II 
112TH CONGRESS 
1ST SESSION H. R. 3765 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 23, 2011 
Ordered received 
AN ACT 
To extend the payroll tax holiday, unemployment compensa-
tion, Medicare physician payment, provide for the consid-
eration of the Keystone XL pipeline, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Temporary Payroll Tax Cut Continuation Act of 2011’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—TEMPORARY PAYROLL TAX RELIEF 
Sec. 101. Extension of payroll tax holiday. 
TITLE II—TEMPORARY EXTENSION OF UNEMPLOYMENT 
COMPENSATION PROVISIONS 
Sec. 201. Temporary extension of unemployment compensation provisions. 
Sec. 202. Extended unemployment benefits under the Railroad Unemployment 
Insurance Act. 
TITLE III—TEMPORARY EXTENSION OF HEALTH PROVISIONS 
Sec. 301. Medicare physician payment update. 
Sec. 302. 2-month extension of MMA section 508 reclassifications. 
Sec. 303. Extension of Medicare work geographic adjustment floor. 
Sec. 304. Extension of exceptions process for Medicare therapy caps. 
Sec. 305. Extension of payment for technical component of certain physician 
pathology services. 
Sec. 306. Extension of ambulance add-ons. 
Sec. 307. Extension of physician fee schedule mental health add-on payment. 
Sec. 308. Extension of outpatient hold harmless provision. 
Sec. 309. Extending minimum payment for bone mass measurement. 
Sec. 310. Extension of the qualifying individual (QI) program. 
Sec. 311. Extension of Transitional Medical Assistance (TMA). 
Sec. 312. Extension of the temporary assistance for needy families program. 
TITLE IV—MORTGAGE FEES AND PREMIUMS 
Sec. 401. Guarantee Fees. 
Sec. 402. FHA guarantee fees. 
TITLE V—OTHER PROVISIONS 
Subtitle A—Keystone XL Pipeline 
Sec. 501. Permit for Keystone XL pipeline. 
Subtitle B—Budgetary Provisions 
Sec. 511. Senate point of order against an emergency designation. 
Sec. 512. PAYGO scorecard estimates. 
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TITLE I—TEMPORARY PAYROLL 
TAX RELIEF 
SEC. 101. EXTENSION OF PAYROLL TAX HOLIDAY. 
(a) IN GENERAL.—Subsection (c) of section 601 of 
the Tax Relief, Unemployment Insurance Reauthorization, 
and Job Creation Act of 2010 (26 U.S.C. 1401 note) is 
amended to read as follows: 
‘‘(c) PAYROLL TAX HOLIDAY PERIOD.—The term 
‘payroll tax holiday period’ means— 
‘‘(1) in the case of the tax described in sub-
section (a)(1), calendar years 2011 and 2012, and 
‘‘(2) in the case of the taxes described in sub-
section (a)(2), the period beginning January 1, 
2011, and ending February 29, 2012.’’. 
(b) SPECIAL RULES FOR 2012.—Section 601 of such 
Act (26 U.S.C. 1401 note) is amended by adding at the 
end the following new subsection: 
‘‘(f) SPECIAL RULES FOR 2012.— 
‘‘(1) LIMITATION
ON
SELF-EMPLOYMENT
IN-
COME.—In the case of any taxable year beginning in 
2012, subsection (a)(1) shall only apply with respect 
to so much of the taxpayer’s self-employment income 
(as defined in section 1402(b) of the Internal Rev-
enue Code of 1986) as does not exceed the excess (if 
any) of— 
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‘‘(A) $18,350, over 
‘‘(B) the amount of wages and compensa-
tion received during the portion of the payroll 
tax holiday period occurring during 2012 sub-
ject to tax under section 3101(a) of such Code 
or section 3201(a) of such Code. 
‘‘(2) COORDINATION WITH DEDUCTION FOR EM-
PLOYMENT TAXES.—In the case of a taxable year 
beginning in 2012, subparagraph (A) of subsection 
(b)(2) shall be applied as if it read as follows: 
‘‘ ‘(A) the sum of— 
‘‘ ‘(i) 59.6 percent of the portion of 
such taxes attributable to the tax imposed 
by section 1401(a) of such Code (deter-
mined after the application of this section) 
on so much of self-employment income (as 
defined in section 1402(b) of such Code) 
as does not exceed the amount of self-em-
ployment income described in paragraph 
(1), plus 
‘‘ ‘(ii) one-half of the portion of such 
taxes attributable to the tax imposed by 
section 1401(a) of such Code (determined 
without regard to this section) on self-em-
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ployment income (as so defined) in excess 
of such amount, plus’.’’. 
(c) RECAPTURE OF EXCESS BENEFIT.—Section 601 
of such Act (26 U.S.C. 1401 note), as amended by sub-
section (b), is further amended by adding at the end the 
following new subsection: 
‘‘(g) RECAPTURE OF EXCESS BENEFIT.— 
‘‘(1) IN GENERAL.—There is hereby imposed on 
the income of every individual a tax equal to 2 per-
cent of the sum of wages (within the meaning of sec-
tion 3121(a)(1) of the Internal Revenue Code of 
1986) and compensation (to which section 3201(a) 
of such Code applies) received during the period be-
ginning January 1, 2012, and ending February 29, 
2012, to the extent the amount of such sum exceeds 
$18,350. 
‘‘(2) REGULATIONS.—The Secretary of the 
Treasury or the Secretary’s delegate shall prescribe 
such regulations or other guidance as may be nec-
essary or appropriate to carry out this subsection, 
including guidance for payment by the employee of 
the tax imposed by paragraph (1).’’. 
(d) TECHNICAL AMENDMENTS.—Paragraph (2) of 
section 601(b) of such Act (26 U.S.C. 1401 note) is 
amended— 
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(1) by inserting ‘‘of such Code’’ after ‘‘164(f)’’; 
(2) 
by 
inserting 
‘‘of 
such 
Code’’ 
after 
‘‘1401(a)’’ in subparagraph (A); and 
(3) 
by 
inserting 
‘‘of 
such 
Code’’ 
after 
‘‘1401(b)’’ in subparagraph (B). 
(e) EFFECTIVE DATES.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to remuneration received, and taxable 
years beginning, after December 31, 2011. 
(2) TECHNICAL
AMENDMENTS.—The amend-
ments made by subsection (d) shall take effect as if 
included in the enactment of section 601 of the Tax 
Relief, Unemployment Insurance Reauthorization, 
and Job Creation Act of 2010. 
TITLE II—TEMPORARY EXTEN-
SION 
OF 
UNEMPLOYMENT 
COMPENSATION PROVISIONS 
SEC. 201. TEMPORARY EXTENSION OF UNEMPLOYMENT 
COMPENSATION PROVISIONS. 
(a) IN GENERAL.—(1) Section 4007 of the Supple-
mental Appropriations Act, 2008 (Public Law 110–252; 
26 U.S.C. 3304 note) is amended— 
(A) by striking ‘‘January 3, 2012’’ each place 
it appears and inserting ‘‘March 6, 2012’’; 
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(B) in the heading for subsection (b)(2), by 
striking ‘‘JANUARY 3, 2012’’ and inserting ‘‘MARCH 6, 
2012’’; and 
(C) in subsection (b)(3), by striking ‘‘June 9, 
2012’’ and inserting ‘‘August 15, 2012’’. 
(2) Section 2005 of the Assistance for Unemployed 
Workers and Struggling Families Act, as contained in 
Public Law 111–5 (26 U.S.C. 3304 note; 123 Stat. 444), 
is amended— 
(A) by striking ‘‘January 4, 2012’’ each place 
it appears and inserting ‘‘March 7, 2012’’; and 
(B) in subsection (c), by striking ‘‘June 11, 
2012’’ and inserting ‘‘August 15, 2012’’. 
(3) Section 5 of the Unemployment Compensation 
Extension Act of 2008 (Public Law 110–449; 26 U.S.C. 
3304 note) is amended by striking ‘‘June 10, 2012’’ and 
inserting ‘‘August 15, 2012’’. 
(4) Section 203 of the Federal-State Extended Un-
employment Compensation Act of 1970 (26 U.S.C. 3304 
note) is amended— 
(A) in subsection (d), in the second sentence of 
the flush matter following paragraph (2), by striking 
‘‘December 31, 2011’’ and inserting ‘‘February 29, 
2012’’; and 
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(B) in subsection (f)(2), by striking ‘‘December 
31, 2011’’ and inserting ‘‘February 29, 2012’’. 
(b) FUNDING.—Section 4004(e)(1) of the Supple-
mental Appropriations Act, 2008 (Public Law 110–252; 
26 U.S.C. 3304 note) is amended— 
(1) in subparagraph (F), by striking ‘‘and’’ at 
the end; and 
(2) by inserting after subparagraph (G) the fol-
lowing: 
‘‘(H) the amendments made by section 
201(a)(1) of the Temporary Payroll Tax Cut 
Continuation Act of 2011; and’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of the Tax Relief, Unemployment Insurance Reau-
thorization, and Job Creation Act of 2010 (Public Law 
111–312). 
SEC. 202. EXTENDED UNEMPLOYMENT BENEFITS UNDER 
THE RAILROAD UNEMPLOYMENT INSURANCE 
ACT. 
(a) EXTENSION.—Section 2(c)(2)(D)(iii) of the Rail-
road Unemployment Insurance Act, as added by section 
2006 of the American Recovery and Reinvestment Act of 
2009 (Public Law 111–5) and as amended by section 9 
of the Worker, Homeownership, and Business Assistance 
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Act of 2009 (Public Law 111–92) and section 505 of the 
Tax Relief, Unemployment Insurance Reauthorization, 
and Job Creation Act of 2010 (Public Law 111–312), is 
amended— 
(1) by striking ‘‘June 30, 2011’’ and inserting 
‘‘August 31, 2011’’; and 
(2) by striking ‘‘December 31, 2011’’ and in-
serting ‘‘February 29, 2012’’. 
(b) 
CLARIFICATION
ON
AUTHORITY
TO
USE 
FUNDS.—Funds appropriated under either the first or 
second sentence of clause (iv) of section 2(c)(2)(D) of the 
Railroad Unemployment Insurance Act shall be available 
to cover the cost of additional extended unemployment 
benefits provided under such section 2(c)(2)(D) by reason 
of the amendments made by subsection (a) as well as to 
cover the cost of such benefits provided under such section 
2(c)(2)(D), as in effect on the day before the date of the 
enactment of this Act. 
TITLE III—TEMPORARY EXTEN-
SION OF HEALTH PROVISIONS 
SEC. 301. MEDICARE PHYSICIAN PAYMENT UPDATE. 
Section 1848(d) of the Social Security Act (42 U.S.C. 
1395w–4(d)) is amended by adding at the end the fol-
lowing new paragraph: 
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‘‘(13) UPDATE
FOR
FIRST
TWO
MONTHS
OF 
2012.— 
‘‘(A) IN GENERAL.—Subject to paragraphs 
(7)(B), (8)(B), (9)(B), (10)(B), (11)(B), and 
(12)(B), in lieu of the update to the single con-
version factor established in paragraph (1)(C) 
that would otherwise apply for the period begin-
ning on January 1, 2012, and ending on Feb-
ruary 29, 2012, the update to the single conver-
sion factor shall be zero percent. 
‘‘(B) NO
EFFECT
ON
COMPUTATION
OF 
CONVERSION FACTOR FOR REMAINING PORTION 
OF 2012 AND SUBSEQUENT YEARS.—The con-
version factor under this subsection shall be 
computed under paragraph (1)(A) for the pe-
riod beginning on March 1, 2012, and ending 
on December 31, 2012, and for 2013 and sub-
sequent years as if subparagraph (A) had never 
applied.’’. 
SEC. 302. 2-MONTH EXTENSION OF MMA SECTION 508 RE-
CLASSIFICATIONS. 
(a) IN GENERAL.—Section 106(a) 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, 
Medicaid, and SCHIP Extension Act of 2007 (Public Law 
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110–173), section 124 of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110– 
275), sections 3137(a) and 10317 of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148), and 
section 102(a) of the Medicare and Medicaid Extenders 
Act of 2010 (Public Law 111–309), is amended by strik-
ing ‘‘September 30, 2011’’ and inserting ‘‘November 30, 
2011’’. 
(b) SPECIAL RULE FOR OCTOBER AND NOVEMBER 
2011.— 
(1) IN GENERAL.—Subject to paragraph (2), 
for purposes of implementation of the amendment 
made by subsection (a), including for purposes of 
the implementation of paragraph (2) of section 
117(a) of the Medicare, Medicaid, and SCHIP Ex-
tension Act of 2007 (Public Law 110–173), for the 
period beginning on October 1, 2011, and ending on 
November 30, 2011, the Secretary of Health and 
Human Services shall use the hospital wage index 
that was promulgated by the Secretary of Health 
and Human Services in the Federal Register on Au-
gust 18, 2011 (76 Fed. Reg. 51476), and any subse-
quent corrections. 
(2) EXCEPTION.—In determining the wage 
index applicable to hospitals that qualify for wage 
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index reclassification, the Secretary shall, for the pe-
riod beginning on October 1, 2011, and ending on 
November 30, 2011, include the average hourly wage 
data of hospitals whose reclassification was extended 
pursuant to the amendment made by subsection (a) 
only if including such data results in a higher appli-
cable reclassified wage index. Any revision to hos-
pital wage indexes made as a result of this para-
graph shall not be effected in a budget neutral man-
ner. 
(c) TIMEFRAME
FOR PAYMENTS.—The Secretary 
shall make payments required under subsections (a) and 
(b) by not later than December 31, 2012. 
SEC. 303. EXTENSION OF MEDICARE WORK GEOGRAPHIC 
ADJUSTMENT FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘before 
January 1, 2012’’ and inserting ‘‘before March 1, 2012’’. 
SEC. 304. EXTENSION OF EXCEPTIONS PROCESS FOR MEDI-
CARE THERAPY CAPS. 
Section 1833(g)(5) of the Social Security Act (42 
U.S.C. 1395l(g)(5)) is amended by striking ‘‘December 
31, 2011’’ and inserting ‘‘February 29, 2012’’. 
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SEC. 305. EXTENSION OF PAYMENT FOR TECHNICAL COM-
PONENT OF CERTAIN PHYSICIAN PATHOL-
OGY SERVICES. 
Section 542(c) of the Medicare, Medicaid, and 
SCHIP Benefits Improvement and Protection Act of 2000 
(as enacted into law by section 1(a)(6) of Public Law 106– 
554), as amended by section 732 of the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 
(42 U.S.C. 1395w–4 note), section 104 of division B of 
the Tax Relief and Health Care Act of 2006 (42 U.S.C. 
1395w–4 note), section 104 of the Medicare, Medicaid, 
and SCHIP Extension Act of 2007 (Public Law 110– 
173), section 136 of the Medicare Improvements for Pa-
tients and Providers Act of 2008 (Public Law 110–275), 
section 3104 of the Patient Protection and Affordable 
Care Act (Public Law 111–148), and section 105 of the 
Medicare and Medicaid Extenders Act of 2010 (Public 
Law 111–309), is amended by striking ‘‘and 2011’’ and 
inserting ‘‘2011, and the first two months of 2012’’. 
SEC. 306. EXTENSION OF AMBULANCE ADD-ONS. 
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) 
of the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) 
is amended— 
(1) in the matter preceding clause (i), by strik-
ing ‘‘January 1, 2012’’ and inserting ‘‘March 1, 
2012’’; and 
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(2) in each of clauses (i) and (ii), by striking 
‘‘January 1, 2012’’ and inserting ‘‘March 1, 2012’’ 
each place it appears. 
(b) AIR AMBULANCE.—Section 146(b)(1) of the 
Medicare Improvements for Patients and Providers Act of 
2008 (Public Law 110–275), as amended by sections 
3105(b) and 10311(b) of Public Law 111–148 and section 
106(b) of the Medicare and Medicaid Extenders Act of 
2010 (Public Law 111–309), is amended by striking ‘‘De-
cember 31, 2011’’ and inserting ‘‘February 29, 2012’’. 
(c) 
SUPER
RURAL
AMBULANCE.—Section 
1834(l)(12)(A) of the Social Security Act (42 U.S.C. 
1395m(l)(12)(A)) is amended by striking ‘‘January 1, 
2012’’ and inserting ‘‘March 1, 2012’’. 
SEC. 307. EXTENSION OF PHYSICIAN FEE SCHEDULE MEN-
TAL HEALTH ADD-ON PAYMENT. 
Section 138(a)(1) of the Medicare Improvements for 
Patients and Providers Act of 2008 (Public Law 110– 
275), as amended by section 3107 of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148) and 
section 107 of the Medicare and Medicaid Extenders Act 
of 2010 (Public Law 111–309), is amended by striking 
‘‘December 31, 2011’’ and inserting ‘‘February 29, 
2012’’. 
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SEC. 308. EXTENSION OF OUTPATIENT HOLD HARMLESS 
PROVISION. 
Section 1833(t)(7)(D)(i) of the Social Security Act 
(42 U.S.C. 1395l(t)(7)(D)(i)), as amended by section 
3121(a) of the Patient Protection and Affordable Care Act 
(Public Law 111–148) and section 108 of the Medicare 
and Medicaid Extenders Act of 2010 (Public Law 111– 
309), is amended— 
(1) in subclause (II)— 
(A) in the first sentence, by striking ‘‘Jan-
uary 1, 2012’’ and inserting ‘‘March 1, 2012’’; 
and 
(B) in the second sentence, by striking ‘‘or 
2011’’ and inserting ‘‘2011, or the first two 
months of 2012’’; and 
(2) in subclause (III)— 
(A) in the first sentence, by striking 
‘‘2009, and’’ and all that follows through ‘‘for 
which’’ and inserting ‘‘2009, and before March 
1, 2012, for which’’; and 
(B) in the second sentence, by striking 
‘‘2010, and’’ and all that follows through ‘‘the 
preceding’’ and inserting ‘‘2010, and before 
March 1, 2012, the preceding’’. 
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SEC. 309. EXTENDING MINIMUM PAYMENT FOR BONE MASS 
MEASUREMENT. 
Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4) is amended— 
(1) in subsection (b)— 
(A) in paragraph (4)(B), by striking ‘‘and 
2011’’ and inserting ‘‘, 2011, and the first 2 
months of 2012’’; and 
(B) in paragraph (6)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘and 2011’’ and in-
serting ‘‘, 2011, and the first 2 months of 
2012’’; and 
(ii) in subparagraph (C), by striking 
‘‘and 2011’’ and inserting ‘‘, 2011, and the 
first 2 months of 2012’’; and 
(2) in subsection (c)(2)(B)(iv)(IV), by striking 
‘‘or 2011’’ and inserting ‘‘, 2011, or the first 2 
months of 2012’’. 
SEC. 310. EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) 
PROGRAM. 
(a) EXTENSION.—Section 1902(a)(10)(E)(iv) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is 
amended by striking ‘‘December 2011’’ and inserting 
‘‘February 2012’’. 
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(b) EXTENDING TOTAL AMOUNT AVAILABLE FOR 
ALLOCATION.—Section 1933(g) of such Act (42 U.S.C. 
1396u–3(g)) is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (O); 
(B) in subparagraph (P), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) for the period that begins on January 
1, 2012, and ends on February 29, 2012, the 
total allocation amount is $150,000,000.’’. 
SEC. 311. EXTENSION OF TRANSITIONAL MEDICAL ASSIST-
ANCE (TMA). 
Sections 1902(e)(1)(B) and 1925(f) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)) are 
each amended by striking ‘‘December 31, 2011’’ and in-
serting ‘‘February 29, 2012’’. 
SEC. 312. EXTENSION OF THE TEMPORARY ASSISTANCE 
FOR NEEDY FAMILIES PROGRAM. 
Activities authorized by part A of title IV and section 
1108(b) of the Social Security Act (other than under sub-
sections (a)(3) and (b) of section 403 of such Act) shall 
continue through February 29, 2012, in the manner au-
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(C) if the modified route submitted by the 
Governor 
of 
Nebraska 
under 
subsection 
(d)(3)(B) crosses the Sand Hills region, the 
measures agreed to by the permittee for the 
Sand Hills region found in appendix H of the 
final environmental impact statement described 
in subparagraph (A); and 
(D) the stipulations identified in appendix 
S of the final environmental impact statement 
described in subparagraph (A). 
(6) Other requirements that are standard in-
dustry practice or commonly included in Federal 
permits that are similar to a permit issued under 
subsection (a). 
(d) MODIFICATION.—The permit issued under sub-
section (a) shall require— 
(1) the reconsideration of routing of the Key-
stone XL pipeline within the State of Nebraska; 
(2) a review period during which routing within 
the State of Nebraska may be reconsidered and the 
route of the Keystone XL pipeline through the State 
altered with any accompanying modification to the 
Plan described in subsection (c)(5)(A); and 
(3) the President— 
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