torily submitted data on quality measures 
under this subsection. 
‘‘(ii) The eligible professionals (or, in 
the case of reporting under paragraph 
(3)(C), the group practices) who are suc-
cessful electronic prescribers.’’; and 
(F) in paragraph (6), by striking subpara-
graph (C) and inserting the following: 
‘‘(C) REPORTING PERIOD.— 
‘‘(i) IN GENERAL.—Subject to clauses 
(ii) and (iii), the term ‘reporting period’ 
means— 
‘‘(I) for 2007, the period begin-
ning on July 1, 2007, and ending on 
December 31, 2007; and 
‘‘(II) for 2008, 2009, 2010, and 
2011, the entire year. 
‘‘(ii) AUTHORITY TO REVISE REPORT-
ING PERIOD.—For years after 2009, the 
Secretary may revise the reporting period 
under clause (i) if the Secretary deter-
mines such revision is appropriate, pro-
duces valid results on measures reported, 
and is consistent with the goals of maxi-
mizing scientific validity and reducing ad-
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ministrative burden. If the Secretary re-
vises such period pursuant to the preceding 
sentence, the term ‘reporting period’ shall 
mean such revised period. 
‘‘(iii) REFERENCE.—Any reference in 
this subsection to a reporting period with 
respect to the application of subsection 
(a)(5) shall be deemed a reference to the 
reporting 
period 
under 
subparagraph 
(D)(iii) of such subsection.’’. 
(4) INCLUSION
OF
QUALIFIED
AUDIOLOGISTS 
AS ELIGIBLE PROFESSIONALS.— 
(A) IN GENERAL.—Section 1848(k)(3)(B) 
of the Social Security Act (42 U.S.C. 1395w– 
4(k)(3)(B)), is amended by adding at the end 
the following new clause: 
‘‘(iv) Beginning with 2009, a qualified 
audiologist 
(as 
defined 
in 
section 
1861(ll)(3)(B)).’’. 
(B) NO CHANGE IN BILLING.—Nothing in 
the amendment made by subparagraph (A) 
shall be construed to change the way in which 
billing for audiology services (as defined in sec-
tion 1861(ll)(2) of the Social Security Act (42 
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U.S.C. 1395x(ll)(2))) occurs under title XVIII 
of such Act as of July 1, 2008. 
(5) 
CONFORMING
AMENDMENTS.—Section 
1848(m) of the Social Security Act, as added and 
amended by paragraphs (2) and (3), is amended— 
(A) in paragraph (5)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘section 1848(k) 
of the Social Security Act, as added 
by subsection (b),’’ and inserting 
‘‘subsection (k)’’; and 
(II) by striking ‘‘such section’’ 
and inserting ‘‘such subsection’’; 
(ii) in subparagraph (B), by striking 
‘‘of the Social Security Act (42 U.S.C. 
1395l)’’; 
(iii) in subparagraph (E), in the mat-
ter preceding clause (i), by striking ‘‘1869 
or 1878 of the Social Security Act or oth-
erwise’’ and inserting ‘‘1869, section 1878, 
or otherwise’’; and 
(iv) in subparagraph (F)— 
(I) by striking ‘‘paragraph (2)(B) 
of section 1848(k) of the Social Secu-
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rity Act (42 U.S.C. 1395w–4(k))’’ and 
inserting ‘‘subsection (k)(2)(B)’’; and 
(II) by striking ‘‘paragraph (4) 
of such section’’ and inserting ‘‘sub-
section (k)(4)’’; 
(B) in paragraph (6)— 
(i) in subparagraph (A), by striking 
‘‘section 1848(k)(3) of the Social Security 
Act, as added by subsection (b)’’ and in-
serting ‘‘subsection (k)(3)’’; and 
(ii) in subparagraph (B), by striking 
‘‘section 1848(k) of the Social Security 
Act, as added by subsection (b)’’ and in-
serting ‘‘subsection (k)’’; and 
(C) by striking paragraph (6)(D). 
(6) NO AFFECT ON INCENTIVE PAYMENTS FOR 
2007 OR 2008.—Nothing in the amendments made by 
this subsection or section 132 shall affect the oper-
ation of the provisions of section 1848(m) of the So-
cial Security Act, as redesignated and amended by 
such subsection and section, with respect to 2007 or 
2008. 
(c) PHYSICIAN FEEDBACK PROGRAM TO IMPROVE 
EFFICIENCY AND CONTROL COSTS.— 
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(1) IN GENERAL.—Section 1848 of the Social 
Security Act (42 U.S.C. 1395w–4), as amended by 
subsection (b), is amended by adding at the end the 
following new subsection: 
‘‘(n) PHYSICIAN FEEDBACK PROGRAM.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish a Physician Feedback Program (in 
this subsection referred to as the ‘Program’) 
under which the Secretary shall use claims data 
under this title (and may use other data) to 
provide confidential reports to physicians (and, 
as determined appropriate by the Secretary, to 
groups of physicians) that measure the re-
sources involved in furnishing care to individ-
uals under this title. If determined appropriate 
by the Secretary, the Secretary may include in-
formation on the quality of care furnished to in-
dividuals under this title by the physician (or 
group of physicians) in such reports. 
‘‘(B) RESOURCE USE.—The resources de-
scribed in subparagraph (A) may be meas-
ured— 
‘‘(i) on an episode basis; 
‘‘(ii) on a per capita basis; or 
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‘‘(iii) on both an episode and a per 
capita basis. 
‘‘(2) IMPLEMENTATION.—The Secretary shall 
implement the Program by not later than January 
1, 2009. 
‘‘(3) DATA FOR REPORTS.—To the extent prac-
ticable, reports under the Program shall be based on 
the most recent data available. 
‘‘(4) AUTHORITY TO FOCUS APPLICATION.—The 
Secretary may focus the application of the Program 
as appropriate, such as focusing the Program on— 
‘‘(A) physician specialties that account for 
a certain percentage of all spending for physi-
cians’ services under this title; 
‘‘(B) physicians who treat conditions that 
have a high cost or a high volume, or both, 
under this title; 
‘‘(C) physicians who use a high amount of 
resources compared to other physicians; 
‘‘(D) physicians practicing in certain geo-
graphic areas; or 
‘‘(E) physicians who treat a minimum 
number of individuals under this title. 
‘‘(5) AUTHORITY TO EXCLUDE CERTAIN INFOR-
MATION IF INSUFFICIENT INFORMATION.—The Sec-
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retary may exclude certain information regarding a 
service from a report under the Program with re-
spect to a physician (or group of physicians) if the 
Secretary determines that there is insufficient infor-
mation relating to that service to provide a valid re-
port on that service. 
‘‘(6) ADJUSTMENT
OF
DATA.—To the extent 
practicable, the Secretary shall make appropriate ad-
justments to the data used in preparing reports 
under the Program, such as adjustments to take 
into account variations in health status and other 
patient characteristics. 
‘‘(7) EDUCATION
AND
OUTREACH.—The Sec-
retary shall provide for education and outreach ac-
tivities to physicians on the operation of, and meth-
odologies employed under, the Program. 
‘‘(8) DISCLOSURE EXEMPTION.—Reports under 
the Program shall be exempt from disclosure under 
section 552 of title 5, United States Code.’’. 
(2) GAO STUDY AND REPORT ON THE PHYSI-
CIAN FEEDBACK PROGRAM.— 
(A) STUDY.—The Comptroller General of 
the United States shall conduct a study of the 
Physician Feedback Program conducted under 
section 1848(n) of the Social Security Act, as 
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added by paragraph (1), including the imple-
mentation of the Program. 
(B) REPORT.—Not later than March 1, 
2011, the Comptroller General of the United 
States shall submit a report to Congress con-
taining the results of the study conducted under 
subparagraph (A), together with recommenda-
tions for such legislation and administrative ac-
tion as the Comptroller General determines ap-
propriate. 
(d) PLAN FOR TRANSITION TO VALUE-BASED PUR-
CHASING PROGRAM FOR PHYSICIANS AND OTHER PRACTI-
TIONERS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall develop a plan to transition to 
a value-based purchasing program for payment 
under the Medicare program for covered professional 
services (as defined in section 1848(k)(3)(A) of the 
Social Security Act (42 U.S.C. 1395w–4(k)(3)(A))). 
(2) REPORT.—Not later than May 1, 2010, the 
Secretary of Health and Human Services shall sub-
mit a report to Congress containing the plan devel-
oped under paragraph (1), together with rec-
ommendations for such legislation and administra-
tive action as the Secretary determines appropriate. 
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SEC. 132. INCENTIVES FOR ELECTRONIC PRESCRIBING. 
(a) INCENTIVE PAYMENTS.—Section 1848(m) of the 
Social Security Act, as added and amended by section 
131(b), is amended— 
(1) by inserting after paragraph (1), the fol-
lowing new paragraph: 
‘‘(2) INCENTIVE PAYMENTS FOR ELECTRONIC 
PRESCRIBING.— 
‘‘(A) IN
GENERAL.—For 2009 through 
2013, with respect to covered professional serv-
ices furnished during a reporting period by an 
eligible professional, if the eligible professional 
is a successful electronic prescriber for such re-
porting period, in addition to the amount other-
wise paid under this part, there also shall be 
paid to the eligible professional (or to an em-
ployer or facility in the cases described in 
clause (A) of section 1842(b)(6)) or, in the case 
of a group practice under paragraph (3)(C), to 
the group practice, from the Federal Supple-
mentary Medical Insurance Trust Fund estab-
lished under section 1841 an amount equal to 
the applicable electronic prescribing percent of 
the Secretary’s estimate (based on claims sub-
mitted not later than 2 months after the end of 
the reporting period) of the allowed charges 
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under this part for all such covered professional 
services furnished by the eligible professional 
(or, in the case of a group practice under para-
graph (3)(C), by the group practice) during the 
reporting period. 
‘‘(B) LIMITATION WITH RESPECT TO ELEC-
TRONIC
PRESCRIBING
QUALITY
MEASURES.— 
The provisions of this paragraph and subsection 
(a)(5) shall not apply to an eligible professional 
(or, in the case of a group practice under para-
graph (3)(C), to the group practice) if, for the 
reporting period (or, for purposes of subsection 
(a)(5), for the reporting period for a year)— 
‘‘(i) the allowed charges under this 
part for all covered professional services 
furnished by the eligible professional (or 
group, as applicable) for the codes to 
which the electronic prescribing quality 
measure applies (as identified by the Sec-
retary and published on the Internet 
website of the Centers for Medicare & 
Medicaid Services as of January 1, 2008, 
and as subsequently modified by the Sec-
retary) are less than 10 percent of the 
total of the allowed charges under this part 
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for all such covered professional services 
furnished by the eligible professional (or 
the group, as applicable); or 
‘‘(ii) if determined appropriate by the 
Secretary, the eligible professional does not 
submit (including both electronically and 
nonelectronically) a sufficient number (as 
determined by the Secretary) of prescrip-
tions under part D. 
If the Secretary makes the determination to 
apply clause (ii) for a period, then clause (i) 
shall not apply for such period. 
‘‘(C) 
APPLICABLE
ELECTRONIC
PRE-
SCRIBING PERCENT.—For purposes of subpara-
graph (A), the term ‘applicable electronic pre-
scribing percent’ means— 
‘‘(i) for 2009 and 2010, 2.0 percent; 
‘‘(ii) for 2011 and 2012, 1.0 percent; 
and 
‘‘(iii) for 2013, 0.5 percent.’’; 
(2) in paragraph (3), as redesignated by section 
131(b)— 
(A) in the heading, by inserting ‘‘AND SUC-
CESSFUL ELECTRONIC PRESCRIBER’’ after ‘‘RE-
PORTING’’; and 
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(B) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) 
SUCCESSFUL
ELECTRONIC
PRE-
SCRIBER.— 
‘‘(i) IN
GENERAL.—For purposes of 
paragraph (2) and subsection (a)(5), an el-
igible professional shall be treated as a 
successful electronic prescriber for a re-
porting period (or, for purposes of sub-
section (a)(5), for the reporting period for 
a year) if the eligible professional meets 
the requirement described in clause (ii), or, 
if the Secretary determines appropriate, 
the requirement described in clause (iii). If 
the Secretary makes the determination 
under the preceding sentence to apply the 
requirement described in clause (iii) for a 
period, then the requirement described in 
clause (ii) shall not apply for such period. 
‘‘(ii) REQUIREMENT FOR SUBMITTING 
DATA ON ELECTRONIC PRESCRIBING QUAL-
ITY
MEASURES.—The 
requirement 
de-
scribed in this clause is that, with respect 
to covered professional services furnished 
by an eligible professional during a report-
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ing period (or, for purposes of subsection 
(a)(5), for the reporting period for a year), 
if there are any electronic prescribing qual-
ity measures that have been established 
under the physician reporting system and 
are applicable to any such services fur-
nished by such professional for the period, 
such professional reported each such meas-
ure under such system in at least 50 per-
cent of the cases in which such measure is 
reportable by such professional under such 
system. 
‘‘(iii) REQUIREMENT FOR ELECTRONI-
CALLY PRESCRIBING UNDER PART D.—The 
requirement described in this clause is that 
the eligible professional electronically sub-
mitted a sufficient number (as determined 
by the Secretary) of prescriptions under 
part D during the reporting period (or, for 
purposes of subsection (a)(5), for the re-
porting period for a year). 
‘‘(iv) USE
OF
PART
D
DATA.—Not-
withstanding sections 1860D–15(d)(2)(B) 
and 1860D–15(f)(2), the Secretary may 
use data regarding drug claims submitted 
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for purposes of section 1860D–15 that are 
necessary for purposes of clause (iii), para-
graph (2)(B)(ii), and paragraph (5)(G). 
‘‘(v) STANDARDS
FOR
ELECTRONIC 
PRESCRIBING.—To the extent practicable, 
in determining whether eligible profes-
sionals 
meet 
the 
requirements 
under 
clauses (ii) and (iii) for purposes of clause 
(i), the Secretary shall ensure that eligible 
professionals utilize electronic prescribing 
systems in compliance with standards es-
tablished for such systems pursuant to the 
Part D Electronic Prescribing Program 
under section 1860D–4(e).’’; and 
(3) in paragraph (5)(E), by striking clause (iii) 
and inserting the following new clause: 
‘‘(iii) the determination of a successful 
electronic prescriber under paragraph (3), 
the limitation under paragraph (2)(B), and 
the exception under subsection (a)(5)(B); 
and’’. 
(b) INCENTIVE PAYMENT ADJUSTMENT.—Section 
1848(a) of the Social Security Act (42 U.S.C. 1395w– 
4(a)) is amended by adding at the end the following new 
paragraph: 
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‘‘(5) 
INCENTIVES
FOR
ELECTRONIC
PRE-
SCRIBING.— 
‘‘(A) ADJUSTMENT.— 
‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (B) and subsection (m)(2)(B), 
with respect to covered professional serv-
ices furnished by an eligible professional 
during 2012 or any subsequent year, if the 
eligible professional is not a successful 
electronic prescriber for the reporting pe-
riod for the year (as determined under 
subsection (m)(3)(B)), the fee schedule 
amount for such services furnished by such 
professional during the year (including the 
fee schedule amount for purposes of deter-
mining a payment based on such amount) 
shall be equal to the applicable percent of 
the fee schedule amount that would other-
wise apply to such services under this sub-
section (determined after application of 
paragraph (3) but without regard to this 
paragraph). 
‘‘(ii) 
APPLICABLE
PERCENT.—For 
purposes of clause (i), the term ‘applicable 
percent’ means— 
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‘‘(I) for 2012, 99 percent; 
‘‘(II) for 2013, 98.5 percent; and 
‘‘(III) for 2014 and each subse-
quent year, 98 percent. 
‘‘(B) 
SIGNIFICANT
HARDSHIP
EXCEP-
TION.—The Secretary may, on a case-by-case 
basis, exempt an eligible professional from the 
application of the payment adjustment under 
subparagraph (A) if the Secretary determines, 
subject to annual renewal, that compliance with 
the requirement for being a successful elec-
tronic prescriber would result in a significant 
hardship, such as in the case of an eligible pro-
fessional who practices in a rural area without 
sufficient Internet access. 
‘‘(C) APPLICATION.— 
‘‘(i) PHYSICIAN
REPORTING
SYSTEM 
RULES.—Paragraphs (5), (6), and (8) of 
subsection (k) shall apply for purposes of 
this paragraph in the same manner as they 
apply for purposes of such subsection. 
‘‘(ii) INCENTIVE
PAYMENT
VALIDA-
TION RULES.—Clauses (ii) and (iii) of sub-
section (m)(5)(D) shall apply for purposes 
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100 
of this paragraph in a similar manner as 
they apply for purposes of such subsection. 
‘‘(D) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) ELIGIBLE
PROFESSIONAL; COV-
ERED
PROFESSIONAL
SERVICES.—The 
terms ‘eligible professional’ and ‘covered 
professional services’ have the meanings 
given such terms in subsection (k)(3). 
‘‘(ii) 
PHYSICIAN
REPORTING
SYS-
TEM.—The term ‘physician reporting sys-
tem’ means the system established under 
subsection (k). 
‘‘(iii) REPORTING PERIOD.—The term 
‘reporting period’ means, with respect to a 
year, a period specified by the Secretary.’’. 
(c) GAO REPORT ON ELECTRONIC PRESCRIBING.— 
Not later than September 1, 2012, the Comptroller Gen-
eral of the United States shall submit to Congress a report 
on the implementation of the incentives for electronic pre-
scribing established under the provisions of, and amend-
ments made by, this section. Such report shall include in-
formation regarding the following: 
(1) The percentage of eligible professionals (as 
defined in section 1848(k)(3) of the Social Security 
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102 
regarding the beneficiary’s prescription drug 
utilization; and 
(B) the extent to which current law re-
quires sufficient and appropriate oversight and 
audit capabilities to monitor the practice of pre-
scription drug data mining. 
(6) Such other recommendations and adminis-
trative action as the Comptroller General determines 
to be appropriate. 
SEC. 133. EXPANDING ACCESS TO PRIMARY CARE SERV-
ICES. 
(a) REVISIONS TO THE MEDICARE MEDICAL HOME 
DEMONSTRATION PROJECT.— 
(1) AUTHORITY TO EXPAND.—Section 204(b) 
of division B of the Tax Relief and Health Care Act 
of 2006 (42 U.S.C. 1395b–1 note) is amended— 
(A) in paragraph (1), by striking ‘‘The 
project’’ and inserting ‘‘Subject to paragraph 
(3), the project’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(3) EXPANSION.—The Secretary may expand 
the duration and the scope of the project under 
paragraph (1), to an extent determined appropriate 
by the Secretary, if the Secretary determines that 
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103 
such expansion will result in any of the following 
conditions being met: 
‘‘(A) The expansion of the project is ex-
pected to improve the quality of patient care 
without increasing spending under the Medicare 
program (not taking into account amounts 
available under subsection (g)). 
‘‘(B) The expansion of the project is ex-
pected to reduce spending under the Medicare 
program (not taking into account amounts 
available under subsection (g)) without reducing 
the quality of patient care.’’. 
(2) FUNDING AND APPLICATION.—Section 204 
of division B of the Tax Relief and Health Care Act 
of 2006 (42 U.S.C. 1395b–1 note) is amended by 
adding at the end the following new subsections: 
‘‘(g) FUNDING FROM SMI TRUST FUND.—There 
shall be available, from the Federal Supplementary Med-
ical Insurance Trust Fund (under section 1841 of the So-
cial Security Act (42 U.S.C. 1395t)), the amount of 
$100,000,000 to carry out the project. 
‘‘(h) APPLICATION.—Chapter 35 of title 44, United 
States Code, shall not apply to the conduct of the 
project.’’. 
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104 
(b) APPLICATION OF BUDGET-NEUTRALITY ADJUS-
TOR TO CONVERSION FACTOR.—Section 1848(c)(2)(B) of 
the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is 
amended by adding at the end the following new clause: 
‘‘(vi) ALTERNATIVE APPLICATION OF 
BUDGET-NEUTRALITY ADJUSTMENT.—Not-
withstanding subsection (d)(9)(A), effective 
for fee schedules established beginning 
with 2009, with respect to the 5-year re-
view of work relative value units used in 
fee schedules for 2007 and 2008, in lieu of 
continuing to apply budget-neutrality ad-
justments required under clause (ii) for 
2007 and 2008 to work relative value 
units, the Secretary shall apply such budg-
et-neutrality adjustments to the conversion 
factor otherwise determined for years be-
ginning with 2009.’’. 
SEC. 134. EXTENSION OF FLOOR ON MEDICARE WORK GEO-
GRAPHIC ADJUSTMENT UNDER THE MEDI-
CARE PHYSICIAN FEE SCHEDULE. 
(a) IN GENERAL.—Section 1848(e)(1)(E) of the So-
cial Security Act (42 U.S.C. 1395w–4(e)(1)(E)), as 
amended by section 103 of the Medicare, Medicaid, and 
SCHIP Extension Act of 2007 (Public Law 110–173), is 
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105 
amended by striking ‘‘before July 1, 2008’’ and inserting 
‘‘before January 1, 2010’’. 
(b) TREATMENT OF PHYSICIANS’ SERVICES FUR-
NISHED IN CERTAIN AREAS.—Section 1848(e)(1)(G) of 
the Social Security Act (42 U.S.C. 1395w–4(e)(1)(G)) is 
amended by adding at the end the following new sentence: 
‘‘For purposes of payment for services furnished in the 
State described in the preceding sentence on or after Jan-
uary 1, 2009, after calculating the work geographic index 
in subparagraph (A)(iii), the Secretary shall increase the 
work geographic index to 1.5 if such index would otherwise 
be less than 1.5’’. 
(c) TECHNICAL CORRECTION.—Section 602(1) of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2301) is amended to read as follows: 
‘‘(1) in subparagraph (A), by striking ‘subpara-
graphs (B), (C), and (E)’ and inserting ‘subpara-
graphs (B), (C), (E), and (G)’; and’’. 
SEC. 135. IMAGING PROVISIONS. 
(a) ACCREDITATION REQUIREMENT.— 
(1) ACCREDITATION
REQUIREMENT.—Section 
1834 of the Social Security Act (42 U.S.C. 1395m) 
is amended by inserting after subsection (d) the fol-
lowing new subsection: 
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‘‘(e) ACCREDITATION REQUIREMENT FOR ADVANCED 
DIAGNOSTIC IMAGING SERVICES.— 
‘‘(1) IN GENERAL.— 
‘‘(A) IN GENERAL.—Beginning with Janu-
ary 1, 2012, with respect to the technical com-
ponent of advanced diagnostic imaging services 
for which payment is made under the fee sched-
ule established under section 1848(b) and that 
are furnished by a supplier, payment may only 
be made if such supplier is accredited by an ac-
creditation organization designated by the Sec-
retary under paragraph (2)(B)(i). 
‘‘(B) ADVANCED
DIAGNOSTIC
IMAGING 
SERVICES
DEFINED.—In this subsection, the 
term ‘advanced diagnostic imaging services’ in-
cludes— 
‘‘(i) diagnostic magnetic resonance 
imaging, computed tomography, and nu-
clear medicine (including positron emission 
tomography); and 
‘‘(ii) such other diagnostic imaging 
services, including services described in 
section 1848(b)(4)(B) (excluding X-ray, 
ultrasound, and fluoroscopy), as specified 
by the Secretary in consultation with phy-
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sician specialty organizations and other 
stakeholders. 
‘‘(C) SUPPLIER
DEFINED.—In this sub-
section, the term ‘supplier’ has the meaning 
given such term in section 1861(d). 
‘‘(2) ACCREDITATION ORGANIZATIONS.— 
‘‘(A) FACTORS FOR DESIGNATION OF AC-
CREDITATION ORGANIZATIONS.—The Secretary 
shall consider the following factors in desig-
nating accreditation organizations under sub-
paragraph (B)(i) and in reviewing and modi-
fying the list of accreditation organizations des-
ignated pursuant to subparagraph (C): 
‘‘(i) The ability of the organization to 
conduct timely reviews of accreditation ap-
plications. 
‘‘(ii) Whether the organization has es-
tablished a process for the timely integra-
tion of new advanced diagnostic imaging 
services into the organization’s accredita-
tion program. 
‘‘(iii) Whether the organization uses 
random site visits, site audits, or other 
strategies for ensuring accredited suppliers 
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maintain adherence to the criteria de-
scribed in paragraph (3). 
‘‘(iv) The ability of the organization 
to take into account the capacities of sup-
pliers located in a rural area (as defined in 
section 1886(d)(2)(D)). 
‘‘(v) Whether the organization has es-
tablished reasonable fees to be charged to 
suppliers applying for accreditation. 
‘‘(vi) Such other factors as the Sec-
retary determines appropriate. 
‘‘(B) DESIGNATION.—Not later than Janu-
ary 1, 2010, the Secretary shall designate orga-
nizations to accredit suppliers furnishing the 
technical component of advanced diagnostic im-
aging services. The list of accreditation organi-
zations so designated may be modified pursuant 
to subparagraph (C). 
‘‘(C) REVIEW AND MODIFICATION OF LIST 
OF ACCREDITATION ORGANIZATIONS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall review the list of accreditation organi-
zations designated under subparagraph (B) 
taking into account the factors under sub-
paragraph (A). Taking into account the re-
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sults of such review, the Secretary may, by 
regulation, modify the list of accreditation 
organizations designated under subpara-
graph (B). 
‘‘(ii) SPECIAL RULE FOR ACCREDITA-
TIONS
DONE
PRIOR
TO
REMOVAL
FROM 
LIST OF DESIGNATED ACCREDITATION OR-
GANIZATIONS.—In the case where the Sec-
retary removes an organization from the 
list of accreditation organizations des-
ignated under subparagraph (B), any sup-
plier that is accredited by the organization 
during the period beginning on the date on 
which the organization is designated as an 
accreditation organization under subpara-
graph (B) and ending on the date on 
which the organization is removed from 
such list shall be considered to have been 
accredited by an organization designated 
by the Secretary under subparagraph (B) 
for the remaining period such accreditation 
is in effect. 
‘‘(3) CRITERIA FOR ACCREDITATION.—The Sec-
retary shall establish procedures to ensure that the 
criteria used by an accreditation organization des-
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110 
ignated under paragraph (2)(B) to evaluate a sup-
plier that furnishes the technical component of ad-
vanced diagnostic imaging services for the purpose 
of accreditation of such supplier is specific to each 
imaging modality. Such criteria shall include— 
‘‘(A) standards for qualifications of med-
ical personnel who are not physicians and who 
furnish the technical component of advanced di-
agnostic imaging services; 
‘‘(B) standards for qualifications and re-
sponsibilities of medical directors and super-
vising physicians, including standards that rec-
ognize the considerations described in para-
graph (4); 
‘‘(C) procedures to ensure that equipment 
used in furnishing the technical component of 
advanced diagnostic imaging services meets per-
formance specifications; 
‘‘(D) standards that require the supplier 
have procedures in place to ensure the safety of 
persons who furnish the technical component of 
advanced diagnostic imaging services and indi-
viduals to whom such services are furnished; 
‘‘(E) standards that require the establish-
ment and maintenance of a quality assurance 
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and quality control program by the supplier 
that is adequate and appropriate to ensure the 
reliability, clarity, and accuracy of the technical 
quality of diagnostic images produced by such 
supplier; and 
‘‘(F) any other standards or procedures 
the Secretary determines appropriate. 
‘‘(4) RECOGNITION
IN
STANDARDS
FOR
THE 
EVALUATION OF MEDICAL DIRECTORS AND SUPER-
VISING
PHYSICIANS.—The standards described in 
paragraph (3)(B) shall recognize whether a medical 
director or supervising physician— 
‘‘(A) in a particular specialty receives 
training in advanced diagnostic imaging serv-
ices in a residency program; 
‘‘(B) has attained, through experience, the 
necessary expertise to be a medical director or 
a supervising physician; 
‘‘(C) has completed any continuing medical 
education courses relating to such services; or 
‘‘(D) has met such other standards as the 
Secretary determines appropriate. 
‘‘(5) RULE FOR ACCREDITATIONS MADE PRIOR 
TO DESIGNATION.—In the case of a supplier that is 
accredited before January 1, 2010, by an accredita-
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tion organization designated by the Secretary under 
paragraph (2)(B) as of January 1, 2010, such sup-
plier shall be considered to have been accredited by 
an organization designated by the Secretary under 
such paragraph as of January 1, 2012, for the re-
maining period such accreditation is in effect.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) IN GENERAL.—Section 1862(a) of the 
Social Security Act (42 U.S.C. 1395y(a)) is 
amended— 
(i) in paragraph (21), by striking ‘‘or’’ 
at the end; 
(ii) in paragraph (22), by striking the 
period at the end and inserting ‘‘; or’’; and 
(iii) by inserting after paragraph (22) 
the following new paragraph: 
‘‘(23) which are the technical component of ad-
vanced diagnostic imaging services described in sec-
tion 1834(e)(1)(B) for which payment is made under 
the fee schedule established under section 1848(b) 
and that are furnished by a supplier (as defined in 
section 1861(d)), if such supplier is not accredited 
by an accreditation organization designated by the 
Secretary under section 1834(e)(2)(B).’’. 
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(B) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to advanced 
diagnostic imaging services furnished on or 
after January 1, 2012. 
(b) DEMONSTRATION PROJECT TO ASSESS THE AP-
PROPRIATE USE OF IMAGING SERVICES.— 
(1) CONDUCT OF DEMONSTRATION PROJECT.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’) shall conduct a 
demonstration project using the models de-
scribed in paragraph (2)(E) to collect data re-
garding physician compliance with appropriate-
ness criteria selected under paragraph (2)(D) in 
order to determine the appropriateness of ad-
vanced diagnostic imaging services furnished to 
Medicare beneficiaries. 
(B) 
ADVANCED
DIAGNOSTIC
IMAGING 
SERVICES.—In this subsection, the term ‘‘ad-
vanced diagnostic imaging services’’ has the 
meaning 
given 
such 
term 
in 
section 
1834(e)(1)(B) of the Social Security Act, as 
added by subsection (a). 
(C) AUTHORITY
TO
FOCUS
DEMONSTRA-
TION PROJECT.—The Secretary may focus the 
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demonstration project with respect to certain 
advanced diagnostic imaging services, such as 
services that account for a large amount of ex-
penditures under the Medicare program, serv-
ices that have recently experienced a high rate 
of growth, or services for which appropriateness 
criteria exists. 
(2) IMPLEMENTATION
AND
DESIGN
OF
DEM-
ONSTRATION PROJECT.— 
(A) IMPLEMENTATION AND DURATION.— 
(i) IMPLEMENTATION.—The Secretary 
shall implement the demonstration project 
under this subsection not later than Janu-
ary 1, 2010. 
(ii) DURATION.—The Secretary shall 
conduct the demonstration project under 
this subsection for a 2-year period. 
(B) APPLICATION AND SELECTION OF PAR-
TICIPATING PHYSICIANS.— 
(i) 
APPLICATION.—Each 
physician 
that desires to participate in the dem-
onstration project under this subsection 
shall submit an application to the Sec-
retary at such time, in such manner, and 
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115 
containing such information as the Sec-
retary may require. 
(ii) SELECTION.—The Secretary shall 
select physicians to participate in the dem-
onstration project under this subsection 
from among physicians submitting applica-
tions under clause (i). The Secretary shall 
ensure that the physicians selected— 
(I) represent a wide range of geo-
graphic areas, demographic character-
istics (such as urban, rural, and sub-
urban), and practice settings (such as 
private and academic practices); and 
(II) have the capability to submit 
data to the Secretary (or an entity 
under a subcontract with the Sec-
retary) in an electronic format in ac-
cordance with standards established 
by the Secretary. 
(C) ADMINISTRATIVE COSTS AND INCEN-
TIVES.—The Secretary shall— 
(i) reimburse physicians for reason-
able administrative costs incurred in par-
ticipating in the demonstration project 
under this subsection; and 
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(ii) provide reasonable incentives to 
physicians to encourage participation in 
the demonstration project under this sub-
section. 
(D) 
USE
OF
APPROPRIATENESS
CRI-
TERIA.— 
(i) IN GENERAL.—The Secretary, in 
consultation with medical specialty soci-
eties and other stakeholders, shall select 
criteria with respect to the clinical appro-
priateness of advanced diagnostic imaging 
services for use in the demonstration 
project under this subsection. 
(ii) CRITERIA
SELECTED.—Any cri-
teria selected under clause (i) shall— 
(I) be developed or endorsed by a 
medical specialty society; and 
(II) be developed in adherence to 
appropriateness principles developed 
by a consensus organization, such as 
the AQA alliance. 
(E) MODELS FOR COLLECTING DATA RE-
GARDING
PHYSICIAN
COMPLIANCE
WITH
SE-
LECTED
CRITERIA.—Subject to subparagraph 
(H), in carrying out the demonstration project 
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under this subsection, the Secretary shall use 
each of the following models for collecting data 
regarding physician compliance with appro-
priateness criteria selected under subparagraph 
(D): 
(i) A model described in subparagraph 
(F). 
(ii) A model described in subpara-
graph (G). 
(iii) Any other model that the Sec-
retary determines to be useful in evalu-
ating the use of appropriateness criteria 
for advanced diagnostic imaging services. 
(F) POINT
OF
SERVICE
MODEL
DE-
SCRIBED.—A model described in this subpara-
graph is a model that— 
(i) uses an electronic or paper intake 
form that— 
(I) contains a certification by the 
physician furnishing the imaging serv-
ice that the data on the intake form 
was confirmed with the Medicare ben-
eficiary before the service was fur-
nished; 
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(II) contains standardized data 
elements for diagnosis, service or-
dered, service furnished, and such 
other information determined by the 
Secretary, in consultation with med-
ical specialty societies and other 
stakeholders, to be germane to evalu-
ating the effectiveness of the use of 
appropriateness criteria selected under 
subparagraph (D); and 
(III) is accessible to physicians 
participating in the demonstration 
project under this subsection in a for-
mat that allows for the electronic sub-
mission of such form; and 
(ii) provides for feedback reports in 
accordance with paragraph (3)(B). 
(G) 
POINT
OF
ORDER
MODEL
DE-
SCRIBED.—A model described in this subpara-
graph is a model that— 
(i) uses a computerized order-entry 
system that requires the transmittal of rel-
evant supporting information at the time 
of referral for advanced diagnostic imaging 
services and provides automated decision- 
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support feedback to the referring physician 
regarding the appropriateness of fur-
nishing such imaging services; and 
(ii) provides for feedback reports in 
accordance with paragraph (3)(B). 
(H) LIMITATION.—In no case may the 
Secretary use prior authorization— 
(i) as a model for collecting data re-
garding physician compliance with appro-
priateness criteria selected under subpara-
graph (D) under the demonstration project 
under this subsection; or 
(ii) under any model used for col-
lecting such data under the demonstration 
project. 
(I) REQUIRED CONTRACTS AND PERFORM-
ANCE STANDARDS FOR CERTAIN ENTITIES.— 
(i) IN GENERAL.—The Secretary shall 
enter into contracts with entities to carry 
out the model described in subparagraph 
(G). 
(ii) PERFORMANCE STANDARDS.—The 
Secretary shall establish and enforce per-
formance standards for such entities under 
the contracts entered into under clause (i), 
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including performance standards with re-
spect to— 
(I) the satisfaction of Medicare 
beneficiaries who are furnished ad-
vanced diagnostic imaging services by 
a physician participating in the dem-
onstration project; 
(II) the satisfaction of physicians 
participating in the demonstration 
project; 
(III) if applicable, timelines for 
the provision of feedback reports 
under paragraph (3)(B); and 
(IV) any other areas determined 
appropriate by the Secretary. 
(3) COMPARISON
OF
UTILIZATION
OF
AD-
VANCED DIAGNOSTIC IMAGING SERVICES AND FEED-
BACK REPORTS.— 
(A) COMPARISON OF UTILIZATION OF AD-
VANCED DIAGNOSTIC IMAGING SERVICES.—The 
Secretary shall consult with medical specialty 
societies and other stakeholders to develop 
mechanisms for comparing the utilization of ad-
vanced diagnostic imaging services by physi-
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cians participating in the demonstration project 
under this subsection against— 
(i) the appropriateness criteria se-
lected under paragraph (2)(D); and 
(ii) to the extent feasible, the utiliza-
tion of such services by physicians not par-
ticipating in the demonstration project. 
(B) FEEDBACK REPORTS.—The Secretary 
shall, in consultation with medical specialty so-
cieties and other stakeholders, develop mecha-
nisms to provide feedback reports to physicians 
participating in the demonstration project 
under this subsection. Such feedback reports 
shall include— 
(i) a profile of the rate of compliance 
by the physician with appropriateness cri-
teria selected under paragraph (2)(D), in-
cluding a comparison of— 
(I) the rate of compliance by the 
physician with such criteria; and 
(II) the rate of compliance by the 
physician’s peers (as defined by the 
Secretary) with such criteria; and 
(ii) to the extent feasible, a compari-
son of— 
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(I) the rate of utilization of ad-
vanced diagnostic imaging services by 
the physician; and 
(II) the rate of utilization of such 
services by the physician’s peers (as 
defined by the Secretary) who are not 
participating in the demonstration 
project. 
(4) CONDUCT
OF
DEMONSTRATION
PROJECT 
AND WAIVER.— 
(A) 
CONDUCT
OF
DEMONSTRATION 
PROJECT.—Chapter 35 of title 44, United 
States Code, shall not apply to the conduct of 
the demonstration project under this sub-
section. 
(B) WAIVER.—The Secretary may waive 
such provisions of titles XI and XVIII of the 
Social Security Act (42 U.S.C. 1301 et seq.; 
1395 et seq.) as may be necessary to carry out 
the demonstration project under this sub-
section. 
(5) EVALUATION AND REPORT.— 
(A) EVALUATION.—The Secretary shall 
evaluate the demonstration project under this 
subsection to— 
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123 
(i) assess the timeliness and efficacy 
of the demonstration project; 
(ii) assess the performance of entities 
under a contract entered into under para-
graph (2)(I)(i); 
(iii) analyze data— 
(I) on the rates of appropriate, 
uncertain, and inappropriate advanced 
diagnostic imaging services furnished 
by physicians participating in the 
demonstration project; 
(II) on patterns and trends in 
the appropriateness and inappropri-
ateness of such services furnished by 
such physicians; 
(III) on patterns and trends in 
national and regional variations of 
care with respect to the furnishing of 
such services; and 
(IV) on the correlation between 
the appropriateness of the services 
furnished and image results; and 
(iv) address— 
(I) the thresholds used under the 
demonstration project to identify ac-
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ceptable and outlier levels of perform-
ance with respect to the appropriate-
ness of advanced diagnostic imaging 
services furnished; 
(II) whether prospective use of 
appropriateness criteria could have an 
effect on the volume of such services 
furnished; 
(III) whether expansion of the 
use of appropriateness criteria with 
respect to such services to a broader 
population of Medicare beneficiaries 
would be advisable; 
(IV) whether, under such an ex-
pansion, physicians who demonstrate 
consistent compliance with such ap-
propriateness criteria should be ex-
empted from certain requirements; 
(V) the use of incident-specific 
versus practice-specific outlier infor-
mation in formulating future rec-
ommendations with respect to the use 
of appropriateness criteria for such 
services under the Medicare program; 
and 
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(VI) the potential for using 
methods (including financial incen-
tives), in addition to those used under 
the models under the demonstration 
project, to ensure compliance with 
such criteria. 
(B) REPORT.—Not later than 1 year after 
the completion of the demonstration project 
under this subsection, the Secretary shall sub-
mit to Congress a report containing the results 
of the evaluation of the demonstration project 
conducted under subparagraph (A), together 
with recommendations for such legislation and 
administrative action as the Secretary deter-
mines appropriate. 
(6) FUNDING.—The Secretary shall provide for 
the transfer from the Federal Supplementary Med-
ical Insurance Trust Fund established under section 
1841 of the Social Security Act (42 U.S.C. 1395t) 
of $10,000,000, for carrying out the demonstration 
project under this subsection (including costs associ-
ated with administering the demonstration project, 
reimbursing physicians for administrative costs and 
providing incentives to encourage participation under 
paragraph (2)(C), entering into contracts under 
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paragraph (2)(I), and evaluating the demonstration 
project under paragraph (5)). 
(c) GAO STUDY AND REPORTS ON ACCREDITATION 
REQUIREMENT
FOR ADVANCED DIAGNOSTIC IMAGING 
SERVICES.— 
(1) STUDY.— 
(A) IN GENERAL.—The Comptroller Gen-
eral of the United States (in this subsection re-
ferred to as the ‘‘Comptroller General’’) shall 
conduct a study, by imaging modality, on— 
(i) the effect of the accreditation re-
quirement under section 1834(e) of the So-
cial Security Act, as added by subsection 
(a); and 
(ii) any other relevant questions in-
volving access to, and the value of, ad-
vanced diagnostic imaging services for 
Medicare beneficiaries. 
(B) ISSUES.—The study conducted under 
subparagraph (A) shall examine the following: 
(i) The impact of such accreditation 
requirement on the number, type, and 
quality of imaging services furnished to 
Medicare beneficiaries. 
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(ii) The cost of such accreditation re-
quirement, including costs to facilities of 
compliance with such requirement and 
costs to the Secretary of administering 
such requirement. 
(iii) Access to imaging services by 
Medicare beneficiaries, especially in rural 
areas, before and after implementation of 
such accreditation requirement. 
(iv) Such other issues as the Sec-
retary determines appropriate. 
(2) REPORTS.— 
(A) PRELIMINARY
REPORT.—Not later 
than March 1, 2013, the Comptroller General 
shall submit a preliminary report to Congress 
on the study conducted under paragraph (1). 
(B) FINAL
REPORT.—Not later than 
March 1, 2014, the Comptroller General shall 
submit a final report to Congress on the study 
conducted under paragraph (1), together with 
recommendations for such legislation and ad-
ministrative action as the Comptroller General 
determines appropriate. 
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SEC. 136. EXTENSION OF TREATMENT OF CERTAIN PHYSI-
CIAN PATHOLOGY SERVICES UNDER MEDI-
CARE. 
Section 542(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), as amended by section 732 of the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 
(42 U.S.C. 1395w–4 note), section 104 of division B of 
the Tax Relief and Health Care Act of 2006 (42 U.S.C. 
1395w–4 note), and section 104 of the Medicare, Med-
icaid, and SCHIP Extension Act of 2007 (Public Law 
110–173), is amended by striking ‘‘2007, and the first 6 
months of 2008’’ and inserting ‘‘2007, 2008, and 2009’’. 
SEC. 137. ACCOMMODATION OF PHYSICIANS ORDERED TO 
ACTIVE DUTY IN THE ARMED SERVICES. 
Section 1842(b)(6)(D)(iii) of the Social Security Act 
(42 U.S.C. 1395u(b)(6)(D)(iii)), as amended by section 
116 of the Medicare, Medicaid, and SCHIP Extension Act 
of 2007 (Public Law 110–173), is amended by striking 
‘‘(before July 1, 2008)’’. 
SEC. 138. ADJUSTMENT FOR MEDICARE MENTAL HEALTH 
SERVICES. 
(a) PAYMENT ADJUSTMENT.— 
(1) IN GENERAL.—For purposes of payment for 
services furnished under the physician fee schedule 
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under section 1848 of the Social Security Act (42 
U.S.C. 1395w–4) during the period beginning on 
July 1, 2008, and ending on December 31, 2009, 
the Secretary of Health and Human Services shall 
increase the fee schedule otherwise applicable for 
specified services by 5 percent. 
(2) 
NONAPPLICATION
OF
BUDGET-NEU-
TRALITY.—The budget-neutrality provision of sec-
tion 1848(c)(2)(B)(ii) of the Social Security Act (42 
U.S.C. 1395w–4(c)(2)(B)(ii)) shall not apply to the 
adjustments described in paragraph (1). 
(b) DEFINITION OF SPECIFIED SERVICES.—In this 
section, the term ‘‘specified services’’ means procedure 
codes for services in the categories of the Health Care 
Common Procedure Coding System, established by the 
Secretary of Health and Human Services under section 
1848(c)(5) of the Social Security Act (42 U.S.C. 1395w– 
4(c)(5)), as of July 1, 2007, and as subsequently modified 
by the Secretary, consisting of psychiatric therapeutic pro-
cedures furnished in office or other outpatient facility set-
tings or in inpatient hospital, partial hospital, or residen-
tial care facility settings, but only with respect to such 
services in such categories that are in the subcategories 
of services which are— 
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(1) insight oriented, behavior modifying, or sup-
portive psychotherapy; or 
(2) interactive psychotherapy. 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this section 
by program instruction or otherwise. 
SEC. 139. IMPROVEMENTS FOR MEDICARE ANESTHESIA 
TEACHING PROGRAMS. 
(a) SPECIAL PAYMENT RULE FOR TEACHING ANES-
THESIOLOGISTS.—Section 1848(a) of the Social Security 
Act (42 U.S.C. 1395w–4(a)), as amended by section 
132(b), is amended— 
(1) in paragraph (4)(A), by inserting ‘‘except as 
provided in paragraph (5),’’ after ‘‘anesthesia 
cases,’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL RULE FOR TEACHING ANESTHE-
SIOLOGISTS.—With respect to physicians’ services 
furnished on or after January 1, 2010, in the case 
of teaching anesthesiologists involved in the training 
of physician residents in a single anesthesia case or 
two concurrent anesthesia cases, the fee schedule 
amount to be applied shall be 100 percent of the fee 
schedule amount otherwise applicable under this sec-
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tion if the anesthesia services were personally per-
formed by the teaching anesthesiologist alone and 
paragraph (4) shall not apply if— 
‘‘(A) 
the 
teaching 
anesthesiologist 
is 
present during all critical or key portions of the 
anesthesia service or procedure involved; and 
‘‘(B) the teaching anesthesiologist (or an-
other anesthesiologist with whom the teaching 
anesthesiologist has entered into an arrange-
ment) is immediately available to furnish anes-
thesia services during the entire procedure.’’. 
(b) TREATMENT OF CERTIFIED REGISTERED NURSE 
ANESTHETISTS.—With respect to items and services fur-
nished on or after January 1, 2010, the Secretary of 
Health and Human Services shall make appropriate ad-
justments to payments under the Medicare program under 
title XVIII of the Social Security Act for teaching certified 
registered nurse anesthetists to implement a policy with 
respect to teaching certified registered nurse anesthetists 
that— 
(1) is consistent with the adjustments made by 
the special rule for teaching anesthesiologists under 
section 1848(a)(6) of the Social Security Act, as 
added by subsection (a); and 
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132 
(2) maintains the existing payment differences 
between teaching anesthesiologists and teaching cer-
tified registered nurse anesthetists. 
PART 2—OTHER PAYMENT AND COVERAGE 
IMPROVEMENTS 
SEC. 141. EXTENSION OF EXCEPTIONS PROCESS FOR MEDI-
CARE THERAPY CAPS. 
Section 1833(g)(5) of the Social Security Act (42 
U.S.C. 1395l(g)(5)), as amended by section 105 of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 
(Public Law 110–173), is amended by striking ‘‘June 30, 
2008’’ and inserting ‘‘December 31, 2009’’. 
SEC. 
142. 
EXTENSION 
OF 
PAYMENT 
RULE 
FOR 
BRACHYTHERAPY AND THERAPEUTIC RADIO-
PHARMACEUTICALS. 
Section 1833(t)(16)(C) of the Social Security Act (42 
U.S.C. 1395l(t)(16)(C)), as amended by section 106 of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 
(Public Law 110–173), is amended by striking ‘‘July 1, 
2008’’ each place it appears and inserting ‘‘January 1, 
2010’’. 
SEC. 143. SPEECH-LANGUAGE PATHOLOGY SERVICES. 
(a) IN GENERAL.—Section 1861(ll) of the Social Se-
curity Act (42 U.S.C. 1395x(ll)) is amended— 
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(1) by redesignating paragraphs (2) and (3) as 
paragraphs (3) and (4), respectively; and 
(2) by inserting after paragraph (1) the fol-
lowing new paragraph: 
‘‘(2) The term ‘outpatient speech-language pathology 
services’ has the meaning given the term ‘outpatient phys-
ical therapy services’ in subsection (p), except that in ap-
plying such subsection— 
‘‘(A) ‘speech-language pathology’ shall be sub-
stituted for ‘physical therapy’ each place it appears; 
and 
‘‘(B) ‘speech-language pathologist’ shall be sub-
stituted for ‘physical therapist’ each place it ap-
pears.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1832(a)(2)(C) of the Social Security 
Act (42 U.S.C. 1395k(a)(2)(C)) is amended— 
(A) by striking ‘‘and outpatient’’ and in-
serting ‘‘, outpatient’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and outpatient speech- 
language pathology services (other than services 
to which the second sentence of section 1861(p) 
applies through the application of section 
1861(ll)(2))’’. 
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134 
(2) Subparagraphs (A) and (B) of section 
1833(a)(8) of the Social Security Act (42 U.S.C. 
1395l(a)(8)) are each amended by striking ‘‘(which 
includes outpatient speech-language pathology serv-
ices)’’ and inserting ‘‘, outpatient speech-language 
pathology services,’’. 
(3) Section 1833(g)(1) of the Social Security 
Act (42 U.S.C. 1395l(g)(1)) is amended— 
(A) by inserting ‘‘and speech-language pa-
thology services of the type described in such 
section through the application of section 
1861(ll)(2)’’ after ‘‘1861(p)’’; and 
(B) by inserting ‘‘and speech-language pa-
thology services’’ after ‘‘and physical therapy 
services’’. 
(4) The second sentence of section 1835(a) of 
the Social Security Act (42 U.S.C. 1395n(a)) is 
amended— 
(A) by striking ‘‘section 1861(g)’’ and in-
serting ‘‘subsection (g) or (ll)(2) of section 
1861’’ each place it appears; and 
(B) by inserting ‘‘or outpatient speech-lan-
guage pathology services, respectively’’ after 
‘‘occupational therapy services’’. 
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135 
(5) Section 1861(p) of the Social Security Act 
(42 U.S.C. 1395x(p)) is amended by striking the 
fourth sentence. 
(6) Section 1861(s)(2)(D) of the Social Secu-
rity Act (42 U.S.C. 1395x(s)(2)(D)) is amended by 
inserting ‘‘, outpatient speech-language pathology 
services,’’ after ‘‘physical therapy services’’. 
(7) Section 1862(a)(20) of the Social Security 
Act (42 U.S.C. 1395y(a)(20)) is amended— 
(A) by striking ‘‘outpatient occupational 
therapy services or outpatient physical therapy 
services’’ and inserting ‘‘outpatient physical 
therapy services, outpatient speech-language pa-
thology services, or outpatient occupational 
therapy services’’; and 
(B) by striking ‘‘section 1861(g)’’ and in-
serting ‘‘subsection (g) or (ll)(2) of section 
1861’’. 
(8) Section 1866(e)(1) of the Social Security 
Act (42 U.S.C. 1395cc(e)(1)) is amended— 
(A) by striking ‘‘section 1861(g)’’ and in-
serting ‘‘subsection (g) or (ll)(2) of section 
1861’’ the first two places it appears; 
(B) by striking ‘‘defined) or’’ and inserting 
‘‘defined),’’; and 
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136 
(C) by inserting before the semicolon at 
the end the following: ‘‘, or (through the oper-
ation of section 1861(ll)(2)) with respect to the 
furnishing of outpatient speech-language pa-
thology’’. 
(9) Section 1877(h)(6) of the Social Security 
Act (42 U.S.C. 1395nn(h)(6)) is amended by adding 
at the end the following new subparagraph: 
‘‘(L) Outpatient speech-language pathology 
services.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
July 1, 2009. 
(d) CONSTRUCTION.—Nothing in this section shall be 
construed to affect existing regulations and policies of the 
Centers for Medicare & Medicaid Services that require 
physician oversight of care as a condition of payment for 
speech-language pathology services under part B of the 
Medicare program. 
SEC. 144. 
(a) COVERAGE OF PULMONARY AND CARDIAC REHA-
BILITATION.— 
(1) IN GENERAL.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x), as amended by sec-
tion 101(a), is amended— 
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(A) in subsection (s)(2)— 
(i) in subparagraph (AA), by striking 
‘‘and’’ at the end; 
(ii) by adding at the end the following 
new subparagraphs: 
‘‘(CC) items and services furnished under 
a cardiac rehabilitation program (as defined in 
subsection (eee)(1)) or under a pulmonary reha-
bilitation program (as defined in subsection 
(fff)(1)); and 
‘‘(DD) items and services furnished under 
an intensive cardiac rehabilitation program (as 
defined in subsection (eee)(4));’’; and 
(B) by adding at the end the following new 
subsections: 
‘‘Cardiac Rehabilitation Program; Intensive Cardiac 
Rehabilitation Program 
‘‘(eee)(1) The term ‘cardiac rehabilitation program’ 
means a physician-supervised program (as described in 
paragraph (2)) that furnishes the items and services de-
scribed in paragraph (3). 
‘‘(2) A program described in this paragraph is a pro-
gram under which— 
‘‘(A) items and services under the program are 
delivered— 
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138 
‘‘(i) in a physician’s office; 
‘‘(ii) in a hospital on an outpatient basis; 
or 
‘‘(iii) in other settings determined appro-
priate by the Secretary. 
‘‘(B) a physician is immediately available and 
accessible for medical consultation and medical 
emergencies at all times items and services are being 
furnished under the program, except that, in the 
case of items and services furnished under such a 
program in a hospital, such availability shall be pre-
sumed; and 
‘‘(C) individualized treatment is furnished 
under a written plan established, reviewed, and 
signed by a physician every 30 days that describes— 
‘‘(i) the individual’s diagnosis; 
‘‘(ii) the type, amount, frequency, and du-
ration of the items and services furnished under 
the plan; and 
‘‘(iii) the goals set for the individual under 
the plan. 
‘‘(3) The items and services described in this para-
graph are— 
‘‘(A) physician-prescribed exercise; 
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139 
‘‘(B) cardiac risk factor modification, including 
education, counseling, and behavioral intervention 
(to the extent such education, counseling, and behav-
ioral intervention is closely related to the individual’s 
care and treatment and is tailored to the individual’s 
needs); 
‘‘(C) psychosocial assessment; 
‘‘(D) outcomes assessment; and 
‘‘(E) such other items and services as the Sec-
retary may determine, but only if such items and 
services are— 
‘‘(i) reasonable and necessary for the diag-
nosis or active treatment of the individual’s 
condition; 
‘‘(ii) reasonably expected to improve or 
maintain the individual’s condition and func-
tional level; and 
‘‘(iii) furnished under such guidelines re-
lating to the frequency and duration of such 
items and services as the Secretary shall estab-
lish, taking into account accepted norms of 
medical practice and the reasonable expectation 
of improvement of the individual. 
‘‘(4)(A) The term ‘intensive cardiac rehabilitation 
program’ means a physician-supervised program (as de-
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140 
scribed in paragraph (2)) that furnishes the items and 
services described in paragraph (3) and has shown, in 
peer-reviewed published research, that it accomplished— 
‘‘(i) one or more of the following: 
‘‘(I) positively affected the progression of 
coronary heart disease; or 
‘‘(II) reduced the need for coronary bypass 
surgery; or 
‘‘(III) reduced the need for percutaneous 
coronary interventions; and 
‘‘(ii) a statistically significant reduction in 5 or 
more of the following measures from their level be-
fore receipt of cardiac rehabilitation services to their 
level after receipt of such services: 
‘‘(I) low density lipoprotein; 
‘‘(II) triglycerides; 
‘‘(III) body mass index; 
‘‘(IV) systolic blood pressure; 
‘‘(V) diastolic blood pressure; or 
‘‘(VI) the need for cholesterol, blood pres-
sure, and diabetes medications. 
‘‘(B) To be eligible for an intensive cardiac rehabilita-
tion program, an individual must have— 
‘‘(i) had an acute myocardial infarction within 
the preceding 12 months; 
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141 
‘‘(ii) had coronary bypass surgery; 
‘‘(iii) stable angina pectoris; 
‘‘(iv) had heart valve repair or replacement; 
‘‘(v) had percutaneous transluminal coronary 
angioplasty (PTCA) or coronary stenting; or 
‘‘(vi) had a heart or heart-lung transplant. 
‘‘(C) An intensive cardiac rehabilitation program may 
be provided in a series of 72 one-hour sessions (as defined 
in section 1848(b)(5)), up to 6 sessions per day, over a 
period of up to 18 weeks. 
‘‘(5) The Secretary shall establish standards to en-
sure that a physician with expertise in the management 
of individuals with cardiac pathophysiology who is licensed 
to practice medicine in the State in which a cardiac reha-
bilitation program (or the intensive cardiac rehabilitation 
program, as the case may be) is offered— 
‘‘(A) is responsible for such program; and 
‘‘(B) in consultation with appropriate staff, is 
involved substantially in directing the progress of in-
dividual in the program. 
‘‘Pulmonary Rehabilitation Program 
‘‘(fff)(1) The term ‘pulmonary rehabilitation pro-
gram’ means a physician-supervised program (as de-
scribed in subsection (eee)(2) with respect to a program 
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143 
medical practice and the reasonable expectation 
of improvement of the individual. 
‘‘(3) The Secretary shall establish standards to en-
sure that a physician with expertise in the management 
of individuals with respiratory pathophysiology who is li-
censed to practice medicine in the State in which a pul-
monary rehabilitation program is offered— 
‘‘(A) is responsible for such program; and 
‘‘(B) in consultation with appropriate staff, is 
involved substantially in directing the progress of in-
dividual in the program.’’. 
(2) PAYMENT FOR INTENSIVE CARDIAC REHA-
BILITATION PROGRAMS.— 
(A) INCLUSION IN PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of the Social Security 
Act (42 U.S.C. 1395w–4(j)(3)) is amended by 
inserting ‘‘(2)(DD),’’ after ‘‘(2)(AA),’’. 
(B) CONFORMING
AMENDMENT.—Section 
1848(b) of the Social Security Act (42 U.S.C. 
1395w–4(b)) is amended by adding at the end 
the following new paragraph: 
‘‘(5) TREATMENT OF INTENSIVE CARDIAC RE-
HABILITATION PROGRAM.— 
‘‘(A) IN GENERAL.—In the case of an in-
tensive cardiac rehabilitation program described 
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144 
in section 1861(eee)(4), the Secretary shall sub-
stitute the Medicare OPD fee schedule amount 
established under the prospective payment sys-
tem for hospital outpatient department service 
under paragraph (3)(D) of section 1833(t) for 
cardiac rehabilitation (under HCPCS codes 
93797 and 93798 for calendar year 2007, or 
any succeeding HCPCS codes for cardiac reha-
bilitation). 
‘‘(B) DEFINITION OF SESSION.—Each of 
the services described in subparagraphs (A) 
through (E) of section 1861(eee)(3), when fur-
nished for one hour, is a separate session of in-
tensive cardiac rehabilitation. 
‘‘(C) MULTIPLE SESSIONS PER DAY.—Pay-
ment may be made for up to 6 sessions per day 
of the series of 72 one-hour sessions of inten-
sive cardiac rehabilitation services described in 
section 1861(eee)(4)(B).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to items and services 
furnished on or after January 1, 2010. 
(b) REPEAL OF TRANSFER OF OWNERSHIP OF OXY-
GEN EQUIPMENT.— 
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145 
(1) IN GENERAL.—Section 1834(a)(5)(F) of 
the Social Security Act (42 U.S.C. 1395m(a)(5)(F)) 
is amended— 
(A) in the heading, by striking ‘‘OWNER-
SHIP 
OF 
EQUIPMENT’’ 
and 
inserting 
‘‘RENTAL CAP’’; and 
(B) by striking clause (ii) and inserting the 
following: 
‘‘(ii) PAYMENTS
AND
RULES
AFTER 
RENTAL CAP.—After the 36th continuous 
month during which payment is made for 
the equipment under this paragraph— 
‘‘(I) the supplier furnishing such 
equipment under this subsection shall 
continue to furnish the equipment 
during any period of medical need for 
the remainder of the reasonable useful 
lifetime of the equipment, as deter-
mined by the Secretary; 
‘‘(II) payments for oxygen shall 
continue to be made in the amount 
recognized for oxygen under para-
graph (9) for the period of medical 
need; and 
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146 
‘‘(III) maintenance and servicing 
payments shall, if the Secretary deter-
mines such payments are reasonable 
and necessary, be made (for parts and 
labor not covered by the supplier’s or 
manufacturer’s warranty, as deter-
mined by the Secretary to be appro-
priate for the equipment), and such 
payments shall be in an amount deter-
mined to be appropriate by the Sec-
retary.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on January 1, 
2009. 
SEC. 145. CLINICAL LABORATORY TESTS. 
(a) REPEAL OF MEDICARE COMPETITIVE BIDDING 
DEMONSTRATION PROJECT FOR CLINICAL LABORATORY 
SERVICES.— 
(1) IN GENERAL.—Section 1847 of the Social 
Security Act (42 U.S.C. 1395w–3) is amended by 
striking subsection (e). 
(2) 
CONFORMING
AMENDMENTS.—Section 
1833(a)(1)(D) of the Social Security Act (42 U.S.C. 
1395l(a)(1)(D)) is amended— 
(A) by inserting ‘‘or’’ before ‘‘(ii)’’; and 
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147 
(B) by striking ‘‘or (iii) on the basis’’ and 
all that follows before the comma at the end. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on the date of the 
enactment of this Act. 
(b) CLINICAL LABORATORY TEST FEE SCHEDULE 
UPDATE ADJUSTMENT.—Section 1833(h)(2)(A)(i) of the 
Social Security Act (42 U.S.C. 1395l(h)(2)(A)(ii)) is 
amended by inserting ‘‘minus, for each of the years 2009 
through 2013, 0.5 percentage points’’ after ‘‘city aver-
age)’’. 
SEC. 146. IMPROVED ACCESS TO AMBULANCE SERVICES. 
(a) EXTENSION
OF INCREASED MEDICARE PAY-
MENTS FOR GROUND AMBULANCE SERVICES.—Section 
1834(l)(13) of the Social Security Act (42 U.S.C. 
1395m(l)(13)) is amended— 
(1) in subparagraph (A)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘and for such services furnished on or 
after July 1, 2008, and before January 1, 
2010’’ after ‘‘2007,’’; 
(B) in clause (i), by inserting ‘‘(or 3 per-
cent if such service is furnished on or after July 
1, 2008, and before January 1, 2010)’’ after ‘‘2 
percent’’; and 
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148 
(C) in clause (ii), by inserting ‘‘(or 2 per-
cent if such service is furnished on or after July 
1, 2008, and before January 1, 2010)’’ after ‘‘1 
percent’’; and 
(2) in subparagraph (B)— 
(A) in the heading, by striking ‘‘2006’’ and 
inserting ‘‘APPLICABLE PERIOD’’; and 
(B) by inserting ‘‘applicable’’ before ‘‘pe-
riod’’. 
(b) AIR AMBULANCE PAYMENT IMPROVEMENTS.— 
(1) TREATMENT OF CERTAIN AREAS FOR PAY-
MENT FOR AIR AMBULANCE SERVICES UNDER THE 
AMBULANCE FEE SCHEDULE.—Notwithstanding any 
other provision of law, for purposes of making pay-
ments under section 1834(l) of the Social Security 
Act (42 U.S.C. 1395m(l)) for air ambulance services 
furnished during the period beginning on July 1, 
2008, and ending on December 31, 2009, any area 
that was designated as a rural area for purposes of 
making payments under such section for air ambu-
lance services furnished on December 31, 2006, shall 
be treated as a rural area for purposes of making 
payments under such section for air ambulance serv-
ices furnished during such period. 
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149 
(2) CLARIFICATION REGARDING SATISFACTION 
OF REQUIREMENT OF MEDICALLY NECESSARY.— 
(A) 
IN
GENERAL.—Section 
1834(l)(14)(B)(i) of the Social Security Act (42 
U.S.C. 1395m(l)(14)(B)(i)) is amended by 
striking ‘‘reasonably determines or certifies’’ 
and inserting ‘‘certifies or reasonably deter-
mines’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply to serv-
ices furnished on or after the date of the enact-
ment of this Act. 
SEC. 147. EXTENSION AND EXPANSION OF THE MEDICARE 
HOLD HARMLESS PROVISION UNDER THE 
PROSPECTIVE PAYMENT SYSTEM FOR HOS-
PITAL OUTPATIENT DEPARTMENT (HOPD) 
SERVICES FOR CERTAIN HOSPITALS. 
Section 1833(t)(7)(D)(i) of the Social Security Act 
(42 U.S.C. 1395l(t)(7)(D)(i)) is amended— 
(1) in subclause (II)— 
(A) in the first sentence, by striking 
‘‘2009’’ and inserting ‘‘2010’’; and 
(B) by striking the second sentence and in-
serting the following new sentence: ‘‘For pur-
poses of the preceding sentence, the applicable 
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percentage shall be 95 percent with respect to 
covered OPD services furnished in 2006, 90 
percent with respect to such services furnished 
in 2007, and 85 percent with respect to such 
services furnished in 2008 or 2009.’’; and 
(2) by adding at the end the following new sub-
clause: 
‘‘(III) In the case of a sole community 
hospital 
(as 
defined 
in 
section 
1886(d)(5)(D)(iii)) that has not more than 
100 beds, for covered OPD services fur-
nished on or after January 1, 2009, and 
before January 1, 2010, for which the 
PPS amount is less than the pre-BBA 
amount, the amount of payment under this 
subsection shall be increased by 85 percent 
of the amount of such difference.’’. 
SEC. 148. CLARIFICATION OF PAYMENT FOR CLINICAL LAB-
ORATORY TESTS FURNISHED BY CRITICAL 
ACCESS HOSPITALS. 
(a) IN GENERAL.—Section 1834(g)(4) of the Social 
Security Act (42 U.S.C. 1395m(g)(4)) is amended— 
(1) in the heading, by striking ‘‘NO
BENE-
FICIARY COST-SHARING FOR’’ and inserting ‘‘TREAT-
MENT OF’’; and 
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151 
(2) by adding at the end the following new sen-
tence: ‘‘For purposes of the preceding sentence and 
section 1861(mm)(3), clinical diagnostic laboratory 
services furnished by a critical access hospital shall 
be treated as being furnished as part of outpatient 
critical access services without regard to whether the 
individual with respect to whom such services are 
furnished is physically present in the critical access 
hospital, or in a skilled nursing facility or a clinic 
(including a rural health clinic) that is operated by 
a critical access hospital, at the time the specimen 
is collected.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to services furnished on or after 
July 1, 2009. 
SEC. 149. ADDING CERTAIN ENTITIES AS ORIGINATING 
SITES FOR PAYMENT OF TELEHEALTH SERV-
ICES. 
(a) IN GENERAL.—Section 1834(m)(4)(C)(ii) of the 
Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is 
amended by adding at the end the following new sub-
clauses: 
‘‘(VI) A hospital-based or critical 
access hospital-based renal dialysis 
center (including satellites). 
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‘‘(VII) A skilled nursing facility 
(as defined in section 1819(a)). 
‘‘(VIII) A community mental 
health center (as defined in section 
1861(ff)(3)(B)).’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘telehealth 
services furnished under section 1834(m)(4)(C)(ii)(VII),’’ 
after ‘‘section 1861(s)(2),’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1, 2009. 
SEC. 150. MEDPAC STUDY AND REPORT ON IMPROVING 
CHRONIC 
CARE 
DEMONSTRATION 
PRO-
GRAMS. 
(a) STUDY.—The Medicare Payment Advisory Com-
mission (in this section referred to as the ‘‘Commission’’) 
shall conduct a study on the feasability and advisability 
of establishing a Medicare Chronic Care Practice Research 
Network that would serve as a standing network of pro-
viders testing new models of care coordination and other 
care approaches for chronically ill beneficiaries, including 
the initiation, operation, evaluation, and, if appropriate, 
expansion of such models to the broader Medicare patient 
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population. In conducting such study, the Commission 
shall take into account the structure, implementation, and 
results of prior and existing care coordination and disease 
management demonstrations and pilots, including the 
Medicare Coordinated Care Demonstration Project under 
section 4016 of the Balanced Budget Act of 1997 (42 
U.S.C. 1395b–1 note) and the chronic care improvement 
programs under section 1807 of the Social Security Act 
(42 U.S.C. 1395b–8), commonly known to as ‘‘Medicare 
Health Support’’. 
(b) REPORT.—Not later than June 15, 2009, the 
Commission shall submit to Congress a report containing 
the results of the study conducted under subsection (a). 
SEC. 151. INCREASE OF FQHC PAYMENT LIMITS. 
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by adding at the 
end the following new subsection: 
‘‘(v) INCREASE OF FQHC PAYMENT LIMITS.—In the 
case of services furnished by federally qualified health cen-
ters (as defined in section 1861(aa)(4)), the Secretary 
shall establish payment limits with respect to such services 
under this part for services furnished— 
‘‘(1) in 2010, at the limits otherwise established 
under this part for such year increased by $5; and 
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