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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.’’. 
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 
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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 
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. 
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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 
(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 
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implement changes responsive to any deficiencies identi-
fied 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 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-
ices furnished during fiscal years 2014 through 
2017, $19,900,000,000. 
‘‘(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 
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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.’’. 
(2) CONTINGENCY.— 
(A) IN GENERAL.—If there is enacted, be-
fore, on, or after the date of the enactment of 
this Act, a Supplemental Appropriations Act, 
2008 that includes a provision providing 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 amend-
ment made by paragraph (1); and 
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(ii) shall be executed after such provi-
sion in such Supplemental Appropriations 
Act. 
(B) 
ALTERNATIVE
AMENDMENT
DE-
SCRIBED.—The 
alternative 
amendment 
de-
scribed in this subparagraph is as follows: Sec-
tion 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 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 provisions 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 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 
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Management Account for the period of fiscal years 2009 
through 2013. 
SEC. 189. INCLUSION OF MEDICARE PROVIDERS AND SUP-
PLIERS IN FEDERAL PAYMENT LEVY AND AD-
MINISTRATIVE OFFSET PROGRAM. 
(a) IN GENERAL.—Section 1874 of the Social Secu-
rity Act (42 U.S.C. 1395kk) is amended by adding at the 
end the following new subsection: 
‘‘(d) INCLUSION OF MEDICARE PROVIDER AND SUP-
PLIER PAYMENTS
IN FEDERAL PAYMENT LEVY PRO-
GRAM.— 
‘‘(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 
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‘‘(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 pro-
vide assistance to the Centers for Medicare & Med-
icaid Services to ensure that all payments described 
in paragraph (1) are included in the Federal Pay-
ment Levy Program by the deadlines specified in 
that subsection.’’. 
(b) APPLICATION OF ADMINISTRATIVE OFFSET PRO-
VISIONS
TO MEDICARE PROVIDER
OR SUPPLIER PAY-
MENTS.—Section 3716 of title 31, United States Code, is 
amended— 
(1) by inserting ‘‘the Department of Health and 
Human Services,’’ after ‘‘United States Postal Serv-
ice,’’ 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 
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debts, and to amounts payable, under title 
XVIII of the Social Security Act.’’. 
(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 ASSIST-
ANCE (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, 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 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’’. 
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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-
ber 31, 2009, the DSH allotment for Ten-
nessee 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.’’; 
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(B) in clause (ii), by striking ‘‘or for a pe-
riod 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 in-
serting ‘‘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 in-
serting ‘‘, 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 in-
serting ‘‘, 2008, 2009, or for a period in 
fiscal year 2010’’; and 
(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 in-
serting the following: ‘‘Only with respect to fis-
cal year 2010 for the period ending on Decem-
ber 31, 2009, the DSH allotment for Hawaii 
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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 MULTIPLE SOURCE DRUGS UNDER MED-
ICAID.—Notwithstanding paragraphs (4) and (5) of sub-
section (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 pay-
ments 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 
availability of Federal financial participation for 
such payments; and 
(2) the Secretary of Health and Human Serv-
ices shall not, prior to October 1, 2009, finalize, im-
plement, 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 
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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 Reg-
ulations as published on July 17, 2007 (72 Federal 
Register 39142). 
(b) TEMPORARY SUSPENSION
OF UPDATED PUB-
LICLY 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 manufacturer 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). 
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SEC. 204. REVIEW OF ADMINISTRATIVE CLAIM DETERMINA-
TIONS. 
(a) IN GENERAL.—Section 1116 of the Social Secu-
rity 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 finan-
cial participation is claimed under title XIX shall be dis-
allowed for such participation, the State shall be entitled 
to and upon request shall receive a reconsideration of the 
disallowance, provided that such request is made during 
the 60-day period that begins on the date the State re-
ceives 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 disallow-
ance, during the 60-day period that begins on the date 
the State receives notice of the disallowance or of the unfa-
vorable reconsideration, in whole or in part, to the Depart-
mental 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 recon-
sideration of a disallowance) on the basis of such docu-
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mentation as the State may submit and as the Board may 
require to support the final decision of the Board. In de-
ciding 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 thor-
ough review of the issues, taking into account all relevant 
evidence. The Board’s decision of an appeal under sub-
paragraph (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 judi-
cial 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 Dis-
trict Court located within the appealing State (or, if sev-
eral 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 ac-
tion 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 
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‘‘(ii) if such a motion was filed within such pe-
riod, 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 Fed-
eral 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 ORGANI-
ZATIONS. 
(a) IN GENERAL.—Section 9517(c)(3) of the Consoli-
dated Omnibus Budget Reconciliation Act of 1985 (42 
U.S.C. 1396b note), as added by section 4734 of the Om-
nibus Budget Reconciliation Act of 1990 and as amended 
by section 704 of the Medicare, Medicaid, and SCHIP 
Benefits Improvement and Protection Act of 2000, is 
amended— 
(1) in subparagraph (A), by inserting ‘‘, in the 
case of any health insuring organization described in 
such subparagraph that is operated by a public enti-
ty established by Ventura County, and in the case 
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of any health insuring organization described in such 
subparagraph that is operated by a public entity es-
tablished by Merced County’’ after ‘‘described in 
subparagraph (B)’’; and 
(2) in subparagraph (C), by striking ‘‘14 per-
cent’’ and inserting ‘‘16 percent’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
TITLE III—MISCELLANEOUS 
SEC. 301. EXTENSION OF TANF SUPPLEMENTAL GRANTS. 
(a) EXTENSION THROUGH FISCAL YEAR 2009.—Sec-
tion 7101(a) of the Deficit Reduction Act of 2005 (Public 
Law 109–171; 120 Stat. 135) is amended by striking ‘‘fis-
cal 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 ap-
plied as if ‘fiscal year 2009’ were sub-
stituted for ‘fiscal year 2001’; and’’. 
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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 Secu-
rity Act (42 U.S.C. 674(a)) is amended in each of para-
graphs (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 PRO-
GRAMS. 
(a) SPECIAL DIABETES PROGRAMS FOR TYPE I DIA-
BETES.—Section 330B(b)(2)(C) of the Public Health 
Service Act (42 U.S.C. 254c–2(b)(2)) is amended by strik-
ing ‘‘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 Balanced Budget Act of 1997 (42 U.S.C. 1254c– 
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2 note), as amended by section 931(c) of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protec-
tion 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 insert-
ing ‘‘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: 
‘‘(3) a report on such evaluation not later than 
January 1, 2011.’’. 
SEC. 304. IOM REPORTS ON BEST PRACTICES FOR CON-
DUCTING SYSTEMATIC REVIEWS OF CLIN-
ICAL EFFECTIVENESS RESEARCH AND FOR 
DEVELOPING CLINICAL PROTOCOLS. 
(a) SYSTEMATIC REVIEWS OF CLINICAL EFFECTIVE-
NESS 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 con-
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tract with the Institute of Medicine of the National 
Academies (in this section referred to as the ‘‘Insti-
tute’’) under which the Institute shall conduct a 
study to identify the methodological standards for 
conducting systematic reviews of clinical effective-
ness research on health and health care in order to 
ensure that organizations conducting such reviews 
have information on methods that are objective, sci-
entifically 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 Serv-
ices and the appropriate committees of jurisdiction 
of Congress a report containing the results of the 
study conducted under paragraph (1), together with 
recommendations for such legislation and adminis-
trative action as the Institute determines appro-
priate. 
(3) PARTICIPATION.—The contract under para-
graph (1) shall require that stakeholders with exper-
tise in conducting clinical effectiveness research par-
ticipate on the panel responsible for conducting the 
study under paragraph (1) and preparing the report 
under paragraph (2). 
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HR 6331 PCS
(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 con-
tract with the Institute of Medicine of the National 
Academies (in this section referred to as the ‘‘Insti-
tute’’) under which the Institute shall conduct a 
study on the best methods used in developing clinical 
practice guidelines in order to ensure that organiza-
tions developing such guidelines have information on 
approaches 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 Serv-
ices and the appropriate committees of jurisdiction 
of Congress a report containing the results of the 
study conducted under paragraph (1), together with 
recommendations for such legislation and adminis-
trative action as the Institute determines appro-
priate. 
(3) PARTICIPATION.—The contract under para-
graph (1) shall require that stakeholders with exper-
tise in making clinical recommendations participate 
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