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Fund (in this section referred to as the ‘Fund’) which shall 
be available to the Secretary to make improvements under 
the original 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 services 
furnished during fiscal year 2014, $2,220,000,000. 
‘‘(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 Insur-
ance Trust Fund in such proportion as the Secretary 
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 obligate 
funds from the Fund only if the Secretary determines 
(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 
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•HR 2642 EAH2 
amounts to cover all such obligations incurred con-
sistent with the previous sentence.’’. 
(b) MEDICAID IMPROVEMENT FUND.— Title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.), as amended 
by section 7001(d), is further amended by adding at the 
end the following new section: 
‘‘MEDICAID IMPROVEMENT FUND 
‘‘SEC. 1941. (a) ESTABLISHMENT.—The Secretary 
shall establish under this title a Medicaid Improvement 
Fund (in this section referred to as the ‘Fund’) which shall 
be available to the Secretary to improve the management 
of the Medicaid program by the Centers for Medicare & 
Medicaid Services, including oversight of contracts and con-
tractors and evaluation of demonstration projects. Pay-
ments made for activities under this subsection shall be in 
addition to payments that would otherwise be made for such 
activities. 
‘‘(b) FUNDING.— 
‘‘(1) IN GENERAL.—There shall be available to 
the Fund, for expenditures from the Fund— 
‘‘(A) for fiscal year 2014, $100,000,000; and 
‘‘(B) for fiscal years 2015 through 2018, 
$150,000,000. 
‘‘(2) FUNDING
LIMITATION.—Amounts in the 
Fund shall be available in advance of appropriations 
but only if the total amount obligated from the Fund 
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does not exceed the amount available to the Fund 
under paragraph (1). The Secretary may obligate 
funds from the Fund only if the Secretary determines 
(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 con-
sistent with the previous sentence.’’. 
(c) ADJUSTMENT TO PAQI FUND.—Section 1848(l)(2) 
of the Social Security Act (42 U.S.C. 1395w-4(l)(2)), as 
amended by section 101(a)(2) of the Medicare, Medicaid, 
and SCHIP Extension Act of 2007 (Public Law 110-173), 
is amended— 
(1) in subparagraph (A)(i)— 
(A) 
in 
subclause 
(III), 
by 
striking 
‘‘$4,960,000,000’’ 
and 
inserting 
‘‘$4,670,000,000’’; and 
(B) by adding at the end the following new 
subclause: 
‘‘(IV) For expenditures during 
2014, 
an 
amount 
equal 
to 
$290,000,000.’’; 
(2) in subparagraph (A)(ii), by adding at the 
end the following new subclause: 
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‘‘(IV) 2014.—The amount avail-
able for expenditures during 2014 shall 
only be available for an adjustment to 
the update of the conversion factor 
under subsection (d) for that year.’’; 
and 
(3) in subparagraph (B)— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iv) 2014 for payment with respect to 
physicians’ 
services 
furnished 
during 
2014.’’. 
TITLE VIII—GENERAL PROVISIONS, THIS ACT 
AVAILABILITY OF FUNDS 
SEC. 8001. No part of any appropriation contained 
in this Act shall remain available for obligation beyond the 
current fiscal year unless expressly so provided herein. 
EMERGENCY DESIGNATION 
SEC. 8002. Each amount in each title of this Act is 
designated as an emergency requirement and necessary to 
meet emergency needs pursuant to section 204(a) of S. Con. 
Res. 21 (110th Congress) and section 301(b)(2) of S. Con. 
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Res. 70 (110th Congress), the concurrent resolutions on the 
budget for fiscal years 2008 and 2009. 
REDUCTION IN DEFENSE AMOUNTS 
SEC. 8003. Notwithstanding any other provision of 
this Act, the total amount appropriated in chapter 1 of title 
IX of this Act under the headings ‘‘Procurement’’, ‘‘Re-
search, Development, Test and Evaluation’’, and ‘‘Defense 
Working 
Capital 
Funds’’ 
is 
hereby 
reduced 
by 
$3,577,845,000. Such reduction shall be applied proportion-
ally to each appropriation account under such headings, 
and to each program, project, and activity within each such 
appropriation account. 
JOINT BASING INITIATIVES 
SEC. 8004. Section 9310 of this Act is amended by in-
serting ‘‘, except funds deposited in the Department of De-
fense Base Closure Account 2005,’’ after ‘‘None of the funds 
available to the Department of Defense’’. 
DEFENSE HEALTH PROGRAM 
SEC. 8005. Amounts provided for ‘‘Defense Health 
Program’’ in Public Law 110-28 for Post Traumatic Stress 
Disorder and Traumatic Brain Injury (TBI) within oper-
ation and maintenance which remain available for obliga-
tion shall be made available for psychological health and 
traumatic brain injury. 
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