240 
strued as diminishing the significant contributions of 
the Boards of Medicine, the quality alliances, and 
other clinical and technical experts to efforts to 
measure and improve the quality of health care serv-
ices. 
(b) GAO STUDY AND REPORTS ON THE PERFORM-
ANCE AND COSTS OF THE CONSENSUS-BASED ENTITY 
UNDER THE CONTRACT.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study on— 
(A) the performance of the entity with a 
contract with the Secretary of Health and 
Human Services under section 1890(a) of the 
Social Security Act, as added by subsection (a), 
of its duties under such contract; and 
(B) the costs incurred by such entity in 
performing such duties. 
(2) REPORTS.—Not later than 18 months and 
36 months after the effective date of the first con-
tract entered into under such section 1890(a), the 
Comptroller General of the United States shall sub-
mit to Congress a report containing the results of 
the study conducted under paragraph (1), together 
with recommendations for such legislation and ad-
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ministrative action as the Comptroller General deter-
mines appropriate. 
SEC. 184. COST-SHARING FOR CLINICAL TRIALS. 
Section 1833 of the Social Security Act (42 U.S.C. 
1395l), as amended by section 152(a), is amended by add-
ing at the end the following new subsection: 
‘‘(x) METHODS OF PAYMENT.—The Secretary may 
develop alternative methods of payment for items and 
services provided under clinical trials and comparative ef-
fectiveness studies sponsored or supported by an agency 
of the Department of Health and Human Services, as de-
termined by the Secretary, to those that would otherwise 
apply under this section, to the extent such alternative 
methods are necessary to preserve the scientific validity 
of such trials or studies, such as in the case where mask-
ing the identity of interventions from patients and inves-
tigators is necessary to comply with the particular trial 
or study design.’’. 
SEC. 185. ADDRESSING HEALTH CARE DISPARITIES. 
Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by inserting after section 1808 
the following new section: 
‘‘ADDRESSING HEALTH CARE DISPARITIES 
‘‘SEC. 1809. (a) EVALUATING DATA COLLECTION 
APPROACHES.—The Secretary shall evaluate approaches 
for the collection of data under this title, to be performed 
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in conjunction with existing quality reporting require-
ments and programs under this title, that allow for the 
ongoing, accurate, and timely collection and evaluation of 
data on disparities in health care services and performance 
on the basis of race, ethnicity, and gender. In conducting 
such evaluation, the Secretary shall consider the following 
objectives: 
‘‘(1) Protecting patient privacy. 
‘‘(2) Minimizing the administrative burdens of 
data collection and reporting on providers and health 
plans participating under this title. 
‘‘(3) Improving Medicare program data on race, 
ethnicity, and gender. 
‘‘(b) REPORTS TO CONGRESS.— 
‘‘(1) REPORT ON EVALUATION.—Not later than 
18 months after the date of the enactment of this 
section, the Secretary shall submit to Congress a re-
port on the evaluation conducted under subsection 
(a). Such report shall, taking into consideration the 
results of such evaluation— 
‘‘(A) identify approaches (including defin-
ing methodologies) for identifying and collecting 
and evaluating data on health care disparities 
on the basis of race, ethnicity, and gender for 
the original Medicare fee-for-service program 
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under parts A and B, the Medicare Advantage 
program under part C, and the Medicare pre-
scription drug program under part D; and 
‘‘(B) include recommendations on the most 
effective strategies and approaches to reporting 
HEDIS quality measures as required under sec-
tion 1852(e)(3) and other nationally recognized 
quality performance measures, as appropriate, 
on the basis of race, ethnicity, and gender. 
‘‘(2) REPORTS ON DATA ANALYSES.—Not later 
than 4 years after the date of the enactment of this 
section, and 4 years thereafter, the Secretary shall 
submit to Congress a report that includes rec-
ommendations for improving the identification of 
health care disparities for Medicare beneficiaries 
based on analyses of the data collected under sub-
section (c). 
‘‘(c) IMPLEMENTING EFFECTIVE APPROACHES.—Not 
later than 24 months after the date of the enactment of 
this section, the Secretary shall implement the approaches 
identified in the report submitted under subsection (b)(1) 
for the ongoing, accurate, and timely collection and eval-
uation of data on health care disparities on the basis of 
race, ethnicity, and gender.’’. 
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SEC. 186. DEMONSTRATION TO IMPROVE CARE TO PRE-
VIOUSLY UNINSURED. 
(a) ESTABLISHMENT.—Within one year after the 
date of the enactment of this Act, the Secretary (in this 
section referred to as the ‘‘Secretary’’) shall establish a 
demonstration project to determine the greatest needs and 
most effective methods of outreach to medicare bene-
ficiaries who were previously uninsured. 
(b) SCOPE.—The demonstration shall be in no fewer 
than 10 sites, and shall include state health insurance as-
sistance programs, community health centers, community- 
based organizations, community health workers, and other 
service providers under parts A, B, and C of title XVIII 
of the Social Security Act. Grantees that are plans oper-
ating under part C shall document that enrollees who were 
previously uninsured receive the ‘‘Welcome to Medicare’’ 
physical exam. 
(c) DURATION.—The Secretary shall conduct the 
demonstration project for a period of 2 years. 
(d) REPORT AND EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration and not later 
than 1 year after the completion of the project shall sub-
mit to Congress a report including the following: 
(1) An analysis of the effectiveness of outreach 
activities targeting beneficiaries who were previously 
uninsured, such as revising outreach and enrollment 
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materials (including the potential for use of video in-
formation), providing one-on-one counseling, working 
with community health workers, and amending the 
Medicare and You handbook. 
(2) The effect of such outreach on beneficiary 
access to care, utilization of services, efficiency and 
cost-effectiveness of health care delivery, patient sat-
isfaction, and select health outcomes. 
SEC. 187. OFFICE OF THE INSPECTOR GENERAL REPORT 
ON COMPLIANCE WITH AND ENFORCEMENT 
OF NATIONAL STANDARDS ON CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES (CLAS) IN MEDICARE. 
(a) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Inspector General of the 
Department of Health and Human Services shall prepare 
and publish a report on— 
(1) the extent to which Medicare providers and 
plans are complying with the Office for Civil Rights’ 
Guidance to Federal Financial Assistance Recipients 
Regarding Title VI Prohibition Against National Or-
igin Discrimination Affecting Limited English Pro-
ficient Persons and the Office of Minority Health’s 
Culturally and Linguistically Appropriate Services 
Standards in health care; and 
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(2) a description of the costs associated with or 
savings related to the provision of language services. 
Such report shall include recommendations on improving 
compliance with CLAS Standards and recommendations 
on improving enforcement of CLAS Standards. 
(b) IMPLEMENTATION.—Not later than one year 
after the date of publication of the report under subsection 
(a), the Department of Health and Human Services shall 
implement changes responsive to any deficiencies identi-
fied in the report. 
SEC. 188. MEDICARE IMPROVEMENT FUNDING. 
(a) MEDICARE IMPROVEMENT FUND.—Title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section: 
‘‘MEDICARE IMPROVEMENT FUND 
‘‘SEC. 1898. (a) ESTABLISHMENT.— 
‘‘The Secretary shall establish under this title a 
Medicare Improvement Fund (in this section re-
ferred to as the ‘Fund’) which shall be available to 
the Secretary to make improvements under the origi-
nal fee-for-service program under parts A and B for 
individuals entitled to, or enrolled for, benefits under 
part A or enrolled under part B. 
‘‘(b) FUNDING.— 
‘‘(1) IN GENERAL.—There shall be available to 
the Fund, for expenditures from the Fund for serv-
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ices furnished during fiscal years 2013–2017, 
$22,450,000,000. 
‘‘(2) PAYMENT
FROM
TRUST
FUNDS.—The 
amount specified under paragraph (1) shall be avail-
able to the Fund, as expenditures are made from the 
Fund, from the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary Medical In-
surance Trust Fund in such proportion as the Sec-
retary determines appropriate. 
‘‘(3) FUNDING LIMITATION.—Amounts in the 
Fund shall be available in advance of appropriations 
but only if the total amount obligated from the 
Fund does not exceed the amount available to the 
Fund under paragraph (1). The Secretary may obli-
gate funds from the Fund only if the Secretary de-
termines (and the Chief Actuary of the Centers for 
Medicare & Medicaid Services and the appropriate 
budget officer certify) that there are available in the 
Fund sufficient amounts to cover all such obligations 
incurred consistent with the previous sentence.’’. 
(b) IMPLEMENTATION.—For purposes of carrying out 
the provisions of, and amendments made by, this Act, in 
addition to any other amounts provided in such provisions 
and amendments, the Secretary of Health and Human 
Services shall provide for the transfer, from the Federal 
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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 under sec-
tion 1841 of such Act (42 U.S.C. 1395t), in the same pro-
portion as the Secretary determines under section 1853(f) 
of such Act (42 U.S.C. 1395w–23(f)), of $140,000,000 
to the Centers for Medicare & Medicaid Services Program 
Management Account for the period of fiscal years 2009 
through 2013. 
TITLE II—MEDICAID 
SEC. 201. EXTENSION OF TRANSITIONAL MEDICAL ASSIST-
ANCE (TMA). 
Section 401 of division B of the Tax Relief and 
Health Care Act of 2006 (Public Law 109–432, 120 Stat. 
2994), as amended by section 1 of Public Law 110–48 
(121 Stat. 244), section 2 of the TMA, Abstinence, Edu-
cation, and QI Programs Extension Act of 2007 (Public 
Law 110–90, 121 Stat. 984), and section 202 of the Medi-
care, Medicaid, and SCHIP Extension Act of 2007 (Public 
Law 110–173) is amended— 
(1) by inserting after ‘‘June 30, 2008’’ the fol-
lowing ‘‘(or, in the case of section 1925, through De-
cember 31, 2009)’’; 
(2) by inserting after ‘‘the third quarter of fis-
cal year 2008’’ the following: ‘‘(or, in the case of 
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such section 1925, the first quarter of fiscal year 
2010)’’; and 
(3) by inserting after ‘‘the third quarter of fis-
cal year 2007’’ the following: ‘‘(or, in the case of 
such section 1925, the first quarter of fiscal year 
2008)’’. 
SEC. 202. MEDICAID DSH EXTENSION. 
Section 1923(f)(6) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)) is amended— 
(1) in the heading, by striking ‘‘FISCAL YEAR 
2007 AND PORTIONS OF FISCAL YEAR 2008’’ and in-
serting ‘‘FISCAL YEARS 2007 THROUGH 2009 AND THE 
FIRST CALENDAR QUARTER OF FISCAL YEAR 2010’’; 
and 
(2) in subparagraph (A)— 
(A) in clause (i)— 
(i) in the second sentence— 
(I) by striking ‘‘fiscal year 2008 
for the period ending on June 30, 
2008’’ and inserting ‘‘fiscal years 
2008 and 2009’’; and 
(II) by striking ‘‘3⁄4 of’’; and 
(ii) by adding at the end the following 
new sentences: ‘‘Only with respect to fiscal 
year 2010 for the period ending on Decem-
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