H. R. 3590—898 
work is longshore work (as defined in section 258(b) of the Immigra-
tion and Nationality Act (8 U.S.C. 1288(b)), determined without 
regard to paragraph (2) thereof),’’ before ‘‘and individuals engaged 
in the construction, mining’’. 
(b) EXEMPTION FROM HIGH-COST INSURANCE TAX INCLUDES CER-
TAIN
ADDITIONAL
EXCEPTED
BENEFITS.—Clause (i) of section 
4980I(d)(1)(B) of the Internal Revenue Code of 1986, as added 
by section 9001 of this Act, is amended by striking ‘‘section 
9832(c)(1)(A)’’ and inserting ‘‘section 9832(c)(1) (other than subpara-
graph (G) thereof)’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to taxable years beginning after December 31, 2012. 
SEC. 10902. INFLATION ADJUSTMENT OF LIMITATION ON HEALTH 
FLEXIBLE SPENDING ARRANGEMENTS UNDER CAFE-
TERIA PLANS. 
(a) IN GENERAL.—Subsection (i) of section 125 of the Internal 
Revenue Code of 1986, as added by section 9005 of this Act, is 
amended to read as follows: 
‘‘(i) LIMITATION
ON HEALTH FLEXIBLE SPENDING ARRANGE-
MENTS.— 
‘‘(1) IN GENERAL.—For purposes of this section, if a benefit 
is provided under a cafeteria plan through employer contribu-
tions to a health flexible spending arrangement, such benefit 
shall not be treated as a qualified benefit unless the cafeteria 
plan provides that an employee may not elect for any taxable 
year to have salary reduction contributions in excess of $2,500 
made to such arrangement. 
‘‘(2) ADJUSTMENT FOR INFLATION.—In the case of any tax-
able year beginning after December 31, 2011, the dollar amount 
in paragraph (1) shall be increased by an amount equal to— 
‘‘(A) such amount, multiplied by 
‘‘(B) the cost-of-living adjustment determined under 
section 1(f)(3) for the calendar year in which such taxable 
year begins by substituting ‘calendar year 2010’ for ‘cal-
endar year 1992’ in subparagraph (B) thereof. 
If any increase determined under this paragraph is not a mul-
tiple of $50, such increase shall be rounded to the next lowest 
multiple of $50.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2010. 
SEC. 10903. MODIFICATION OF LIMITATION ON CHARGES BY CHARI-
TABLE HOSPITALS. 
(a) IN GENERAL.—Subparagraph (A) of section 501(r)(5) of the 
Internal Revenue Code of 1986, as added by section 9007 of this 
Act, is amended by striking ‘‘the lowest amounts charged’’ and 
inserting ‘‘the amounts generally billed’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after the date of the enact-
ment of this Act. 
SEC. 10904. MODIFICATION OF ANNUAL FEE ON MEDICAL DEVICE 
MANUFACTURERS AND IMPORTERS. 
(a) IN GENERAL.—Section 9009 of this Act is amended— 
(1) by striking ‘‘2009’’ in subsection (a)(1) and inserting 
‘‘2010’’,
H. R. 3590—899 
(2) by inserting ‘‘($3,000,000,000 after 2017)’’ after 
‘‘$2,000,000,000’’, and 
(3) by striking ‘‘2008’’ in subsection (i) and inserting ‘‘2009’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall take effect as if included in the enactment of section 9009. 
SEC. 10905. MODIFICATION OF ANNUAL FEE ON HEALTH INSURANCE 
PROVIDERS. 
(a) DETERMINATION OF FEE AMOUNT.—Subsection (b) of section 
9010 of this Act is amended to read as follows: 
‘‘(b) DETERMINATION OF FEE AMOUNT.— 
‘‘(1) IN
GENERAL.—With respect to each covered entity, 
the fee under this section for any calendar year shall be equal 
to an amount that bears the same ratio to the applicable 
amount as— 
‘‘(A) the covered entity’s net premiums written with 
respect to health insurance for any United States health 
risk that are taken into account during the preceding cal-
endar year, bears to 
‘‘(B) the aggregate net premiums written with respect 
to such health insurance of all covered entities that are 
taken into account during such preceding calendar year. 
‘‘(2) AMOUNTS TAKEN INTO ACCOUNT.—For purposes of para-
graph (1), the net premiums written with respect to health 
insurance for any United States health risk that are taken 
into account during any calendar year with respect to any 
covered entity shall be determined in accordance with the fol-
lowing table: 
‘‘With respect to a covered entity’s net pre-
miums written during the calendar year that 
are: 
The percentage of 
net premiums writ-
ten that are taken 
into account is: 
Not more than $25,000,000 .....................
0 percent 
More than $25,000,000 but not more 
than $50,000,000.
50 percent 
More than $50,000,000 .............................
100 percent. 
‘‘(3) SECRETARIAL
DETERMINATION.—The Secretary shall 
calculate the amount of each covered entity’s fee for any cal-
endar year under paragraph (1). In calculating such amount, 
the Secretary shall determine such covered entity’s net pre-
miums written with respect to any United States health risk 
on the basis of reports submitted by the covered entity under 
subsection (g) and through the use of any other source of 
information available to the Secretary.’’. 
(b) APPLICABLE AMOUNT.—Subsection (e) of section 9010 of 
this Act is amended to read as follows: 
‘‘(e) APPLICABLE AMOUNT.—For purposes of subsection (b)(1), 
the applicable amount shall be determined in accordance with the 
following table: 
‘‘Calendar year 
Applicable 
amount 
2011 ...........................................................
$2,000,000,000 
2012 ...........................................................
$4,000,000,000
H. R. 3590—900 
2013 ...........................................................
$7,000,000,000 
2014, 2015 and 2016 .................................
$9,000,000,000 
2017 and thereafter ..................................
$10,000,000,000.’’. 
(c) EXEMPTION FROM ANNUAL FEE ON HEALTH INSURANCE FOR 
CERTAIN NONPROFIT ENTITIES.—Section 9010(c)(2) of this Act is 
amended by striking ‘‘or’’ at the end of subparagraph (A), by striking 
the period at the end of subparagraph (B) and inserting a comma, 
and by adding at the end the following new subparagraphs: 
‘‘(C) any entity— 
‘‘(i)(I) which is incorporated as, is a wholly owned 
subsidiary of, or is a wholly owned affiliate of, a non-
profit corporation under a State law, or 
‘‘(II) which is described in section 501(c)(4) of the 
Internal Revenue Code of 1986 and the activities of 
which consist of providing commercial-type insurance 
(within the meaning of section 501(m) of such Code), 
‘‘(ii) the premium rate increases of which are regu-
lated by a State authority, 
‘‘(iii) which, as of the date of the enactment of 
this section, acts as the insurer of last resort in the 
State and is subject to State guarantee issue require-
ments, and 
‘‘(iv) for which the medical loss ratio (determined 
in a manner consistent with the determination of such 
ratio under section 2718(b)(1)(A) of the Public Health 
Service Act) with respect to the individual insurance 
market for such entity for the calendar year is not 
less than 100 percent, 
‘‘(D) any entity— 
‘‘(i)(I) which is incorporated as a nonprofit corpora-
tion under a State law, or 
‘‘(II) which is described in section 501(c)(4) of the 
Internal Revenue Code of 1986 and the activities of 
which consist of providing commercial-type insurance 
(within the meaning of section 501(m) of such Code), 
and 
‘‘(ii) for which the medical loss ratio (as so deter-
mined)— 
‘‘(I) with respect to each of the individual, 
small group, and large group insurance markets 
for such entity for the calendar year is not less 
than 90 percent, and 
‘‘(II) with respect to all such markets for such 
entity for the calendar year is not less than 92 
percent, or 
‘‘(E) any entity— 
‘‘(i) which is a mutual insurance company, 
‘‘(ii) which for the period reported on the 2008 
Accident and Health Policy Experience Exhibit of the 
National Association of Insurance Commissioners 
had— 
‘‘(I) a market share of the insured population 
of a State of at least 40 but not more than 60 
percent, and
H. R. 3590—901 
‘‘(II) with respect to all markets described in 
subparagraph (D)(ii)(I), a medical loss ratio of not 
less than 90 percent, and 
‘‘(iii) with respect to annual payment dates in cal-
endar years after 2011, for which the medical loss 
ratio (determined in a manner consistent with the 
determination of such ratio under section 2718(b)(1)(A) 
of the Public Health Service Act) with respect to all 
such markets for such entity for the preceding calendar 
year is not less than 89 percent (except that with 
respect to such annual payment date for 2012, the 
calculation under 2718(b)(1)(B)(ii) of such Act is deter-
mined by reference to the previous year, and with 
respect to such annual payment date for 2013, such 
calculation is determined by reference to the average 
for the previous 2 years).’’. 
(d) CERTAIN INSURANCE EXEMPTED FROM FEE.—Paragraph (3) 
of section 9010(h) of this Act is amended to read as follows: 
‘‘(3) HEALTH INSURANCE.—The term ‘health insurance’ shall 
not include— 
‘‘(A) any insurance coverage described in paragraph 
(1)(A) or (3) of section 9832(c) of the Internal Revenue 
Code of 1986, 
‘‘(B) any insurance for long-term care, or 
‘‘(C) any medicare supplemental health insurance (as 
defined in section 1882(g)(1) of the Social Security Act).’’. 
(e) ANTI-AVOIDANCE GUIDANCE.—Subsection (i) of section 9010 
of this Act is amended by inserting ‘‘and shall prescribe such regula-
tions as are necessary or appropriate to prevent avoidance of the 
purposes of this section, including inappropriate actions taken to 
qualify as an exempt entity under subsection (c)(2)’’ after ‘‘section’’. 
(f) CONFORMING AMENDMENTS.— 
(1) Section 9010(a)(1) of this Act is amended by striking 
‘‘2009’’ and inserting ‘‘2010’’. 
(2) Section 9010(c)(2)(B) of this Act is amended by striking 
‘‘(except’’ and all that follows through ‘‘1323)’’. 
(3) Section 9010(c)(3) of this Act is amended by adding 
at the end the following new sentence: ‘‘If any entity described 
in subparagraph (C)(i)(I), (D)(i)(I), or (E)(i) of paragraph (2) 
is treated as a covered entity by reason of the application 
of the preceding sentence, the net premiums written with 
respect to health insurance for any United States health risk 
of such entity shall not be taken into account for purposes 
of this section.’’. 
(4) Section 9010(g)(1) of this Act is amended by striking 
‘‘and third party administration agreement fees’’. 
(5) Section 9010(j) of this Act is amended— 
(A) by striking ‘‘2008’’ and inserting ‘‘2009’’, and 
(B) by striking ‘‘, and any third party administration 
agreement fees received after such date’’. 
(g) EFFECTIVE DATE.—The amendments made by this section 
shall take effect as if included in the enactment of section 9010.
H. R. 3590—902 
SEC. 10906. MODIFICATIONS TO ADDITIONAL HOSPITAL INSURANCE 
TAX ON HIGH-INCOME TAXPAYERS. 
(a) FICA.—Section 3101(b)(2) of the Internal Revenue Code 
of 1986, as added by section 9015(a)(1) of this Act, is amended 
by striking ‘‘0.5 percent’’ and inserting ‘‘0.9 percent’’. 
(b) SECA.—Section 1401(b)(2)(A) of the Internal Revenue Code 
of 1986, as added by section 9015(b)(1) of this Act, is amended 
by striking ‘‘0.5 percent’’ and inserting ‘‘0.9 percent’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply with respect to remuneration received, and taxable 
years beginning, after December 31, 2012. 
SEC. 10907. EXCISE TAX ON INDOOR TANNING SERVICES IN LIEU OF 
ELECTIVE COSMETIC MEDICAL PROCEDURES. 
(a) IN GENERAL.—The provisions of, and amendments made 
by, section 9017 of this Act are hereby deemed null, void, and 
of no effect. 
(b) EXCISE TAX
ON INDOOR TANNING SERVICES.—Subtitle D 
of the Internal Revenue Code of 1986, as amended by this Act, 
is amended by adding at the end the following new chapter: 
‘‘CHAPTER 49—COSMETIC SERVICES 
‘‘Sec. 5000B. Imposition of tax on indoor tanning services. 
‘‘SEC. 5000B. IMPOSITION OF TAX ON INDOOR TANNING SERVICES. 
‘‘(a) IN GENERAL.—There is hereby imposed on any indoor tan-
ning service a tax equal to 10 percent of the amount paid for 
such service (determined without regard to this section), whether 
paid by insurance or otherwise. 
‘‘(b) INDOOR TANNING SERVICE.—For purposes of this section— 
‘‘(1) IN GENERAL.—The term ‘indoor tanning service’ means 
a service employing any electronic product designed to incor-
porate 1 or more ultraviolet lamps and intended for the irradia-
tion of an individual by ultraviolet radiation, with wavelengths 
in air between 200 and 400 nanometers, to induce skin tanning. 
‘‘(2) EXCLUSION OF PHOTOTHERAPY SERVICES.—Such term 
does not include any phototherapy service performed by a 
licensed medical professional. 
‘‘(c) PAYMENT OF TAX.— 
‘‘(1) IN GENERAL.—The tax imposed by this section shall 
be paid by the individual on whom the service is performed. 
‘‘(2) COLLECTION.—Every person receiving a payment for 
services on which a tax is imposed under subsection (a) shall 
collect the amount of the tax from the individual on whom 
the service is performed and remit such tax quarterly to the 
Secretary at such time and in such manner as provided by 
the Secretary. 
‘‘(3) SECONDARY LIABILITY.—Where any tax imposed by sub-
section (a) is not paid at the time payments for indoor tanning 
services are made, then to the extent that such tax is not 
collected, such tax shall be paid by the person who performs 
the service.’’. 
(c) CLERICAL AMENDMENT.—The table of chapter for subtitle 
D of the Internal Revenue Code of 1986, as amended by this 
Act, is amended by inserting after the item relating to chapter 
48 the following new item:
H. R. 3590—903 
‘‘CHAPTER 49—COSMETIC SERVICES’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply to services performed on or after July 1, 2010. 
SEC. 10908. EXCLUSION FOR ASSISTANCE PROVIDED TO PARTICIPANTS 
IN STATE STUDENT LOAN REPAYMENT PROGRAMS FOR 
CERTAIN HEALTH PROFESSIONALS. 
(a) IN GENERAL.—Paragraph (4) of section 108(f) of the Internal 
Revenue Code of 1986 is amended to read as follows: 
‘‘(4) PAYMENTS UNDER NATIONAL HEALTH SERVICE CORPS 
LOAN REPAYMENT PROGRAM AND CERTAIN STATE LOAN REPAY-
MENT PROGRAMS.—In the case of an individual, gross income 
shall not include any amount received under section 338B(g) 
of the Public Health Service Act, under a State program 
described in section 338I of such Act, or under any other 
State loan repayment or loan forgiveness program that is 
intended to provide for the increased availability of health 
care services in underserved or health professional shortage 
areas (as determined by such State).’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to amounts received by an individual in taxable years 
beginning after December 31, 2008. 
SEC. 10909. EXPANSION OF ADOPTION CREDIT AND ADOPTION ASSIST-
ANCE PROGRAMS. 
(a) INCREASE IN DOLLAR LIMITATION.— 
(1) ADOPTION CREDIT.— 
(A) IN
GENERAL.—Paragraph (1) of section 23(b) of 
the Internal Revenue Code of 1986 (relating to dollar 
limitation) is amended by striking ‘‘$10,000’’ and inserting 
‘‘$13,170’’. 
(B) CHILD WITH SPECIAL NEEDS.—Paragraph (3) of sec-
tion 23(a) of such Code (relating to $10,000 credit for adop-
tion of child with special needs regardless of expenses) 
is amended— 
(i) in the text by striking ‘‘$10,000’’ and inserting 
‘‘$13,170’’, and 
(ii) in the heading by striking ‘‘$10,000’’ and 
inserting ‘‘$13,170’’. 
(C) CONFORMING AMENDMENT TO INFLATION ADJUST-
MENT.—Subsection (h) of section 23 of such Code (relating 
to adjustments for inflation) is amended to read as follows: 
‘‘(h) ADJUSTMENTS FOR INFLATION.— 
‘‘(1) DOLLAR LIMITATIONS.—In the case of a taxable year 
beginning after December 31, 2010, each of the dollar amounts 
in subsections (a)(3) and (b)(1) shall be increased by an amount 
equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment determined under 
section 1(f)(3) for the calendar year in which the taxable 
year begins, determined by substituting ‘calendar year 
2009’ for ‘calendar year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sentence is 
not a multiple of $10, such amount shall be rounded to the 
nearest multiple of $10. 
‘‘(2) INCOME LIMITATION.—In the case of a taxable year 
beginning after December 31, 2002, the dollar amount in sub-
section (b)(2)(A)(i) shall be increased by an amount equal to—
H. R. 3590—904 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment determined under 
section 1(f)(3) for the calendar year in which the taxable 
year begins, determined by substituting ‘calendar year 
2001’ for ‘calendar year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sentence is 
not a multiple of $10, such amount shall be rounded to the 
nearest multiple of $10.’’. 
(2) ADOPTION ASSISTANCE PROGRAMS.— 
(A) IN GENERAL.—Paragraph (1) of section 137(b) of 
the Internal Revenue Code of 1986 (relating to dollar 
limitation) is amended by striking ‘‘$10,000’’ and inserting 
‘‘$13,170’’. 
(B) CHILD WITH SPECIAL NEEDS.—Paragraph (2) of sec-
tion 137(a) of such Code (relating to $10,000 exclusion 
for adoption of child with special needs regardless of 
expenses) is amended— 
(i) in the text by striking ‘‘$10,000’’ and inserting 
‘‘$13,170’’, and 
(ii) in the heading by striking ‘‘$10,000’’ and 
inserting ‘‘$13,170’’. 
(C) CONFORMING AMENDMENT TO INFLATION ADJUST-
MENT.—Subsection (f) of section 137 of such Code (relating 
to adjustments for inflation) is amended to read as follows: 
‘‘(f) ADJUSTMENTS FOR INFLATION.— 
‘‘(1) DOLLAR LIMITATIONS.—In the case of a taxable year 
beginning after December 31, 2010, each of the dollar amounts 
in subsections (a)(2) and (b)(1) shall be increased by an amount 
equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment determined under 
section 1(f)(3) for the calendar year in which the taxable 
year begins, determined by substituting ‘calendar year 
2009’ for ‘calendar year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sentence is 
not a multiple of $10, such amount shall be rounded to the 
nearest multiple of $10. 
‘‘(2) INCOME LIMITATION.—In the case of a taxable year 
beginning after December 31, 2002, the dollar amount in sub-
section (b)(2)(A) shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment determined under 
section 1(f)(3) for the calendar year in which the taxable 
year begins, determined by substituting ‘calendar year 
2001’ for ‘calendar year 1992’ in subparagraph thereof. 
If any amount as increased under the preceding sentence is 
not a multiple of $10, such amount shall be rounded to the 
nearest multiple of $10.’’. 
(b) CREDIT MADE REFUNDABLE.— 
(1) CREDIT MOVED TO SUBPART RELATING TO REFUNDABLE 
CREDITS.—The Internal Revenue Code of 1986 is amended— 
(A) by redesignating section 23, as amended by sub-
section (a), as section 36C, and 
(B) by moving section 36C (as so redesignated) from 
subpart A of part IV of subchapter A of chapter 1 to 
the location immediately before section 37 in subpart C 
of part IV of subchapter A of chapter 1.
H. R. 3590—905 
(2) CONFORMING AMENDMENTS.— 
(A) Section 24(b)(3)(B) of such Code is amended by 
striking ‘‘23,’’. 
(B) Section 25(e)(1)(C) of such Code is amended by 
striking ‘‘23,’’ both places it appears. 
(C) Section 25A(i)(5)(B) of such Code is amended by 
striking ‘‘23, 25D,’’ and inserting ‘‘25D’’. 
(D) Section 25B(g)(2) of such Code is amended by 
striking ‘‘23,’’. 
(E) Section 26(a)(1) of such Code is amended by striking 
‘‘23,’’. 
(F) Section 30(c)(2)(B)(ii) of such Code is amended by 
striking ‘‘23, 25D,’’ and inserting ‘‘25D’’. 
(G) Section 30B(g)(2)(B)(ii) of such Code is amended 
by striking ‘‘23,’’. 
(H) Section 30D(c)(2)(B)(ii) of such Code is amended 
by striking ‘‘sections 23 and’’ and inserting ‘‘section’’. 
(I) Section 36C of such Code, as so redesignated, is 
amended— 
(i) by striking paragraph (4) of subsection (b), and 
(ii) by striking subsection (c). 
(J) Section 137 of such Code is amended— 
(i) by striking ‘‘section 23(d)’’ in subsection (d) and 
inserting ‘‘section 36C(d)’’, and 
(ii) by striking ‘‘section 23’’ in subsection (e) and 
inserting ‘‘section 36C’’. 
(K) Section 904(i) of such Code is amended by striking 
‘‘23,’’. 
(L) Section 1016(a)(26) is amended by striking ‘‘23(g)’’ 
and inserting ‘‘36C(g)’’. 
(M) Section 1400C(d) of such Code is amended by 
striking ‘‘23,’’. 
(N) Section 6211(b)(4)(A) of such Code is amended by 
inserting ‘‘36C,’’ before ‘‘53(e)’’. 
(O) The table of sections for subpart A of part IV 
of subchapter A of chapter 1 of such Code of 1986 is 
amended by striking the item relating to section 23. 
(P) Paragraph (2) of section 1324(b) of title 31, United 
States Code, as amended by this Act, is amended by 
inserting ‘‘36C,’’ after ‘‘36B,’’. 
(Q) The table of sections for subpart C of part IV 
of subchapter A of chapter 1 of the Internal Revenue Code 
of 1986, as amended by this Act, is amended by inserting 
after the item relating to section 36B the following new 
item: 
‘‘Sec. 36C. Adoption expenses.’’. 
(c) APPLICATION AND EXTENSION OF EGTRRA SUNSET.—Not-
withstanding section 901 of the Economic Growth and Tax Relief 
Reconciliation Act of 2001, such section shall apply to the amend-
ments made by this section and the amendments made by section 
202 of such Act by substituting ‘‘December 31, 2011’’ for ‘‘December 
31, 2010’’ in subsection (a)(1) thereof.
H. R. 3590—906 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply to taxable years beginning after December 31, 2009. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.