CCi2-1507U-br1a3rv.- II .'•SIO'OirrS.\rr:TcSu.:1MtayrByitvedr..j 21244 110thcongress H. R. 3668 1stSession IN THE SENATE OF THE UNITED STATES September26,2007 Keceived AN ACT To pro\ide for the extension of transitional medical assist- ance (TIVIA), the abstinence education pro-am, and the qualifying indi\iduals (QI) program, and for other pur- poses. 1 BeitenactedbytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 2 1 SECTION1.SHORTTITLE. 2 ThisActmaybecitedasthe"TMA,AbstinenceEdu- 3 cation,andQIProgramsExtensionActof2007". 4 SEC. 2. EXTENSION OF TRANSITIONAL MEDICAL ASSIST- 5 ANCE (TMA) AND ABSTINENCE EDUCATION 6 PROGRAMTHROUGHDECEMBER31,2007. 7 Section 401 of division B of the Tax Rehef and 8 Health Care Act of 2006 (Pubhc Law 109-432), as 9 amended by section 1 ofPubhc Law 110-48, is amend- 10 ed— 11 (1) by striking "September 30" and inserting 12 "December31"; 13 (2) by striking "for fiscal year 2006" and in- 14 serting''forfiscalyear2007"; 15 (3) by striking "the fourth quarter of fiscal 16 year2007" andinserting"thefirstquarteroffiscal 17 year2008";and 18 (4) by striking "the fourth quarter of fiscal 19 year2006" andinserting"thefirstquarteroffiscal 20 year2007". 21 SEC.3.EXTENSIONOFQUALIFYINGINDIVIDUAL(QI)PRO- 22 GRAMTHROUGHDECEMBER2007. 23 (a) Through December 2007.—Section 24 1902(a)(10)(E)(iv) ofthe Social SecurityAct (42 U.S.C. 25 1396a(a)(10)(E)(iv)) is amendedbystriking"September 26 2007"andinserting"December2007". HR3668RDS — — 3 1 (b) Extending Total i\jviouNT Availai^le for 2 Allocation.—Section 1933(g) of such Act (42 U.S.C. 3 1396ii-3(g:))isamended 4 (1) inparagraph (2) 5 (A) b}^ striking: "and" at the end of sub- 6 paragn^aph(F); 7 (B) by striking the period at the end of 8 subparagraph (G) andinserting and";and 9 (C) byaddingattheendthefollowingnew 10 subparagi-aph: 11 "(H) fortheperiodthatbeginson October 12 1, 2007, and ends on December 31, 2007, the 13 total allocation amount is $100,000,000."; and 14 (2) in paragraph (3), in the matter preceding 15 subparagraph (A), by striking "or (P)" and insert- 16 ing"(F),or(H)". — 17 (c) Effective Date. The amendments made by 18 tliis section shall be effective as ofSeptember 30, 2007. 19 SEC.4.EXTENSIONOFSSIWEBBASEDASSETDEMONSTRA- 20 TIONPROJECTTOTHEMEDICAIDPROGRAM. — 21 (a) In General. Beginning on October 1, 2007, 22 and ending on September 30, 2012, the Secretary of 23 HealthandHumanSendeesshallprovidefortheapphca- 24 tiontoasseteligibihtydeterminationsundertheMedicaid 25 progi-amundertitleXIXoftheSocialSecurityActofthe HR3668RDS 4 1 automated, secure, web-based asset verification request 2 and responseprocessbeing-applied fordeterminingeligi- 3 bilityforbenefitsundertheSupplementalSecurityIncome XM 4 (SSI) progr-amundertitle ofsuchActundera dem- 5 onstration project conducted under the authority ofsec- 6 tion l()31(e)(l)(B)(ii) of such Act (42 U.S.C. 7 1383(e)(l)(B)(ii)). — 8 (b) Limitation. Suchapphcation shallonlyextend 9 tothoseStatesinwhichsuchdemonstrationprojectisop- 10 crating and only for the period in which such project is 11 otherwisepro\dded. — 12 (e) Rules of Application. For purposes ofcar- 13 ryingoutsubsection (a),not^\^thstandinganyotherprovi- 14 sionoflaw,informationobtainedfromafinancialinstitu- 15 tionthatisusedforpurposesofehgibilitydeterminations 16 undersuchdemonstrationprojectA\ithrespecttotheSec- 17 retar}'ofHealth andHumanSenicesundertheSSIpro- 18 gr-ammayalsobesharedandusedbyStatesforpurposes 19 ofeligibilitydeterminationsundertheMedicaidprogr-am. 20 In apphingsection 1631(e)(l)(B)(ii) ofthe Social Secu- 21 rityActunderthissubsection, referencestotheCommis- 22 sionerofSocial Securityand benefits under titleXVI of 23 such Act shall be treated as including a reference to a 24 State described in subsection (b) and medical assistance 25 undertitleXEXofsuchActpro\idedbysuchaState. HR3668RDS — 1 SEC. 5. 6-MONTH DELAY IN REQUIREMENT TO USE TAM- 2 PER-RESISTANTPRESCRIPTIONPADSUNDER 3 MEDICAID. 4 Effective as ifincluded in the enactment ofsection 5 7002(b) of the U.S. Troop Readiness, Veterans' Care, 6 KatrinaRecovery,andIraqAccountabilityAppropriations 7 Act,2007 (PublicLaw110-28, 121 Sta. 187),paragraph 8 (2)ofsuchsectionisamendedbystriking"September30, 9 2007"andinserting"March31,2008". 10 SEC.6.ADDITIONALFUNDINGFORTHEMEDICAREPHYSI- 11 CIAN ASSISTANCE AND QUALITYINITIATIVE 12 FUND. 13 Section 1848(1)(2) of the Social Security Act (42 14 U.S.C. 1395w-4(l)(2))isamended— 15 (1) in subparagraph (A), by adding at the end 16 the following: "In addition, there shall be available 17 to the Fund for expenditures during 2009 an 18 amount equalto $325,000,000 andforexpenditures 19 during or after 2013 an amount equal to 20 $60,000,000.";and 21 (2)insubparagraph (B) 22 (A) in the heading, by striking "fur- 23 NISHEDDURING2008"; 24 (B) bystriking"specified in subparagraph 25 (A)" and inserting "specified in the first sen- 26 fenceofsubparagraph (A)";and HR3668RDS 6 1 (C) by inserting after "furnished during 2 2008" the following: "and forthe obhgation of 3 the entire first amount specified in the second 4 sentence of such subparagrapli for payment 5 with respect to physicians' services furnished 6 during 2009 and of the entire second amount 7 so specified for paymentwith respect to physi- 8 cians' servicesfurnished on orafterJanuary 1, 9 2013". 10 SEC. 7. LIMITATION ON IMPLEMENTATION FOR FISCAL 11 YEARS 2008 AND 2009 OF A PROSPECTIVE 12 DOCUMENTATIONANDCODINGADJUSTMENT 13 INRESPONSETOTHEIMPLEMENTATIONOF 14 THE MEDICARE SEVERITY DIAGNOSIS RE- 15 LATEDGROUP(MS-DRG)SYSTEMUNDERTHE 16 MEDICARE PROSPECTIVE PAYMENT SYSTEM 17 FORINPATIENTHOSPITALSERVICES. — 18 (a) In General. In implementing the final rule 19 published onAugust 22, 2007, on pages 47130 through 20 48175ofvolume72oftheFederalRegister,theSecretary 21 ofHealth and Human Senices (in this section referred 22 toasthe"Secretary") shaU applyprospectivedocumenta- 23 tionandcodingadjustments (madeinresponsetotheim- 24 plementation of a Medicare Severity Diagnosis Related 25 Group (MS-DRG) system under the hospital inpatient HR3668RDS — 7 1 prospectivepajinent systemundersection 1886(d) ofthe 2 SocialSecurityAct(42U.S.C. 1395w(d))of— 3 (1) for dischargees occurring- during fiscal year 4 2008, 0.6 percent ratherthanthe 1.2 percent speci- 5 fiedinsuchfinalrule; and 6 (2) for discharges occurring during fiscal year 7 2009, 0.9 percentratherthanthe 1.8 percentspeci- 8 fiedinsuchfinalrule. — 9 (b)SubsequentAdjustments. — 10 (1) In general. Notwithstanding any other 11 provisionoflaw,iftheSecretary^determinesthatim- 12 plementation of such Medicare Severity Diagnosis 13 Related Group (MS-DRG) system resulted in 14 changesin codingand classificationthat did not re- 15 fleet real changes in casemixundersection 1886(d) 16 of the Social Security Act (42 U.S.C. 1395w(d)) 17 tor discharges occurring during fiscal year 2008 or 18 2009 that are different than the prospective docu- 19 mentation and coding adjustments applied under 20 subsection (a),theSecretan-shall 21 (A) makeanappropriate adjustmentunder 22 paragraph (3)(A)(vi) of such section 1886(d); 23 and 24 (B) make an additional adjustment to the 25 standardized amounts under such section HR3668RDS — 8 1 1886(d) for discharges occurring only during 2 fiscalyears 2010, 2011, and 2012 to offsetthe 3 estimatedamountoftheincreaseordecreasein 4 aggregate payments (including interest as de- 5 termined b}^ the Secretar\0 determined, based 6 upon a retrospective evaluation of claims data 7 submitted under such Medicare Severity Diag- 8 nosisRelated Group (MS-DRG) system, bythe 9 Secretary with respect to discharges occurring 10 duringfiscalyears2008and2009. — 11 (2) Requirement. ^Any adjustment under 12 paragraph (])(B) shallreflectthedifferencebetween 13 the amount the Secretary estimates that implemen- 14 tation of such Medicare Severity Diagnosis Related 15 Group (MS-DRG) system resulted in changes in 16 coding and classification that did not reflect real 17 changes in case mixandtheprospectivedocumenta- 18 tion and coding adjustments applied under sub- 19 section (a). An adjustment made under paragraph 20 (1)(B) for discharges occurring in a year shall not 21 be included in the determination of standardized 22 amounts for discharges occurring in a subsequent 23 vear. — 24 (3) Rule op construction. Nothingin this 25 sectionshallbeconstruedas HR3668RDS CilSLibrarv C2-07-13 Q 7500Socurih/Blvd. B^ltimoi-g. Maiy!rr!!i 21244 1 (A) reqiiiriiijy the Secretarj^ to adjust the 2 average standardized amountsunderpara^aph 3 (3)(A)(vi)ofsuchsection 1886(d) otherthanas 4 pro\idedunderthissection;or 5 (B) pro\iding autliority to apply tlie ad- 6 justment under paragraph (1)(B) other than 7 for discharges occurring during fiscal years 8 2010, 2011,and2012. — 9 (4) JUDICIAI. REVIEW. There shall be no ad- 10 ministrative orjudicial re\iewundersection 1878 of 11 theSocialSecurityAct (42U.S.C. 1395oo) orother- 12 wise of any determination or adjustments made 13 underthissubsection. Passed the House ofRepresentatives September 26, 2007. Attest: LORRAINE C. MILLER, Clerk. HR3668HDS ensHBSORV 3 ams DDDL0E7b Q 4