257 
SEC. 186. DEMONSTRATION TO IMPROVE CARE TO PRE-
VIOUSLY UNINSURED. 
(a) ESTABLISHMENT.—Within one year after the 
date of the enactment of this Act, the Secretary (in this 
section referred to as the ‘‘Secretary’’) shall establish a 
demonstration project to determine the greatest needs and 
most effective methods of outreach to Medicare bene-
ficiaries who were previously uninsured. 
(b) SCOPE.—The demonstration shall be in no fewer 
than 10 sites, and shall include state health insurance as-
sistance programs, community health centers, community- 
based organizations, community health workers, and other 
service providers under parts A, B, and C of title XVIII 
of the Social Security Act. Grantees that are plans oper-
ating under part C shall document that enrollees who were 
previously uninsured receive the ‘‘Welcome to Medicare’’ 
physical exam. 
(c) DURATION.—The Secretary shall conduct the 
demonstration project for a period of 2 years. 
(d) REPORT AND EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration and not later 
than 1 year after the completion of the project shall sub-
mit to Congress a report including the following: 
(1) An analysis of the effectiveness of outreach 
activities targeting beneficiaries who were previously 
uninsured, such as revising outreach and enrollment 
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258 
materials (including the potential for use of video in-
formation), providing one-on-one counseling, working 
with community health workers, and amending the 
Medicare and You handbook. 
(2) The effect of such outreach on beneficiary 
access to care, utilization of services, efficiency and 
cost-effectiveness of health care delivery, patient sat-
isfaction, and select health outcomes. 
SEC. 187. OFFICE OF THE INSPECTOR GENERAL REPORT 
ON COMPLIANCE WITH AND ENFORCEMENT 
OF NATIONAL STANDARDS ON CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES (CLAS) IN MEDICARE. 
(a) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Inspector General of the 
Department of Health and Human Services shall prepare 
and publish a report on— 
(1) the extent to which Medicare providers and 
plans are complying with the Office for Civil Rights’ 
Guidance to Federal Financial Assistance Recipients 
Regarding Title VI Prohibition Against National Or-
igin Discrimination Affecting Limited English Pro-
ficient Persons and the Office of Minority Health’s 
Culturally and Linguistically Appropriate Services 
Standards in health care; and 
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259 
(2) a description of the costs associated with or 
savings related to the provision of language services. 
Such report shall include recommendations on improving 
compliance with CLAS Standards and recommendations 
on improving enforcement of CLAS Standards. 
(b) IMPLEMENTATION.—Not later than one year 
after the date of publication of the report under subsection 
(a), the Department of Health and Human Services shall 
implement changes responsive to any deficiencies identi-
fied in the report. 
SEC. 188. MEDICARE IMPROVEMENT FUNDING. 
(a) MEDICARE IMPROVEMENT FUND.— 
(1) IN GENERAL.—Subject to paragraph (2), 
title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by adding at the end the 
following new section: 
‘‘MEDICARE IMPROVEMENT FUND 
‘‘SEC. 1898. (a) ESTABLISHMENT.— 
‘‘The Secretary shall establish under this title a 
Medicare Improvement Fund (in this section re-
ferred to as the ‘Fund’) which shall be available to 
the Secretary to make improvements under the origi-
nal fee-for-service program under parts A and B for 
individuals entitled to, or enrolled for, benefits under 
part A or enrolled under part B. 
‘‘(b) FUNDING.— 
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260 
‘‘(1) IN GENERAL.—There shall be available to 
the Fund, for expenditures from the Fund for serv-
ices furnished during fiscal years 2014 through 
2017, $19,900,000,000. 
‘‘(2) PAYMENT
FROM
TRUST
FUNDS.—The 
amount specified under paragraph (1) shall be avail-
able to the Fund, as expenditures are made from the 
Fund, from the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary Medical In-
surance Trust Fund in such proportion as the Sec-
retary determines appropriate. 
‘‘(3) FUNDING LIMITATION.—Amounts in the 
Fund shall be available in advance of appropriations 
but only if the total amount obligated from the 
Fund does not exceed the amount available to the 
Fund under paragraph (1). The Secretary may obli-
gate funds from the Fund only if the Secretary de-
termines (and the Chief Actuary of the Centers for 
Medicare & Medicaid Services and the appropriate 
budget officer certify) that there are available in the 
Fund sufficient amounts to cover all such obligations 
incurred consistent with the previous sentence.’’. 
(2) CONTINGENCY.— 
(A) IN GENERAL.—If there is enacted, be-
fore, on, or after the date of the enactment of 
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261 
this Act, a Supplemental Appropriations Act, 
2008 that includes a provision providing for a 
Medicare Improvement Fund under a section 
1898 of the Social Security Act, the alternative 
amendment described in subparagraph (B)— 
(i) shall apply instead of the amend-
ment made by paragraph (1); and 
(ii) shall be executed after such provi-
sion in such Supplemental Appropriations 
Act. 
(B) 
ALTERNATIVE
AMENDMENT
DE-
SCRIBED.—The 
alternative 
amendment 
de-
scribed in this subparagraph is as follows: Sec-
tion 1898(b)(1) of the Social Security Act, as 
added by the Supplemental Appropriations Act, 
2008, is amended by inserting before the period 
at the end the following: ‘‘ and, in addition for 
services furnished during fiscal years 2014 
through 2017, $19,900,000,000’’. 
(b) IMPLEMENTATION.—For purposes of carrying out 
the provisions of, and amendments made by, this title, in 
addition to any other amounts provided in such provisions 
and amendments, the Secretary of Health and Human 
Services shall provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under section 1817 of the 
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263 
such program beginning within 1 year after the 
date of the enactment of this section; 
‘‘(B) at least 75 percent of all payments 
under parts A and B are processed through 
such program beginning within 2 years after 
such date; and 
‘‘(C) all payments under parts A and B 
are processed through such program beginning 
not later than September 30, 2011. 
‘‘(2) ASSISTANCE.—The Financial Management 
Service and the Internal Revenue Service shall pro-
vide assistance to the Centers for Medicare & Med-
icaid Services to ensure that all payments described 
in paragraph (1) are included in the Federal Pay-
ment Levy Program by the deadlines specified in 
that subsection.’’. 
(b) APPLICATION OF ADMINISTRATIVE OFFSET PRO-
VISIONS
TO MEDICARE PROVIDER
OR SUPPLIER PAY-
MENTS.—Section 3716 of title 31, United States Code, is 
amended— 
(1) by inserting ‘‘the Department of Health and 
Human Services,’’ after ‘‘United States Postal Serv-
ice,’’ in subsection (c)(1)(A); and 
(2) by adding at the end of subsection (c)(3) 
the following new subparagraph: 
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‘‘(D) This section shall apply to payments 
made after the date which is 90 days after the 
enactment of this subparagraph (or such earlier 
date as designated by the Secretary of Health 
and Human Services) with respect to claims or 
debts, and to amounts payable, under title 
XVIII of the Social Security Act.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. 
TITLE J—MEDICAID 
SEC. 201. EXTENSION OF TRANSITIONAL MEDICAL ASSIST-
ANCE (TMA) AND ABSTINENCE EDUCATION 
PROGRAM. 
Section 401 of division B of the Tax Relief and 
Health Care Act of 2006 (Public Law 109–432, 120 Stat. 
2994), as amended by section 1 of Public Law 110–48 
(121 Stat. 244), section 2 of the TMA, Abstinence, Edu-
cation, and QI Programs Extension Act of 2007 (Public 
Law 110–90, 121 Stat. 984), and section 202 of the Medi-
care, Medicaid, and SCHIP Extension Act of 2007 (Public 
Law 110–173) is amended— 
(1) by striking ‘‘June 30, 2008’’ and inserting 
‘‘June 30, 2009’’; 
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(2) by striking ‘‘the third quarter of fiscal year 
2008’’ and inserting ‘‘the third quarter of fiscal year 
2009’’; and 
(3) by striking ‘‘the third quarter of fiscal year 
2007’’ and inserting ‘‘the third quarter of fiscal year 
2008’’. 
SEC. 202. MEDICAID DSH EXTENSION. 
Section 1923(f)(6) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)) is amended— 
(1) in the heading, by striking ‘‘FISCAL YEAR 
2007 AND PORTIONS OF FISCAL YEAR 2008’’ and in-
serting ‘‘FISCAL YEARS 2007 THROUGH 2009 AND THE 
FIRST CALENDAR QUARTER OF FISCAL YEAR 2010’’; 
and 
(2) in subparagraph (A)— 
(A) in clause (i)— 
(i) in the second sentence— 
(I) by striking ‘‘fiscal year 2008 
for the period ending on June 30, 
2008’’ and inserting ‘‘fiscal years 
2008 and 2009’’; and 
(II) by striking ‘‘3⁄4 of’’; and 
(ii) by adding at the end the following 
new sentences: ‘‘Only with respect to fiscal 
year 2010 for the period ending on Decem-
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266 
ber 31, 2009, the DSH allotment for Ten-
nessee for such portion of the fiscal year, 
notwithstanding such table or terms, shall 
be 1⁄4 of the amount specified in the first 
sentence for fiscal year 2007.’’; 
(B) in clause (ii), by striking ‘‘or for a pe-
riod in fiscal year 2008’’ and inserting ‘‘, 2008, 
2009, or for a period in fiscal year 2010’’; 
(C) in clause (iv)— 
(i) in the heading, by striking ‘‘FISCAL 
YEAR 2007 AND FISCAL YEAR 2008’’ and in-
serting ‘‘FISCAL YEARS 2007 THROUGH 2009 
AND THE FIRST CALENDAR QUARTER OF 
FISCAL YEAR 2010’’; 
(ii) in subclause (I), by striking ‘‘or 
for a period in fiscal year 2008’’ and in-
serting ‘‘, 2008, 2009, or for a period in 
fiscal year 2010’’; and 
(iii) in subclause (II), by striking ‘‘or 
for a period in fiscal year 2008’’ and in-
serting ‘‘, 2008, 2009, or for a period in 
fiscal year 2010’’; and 
(3) in subparagraph (B)(i)— 
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(A) in the first sentence, by striking ‘‘fiscal 
year 2007’’ and inserting ‘‘each of fiscal years 
2007 through 2009’’; and 
(B) by striking the second sentence and in-
serting the following: ‘‘Only with respect to fis-
cal year 2010 for the period ending on Decem-
ber 31, 2009, the DSH allotment for Hawaii 
for such portion of the fiscal year, notwith-
standing the table set forth in paragraph (2), 
shall be $2,500,000.’’. 
SEC. 203. PHARMACY REIMBURSEMENT UNDER MEDICAID. 
(a) DELAY
IN APPLICATION
OF NEW PAYMENT 
LIMIT
FOR MULTIPLE SOURCE DRUGS UNDER MED-
ICAID.—Notwithstanding paragraphs (4) and (5) of sub-
section (e) of section 1927 of the Social Security Act (42 
U.S.C. 1396r–8) or part 447 of title 42, Code of Federal 
Regulations, as published on July 17, 2007 (72 Federal 
Register 39142)— 
(1) the specific upper limit under section 
447.332 of title 42, Code of Federal Regulations (as 
in effect on December 31, 2006) applicable to pay-
ments made by a State for multiple source drugs 
under a State Medicaid plan shall continue to apply 
through September 30, 2009, for purposes of the 
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