H. R. 6331—95 
of health care disparities for Medicare beneficiaries based on 
analyses of the data collected under subsection (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 evaluation of data on health care disparities 
on the basis of race, ethnicity, and gender.’’. 
SEC. 186. DEMONSTRATION TO IMPROVE CARE TO PREVIOUSLY UNIN-
SURED. 
(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 deter-
mine the greatest needs and most effective methods of outreach 
to medicare beneficiaries who were previously uninsured. 
(b) SCOPE.—The demonstration shall be in no fewer than 10 
sites, and shall include state health insurance assistance programs, 
community health centers, community-based organizations, commu-
nity health workers, and other service providers under parts A, 
B, and C of title XVIII of the Social Security Act. Grantees that 
are plans operating 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 submit 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 materials (including the 
potential for use of video information), 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 satisfaction, and select health 
outcomes. 
SEC. 187. OFFICE OF THE INSPECTOR GENERAL REPORT ON COMPLI-
ANCE WITH AND ENFORCEMENT OF NATIONAL STAND-
ARDS ON CULTURALLY AND LINGUISTICALLY APPRO-
PRIATE SERVICES (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 Origin Discrimination Affecting Limited 
English Proficient Persons and the Office of Minority Health’s 
Culturally and Linguistically Appropriate Services Standards 
in health care; and 
(2) a description of the costs associated with or savings 
related to the provision of language services.
H. R. 6331—96 
Such report shall include recommendations on improving compli-
ance 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 identified in the report. 
SEC. 188. MEDICARE IMPROVEMENT FUNDING. 
(a) MEDICARE IMPROVEMENT FUND.— 
(1) IN GENERAL.—Subject to paragraph (2), 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 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 years 2014 through 2017, $19,900,000,000. 
‘‘(2) PAYMENT FROM TRUST FUNDS.—The amount specified 
under paragraph (1) shall be available to the Fund, as expendi-
tures are made from the Fund, from the Federal Hospital 
Insurance Trust Fund and the Federal Supplementary Medical 
Insurance 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 amounts to cover all such 
obligations incurred consistent with the previous sentence.’’. 
(2) CONTINGENCY.— 
(A) IN GENERAL.—If there is enacted, before, on, or 
after the date of the enactment of this Act, a Supplemental 
Appropriations Act, 2008 that includes a provision pro-
viding for a Medicare Improvement Fund under a section 
1898 of the Social Security Act, the alternative amendment 
described in subparagraph (B)— 
(i) shall apply instead of the amendment made 
by paragraph (1); and 
(ii) shall be executed after such provision in such 
Supplemental Appropriations Act. 
(B) ALTERNATIVE AMENDMENT DESCRIBED.—The alter-
native amendment described in this subparagraph is as 
follows: Section 1898(b)(1) of the Social Security Act, as 
added by the Supplemental Appropriations Act, 2008, is 
amended by inserting before the period at the end the
H. R. 6331—97 
following: ‘‘ and, in addition for services furnished during 
fiscal years 2014 through 2017, $19,900,000,000’’. 
(b) IMPLEMENTATION.—For purposes of carrying out the provi-
sions of, and amendments made by, this title, 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 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 proportion 
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. 
SEC. 189. INCLUSION OF MEDICARE PROVIDERS AND SUPPLIERS IN 
FEDERAL PAYMENT LEVY AND ADMINISTRATIVE OFFSET 
PROGRAM. 
(a) IN GENERAL.—Section 1874 of the Social Security Act (42 
U.S.C. 1395kk) is amended by adding at the end the following 
new subsection: 
‘‘(d) INCLUSION
OF MEDICARE PROVIDER
AND SUPPLIER PAY-
MENTS IN FEDERAL PAYMENT LEVY PROGRAM.— 
‘‘(1) IN GENERAL.—The Centers for Medicare & Medicaid 
Services shall take all necessary steps to participate in the 
Federal Payment Levy Program under section 6331(h) of the 
Internal Revenue Code of 1986 as soon as possible and shall 
ensure that— 
‘‘(A) at least 50 percent of all payments under parts 
A and B are processed through such program beginning 
within 1 year after the date of the enactment of this section; 
‘‘(B) at least 75 percent of all payments under parts 
A and B are processed through such program beginning 
within 2 years after such date; and 
‘‘(C) all payments under parts A and B are processed 
through such program beginning not later than September 
30, 2011. 
‘‘(2) ASSISTANCE.—The Financial Management Service and 
the Internal Revenue Service shall provide assistance to the 
Centers for Medicare & Medicaid Services to ensure that all 
payments described in paragraph (1) are included in the Federal 
Payment Levy Program by the deadlines specified in that sub-
section.’’. 
(b) APPLICATION
OF ADMINISTRATIVE OFFSET PROVISIONS
TO 
MEDICARE PROVIDER OR SUPPLIER PAYMENTS.—Section 3716 of title 
31, United States Code, is amended— 
(1) by inserting ‘‘the Department of Health and Human 
Services,’’ after ‘‘United States Postal Service,’’ in subsection 
(c)(1)(A); and 
(2) by adding at the end of subsection (c)(3) the following 
new subparagraph: 
‘‘(D) This section shall apply to payments made after 
the date which is 90 days after the enactment of this 
subparagraph (or such earlier date as designated by the 
Secretary of Health and Human Services) with respect 
to claims or debts, and to amounts payable, under title 
XVIII of the Social Security Act.’’.
H. R. 6331—98 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall take effect on the date of the enactment of this Act. 
TITLE II—MEDICAID 
SEC. 201. EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA) 
AND ABSTINENCE EDUCATION PROGRAM. 
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, Education, and QI Programs Extension Act 
of 2007 (Public Law 110–90, 121 Stat. 984), and section 202 of 
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
Law 110–173) is amended— 
(1) by striking ‘‘June 30, 2008’’ and inserting ‘‘June 30, 
2009’’; 
(2) by striking ‘‘the third quarter of fiscal year 2008’’ and 
inserting ‘‘the third quarter of fiscal year 2009’’; and 
(3) by striking ‘‘the third quarter of fiscal year 2007’’ and 
inserting ‘‘the third 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 POR-
TIONS OF FISCAL YEAR 2008’’ and inserting ‘‘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 sen-
tences: ‘‘Only with respect to fiscal year 2010 for the 
period ending on December 31, 2009, the DSH allot-
ment for Tennessee for such portion of the fiscal year, 
notwithstanding such table or terms, shall be 1⁄4 of 
the amount specified in the first sentence for fiscal 
year 2007.’’; 
(B) in clause (ii), by striking ‘‘or for a period in fiscal 
year 2008’’ and inserting ‘‘, 2008, 2009, or for a period 
in fiscal year 2010’’; 
(C) in clause (iv)— 
(i) in the heading, by striking ‘‘FISCAL YEAR 2007 
AND FISCAL YEAR 2008’’ and inserting ‘‘FISCAL YEARS 
2007 THROUGH 2009 AND THE FIRST CALENDAR QUARTER 
OF FISCAL YEAR 2010’’; 
(ii) in subclause (I), by striking ‘‘or for a period 
in fiscal year 2008’’ and inserting ‘‘, 2008, 2009, or 
for a period in fiscal year 2010’’; and 
(iii) in subclause (II), by striking ‘‘or for a period 
in fiscal year 2008’’ and inserting ‘‘, 2008, 2009, or 
for a period in fiscal year 2010’’; and
H. R. 6331—99 
(3) in subparagraph (B)(i)— 
(A) in the first sentence, by striking ‘‘fiscal year 2007’’ 
and inserting ‘‘each of fiscal years 2007 through 2009’’; 
and 
(B) by striking the second sentence and inserting the 
following: ‘‘Only with respect to fiscal year 2010 for the 
period ending on December 31, 2009, the DSH allotment 
for Hawaii for such portion of the fiscal year, notwith-
standing the table set forth in paragraph (2), shall be 
$2,500,000.’’. 
SEC. 203. PHARMACY REIMBURSEMENT UNDER MEDICAID. 
(a) DELAY IN APPLICATION OF NEW PAYMENT LIMIT FOR MUL-
TIPLE SOURCE DRUGS UNDER MEDICAID.—Notwithstanding para-
graphs (4) and (5) of subsection (e) of section 1927 of the Social 
Security Act (42 U.S.C. 1396r–8) or part 447 of title 42, Code 
of Federal Regulations, as published on July 17, 2007 (72 Federal 
Register 39142)— 
(1) the specific upper limit under section 447.332 of title 
42, Code of Federal Regulations (as in effect on December 
31, 2006) applicable to payments made by a State for multiple 
source drugs under a State Medicaid plan shall continue to 
apply through September 30, 2009, for purposes of the avail-
ability of Federal financial participation for such payments; 
and 
(2) the Secretary of Health and Human Services shall 
not, prior to October 1, 2009, finalize, implement, enforce, or 
otherwise take any action (through promulgation of regulation, 
issuance of regulatory guidance, use of Federal payment audit 
procedures, or other administrative action, policy, or practice, 
including a Medical Assistance Manual transmittal or letter 
to State Medicaid directors) to impose the specific upper limit 
established under section 447.514(b) of title 42, Code of Federal 
Regulations as published on July 17, 2007 (72 Federal Register 
39142). 
(b) TEMPORARY SUSPENSION OF UPDATED PUBLICLY AVAILABLE 
AMP DATA.—Notwithstanding clause (v) of section 1927(b)(3)(D) 
of the Social Security Act (42 U.S.C. 1396r–8(b)(3)(D)), the Secretary 
of Health and Human Services shall not, prior to October 1, 2009, 
make publicly available any AMP disclosed to the Secretary. 
(c) DEFINITIONS.—In this subsection: 
(1) The term ‘‘multiple source drug’’ has the meaning given 
that term in section 1927(k)(7)(A)(i) of the Social Security Act 
(42 U.S.C. 1396r–8(k)(7)(A)(i)). 
(2) The term ‘‘AMP’’ has the meaning given ‘‘average manu-
facturer price’’ in section 1927(k)(1) of the Social Security Act 
(42 U.S.C. 1396r–8(k)(1)) and ‘‘AMP’’ in section 447.504(a) of 
title 42, Code of Federal Regulations as published on July 
17, 2007 (72 Federal Register 39142). 
SEC. 204. REVIEW OF ADMINISTRATIVE CLAIM DETERMINATIONS. 
(a) IN GENERAL.—Section 1116 of the Social Security Act (42 
U.S.C. 1316) is amended by adding at the end the following new 
subsection: 
‘‘(e)(1) Whenever the Secretary determines that any item or 
class of items on account of which Federal financial participation 
is claimed under title XIX shall be disallowed for such participation, 
the State shall be entitled to and upon request shall receive a
H. R. 6331—100 
reconsideration of the disallowance, provided that such request 
is made during the 60-day period that begins on the date the 
State receives notice of the disallowance. 
‘‘(2)(A) A State may appeal a disallowance of a claim for federal 
financial participation under title XIX by the Secretary, or an 
unfavorable reconsideration of a disallowance, during the 60-day 
period that begins on the date the State receives notice of the 
disallowance or of the unfavorable reconsideration, in whole or 
in part, to the Departmental Appeals Board, established in the 
Department of Health and Human Services (in this paragraph 
referred to as the ‘Board’), by filing a notice of appeal with the 
Board. 
‘‘(B) The Board shall consider a State’s appeal of a disallowance 
of such a claim (or of an unfavorable reconsideration of a disallow-
ance) on the basis of such documentation as the State may submit 
and as the Board may require to support the final decision of 
the Board. In deciding whether to uphold a disallowance of such 
a claim or any portion thereof, the Board shall be bound by all 
applicable laws and regulations and shall conduct a thorough review 
of the issues, taking into account all relevant evidence. The Board’s 
decision of an appeal under subparagraph (A) shall be the final 
decision of the Secretary and shall be subject to reconsideration 
by the Board only upon motion of either party filed during the 
60-day period that begins on the date of the Board’s decision or 
to judicial review in accordance with subparagraph (C). 
‘‘(C) A State may obtain judicial review of a decision of the 
Board by filing an action in any United States District Court 
located within the appealing State (or, if several States jointly 
appeal the disallowance of claims for Federal financial participation 
under section 1903, in any United States District Court that is 
located within any State that is a party to the appeal) or the 
United States District Court for the District of Columbia. Such 
an action may only be filed— 
‘‘(i) if no motion for reconsideration was filed within the 
60-day period specified in subparagraph (B), during such 60- 
day period; or 
‘‘(ii) if such a motion was filed within such period, during 
the 60-day period that begins on the date of the Board’s decision 
on such motion.’’. 
(b) CONFORMING AMENDMENT.—Section 1116(d) of such Act (42 
U.S.C. 1316(d)) is amended by striking ‘‘or XIX,’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
take effect on the date of the enactment of this Act and apply 
to any disallowance of a claim for Federal financial participation 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
made on or after such date or during the 60-day period prior 
to such date. 
SEC. 205. COUNTY MEDICAID HEALTH INSURING ORGANIZATIONS. 
(a) IN GENERAL.—Section 9517(c)(3) of the Consolidated Omni-
bus Budget Reconciliation Act of 1985 (42 U.S.C. 1396b note), 
as added by section 4734 of the Omnibus Budget Reconciliation 
Act of 1990 and as amended by section 704 of the Medicare, Med-
icaid, and SCHIP Benefits Improvement and Protection Act of 2000, 
is amended—
H. R. 6331—101 
(1) in subparagraph (A), by inserting ‘‘, in the case of 
any health insuring organization described in such subpara-
graph that is operated by a public entity established by Ventura 
County, and in the case of any health insuring organization 
described in such subparagraph that is operated by a public 
entity established by Merced County’’ after ‘‘described in 
subparagraph (B)’’; and 
(2) in subparagraph (C), by striking ‘‘14 percent’’ and 
inserting ‘‘16 percent’’. 
(b) EFFECTIVE DATE.—The amendments made by subsection 
(a) shall take effect on the date of the enactment of this Act. 
TITLE III—MISCELLANEOUS 
SEC. 301. EXTENSION OF TANF SUPPLEMENTAL GRANTS. 
(a) EXTENSION THROUGH FISCAL YEAR 2009.—Section 7101(a) 
of the Deficit Reduction Act of 2005 (Public Law 109–171; 120 
Stat. 135) is amended by striking ‘‘fiscal year 2008’’ and inserting 
‘‘fiscal year 2009’’. 
(b) CONFORMING AMENDMENT.—Section 403(a)(3)(H)(ii) of the 
Social Security Act (42 U.S.C. 603(a)(3)(H)(ii)) is amended to read 
as follows: 
‘‘(ii) subparagraph (G) shall be applied as if ‘fiscal 
year 2009’ were substituted for ‘fiscal year 2001’; and’’. 
SEC. 302. 70 PERCENT FEDERAL MATCHING FOR FOSTER CARE AND 
ADOPTION ASSISTANCE FOR THE DISTRICT OF COLUMBIA. 
(a) IN GENERAL.—Section 474(a) of the Social Security Act 
(42 U.S.C. 674(a)) is amended in each of paragraphs (1) and (2) 
by striking ‘‘(as defined in section 1905(b) of this Act)’’ and inserting 
‘‘(which shall be as defined in section 1905(b), in the case of a 
State other than the District of Columbia, or 70 percent, in the 
case of the District of Columbia)’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall take effect on October 1, 2008, and shall apply to calendar 
quarters beginning on or after that date. 
SEC. 303. EXTENSION OF SPECIAL DIABETES GRANT PROGRAMS. 
(a) SPECIAL DIABETES PROGRAMS FOR TYPE I DIABETES.—Sec-
tion 330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c– 
2(b)(2)) is amended by striking ‘‘2009’’ and inserting ‘‘2011’’. 
(b) SPECIAL
DIABETES
PROGRAMS
FOR
INDIANS.—Section 
330C(c)(2)(C) of the Public Health Service Act (42 U.S.C. 254c– 
3(c)(2)(C)) is amended by striking ‘‘2009’’ and inserting ‘‘2011’’. 
(c) REPORT ON GRANT PROGRAMS.—Section 4923(b) of the Bal-
anced Budget Act of 1997 (42 U.S.C. 1254c–2 note), as amended 
by section 931(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, and section 1(c) of Public 
Law 107–360, is amended— 
(1) in paragraph (1), by striking ‘‘and’’ at the end; 
(2) in paragraph (2)— 
(A) by striking ‘‘a final report’’ and inserting ‘‘a second 
interim report’’; and 
(B) by striking the period at the end and inserting 
‘‘; and’’; and 
(3) by adding at the end the following new paragraph:
H. R. 6331—102 
‘‘(3) a report on such evaluation not later than January 
1, 2011.’’. 
SEC. 304. IOM REPORTS ON BEST PRACTICES FOR CONDUCTING 
SYSTEMATIC 
REVIEWS 
OF 
CLINICAL 
EFFECTIVENESS 
RESEARCH AND FOR DEVELOPING CLINICAL PROTOCOLS. 
(a) 
SYSTEMATIC
REVIEWS
OF
CLINICAL
EFFECTIVENESS 
RESEARCH.— 
(1) STUDY.—Not later than 60 days after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall enter into a contract with the Institute of Medi-
cine of the National Academies (in this section referred to 
as the ‘‘Institute’’) under which the Institute shall conduct 
a study to identify the methodological standards for conducting 
systematic reviews of clinical effectiveness research on health 
and health care in order to ensure that organizations conducting 
such reviews have information on methods that are objective, 
scientifically valid, and consistent. 
(2) REPORT.—Not later than 18 months after the effective 
date of the contract under paragraph (1), the Institute, as 
part of such contract, shall submit to the Secretary of Health 
and Human Services and the appropriate committees of juris-
diction of Congress a report containing the results of the study 
conducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Institute 
determines appropriate. 
(3) PARTICIPATION.—The contract under paragraph (1) shall 
require that stakeholders with expertise in conducting clinical 
effectiveness research participate on the panel responsible for 
conducting the study under paragraph (1) and preparing the 
report under paragraph (2). 
(b) CLINICAL PROTOCOLS.— 
(1) STUDY.—Not later than 60 days after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall enter into a contract with the Institute of Medi-
cine of the National Academies (in this section referred to 
as the ‘‘Institute’’) under which the Institute shall conduct 
a study on the best methods used in developing clinical practice 
guidelines in order to ensure that organizations developing 
such guidelines have information on approaches that are objec-
tive, scientifically valid, and consistent. 
(2) REPORT.—Not later than 18 months after the effective 
date of the contract under paragraph (1), the Institute, as 
part of such contract, shall submit to the Secretary of Health 
and Human Services and the appropriate committees of juris-
diction of Congress a report containing the results of the study 
conducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Institute 
determines appropriate. 
(3) PARTICIPATION.—The contract under paragraph (1) shall 
require that stakeholders with expertise in making clinical 
recommendations participate on the panel responsible for con-
ducting the study under paragraph (1) and preparing the report 
under paragraph (2).
H. R. 6331—103 
(c) FUNDING.—Out of any funds in the Treasury not otherwise 
appropriated, there are appropriated for the period of fiscal years 
2009 and 2010, $3,000,000 to carry out this section. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.