In the Senate of the United States, 
June 18, 2010. 
Resolved, That the bill from the House of Representa-
tives (H.R. 3962) entitled ‘‘An Act to provide affordable, 
quality health care for all Americans and reduce the growth 
in health care spending, and for other purposes.’’, do pass 
with the following 
AMENDMENTS: 
Strike all after the enacting clause and insert the 
following: 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Preservation of Access 
to Care for Medicare Beneficiaries and Pension Relief Act 
of 2010’’. 
TITLE I—HEALTH PROVISIONS 
SEC. 101. PHYSICIAN PAYMENT UPDATE. 
(a) IN GENERAL.—Section 1848(d) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(d)) is amended—
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(1) in paragraph (10), in the heading, by strik-
ing ‘‘PORTION’’ and inserting ‘‘JANUARY THROUGH 
MAY ’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(11) UPDATE FOR JUNE THROUGH NOVEMBER 
OF 2010.— 
‘‘(A) IN GENERAL.—Subject to paragraphs 
(7)(B), (8)(B), (9)(B), and (10)(B), in lieu of the 
update to the single conversion factor established 
in paragraph (1)(C) that would otherwise apply 
for 2010 for the period beginning on June 1, 
2010, and ending on November 30, 2010, the up-
date to the single conversion factor shall be 2.2 
percent. 
‘‘(B) NO EFFECT ON COMPUTATION OF CON-
VERSION FACTOR FOR REMAINING PORTION OF 
2010 AND SUBSEQUENT YEARS.—The conversion 
factor under this subsection shall be computed 
under paragraph (1)(A) for the period beginning 
on December 1, 2010, and ending on December 
31, 2010, and for 2011 and subsequent years as 
if subparagraph (A) had never applied.’’. 
(b) STATUTORY PAYGO.—The budgetary effects of this 
Act, for the purpose of complying with the Statutory Pay-
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As-You-Go Act of 2010, shall be determined by reference to 
the latest statement titled ‘‘Budgetary Effects of PAYGO 
Legislation’’ for this Act, jointly submitted for printing in 
the Congressional Record by the Chairmen of the House and 
Senate Budget Committees, provided that such statement 
has been submitted prior to the vote on passage in the House 
acting first on this conference report or amendment between 
the Houses. 
SEC. 102. CLARIFICATION OF 3-DAY PAYMENT WINDOW. 
(a) IN GENERAL.—Section 1886 of the Social Security 
Act (42 U.S.C. 1395ww) is amended— 
(1) by adding at the end of subsection (a)(4) the 
following new sentence: ‘‘In applying the first sen-
tence of this paragraph, the term ‘other services re-
lated to the admission’ includes all services that are 
not diagnostic services (other than ambulance and 
maintenance renal dialysis services) for which pay-
ment may be made under this title that are provided 
by a hospital (or an entity wholly owned or operated 
by the hospital) to a patient— 
‘‘(A) on the date of the patient’s inpatient 
admission; or 
‘‘(B) during the 3 days (or, in the case of 
a hospital that is not a subsection (d) hospital, 
during the 1 day) immediately preceding the
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date of such admission unless the hospital dem-
onstrates (in a form and manner, and at a time, 
specified by the Secretary) that such services are 
not related (as determined by the Secretary) to 
such admission.’’; and 
(2) in subsection (d)(7)— 
(A) in subparagraph (A), by striking ‘‘and’’ 
at the end; 
(B) in subparagraph (B), by striking the 
period and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) the determination of whether services 
provided prior to a patient’s inpatient admis-
sion are related to the admission (as described in 
subsection (a)(4)).’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply to services furnished on or after the 
date of the enactment of this Act. 
(c) NO
REOPENING
OF
PREVIOUSLY
BUNDLED 
CLAIMS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services may not reopen a claim, adjust a 
claim, or make a payment pursuant to any request 
for payment under title XVIII of the Social Security
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Act, submitted by an entity (including a hospital or 
an entity wholly owned or operated by the hospital) 
for services described in paragraph (2) for purposes of 
treating, as unrelated to a patient’s inpatient admis-
sion, services provided during the 3 days (or, in the 
case of a hospital that is not a subsection (d) hospital, 
during the 1 day) immediately preceding the date of 
the patient’s inpatient admission. 
(2) SERVICES
DESCRIBED.—For purposes of 
paragraph (1), the services described in this para-
graph are other services related to the admission (as 
described in section 1886(a)(4) of the Social Security 
Act (42 U.S.C. 1395ww(a)(4)), as amended by sub-
section (a)) which were previously included on a 
claim or request for payment submitted under part A 
of title XVIII of such Act for which a reopening, ad-
justment, or request for payment under part B of 
such title, was not submitted prior to the date of the 
enactment of this Act. 
(d) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
ices may implement the provisions of this section (and 
amendments made by this section) by program instruction 
or otherwise.
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(e) RULE OF CONSTRUCTION.—Nothing in the amend-
ments made by this section shall be construed as changing 
the policy described in section 1886(a)(4) of the Social Se-
curity Act (42 U.S.C. 1395ww(a)(4)), as applied by the 
Secretary of Health and Human Services before the date 
of the enactment of this Act, with respect to diagnostic serv-
ices. 
SEC. 103. ESTABLISH A CMS–IRS DATA MATCH TO IDENTIFY 
FRAUDULENT PROVIDERS. 
(a) AUTHORITY TO DISCLOSE RETURN INFORMATION 
CONCERNING OUTSTANDING TAX DEBTS FOR PURPOSES OF 
ENHANCING MEDICARE PROGRAM INTEGRITY.— 
(1) IN GENERAL.—Section 6103(l) of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new paragraph: 
‘‘(22) DISCLOSURE OF RETURN INFORMATION TO 
DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR 
PURPOSES OF ENHANCING MEDICARE PROGRAM IN-
TEGRITY.— 
‘‘(A) IN
GENERAL.—The Secretary shall, 
upon written request from the Secretary of 
Health and Human Services, disclose to officers 
and employees of the Department of Health and 
Human Services return information with respect 
to a taxpayer who has applied to enroll, or re-
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enroll, as a provider of services or supplier under 
the Medicare program under title XVIII of the 
Social Security Act. Such return information 
shall be limited to— 
‘‘(i) the taxpayer identity information 
with respect to such taxpayer; 
‘‘(ii) the amount of the delinquent tax 
debt owed by that taxpayer; and 
‘‘(iii) the taxable year to which the de-
linquent tax debt pertains. 
‘‘(B) RESTRICTION
ON
DISCLOSURE.—Re-
turn information disclosed under subparagraph 
(A) may be used by officers and employees of the 
Department of Health and Human Services for 
the purposes of, and to the extent necessary in, 
establishing the taxpayer’s eligibility for enroll-
ment or reenrollment in the Medicare program, 
or in any administrative or judicial proceeding 
relating to, or arising from, a denial of such en-
rollment or reenrollment, or in determining the 
level of enhanced oversight to be applied with re-
spect to such taxpayer pursuant to section 
1866(j)(3) of the Social Security Act. 
‘‘(C) DELINQUENT
TAX
DEBT.—For pur-
poses of this paragraph, the term ‘delinquent tax
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debt’ means an outstanding debt under this title 
for which a notice of lien has been filed pursuant 
to section 6323, but the term does not include a 
debt that is being paid in a timely manner pur-
suant to an agreement under section 6159 or 
7122, or a debt with respect to which a collection 
due process hearing under section 6330 is re-
quested, pending, or completed and no payment 
is required.’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
6103(p)(4) of such Code, as amended by sections 1414 
and 3308 of Public Law 111–148, in the matter pre-
ceding subparagraph (A) and in subparagraph 
(F)(ii), is amended by striking ‘‘or (17)’’ and insert-
ing ‘‘(17), or (22)’’ each place it appears. 
(b) SECRETARY’S AUTHORITY TO USE INFORMATION 
FROM THE DEPARTMENT OF TREASURY IN MEDICARE EN-
ROLLMENTS AND REENROLLMENTS.—Section 1866(j)(2) of 
the Social Security Act (42 U.S.C. 1395cc(j)), as inserted 
by section 6401(a) of Public Law 111–148, is further 
amended— 
(1) by redesignating subparagraph (E) as sub-
paragraph (F); and 
(2) by inserting after subparagraph (D) the fol-
lowing new subparagraph:
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‘‘(E) USE OF INFORMATION FROM THE DE-
PARTMENT
OF
TREASURY
CONCERNING
TAX 
DEBTS.—In reviewing the application of a pro-
vider of services or supplier to enroll or reenroll 
under the program under this title, the Secretary 
shall take into account the information supplied 
by the Secretary of the Treasury pursuant to sec-
tion 6103(l)(22) of the Internal Revenue Code of 
1986, in determining whether to deny such ap-
plication or to apply enhanced oversight to such 
provider of services or supplier pursuant to 
paragraph (3) if the Secretary determines such 
provider of services or supplier owes such a 
debt.’’. 
(c) AUTHORITY TO ADJUST PAYMENTS OF PROVIDERS 
OF SERVICES AND SUPPLIERS WITH THE SAME TAX IDEN-
TIFICATION NUMBER FOR MEDICARE OBLIGATIONS.—Sec-
tion 1866(j)(6) of the Social Security Act (42 U.S.C. 
1395cc(j)(6)), as inserted by section 6401(a) of Public Law 
111–148 and as redesignated by section 1304 of Public Law 
111–152, is amended— 
(1) in the paragraph heading, by striking ‘‘PAST- 
DUE’’ and inserting ‘‘MEDICARE’’; 
(2) in subparagraph (A), by striking ‘‘past-due 
obligations described in subparagraph (B)(ii) of an’’
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and inserting ‘‘amount described in subparagraph 
(B)(ii) due from such’’; and 
(3) in subparagraph (B)(ii), by striking ‘‘a past- 
due obligation’’ and inserting ‘‘an amount that is 
more than the amount required to be paid’’. 
TITLE II—PENSION FUNDING 
RELIEF 
Subtitle A—Single Employer Plans 
SEC. 201. EXTENDED PERIOD FOR SINGLE-EMPLOYER DE-
FINED BENEFIT PLANS TO AMORTIZE CER-
TAIN SHORTFALL AMORTIZATION BASES. 
(a) AMENDMENTS TO ERISA.— 
(1) IN
GENERAL.—Paragraph (2) of section 
303(c) of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1083(c)) is amended by add-
ing at the end the following subparagraph: 
‘‘(D) SPECIAL
ELECTION
FOR
ELIGIBLE 
PLAN YEARS.— 
‘‘(i) IN GENERAL.—If a plan sponsor 
elects to apply this subparagraph with re-
spect to the shortfall amortization base of a 
plan for any eligible plan year (in this sub-
paragraph and paragraph (7) referred to as 
an ‘election year’), then, notwithstanding 
subparagraphs (A) and (B)—
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‘‘(I) the shortfall amortization in-
stallments with respect to such base 
shall be determined under clause (ii) or 
(iii), whichever is specified in the elec-
tion, and 
‘‘(II) the shortfall amortization 
installment for any plan year in the 9- 
plan-year period described in clause 
(ii) or the 15-plan-year period de-
scribed in clause (iii), respectively, 
with respect to such shortfall amortiza-
tion base is the annual installment de-
termined under the applicable clause 
for that year for that base. 
‘‘(ii) 2 PLUS 7 AMORTIZATION SCHED-
ULE.—The shortfall amortization install-
ments determined under this clause are— 
‘‘(I) in the case of the first 2 plan 
years in the 9-plan-year period begin-
ning with the election year, interest on 
the shortfall amortization base of the 
plan for the election year (determined 
using the effective interest rate for the 
plan for the election year), and
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‘‘(II) in the case of the last 7 plan 
years in such 9-plan-year period, the 
amounts necessary to amortize the re-
maining balance of the shortfall amor-
tization base of the plan for the elec-
tion year in level annual installments 
over such last 7 plan years (using the 
segment rates under subparagraph (C) 
for the election year). 
‘‘(iii) 15-YEAR
AMORTIZATION.—The 
shortfall amortization installments deter-
mined under this subparagraph are the 
amounts necessary to amortize the shortfall 
amortization base of the plan for the elec-
tion year in level annual installments over 
the 15-plan-year period beginning with the 
election year (using the segment rates under 
subparagraph (C) for the election year). 
‘‘(iv) ELECTION.— 
‘‘(I) 
IN
GENERAL.—The 
plan 
sponsor of a plan may elect to have 
this subparagraph apply to not more 
than 2 eligible plan years with respect 
to the plan, except that in the case of 
a plan described in section 106 of the
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Pension Protection Act of 2006, the 
plan sponsor may only elect to have 
this subparagraph apply to a plan 
year beginning in 2011. 
‘‘(II) 
AMORTIZATION
SCHED-
ULE.—Such 
election 
shall 
specify 
whether 
the 
amortization 
schedule 
under clause (ii) or (iii) shall apply to 
an election year, except that if a plan 
sponsor elects to have this subpara-
graph apply to 2 eligible plan years, 
the plan sponsor must elect the same 
schedule for both years. 
‘‘(III) OTHER RULES.—Such elec-
tion shall be made at such time, and in 
such form and manner, as shall be pre-
scribed by the Secretary of the Treas-
ury, and may be revoked only with the 
consent of the Secretary of the Treas-
ury. The Secretary of the Treasury 
shall, before granting a revocation re-
quest, provide the Pension Benefit 
Guaranty Corporation an opportunity 
to comment on the conditions applica-
ble to the treatment of any portion of
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the election year shortfall amortization 
base that remains unamortized as of 
the revocation date. 
‘‘(v) ELIGIBLE PLAN YEAR.—For pur-
poses of this subparagraph, the term ‘eligi-
ble plan year’ means any plan year begin-
ning in 2008, 2009, 2010, or 2011, except 
that a plan year shall only be treated as an 
eligible plan year if the due date under sub-
section (j)(1) for the payment of the min-
imum required contribution for such plan 
year occurs on or after the date of the enact-
ment of this subparagraph. 
‘‘(vi) REPORTING.—A plan sponsor of 
a plan who makes an election under clause 
(i) shall— 
‘‘(I) give notice of the election to 
participants and beneficiaries of the 
plan, and 
‘‘(II) inform the Pension Benefit 
Guaranty Corporation of such election 
in such form and manner as the Direc-
tor of the Pension Benefit Guaranty 
Corporation may prescribe.
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‘‘(vii) INCREASES
IN
REQUIRED
IN-
STALLMENTS IN CERTAIN CASES.—For in-
creases in required contributions in cases of 
excess compensation or extraordinary divi-
dends or stock redemptions, see paragraph 
(7).’’. 
(2) INCREASES IN REQUIRED INSTALLMENTS IN 
CERTAIN CASES.—Section 303(c) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1083(c)) is amended by adding at the end the fol-
lowing paragraph: 
‘‘(7) INCREASES IN ALTERNATE REQUIRED IN-
STALLMENTS IN CASES OF EXCESS COMPENSATION OR 
EXTRAORDINARY
DIVIDENDS
OR
STOCK
REDEMP-
TIONS.— 
‘‘(A) IN GENERAL.—If there is an install-
ment acceleration amount with respect to a plan 
for any plan year in the restriction period with 
respect to an election year under paragraph 
(2)(D), then the shortfall amortization install-
ment otherwise determined and payable under 
such paragraph for such plan year shall, subject 
to the limitation under subparagraph (B), be in-
creased by such amount.
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‘‘(B) TOTAL
INSTALLMENTS
LIMITED
TO 
SHORTFALL BASE.—Subject to rules prescribed 
by the Secretary of the Treasury, if a shortfall 
amortization installment with respect to any 
shortfall amortization base for an election year 
is required to be increased for any plan year 
under subparagraph (A)— 
‘‘(i) such increase shall not result in 
the amount of such installment exceeding 
the present value of such installment and all 
succeeding installments with respect to such 
base (determined without regard to such in-
crease but after application of clause (ii)), 
and 
‘‘(ii) subsequent shortfall amortization 
installments with respect to such base shall, 
in reverse order of the otherwise required in-
stallments, be reduced to the extent nec-
essary to limit the present value of such 
subsequent shortfall amortization install-
ments (after application of this paragraph) 
to the present value of the remaining 
unamortized shortfall amortization base. 
‘‘(C) 
INSTALLMENT
ACCELERATION 
AMOUNT.—For purposes of this paragraph—
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‘‘(i) IN GENERAL.—The term ‘install-
ment acceleration amount’ means, with re-
spect to any plan year in a restriction pe-
riod with respect to an election year, the 
sum of— 
‘‘(I) the aggregate amount of ex-
cess employee compensation determined 
under subparagraph (D) with respect 
to all employees for the plan year, plus 
‘‘(II) the aggregate amount of ex-
traordinary dividends and redemp-
tions determined under subparagraph 
(E) for the plan year. 
‘‘(ii) ANNUAL
LIMITATION.—The in-
stallment acceleration amount for any plan 
year shall not exceed the excess (if any) of— 
‘‘(I) the sum of the shortfall amor-
tization installments for the plan year 
and all preceding plan years in the 
amortization 
period 
elected 
under 
paragraph (2)(D) with respect to the 
shortfall amortization base with respect 
to an election year, determined without 
regard to paragraph (2)(D) and this 
paragraph, over
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‘‘(II) the sum of the shortfall am-
ortization installments for such plan 
year and all such preceding plan 
years, determined after application of 
paragraph (2)(D) (and in the case of 
any preceding plan year, after appli-
cation of this paragraph). 
‘‘(iii) CARRYOVER OF EXCESS INSTALL-
MENT ACCELERATION AMOUNTS.— 
‘‘(I) IN GENERAL.—If the install-
ment acceleration amount for any plan 
year (determined without regard to 
clause (ii)) exceeds the limitation 
under clause (ii), then, subject to sub-
clause (II), such excess shall be treated 
as an installment acceleration amount 
with respect to the succeeding plan 
year. 
‘‘(II) CAP
TO
APPLY.—If any 
amount treated as an installment ac-
celeration amount under subclause (I) 
or this subclause with respect any suc-
ceeding plan year, when added to other 
installment acceleration amounts (de-
termined without regard to clause (ii))
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with respect to the plan year, exceeds 
the limitation under clause (ii), the 
portion of such amount representing 
such excess shall be treated as an in-
stallment acceleration amount with re-
spect to the next succeeding plan year. 
‘‘(III) LIMITATION ON YEARS TO 
WHICH
AMOUNTS
CARRIED
FOR.—No 
amount shall be carried under sub-
clause (I) or (II) to a plan year which 
begins after the first plan year fol-
lowing the last plan year in the re-
striction period (or after the second 
plan year following such last plan year 
in the case of an election year with re-
spect to which 15-year amortization 
was elected under paragraph (2)(D)). 
‘‘(IV) 
ORDERING
RULES.—For 
purposes of applying subclause (II), 
installment acceleration amounts for 
the plan year (determined without re-
gard to any carryover under this 
clause) shall be applied first against 
the limitation under clause (ii) and 
then carryovers to such plan year shall
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be applied against such limitation on 
a first-in, first-out basis. 
‘‘(D) EXCESS EMPLOYEE COMPENSATION.— 
For purposes of this paragraph— 
‘‘(i) IN
GENERAL.—The term ‘excess 
employee compensation’ means, with respect 
to any employee for any plan year, the ex-
cess (if any) of— 
‘‘(I) the aggregate amount includ-
ible in income under chapter 1 of the 
Internal Revenue Code of 1986 for re-
muneration during the calendar year 
in which such plan year begins for 
services performed by the employee for 
the plan sponsor (whether or not per-
formed during such calendar year), 
over 
‘‘(II) $1,000,000. 
‘‘(ii) AMOUNTS SET ASIDE FOR NON-
QUALIFIED
DEFERRED
COMPENSATION.—If 
during any calendar year assets are set 
aside or reserved (directly or indirectly) in 
a trust (or other arrangement as determined 
by the Secretary of the Treasury), or trans-
ferred to such a trust or other arrangement,