H. R. 3590—826 
than 30 rural community hospitals may participate in the dem-
onstration program under this section. 
‘‘(4) HOSPITALS IN DEMONSTRATION PROGRAM ON DATE OF 
ENACTMENT.—In the case of a rural community hospital that 
is participating in the demonstration program under this sec-
tion as of the last day of the initial 5-year period, the Sec-
retary— 
‘‘(A) shall provide for the continued participation of 
such rural community hospital in the demonstration pro-
gram during the 5-year extension period unless the rural 
community hospital makes an election, in such form and 
manner as the Secretary may specify, to discontinue such 
participation; and 
‘‘(B) in calculating the amount of payment under sub-
section (b) to the rural community hospital for covered 
inpatient hospital services furnished by the hospital during 
such 5-year extension period, shall substitute, under para-
graph (1)(A) of such subsection— 
‘‘(i) the reasonable costs of providing such services 
for discharges occurring in the first cost reporting 
period beginning on or after the first day of the 5- 
year extension period, for 
‘‘(ii) the reasonable costs of providing such services 
for discharges occurring in the first cost reporting 
period beginning on or after the implementation of 
the demonstration program.’’. 
(b) CONFORMING AMENDMENTS.—Subsection (a)(5) of section 
410A of the Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 2272), as 
amended by section 3123(b) of this Act, is amended by striking 
‘‘1-year extension’’ and inserting ‘‘5-year extension’’. 
SEC. 10314. ADJUSTMENT TO LOW-VOLUME HOSPITAL PROVISION. 
Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12), as amended by section 3125, is amended— 
(1) in subparagraph (C)(i), by striking ‘‘1,500 discharges’’ 
and inserting ‘‘1,600 discharges’’; and 
(2) in subparagraph (D), by striking ‘‘1,500 discharges’’ 
and inserting ‘‘1,600 discharges’’. 
SEC. 10315. REVISIONS TO HOME HEALTH CARE PROVISIONS. 
(a) REBASING.—Section 1895(b)(3)(A)(iii) of the Social Security 
Act, as added by section 3131, is amended— 
(1) in the clause heading, by striking ‘‘2013’’ and inserting 
‘‘2014’’; 
(2) in subclause (I), by striking ‘‘2013’’ and inserting ‘‘2014’’; 
and 
(3) in subclause (II), by striking ‘‘2016’’ and inserting 
‘‘2017’’. 
(b) REVISION OF HOME HEALTH STUDY AND REPORT.—Section 
3131(d) is amended to read as follows: 
‘‘(d) STUDY
AND REPORT
ON
THE DEVELOPMENT
OF HOME 
HEALTH PAYMENT REVISIONS IN ORDER TO ENSURE ACCESS TO CARE 
AND PAYMENT FOR SEVERITY OF ILLNESS.— 
‘‘(1) IN GENERAL.—The Secretary of Health and Human 
Services (in this section referred to as the ‘Secretary’) shall 
conduct a study on home health agency costs involved with
H. R. 3590—827 
providing ongoing access to care to low-income Medicare bene-
ficiaries or beneficiaries in medically underserved areas, and 
in treating beneficiaries with varying levels of severity of ill-
ness. In conducting the study, the Secretary may analyze items 
such as the following: 
‘‘(A) Methods to potentially revise the home health 
prospective payment system under section 1895 of the 
Social Security Act (42 U.S.C. 1395fff) to account for costs 
related to patient severity of illness or to improving bene-
ficiary access to care, such as— 
‘‘(i) payment adjustments for services that may 
involve additional or fewer resources; 
‘‘(ii) changes to reflect resources involved with pro-
viding home health services to low-income Medicare 
beneficiaries or Medicare beneficiaries residing in 
medically underserved areas; 
‘‘(iii) ways outlier payments might be revised to 
reflect costs of treating Medicare beneficiaries with 
high levels of severity of illness; and 
‘‘(iv) other issues determined appropriate by the 
Secretary. 
‘‘(B) 
Operational 
issues 
involved 
with 
potential 
implementation of potential revisions to the home health 
payment system, including impacts for both home health 
agencies and administrative and systems issues for the 
Centers for Medicare & Medicaid Services, and any possible 
payment vulnerabilities associated with implementing 
potential revisions. 
‘‘(C) Whether additional research might be needed. 
‘‘(D) Other items determined appropriate by the Sec-
retary. 
‘‘(2) CONSIDERATIONS.—In conducting the study under para-
graph (1), the Secretary may consider whether patient severity 
of illness and access to care could be measured by factors, 
such as— 
‘‘(A) population density and relative patient access to 
care; 
‘‘(B) variations in service costs for providing care to 
individuals who are dually eligible under the Medicare 
and Medicaid programs; 
‘‘(C) the presence of severe or chronic diseases, which 
might be measured by multiple, discontinuous home health 
episodes; 
‘‘(D) poverty status, such as evidenced by the receipt 
of Supplemental Security Income under title XVI of the 
Social Security Act; and 
‘‘(E) other factors determined appropriate by the Sec-
retary. 
‘‘(3) REPORT.—Not later than March 1, 2014, the Secretary 
shall submit to Congress a report on the study conducted under 
paragraph (1), together with recommendations for such legisla-
tion and administrative action as the Secretary determines 
appropriate. 
‘‘(4) CONSULTATIONS.—In conducting the study under para-
graph (1), the Secretary shall consult with appropriate stake-
holders, such as groups representing home health agencies 
and groups representing Medicare beneficiaries.
H. R. 3590—828 
‘‘(5) MEDICARE
DEMONSTRATION
PROJECT
BASED
ON
THE 
RESULTS OF THE STUDY.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (D), taking 
into account the results of the study conducted under para-
graph (1), the Secretary may, as determined appropriate, 
provide for a demonstration project to test whether making 
payment adjustments for home health services under the 
Medicare program would substantially improve access to 
care for patients with high severity levels of illness or 
for low-income or underserved Medicare beneficiaries. 
‘‘(B) WAIVING
BUDGET
NEUTRALITY.—The Secretary 
shall not reduce the standard prospective payment amount 
(or amounts) under section 1895 of the Social Security 
Act (42 U.S.C. 1395fff) applicable to home health services 
furnished during a period to offset any increase in pay-
ments during such period resulting from the application 
of the payment adjustments under subparagraph (A). 
‘‘(C) NO EFFECT ON SUBSEQUENT PERIODS.—A payment 
adjustment resulting from the application of subparagraph 
(A) for a period— 
‘‘(i) shall not apply to payments for home health 
services under title XVIII after such period; and 
‘‘(ii) shall not be taken into account in calculating 
the payment amounts applicable for such services after 
such period. 
‘‘(D) DURATION.—If the Secretary determines it appro-
priate to conduct the demonstration project under this sub-
section, the Secretary shall conduct the project for a four 
year period beginning not later than January 1, 2015. 
‘‘(E) FUNDING.—The Secretary shall provide for the 
transfer from the Federal Hospital Insurance Trust Fund 
under section 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical Insurance 
Trust Fund established under section 1841 of such Act 
(42 U.S.C. 1395t), in such proportion as the Secretary 
determines appropriate, of $500,000,000 for the period of 
fiscal years 2015 through 2018. Such funds shall be made 
available for the study described in paragraph (1) and 
the design, implementation and evaluation of the dem-
onstration described in this paragraph. Amounts available 
under this subparagraph shall be available until expended. 
‘‘(F) EVALUATION AND REPORT.—If the Secretary deter-
mines it appropriate to conduct the demonstration project 
under this subsection, the Secretary shall— 
‘‘(i) provide for an evaluation of the project; and 
‘‘(ii) submit to Congress, by a date specified by 
the Secretary, a report on the project. 
‘‘(G) ADMINISTRATION.—Chapter 35 of title 44, United 
States Code, shall not apply with respect to this sub-
section.’’. 
SEC. 10316. MEDICARE DSH. 
Section 1886(r)(2)(B) of the Social Security Act, as added by 
section 3133, is amended— 
(1) in clause (i)— 
(A) in the matter preceding subclause (I), by striking 
‘‘(divided by 100)’’;
H. R. 3590—829 
(B) in subclause (I), by striking ‘‘2012’’ and inserting 
‘‘2013’’; 
(C) in subclause (II), by striking the period at the 
end and inserting a comma; and 
(D) by adding at the end the following flush matter: 
‘‘minus 1.5 percentage points.’’. 
(2) in clause (ii)— 
(A) in the matter preceding subclause (I), by striking 
‘‘(divided by 100)’’; 
(B) in subclause (I), by striking ‘‘2012’’ and inserting 
‘‘2013’’; 
(C) in subclause (II), by striking the period at the 
end and inserting a comma; and 
(D) by adding at the end the following flush matter: 
‘‘and, for each of 2018 and 2019, minus 1.5 percentage 
points.’’. 
SEC. 10317. REVISIONS TO EXTENSION OF SECTION 508 HOSPITAL 
PROVISIONS. 
Section 3137(a) is amended to read as follows: 
‘‘(a) EXTENSION.— 
‘‘(1) IN GENERAL.—Subsection (a) of section 106 of division 
B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 
1395 note), as amended by section 117 of the Medicare, Med-
icaid, and SCHIP Extension Act of 2007 (Public Law 110– 
173) and section 124 of the Medicare Improvements for Patients 
and Providers Act of 2008 (Public Law 110–275), is amended 
by striking ‘September 30, 2009’ and inserting ‘September 30, 
2010’. 
‘‘(2) SPECIAL RULE FOR FISCAL YEAR 2010.— 
‘‘(A) IN
GENERAL.—Subject to subparagraph (B), for 
purposes of implementation of the amendment made by 
paragraph (1), including (notwithstanding paragraph (3) 
of section 117(a) of the Medicare, Medicaid and SCHIP 
Extension Act of 2007 (Public Law 110–173), as amended 
by section 124(b) of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110–275)) 
for purposes of the implementation of paragraph (2) of 
such section 117(a), during fiscal year 2010, the Secretary 
of Health and Human Services (in this subsection referred 
to as the ‘Secretary’) shall use the hospital wage index 
that was promulgated by the Secretary in the Federal 
Register on August 27, 2009 (74 Fed. Reg. 43754), and 
any subsequent corrections. 
‘‘(B) EXCEPTION.—Beginning on April 1, 2010, in deter-
mining the wage index applicable to hospitals that qualify 
for wage index reclassification, the Secretary shall include 
the average hourly wage data of hospitals whose reclassi-
fication was extended pursuant to the amendment made 
by paragraph (1) only if including such data results in 
a higher applicable reclassified wage index. 
‘‘(3) ADJUSTMENT FOR CERTAIN HOSPITALS IN FISCAL YEAR 
2010.— 
‘‘(A) IN GENERAL.—In the case of a subsection (d) hos-
pital (as defined in subsection (d)(1)(B) of section 1886 
of the Social Security Act (42 U.S.C. 1395ww)) with respect 
to which—
H. R. 3590—830 
‘‘(i) a reclassification of its wage index for purposes 
of such section was extended pursuant to the amend-
ment made by paragraph (1); and 
‘‘(ii) the wage index applicable for such hospital 
for the period beginning on October 1, 2009, and ending 
on March 31, 2010, was lower than for the period 
beginning on April 1, 2010, and ending on September 
30, 2010, by reason of the application of paragraph 
(2)(B); 
the Secretary shall pay such hospital an additional pay-
ment that reflects the difference between the wage index 
for such periods. 
‘‘(B) TIMEFRAME FOR PAYMENTS.—The Secretary shall 
make payments required under subparagraph by not later 
than December 31, 2010.’’. 
SEC. 10318. REVISIONS TO TRANSITIONAL EXTRA BENEFITS UNDER 
MEDICARE ADVANTAGE. 
Section 1853(p)(3)(A) of the Social Security Act, as added by 
section 3201(h), is amended by inserting ‘‘in 2009’’ before the period 
at the end. 
SEC. 10319. REVISIONS TO MARKET BASKET ADJUSTMENTS. 
(a) INPATIENT ACUTE HOSPITALS.—Section 1886(b)(3)(B)(xii) of 
the Social Security Act, as added by section 3401(a), is amended— 
(1) in subclause (I), by striking ‘‘and’’ at the end; 
(2) by redesignating subclause (II) as subclause (III); 
(3) by inserting after subclause (II) the following new sub-
clause: 
‘‘(II) for each of fiscal years 2012 and 2013, by 0.1 percent-
age point; and’’; and 
(4) in subclause (III), as redesignated by paragraph (2), 
by striking ‘‘2012’’ and inserting ‘‘2014’’. 
(b) LONG-TERM CARE HOSPITALS.—Section 1886(m)(4) of the 
Social Security Act, as added by section 3401(c), is amended— 
(1) in subparagraph (A)— 
(A) in clause (i)— 
(i) by striking ‘‘each of rate years 2010 and 2011’’ 
and inserting ‘‘rate year 2010’’; and 
(ii) by striking ‘‘and’’ at the end; 
(B) by redesignating clause (ii) as clause (iv); 
(C) by inserting after clause (i) the following new 
clauses: 
‘‘(ii) for rate year 2011, 0.50 percentage point; 
‘‘(iii) for each of the rate years beginning in 2012 
and 2013, 0.1 percentage point; and’’; and 
(D) in clause (iv), as redesignated by subparagraph 
(B), by striking ‘‘2012’’ and inserting ‘‘2014’’; and 
(2) in subparagraph (B), by striking ‘‘(A)(ii)’’ and inserting 
‘‘(A)(iv)’’. 
(c) 
INPATIENT
REHABILITATION
FACILITIES.—Section 
1886(j)(3)(D)(i) of the Social Security Act, as added by section 
3401(d), is amended— 
(1) in subclause (I), by striking ‘‘and’’ at the end; 
(2) by redesignating subclause (II) as subclause (III); 
(3) by inserting after subclause (II) the following new sub-
clause:
H. R. 3590—833 
(ii) by redesignating subparagraphs (A) and (B) 
as clauses (i) and (ii), respectively, and indenting 
appropriately; and 
(iii) by adding at the end the following new 
subparagraph: 
‘‘(B) LIMITED ADDITIONAL EXCEPTION.— 
‘‘(i) IN GENERAL.—Subject to clause (ii), the Sec-
retary shall not implement the recommendations con-
tained in a proposal submitted by the Board or the 
President to Congress pursuant to this section in a 
proposal year (beginning with proposal year 2019) if— 
‘‘(I) the Board was required to submit a pro-
posal to Congress under this section in the year 
preceding the proposal year; and 
‘‘(II) the Chief Actuary of the Centers for Medi-
care & Medicaid Services makes a determination 
in the determination year that the growth rate 
described in subsection (c)(8) exceeds the growth 
rate described in subsection (c)(6)(A)(i). 
‘‘(ii) LIMITED ADDITIONAL EXCEPTION MAY NOT BE 
APPLIED IN TWO CONSECUTIVE YEARS.—This subpara-
graph shall not apply if the recommendations contained 
in a proposal submitted by the Board or the President 
to Congress pursuant to this section in the year pre-
ceding the proposal year were not required to be imple-
mented by reason of this subparagraph. 
‘‘(iii) NO AFFECT ON REQUIREMENT TO SUBMIT PRO-
POSALS OR FOR CONGRESSIONAL CONSIDERATION OF PRO-
POSALS.—Clause (i) and (ii) shall not affect— 
‘‘(I) the requirement of the Board or the Presi-
dent to submit a proposal to Congress in a proposal 
year in accordance with the provisions of this sec-
tion; or 
‘‘(II) Congressional consideration of a legisla-
tive proposal (described in subsection (c)(3)(B)(iv)) 
contained such a proposal in accordance with sub-
section (d).’’; 
(4) in subsection (f)(3)(B)— 
(A) by striking ‘‘or advisory reports to Congress’’ and 
inserting ‘‘, advisory reports, or advisory recommendations’’; 
and 
(B) by inserting ‘‘or produce the public report under 
subsection (n)’’ after ‘‘this section’’; and 
(5) by adding at the end the following new subsections: 
‘‘(n) ANNUAL PUBLIC REPORT.— 
‘‘(1) IN
GENERAL.—Not later than July 1, 2014, and 
annually thereafter, the Board shall produce a public report 
containing standardized information on system-wide health 
care costs, patient access to care, utilization, and quality-of- 
care that allows for comparison by region, types of services, 
types of providers, and both private payers and the program 
under this title. 
‘‘(2) REQUIREMENTS.—Each report produced pursuant to 
paragraph (1) shall include information with respect to the 
following areas: 
‘‘(A) The quality and costs of care for the population 
at the most local level determined practical by the Board
H. R. 3590—834 
(with quality and costs compared to national benchmarks 
and reflecting rates of change, taking into account quality 
measures described in section 1890(b)(7)(B)). 
‘‘(B) Beneficiary and consumer access to care, patient 
and caregiver experience of care, and the cost-sharing or 
out-of-pocket burden on patients. 
‘‘(C) Epidemiological shifts and demographic changes. 
‘‘(D) The proliferation, effectiveness, and utilization of 
health care technologies, including variation in provider 
practice patterns and costs. 
‘‘(E) Any other areas that the Board determines affect 
overall spending and quality of care in the private sector. 
‘‘(o) ADVISORY RECOMMENDATIONS FOR NON-FEDERAL HEALTH 
CARE PROGRAMS.— 
‘‘(1) IN GENERAL.—Not later than January 15, 2015, and 
at least once every two years thereafter, the Board shall submit 
to Congress and the President recommendations to slow the 
growth in national health expenditures (excluding expenditures 
under this title and in other Federal health care programs) 
while preserving or enhancing quality of care, such as rec-
ommendations— 
‘‘(A) that the Secretary or other Federal agencies can 
implement administratively; 
‘‘(B) that may require legislation to be enacted by Con-
gress in order to be implemented; 
‘‘(C) that may require legislation to be enacted by State 
or local governments in order to be implemented; 
‘‘(D) that private sector entities can voluntarily imple-
ment; and 
‘‘(E) with respect to other areas determined appropriate 
by the Board. 
‘‘(2) COORDINATION.—In making recommendations under 
paragraph (1), the Board shall coordinate such recommenda-
tions with recommendations contained in proposals and 
advisory reports produced by the Board under subsection (c). 
‘‘(3) AVAILABLE
TO
PUBLIC.—The Board shall make rec-
ommendations submitted to Congress and the President under 
this subsection available to the public.’’. 
(b) NAME CHANGE.—Any reference in the provisions of, or 
amendments made by, section 3403 to the ‘‘Independent Medicare 
Advisory Board’’ shall be deemed to be a reference to the ‘‘Inde-
pendent Payment Advisory Board’’. 
(c) RULE OF CONSTRUCTION.—Nothing in the amendments made 
by this section shall preclude the Independent Medicare Advisory 
Board, as established under section 1899A of the Social Security 
Act (as added by section 3403), from solely using data from public 
or private sources to carry out the amendments made by subsection 
(a)(4). 
SEC. 10321. REVISION TO COMMUNITY HEALTH TEAMS. 
Section 3502(c)(2)(A) is amended by inserting ‘‘or other primary 
care providers’’ after ‘‘physicians’’. 
SEC. 10322. QUALITY REPORTING FOR PSYCHIATRIC HOSPITALS. 
(a) IN GENERAL.—Section 1886(s) of the Social Security Act, 
as added by section 3401(f), is amended by adding at the end 
the following new paragraph: 
‘‘(4) QUALITY REPORTING.—
H. R. 3590—835 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE TO REPORT.— 
‘‘(i) IN GENERAL.—Under the system described in 
paragraph (1), for rate year 2014 and each subsequent 
rate year, in the case of a psychiatric hospital or psy-
chiatric unit that does not submit data to the Secretary 
in accordance with subparagraph (C) with respect to 
such a rate year, any annual update to a standard 
Federal rate for discharges for the hospital during 
the rate year, and after application of paragraph (2), 
shall be reduced by 2 percentage points. 
‘‘(ii) SPECIAL
RULE.—The application of this 
subparagraph may result in such annual update being 
less than 0.0 for a rate year, and may result in payment 
rates under the system described in paragraph (1) 
for a rate year being less than such payment rates 
for the preceding rate year. 
‘‘(B) NONCUMULATIVE
APPLICATION.—Any reduction 
under subparagraph (A) shall apply only with respect to 
the rate year involved and the Secretary shall not take 
into account such reduction in computing the payment 
amount under the system described in paragraph (1) for 
a subsequent rate year. 
‘‘(C) SUBMISSION OF QUALITY DATA.—For rate year 2014 
and each subsequent rate year, each psychiatric hospital 
and psychiatric unit shall submit to the Secretary data 
on quality measures specified under subparagraph (D). 
Such data shall be submitted in a form and manner, and 
at a time, specified by the Secretary for purposes of this 
subparagraph. 
‘‘(D) QUALITY MEASURES.— 
‘‘(i) IN
GENERAL.—Subject to clause (ii), any 
measure specified by the Secretary under this subpara-
graph must have been endorsed by the entity with 
a contract under section 1890(a). 
‘‘(ii) EXCEPTION.—In the case of a specified area 
or medical topic determined appropriate by the Sec-
retary for which a feasible and practical measure has 
not been endorsed by the entity with a contract under 
section 1890(a), the Secretary may specify a measure 
that is not so endorsed as long as due consideration 
is given to measures that have been endorsed or 
adopted by a consensus organization identified by the 
Secretary. 
‘‘(iii) TIME FRAME.—Not later than October 1, 2012, 
the Secretary shall publish the measures selected 
under this subparagraph that will be applicable with 
respect to rate year 2014. 
‘‘(E) PUBLIC AVAILABILITY OF DATA SUBMITTED.—The 
Secretary shall establish procedures for making data sub-
mitted under subparagraph (C) available to the public. 
Such procedures shall ensure that a psychiatric hospital 
and a psychiatric unit has the opportunity to review the 
data that is to be made public with respect to the hospital 
or unit prior to such data being made public. The Secretary 
shall report quality measures that relate to services fur-
nished in inpatient settings in psychiatric hospitals and
H. R. 3590—836 
psychiatric units on the Internet website of the Centers 
for Medicare & Medicaid Services.’’. 
(b) CONFORMING AMENDMENT.—Section 1890(b)(7)(B)(i)(I) of the 
Social Security Act, as added by section 3014, is amended by 
inserting ‘‘1886(s)(4)(D),’’ after ‘‘1886(o)(2),’’. 
SEC. 10323. MEDICARE COVERAGE FOR INDIVIDUALS EXPOSED TO 
ENVIRONMENTAL HEALTH HAZARDS. 
(a) IN GENERAL.—Title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) is amended by inserting after section 1881 
the following new section: 
‘‘SEC. 1881A. MEDICARE COVERAGE FOR INDIVIDUALS EXPOSED TO 
ENVIRONMENTAL HEALTH HAZARDS. 
‘‘(a) DEEMING OF INDIVIDUALS AS ELIGIBLE FOR MEDICARE BENE-
FITS.— 
‘‘(1) IN GENERAL.—For purposes of eligibility for benefits 
under this title, an individual determined under subsection 
(c) to be an environmental exposure affected individual 
described in subsection (e)(2) shall be deemed to meet the 
conditions specified in section 226(a). 
‘‘(2) DISCRETIONARY DEEMING.—For purposes of eligibility 
for benefits under this title, the Secretary may deem an indi-
vidual determined under subsection (c) to be an environmental 
exposure affected individual described in subsection (e)(3) to 
meet the conditions specified in section 226(a). 
‘‘(3) EFFECTIVE DATE OF COVERAGE.—An Individual who 
is deemed eligible for benefits under this title under paragraph 
(1) or (2) shall be— 
‘‘(A) entitled to benefits under the program under Part 
A as of the date of such deeming; and 
‘‘(B) eligible to enroll in the program under Part B 
beginning with the month in which such deeming occurs. 
‘‘(b) PILOT
PROGRAM
FOR
CARE
OF
CERTAIN
INDIVIDUALS 
RESIDING IN EMERGENCY DECLARATION AREAS.— 
‘‘(1) PROGRAM; PURPOSE.— 
‘‘(A) PRIMARY
PILOT
PROGRAM.—The Secretary shall 
establish a pilot program in accordance with this subsection 
to provide innovative approaches to furnishing comprehen-
sive, coordinated, and cost-effective care under this title 
to individuals described in paragraph (2)(A). 
‘‘(B) OPTIONAL PILOT PROGRAMS.—The Secretary may 
establish a separate pilot program, in accordance with this 
subsection, with respect to each geographic area subject 
to an emergency declaration (other than the declaration 
of June 17, 2009), in order to furnish such comprehensive, 
coordinated and cost-effective care to individuals described 
in subparagraph (2)(B) who reside in each such area. 
‘‘(2) INDIVIDUAL
DESCRIBED.—For purposes of paragraph 
(1), an individual described in this paragraph is an individual 
who enrolls in part B, submits to the Secretary an application 
to participate in the applicable pilot program under this sub-
section, and— 
‘‘(A) is an environmental exposure affected individual 
described in subsection (e)(2) who resides in or around 
the geographic area subject to an emergency declaration 
made as of June 17, 2009; or