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March 3, 2010, 12:00 am ET - Amendment SA 3352 proposed by Senator Grassley to Amendment SA 3336.
March 3, 2010, 3:22 pm ET - On the Motion to Table (Motion to Table Grassley Amdt. No. 3352)

Full Text of this Amendment

SA 3352. Mr. GRASSLEY (for himself, Mr. CRAPO, Mr. ROBERTS, Mr. ENSIGN, and Mr. HATCH) submitted an amendment intended to be proposed by him to the bill H.R. 4213, to amend the Internal Revenue Code of 1986 to extend certain expiring provisions, and for other purposes; which was ordered to lie on the table; as follows:

At the end, add the following:
TITLE VIII--MEDICARE AND OTHER PROVISIONS


SEC. 801. CONFORMING REPEAL.
Sections 212 through 231, section 233, section 243, section 431, and section 601 of this Act are repealed.
SEC. 802. INCREASE IN THE MEDICARE PHYSICIAN PAYMENT UPDATE FOR THE LAST 10 MONTHS OF 2010.
Paragraph (10) of section 1848(d) of the Social Security Act, as added by section 1011(a) of the Department of Defense Appropriations Act, 2010 (Public Law 111-118), is amended to read as follows:
"(10) UPDATE FOR 2010.--
"(A) IN GENERAL.--Subject to paragraphs (7)(B), (8)(B), and (9)(B), in lieu of the update to the single conversion factor established in paragraph (1)(C) that would otherwise apply for 2010, the update to the single conversion factor shall be 0 percent for 2010.
"(B) NO EFFECT ON COMPUTATION OF CONVERSION FACTOR FOR 2011 AND SUBSEQUENT YEARS.--The conversion factor under this subsection shall be computed under paragraph (1)(A) for 2011 and subsequent years as if subparagraph (A) had never applied.".
SEC. 803. EXTENSION OF THERAPY CAPS EXCEPTIONS PROCESS.
Section 1833(g)(5) of the Social Security Act (42 U.S.C. 1395l(g)(5)) is amended by striking "December 31, 2009" and inserting "December 31, 2010".
SEC. 804. TREATMENT OF PHARMACIES UNDER DURABLE MEDICAL EQUIPMENT ACCREDITATION REQUIREMENTS.
(a) In General.--Section 1834(a)(20) of the Social Security Act (42 U.S.C. 1395m(a)(20)) is amended--
(1) in subparagraph (F)--
(A) in clause (i)--
(i) by striking "clause (ii)" and inserting "clauses (ii) and (iii)";
(ii) by striking "January 1, 2010" and inserting "January 1, 2011"; and
(iii) by striking "and" at the end;
(B) in clause (ii)(II), by striking the period at the end and inserting "; and";
(C) by inserting after clause (ii)(II) the following new clause:
"(iii)(I) subject to subclause (II), with respect to items and services furnished on or after January 1, 2011, the accreditation requirement of clause (i) shall not apply to a pharmacy described in subparagraph (G); and
"(II) effective with respect to items and services furnished on or after the date of the enactment of this subparagraph, the Secretary may apply to pharmacies quality standards and an accreditation requirement established by the Secretary that are an alternative to the quality standards and accreditation requirement otherwise applicable under this paragraph if the Secretary determines such alternative quality standards and accreditation requirement are appropriate for pharmacies."; and
(D) by adding at the end the following flush sentence:

"If determined appropriate by the Secretary, any alternative quality standards and accreditation requirement established under clause (iii)(II) may differ for categories of pharmacies established by the Secretary (such as pharmacies described in subparagraph (G))."; and
(2) by adding at the end the following new subparagraph:
"(G) PHARMACY DESCRIBED.--A pharmacy described in this subparagraph is a pharmacy that meets each of the following criteria:
"(i) The total billings by the pharmacy for such items and services under this title are less than 5 percent of total pharmacy sales for a previous period (of not less than 24 months) specified by the Secretary.
"(ii) The pharmacy has been enrolled under section 1866(j) as a supplier of durable medical equipment, prosthetics, orthotics, and supplies, has been issued (which may include the renewal of) a provider number for at least 2 years, and for which a final adverse action (as defined in section 424.57(a) of title 42, Code of Federal Regulations) has not been imposed in the past 2 years.
"(iii) The pharmacy submits to the Secretary an attestation, in a form and manner, and at a time, specified by the Secretary, that the pharmacy meets the criteria described in clauses (i) and (ii).
"(iv) The pharmacy agrees to submit materials as requested by the Secretary, or during the course of an audit conducted on a random sample of pharmacies selected annually, to verify that the pharmacy meets the criteria described in clauses (i) and (ii). Materials submitted under the preceding sentence shall include a certification by an independent accountant on behalf of the pharmacy or the submission of tax returns filed by the pharmacy during the relevant periods, as requested by the Secretary.".
(b) Conforming Amendments.--Section 1834(a)(20)(E) of the Social Security Act (42 U.S.C. 1395m(a)(20)(E)) is amended--
(1) in the first sentence, by striking "The" and inserting "Except as provided in the third sentence, the"; and
(2) by adding at the end the following new sentences: "Notwithstanding the preceding sentences, any alternative quality standards and accreditation requirement established under subparagraph (F)(iii)(II) shall be established through notice and comment rulemaking. The Secretary may implement by program instruction or otherwise subparagraph (G) after consultation with representatives of relevant parties. The specifications developed by the Secretary in order to implement subparagraph (G) shall
be posted on the Internet website of the Centers for Medicare & Medicaid Services.".
(c) Administration.--Chapter 35 of title 44, United States Code, shall not apply to this section.
(d) Rule of Construction.--Nothing in the provisions of, or amendments made by, this section shall be construed as affecting the application of an accreditation requirement for pharmacies to qualify for bidding in a competitive acquisition area under section 1847 of the Social Security Act (42 U.S.C. 1395w-3).
(e) Waiver of 1-Year Reenrollment Bar.--In the case of a pharmacy described in subparagraph (G) of section 1834(a)(20) of the Social Security Act, as added by subsection (a), whose billing privileges were revoked prior to January 1, 2011, by reason of noncompliance with subparagraph (F)(i) of such section, the Secretary of Health and Human Services shall waive any reenrollment bar imposed pursuant to section 424.535(d) of title 42, Code of Federal Regulations (as in effect on the date
of the enactment of this Act) for such pharmacy to reapply for such privileges.
SEC. 805. ENHANCED PAYMENT FOR MENTAL HEALTH SERVICES.
Section 138(a)(1) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275) is amended by striking "December 31, 2009" and inserting "December 31, 2010".
SEC. 806. EXTENSION OF AMBULANCE ADD-ONS.
(a) In General.--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 striking "before January 1, 2010" and inserting "before January 1, 2011"; and
(B) in each of clauses (i) and (ii), by striking "before January 1, 2010" and inserting "before January 1, 2011".
(b) Air Ambulance Improvements.--Section 146(b)(1) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275) is amended by striking "ending on December 31, 2009" and inserting "ending on December 31, 2010".
(c) Super Rural Ambulance.--Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended--
(1) in the first sentence, by striking "2010" and inserting "2011"; and
(2) by adding at the end the following new sentence: "For purposes of applying this subparagraph for ground ambulance services furnished on or after January 1, 2010, and before January 1, 2011, the Secretary shall use the percent increase that was applicable under this subparagraph to ground ambulance services furnished during 2009.".
SEC. 807. EXTENSION OF GEOGRAPHIC FLOOR FOR WORK.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)(E)) is amended by striking "before January 1, 2010" and inserting "before January 1, 2011".
SEC. 808. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.
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 Prescription 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), section 104 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), and section
136 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), is amended by striking "and 2009" and inserting "2009, and 2010".
SEC. 809. 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. 810. EHR CLARIFICATION.
(a) Qualification for Clinic-Based Physicians.--
(1) MEDICARE.--Section 1848(o)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w-4(o)(1)(C)(ii)) is amended by striking "setting (whether inpatient or outpatient)" and inserting "inpatient or emergency room setting".
(2) MEDICAID.--Section 1903(t)(3)(D) of the Social Security Act (42 U.S.C. 1396b(t)(3)(D)) is amended by striking "setting (whether inpatient or outpatient)" and inserting "inpatient or emergency room setting".
(b) Effective Date.--The amendments made by subsection (a) shall be effective as if included in the enactment of the HITECH Act (included in the American Recovery and Reinvestment Act of 2009 (Public Law 111-5)).
(c) Implementation.--Notwithstanding any other provision of law, the Secretary may implement the amendments made by this section by program instruction or otherwise.
SEC. 811. EXTENSION OF REIMBURSEMENT FOR ALL MEDICARE PART B SERVICES FURNISHED BY CERTAIN INDIAN HOSPITALS AND CLINICS.
Section 1880(e)(1)(A) of the Social Security Act (42 U.S.C. 1395qq(e)(1)(A)) is amended by striking "5-year period" and inserting "6-year period".
SEC. 812. EXTENSION OF CERTAIN PAYMENT RULES FOR LONG-TERM CARE HOSPITAL SERVICES AND OF MORATORIUM ON THE ESTABLISHMENT OF CERTAIN HOSPITALS AND FACILITIES.
(a) Extension of Certain Payment Rules.--Section 114(c) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww note), as amended by section 4302(a) of the American Recovery and Reinvestment Act (Public Law 111-5), is amended by striking "3-year period" each place it appears and inserting "4-year period".
(b) Extension of Moratorium.--Section 114(d)(1) of such Act (42 U.S.C. 1395ww note), as amended by section 4302(b) of the American Recovery and Reinvestment Act (Public Law 111-5), in the matter preceding subparagraph (A), is amended by striking "3-year period" and inserting "4-year period".
SEC. 813. EXTENSION OF THE MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM.
Section 1820(j) of the Social Security Act (42 U.S.C. 1395i-4(j)) is amended--
(1) by striking "2010, and for" and inserting "2010, for"; and
(2) by inserting "and for making grants to all States under subsection (g), such sums as may be necessary in fiscal year 2011, to remain available until expended" before the period at the end.
SEC. 814. EXTENSION OF SECTION 508 HOSPITAL RECLASSIFICATIONS.
(a) In General.--Subsection (a) of section 106 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395 note), as amended by section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) and section 124 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), is amended by striking "September 30, 2009" and inserting "September 30, 2010".
(b) Special Rule for Fiscal Year 2010.--For purposes of implementation of the amendment made by subsection (a), including (notwithstanding paragraph (3) of section 117(a) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), as amended by section 124(b) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275)) for purposes of the implementation of paragraph (2) of such section 117(a), during fiscal year 2010, the Secretary of
Health and Human Services (in this subsection referred to as the "Secretary") shall use the hospital wage index that was promulgated by the Secretary in the Federal Register on August 27, 2009 (74 Fed. Reg. 43754), and any subsequent corrections.
SEC. 815. TECHNICAL CORRECTION RELATED TO CRITICAL ACCESS HOSPITAL SERVICES.
(a) In General.--Subsections (g)(2)(A) and (l)(8) of section 1834 of the Social Security Act (42 U.S.C. 1395m) are each amended by inserting "101 percent of" before "the reasonable costs".
(b) Effective Date.--The amendments made by subsection (a) shall take effect as if included in the enactment of section 405(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2266).
SEC. 816. EXTENSION FOR SPECIALIZED MA PLANS FOR SPECIAL NEEDS INDIVIDUALS.
(a) In General.--Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-28(f)(1)) is amended by striking "2011" and inserting "2012".
(b) Temporary Extension of Authority To Operate but No Service Area Expansion for Dual Special Needs Plans That Do Not Meet Certain Requirements.--Section 164(c)(2) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275) is amended by striking "December 31, 2010" and inserting "December 31, 2011".
SEC. 817. EXTENSION OF REASONABLE COST CONTRACTS.
Section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)) is amended, in the matter preceding subclause (I), by striking "January 1, 2010" and inserting "January 1, 2011".
SEC. 818. EXTENSION OF PARTICULAR WAIVER POLICY FOR EMPLOYER GROUP PLANS.
For plan year 2011 and subsequent plan years, to the extent that the Secretary of Health and Human Services is applying the 2008 service area extension waiver policy (as modified in the April 11, 2008, Centers for Medicare & Medicaid Services' memorandum with the subject "2009 Employer Group Waiver-Modification of the 2008 Service Area Extension Waiver Granted to Certain MA Local Coordinated Care Plans") to Medicare Advantage coordinated care plans, the Secretary shall extend the application
of such waiver policy to employers who contract directly with the Secretary as a Medicare Advantage private fee-for-service plan under section 1857(i)(2) of the Social Security Act (42 U.S.C. 1395w-27(i)(2)) and that had enrollment as of January 1, 2010.
SEC. 819. EXTENSION OF CONTINUING CARE RETIREMENT COMMUNITY PROGRAM.
Notwithstanding any other provision of law, the Secretary of Health and Human Services shall continue to conduct the Erickson Advantage Continuing Care Retirement Community (CCRC) program under part C of title XVIII of the Social Security Act through December 31, 2011.
SEC. 820. FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME PROGRAMS.
(a) Additional Funding for State Health Insurance Programs.--Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note) is amended by striking "(42 U.S.C. 1395w-23(f))" and all that follows through the period at the end and inserting "(42 U.S.C. 1395w-23(f)), to the Centers for Medicare & Medicaid Services Program Management Account--
"(i) for fiscal year 2009, of $7,500,000; and
"(ii) for fiscal year 2010, of $6,000,000.
Amounts appropriated under this subparagraph shall remain available until expended.".
(b) Additional Funding for Area Agencies on Aging.--Subsection (b)(1)(B) of such section 119 is amended by striking "(42 U.S.C. 1395w-23(f))" and all that follows through the period at the end and inserting "(42 U.S.C. 1395w-23(f)), to the Administration on Aging--
"(i) for fiscal year 2009, of $7,500,000; and
"(ii) for fiscal year 2010, of $6,000,000.
Amounts appropriated under this subparagraph shall remain available until expended.".
(c) Additional Funding for Aging and Disability Resource Centers.--Subsection (c)(1)(B) of such section 119 is amended by striking "(42 U.S.C. 1395w-23(f))" and all that follows through the period at the end and inserting "(42 U.S.C. 1395w-23(f)), to the Administration on Aging--
"(i) for fiscal year 2009, of $5,000,000; and
"(ii) for fiscal year 2010, of $6,000,000.
Amounts appropriated under this subparagraph shall remain available until expended.".
(d) Additional Funding for Contract With the National Center for Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 119 is amended by striking "(42 U.S.C. 1395w-23(f))" and all that follows through the period at the end and inserting "(42 U.S.C. 1395w-23(f)), to the Administration on Aging--
"(i) for fiscal year 2009, of $5,000,000; and
"(ii) for fiscal year 2010, of $2,000,000.
Amounts appropriated under this subparagraph shall remain available until expended.".
SEC. 821. FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.
Section 501(c)(1)(A)(iii) of the Social Security Act (42 U.S.C. 701(c)(1)(A)(iii)) is amended by striking "fiscal year 2009" and inserting "each of fiscal years 2009 through 2011".
SEC. 822. IMPLEMENTATION FUNDING.
For purposes of carrying out the provisions of, and amendments made by, this title that relate to titles XVIII and XIX of the Social Security Act, there are appropriated to the Secretary of Health and Human Services for the Centers for Medicare & Medicaid Services Program Management Account, from amounts in the general fund of the Treasury not otherwise appropriated, $100,000,000. Amounts appropriated under the preceding sentence shall remain available until expended.
SEC. 823. STATE COURT IMPROVEMENT PROGRAM.
Section 438 of the Social Security Act (42 U.S.C. 629h) is amended--
(1) in subsection (c)(2)(A), by striking "2010" and inserting "2011"; and
(2) in subsection (e), by striking "2010" and inserting "2011".
SEC. 824. EXTENSION OF GAINSHARING DEMONSTRATION.
(a) In General.--Subsection (d)(3) of section 5007 of the Deficit Reduction Act of 2005 (Public Law 109-171) is amended by inserting "(or 21 months after the date of the enactment of the American Workers, State, and Business Relief Act of 2010, in the case of a demonstration project in operation as of October 1, 2008)" after "December 31, 2009".
(b) Funding.--
(1) IN GENERAL.--Subsection (f)(1) of such section is amended by inserting "and for fiscal year 2010, $1,600,000," after "$6,000,000,".
(2) AVAILABILITY.--Subsection (f)(2) of such section is amended by striking "2010" and inserting "2014 or until expended".
(c) Reports.--
(1) QUALITY IMPROVEMENT AND SAVINGS.--Subsection (e)(3) of such section is amended by striking "December 1, 2008" and inserting "18 months after the date of the enactment of the American Workers, State, and Business Relief Act of 2010".
(2) FINAL REPORT.--Subsection (e)(4) of such section is amended by striking "May 1, 2010" and inserting "42 months after the date of the enactment of the American Workers, State, and Business Relief Act of 2010".
SEC. 825. REVISION TO THE MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)), as amended by section 1011(b) of the Department of Defense Appropriations Act, 2010 (Public Law 111-118), is amended--
(1) in subparagraph (A), by striking "$20,740,000,000" and inserting "$2,940,000,000"; and
(2) in subparagraph (B), by striking "$550,000,000" and inserting "$4,550,000,000".


(As printed in the Congressional Record for the Senate on Mar 2, 2010.)