HR 3668 RDS 
SEC. 5. 6-MONTH DELAY IN REQUIREMENT TO USE TAM-
PER-RESISTANT PRESCRIPTION PADS UNDER 
MEDICAID. 
Effective as if included in the enactment of section 
7002(b) of the U.S. Troop Readiness, Veterans’ Care, 
Katrina Recovery, and Iraq Accountability Appropriations 
Act, 2007 (Public Law 110–28, 121 Sta. 187), paragraph 
(2) of such section is amended by striking ‘‘September 30, 
2007’’ and inserting ‘‘March 31, 2008’’. 
SEC. 6. ADDITIONAL FUNDING FOR THE MEDICARE PHYSI-
CIAN ASSISTANCE AND QUALITY INITIATIVE 
FUND. 
Section 1848(l)(2) of the Social Security Act (42 
U.S.C. 1395w–4(l)(2)) is amended— 
(1) in subparagraph (A), by adding at the end 
the following: ‘‘In addition, there shall be available 
to the Fund for expenditures during 2009 an 
amount equal to $325,000,000 and for expenditures 
during or after 2013 an amount equal to 
$60,000,000.’’; and 
(2) in subparagraph (B)— 
(A) in the heading, by striking ‘‘FUR-
NISHED DURING 2008’’; 
(B) by striking ‘‘specified in subparagraph 
(A)’’ and inserting ‘‘specified in the first sen-
tence of subparagraph (A)’’; and 
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(C) by inserting after ‘‘furnished during 
2008’’ the following: ‘‘and for the obligation of 
the entire first amount specified in the second 
sentence of such subparagraph for payment 
with respect to physicians’ services furnished 
during 2009 and of the entire second amount 
so specified for payment with respect to physi-
cians’ services furnished on or after January 1, 
2013’’. 
SEC. 7. LIMITATION ON IMPLEMENTATION FOR FISCAL 
YEARS 2008 AND 2009 OF A PROSPECTIVE 
DOCUMENTATION AND CODING ADJUSTMENT 
IN RESPONSE TO THE IMPLEMENTATION OF 
THE MEDICARE SEVERITY DIAGNOSIS RE-
LATED GROUP (MS–DRG) SYSTEM UNDER THE 
MEDICARE PROSPECTIVE PAYMENT SYSTEM 
FOR INPATIENT HOSPITAL SERVICES. 
(a) IN GENERAL.—In implementing the final rule 
published on August 22, 2007, on pages 47130 through 
48175 of volume 72 of the Federal Register, the Secretary 
of Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall apply prospective documenta-
tion and coding adjustments (made in response to the im-
plementation of a Medicare Severity Diagnosis Related 
Group (MS–DRG) system under the hospital inpatient 
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prospective payment system under section 1886(d) of the 
Social Security Act (42 U.S.C. 1395ww(d)) of— 
(1) for discharges occurring during fiscal year 
2008, 0.6 percent rather than the 1.2 percent speci-
fied in such final rule; and 
(2) for discharges occurring during fiscal year 
2009, 0.9 percent rather than the 1.8 percent speci-
fied in such final rule. 
(b) SUBSEQUENT ADJUSTMENTS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, if the Secretary determines that im-
plementation of such Medicare Severity Diagnosis 
Related Group (MS–DRG) system resulted in 
changes in coding and classification that did not re-
flect real changes in case mix under section 1886(d) 
of the Social Security Act (42 U.S.C. 1395ww(d)) 
for discharges occurring during fiscal year 2008 or 
2009 that are different than the prospective docu-
mentation and coding adjustments applied under 
subsection (a), the Secretary shall— 
(A) make an appropriate adjustment under 
paragraph (3)(A)(vi) of such section 1886(d); 
and 
(B) make an additional adjustment to the 
standardized 
amounts 
under 
such 
section 
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1886(d) for discharges occurring only during 
fiscal years 2010, 2011, and 2012 to offset the 
estimated amount of the increase or decrease in 
aggregate payments (including interest as de-
termined by the Secretary) determined, based 
upon a retrospective evaluation of claims data 
submitted under such Medicare Severity Diag-
nosis Related Group (MS–DRG) system, by the 
Secretary with respect to discharges occurring 
during fiscal years 2008 and 2009. 
(2) REQUIREMENT.—Any adjustment under 
paragraph (1)(B) shall reflect the difference between 
the amount the Secretary estimates that implemen-
tation of such Medicare Severity Diagnosis Related 
Group (MS–DRG) system resulted in changes in 
coding and classification that did not reflect real 
changes in case mix and the prospective documenta-
tion and coding adjustments applied under sub-
section (a). An adjustment made under paragraph 
(1)(B) for discharges occurring in a year shall not 
be included in the determination of standardized 
amounts for discharges occurring in a subsequent 
year. 
(3) RULE OF CONSTRUCTION.—Nothing in this 
section shall be construed as— 
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(A) requiring the Secretary to adjust the 
average standardized amounts under paragraph 
(3)(A)(vi) of such section 1886(d) other than as 
provided under this section; or 
(B) providing authority to apply the ad-
justment under paragraph (1)(B) other than 
for discharges occurring during fiscal years 
2010, 2011, and 2012. 
(4) JUDICIAL REVIEW.—There shall be no ad-
ministrative or judicial review under section 1878 of 
the Social Security Act (42 U.S.C. 1395oo) or other-
wise of any determination or adjustments made 
under this subsection. 
Passed the House of Representatives September 26, 
2007. 
Attest: 
LORRAINE C. MILLER, 
Clerk. 
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