Medicare Improvements for Patients and Providers Act of 2008

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    110TH UNITED STATES CONGRESS
    2ND SESSION


    An Act
    To amend Titles XVIII and XIX of the Social Security Act to extend expiring provisions under the Medicare Program, to improve beneficiary access to preventive and mental health services, to enhance low-income benefit programs, and to maintain access to care in rural areas, including pharmacy access, and for other purposes.


    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

    Section 1. Short Title; Table of Contents.[edit]

    (a) Short Title.—
    This Act may be cited as the ``Medicare Improvements for Patients and Providers Act of 2008´´.
    (b) Table of Contents.—
    The table of contents of this Act is as follows:
    Sec. 1. Short Title; Table of Contents.
    Title I—Medicare
    Subtitle A—Beneficiary Improvements
    Part I—Prevention, Mental Health, and Marketing
    Sec. 101. Improvements to Coverage of Preventive Services.
    Sec. 102. Elimination of Discriminatory Copayment Rates for Medicare Outpatient Psychiatric Services.
    Sec. 103. Prohibitions and Limitations on Certain Sales and Marketing Activities Under Medicare Advantage Plans and Prescription Drug Plans.
    Sec. 104. Improvements to the Medigap Program.
    Part II—Income Programs
    Sec. 111. Extension of Qualifying Individual (QI) Program.
    Sec. 112. Application of Full LIS Subsidy Assets Test Under Medicare Savings Program.
    Sec. 113. Eliminating Barriers to Enrollment.
    Sec. 114. Elimination of Medicare PART D Late Enrollment Penalties Paid by Subsidy Eligible Individuals.
    Sec. 115. Eliminating Application of Estate Recovery.
    Sec. 116. Exemptions From Income and Resources for Determination of Eligibility for Low-Income Subsidy.
    Sec. 117. Judicial Review of Decisions of the Commissioner of Social Security Under the Medicare PART D Low-Income Subsidy Program.
    Sec. 118. Translation of Model Form.
    Sec. 119. Medicare Enrollment Assistance.
    Subtitle B—Provisions Relating to PART A
    Sec. 121. Expansion and Extension of the Medicare Rural Hospital Flexibility Program.
    Sec. 122. Rebasing for Sole Community Hospitals.
    Sec. 123. Demonstration Project on Community Health Integration Models in Certain Rural Counties.
    Sec. 124. Extension of the Reclassification of Certain Hospitals.
    Sec. 125. Revocation of Unique Deeming Authority of the Joint Commission.
    Subtitle C—Provisions Relating to PART B
    Part I—Physicians' Services
    Sec. 131. Physician Payment, Efficiency, and Quality Improvements.
    Sec. 132. Incentives for Electronic Prescribing.
    Sec. 133. Expanding Access to Primary Care Services.
    Sec. 134. Extension of Floor on Medicare Work Geographic Adjustment Under the Medicare Physician Fee Schedule.
    Sec. 135. Imaging Provisions.
    Sec. 136. Extension of Treatment of Certain Physician Pathology Services Under Medicare.
    Sec. 137. Accommodation of Physicians Ordered to Active Duty in the Armed Services.
    Sec. 138. Adjustment for Medicare Mental Health Services.
    Sec. 139. Improvements for Medicare Anesthesia Teaching Programs.
    Part II—Other Payment and Coverage Improvements
    Sec. 141. Extension of Exceptions Process for Medicare Therapy Caps.
    Sec. 142. Extension of Payment Rule for Brachytherapy and Therapeutic Radiopharmaceuticals.
    Sec. 143. Speech-Language Pathology Services.
    Sec. 144. Payment and Coverage Improvements for Patients with Chronic Obstructive Pulmonary Disease and Other Conditions.
    Sec. 145. Clinical Laboratory Tests.
    Sec. 146. Improved Access to Ambulance Services.
    Sec. 147. Extension and Expansion of the Medicare Hold Harmless Provision Under the Prospective Payment System for Hospital Outpatient Department (HOPD) Services for Certain Hospitals.
    Sec. 148. Clarification of Payment for Clinical Laboratory Tests Furnished by Critical Access Hospitals.
    Sec. 149. Adding Certain Entities as Originating Sites for Payment of TeleHealth Services.
    Sec. 150. MedPAC Study and Report on Improving Chronic Care Demonstration Programs.
    Sec. 151. Increase of FQHC Payment Limits.
    Sec. 152. Kidney Disease Education and Awareness Provisions.
    Sec. 153. Renal Dialysis Provisions.
    Sec. 154. Delay In and Reform of Medicare DMEPOS Competitive Acquisition Program.
    Subtitle D—Provisions Relating to PART C
    Sec. 161. Phase-Out of Indirect Medical Education (IME).
    Sec. 162. Revisions to Requirements for Medicare Advantage Private Fee-for-Service Plans.
    Sec. 163. Revisions to Quality Improvement Programs.
    Sec. 164. Revisions Relating to Specialized Medicare Advantage plans for special needs individuals.
    Sec. 165. Limitation on out-of-pocket costs for dual eligibles and qualified Medicare Beneficiaries Enrolled in a Specialized Medicare Advantage Plan for Special Needs Individuals.
    Sec. 166. Adjustment to the Medicare Advantage Stabilization Fund.
    Sec. 167. Access to Medicare Reasonable Cost Contract Plans.
    Sec. 168. MedPAC Study and Report on Quality Measures.
    Sec. 169. MedPAC Study and Report on Medicare Advantage Payments.
    Subtitle E—Provisions Relating to PART D
    Part I—Improving Pharmacy Access
    Sec. 171. Prompt Payment by Prescription Drug Plans and MA–PD Plans Under PART D.
    Sec. 172. Submission of Claims by Pharmacies Located in or Contracting with Long-Term Care Facilities.
    Sec. 173. Regular Update of Prescription Drug Pricing Standard.
    Part II—Other Provisions
    Sec. 175. Inclusion of Barbiturates and Benzodiazepines as Covered PART D Drugs.
    Sec. 176. Formulary Requirements with Respect to Certain Categories or Classes of Drugs.
    Subtitle F—Other Provisions
    Sec. 181. Use of PART D Data.
    Sec. 182. Revision of Definition of Medically Accepted Indication for Drugs.
    Sec. 183. Contract with a Consensus-Based Entity Regarding Performance Measurement.
    Sec. 184. Cost-Sharing for Clinical Trials.
    Sec. 185. Addressing Health Care Disparities.
    Sec. 186. Demonstration to Improve Care to Previously Uninsured.
    Sec. 187. Office of the Inspector General Report on Compliance With and Enforcement Of National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Medicare.
    Sec. 188. Medicare Improvement Funding.
    Sec. 189. Inclusion of Medicare Providers and Suppliers in Federal Payment Levy and Administrative Offset Program.
    Title II—Medicaid
    Sec. 201. Extension of Transitional Medical Assistance (TMA) and Abstinence Education Program.
    Sec. 202. Medicaid DSH Extension.
    Sec. 203. Pharmacy Reimbursement Under Medicaid.
    Sec. 204. Review of Administrative Claim Determinations.
    Sec. 205. County Medicaid Health Insuring Organizations.
    Title III—Miscellaneous
    Sec. 301. Extension of TANF Supplemental Grants.
    Sec. 302. 70 Percent Federal Matching for Foster Care and Adoption Assistance for the District of Columbia.
    Sec. 303. Extension of Special Diabetes Grant Programs.
    Sec. 304. IOM Reports on Best Practices for Conducting Systematic Reviews of Clinical Effectiveness Research and for Developing Clinical Protocols.


    Approved July 15, 2008.


    Legislative History[edit]

    • CONGRESSIONAL RECORD, Vol. 154 (2008):
      • June 24, considered and passed House.
      • July 9, considered and passed Senate.
    • WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 44 (2008):
      • July 15, Presidential veto message.
    • CONGRESSIONAL RECORD, Vol. 154 (2008):
      • July 15, House and Senate Overrode Veto.