average), for fiscal year 2020. 
‘‘(B) FISCAL YEAR 2022.—Only with respect 
to fiscal year 2022, the DSH allotment for a 
State, in lieu of the amount determined under 
paragraph (3) for the State for that year, shall 
be equal to the DSH allotment for the State for 
fiscal year 2021, as determined under subpara-
graph (A), increased, subject to subparagraphs 
(B) and (C) of paragraph (3), and paragraph 
(5), by the percentage change in the consumer 
price index for all urban consumers (all items; 
U.S. city average), for fiscal year 2021. 
‘‘(C) SUBSEQUENT
FISCAL
YEARS.—The 
DSH allotment for a State for fiscal years after 
fiscal year 2022 shall be calculated under para-
graph (3) without regard to this paragraph and 
paragraph (7).’’.