P.L. 110-275 , the Medicare Improvements for Patients and Providers Act (MIPPA) became law on July 15, 2008, after Congress overrode a Presidential veto on H.R. 6331 . The bill was originally passed by the House on June 24, 2008, under suspension of the rules by a vote of 355 to 59. On July 9, 2008, the Senate passed the bill without amendment by unanimous consent after approval was given for cloture by a vote of 69-30. The bill was cleared for the White House. On July 15, 2008 President Bush vetoed the bill. On the same day, the House voted 383-41 to override the veto and the Senate later voted 70-26 to override the veto. MIPPA is designed to avert a statutory Medicare reduction in payments for physicians and make other changes. MIPPA freezes physician fees at the June 2008 level until January 2009. In January 2009, fees will increase by 1.1%. In 2010, the statutory reduction will again apply, resulting in a 21% reduction in Medicare physician payment levels, according to the Congressional Budget Office (CBO). CBO estimates that the physician payments provision cost $9.4 billion (over the 2008-2010 period). Other provisions in the Act will offset these and other costs, so that in total, the provisions in MIPPA will reduce deficits (or increase surpluses) by an estimated $0.1 billion over the 2008-2013 period and by less than an estimated $50 million over the 2008-2018 period. The main source for these offsets comes from reductions in spending for (1) the Medicare Advantage program, and (2) the physician assistance and quality initiative (PAQI) fund. The Act also makes further changes to Medicare, Medicaid, and other programs under the Social Security Act. For example, MIPPA (1) adds "additional preventive services" to the list of Medicare-covered preventive services; (2) increases the percentage that Medicare generally pays for mental health services and in 2014, outpatient psychiatric services will be paid on the same basis as other Part B services; (3) increases the assets tests applicable under the Medicare Savings program (MSP) to those applicable under the low-income subsidy program under the Medicare Part D prescription drug program; (4) repeals the current law requirement for competitive bidding for clinical laboratory services; (5) makes changes to low-income programs for Medicare beneficiaries, as well as Medicaid; and (6) makes changes to Medicare provisions for hospitals, renal dialysis coverage, and Medicare prescription drug coverage, among others. Finally, MIPPA terminates all contracts under the first round of the Durable Medical Equipment, prosthetics, orthotics, and other medical supplies (DMEPOS) competitive acquisition program, set to start July 1, 2008. It requires the Secretary to re-bid the first round in 2009 and delays the second round of bidding until 2011. This report provides a description of each of the provisions of MIPPA. In this report, references are also made to the following public laws: Balanced Budget Act of 1997 ( P.L. 105-33 , BBA) Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( P.L. 108-173 , MMA) Deficit Reduction Act ( P.L. 109-171 , DRA) Tax Relief and Health Care Act of 2006 ( P.L. 109-432 , TRHCA) Medicare, Medicaid, and SCHIP Extension Act of 2007 ( P.L. 110-173 , MMSEA) P.L. 110-275 makes changes to the Medicare, and Medicaid programs, briefly described below. More complete and detailed descriptions are available from CRS. It also makes changes to other programs, such as Temporary Assistance for Needy Families (TANF) and Foster Care and Adoption Assistance. Medicare is the nation's health insurance program for persons aged 65 and over and certain disabled persons. In FY2008, the program will cover an estimated 44.6 million persons (37.3 million aged and 7.3 million disabled) at a total cost of $459.4 billion, according to the CBO March 2008 baseline. Federal costs (after deduction of beneficiary premiums and other offsetting receipts) will total $389.9 billion. In FY2007, federal Medicare spending represented approximately 13% of the total federal budget and 3% of GDP. Medicare is an entitlement program, which means that it is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. Medicare consists of four distinct parts: Part A (Hospital Insurance, or HI); Part B (Supplementary Medical Insurance, or SMI); Part C (Medicare Advantage, or MA); and Part D (the prescription drug benefit added by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, or MMA). The program is administered by the Centers for Medicare and Medicaid Services (CMS). Medicaid is a means-tested entitlement program that finances the delivery of primary and acute medical services as well as long-term care to more than 63 million people at an estimated cost to the federal government of roughly $206.9 billion, according to the CBO March 2008 baseline. Federal expenditures represent approximately 57% of total costs for the year, with states paying the remainder. Each state designs and administers its own version of Medicaid under broad federal rules. State variability in eligibility, covered services, and how those services are reimbursed and delivered is the rule rather than the exception. In the federal budget, Medicaid is an entitlement program that constitutes a large share of mandatory spending. Federal Medicaid spending is open-ended, with total outlays dependent on the spending levels of state Medicaid programs. The provision adds "additional preventive services" to the list of Medicare-covered preventive services. The term "additional preventive services" means services not otherwise described in Medicare law that identify medical conditions or risk factors and that the Secretary determines are (1) reasonable and necessary for the prevention or early detection of an illness or disability, (2) recommended with a grade of A or B by the United States Preventive Services Task Force, and (3) appropriate for individuals entitled to Medicare Part A or enrolled in Part B. In making the determinations, the Secretary is required to use the process for making national coverage determinations. As part of the use of such process, the Secretary may conduct an assessment of the relation between predicted outcomes and the expenditures for such services and may take into the account the results of such assessment in making such determination. The provision modifies the list of services covered under the initial preventive physical exam (also known as "Welcome to Medicare") to include measurement of body mass index. It also adds end-of-life planning upon agreement with the individual. End of life planning is defined as verbal or written information regarding an individual's ability to prepare an advance directive in the case that an injury or illness caused the individual to be unable to make health care decisions and whether or not the physician is willing to follow the individual's wishes as expressed in an advance directive. The provision waives the deductible for the initial preventive screening exam and extends the eligibility period for this service from the first six months to the first year of Part B enrollment. This section applies to services furnished on or after January 1, 2009. Medicare Part B generally pays 80% of the approved amount for covered services in excess of the annual deductible. However, Medicare recognizes only 62.5% of covered expenses incurred in connection with the treatment of mental, psychoneurotic and personality disorders of a person who is not a hospital inpatient. As a result, it generally pays 50% (80% X 62.5%) of Medicare's recognized amount for these services. The provision raises the 62.5% level to 68.75% in 2010 and 2011, 75% in 2012, 81.25% in 2013, and 100% in 2014 and subsequent years. When the provision is fully phased-in in 2014, outpatient psychiatric services will be paid on the same basis as other Part B services. This provision establishes new prohibitions on the marketing activities of Medicare Advantage (MA) plans and Prescription Drug Plans (PDPs) and their agents. Except in instances when the beneficiary initiates contact, plans will be prohibited from soliciting beneficiaries door-to-door or on the phone. Cross-selling of non-health related products, providing meals to prospective enrollees, marketing in areas where health care is delivered (i.e., physician offices or pharmacies), and using sales agents that are not state licensed are also prohibited. The provision requires that by November 15, 2008, the Secretary establish limitations on other plan marketing activities such as co-branding, marketing appointments with prospective enrollees, and agent compensation and training. MA and PDP plans will be required to provide states with information on (1) agent and broker terminations, and (2) at state request, performance and licensing of agents and brokers. Finally, after January 1, 2010, MA and PDP plans will be required to include plan type in all plan names. Many Medicare beneficiaries have individually purchased health insurance policies, commonly referred to as "Medigap" policies that supplement Medicare's coverage. Medigap policies are subject to certain statutory requirements. The law incorporates by reference, as part of the statutory requirements, certain minimum standards established by the National Association of Insurance Commissioners (NAIC) and provides for modification where appropriate to reflect program changes. The provision requires the Secretary to provide for the implementation of the changes in the NAIC model law and regulation approved by the NAIC on March 11, 2007, as modified to reflect the changes in this Act and the Genetic Information Nondiscrimination Act of 2008 (GINA, P.L. 110-233 ).