H. R. 3590—304 
SEC. 3113. TREATMENT OF CERTAIN COMPLEX DIAGNOSTIC LABORA-
TORY TESTS. 
(a) DEMONSTRATION PROJECT.— 
(1) IN
GENERAL.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) shall 
conduct a demonstration project under part B title XVIII of 
the Social Security Act under which separate payments are 
made under such part for complex diagnostic laboratory tests 
provided to individuals under such part. Under the demonstra-
tion project, the Secretary shall establish appropriate payment 
rates for such tests. 
(2) COVERED
COMPLEX
DIAGNOSTIC
LABORATORY
TEST 
DEFINED.—In this section, the term ‘‘complex diagnostic labora-
tory test’’ means a diagnostic laboratory test— 
(A) that is an analysis of gene protein expression, 
topographic genotyping, or a cancer chemotherapy sensi-
tivity assay; 
(B) that is determined by the Secretary to be a labora-
tory test for which there is not an alternative test having 
equivalent performance characteristics; 
(C) which is billed using a Health Care Procedure 
Coding System (HCPCS) code other than a not otherwise 
classified code under such Coding System; 
(D) which is approved or cleared by the Food and 
Drug Administration or is covered under title XVIII of 
the Social Security Act; and 
(E) is described in section 1861(s)(3) of the Social Secu-
rity Act (42 U.S.C. 1395x(s)(3)). 
(3) SEPARATE PAYMENT DEFINED.—In this section, the term 
‘‘separate payment’’ means direct payment to a laboratory 
(including a hospital-based or independent laboratory) that per-
forms a complex diagnostic laboratory test with respect to a 
specimen collected from an individual during a period in which 
the individual is a patient of a hospital if the test is performed 
after such period of hospitalization and if separate payment 
would not otherwise be made under title XVIII of the Social 
Security 
Act 
by 
reason 
of 
sections 
1862(a)(14) 
and 
1866(a)(1)(H)(i) of the such Act (42 U.S.C. 1395y(a)(14); 42 
U.S.C. 1395cc(a)(1)(H)(i)). 
(b) DURATION.—Subject to subsection (c)(2), the Secretary shall 
conduct the demonstration project under this section for the 2- 
year period beginning on July 1, 2011. 
(c) PAYMENTS
AND LIMITATION.—Payments under the dem-
onstration project under this section shall— 
(1) be made from the Federal Supplemental Medical Insur-
ance Trust Fund under section 1841 of the Social Security 
Act (42 U.S.C. 1395t); and 
(2) may not exceed $100,000,000. 
(d) REPORT.—Not later than 2 years after the completion of 
the demonstration project under this section, the Secretary shall 
submit to Congress a report on the project. Such report shall 
include— 
(1) an assessment of the impact of the demonstration 
project on access to care, quality of care, health outcomes, 
and expenditures under title XVIII of the Social Security Act 
(including any savings under such title); and
H. R. 3590—305 
(2) such recommendations as the Secretary determines 
appropriate. 
(e) IMPLEMENTATION FUNDING.—For purposes of administering 
this section (including preparing and submitting the report under 
subsection (d)), the Secretary shall provide for the transfer, from 
the Federal Supplemental Medical Insurance Trust Fund under 
section 1841 of the Social Security Act (42 U.S.C. 1395t), to the 
Centers for Medicare & Medicaid Services Program Management 
Account, of $5,000,000. Amounts transferred under the preceding 
sentence shall remain available until expended. 
SEC. 3114. IMPROVED ACCESS FOR CERTIFIED NURSE-MIDWIFE SERV-
ICES. 
Section 1833(a)(1)(K) of the Social Security Act (42 U.S.C. 
1395l(a)(1)(K)) is amended by inserting ‘‘(or 100 percent for services 
furnished on or after January 1, 2011)’’ after ‘‘1992, 65 percent’’. 
PART II—RURAL PROTECTIONS 
SEC. 3121. EXTENSION OF OUTPATIENT HOLD HARMLESS PROVISION. 
(a) IN GENERAL.—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 ‘‘2010’’and 
inserting ‘‘2011’’; and 
(B) in the second sentence, by striking ‘‘or 2009’’ and 
inserting ‘‘, 2009, or 2010’’; and 
(2) in subclause (III), by striking ‘‘January 1, 2010’’ and 
inserting ‘‘January 1, 2011’’. 
(b) PERMITTING
ALL
SOLE
COMMUNITY
HOSPITALS
TO
BE 
ELIGIBLE FOR HOLD HARMLESS.—Section 1833(t)(7)(D)(i)(III) of the 
Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)(III)) is amended by 
adding at the end the following new sentence: ‘‘In the case of 
covered OPD services furnished on or after January 1, 2010, and 
before January 1, 2011, the preceding sentence shall be applied 
without regard to the 100-bed limitation.’’. 
SEC. 3122. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS 
FOR 
CERTAIN 
CLINICAL 
DIAGNOSTIC 
LABORATORY 
TESTS FURNISHED TO HOSPITAL PATIENTS IN CERTAIN 
RURAL AREAS. 
Section 416(b) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (42 U.S.C. 1395l–4), as amended 
by section 105 of division B of the Tax Relief and Health Care 
Act of 2006 (42 U.S.C. 1395l note) and section 107 of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395l note), 
is amended by inserting ‘‘or during the 1-year period beginning 
on July 1, 2010’’ before the period at the end. 
SEC. 3123. EXTENSION OF THE RURAL COMMUNITY HOSPITAL DEM-
ONSTRATION PROGRAM. 
(a) ONE-YEAR
EXTENSION.—Section 410A of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 
(Public Law 108–173; 117 Stat. 2272) is amended by adding at 
the end the following new subsection: 
‘‘(g) ONE-YEAR EXTENSION OF DEMONSTRATION PROGRAM.— 
‘‘(1) IN GENERAL.—Subject to the succeeding provisions of 
this subsection, the Secretary shall conduct the demonstration
H. R. 3590—306 
program under this section for an additional 1-year period 
(in this section referred to as the ‘1-year extension period’) 
that begins on the date immediately following the last day 
of the initial 5-year period under subsection (a)(5). 
‘‘(2) EXPANSION
OF
DEMONSTRATION
STATES.—Notwith-
standing subsection (a)(2), during the 1-year extension period, 
the Secretary shall expand the number of States with low 
population densities determined by the Secretary under such 
subsection to 20. In determining which States to include in 
such expansion, the Secretary shall use the same criteria and 
data that the Secretary used to determine the States under 
such subsection for purposes of the initial 5-year period. 
‘‘(3) INCREASE IN MAXIMUM NUMBER OF HOSPITALS PARTICI-
PATING
IN
THE
DEMONSTRATION
PROGRAM.—Notwithstanding 
subsection (a)(4), during the 1-year extension period, not more 
than 30 rural community hospitals may participate in the dem-
onstration program under this section. 
‘‘(4) NO AFFECT ON HOSPITALS IN DEMONSTRATION PROGRAM 
ON DATE OF ENACTMENT.—In the case of a rural community 
hospital that is participating in the demonstration program 
under this section as of the last day of the initial 5-year 
period, the Secretary shall provide for the continued participa-
tion of such rural community hospital in the demonstration 
program during the 1-year extension period unless the rural 
community hospital makes an election, in such form and 
manner as the Secretary may specify, to discontinue such 
participation.’’. 
(b) CONFORMING AMENDMENTS.—Subsection (a)(5) of section 
410A of the Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 2272) is 
amended by inserting ‘‘(in this section referred to as the ‘initial 
5-year period’) and, as provided in subsection (g), for the 1-year 
extension period’’ after ‘‘5-year period’’. 
(c) TECHNICAL AMENDMENTS.— 
(1) Subsection (b) of section 410A of the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108–173; 117 Stat. 2272) is amended— 
(A) in paragraph (1)(B)(ii), by striking ‘‘2)’’ and 
inserting ‘‘2))’’; and 
(B) in paragraph (2), by inserting ‘‘cost’’ before 
‘‘reporting period’’ the first place such term appears in 
each of subparagraphs (A) and (B). 
(2) Subsection (f)(1) of section 410A of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173; 117 Stat. 2272) is amended— 
(A) in subparagraph (A)(ii), by striking ‘‘paragraph (2)’’ 
and inserting ‘‘subparagraph (B)’’; and 
(B) in subparagraph (B), by striking ‘‘paragraph (1)(B)’’ 
and inserting ‘‘subparagraph (A)(ii)’’. 
SEC. 3124. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL 
(MDH) PROGRAM. 
(a) 
EXTENSION
OF
PAYMENT
METHODOLOGY.—Section 
1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) 
is amended— 
(1) in clause (i), by striking ‘‘October 1, 2011’’ and inserting 
‘‘October 1, 2012’’; and
H. R. 3590—307 
(2) in clause (ii)(II), by striking ‘‘October 1, 2011’’ and 
inserting ‘‘October 1, 2012’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION OF TARGET AMOUNT.—Section 1886(b)(3)(D) 
of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
amended— 
(A) in the matter preceding clause (i), by striking 
‘‘October 1, 2011’’ and inserting ‘‘October 1, 2012’’; and 
(B) in clause (iv), by striking ‘‘through fiscal year 2011’’ 
and inserting ‘‘through fiscal year 2012’’. 
(2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION.— 
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act 
of 1993 (42 U.S.C. 1395ww note) is amended by striking 
‘‘through fiscal year 2011’’ and inserting ‘‘through fiscal year 
2012’’. 
SEC. 
3125. 
TEMPORARY 
IMPROVEMENTS 
TO 
THE 
MEDICARE 
INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR LOW- 
VOLUME HOSPITALS. 
Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended— 
(1) in subparagraph (A), by inserting ‘‘or (D)’’ after 
‘‘subparagraph (B)’’; 
(2) in subparagraph (B), in the matter preceding clause 
(i), by striking ‘‘The Secretary’’ and inserting ‘‘For discharges 
occurring in fiscal years 2005 through 2010 and for discharges 
occurring in fiscal year 2013 and subsequent fiscal years, the 
Secretary’’; 
(3) in subparagraph (C)(i)— 
(A) by inserting ‘‘(or, with respect to fiscal years 2011 
and 2012, 15 road miles)’’ after ‘‘25 road miles’’; and 
(B) by inserting ‘‘(or, with respect to fiscal years 2011 
and 2012, 1,500 discharges of individuals entitled to, or 
enrolled for, benefits under part A)’’ after ‘‘800 discharges’’; 
and 
(4) by adding at the end the following new subparagraph: 
‘‘(D) TEMPORARY APPLICABLE PERCENTAGE INCREASE.— 
For discharges occurring in fiscal years 2011 and 2012, 
the Secretary shall determine an applicable percentage 
increase for purposes of subparagraph (A) using a contin-
uous linear sliding scale ranging from 25 percent for low- 
volume hospitals with 200 or fewer discharges of individ-
uals entitled to, or enrolled for, benefits under part A 
in the fiscal year to 0 percent for low-volume hospitals 
with greater than 1,500 discharges of such individuals 
in the fiscal year.’’. 
SEC. 3126. IMPROVEMENTS TO THE DEMONSTRATION PROJECT ON 
COMMUNITY HEALTH INTEGRATION MODELS IN CERTAIN 
RURAL COUNTIES. 
(a) REMOVAL OF LIMITATION ON NUMBER OF ELIGIBLE COUNTIES 
SELECTED.—Subsection (d)(3) of section 123 of the Medicare 
Improvements for Patients and Providers Act of 2008 (42 U.S.C. 
1395i–4 note) is amended by striking ‘‘not more than 6’’. 
(b) REMOVAL OF REFERENCES TO RURAL HEALTH CLINIC SERV-
ICES AND INCLUSION OF PHYSICIANS’ SERVICES IN SCOPE OF DEM-
ONSTRATION PROJECT.—Such section 123 is amended—