P.L. 110-173: Provisions in the Medicare, Medicaid, and SCHIP Extension Act of 2007

P.L. 110-173: Provisions in the Medicare,
Medicaid, and SCHIP Extension Act of 2007
February 7, 2008
Hinda Chaikind, Jim Hahn, Jean Hearne, Elicia J. Herz,
Gretchen A. Jacobson, Paulette C. Morgan, Chris L. Peterson,
Holly Stockdale, Jennifer O’Sullivan, Julie Stone, and Sibyl Tilson
Domestic Social Policy Division



P.L. 110-173: Provisions in the Medicare, Medicaid,
and SCHIP Extension Act of 2007
Summary
On December 29, 2007, the President signed S. 2499, the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (P.L. 110-173). This Act was passed by the
House on December 19, 2007, and by a voice vote in the Senate on December 18,

2007. The Act makes changes to the nation’s three major health programs, Medicare,


Medicaid, and the State Children’s Health Insurance Program (SCHIP), as well as
other federally funded programs.
The most prominent provisions in the Act were to (1) suspend the Medicare
physician payment cut scheduled to take effect and (2) provide SCHIP funding
through March 2009. P.L. 110-173 mandates a 0.5% increase in the Medicare
physician fee schedule for the six-month period from January 1, 2008, through June
30, 2008, and provides FY2008 and FY2009 SCHIP funding allotments through
March 31, 2009. The Act also extends a number of expiring provisions and
programs. These extensions affect Medicare plans and providers and Medicaid
payments and programs. The Act also includes funding for some miscellaneous
activities.
The Act’s Medicare extensions include incentive payments for certain
physicians, and extensions of current law provisions for Medicare Special Needs
Plans and cost-based plans. A variety of extensions also affect how long-term care,
rural, and acute care hospitals are paid or classified. Other extensions affect
Medicare payments for certain services and providers, outpatient physical therapy
services, speech language pathology services, certain pathology laboratories,
brachytherapy services, and therapeutic radiopharmaceuticals.
The Act also includes Medicaid provisions designed to extend certain payments
and programs, such as Medicaid disproportionate hospital share (DSH) allotments
for Tennessee and Hawaii, the Transitional Medical Assistance (TMA) program, and
the Qualifying Individual (QI) program, among other provisions.
Miscellaneous provisions include using Medicare funds to make grants to State
Health Insurance Assistance Programs, Area Agencies on Aging, and Aging and
Disability Resource Centers. The Act also establishes the Medicare Payment
Advisory Commission (MedPAC) as a congressional agency.
The Act provides a number of offsets to pay for the spending increases,
including a reduction in the Medicare Advantage stabilization fund in 2012. The Act
also includes provisions affecting Medicare’s responsibility as a secondary payer for
covered services, Medicare payments for Inpatient Rehabilitation Facilities (IRFs),
payments for most Medicare part B drugs, payments for certain diagnostic laboratory
tests, and Medicare Long-Term Care Hospitals.
This report provides short descriptions of the provisions contained in P.L. 110-

173.



Contents
A Brief Description of the Current Programs............................3
Medicare ....................................................3
Medicaid ....................................................4
SCHIP ......................................................4
Summary of Provisions in S. 2499....................................5
Title I — Medicare.............................................5
Section 101. Increase in physician payment update; extension of
the physician quality reporting system......................5
Section 102. Extension of Medicare incentive payment program
for physician scarcity areas..............................6
Section 103. Extension of floor on work geographic adjustment under
the Medicare physician fee schedule.......................6
Section 104. Extension of treatment of certain physician
pathology services under Medicare........................6
Section 105. Extension of exceptions process for Medicare
therapy caps..........................................6
Section 106. Extension of payment rule for brachytherapy; extension
to therapeutic radiopharmaceuticals........................7
Section 107. Extension of Medicare reasonable costs payments for
certain clinical diagnostic laboratory tests furnished to
hospital patients in certain rural areas......................7
Section 108. Extension of authority of specialized Medicare
Advantage plans for special needs individuals to
restrict enrollment.....................................7
Section 109. Extension of deadline for application of limitation
on extension or renewal of Medicare reasonable cost
contract plans.........................................7
Section 110. Adjustment to the Medicare Advantage
stabilization fund......................................7
Section 111. Medicare secondary payor........................7
Section 112. Payment for part B drugs.........................8
Section 113. Payment rate for certain diagnostic laboratory tests....9
Section 114. Long-term care hospitals........................10
Section 115. Payment for inpatient rehabilitation facility
(IRF) services........................................12
Section 116. Extension of accommodation of physicians ordered to
active duty in the Armed Services........................12
Section 117. Treatment of certain hospitals....................12
Section 118. Additional Funding for State Health Insurance
Assistance Programs, Area Agencies on Aging, and
Aging and Disability Resource Centers....................13
Title II — Medicaid and SCHIP.................................13
Section 201. Extending SCHIP funding through March 31, 2009...13
Section 202. Extension of transitional medical assistance (TMA)
and abstinence education program........................15
Section 203. Extension of qualifying individual (QI) program.....15



Section 205. Improving data collection.......................16
Section 206. Moratorium on certain payment restrictions.........16
Title III — Miscellaneous......................................16
Section 301. Medicare Payment Advisory Commission status.....16
Section 302. Special Diabetes Programs for Type I Diabetes
and Indians..........................................16
List of Tables
Table 1. Key Policy Staff: Medicare, Medicaid, and SCHIP Extension Act
of 2007.....................................................17



P.L. 110-173: Provisions in the Medicare,
Medicaid, and SCHIP Extension Act of 2007
On December 29, 2007, the President signed S. 2499, the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (P.L. 110-173). This Act was passed by the
House on December 19, 2007, and by a voice vote in the Senate on December 18,

2007. The Act makes changes to the nation’s three major health programs, Medicare,


Medicaid, and the State Children’s Health Insurance Program (SCHIP), as well as
other federally funded programs.
Perhaps the most prominent provisions of the Act were to (1) suspend the
Medicare physician payment cut scheduled to take effect and (2) provide SCHIP
funding through March 2009. The update formula for Medicare physician payment
would have required a reduction in the fee schedule for physician reimbursement of
10.1% as of January 1, 2008, and by roughly 5% annually thereafter. SCHIP needed
to be reauthorized because Title XXI of the Social Security Act, as established by the
Balanced Budget Act of 1997 (BBA 97, P.L. 105-33), specified national
appropriation amounts only from FY1998 to FY2007. The President vetoed two bills
prior to P.L. 110-173 (H.R. 976, H.R. 3963) that would have provided federal
funding for SCHIP in FY2008 through FY2012. In response to these vetoes, four
continuing resolutions (P.L. 110-92, P.L. 110-116, P.L. 110-137, and P.L. 110-149)
appropriated $5 billion for federal SCHIP allotments in FY2008 through December

31, 2007.


P.L. 110-173 mandates a 0.5% increase in the Medicare physician fee schedule
for the six-month period from January 1, 2008, through June 30, 2008, and provides
FY2008 and FY2009 SCHIP allotments through March 31, 2009.1 It also
redistributes any FY2006 funds that are unspent by FY2008 to states that are
projected to experience shortfalls. For 2008, the Act provides up to $1.6 billion to
shortfall states and additional sums to territories. For the first two quarters of
FY2009, up to $275 million is appropriated for the same purpose.
The Act also extends a number of expiring provisions and programs. These
extensions affect Medicare plans and providers and Medicaid payments and
programs. The Act also includes funding for some miscellaneous activities.
Regarding Medicare Advantage plans, the Act allows Medicare Special Needs
Plans to continue to restrict their enrollment to Medicaid-entitled institutionalized
beneficiaries and other specified individuals until January 1, 2010. Also, cost-based
plans under Medicare may continue to operate in an area with two local or two
regional Medicare Advantage plans until January 1, 2009.


1 For more projections of states’ FY2008 SCHIP federal funding and expenditures, see CRS
Report RS22739, FY2008 Federal SCHIP Financing, by Chris L. Peterson.

Extensions that affect Medicare payments for certain providers and services
include, among others, extending the secretarial authority to reclassify certain
hospitals to areas with higher wage index values. The Act allows qualified rural
hospitals that provide clinical diagnostic laboratory services to continue to be
reimbursed under a reasonable cost system rather than a fee schedule. The Act also
extends exceptions to annual per beneficiary payment limits on outpatient physical
therapy services and speech language pathology services for the next six months.
Certain pathology laboratories are allowed to continue billing hospitals directly for
their services. The Act extends the Medicare incentive payment program for certain
physicians providing services in scarcity areas and Medicare payments for the
accommodation of physicians ordered to active duty in the Armed Services. The Act
also extends cost reimbursement for brachytherapy services and cost reimbursement
to therapeutic radiopharmaceuticals.
Many extensions also affect certain Medicaid payments and programs. The Act
extends increased payments for Medicaid disproportionate hospital share (DSH)
allotments for Tennessee and Hawaii to provide additional assistance to certain
hospitals that provide a disproportionate share of care to low-income patients with
special needs. It also continues Medicaid benefits through June 30, 2008, for certain
low-income families that would otherwise lose coverage because of changes in their
income under the Transitional Medical Assistance (TMA) program. Medicaid’s
coverage of Medicare part B premiums under the Qualifying Individual (QI) program
is extended through June 2008, including an allocation of $200 million for this
program. S. 2499 also prohibits the Secretary from taking action to restrict Medicaid
coverage of school-based, health-related services, including transportation and
administrative activities for the next six months.
Miscellaneous activities include providing additional funds under the State
Health Insurance Assistance Programs to assist Medicare-eligible individuals in
obtaining information and counseling on enrollment in health insurance. Medicare
funds are also used to make grants for Area Agencies on Aging and Aging and
Disability Resource Centers for FY2008 and FY2009. The Act also includes
provisions that extend the Title V Abstinence Education block grant through June 30,
2008, and amend the Public Health Service Act to provide for research into the
prevention of Type I diabetes. Grants for the prevention and treatment of diabetes
among American Indians and Alaskan Natives are also provided. In addition, the
Medicare Payment Advisory Commission (MedPAC) will become a congressional
agency. Finally, additional funds are provided to the Current Population Survey to
improve the collection of data on state populations of low-income children
Because the pay-go rule as reestablished by the 110th Congress requires all
considered bills to neither have the net effect of increasing the deficit nor reducing
the surplus, the Act includes a number of offsets to pay for the aforementioned
provisions. These offsets include a reduction in federal payments for the Medicare
Advantage stabilization fund in 2012. The Act also strengthened procedures and
additional funding for the determination of Medicare’s responsibility as a secondary
rather than a primary payer for covered services. The market basket update for
certain discharges is eliminated, and the compliance requirements for payment are
modified for Inpatient Rehabilitation Facilities (IRFs) for FY2008 and FY2009.
Another offset requires the Secretary of Health and Human Services (HHS) to use



constant volume weighting in the computation of the average sales price (ASP) for
the payments for most Medicare part B drugs. Payment rates for certain diagnostic
laboratory tests are also changed. Finally, the Act modifies the statutory definition
of and requirements for Long-Term Care Hospitals that participate in Medicare and
authorizes a study on the establishment of a national long-term care hospital facility
and patient criteria, among other purposes.
The Congressional Budget Office (CBO) estimated that S. 2499 would result in
a net savings to the federal government of $100 million between FY2008 and
FY2012.2 Included in this calculation is an estimate of a spending increase for
certain SCHIP, Medicaid, and miscellaneous provisions that would total
approximately $1.8 billion. It also includes an estimate of approximately $1.8 billion
in savings as a result of the direct effects of the Medicare provisions (saving
approximately $1.6 billion) and the interactions between provisions (saving
approximately $200 million).
This report provides short descriptions of the provisions contained in S. 2499.
For additional assistance, please contact a CRS specialist or analyst. Contact
information for these individuals is included in Table 1.
A Brief Description of the Current Programs
The Medicare, Medicaid, and SCHIP programs are briefly described below.
More complete and detailed descriptions of the programs are available from CRS.3
Medicare
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 $456.3
billion. Federal costs (after deduction of beneficiary premiums and other offsetting
receipts) will total $389.7 billion. In FY2007, federal Medicare spending will
represent 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


2 CBO Estimate of the Medicare, Medicaid, and SCHIP Extension Act of 2007
(GOEO7DO3), December 18, 2007. Available at [http://www.cbo.gov/ftpdocs/88xx/
doc8898/SFC_MMS_ExtensionGOE07D03.pdf]. Savings and expenditures for the
Medicare, Medicaid, SCHIP and miscellaneous provisions do not add up to the net savings
estimated by CBO due to rounding by CBO.
3 See, for example, CRS Report RL33712, Medicare: A Primer, by Jennifer O’Sullivan;
CRS Report RL33202, Medicaid: A Primer, by Elicia J. Herz; and CRS Report RL30473,
State Children’s Health Insurance Program (SCHIP): A Brief Overview, by Elicia J. Herz,
Chris L. Peterson, and Evelyne P. Baumrucker.

MA); and Part D (the new prescription drug benefit added by the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003, or MMA, P.L.
108-173). The program is administered by the Centers for Medicare and Medicaid
Services (CMS) in the Department of HHS.
Medicaid
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 and state governments of roughly
$317 billion. Each state designs and administers its own version of Medicaid under
broad federal rules. State variability in eligibility and 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.
SCHIP
SCHIP is authorized under Title XXI of the Social Security Act. In general, this
program allows states to cover targeted low-income children with no health insurance
in families with income that is above Medicaid eligibility levels. As of July 2006,
the highest upper-income eligibility limit under SCHIP had reached 350% of the
federal poverty level (FPL) in one state. States may enroll targeted low-income
children in an SCHIP-financed expansion of Medicaid, create a new separate state
SCHIP program, or devise a combination of both approaches. States choosing the
Medicaid option must provide all mandatory benefits and all optional services
covered under the state plan, and must follow the nominal Medicaid cost-sharing
rules (with some exceptions). In general, separate state programs must follow certain
coverage and benefit options outlined in SCHIP law. While some cost-sharing
provisions vary by family income, the total annual aggregate cost-sharing (including
premiums, copayments, and other similar charges) for a family may not exceed 5%
of total income in a year. Preventive services are exempt from cost-sharing.
In the Balanced Budget Act of 1997, nearly $40 billion was appropriated for
SCHIP for FY1998 to FY2007. Appropriations for FY2007 equaled about $5.7
billion.4 Annual allotments among the states are determined by a formula that is
based on a combination of the number of low-income children and low-income
uninsured children in the state, and includes a cost factor that represents the average
health service industry wages in the state compared with the national average. Like
Medicaid, SCHIP is a federal-state matching program. While the Medicaid federal
medical assistance percentage (FMAP) ranged from 50% to 75.89% in FY2007, the
enhanced SCHIP FMAP ranged from 65% to 83.12% across states.


4 In addition to the original appropriation level of $5.04 billion this appropriation amount
includes supplemental funding up to $650 million. In some years, there were unspent prior
year funds that were available for a state’s use. As a result, relying on appropriation
amounts alone may not accurately reflect total funds available in any given year.

All states, the District of Columbia, and five territories have SCHIP programs.
As of November 2006, 17 use Medicaid expansions, 18 use separate state programs,
and 21 use a combination approach. Approximately 6.7 million children were
enrolled in SCHIP during FY2006. In addition, 12 states reported enrolling about

700,000 adults in SCHIP through program waivers.


Summary of Provisions in S. 2499
Title I — Medicare
Section 101. Increase in physician payment update; extension of
the physician quality reporting system. This provision increases the physician
payment update factor, modifies the amounts available in the Physician Assistance
and Quality Initiative (PAQI) Fund, and extends the Physician Quality Reporting
System.
The current update formula for Medicare physician payment would have
required a reduction in the fee schedule for physician reimbursement of 10.1% in
2008 and by roughly 5% annually for at least several years thereafter. This provision
averts this reduction and mandates a 0.5% increase in the physician fee schedule for
the six-month period from January 1, 2008, through June 30, 2008. The conversion
factor for the remaining six months of 2008 and afterwards will be computed as if the
modification to the conversion factor for the first six months of 2008 had never
applied.
The Tax Relief and Health Care Act of 2006 (TRHCA; P.L. 109-432)
authorized $1.35 billion for FY2008 for the PAQI Fund, which is to be available to
the Secretary of HHS for physician payment and quality improvement initiatives.
This provision modifies the amounts that will be available in the PAQI Fund and the
years in which the monies can be spent. However, there are provisions in the
Department of Labor, Health and Human Services, and Education and Related
Agencies Appropriations Act of 2008 (division G of the Consolidated Appropriations
Act of 2008) that also affect the PAQI Fund. The net effect of these two laws is that
no funds remain available in the PAQI Fund for the years 2008 through 2012, and
$4.96 billion are available in 2013. This provision requires that the amount available
for expenditures during 2013 be available only for an adjustment to the update of the
conversion factor for that year. The amount of money that would have been available
in the PAQI Fund for payment with respect to physicians’ services furnished prior to
January 1, 2013, is to be deposited into the Federal Supplementary Medical Insurance
Trust Fund, and these funds are to be made available for expenditures.
The provision also extends and modifies the existing Physician Quality
Reporting System for physicians and other health care professionals under Medicare
for FY2008 and FY2009. The CMS Program Management Account is authorized to
be appropriated $25 million for FY2008 and FY2009 to carry out the Physician
Quality Reporting System.



Section 102. Extension of Medicare incentive payment program for
physician scarcity areas. Current law provides a 5% bonus payment for certain
physicians providing services in scarcity areas for the period January 1, 2005, through
December 31, 2007. The provision extends the add-on payments through June 30,
2008. During the extension period, the Secretary is required to use the primary care
scarcity counties and specialty care scarcity counties that the Secretary was using on
December 31, 2007.
Section 103. Extension of floor on work geographic adjustment
under the Medicare physician fee schedule. Medicare makes payment for
physician services under the fee schedule. Three factors enter into the calculation of
the fee schedule payment amount: the relative value for the service, a geographic
adjustment, and a national dollar conversion factor. The geographic adjustments are
indexes that reflect cost differences among areas compared with the national average
in a “market basket” of goods.5 These geographic adjustments are made in 89
distinct payment localities; 34 are statewide and include urban and rural areas. A
value of 1.00 represents expenses equal to the average across all areas. A value less
than 1.00 represents expenses below the national average. Current law includes a
temporary provision under which the value of any work geographic index under the
physician fee schedule that is below 1.00 is increased to 1.00 for services furnished
on or after January 1, 2004, and before January 1, 2008. The provision extends the
floor through June 30, 2008.
Section 104. Extension of treatment of certain physician pathology
services under Medicare. The provision extends through June 30, 2008, the
temporary provision that allows independent laboratories providing services to
hospitals to continue to bill directly for such services. The provision is limited to
laboratories that had agreements with hospitals on July 22, 1999, to bill directly for
the technical component of pathology services.
Section 105. Extension of exceptions process for Medicare therapy
caps. The Balanced Budget Act of 1997 established annual per beneficiary payment
limits for all outpatient therapy services provided by non-hospital providers. The
limits applied to services provided by independent therapists, as well as to those
provided by comprehensive outpatient rehabilitation facilities (CORFs) and other
rehabilitation agencies. The limits did not apply to outpatient therapy services
provided by hospitals. The Deficit Reduction Act of 2005 required the Secretary to
implement an exceptions process for 2006 for cases in which the provision of
additional therapy services was determined to be medically necessary. The
exceptions process was slated to end December 31, 2007. The provision extends the
exceptions process through the first six months of 2008.


5 The law specifies that the practice expense and malpractice indices reflect the full relative
differences. However, the work index must reflect only one-quarter of the difference.
Using only one-quarter of the difference generally means that rural and small urban areas
receive higher payments and large urban areas lower payments than if the full difference
were used.

Section 106. Extension of payment rule for brachytherapy;
extension to therapeutic radiopharmaceuticals. MMA required Medicare’s
outpatient prospective payment system to make separate payments for specified
brachytherapy sources. As mandated by the TRHCA, until January 1, 2008, this
separate payment will be made using hospitals’ charges adjusted to their costs. The
provision extends cost reimbursement for brachytherapy services until July 1, 2008.
Therapeutic radiopharmaceuticals will be paid using this methodology for services
provided on or after January 1, 2008, and before July 1, 2008.
Section 107. Extension of Medicare reasonable costs payments for
certain clinical diagnostic laboratory tests furnished to hospital
patients in certain rural areas. Generally, hospitals that provide clinical
diagnostic laboratory services under Part B are reimbursed using a fee schedule.
Hospitals with under 50 beds in qualified rural areas (certain rural areas with low
population densities) receive 100% of reasonable cost reimbursement for the clinical
diagnostic laboratories covered under Part B that are provided as outpatient hospital
services. This provision extends reasonable cost reimbursement for clinical
laboratory services provided by qualified rural hospitals through June 30, 2008.
Section 108. Extension of authority of specialized Medicare
Advantage plans for special needs individuals to restrict enrollment.
Special Needs Plans (SNPs) are Medicare Advantage (MA) plans that exclusively
serve special needs beneficiaries. Special needs beneficiaries are defined as eligible
enrollees who are institutionalized, are entitled to Medicaid, or would benefit from
enrollment in a SNP (as determined by the Secretary of HHS). This provision allows
SNPs to restrict enrollment to one or more class of special needs beneficiaries until
January 1, 2010. The provision also restricts the Secretary from designating other
MA plans as SNPs and imposes a moratorium on new SNP plans until January 1,

2010.


Section 109. Extension of deadline for application of limitation on
extension or renewal of Medicare reasonable cost contract plans. Cost-
based Medicare plans are those managed care plans that are reimbursed by Medicare
for the actual cost of furnishing covered services to Medicare beneficiaries. After
January 1, 2008, any cost-based plan operating within the service area of either two
local or two regional MA plans would not have its contract with Medicare renewed.
This provision extends for one year — from January 1, 2008, to January 1, 2009 —
the length of time a cost-based plan can continue operating in an area with two local
or two regional MA plans.
Section 110. Adjustment to the Medicare Advantage stabilization
fund. The Secretary is required to establish an MA Regional Plan stabilization fund
to provide incentives for plan entry and plan retention in MA regions. Funding for
the stabilization fund was to be $1.6 billion in 2012 and $1.79 billion in 2013, with
additional funds available in an amount equal to 12.5% of the average per capita
monthly savings from regional plans. This provision eliminates the $1.6 billion in
funds available for the stabilization fund in 2012.
Section 111. Medicare secondary payor. Generally, Medicare is the
“primary payer” — that is, it pays health claims first, and if a beneficiary has other



insurance, that insurance may fill in all or some of Medicare’s gaps. However, in
some situations, the Medicare Secondary Payer (MSP) rules prohibit Medicare from
making payments for any item or service when payment has been made or can
reasonably be expected to be made by a third-party payer. The law authorizes several
methods to identify cases when an insurer other than Medicare is the primary payer
and to facilitate recoveries when incorrect Medicare payments have been made.6
This provision requires an insurer or third-party administrator for a group health
plan (and in the case of a group health plan that is self-insured and self-administered,
a plan administrator or fiduciary) to (1) secure from the plan sponsor and participants
information required by the Secretary for the purpose of identifying situations where
the group health plan is or has been a primary plan to Medicare, and (2) submit
information specified by the Secretary. If an insurer or third-party administrator for
a group health plan fails to comply, then a $1,000 per day civil monetary penalty will
be imposed for each individual for which information should have been submitted.
The provision requires the Secretary to share information on Medicare Part A
entitlement and Part B enrollment with entities, plan administrators, and fiduciaries.
The Secretary may share this information with other entities and may share
information as necessary for the proper coordination of benefits.
An applicable plan (defined as laws, plans, or other arrangements, including the
fiduciary or administrator for liability insurance, no fault insurance, and worker’s
compensation law or plans) is required to determine whether a claimant is entitled
to benefits under Medicare on any basis, and if so, to submit required information to
the Secretary, including (1) the claimant’s identity and (2) other information specified
by the Secretary to enable an appropriate determination concerning coordination of
benefits and any applicable recovery claims. Failure to comply will result in a $1,000
per day civil monetary penalty for each claimant. The Secretary can share this
information as necessary for proper coordination of benefits.
For purposes of using this new information to ensure appropriate Medicare
payments, the Secretary will transfer, in appropriate parts, from the Federal Hospital
Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund
$35 million to the CMS Program Management Account for fiscal years 2008, 2009,
and 2010.
Section 112. Payment for part B drugs. MMA revised the way Part B
pays for covered drugs. Payments for most Part B drugs are based on an average
sales price (ASP) payment methodology; the Secretary has the authority to reduce the
ASP payment amount if the widely available market price is significantly below the
ASP. Alternatively, beginning in 2006, drugs can be provided through the
competitive acquisition program (CAP). Each year, each physician is given the
opportunity either to receive payment using the ASP methodology or to obtain drugs
and biologicals through the CAP.


6 For more information, see CRS Report RL33587, Medicare Secondary Payer —
Coordination of Benefits, by Hinda Chaikind.

Under the ASP methodology, Medicare’s payment for Part B equals 106% of
the applicable price for a multiple source drug or single source drug, subject to the
beneficiary deductible and coinsurance. Applicable prices are derived from data
reported by manufacturers under the Medicaid program. The applicable price for
multiple source drugs is the volume-weighted average of the ASPs calculated by
National Drug Code (NDC) for each calendar quarter. The applicable price for single
source drugs is the lesser of the volume-weighted ASP or the wholesale acquisition
cost.
MMA included language specifying how to calculate a volume-weighted ASP
based on information reported by manufacturers. The reporting unit was the lowest
identifiable quantity of the drug (e.g., one milliliter, one tablet). However, the MMA
allowed the Secretary, beginning in 2004, to use a different reporting unit. The
Secretary used his discretion and changed to the amount of the drug represented by
the NDC. The amount of the drug represented by one NDC may differ from the
amount represented by another NDC.
In February 2006, the Office of the Inspector General (OIG) of the Department
of HHS issued a report (OEI-03-05-00310) which stated that the method used by
CMS was incorrect because it did not use billing units consistently throughout the
equation. It stated that although CMS used billing units to standardize ASPs across
NDCs for each Healthcare Common Procedure Coding System (HCPCS) code, it did
not similarly standardize sales volume across NDCs. The HCPCS, established by the
American Medical Association, is the set of health care procedure codes used by
Medicare, Medicaid, and other insurers to process insurance claims.
The provision requires the Secretary to use constant volume weighting in the
computation of the ASP, using the formula recommended by the February 2006
Inspector General’s report; this requirement applies with respect to payment for
multiple source and single source drugs and biologicals furnished on or after April
1, 2008. For all drug products included within the same multiple source billing and
payment code, the provision defines the numerator of the volume-weighted average
of the average sales price as the sum of the products (for each NDC assigned to such
drug products) of (1) the manufacturer’s average sales price, as determined by the
Secretary without dividing such price by the total number of billing units for the
NDC for the billing and payment code, and (2) the total number of units sold. The
numerator is then divided by the denominator, which is defined as the sum of the
products (for each NDC assigned to such drug products) of (1) the total number of
units sold and (2) the total number of billing units for the NDC for the billing and
payment code. The provision defines the “billing unit” as the identifiable quantity
associated with a billing and payment code, as established by the Secretary.
Beginning on April 1, 2008, for each multiple source drug or biological and for each
single source drug or biological that is treated as a multiple source drug because it is
pharmaceutically equivalent or bioequivalent to another drug, the payment amount
will be the lowest price option available to the Secretary.
Section 113. Payment rate for certain diagnostic laboratory tests.
Glycosylated hemoglobin (HbA1c) is used to monitor how well blood glucose levels
are controlled in diabetes patients. The current Medicare payment rate for HbA1c is
tied to two HCPCS codes: 83036 and 83037. HCPCS code 83037 was developed in



2006 to cover the testing for HbA1c by a device approved by the Food and Drug
Administration (FDA) for home use; 83036 is the default code, used for the majority
of glycosylated hemoglobin tests, and not limited to specific methodology. This
provision changes the Medicare payment rate for HCPCS code 83037 to the rate
established for 83036, for HbA1c tests that are furnished on or after April 1, 2008.
Section 114. Long-term care hospitals. A long-term care hospital
(LTCH) is an acute care general hospital that has a Medicare inpatient average length
of stay greater than 25 days. Since 2002, LTCHs have been paid under their own
prospective payment system (LTCH-PPS). Provisions establishing this PPS are
contained in Section 123 of the Medicare, Medicaid, and SCHIP Balanced Budget
Refinement Act of 1999 (BBRA; P.L. 106-113) and Section 307 of the Medicare,
Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA; P.L.
106-554). These LTCH-PPS provisions have not been incorporated into the Social
Security Act (SSA). Each year, the LTCH base rate (per discharge payment amount)
is updated.
Presently, LTCHs are not explicitly permitted in statute to be units of other
facilities. CMS established a new LTCH policy for cost reporting periods beginning
on or after July 1, 2007, for determining whether a freestanding LTCH was acting as
a unit of independent host hospitals. The regulation had originally been applied only
to those LTCHs established as hospitals-within-hospitals (HwHs) or satellite
hospitals. The policy (referred to as the “25% rule”) limits the proportion of patients
who can be admitted from a co-located or host hospital during a cost reporting period
and be paid under the LTCH-PPS. After the threshold is reached, the LTCH is paid
the lesser of the LTCH PPS rate or the acute hospital PPS rate. The HwH threshold
for most admissions from its host hospital for rate year (RY) 2008 is 25%. The
expansion of the policy to freestanding LTCHs will occur on a phased-in basis over
a three-year transition period.
There are some exceptions to the 25% rule. Generally, for rural HwHs, the
applicable percentage is 50%. Urban single HwHs or those located in metropolitan
statistical areas (MSAs) with dominant hospitals — those with one-fourth or more
of acute care cases for the MSA — also have a threshold of 50%.
A short-stay outlier under the LTCH-PPS is a discharge for stays that are
considerably shorter than the average length of stay for a long-term care DRG
(five-sixths of the geometric average length of stay for each DRG). These short-stay
outliers have an adjustment made to their payment that allows Medicare to pay less
than cases that receive a full episode of care. Recent policy changes added a new
class of short-stay outliers.
Under CMS policy, the Secretary reviews the payment system and may make
a one-time prospective adjustment to the long-term care hospital prospective payment
system rates on or before July 1, 2008, so that the effect of any significant difference
between actual payments and estimated payments for the first year of the long-term
care hospital prospective payment system is not perpetuated in the prospective
payment rates for future years.



This provision establishes section 1861(ccc) in the SSA that would define an
LTCH as an institution that (1) is primarily engaged in providing inpatient services
by or under the supervision of a physician to Medicare beneficiaries whose medically
complex conditions require a long hospital stay and programs of care provided by a
LTCH; (2) has a Medicare inpatient average length of stay greater than 25 days; (3)
satisfies Medicare’s hospital definition; and (4) meets certain facility criteria,
including a patient review process with patient validation within 48 hours of
admission. Also, the institution will have active physician involvement with patients,
an organized medical staff, on-site physician availability on a daily basis, and
consulting physicians on call and accessible. The institution is required to have
interdisciplinary teams, including physicians, to prepare and treat patients using
individualized patient treatment plans.
The Secretary is required to conduct a study on the establishment of national
long-term care hospital facility and patient criteria. Not later than 18 months from
enactment, the Secretary will submit a report to Congress including recommendations
for legislation and administrative actions.
During a three-year moratorium period beginning with the enactment of this
provision, the Secretary will not apply the 25% rule or a similar policy to
freestanding LTCHs or certain LTCH HwHs (referred to as “grandfathered LTCHs”)
that have been considered to be freestanding. The admission threshold for HwHs
or satellite facilities in rural areas or LTCHs that are co-located with an urban single
or MSA dominant hospital will increase from 50% to 75%. For other HwHs or
satellite facilities, the admission threshold from a co-located hospital will be set at
50%. The Secretary is not able to apply the new short-stay outlier policy during a
three-year moratorium period that begins on the date of enactment. The Secretary is
not able to make the one-time prospective adjustment to LTCH prospective payments
during a three-year moratorium period that begins on the date of enactment.
The Secretary will impose a temporary moratorium on the certification of new
LTCHs, satellite facilities, long-term care hospital, and satellite facility beds for a
three-year period beginning at the enactment date. The moratorium does not apply
to an LTCH hospital, satellite facility, or additional beds that are under development
as of the enactment date. The moratorium does not apply to an existing LTCH bed
increase request where there is closure of an LTCH or a significant decrease in the
number of LTCHS beds in a state where there is only one other LTCH. There is no
administrative or judicial review of a Secretary’s decision on these exceptions.
This provision establishes 1886(m) of the SSA entitled “Prospective Payment
for Long Term Care Hospitals,” which would provide specific references to the
sections of BBRA and BIPA that contain the LTCH-PPS provisions.
The base rate for LTCH’s rate year (RY) 2008 (from July 1, 2007, through June

30, 2008) is the same as that used for discharges in RY2007 (from July 1, 2006,


through June 30, 2007). The provision does not apply to discharges starting July 1,

2007, and before April 1, 2008.


Starting for discharges on October 1, 2007, the Secretary will contract with
fiscal intermediaries or Medicare administrative contractors to review the medical



necessity of LTCH admissions and continued stays. These reviews will be conducted
annually and will provide a statistically valid sample (at a 95% confidence interval)
and guarantee that at least 75% of the overpayments are identified and recovered.
The Secretary will establish an error rate that would require further review. These
medical necessity reviews will stop for discharges after October 1, 2010, unless
otherwise determined by the Secretary. To carry out these activities, $35 million will
be appropriated from the Treasury into the Program Management Account of CMS
in FY2008 and FY2009. The costs of the medical necessity reviews will be funded
from the aggregate overpayments recouped from the LTCHs; such amounts will not
exceed 40% of such recovered overpayments.
Section 115. Payment for inpatient rehabilitation facility (IRF)
services. Starting January 1, 2002, payments to inpatient rehabilitation facilities
(IRFs) are made under a discharge-based prospective payment system where one
payment covers capital and operating costs. Each year, the per discharge payment
amount is increased by an update factor based on the increase in the market basket
index. The provision establishes the IRF update factor at 0% in FY2008 and
FY2009, starting for discharges on April 1, 2008. Starting for cost reporting periods
on or after July 1, 2007, the IRF compliance threshold (which determines whether a
facility is an IRF or an acute care hospital) is established as no greater than the 60%
compliance rate that became effective for cost reporting periods beginning July 1,
2006; comorbidities are included as qualifying conditions. No later than 18 months
from enactment, the Secretary will consult with certain parties and submit a report
to the committees with jurisdiction over Medicare. The study will analyze access to
medically necessary rehabilitation services and alternatives to the IRF compliance
thresholds.
Section 116. Extension of accommodation of physicians ordered
to active duty in the Armed Services. Medicare payment may be made to a
physician for services furnished by a second physician to patients of the first
physician provided certain conditions are met. In general, the services cannot be
provided by the second physician for more than 60 days. P.L. 110-54 (enacted
August 3, 2007) permitted, for services provided prior to January 1, 2008, reciprocal
billing over a longer period in cases where the first physician was called or ordered
to active duty as a member of a reserve component of the Armed Forces. The
provision extends this accommodation through June 30, 2008.
Section 117. Treatment of certain hospitals. Under IPPS, a hospital (or
group of hospitals) can increase its Medicare payments though administrative
reclassification (by the Medicare Geographic Classification Review Board or
MGCRB) to a different area with a higher wage index value. These reclassifications
are budget-neutral. Other hospitals have been reclassified by legislation. Section 508
of MMA provided $900 million for a one-time, three-year geographic reclassification
of certain hospitals that were otherwise unable to qualify for administrative
reclassification to areas with higher wage index values. These reclassifications were
extended from March 31, 2006, to September 30, 2007, by TRHCA. This extension
was exempt from any budget neutrality requirements. Under this legislation, Section
508 reclassifications are extended until September 30, 2008. Hospitals that were
reclassified through the Secretary’s authority to make exceptions and adjustments
during the FY2005 rulemaking process will have their reclassification extended until



September 30, 2008. A hospital that has been reclassified under Section 508 (as
extended) will not prevent the group reclassification of otherwise eligible hospitals
during FY2008. Those Section 508 reclassifications, which were extended until
September 30, 2007, where the applicable wage index was lower during the
six-month extension (from April 1 2007 until September 30, 2007) than the wage
index applied to the hospital from October 1, 2006, through March 31, 2007, will
have the higher wage index used for the entire FY2007 period. Any additional
Medicare payments will be paid to the hospitals within 90 days after settlement of the
applicable cost report.
Section 118. Additional Funding for State Health Insurance
Assistance Programs, Area Agencies on Aging, and Aging and
Disability Resource Centers. State Health Insurance Assistance Programs
(SHIPs) provide information, counseling, and assistance to Medicare-eligible
individuals on obtaining adequate and appropriate health insurance. State Area
Agencies on Aging and State Aging and Disability Resource Centers also conduct
health insurance outreach to Medicare-eligible individuals, in addition to
administering elder rights programs, providing legal services to the elderly, and
coordinating information about long-term care services. This provision requires the
Secretary to transfer $15,000,000 from the Medicare Part A and B Trust Funds to the
CMS program management account to provide grants to state SHIP programs for
FY2008. The provision also requires the Secretary to transfer $5,000,000 from the
CMS program management account to provide grants to Area Agencies on Aging and
Aging and Disability Resource Centers for FY2008 and FY2009.
Title II — Medicaid and SCHIP
Section 201. Extending SCHIP funding through March 31, 2009.
SCHIP allotments. Title XXI of the Social Security Act specifies national
appropriation amounts from FY1998 to FY2007 for SCHIP. Continuing Resolutions
(P.L. 110-92, P.L. 110-116, P.L. 110-137) have provided through December 21,
2007, the same level of SCHIP appropriations for FY2008 as was appropriated
initially for FY2007 ($5.0 billion for the states and territories, plus an additional $40
million for the territories). The national appropriation available to states is allotted
using a formula based on the estimated number of low-income children and
low-income uninsured children in each state, adjusted slightly by a geographic cost
factor. Allotments are available for three years, after which any unspent funds are
redistributed to other states.
Under S. 2499, $5.04 billion is appropriated in FY2008 and in FY2009 for
SCHIP allotments, as in FY2007. The formula for allotting the funds among the
states and territories is unchanged. The FY2009 allotments are available only
through March 31, 2009 (or the date of enactment of legislation to reauthorize
SCHIP, whichever comes first).
Redistribution. Allotments unspent after three years are redistributed to other
states. Under the Continuing Resolutions, FY2005 allotments unspent at the end of
FY2007 were to be redistributed to states projected to exhaust all of their SCHIP
funds in FY2008. The redistributed FY2005 funds would be provided, until



exhausted, to states in the order in which their shortfalls occur. This methodology
for redistribution was to be in effect until December 21, 2007, unless legislation was
enacted beforehand to reauthorize SCHIP.
Under S. 2499, the methodology specified in the Continuing Resolutions for
redistributing unspent FY2005 federal SCHIP funds is made permanent. In addition,
under S. 2499, FY2006 allotments unspent at the end of FY2008 will be redistributed
to states projected to exhaust all of their SCHIP funds in FY2009 before March 31,
2009. The redistributed FY2006 funds will be provided, until exhausted, to states in
the order in which those shortfalls occur.
Additional appropriations for states’ shortfalls of federal SCHIP
funds. In early FY2006, several states were projected to exhaust their federal
SCHIP funds during the year, with a shortfall projected at $283 million. Congress
appropriated $283 million in the Deficit Reduction Act of 2005 (P.L. 109-171) for
the purpose of eliminating states’ shortfalls in FY2006, with 1.05% of the
appropriation provided to the territories. To eliminate shortfalls of some states’
federal SCHIP funds in FY2007, Congress appropriated such sums as necessary, not
to exceed $650 million, in the U.S. Troop Readiness, Veterans’ Care, Katrina
Recovery, and Iraq Accountability Appropriations Act, 2007 (P.L. 110-28). The
territories received no portion of this appropriation.
Under S. 2499, such sums as necessary, not to exceed $1.6 billion, are
appropriated in FY2008: (1) to eliminate states’ shortfalls of federal SCHIP funds
and (2) to provide 1.05% of states’ projected shortfall amounts to the territories.
These funds are available only for FY2008, and unspent funds are not available for
redistribution. If the $1.6 billion appropriation is insufficient to cover states’
shortfalls and the associated payments to the territories, then the payments to the
states and territories would be reduced proportionally. Based on states’ latest
projections, the total FY2008 shortfalls are projected at less than $1.2 billion.
Under S. 2499, such sums as necessary, not to exceed $275 million, are
appropriated in FY2009: (1) to eliminate states’ shortfalls of federal SCHIP funds
in the first two quarters of FY2009 and (2) to provide 1.05% of states’ projected
shortfall amounts to the territories. These funds are available only for the first two
quarters of FY2009, and unspent funds are not available for redistribution. If the
$275 million appropriation is insufficient to cover states’ shortfalls and the associated
payments to the territories, then the payments to the states and territories would be
reduced proportionally. Based on states’ latest projections, the total FY2009
shortfalls through March 31, 2009, are projected at approximately $200 million.
Qualifying states. Eleven states (Connecticut, Hawaii, Maryland, Minnesota,
New Hampshire, New Mexico, Rhode Island, Tennessee, Vermont, Washington, and
Wisconsin) are considered “qualifying states” for purposes of using SCHIP funds
under §2105(g) for some children enrolled in Medicaid. For qualifying states, federal
SCHIP funds may be used to pay the difference between SCHIP’s enhanced FMAP
and the Medicaid FMAP that the state is already receiving for children above 150%
of poverty who are enrolled in Medicaid. Qualifying states are limited in the amount
they can claim for this purpose to the lesser of (1) 20% of the state’s original SCHIP
allotment amounts (if available) from FY1998-FY2001 and FY2004-FY2008, with



the ability to use the FY2008 allotment linked to the December 21, 2007, termination
date in the latest Continuing Resolution, and (2) the state’s available balances of
those allotments. The statutory definitions for qualifying states capture most states
that had expanded their upper-income eligibility levels for children in their Medicaid
programs to 185% of poverty prior to the enactment of SCHIP.
Under S. 2499, the ability of qualifying states to use their FY2008 allotments
for expenditures under §2105(g) is made permanent; their ability to use FY2009
allotments under §2105(g) is permitted through March 31, 2009.
Section 202. Extension of transitional medical assistance (TMA)
and abstinence education program. States are required to continue Medicaid
benefits for certain low-income families that would otherwise lose coverage because
of changes in their income. This continuation is called transitional medical assistance
(TMA). Federal law permanently requires four months of TMA for families that lose
medicaid eligibility because of increased child or spousal support collections, as well
as those that lose eligibility because of an increase in earned income or hours of
employment. Congress expanded work-related TMA under Section 1925 of the
Social Security Act in 1988, requiring states to provide TMA to families that lose
medicaid for work-related reasons for at least six and up to 12 months. Since 2001,
work-related TMA requirements under Section 1925 have been funded by a series of
short-term extensions, most recently through December 31, 2007.
P.L. 104-193, the 1996 welfare reform law, provided $250 million in federal
funds specifically for an abstinence education program ($50 million per year for each
of five years, FY1998 through FY2002). This program is referred to as the Title V
Abstinence Education block grant. Funds must be requested by states when they
solicit Title V Maternal and Child Health (MCH) block grant funds and must be used
exclusively for teaching abstinence. To receive federal funds, a state must match
every $4 in federal funds with $3 in state funds. This means that if maximum federal
funding is provided, funding for Title V Abstinence Education must total at least
$87.5 million annually. Although the Title V Abstinence Education block grant has
not yet been reauthorized, the latest temporary extension continues funding through
December 31, 2007. This provision extends both TMA and the Title V Abstinence
Education block grant through June 30, 2008.
Section 203. Extension of qualifying individual (QI) program.
Certain low-income individuals are eligible to have their Medicare part B premiums
paid for by Medicaid under the Medicare Savings Program (MSP). One eligible
group is Qualifying Individuals (QIs). These persons have incomes between 120%
and 135% of poverty. Federal spending under the QI program is subject to annual
limits. The program was slated to terminate December 31, 2007. The provision
extends the program through June 2008 and specifies that the amount available for
allocation for the six-month period beginning January 1, 2008, is $200 million.
Section 204. Medicaid DSH Extension. When establishing hospital
payment rates, state Medicaid programs are required to recognize the situation of
hospitals that provide a disproportionate share of care to low-income patients with
special needs. Total federal reimbursement for each state’s DSH payments, however,
are capped at a statewide ceiling, referred to as the state’s DSH allotment. Those



amounts are specified in statute. As part of TRHCA, allotments for only one year,
2007, for the states of Tennessee and Hawaii were raised. Tennessee’s DSH
allotment for the year was to be based on a formula, and Hawaii’s was set at $10
million. After that, allotments for those states would have reverted to former, lower
amounts. S. 2499 extends those special allotment provisions, so that for the portion
of FY2008 that ends on June 30, 2008, Tennessee’s DSH allotment is set at
three-quarters of the 2007 level, and the allotment for Hawaii is equal to $7.5 million.
Section 205. Improving data collection. Because of concerns about
inadequate sample sizes in the Current Population Survey (CPS) for making
estimates of states’ number of low-income children, for purposes of determining
states’ federal SCHIP allotments, $10 million was appropriated in SCHIP statute
annually beginning in FY2000. S. 2499 provides $20 million, instead of $10 million,
in SCHIP statute for the CPS in FY2008.
Section 206. Moratorium on certain payment restrictions. Medicaid
can cover school-based, health-related services required under the Individuals with
Disabilities Education Act (IDEA), including transportation, as well as related
administrative activities (e.g., outreach for Medicaid enrollment purposes, medical
care coordination/monitoring). Medicaid also covers rehabilitation services for
eligible beneficiaries in a wide variety of settings. The Bush Administrative issued
proposed rules affecting rehabilitation and school-based services in August and
September 2007, respectively.
Relative to policies in place on July 1, 2007, S. 2499 prohibits the Secretary of
HHS from taking any action to further restrict Medicaid coverage or payments for
rehabilitation services and for school-based transportation and administrative
activities. This moratorium would be in effect until June 30, 2008.
Title III — Miscellaneous
Section 301. Medicare Payment Advisory Commission status. The
Medicare Payment Advisory Commission (MedPAC) is an independent federal body
established by the Balanced Budget Act of 1997 to advise the U.S. Congress on
issues affecting the Medicare program. The commission’s statutory mandate is (1)
to advise Congress on payments to private health plans participating in Medicare and
providers in Medicare’s traditional fee-for-service program and (2) to analyze access
to care, quality of care, and other issues affecting Medicare. This provision would
establish MedPAC as an agency of Congress.
Section 302. Special Diabetes Programs for Type I Diabetes and
Indians. As specified in Section 330B of the Public Health Service Act, the
Secretary, directly or through grants, must provide for research into the prevention
and cure of Type I diabetes. Appropriations are set at $150 million per year during
the period FY2004 through FY2008. As specified in Section 330C of the Public
Health Service Act, the Secretary must make grants for providing services for the
prevention and treatment of diabetes among American Indians and Alaskan Natives.
Appropriations are set at $150 million per year during the period FY2004 through
FY2008. For each of these two grant programs, S. 2499 provides $150 million for
FY2009.



Table 1. Key Policy Staff: Medicare, Medicaid, and SCHIP
Extension Act of 2007
Area of ExpertiseNamePhoneE-mail
Title I — Medicare
Section 101Jim Hahn7-4914jhahn@crs.loc.gov
Section 102Jennifer O’Sullivan7-7359josullivan@crs.loc.gov
Section 103Jennifer O’Sullivan7-7359josullivan@crs.loc.gov
Section 104Jennifer O’Sullivan7-7359josullivan@crs.loc.gov
Section 105Jennifer O’Sullivan7-7359josullivan@crs.loc.gov
Section 106Sibyl Tilson7-7368stilson@crs.loc.gov
Section 107Sibyl Tilson7-7368stilson@crs.loc.gov
Section 108Holly Stockdale7-9553hstockdale@crs.loc.gov
Paulette Morgan7-7317pcmorgan@crs.loc.gov
Hinda Chaikind7-7569hchaikind@crs.loc.gov
Section 109Holly Stockdale7-9553hstockdale@crs.loc.gov
Paulette Morgan7-7317pcmorgan@crs.loc.gov
Hinda Chaikind7-7569hchaikind@crs.loc.gov
Section 110Holly Stockdale7-9553hstockdale@crs.loc.gov
Paulette Morgan7-7317pcmorgan@crs.loc.gov
Hinda Chaikind7-7569hchaikind@crs.loc.gov
Section 111Hinda Chaikind7-7569hchaikind@crs.loc.gov
Section 112Gretchen Jacobson7-1686gjacobson@crs.loc.gov
Section 113Gretchen Jacobson7-1686gjacobson@crs.loc.gov
Section 114Sibyl Tilson7-7368stilson@crs.loc.gov
Section 115Sibyl Tilson7-7368stilson@crs.loc.gov
Section 116Jennifer O’Sullivan7-7359josullivan@crs.loc.gov
Section 117Sibyl Tilson7-7368stilson@crs.loc.gov
Section 118Holly Stockdale7-9553hstockdale@crs.loc.gov
Paulette Morgan7-7317pcmorgan@crs.loc.gov
Hinda Chaikind7-7569hchaikind@crs.loc.gov
Title II — Medicaid and SCHIP
Section 201Chris Peterson7-4681cpeterson@crs.loc.gov
Section 202Elicia Herz7-1377eherz@crs.loc.gov
Section 203Jennifer O’Sullivan7-7359josullivan@crs.loc.gov
Section 204Jean Hearne7-7362jhearne@crs.loc.gov
Section 205Chris Peterson7-4681cpeterson@crs.loc.gov
Section 206Elicia Herz7-1377eherz@crs.loc.gov
Title III — Miscellaneous
Section 301Jim Hahn7-4914jhahn@crs.loc.gov
Section 302Elicia Herz7-1377eherz@crs.loc.gov