Estimate of Effects on Direct Spending for Senate Amendment 4369, a Substitute for H.R.

4213, the American Jobs and Closing Tax Loopholes Act of 2010, Title V, Subtitle B
As introduced in the Senate on June 16, 2010 MAT10482
Assumed enactment July 1, 2010
By fiscal year, in billions of dollars.
2010- 2010-
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2015 2020

Section 1/
511 Extension of Sec. 508 reclassifications 0 0.3 * 0 0 0 0 0 0 0 0 0.3 0.3
512 Repeal of delay of RUG-IV 0 0 0 0 0 0 0 0 0 0 0 0 0
513 Limitation on reasonable cost payments for certain lab tests in rural areas Need *decision *on policy.
0 0 0 0 0 0 0 0 0 * *
514 Funding for claims reprocessing 0.1 0.1 0 0 0 0 0 0 0 0 0 0.2 0.2
515 Medicaid and CHIP technical corrections 0 0 0 0 0 0 0 0 0 0 0 0 0
516 Addition of inpatient drug discount program to 340B drug discount program 0 * * * * * * * * * * * *
517 Continued inclusion of orphan drugs in definition of covered outpatient drugs in 340B 0 0 0 0 0 0 0 0 0 0 0 0 0
518 Conforming amendment related to waiver of coinsurance for preventive services 0 0 0 0 0 0 0 0 0 0 0 0 0
519 CMS-IRS data match 2/ 0 0 * * -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.2 -0.4
520 Clarification of effective date of Part B special enrollment period for disabled TRICARE beneficiaries 0 * * * * * * * * * * * *
521 Physician payment update 2.7 3.8 0 0 0 0 0 0 0 0 0 6.5 6.5
522 Adjustment to Medicare payment localities 0 0 * 0.1 0.1 0.1 0.1 * 0 0 0 0.3 0.4
523 Clarification of 3-day payment window -3.2 -1.1 0 0 0 0 0 0 0 0 0 -4.2 -4.2
524 Extension of ARRA Increase in FMAP 0 25.4 -1.2 * 0 0 0 0 0 0 0 24.1 24.1
525 Clarification for Affiliated Hospitals for Distribution of Additional Residency Positions 0 0 * * * * * * * * * * *

INTERACTIONS

Medicare Advantage Interaction 0 0 * * * * * * * * * 0.1 0.1

Premium Interactions 0 0.3 0.1 0.1 * * * * * * * 0.5 0.5
Medicaid Interactions with Medicare Part B Provisions 0 0 0 0 0 0 0 0 0 0 0 0 0
TRICARE Interaction * * * * * * * * 0 0 0 * *
IPAB Interaction 0 0 0 0 0 0 0 0 * 0.1 0.1 0 0.2

Total, Changes in Direct Spending - Title V, Subtitle B -0.4 28.8 -1.0 0.2 * * * * * * * 27.6 27.6

NOTES:
" * " is between $50 million and -$50 million.
Components may not sum to totals because of rounding.

1/ Estimates for individual sections do not include MA, Part B premium, Medicaid, TRICARE, or IPAB interactions.
2/ Included in table provided by the Joint Committee on Taxation.

ARRA = American Recovery and Reinvestment Act; CHIP = Children's Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; FMAP = federal medical assistance percentage;
IPAB = Independent Payment Advisory Board; IRS = Internal Revenue Service; MA = Medicare Advantage; RUG-IV = Resource Utilization Group, version four;
TRICARE is the health plan operated by the Department of Defense.

Total Spending for Section 521: Physician payment update - including estimated interactions with Medicare
Advantage, Medicaid, TRICARE, and Part B Premiums 2.8 3.8 * * 0 0 0 0 0 0 0 6.5 6.5

Congressional Budget Office Page 1 of 1 June 17, 2010