727 
AMDT. NO. 570 
State or Federal administrative management sys-
tems. 
‘‘(6)(A) In no case shall the payments described in 
paragraph (1), with respect to a hospital, exceed in the 
aggregate the product of— 
‘‘(i) the overall hospital EHR amount for the 
hospital computed under subparagraph (B); and 
‘‘(ii) the Medicaid share for such hospital com-
puted under subparagraph (C). 
‘‘(B) For purposes of this paragraph, the overall hos-
pital EHR amount, with respect to a hospital, is the sum 
of 
the 
applicable 
amounts 
specified 
in 
section 
1886(n)(2)(A) for such hospital for the first 4 payment 
years (as estimated by the Secretary) determined as if the 
Medicare share specified in clause (ii) of such section were 
1. The Secretary shall publish in the Federal Register the 
overall hospital EHR amount for each hospital eligible for 
payments under this subsection. In computing amounts 
under clause (ii) for payment years after the first payment 
year, the Secretary shall assume that in subsequent pay-
ment years discharges increase at the average annual rate 
of growth of the most recent three years for which dis-
charge data are available. 
‘‘(C) The Medicaid share computed under this sub-
paragraph, for a hospital for a period specified by the Sec-
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00727
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
728 
AMDT. NO. 570 
retary, shall be calculated in the same manner as the 
Medicare share under section 1886(n)(2)(D) for such a 
hospital and period, except that there shall be substituted 
for the numerator under clause (i) of such section the 
amount that is equal to the number of inpatient-bed-days 
(as established by the Secretary) which are attributable 
to individuals who are receiving medical assistance under 
this title and who are not described in section 
1886(n)(2)(D)(i). In computing inpatient-bed-days under 
the previous sentence, the Secretary shall take into ac-
count inpatient-bed-days attributable to inpatient-bed- 
days that are paid for individuals enrolled in a Medicaid 
managed care plan (under section 1903(m) or section 
1932). 
‘‘(7) With respect to health care providers other than 
hospitals, the Secretary shall establish and implement a 
detailed process to ensure coordination of the different 
programs for payment of such health care providers for 
adoption or use of health information technology (includ-
ing certified EHR technology), as well as payments for 
such health care providers provided under this title or title 
XVIII, to assure no duplication of funding. The Secretary 
shall promulgate regulations to carry out the preceding 
sentence. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00728
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
729 
AMDT. NO. 570 
‘‘(8) In carrying out paragraph (5)(C), the State and 
Secretary shall seek, to the maximum extent practicable, 
to avoid duplicative requirements from Federal and State 
Governments to demonstrate meaningful use of certified 
EHR technology under this title and title XVIII. In doing 
so, the Secretary may deem satisfaction of requirements 
for such meaningful use for a payment year under title 
XVIII to be sufficient to qualify as meaningful use under 
this subsection. The Secretary may also specify the report-
ing periods under this subsection in order to carry out this 
paragraph. 
‘‘(9) In order to be provided Federal financial partici-
pation under subsection (a)(3)(F)(ii), a State must dem-
onstrate to the satisfaction of the Secretary, that the 
State— 
‘‘(A) is using the funds provided for the pur-
poses of administering payments under this sub-
section, including tracking of meaningful use by 
Medicaid providers; 
‘‘(B) is conducting adequate oversight of the 
program under this subsection, including routine 
tracking of meaningful use attestations and report-
ing mechanisms; and 
‘‘(C) is pursuing initiatives to encourage the 
adoption of certified EHR technology to promote 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00729
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
730 
AMDT. NO. 570 
health care quality and the exchange of health care 
information under this title, subject to applicable 
laws and regulations governing such exchange. 
‘‘(10) The Secretary shall periodically submit reports 
to the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance of the 
Senate on status, progress, and oversight of payments 
under paragraph (1).’’. 
(b) IMPLEMENTATION FUNDING.—In addition to 
funds otherwise available, out of any funds in the Treas-
ury not otherwise appropriated, there are appropriated to 
the Secretary of Health and Human Services for the Cen-
ter for Medicare & Medicaid Services Program Manage-
ment Account, $40,000,000 for each of fiscal years 2009 
through 2015 and $20,000,000 for each succeeding fiscal 
year through fiscal year 2018, which shall be available for 
purposes of carrying out the provisions of (and the amend-
ments made by) this part. Amounts appropriated under 
this subsection for a fiscal year shall be available until ex-
pended. 
(c) HHS REPORT
ON IMPLEMENTATION
OF DE-
TAILED PROCESS TO ASSURE NO DUPLICATION OF FUND-
ING.—Not later than July 1, 2012, the Secretary of 
Health and Human Services shall submit to Congress a 
report on the establishment and implementation of the de-
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00730
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
731 
AMDT. NO. 570 
tailed process under section 1903(t)(7) of the Social Secu-
rity Act, as added by subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Secretary determines appropriate. 
TITLE V—STATE FISCAL RELIEF 
SEC. 5000. PURPOSES; TABLE OF CONTENTS. 
(a) PURPOSES.—The purposes of this title are as fol-
lows: 
(1) To provide fiscal relief to States in a period 
of economic downturn. 
(2) To protect and maintain State Medicaid 
programs during a period of economic downturn, in-
cluding by helping to avert cuts to provider payment 
rates and benefits or services, and to prevent con-
strictions of income eligibility requirements for such 
programs, but not to promote increases in such re-
quirements. 
(b) TABLE OF CONTENTS.—The table of contents for 
this title is as follows: 
TITLE V—STATE FISCAL RELIEF 
Sec. 5000. Purposes; table of contents. 
Sec. 5001. Temporary increase of Medicaid FMAP. 
Sec. 5002. Extension and update of special rule for increase of Medicaid DSH 
allotments for low DSH States. 
Sec. 5003. Payment of Medicare liability to States as a result of the Special 
Disability Workload Project. 
Sec. 5004. Funding for the Department of Health and Human Services Office 
of the Inspector General. 
Sec. 5005. GAO study and report regarding State needs during periods of na-
tional economic downturn. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00731
Fmt 6654
Sfmt 6211
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
732 
AMDT. NO. 570 
SEC. 5001. TEMPORARY INCREASE OF MEDICAID FMAP. 
(a) PERMITTING MAINTENANCE OF FMAP.—Subject 
to subsections (e), (f), and (g), if the FMAP determined 
without regard to this section for a State for— 
(1) fiscal year 2009 is less than the FMAP as 
so determined for fiscal year 2008, the FMAP for 
the State for fiscal year 2008 shall be substituted 
for the State’s FMAP for fiscal year 2009, before 
the application of this section; 
(2) fiscal year 2010 is less than the FMAP as 
so determined for fiscal year 2008 or fiscal year 
2009 (after the application of paragraph (1)), the 
greater of such FMAP for the State for fiscal year 
2008 or fiscal year 2009 shall be substituted for the 
State’s FMAP for fiscal year 2010, before the appli-
cation of this section; and 
(3) fiscal year 2011 is less than the FMAP as 
so determined for fiscal year 2008, fiscal year 2009 
(after the application of paragraph (1)), or fiscal 
year 2010 (after the application of paragraph (2)), 
the greatest of such FMAP for the State for fiscal 
year 2008, fiscal year 2009, or fiscal year 2010 shall 
be substituted for the State’s FMAP for fiscal year 
2011, before the application of this section, but only 
for the first calendar quarter in fiscal year 2011. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00732
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
733 
AMDT. NO. 570 
(b) GENERAL 7.6 PERCENTAGE POINT INCREASE.— 
Subject to subsections (e), (f), and (g), for each State for 
calendar quarters during the recession adjustment period 
(as defined in subsection (h)(2)) , the FMAP (after the 
application of subsection (a)) shall be increased (without 
regard to any limitation otherwise specified in section 
1905(b) of the Social Security Act) by 7.6 percentage 
points. 
(c) ADDITIONAL RELIEF BASED ON INCREASE IN 
UNEMPLOYMENT.— 
(1) IN GENERAL.—Subject to subsections (e), 
(f), and (g), if a State is a qualifying State under 
paragraph (2) for a calendar quarter occurring dur-
ing the recession adjustment period, the FMAP for 
the State shall be further increased by the number 
of percentage points equal to the product of the 
State percentage applicable for the State under sec-
tion 1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)) after the application of subsections (a) 
and (b) and the applicable percent determined in 
paragraph (3) for the calendar quarter (or, if great-
er, for a previous such calendar quarter, subject to 
paragraph (4)) . 
(2) QUALIFYING CRITERIA.— 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00733
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
734 
AMDT. NO. 570 
(A) IN GENERAL.—For purposes of para-
graph (1), a State qualifies for additional relief 
under this subsection for a calendar quarter oc-
curring during the recession adjustment period 
if the State is 1 of the 50 States or the District 
of Columbia and the State satisfies any of the 
following criteria for the quarter: 
(i) An increase of at least 1.5 percent-
age points, but less than 2.5 percentage 
points, in the average monthly unemploy-
ment rate, seasonally adjusted, for the 
State or District, as determined by com-
paring months in the most recent previous 
3-consecutive month period for which data 
are available for the State or District to 
the lowest average monthly unemployment 
rate, seasonally adjusted, for the State or 
District for any 3-consecutive-month pe-
riod preceding that period and beginning 
on or after January 1, 2006 (based on the 
most recently available monthly publica-
tions of the Bureau of Labor Statistics of 
the Department of Labor). 
(ii) An increase of at least 2.5 per-
centage points, but less than 3.5 percent-
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00734
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
735 
AMDT. NO. 570 
age points, in the average monthly unem-
ployment rate, seasonally adjusted, for the 
State or District (as so determined). 
(iii) An increase of at least 3.5 per-
centage points for the State or District, in 
the average monthly unemployment rate, 
seasonally adjusted, for the State or Dis-
trict (as so determined). 
(B) MAINTENANCE
OF
STATUS.—If a 
State qualifies for additional relief under this 
subsection for a calendar quarter, it shall be 
deemed to have qualified for such relief for each 
subsequent calendar quarter ending before July 
1, 2010. 
(3) APPLICABLE
PERCENT.—For purposes of 
paragraph (1), the applicable percent is— 
(A) 2.5 percent, if the State satisfies the 
criteria described in paragraph (2)(A)(i) for the 
calendar quarter; 
(B) 4.5 percent if the State satisfies the 
criteria described in paragraph (2)(A)(ii) for 
the calendar quarter; and 
(C) 6.5 percent if the State satisfies the 
criteria described in paragraph (2)(A)(iii) for 
the calendar quarter. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00735
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
736 
AMDT. NO. 570 
(4) MAINTENANCE
OF
HIGHER
PERCENTAGE 
REDUCTION FOR PERIOD AFTER LOWER PERCENT-
AGE
DEDUCTION
WOULD
OTHERWISE
TAKE
EF-
FECT.— 
(A) HOLD HARMLESS PERIOD.—If the per-
centage reduction applied to a State under 
paragraph (3) for any calendar quarter in the 
recession adjustment period beginning on or 
after January 1, 2009, and ending before July 
1, 2010, (determined without regard to this 
paragraph) is less than the percentage reduc-
tion applied for the preceding quarter (as so de-
termined), the higher percentage reduction shall 
continue in effect for each subsequent calendar 
quarter ending before July 1, 2010. 
(B) NOTICE OF DECREASE IN PERCENT-
AGE REDUCTION.—The Secretary shall notify a 
State at least 3 months prior to applying any 
lower percentage reduction to the State under 
paragraph (3). 
(d) INCREASE IN CAP ON MEDICAID PAYMENTS TO 
TERRITORIES.—Subject to subsections (f) and (g), with 
respect to entire fiscal years occurring during the reces-
sion adjustment period and with respect to fiscal years 
only a portion of which occurs during such period (and 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00736
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
737 
AMDT. NO. 570 
in proportion to the portion of the fiscal year that occurs 
during such period), the amounts otherwise determined for 
Puerto Rico, the Virgin Islands, Guam, the Northern Mar-
iana Islands, and American Samoa under subsections (f) 
and (g) of section 1108 of the Social Security Act (42 
6 U.S.C. 1308) shall each be increased by 15.2 percent. 
(e) SCOPE OF APPLICATION.—The increases in the 
FMAP for a State under this section shall apply for pur-
poses of title XIX of the Social Security Act and shall 
not apply with respect to— 
(1) disproportionate share hospital payments 
described in section 1923 of such Act (42 U.S.C. 
1396r–4); 
(2) payments under title IV of such Act (42 
U.S.C. 601 et seq.) (except that the increases under 
subsections (a) and (b) shall apply to payments 
under part E of title IV of such Act (42 U.S.C. 670 
et seq.)); 
(3) payments under title XXI of such Act (42 
U.S.C. 1397aa et seq.); 
(4) any payments under title XIX of such Act 
that are based on the enhanced FMAP described in 
section 2105(b) of such Act (42 U.S.C. 1397ee(b)); 
or 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00737
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
738 
AMDT. NO. 570 
(5) any payments under title XIX of such Act 
that are attributable to expenditures for medical as-
sistance provided to individuals made eligible under 
a State plan under title XIX of the Social Security 
Act (including under any waiver under such title or 
under section 1115 of such Act (42 U.S.C. 1315)) 
because of income standards (expressed as a per-
centage of the poverty line) for eligibility for medical 
assistance that are higher than the income stand-
ards (as so expressed) for such eligibility as in effect 
on July 1, 2008. 
(f) STATE INELIGIBILITY.— 
(1) MAINTENANCE
OF
ELIGIBILITY
REQUIRE-
MENTS.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), a State is not eligible for 
an increase in its FMAP under subsection (a), 
(b), or (c), or an increase in a cap amount 
under subsection (d), if eligibility standards, 
methodologies, or procedures under its State 
plan under title XIX of the Social Security Act 
(including any waiver under such title or under 
section 1115 of such Act (42 U.S.C. 1315)) are 
more restrictive than the eligibility standards, 
methodologies, 
or 
procedures, 
respectively, 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00738
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
739 
AMDT. NO. 570 
under such plan (or waiver) as in effect on July 
1, 2008. 
(B) STATE
REINSTATEMENT
OF
ELIGI-
BILITY PERMITTED.—Subject to subparagraph 
(C), a State that has restricted eligibility stand-
ards, methodologies, or procedures under its 
State plan under title XIX of the Social Secu-
rity Act (including any waiver under such title 
or under section 1115 of such Act (42 U.S.C. 
1315)) after July 1, 2008, is no longer ineli-
gible under subparagraph (A) beginning with 
the first calendar quarter in which the State 
has reinstated eligibility standards, methodolo-
gies, or procedures that are no more restrictive 
than the eligibility standards, methodologies, or 
procedures, respectively, under such plan (or 
waiver) as in effect on July 1, 2008. 
(C) SPECIAL RULES.—A State shall not be 
ineligible under subparagraph (A)— 
(i) for the calendar quarters before 
July 1, 2009, on the basis of a restriction 
that was applied after July 1, 2008, and 
before the date of the enactment of this 
Act, if the State prior to July 1, 2009, has 
reinstated eligibility standards, methodolo-
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00739
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
740 
AMDT. NO. 570 
gies, or procedures that are no more re-
strictive than the eligibility standards, 
methodologies, or procedures, respectively, 
under such plan (or waiver) as in effect on 
July 1, 2008; or 
(ii) on the basis of a restriction that 
was directed to be made under State law 
as of July 1, 2008, and would have been 
in effect as of such date, but for a delay 
in the request for, and approval of, a waiv-
er under section 1115 of such Act with re-
spect to such restriction. 
(2) COMPLIANCE WITH PROMPT PAY REQUIRE-
MENTS.—No State shall be eligible for an increased 
FMAP rate as provided under this section for any 
claim submitted by a provider subject to the terms 
of section 1902(a)(37)(A) of the Social Security Act 
(42 U.S.C. 1396a(a)(37)(A)) during any period in 
which that State has failed to pay claims in accord-
ance with section 1902(a)(37)(A) of such Act. Each 
State shall report to the Secretary, no later than 30 
days following the 1st day of the month, its compli-
ance 
with 
the 
requirements 
of 
section 
1902(a)(37)(A) of the Social Security Act as they 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00740
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
741 
AMDT. NO. 570 
pertain to claims made for covered services during 
the preceding month. 
(3) NO
WAIVER
AUTHORITY.—The Secretary 
may not waive the application of this subsection or 
subsection (g) under section 1115 of the Social Se-
curity Act or otherwise. 
(g) REQUIREMENTS.— 
(1) IN GENERAL.—A State may not deposit or 
credit the additional Federal funds paid to the State 
as a result of this section to any reserve or rainy day 
fund maintained by the State. 
(2) STATE REPORTS.—Each State that is paid 
additional Federal funds as a result of this section 
shall, not later than September 30, 2011, submit a 
report to the Secretary, in such form and such man-
ner as the Secretary shall determine, regarding how 
the additional Federal funds were expended. 
(3) ADDITIONAL REQUIREMENT FOR CERTAIN 
STATES.—In the case of a State that requires polit-
ical subdivisions within the State to contribute to-
ward the non-Federal share of expenditures under 
the State Medicaid plan required under section 
1902(a)(2) of the Social Security Act (42 U.S.C. 
1396a(a)(2)), the State is not eligible for an in-
crease in its FMAP under subsection (b) or (c), or 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00741
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
742 
AMDT. NO. 570 
an increase in a cap amount under subsection (d), 
if it requires that such political subdivisions pay for 
quarters during the recession adjustment period a 
greater percentage of the non-Federal share of such 
expenditures, or a greater percentage of the non- 
Federal share of payments under section 1923, than 
the respective percentage that would have been re-
quired by the State under such plan on September 
30, 2008, prior to application of this section. 
(h) DEFINITIONS.—In this section, except as other-
wise provided: 
(1) FMAP.—The term ‘‘FMAP’’ means the 
Federal medical assistance percentage, as defined in 
section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)), as determined without regard to 
this section except as otherwise specified. 
(2) POVERTY LINE.—The term ‘‘poverty line’’ 
has the meaning given such term in section 673(2) 
of the Community Services Block Grant Act (42 
U.S.C. 9902(2)), including any revision required by 
such section. 
(3) RECESSION
ADJUSTMENT
PERIOD.—The 
term ‘‘recession adjustment period’’ means the pe-
riod beginning on October 1, 2008, and ending on 
December 31, 2010. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00742
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
743 
AMDT. NO. 570 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
(i) SUNSET.—This section shall not apply to items 
and services furnished after the end of the recession ad-
justment period. 
SEC. 5002. EXTENSION AND UPDATE OF SPECIAL RULE FOR 
INCREASE OF MEDICAID DSH ALLOTMENTS 
FOR LOW DSH STATES. 
Section 1923(f)(5) of the Social Security Act (42 
U.S.C. 1396r–4(f)(5)) is amended— 
(1) in subparagraph (B)— 
(A) in the subparagraph heading, by strik-
ing ‘‘YEAR
2004
AND
SUBSEQUENT
FISCAL 
YEARS’’ and inserting ‘‘YEARS 2004 THROUGH 
2008’’; 
(B) in clause (i), by inserting ‘‘and’’ after 
the semicolon; 
(C) in clause (ii), by striking ‘‘; and’’ and 
inserting a period; and 
(D) by striking clause (iii); and 
(2) by adding at the end the following subpara-
graph: 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00743
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
744 
AMDT. NO. 570 
‘‘(C) FOR FISCAL YEAR 2009 AND SUBSE-
QUENT FISCAL YEARS.—In the case of a State 
in which the total expenditures under the State 
plan (including Federal and State shares) for 
disproportionate share hospital adjustments 
under this section for fiscal year 2006, as re-
ported to the Administrator of the Centers for 
Medicare & Medicaid Services as of August 31, 
2009, is greater than 0 but less than 3 percent 
of the State’s total amount of expenditures 
under the State plan for medical assistance 
during the fiscal year, the DSH allotment for 
the State with respect to— 
‘‘(i) fiscal year 2009, shall be the 
DSH allotment for the State for fiscal year 
2008 increased by 16 percent; 
‘‘(ii) fiscal year 2010, shall be the 
DSH allotment for the State for fiscal year 
2009 increased by 16 percent; 
‘‘(iii) fiscal year 2011 for the period 
ending on December 31, 2010, shall be 1⁄4 
of the DSH allotment for the State for fis-
cal year 2010 increased by 16 percent; 
‘‘(iv) fiscal year 2011 for the period 
beginning on January 1, 2011, and ending 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00744
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
745 
AMDT. NO. 570 
on September 30, 2011, shall be 3⁄4 of the 
DSH allotment that would have been de-
termined under this subsection for the 
State for fiscal year 2011 if this subpara-
graph had not been enacted; 
‘‘(v) fiscal year 2012, shall be the 
DSH allotment that would have been de-
termined under this subsection for the 
State for fiscal year 2012 if this subpara-
graph had not been enacted; and 
‘‘(vi) fiscal year 2013 and any subse-
quent fiscal year, shall be the DSH allot-
ment for the State for the previous fiscal 
year subject to an increase for inflation as 
provided in paragraph (3)(A).’’. 
SEC. 5003. PAYMENT OF MEDICARE LIABILITY TO STATES 
AS A RESULT OF THE SPECIAL DISABILITY 
WORKLOAD PROJECT. 
(a) IN GENERAL.—The Secretary, in consultation 
with the Commissioner, shall work with each State to 
reach an agreement, not later than 3 months after the 
date of enactment of this Act, on the amount of a payment 
for the State related to the Medicare program liability as 
a result of the Special Disability Workload project, subject 
to the requirements of subsection (c). 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00745
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
746 
AMDT. NO. 570 
(b) PAYMENTS.— 
(1) DEADLINE FOR MAKING PAYMENTS.—Not 
later than 30 days after reaching an agreement with 
a State under subsection (a), the Secretary shall pay 
the State, from the amounts appropriated under 
paragraph (2), the payment agreed to for the State. 
(2) APPROPRIATION.—Out of any money in the 
Treasury not otherwise appropriated, there is appro-
priated $3,000,000,000 for fiscal year 2009 for 
making payments to States under paragraph (1). 
(3) LIMITATIONS.—In no case may— 
(A) the aggregate amount of payments 
made by the Secretary to States under para-
graph (1) exceed $3,000,000,000; or 
(B) any payments be provided by the Sec-
retary under this section after the first day of 
the first month that begins 4 months after the 
date of enactment of this Act. 
(c) REQUIREMENTS.—The requirements of this sub-
section are the following: 
(1) FEDERAL
DATA
USED
TO
DETERMINE 
AMOUNT OF PAYMENTS.—The amount of the pay-
ment under subsection (a) for each State is deter-
mined on the basis of the most recent Federal data 
available, including the use of proxies and reasonable 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00746
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
747 
AMDT. NO. 570 
estimates as necessary, for determining expeditiously 
the amount of the payment that shall be made to 
each State that enters into an agreement under this 
section. The payment methodology shall consider the 
following factors: 
(A) The number of SDW cases found to 
have been eligible for benefits under the Medi-
care program and the month of the initial 
Medicare program eligibility for such cases. 
(B) The applicable non-Federal share of 
expenditures made by a State under the Med-
icaid program during the time period for SDW 
cases. 
(C) Such other factors as the Secretary 
and the Commissioner, in consultation with the 
States, determine appropriate. 
(2) CONDITIONS
FOR
PAYMENTS.—A State 
shall not receive a payment under this section unless 
the State— 
(A) waives the right to file a civil action 
(or to be a party to any action) in any Federal 
or State court in which the relief sought in-
cludes a payment from the United States to the 
State related to the Medicare liability under 
title XVIII of the Social Security Act (42 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00747
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
748 
AMDT. NO. 570 
U.S.C. 1395 et seq.) as a result of the Special 
Disability Workload project; and 
(B) releases the United States from any 
further claims for reimbursement of State ex-
penditures as a result of the Special Disability 
Workload project. 
(3) NO INDIVIDUAL STATE CLAIMS DATA RE-
QUIRED.—No State shall be required to submit indi-
vidual claims evidencing payment under the Med-
icaid program as a condition for receiving a payment 
under this section. 
(4) INELIGIBLE STATES.—No State that is a 
party to a civil action in any Federal or State court 
in which the relief sought includes a payment from 
the United States to the State related to the Medi-
care liability under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) as a result of the Spe-
cial Disability Workload project shall be eligible to 
receive a payment under this section while such an 
action is pending or if such an action is resolved in 
favor of the State. 
(d) DEFINITIONS.—In this section: 
(1) 
COMMISSIONER.—The 
term 
‘‘Commis-
sioner’’ means the Commissioner of Social Security. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00748
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
749 
AMDT. NO. 570 
(2) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means the program of medical assistance 
established under title XIX of the Social Security 
Act (42 U.S.C. 1396a et seq.) and includes medical 
assistance provided under any waiver of that pro-
gram approved under section 1115 or 1915 of such 
Act (42 U.S.C. 1315, 1396n) or otherwise. 
(3) MEDICARE PROGRAM.—The term ‘‘Medicare 
program’’ means the program established under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) SDW CASE.—The term ‘‘SDW case’’ means 
a case in the Special Disability Workload project in-
volving an individual determined by the Commis-
sioner to have been eligible for benefits under title 
II of the Social Security Act (42 U.S.C. 401 et seq.) 
for a period during which such benefits were not 
provided to the individual and who was, during all 
or part of such period, enrolled in a State Medicaid 
program. 
(6) 
SPECIAL
DISABILITY
WORKLOAD 
PROJECT.—The term ‘‘Special Disability Workload 
project’’ means the project described in the 2008 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00749
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
750 
AMDT. NO. 570 
Annual Report of the Board of Trustees of the Fed-
eral Old-Age and Survivors Insurance and Federal 
Disability Insurance Trust Funds, H.R. Doc. No. 
110-104, 110th Cong. (2008). 
(7) STATE.—The term ‘‘State’’ means each of 
the 50 States and the District of Columbia. 
SEC. 5004. FUNDING FOR THE DEPARTMENT OF HEALTH 
AND HUMAN SERVICES OFFICE OF THE IN-
SPECTOR GENERAL. 
For purposes of ensuring the proper expenditure of 
Federal funds under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), there is appropriated to the Of-
fice of the Inspector General of the Department of Health 
and Human Services, out of any money in the Treasury 
not otherwise appropriated and without further appropria-
tion, $31,250,000 for the recession adjustment period (as 
defined in section 5001(h)(3)). Amounts appropriated 
under this section shall remain available for expenditure 
until September 30, 2012, and shall be in addition to any 
other amounts appropriated or made available to such Of-
fice for such purposes. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00750
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
751 
AMDT. NO. 570 
SEC. 5005. GAO STUDY AND REPORT REGARDING STATE 
NEEDS DURING PERIODS OF NATIONAL ECO-
NOMIC DOWNTURN. 
(a) IN GENERAL.—The Comptroller General of the 
United States shall study the period of national economic 
downturn in effect on the date of enactment of this Act, 
as well as previous periods of national economic downturn 
since 1974, for the purpose of developing recommenda-
tions for addressing the needs of States during such peri-
ods. As part of such analysis, the Comptroller General 
shall study the past and projected effects of temporary in-
creases in the Federal medical assistance percentage 
under the Medicaid program with respect to such periods. 
(b) REPORT.—Not later than April 1, 2011, the 
Comptroller General of the United States shall submit a 
report to the appropriate committees of Congress on the 
results of the study conducted under paragraph (1). Such 
report shall include the following: 
(1) Such recommendations as the Comptroller 
General determines appropriate for modifying the 
national economic downturn assistance formula for 
temporary adjustment of the Federal medical assist-
ance percentage under Medicaid (also referred to as 
a ‘‘countercyclical FMAP’’) described in GAO report 
number GAO–07–97 to improve the effectiveness of 
the application of such percentage in addressing the 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00751
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
752 
AMDT. NO. 570 
needs of States during periods of national economic 
downturn, including recommendations for— 
(A) improvements to the factors that would 
begin and end the application of such percent-
age; 
(B) how the determination of the amount 
of such percentage could be adjusted to address 
State and regional economic variations during 
such periods; and 
(C) how the determination of the amount 
of such percentage could be adjusted to be more 
responsive to actual Medicaid costs incurred by 
States during such periods. 
(2) An analysis of the impact on States during 
such periods of— 
(A) declines in private health benefits cov-
erage; 
(B) declines in State revenues; and 
(C) caseload maintenance and growth 
under Medicaid, the State Children’s Health In-
surance Program, or any other publicly-funded 
programs to provide health benefits coverage 
for State residents. 
(3) Identification of, and recommendations for 
addressing, the effects on States of any other spe-
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00752
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
753 
AMDT. NO. 570 
cific economic indicators that the Comptroller Gen-
eral determines appropriate. 
TITLE VI—EXECUTIVE 
COMPENSATION 
SUBTITLE A—OVERSIGHT 
TITLE VI—EXECUTIVE COMPENSATION OVERSIGHT 
Sec. 6001. Definitions. 
Sec. 6002. Executive compensation and corporate governance. 
Sec. 6003. Board Compensation Committee. 
Sec. 6004. Limitation on luxury expenditures. 
Sec. 6005. Shareholder approval of executive compensation. 
Sec. 6006. Review of prior payments to executives. 
SEC. 6001. DEFINITIONS. 
For purposes of this title, the following definitions 
shall apply: 
(1) SENIOR
EXECUTIVE
OFFICER.—The term 
‘‘senior executive officer’’ means an individual who is 
1 of the top 5 most highly paid executives of a pub-
lic company, whose compensation is required to be 
disclosed pursuant to the Securities Exchange Act of 
1934, and any regulations issued thereunder, and 
non-public company counterparts. 
(2) GOLDEN PARACHUTE PAYMENT.—The term 
‘‘golden parachute payment’’ means any payment to 
a senior executive officer for departure from a com-
pany for any reason, except for payments for serv-
ices performed or benefits accrued. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00753
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
754 
AMDT. NO. 570 
(3) TARP.—The term ‘‘TARP’’ means the 
Troubled Asset Relief Program established under 
the Emergency Economic Stabilization Act of 2008 
(Public Law 110–343, 12 U.S.C. 5201 et seq.). 
(4) TARP RECIPIENT.—The term ‘‘TARP re-
cipient’’ means any entity that has received or will 
receive financial assistance under the financial as-
sistance provided under the TARP. 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of the Treasury. 
(6) COMMISSION.—The term ‘‘Commission’’ 
means the Securities and Exchange Commission. 
SEC. 6002. EXECUTIVE COMPENSATION AND CORPORATE 
GOVERNANCE. 
(a) IN GENERAL.—During the period in which any 
obligation arising from financial assistance provided under 
the TARP remains outstanding, each TARP recipient 
shall be subject to— 
(1) the standards established by the Secretary 
under this title; and 
(2) the provisions of section 162(m)(5) of the 
Internal Revenue Code of 1986, as applicable. 
(b) STANDARDS REQUIRED.—The Secretary shall re-
quire each TARP recipient to meet appropriate standards 
for executive compensation and corporate governance. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00754
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
755 
AMDT. NO. 570 
(c) SPECIFIC REQUIREMENTS.—The standards es-
tablished under subsection (b) shall include— 
(1) limits on compensation that exclude incen-
tives for senior executive officers of the TARP re-
cipient to take unnecessary and excessive risks that 
threaten the value of such recipient during the pe-
riod that any obligation arising from TARP assist-
ance is outstanding; 
(2) a provision for the recovery by such TARP 
recipient of any bonus, retention award, or incentive 
compensation paid to a senior executive officer and 
any of the next 20 most highly-compensated employ-
ees of the TARP recipient based on statements of 
earnings, revenues, gains, or other criteria that are 
later found to be materially inaccurate; 
(3) a prohibition on such TARP recipient mak-
ing any golden parachute payment to a senior execu-
tive officer or any of the next 5 most highly-com-
pensated employees of the TARP recipient during 
the period that any obligation arising from TARP 
assistance is outstanding; 
(4) a prohibition on such TARP recipient pay-
ing or accruing any bonus, retention award, or in-
centive compensation during the period that the obli-
gation is outstanding to at least the 25 most highly- 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00755
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
756 
AMDT. NO. 570 
compensated employees, or such higher number as 
the Secretary may determine is in the public interest 
with respect to any TARP recipient; 
(5) a prohibition on any compensation plan that 
would encourage manipulation of the reported earn-
ings of such TARP recipient to enhance the com-
pensation of any of its employees; and 
(6) a requirement for the establishment of a 
Board Compensation Committee that meets the re-
quirements of section 6003. 
(d) CERTIFICATION OF COMPLIANCE.—The chief ex-
ecutive officer and chief financial officer (or the equiva-
lents thereof) of each TARP recipient shall provide a writ-
ten certification of compliance by the TARP recipient with 
the requirements of this title— 
(1) in the case of a TARP recipient, the securi-
ties of which are publicly traded, to the Securities 
and Exchange Commission, together with annual fil-
ings required under the securities laws; and 
(2) in the case of a TARP recipient that is not 
a publicly traded company, to the Secretary. 
SEC. 6003. BOARD COMPENSATION COMMITTEE. 
(a) ESTABLISHMENT OF BOARD REQUIRED.—Each 
TARP recipient shall establish a Board Compensation 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00756
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
757 
AMDT. NO. 570 
Committee, comprised entirely of independent directors, 
for the purpose of reviewing employee compensation plans. 
(b) MEETINGS.—The Board Compensation Com-
mittee of each TARP recipient shall meet at least semi-
annually to discuss and evaluate employee compensation 
plans in light of an assessment of any risk posed to the 
TARP recipient from such plans. 
SEC. 6004. LIMITATION ON LUXURY EXPENDITURES. 
(a) POLICY REQUIRED.—The board of directors of 
any TARP recipient shall have in place a company-wide 
policy regarding excessive or luxury expenditures, as iden-
tified by the Secretary, which may include excessive ex-
penditures on— 
(1) entertainment or events; 
(2) office and facility renovations; 
(3) aviation or other transportation services; or 
(4) other activities or events that are not rea-
sonable expenditures for conferences, staff develop-
ment, reasonable performance incentives, or other 
similar measures conducted in the normal course of 
the business operations of the TARP recipient. 
SEC. 6005. SHAREHOLDER APPROVAL OF EXECUTIVE COM-
PENSATION. 
(a) ANNUAL SHAREHOLDER APPROVAL OF EXECU-
TIVE COMPENSATION.—Any proxy or consent or author-
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00757
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
758 
AMDT. NO. 570 
ization for an annual or other meeting of the shareholders 
of any TARP recipient during the period in which any ob-
ligation arising from financial assistance provided under 
the TARP remains outstanding shall permit a separate 
shareholder vote to approve the compensation of execu-
tives, as disclosed pursuant to the compensation disclosure 
rules of the Commission (which disclosure shall include the 
compensation discussion and analysis, the compensation 
tables, and any related material). 
(b) NONBINDING VOTE.—A shareholder vote de-
scribed in subsection (a) shall not be binding on the board 
of directors of a TARP recipient, and may not be con-
strued as overruling a decision by such board, nor to cre-
ate or imply any additional fiduciary duty by such board, 
nor shall such vote be construed to restrict or limit the 
ability of shareholders to make proposals for inclusion in 
proxy materials related to executive compensation. 
(c) DEADLINE FOR RULEMAKING.—Not later than 1 
year after the date of enactment of this Act, the Commis-
sion shall issue any final rules and regulations required 
by this section. 
SEC. 6006. REVIEW OF PRIOR PAYMENTS TO EXECUTIVES. 
(a) IN GENERAL.—The Secretary shall review bo-
nuses, retention awards, and other compensation paid to 
employees of each entity receiving TARP assistance before 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00758
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
759 
AMDT. NO. 570 
the date of enactment of this Act to determine whether 
any such payments were excessive, inconsistent with the 
purposes of this Act or the TARP, or otherwise contrary 
to the public interest. 
(b) NEGOTIATIONS FOR REIMBURSEMENT.—If the 
Secretary makes a determination described in subsection 
(a), the Secretary shall seek to negotiate with the TARP 
recipient and the subject employee for appropriate reim-
bursements to the Federal Government with respect to 
compensation or bonuses. 
Subtitle B—Limits on Executive 
Compensation 
SEC. 6011. SHORT TITLE. 
This subtitle may be cited as the ‘‘Cap Executive Of-
ficer Pay Act of 2009’’. 
SEC. 6012. LIMIT ON EXECUTIVE COMPENSATION. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law or agreement to the contrary, no person who 
is an officer, director, executive, or other employee of a 
financial institution or other entity that receives or has 
received funds under the Troubled Asset Relief Program 
(or ‘‘TARP’’), established under section 101 of the Emer-
gency Economic Stabilization Act of 2008, may receive an-
nual compensation in excess of the amount of compensa-
tion paid to the President of the United States. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00759
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
760 
AMDT. NO. 570 
(b) DURATION.—The limitation in subsection (a) 
shall be a condition of the receipt of assistance under the 
TARP, and of any modification to such assistance that 
was received on or before the date of enactment of this 
Act, and shall remain in effect with respect to each finan-
cial institution or other entity that receives such assistance 
or modification for the duration of the assistance or obli-
gation provided under the TARP. 
SEC. 6013. RULEMAKING AUTHORITY. 
The Secretary shall expeditiously issue such rules as 
are necessary to carry out this subtitle, including with re-
spect to reimbursement of compensation amounts, as ap-
propriate. 
SEC. 6014. COMPENSATION. 
As used in this subtitle, the term ‘‘compensation’’ in-
cludes wages, salary, deferred compensation, retirement 
contributions, options, bonuses, property, and any other 
form of compensation or bonus that the Secretary of the 
Treasury determines is appropriate. 
Subtitle C—Excessive Bonuses 
SEC. 6021. TREATMENT OF EXCESSIVE BONUSES BY TARP 
RECIPIENTS. 
(a) IN GENERAL.—If, before the date of enactment 
of this Act, the preferred stock of a financial institution 
was purchased by the Government using funds provided 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00760
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
761 
AMDT. NO. 570 
under the Troubled Asset Relief Program established pur-
suant to the Emergency Economic Stabilization Act of 
2008, then, notwithstanding any otherwise applicable re-
striction on the redeemability of such preferred stock, such 
financial institution shall redeem an amount of such pre-
ferred stock equal to the aggregate amount of all excessive 
bonuses paid or payable to all covered individuals. 
(b) TIMING.—Each financial institution described in 
subsection (a) shall comply with the requirements of sub-
section (a)— 
(1) not later than 120 days after the date of 
enactment of this Act, with respect to excessive bo-
nuses (or portions thereof) paid before the date of 
enactment of this Act; and 
(2) not later than the day before an excessive 
bonus (or portion thereof) is paid, with respect to 
any excessive bonus (or portion thereof) paid on or 
after the date of enactment of this Act. 
(c) DEFINITIONS.—As used in this section, the fol-
lowing definitions shall apply: 
(1) EXCESSIVE BONUS.— 
(A) IN
GENERAL.—The term ‘‘excessive 
bonus’’ means the portion of the applicable 
bonus payments made to a covered individual in 
excess of $100,000. 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00761
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS
762 
AMDT. NO. 570 
(B) APPLICABLE BONUS PAYMENTS.— 
(i) IN GENERAL.—The term ‘‘applica-
ble bonus payment’’ means any bonus pay-
ment to a covered individual— 
(I) which is paid or payable by 
reason of services performed by such 
individual in a taxable year of the fi-
nancial institution (or any member of 
a controlled group described in sub-
paragraph (D)) ending in 2008, and 
(II) the amount of which was 
first communicated to such individual 
during the period beginning on Janu-
ary 1, 2008, and ending January 31, 
2009, or was based on a resolution of 
the board of directors of such institu-
tion that was adopted before the end 
of such taxable year. 
(ii) CERTAIN PAYMENTS AND CONDI-
TIONS
DISREGARDED.—In 
determining 
whether a bonus payment is described in 
clause (i)(I)— 
(I) a bonus payment that relates 
to services performed in any taxable 
year before the taxable year described 
VerDate Nov 24 2008 
02:51 Feb 08, 2009
Jkt 079200
PO 00000
Frm 00762
Fmt 6654
Sfmt 6201
E:\BILLS\H1.AS2
H1
smartinez on PROD1PC64 with BILLS