To improve the bill.

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431, and section 601 of this Act are repealed.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.

[[Page S957]]

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.''.

[[Page S958]]

(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''.
______